Sat

22

Aug

2015

Bursitis Of The Foot Anatomy

Overview

Bursitis is defined as inflammation of a bursa. Humans have approximately 160 bursae. These are saclike structures between skin and bone or between tendons, ligaments, and bone. The bursae are lined by synovial tissue, which produces fluid that lubricates and reduces friction between these structures.

Causes

Inflammation of the bursa causes synovial cells to multiply and thereby increases collagen formation and fluid production. A more permeable capillary membrane allows entrance of high protein fluid. The bursal lining may be replaced by granulation tissue followed by fibrous tissue. The bursa becomes filled with fluid, which is often rich in fibrin, and the fluid can become hemorrhagic. One study suggests that this process may be mediated by cytokines, metalloproteases, and cyclooxygenases.

Symptoms

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

Diagnosis

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

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

Surgical Treatment

Surgery 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.
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Tue

23

Jun

2015

Rigid Hammertoes Surgery

HammertoeOverview

A Hammer toe is a term used to describe a crooked, deviated, or contracted toe. Although the condition usually stems from muscle imbalance, it is often aggravated by poor-fitting shoes or socks that cramp the toes. Over a period of years, the tendons that move the toe up and down begin to pull the toe with unequal tension, and the toe then begins to buckle or become contracted, causing an abnormal "v"-shaped bending of the little toes. Patients with this condition often experience pain, swelling, redness and stiffness in the affected toes.

Causes

Hammer toe is most often caused by wearing compressive shoes. It might also be caused by the pressure from a bunion. A bunion is a corn on the top of a toe and a callus on the sole of the foot develop which makes walking painful. A high foot arch may also develop.

Hammer ToeSymptoms

The most obvious sign of hammertoes are bent toes, other symptoms may include pain and stiffness during movement of the toe. Painful corns on the tops of the toe or toes from rubbing against the top of the shoe's toe box. Painful calluses on the bottoms of the toe or toes. Pain on the bottom of the ball of the foot. Redness and swelling at the joints.

Diagnosis

A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.

Non Surgical Treatment

Padding and Taping. Often this is the first step in a treatment plan. Padding the hammertoe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain. Medication. Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity. Orthotic Devices. Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammertoe deformity.

Surgical Treatment

If conservative measures fail to provide relief, or if your hammertoe is in advanced stages with rigidity and a significant amount of pain, surgery may be required. Some patients also require surgery if they have open sores or wounds related to their hammertoe. For patients who also suffer from bunions, a combined procedure may be appropriate, addressing both conditions within the same surgery. Recovery time will vary from patient to patient, depending on the Hammer toe extent of the surgical repair and other conditions that may also be present.
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Fri

05

Jun

2015

The Causes And Treatments Of Overpronation Of The Foot

Overview

Everyone pronates! Contrary to popular misconception it is healthy and normal. The problem begins when one or both of our feet pronate too much. When the arches flex too far inward or stay collapsed for too long pronation is considered excessive. We call this overpronation. Overpronation is by far the most common foot type. Pronation is not linked one-to-one with low arches. Although pronation lowers the arches, this does not mean that only those with low arches overpronate. People with high arches can also overpronate! Some of us have always overpronated, for others overpronation develops with age, weight gain, regular standing work or intensive exercise.Over Pronation

Causes

Acquired "Flat Feet" this develops over a period of time rather than at birth (unlike Congenital "Flat Feet"). In children, many different factors may contribute to the development of this condition such as the type of shoes that a child wears, a child's sitting or sleeping positions or it may occur as some type of compensation for other abnormalities located further up the leg. Compensation may occur due to the rupture (tearing) of ligaments or tendons in the foot. One common reason for this condition is that the foot is compensating for a tight Achilles Tendon. If this tendon is tight it may cause the foot to point downward away from the body. This gives the body the perception that the affected leg is longer in length and the body attempts to compensate for the perceived additional length by flattening out the foot arch in an attempt to provide balance and stability.

Symptoms

Overpronation may have secondary effects on the lower legs, such as increased rotation of the tibia, which may result in lower leg or knee problems. Overpronation is usually associated with many overuse injuries in running including medial tibial stress syndrome, or shin splints, and knee pain Individuals with injuries typically have pronation movement that is about two to four degrees greater than that of those with no injuries. Between 40% and 50% of runners who overpronate do not have overuse injuries. This suggests that although pronation may have an effect on certain injuries, it is not the only factor influencing their development.

Diagnosis

Do the wet foot test. Get your feet wet and walk along a paved surface or sand and look at the footprints you leave. If you have neutral feet you will see a print of the heel with a thin strip connecting to your forefoot, but if you're overpronating your foot print will look a bit like a giant blob with toes.Overpronation

Non Surgical Treatment

Anti-Pronation Insoles provide a unique foot support system that aligns the lower body. The major cause of foot and leg pain is over pronation (rolling over of the feet) which causes excessive pressure on the muscles, ligaments and bones of the lower body. Running insoles treat the underlying cause of over pronation and prevent future occurrences of the associated foot or leg condition. A project conducted at the NIKE Sport Research Laboratory studied the effects of orthotics on rear foot movement in running. Nine well-trained runners who wore orthotics were chosen as subjects. The results of the study indicated that orthotics reduced rear foot movement by roughly one degree or approximately nine percent of the amount found in runners not using orthotics. The average reduction of the maximum velocity of pronation was fifteen percent. Thus this study indicates that orthotics and insoles control over pronation which will treat and prevent many sporting injuries.

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.
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Sat

23

May

2015

Physical Therapy And Severs Disease

Overview

Sever?s disease occurs in children when the growing part of the heel is injured. This growing part is called the growth plate. The foot is one of the first body parts to grow to full size. This usually occurs in early puberty. During this time, bones often grow faster than muscles and tendons. As a result, muscles and tendons become ?tight.? The heel area is less flexible. During weight-bearing activity (activity performed while standing), the tight heel tendons may put too much pressure at the back of the heel (where the Achilles tendon attaches). This may injure the heel.

Causes

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

Symptoms

Pain in the lower calf and heel area which may be worse when applying pressure either side. Pain worse on activity especially those involving running or jumping. In severe cases this may cause the child to limp when walking. One or both heels affected.

Diagnosis

Radiography. Most of the time radiographs are not helpful because the calcaneal apophysis is frequently fragmented and dense in normal children. But they can be used to exclude other traumas. Ultrasonography. could show the fragmentation of secondary nucleus of ossification of the calcaneus in severs?s disease. This is a safe diagnostic tool since there is no radiation. This diagnostic tool can also be used to exclude Achilles tendinitis and/or retrocalcaneal bursitis.

Non Surgical Treatment

If your child lets you know that his heels are hurting, schedule a doctor's appointment. Your family doctor may or may not refer you to a podiatrist. Treatment for Sever's Disease typically consists of one or more of the following steps. Reducing physical activity. Because Sever's Disease appears to be most common in athletic children, reducing exercise periods will relieve pressure on the heel bones, thereby reducing pain. Your doctor may recommend that your child take a complete break from athletic activity for a set amount of time. Icing the heel bones can help to lower both inflammation and pain levels. Use a cold pack or wrap ice in a towel and apply it to the heels. A new exercise regimen that involves simple stretches designed to lengthen the calf muscles and tendons. Your doctor may prescribe the use of orthotic shoe inserts that will assist your child in maintaining a good level of physical activity. HTP Heel Seats may be an excellent option and have been purchased by many parents as an effective aide for children suffering from Sever's Disease. Read about HTP Heel Seats here and ask your doctor if they are right for your child's unique case. In extreme cases, a doctor may recommend a plaster cast or boot, but typically only if other less cumbersome solutions fail to reduce pain. Some doctors may prescribe anti-inflammatory medications. Never give these to a child yourself, without first seeking a doctor's advice. Some medications carry the risk of serious side effects for children. Only give medications if specifically prescribed your child's physician.

Recovery

Although Sever's disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child's growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.
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Sun

29

Mar

2015

Everything You Will Need To Know About Heel Serious Pain

Overview

Foot Pain

Every time you take a step, one of your heels has to support the whole weight of your body. As you move, the load is equal to 20 times your own body weight. The load is softened by a pillow of fat under the heel and a large sinew or ligament (the fibrous tissue that joins muscle and bone together) under the sole of the foot. This sinew is called the plantar fascia and it pulls the heel bone forward (in opposition to the Achilles tendon, which pulls it backwards). If an athlete does not warm up properly or a person with a sedentary job exercises heavily during the weekends, they might overload the muscles of the calf or strain the Achilles tendon, which joins these muscles to the heel bone. When overloaded the tendon becomes tight and painfully inflamed, which places extra strain on the plantar fascia and muscles in the soles of the foot. The strained plantar fascia becomes inflamed and may even develop tiny cracks. This is known as plantar fasciitis. Every time you sit down, sleep or otherwise rest your legs, the muscles of the sole of the foot will contract in an attempt to protect the damaged sinew. The pain in the heel will then no longer be felt. But when you get up again and put weight on the foot, the foot and ankle may feel stiff (because of the inflammation) and the pain will return either at the back of the heel or on the soles of the feet. When you start to move, the plantar fascia may crack even more causing a vicious cycle of damage and Heel Pain. Inflammation at the point where the Achilles tendon (at the back of the heel) or the plantar fascia (under the heel) join the heel bone (a bone known as the Calcaneum) stimulates cells that form bone to deposit bone in this area, eventually leading to the build up of a bony prominence on the heel bone called a calcaneal spur. But it's not the spur itself that causes the pain. The spur is a sign of chronic inflammation in the connective tissues, which is the result of a prolonged overload. It should also be pointed out that heel spurs can occur on their own, without plantar fasciitis or pain, or may be linked to some types of arthritis (inflammation of the joints). And plantar fasciitis or Achilles tendonitis don't necessarily lead to spur formation.

Causes

some heel pain can be caused by rheumatological diseases, and these pains can do a real good impersonation of plantar fasciitis symptoms. Seronegative Arthropathies such as Psoriatic Arthritis, Reactive Arthritis and Ankylosing Spondylisis are the most common types to cause heel pain by producing an inflammatory reaction where the fascia attaches to the heel. This is called an enthesitis. If you have a history of Psoriasis or a family history of other arthritic conditions listed above we recommend you see a clinician about your heel pain to confirm the diagnosis. Another occasional cause of heel pain is loss of the cushioning fat pad of the heel, which can result in a bruised heel bone (calcaneus). If you can easily feel your heel bone through your skin on the bottom of your foot you may well have poor fatty tissue on your heel. Pressing on the centre of your heel should feel like pushing into firm rubber, and your skin should not move easily. If you can pinch the skin under your heel and feel a very hard lump when you press the bottom of your heel then it is likely you have a heel fat pad problem. One simple final test is to walk on a hard floor. If you feel the pain only when your heel hits the ground a fat pad problem is most likely. If the pain mainly occurs as you lift the heel off the ground it is more likely to be plantar fasciitis.

Symptoms

The heel can be painful in many different ways, depending on the cause. Plantar fasciitis commonly causes intense heel pain along the bottom of the foot during the first few steps after getting out of bed in the morning. This heel pain often goes away once you start to walk around, but it may return in the late afternoon or evening. Although X-ray evidence suggests that about 10% of the general population has heels spurs, many of these people do not have any symptoms. In others, heel spurs cause pain and tenderness on the undersurface of the heel that worsen over several months. In a child, this condition causes pain and tenderness at the lower back portion of the heel. The affected heel is often sore to the touch but not obviously swollen. 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. Pump bump, this condition causes a painful enlargement at the back of the heel, especially when wearing shoes that press against the back of the heel. Heel bruises, like bruises elsewhere in the body, may cause pain, mild swelling, soreness and a black-and-blue discoloration of the skin. Achilles tendonitis, this condition causes pain at the back of the heel where the Achilles tendon attaches to the heel. The pain typically becomes worse if you exercise or play sports, and it often is followed by soreness, stiffness and mild swelling. A trapped nerve can cause pain, numbness or tingling almost anywhere at the back, inside or undersurface of the heel. In addition, there are often other symptoms, such as swelling or discoloration - if the trapped nerve was caused by a sprain, fracture or other injury.

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

Non Surgical Treatment

The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments. A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery. Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

Prevention

Heel Discomfort

Flexibility is key when it comes to staving off the pain associated with these heel conditions. The body is designed to work in harmony, so stretching shouldn?t be concentrated solely on the foot itself. The sympathetic tendons and muscles that move the foot should also be stretched and gently exercised to ensure the best results for your heel stretches. Take the time to stretch thighs, calves and ankles to encourage healthy blood flow and relaxed muscle tension that will keep pain to a minimum. If ice is recommended by a doctor, try freezing a half bottle of water and slowly rolling your bare foot back and forth over it for as long as is comfortable. The use of elastic or canvas straps to facilitate stretching of an extended leg can also be helpful when stretching without an assistant handy. Once cleared by a doctor, a daily regimen of over-the-counter anti-inflammatory medication like Naproxen Sodium will keep pain at bay and increase flexibility in those afflicted by heel pain. While this medication is not intended to act as a substitute for medical assessments, orthopedics or stretching, it can nonetheless be helpful in keeping discomfort muted enough to enjoy daily life. When taking any medication for your heel pain, be sure to follow directions regarding food and drink, and ask your pharmacist about possible interactions with existing medications or frequent activities.
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