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March 02 2016

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Shoe Lifts The Professionals Option For Leg Length Imbalances

There are actually two different kinds of leg length discrepancies, congenital and acquired. Congenital implies you are born with it. One leg is anatomically shorter in comparison to the other. Through developmental periods of aging, the brain senses the walking pattern and recognizes some difference. Our bodies typically adapts by dipping one shoulder over to the "short" side. A difference of under a quarter inch isn't really abnormal, doesn't need Shoe Lifts to compensate and usually doesn't have a serious effect over a lifetime.

Leg Length Discrepancy Shoe Lifts

Leg length inequality goes mainly undiscovered on a daily basis, yet this problem is very easily solved, and can eradicate numerous cases of upper back pain.

Therapy for leg length inequality commonly involves Shoe Lifts. These are generally low cost, frequently costing under twenty dollars, compared to a custom orthotic of $200 or higher. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Upper back pain is easily the most widespread health problem impacting men and women today. Over 80 million men and women suffer from back pain at some stage in their life. It's a problem which costs companies millions every year as a result of lost time and output. Innovative and more effective treatment methods are continually sought after in the hope of minimizing the economical influence this condition causes.

Shoe Lift

Men and women from all corners of the earth suffer the pain of foot ache as a result of leg length discrepancy. In most of these cases Shoe Lifts might be of worthwhile. The lifts are capable of eliminating any discomfort and pain in the feet. Shoe Lifts are recommended by countless qualified orthopaedic orthopedists.

So that you can support the human body in a balanced fashion, feet have a crucial role to play. Irrespective of that, it is often the most neglected zone in the body. Some people have flat-feet meaning there is unequal force placed on the feet. This causes other areas of the body such as knees, ankles and backs to be impacted too. Shoe Lifts make sure that the right posture and balance are restored.
Tags: Shoe Lifts

September 28 2015

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Posterior Calcaneal Spur Causes

Calcaneal Spur

Overview

Heel spurs are a common reason for people to visit their podiatrist serving Scottsdale. These small calcium deposits can cause major pain, but treatments are available to relieve your symptoms. Heel spurs grow along the plantar fascia and create a sensation similar to that of a pebble being stuck in your shoe. Your podiatrist will use a physical exam plus X-rays to determine if a heel spur is the cause of your foot pain before beginning treatment. If you do have a heel spur, your podiatrist may recommend a cortisone injection to ease inflammation. Other techniques, such as stretching the calf muscles, treating the heel with ice, and wearing a custom orthotic may also provide relief from the discomfort of a heel spur.

Causes

A heel spur usually develops as a result of wear and tear over time, which leads to the degeneration of connective tissue called fascia. Standing for prolonged periods and wearing shoes that do not provide the right type of arch support can also lead to connective tissue damage in the heel. The body attempts to repair the damaged tissue by delivering calcium to the affected region, but sometimes too much calcium begins to accumulate and this results in painful plantar fasciitis.

Calcaneal 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

Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts. X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.

Non Surgical Treatment

Treatment of heel spurs is the same as treatment of plantar fasciitis. Because these problems are related, the treatment is the same. The first step in the treatment of a heel spur is short-term rest and inflammation control. Here are the steps patients should take in order to cure the symptoms of plantar fasciitis and heel spurs. Avoiding the activity that caused the symptoms is the first step in treatment. For example, take a few day off jogging or prolonged standing/walking. Just resting usually helps to eliminate the most severe pain, and will allow the inflammation to begin to cool down. Icing will help to diminish some of the symptoms and control the heel pain. Icing is especially helpful after a sudden flare up of symptoms. Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help patients feel better quickly. Many patients will work with a physical therapist, or you can try some simple activities on your own. If you need some help, meet with a therapist for a few sessions to learn a program you can continue on your own.

Surgical Treatment

In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.

September 22 2015

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The Diagnosis Of Heel Spur

Heel Spur

Overview

A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome." Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Causes

Over-pronation (flat feet) is a common cause of heel spurs, but people with unusually high arches (pes cavus) can also develop heel spurs. Women have a significantly higher incidence of heel spurs due to the types of footwear often worn on a regular basis.

Inferior Calcaneal Spur

Symptoms

Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain, especially while walking, jogging, or running, if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning, a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.

Diagnosis

Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts. X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.

Non Surgical Treatment

Treatment of Heel Spurs is the same as treatment of plantar fasciitis. To arrive at an accurate diagnosis, our foot and ankle Chartered Physiotherapists will obtain your medical history and examine your foot. Throughout this process the physio will rule out all the possible causes for your heel pain other than plantar fasciitis. The following treatment may be used. Orthotics/Insoles. Inflammation reduction. Mobilisation. Taping and Strapping. Rest.

Surgical Treatment

In some cases, heel spurs are removed by surgery after an X-ray. While the surgery is typically effective, it?s a timely and expensive procedure. Even after surgery, heel spurs can re-form if the patient continues the lifestyle that led to the problem. These reasons are why most people who develop painful heel spurs begin looking for natural remedies for joint and bone pain. Surgery isn?t required to cure a heel spur. In fact, more than 90 percent of people get better with nonsurgical treatments. If nonsurgical methods fail to treat symptoms of heel spurs after 12 months, surgery may be necessary to alleviate pain and restore mobility.

August 24 2015

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What Is Bursitis On The Feet?

Overview

Bursitis is inflammation or irritation of a bursa, a small sac located between a bone and muscle, skin, or tendon. The bursa allows smooth gliding between these structures. Below are some of the specific types of bursitis. Subacromial bursitis The subacromial bursa lies just above the rotator cuff. Bursitis often develops due to injury, impingement (pinching), overuse of the shoulder, or calcium deposits. Symptoms include pain in the upper shoulder or upper third of the arm, and severe pain upon moving the shoulder.

Causes

The most common causes of bursitis are injury or overuse, although infection may also be a cause. Bursitis is also associated with other causes, such as arthritis, gout, tendinitis, diabetes, and thyroid disease.

Symptoms

Pain at the back of the heel, especially when running uphill. Pain may get worse when rising on the toes (standing on tiptoes). Tenderness at the back of heel. Swelling at the back of heel.

Diagnosis

Like all other forms of bursitis, initially the physician will take down the history of symptoms experienced by the patient, this will be followed by a detailed physical examination which involves checking for inflammation signs like pain, redness, and warmth of the heel area. The physician might examine further by moving the ankle a little to determine the exact location of pain. Further diagnostic tests including x-ray, bone scans, and MRI scan might be suggested if required.

Non Surgical Treatment

Surgery should always be the last option. We believe that biologic treatments that preserve normal anatomy are very helpful, particularly for runner, athletes, and active professionals with buy schedules. All non-surgical approaches attempt to calm down the inflammation of the bursa and Achilles tendon. They do not address the bony bump, but they can substantially reduce and shrink the inflamed soft tissue. Some non-surgical treatments include Oral Anti-inflammatory Medications. NSAID's (non-steroidal anti-inflammatory medications) such as Motrin, Aleve, and Steroids (like prednisone) may help control the pain and stop the inflammation. Topical Anti-inflammatory Medications. NSAID's in cream or lotion form may be applied directly to the inflamed area. With these, there is no concern for stomach upset or other problems associated with oral medication. Ice. Ice can applied be applied right to the red, inflamed area and help calm it down. Try applying a podiatrist-approved ice pack to the affected area for 20 minutes of each hour. Just make sure you don't put ice directly against the skin. Exercises. Stretching exercises may relieve some of the tension in the Achilles tendon that started the problem. If you have Equinus Deformity (or a tight heel cord) this is critical to prevent it from coming back again. Heel lifts. Heel lifts placed inside the shoe can decrease the pressure on the Achilles tendon. Remember, pressure and friction cause the bump to become inflamed. Heel pads. Placing gel padding to cushion the Achilles tendon (at the back of the heel) can also help reduce irritation from shoes. Shoe modification. Wearing open-backed shoes, or shoes that have soft backs. This will also help stop the irritation. Physical therapy. Physical therapy, such as ultrasound, massage and stretching can all reduce the inflammation without surgery. Orthotic devices. Custom arch supports known as foot orthotics control abnormal motion in the foot that can allow the heel to tilt over and rub against the heel counter. Orthotics can decrease symptoms and help prevent it from happening again. Immobilization. In some cases, a walking cast boot or plaster/fiberglass cast is necessary to take pressure off the bursa and tendon, while allowing the area to calm down. ESWT. Extra-corporeal Shock Wave Therapy uses high energy sound waves to break up diseased tissue in the bursa and Achilles tendon and stimulate your own bodies healing processes to repair the diseased area. It may be done in the office or in a an outpatient surgery center. There is no incision and no stitches with ESWT. PRP. Platelet Rich Plasma (PRP) is a therapeutic injection. A small sample of blood is drawn from the patient and the healing factors found in the platelets are concentrated in a centrifuge. By injecting the concentrated solution right into the damaged Achilles tendon, a powerful healing can be stimulated. This can be done in the office. No hospital or surgery required.

Surgical Treatment

Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).

Prevention

Prevention can be accomplished by controlling your foot structure with good supportive shoes or arch supports. Pay attention to early signs of friction like blister formation. This tells you where the areas that are more likely to cause a bursa to form and subsequently a bursitis.

June 24 2015

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Hammertoe Repair

HammertoeOverview

hammertoe is a secondary problem originating from fallen cross arches. The toes start to curl and get pulled backwards, as the collapsed or pushed out metatarsal bones pull the tendons and ligaments, and causes them to get shorter and tighter. This condition causes the toes have higher pressure and they have limited movement and cannot be straightened fully. This can lead to numbness and pain in the toes as muscles, nerves, joints and little ligaments are involved with this condition. As the top part of the toe can rub against the shoe, it can cause corns and calluses.

Causes

Wearing ill-fitting shoes is probably the main cause of hammer toe. As the toe bends, tendons add to the problem by contracting in such a way that the bending is reinforced to the point of becoming permanent. In some cases, tendons that are abnormal to begin with may start the bending process.

HammertoeSymptoms

Symptoms of a hammertoe are Hammer toe usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most common at the level of the affected joint due to continuous friction of the deformity against your shoes.

Diagnosis

Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.

Non Surgical Treatment

Symptoms of hammer toe might be helped through corn pads or cushions to alleviate them. If the person's hammer toes were caused by an underlying disease, the person should ask for their doctor's advice prior to performing any exercises without consent. It is also important for a person with hammer toes to remember that they must not attempt to treat or remove corns by themselves. If open cuts result from attempts to remove them, an infection becomes a very real possibility. People who experience diabetes or conditions that lead to poor circulation in their feet need to be especially careful.

Surgical Treatment

Sometimes, if the deformity is severe enough or surgical modification is needed, the toe bones may be fused so that the toe does not bend. Buried wires are used to allow for the fusion to heal, and they remain in place after healing. Your skin is closed with fine sutures, which are typically removed seven to ten days after surgery. A dressing is used to help keep your toes in their new position. Dressings should not get wet or be removed. After surgery, your doctor may prescribe pain relievers, typically for the initial four to seven days. Most people heal completely within one month of surgery, with few complications, if any. Crutches or a cane may be needed to help you keep weight off your affected foot, depending on the procedure. Occasionally, patients receive a special post-op shoe or a walking boot that is to be worn during the healing process. Most people are able to shower normally after surgery, but must protect the dressing from getting wet. Many patients are allowed to resume driving within one week after the procedure, but care needs to be taken.

HammertoePrevention

The best treatment is good prevention! Hammertoe can be prevented by wearing shoes with ample toe room, avoiding high heels, and wearing adjustable shoes to assure a looser fit. When buying shoes, shop at the end of the day when your feet are swollen from daily activity, try both shoes on to confirm they fit properly, and if necessary, visit a shoe repair store to see if they can stretch your shoes for a better fit.
Tags: Hammertoe

June 07 2015

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What Are The Solutions For Bunions?

Overview
Bunions A bunion is an abnormal, bony bump that forms on the joint at the base of your big toe. Your big toe joint becomes enlarged, forcing the toe to crowd against your other toes. This puts pressure on your big toe joint, pushing it outward beyond the normal profile of your foot, and resulting in pain. Bunions can also occur on the joint of your little toe (bunionette). Bunions can occur for a number of reasons, but a common cause is wearing shoes that fit too tightly. They can also develop as a result of inherited structural defect, injury, stress on your foot or another medical condition.

Causes
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won?t actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.

Symptoms
Movement of the big toe towards the smaller toes. Bulging bump on the outside of the base of the big toe. Restricted movement of the big toe. Swelling, inflammation, redness or soreness around your big toe joint. Persistent or sporadic dull, sharp or aching pain in or around the big toe. Corns, blisters and calluses which can develop when the first and second toes overlap. Over time, more severe symptoms can occur such as arthritis of the big toe, stress fractures and problems walking.

Diagnosis
People with bunions may be concerned about the changing appearance of their feet, but it is usually the pain caused by the condition that leads them to consult their doctor. The doctor will evaluate any symptoms experienced and examine the affected foot for joint enlargement, tissue swelling and/or tenderness. They will also assess any risk factors for the condition and will ask about family history. An x-ray of the foot is usually recommended so that the alignment of big toe joint can be assessed. This would also allow any other conditions that may be affecting the joint, such as arthritis, to be seen.

Non Surgical Treatment
Most bunions can be treated without surgery. The first step for treating bunions is to ensure that your shoes fit correctly. Often good footwear is all that is needed to alleviate the problem. Shoes that are wide enough to avoid pressure on the bunion are the obvious first step. Look for shoes with wide insteps and broad toes and definitely no high heels. Sometimes, you can get your existing shoes stretched out by a shoe repairer. Seek advice from a podiatrist. Pads and toe inserts. Protective bunion pads may help to cushion the joint and reduce pain. Toe inserts are available that splint the toes straight. It may be recommended that you wear some orthotics to improve your foot position when walking. Medicines. Some people find anti-inflammatory medicines, such as ibuprofen or aspirin, or paracetamol help ease the pain of their bunions. Bunions hard skin

Surgical Treatment
Surgery may be considered if your symptoms are severe and don't respond to non-surgical treatments. The type of surgery will depend on the level of deformity, the severity of your symptoms, your age, and any other associated medical conditions.

Prevention
Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunion problems can be managed without surgery. In general, bunions that are not painful do not need surgical correction. For this reason, orthopaedic surgeons do not recommend "preventive" surgery for bunions that do not hurt; with proper preventive care, they may never become a problem.
Tags: Bunions

June 05 2015

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Is Over-Pronation Of The Feet Uncomfortable

Overview

Pronation is the natural act of the body spreading the impact of walking, jogging or running throughout the foot evenly. As the foot strikes the ground, the ankle naturally rolls inward absorbing the shock of the ground and mobilizing to the terrain. Overpronation is when the ankle of the foot rolls in past its normal 15? of inward rotation. The cause of this could be many things such as foot type, biomechanics, or compensation strategies. People with flat feet often, although not always, overpronate.Over-Pronation

Causes

There are many biomechanical issues that can contribute to excessive pronation, including weak foot intrinsic muscles, limited ankle dorsiflexion mobility and calf flexibility, weak ankle invertor muscles (e.g. posterior tibialis), weak forefoot evertor muscles (peroneus longus), poor hip strength and control, Anterior pelvic tilting, heel InversionIn a person who overpronates, the heel bone goes into an everted position meaning that it turns out away from the midline of the body. The opposite motion of eversion is inversion. Inversion is a motion that needs to be controlled to prevent the foot from excessively pronating.

Symptoms

With over pronation, sufferers are most likely to experience pain through the arch of the foot. A lack of stability is also a common complaint. Over pronation also causes the foot to turn outward during movement at the ankle, causing sufferers to walk along the inner portion of the foot. This not only can deliver serious pain through the heel and ankle, but it can also be the cause of pain in the knees or lower back as well. This condition also causes the arch to sink which places stress on the bones, ligaments, and tendons throughout the foot. This may yield other common conditions of foot pain such as plantar fasciitis and heel spurs.

Diagnosis

One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).Pronation

Non Surgical Treatment

Overpronation of the feet can be corrected in some cases and in others it can be effectively managed. Overpronators can train themselves to change their running gait, wear arch supports, orthotic insoles or specialist shoes for overpronators. In order to determine exactly what is happening during the stride, it is necessary to have a gait analysis conducted by a professional. The extent of overpronation can then be determined, and the causes can be identified and corrected directly. The main corrective methods used for excessive pronation are orthotics. Orthotics are the most straightforward and simplest solution to overpronation. Orthotics are devices which can be slipped into shoes which will offer varying degrees of correction to the motion of the foot. Orthotics help to support the arches and distribute the body weight effectively, and are usually the best treatment choice for moderate to severe overpronation. Orthotics may require existing insoles to be removed from your shoes to accommodate them; although most running shoes will have a removable insole to accommodate an orthotic insole.

Prevention

Custom-made orthotics supports not only the arch as a whole, but also each individual bone and joint that forms the arch. It is not enough to use an over-the-counter arch support, as these generic devices will not provide the proper support to each specific structure of the arch and foot. Each pronated foot?s arch collapses differently and to different degrees. The only way to provide the support that you may need is with a custom-made device. This action of the custom-made orthotic will help to prevent heel spurs, plantar fasciitis, calluses, arch pain, and weakness of the entire foot.

May 23 2015

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Will Severs Disease Necessitate Surgery Treatment?

Overview

The true name of this complaint is calcaneal apophysitis which just means an inflamation of the growth centre of the bone in your heel as a result of pulling by the Achilles tendon - it is important to realise that it is not a disease but rather a condition that develops in the growing skeleton with activity. It is the most common cause of heel pain in young athletes, and is the second most common condition of its kind in the younger athelete after Osgood-Schlatter's disease. It is often seen at a time of rapid growth during which the muscles and soft tissues become tighter as the bones get longer. It occurs more in boys than girls and is seen most commonly between the ages of 8 and 14 years though it tends to be more prevalent in the younger of this group.

Causes

Children are at greatest risk of developing Sever's disease when they have reached the early part of a growth spurt in early puberty. For girls, this is typically around ages 8 to 10. For boys, it happens somewhere between the ages of 10 to 12. By the age of 15, the back of the heel has typically stopped growing in most children, and Sever's disease becomes rare. Any running or jumping activities can increase the odds that a child will develop Sever's disease. Soccer and gymnastics are two common sports that tend to put kids at risk.

Symptoms

The most common symptom of Sever's disease is acute pain felt in the heel when a child engages in physical activity such as walking, jumping or running. Children who are very active athletes are among the group most susceptible to experiencing Sever's disease because of the extreme stress and tension they place on their growing feet. Improper pronation, the rolling movement of the foot during walking or running, and obesity are all additional conditions linked to causing Sever's disease.

Diagnosis

Your Podiatrist or Physiotherapist will assist in diagnosing the injury and the extent of the damage. From this, they will develop a management plan which may include rest or activity modification, soft tissue treatment such as massage and stretching, correction of biomechanics through heel raises or orthoses and the progression through a series of specific strengthening exercises.

Non Surgical Treatment

In general, the goals for treatment include reducing the localized areas of inflammation. We recommend that patients utilize Ibuprofen every six to eight hours as needed. Stretching exercises on a daily basis, as well as prior to activity is thought to be helpful as well. Following work-outs and increased activities, it may be helpful to apply ice over affected areas. Heel cups are also available to provide cushion in shoes. In addition, for more severe symptoms, it may be helpful to refrain from sports and/or immobilize the area for a few weeks to help reduce the inflammation.

Prevention

Prevention consists of maintaining good flexibility through stretching exercises, avoid excessive running on hard surfaces, and use quality, well-fitting shoes with firm support and a shock-absorbent sole.

May 01 2015

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Ruptured Achilles Tendon Fallacies

Overview
Achilles tendonitis A rupture of the Achilles tendon is one of the more common types of tendon ruptures. As the largest tendon in the human body, the Achilles tendon is very important to one?s balance and stability. Patients who suffer an Achilles tendon rupture experience severe pain and often require Achilles tendon surgery to repair the damage. There are also less invasive methods of Achilles tendon treatment including, icing, anti-inflammatory medications, rehabilitation, taping or bracing, sports massages and more. Achilles tendon recovery is dependent on the health of the patient, and the severity of the injury.

Causes
Factors that may increase your risk of Achilles tendon rupture include some of the following. Age. The peak age for Achilles tendon rupture is 30 to 40. Sex. Achilles tendon rupture is up to five times more likely to occur in men than in women. Recreational sports. Achilles tendon injuries occur more often during sports that involve running, jumping, and sudden starts and stops, such as soccer, basketball and tennis. Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures. Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture.

Symptoms
Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel, an inability to bend your foot downward or "push off" the injured leg when you walk, an inability to stand on your toes on the injured leg, a popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward.

Diagnosis
Your doctor will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your doctor may ask you to do a series of movements or exercises to see how well you can move your lower leg. He or she may also examine your leg, heel and ankle and may squeeze your calf muscle to check the movement of your foot. You may need to have further tests to confirm if your tendon is torn, which may include the following. An ultrasound scan. This uses sound waves to produce an image of the inside of your leg. An MRI scan. This uses magnets and radio waves to produce images of the inside of your leg.

Non Surgical Treatment
Your doctor will advise you exactly when to start your home physical therapy program, what exercises to do, how much, and for how long to continue them. Alphabet Range of Motion exercises. Typically, the first exercise to be started (once out of a non-removable cast). While holding your knee and leg still (or cross your leg), you simply write the letters of the alphabet in an imaginary fashion while moving your foot and ankle (pretend that the tip of your toe is the tip of a pencil). Motion the capital letter A, then B, then C, all the way through Z. Do this exercise three times per day (or as your doctor advises). Freeze a paper cup with water, and then use the ice to massage the tendon area as deeply as tolerated. The massage helps to reduce the residual inflammation and helps to reduce the scarring and bulkiness of the tendon at the injury site. Do the ice massage for 15-20 minutes, three times per day (or as your doctor advises). Calf Strength exercises. This exercise is typically delayed and not used in the initial stages of rehabilitation, begin only when your doctor advises. This exercise is typically done while standing on just the foot of the injured side. Sometimes, the doctor will advise you to start with standing on both feet. Stand on a step with your forefoot on the step and your heel off the step. The heel and forefoot should be level (neither on your tip toes nor with your heel down). Lower your heel very slowly as low as it will go, then rise back up to the level starting position, again very slowly. This is not a fast exercise. Repeat the exercise as tolerated. The number of repetitions may be very limited at first. Progress the number of repetitions as tolerated. Do this exercise one to two times per day (or as your doctor advises). Achilles tendinitis

Surgical Treatment
Regaining Achilles tendon function after an injury is critical for walking. The goal of Achilles tendon repair is to reconnect the calf muscles with the heel bone to restore push-off strength. Those best suited for surgical repair of an acute or chronic Achilles tendon rupture include healthy, active people who want to return to activities such as jogging, running, biking, etc. Even those who are less active may be candidates for surgical repair. Non-operative treatment may also be an option. The decision to operate should be discussed with your orthopaedic foot and ankle surgeon.

Prevention
Here are some suggestions to help to prevent this injury. Corticosteroid medication such as prednisolone, should be used carefully and the dose should be reduced if possible. But note that there are many conditions where corticosteroid medication is important or lifesaving. Quinolone antibiotics should be used carefully in people aged over 60 or who are taking steroids.

April 27 2015

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Leg Length Discrepancy And Hip Pain

Overview

There are generally two kinds of leg length discrepancies. Structural discrepancy occurs when either the thigh (femur) or shin (tibia) bone in one leg is actually shorter than the corresponding bone in the other leg. Functional discrepancy occurs when the leg lengths are equal, but symmetry is altered somewhere above the leg, which in turn disrupts the symmetry of the legs. For example, developmental dislocation of the hip (DDH) can cause a functional discrepancy. In DDH, the top of the leg bone (femur) that is not properly positioned in the hip socket may hang lower than the femur on the other side, giving the appearance and symptoms of a leg length discrepancy.Leg Length Discrepancy

Causes

Leg length discrepancies can be caused by poor alignment of the pelvis or simply because one leg is structurally longer than the other. Regardless of the reason, your body wants to be symmetrical and will do its best to compensate for the length difference. The greater the leg length difference, the earlier the symptoms will present themselves to the patient. Specific diagnoses that coincide with leg length discrepancy include: scoliosis, lumbar herniated discs, sacroiliitis, pelvic obiliquity, greater trochanteric bursitis, hip arthritis, piriformis syndrome, patellofemoral syndrome and foot pronation. Other potential causes could be due to an injury (such as a fracture), bone disease, bone tumors, congenital problems (present at birth) or from a neuromuscular problem.

Symptoms

In addition to the distinctive walk of a person with leg length discrepancy, over time, other deformities may be noted, which help compensate for the condition. Toe walking on the short side to decrease the swaying during gait. The foot will supinate (high arch) on the shorter side. The foot will pronate (flattening of the arch) on the longer side. Excessive pronation leads to hypermobility and instability, resulting in metatarsus primus varus and associated unilateral juvenile hallux valgus (bunion) deformity.

Diagnosis

On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD. The LLD should be measured using bony fixed points. X-Ray should be taken in a standing position. The osteopath, physiotherapist or chiropractor will look at femoral head & acetabulum, knee joints, ankle joints.

Non Surgical Treatment

The treatment of LLD depends primarily on the diagnosed cause, the age of the patient, and the severity of the discrepancy. Non-operative treatment is usually the first step in management and, in many cases, LLD is mild or is predicted to lessen in the future, based on growth rate estimates in the two legs. In such cases, no treatment may be necessary or can be delayed until a later stage of physical maturity that allows for clearer prognostic approximation. For LLD of 2cm to 2.5cm, treatment may be as simple as insertion of a heel lift or other shoe insert that evens out leg lengths, so to speak. For more severe cases, heel lifts can affect patient comfort when walking, decrease ankle stability, and greatly increase the risk of sprains. For infants with congenital shortening of the limb, a prosthetic ? often a custom-fit splint made of polypropylene ? may be successful in treating more severe LLD without surgery. In many instances, however, a surgical operation is the best treatment for LLD.

Leg Length Discrepancy Insoles

Surgical Treatment

Large leg length inequalities can be treated by staged lengthenings or by simultaneous ipsilateral femoral and tibial lengthenings. Additionally, lengthenings can be combined with appropriately timed epiphysiodesis in an effort to produce leg length equality. Staged lengthenings are often used for congenital deficiencies such as fibular hemimelia, in which 15 cm or more may be needed to produce leg length equality. We typically plan for the final lengthening to be completed by age 13 or 14 years, and allow at least 3 years between lengthenings. Lengthening of both the tibia and femur simultaneously requires aggressive therapy and treatment of soft tissue contractures. Curran et al[57] reported the need for surgical release of soft tissue contractures in 3 of 8 patients treated with simultaneous ipsilateral femoral and tibial lengthenings. Lengthening over an IM nail can be done in an effort to decrease the amount of time the fixator needs to be worn and to prevent angular malalignment. This technique requires that the patient be skeletally mature and it carries a higher risk of osteomyelitis (up to 15%). Additionally, if premature consolidation occurs, a repeat corticotomy is more difficult.

April 19 2015

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What Is The Cause And Treatment For Adult Aquired Flat Feet

Overview
Posterior tibial tendon dysfunction is one of several terms to describe a painful, progressive flatfoot deformity in adults. Other terms include posterior tibial tendon insufficiency and adult acquired flatfoot. The term adult acquired flatfoot is more appropriate because it allows a broader recognition of causative factors, not only limited to the posterior tibial tendon, an event where the posterior tibial tendon looses strength and function. The adult acquired flatfoot is a progressive, symptomatic (painful) deformity resulting from gradual stretch (attenuation) of the tibialis posterior tendon as well as the ligaments that support the arch of the foot. 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
Symptoms are minor and may go unnoticed, Pain dominates, rather than deformity. Minor swelling may be visible along the course of the tendon. Pain and swelling along the course of the tendon. Visible decrease in arch height. Aduction of the forefoot on rearfoot. Subluxed tali and navicular joints. Deformation at this point is still flexible. Considerable deformity and weakness. Significant pain. Arthritic changes in the tarsal joints. Deformation at this point is rigid.

Diagnosis
Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course. Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is available. Check the anterior tibial tendon for size and strength.

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. Acquired flat feet

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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