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July 05 2017

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Pes Planus Causes, Conditions And Treatment Solution

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Adult Acquired Flat Foot

Flat feet, fallen arches, or ?pes planus? is normally a symptomless and fortunately painless condition. It is characterized by the arch of the foot collapsing completely, which causes the entire sole of the foot to come into perfect contact with the ground. An estimated 20-30 percent of the entire population has some form of flat feet, ranging in severity from asymptomatic to somewhat problematic. Most people who endure this problem are able to experience life pain and symptom free from the nearly unnoticeable abnormality. However, a small sector of those affected do experience pain or discomfort, which is when a treatment program needs to be put in action.

Causes

Most cases of flatfeet are simply the result of normal development. When that is not the case, the condition can be caused by a number of factors, including the following, Age, disease, injury, obesity or being overweight, physical abnormality, pregnancy. Flattened arches in adults may result from the stresses of aging, weight gain, and the temporary increase in elastin (protein in connective tissue) due to pregnancy. In some cases, flatfeet are caused by a physical abnormality, such as tarsal coalition (two or more bones in the foot that have grown together) or accessory navicular (an extra bone along the side of the foot). The effects of diseases such as diabetes and rheumatoid arthritis can lead to flatfeet. An injury (e.g., bone fracture, dislocation, sprain or tear in any of the tendons and ligaments in the foot and leg) also can cause flatfeet.

Symptoms

A significant number of people with fallen arches (flat feet) experience no pain and have no problems. Some, however, may experience pain in their feet, especially when the connecting ligaments and muscles are strained. The leg joints may also be affected, resulting in pain. If the ankles turn inwards because of flat feet the most likely affected areas will be the feet, ankles and knees. Some people have flat feet because of a developmental fault during childhood, while others may find that the problem develops as they age, or after a pregnancy. There are some simple devices which may prevent the complications of flat feet.

Diagnosis

Diagnosis of flat feet or fallen arches can be made by your health practitioner and is based on the following. Clinical assessment involving visual gait assessment, as well as biomechanical assessment. A detailed family and medical history. A pain history assessment determining the location of painful symptoms. Physical palpation of the feet and painful areas. Imaging such as MRI or x-ray can be used by your practitioner to assist in the diagnosis.

What is PES Planovalgus deformity?

Non Surgical Treatment

The simplest form of treatment is the use of custom fitted orthotics. For this, it is best to see a podiatrist, who is a trained medical professional that assesses feet and gives you a prescription for the orthotic. If the orthotics do not work - or if the deformity is very severe - then surgical management may be needed. There is a very wide range of procedures available, with varying downtimes and complexity. The simplest procedure of all is a simple calf release. This can be done at the back of the knee or the calf, and has a very quick recovery. It is a day-surgery procedure, and the patient can walk immediately after the surgery without the need for a cast. Recovery back to jogging can be as early as three weeks. The calf release stops the deforming force but obviously does not correct the arch itself. It is usually done in combination with some of the other procedures mentioned below. Done by itself, the patient will probably still require orthotics but by releasing the calf, it allows the orthotics to be much more effective. The other end of the spectrum is a complete reconstruction of the arch with bone work and screws to fuse joints.

Surgical Treatment

Adult Acquired Flat Feet

Since there are many different causes of flatfoot, the types of flatfoot reconstruction surgery are best categorized by the conditions. Posterior tibial tendon dysfunction. In this condition, the tendon connecting the calf muscle to the inner foot is torn or inflamed. Once the tendon is damaged it no longer can serve its main function of supporting the arch of the foot. Flatfoot is the main result of this type of condition and can be treated by the following flatfoot reconstruction surgeries. Lengthening of the Achilles tendon. Otherwise known as gastrocnemius recession, this procedure is used to lengthen the calf muscles in the leg. This surgery treats flatfoot and prevents it from returning in the future. This procedure is often combined with other surgeries to correct posterior tibial tendon dysfunction. Cleaning the tendon. Also known as tenosynovectomy, this procedure is used in the earlier and less severe stages of posterior tibial tendon dysfunction. It is performed before the arch collapses and while the tendon is only mildly affected. The inflamed tissue is cleaned away and removed from the remaining healthy tendon. Tendon transfer. This procedure is done to correct flatfoot and reform the lost arch in the foot. During the procedure, the diseased tendon is removed and replaced by tendon from another area of the foot. If the tendon is only partially damaged, the inflamed part is cleaned and removed then attached to a new tendon. Cutting and shifting bones. Also called an osteotomy, this procedure consists of cutting and reconstructing bones in the foot to reconstruct the arch. The heel bone and the midfoot are most likely reshaped to achieve this desired result. A bone graft may be used to fuse the bones or to lengthen the outside of the foot. Temporary instrumentation such as screws and plates can also be used to hold the bones together while they heal.

June 29 2017

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Everything You Might Want To Know About Heel Painfulness

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Feet Pain

Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected. This guide will help you understand how plantar fasciitis develops, how the condition causes problems, what can be done for your pain.

Causes

A sharp stabbing pain, like a nail going into the bottom of the heel when first stepping on the foot after getting out of bed or after sitting for period of time, is the most common description for plantar fasciitis or heel spur syndrome. Typically the pain eases off as the day goes on but it may not go away completely. A thick ligament that attaches to the bottom of the heel and runs the length of the foot to the toes can become inflamed and swollen at the attachment site. This tends to be an overuse type of injury where poor foot structure is involved; also, wearing of shoe gear that lacks adequate support (ie: worn out shoes, boots and flip-flops) and prolonged standing or walking are often implicated. A throbbing pain that gets worse as the day goes on and can be worse at night when laying in bed is most often associated with an irritated or entrapped nerve on the inside of the ankle or heel. This is similar to carpel tunnel syndrome in the wrist and hand. Approximately 7 / 10 patients with heel pain have a component of nerve entrapment as the cause of their heel pain. This is also one of the most common causes of chronic heel pain because it is often missed as a diagnosis. When nerve entrapment is considered to be a cause, painless neurosensory testing is performed with the Pressure Specified Sensory Device? (PSSD) at The Foot & Ankle Center, PC to determine the extent of compression. A less common cause of heel pain but a stress fracture is often considered in athletes, such as long distance runners, who have heel pain. Posterior Heel Pain (Retrocalcaneal) This is pain in the back of the heel that flares up when first starting an activity. It is often associated with a large bump that can be irritated by shoes. The Achilles tendon attaches to the back of the heel and, like on the bottom, this attachment site can often become inflamed; a spur may or may not be present. Another painful area is a sac of fluid (bursa) that sits between the tendon and bone to act as a cushion for the tendon. This bursa can become inflamed often leading to significant pain called retrocalcaneal bursitis.

Symptoms

Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

Non Surgical Treatment

Treatment of heel pain depends on its cause. Plantar fasciitis. Most doctors recommend a six- to eight-week program of conservative treatment, including temporary rest from sports that trigger the foot problem, stretching exercises, ice massage to the sole of the foot, footwear modifications, taping of the sole of the injured foot, and acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin and others) for pain. If this conservative treatment doesn't help, your doctor may recommend that you wear a night splint or a short leg cast, or he or she may inject corticosteroid medication into the painful area. Surgery is rarely necessary and is not always successful. Heel spur. Conservative treatment includes the use of shoe supports (either a heel raise or a donut-shaped heel cushion) and a limited number of local corticosteroid injections (usually up to three per year). As in plantar fasciitis, surgery is a last resort. Calcaneal apophysitis. This condition usually goes away on its own. In the meantime, conservative treatment includes rest and the use of heel pads and heel cushions. Bursitis. Treatment is similar to the treatment of heel spurs. Changing the type of footwear may be essential.

Surgical Treatment

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.

what does a heel spur look like

Prevention

Painful Heel

Wearing real good, supportive shoes are a great way to avoid heel pain. Usually, New Balance is a good shoe to wear, just for everyday shoe gear. By wearing proper footwear and performing thorough stretches, athletes can help prevent frequent heel pain. If you are starting to get a little discomfort or pain in the feet or heel, know that pain is not normal. So if you are having pain, you should be proactive and visit our office. If you let heel pain get out of control you could run into several other problems. It is always suggested to visit a podiatrist whenever you are experiencing pain.

June 27 2017

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Leg Length Discrepancy Running Symptoms

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Epiphysiodesis is a surgical option designed to slow down the growth of the long leg over a period of months to years. It is only used in growing children. The operation involves a general anaesthetic. Small incisions are made around the knee near the growth plates of the thigh bone and the shin bone. The growth plates are prevented from growing by the use of small screws and plates (?8 - plates?). The screws are buried beneath the skin and are not visible. Stitches are buried beneath the skin and do not need to be removed. The child is normally in hospital for 2-3 days. The child can weight bear immediately and return back to normal activity within a few weeks. Long term follow up is required to monitor the effects of the surgery. The timing of the surgery is based on the amount of growth predicted for the child. Therefore, this procedure can under- and over-correct the difference in leg length. Occasionally the screws have to be removed to allow growth to continue. This procedure can be used on one half of the growth plate to correct deformity in a limb e.g. knock-knees or bow legs. This is known as hemiepiphysiodesis.Leg Length Discrepancy

Causes

There are many causes of leg length discrepancy. Structural inequality is due to interference of normal bone growth of the lower extremity, which can occur from trauma or infection in a child. Functional inequality has many causes, including Poliomyelitis or other paralytic deformities can retard bone growth in children. Contracture of the Iliotibial band. Scoliosis or curvature of the spine. Fixed pelvic obliquity. Abduction or flexion contraction of the hip. Flexion contractures or other deformities of the knee. Foot deformities.

Symptoms

LLD do not have any pain or discomfort directly associated with the difference of one leg over the other leg. However, LLD will place stress on joints throughout the skeletal structure of the body and create discomfort as a byproduct of the LLD. Just as it is normal for your feet to vary slightly in size, a mild difference in leg length is normal, too. A more pronounced LLD, however, can create abnormalities when walking or running and adversely affect healthy balance and posture. Symptoms include a slight limp. Walking can even become stressful, requiring more effort and energy. Sometimes knee pain, hip pain and lower back pain develop. Foot mechanics are also affected causing a variety of complications in the foot, not the least, over pronating, metatarsalgia, bunions, hammer toes, instep pain, posterior tibial tendonitis, and many more.

Diagnosis

On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD. The LLD should be measured using bony fixed points. X-Ray should be taken in a standing position. The osteopath, physiotherapist or chiropractor will look at femoral head & acetabulum, knee joints, ankle joints.

Non Surgical Treatment

You may be prescribed a heel lift, which will equal out your leg length and decrease stress on your low back and legs. If it?s your pelvis causing the leg length discrepancy, then your physical therapist could use your muscles to realign your pelvis and then strengthen your core/abdominal region to minimize the risk of such malalignment happening again. If you think that one leg may be longer than the other and it is causing you to have pain or you are just curious, then make an appointment with a physical therapist.

LLD Insoles

leg length discrepancy hip pain

Surgical Treatment

Surgical treatments vary in complexity. Sometimes the goal of surgery is to stop the growth of the longer limb. Other times, surgeons work to lengthen the shorter limb. Orthopedic surgeons may treat children who have limb-length conditions with one or a combination of these surgical techniques. Bone resection. An operation to remove a section of bone, evening out the limbs in teens or adults who are no longer growing. Epiphyseal stapling. An operation to slow the rate of growth of the longer limb by inserting staples into the growth plate, then removing them when the desired result is achieved. Epiphysiodesis. An operation to slow the rate of growth of the longer limb by creating a permanent bony ridge near the growth plate. Limb lengthening. A procedure (also called distraction osteogenesis or the Ilizarov procedure) that involves attaching an internal or external fixator to a limb and gradually pulling apart bone segments to grow new bone between them. There are several ways your doctor can predict the final LLD, and thus the timing of the surgery. The easiest way is the so-called Australian method, popularised by Dr. Malcolm Menelaus, an Australian orthopedic surgeon. According to this method, growth in girls is estimated to stop at age 14, and in boys at age 16 years. The femur grows at the rate of 10 mm. a year, and the upper tibia at the rate of 6 mm. a year. Using simple arithmetic, one can get a fairly good prediction of future growth. This of course, is an average, and the patient may be an average. To cut down the risk of this, the doctor usually measures leg length using special X-ray technique (called a Scanogram) on three occasions over at least one year duration to estimate growth per year. He may also do an X-ray of the left hand to estimate the bone age (which in some cases may differ from chronological age) by comparing it with an atlas of bone age. In most cases, however, the bone age and chronological age are quite close. Another method of predicting final LLD is by using Anderson and Green?s remaining growth charts. This is a very cumbersome method, but was till the 1970?s, the only method of predicting remaining growth. More recently, however, a much more convenient method of predicting LLD was discovered by Dr. Colin Moseley from Montreal. His technique of using straight line graphs to plot growth of leg lengths is now the most widely used method of predicting leg length discrepancy. Whatever method your doctor uses, over a period of one or two years, once he has a good idea of the final LLD, he can then formulate a plan to equalize leg lengths. Epiphyseodesis is usually done in the last 2 to 3 years of growth, giving a maximum correction of about 5 cm. Leg lengthening can be done at any age, and can give corrections of 5 to10 cm., or more.

May 31 2017

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Mortons Neuroma Causes

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interdigital neuromaMorton's neuroma is an enlarged nerve that usually occurs in the third interspace, which is between the third and fourth toes. To understand Morton's neuroma further, it may be helpful to look at the anatomy of the foot. Problems often develop in the third interspace because part of the lateral plantar nerve combines with part of the medial plantar nerve here. When the two nerves combine, they are typically larger in diameter than those going to the other toes. Also, the nerve lies in subcutaneous tissue, just above the fat pad of the foot, close to an artery and vein. Above the nerve is a structure called the deep transverse metatarsal ligament. This ligament is very strong, holds the metatarsal bones together, and creates the ceiling of the nerve compartment. With each step, the ground pushes up on the enlarged nerve and the deep transverse metatarsal ligament pushes down. This causes compression in a confined space.

Causes

The exact cause of Morton?s neuroma is not known, but the choice of footwear seems be a factor. Wearing high heels (shoes with heels over 2 inches) can put extra pressure on the balls of the feet. Wearing tight or pointed toed shoes may squeeze the toes together or otherwise constrict their movement. For that reason, women are about 8 to 10 times more likely to develop Morton?s neuroma compared with men. People who are born with flat feet, high arches, or an abnormal position of the toes are more prone to developing Morton?s neuroma. This may be due to instability around the toe joints. Certain conditions that develop over time, such as bunions or hammer toes, are also associated with Morton?s neuroma. Some sports that involve running, including tennis and other racquet sports, can also increase the chance of developing Morton?s neuroma due to trauma or injury to the foot.

Symptoms

Symptoms include: pain on weight bearing, frequently after only a short time. The nature of the pain varies widely among individuals. Some people experience shooting pain affecting the contiguous halves of two toes. Others describe a feeling like having a pebble in their shoe or walking on razor blades. Burning, numbness, and paresthesia may also be experienced. Morton's neuroma lesions have been found using MRI in patients without symptoms.

Diagnosis

Podiatrists conduct a physical examination and may order imaging tests, such as x-ray or MRI scan to diagnose Morton's neuroma. Conservative treatment options include custom-fitted orthotics, medication, and/or alcohol injections designed to harden the nerve. However, most patients with Morton's neuroma need minor surgery.

Non Surgical Treatment

Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first. Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over-the-counter, or your doctor may prescribe a custom-made, individually designed shoe insert, molded to fit the exact contours of your foot.intermetatarsal neuroma

Surgical Treatment

Should the problem have progressed beyond the point where these measures are sufficient, the podiatric professional may recommend surgery. This procedure involves excision of the involved nerve mass. This will relieve the pain. Many patients report permanent numbness in the spot formerly affected by the neuroma, but prefer it to the pain. Most surgeries are successful; unfortunately, there are cases where the patient suffers another neuroma, sometimes in or near the same spot as before. A podiatric professional can explain the statistics of recurrence in various cases. If you suspect a neuroma, don?t wait for it to get better on its own. The earlier the diagnosis, the higher the likelihood that it can be treated with conservative measures. Don?t think that foot pain of any kind is inevitable, either, even if it runs in your family.

Prevention

It is not always possible to prevent a Morton's neuroma. However, you probably can reduce your risk by wearing comfortable shoes that have low heels, plenty of toe space and good arch support.

June 21 2015

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Hammer Toe Causes

Hammer ToeOverview

A Hammer toe can be flexible or rigid. Hammertoes often start out flexible and become rigid over time as your toe becomes accustomed to its crooked position. Flexible hammertoes are less serious than rigid hammertoes, as they can be easily diagnosed and treated in their initial stages. Flexible hammertoes are named as such because your affected toe still possesses some degree of movement.

Causes

As described above, the main reason people develop hammertoes is improper footwear, or footwear that is too short for the toes. Shoes that do not allow our toes to lie flat are the biggest cause of hammertoes, though there are others, including genetics, injury or trauma in which the toe is jammed or broken. Diseases that affect the nerves and muscles, such as arthritis. Abnormal foot mechanics due to nerve or muscle damage, causing an imbalance of the flexor and extensor tendons of the toe. Systematic diseases such as arthritis can also lead to problems such as hammertoe. Some people are born with hammertoes, while others are more prone to developing the condition due to genetics. If you have ever broken a toe, you know there is not much that can be done for it. It is one of the only bones in the body that heals without the use of a cast. A broken toe may be splinted, however, which may help prevent a hammertoe from forming.

HammertoeSymptoms

A toe stuck in an upside-down "V" is probably a hammertoe. Some symptoms are, pain at the top of the bent toe when putting on a shoe. Corns forming on the top of the toe joint. The toe joint swelling and taking on an angry red colour. Difficulty in moving the toe joint and pain when you try to so. Pain on the ball of the foot under the bent toe. Seek medical advice if your feet regularly hurt, you should see a doctor or podiatrist. If you have a hammertoe, you probably need medical attention. Ask your doctor for a referral to a podiatrist or foot surgeon. Act now, before the problem gets worse.

Diagnosis

First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates hammertoes that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.

Non Surgical Treatment

Wear wide shoes with plenty of room in the toes and resilient soles. Avoid wearing shoes with pointed toes. Commercially available felt pads or cushions may ease pressure from the shoe on the toe. Toe caps (small, padded sleeves that fit around the tip of the toe) may relieve the pain of hammer toe. Do toe exercises, to help toe muscles become stronger and more flexible.

Arch supports or an orthotic shoe insert prescribed by your doctor or podiatrist may help to redistribute weight on the foot. These devices do not cure the problem but may ease the symptoms of either hammer toe or mallet toe.

Surgical Treatment

A variety of anaesthetic techniques are possible. Be sure an discuss this with your surgeon during your pre-op assessment. The type of surgery performed will depend on the problem with your toes and may involve releasing or lengthening tendons, putting joints back into place, straightening a toe and changing the shape of a bone.Your surgeon may fix the toes in place with wires or tiny screws.

HammertoePrevention

elect and wear the right shoe for specific activities (such as running shoes for running). Alternate shoes. Don't wear the same pair of shoes every day. Avoid walking barefoot, which increases the risk for injury and infection. At the beach or when wearing sandals, always use sunblock on your feet, as you would on the rest of your body. Be cautious when using home remedies for foot ailments. Self-treatment can often turn a minor problem into a major one. It is critical that people with diabetes see a podiatric physician at least once a year for a checkup. People with diabetes, poor circulation, or heart problems should not treat their own feet, including toenails, because they are more prone to infection.
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June 14 2015

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Do Bunions Require Surgery?

Overview
Bunions A bunion is a growth of skin at the joint of the big toe, often a result of enlarged tissue or misaligned bone. In some cases, the bunion may be so extreme that it pushes the big toe inward toward the second toe. Skin and tissue surrounding the joint may experience sensitivity to touch, tenderness and pain.

Causes
Bunions are the byproduct of unnatural forces and motion being applied to the joints and tendons of your foot over a prolonged period of time. They can also be caused by traumas to the foot as well as congenital deformities. Occupations or athletic activities that place abnormal stress on your feet can also lead to the formation of bunions. Bunions have a tendency to run in families, but it?s not the bunion itself that is hereditary. It?s the the foot type which *causes* the bunion that is hereditary. Also, wearing shoes such as high heels that do not distribute your body weight evenly can lead to bunions, which explains why so many women suffer from bunions.

Symptoms
The signs and symptoms of a bunion include a bulging bump on the outside of the base of your big toe, swelling, redness or soreness around your big toe joint, Thickening of the skin at the base of your big toe, Corns or calluses, these often develop where the first and second toes overlap, persistent or intermittent pain, restricted movement of your big toe. Although bunions often require no medical treatment, see your doctor or a doctor who specializes in treating foot disorders (podiatrist or orthopedic foot specialist) if you have persistent big toe or foot pain, a visible bump on your big toe joint, decreased movement of your big toe or foot, difficulty finding shoes that fit properly because of a bunion.

Diagnosis
Generally, observation is adequate to diagnose a bunion, as the bump is obvious on the side of the foot or base of the big toe. However, your physician may order X-rays that will show the extent of the deformity of the foot.

Non Surgical Treatment
Long-term treatment of bunions must be directed towards re-balancing the foot, so that we no longer walk with our weight forced on to the inner border of the foot. This is accomplished by controlling and reducing pronation with the use of a high quality arch support or custom made orthotics. These devices comfortably re-balance the feet and overcome pronation. This reduces the abnormal weight forces on the big toe and its metatarsal head, allowing the feet to function normally. As a result, the deformity should not worsen, and the pain should gradually subside. If the foot is not re-balanced, the deformity and pain will become worse. Bunions

Surgical Treatment
When these above measures no longer help to relieve the pain in the big toe, surgery to correct the bunion deformity is considered. Numerous surgical procedures have been recommended for bunions. What is most critical is that the type of deformity is carefully evaluated, because one bunion surgery cannot be used for all types of bunions. If the big toe joint is rotated out of place, the joint must be rotated back in place for the procedure to work. Conversely, a bunion can occur with the big toe still ?in place.? If surgery is considered, the bunion must be corrected with the toe joint left in its current position. In other words, one type of bunion repair does not work for everyone. In all types of bunion repairs, ligaments and tendons (soft tissues) around the big toe joint are reconstructed, to allow the toe to be straightened. Most bunion procedures also require cutting the metatarsal bone, which is then fixed with metal screws to hold the bone in position until it heals. It usually takes 2 to 4 months to fully recover from bunion surgery, which is why it is always the last course of treatment.

Prevention
Choosing footwear that fits correctly, especially low heeled shoes with plenty of space for the toes, is one of the main ways that bunions can be prevented. Always stand when trying on shoes to ensure they still fit comfortably when the foot expands under your body weight. Try shoes on both feet, and select the size appropriate for your larger foot. Use an extra insole if one shoe is looser than the other. Do not cramp the larger foot. People prone to flat-footedness should consider the use of arch supports, orthotic shoe inserts or special orthotic shoes to prevent or delay the development of bunions.
Tags: Bunions

May 31 2015

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How Can I Tell If I Have Got Over-Pronation Of The Foot

Overview

Overpronating is a term that is thrown around loosely, whether it be a clinician?s office (PT, Ortho Doc, Podiatrist), in print publication, online, or at your local shoe shop.Being classified as an overpronator is fairly subjective. There?s no criteria to classify you as a runner who overpronates. Pronation is completely normal. Pronation allows your foot to unlock and distribute force up the chain (leg). Pronation that fails to occur, whether it be due to an orthotic, bony structure (high arch), or motion control shoe, may actually increase ground reaction forces (impact). It should make sense, too. Blocking your foot from pronating disengages the first anatomical system for absorbing impact forces. ?Over? insinuates that you pronate too much, but who gets to determine what?s considered normal? We have values that are deemed ?normal,? but varying foot structures complicate the situation. Varying degrees of high, neutral, and low arches all affect this ?normal? pronation number. ?Normal? pronation numbers will simply be out of reach for rigid arches, while flexible feet with surpass the numbers. To dilute the situation further, your strength, habits, and flexibility can all influence how much you pronate.Over Pronation

Causes

There is a relationship between biomechanics and injury that is specific to each body part. Overall though, poor mechanics will either increase the landing forces acting on the body or increase the work to be done by the muscles. Both increase the stress, which, depending on the individual and the amount of running can become excessive and cause injury.

Symptoms

Symptoms can manifest in many different ways. The associated conditions depend on the individual lifestyle of each patient. Here is a list of some of the conditions associated with Over Pronation. Hallux Abducto Valgus (bunions). Hallux Rigidus (stiff 1st toe). Arch Pain. Heel Pain (plantar fascitis). Metatarsalgia (ball of the foot pain). Ankle sprains. Shin Splints. Achilles Tendonitis. Osteochondrosis. Knee Pain. Corns & Calluses. Flat Feet. Hammer Toes.

Diagnosis

To easily get an idea of whether a person overpronates, look at the position and condition of certain structures in the feet and ankles when he/she stands still. When performing weight-bearing activities like walking or running, muscles and other soft tissue structures work to control gravity's effect and ground reaction forces to the joints. If the muscles of the leg, pelvis, and feet are working correctly, then the joints in these areas such as the knees, hips, and ankles will experience less stress. However, if the muscles and other soft tissues are not working efficiently, then structural changes and clues in the feet are visible and indicate habitual overpronation.Overpronation

Non Surgical Treatment

Over-pronation and the problems that go with it are treated with shoe inserts called arch supports or orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom made. Make sure the arch supports are firm. If you can easily bend them in half, they may be too flexible.

Prevention

Duck stance: Stand with your heels together and feet turned out. Tighten the buttock muscles, slightly tilt your pelvis forwards and try to rotate your legs outwards. You should feel your arches rising while you do this exercise.

Calf stretch:Stand facing a wall and place hands on it for support. Lean forwards until stretch is felt in the calves. Hold for 30 seconds. Bend at knees and hold for a further 30 seconds. Repeat 5 times.

Golf ball:While drawing your toes upwards towards your shins, roll a golf ball under the foot between 30 and 60 seconds. If you find a painful point, keep rolling the ball on that spot for 10 seconds.

Big toe push: Stand with your ankles in a neutral position (without rolling the foot inwards). Push down with your big toe but do not let the ankle roll inwards or the arch collapse. Hold for 5 seconds. Repeat 10 times. Build up to longer times and fewer repetitions.

Ankle strengthener: Place a ball between your foot and a wall. Sitting down and keeping your toes pointed upwards, press the outside of the foot against the ball, as though pushing it into the wall. Hold for 5 seconds and repeat 10 times.

Arch strengthener: Stand on one foot on the floor. The movements needed to remain balanced will strengthen the arch. When you are able to balance for 30 seconds, start doing this exercise using a wobble board.

May 19 2015

baxtermarzerrljs

Therapy And Severs Disease

Overview

Children with Sever's disease, which is also called calcaneal apophysitis, develop microfractures where the Achilles tendon inserts on the calcaneus, the large bone that makes up the heel of the foot. These microfractures cause pain, which can vary depending on the type of activity your child is doing, and is generally worse after activity and improves with rest. Sever's disease is more common in boys and typically occurs when a child is between 8 and 13 years old. Although it can affect both heels, it more commonly just affects one foot.

Causes

Heel pain is very common in children because of the very nature of their growing feet and legs. In children, the heel bone (the calcaneus) is not fully developed until the age of 14 or older. Until then, new bone is forming at the growth plate of the foot (the apophysis, located at the back of the heel), an area which is softer than others due to its role in accommodating the growth. Repetitive stress on the growth plate due to walking, running and sports causes inflammation in the heel area. Because the heel's growth plate is sensitive, repeated running and pounding on hard surfaces can result in pediatric heel pain. Children and adolescents involved in football, soccer, running or basketball are especially vulnerable. Over-pronation (fallen arches and rolling inwards of the feet) will increase the stress on the growth plate and is therefore a significant cause and a major contributing factor to heel pain in children.

Symptoms

The pain is at the heel or around the Achilles tendon. This is felt commonly during exercise, particularly activities involving running or jumping. The back of the heel may also be tender to touch and there may be localised swelling. There may be stiffness in the calf muscles first thing in the morning and you may notice limping or a tendency to tiptoe.

Diagnosis

A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.

Non Surgical Treatment

Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.

Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.

Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).

Anti-inflammatory creams: Also an effective management tool.

Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.

Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.

Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.

Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Recovery

If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position. If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.

May 02 2015

baxtermarzerrljs

Causes Signals And Remedy For An Achilles Tendon Rupture

Overview
Achilles tendon The Achilles tendon is the largest and most vulnerable tendon in the body. It joins the gastrocnemius (calf) and the soleus muscles of the lower leg to heel of the foot. The gastrocnemius muscle crosses the knee, the ankle, and the subtalar joints and can create stress and tension in the Achilles tendon . Tendons are strong, but not very flexible so they can only so far before they get inflammed and tear or rupture.

Causes
Factors that may increase your risk of Achilles tendon rupture include Age. The peak age for Achilles tendon rupture is 30 to 40. Your sex. Achilles tendon rupture is up to five times more likely to occur in men than in women. Playing recreational sports. Achilles tendon injuries occur more often in sports that involve running, jumping and sudden starts and stops - such as soccer, basketball and tennis. Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures. Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture.

Symptoms
Often the person feels a whip-like blow that is followed by weakness in the affected leg - usually he or she is not able to walk afterwards. At place where the tendon ruptured, a significant dent is palpable. Often the experienced physician can diagnose a ruptured Achilles tendon by way of clinical examination and special function tests. Imaging techniques, such as ultrasound and magnetic resonance imaging (MRI) allow for a more precise diagnosis.

Diagnosis
It is usually possible to detect a complete rupture of the Achilles tendon on the history and examination. A gap may be felt in the tendon, usually 4-5cm above the heel bone. This is the normal site of injury and is called an intra-substance tear. The tear can occur higher up about 10cm above the insertion into the heel at the site where the muscles join the tendon, this is known as a musculo-tendinous tear. A special test will be performed which involves squeezing the calf. Normally if the Achilles tendon is intact this causes the foot to point downwards but if it is ruptured it causes no movement. To confirm the diagnosis and the exact site of the rupture it may be necessary to perform an Ultra-sound or MRI scan.

Non Surgical Treatment
Treatment of the initial injury is with use of ice, elevation, and immobilization. If suspected you should contact your podiatrist or physician. Further treatment with continued immobilization, pain medication, or anti-inflammatory medications may be advised. If casted the foot is usually placed in a plantarflexed position to decrease the stretch on the tendon. As healing progresses the cast is changed to a more dorsiflexed position at the ankle. The casting processes can be up to 8 weeks or more. Achilles tendonitis

Surgical Treatment
There are two different types of surgeries; open surgery and percutaneous surgery. During an open surgery an incision is made in the back of the leg and the Achilles tendon is stitched together. In a complete or serious rupture the tendon of plantaris or another vestigial muscle is harvested and wrapped around the Achilles tendon, increasing the strength of the repaired tendon. If the tissue quality is poor, e.g. the injury has been neglected, the surgeon might use a reinforcement mesh (collagen, Artelon or other degradable material). In percutaneous surgery, the surgeon makes several small incisions, rather than one large incision, and sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture to let the swelling go down. For sedentary patients and those who have vasculopathy or risks for poor healing, percutaneous surgical repair may be a better treatment choice than open surgical repair.

Prevention
You can help to reduce your risk of an injury to your Achilles tendon by doing the following. When you start a new exercise regime, gradually increase the intensity and the length of time you spend being active. Warm up your muscles before you exercise and cool them down after you have finished. The benefit of stretching before or after exercise is unproven. However, it may help to stretch your calf muscles, which will help to lengthen your Achilles tendon, before you exercise. Wear appropriate and well-fitting shoes when you exercise.
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