Dealing With Mortons Neuroma

Overview

Morton?s Neuroma is a pathological condition of the common digital nerve in the foot, most frequently between the third and fourth metatarsals (third inter-metatarsal space). The nerve sheath becomes abnormally thickened with fibrous (scar) tissue and the nerve fibres eventually deteriorate.This condition is named for the American surgeon, Thomas George Morton (1835-1903), who first recognised the condition in 1876. Incidentally his father was the dentist who discovered the anaesthetics; initially Nitrous oxide, the very gas used today in cryosurgery for the condition his son lent his name to? Morton?s neuroma.

Causes

Poorly fitted footwear can be a cause. Shoes that have a tight and narrow toe box can cause the never to become entrapped causing the pain. High heeled shoes abnormally place the metatarsals under extreme pressure which can cause Morton?s Neuroma. In cases of abnormal pronation, there can be significant motion between the 3rd and 4th metatarsals which can cause an irritation to the nerve that runs between them. This inflammation causes the pain.

Symptoms

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

Diagnosis

If you suspect Morton?s Neuroma, it is essential that you confirm your suspicions by consulting with a podiatric physician. Don?t wait for the symptoms to go away for good (even if they tend to come and go). Also, remember that many conditions have similar symptoms, and only a professional can tell the difference.

Non Surgical Treatment

Most non-operative treatment is usually successful, although it can take a while to figure out what combination of non-operative treatment works best for each individual patient. Non-operative treatment may include the use of comfort shoe wear. The use of a metatarsal pad to decrease the load through the involved area of the plantar forefoot. A period of activity modification to decrease or eliminate activities, which maybe exacerbating the patient?s symptoms. For example, avoiding long periods of standing or other activities that result in significant repetitive loading to the forefoot can be very helpful. Wearing high heels should be avoided. Local corticosteroid injections can help decrease inflammation associated with the nerve. However, this does not necessarily address the underlying loading forces that maybe causing the injury to the nerve in the first place. It has been proposed that an alcohol injection in and around the nerve will cause a controlled death to the nerve and subsequently eliminate symptoms from the nerve. In theory, this may be helpful. In practice, adequate prospective studies have not demonstrated the benefit of this procedure above and beyond the other standard non-operative treatments available. In addition there is the concern that the alcohol will cause excessive scarring and death of other important structures in the area.Morton neuroma

Surgical Treatment

Majority of publications including peer review journal articles, surgical technique description and textbooks promote surgical excision as a gold standard treatment. Surgical excision is described as the most definitive mode of treatment for symptomatic Morton?s neuroma with reported success rates varying between 79% and 93%. Various surgical techniques are described, essentially categorised as dorsal versus plantar incision approaches. Beyond this the commonest technical variation described as influencing the outcome of surgery involves burying and anchoring transacted nerve into soft tissue such as muscle.

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Addressing Inferior Calcaneal Spur

Heel Spur

Overview

A heel spur is a bony projection on the sole (bottom) of the heel bone. This condition may accompany or result from severe cases of inflammation to the structure called plantar fascia. The plantar fascia is a fibrous band of connective tissue on the sole of the foot, extending from the heel to the toes. Heel spurs are a common foot problem resulting from excess bone growth on the heel bone. The bone growth is usually located on the underside of the heel bone, and may extend forward toward the toes. A painful tear in the plantar fascia between the toes and heel can produce a heel spur and/or inflammation of the plantar fascia. Because this condition is often correlated to a decrease in the arch of the foot, it is more prevalent after the ages of six to eight years, when the arch is fully developed.

Causes

Over-pronation (flat feet) is a common cause of heel spurs, but people with unusually high arches (pes cavus) can also develop heel spurs. Women have a significantly higher incidence of heel spurs due to the types of footwear often worn on a regular basis.

Inferior Calcaneal Spur

Symptoms

Most of the time heel spurs present as pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.

Diagnosis

Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts. X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.

Non Surgical Treatment

Common and effective treatments for Heel Spurs include: Stretching exercises, changing to specific shoes, taping or strapping to rest stressed muscles and tendons, custom orthotic devices and physiotherapy. There are many things you can do to treat heel spurs. You should stretch the muscles and ligaments around the area regularly and ensure you are wearing the right footwear for your feet. There are also tapes and straps that you can apply to the muscles and tendons around the area. For more severe cases, custom orthotics may be the way to go along with aggressive physiotherapy. To treat the pain, over the counter NSAIDs (anti-inflammatory medications) is recommended, but use with caution as prolonged use can lead to the development of ulcers. It is therefore best to apply a topical treatment such as Zax?s Original Heelspur Cream, which contains natural ingredients proven to reduce pain and inflammation. More severe forms of the condition may require corticosteroid injections or surgical procedures, but these are very rare cases. Still, should pain become worse and persist, you should consult with your doctor.

Surgical Treatment

Almost 90% of the people suffering from heel spur get better with nonsurgical treatments. However, if the conservative treatments do not help you and you still have pain even after 9 to 12 months, your doctor may advise surgery for treating heel spur. The surgery helps in reducing the pain and improving your mobility. Some of the surgical techniques used by doctors are release of the plantar fascia. Removal of a spur. Before the surgery, the doctor will go for some pre-surgical tests and exams. After the operation, you will need to follow some specific recommendations which may include elevation of the foot, waiting time only after which you can put weight on the foot etc.

Prevention

To prevent this condition, wearing shoes with proper arches and support is very important. Proper stretching is always a necessity, especially when there is an increase in activities or a change in running technique. It is not recommended to attempt working through the pain, as this can change a mild case of heel spurs and plantar fascitis into a long lasting and painful episode of this condition.

What Is The Best Solution For Calcaneal Spur

Posterior Calcaneal Spur

Overview

Heel spurs are a relatively common cause of heel pain. A heel spur is a pointed bone fragment that extends forward from the bottom of the heel from the heel bone, also referred to as a calcaneous. Serious pain and discomfort often develops with this condition. In many cases, a heel spur develops along with plantar fasciitis which occurs when the plantar fascia ligament becomes inflamed.

Causes

One common cause of heel spurs and related injuries is due to abnormal mechanics and movement of the foot, also referred to as pronation. Abnormal gait, which is the way our feet hit the ground as we walk, also stresses the tissue of the foot, leading to conditions such as plantar fasciitis and heel spurs. Pronation can cause the foot to become unstable during movement, affecting the gait and leading to damage. A sudden increase in weight can also influence the development of a painful heel spur.

Inferior Calcaneal Spur

Symptoms

Most of the time heel spurs present as pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.

Diagnosis

A thorough medical history and physical exam by a physician is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.

Non Surgical Treatment

The key for the proper treatment of heel spurs is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rear foot posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal. Other common treatments include stretching exercises, losing weight, wearing shoes that have a cushioned heel that absorbs shock, and elevating the heel with the use of a heel cradle, heel cup, or orthotic. Heel cradles and heel cups provide extra comfort and cushion to the heel, and reduce the amount of shock and shear forces experienced from everyday activities.

Surgical Treatment

In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.

Bursitis Ball Of Foot Treatment

Overview

Retrocalcaneal bursitis is a condition characterized by tissue damage and inflammation of the retrocalcaneal bursa (a small fluid filled sac located at the back of the heel) causing pain in the heel region. A bursa is a thin fluid filled sac found in various places throughout the body. Bursae are designed to reduce friction between adjacent layers of tissue and are filled with lubricating fluid. They are typically located in regions of the body where tissue layers may rub against each other or against bony prominences The muscle group at the back of the lower leg is commonly called the calf. The calf comprises of 2 major muscles (gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon. Between the Achilles tendon and the heel bone lies a bursa known as the retrocalcaneal bursa.

Causes

Certain medical conditions and medications suppress people’s immune systems and make them more susceptible to septic bursitis. For example, people with cancer, HIV/AIDS, lupus, alcoholism, chronic obstructive pulmonary disease (COPD), and diabetes may be more likely to get septic bursitis. History of inflammation of the bursa. Patients who have had bursitis in the past have an increased chance of getting it again. There may be more than one reason why the retrocalcaneal bursa is inflamed. In these cases, treatment should address all of the causes.

Symptoms

Symptoms of bursitis include pain in the heel, especially with walking, running, or when the area is touched. The skin over the back of the heel may be red and warm, and the pain may be worse with attempted toe rise (standing on tippy-toes).

Diagnosis

Your doctor will check for bursitis by asking questions about your past health and recent activities and by examining the area. If your symptoms are severe or get worse even after treatment, you may need other tests. Your doctor may drain fluid from the bursa through a needle (aspiration) and test it for infection. Or you may need X-rays, an MRI, or an ultrasound.

Non Surgical Treatment

Treatment for soft tissue conditions focuses on reducing pain and inflammation, and on preserving mobility and preventing disability and recurrence. The treatment for many soft tissue conditions is similar. A doctor’s recommendations may include a combination of rest, splints, heat and cold application, medications, physical therapy, or occupational therapy. A person with a soft tissue condition may try several treatments before he or she finds the best one for his or her specific condition.

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.

Prevention

Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition. Proper stretching of the Achilles tendon helps prevent injury.

Hammer Toe Surgery Procedure

Hammer ToeOverview

When a person has Hammer toe, the end of their toe bends downward and the middle joint curls up. Eventually, the toe gets stuck in a stiff, claw-like position. When the inside of your shoe rubs against a hammer toe, corns, blisters or calluses may form on top of the toe or on the bottom of your foot. This can make walking painful. You may also have pain in the joint where your big toe joins your foot. Hammer toe usually affects a person?s second toe (the toe next to the big toe), but it can affect other toes too.

Causes

The muscles of each toe work in pairs. When the toe muscles get out of balance, a hammertoe can form. Muscle imbalance puts a lot of pressure on the toe’s tendons and joints. This pressure forces the toe into a hammerhead shape. How do the toe muscles get out of balance? There are three main reasons. Genes. you may have inherited a tendency to develop hammertoes because your feet are somewhat unstable, they may be flat or have a high arch. Arthritis. Injury to the toe, ill-fitting shoes are the main culprits. If shoes are too tight, too short, or too pointy, they push the toes out of balance. Pointy, high-heeled shoes put particularly severe pressure on the toes.

Hammer ToeSymptoms

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

Most health care professionals can diagnose hammertoe Hammer toe 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.

Non Surgical Treatment

Conservative treatment is limited to accommodation, not correction, of the deformity, though some patients find the relief they can get from these options to be more than enough to put off or even avoid surgery. These include better Footwear. Shoe gear with a wider toe box and higher volume causes less friction to the toes. Toe Braces and Strapping. Some toe braces and strapping techniques take some pressure off the toes during gait. Custom molded orthotics can redistribute the forces through the tendons that control the toe, lessening the pain and extent of the deformity.The calluses on the toe and the ball of the foot can be shaved occasionally to reduce some pain and pressure, although they will return due to the constant deformity.

Surgical Treatment

Sometimes, if the deformity is severe enough or surgical modification is needed, the toe bones may be fused so that the toe does not bend. Buried wires are used to allow for the fusion to heal, and they remain in place after healing. Your skin is closed with fine sutures, which are typically removed seven to ten days after surgery. A dressing is used to help keep your toes in their new position. Dressings should not get wet or be removed. After surgery, your doctor may prescribe pain relievers, typically for the initial four to seven days. Most people heal completely within one month of surgery, with few complications, if any. Crutches or a cane may be needed to help you keep weight off your affected foot, depending on the procedure. Occasionally, patients receive a special post-op shoe or a walking boot that is to be worn during the healing process. Most people are able to shower normally after surgery, but must protect the dressing from getting wet. Many patients are allowed to resume driving within one week after the procedure, but care needs to be taken.

Over-Pronation Of The Foot Treatments And Causes

Overview

Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion, and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body. When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.Over Pronation

Causes

Pronation can occur as an overuse syndrome in active runners, where a great deal of stress is placed on ligaments and tendons that support the medial column. Obesity is another predictor for pronation and deterioration of the medial ligaments and posterior tibial tendon due to excessive stress on these tissues. Acute Trauma can also lead to over-pronation when ligaments are torn or tendon is ruptured. Once again this can lead to a collapse of the medial column. Arthritic conditions involving the knee joint when the joint is in varus (inner collapse) posture, this places the center of gravity over the ankle joint rather than the foot causing undue pressure on the inner ankle.

Symptoms

Eventually, over-pronation can lead to a full list of maladies including flat feet, plantar fasciitis, plantar fibroma, neuromas, heel spurs, shin splints, ankle sprains, bunions, hammertoes, calluses, and pain in the arches, knee, hip and lower back. But it doesn?t have to go that far, because there are steps we can take to correct the over-pronation. In the vast majority of cases, we?ll prescribe custom foot orthotics, which will realign your ankles, redistribute the weight, support the arch and reduce the twisting. Many orthotics will fit snugly into your normal shoes. Although we?ll also take a look at the type of shoes you wear to see if they are contributing to the problem.

Diagnosis

You can test for pronation by looking at the leg and foot from the back. Normally you can see the Achilles Tendon run straight down the leg into the heel. If the foot is pronated, the tendon will run straight down the leg, but when it lies on the heel it will twist outward. This makes the inner ankle bone much more prominent than the outer ankle bone.Foot Pronation

Non Surgical Treatment

The following exercises help retrain the foot and ankle complex to correct overpronation. Exercises may be performed while wearing shoes, or for an even greater challenge, in bare feet. Duck Stand. This exercise is designed to prepare for the more dynamic BT exercises ahead by waking up the gluteal muscles and teaching clients how the gluteal muscles control the degree of foot pronation. For example, when the glutes contract concentrically, they rotate the leg outward. As the leg rotates outward, the arch of the foot raises (i.e., supinates). Stand beside the BT with both heels together and feet turned outward. (Note: As you progress, perform this exercise while standing on the BT.) Try to rotate legs outward by tightening buttock muscles while tilting pelvis under. As legs rotate outward, arches of the feet raise up out of pronation. Hold position for 30 seconds. Big Toe Pushdowns. This exercise is designed to strengthen the muscle of the big toe that holds up the arch of the foot (i.e., flexor hallucis longus muscle). This stops the foot from overpronating. Stand on top of the BT dome with feet facing forward. Use gluteal muscles to raise the arches of the feet (see previous exercise – “Duck Stand”). Keep arches raised while pushing down big toe into the BT. While pushing down, tension build in the arch on the underside of their foot should be felt. Hold position for 15 seconds.

Surgical Treatment

Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.

Severs Disease In Older People

Overview

It is important to know that foot pain is not only limited to grown-ups. Often active, healthy children will complain of pain in one or both heels shortly after walking, running, engaging or playing sports. The pain is usually felt at the back of, or under the heel. The cause of heel pain in children is usually a condition called calcaneal apophysitis or Sever’s Disease, normally reported by 8 to 14 year olds.

Causes

At birth, most of our foot bones are still made of cartilage, which ossifies (becomes bony) over the first few years of life. At the back of the heel, there is a growth plate that is attached to the main body of the heel bone by a cartilaginous join. At about the age of 14-15 years, this area of cartilage between the growth plate and the heel bone ossifies, fusing the area to the heel. Sever?s disease occurs when there is too much motion or strain across the growth plate, resulting in this area becoming inflamed and painful.

Symptoms

If your child is suffering from this disease they will be experiencing pain and tenderness in the back of their foot. This soreness can also extend to the sides of the feet. Other sure signs of this disorder include swelling and sensitivity to touch. Because of the amount of discomfort, your child may find it difficult to walk or run. Pay attention to the way your child is walking. If you notice unusual posture or abnormal gait they may be avoiding placing pressure on the heel. These symptoms typically become apparent during activity and exercise or directly following it. If your child is indicating pain in their heel, schedule an appointment with us today.

Diagnosis

Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a “squeeze test” and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.

Non Surgical Treatment

Occasionally, an orthotic may need to be prescribed for temporary or long-term correction of their foot biomechanics (eg flat feet or high arches). During the acute phase of Sever’s disease a small heel rise or shock-absorbing heel cup placed under the heel pad of your child’s foot may help to ease the symptoms. Your podiatrist or physiotherapist can assess your child’s arch and guide you in the best management of your child’s condition. We recommend that your child should never go barefooted during the painful stages of Sever’s disease.

Severs Disease In Older People

Overview

It is important to know that foot pain is not only limited to grown-ups. Often active, healthy children will complain of pain in one or both heels shortly after walking, running, engaging or playing sports. The pain is usually felt at the back of, or under the heel. The cause of heel pain in children is usually a condition called calcaneal apophysitis or Sever’s Disease, normally reported by 8 to 14 year olds.

Causes

At birth, most of our foot bones are still made of cartilage, which ossifies (becomes bony) over the first few years of life. At the back of the heel, there is a growth plate that is attached to the main body of the heel bone by a cartilaginous join. At about the age of 14-15 years, this area of cartilage between the growth plate and the heel bone ossifies, fusing the area to the heel. Sever?s disease occurs when there is too much motion or strain across the growth plate, resulting in this area becoming inflamed and painful.

Symptoms

If your child is suffering from this disease they will be experiencing pain and tenderness in the back of their foot. This soreness can also extend to the sides of the feet. Other sure signs of this disorder include swelling and sensitivity to touch. Because of the amount of discomfort, your child may find it difficult to walk or run. Pay attention to the way your child is walking. If you notice unusual posture or abnormal gait they may be avoiding placing pressure on the heel. These symptoms typically become apparent during activity and exercise or directly following it. If your child is indicating pain in their heel, schedule an appointment with us today.

Diagnosis

Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a “squeeze test” and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.

Non Surgical Treatment

Occasionally, an orthotic may need to be prescribed for temporary or long-term correction of their foot biomechanics (eg flat feet or high arches). During the acute phase of Sever’s disease a small heel rise or shock-absorbing heel cup placed under the heel pad of your child’s foot may help to ease the symptoms. Your podiatrist or physiotherapist can assess your child’s arch and guide you in the best management of your child’s condition. We recommend that your child should never go barefooted during the painful stages of Sever’s disease.

What Exactly Is It About Adult Aquired Flat Feet (AAF)

Overview

A more serious condition, according to ACFAS, is adult-acquired flatfoot, often cause by posterior tibial tendon dysfunction (PTTD). In this case, the tendon that supports the arch weakens and fails, leading to a rigid flatfoot where the arch stays flat even when you aren’t standing. It can lead to a loss of range of motion in the foot and ankle and pain in the arch. The ACFAS clinical guideline recommends that flatfoot caused by PTTD can be treated with custom shoe orthotics, soft casts, walking boots, physical therapy and non-steroidal anti-inflammatory medications. If there is no relief or the condition worsens, then the patient may be referred to surgery.Acquired Flat Feet


Causes

Adult flatfoot typically occurs very gradually. If often develops in an obese person who already has somewhat flat feet. As the person ages, the tendons and ligaments that support the foot begin to lose their strength and elasticity.


Symptoms

Symptoms shift around a bit, depending on what stage of PTTD you?re in. For instance, you?re likely to start off with tendonitis, or inflammation of the posterior tibial tendon. This will make the area around the inside of your ankle and possibly into your arch swollen, reddened, warm to the touch, and painful. Inflammation may actually last throughout the stages of PTTD. The ankle will also begin to roll towards the inside of the foot (pronate), your heel may tilt, and you may experience some pain in your leg (e.g. shin splints). As the condition progresses, the toes and foot begin to turn outward, so that when you look at your foot from the back (or have a friend look for you, because-hey-that can be kind of a difficult

maneuver to pull off) more toes than usual will be visible on the outside (i.e. the side with the pinky toe). At this stage, the foot?s still going to be flexible, although it will likely have flattened somewhat due to the lack of support from the posterior tibial tendon. You may also find it difficult to stand on your toes. Finally, you may reach a stage in which your feet are inflexibly flat. At this point, you may experience pain below your ankle on the outside of your foot, and you might even develop arthritis in the ankle.


Diagnosis

Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon, the tendon which is primarily responsible for supporting the arch structure of the foot.


Non surgical Treatment

Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support.

Acquired Flat Foot


Surgical Treatment

Surgical intervention for adult acquired flatfoot is appropriate when there is pain and swelling, and the patient notices that one foot looks different than the other because the arch is collapsing. As many as three in four adults with flat feet eventually need surgery, and it?s better to have the joint preservation procedure done before your arch totally collapses. In most cases, early and appropriate surgical treatment is successful in stabilizing the condition.

Achilles Tendonitis

Overview

Achilles TendonitisYou?re a prime candidate for acquiring Achilles Tendonitis if you?re a runner or some other kind of athlete requiring heavy use of your calves and their attached tendons. Then again, -anybody- can get tendonitis of the Achilles tendons. All for very predictable reasons. Perhaps you have Achilles Tendon pain from cycling. Or standing at work. Or walking around a lot. Anything we do on our feet uses our lower leg structures, and the Achilles tendon bears LOTS of torque, force, load, etc. The physical dynamic called Tendonitis can show up anywhere. On the Achilles Tendon is as good a place as any. Repetitive strain injury can show up anywhere in the body that there is repetitive strain. It’s an obvious statement, but worth paying attention to.

Causes

Tendinitis most often occurs when a tendon is over used. As the foot extends the Achilles tendon engages the calf muscles. The calf muscle generates force, which is transferred to the foot via this tendon. As this action repeats the tendon will endure large amounts of stress. An under-trained or inexperienced athlete is most likely to be affected by tendinitis since their body is not accustomed to the stress involved with athletics. Improper foot mechanics is another common cause of Achilles tendinitis. A properly functioning foot will distribute weight evenly across the foot. On the contrary, if the foot is experiencing improper mechanics, the weight of the body will not be evenly distributed. This can result in tendinitis, plantar fasciitis, calluses, bunions, neuromas and much more.

Symptoms

Signs and symptoms of Achilles Tendinitis generally include pain and stiffness along your achilles tendon, especially in the morning. Pain in the back of your heel that gets worse with activity. Severe pain the day after exercising. Swelling that gets worse with activity. If you feel a pop in the back of your heel or bottom of you calf, you may have ruptured or torn you achilles tendon.

Diagnosis

X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.

Nonsurgical Treatment

There is insufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate for the treatment of acute or chronic Achilles tendonitis. The patient should abstain from aggravating activities, but with a minimum of rest in order to preserve overall fitness. Possible treatments are non-steroidal anti-inflammatory drugs (NSAIDs), ice, rest, increased warm-up/stretching exercises, physiotherapy and heel lifts (orthotic devices – used on both sides to prevent a gait imbalance). Other treatments evaluated in a Cochrane review were heparin, steroid injections, glycosaminoglycan sulfate, Actovegin?, and topical laser treatment. There was no clear evidence of benefit from these. Casting is an option for resistant Achilles tendonitis. Drugs – analgesics and NSAIDs. Surgery is sometimes used for resistant Achilles tendonitis, but usually as a last resort. Other recently reported treatments include continuing sporting activity in conjunction with rehabilitation, low-energy shock wave therapy[4] and topical glyceryl trinitrate .

Achilles Tendinitis

Surgical Treatment

Not every Achilles tendon injury or condition requires surgery. It is generally understood by doctors and surgeons, that surgery will introduce more scar tissue into the Achilles tendon. This added scar tissue will be problematic, requiring physical therapy and conservative treatment options post-surgery. If not dealt with properly, your ankle and Achilles tendon could end up in worse condition than before the surgery! This is why surgery is only performed as a last resort.

Prevention

To lower your risk of Achilles tendonitis, stretch your calf muscles. Stretching at the beginning of each day will improve your agility and make you less prone to injury. You should also try to stretch both before and after workouts. To stretch your Achilles, stand with a straight leg, and lean forward as you keep your heel on the ground. If this is painful, be sure to check with a doctor. It is always a good idea to talk to your doctor before starting a new exercise routine. Whenever you begin a new fitness regimen, it is a good idea to set incremental goals. Gradually intensifying your physical activity is less likely to cause injury. Limiting sudden movements that jolt the heels and calves also helps to reduce the risk of Achilles tendonitis. Try combining both high- and low-impact exercises in your workouts to reduce stress on the tendon. For example, playing basketball can be combined with swimming. It doesn?t matter if you?re walking, running, or just hanging out. To decrease pressure on your calves and Achilles tendon, it?s important to always wear the right shoes. That means choosing shoes with proper cushioning and arch support. If you?ve worn a pair of shoes for a long time, consider replacing them or using arch supports. Some women feel pain in the Achilles tendon when switching from high heels to flats. Daily wearing of high heels can both tighten and shorten the Achilles tendon. Wearing flats causes additional bending in the foot. This can be painful for the high-heel wearer who is not accustomed to the resulting flexion. One effective strategy is to reduce the heel size of shoes gradually. This allows the tendon to slowly stretch and increase its range of motion.

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