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July 04 2017

availabledepict09

Do Fallen Arches Have To Have Surgery?

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Flat Feet

Flat feet is the most common foot deformity known. In fact, sixty million Americans or 25% of the U.S. population have flat feet. Some of these people may experience problems that limit their activities, while others can run marathons or play in the NBA. If you've ever seen your footprints in the sand and they looked more like bricks than feet, then you probably have flat feet. Simply stated, a flat foot is a foot that does not have an arch when standing. In the medical world, flat feet are associated with "pronated" feet. Pronated is merely the term used to describe the position of the foot when it is flexed upward (dorsiflexed), turned away from the body (abducted), and the heel is rolled outward (everted), all at the same time. A certain amount of pronation is required for normal walking, but too much pronation is often considered a foot's "worst enemy." Over time, excessive pronation can lead to many unpleasant problems including heel pain, bunions, hammertoes, shin splints, and even knee, hip, or back pain. In fact, one orthopedic surgeon discovered that 95% of his total knee replacement patients and 90% of his total hip replacement patients had flat feet. An easy way to tell if you pronate too much is to take a look at your athletic shoes-excessive wearing of the inside heel (arch side of the shoe) as compared to the outside is a classic indication of excessive pronation.

Causes

A fallen arch occurs because one of the main structures that support the arch has broken or torn. Usually it occurs without trauma, although a small injury associated with the onset of the pain is often recalled, it is sometimes difficult to determine whether the injury was clearly big enough to permanently injure the leg. I suspect that even before the symptoms that the structure that broke was weakening and the injury was simply the ?needle that broke the camels back?. The structure that is most commonly torn is the posterior tibial tendon. This tendon is attached to a muscle on the inside of the back of the ankle, and runs along the medial malleolus, the bony prominence on the inside of the ankle, to attach to a bone in the arch called the navicular bone. It usually begins to weaken and stretch along the back of the medial malleolus. It often begins as a swelling and the arch flattens over the next several weeks to months. As the arch flattens, other structures that support the arch begin to stretch and tear. The bones along the outside of the ankle begin to crush together, causing pain and swelling in this are, and the toes may tilt to the outside as the arch collapses. It is not known why this process begins. It is often associated with diabetes and rheumatoid arthritis and other inflammatory diseases. It also is more common as a person enters the fifty to seventy year age range. ?Fallen arches? are much more common in people who are already flat footed.

Symptoms

Flat feet may not cause any symptoms at all. Rigid flat feet may cause pain, calluses, blisters, or skin redness on the inner side of the foot. A stiff foot, weakness or numbness of the foot, Rapid wearing out of shoes-worn shoes lean in toward each other. Difficulty or pain with activities like running-in the foot, knee or hip.

Diagnosis

Diagnosis of flat feet or fallen arches can be made by your health practitioner and is based on the following. Clinical assessment involving visual gait assessment, as well as biomechanical assessment. A detailed family and medical history. A pain history assessment determining the location of painful symptoms. Physical palpation of the feet and painful areas. Imaging such as MRI or x-ray can be used by your practitioner to assist in the diagnosis.

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Non Surgical Treatment

Physiotherapists will carry out a detailed biomechanical assessment of your feet and lower limb. Once the causes have been identified a number of treatment methods may be used to help relieve pain and restore function in the feet including the use of custom made orthotics to support the foot and offload the areas which are painful, strengthening exercises for weakened muscles and tendons in the arch, and massage and mobilisation techniques to help mobilise stiff tissue and joints in the foot.

Surgical Treatment

Acquired Flat Feet

Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.

Prevention

Strap the arches into the anatomically correct positions with athletic tape and leave them like this for some time. If the fallen arches are an issue with the muscular structure, this may give the muscles an opportunity to strengthen. This is definitely not a fallen arches cure all the time but it can help prevent it more times than not. Ask a doctor or physical therapists to show you how to do this taping. Find shoes that fit. This may require that you get your foot measured and molded to ensure that the shoe will fit. Shoes that are too big, too tight or too short, may not directly cause the fallen arches, but they can assist with the damage to the area. These shoes should have thick cushioning inside and have plenty of room for your toes. Walk without shoes as much as possible. Shoes directly assist with weakening and distorting the arches of the feet so going without shoes can actually help strengthen your arches and prevent fallen arches. Walking on hard and bumpy surfaces barefooted makes the muscles in your feet strengthen in order to prevent injury. It is a coping mechanism by your body. Insert heel cups or insoles into the shoes that you wear the most. Many people wear uncomfortable shoes to work and these are the same shoes that cause their arches the most problems. Inserting the heel cups and insoles into these shoes can prevent fallen arches from occurring. Many people place these inserts into all their shoes to ensure support. Ask a medical professional, either your doctor or a physical therapist, about daily foot exercises that may keep the arches stronger than normal. Many times, you can find exercises and stretches on the Internet on various websites. Curling your toes tightly and rotating your feet will help strengthen your longitudinal arches. Relax your feet and shake them for a minute or so before you do any arch exercises. This will loosen the muscles in your feet that stay tight due to normal daily activities. Wear rigid soled sandals whenever possible to provide a strong support for your arches. Wooden soled sandals are the best ones if available. Walk or jog on concrete as much as you can. This will create a sturdy support for your arches. Running or walking in sandy areas or even on a treadmill, does not give rigid support. Instead, these surfaces absorb the step, offering no support for arches.

After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.

July 03 2017

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What Are The Causes Of Heel Soreness

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Painful Heel

Heel pain accounts for one of the most common types of pain felt in the foot. Pain in the heel of the foot can be caused as a result of exercise, daily work routines or recreational activities. Some type of repetitive stress on the foot is often at the root of heel pain. The largest bone in the foot is the calcaneus, or heel bone. When we walk, the heel bone is usually the first part of the foot that hits the ground and is responsible for supporting much of the body's weight. This makes the heel of the foot prone to injury.

Causes

Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel may become tender or swollen from shoes with poor support or shock absorption, running on hard surfaces, like concrete, running too often, tightness in your calf muscle or the Achilles tendon. Sudden inward or outward turning of your heel, landing hard or awkwardly on the heel. Conditions that may cause heel pain include when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot, swelling of the fluid-filled sac (bursa) at the back of the heel bone under the Achilles tendon (bursitis). Bone spurs in the heel. Swelling of the thick band of tissue on the bottom of your foot (plantar fasciitis). Fracture of the heel bone that is related to landing very hard on your heel from a fall (calcaneus fracture).

Symptoms

The most common complaint is pain and stiffness in the bottom of the heel. Heel pain may be sharp or dull, and it may develop slowly over time or suddenly after intense activity. The pain is typically worse in the morning, when taking your first steps of the day. After standing or sitting for a while. When climbing stairs.

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non Surgical Treatment

Once diagnosed, treatment for plantar fasciitis may include one or more of the following: advice on footwear, in particular use of arch-supportive footwear; avoid walking barefoot; stretching exercises, shoe modifications such as heel pads, taping and strapping, anti-inflammatories and orthotic devices to correct abnormal foot mechanics. Injection therapy with corticosteroids is only advisable if all the conservative treatment methods mentioned above have been exhausted due to undesired effects implicated with steroid infusion in the heels.

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).

heel spur exercises

Prevention

Pain Of The Heel

You can reduce the risk of heel pain in many ways, including. Wear shoes that fit you properly with a firm fastening, such as laces. Choose shoes with shock-absorbent soles and supportive heels. Repair or throw out any shoes that have worn heels. Always warm up and cool down when exercising or playing sport, include plenty of slow, sustained stretches. If necessary, your podiatrist will show you how to tape or strap your feet to help support the muscles and ligaments. Shoe inserts (orthoses) professionally fitted by your podiatrist can help support your feet in the long term.

July 01 2017

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Leg Length Discrepancy Gait And Posture

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Bone growth restriction (epiphysiodesis) The objective of this surgical procedure is to slow down growth in the longer leg. During surgery, doctors alter the growth plate of the bone in the longer leg by inserting a small plate or staples. This slows down growth, allowing the shorter leg to catch up over time. Your child may spend a night in the hospital after this procedure or go home the same day. Doctors may place a knee brace on the leg for a few days. It typically takes 2 to 3 months for the leg to heal completely. An alternative approach involves lengthening the shorter bone. We are more likely to recommend this approach if your child is on the short side of the height spectrum.Leg Length Discrepancy

Causes

The causes of LLD may be divided into those that shorten a limb versus those that lengthen a limb, or they may be classified as affecting the length versus the rate of growth in a limb. For example, a fracture that heals poorly may shorten a leg slightly, but does not affect its growth rate. Radiation, on the other hand, can affect a leg's long-term ability to expand, but does not acutely affect its length. Causes that shorten the leg are more common than those that lengthen it and include congenital growth deficiencies (seen in hemiatrophy and skeletal dysplasias ), infections that infiltrate the epiphysis (e.g. osteomyelitis ), tumors, fractures that occur through the growth plate or have overriding ends, Legg-Calve-Perthes disease, slipped capital femoral epiphysis (SCFE), and radiation. Lengthening can result from unique conditions, such as hemihypertrophy , in which one or more structures on one side of the body become larger than the other side, vascular malformations or tumors (such as hemangioma ), which cause blood flow on one side to exceed that of the other, Wilm's tumor (of the kidney), septic arthritis, healed fractures, or orthopaedic surgery. Leg length discrepancy may arise from a problem in almost any portion of the femur or tibia. For example, fractures can occur at virtually all levels of the two bones. Fractures or other problems of the fibula do not lead to LLD, as long as the more central, weight-bearing tibia is unaffected. Because many cases of LLD are due to decreased rate of growth, the femoral or tibial epiphyses are commonly affected regions.

Symptoms

Children whose limbs vary in length often experience difficulty using their arms or legs. They might have difficulty walking or using both arms to engage in everyday activities.

Diagnosis

The most accurate method to identify leg (limb) length inequality (discrepancy) is through radiography. It?s also the best way to differentiate an anatomical from a functional limb length inequality. Radiography, A single exposure of the standing subject, imaging the entire lower extremity. Limitations are an inherent inaccuracy in patients with hip or knee flexion contracture and the technique is subject to a magnification error. Computed Tomography (CT-scan), It has no greater accuracy compared to the standard radiography. The increased cost for CT-scan may not be justified, unless a contracture of the knee or hip has been identified or radiation exposure must be minimized. However, radiography has to be performed by a specialist, takes more time and is costly. It should only be used when accuracy is critical. Therefore two general clinical methods were developed for assessing LLI. Direct methods involve measuring limb length with a tape measure between 2 defined points, in stand. Two common points are the anterior iliac spine and the medial malleolus or the anterior inferior iliac spine and lateral malleolus. Be careful, however, because there is a great deal of criticism and debate surrounds the accuracy of tape measure methods. If you choose for this method, keep following topics and possible errors in mind. Always use the mean of at least 2 or 3 measures. If possible, compare measures between 2 or more clinicians. Iliac asymmetries may mask or accentuate a limb length inequality. Unilateral deviations in the long axis of the lower limb (eg. Genu varum,?) may mask or accentuate a limb length inequality. Asymmetrical position of the umbilicus. Joint contractures. Indirect methods. Palpation of bony landmarks, most commonly the iliac crests or anterior iliac spines, in stand. These methods consist in detecting if bony landmarks are at (horizontal) level or if limb length inequality is present. Palpation and visual estimation of the iliac crest (or SIAS) in combination with the use of blocks or book pages of known thickness under the shorter limb to adjust the level of the iliac crests (or SIAS) appears to be the best (most accurate and precise) clinical method to asses limb inequality. You should keep in mind that asymmetric pelvic rotations in planes other than the frontal plane may be associated with limb length inequality. A review of the literature suggest, therefore, that the greater trochanter major and as many pelvic landmarks should be palpated and compared (left trochanter with right trochanter) when the block correction method is used.

Non Surgical Treatment

The non-surgical intervention is mainly usedfor the functional and environmental types of leg length discrepancies. It is also applied to the mild category of limb length inequality. Non-surgical intervention consists of stretching the muscles of the lower extremity. This is individually different, whereby the M. Tensor Fascia latae, the adductors, the hamstring muscles, M. piriformis and M. Iliopsoas are stretched. In this non-surgical intervention belongs also the use of shoe lifts. These shoe lifts consists of either a shoe insert (up to 10-20mm of correction), or building up the sole of the shoe on the shorter leg (up to 30-60mm of correction). This lift therapy should be implemented gradually in small increments. Several studies have examined the treatment of low back pain patients with LLD with shoe lifts. Gofton obtained good results: the patients experienced major or complete pain relief that lasted upon follow-up ranging from 3 to 11 years. Helliwell also observed patients whereby 44% experienced complete pain relief, and 45% had moderate or substantial pain relief. Friberg found that 157 (of 211) patients with LBP, treated with shoe lifts, were symprom-free after a mean follow-up of 18 months.

LLD Insoles

how to increase height in 1 week

Surgical Treatment

Bone growth restriction (epiphysiodesis) The objective of this surgical procedure is to slow down growth in the longer leg. During surgery, doctors alter the growth plate of the bone in the longer leg by inserting a small plate or staples. This slows down growth, allowing the shorter leg to catch up over time. Your child may spend a night in the hospital after this procedure or go home the same day. Doctors may place a knee brace on the leg for a few days. It typically takes 2 to 3 months for the leg to heal completely. An alternative approach involves lengthening the shorter bone. We are more likely to recommend this approach if your child is on the short side of the height spectrum.

June 05 2017

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Mortons Neuroma Remedies

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MortonThe nerves located on the bottom of the foot between the metatarsal heads (the bone of the toe closest to the foot) supply feeling, or sensation, to the toes. One of these nerves may become irritated by the ligament located above it, causing it to become thickened and painful. Generally this problem occurs most often between the third and fourth toes, but it can occur between the second and third toes as well. It is uncommon for a neuroma to be located between the first and second or fourth and fifth metatarsals. Rarely is there more than one neuroma in a foot.

Causes

Morton's neuroma is an inflammation caused by a buildup of fibrous tissue on the outer coating of nerves. This fibrous buildup is a reaction to the irritation resulting from nearby bones and ligaments rubbing against the nerves. Irritation can be caused by Wearing shoes that are too tight. Wearing shoes that place the foot in an awkward position, such as high heels. A foot that is mechanically unstable. Repetitive trauma to the foot such as from sports activities like tennis, basketball, and running. Trauma to the foot caused by an injury such as a sprain or fracture. It is unusual for more than one Morton's neuroma to occur on one foot at the same time. It is rare for Morton's neuroma to occur on both feet at the same time.

Symptoms

Morton's neuroma can cause a very painful burning or sharp pain in your foot that feels worse when you walk. It may feel like a small lump inside the ball of your foot. It is usually between the third and fourth toes, but it can also be between other toes.

Diagnosis

If you suspect Morton?s Neuroma, it is essential that you confirm your suspicions by consulting with a podiatric physician. Don?t wait for the symptoms to go away for good (even if they tend to come and go). Also, remember that many conditions have similar symptoms, and only a professional can tell the difference.

Non Surgical Treatment

Most non-operative treatment is usually successful, although it can take a while to figure out what combination of non-operative treatment works best for each individual patient. Non-operative treatment may include the use of comfort shoe wear. The use of a metatarsal pad to decrease the load through the involved area of the plantar forefoot. A period of activity modification to decrease or eliminate activities, which maybe exacerbating the patient?s symptoms. For example, avoiding long periods of standing or other activities that result in significant repetitive loading to the forefoot can be very helpful. Wearing high heels should be avoided. Local corticosteroid injections can help decrease inflammation associated with the nerve. However, this does not necessarily address the underlying loading forces that maybe causing the injury to the nerve in the first place. It has been proposed that an alcohol injection in and around the nerve will cause a controlled death to the nerve and subsequently eliminate symptoms from the nerve. In theory, this may be helpful. In practice, adequate prospective studies have not demonstrated the benefit of this procedure above and beyond the other standard non-operative treatments available. In addition there is the concern that the alcohol will cause excessive scarring and death of other important structures in the area.intermetatarsal neuroma

Surgical Treatment

If pain persists with conservative care, surgery may be an appropriate option. The common digitial nerve is cut and the Mortons neuroma removed. This will result is numbness along the inside of the toes affected, and there is a small chance the end of the nerve will form a Stump Neuroma. Approximately 75% of people receive symptom resolution for Mortons Neuroma with conservative care.

Prevention

While Morton?s Neuroma has been an ongoing topic of clinical investigation, the condition is in some cases difficult to either treat or prevent. Experimental efforts involving the injection of muscle or bone with chemicals such as alcohol, as well as suturing, and covering affected areas with silicone caps have been attempted, with varying success.

June 21 2015

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Flexible Hammertoe Treatment

Hammer ToeOverview

A hammertoe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery. People with hammer toe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes

Some causes of hammertoe are shoes that are too tight or short, shoes with high heels, injury, Diseases that affect the nerves and muscles, such as arthritis and diabetes. When shoes do not fit well, over time the pressure of the shoes pushes the toes into a bent position. After a while, the muscles become unable to straighten the toe, even when you are not wearing shoes. Similarly, when there is damage or disease of the nerves or muscles in the toes, the toe may rest in the bent position until the tendons become permanently shortened and the toe becomes a rigid hammertoe. The risk of developing a hammertoe increases with age. Women are much more likely to develop a hammertoe than men.

HammertoeSymptoms

For some people, a hammer toe is nothing more than an unsightly deformity that detracts from the appearance of the foot. However, discomfort may develop if a corn or callus develops on the end or top of the toe. If pressure and friction continue on the end or top of the toe, a painful ulcer may develop. Discomfort or pain can lead to difficulty walking.

Diagnosis

Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

Non Surgical Treatment

Your podiatrist may recommend conservative treatment techniques for your hammertoes based on your foot structure, which will likely involve removing any thick, painful skin, padding your painful area, and recommending for you shoes that give your curled toes adequate room. Conservative care strategies for this health purpose may also involve the use of Correct Toes, our toe straightening and toe spacing device.

Surgical Treatment

In more advanced cases of hammer toe, or when the accompanying pain cannot be relieved by conservative treatment, surgery may be required. Different types of surgical procedures are performed to correct hammer toe, depending on the Hammer toe location and extent of the problem. Surgical treatment is generally effective for both flexible and fixed (rigid) forms of hammer toe. Recurrence following surgery may develop in persons with flexible hammer toe, particularly if they resume wearing poorly-fitted shoes after the deformity is corrected.
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May 30 2015

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What Does Over-Pronation Mean

Overview

Pronation is a turning outward of the foot at the ankle, which allows the foot to flatten. The pronation helps to absorb some of the compressive shock forces, torque conversion, adjustment to uneven ground contours, and maintenance of balance. It is necessary to have a certain amount of pronation to disseminate the energy of the foot-strike. If there is too little or too much pronation injuries may occur. When a foot and ankle pronates to a great degree, we call it over-pronation. Normally you can see the Achilles Tendon run straight down the leg into the heel. If the foot is over-pronated, the tendon will run straight down the leg, but when it lies on the heel it will twist outward. This makes the inner ankle bone much more prominent than the outer ankle bone.Over-Pronation

Causes

Generally fallen arches are a condition inherited from one or both parents. In addition, age, obesity, and pregnancy cause our arches to collapse. Being in a job that requires long hours of standing and/or walking (e.g. teaching, retail, hospitality, building etc) contributes to this condition, especially when standing on hard surfaces like concrete floors. Last, but not least unsupportive footwear makes our feet roll in more than they should.

Symptoms

Overpronation causes alterations in proper muscle recruitment patterns leading to tightness in the outside of the ankle (lateral gastrocnemius, soleus, and peroneals). This tightness can lead to weakness in the opposing muscles such as the medial gastrocnemius, anterior tibialis, and posterior tibialis. If these muscles are weak, they will not be able to keep the knee in proper alignment, causing the valgus position. All this tightness and weakness can cause pain within the ankle, calf, and knee region. And it can send imbalance and pain all the way up to the upper back, if deep core strength is lacking and can't hold the pelvis in neutral.

Diagnosis

So, how can you tell if you have overpronation, or abnormal motion in your feet, and what plantar fasciitis treatment will work to correct it? Look at your feet. While standing, do you clearly see the arch on the inside of your foot? If not, and if the innermost part of your sole touches the floor, then your feet are overpronated. Look at your (running/walking) shoes. If your shoes are more worn on the inside of the sole in particular, then pronation may be a problem for you. Use the wet foot test. Wet your feet and walk along a section of pavement, then look at the footprints you leave behind. A normal foot will leave a print of the heel connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you?re feet are pronated there may be little distinction between the rear and forefoot.Over Pronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improper fitting footwear can lead to additional problems of the foot.

Surgical Treatment

The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.

May 17 2015

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Find Out How To Spot Severs Disease?

Overview

One of the most important things to know about Sever's disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. Most children can return to physical activity without any trouble once the pain and other symptoms go away. The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.

Causes

This condition is more common in boys than girls. It generally presents between the ages of 9-14 and peaks between ages 10-12 years. This injury can reoccur up until the age of 17, when the growth plate of the calcaneous generally closes. These types of injuries will commonly occur during periods of rapid growth. Sever?s Disease occurs more frequently in child with flat feet, but all children with flat feet will not get Sever?s.

Symptoms

The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localized to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) is absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.

Diagnosis

Children or adolescents who are experiencing pain and discomfort in their feet should be evaluated by a physician. In some cases, no imaging tests are needed to diagnose Sever?s disease. A podiatrist or other healthcare professional may choose to order an x-ray or imaging study, however, to ensure that there is no other cause for the pain, such as a fracture. Sever?s disease will not show any findings on an x-ray because it affects cartilage.

Non Surgical Treatment

The doctor might recommend that a child with Sever's disease. perform foot and leg exercises to stretch and strengthen the leg muscles and tendons, elevate and apply ice (wrapped in a towel, not applied directly to the skin) to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling, use an elastic wrap or compression stocking that is designed to help decrease pain and swelling, take an over-the-counter medicine to reduce pain and swelling, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).

Prevention

After the painful symptoms of Sever's disease have gone away, it is important to continue stretching the heel, particularly before a vigorous exercise, and wearing good supportive shoes fitted with children's arch supports. This will prevent heel pain recurrence until the child's heel is fully developed and less prone to injury.

May 05 2015

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Achilles Tendon Rupture Recovery Exercises

Overview
Achilles tendinitis The Achilles tendon connects the muscles in the back of your lower leg to your heel bone. It allows you to move your foot down (?step on the gas? motion). This movement is essential for walking, running, and jumping. A sudden strong contraction of the lower leg (such as when playing sports) can partially tear or rupture the Achilles tendon. This injury is more likely if there is prior injury or inflammation of that tendon from prior stress. You may feel a pop or snap, or like you have been kicked. An Achilles tendon tear will cause local swelling and pain and difficulty in walking. A complete Achilles rupture is usually treated with surgery to attach the torn ends of the tendon. This is followed by 6-8 weeks in a walking cast, boot, or splint. Nonsurgical treatment is an option, but it will take longer to heal and the risk of repeat rupture is greater. With either type of treatment, you will need a physical therapy program to strengthen your Achilles tendon. It will take 4-6 months to return to your former level of activity.

Causes
The exact cause of Achilles tendon ruptures is hard to say. It can happen suddenly, without warning, or following an Achilles tendonitis . It seems that weak calf muscles may contribute to problems. If the muscles are weak and become fatigued, they may tighten and shorten. Overuse can also be a problem by leading to muscle fatigue . The more fatigued the calf muscles are, the shorter and tighter they will become. This tightness can increase the stress on the Achilles tendon and result in a rupture. Additionally, an imbalance of strength of the anterior lower leg muscles and the posterior lower leg muscles may also put an athlete at risk for an injury to the Achilles tendon. An Achilles tendon rupture is more likely when the force on the tendon is greater than the strength of the tendon. If the foot is dorsiflexed while the lower leg moves forward and the calf muscles contract, a rupture may occur. Most ruptures happen during a forceful stretch of the tendon while the calf muscles contract. Other factors that may increase the risk of Achilles tendon rupture include. Tight calf muscles and/or Achilles tendon. Change in running surface eg: from grass to concrete. Incorrect or poor footwear. A change of footwear eg: from heeled to flat shoes. It is thought that some medical conditions, such as gout, tuberculosis and systemic lupus erythematosus, may increase the risk of Achilles tendon rupture.

Symptoms
Many people say that a ruptured Achilles feels like ?being shot in the heel?, if you can imagine how enjoyable that feels. You may hear a snap sound or feel a sudden sharp pain when the tendon tears. After a few moments, the pain settles and the back of the lower leg aches. You can walk and bear weight, but you may find it difficult to point the foot downward or push off the ground on the affected side. You will be unable to stand on tiptoe. Bruising and swelling are likely, and persistent pain will be present. Similar symptoms may be caused by an inflamed Achilles tendon (Achilles tendonitis), a torn calf muscle, arthritis of the ankle, or deep vein thrombosis in the calf, so an MRI or ultrasound scan will likely be used to diagnose your condition.

Diagnosis
During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if it has ruptured completely. The doctor may also ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she may then squeeze your calf muscle to see if your foot will automatically flex. If it doesn't, you probably have ruptured your Achilles tendon. If there's a question about the extent of your Achilles tendon injury, whether it's completely or only partially ruptured, your doctor may order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.

Non Surgical Treatment
Achilles tendon rupture is treated using non surgical method or surgical method. Non surgical treatment involves wearing a cast or special brace which is changed after some period of time to bring the tendon back to its normal length. Along with cast or brace, physical therapy may be recommended to improve the strength and flexibility of leg muscles and Achilles tendon. Achilles tendon

Surgical Treatment
Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was long thought to offer a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%). Of course, surgery imposes higher relative risks of perioperative mortality and morbidity e.g. infection including MRSA, bleeding, deep vein thrombosis, lingering anesthesia effects, etc.

Prevention
There are things you can do to help prevent an Achilles tendon injury. You should try the following. Cut down on uphill running. Wear shoes with good support that fit well. Always increase the intensity of your physical activity slowly. Stop exercising if you feel pain or tightness in the back of your calf or heel.

April 26 2015

availabledepict09

True Leg Length Discrepancy Testing

Overview

Although many of us assume our legs are the same length, it is very common for people to have one leg that is longer than the other. A leg length discrepancy (LLD) sounds alarming but people who have a discrepancy of 1cm may not even know their legs are differing lengths as often they don?t experience any problems. A Pedorthist will advise you if a leg length discrepancy or another foot or lower limb condition is the cause of your discomfort and develop a treatment plan for it.Leg Length Discrepancy

Causes

Leg length discrepancies can be caused by: hip and knee replacements, lower limb injuries, bone diseases, neuromuscular issues and congenital problems. Although discrepancies of 2 cm or less are most common, discrepancies can be greater than 6 cm. People who have LLD tend to make up for the difference by over bending their longer leg or standing on the toes of their shorter leg. This compensation leads to an inefficient, up and down gait, which is quite tiring and over time can result in posture problems as well as pain in the back, hips, knees and ankles.

Symptoms

Patients with significant lower limb length discrepancies may walk with a limp, have the appearance of a curved spine (non-structural scoliosis), and experience back pain or fatigue. In addition, clothes may not fit right.

Diagnosis

The evaluation of leg length discrepancy typically involves sequential x-rays to measure the exact discrepancy, while following its progression. In addition, an x-ray of the wrist allows us to more carefully age your child. Skeletal age and chronological age do not necessarily equal each other and frequently a child's bone age will be significantly different than his or her stated age. Your child's physician can establish a treatment plan once all the facts are known: the bone age, the exact amount of discrepancy, and the cause, if it can be identified.

Non Surgical Treatment

Treatment depends on the amount and cause of the leg length discrepancy as well as the age of your child. Typically, if the difference is less than 2 cm we don?t recommend immediate treatment. We may recommend that your child wear a heel lift in one shoe to make walking and running more comfortable. If the leg length discrepancy is more significant, your doctor may recommend surgery to shorten or lengthen a leg. The procedure used most often to shorten a leg is called epiphysiodesis.

Leg Length Discrepancy Insoles

Surgical Treatment

Bone growth restriction (epiphysiodesis) The objective of this surgical procedure is to slow down growth in the longer leg. During surgery, doctors alter the growth plate of the bone in the longer leg by inserting a small plate or staples. This slows down growth, allowing the shorter leg to catch up over time. Your child may spend a night in the hospital after this procedure or go home the same day. Doctors may place a knee brace on the leg for a few days. It typically takes 2 to 3 months for the leg to heal completely. An alternative approach involves lengthening the shorter bone. We are more likely to recommend this approach if your child is on the short side of the height spectrum.
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