How To Prevent Inferior Calcaneal Spur

23 Sep 2015 
Inferior 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


A major cause of heel spur pain comes from the development of new fibrous tissue around the bony spur, which acts as a cushion over the area of stress. As this tissue grows, a callus forms and takes up even more space than the heel spur, leading to less space for the thick surrounding network of tendons, nerves, ligaments and supporting tissue. These important structures in the foot have limited space because of calcium or tissue buildup, which leads to swelling and redness of the foot, and a deep throbbing pain worsened with exercise.


Heel Spur


Symptoms


With heel spurs, people often talk about a dull ache which is felt most of the time with episodes of a sharp pain in the center of the heel or on the inside margin of the heel. Often the pain is worse on first rising in the morning and after rest and is aggravated by prolonged weight bearing and thin-soled shoes.


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


The first line of treatment for Heel Spur is to avoid the activities and positions that cause the pain. A physician can evaluate your foot with an X-ray to diagnose Heel Spur and determine a course of treatment. This condition can often be treated by non-surgical means; however in severe cases surgery may be necessary to relieve the pain. The most common surgical procedures treat the soft tissues around the Heel Spur, often a tarsal tunnel release or a plantar fascia release. Injections for heel spurs are sometimes controversial as steroids may cause heel pad atrophy or damage the plantar fascia.


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


The best way to prevent heel spurs is by wearing properly fitted footwear. Shoes should have a shock absorbing tread and soles and should be effective in supporting the heel and arch. Proper warm up and stretching before embarking on any physical activity that will put pressure or impact on the area is highly recommended. Also, just as it?s important for your general health, if you can lose some extra pounds, you will be more likely to avoid heel spurs. If you are starting to feel the onset of pain, it may not be heel spurs, but could be a tendonitis condition that could lead to heel spurs.
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Cure For Bursitis Of The Foot

23 Agos 2015 
Overview


This is a very common condition that leads to foot pain . Once you understand what it actually is you will wonder why it does not occur more often, particularly in the foot. It is an inflamed bursal sac. A bursal sac is a sac filled with fluid that acts to lubricate and reduce the friction between two surfaces in the body, usually muscles and tendons as they glide over bony prominences, however their purpose in not limited to just muscles and tendons. The body contains literally hundreds of bursal sacs but in the foot there is just one naturally occurring (adventitious) bursal sac. It is located between the Achilles tendon and the heel bone (calcaneaus), otherwise known as an achilles tendon bursal sac.In this instance the Achilles tendon is protected from the pressure of the heel bone pressing against it when we walk.


Causes


Overtraining in an athlete. Tight or poorly fitting shoes that produce excessive pressure at the posterior heel. Haglund deformity. Altered joint axis. Inflammation of the calcaneal bursae is most commonly caused by repetitive (cumulative) trauma or overuse, and the condition is aggravated by pressure, such as when athletes wear tight-fitting shoes. Retrocalcaneal bursitis may also be associated with conditions such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies. In some cases, retrocalcaneal bursitis may be caused by bursal impingement between the Achilles tendon and an excessively prominent posterosuperior aspect of the calcaneus (Haglund deformity). In Haglund disease, impingement occurs during ankle dorsiflexion.


Symptoms


Achiness or stiffness in the affected joint. Worse pain when you press on or move the joint. A joint that looks red and swollen (especially when the bursae in the knee or elbow are affected). A joint that feels warm to the touch, compared to the unaffected joint, which could be a sign that you have an infection in the bursa. A ?squishy? feeling when you touch the affected part. Symptoms that rapidly reappear after an injury or sharp blow to the affected area.


Diagnosis


Your doctor will examine you, including an evaluation of your gait, while you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk. An examination of your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.


Non Surgical Treatment


Gradual and progressive stretching of the Achilles tendon. Exercises to strengthen and support the ankle. Rest or reduced weight bearing activities. Immobilisation in a cast for 4-6 weeks for severe cases. Ice. Proper fitting and supportive footwear. Massage. Joint mobilisation. Anti-inflammatory medications: only if this does not have adverse results with the patient's current medication. Heel pads and heel lifts. Footwear Advice. Strapping and padding Orthoses/innersoles. The orthotics prescribed and designed by the podiatrists at the Heel and Arch Pain Clinic (affiliated with Beyond Podiatry) are made to align the foot in the correct posture. Surgery is indicated in severe cases when conservative treatment has not resolved the problem.


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.


Prevention


Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.
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Hammer Toes Cause And Treatment

20 Agos 2015 
HammertoeOverview


A hammertoes is a term that is commonly used to describe any type of toe deformity. It is a common problem that may or may not be a problem. What does a hammer toe look like? In a hammertoe the deformity usually exists in one toe (at the proximal inter phalangeal joint) - the base of the toe points upward and the end of the toe points down.


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.


HammertoeSymptoms


A hammertoe may be present but not always painful unless irritated by shoes. One may have enlarged toe joints with some thickened skin and no redness or swelling. However, if shoes create pressure on the joint, the pain will usually range from pinching and squeezing to sharp and burning. In long standing conditions, the dislocated joints can cause the pain of arthritis.


Diagnosis


Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.


Non Surgical Treatment


A number of approaches can be undertaken to the manage a hammer toe. It is important that any footwear advice is followed. The correct amount of space in the toe box will allow room for the toes to function without excessive pressure. If a corn is present, this will need to be treated. If the toe is still flexible, it may be possible to use splints or tape to try and correct the toe. Without correct fitting footwear, this is often unsuccessful. Padding is often used to get pressure off the toe to help the symptoms. If conservative treatment is unsuccessful at helping the symptoms, surgery is often a good option.


Surgical Treatment


Any surgery must be carefully considered and approached in a serious manner, as any procedure is serious for the patient. But hammertoes in most cases the procedure is relatively straight forward. The surgery can be done using local anesthetic and does not require hospitalization. The patient goes home in a special post-operative shoe or a regular sandal, and in most cases can walk immediately. That's not to say that the patient is walking or functioning normally immediately after the procedure. The patient must take some time off work to rest the foot and allow it to heal.
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Hammer Toe Surgery

23 Jun 2015 
HammertoeOverview


A hammertoe is a contracture, or bending, of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammer toes are more common in females than males.


Causes


Claw, hammer and mallet toe are most commonly caused by wearing high heels or ill-fitting shoes that are too tight e.g. narrow toebox. If shoes like this are worn for long periods, the foot is held in a slightly bent position and gradually over time, the muscles tighten and shorten. If this continues for long enough, then the muscles become so tight that even when shoes are removed, the toe is still held in the bent position. Another common cause is Morton?s Toe, where the second toe is longer than the big toe. In this case, the second toe is commonly squashed into a shoe into an unnaturally bent position.


Hammer ToeSymptoms


A hammer toe may be painful, especially when irritated by a shoe. All four toe conditions may cause cramps in the toes, foot and leg due to the abnormal function of the tendons in the foot. If a mallet toe has occurred, you are likely to suffer from a corn at the end of the toe. A hammertoe may cause a corn on the top of the toe. Infections and ulcers can also occur. In severe cases a mallet toe, trigger toe, claw toe or a hammer toe may create a downward pressure on the foot, which can result in hard skin and corns on the soles of the feet.


Diagnosis


Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.


Non Surgical Treatment


Apply a commercial, non-medicated hammer toe pad around the bony prominence of the hammer toe to decrease pressure on the area. Wear a shoe with a deep toe box. If the hammer toe becomes inflamed and painful, apply ice packs several times a day to reduce swelling. Avoid heels more than two inches tall. A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. While this treatment will make the hammer toe feel better, it is important to remember that it does not cure the condition. A trip to the podiatrist's office will be necessary to repair the toe to allow for normal foot function. Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.


Surgical Treatment


Sometimes surgery can not be avoided. If needed, the surgery chosen is decided by whether we are dealing with a flexible or rigid hammer toe. If the surgery is on a flexible hammer toe, it is performed on soft tissue structures like the tendon and or Hammer toes capsule of the flexor hammer toe. Rigid hammer toes need bone surgeries into the joint of the toe to repair it. This bone surgery is called an arthroplasty.
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Over-Pronation Causes

02 Jun 2015 
Overview


When standing, pronation occurs as the foot rolls inwards and the arch of the foot flattens. Pronation is a normal part of the gait cycle which helps to provide shock absorption at the foot. The opposite movement to pronation is supination. This is also a normal part of the gait cycle just after the heel strike however over-supination is also not good.Over-Pronation


Causes


Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding additional stress to other parts of the foot. Therefore over-pronation can often lead to a case of Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions. There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. People with flat feet often do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.


Symptoms


Not all foot injuries affecting runners are necessarily down to a particular running gait; it is rarely that simple to diagnose how a foot problem developed . Simply being an overpronator does not mean that a foot injury has been caused by the running gait and it could be due to a number of factors. However mild to severe overpronators tend to be at a higher risk of developing musculoskeletal problems due to the increased stresses and strains which are placed on the body when the foot does not move in an optimum manner. The following injuries are frequently due to overpronation of the feet. Tarsal tunnel syndrome. Shin splints. Anterior compartment syndrome. Plantar fasciitis. Achilles tendonitis. Bunions. Sesamoiditis. Stress fractures. Back and hip pain. Ankle pain.


Diagnosis


One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).Foot Pronation


Non Surgical Treatment


Personal orthotics can be prescribed via your healthcare professional. If finances or insurance are issues, similar and often better options can be purchased online for overpronation. The right walking shoes are also essential. Most shoes cater to neutral foot gaits, unless they specifically state otherwise. That won?t help you if your foot rolls inward. In order to correct the issue, you need shoes with stability or motion control abilities, low heels, deep heel cups, and good arch support.


Surgical Treatment


Hyperpronation can only be properly corrected by internally stabilizing the ankle bone on the hindfoot bones. Several options are available. Extra-Osseous TaloTarsal Stabilization (EOTTS) There are two types of EOTTS procedures. Both are minimally invasive with no cutting or screwing into bone, and therefore have relatively short recovery times. Both are fully reversible should complications arise, such as intolerance to the correction or prolonged pain. However, the risks/benefits and potential candidates vary. Subtalar Arthroereisis. An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer. HyProCure Implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.
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