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Sep272015

Preventing Heel Spur

Heel 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


This condition is a constellation of many causes; overweight, ill fitting shoes, bio-mechanical problems (mal-alignment of the heel), gout, pronation (a complex motion including outward rotation of the heel and inward rotation of the ankle) and rheumatoid arthritis are some of the causes of heel pain.


Inferior Calcaneal Spur


Symptoms


Heel spurs result in a jabbing or aching sensation on or under the heel bone. The pain is often worst when you first arise in the morning and get to your feet. You may also experience pain when standing up after prolonged periods of sitting, such as work sessions at a desk or car rides. The discomfort may lessen after you spend several minutes walking, only to return later. Heel spurs can cause intermittent or chronic pain.


Diagnosis


Your doctor will review your medical history and examine your foot. X-rays are used to identify the location and size of the heel spur.


Non Surgical Treatment


The key is to identify what is causing excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support will help reduce the over-pronation and thus allow the condition to heal. Other common treatments for heel spurs include Stretching exercises. Losing weight. Wearing shoes that have a cushioned heel that absorbs shock. Elevating the heel with the use of a heel cradle, heel cup, or orthotics. For example, heel cradles and heel cups provide extra comfort and cushion to the heel, reducing the amount of shock and shear forces experienced from everyday activities.


Surgical Treatment


Surgery, which is a more radical treatment, can be a permanent correction to remove the spur itself. If your doctor believes that surgery is indicated, he will recommend an operation - but only after establishing that less drastic methods of treatment are not successful.

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Sep232015

What Causes Posterior Calcaneal Spur

Posterior Calcaneal Spur


Overview


A heel spur occurs when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping. Heel spurs often cause no symptoms but can be associated with intermittent pain, especially while walking, jogging, or running. Sharp pain in the heel can also be experienced when standing after sitting for a long period of time. Heel spurs can be a result of plantar fasciitis.


Causes


Heel spurs develop in some people that have a condition called plantar fasciitis, inflammation of the plantar fascia. Heel spurs form when the plantar fascia separates from the calcaneus. An abnormal bone growth, a hook-like spur, forms from calcium deposits that grow at the site of inflammation. Heel spurs are more common in middle-aged adults and people that have had plantar fasciitis for a long time. People with flat feet or high arches are vulnerable to heel spurs. Women who wear high-heeled shoes are more susceptible, as well.


Posterior Calcaneal Spur


Symptoms


Pain and discomfort associated with heel spurs does not occur from the spur itself. The bone growth itself has no feeling. However, as you move, this growth digs into sensitive nerves and tissue along the heel of the foot, resulting in severe pain. Pain can also be generated when pushing off with the toes while walking. Swelling along the heel is also common.


Diagnosis


Your doctor will review your medical history and examine your foot. X-rays are used to identify the location and size of the heel spur.


Non Surgical Treatment


Perform some exercises. Exercises that strengthen and lengthen your plantar fascia can also be very helpful for heel spurs. Try some of the following activities. Calf stretch. Place your hands on a wall. Extend 1 foot (0.3 m) behind you with your knee straight and place the other foot in front of you with the knee bent. Push your hips toward the wall and hold the stretch for 10 seconds. You should feel a pull in your calf muscles. Repeat the stretch 20 times for each foot. Plantar fascia stretch, Perform this exercise in the morning before you've done any standing or walking. Cross your injured foot over the knee of your other leg. Grasp your toes and gently pull them toward you. If you can't reach your toes, then wrap a towel around them and pull on the towel. Hold the stretch for 10 seconds and repeat 20 times for each foot.


Surgical Treatment


Have surgery if no other treatments work. Before performing surgery, doctors usually give home treatments and improved footwear about a year to work. When nothing else eases the pain, here's what you need to know about surgical options. Instep plantar fasciotomy. Doctors remove part of the plantar fascia to ease pressure on the nerves in your foot. Endoscopy. This surgery performs the same function as an instep plantar fasciotomy but uses smaller incisions so that you'll heal faster. However, endoscopy has a higher rate of nerve damage, so consider this before you opt for this option. Be prepared to wear a below-the-knee walking cast to ease the pain of surgery and to speed the healing process. These casts, or "boots," usually work better than crutches to speed up your recovery time.


Prevention


In 2002, researchers attempted to compare the effects of various running techniques on pronation and resulting injuries like stress fractures and heel spurs. They suggested that it is possible to teach runners to stride in such a way as to minimize impact forces. One way is to lower running speed. Another is to take longer rest periods following a run.

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Aug282015

Treatment For Bursitis Of The Foot

Overview


Heel Bursitis is a condition where one of the bursae at the back of the heel becomes swollen, inflamed and painful. A bursa is a fluid filled sac that cushions muscles, tendons and joints. There are 3 main types of bursitis associated with heel bursitis. These include Retro-calcaneal bursitis, Achilles bursitis, and Sub-calcaneal bursitis. The locations of the 3 bursae are: the insertion point of the Achilles tendon at the back of the heel (retro-calcaneal bursa), between the Achilles tendon and the skin at the back of the heel (Achilles bursa), and the bottom of the heel (sub-calcaneal bursa).


Causes


Bursitis has many causes, including autoimmune disorders, crystal deposition (gout and pseudogout), infectious diseases, traumatic events, and hemorrhagic disorders, as well as being secondary to overuse. Repetitive injury within the bursa results in local vasodilatation and increased vascular permeability, which stimulate the inflammatory cascade.


Symptoms


Common signs and symptoms associated with infracalcaneal bursitis include redness under the heel. Pain and swelling under the heel. Pain or ache in the middle part of the underside of the heel. Heel pain or discomfort that increases with prolonged weight-bearing activities.


Diagnosis


When you suspect you have retrocalcaneal bursitis, your foot doctor will begin by taking a complete history of the condition. A physical exam will also be performed. X-rays are usually taken on the first visit as well to determine the shape of the heel bone, joint alignment in the rearfoot, and to look for calcium deposits in the Achilles tendon. The history, exam and x-rays may sufficient for your foot surgeon to get an idea of the treatment that will be required. In some cases, it may be necessary to get an ultrasound or MRI to further evaluate the Achilles tendon or its associated bursa. While calcium deposits can show up on xray, the inflammation in the tendon and bursa will show up much better on ultrasound and MRI. The results of these tests can usually be explained on the first visit. You can then have a full understanding of how the problem started, what you can do to treat prevent it from getting worse/ You will also know which treatment will be most helpful in making your heel pain go away.


Non Surgical Treatment


Treatments should involve decreasing swelling, relieving pain and stress on the Achilles, correcting any biomechanical dysfunction (over-pronation or flat feet), treating scar tissue, and then restoring strength and movement. If you are performing an activity that could cause further trauma to the bursa, it is recommended that you protect the area with padding and/or proper footwear to prevent further irritation or damage.


Surgical Treatment


Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.

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Aug182015

Hammer Toe Fusion Surgery

Hammer ToeOverview


Hammer, mallet, and claw toes have distinctive differences that can assist you in determining what kind of toe problem you are dealing with. All three conditions deal with toes that are curved into abnormal positions, which possibly look strange and may cause pain. Typically, the big toe is not affected by these problems. A hammertoe tends to bend downward at the center of a toe joint. It generally affects your second toe. The affliction causes the center of your toe to rise and is often accompanied with a bony lump.


Causes


People who have a high-arched feet have an increased chance of hammer toes occurring. Also, patients with bunion deformities notice the second toe elevating and becoming hammered to make room for the big toe that is moving toward it. Some patients damage the ligament that holds the toe in place at the bottom of the joint that connects the toe and foot. When this ligament (plantar plate) is disrupted or torn, the toe floats upward at this joint. Hammer toes also occur in women wearing ill-fitting shoes or high heels, and children wearing shoes they have outgrown.


HammertoeSymptoms


The most obvious symptom of hammertoe is the bent, hammer-like or claw-like appearance of one or more of your toes. Typically, the proximal joint of a toe will be bending upward and the distal joint will be bending downward. In some cases, both joints may bend downward, causing the toes to curl under the foot. In the variation of mallet toe, only the distal joint bends downward. Other symptoms may include Pain and stiffness during movement of the toe, Painful corns on the tops of the toe or toes from rubbing against the top of the shoe's toe box, Painful calluses on the bottoms of the toe or toes, Pain on the bottom of the ball of the foot, Redness and swelling at the joints. If you have any of these symptoms, especially the hammer shape, pain or stiffness in a toe or toes, you should consider consulting your physician. Even if you're not significantly bothered by some of these symptoms, the severity of a hammertoe can become worse over time and should be treated as soon as possible. Up to a point hammertoes can be treated without surgery and should be taken care of before they pass that point. After that, surgery may be the only solution.


Diagnosis


Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.


Non Surgical Treatment


Changing the type of footwear worn is a very important step in the treatment of hammer toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the hammer toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes. Other conservative treatments include using forefoot products designed to relieve hammer toes, such as hammer toe crests and hammer toe splints. These devices will help hold down the hammer toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.


Surgical Treatment


Your podiatrist may recommend a Hammer toes surgical procedure if your hammertoes are not helped by the conservative care methods listed above. Surgery for hammertoes is performed to help straighten your crooked toe. Your surgery will be performed in your podiatrist?s office or at a hospital, depending on the severity of your hammertoe. A metal pin is sometimes used to help your affected toe maintain its straight position during your recovery.

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Jun212015

Hammer Toe Causes

HammertoeOverview


The Hammer toes smallest four toes of each foot have three bony segments connected by two joints, just as the fingers do. hammertoes is a deformity in which one or more of the small toes develops a bend at the joint between the first and second segments so that the tip of the toe turns downward, making it looks like a hammer or claw. The second toe is affected most often.


Causes


The APMA says that hammertoe can result from a muscle imbalance in the foot that puts undue pressure on the joints, ultimately causing deformity. Inherited factors can contribute to the likelihood of developing hammertoe. Arthritis, stroke or nerve damage from diabetes or toe injuries such as jamming or breaking a toe can affect muscle balance in the foot, leading to hammertoe. The Mayo Clinic says that wearing improper shoes often causes hammertoe. Shoes that squeeze the toes, such as those with a tight toe box or with heels higher than two inches, can put too much pressure on the toe joints.


HammertoeSymptoms


If the toes remain in the hammertoe position for long periods, the tendons on the top of the foot will tighten over time because they are not stretched to their full length. Eventually, the tendons shorten enough that the toe stays bent, even when shoes are not being worn. The symptoms of hammertoe include a curling toe, pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward, thickening of the skin above or below the affected toe with the formation of corns or calluses, difficulty finding shoes that fit well. In its early stages, hammertoe is not obvious. Frequently, hammertoe does not cause any symptoms except for the claw-like toe shape.


Diagnosis


Hammer toes may be easily detected through observation. The malformation of the person's toes begin as mild distortions, yet may worsen over time - especially if the factors causing the hammer toes are not eased or removed. If the condition is paid attention to early enough, the person's toes may not be permanently damaged and may be treated without having to receive surgical intervention. If the person's toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.


Non Surgical Treatment


You should seek medical advice if you have a hammer toe. Here are some things you can do in the meantime. None of these things will cure the hammer toe, but they may relieve the pain and discomfort. Only wear shoes that are high and broad across the toes. There should be at least 1.5 cm of space between your longest toe and the tip of the shoe. Keep in mind that this could be either your big toe or your second toe. Don't wear heels higher than 5 cm. Wear the appropriate shoe for the activity you are doing. You can buy non-medicated hammer toe pads. They fit around the pointy top of the toe joint and help relieve painful pressure. Gently massaging the toe may help relieve pain. Put ice packs wrapped in cloth on the hammer toe to reduce painful swelling.


Surgical Treatment


If this fails or if treatment is not sought until the toes are permanently misaligned, then surgery may be required. Surgery may involve either cutting the tendon or fusing the joint. Congenital conditions should be treated in early childhood with manipulations and splinting.


HammertoePrevention


The key to prevention is to wear shoes that fit you properly and provide plenty of room for your toes. Here?s how to get the right fit. Have your feet properly measured. The best way to do this is to get someone to draw the outline of your foot while you stand barefoot with your full weight on it, then measure the outline at the widest point. Measure the soles of your shoes. Ideally, they should be as wide as your feet, but certainly no more than half an inch narrower. Length matters, too, of course: your shoes should be half an inch longer than your longest toe.

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Jun142015

Do Bunions Require Surgery

Overview
Bunions Callous The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents additional bone formation, often in combination with a misalignment of the big toe. The misalignment causes the big toe to move outward (medically termed hallux valgus deformity). The normal position of the big toe (straight forward) becomes outward directed toward the smaller toes. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion.

Causes
The most important causative factor is poor fitting footwear. This accounts for an higher incidence among women than men. Family history of bunions. Abnormal foot function, excessive pronation. Poor foot mechanics, such as excessive pronation (rolling inwards of the foot), causes a medial force which exerts pressure and can lead to the formation of bunions. Rheumatoid or osteoarthritis. Genetic and neuromuscular diseases, which can result in a muscular imbalance such as Down's syndrome. If one leg is longer then the other, the longer leg is more inclined to develop a bunion. If the ligaments in the feet are very weak. In some cases, bunions can occur due to trauma or injury to the feet.

Symptoms
The dominant symptom of a bunion is a big bulging bump on the inside of the base of the big toe. Other symptoms include swelling, soreness and redness around the big toe joint, a tough callus at the bottom of the big toe and persistent or intermittent pain.

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
Most bunions can be treated without surgery. The first step for treating bunions is to ensure that your shoes fit correctly. Often good footwear is all that is needed to alleviate the problem. Shoes that are wide enough to avoid pressure on the bunion are the obvious first step. Look for shoes with wide insteps and broad toes and definitely no high heels. Sometimes, you can get your existing shoes stretched out by a shoe repairer. Seek advice from a podiatrist. Pads and toe inserts. Protective bunion pads may help to cushion the joint and reduce pain. Toe inserts are available that splint the toes straight. It may be recommended that you wear some orthotics to improve your foot position when walking. Medicines. Some people find anti-inflammatory medicines, such as ibuprofen or aspirin, or paracetamol help ease the pain of their bunions. Bunion Pain

Surgical Treatment
Several surgical procedures are available to the podiatric physician The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatric physician.

Prevention
If you are genetically at risk, not a lot. But shoes that are too narrow, too tight (even ballet flats) or have very high heels that force your toes down into the pointed end are asking for trouble. Aim for a 1cm gap between your toes and the end of your shoes. This doesn?t mean wearing frumpy flatties, the Society of Podiatrists and Chiropodists recommends sticking to 4cm heels for everyday wear, and wearing different types of shoe to vary the position of your foot. Gladiator styles can help because the straps stop your foot pushing down into the point of the shoe, ditto Mary Janes (sorry but for beautiful feet they need to have a strap), and flat, wide-fitting brogues are a no-brainer. Alternatively, in summer you can wear flip-flops to keep the space between your big and second toe as wide as possible. If you have children it?s vital to make sure that their feet are measured for properly fitting shoes to nip any potential problems in the bud. Keeping your feet and lower legs supple and strong is important too, that?s how A-list celebs get away with wearing killer heels, they all work-out like crazy. Exercises like trying to widen the space between your big toe and the second one with your foot flat on the floor, a few times a day can help, as can calf stretches. If you are devoted to any exercise that involves high impact for your feet, it might be worth checking that your gait and shoes are correct with a specialist shop such as Runners Need, as poor styles can cause irreparable bunion-related problems that will consign your trainers to the back of the cupboard for ever.

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May312015

Over-Pronation

Overview


Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person?s arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, possibly causing severe discomfort and leading to other foot problems.Foot Pronation


Causes


In adults, the most common reason for the onset of Over-Pronation is a condition known as Post Tibial Tendonitis. This condition develops from repetitive stress on the main supporting tendon (Posterior Tibial Tendon) of the foot arch. As the body ages, ligaments and muscles can weaken. When this occurs the job of providing the majority of the support required by the foot arch is placed upon this tendon. Unfortunately, this tendon cannot bear the weight of this burden for too long. Eventually it fatigues under the added strain and in doing so the foot arch becomes progressively lower over a period of time.


Symptoms


Overpronation can negatively affect overall body alignment. The lowering of the longitudinal arch pulls the heel bone in, causing the leg, thigh bone and hip to rotate inwards, and an anterior tilt of the pelvis. Unnecessary strain to the ankles, knees, hips and back can result. Plantar fasciitis and inflammation, metatarsal pain, problems with the Achilles tendon, pain on the inside of the knee, and bursitis in the hip are just some of the conditions commonly associated with pronation.


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.Pronation


Non Surgical Treatment


When you see the doctor, he or she will likely perform a complete examination of your feet and watch you walk. The doctor will need to take x-rays to determine the cause of your flat feet. In some cases, further imaging may be needed, especially if your symptoms are severe and sudden in nature. Once you are properly diagnosed, your doctor will create an appropriate treatment plan. There are several options to correct overpronation, such as orthotics. In many cases, overpronation can be treated with non-surgical methods and over-the-counter orthotics. In severe cases, however, custom-made orthotics may work better. Orthotics provide arch support and therefore prevent collapse of the arch with weight bearing. They are made of materials such as spongy rubber or hard plastic. Your doctor will also want to examine your footwear to ensure they fit properly and offer enough medial support. Extra support and stability can be achieved with footwear that has a firm heel counter. If you are experiencing pain, you should be able to use over-the-counter pain medications such as ibuprofen to relieve symptoms.


Prevention


Many of the prevention methods for overpronation orthotics, for example, can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.

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May162015

Therapy And Severs Disease

Overview


The large heel bone (called the calcaneus) has a growth plate at the back of the heel. This growth plate is made of soft cartilage and it gradually narrows and starts to turn into solid bone around 8 to 13 years of age. This growth plate is prone to becoming inflamed and painful at this time. The strong Achilles tendon happens to join onto the back of the heel bone and pulls on this growth plate when running causing Sever?s disease.


Causes


Sever disease, like other similar conditions (eg, Osgood-Schlatter disease, little-leaguer's elbow, and iliac apophysitis), is believed to be caused by decreased resistance to shear stress at the bone-growth plate interface. Studies have indicated that traction apophyses have a higher composition of fibrocartilage than epiphyses subjected more to axial load, which are composed predominantly of hyaline cartilage. The anatomy of the calcaneal apophysis lends to significant shear stress because of its vertical orientation and the direction of pull from the strong gastrocnemius-soleus muscle group.


Symptoms


In Sever?s disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she stands on tiptoe. Your child?s heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your provider may also find that your child?s heel tendons have become tight.


Diagnosis


Your Podiatrist or Physiotherapist will assist in diagnosing the injury and the extent of the damage. From this, they will develop a management plan which may include rest or activity modification, soft tissue treatment such as massage and stretching, correction of biomechanics through heel raises or orthoses and the progression through a series of specific strengthening exercises.


Non Surgical Treatment


The physiotherapist will thoroughly assess the affected areas and general mechanics to determine what factors may be contributing, also to rule out any other injuries or stress fractures, etc. Treatment focusing on the affected area will consist of modified rest, ice, massage, stretches and electrotherapy. A foam heel raise may also be given to help decrease pain. The physiotherapist may also treat other areas if biomechanical problems are noted. This may include massage, mobilization and exercises to stretch and strengthen certain areas. They may also refer the patient to see a podiatrist if they believe the foot posture is a factor.


Recovery


One of the most important things to know about Sever's disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever's disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away. Although Sever's disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child's growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.

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Mar142015

What Is The Treatment And Cause Of Adult Aquired Flat Foot

Overview


PTTD is a common condition treated by foot and ankle specialists. Although there is a role for surgical treatment of PTTD, conservative care often can prevent or delay surgical intervention. Decreasing inflammation and stabilizing the affected joints associated with the posterior tibial tendon can decrease pain and increase functional levels. With many different modalities available, aggressive nonoperative methods should be considered in the treatment of PTTD, including early immobilization, the use of long-term bracing, physical therapy, and anti-inflammatory medications. If these methods fail, proper evaluation and work-up for surgical intervention should be employed.Flat Foot






Causes


Posterior tibial tendon dysfunction is the most common cause of acquired adult flatfoot deformity. There is often no specific event that starts the problem, such as a sudden tendon injury. More commonly, the tendon becomes injured from cumulative wear and tear. Posterior tibial tendon dysfunction occurs more commonly in patients who already have a flat foot for other reasons. As the arch flattens, more stress is placed on the posterior tibial tendon and also on the ligaments on the inside of the foot and ankle. The result is a progressive disorder.






Symptoms


The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.






Diagnosis


The history and physical examination are probably the most important tools the physician uses to diagnose this problem. The wear pattern on your shoes can offer some helpful clues. Muscle testing helps identify any areas of weakness or muscle impairment. This should be done in both the weight bearing and nonweight bearing positions. A very effective test is the single heel raise. You will be asked to stand on one foot and rise up on your toes. You should be able to lift your heel off the ground easily while keeping the calcaneus (heel bone) in the middle with slight inversion (turned inward). X-rays are often used to study the position, shape, and alignment of the bones in the feet and ankles. Magnetic resonance (MR) imaging is the imaging modality of choice for evaluating the posterior tibial tendon and spring ligament complex.






Non surgical Treatment


Depending on the stage of the deformity and patient?s functional goals, various treatment options are available. Some patients improve with conservative care which includes rest and immobilization, shoe modifications, orthoses and bracing, or physical therapy. Surgery might be warranted for advanced stages of the condition. Often a combination of procedures including tendon and muscle augmentation, tendon transfers, realigning of bones or fusion of certain joints might be necessary in more advanced cases. Your doctor will evaluate and recommend an individualized plan of care with your specific needs in mind.


Flat Foot






Surgical Treatment


A new type of surgery has been developed in which surgeons can re-construct the flat foot deformity and also the deltoid ligament using a tendon called the peroneus longus. A person is able to function fully without use of the peroneus longus but they can also be taken from deceased donors if needed. The new surgery was performed on four men and one woman. An improved alignment of the ankle was still evident nine years later, and all had good mobility 8 to 10 years after the surgery. None had developed arthritis.

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