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Unusual Feelings

Journal On Every Little Thing

What Is Pes Planus?

July 4, 2017
Overview

Acquired Flat Feet

Because young children are unlikely to suspect or identify flat feet on their own, it is a good idea for parents or other adult caregivers to check on this themselves. Besides visual inspection, parents should notice whether a child begins to walk oddly or clumsily, for example on the outer edges of the feet, or to limp, during long walks, and to ask the child whether he or she feels foot pain or fatigue during such walks. Children who complain about calf muscle pains or any other pains around the foot area, may be developing or have flat feet. Pain or discomfort may also develop in the knee joints. A recent randomized controlled trial found no evidence for the efficacy of treatment of flat feet in children either for expensive prescribed orthoses (shoe inserts) or less expensive over-the-counter orthoses.

Causes

Over-pronation is a common biomechanical problem that occurs when the arches collapse while walking or standing. This condition hampers our natural walking pattern, causing an imbalance, and leading to wear and tear in other parts of the body with every step we take. Whether you suffer from over-pronation like most of the population, or you have a true flat foot, in both cases your poor walking pattern may contribute to a range of different complaints. As we age, poor aligment of the feet causes very common conditions such as heel pain or knee pain. Over-pronation has different causes. Obesity, pregnancy, age or repetitive pounding on a hard surface can weaken the arch, leading to over-pronation. Over-pronation is also very common with athletes, especially runners, who most of them nowadays use orthotics inside their shoes.

Symptoms

Arches can be seen as ?rolling downward? or collapsing when walking. Pain may present in lower back, hips or knees. Pain may be present on the bottom of the heels, within the arch, within the ankles or even the forefoot. Swelling can occur. Pain may occur in the anterior leg muscles.

Diagnosis

Podiatrists are trained in expertly assessing flat feet and identifying different risk factors and the causes for it. Initial assessment will begin with a detailed history attempting to find out if any underlying illness has resulted in this. A detailed clinical examination normally follows. The patient may be asked to perform certain movements such as walking or standing on their toes to assess the function of the foot. Footwear will also be analysed to see if there has been excessive wear or if they are contributing to the pronation of the foot. To assess the structure of the foot further, the podiatrist may perform certain x-rays to get a detailed idea of the way the bones are arranged and how the muscle tissues may be affecting them. It also helps assess any potential birth defects in a bit more detail.

fallen arches exercises

Non Surgical Treatment

The type of treatment will depend on the stage of PTTD present. There are four stages of posterior tibial tendon dysfunction. Stage I. The posterior tibial tendon is inflamed but has normal strength. There is little to no change in the arch of the foot. The patient can still perform a single-limb heel rise and has a flexible hindfoot. Orthotic treatment options include modified off the shelf inserts and custom molded orthotics. Stage 2. The tendon is partially torn or shows degenerative changes and as a result loses strength.There is considerable flattening of the arch without arthritic changes in the foot. The patient cannot perform single-limb heel rise. Pain is now present on the lateral aspect of the ankle. Orthotic treatment is similar as that in stage I, with the addition of more rigid arch supports and wedging. Stage 3. Results when the posterior tibial tendon is torn and not functioning. As a result the arch is completely collapsed with arthritic changes in the foot. A solid ankle AFO is suggested in conjunction with a modified orthopedic shoe. Stage 4. Is identical to stage three except that the ankle joint also becomes arthritic. A rigid AFO and modified orthopedic shoe is required.

Surgical Treatment

Acquired Flat Feet

Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.

Leg Length Discrepancy Symptoms Cycling

June 30, 2017
Overview

Surgical lengthening of the shorter extremity (upper or lower) is another treatment option. The bone is lengthened by surgically applying an external fixator to the extremity in the operating room. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins or both. A small crack is made in the bone and tension is created by the frame when it is "distracted" by the patient or family member who turns an affixed dial several times daily. The lengthening process begins approximately five to ten days after surgery. The bone may lengthen one millimeter per day, or approximately one inch per month. Lengthening may be slower in adults overall and in a bone that has been previously injured or undergone prior surgery. Bones in patients with potential blood vessel abnormalities (i.e., cigarette smokers) may also lengthen more slowly. The external fixator is worn until the bone is strong enough to support the patient safely, approximately three months per inch of lengthening. This may vary, however, due to factors such as age, health, smoking, participation in rehabilitation, etc. Risks of this procedure include infection at the site of wires and pins, stiffness of the adjacent joints and slight over or under correction of the bone?s length. Lengthening requires regular follow up visits to the physician?s office, meticulous hygiene of the pins and wires, diligent adjustment of the frame several times daily and rehabilitation as prescribed by your physician.Leg Length Discrepancy

Causes

A number of causes may lead to leg length discrepancy in children. Differences in leg length frequently follow fractures in the lower extremities in children due to over or under stimulation of the growth plates in the broken leg. Leg length discrepancy may also be caused by a congenital abnormality associated with a condition called hemihypertrophy. Or it may result from neuromuscular diseases such as polio and cerebral palsy. Many times, no cause can be identified. A small leg length discrepancy of a quarter of an inch or less is quite common in the general population and of no clinical significance. Larger leg length discrepancies become more significant. The long-term consequences of a short leg may include knee pain, back pain, and abnormal gait or limp.

Symptoms

Many people walk around with LLD?s of up to 2 cm. and not even know it. However, discrepancies above 2 cm. becomes more noticeable, and a slight limp is present. But even up to 3 cm. a small lift compensates very well, and many patients are quite happy with this arrangement. Beyond 3 cm. however, the limp is quite pronounced, and medical care is often sought at that point. Walking with a short leg gait is not only unsightly, but increases energy expenditure during ambulation. It could also put more stress on the long leg, and causes functional scoliosis. Where the discrepancy is more severe, walking becomes grotesque or virtually impossible.

Diagnosis

The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.

Non Surgical Treatment

The non-surgical intervention is mainly usedfor the functional and environmental types of leg length discrepancies. It is also applied to the mild category of limb length inequality. Non-surgical intervention consists of stretching the muscles of the lower extremity. This is individually different, whereby the M. Tensor Fascia latae, the adductors, the hamstring muscles, M. piriformis and M. Iliopsoas are stretched. In this non-surgical intervention belongs also the use of shoe lifts. These shoe lifts consists of either a shoe insert (up to 10-20mm of correction), or building up the sole of the shoe on the shorter leg (up to 30-60mm of correction). This lift therapy should be implemented gradually in small increments. Several studies have examined the treatment of low back pain patients with LLD with shoe lifts. Gofton obtained good results: the patients experienced major or complete pain relief that lasted upon follow-up ranging from 3 to 11 years. Helliwell also observed patients whereby 44% experienced complete pain relief, and 45% had moderate or substantial pain relief. Friberg found that 157 (of 211) patients with LBP, treated with shoe lifts, were symprom-free after a mean follow-up of 18 months.

LLL Shoe Insoles

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Surgical Treatment

Surgical options in leg length discrepancy treatment include procedures to lengthen the shorter leg, or shorten the longer leg. Your child's physician will choose the safest and most effective method based on the aforementioned factors. No matter the surgical procedure performed, physical therapy will be required after surgery in order to stretch muscles and help support the flexibility of the surrounding joints. Surgical shortening is safer than surgical lengthening and has fewer complications. Surgical procedures to shorten one leg include removing part of a bone, called a bone resection. They can also include epiphysiodesis or epiphyseal stapling, where the growth plate in a bone is tethered or stapled. This slows the rate of growth in the surgical leg.

Coping with Mortons Neuroma

June 4, 2017
Overview

MortonMorton neuromas are focal areas of symptomatic perineural fibrosis around a plantar digital nerve of the foot. The abnormality is non-neoplastic and does not represent a true neuroma. It may more correctly be known as Morton?s metatarsalgia. The condition is thought to be due to chronic entrapment of the nerve by the intermetatarsal ligament. It most often occurs in middle-aged individuals and is many times more common in women than men. Approximately 30% of asymptomatic middle-aged persons have the radiological pathologic findings of a Morton?s neuroma.

Causes

Some experts believe that other foot conditions may also be associated with Morton's neuroma. This is because other conditions may cause the metatarsal bones to rub against the nerve in your foot. Foot problems that may increase your risk of developing Morton's neuroma include abnormally positioned toes, high arches, where the arch or instep of your foot is raised more than normal, flat feet, low arches or no arches at all, bunions a bony swelling at the base of the toe. Hammer toe, where the toe is bent at the middle joint. Being active and playing sport can make the painful symptoms of Morton's neuroma worse. In particular, running or sports that involve running, such as racquet sports, can place extra pressure on the nerve in your foot, which can aggravate the problem.

Symptoms

Episodes of pain are intermittent. Patients may experience 2 attacks in a week and then none for a year. Recurrences are variable and tend to become more frequent. Between attacks, no symptoms or physical signs occur. Two neuromas coexist on the same foot about 2-3% of the time. Other diagnoses should be considered when 2 or more areas of tenderness are present.

Diagnosis

Your podiatric physician will begin by taking a history of your problem. Assist him or her by describing your condition as well as you can. Keep track of when the symptoms started and how, any changes you?ve noted (whether the pain has gotten worse, or whether other symptoms have appeared as well, etc.). If you?ve noticed that certain activities or footwear make things worse or bring about additional symptoms, be sure to mention that. If you work in specific footwear, or if you participate in any certain sports, bring the shoes you use. Your doctor may be able to learn quite a lot about your condition that way!

Non Surgical Treatment

Conservative treatment involves a reduction in the inflammation and removing the impingement factor. Reduction in inflammation is achieved via rest, elevation, ice, and massage with anti-inflammatory gels. Removing foot wear and and/r wearing broad type footwear would also help. Injection therapy is useful in reducing symptoms but not very successful in providing long term relief. The only time when it is most appropriate is when the cause of the space occupying object is not a neuroma but an inflamed bursa. Injection would help to relieve symptoms, and often cortisone is not even necessary.Morton neuroma

Surgical Treatment

When conservative measures are unsuccessful, surgery can be a good choice in the treatment of Morton's neuroma. The operation for Morton's neuroma does not require an overnight hospital stay. The anesthetic used is an ankle block, which completely numbs the foot during the surgery. The physician removes the neuroma from an incision made on the top of the foot between the involved metatarsal heads. The nerve to the interspace is exposed and cut next to the metatarsal heads.

What Causes Heel Spur

September 29, 2015
Inferior Calcaneal 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

Heel spurs develop as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia pulls away from the heel. This stretching of the plantar fascia is usually the result of over-pronation (flat feet), 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.

Posterior Calcaneal Spur

Symptoms

An individual with the lower legs turning inward, a condition called genu valgus or "knock knees," can have a tendency toward excessive pronation. This can lead to a fallen arch and problems with the plantar fascia and heel spurs. Women tend to suffer from this condition more than men. Heel spurs can also result from an abnormally high arch. Other factors leading to heel spurs include a sudden increase in daily activities, an increase in weight, or a thinner cushion on the bottom of the heel due to old age. A significant increase in training intensity or duration may cause inflammation of the plantar fascia. High-heeled shoes, improperly fitted shoes, and shoes that are too flexible in the middle of the arch or bend before the toe joints will cause problems with the plantar fascia and possibly lead to heel spurs.

Diagnosis

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

Non Surgical Treatment

Ice and use arch support . If you can localize the spur, cut a hole in a pad of felt and lay the hole over the spur. This supports the area around the spur and reduces pressure on it. Massage the spur. Start gently with your thumb and gradually increase the pressure until you?re pushing hard directly on the spur with your knuckle or another firm object. Even it if hurts, it should help. Arch support. Build up an arch support system in your shoes. Try to equalize the pressure of your body weight throughout your arch and away from the plantar area. Use a ?cobra pad? or other device that supports the arch but releases pressure on the painful area. If homemade supports do not work, see a podiatrist about custom orthotics.

Surgical Treatment

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

The Diagnosis Of Calcaneal Spur

September 28, 2015
Calcaneal Spur

Overview

A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome." Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Causes

A strong band of sinew (plantar fascia) stretches across the sole of the foot below the surface of the skin and is attached to a point in the middle of the under surface of the heel bone. With repeated activity on our feet, the plantar fascia can become tight and cause persistent traction (tugging) on its attachment point into the heel bone, and inflammation and pain may develop at this site. This painful condition is known as plantar fasciitis. Sometimes a ?spur? develops at the site of this traction on the bone and protrudes into the surrounding tissue. This is a heel spur.

Heel Spur

Symptoms

Heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain. Your heel pain may be worse in the morning when you first wake up or during certain activities.

Diagnosis

A thorough history and physical exam 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

Initially, treatment usually consists of a combination of ice therapy, stretching exercises to improve flexibility (especially in the mornings), anti-inflammatory medications, and physical therapy. Most patients will also need custom-molded orthotics to help control the motion in the foot and arch, which takes the strain off the plantar fascia. If the pain continues, a cortisone injection may be used to calm the severe swelling and pain. There may the need for a night splint to maintain a stretch in the plantar fascia throughout the night.

Surgical Treatment

Heel spur surgery should only be considered after less invasive treatment methods have been explored and ruled insufficient. The traditional surgical approach to treating heel spurs requires a scalpel cut to the bottom of the food which allows the surgeon to access the bone spur. Endoscopic plantar fasciotomies (EPF) involve one or two small incisions in the foot which allow the surgeon to access and operate on the bone spur endoscopically. Taking a surgical approach to heel spur treatment is a topic to explore with a foot and ankle specialist.

Do I Have Posterior Calcaneal Spur

September 26, 2015
Posterior Calcaneal Spur

Overview

Heel spurs are new bone that forms in response to stress to the heel. They serve to protect the bone against the development of microfractures. Spurs start out as cartilage and progress to solid bone. They are present in about 50 percent of the population, yet not everyone has heel pain- that's the first clue that heel spurs don't always cause heel pain.

Causes

A heel spur is caused by chronic plantar fasciitis. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis. When plantar fasciitis healing is delayed or injury persists, your body repairs the weak and injured soft tissue with bone. Usually your injured fascia will be healed via fibroblastic activity. They'll operate for at least six weeks. If your injury persists beyond this time, osteoblasts are recruited to the area. Osteoblasts form bone and the end result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs. This scenario is most common in the traction type injury. The additional bone growth is known as a heel spur or calcaneal spur.

Calcaneal Spur

Symptoms

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

Diagnosis

Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products such as Advil or Ibuprofin are helpful in eradicating the pain. Pain creams, such as Neuro-eze, BioFreeze & Boswella Cream can help to relieve pain and help increase circulation.

Non Surgical Treatment

In some cases, heel spur pain may not be resolved through conservative treatment options. In those cases, cortisone injections may be used to reduce inflammation associated with the condition, helping to reduce discomfort. However, treatment options such as these must be discussed in detail with your physician, since more serious forms of treatment could yield negative side effects, such as atrophy of the heel's fat pad, or the rupture of the plantar fascia ligament. Although such side effects are rare, they are potential problems that could deliver added heel pain.

Surgical Treatment

Surgery involves releasing a part of the plantar fascia from its insertion in the heel bone, as well as removing the spur. Many times during the procedure, pinched nerves (neuromas), adding to the pain, are found and removed. Often, an inflamed sac of fluid call an accessory or adventitious bursa is found under the heel spur, and it is removed as well. Postoperative recovery is usually a slipper cast and minimal weight bearing for a period of 3-4 weeks. On some occasions, a removable short-leg walking boot is used or a below knee cast applied.

Ways To Protect Against Heel Spur

September 26, 2015
Heel Spur

Overview

Heel spurs are a condition that usually makes its presence known first thing in the morning via heel pain. Discomfort is typically felt in the front and bottom of the heel (calcaneal). Pain can be constant for several months or intermittent for lengthy periods of time.

Causes

Bone spurs can occur all over the body including the spine, shoulders, hands, hips and feet. The feet are a common place to find them. A heel spur happens when the body tries to mend itself. Building extra bone is one way your body tries to correct a weakness. Wearing shoes that are too tight in the heel can cause bone spurs. More women than men get heel spurs because of the kinds of shoes they wear. Athletes who stress their feet and legs routinely are also prone to heel spurs. Being overweight can also indirectly cause heel spurs by over-exerting the plantar fascia. Some heel spurs are caused by the aging process, in which the cartilage covering the ends of bones wears away. This process can lead to pain, swelling and spur formation. Stress-related problems with the plantar fascia frequently lead to heel spurs.

Heel Spur

Symptoms

Symptoms may be similar to those of plantar fasciitis and include pain and tenderness at the base of the heel, pain on weight bearing and in severe cases difficulty walking. The main diagnosis of a heel spur is made by X-ray where a bony growth on the heel can be seen. A heel spur can occur without any symptoms at all and the athlete would never know they have the bony growth on the heel. Likewise, Plantar fasciitis can occur without the bone growth present.

Diagnosis

Sharp pain localized to the heel may be all a doctor needs to understand in order to diagnose the presence of heel spurs. However, you may also be sent to a radiologist for X-rays to confirm the presence of heel spurs.

Non Surgical Treatment

Heel spurs can be solved with simple solutions that do not involve surgery. Avoiding extended periods of activity such as running, sports and walking. Applying ice directly to the heel for 5 minutes at a time. This helps soothe and reduce inflammation. Lose weight to reduce stress on your heels. A series of simple exercises. Inexpensive orthotic shoe inserts. The best way to treat heel spurs is by treating the underlying cause of the problem. This involves correcting the dynamics of your foot motion with orthotic insoles.

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

You can prevent heel spurs by wearing well-fitting shoes with shock-absorbent soles, rigid shanks, and supportive heel counters; choosing appropriate shoes for each physical activity; warming up and doing stretching exercises before each activity; and pacing yourself during the activities. Avoid wearing shoes with excessive wear on the heels and soles. If you are overweight, losing weight may also help prevent heel spurs.

Bursitis Of The Foot Bursa Sac

August 28, 2015
Overview

Retrocalcaneal bursitis is the inflammation of the fluid-filled sac (bursa) at the back of the heel bone (calcaneus). The retrocalcaneal bursa is located between the Achilles tendon and the heel bone and is designed to reduce friction between the Achilles tendon and the heel bone. During contraction of the calf muscle, tension is generated through the Achilles tendon and it rubs against the retrocalcaneal bursa. When there is excessive friction due to repetitive rubbing of the tendon against the bursa or high impact force translating through the Achilles tendon, irritation and inflammation of the bursa may occur. The inflammation can also be aggravated by pressure, such as when athletes wear tight-fitting shoes. This condition is often mistaken for Achilles tendinitis but it can also occur in conjunction with Achilles tendinitis.

Causes

Bursitis occurs when the synovial lining becomes thickened and produces excessive fluid, leading to localized swelling and pain. It most commonly affects the subacromial, olecranon, trochanteric, prepatellar, and infrapatellar bursae. Symptoms of bursitis may include localized tenderness, pain, edema, erythema, or reduced movement. Pain is aggravated by movement of the specific joint, tendon, or both.

Symptoms

Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down.

Diagnosis

In addition to a complete medical history and physical examination, diagnostic procedures for bursitis may include the following. X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. Ultrasound. A diagnostic technique that uses high-frequency sound waves to create an image of the internal organs. Aspiration. A procedure that involves removal of fluid from the swollen bursa to exclude infection or gout as causes of bursitis. Blood tests. Lab tests that are done to confirm or eliminate other conditions.

Non Surgical Treatment

The following exercises are commonly prescribed to patients with retrocalcaneal bursitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2, 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in a circle as large as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free.

Surgical Treatment

Surgery is rarely done strictly for treatment of a bursitis. If any underlying cause is the reason, this may be addressed surgically. During surgery for other conditions, a bursa may be seen and removed surgically.

Prevention

Because many soft tissue conditions are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause problems. Underlying conditions such as leg length differences, improper position or poor technique in sports or work must be corrected. Be aware of potential overuse or injury in your daily activities and change your lifestyle to prevent problems. Otherwise, problems may persist or occur repeatedly. Following are some ways you can avoid future problems. Wear walking or jogging shoes that provide good support. High-top shoes provide support for people with ankle problems. Wear comfortable shoes that fit properly. Wear heel cups or other shoe inserts as recommended by your doctor. Exercise on level, graded surfaces.

What Is Bursitis Of The Foot?

August 25, 2015
Overview

Retrocalcaneal and retroachilles bursitis are both common types of bursitis that can cause pain at the back of the foot, just above the heel. This pain, and often swelling, occurs when one or both bursae at the back of the heel become irritated and inflamed. Because they have similar symptoms, heel bursitis is sometimes confused with problems affecting the Achilles tendon, which is a long strip of fibrous tissue that connects the back of the heel to the calf muscle. Other times, Achilles tendon problems may bring about the bursitis. For example, tight calf muscles can contribute to chronic pulling where the Achilles tendon inserts into the back of the heel. This pulling can result in friction and irritation that eventually lead to bursitis.

Causes

The most common cause for bursitis in the heel is overuse. If you repeatedly use your ankle, the bursa becomes irritated, causing swelling and inflammation. This is usually seen in individuals who do too much walking or running. The risk for developing this condition worsens if you suddenly start an intensive workout routine without conditioning your body to become used to the intensity.

Symptoms

Where the tendon joins the calcaneal bone, friction can cause the spaces between the tendon, bone and skin to swell and inflame with bursitis. This constitutes a calcaneal bursa. Apart from swelling over the back of the heel, you?ll feel acute tenderness and pain when you move it or even apply light pressure. Your swollen heel may look more red than the other one, and the swelling is often so hard it can feel like bone, partly because it sometimes is, as a bony overgrowth can occur in chronic cases.

Diagnosis

The doctor will discuss your symptoms and visually assess the bones and soft tissue in your foot. If a soft tissue injury is suspected, an MRI will likely be done to view where and how much the damage is in your ankle. An x-ray may be recommended to rule out a bone spur or other foreign body as the cause of your ankle pain. As the subcutaneous bursa is close to the surface of the skin, it is more susceptible to septic, or infectious, bursitis caused by a cut or scrape at the back of the heel. Septic bursitis required antibiotics to get rid of the infection. Your doctor will be able to determine whether there is an infection or not by drawing a small sample of the bursa fluid with a needle.

Non Surgical Treatment

The most important factor in healing bursitis is resting your foot and ankle. This can be difficult when you have to carry on with daily activities, but resting and elevating your foot whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that stress your bursa until your pain and inflammation settle.

Surgical Treatment

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

Hammer Toe Operation

June 24, 2015
HammertoeOverview

When a person has hammertoe, 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 Hammer toes 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 cause of hammertoes varies, but causes include genetics, arthritis and injury to the toe. Treatment for hammertoes depends on the severity and can include anti-inflammatory medication, metatarsal pads, foot exercises and better-fitting shoes. If the pain caused by a hammertoe is so severe that wearing a shoe is uncomfortable, surgery may be necessary. Typically this surgery is an outpatient procedure that doesn?t require general anesthesia, though it is an option. Recovery from surgery usually takes a few weeks, and patients are given special shoes to wear.

HammertoeSymptoms

The symptoms of a hammer toe include the following. Pain at the top of the bent toe upon pressure from footwear. 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.

Diagnosis

Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.

Non Surgical Treatment

If the toes are still mobile enough that they are able to stretch out and lay flat, the doctor will likely suggest a change of footwear. In addition, she may choose to treat the pain that may result from the condition. The doctor may prescribe pads to ease the pain of any corns and calluses, and medications ranging from ibuprofen to steroid injections for the inflammation and pain. Other options for non-surgical treatments include orthotic devices to help with the tendon and muscle imbalance or splinting to help realign the toe. Splinting devices come in a variety of shapes and sizes but the purpose of each is the same: to stretch the muscles and tendon and flatten the joint to remove the pain and pressure that comes from corns.

Surgical Treatment

If conservative treatments fail and your symptoms persist, the doctor may recommend a surgical option to straighten the toe. The procedures used vary greatly, depending upon the reasons for the hammertoe. There are a number of different operations to correct hammertoes, the most common ones involve Soft tissue corrections such as tendon transfers, tendon lengthening, and joint capsule repairs. Digital arthroplasty involves removal of bone from the bent joint to allow the toe to straighten. The temporary use of pins or K-wires may be necessary to keep the toe straight during the healing period. Joint implants are sometimes used to allow for a better range of motion in the toe following surgery. Digital arthrodesis involves the removal of bone from the bent joint and fusing the toe in a straight position. If the corn is due to a bone spur, the most common procedure used is an exostectomy, in which surgically removing it or filing it down removes the bone spur. Because of the possible complications involved with any surgery, one should be sure to understand the risks that may be involved with surgery to correct hammertoes and remove bone spurs.

Hammer ToePrevention

You can avoid many foot, heel and ankle problems with shoes that fit properly. Here's what to look for when buying shoes. Adequate toe room. Avoid shoes with pointed toes. Low heels. Avoiding high heels will help you avoid back problems. Adjustability. Laced shoes are roomier and adjustable.

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