Coping with Mortons Neuroma

Overview

Morton 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

The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon. Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour.

Symptoms

What are the symptoms of Morton?s neuroma? A sharp or stinging pain between the toes when standing or walking. Pain in the forefoot between the toes. Swelling between the toes. Tingling (?pins and needles?) and numbness. Feeling like there is a ?bunched up sock? or a pebble or marble under the ball of the foot.

Diagnosis

A GP (general practitioner, primary care physician) or a podiatrist (foot specialist doctor) will ask the patient to describe the pain as well as its intensity, when symptoms started, what types of shoes are worn, as well as some questions about their job, lifestyle and hobbies. The doctor will then examine the foot and try to locate the affected nerve. This may involve attempting to reproduce symptoms by manipulating the foot. In order to get a detailed image of the inside of the food, one of the following scans may be ordered. X-ray, this is a type of high-energy radiation. In low doses they are used to diagnose diseases and condition by making pictures of the inside of the body. In higher doses they are used to treat cancer. This procedure is non-invasive and painless. Ultrasound scan, high frequency sound waves are pointed at a specific part of the body, which in this case is the foot. The ultrasound waves bounce of tissues; their echoes are then converted into a picture, called a sonogram. This allows the doctor to get an inside view of the foot. This procedure is non-invasive and painless. MRI (magnetic resonance imagining) a device that uses a magnetic field and radio waves to create detailed images of the body. Unlike CT scanning or general x-ray studies, no ionizing radiation is involved with an MRI. This procedure is non-invasive and painless. The doctor will have to rule out other conditions which may have similar symptoms, including capsulitis, bursitis, or Freiberg’s disease.

Non Surgical Treatment

If symptoms are severe or persistent and self-help measures did not help, the doctor may recommend corticosteroid injections, a steroid medication that reduces inflammation and pain is injected into the area of the neuroma. Only a limited number of injections are advised, otherwise the risk of undesirable side effects increases, including hypertension (high blood pressure) and weight gain. Alcohol sclerosing injections, studies have shown that alcohol injections reduce the size of Morton’s neuromas as well as alleviating pain. This is a fairly new therapy and may not be available everywhere. The doctor injects alcohol in the area of the neuroma to help sclerose (harden) the nerve and relieve pain. Injections are typically administered every 7 to 10 days. For maximum relief 4 to 7 injections are usually needed.

Surgical Treatment

Operative treatment of Morton?s neuroma should be entertained only after failure of nonoperative management. Standard operative treatment involves identifying the nerve and cutting (resecting) it proximal to the point where it is irritate/injured. This is usually done through an incision on the top (dorsal) aspect of the foot, although in rare instances, an incision on the sole (plantar) aspect of the foot maybe used. An incision on the sole of the foot works very well, unless an excessive scar forms in which case it can be problematic. Some physicians will attempt to treat Morton?s neuroma by releasing the intermetatarsal ligament and freeing the nerve of local scar tissue. This may also be beneficial.

Prevention

Wearing shoes that fit properly and that have plenty of room in the toe area may help prevent Morton’s neuroma.

Protecting Against Calcaneal Spur

Overview

Heel Spurs should be called a traction spurs because they grow in the same direction that the tendons pull away from the heel bone, which is why it can occur on the bottom of the heel (Plantar Fasciitis) and on the back of the heel (Achilles Tendonitis). Some patients may only develop one type of heel spur, but both these problems are closely related so it’s not unusual for a patient to have both heel spurs. It’s important to note though that most heel spurs aren’t the cause of your heel pain.

Causes

A heel spur usually develops as a result of wear and tear over time, which leads to the degeneration of connective tissue called fascia. Standing for prolonged periods and wearing shoes that do not provide the right type of arch support can also lead to connective tissue damage in the heel. The body attempts to repair the damaged tissue by delivering calcium to the affected region, but sometimes too much calcium begins to accumulate and this results in painful plantar fasciitis.

Symptoms

Symptoms of heel spur syndrome often include pain early in the morning or after rest, as you take the first few steps. It may also include severe pain after standing or walking long hours, especially on hard cement floors. Usually more pain exist while wearing a very flat soled shoe. A higher heel may actually relieve the pain as an arch is created. The pain is usually sharp, but can also be a dull ache. The pain may only be at the bottom of the heel, or may also travel along the arch of the foot.

Diagnosis

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

Non Surgical Treatment

Conventional treatment for heel spurs typically includes rest, stretching exercises, icing and anti-inflammatory medications. Many people find it difficult to go through the day without some sort of routine activity or exercise, and this prolongs the heel spur and forces people to rely on anti-inflammatory medications for a longer period of time. This can be detrimental due to the many side effects of these medications, including gastrointestinal problems like leaky gut, bleeding and ulcer symptoms.

Surgical Treatment

Approximately 2% of people with painful heel spurs need surgery, meaning that 98 out of 100 people do well with the non-surgical treatments previously described. However, these treatments can sometimes be rather long and drawn out, and may become considerably expensive. Surgery should be considered when conservative treatment is unable to control and prevent the pain. If the pain goes away for a while, and continues to come back off and on, despite conservative treatments, surgery should be considered. If the pain really never goes away, but reaches a plateau, beyond which it does not improve despite conservative treatments, surgery should be considered. If the pain requires three or more injections of “cortisone” into the heel within a twelve month period, surgery should be considered.

Prevention

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

The Diagnosis Of Heel Spur

Overview

A heel spur is a deposit of calcium on the heel bone. This calcification takes the form of a bony protrusion, which can cause considerable pain when standing and walking. This foot problem is closely related to plantar fasciitis, a condition in which the band of fibrous tissue on the bottom of the foot becomes over-stressed. It pulls away from the heel and causes the calcium deposits to form. For this reason, treating a heel spur involves treating the plantar fascia as well.

Causes

Heel Spurs develop when the plantar fascia is excessively and repetitively pulled away from the heel bone. In many cases, a heel spur can develop along with plantar fasciitis, but can also occur by itself. Heel spurs often develop in middle-aged patients, but can also occur in younger people as well. Athletes are especially prone to heel spur due to the regular stress on their heels.

Symptoms

Heel spurs often do not show any symptoms. If you have intermittent or chronic pain when you walk, run or jog, it may be heel spur. There will be inflammation the point where spur formation happens. The pain is caused by soft tissue injury in the heel. Patients often describe the pain as a pin or knife sticking to the heel. The pain is more specially in the morning when the patient stands up for the first time.

Diagnosis

A heel spur is often seen on X-ray as a bony protrusion, which can vary in size. However, because a Heel Spur only indicates increased load on the plantar fascia, and not pain, an ultra sound may be required to assess other actual cause of the heel pain such and may include checking to see if the plantar fascia is inflamed or degenerated.

Non Surgical Treatment

Only in rare cases do the symptoms of heel spurs fail to be resolved through conservative treatment. Conservative treatment, although not 100% effective, is successful in most cases and should be given ample time to work. In many cases, conservative methods should be utilized as long as a year depending on the rate at which your body responds to the treatment. When treatment is unsuccessful, surgery may be considered. A common surgical procedure for this condition is plantar fascia release surgery. In this procedure, the tension of the plantar fascia ligament is released, lessening tension in the heel and helping to prevent damage.

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

Walk around before you buy shoes. Before you purchase your shoes, do the following. Re-lace the shoes if you’re trying on athletic shoes. Start at the farthest eyelets and apply even pressure to the laces as you come closer to the tongue of the shoe. Make sure that you can wiggle your toes freely inside of the shoe. Also, make sure that you have at enough space between your tallest toe and the end of the shoe. You should have room equal to about the width of your thumb in the tip of your shoe. Walk around to make sure that the shoe has a firm grip on your heel without sliding up and down. Walk or run a few steps to make sure your shoes are comfortable. Shoes that fit properly require no break-in period.

Natural Treatment For Bursitis Feet

Overview

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

Causes

High impact activity, such as running. Trauma to the heel such as jumping from a height. Increase in training levels. Lack of shock absorbency in the trainers worn. Worn running shoes. Poor biomechanics. Loss of the fat pad under the heel. Increase in weight.

Symptoms

Pain at the back of the heel, especially with jumping, hopping, tip-toeing, walking or running uphill or on soft surfaces. If tendonitis is also present, the pain can radiate away from the bursa. Direct pressure on the bursa will exacerbate the pain and should be avoided if possible. Tenderness and swelling which might make it difficult to wear certain shoes on the feet. As the bursa becomes more inflamed you will experience swelling and warmth. In severe cases, the bursa will appear as a bump, called a “pump bump”, and is usually red, and extremely tender. Swelling can cause difficulties moving as the range of motion in the ankle can be affected. Limping due to the pain may occur. If you press on both sides of the inflamed heel, there may be a firm spongy feeling. Weakness in the tendons and muscles surrounding the bursa can develop as the pain worsens and the inflammation in the area spreads. Possibly a fever if you are suffering from septic bursitis (You will need to see a doctor for medication to get rid of the infection). Pain at the back of the heel makes it difficult to continue wearing shoes, especially high heels with straps or shoes that don’t fit properly.

Diagnosis

On physical examination, patients have tenderness at the site of the inflamed bursa. If the bursa is superficial, physical examination findings are significant for localized tenderness, warmth, edema, and erythema of the skin. Reduced active range of motion with preserved passive range of motion is suggestive of bursitis, but the differential diagnosis includes tendinitis and muscle injury. A decrease in both active and passive range of motion is more suggestive of other musculoskeletal disorders. In patients with chronic bursitis, the affected limb may show disuse atrophy and weakness. Tendons may also be weakened and tender.

Non Surgical Treatment

Gradually progressive stretching of the Achilles tendon may help to relieve impingement on the subtendinous calcaneal bursa. Stretching of the Achilles tendon can be performed by having the patient place the affected foot flat on the floor and lean forward toward the wall until a gentle stretch is felt in the ipsilateral Achilles tendon. The stretch is maintained for 20-60 seconds and then is relaxed. Achilles stretch 1. The patient stands with the affected foot flat on the floor and leans forward toward the wall until a gentle stretch is felt in the ipsilateral Achilles tendon. The stretch is maintained for 20-60 seconds and then is relaxed. Achilles stretch 2. This stretch, which is somewhat more advanced than that shown in Images 1-2, isolates the Achilles tendon. It is held for at least 20-30 seconds and then is relaxed. To maximize the benefit of the stretching program, the patient should repeat the exercise for multiple stretches per set, multiple times per day. Ballistic (ie, abrupt, jerking) stretches should be avoided in order to prevent clinical exacerbation. The patient should be instructed to ice the posterior heel and ankle in order to reduce inflammation and pain. Icing can be performed for 15-20 minutes at a time, several times a day, during the acute period, which may last for several days. Some clinicians also advocate the use of contrast baths, ultrasound or phonophoresis, iontophoresis, or electrical stimulation for treatment of calcaneal bursitis. If the patient’s activity level needs to be decreased as a result of this condition, alternative means of maintaining strength and cardiovascular fitness (eg, swimming, water aerobics) should be suggested.

Surgical Treatment

Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.

Long-Term Pain After Hammertoe Surgery

Overview

Hammer toes is a Z-shaped deformity caused by dorsal subluxation at the metatarsophalangeal joint. Diagnosis is clinical. Treatment is modification of footwear and/or orthotics. The usual cause is misalignment of the joint surfaces due to a genetic predisposition toward aberrant foot biomechanics and tendon contractures. RA and neurologic disorders such as Charcot-Marie-Tooth disease are other causes.

Causes

The main cause of hammer toe is poorly fitted and/or poorly designed footwear. Any footwear that is too tight in the toe box, especially high-heeled shoes, can push the toes forward, crowding one or more of them into a space that is not large enough to allow the toes to lie flat and spread as they should. Other causes include the following. Changes in foot anatomy. Sometimes the metatarsal bones in the ball of the foot can ?drop,? creating a situation in which the toes do not make contact with the surface of the shoe. The toes may then contract at one or both of the joints to re-establish contact with the surface. Traumatic injuries in which toes are jammed or broken. Diabetic neuropathy. This can cause abnormal foot biomechanics due to nerve and/or muscle damage. Damage to nerves and muscles from other conditions, such as arthritis or stroke. Heredity.

Symptoms

A hammertoe causes you discomfort when you walk. It can also cause you pain when trying to stretch or move the affected toe or those around it. Hammertoe symptoms may be mild or severe. Mild Symptoms, a toe that is bent downward, corns or calluses. Severe Symptoms, difficulty walking, the inability to flex your foot or wiggle your toes, claw-like toes. See your doctor or podiatrist right away if you develop any of these symptoms.

Diagnosis

Hammer toes may be easily detected through observation. The malformation of the person’s toes begin as mild distortions, yet may worsen over time – especially if the factors causing the hammer toes are not eased or removed. If the condition is paid attention to early enough, the person’s toes may not be permanently damaged and may be treated without having to receive surgical intervention. If the person’s toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.

Non Surgical Treatment

Hammertoes that are not painful (asymptomatic) and still flexible may not require treatment. In mild cases, open-toed, low-heeled, or wider shoes and foam or moleskin pads can provide symptomatic relief by reducing pressure. Taping (strapping) the affected toe can help to reduce deformity and pain. Physical therapy to instruct patients in exercises that passively stretch tight structures and strengthen weak foot intrinsic muscles is also helpful with mild cases. Periodic trimming (debridement) of Hammer toe corns (clavi, helomata) by a podiatrist can provide temporary relief. Corticosteroid injections are often very effective in reducing pain.

Surgical Treatment

If conservative treatments don’t help, your doctor may recommend surgery to release the tendon that’s preventing your toe from lying flat. In some cases, your doctor might also remove some pieces of bone to straighten your toe.

How To Treat Hammer Toes Without Surgery

Overview

Hammer toes is the general term used to describe an abnormal contraction or “buckling” of the toe because of a partial or complete dislocation of one of the joints of the toe or the joint where the toe joins with the rest of the foot. As the toe becomes deformed, it rubs against the shoe and the irritation causes the body to build up more and thicker skin to help protect the area. The common name for the thicker skin is a corn.

Causes

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

Symptoms

People who have painful hammertoes visit their podiatrist because their affected toe is either rubbing on the end their shoe (signaling a contracted flexor tendon), rubbing on the top of their shoe (signaling a contracted extensor tendon), or rubbing on another toe and causing a painful buildup of thick skin, known as a corn.

Diagnosis

The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Non Surgical Treatment

In many cases, conservative treatment consisting of physical therapy and new shoes with soft, spacious toe boxes is enough to resolve the condition, while in more severe or longstanding cases podiatric surgery may be necessary to correct the deformity. The patient’s doctor may also prescribe some toe exercises that can be done at home to stretch and strengthen the muscles. For example, the individual can gently stretch the toes manually, or use the toes to pick hammertoe things up off the floor. While watching television or reading, one can put a towel flat under the feet and use the toes to crumple it. The doctor can also prescribe a brace that pushes down on the toes to force them to stretch out their muscles.

Surgical Treatment

For severe hammer toe, you will need an operation to straighten the joint. The surgery often involves cutting or moving tendons and ligaments. Sometimes the bones on each side of the joint need to be connected (fused) together. Most of the time, you will go home on the same day as the surgery. The toe may still be stiff afterward, and it may be shorter. If the condition is treated early, you can often avoid surgery. Treatment will reduce pain and walking difficulty.

Bunions Reasons Indicators And Treatment Procedures

Overview

A bunion is a deviation and inflammation of joint where the big toe connects to the 1st metatarsal, also known as the 1st MTP. The capsule of the joint is displaced, thickened and enlarged, and the cartilage of the joint is damaged. There are three degrees of bunions: mild, moderate and severe. It is important to know that bunions are not hereditary, although the tendency to overpronate, which is one of the main causes of bunions, has a hereditary component. Patients complain of pain in the joint and have a big toe that points away from the midline of the body. Often, they are only able to wear very wide shoes.

Causes
Bunions, Corns, and Calluses are all related in that they can each be caused by tight and/or poor fitting footwear. Each can also be caused by the following, footwear that is too narrow and/or too small. Constrictive toe boxes (toe area). Tapered toe boxes can cause bunions and cause them to worsen to the point of needing surgery.
SymptomsThe most obvious symptoms of a bunion are. Pain in the area of the MTP joint, the joint where your big toe connects to your foot. Bending of the big toe in towards the other toes. An enlarged bump of bone or tissue at the MTP joint. Each symptom can range in degree from small to severe. Sometimes the pain can be sufficient to make it difficult to walk in normal shoes. Other symptoms may include. Swelling and inflammation of the skin around the MTP joint. Thickening of the skin in the area of the joint. Restricted motion in your big toe. Pressure from the inward bending of your big toe can affect your other toes, leading to corns on your smaller toes. Ingrown toenails on the smaller toes. Development of hammertoes in the other toes. Calluses on the bottom of your foot. If you have any of these symptoms, especially pain, displacement of your big toe or development of a bulge, you should consider consulting your physician. Even if you’re not significantly bothered by some of these symptoms, bunions tend to continue getting bigger and more serious over time and should be taken care of before they do so.

Diagnosis
Although bunions are usually obvious from the pain and unusual shape of the toe, further investigation is often advisable. Your doctor will usually send you for X-rays to determine the extent of the deformity. Blood tests may be advised to see if some type of arthritis could be causing the pain. Based on this evaluation, your doctor can determine whether you need orthopaedic shoes, medication, surgery or other treatment.

Non Surgical Treatment
Patients should immediately cease using improperly fitted shoes. Footwear selection should have a wide and roomy toebox to accommodate the full width of the foot. If the problem is the over-pronation, the patient should be fitted with orthotics and can expect a slow recovery from pain over a period of months. Orthotics will not cause the physical deformity to regress, but will simply arrest any further progression and likely stop the pain. It is important to note however, that when bunions are severe and require surgery, the bunion can be corrected, but will develop again unless the root cause of over-pronation is corrected. If over-pronation is the root cause, orthotics will still be necessary.

Surgical Treatment
Research shows that 85% of people who have bunion corrections are satisfied with the results. However, a number of problems can arise. The big toe is usually stiffer than before. For most people this does not matter, but for athletes or dancers it is very important. As mentioned before, the big toe is slightly weaker with a bunion, and this transfers weight onto the ball of the foot. After bunion surgery, this transfer of weight can increase. Therefore, if you have pain under the ball of the foot (“metatarsalgia”) it may be worse after bunion surgery, and it may also develop for the first time. Careful surgical technique can reduce this risk, but it cannot avoid it completely. Most people who develop metatarsalgia are comfortable with a simple insole in the shoe but occasionally surgery is required. In some people the big toe slowly tilts back toward the original position and occasionally this is bad enough to need to have the operation redone. On the other hand, the toe can tilt the other way, though much more rarely. Again, occasionally this is bad enough to need to have the operation redone. Infections in the wound, plaster problems and minor damage to the nerves of the toe can occur in any foot surgery. Usually these are minor problems that get better quickly. This may sound like a lot of possible problems, but in fact most people do not get them and are satisfied with their bunion surgery. However, this may help you to see how important it is to have any bunion surgery carried out by a properly trained and experienced foot and ankle surgeon.

What Actually Will Cause Feet To Over Pronate

Overview

Over Pronation (Flat Feet) refers to the biomechanical shock-absorbing motion of the ankle, foot and lower leg. It is the natural inward flexing motion of the lower leg and ankle. Standing, walking, and running cause the ankle joint to pronate which in turn helps the body to absorb shock and allows it to control balance. An ankle joint that is too flexible causes more pronation than desired. This common condition is called Over- Pronation (sometimes referred to as “Flat Feet”). This foot condition places an extreme degree of strain on various connective tissues of the ankle, foot, and knee. If this condition is not addressed foot pain and toe deformities such as bunions and hammer toes (just to name a couple) may develop. Hip and lower back pain may also be residual results from this condition.

Causes

In adults, the most common reason for the onset of Over-Pronation is a condition known as Post Tibial Tendonitis. This condition develops from repetitive stress on the main supporting tendon (Posterior Tibial Tendon) of the foot arch. As the body ages, ligaments and muscles can weaken. When this occurs the job of providing the majority of the support required by the foot arch is placed upon this tendon. Unfortunately, this tendon cannot bear the weight of this burden for too long. Eventually it fatigues under the added strain and in doing so the foot arch becomes progressively lower over a period of time.

Symptoms

Over-pronation is a condition where the arch flattens out which makes the feet roll inward while walking. This condition is also known as flat feet. It imposes extreme additional stresses on the plantar fascia, a fibrous band of tissue which connects the heel to the forefoot. Over-pronation makes walking a painful experience because of the additional strain on the calves, heel and/or back. Treatment for over-pronation involves the use of specially-made orthotics which offers arch support and medial rear foot posting as corrective measures.

Diagnosis

A quick way to see if you over-pronate is to look for these signs. While standing straight with bare feet on the floor, look so see if the inside of your arch or sole touches the floor. Take a look at your hiking or running shoes; look for wear on the inside of the sole. Wet your feet and walk on a surface that will show the foot mark. If you have a neutral foot you should see your heel connected to the ball of your foot by a mark roughly half of width of your sole. If you over-pronate you will see greater than half and up to the full width of your sole.

Non Surgical Treatment

The following exercises help retrain the foot and ankle complex to correct overpronation. Step Up and Over. This exercise is designed to integrate skills learned in the Duck Stand, Big Toe Pushdowns and Side Step with Opposite Reach exercises to mimic walking and even running. Using the gluteal muscles and big toe in tandem will prevent overpronation while moving back and forth over the BT in a more effective, balanced motion. Movement Directions. Stand with left foot on top of the BT dome. (Note: For added balance, the right foot can tap on the ground, if needed). Extend right foot backwards to the ground and drop hips into a lunge position. Make sure that the right arm rotates across the left leg (this will activate the gluteal muscles on the left side). Now, step through and over the BT into a front lunge with the right leg forward. While lunging forward, the torso and left arm now rotate over the right leg. Throughout the exercise, push big toe down into the BT. Perform 8 to 10 repetitions on both sides.

Surgical Treatment

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

What Are The Causes Of Severs Disease?

Overview

During a growth spurt, your child?s heel bone grows faster than the muscles, tendons, and ligaments in her leg. In fact, the heel is one of your child?s first body parts to reach full adult size. When the muscles and tendons can?t grow fast enough to keep up, they are stretched too tight. If your child is very active, especially if she plays a sport that involves a lot of running and jumping on hard surfaces (such as soccer, basketball, or gymnastics), it can put extra strain on her already overstretched tendons. This leads to swelling and pain at the point where the tendons attach to the growing part of her heel.

Causes

Having flatfeet or very pronated feet can make one prone to Sever’s disease. But also patient?s that have a very high arch foot structure tend to have a very high shock and high impact heel strike. This also puts extra stress on the heel and apophysis.

Symptoms

This is a condition that affects the cartilage growth plate and the separate island of growing bone on the back of the heel bone. This growth plate is called the physeal plate. The island of growing bone is called the apophysis. It has the insertion attachment of the Achilles tendon, and the attachment of the plantar fascia. This island of bone is under traction from both of these soft tissue tendon and tendon-like attachments.

Diagnosis

Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.

Non Surgical Treatment

Decreasing or stopping sport is necessary until the pain reduces. Let pain be your guide, as it decreases you can slowly return to all activities. To help settle inflammation use an ice pack or rub an ice cube over the

painful area for 5 minutes daily whilst pain persists. Wearing supportive trainers during the day can help to soften the impact of walking on the heel. Encourage a normal pattern of walking. Complete the stretches below every day and before and after activity until your symptoms settle.

The Leading Causes And Therapies Of Achilles Tendon Pain

Overview

Achilles tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common injury that tends to occur in recreational athletes. Overuse of the Achilles tendon can cause inflammation that can lead to pain and swelling. Achilles tendonitis is differentiated from another common Achilles tendon condition called Achilles tendinosis. Patients with Achilles tendinosis have chronic Achilles swelling and pain as a result of degenerative, microscopic tears within the tendon.

Causes

A lot of stress on the feet is the cause of Achilles tendinitis. It is a common athletic injury. Things that can cause tendinitis include, pushing your body too fast and too soon, sudden increase in activity, sports that cause you to quickly start and stop, poor fitting shoes, bad footwear, severe injury to the Achilles tendon, running or exercising on uneven ground, running uphill, tight calf muscles, bone spur (extra bone growth in heel that rubs the tendon and causes pain), flat arches, feet that roll in (overpronation), and weak calf muscles, not warming up before exercising.

Symptoms

People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.

Diagnosis

Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon. MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the symptoms. Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis. Once the specific diagnosis is confirmed, the appropriate treatment of tendonitis can be initiated.

Nonsurgical Treatment

In addition to stretching, using a foam roller and getting regular massage to keep the joint mobile can help prevent any problems from starting. If you start to feel inflammation in your tendon or have Achilles tendinitis once, it isn?t necessarily the end of the world. Let it rest and recover, which can sometimes take as long as four to six weeks if you waited until the pain was acute. The real problem is if Achilles tendinitis becomes an ongoing injury. If it keeps recurring, then it?s time for the perpetually injured to examine what they?re doing to cause the problem.

Surgical Treatment

Most people will improve with simple measures or physiotherapy. A small number continue to have major problems which interfere with their lifestyle. In this situation an operation may be considered. If an operation is being considered, the surgeon will interview you and examine you again and may want you to have further treatment before making a decision about an operation. Before undergoing Achilles tendonitis surgery, London based patients, and those who can travel, will be advised to undergo a scan, which will reveal whether there is a problem in the tendon which can be corrected by surgery. Patients will also have the opportunity to ask any questions and raise any concerns that they may have, so that they can proceed with the treatment with peace of mind.

Prevention

Suggestions to reduce your risk of Achilles tendonitis include, icorporate stretching into your warm-up and cool-down routines. Maintaining an adequate level of fitness for your sport. Avoid dramatic increases in sports training. If you experience pain in your Achilles tendon, rest the area. Trying to ?work through? the pain will only make your injury worse. Wear good quality supportive shoes appropriate to your sport. If there is foot deformity or flattening, obtain orthoses. Avoid wearing high heels on a regular basis. Maintaining your foot in a ?tiptoe? position shortens your calf muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury. Maintain a normal healthy weight.