Adena Saadat

Diabetes Foot Problems Toes

What Is The Perfect Strategy For Posterior Calcaneal Spur

Heel Spur

Overview

If you're feeling pain on the bottom of your foot near your heel, pain after exercise or activity, or pain first thing in the morning or after a long period of sitting, then you may have a heel spur. Heel spurs don't have a magic cure, but you can take steps to ease the pain and to eventually get rid of them.

Causes

One of the most common causes for the development of heel spurs is the wearing of shoes that are too tight. That?s why more women suffer from heel spurs more than men. Athletes who tend to stress their feet a lot, people are overweight who have more pressure on their lower extremities and the elderly also tend to suffer more from heel spurs.

Heel Spur

Symptoms

Most of the time heel spurs present as pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.

Diagnosis

A thorough medical history and physical exam by a physician is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.

Non Surgical Treatment

Heel spurs and plantar fascitis (inflammation of the plantar fascia) are usually controlled with conservative treatment. Early intervention includes stretching the calf muscles while avoiding reinjury to the plantar fascia. Decreasing or changing activities, losing excess weight, and improving the fit of shoes are all important measures to decrease foot pain. Modification of footwear includes well-padded shoes with a raised heel and better arch support. Shoe inserts recommended by a healthcare professional are often very helpful when used with exercises to increase the strength of the foot muscles and arch. The inserts prevent excessive pronation and continued tearing of the plantar fascia.

Surgical Treatment

Usually, heel spurs are curable with conservative treatment. If not, heel spurs are curable with surgery, although there is the possibility of them growing back. About 10% of those who continue to see a physician for plantar fascitis have it for more than a year. If there is limited success after approximately one year of conservative treatment, patients are often advised to have surgery.

What Are Bursitis Of The Foot Indications

Overview

Bursitis commonly affects joints used in repeated motions such as throwing a ball, or joints that bear pressure from being in the same position for a while, such as leaning on your elbows. The most common spots for bursitis are the shoulders, elbows or hips. Bursitis can also affect the knees (sometimes called ?housemaid?s knee? or ?vicar?s or preacher?s knee?), the heel of the foot or the base of the big toe. The good news is bursitis usually goes away with simple self-care treatments. However, not all cases of bursitis are from overuse, it can also be caused by an infection (called septic bursitis) or another condition such as arthritis. Therefore, it?s important to talk to your doctor if you think you have bursitis.

Causes

A bursa acts as a cushion and lubricant between tendons or muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel. It is where the large Achilles tendon connects the calf muscles to the heel bone. Repeated or too much use of the ankle can cause this bursa to become irritated and inflamed. Possible causes are too much walking, running, or jumping. This condition is usually linked to Achilles tendinitis. Sometimes retrocalcaneal bursitis may be mistaken for Achilles tendinitis. Risks for this condition include starting an aggressive workout schedule, or suddenly increasing activity level without the right conditioning.

Symptoms

Pain and tenderness usually develop slowly over time. Applying pressure to the back of the heel can cause pain. Wearing shoes may become uncomfortable. The back of the heel may feel achy. Pain is exacerbated when the foot is pointed or flexed, because the swollen bursa can get squeezed. A person with retrocalcaneal bursitis may feel pain when standing on their toes. Fever or chills in addition to other bursitis symptoms can be a sign of septic bursitis. Though uncommon, septic retrocalcaneal bursitis is a serious condition, and patients should seek medical care to ensure the infection does not spread.

Diagnosis

During the physical examination of a patient with calcaneal bursitis, the physician should keep the following considerations in mind. Swelling and redness of the posterior heel (the pump bump) may be clearly apparent. The inflamed area, which may be slightly warm to the touch, is generally tender to palpation. Careful examination can help the clinician to distinguish whether the inflammation is posterior to the Achilles tendon (within the subcutaneous calcaneal bursa) or anterior to the tendon (within the subtendinous calcaneal bursa). Differentiating Achilles tendinitis/tendinosis from bursitis may be impossible. At times, the 2 conditions co-exist. Isolated subtendinous calcaneal bursitis is characterized by tenderness that is best isolated by palpating just anterior to the medial and lateral edges of the distal Achilles tendon. Conversely, insertional Achilles tendinitis is notable for tenderness that is located slightly more distally, where the Achilles tendon inserts on the posterior calcaneus. A patient with plantar fasciitis has tenderness along the posterior aspect of the sole, but he/she should not have tenderness with palpation of the posterior heel or ankle. A patient with a complete avulsion or rupture of the Achilles tendon demonstrates a palpable defect in the tendon, weakness in plantarflexion, and a positive Thompson test on physical examination. During the Thompson test, the examiner squeezes the calf. The test is negative if this maneuver results in passive plantarflexion of the ankle, which would indicate that the Achilles tendon is at least partially intact.

Non Surgical Treatment

Most patients with achilles and retrocalcaneal bursitis heal well with appropriate physiotherapy and other usual bursitis conventional and natural cures being administered. Specific treatments for ankle / heel bursitis may include footwear correction. Get well-fitting, soft-backed (or even open-backed whenever possible) shoes for both day to day wear and exercise. High-heels should really be a no no or worn sparingly, ladies. Heel protectors. Heel pads and heel lifts are great simple solutions to cushion and protect the Achilles area from the irritation of the shoes. Orthotics. There are various orthotic devices out there (some only available over-the-counter). One example is a custom arch suppport. These can control abnormal motion in your feet by lining them up correctly in your shoes to help you move in the right matter so the bursitis heals faster and does not return back again. Exercise modification Stretch your heel, mainly Achilles tendon, frequently, particularly before and after excercise or prolonged sitting. If you are a jogger, try to run on softer surfaces (no hard concrete, please). Running uphill training is best to be avoided by Achilles and retrocalcaneal bursitis sufferers.

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.

Hammer Toe Surgery

Hammer ToeOverview

Hammer, claw, and mallet toes are toes that do not have the right shape. They may look odd or may hurt, or both. Tight shoes are the most common cause of these toe problems. A Hammer toes is a toe that bends down toward the floor at the middle toe joint. It usually happens in the second toe. This causes the middle toe joint to rise up. Hammer toes often occur with bunions. Claw toe often happens in the four smaller toes at the same time. The toes bend up at the joints where the toes and the foot meet. They bend down at both the middle joints and at the joints nearest the tip of the toes. This causes the toes to curl down toward the floor. A mallet toe often happens to the second toe, but it may happen in the other toes as well. The toe bends down at the joint closest to the tip of the toe.

Causes

While there are a number of causes, there aren't many specific risk factors for hammertoes, women tend to get these problems more than men, but they occur without rhyme or reason. Diabetics, however, are more likely to get a hammertoe if they have underlying nerve damage in the toes and feet.

Hammer ToeSymptoms

At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses.

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

What will a doctor do? Treat any foot complaints such as corns, calluses by periodically reducing the lesion and applying appropriate pads and dressings. Recommend the silicone toe prop. If an infection is present, then anti-septic dressings, antibiotics and pads hammertoes to redistribute pressure away from the lesion may be necessary. In the case of a mallet toe, trigger toe or claw toe. If a corn occurs at the end of the toe, a silicone or leather prop may be used to straighten the toe. In a hammertoe deformity, a silicone prop to redistribute pressure away from a corn may be necessary. The doctor may give footwear advice. In severe cases, corrective surgery may be necessary. The doctor may recommend orthosis to correct a mechanical complaint of the foot, such as 3/4 length silicone insoles.

Surgical Treatment

Surgery is used when other types of treatment fail to relieve symptoms or for advanced cases of hammertoe. There are several types of surgeries to treat hammertoe. A small piece of bone may be removed from the joint (arthroplasty). The toe joint may be fused to straighten it (arthrodesis). Surgical hardware, such as a pin, may be used to hold the bones in place while they heal. Other types of surgery involve removing skin (wedging) or correcting muscles and tendons to balance the joint.

Effective Home Treatment For Bunions

Overview
Bunions Hard Skin A bunion is a firm, painful bump that forms over a bony bulge at the base of the big toe. In most cases, the big toe joint also is enlarged and has degenerative arthritis. The toe also may be pushed toward the second toe (hallux valgus). Bunions tend to be inherited, but they also are common in the following groups. Women who wear high heels. People who wear shoes that are too narrow or too pointed. People with flatfeet. All of these situations force the big toe to drift toward the little toes, and this can cause bunions to form.

Causes
A true bunion or hallux valgus results from a drifting inwards of the big toe metatarsal from its normal position closer to the second metatarsal. The bunion is the head of this first metatarsal which produces the prominence on the inner side of the now wider foot. Tendons run circumferentially around the metatarsal and toe. They both move and stabilise the toe under normal circumstances. In a bunion or hallux valgus, with the shift/displacement of the first metatarsal these tendons no longer lie in the correct axis and in fact act as a deforming force, contributing to the bunion condition.

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
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.

Non Surgical Treatment
Wear comfortable shoes that don't squeeze your toes together. Sandals are ideal in warm weather. Cushioning the bunion with a donut-shaped bunion pad sold at drugstores can prevent any direct rubbing against your shoes. Have your shoes stretched to give your foot more room or consider switching to footwear customized to relieve pressure on the affected area. Soak your foot in warm water to help lessen the pain after a day on your feet. Apply ice packs several times a day to reduce swelling of painful and inflamed bunions. Take aspirin or ibuprofen for the inflammation and pain, and try supplementing with anti-inflammatory herbs such as ginger and turmeric (these work more slowly than the drugs). See a podiatrist for specially fitted shoes or orthotic devices that may help. Sometimes, surgery is necessary. Seek a second opinion before scheduling any operation. Bunions Hard Skin

Surgical Treatment
The decision to have bunion surgery is personal and different everyone. While there are many reasons to have bunion surgery, the most common reasons include. Pain. Difficulty walking. Difficulty fitting shoes. Worsening bunion. Pain at the ball of the foot. Failed conservative measures. See Non-surgical Treatment. Some people have surgery simply because they don?t like the way the bunion looks. While some doctors may correct your bunion if it doesn?t hurt, you should be aware that permanent pain may occur after your surgery.

The Treatments And Causes Of Overpronation

Overview

Excessive pronation is a common fault that occurs with the dynamic structure of the foot. Some degree of pronation is necessary for shock absorption. Excessive pronation, or collapsing of the arch, limits the foot?s ability to efficiently support the weight of the body. The altered position of the foot and ankle complex that occurs with high degrees of pronation also forces the rest of the lower body out of alignment. This can cause mechanical problems in muscles and joints traveling all the way up to the back. Arch strengthening is a vital part of maintaining healthy feet.Pronation

Causes

Unless there is a severe, acute injury, overpronation develops as a gradual biomechanical distortion. Several factors contribute to developing overpronation, including tibialis posterior weakness, ligament weakness, excess weight, pes planus (flat foot), genu valgum (knock knees), subtalar eversion, or other biomechanical distortions in the foot or ankle. Tibialis posterior weakness is one of the primary factors leading to overpronation. Pronation primarily is controlled by the architecture of the foot and eccentric activation of the tibialis posterior. If the tibialis posterior is weak, the muscle cannot adequately slow the natural pronation cycle.

Symptoms

Overpronation can lead to injuries and pain in the foot, ankle, knee, or hip. Overpronation puts extra stress on all the bones in the feet. The repeated stress on the knees, shins, thighs, and pelvis puts additional stress on the muscles, tendons, and ligaments of the lower leg. This can put the knee, hip, and back out of alignment, and it can become very painful.

Diagnosis

To easily get an idea of whether a person overpronates, look at the position and condition of certain structures in the feet and ankles when he/she stands still. When performing weight-bearing activities like walking or running, muscles and other soft tissue structures work to control gravity's effect and ground reaction forces to the joints. If the muscles of the leg, pelvis, and feet are working correctly, then the joints in these areas such as the knees, hips, and ankles will experience less stress. However, if the muscles and other soft tissues are not working efficiently, then structural changes and clues in the feet are visible and indicate habitual overpronation.Foot Pronation

Non Surgical Treatment

An orthotic is a device inserted inside the shoe to assist in prevention and/or rehabilitation of injury. Orthotics support the arch, prevent or correct functional deformities, and improve biomechanics. Prescription foot orthoses are foot orthoses which are fabricated utilizing a three dimensional representation of the plantar foot and are specifically constructed for an individual using both weightbearing and nonweightbearing measurement parameters and using the observation of the foot and lower extremity functioning during weightbearing activities. Non-prescription foot orthoses are foot which are fabricated in average sizes and shapes in an attempt to match the most prevalent sizes and shapes of feet within the population without utilizing a three dimensional representation of the plantar foot of the individual receiving the orthosis.

Surgical Treatment

Calcaneal "Slide" (Sliding Calcaneal Osteotomy) A wedge is cut into the heel bone (calcaneus) and a fixation device (screws, plate) is used to hold the bone in its new position. This is an aggressive option with a prolonged period of non-weightbearing, long recovery times and many potential complications. However, it can and has provided for successful patient outcomes.

Will Severs Disease Demand Surgery Treatment?

Overview

Sever disease refers to a calcaneal apophysitis (an inflammation of the apophysis of the heel) which occurs in children and young adolescents. It typically presents in active young children (especially ones who engage in jumping and running sports).

Causes

Sever disease is more common in children who do regular sports or exercise that puts pressure on the heels. Activities such as running and jumping can put stress on the tight muscles and tendons.

Symptoms

The condition can be quite disabling and tends to affect those who are very busy with sporting activities. In the initial stages of the condition, most children displaying signs of Severs disease will tend to hobble or limp off the sports field or court and complain of sore heels near the end of activity. As the condition progresses, children may complain of pain during activity and in severe cases prior to sporting activities. Kids heel pain can be quite discouraging for active children but, early treatment can resolve this type of foot pain in children very quickly.

Diagnosis

Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.

Non Surgical Treatment

The disease itself is self limiting and will resolve regardless of treatment once the growth plate has fully closed. Depending on the age of the youth at onset this could be a problem for many years. Treatment has always been aimed at managing the pain as well as the inflammation. This is done with the rest, ice, non steroidal anti-inflammatories like ibuprofen, stretching, taping, heel cups, heel lifts and orthotics. In severe cases, cast or walking boot immobilization is used. Each of these have differing levels of efficacy but in my experience orthotics are the golden treatment or the silver bullet. I am not talking about your run of the mill over the counter Dr. Scholls shoe insert. These definitely have their place in the world but not here. Custom molded orthotics made from a mold taken of the youths foot will provide the necessary control and support to stop the pain cycle. We can safely report over 85% of patients who are able to get back to sports and other activities as long as they wear the orthotics in supportive shoes as directed.

Causes Signals And Treating Of An Achilles Tendon Rupture

Overview
Achilles Tendinitis The Achilles' tendon is located in the leg just behind and above the heel. As the connection between the heel and calf muscle, its function is to allow the bending of the foot downwards. Generally if there is a tear to the Achilles' tendon it will be known as a rupture. This can be a partial tear or a complete tear, although partial tears are much rarer.

Causes
The cause of Achilles tendon ruptures besides obviously direct trauma, is multifactorial. In many instances the rupture occurs about 2-6 cm before its attachment to the calcaneous (heel bone). In this area there is a weaker blood supply making it more susceptible to injury and rupture. Rigid soled shoes can also be the causative factor in combination with the structure of your foot being susceptible to injury.

Symptoms
Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected side.

Diagnosis
When Achilles tendon injury is suspected, the entire lower lag is examined for swelling, bruising, and tenderness. If there is a full rupture, a gap in the tendon may be noted. Patients will not be able to stand on the toes if there is a complete Achilles tendon rupture. Several tests can be performed to look for Achilles tendon rupture. One of the most widely used tests is called the Thompson test. The patient is asked to lie down on the stomach and the examiner squeezes the calf area. In normal people, this leads to flexion of the foot. With Achilles tendon injury, this movement is not seen.

Non Surgical Treatment
The treatments of Achilles tendonitis include resting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling Achilles tendonitis. In patients who have more significant symptoms, a period of immobilization can help. Either a removable walking boot or a cast can allow the inflamed tendon to cool down quickly. A heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic and work shoes. Applying ice to the area of inflammation can help stimulate blood flow to the area and relieve the pain associated with inflammation. Apply ice several times a day, including after exercise. The pain and swelling most commonly associated with Achilles tendonitis can be improved with non-steroidal, anti-inflammatory medications (NSAIDs) which include Celebrex?, Advil?, Motrin?, Naprosyn?. Be sure to consult your physician before starting any medications. Physical therapists can help formulate a stretching and rehabilitation program to improve flexibility of the Achilles tendon. Cortisone injections should not be used for Achilles tendonitis. Studies have shown an increased incidence of Achilles tendon rupture after cortisone injections. Achilles Tendonitis

Surgical Treatment
Surgery is a common treatment for a complete rupture of the Achilles tendon. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair may be reinforced with other tendons. Surgical complications can include infection and nerve damage. Infection rates are reduced in surgeries that employ smaller incisions. After treatment, whether surgical or nonsurgical, you'll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months.