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September 28 2015

obedientsolitud24

The Best Way To Treat Inferior Calcaneal Spur

Inferior Calcaneal Spur

Overview

While the term heel spur may create the impression of a sharp bony projection on the bottom of the heel that pokes the bottom of our foot causing our pain. Painful heel spurs are actually a result of damage to the soft tissue at the bottom of the foot. While this may be confusing, we'll try to explain. Heel spurs is the more common name for a condition that is medically referred to as plantar fascitiis or heel spur syndrome. Plantar fasciitis is a location oriented term that refers to the bottom of the foot(i.e. plantar warts). Fascia is a tough, inelastic band. 'itis'is a term used to describe something that is inflamed (i.e. tendonitis, bursitis).

Causes

The calcaneal spur is seen most often in persons over the age of 40. The condition can also be associated with osteoarthritis, rheumatoid arthritis, poor circulation of the blood and other degenerative diseases. Men and women are equally likely to have them.

Posterior Calcaneal Spur

Symptoms

Most people think that a bone "spur" is sharp and produces pain by pressing on tissue, when in fact, these bony growths are usually smooth and flat. Although they rarely cause pain on their own, bone spurs in the feet can lead to callus formation as tissue builds up to provide added cushion over the area of stress. Over time, wear and tear on joints may cause these spurs to compress neighboring ligaments, tendons or nerves, thus injuring tissue and causing swelling, pain and tearing.

Diagnosis

Your doctor will discuss your medical history and will examine your foot and heel for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray or blood tests (to rule out diseases or infections) may be requested.

Non Surgical Treatment

The most important part of treatment is to rest. Do not undertake activities which hurt the foot or aggravate symptoms as will only cause painful symptoms to persist. Apply an ice pack regularly for 10 minutes at a time every hour initially to reduce pain and inflammation of the surrounding tissues. As symptoms subside frequency of application can reduce to 2 or 3 times per day. Exercises and stretches to keep the foot and ankle strong and mobile are important as long as pain allows. Stretching the plantar fascia is important, especially if symptoms are worse in the morning. A plantar fasciitis night splint is excellent for stretching and preventing the plantar fascia tightening up over night. Anti-Inflammatory medicine (e.g. ibuprofen) may be prescribed by a doctor but always check with a medical professional first as taking some medications such as ibuprofen should not be done if the patient has asthma. Shoe inserts can help to take the pressure off of the spur and reduce pain. If these treatments do not significantly ease the symptoms then surgery may be an option.

Surgical Treatment

When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide relief of pain and restore mobility. The type of procedure used is based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. Depending on the presence of excess bony build up, the procedure may or may not include removal of heel spurs. Similar to other surgical interventions, there are various modifications and surgical enhancements regarding surgery of the heel.

September 23 2015

obedientsolitud24

What Are The Key Causes Of Calcaneal Spur

Posterior Calcaneal Spur

Overview

Heel spurs (calcaneal spurs) are protrusions (bumps) on the forward underside of the heel bone that can occur when the plantar tendon pulls excessively in the area where it attaches to the bone. The condition is often associated with plantar fasciitis, although it can also occur on its own. Heel spurs typically are not painful unless they intrude into the soft tissue (plantar fascia), where they can cause irritation that results in heel pain.

Causes

A heel spur is a bony overgrowth on the bottom of your heel bone. The heel spur is usually a result of an inflamed ligament (plantar fascia) on the bottom of the foot that attaches to the heel bone. Constant abnormal pulling of this ligament irritates the heel bone and the body lays down a bone spur as a protective mechanism. The patient usually complains of pain with the first step in the morning, some relief following activity, but returning after extended amounts of time standing or walking.

Posterior Calcaneal Spur

Symptoms

The following symptoms are typical of heel spur. Stabbing pain when treading on the area affected. Dull, irregularly occurring pains in the heel area also without exerting pressure (e.g. in a reclining position) Pain when taking the first steps in the morning (after lying or sitting down for an extended period, especially in the morning) Occasional swelling in the ankle area. For the lower heel spur, extreme sensitivity at the tendon attachment (laterally in the lower heel area) For the upper heel spur, extreme pressure sensitivity of the Achilles tendon, primarily at approximately ankle height.

Diagnosis

Diagnosis of a heel spur can be done with an x-ray, which will be able to reveal the bony spur. Normally, it occurs where the plantar fascia connects to the heel bone. When the plantar fascia ligament is pulled excessively it begins to pull away from the heel bone. When this excessive pulling occurs, it causes the body to respond by depositing calcium in the injured area, resulting in the formation of the bone spur. The Plantar fascia ligament is a fibrous band of connective tissue running between the heel bone and the ball of the foot. This structure maintains the arch of the foot and distributes weight along the foot as we walk. However, due to the stress that this ligament must endure, it can easily become damaged which commonly occurs along with heel spurs.

Non Surgical Treatment

The most important part of treatment is to rest. Do not undertake activities which hurt the foot or aggravate symptoms as will only cause painful symptoms to persist. Apply an ice pack regularly for 10 minutes at a time every hour initially to reduce pain and inflammation of the surrounding tissues. As symptoms subside frequency of application can reduce to 2 or 3 times per day. Exercises and stretches to keep the foot and ankle strong and mobile are important as long as pain allows. Stretching the plantar fascia is important, especially if symptoms are worse in the morning. A plantar fasciitis night splint is excellent for stretching and preventing the plantar fascia tightening up over night. Anti-Inflammatory medicine (e.g. ibuprofen) may be prescribed by a doctor but always check with a medical professional first as taking some medications such as ibuprofen should not be done if the patient has asthma. Shoe inserts can help to take the pressure off of the spur and reduce pain. If these treatments do not significantly ease the symptoms then surgery may be an option.

Surgical Treatment

Usually, heel spurs are curable with conservative treatment. If not, heel spurs are curable with surgery, although there is the possibility of them growing back. About 10% of those who continue to see a physician for plantar fascitis have it for more than a year. If there is limited success after approximately one year of conservative treatment, patients are often advised to have surgery.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don't underestimate your body's need for rest and good nutrition. If obese, lose weight.

August 26 2015

obedientsolitud24

Bursitis Of The Feet An Operation

Overview

That dull misery in the shoulder, knee or elbow known as bursitis can strike anybody, from the couch potato to the highly trained athlete. Though bursitis may hurt as much as arthritis, it isn?t a joint disease. Rather, it's an acute or chronic painful inflammation of a bursa. Bursae (from the Greek word for wine-skin and related to the English word purse) are small, closed, fluid-filled sacs that protect muscles and tendons from irritation produced by contact with bones. If friction becomes too great, from overexercising, hard work, or injury, for instance-the bursae themselves may get inflamed. Though the shoulder is a common locale for bursitis, any of the bursae in the human body-there are approximately 150-can become irritated. Occupational bursitis is not uncommon and is known by old, familiar names such as "housemaid's knee," and "policeman's heel." One of the most common foot ailments, the bunion, is a form of bursitis.

Causes

Improper foot wear, tight shoes or shoes that do not fit properly can cause extra pressure and friction on the back of the heel. Overtime, this pressure causes irritation of the bursae that protects the Achilles tendon causing one or both to swell and become inflamed. Athletes who overtrain or runners that increase their distance to quickly are at greater risk of experiencing Achilles bursitis. With over use, the Achilles bursae and tendon can become irritated and inflamed leading to thickening of the bursae lining and wearing of the tendon. Fluid builds in the bursa when it becomes irritated causing swelling of the Achilles bursa and pain at the back of the heel.

Symptoms

Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise the arm out from the side of the body. Putting on a jacket or combing the hair becomes a troublesome activity. In acute bursitis symptoms appear suddenly, with chronic bursitis, pain, tenderness, and limited movement reappear after exercise or strain.

Diagnosis

Your health care provider will take a history to find out if you have symptoms of retrocalcaneal bursitis. Examining your ankle can find the location of the pain. The physician will look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex). Or, the pain may be worse when you rise on your toes. You will not usually need imaging studies such as x-ray and MRI at first. If the first treatment does not improve the symptoms, your health care provider may recommend these tests. MRI may show inflammation.

Non Surgical Treatment

With anterior and posterior Achilles tendon bursitis, applying warm or cool compresses to the area and using nonsteroidal anti-inflammatory drugs (NSAIDs) can temporarily relieve the pain and inflammation, as can injections of a corticosteroid/anesthetic mixture into the inflamed bursa. The doctor is careful not to inject the mixture into the tendon. After this treatment, the person should rest. When these treatments are not effective, part of the heel bone may need to be surgically removed.

Surgical Treatment

Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to remove the inflamed bursa.

Prevention

People can lower the risk of bursitis by gradually strengthening and stretching the muscles around the joints and taking regular breaks from repetitive motion that might irritate bursae. Prolonged time resting on the elbows or kneeling should be avoided, if it cannot be avoided, wearing cushioned elbow and knee pads can help protect the bursae. Comfortable, supportive, low-heeled shoes can help prevent bursitis in the foot.

June 26 2015

obedientsolitud24

How To Relieve Hammer Toe Pain

Hammer ToeOverview

A hammertoe is a contracture, or bending, of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammer toes are more common in females than males.

Causes

A person may be born with hammer toe or may develop it from wearing short, narrow shoes. Hammer toe can occur in children who outgrow shoes rapidly. Sometimes hammer toe is genetic and is caused by a nerve disorder in the foot. High heeled shoes are can also cause hammer toe. The reason for this is that the toes are not only bunched up, but the weight of the body is pushing them forward even further.

HammertoeSymptoms

Hammer toes can cause problems with walking and lead to other foot problems, such as blisters, calluses, and sores. Pain is caused by constant friction over the top of the toe?s main joint. It may be difficult Hammer toe to fit into some shoe gear due to the extra space required for the deformed toe. In many cases there will be pain on the ball of the foot over the metatarsals along with callus formation. This is due to the toes not functioning properly, failing to properly touch the ground during the gait cycle. The ball of the foot then takes the brunt of the ground forces, which causes chronic pain.

Diagnosis

The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Non Surgical Treatment

Try to find shoes that are soft, roomy, and comfortable and avoid tight shoes or shoes with high heels. A shoe repair shop may be able to stretch a small pocket in regular shoes to make room for the hammertoe. Have a professional pedicure. Sometimes a skilled manicurist can file down a painful corn. Follow your healthcare provider's instructions. Ask your provider what activities you should avoid and when you can return to your normal activities, how to take care of yourself at home, what symptoms or problems you should watch for and what to do if you have them. Make sure you know when you should come back for a checkup.

Surgical Treatment

Toes can be surgically realigned and made straight again. They can even be made shorter. The good news is that toes can be corrected. Hammer toe surgery is often synonymous with ?toe shortening?, ?toe job? and/or ?toe augmentation?. Depending on the severity and length of the toe, there are several methods to surgically correct a hammer toe. In general, the surgery involves removing a portion of the bone at the contracted joint, to realign the toe.
Tags: Hammer Toe
obedientsolitud24

Non Surgical Hammer Toe Treatment

Hammer ToeOverview

hammertoes affects both joints of a toe, causing the toe to bend upwards at the proximal joint (the joint closest to the foot) and down at the distal joint (the one farthest away from the foot). The resulting unnatural bend is often compared to an upside down "V" and also to a hammer or a claw (The condition is sometimes referred to as clawtoe or clawfoot). A similar condition, in which the first joint of a toe simply bends downward, is called mallet toe. Since the arched bending of hammertoe often causes the toe to rub against the top of the shoe's toe box and against the sole, painful corns and calluses develop on the toes. Hammertoe can also be a result of squeezing within a too-small or ill-fitting shoe or wearing high heels that jam your toes into a tight toe box inside your shoe, arthritis, trauma and muscle and nerve damage from diseases such as diabetes. Probably because of the tight-shoe and high-heel shoe factors, hammertoe tends to occur far more often in women than in men.

Causes

A common cause of hammer toe is wearing shoes that do not fit properly. Poorly-fitting shoes can hold the toes in an abnormal position and result in tightening of the muscles required to maintain that position. In particular, shoes that have high heels and are narrow at front tend to push the toes into an abnormal, bent position. Less commonly, diseases of the nerves, muscles, or joints (such as arthritis) can result in the hammer toe deformity.

HammertoeSymptoms

Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most common at the level of the affected joint due to continuous friction of the deformity against your shoes.

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.

Non Surgical Treatment

Mild hammer toe in children can be treated by manipulating and splinting the affected toe. The following changes in footwear may help relieve symptoms. Wear the right size shoes or shoes with wide toe boxes for comfort, and to avoid making hammer toe worse. Avoid high heels as much as possible. Wear soft insoles to relieve pressure on the toe. Protect the joint that is sticking out with corn pads or felt pads. A foot doctor can make foot devices called hammer toe regulators or straighteners for you, or you can buy them at the store. Exercises may be helpful. You can try gentle stretching exercises if the toe is not already in a fixed position. PIcking up a towel with your toes can help stretch and straighten the small muscles in the foot.

Surgical Hammer toe Treatment

There are several surgical methods to correct a hammer toe. Your physician will decide which method will be most beneficial to you depending on the severity of your deformity, the direction the toe is deviating and the length of the affected toe. Some common surgical methods include. Arthroplasty. To promote straightening, half of the joint located directly underneath the crooked part of the toe is removed. Arthrodesis (fusion) To promote straightening, the joint directly underneath where the toe is crooked is completely removed. A wire or pin is inserted to aid healing. Tendon transfer. Performed alone or in combination with other procedures, a surgeon will take tendons from under the toe and ?re-route? them to the top of the toe to promote straightening. Basal phalangectomy. Performed to assist patients with severe stiffness, this procedure removes the base of the bone underneath the toe. Weil osteotomy. Performed to assist patients with severe stiffness, this procedure involves shortening the metatarsal bone and inserting surgical hardware to aid healing.
Tags: Hammer Toes

June 05 2015

obedientsolitud24

What Are Hallux Valgus?

Overview
Bunion pain Bunions, Corns, and Calluses are common foot ailments associated with improperly-fitted footwear. Please contact your family doctor or Podiatrist to ask them how Birkenstock footwear or arch supports can help treat your symptoms. Also, feel free to contact your local Birkenstock retailer about their healthy footwear recommendations. Birkenstock has many products that can help with Bunions, Corns, and Calluses. Bunions are a prominent bump on the inside of the foot around the big toe joint. Corns are an accumulation of dead skin cells usually found on the toes, forming thick hardened areas. They contain a cone-shaped core whose point can press on a nerve below causing pain. Calluses are also an accumulation of dead skin cells that harden and thicken over an area of the foot. They are the body?s defense mechanism against excessive pressure and friction. Calluses are normally found on the bottom of the foot, the heel, and/or the inside of the big toe.

Causes
Bunions tend to run in families, but that does not mean that if you have a bunion, your children will inevitably have one too. The connection may be that bunions are a bit commoner in people with unusually flexible joints, and this can be hereditary. They are also commoner in women than in men. Bunions do occur in cultures in which shoes are not worn, but much less commonly. Shoes which squeeze the big toe or do not fit properly, or have an excessively high heel, may worsen the deformity, particularly in people who are at higher risk anyway.

Symptoms
The major symptom of bunions is a hard bump on the outside edge of the foot or at the base of the big toe. Redness, pain and swelling surrounding or at the MTP joint can also occur.

Diagnosis
Diagnosis begins with a careful history and physical examination by your doctor. This will usually include a discussion about shoe wear and the importance of shoes in the development and treatment of the condition. X-rays will probably be suggested. This allows your doctor to measure several important angles made by the bones of the feet to help determine the appropriate treatment.

Non Surgical Treatment
The initial treatment of a bunion should be non-operative. Symptoms can often be greatly improved with simple non-operative interventions. Non-operative treatment may include properly fitted shoes, Properly fitting comfort shoes with a wide non-constrictive toe box, especially one that is made out of a soft material such as leather, can be quite helpful in reducing the irritation over the prominent bunion. In some instances, it is helpful to have a shoemaker stretch the inside aspect of the shoe. Jamming a foot with a bunion into a constrictive shoe will likely lead to the development of uncomfortable symptoms. Bunion pads, Medial bunion pads may also be helpful in decreasing the symptoms associated with the bunion. These pads can be obtained at many drugstores. Essentially, they serve to lessen the irritation over the medial prominence and, thereby, decrease the associated inflammation This should be combined with comfortable non-constrictive shoes. A toe spacer placed between the great toe and the second toe can help to reduce the bunion deformity and, thereby, decrease the stretch on the medial tissue and the irritation associated with the bunion. Toe spacers can be obtained at most drug stores or online. Soft shoe inserts. Over-the-counter accommodative orthotics may also help bunion symptoms. This product is particularly helpful if bunion symptoms include pain that is under the ball of the foot. Orthotics with a slight medial longitudinal arch may be helpful for patients that have associated flatfoot deformity. These can be purchased at many sports stores, outdoors stores, or pharmacies. Bunion splints have often been used to treat the symptoms associated with hallux valgus. These splints are typically worn at night in an effort to reduce the bunion deformity. There is no evidence to suggest that these splints decrease the rate at which bunion deformities occur. There is also no evidence that clearly supports their effectiveness. However, some patients report good relief with the use of these splints. Bunions

Surgical Treatment
Recent advances in surgical techniques have led to very high success rates for bunion surgery. In most cases the patient can walk immediately after surgery without crutches. As well most patients find the surgery to be virtually pain free. Almost all bunion surgery is done as an outpatient at a surgery center. Most bunion surgery is performed with a local anesthetic block and IV sedation (twilight sleep). After the procedure you will be moved to the recovery room for about an hour. You will then be ready to go home.

Prevention
Proper footwear may prevent bunions. Wear roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint. Medicine will not prevent or cure bunions.
Tags: Bunions

May 30 2015

obedientsolitud24

What Actually Will Cause Feet To Over Pronate

Overview

Pronation refers to the inward roll of the foot during normal motion and occurs as the outer edge of the heel strikes the ground and the foot rolls inward and flattens out. A moderate amount of pronation is required for the foot to function properly, however damage and injury can occur during excessive pronation. When excessive pronation does occur the foot arch flattens out and stretches the muscles, tendons and ligaments underneath the foot.Foot Pronation

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

Overpronation causes alterations in proper muscle recruitment patterns leading to tightness in the outside of the ankle (lateral gastrocnemius, soleus, and peroneals). This tightness can lead to weakness in the opposing muscles such as the medial gastrocnemius, anterior tibialis, and posterior tibialis. If these muscles are weak, they will not be able to keep the knee in proper alignment, causing the valgus position. All this tightness and weakness can cause pain within the ankle, calf, and knee region. And it can send imbalance and pain all the way up to the upper back, if deep core strength is lacking and can't hold the pelvis in neutral.

Diagnosis

Look at the wear on your shoes and especially running trainers; if you overpronate it's likely the inside of your shoe will be worn down (or seem crushed if they're soft shoes) from the extra strain.Over Pronation

Non Surgical Treatment

Pronation and supination are bio-mechanical problems, and are best treated and prevented with orthotic inserts. But before you run out to buy orthotics it makes sense to get the right advice on footwear, and the best advice I can give you, is to go and see a qualified podiatrist for a complete foot-strike and running gait analysis. They will be able to tell you if there are any concerns regarding the way your running gait is functioning. After your running gait has been analysed, have your podiatrist, or competent sports footwear sales person recommend a number of shoes that suit your requirements. Good quality footwear will go a long way in helping to prevent pronation and supination. And, if needed, invest in a pair of orthotic inserts to further prevent excessive pronation or supination.

Surgical Treatment

The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.

May 14 2015

obedientsolitud24

Physical Therapy And Calcaneal Apophysitis

Overview

Sever?s Disease (calcaneal aphophysitis) is not really a disease, but more a repetitious strain injury. This is the most common cause of kids heel pain seen at Podiatry Care. Active children in football, soccer, basketball, netball and tennis with this type of foot pain complain of pain in the region of the heel bone particularly after exercise. In severe cases, children will complain of pain during exercise as well. It is a frequent cause of heel pain in children, particularly in the very active child. It is most often seen in children between the ages of 8 to 15 years as the growth plate is not fully developed or calcified at this time.

Causes

With early puberty, the growth plate at the end of the heel develops, transforming cartilage cells into bone cells. This painful heel condition occurs during these growth spurts, when the heel bone grows more rapidly than the muscles and tendons of the leg. The discrepancy between rates of development causes excess pressure and tension to be placed upon the heel and it becomes less flexible. This condition affects active children the most. Due to the amount of exercise, more stress is placed upon the tendons which in turn causes more damage to the growth plate. The bone plates fully mature and harden by the time a child reaches the age of 15.

Symptoms

Acute pain, pain asscoiatied with Sever?s disease is usually felt in the heel when the child engages in physical activity such as walking, jumping and or running. Highly active - children who are very active are among the most susceptible in experiencing Sever?s disease, because of the stress and tension placed on their feet.

Diagnosis

Most often, a healthcare professional can diagnose Sever?s disease by taking a careful history and administering a few simple tests during the physical exam. A practitioner may squeeze the heel on either side; when this move produces pain, it may be a sign of Sever?s disease. The practitioner may also ask the child to stand on their tiptoes, because pain that occurs when standing in this position can also be an indication of Sever?s disease.

Non Surgical Treatment

Ice the heel(s) well after exercise (until the area is cold and numb!) Stretch hamstring and calf muscles 2-3 times daily (exercises below) REST when pain becomes persistent or moderate (even if it means skipping games or practices.) Anti-inflammatory medication such as ibuprofen. If symptoms persist, your child may need to see a physical therapist for additional exercises, and/or an orthopedist for othotics or temporary casting/crutches if pain is severe. Sever?s disease is self-recovering, meaning that it will go away on its own when the heels are rested or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2-8 weeks. However, pain can recur, for example at the start of a new sports season, several times if it is not taken care of.

Exercise

The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Calf Stretch with Towel. Begin this exercise with a resistance band around your foot and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free. Once you can perform 20 repetitions consistently without pain, the exercise can be progressed by gradually increasing the resistance of the band provided there is no increase in symptoms. Bridging. Begin this exercise lying on your back in the position demonstrated. Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.

April 14 2015

obedientsolitud24

Best Surgery For Flat Feet In Adults

Overview
Originally known as posterior tibial tendon dysfunction or insufficiency, adult-acquired flatfoot deformity encompasses a wide range of deformities. These deformities vary in location, severity, and rate of progression. Establishing a diagnosis as early as possible is one of the most important factors in treatment. Prompt early, aggressive nonsurgical management is important. A patient in whom such treatment fails should strongly consider surgical correction to avoid worsening of the deformity. In all four stages of deformity, the goal of surgery is to achieve proper alignment and maintain as much flexibility as possible in the foot and ankle complex. However, controversy remains as to how to manage flexible deformities, especially those that are severe. Acquired flat feet

Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Symptoms
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on the affected side.

Diagnosis
Observe forefoot to hindfoot alignment. Do this with the patient sitting and the heel in neutral, and also with the patient standing. I like to put blocks under the forefoot with the heel in neutral to see how much forefoot correction is necessary to help hold the hindfoot position. One last note is to check all joints for stiffness. In cases of prolonged PTTD or coalition, rigid deformity is present and one must carefully check the joints of the midfoot and hindfoot for stiffness and arthritis in the surgical pre-planning.

Non surgical Treatment
In the early stages, simple pre-fabricated orthotics can help improve the heel position to reduce the mechanical load which is contributing to the symptoms. In advanced stages or long term orthotic use, a plaster of paris or foam box cast can be taken and specific bespoke orthotics manufactured. If the condition develops further a AFO (ankle foot orthotic) may be necessary for greater control. In more advanced stages of symptomatic Adult Acquired flat feet, where the conservative methods of treatment have failed there are various forms of surgery available depending upon the root cause of the issue and severity. Acquired flat foot

Surgical Treatment
In cases where cast immobilization, orthoses and shoe therapy have failed, surgery is the next alternative. The goal of surgery and non-surgical treatment is to eliminate pain, stop progression of the deformity and improve mobility of the patient. Opinions vary as to the best surgical treatment for adult acquired flatfoot. Procedures commonly used to correct the condition include tendon debridement, tendon transfers, osteotomies (cutting and repositioning of bone) and joint fusions. (See surgical correction of adult acquired flatfoot). Patients with adult acquired flatfoot are advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot - meaning you will be on crutches for two months. The bottom line is, Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.

March 28 2015

obedientsolitud24

All You Need To Understand About Heel Serious Pain

Overview

Heel Pain

Heel pain is a common symptom that has many possible causes. Although Heel Pain sometimes is caused by a systemic (body-wide) illness, such as rheumatoid arthritis or gout, it usually is a local condition that affects only the foot. The most common local causes of heel pain includePlantar fasciitis, Heel spur, Calcaneal apophysitis, Bursitis, Pump bump, Local bruises, Achilles tendonitis,Trapped nerve.

Causes

Plantar fasciitis can come from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult. As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body. As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes forms as the body's response to try to firmly attach the fascia to the heelbone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem. As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis. Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. In many cases, the actual source of the painful heel may not be defined clearly. Other factors that may contribute to the development of plantar fasciitis include obesity, trauma, weak plantar flexor muscles, excessive foot pronation (flat foot) or other alignment problems in the foot and or ankle, and poor footwear.

Symptoms

Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest--when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. The pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you're on the foot. Fasciitis can be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, by being overweight. It doesn't help that fascia doesn't heal particularly quickly because it has relatively poor circulation (which is why it's white in colour).

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

The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments. A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery. Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Surgical Treatment

If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.

Prevention

Foot Pain

Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.
Tags: Heel Pain

March 05 2015

obedientsolitud24

Achilles Tendinitis

Overview

Achilles TendinitisAchilles tendinitis occurs when the band of tissue that connects the calf muscles at the back of the lower leg to the heel bone, the Achilles tendon, becomes inflamed. This condition is a result of overuse from intense exercise, jumping, running, and other activities that strain the tendon and calf muscles.

Causes

When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. Achilles tendonitis is often a result of overtraining, or doing too much too soon. Excessive hill running can contribute to it. Flattening of the arch of your foot can place you at increased risk of developing Achilles tendonitis because of the extra stress placed on your Achilles tendon when walking or running.

Symptoms

People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.

Diagnosis

If you think you have Achilles tendinitis, make an appointment to see your doctor. The doctor will ask you questions about your recent activity and look for signs. The foot not flexing when the calf muscle is pressed ( if Achilles ruptures or tears in half). Swelling on the back of the foot. Pain in the back of the foot. Limited range of motion in ankle. An X-ray or MRI scan can check for tendinitis.

Nonsurgical Treatment

Treatment will focus on relieving the pain and preventing further injury. Your podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area for a period of time. (Often, a couple of weeks are needed for the tendon to heal.) Medication can help too. Your podiatrist may recommend or prescribe oral medication.

Achilles Tendinitis

Surgical Treatment

There are two types of Achilles repair surgery for tendonitis (inflammation of the Achilles Tendon), if nonsurgical treatments aren't effective. Gastrocnemius recession - The orthopaedic surgeon lengthens the calf muscles to reduce stress on your Achilles tendon. D?bridement and repair - During this procedure, the surgeon removes the damaged part of the Achilles tendon and repairs the remaining tendon with sutures or stitches. Debridement is done when the tendon has less than 50% damage.

Prevention

The following measures can significantly reduce the risk of developing Achilles tendonitis. Adequately stretch and warm up prior to exercise. Warm down and stretch after exercise. Choose footwear carefully and use footwear appropriate to the sport being undertaken. Use orthotic devices in footwear to correctly support the foot. Exercise within fitness levels and follow a sensible exercise programme. Develop strong, flexible calf muscles.

February 25 2015

obedientsolitud24

Have I Got A Ruptured Achilles Tendon?

Overview

Achilles Tendinitis

Rupture of Achilles tendon is the most common among those taking place in the lower extremities, being twice as common in men than in women between 30-50 years old and usually caused while doing sport. There are some risk factors such as age or chronic treatments based on corticosteroids or antibiotics when belonging to Quinolones group. Spontaneous bilateral rupture of the Achilles tendon is much more infrequent, being almost exceptional in young and healthy patients without known pathological conditions.



Causes

The Achilles tendon usually ruptures as a result of a sudden forceful contraction of the calf muscles. Activities such as jumping, lunging, or sprinting can cause undue stress on the Achilles tendon and cause it to rupture. Often there is a background of Achilles tendinitis. Direct trauma to the area, poor flexibility or weakness of the calf muscles or of the Achilles tendon and increasing age are some of the other factors that are associated with an Achilles tendon rupture.



Symptoms

Patients with an Achilles tendon rupture will often complain of a sudden snap in the back of the leg. The pain is often intense. With a complete rupture, the individual will only be ambulate with a limp. Most people will not be able to climb stairs, run, or stand on their toes. Swelling around the calf may occur. Patients may often have had a sudden increase in exercise or intensity of activity. Some patients may have had recent corticosteroid injections or use of fluoroquinolone antibiotics. Some athletes may have had a prior injury to the tendon.



Diagnosis

To diagnose an Achilles tendon injury, your health care provider will give you a thorough physical exam. He or she may want to see you walk or run to look for problems that might have contributed to your Achilles tendon injury.



Non Surgical Treatment

Medical therapy for a patient with an Achilles tendon rupture consists of rest, pain control, serial casting, and rehabilitation to maximize function. Ongoing debate surrounds the issue of whether medical or surgical therapy is more appropriate for this injury. Conservative management of Achilles tendinosis and paratenonitis includes the following. Physical therapy. Eccentric exercises are the cornerstone of strengthening treatment, with most patients achieving 60-90% pain relief. Orthotic therapy in Achilles tendinosis consists of the use of heel lifts. Nonsteroidal anti-inflammatory drugs (NSAIDs). Tendinosis tends to be less responsive than paratenonitis to NSAIDs. Steroid injections. Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture. Vessel sclerosis. Platelet-rich plasma injections. Nitric oxide. Shock-wave therapy.

Achilles Tendon



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

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 16 2015

obedientsolitud24

Have I Sustained A Ruptured Achilles Tendon?

Overview

Achilles Tendinitis

The Achilles tendon is the largest and strongest tendon in the body. It functions to help control the foot when walking and running. Ruptures of the Achilles tendon commonly occur in individuals in their 30s and 40s. This age group is affected because these patients are still quite active, but over time their tendons tend to become stiffer and gradually weaken. These ruptures usually occur when an athlete loads the Achilles in preparation to pushing off. This can occur when suddenly changing directions, starting to run, or preparing to jump. These ruptures occur because the calf muscle generates tremendous force through the Achilles tendon in the process of propelling the body. Patients will feel a sharp intense pain in the back of their heel. Patients often initially think that they were ?struck in the back of the heel? and then realize that there was no one around them. After the injury, patients will have some swelling. If they can walk at all, it will be with a marked limp. It is very rare that a rupture of the Achilles is partial. However, a painful Achilles tendonitis or a partial rupture of the calf muscle (gastrocnemius) as it inserts into the Achilles can also cause pain in this area. The pain of an Achilles rupture can subside quickly and this injury may be misdiagnosed in the Emergency Department as a sprain. Important clues to the diagnosis are an inability to push off with the foot and a visible or palpable defect just above the heel bone in the back of the leg.

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

The classic sign of an Achilles' tendon rupture is a short sharp pain in the Achilles' area, which is sometimes accompanied by a snapping sound as the tendon ruptures. The pain usually subsides relatively quickly into an aching sensation. Other signs that are likely to be present subsequent to a rupture are the inability to stand on tiptoe, inability to push the foot off the ground properly resulting in a flat footed walk. With complete tears it may be possible to feel the two ends of tendon where it has snapped, however swelling to the area may mean this is impossible.

Diagnosis

To diagnose an Achilles tendon injury, your health care provider will give you a thorough physical exam. He or she may want to see you walk or run to look for problems that might have contributed to your Achilles tendon injury.

Non Surgical Treatment

To give the best prospects for recovery it is important to treat an Achilles' tendon rupture as soon as possible. If a complete rupture is treated early the gap between the two ends of the tendon will be minimised. This can avoid the need for an operation or tendon graft. There are two forms of treatment available for an Achilles' tendon rupture; conservative treatment and surgery. Conservative treatment will involve the affected leg being placed in a cast and series of braces with the foot pointing down to allow the two ends of the tendon to knit together naturally.

Achilles Tendon

Surgical Treatment

Immediate surgical repair of the tendon is indicated in complete tears. Delaying surgery can lead to shortening of the tendon, formation of scar tissue and decreased blood flow, which can lead to a poor outcome. Following surgery your ankle will be put in an immobilizing device and you will be instructed to use crutches to limit weight bearing and protect the joint. Over the next 2-4 weeks weight bearing will be increased and physical therapy will be initiated. The surgeon will determine the physical therapy timeline and program. Physical Therapy, Treatment will emphasize gradual weaning off the immobilizing device, increased weight bearing, restoration of ankle range of motion and strengthening of the lower leg muscles. It is important that the physician and therapist communicate during the early stages and progress your program based on the principles of healing so as not to compromise the Achilles tendon. Patient will be progressed to more functional activities as normal ankle range of motion and strength is restored.

Prevention

Here are some suggestions to help to prevent this injury. Corticosteroid medication such as prednisolone, should be used carefully and the dose should be reduced if possible. But note that there are many conditions where corticosteroid medication is important or lifesaving. Quinolone antibiotics should be used carefully in people aged over 60 or who are taking steroids.
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