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26 Jun 2015 

Non Surgical Hammer Toe Repair

HammertoeOverview


A #LINK is a common and painful deformity in the three middle toes where they appear to always be bent. Causes of hammer toes include shoes that don?t fit properly, foot injuries, bunions and rheumatoid arthritis. Having toe joints sticking out can cause them to rub and a person may walk differently, risking other foot conditions, such as metatarsalgia. Hammer toes can be a serious problem in people with diabetes or poor circulation.


Causes


Wearing shoes that squeeze the toes or high heels that jam the toes into the front of the shoe. Other causes or factors in the development of hammertoes can include an injury hammertoe such as badly stubbing your toe, arthritis and nerve and muscle damage from diseases such as diabetes. And, hammertoes tend to run in families, although it is more likely the faulty foot mechanics that lead to hammertoes that are inherited, not the hammertoes themselves. Hammertoe generally affect the smaller toes of the foot, especially the second toe, which for many people is the longest toe. It's uncommon for the big toe to be bent this way.


Hammer ToeSymptoms


Well-developed hammertoes are distinctive due to the abnormal bent shape of the toe. However, there are many other common symptoms. Some symptoms may be present before the toe becomes overly bent or fixed in the contracted position. Often, before the toe becomes permanently contracted, there will be pain or irritation over the top of the toe, particularly over the joint. The symptoms are pronounced while wearing shoes due to the top of the toe rubbing against the upper portion of the shoe. Often, there is a significant amount of friction between the toe and the shoe or between the toe and the toes on either side of it. The corns may be soft or hard, depending on their location and age. The affected toe may also appear red with irritated skin. In more severe cases, blisters or open sores may form. Those with diabetes should take extra care if they develop any of these symptoms, as they could lead to further complications.


Diagnosis


First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.


Non Surgical Treatment


If your toe is still flexible, your doctor may recommend that you change to roomier and more comfortable footwear and that you wear shoe inserts (orthotics) or pads. Wearing inserts or pads can reposition your toe and relieve pressure and pain. In addition, your doctor may suggest exercises to stretch and strengthen your toe muscles. These may include picking up marbles or a thin towel off the floor with your toes.


Surgical Treatment


In advanced cases in which the toe has become stiff and permanently bent, the toe can be straightened with surgery. One type of surgery involves removing a small section of the toe bone to allow the toe to lie flat. Surgery for hammertoe usually is classified as a cosmetic procedure. Cosmetic foot surgeries sometimes result in complications such as pain or numbness, so it's better to treat the problem with a shoe that fits properly.


Hammer ToePrevention


Daily modifications and correct shoe choices can prevent and slow the progression of hammertoe deformities. The main cause in hammertoe deformities is muscle/tendon dysfunction. Wearing of ill-fitting, tight, high heeled shoes contributes to the progression to hammertoe deformities. Also, bunion conditions can enhance the formation of hammertoes. A key to prevention of hammertoes is the wearing of correct footwear, specifically shoes with appropriate support and a deep, wide toe box.
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18 Jun 2015 

How To Get Rid Of Bunions On Feet

Overview
Bunion Pain A bunion is one problem that can develop due to hallux valgus, a foot deformity. The term "hallux valgus" is Latin and means a turning outward (valgus) of the big toe (hallux). The bone which joins the big toe, the first metatarsal, becomes prominent on the inner border of the foot. This bump is the bunion and is made up of bone and soft tissue.

Causes
Bunions can be caused by the following factors. Hereditary (especially via the female line). Rolling in (pronation) of the feet. Walking with turned out feet. Weakness of muscles controlling the big toe. Weakness of intrinsic muscles of the feet. Leaning on the big toe in a tendu, especially to second or derri?re. Reduced mobility of the big toe when on demi-pointe. Restricted pointe range.

Symptoms
A bunion, also called a hallux valgus, is a bony prominence on the inside of the big toe, caused by a misalignment of the joint. The overlying skin maybe swollen, red and tender. Bunions are often painful and can limit what shoes you can wear.

Diagnosis
Generally, observation is adequate to diagnose a bunion, as the bump is obvious on the side of the foot or base of the big toe. However, your physician may order X-rays that will show the extent of the deformity of the foot.

Non Surgical Treatment
Your doctor may recommend a prescription or over-the-counter pain reliever, as well as medication to relieve the swelling and inflammation. A heat pad or warm foot bath may also help relieve the immediate pain and discomfort. A few people may obtain relief with ice packs. If your bunion isn't persistently painful and you take action early on, changing to well-made, well-fitting shoes may be all the treatment you need. Your doctor may advise use of orthoses (devices that are used to improve and realign the bones of your foot), including bunion pads, splints, or other shoe inserts, provided they don't exert pressure elsewhere on the foot and aggravate other foot problems. In some cases, an orthotist (someone trained to provide splints, braces and special footwear to aid movement, correct deformity and relieve discomfort) can recommend shoes with specially designed insoles and uppers that take the pressure off affected joints and help the foot regain its proper shape. Bunions

Surgical Treatment
There are a range of different surgeries that can be performed with the goal of realigning the joint and relieving pain ranging from shaving off part of the bone to cutting and realigning the bone with pins and screws. Depending on the surgery full recovery can take months and require you to stay off the foot. One new type of surgery, called a tightrope, involves attaching a wire to the bone to try and pull it back into alignment, but be wary of this procedure because there have not been any long-term outcome studies yet.

Prevention
Wear insoles and well-fitting shoes to help slow down the progression of bunions and alleviate discomfort. Cushioning can also help alleviate discomfort. Consider wearing shoes with a wide toe box so they don't crowd your toes. Children can also develop bunions and should wear properly fitting shoes as their feet are still developing.
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21 Mayo 2015 

Severs Disease In Grown Ups

Overview


Sever's Disease, otherwise known as calcaneal apophysitis is an inflammation of the growth plate in the heel of growing children, typically adolescents. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. It usually resolves once the bone has completed growth or activity is lessened.


Causes


Sever?s Disease is thought to be caused by several reasons. Growth spurts. The muscles and tendons become tight due to rapid bone growth. Overuse. Sever?s Disease can also occur in children who are athletically active and overwork his or her muscles. Some physicians are beginning to caution parents about checking their children?s shoes to make sure they fit well and do not pinch or put undue pressure on the child?s feet. Pronation can also bring on Sever?s Disease.


Symptoms


The symptoms of Sever?s disease occur in the heel and the foot, and may worsen with activity. Pain and stiffness can occur in one or both heels. Symptoms can include. Swelling in the heel. Redness in the heel. Antalgic gait (such as limping). Foot pain or stiffness first thing in the morning or while walking. Pain that is worsened by squeezing the heel.


Diagnosis


Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.


Non Surgical Treatment


* Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.


* Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.


* Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).


* Anti-inflammatory creams: Also an effective management tool.


* Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.


* Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.


* Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.


* Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.


Prevention


Sever's disease may be prevented by maintaining good joint and muscle flexibility in the years leading up to, and during, their growth spurts (eg girls 8 to 10, boys 10 to 12). Foot arch problems such as flat feet should be addressed after the age of five if they don't appear to be self-correcting. If you are concerned, please ask your health practitioner. The most important factor is the amount of weight-bearing exercise your child is currently performing.
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15 Mar 2015 

The Causes And Treatment

Overview


Just as an old bridge would become unsafe as the structure was compromised, your feet can experience the same. If you have PTTD and the tendon continues to weaken, it simply won't be able hold up your arch. In this situation, the arch can fall or collapse, which is referred to as adult-acquired flat foot. You may experience pain and tenderness behind the inside of the ankle. Over time, in addition to the flattening of the foot, you may also notice a misalignment of the heel so that it no longer aligns underneath the rest of the leg. A tightening of the heel cord, arthritis, and possible deformity of the ankle joint may also occur. You may feel the discomfort move from the inside to the outside of the ankle as well. Flat foot can also contribute to problems with the plantar fascia, which is the tendon that runs along the length of your arch.Flat Foot






Causes


Posterior tibial tendon dysfunction is the most common cause of acquired adult flatfoot deformity. There is often no specific event that starts the problem, such as a sudden tendon injury. More commonly, the tendon becomes injured from cumulative wear and tear. Posterior tibial tendon dysfunction occurs more commonly in patients who already have a flat foot for other reasons. As the arch flattens, more stress is placed on the posterior tibial tendon and also on the ligaments on the inside of the foot and ankle. The result is a progressive disorder.






Symptoms


Posterior tibial tendon insufficiency is divided into stages by most foot and ankle specialists. In stage I, there is pain along the posterior tibial tendon without deformity or collapse of the arch. The patient has the somewhat flat or normal-appearing foot they have always had. In stage II, deformity from the condition has started to occur, resulting in some collapse of the arch, which may or may not be noticeable. The patient may feel it as a weakness in the arch. Many patients initially present in stage II, as the ligament failure can occur at the same time as the tendon failure and therefore deformity can already be occurring as the tendon is becoming symptomatic. In stage III, the deformity has progressed to the extent where the foot becomes fixed (rigid) in its deformed position. Finally, in stage IV, deformity occurs at the ankle in addition to the deformity in the foot.






Diagnosis


First, both feet should be examined with the patient standing and the entire lower extremity visible. The foot should be inspected from above as well as from behind the patient, as valgus angulation of the hindfoot is best appreciated when the foot is viewed from behind. Johnson described the so-called more-toes sign: with more advanced deformity and abduction of the forefoot, more of the lateral toes become visible when the foot is viewed from behind. The single-limb heel-rise test is an excellent determinant of the function of the posterior tibial tendon. The patient is asked to attempt to rise onto the ball of one foot while the other foot is suspended off the floor. Under normal circumstances, the posterior tibial muscle, which inverts and stabilizes the hindfoot, is activated as the patient begins to rise onto the forefoot. The gastrocnemius-soleus muscle group then elevates the calcaneus, and the heel-rise is accomplished. With dysfunction of the posterior tibial tendon, however, inversion of the heel is weak, and either the heel remains in valgus or the patient is unable to rise onto the forefoot. If the patient can do a single-limb heel-rise, the limb may be stressed further by asking the patient to perform this maneuver repetitively.






Non surgical Treatment


Nonoperative therapy for posterior tibial tendon dysfunction has been shown to yield 67% good-to-excellent results in 49 patients with stage 2 and 3 deformities. A rigid UCBL orthosis with a medial forefoot post was used in nonobese patients with flexible heel deformities correctible to neutral and less than 10? of forefoot varus. A molded ankle foot orthosis was used in obese patients with fixed deformity and forefoot varus greater than 10?. Average length of orthotic use was 15 months. Four patients ultimately elected to have surgery. The authors concluded that orthotic management is successful in older low-demand patients and that surgical treatment can be reserved for those patients who fail nonoperative treatment.


Adult Acquired Flat Foot






Surgical Treatment


Until recently, operative treatment was indicated for most patients with stage 2 deformities. However, with the use of potentially effective nonoperative management , operative treatment is now indicated for those patients that have failed nonoperative management. The principles of operative treatment of stage 2 deformities include transferring another tendon to help serve the role of the dysfunctional posterior tibial tendon (usually the flexor hallucis longus is transferred). Restoring the shape and alignment of the foot. This moves the weight bearing axis back to the center of the ankle. Changing the shape of the foot can be achieved by one or more of the following procedures. Cutting the heel bone and shifting it to the inside (Medializing calcaneal osteotomy). Lateral column lengthening restores the arch and overall alignment of the foot. Medial column stabilization. This stiffens the ray of the big toe to better support the arch. Lengthening of the Achilles tendon or Gastrocnemius. This will allow the ankle to move adequately once the alignment of the foot is corrected. Stage 3 acquired adult flatfoot deformity is treated operatively with a hindfoot fusion (arthrodesis). This is done with either a double or triple arthrodesis - fusion of two or three of the joints in hindfoot through which the deformity occurs. It is important when a hindfoot arthrodesis is performed that it be done in such a way that the underlying foot deformity is corrected first. Simply fusing the hindfoot joints in place is no longer acceptable.
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04 Mar 2015 

What's The Big Cause Of Achilles Tendonitis Problems ?

Overview


Achilles TendonTendinitis is the inflammation of a tendon. Tendons are thick cords of tissue that connect muscles to bone. Achilles tendinitis, or an inflammation of the Achilles tendon, is one of the most common causes of foot or ankle pain. Other types of foot/ankle tendinitis include posterior tibial tendinitis and peroneal tendinitis.


Causes


Tight or tired calf muscles, which transfer too much of the force associated with running onto the Achilles tendon. Not stretching the calves properly or a rapid increase in intensity and frequency of sport training can make calf muscles fatigued. Activities which place a lot of stress on the achilles tendon, such as hill running and sprint training, can also cause Achilles Tendinitis. Runners who overpronate (roll too far inward on their feet during impact) are most susceptible to Achilles Tendinitis. Runners with flat feet are susceptible to Achilles Tendinitis because flat feet cause a 'wringing out' effect on the achilles tendon during running. High arched feet usually absorb less shock from the impact of running so that shock is transferred to the Achilles tendon. Use of inappropriate footwear when playing sport or running e.g., sandals, can also put an extra load on the Achilles tendon. Shoes are now available that have been designed for individual sports and provide cushioning to absorb the shock of impact and support for the foot during forceful movements. Training on hard surfaces e.g., concrete, also increases the risk of Achilles Tendinitis. Landing heavily or continuously on a hard surface can send a shock through the body which is partly absorbed by the Achilles tendon. A soft surface like grass turf helps to lessen the shock of the impact by absorbing some of the force of the feet landing heavily on the ground after a jump or during a running motion.


Symptoms


Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.


Diagnosis


There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.


Nonsurgical Treatment


Treatment can range from cold compress and heel pads for minor cases, to physical rehabilitation, anti-inflammatory medicine, ultrasound therapy, and manual therapy. If you are a Michigan resident that suspects they have Achilles Tendinitis, please contact Dr. Young immediately; Achilles Tendinitis, if left untreated, can eventually result in an Achilles Tendon Rupture, which is a serious condition that is a partial or complete tear in the tendon. It can severely hinder walking and can be extremely painful and slow to recover.


Achilles Tendonitis


Surgical Treatment


There are three common procedures that doctor preform in order help heal the tendinitis depending on the location of the tendinitis and amount of damage to the tendon, including: Gastrocnemius recession - With this surgery doctors lengthen the calf muscles because the tight muscles increases stress on the Achilles tendon. The procedure is typically done on people who have difficulty flexing their feet even with constant stretching. Debridement and Repair - When there is less than 50% damage in the tendon, it is possible for doctors to remove the injured parts and repair the healthy portions. This surgery is most done for patients who are suffering from bone spurs or arthritis. To repair the tendon doctors may use metal or plastic anchors to help hold the Achilles tendon in place. Patients have to wear a boot or cast for 2 weeks or more, depending and the damage done to the tendon. Debridement with Tendon Transfer - When there is more the 50% damage done to the Achilles tendon, and Achilles tendon transfer is preformed because the remain healthy tissue is not strong enough. The tendon that helps the big toe move is attached to give added strength to the damaged Achilles. After surgery, most patients don?t notice any difference when they walk or run.


Prevention


If you're just getting started with your training, be sure to stretch after running, and start slowly, increasing your mileage by no more than 10% per week. Strengthen your calf muscles with exercises such as toe raises. Work low-impact cross-training activities, such as cycling and swimming, into your training.
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