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Archive for March, 2015

Do I Suffer Adult Aquired Flat Foot?

Overview

Adult flatfoot (adult acquired flatfoot) or posterior tibial tendon dysfunction (PTTD) is a common pathology presented to foot and ankle specialists. PTTD is characterized by a valgus (everted) hindfoot, flattening of the longitudinal arch of the foot (collapse) and abduction of the forefoot. This is a progressive deformity that begins flexible and can become rigid over time. The posterior tibial tendon (PT) is one of the main supporting structures of the foot arch. Changes within this tendon cause flattening of the foot. There are four stages of this deformity that begins flexible and progressives, with no treatment, to a rigid deformity and with time may involve the ankle joint. Patients usually present with pain in the foot or ankle stating the ankle is rolling. Its also common for patients to state they have difficulty walking barefoot. Pain is exacerbated after physical activities. Pain is usually isolated to the inside of the foot along the course of the PT tendon.Acquired Flat Foot


Causes

Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.


Symptoms

As different types of flatfoot have different causes, the associated symptoms can be different for different people. Some generalized symptoms are listed. Pain along the course of the posterior tibial tendon which lies on the inside of the foot and ankle. This can be associated with swelling on the inside of the ankle. Pain that is worse with activity. High intensity or impact activities, such as running and jumping, can be very difficult. Some patients can have difficulty walking or even standing for long periods of time and may experience pain at the inside of the ankle and in the arch of the foot. Feeling like one is ?dragging their foot.? When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain in the bones and tendons in the outside of the ankle joint. Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot. These make shoe wear very difficult. Sometimes, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes. Diabetic patients may not experience pain if they have damage to their nerves. They may only notice swelling or a large bump on the bottom of the foot. The large bump can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoe wear is not used.


Diagnosis

There are four stages of adult-acquired flatfoot deformity (AAFD). The severity of the deformity determines your stage. For example, Stage I means there is a flatfoot position but without deformity. Pain and swelling from tendinitis is common in this stage. Stage II there is a change in the foot alignment. This means a deformity is starting to develop. The physician can still move the bones back into place manually (passively). Stage III adult-acquired flatfoot deformity (AAFD) tells us there is a fixed deformity. This means the ankle is stiff or rigid and doesn???t move beyond a neutral (midline) position. Stage IV is characterized by deformity in the foot and the ankle. The deformity may be flexible or fixed. The joints often show signs of degenerative joint disease (arthritis).


Non surgical Treatment

What are the treatment options? In early stages an orthotic that caters for a medially deviated subtalar joint ac-cess. Examples of these are the RX skive, Medafeet MOSI device. Customised de-vices with a Kirby skive or MOSI adaptation will provide greater control than a prefabricated device. If the condition develops further a UCBL orthotic or an AFO (ankle foot orthotic) could be necessary for greater control. Various different forms of surgery are available depending upon the root cause of the issue and severity.

Acquired Flat Feet


Surgical Treatment

Good to excellent results for more than 80% of patients have been reported at five years’ follow up for the surgical interventions recommended below. However, the postoperative recovery is a lengthy process, and most surgical procedures require patients to wear a plaster cast for two to three months. Although many patients report that their function is well improved by six months, in our experience a year is required to recover truly and gain full functional improvement after the surgery. Clearly, some patients are not candidates for such major reconstructive surgery.

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Understanding Heel Discomfort

Overview

Feet Pain

Heel Pain is a very challenging problem as it can be local and/or referred. It has been more prevalent recently due to the hard grounds on which people have to run. Commonly people will present with heel pain, thrusting an x-ray at you, and being adamant that the problem is a heel spur. This is defined as a small bone that grows from the heel, directing forwards towards the toes. This may be as small as 1 mm to anything as large as 8 – 10 mm. Most of the time, this is an incidental finding, as there many heels that are pain free that have heel spurs evident on x-rays. The spur is thought to be a result of traction of the plantar fascia on the heel. In some cases, the spur may contribute to the symptoms, but is not the main cause. This should be explained very carefully to the patient, as the focus on the spur may limit the recovery, as the patient may believe that the only way to eliminate the pain is to remove the spur.

Causes

Common causes of heel pain include Achilles tendinitis, Achilles tendon rupture, Bone tumor, Bursitis, Fibromyalgia, Fracture, Gout, Heel pad wear and tear, Heel spur, Osteomyelitis, Peripheral neuropathy, Pinched nerve, Plantar fasciitis, Rheumatoid arthritis, Stress fractures, Tarsal tunnel syndrome, Tendinitis. Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

Symptoms

Sever?s Disease. This is a condition that occurs in 10 – 15 year old children, predominantly boys and is associated with running and repetitive jumping. It is also associated with flimsy footwear that kids may wear. It occurs when the Achilles tendon continually pulls on the apophysis of the calcaneum and does not allow for it to fuse with the body of the calcaneum. Calcaneal enthesopathy. This occurs when there is repetitive trauma at the attachment of the Achilles tendon, resulting in a spur from the calcaneum up into the Achilles tendon. It is usually visualized on x-ray and may be tender if there is an associated bursitis or tendonitis. “Pump Bump”. Also known as Haglund?s Deformity, this is a bony enlargement that exists on the back of the heel – usually related to a congenital abnormality or with chronic bursitis, causing a thickening. There may have already been trauma or pressure from footwear. Treatment is usually protection of the bump and correct footwear. Associated with a symmetrical swelling at the base of the Achilles tendon. It is usually related to repetitive trauma or inappropriate footwear. It is often red and hot in the early stages. Treatment is usually to correct the footwear, provide padding and treat the local symptoms e.g. ice, rest, physiotherapy and cortisone injection. Fat Pad Syndrome. Direct contact with the base of the heel may result in trauma to the fat pad. Related to obesity, training on hard surfaces, uneven grounds, poor shoes especially overlarge shoes which can cause shearing forces on the heel. These conditions are renowned for taking a long time to recover – usually many months.

Diagnosis

A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.

Non Surgical Treatment

When consulting a doctor about heel pain, a patient can expect to be questioned about their level of pain, how long they?ve been experiencing it, and which activities aggravate or alleviate the condition. The doctor may order x-rays, a physical therapy regimen, or refer the afflicted individual to an orthopedic specialist for further examination. The doctor may attempt to recreate conditions that cause the heel pain to flare up in order to study reaction and cause in the patient, but this will be temporary and the doctor will stop this test at the request of the patient. A patient with heel pain may also be fitted with special inserts for their shoes to help correct arch and heel problems that cause pain. Heel problems can range from the mildly irritating to the nearly devastating, but proper prevention in care will help keep each step pain free. Advanced orthopedics, pain management, and technologically-honed surgical techniques ensure that no patient needs to suffer with the discomfort of heel pain and the restrictions it imposes on an active lifestyle.

Surgical Treatment

Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a “numbing” effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).

Prevention

Heel Discomfort

You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.

Understanding Heel Discomfort

Overview

Feet Pain

Heel Pain is a very challenging problem as it can be local and/or referred. It has been more prevalent recently due to the hard grounds on which people have to run. Commonly people will present with heel pain, thrusting an x-ray at you, and being adamant that the problem is a heel spur. This is defined as a small bone that grows from the heel, directing forwards towards the toes. This may be as small as 1 mm to anything as large as 8 – 10 mm. Most of the time, this is an incidental finding, as there many heels that are pain free that have heel spurs evident on x-rays. The spur is thought to be a result of traction of the plantar fascia on the heel. In some cases, the spur may contribute to the symptoms, but is not the main cause. This should be explained very carefully to the patient, as the focus on the spur may limit the recovery, as the patient may believe that the only way to eliminate the pain is to remove the spur.

Causes

Common causes of heel pain include Achilles tendinitis, Achilles tendon rupture, Bone tumor, Bursitis, Fibromyalgia, Fracture, Gout, Heel pad wear and tear, Heel spur, Osteomyelitis, Peripheral neuropathy, Pinched nerve, Plantar fasciitis, Rheumatoid arthritis, Stress fractures, Tarsal tunnel syndrome, Tendinitis. Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

Symptoms

Sever?s Disease. This is a condition that occurs in 10 – 15 year old children, predominantly boys and is associated with running and repetitive jumping. It is also associated with flimsy footwear that kids may wear. It occurs when the Achilles tendon continually pulls on the apophysis of the calcaneum and does not allow for it to fuse with the body of the calcaneum. Calcaneal enthesopathy. This occurs when there is repetitive trauma at the attachment of the Achilles tendon, resulting in a spur from the calcaneum up into the Achilles tendon. It is usually visualized on x-ray and may be tender if there is an associated bursitis or tendonitis. “Pump Bump”. Also known as Haglund?s Deformity, this is a bony enlargement that exists on the back of the heel – usually related to a congenital abnormality or with chronic bursitis, causing a thickening. There may have already been trauma or pressure from footwear. Treatment is usually protection of the bump and correct footwear. Associated with a symmetrical swelling at the base of the Achilles tendon. It is usually related to repetitive trauma or inappropriate footwear. It is often red and hot in the early stages. Treatment is usually to correct the footwear, provide padding and treat the local symptoms e.g. ice, rest, physiotherapy and cortisone injection. Fat Pad Syndrome. Direct contact with the base of the heel may result in trauma to the fat pad. Related to obesity, training on hard surfaces, uneven grounds, poor shoes especially overlarge shoes which can cause shearing forces on the heel. These conditions are renowned for taking a long time to recover – usually many months.

Diagnosis

A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.

Non Surgical Treatment

When consulting a doctor about heel pain, a patient can expect to be questioned about their level of pain, how long they?ve been experiencing it, and which activities aggravate or alleviate the condition. The doctor may order x-rays, a physical therapy regimen, or refer the afflicted individual to an orthopedic specialist for further examination. The doctor may attempt to recreate conditions that cause the heel pain to flare up in order to study reaction and cause in the patient, but this will be temporary and the doctor will stop this test at the request of the patient. A patient with heel pain may also be fitted with special inserts for their shoes to help correct arch and heel problems that cause pain. Heel problems can range from the mildly irritating to the nearly devastating, but proper prevention in care will help keep each step pain free. Advanced orthopedics, pain management, and technologically-honed surgical techniques ensure that no patient needs to suffer with the discomfort of heel pain and the restrictions it imposes on an active lifestyle.

Surgical Treatment

Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a “numbing” effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).

Prevention

Heel Discomfort

You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.

What’s The Primary Cause Of Achilles Tendonitis Painfulness ?

Overview

Achilles TendonAchilles Tendinitis is a painful condition. Running and walking are made possible by the Achilles tendon, which attaches the calf muscle to the heel bone. Strenuous exercise, jumping, and climbing are all movements that can strain the tendon and calf muscles, causing an inflammation known as tendinitis. The injury to the Achilles can be mild, requiring only rest and over-the-counter anti-inflammatory drugs, or severe, necessitating surgical repair of the damaged tendon. Chronic Achilles tendinitis can lead to micro tears in the tissue (tendinosis), which weaken the tendon and put it at risk for severe damage such as a tear or rupture.

Causes

There are two large muscles in the calf. These muscles are important for walking. They create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel. Heel pain is most often due to overuse of the foot. Rarely it is caused by an injury. Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes. Achilles tendinitis may be more likely to occur if you Suddenly increase the amount or intensity of an activity. Your calf muscles are very tight (not stretched out). You run on hard surfaces such as concrete. You run too often, you jump a lot (such as when playing basketball), you do not have shoes with proper support, your foot suddenly turns in or out. Tendinitis from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.

Symptoms

A symptom is something the patient feels and reports, while a sign is something other people, such as a doctor, detect. For example, pain is a symptom, while a rash is a sign. The most typical symptom of Achilles tendinitis is a gradual buildup of pain that deteriorates with time. With Achilles tendinitis, the Achilles tendon may feel sore a few centimeters above where it meets the heel bone. Other possible signs and symptoms of Achilles tendinitis are, the Achilles tendon feels sore a few centimeters above where it meets the heel bone, lower leg feels stiff or lower leg feels slow and weak. Slight pain in the back of the leg that appears after running or exercising, and worsens, pain in the Achilles tendon that occurs while running or a couple of hours afterwards. Greater pain experienced when running fast (such as sprinting), for a long time (such as cross country), or even when climbing stairs. The Achilles tendon swells or forms a bump or the Achilles tendon creaks when touched or moved. Please note that these symptoms, and others similar can occur in other conditions, so for an accurate diagnosis, the patient would need to visit their doctor.

Diagnosis

Your physiotherapist or sports doctor can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests. Achilles tendons will often have a painful and prominent lump within the tendon. Further investigations include US scan or MRI. X-rays are of little use in the diagnosis.

Nonsurgical Treatment

The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or aspirin, can reduce pain and swelling. Physical therapy and the use of an orthotic (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have failed, surgery may be recommended to remove and repair the damaged tissue.

Achilles Tendonitis

Surgical Treatment

Achilles tendon repair surgery is often used to repair a ruptured or torn Achilles tendon, the strong fibrous cord that connects the two large muscles in the back of your calf to your heel bone. These muscles (the gastrocnemius and the soleus) create the power needed to push off with your foot or rise up on your toes. Achilles tendon ruptures are quite common. Most happen during recreational activities that require sudden bursts of muscle power in the legs. Often a torn Achilles tendon can be diagnosed with a physical examination. If swelling is present, the orthopaedist may delay the Achilles tendon surgery until it subsides.

Prevention

You can take measures to reduce your risk of developing Achilles Tendinitis. This includes, Increasing your activity level gradually, choosing your shoes carefully, daily stretching and doing exercises to strengthen your calf muscles. As well, applying a small amount ZAX?s Original Heelspur Cream onto your Achilles tendon before and after exercise.