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Bursitis Top Of Feet Treatment Methods

Overview

Achilles tendon bursitis occurs mainly in young women but can develop in men. Walking in a way that repeatedly presses the soft tissue behind the heel against the stiff back support of a shoe can cause or aggravate the bursitis. Shoes that taper sharply inward toward the posterior heel (such as high-heeled shoes) can cause irritating pressure that leads to the development of this bursitis. Normally, only one bursa is in the heel, between the Achilles tendon and the heel bone (calcaneus). This bursa may become inflamed, swollen, and painful, resulting in anterior Achilles tendon bursitis. Abnormal pressure and foot dysfunction can cause a protective bursa to form between the Achilles tendon and the skin. This bursa may also become inflamed, swollen, and painful, resulting in posterior Achilles tendon bursitis. Any condition that puts extra strain on the Achilles tendon can cause anterior Achilles tendon bursitis. Injuries to the heel and diseases such as rheumatoid arthritis can also cause it.

Causes

The following are some of the more common causes for heel bursitis. Overuse (common in runners and athletes). Running with the wrong footwear. A sudden impact to the foot. Repetitive stress. Underlying inflammatory condition (such as osteoarthritis).

Symptoms

Symptoms of Achilles bursitis are often mistaken for Achilles tendinitis because of the location of the pain at the back of the heel. When you suffer from Achilles bursitis you will experience some or all of the following symptoms which are most noticeable when you begin activity after resting. High heels can add pressure on the retrocalcaneal bursa, subcutaneous calcaneal bursa, and Achilles tendon.

Diagnosis

The diagnosis is based on the symptoms and an examination. For anterior Achilles tendon bursitis, doctors use x-rays to rule out a fracture of the heel bone or damage to the heel bone caused by rheumatoid arthritis or other inflammatory arthritis.

Non Surgical Treatment

Treatment is primarily comprised of relief from the painful activity (running). It is important that shoes do not pinch the heel. If satisfactory progress is not made during the rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the bursa. Injections should be performed under ultrasound guidance to ensure optimal effect and reduce the risk of injecting into the Achilles itself. If progress is not made neither through rehabilitation nor medicinal treatment, surgical treatment can be attempted.

Surgical Treatment

Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.

Do Hammer Toes Cause Numbness

HammertoeOverview

The smallest four toes of each foot have three bony segments connected by two joints. Hammertoe is a deformity in which one or more of the small toes develops a bend at the joint between the first and second segments. The tip of the toe turns downward, making it look like a hammer or claw. The second toe is the one most often affected. hammertoes may be more likely to occur when the second toe is longer than the first toe or when the arch of the foot is flat.

Causes

A hammertoe is formed due an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammertoe. Arthritis is another factor, because the balance around the toe in people with arthritis is so disrupted that a hammertoe may develop. Wearing shoes that are too tight and cause the toes to squeeze can also be a cause for a hammertoe to form.

HammertoeSymptoms

The most common symptoms of hammertoes include. The toe is bent upward at the middle toe joint, so that the top of this joint rubs against the top of the shoe. The remainder of the toe is bent downward. Pain upon pressure at the top of the bent toe from footwear. The formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe. This occurs because the contracted digit puts pressure on the metatarsal head creating callouse and pressure on the ball of the foot.

Diagnosis

Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).

Non Surgical Treatment

Your podiatrist may recommend conservative treatment techniques for your hammertoes based on your foot structure, which will likely involve removing any thick, painful skin, padding your painful area, and recommending for you shoes that give your curled toes adequate room. Conservative care strategies for this health purpose may also involve the use of Correct Toes, our toe straightening and toe spacing device.

Surgical Treatment

Surgical Options: Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammer toes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatrist.

HammertoePrevention

As you get older, feet get bigger. Get your feet measured every time you buy shoes. Don't go by shoe sizes. Shoe sizes vary among manufacturers; a shoe is the right size only when it fits comfortably. The ball of your foot should fit into the widest part of the shoe. A shoe should be sturdy such that it only bends in the ball of the foot, exactly where your big toes bend. Any shoe that can be bent anywhere hammertoe along the sole or twisted side to side is generally too flimsy.

Hammer Toe Repair

Hammer ToeOverview

A Hammer toes is a toe that tends to remain bent at the middle joint in a claw-like position. There are 2 types of hammer toe. Flexible hammer toe, can be straightened by hand. Rigid hammer toe, cannot be pulled straight and can be extremely painful. The position of the toe can also lead to corns or calluses. These may also be painful. Hammer toe may be present at birth or develop later in life due to tendons that have tightened, causing the toe's joints to curl downward. Occasionally, all toes may be bent. This may be due to problems with the peripheral nerves or the spinal cord.

Causes

Your toe contains two joints that allow it to bend at the middle and bottom. A hammertoe occurs when the middle joint becomes dislocated. Common causes of this joint dislocation include a toe injury, arthritis, a high foot arch, wearing shoes that don?t fit properly, tightened ligaments or tendons in the foot, pressure from a bunion (when your big toe points inward toward your second toe) Spinal cord or peripheral nerve damage may cause all of your toes to curl downward.

Hammer ToeSymptoms

The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes. There may be a bursa under the corn or instead of a corn, depending on the pressure. Most of the symptoms are due to pressure from footwear on the toe. There may be a callus under the metatarsal head at the base of the toe. Initially a hammer toe is usually flexible, but when longstanding it becomes more rigid.

Diagnosis

Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of Hammer toe arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).

Non Surgical Treatment

Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than your longest toe. For many people, the second toe is longer than the big toe.) Avoid wearing tight, narrow, high-heeled shoes. You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. Or, a shoe repair shop may be able to stretch the toe box so that it bulges out around the toe. Sandals may help, as long as they do not pinch or rub other areas of the foot.

Surgical Treatment

If you have a severe case of hammer toe or if the affected toe is no longer flexible, you may need surgery to straighten your toe joint. Surgery requires only a local anesthetic (numbing medicine for the affected area) and is usually an outpatient procedure. This means you don?t have to stay in the hospital for the surgery.

What Causes Bunions?

Overview
Bunions Hard Skin Your big toe is the hardest working toe. Every time your foot pushes off the ground, this toe supports most of your body's weight. Because the big toe is so critical to movement, any problem with it can make walking or even standing painful. A bunion (excess or misaligned bone in the joint) is one of the most common big-toe problems. In addition to causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit. But you don't have to hobble for the rest of your life. Bunions can be treated. With your doctor's help, your feet can feel and look better.

Causes
Abnormality in foot function, particularly a pronated foot. This is probably the most important and common causative factor. Family history of bunions. Narrow toed dress shoes and high heels may contribute to the formation of a bunion. Rheumatoid and Psoriatic arthritis. Genetic and neuromuscular disease (eg. Down's,Ehler-Danlos and Marfan's syndromes) resulting in muscle imbalance. Limb length inequality can cause a bunion on the longer limb. Generalized laxity of the ligaments. Trauma to or surgery on the soft tissue structures around the great toe (first metatarsal-phalangeal) joint.

Symptoms
No matter what stage your bunion is in, you can be in pain. Though bunions take years to develop, you can experience pain at any stage. Some people don?t have bunion pain at all. Pain from a bunion can be severe enough to keep you from walking comfortably in normal shoes. The skin and deeper tissue around the bunion also may become swollen or inflamed.

Diagnosis
Clinical findings are usually specific. Acute circumferential intense pain, warmth, swelling, and redness suggest gouty arthritis (see Gout) or infectious arthritis (see Acute Infectious Arthritis), sometimes mandating examination of synovial fluid. If multiple joints are affected, gout or another systemic rheumatic disease should be considered. If clinical diagnosis of osteoarthritic synovitis is equivocal, x-rays are taken. Suggestive findings include joint space narrowing and bony spurs extending from the metatarsal head or sometimes from the base of the proximal phalanx. Periarticular erosions (Martel sign) seen on imaging studies suggest gout.

Non Surgical Treatment
Bunions can develop at any time. Although bunions often require no medical treatment you should consult your family doctor/chiropodist/podiatrist. Treatment options vary depending on the severity of your bunion and the amount of pain it causes you. Although they don't always cause problems, bunions are permanent unless surgically corrected. If the cushioning sac of fluid (bursa) over the affected joint becomes inflamed (bursitis), a bunion can be very painful and interfere with your normal activities. Bunions may get larger and more painful, making nonsurgical treatment less effective. Apply a non-medicated bunion pad around the bony bump. If a bunion becomes inflamed or painful, apply an ice pack two to three times daily to help reduce swelling. Wear shoes with a wide and deep toe box. Avoid shoes with heels higher than 2 inches (5.1 centimeters). Bunion Pain

Surgical Treatment
If all nonsurgical measures fail to control the symptoms, then surgery may be suggested to treat the hallux valgus condition. Well over 100 surgical procedures exist to treat hallux valgus. The basic considerations in performing any surgical procedure for hallux valgus are to remove the bunion, to realign the bones that make up the big toe, to balance the muscles around the joint so the deformity does not return.

Is Over-Pronation

Overview

Pronation is a normal motion that our feet make as they walk. With each step, the heel touches the ground first, then the foot rolls forward to the toes, causing the ankle to roll inward slightly and the arch to flatten out. That?s normal. But when that rolling inward becomes more pronounced, that?s over-pronation, which is a big problem. You can usually see over-pronation by looking at the back of the leg and foot. The Achilles tendon normally runs straight down from the leg to the foot, hitting the floor at a perpendicular angle. In feet that over-pronate, the Achilles tendon will be at a slight angle to the ground and the ankle bone will appear more prominent than usual.Over-Pronation

Causes

Overpronation often occurs in people with flat feet, whose plantar fascia ligament is too flexible or too long, and therefore unable to properly support the longitudinal arch of the foot. People tend to inherit the foot structure that leads to overpronation. In a normal foot the bones are arranged so that two arches are formed, the longitudinal and the transverse. Ligaments hold all the bones in their correct positions, and tendons attach muscles to bones. If the bones are held together too loosely, they will tend to move inwards as this is the easiest direction for them to go. Over time the soft tissue structures will adjust to the misalignment and the foot will become permanently over-flexible, with a flat arch.

Symptoms

Because pronation is a twisting of the foot, all of the muscles and tendons which run from the leg and ankle into the foot will be twisted. In over-pronation, resulting laxity of the soft tissue structures of the foot and loosened joints cause the bones of the feet shift. When this occurs, the muscles which attach to these bones must also shift, or twist, in order to attach to these bones. The strongest and most important muscles that attach to our foot bones come from our lower leg. So, as these muscles course down the leg and across the ankle, they must twist to maintain their proper attachments in the foot. Injuries due to poor biomechanics and twisting of these muscles due to over-pronation include: shin splints, Achilles Tendonitis, generalized tendonitis, fatigue, muscle aches and pains, cramps, ankle sprains, and loss of muscular efficiency (reducing walking and running speed and endurance). Foot problems due to over-pronation include: bunions, heel spurs, plantar fasciitis, fallen and painful arches, hammer toes, and calluses.

Diagnosis

The best way to discover whether you have a normal gait, or if you overpronate, is to visit a specialty run shop, an exercise physiologist, a podiatrist or a physical therapist who specializes in working with athletes. A professional can analyze your gait, by watching you either walk or run, preferably on a treadmill. Some facilities can videotape your gait, then analyze the movement of your feet in slow-motion. Another (and less costly) way is to look at the bottom of an older pair of run shoes. Check the wear pattern. A person with a normal gait will generally see wear evenly across the heel and front of the shoe. A person who overpronates will likely see more wear on the OUTside of the heel and more wear on the INside of the forefoot (at the ball). A person who supinates will see wear all along the outer edges of the shoe. You can also learn about your gait by looking at your arches. Look at the shape your wet feet leave on a piece of paper or a flat walking surface.Over Pronation

Non Surgical Treatment

Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.

Surgical Treatment

Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.

An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.

Severs Disease Physiotherapy

Overview

What Is Calcaneal Apophysitis? Calcaneal apophysitis is a painful inflammation of the heel?s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop. Calcaneal apophysitis is also called Sever?s disease, although it is not a true ?disease.? It is the most common cause of heel pain in children, and can occur in one or both feet. Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn?t improve in this manner. In fact, walking typically makes the pain worse.

Causes

There are a number of possible causes for a child's heel pain. Because diagnosis can be challenging, a foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan. Sever's disease, also known as calcaneal apophysitis, is by far the most common cause of heel pain in children. Other causes of heel pain include tendo-achilles bursitis, other overuse injuries, and fractures.

Symptoms

Sever?s disease is a clinical diagnosis based on the youth?s presenting symptoms, rather than on diagnostic tests. While x-rays may be ordered in the process of diagnosing the disease, they are used primarily to rule out bone fractures or other bone abnormalities, rather than to confirm the disease. Common Characteristics of Sever?s Disease include Posterior inferior heel pain. Pain is usually absent when waking in the morning. Increased pain with weight bearing, running, or jumping (or activity-related pain). Area often feels stiff or inflexible. Youth may limp at the end of physical activity. Tenderness at the insertion of the tendons. Limited ankle dorsiflexion range that is secondary to tightness of the Achilles tendon. Activity or sport practices on hard surfaces can also contribute to pain, as well as poor quality shoes, worn out shoes, or the wrong shoes for the sport. Typically, the pain from this disease gradually resolves with rest.

Diagnosis

Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.

Non Surgical Treatment

It is important that those with Sever?s Disease are treated by a medical professional to reduce pain and allow children to continue to participate in sporting activities. The Athlete?s Foot recommends a visit to your local medical professional to be diagnosed correctly and receive specialised care. Symptoms include pain through the back of the heel where the Achilles tendon inserts into the heel bone, pain during activity especially running and jumping and the back of the heel may be tender to touch.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

Posterior Tibial Tendon Dysfunction Exercises

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

Causes
Rheumatoid arthritis This type of arthritis attacks the cartilage in the foot, leading to pain and flat feet. It is caused by auto-immune disease, where the body?s immune system attacks its own tissues. Diabetes. Having diabetes can cause nerve damage and affect the feeling in your feet and cause arch collapse. Bones can also fracture but some patients may not feel any pain due to the nerve damage. Obesity and/or hypertension (high blood pressure) This increases your risk of tendon damage and resulting flat foot.

Symptoms
Patients often experience pain and/or deformity at the ankle or hindfoot. When the posterior tibial tendon does not work properly, a number of changes can occur to the foot and ankle. In the earlier stages, symptoms often include pain and tenderness along the posterior tibial tendon behind the inside of the ankle. As the tendon progressively fails, deformity of the foot and ankle may occur. This deformity can include progressive flattening of the arch, shifting of the heel so that it no longer is aligned underneath the rest of the leg, rotation and deformity of the forefoot, tightening of the heel cord, development of arthritis, and deformity of the ankle joint. At certain stages of this disorder, pain may shift from the inside to the outside aspect of the ankle as the heel shifts outward and structures are pinched laterally.

Diagnosis
In the early stages of dysfunction of the posterior tibial tendon, most of the discomfort is located medially along the course of the tendon and the patient reports fatigue and aching on the plantar-medial aspect of the foot and ankle. Swelling is common if the dysfunction is associated with tenosynovitis. As dysfunction of the tendon progresses, maximum pain occurs laterally in the sinus tarsi because of impingement of the fibula against the calcaneus. With increasing deformity, patients report that the shape of the foot changes and that it becomes increasingly difficult to wear shoes. Many patients no longer report pain in the medial part of the foot and ankle after a complete rupture of the posterior tibial tendon has occurred; instead, the pain is located laterally. If a fixed deformity has not occurred, the patient may report that standing or walking with the hindfoot slightly inverted alleviates the lateral impingement and relieves the pain in the lateral part of the foot.

Non surgical Treatment
Nonoperative therapy for adult-acquired flatfoot is a reasonable treatment option that is likely to be beneficial for most patients. In this article, we describe the results of a retrospective cohort study that focused on nonoperative measures, including bracing, physical therapy, and anti-inflammatory medications, used to treat adult-acquired flatfoot in 64 consecutive patients. The results revealed the incidence of successful nonsurgical treatment to be 87.5% (56 of 64 patients), over the 27-month observation period. Overall, 78.12% of the patients with adult-acquired flatfoot were obese (body mass index [BMI] = 30), and 62.5% of the patients who failed nonsurgical therapy were obese; however, logistic regression failed to show that BMI was statistically significantly associated with the outcome of treatment. The use of any form of bracing was statistically significantly associated with successful nonsurgical treatment (fully adjusted OR = 19.8621, 95% CI 1.8774 to 210.134), whereas the presence of a split-tear of the tibialis posterior on magnetic resonance image scans was statistically significantly associated with failed nonsurgical treatment (fully adjusted OR = 0.016, 95% CI 0.0011 to 0.2347). The results of this investigation indicate that a systematic nonsurgical treatment approach to the treatment of the adult-acquired flatfoot deformity can be successful in most cases. 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.