What Causes Mortons Neuroma

Overview

Morton’s Neuroma is the most common neuroma in the foot. It occurs in the forefoot area (the ball of the foot) at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). A neuroma is a thickening, or enlargement, of the nerve as a result of compression or irritation of the nerve. Compression and irritation creates swelling of the nerve, which can eventually lead to permanent nerve damage.

Causes

There are orthoses and corrective shoes that can effectively alleviate disturbances to foot mechanics. A podiatric physician can prescribe the best corrective footwear and shoe inserts for all activities, work, exercise, play, walking, shopping and more, based on an analysis of the patient?s foot and his or her lifestyle. Improper footwear. Podiatric physicians have long believed that constricting, narrow, poor-fitting shoes with a tight or pointed toe box tend to compress the end of the foot, leading to abnormal motion of the foot and to excessive pressure in the area of the nerve. High-heeled shoes are a particular culprit here, since they put pressure on the area around wearer?s toes and the ball of the foot.

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

Patients with classic Morton?s neuroma symptoms will have pain with pressure at the base of the involved toes (either between the 2nd and 3rd toes, or between the 3rd and 4th toes). In addition, squeezing the front of the foot together can exacerbate symptoms. As well, they may have numbness on the sides of one toe and the adjacent toe, as this corresponds with the distribution of the involved nerve.

Non Surgical Treatment

In developing a treatment plan, your foot and ankle surgeon will first determine how long you?ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem. For mild to moderate neuromas, treatment options may include Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking. Placing an icepack on the affected area helps reduce swelling. Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves. Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Treatment may include injections of cortisone, local anesthetics or other agents.

Surgical Treatment

If pain persists with conservative care, surgery may be an appropriate option. The common digitial nerve is cut and the Mortons neuroma removed. This will result is numbness along the inside of the toes affected, and there is a small chance the end of the nerve will form a Stump Neuroma. Approximately 75% of people receive symptom resolution for Mortons Neuroma with conservative care.

Diagnosing Inferior Calcaneal Spur

Overview

Heel spurs usually form under the base of the foot or the back of the heel bone. Spurs that develop underneath the foot may visibly protrude through the skin. In addition, plantar fasciitis as well as heel spurs may eventually lead to chronic pain that persists for three or more months, especially if the sides and base of the heel bone have been affected. A large heel spur can affect movement and prevent an individual from walking or even standing properly. If a heel spur begins to protrude excessively, then surgery usually becomes necessary.

Causes

Everyone can be affected by heel spurs, however, certain groups of people have an increased risk. For example, Plantar Fasciitis is a common running injury. People who walk a lot are much more likely to have heel spurs or people who play golf or play tennis. Over-weight people are also more at risk for heel bone spurs as our feet are not designed to carry around extra weight. As a result the ligaments under the foot are placed under constant stress, which inevitably will lead to foot problems.

Symptoms

The spur itself is not painful, however, if it is sharp and pointed it can poke into soft tissue surrounding the spur itself. As the bone spur irritates the tissue, inflammation and bruising can occur leading to heel pain. Heel spurs can affect your ability to do your usual work and/or activities, and can also trap and irritate the nerves in your heel area. They can change the way you walk, and can lead to knee, hip and low back injuries. If severe, they may require medical intervention.

Diagnosis

The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.

Non Surgical Treatment

Rest your foot. Reduce the amount of weight-bearing activities you participate in. Get off of your feet and elevate them. This will allow healing to begin. Apply ice to your foot. Applications of ice packs that provide a comfortable cooling to the heel and arch (not a freezing cold) will help reduce pain, swelling, and inflammation. Apply the ice to the heel and arch (not the toes). Make sure it is comfortable, and leave on your foot for about 20 minutes, 3 times a day. If you have any medical problems such as diabetes, poor circulation, etc., discuss the use of ice with your doctor before applying the ice. Active Wrap allows you to apply comfortable cold therapy to your foot without messy ice cubes. Use while on the ?go.? Do not walk with bare feet. Always protect your heels, arches, and plantar fascia with good supportive shoes. Vionic Orthotic Flip Flops For Men and Women are designed for walking comfort with built in orthotic foot beds that help reduce foot pain from heel spurs. Use in the house or on the beach.

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

There are heel spur prevention methods available in order to prevent the formation of a heel spur. First, proper footwear is imperative. Old shoes or those that do not fit properly fail to absorb pressure and provide the necessary support. Shoes should provide ample cushioning through the heel and the ball of the foot, while also supporting the arch. Wearing an orthotic shoe insert is one of the best ways to stretch the plantar fascia and prevent conditions such as heel spurs. Stretching the foot and calf is also helpful in preventing damage. Athletes in particular should make sure to stretch prior to any physical activity. Stretching helps prevent heel spurs by making tissue stronger as well as more flexible. In addition, easing into a new or increasingly difficult routine should be done to help avoid strain on the heel and surrounding tissue.

Bursitis Of The Foot Treatment

Overview

Whenever tissues rub against one another, a bursa forms to allow for smooth gliding. A bursa is a fluid-filled sac and occurs normally throughout the body. Only a few cell layers thick, a bursa is filled with a lubricating fluid. However, when irritated, a bursa can become markedly thickened and painful. This is often referred to as bursitis. The retrocalcaneal bursa is positioned to allow the Achilles tendon to glide over the back part (posterior aspect) of the heel bone. When this bone becomes enlarged, inflammation of the retrocalcaneal bursa occurs. This inflammation results in exquisite tenderness along the posterior aspect of the heel.

Causes

Systemic diseases such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, pancreatitis, Whipple disease, oxalosis, uremia, hypertrophic pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome have also been associated with bursitis.

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

Careful examination by your physician or physiotherapist can determine if the inflammation is from the Achilles tendon or from the retrocalcaneal bursa. Tenderness due to insertional Achilles tendinitis is normally located slightly more distal where the tendon inserts into the back of the heel, whereas tenderness caused by the retrocalcaneal bursa is normally palpable at the sides of the distal Achilles tendon. Diagnosis can be confirmed with an ultrasound investigation, MRI or CT scan.

Non Surgical Treatment

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

Surgical Treatment

Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).

Prevention

You may be able to prevent bursitis from happening or coming back. Continue your home treatment with rest, ice, pain relievers, and gentle exercises. When you are ready to try the activity that caused the pain, start slowly and do it for short periods or at a slower speed. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. Use ice afterward to prevent pain and swelling. Change the way you do activities with repeated movements that may strain your muscles or joints. For example if using a certain tool has caused bursitis, start switching hands or change the grip size of your tool. If sitting for long periods has caused bursitis, get up and walk around every hour. If a certain sport is causing bursitis, consider taking lessons to learn proper techniques. Have an expert check your equipment to make sure it’s well suited to your size, strength, and ability. If certain activities at work may be causing bursitis, talk to your human resources department about other ways of doing your job, equipment changes, or other job assignments. Protect your joints from pressure. Cushion knees or elbows on hard surfaces, and wear shoes that fit you well and have good support.

How To Fix Hammer Toes Without Surgery

Overview

There are two main types of Hammer toe. Hammertoes can be flexible, which means that you can still move the toe a bit – these are easier to treat with stretching, wider shoes and in some cases, toe splints. Rigid hammertoes occur when the foot condition has persisted for so long without treatment that the tendons become too rigid to be stretched back to normal. Rigid hammertoes are more common in people with arthritis. This foot condition usually needs to be treated with surgery.

Causes

Flat feet can result in hammertoes, this is due to poor mechanics off the foot. High arched feet can also result in buckling toes. A major cause is in hereditary, all the toe conditions mentioned could be acquired due in hereditary factors. Bunions are a major cause of hammertoes. Claw toes are usually the result of a shoe that is too short. For many people, the second toe is actually longer than the great toe, and if shoes are sized to fit the great toe, the second (and maybe even the third toe) will have to bend to fit into the shoe. Shoes that are pointed make matters even worse. Combine pointed shoes with high heels, the foot is under similar pressure as if it was constantly being pushed downhill into a wall. Rheumatoid arthritis can also lead to bunions, which in turn can lead to hammer toes.

Symptoms

Hammer toe is often distinguished by a toe stuck in an upside-down ?V? position, and common symptoms include corns on the top of your toe joint. Pain at the top of a bent toe when you put on your shoes. Pain when moving a toe joint. Pain on the ball of your foot under the bent toe. Corns developing on the top of the toe joint. It is advisable to seek medical advice if your feet hurt on a regular basis. It is imperative to act fast and seek the care of a podiatrist or foot surgeon. By acting quickly, you can prevent your problem from getting worse.

Diagnosis

The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.

Non Surgical Treatment

The treatment options vary with the type and severity of each hammertoe, although identifying hammertoe the deformity early in its development is important to avoid surgery. Podiatric medical attention should be sought at the first indication of pain and discomfort because, if left untreated, hammertoes tend to become rigid, making a nonsurgical treatment less of an option. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Surgical Treatment

The technique the surgeon applies during the surgery depends on how much flexibility the person’s affected toes still retain. If some flexibility has still been preserved in their affected toes, the hammer toes might be corrected through making a small incision into the toe so the surgeon can manipulate the tendon that is forcing the person’s toes into a curved position. If, however, the person’s toes have become completely rigid, the surgeon might have to do more than re-aligning the person’s tendons. Some pieces of bone may have to be removed so the person’s toe has the ability to straighten out. If this is the case, some pins are attached onto the person’s foot afterwards to fix their bones into place while the injured tissue heals. Following the surgical procedure, the person might have to deal with some stiffness and swelling as they pursue their recovery process. The person should also expect the toes that have been corrected to appear different following the surgery. For example; the person’s toes may appear longer or shorter than they were before. The person will be advised not to pursue too much physical activity that involves their feet for some time to give their injury from surgery enough time to heal properly.

Prevention

Few people realize that their feet grow over the years: actually, the heel stays the same, but the front of the foot becomes wider and longer. The result, most women wear shoes that fit at the heel but are much too narrow in the front. Buy shoes that fit the longer foot. For two out of three people, one foot is significantly bigger than the other. Have both feet measured whenever you buy shoes. Have your feet measured while you’re standing, and buy shoes that fit the larger foot. Shop at the end of the day, when foot swelling is greatest. No shoe should feel tight. Don’t go by numbers. You may think of yourself as a size 8B, but size varies from shoe to shoe. There is no standardization, so pick the shoes that fit best. Limit high-heel use. These shoes increase pressure on the front of the foot by at least 50 percent, so wear them only for special occasions. Flat shoes are more comfortable than high heels, but they, too, can be hard on your feet, especially if they are thin-soled. Change your shoes. If your shoes are too short or too narrow, get another pair. This is especially important for children going through periods of rapid growth. The toe area should be high enough so that it doesn’t rub against the top of your toes-especially if hammer toes have started to develop.

Hammertoe Treatment Options

Overview

There are two different types of Hammer toe. Flexible Hammer Toes. These hammer toes are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammer toes because they are still moveable at the joint. Rigid Hammer Toes. This variety is more developed and more serious than the flexible condition. Rigid hammer toes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammer toe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.

Causes

Hammer toe is often caused by wearing shoes that do not fit properly. If shoes are too small either in length or width, then the toes are held in a shortened position for long periods and the muscles eventually shorten and pull the toes into the bent position. Alternatively it can be caused by overactivity in the extensor digitorum dongus muscle (right) and a weakness in the counteracting muscle under the foot, such as flexor digitorum longus. Sometimes it can be a congenital condition, meaning it is present from birth. It is also more common in those with arthritis in the foot or diabetes.

Symptoms

Here is a look at some of the symptoms hammertoe can cause. They include hammer-like or claw-like appearance of the toe. Pain when walking or moving the foot. Difficulty moving the toe. Corns may form on top of the toe. Callus may form on the sole of the foot. During the initial stages, you may be able to manually straighten your toe. This is called a flexible hammertoe. But as time passes, the toe will not move as easily and will continue to look like a hammer. Pressure and irritation over the joint can cause a blister to develop and become a corn over time. These corns have the potential to become infected and cause additional symptoms such as redness, bleeding, and difficulty wearing shoes and socks. Corns are the main cause of pain when hammertoes are developing.

Diagnosis

First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.

Non Surgical Treatment

Pad it. Mild cases of hammertoe can be treated with corn pads or felt pads available in the pharmacy. Toe caps, the small, padded sleeves that fit Hammer toe around the tip of the toe, may relieve hammer toe pain. Change your shoes. Wear wide shoes with resilient soles. Avoid shoes with pointed toes. Exercise. Certain exercises such as moving and stretching your toe gently with your hands and picking small or soft objects such as marbles or towels can keep your toe joints flexible. Also, while you are watching television or reading, you can also put a towel flat under your feet and use your toes to crumple it. This simple exercise can stretch and strengthen your muscles. Use ice. If your hammer toe becomes painful, applying an ice pack several times a day can help relieve the soreness and swelling.

Take medications. Nonsteroidal anti-inflammatory medicines (also called NSAIDs), such as ibuprofen or naproxen may be helpful in minimizing pain and inflammation. Use orthotic devices. Place a custom orthotic device in your shoe. This will help control the muscle/tendon imbalance.

Surgical Treatment

Hammertoe surgery is performed when conservative measures have been exhausted and pain or deformity still persists. The surgery is performed on an outpatient basis. It typically required about one hour of time. An incision is placed over the inter-phalangeal joint. Once the bone is exposed, the end portion of the bone is removed. Your surgeon may then use pins or other fixation devices to assist in straightening the toe. These devices may be removed at a later date if necessary. Recovery for hammertoe surgery is approximately 10 to 14 days. You are able to walk immediately following the surgery in a surgical shoe. Swelling may be present but is managed as needed. Physical therapy is used to help reduce swelling in the toe or toes after surgery. Most of these toe surgeries can be performed in the office or the outpatient surgery under local anesthesia.

What Actually Causes Feet To Over Pronate

Overview

Pronation occurs at the joint below the ankle, the subtalar joint. It describes the inward rolling motion of the foot just after it lands on the ground. This moment is called initial contact, which is part of the stance phase of the gait cycle. Urthotic Insoles are designed today specifically for different pronation patterns. When you pick your next pair of insoles, your pronation type is a very important factor in your choice.

Causes

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

Symptoms

Overpronation 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

If you have flat feet or low arches, chances are you overpronate. Although not always the case, the lower your arches the greater the overpronate. Stand on a hard surface (in front of a mirror if you need to) and look at your feet, flat feet or low arches are easy to spot. If your feet look flatter than a pancake, have a look at your ankles and see if they seem collapsed or straight. If they are, you’re overpronating.

Non Surgical Treatment

Fortunately, there are simple things you can do to cure and correct your overpronation issues. Certain exercises help. Pull your toes back using a rolled up towel. Roll your feet over a golf or tennis ball for a minute. And do calf raises by standing up and lifting up on your toes. These all help reposition the foot and strengthen the muscles and tendons necessary for proper support. Beyond that, simple adjustments to footwear will help immensely.

Prevention

Massage and stretch the calves to increase dorsiflexion at the foot/ankle. Dorsiflexion is the bending at the ankle. By improving the dorsiflexion, one will have more flexibility at the ankle, which will allow the foot to over-pronate less. Massage the IT Band with a foam roller or tennis ball to quiet down the tightness throughout this part of the leg. The IT Band attaches from the glute maximus and runs down the side of the leg into the knee area. When the IT Band is tight it will accelerate the force of the leg moving inward, which will cause the foot to move inward as well. It is often that tightness through the IT Band that promotes over-pronation. Decreasing over-pronation, which is very prominent in runners, will help add endurance, speed and efficiency to your run and ultimately place less stress on your body.

Tips On How To Spot Calcaneal Apophysitis?

Overview

Sever’s disease is a common cause of heel pain in active children. Sever’s disease, also called calcaneal apophysitis, occurs when the growth plate of the heel is injured by excessive forces during early adolescence.

Causes

The usual cause is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season, or too much weight bearing on the heel. Also, excessive traction could cause this, since the bones and tendons are still developing. Many children who over pronate their feet exhibit symptoms and in most patients, it usually involves both heels.

Symptoms

Sever’s Disease is most commonly seen in physically active girls and boys from ages 10 to 15 years old. These are the years when the growth plate is still “”open,”” and has not fused into mature bone. Also, these are the years when the growth plate is most vulnerable to overuse injuries, which are usually caused by sports activities. The most common symptoms of this disease include. Heel pain in one or both heels. Usually seen in physically active children, especially at the beginning of a new sports season. The pain is usually experienced at the back of the heel, and includes the following areas. The back of the heel (that area which rubs against the back of the shoe). The sides of the heel. Actually, this is one of the diagnostic tests for Sever’s Disease, squeezing the rear portion of the heel from both sides at the same time will produce pain. It is known as the Squeeze Test.

Diagnosis

To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.

Non Surgical Treatment

Treatment depends on the severity of the condition, but may include relative rest and modified activity, a physiotherapist can help work out what, and how much, activity to undertake. Cold packs, apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking. Shoe inserts, small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term. Medication, pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor). Anti-inflammatory creams are also an effective management tool. Splinting or casting, in severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare. Time, generally the pain will ease in one to two weeks, although there may be flare-ups from time to time. Correction of any biomechanical issues, a physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition. Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Prevention

Prevention consists of maintaining good flexibility through stretching exercises, avoid excessive running on hard surfaces, and use quality, well-fitting shoes with firm support and a shock-absorbent sole.

Adult Aquired Flat Foot

Overview

PTTD is most commonly seen in adults and referred to as “adult acquired flatfoot“. Symptoms include pain and swelling along the inside arch and ankle, loss of the arch height and an outward sway of the foot. If not treated early, the condition progresses to increased flattening of the arch, increased inward roll of the ankle and deterioration of the posterior tibial tendon. Often, with end stage complications, severe arthritis may develop. How does all this happen? In the majority of cases, it is overuse of the posterior tibial tendon that causes PTTD. And it is your inherited foot type that may cause a higher possibility that you will develop this condition.

Causes

There are numerous causes of acquired adult flatfoot, including fracture or dislocation, tendon laceration, tarsal coalition, arthritis, neuroarthropathy, neurologic weakness, and iatrogenic causes. The most common cause of acquired adult flatfoot is posterior tibial tendon dysfunction.

Symptoms

The first stage represents inflammation and symptoms originating from an irritated posterior tibial tendon, which is still functional. Stage two is characterized by a change in the alignment of the foot noted on observation while standing (see above photos). The deformity is supple meaning the foot is freely movable and a ?normal? position can be restored by the examiner. Stage two is also associated with the inability to perform a single-leg heel rise. The third stage is dysfunction of the posterior tibial tendon is a flatfoot deformity that becomes stiff because of arthritis. Prolonged deformity causes irritation to the involved joints resulting in arthritis. The fourth phase is a flatfoot deformity either supple (stage two) or stiff (stage 3) with involvement of the ankle joint. This occurs when the deltoid ligament, the major supporting structure on the inside of the ankle, fails to provide support. The ankle becomes unstable and will demonstrate a tilted appearance on X-ray. Failure of the deltoid ligament results from an inward displacement of the weight bearing forces. When prolonged, this change can lead to ankle arthritis. The vast majority of patients with acquired adult flatfoot deformity are stage 2 by the time they seek treatment from a physician.

Diagnosis

Diagnostic testing is often used to diagnose the condition and help determine the stage of the disease. The most common test done in the office setting are weightbearing X-rays of the foot and ankle. These assess joint alignment and osteoarthritis. If tendon tearing or rupture is suspected, the gold standard test would be MRI. The MRI is used to check the tendon, surrounding ligament structures and the midfoot and hindfoot joints. An MRI is essential if surgery is being considered.

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.

Surgical Treatment

Surgery should only be done if the pain does not get better after a few months of conservative treatment. The type of surgery depends on the stage of the PTTD disease. It it also dictated by where tendonitis is located and how much the tendon is damaged. Surgical reconstruction can be extremely complex. Some of the common surgeries include. Tenosynovectomy, removing the inflamed tendon sheath around the PTT. Tendon Transfer, to augment the function of the diseased posterior tibial tendon with a neighbouring tendon. Calcaneo-osteotomy, sometimes the heel bone needs to be corrected to get a better heel bone alignment. Fusion of the Joints, if osteoarthritis of the foot has set in, fusion of the joints may be necessary.

Dealing With Achilles Tendonitis

Overview

A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon. Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts. Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.

Causes

The cause of paratenonitis is not well understood although there is a correlation with a recent increase in the intensity of running or jumping workouts. It can be associated with repetitive activities which overload the tendon structure, postural problems such as flatfoot or high-arched foot, or footwear and training issues such as running on uneven or excessively hard ground or running on slanted surfaces. Tendinosis is also associated with the aging process.

Symptoms

Symptoms of Achilles Tendinitis include the following. Pain and stiffness along the Achilles tendon in the morning. Pain along the tendon or back of the heel that worsens with activity. Severe pain the day after exercising. Thickening of the tendon. Bone spur (insertional tendinitis). Swelling that is present all the time and gets worse throughout the day with activity. If you have an Achilles tendon rupture, you might feel a pop or snap, accompanied by a sharp pain behind your ankle. You are likely to have difficulty walking properly. If you have ruptured your Achilles tendon then surgery is likely to be the best treatment option.

Diagnosis

A doctor or professional therapist will confirm a diagnosis, identify and correct possible causes, apply treatment and prescribe eccentric rehabilitation exercises. An MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis. Gait analysis along with a physical assessment will identify any possible biomechanical factors such as over pronation which may have contributed to the achilles tendonitis and training methods will be considered. Biomechanical problems can be corrected with the use of orthotic inserts and selection of correct footwear.

Nonsurgical Treatment

With proper care for the area, the pain in the tendon should lessen over three weeks, but it should be noted that the healing of the area continues and doesn’t even peak until at least six weeks following the initial injury. This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together. Scar tissue will continue to form past six weeks in some cases and as long as a year in severe cases. After 6 months this condition is considered chronic and much more difficult to treat. The initial approach to treating Achilles tendonitis is to support and protect the tendons by bracing any areas of the tendon that are being pulled on during use. It is important to loosen up the tendon, lessen the pain, and minimize any inflammation.

Surgical Treatment

Surgery is considered the last resort. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.

Prevention

While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you’re just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don’t support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.

What Is Pain Of The Heel And Ways To Treat It

Overview

Plantar fasciitis, the heel pain caused by irritation of the connective tissue on the bottom of the foot, can be lingering and intractable. A recent study of novice runners found that those who developed plantar fasciitis generally required at least five months to recover, and some remained sidelined for a year or more. Until recently, first-line treatments involved stretching and anti-inflammatory painkillers such as ibuprofen or cortisone. But many scientists now believe that anti-inflammatories are unwarranted, because the condition involves little inflammation. Stretching is still commonly recommended.

Causes

Plantar fasciitis is one of those injuries that magically seems to appear for no apparent reason. However, plantar fasciitis is caused by one of two methods. They are either traction or compression injuries. Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles. It is also commonly diagnosed in individuals with poor foot biomechanics that stress the plantar fascia. Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis.

Symptoms

Plantar fasciitis generally occurs in one foot. Bilateral plantar fasciitis is unusual and tends to be the result of a systemic arthritic condition that is exceptionally rare among athletes. Males suffer from a somewhat greater incidence of plantar fasciitis than females, perhaps as a result of greater weight coupled with greater speed and ground impact, as well as less flexibility in the foot. Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.

Diagnosis

If you see a doctor for heel pain, he or she will first ask questions about where you feel the pain. If plantar fasciitis is suspected, the doctor will ask about what activities you’ve been doing that might be putting you at risk. The doctor will also examine your foot by pressing on it or asking you to flex it to see if that makes the pain worse. If something else might be causing the pain, like a heel spur or a bone fracture, the doctor may order an X-ray to take a look at the bones of your feet. In rare cases, if heel pain doesn’t respond to regular treatments, the doctor also might order an MRI scan of your foot. The good news about plantar fasciitis is that it usually goes away after a few months if you do a few simple things like stretching exercises and cutting back on activities that might have caused the problem. Taking over-the-counter medicines can help with pain. It’s rare that people need surgery for plantar fasciitis. Doctors only do surgery as a last resort if nothing else eases the pain.

Non Surgical Treatment

Treatment for plantar fasciitis includes medication, physical therapy, shock wave therapy, or surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are used to treat the inflammation and pain of plantar fasciitis, but they won’t cure the condition. Corticosteroids can also be used to ease pain and reduce inflammation. Corticosteroids are applied either as a topical solution in conjunction with a non-painful electric current or through injections to the affected area.

Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.