Tumblelog by Soup.io
Newer posts are loading.
You are at the newest post.
Click here to check if anything new just came in.

July 03 2017

coldlectern046

Everything You Will Need To Understand About Heel Discomfort

http://coldlectern046.soup.io Overview

Pain At The Heel

The most common form of heel pain, is pain on the bottom of the heel. It tends to occur for no apparent reason and is often worse when first placing weight on the foot. Patients often complain of pain the first thing in the morning or after getting up to stand after sitting. The pain can be a sharp, searing pain or present as a tearing feeling in the bottom of the heel. As the condition progresses there may be a throbbing pain after getting off your feet or there may be soreness that radiates up the back of the leg. Pain may also radiate into the arch of the foot.

Causes

Heel pain can have many causes. If your heel hurts, see your primary care doctor or orthopaedic foot and ankle specialist right away to determine why and get treatment. Tell him or her exactly where you have pain and how long you've had it. Your doctor will examine your heel, looking and feeling for signs of tenderness and swelling. You may be asked to walk, stand on one foot or do other physical tests that help your doctor pinpoint the cause of your sore heel. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.

Symptoms

Symptoms include a dull ache which is felt most of the time with episodes of a sharp pain in the centre of the heel or on the inside margin of the heel. Often the pain is worse on first rising in the morning and after rest and is aggravated by prolonged weight bearing & thin soled shoes.

Diagnosis

Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot. Surgery may be recommended in some cases.

Non Surgical Treatment

Orthotics, by treating the cause of the problem, lead to the cure bette than 90% of the time. A small number of patients have waited so long that the plantar fascia has become thickened and filled with scar tissue and are not helped by ?conventional? means. Those are the patients that have, traditionally, required surgical treatment in which the plantar fascia is cut off the heel bone. Luckily, most surgery has been replaced by a relatively new mode of treatment, ESWT or Extracorporeal Shockwave Therapy. ESWT involves the application of multiple shockwaves to the diseased tendon or ligament and has an approximately 85 to 90% success rate. Keep in mind we are talking about this success rate in patients who are ?tough cases,? that is, already had the conventional treatment. The ESWT machines look like miniature renal lithtripsors (kidney stone crushers). There are virtually no side effects to ESWT other than the price as only about 30% of insurance companies are paying for it. They realize that it is less costly and safer than surgery but also know that many more people who would avoid surgery would have no problem getting ESWT so the volume of services would go up. You don?t have to live with painful heels.

Surgical Treatment

Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).

bestshoelifts

Prevention

Heel Pain

It is not always possible to prevent heel pain, but there are measures you can take to help avoid further episodes. Being overweight can place excess pressure and strain on your feet, particularly on your heels. This increases the risk of damaging your feet and heels. If you are overweight, losing weight and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet can be beneficial for your feet. You can calculate your body mass index (BMI) to find out whether you are a healthy weight for your height and build. To work out your BMI, divide your weight in kilograms by your height in metres squared. A BMI of less than 18.5 means that you are underweight, 18.5-24.9 means that your weight is healthy, 25-29 means that you are overweight, 30-40 means that you are obese, over 40 means that you are morbidly obese. You can also use the BMI healthy weight calculator to work out your BMI.
coldlectern046

Do Fallen Arches Necessitate Surgery?

http://coldlectern046.soup.io Overview

Acquired Flat Feet

Fallen arches, or flat feet as they are often referred to, are a structural deformity whereby the arch of the foot lags or collapses. It?s very common, can be painful or not, can lead to a string of other ailments, but it is easily corrected. It is not more common in sports people or people who are overweight, but you knew all that, right?

Causes

There are a number of different causes that can lead to flat feet or fallen arches. These include, birth defects, while technically not a defect as such, flat feet can be a normal finding in patients from birth. However, a condition called tarsal coalition may occur where some of the bones in the foot are fused together resulting in a flatfoot. Inflammation or damage of the posterior tibial tendon. This tendon forms the end of a muscle that connects the lower leg to the foot, winding around the ankle and attaching to the inner aspect where the arch is normally present. The main role of the posterior tibial tendon is to invert the foot and maintain the arch height throughout the gait cycle. Torn muscles of the leg and foot can cause flat feet. Problems with the nerve supply to the muscles can result in reduction in tone and fallen arches. Fracture dislocation of the bones in the foot. Severe arthritis. While these are the common causes that can result in fallen arches and flat feet, it is important to recognise that there are certain risk factors that can also lead to this condition. These include advancing age, diabetes mellitus, high blood pressure, obesity and pregnancy.

Symptoms

Flat feet don't usually cause problems, but they can put a strain on your muscles and ligaments (ligaments link two bones together at a joint). This may cause pain in your legs when you walk. If you have flat feet, you may experience pain in any of the following areas, the inside of your ankle, the arch of your foot, the outer side of your foot, the calf, the knee, hip or back. Some people with flat feet find that their weight is distributed unevenly, particularly if their foot rolls inwards too much (overpronates). If your foot overpronates, your shoes are likely to wear out quickly. Overpronation can also damage your ankle joint and Achilles tendon (the large tendon at the back of your ankle).

Diagnosis

Flat feet are easy to identify while standing or walking. When someone with flat feet stands, their inner foot or arch flattens and their foot may roll over to the inner side. This is known as overpronation. To see whether your foot overpronates, stand on tiptoes or push your big toe back as far as possible. If the arch of your foot doesn't appear, your foot is likely to overpronate when you walk or run. It can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.

What causes flat foot deformity?

Non Surgical Treatment

If the condition is not bothering you or preventing you from being mobile, you may not need treatment (depending on your doctor?s diagnosis). Generally, treatment is reserved for those who have additional problems. Still, your doctor will probably recommend a simple treatment plan for your condition. This treatment may include rest and icing the arch, changing footwear, anti-inflammatory medication, using orthotics, over-the-counter medication such as ibuprofen, physical therapy. Corticosteroid injection (usually used in cases of severe pain). If these methods do not relieve symptoms of flat feet, your doctor may recommend surgery to reduce pain and improve the alignment of your bones.

Surgical Treatment

Acquired Flat Foot

Generally one of the following procedures is used to surgically repair a flat foot or fallen arch. Arthrodesis. One or more of your bones in the foot or ankle are fused together. Osteotomy. Correcting alignment by cutting and reshaping a bone. Excision. Removing a bone or a bone spur. Synovectomy. Cleaning the sheath that covers the tendon. Tendon transfer. Using a piece of one tendon to lengthen or replace another. Arthroereisis. placing a small device in the subtalar joint to limit motion. For most people, treatment is successful, regardless of the cause, although the cause does does play a major role in determining your prognosis. Some causes do not need treatment, while others require a surgical fix.

June 30 2017

coldlectern046

Functional Leg-Length Discrepancy Stride

http://coldlectern046.soup.io Overview

Leg length discrepancy, or as it has been alternatively termed, the short leg syndrome, is by far the most important postural asymmetry. Limb length discrepancy is simply defined as a condition where one leg is shorter than the other. If a substantial difference exists, disruptive effects on gait and posture can occur. Leg length discrepancy can be divided into two etiological groups. Structural. True shortening of the skeleton from congenital, traumatic or diseased origins. Functional. Development from altered mechanics of the lower body, such as foot hyperpronation or supination, pelvic obliquity, muscle/joint imbalances, poor trunk stabilization and deep fascial strain patterns.Leg Length Discrepancy

Causes

Leg length discrepancies can be caused by: hip and knee replacements, lower limb injuries, bone diseases, neuromuscular issues and congenital problems. Although discrepancies of 2 cm or less are most common, discrepancies can be greater than 6 cm. People who have LLD tend to make up for the difference by over bending their longer leg or standing on the toes of their shorter leg. This compensation leads to an inefficient, up and down gait, which is quite tiring and over time can result in posture problems as well as pain in the back, hips, knees and ankles.

Symptoms

In addition to the distinctive walk of a person with leg length discrepancy, over time, other deformities may be noted, which help compensate for the condition. Toe walking on the short side to decrease the swaying during gait. The foot will supinate (high arch) on the shorter side. The foot will pronate (flattening of the arch) on the longer side. Excessive pronation leads to hypermobility and instability, resulting in metatarsus primus varus and associated unilateral juvenile hallux valgus (bunion) deformity.

Diagnosis

There are several orthopedic tests that are used, but they are rudimentary and have some degree of error. Even using a tape measure with specific anatomic landmarks has its errors. Most leg length differences can be seen with a well trained eye, but I always recommend what is called a scanagram, or a x-ray bone length study (see picture above). This test will give a precise measurement in millimeters of the length difference.

Non Surgical Treatment

For minor limb length discrepancy in patients with no deformity, treatment may not be necessary. Because the risks may outweigh the benefits, surgical treatment to equalize leg lengths is usually not recommended if the difference is less than 1 inch. For these small differences, the physician may recommend a shoe lift. A lift fitted to the shoe can often improve walking and running, as well as relieve any back pain that may be caused by the limb length discrepancy. Shoe lifts are inexpensive and can be removed if they are not effective.

LLD Insoles

how to grow tall after 18

Surgical Treatment

Leg shortening is employed when LLD is severe and when a patient has already reached skeletal maturity. The actual surgery is called an osteotomy , which entails the removal of a small section of bone in the tibia (shinbone) and sometimes the fibula as well, resulting in the loss of around an inch in total height. Leg lengthening is a difficult third option that has traditionally had a high complication rate. Recently, results have improved somewhat with the emergence of a technique known as callotasis , in which only the outer portion of the bone (the cortex ) is cut, (i.e. a corticotomy ). This allows the bone to be more easily lengthened by an external fixation device that is attached to either side of the cut bone with pins through the skin. The ?ex-fix,' as it is sometimes called, is gradually adjusted by an orthopaedic surgeon, and healing can occur at the same time that the leg is being distracted , or lengthened over time. Unlike epiphysiodesis, leg lengthening procedures can be performed at almost any skeletal or chronological age.

May 31 2017

coldlectern046

Mortons Neuroma Symptoms

http://coldlectern046.soup.io Overview

plantar neuromaA Morton's neuroma is a benign (noncancerous) swelling along a nerve in the foot that carries sensations from the toes. The reason the nerve starts to swell is unknown. But once swelling begins, the nearby bones and ligaments put pressure on the nerve, causing more irritation and inflammation. This produces burning pain, numbness, tingling and other abnormal sensations in the toes. A Morton's neuroma also is called an interdigital neuroma, intermetatarsal neuroma or a forefoot neuroma.

Causes

In many cases, a neuroma may develop as a result of excessive loading on the front of the foot. Sometimes, a patient?s anatomic alignment in the forefoot contributes to the overload. There may be some cases where the neuroma develops spontaneously, for no obvious reason. However, once the nerve is irritated, pressure from walking, and from the adjacent bony prominences (metatarsal heads), as well as from the intermetatarsal ligament that binds the heads together, all may contribute to persistent pain. Repetitive pressure on the nerve causes localized injury with resulting scarring and fibrosis of the nerve. This leads to symptoms in the distribution of the nerve.

Symptoms

There may be pain at the end of the push-off phase when walking or running, and this pain is generally worse when the client is wearing shoes as opposed to being barefoot. Clients may also report a relief of symptoms by massaging the foot, which may spread the metatarsal heads and mobilize the entrapped nerve.

Diagnosis

Negative signs include no obvious deformities, erythema, signs of inflammation, or limitation of movement. Direct pressure between the metatarsal heads will replicate the symptoms, as will compression of the forefoot between the finger and thumb so as to compress the transverse arch of the foot. This is referred to as Mulder?s Sign. There are other causes of pain in the forefoot. Too often all forefoot pain is categorized as neuroma. Other conditions to consider are capsulitis, which is an inflammation of ligaments that surrounds two bones, at the level of the joint. In this case, it would be the ligaments that attach the phalanx (bone of the toe) to the metatarsal bone. Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma-type symptoms. Additionally, an intermetatarsal bursitis between the third and fourth metatarsal bones will also give neuroma-type symptoms because it too puts pressure on the nerve. Freiberg's disease, which is an osteochondritis of the metatarsal head, causes pain on weight bearing or compression.

Non Surgical Treatment

Symptoms of a Morton's neuroma can completely resolve with simple treatments, such as resting the foot, better-fitting shoes, anti-inflammation medications, and ice packs. More rapid relief of symptoms can follow a local cortisone injection. Symptoms can progressively worsen with time. For those with persistent symptoms, the swollen nerve tissue is removed with a surgical operation.Morton

Surgical Treatment

If conservative treatments haven't helped, your doctor might suggest injections. Some people are helped by the injection of steroids into the painful area. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.

June 22 2015

coldlectern046

Help For Contracted Toes

HammertoeOverview

hammertoes is a type of crooked toe that involve unnatural contracture, or bending, of your toes. In most cases, a hammertoe is characterized by a toe malposition in which the end of your affected toe points down and the first joint of your same toe-your proximal interphalangeal joint-points up. This crooked toe syndrome usually leads to rubbing within your shoe and pain. A hammertoe resembles an upside-down letter v when viewed from the side. This crooked toe syndrome most commonly affects your second to fifth toes, though it may also affect your big toe. This health problem is more commonly experienced by women than men.

Causes

Hammer toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. This results in the joint curling downward. Arthritis can also lead to many different forefoot deformities, including hammer toes.

HammertoeSymptoms

Some people never have troubles with hammer toes. In fact, some people don't even know they have them. They can become uncomfortable, especially while wearing shoes. Many people who develop symptoms with hammer toes will develop corns, blisters and pain on the top of the toe, where it rubs against the shoe or between the toes, where it rubs against the adjacent toe. You can also develop calluses on the balls of the feet, as well as cramping, aching and an overall fatigue in the foot and leg.

Diagnosis

Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to hammertoes look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.

Non Surgical Treatment

There are many non-surgical treatments to help relieve symptoms of hammertoe. The first step for many people is wearing the right size and type of shoe. Low-heeled shoes with a boxy or roomy toe area are helpful. Cushioned insoles, customized orthopedic inserts, and pads can provided relief as well. Splints or straps may be used to help correct toe position. Your doctor may show you toe stretches and exercises to perform. Your doctor can safely remove corns and calluses. You should not try to remove them at home.

Surgical Treatment

Surgery is used when other types of treatment fail to relieve symptoms or for advanced cases of hammertoe. There are several types of surgeries to treat hammertoe. A small piece of bone may be removed from the joint (arthroplasty). The toe joint may be fused to straighten it (arthrodesis). Surgical hardware, such as a pin, may be used to hold the bones in place while they heal. Other types of surgery involve removing skin (wedging) or correcting muscles and tendons to balance the joint.
Tags: Hammer Toes

May 29 2015

coldlectern046

The Treatment Of Overpronation Of The Foot

Overview

Pes planus is the medical term for flat feet. It comes from Latin, Pes = foot and Planus = plain, level ground. Very few people suffer from this condition, as a true flat foot is very rare. Less than 5% of the population has flat feet. The majority of the population, however, has fallen arches (an estimated 60-70% of the population) known in the medical profession as ?excess pronation? or over-pronation. Over-pronation means the foot and ankle tend to roll inwards and the arch collapses with weight-bearing. This is a quite a destructive position for the foot to function in and may cause a wide variety of foot, leg and lower back conditions.Overpronation

Causes

Over-pronation may happen because the tissue that attaches to your foot bones is loose. You may be born with this problem or it may result from injuries or overuse, like from too much running.

Symptoms

If you overpronate, your symptoms may include discomfort in the arch and sole of foot, your foot may appear to turn outward at the ankle, your shoes wear down faster on the medial (inner) side of your shoes. Pain in ankle, shins, knees, or hips, especially when walking or running are classic symptoms of overpronation. Overpronation can lead to additional problems with your feet, ankles, and knees. Runners in particular find that overpronation can lead to shin splints, tarsal tunnel syndrome, plantar fasciitis, compartment syndrome, achilles tendonitis, bunions or hallux valgus, patello-femoral pain syndrome, heel spurs, metatarsalgia.

Diagnosis

A quick way to see if you over-pronate is to look for these signs. While standing straight with bare feet on the floor, look so see if the inside of your arch or sole touches the floor. Take a look at your hiking or running shoes; look for wear on the inside of the sole. Wet your feet and walk on a surface that will show the foot mark. If you have a neutral foot you should see your heel connected to the ball of your foot by a mark roughly half of width of your sole. If you over-pronate you will see greater than half and up to the full width of your sole.Pronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. This orthotics should be designed with appropriate arch support and medial rear foot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems. If the problem persists, consult your foot doctor.

Prevention

Pronation forces us to bear most of our weight on the inner border of our feet. Custom-made orthotics gently redistributes the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist out at the ankle, but will strike the ground normally when the orthotics is used. This action of the custom-made orthotics will help to prevent shin splints, ankle sprains, knee and hip pain, lower back pain, nerve entrapments, tendonitis, muscle aches, bunions, generalized fatigue, hammer toes, and calluses.

May 22 2015

coldlectern046

What Is Severs Disease?

Overview

Sever's disease is an overuse syndrome involving an immature part of the skeleton. Pain goes away when the overuse is over, or when the growing is done. Hence, the disease is self-limited, in that the pain goes away eventually when growth in the heel bone is complete at about age 13. Even if the child is hurting, as long as he can tolerate it, he may continue to take part in sports. No long term disability is expected from this problem.

Causes

Severs disease is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter as they cannot keep up with the bone growth. The point at which the achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble (a lot like osgood schlatters disease of the knee). Tight calf muscles may contribute as the range of motion at the ankle is reduced resulting in more strain on the achilles tendon. Sever's disease is the second most common injury of this type which is known as an apophysitis.

Symptoms

Activity-related pain that occurs on the back of the heel, where the Achilles tendon attaches on to the heel bone. Tenderness, pain & swelling on the heel bone. Difficulty walking or walking with a limp or on tiptoes.

Diagnosis

X-rays are normal in Sever's disease, but your doctor will probably get X-rays to rule out other problems. Treatment consists of non-steroidal anti-inflammatory medications and use of a heel lift to relieve tension on the calcaneal apophysis. In more severe cases, phycical therapy consisting of modalities to relieve the pain, and stretching exercises may be helpful. In extreme cases, castings have been used.

Non Surgical Treatment

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.

April 16 2015

coldlectern046

Acquired Flat Foot Deformity Surgery

Overview
Dysfunction of the tibialis posterior tendon is a common condition and a common cause of acquired flatfoot deformity in adults. Women older than 40 are most at risk. Patients present with pain and swelling of the medial hindfoot. Patients may also report a change in the shape of the foot or flattening of the foot. The foot develops a valgus heel (the heel rotates laterally when observed from behind), a flattened longitudinal arch, and an abducted forefoot. Conservative treatment includes non-steroidal anti-inflammatory drugs, rest, and immobilisation for acute inflammation; and orthoses to control the more chronic symptoms. Surgical treatment in the early stages is hindfoot osteotomy combined with tendon transfer. Arthrodesis of the hindfoot, and occasionally the ankle, is required in the surgical treatment of the later stages of tibialis posterior dysfunction. Acquired flat feet

Causes
As discussed above, many health conditions can create a painful flatfoot. Damage to the posterior tibial tendon is the most common cause of AAFD. The posterior tibial tendon is one of the most important tendons of the leg. It starts at a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inside of the foot. The main function of this tendon is to hold up the arch and support your foot when you walk. If the tendon becomes inflamed or torn, the arch will slowly collapse. Women and people over 40 are more likely to develop problems with the posterior tibial tendon. Other risk factors include obesity, diabetes, and hypertension. Having flat feet since childhood increases the risk of developing a tear in the posterior tibial tendon. In addition, people who are involved in high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Inflammatory arthritis, such as rheumatoid arthritis, can cause a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the foot to change shape and become flat. The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch.

Symptoms
Pain and swelling behind the inside of your ankle and along your instep. You may be tender behind the inner ankle where the posterior tibial tendon courses and occasionally get burning, shooting, tingling or stabbing pain as a result of inflammation of the nerve inside the tarsal tunnel. Difficulty walking, the inability to walk long distances and a generalised ache while walking even short distances. This may probably become more pronounced at the end of each day. Change in foot shape, sometimes your tendon stretches out, this is due to weakening of the tendon and ligaments. When this occurs, the arch in your foot flattens and a flatfoot deformity occurs, presenting a change in foot shape. Inability to tip-toe, a way of diagnosing Posterior Tibial Tendon Dysfunction is difficulty or inability to ?heel rise? (stand on your toes on one foot). Your tibialis posterior tendon enables you to perform this manoeuvre effectively. You may also experience pain upon attempting to perform a heel rise.

Diagnosis
Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course. Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is available. Check the anterior tibial tendon for size and strength.

Non surgical Treatment
Patients can be treated non-surgically with in-shoe devices and braces to hold their feet in the correct position. This can reduce pain and damage and assist with walking. Physical therapy is also given to improve muscle strength and help prevent injury to the foot. Surgery can be performed if the patient doesn?t find any relief. Adult acquired flat foot

Surgical Treatment
Surgery is usually performed when non-surgical measures have failed. The goal of surgery is to eliminate pain, stop progression of the deformity and improve a patient?s mobility. More than one technique may be used, and surgery tends to include one or more of the following. The tendon is reconstructed or replaced using another tendon in the foot or ankle The name of the technique depends on the tendon used. Flexor digitorum longus (FDL) transfer. Flexor hallucis longus (FHL) transfer. Tibialis anterior transfer (Cobb procedure). Calcaneal osteotomy - the heel bone may be shifted to bring your heel back under your leg and the position fixed with a screw. Lengthening of the Achilles tendon if it is particularly tight. Repair one of the ligaments under your foot. If you smoke, your surgeon may refuse to operate unless you can refrain from smoking before and during the healing phase of your procedure. Research has proven that smoking delays bone healing significantly.

March 20 2015

coldlectern046

Do I Suffer Adult Aquired Flat Foot?

Overview

Adult flatfoot refers to a deformity that develops after skeletal maturity is reached. Adult flatfoot should be differentiated from constitutional flatfoot, which is a common congenital non-pathologic foot morphology. There are numerous causes of acquired adult flatfoot, including fracture or dislocation, tendon laceration, tarsal coalition, arthritis, neuroarthropathy, neurologic weakness, and iatrogenic causes.Acquired Flat Foot



Causes

Posterior tibial tendon dysfunction is the most common cause of acquired adult flatfoot. Sometimes this can be a result of specific trauma, but usually the tendon becomes injured from wear and tear over time. This is more prevalent in individuals with an inherited flat foot but excessive weight, age, and level of activity are also contributing factors.



Symptoms

Often, this condition is only present in one foot, but it can affect both. Adult acquired flatfoot symptoms vary, but can swelling of the foot's inner side and aching heel and arch pain. Some patients experience no pain, but others may experience severe pain. Symptoms may increase during long periods of standing, resulting in fatigue. Symptoms may change over time as the condition worsens. The pain may move to the foot's outer side, and some patients may develop arthritis in the ankle and foot.



Diagnosis

It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal" treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.



Non surgical Treatment

Options range from shoe inserts, orthotics, bracing and physical therapy for elderly and/or inactive patients to reconstructive surgical procedures in those wishing to remain more active. These treatments restore proper function and alignment of the foot by replacing the damaged muscle tendon unit with an undamaged, available and expendable one, lengthening the contracted Achilles tendon and realigning the Os Calcis, or heel bone, while preserving the joints of the hindfoot. If this condition is not recognized before it reaches advanced stages, a fusion of the hindfoot or even the ankle is necessary. Typically this is necessary in elderly individuals with advanced cases that cannot be improved with bracing.

Flat Feet



Surgical Treatment

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.

March 05 2015

coldlectern046

Just What Can Result In Tendonitis Aches In The Achilles ?

Overview

Achilles TendinitisDo you experience dull pain near the back of your heel or in the back of your leg after your regular run or after playing your favourite sport? When you ramp up your exercise is the pain more severe or prolonged? If so, you may have Achilles tendinitis. The Achilles tendon is the thick, strong, springy band of tissue that connects the muscles from the middle of your calf to your heel bone. You use your Achilles tendon when you walk, run or jump. Achilles tendinitis occurs when the Achilles tendon is repeatedly strained. The Achilles tendon becomes less flexible, weaker and more prone to injury as we age. Middle-aged weekend warriors and runners who suddenly intensify their training often suffer from Achilles tendinitis.

Causes

Although a specific incident of overstretching can cause an Achilles tendon disorder, these injuries typically result from a gradually progressive overload of the Achilles tendon or its attachment to bone. The cause of this chronic overload is usually a combination of factors that can put excess stress on the tendon: being overweight, having a tight calf muscle, standing or walking for a long period of time, wearing excessively stiff or flat footwear, or engaging in significant sports activity.

Symptoms

The main symptom of Achilles tendonitis is a feeling of pain and swelling in your heel as you walk or run. Other symptoms include tight calf muscles and limited range of motion when flexing the foot. This condition can also make the skin in your heel feel overly warm to the touch.

Diagnosis

During the physical exam, your doctor will gently press on the affected area to determine the location of pain, tenderness or swelling. He or she will also evaluate the flexibility, alignment, range of motion and reflexes of your foot and ankle. Your doctor may order one or more of the following tests to assess your condition, X-rays. While X-rays can't visualize soft tissues such as tendons, they may help rule out other conditions that can cause similar symptoms. Ultrasound. This device uses sound waves to visualize soft tissues like tendons. Ultrasound can also produce real-time images of the Achilles tendon in motion. Magnetic resonance imaging (MRI). Using radio waves and a very strong magnet, MRI machines can produce very detailed images of the Achilles tendon.

Nonsurgical Treatment

NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions. Steroid injections. Steroids decrease pain and swelling. After you get this shot, you may feel like your Achilles tendon is healed. Do not return to your regular exercise until your caregiver says it is okay. You could make the tendinitis worse, or even tear the tendon. Surgery. If your tendinitis does not heal with other treatments, you may need surgery. Surgery may be done to repair a tear in the tendon, or to remove parts of the tendon. The most important way to manage Achilles tendinitis is to rest. Rest decreases swelling and keeps your tendinitis from getting worse. You may feel pain when you begin to run or exercise. The pain usually goes away as your muscles warm up, but it may come back. Your caregiver may tell you to stop your usual training or exercise activities. He may give you other exercises to do until your Achilles tendon heals. Ice decreases swelling and pain. Put ice in a plastic bag. Cover it with a towel. Put this on your Achilles tendon for 15 to 20 minutes, 3 to 4 times each day. Do this for 2 to 3 days or until the pain goes away. After 2 or 3 days, you may use heat to decrease pain and stiffness. Use a hot water bottle, heating pad, whirlpool, or warm compress. To make a compress, soak a clean washcloth in warm water. Wring out the extra water and put it on your Achilles tendon 15 to 20 minutes, 3 to 4 times each day. Stretching and making the muscles stronger may help decrease stress on your Achilles tendon. Physical therapists can teach you exercises and treatments to help your tendinitis heal faster. You may need to wear inserts in your shoes. You may need to wrap tape around your heel and back of the leg. You may need to wear a cast, brace, or support boot.

Achilles Tendonitis

Surgical Treatment

Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from the transferred tendon.

Prevention

Achilles tendinitis cannot always be prevented but the following tips will help you reduce your risk. If you are new to a sport, gradually ramp up your activity level to your desired intensity and duration. If you experience pain while exercising, stop. Avoid strenuous activity that puts excessive stress on your Achilles tendon. If you have a demanding workout planned, warm up slowly and thoroughly. Always exercise in shoes that are in good condition and appropriate for your activity or sport. Be sure to stretch your calf muscles and Achilles tendon before and after working out. If you suffer from Achilles tendinitis make sure you treat it properly and promptly. If self-care techniques don?t work, don?t delay. Book a consultation with a foot care expert or you may find yourself sidelined from your favourite sports and activities.

February 25 2015

coldlectern046

Achilles Rupture The Facts

Overview

Achilles Tendonitis

A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the ?heel cord,? the Achilles tendon facilitates walking by helping to raise the heel off the ground. The Achilles tendon is at the back of the heel. It can be ruptured by sudden force on the foot or ankle. If your Achilles tendon is ruptured you will be unable to stand on tiptoe, and will have a flat-footed walk. It is important to diagnose and treat this injury as soon as possible, to help promote healing. Treatment involves wearing a plaster cast or brace (orthosis) for several weeks, and possibly having an operation.



Causes

The most common cause of a ruptured Achilles' tendon is when too much stress is placed through the tendon, particularly when pushing off with the foot. This may happen when playing sports such as football, basketball or tennis where the foot is dorsiflexed or pushed into an upward position during a fall. If the Achilles' tendon is weak, it is prone to rupture. Various factors can cause weakness, including corticosteroid medication and injections, certain diseases caused by hormone imbalance and tendonitis. Old age can also increase the risk of Achilles' tendon rupture.



Symptoms

Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel, an inability to bend your foot downward or "push off" the injured leg when you walk, an inability to stand on your toes on the injured leg, a popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward.



Diagnosis

A diagnosis can be made clinically, but an MRI or ultrasound scan can confirm it. On examination, the patient will present with reduced plantarflexion strength, a positive Thompson test and potentially, a palpable gap in the Achilles. The whole length of the tendon should be examined to check for injuries that can occur at the insertion and the musculotendinous junction.



Non Surgical Treatment

There is no definitive protocol for conservative management. Traditionally, conservative treatment involved immobilisation in a cast or boot, with initial non-weight bearing. Recently, good results have been achieved with functional bracing and early mobilisation, and it is common to be immediately weight-bearing in an orthotic. Conservative management reduces the chance of complications, such as infection. There is a risk the tendon can heal too long and more slowly.

Achilles Tendinitis



Surgical Treatment

The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair may be reinforced with other tendons. Surgical complications can include infection and nerve damage. Infection rates are reduced in surgeries that employ smaller incisions. Rehabilitation. After treatment, whether surgical or nonsurgical, you'll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months.



Prevention

To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before any participating in any activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.

February 17 2015

coldlectern046

Causes Signs And Symptoms And Treating Achilles Tendon Ruptures

Overview

Achilles Tendon

Achilles tendon rupture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture). The tendon can rupture completely or just partially. If you have an Achilles tendon rupture, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that usually affects your ability to walk properly. Surgery is often the best treatment option to repair an Achilles tendon rupture. For many people, however, nonsurgical treatment works just as well.

Causes

An Achilles tendon injury might be caused by several factors. Overuse. Stepping up your level of physical activity too quickly. Wearing high heels, which increases the stress on the tendon. Problems with the feet, an Achilles tendon injury can result from flat feet, also known as fallen arches or overpronation. In this condition, the impact of a step causes the arch of your foot to collapse, stretching the muscles and tendons. Muscles or tendons in the leg that are too tight. Achilles tendon injuries are common in people who participate in the following sports. Running. Gymnastics. Dance. Football. Baseball. Softball. Basketball. Tennis. Volleyball. You are more likely to tear an Achilles tendon when you start moving suddenly. For instance, a sprinter might get one at the start of a race. The abrupt tensing of the muscle can be too much for the tendon to handle. Men older than age 30 are particularly prone to Achilles tendon injuries.

Symptoms

Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel, an inability to bend your foot downward or "push off" the injured leg when you walk, an inability to stand on your toes on the injured leg, a popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward.

Diagnosis

In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.

Non Surgical Treatment

The most widely used method of non-surgical treatment involves the use of serial casting with gradual progression from plantar flexion to neutral or using a solid removable boot with heel inserts to bring the ends of the tendon closer together. The advantage of a solid removable boot is that it allows the patient to begin early motion and is removable. Wide variability exists among surgeons in regards to the period of absolute immobilization, initiating range of motion exercises, and progression of weight bearing status.

Achilles Tendinitis

Surgical Treatment

Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was long thought to offer a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%). Of course, surgery imposes higher relative risks of perioperative mortality and morbidity e.g. infection including MRSA, bleeding, deep vein thrombosis, lingering anesthesia effects, etc.

Prevention

There are things you can do to help prevent an Achilles tendon injury. You should try the following. Cut down on uphill running. Wear shoes with good support that fit well. Always increase the intensity of your physical activity slowly. Stop exercising if you feel pain or tightness in the back of your calf or heel.
Older posts are this way If this message doesn't go away, click anywhere on the page to continue loading posts.
Could not load more posts
Maybe Soup is currently being updated? I'll try again automatically in a few seconds...
Just a second, loading more posts...
You've reached the end.

Don't be the product, buy the product!

Schweinderl