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July 04 2017

grotesquesuburb53

Pes Planus Causes, Signs And Symptoms And Treatment

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Flat Foot

We often think of fallen arches as a cause of foot pain, but they also stress your spine. In fact, fallen arches often contribute to unresolved or recurrent back pain. Excessive foot pronation (rolling in) can produce a short leg, pelvic unleveling, and increased curvature in your spine. Fallen arches place stress and strain on your feet, knees, hips, and spine. A custom orthotic can be a key part of your treatment plan in helping you get rid of your pain.

Causes

The arches of most individuals are fully developed by the age of 12 to 13. While some people are born with flat arches, for others, the arches fall over time. The tibial tendon, which runs along the inside of the ankle from above the ankle to the arch, can weaken with age and with heavy activity. The posterior tendon, main support structure for the arch, can become inflamed (tendonitis) or even tear if overloaded. For women, wearing high heels can affect the Achilles tendon and alter the structure and function of the ankle. The posterior tibial tendon may compensate for this stress and break down, causing the arches to fall. Obesity is another contributing factor, as well as a serious injury to the ankle or foot, arthritis and bad circulation such as occurs with diabetes.

Symptoms

The majority of children and adults with flexible flatfeet never have symptoms. However, their toes may tend to point outward as they walk, a condition called out-toeing. A person who develops symptoms usually complains of tired, aching feet, especially after prolonged standing or walking. Symptoms of rigid flatfoot vary depending on the cause of the foot problem. Congenital vertical talus. The foot of a newborn with congenital vertical talus typically has a convex rocker-bottom shape. This is sometimes combined with an actual fold in the middle of the foot. The rare person who is diagnosed at an older age often has a "peg-leg" gait, poor balance and heavy calluses on the soles where the arch would normally be. If a child with congenital vertical talus has a genetic disorder, additional symptoms often are seen in other parts of the body. Tarsal coalition. Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains. Lateral subtalar dislocation. Because this often is caused by a traumatic, high-impact injury, the foot may be significantly swollen and deformed. There also may be an open wound with bruising and bleeding.

Diagnosis

If you notice that your feet are flat, but you?re not really experiencing any pain, then you?re probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it?s better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that?s certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor?s own in-person examination.

fallen arches shoes

Non Surgical Treatment

Treatment in adults generally consists of wearing spacious, comfortable shoes with good arch support. Your doctor may recommend padding for the heel (heel cup) or orthotic shoe devices, which are molded pieces of rubber, leather, metal, plastic, or other synthetic material that are inserted into a shoe. They balance the foot in a neutral position and cushion the foot from excessive pounding. For children, treatment using corrective shoes or inserts is rarely needed, as the arch usually develops normally by age 5.

Surgery is rarely needed.

Surgical Treatment

Adult Acquired Flat Foot

Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.

Prevention

Orthotic inserts, either prescribed or bought over the counter, can help keep the arches fixed into position, but always wear them as although they support, they don?t strengthen, which is why some experts reccomend avoiding them. Gait analysis at a run specialist can help to diagnose overpronation and flat feet. Most brands produce shoes that will give support and help to limit the negative effects of a poor gait on the rest of the body. Barefoot exercises, such as standing on a towel and making fists with the toes, can help to strengthen the arches. Start easy and build up the reps to avoid cramping. Short barefoot running sessions can help take pressure off the arches by using the natural elasticity of the foot?s tendons to take impact and build strength to help prevent flat feet. These should be done on grass for only a few minutes at a time.

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.

June 29 2017

grotesquesuburb53

All The Things You Might Want To Understand About Heel Serious Pain

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Heel Discomfort

One of the most common foot problems seen by physicians is heel pain. Heel pain that occurs in adult patients is most commonly caused by a condition known as plantar fasciitis. This condition is sometimes also known as a heel spur. Heel pain can also be caused by other factors, such as stress fracture, tendinitis, arthritis, nerve entrapment, cyst in the heel bone.

Causes

Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel. The most common causes of heel pain are Plantar fasciitis (plantar fasciosis) - inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot. When the plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too. Heel bursitis, inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse. Heel bumps (pump bumps) common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature Tarsal tunnel syndrome, a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot. Chronic inflammation of the heel pad, caused either by the heel pad becoming too thin, or heavy footsteps. Stress fracture, this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused by osteoporosis. Severs disease (calcaneal apophysitis) the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected. Achilles tendonosis (degenerative tendinopathy) also referred to as tendonitis, tendinosis and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself correctly, the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful.

Symptoms

Symptoms include a dull ache which is felt most of the time with episodes of a sharp pain in the centre of the heel or on the inside margin of the heel. Often the pain is worse on first rising in the morning and after rest and is aggravated by prolonged weight bearing & thin soled shoes.

Diagnosis

In most cases, your GP or a podiatrist (a specialist in foot problems and foot care) should be able to diagnose the cause of your heel pain by asking about your symptoms and medical history, examining your heel and foot.

Non Surgical Treatment

Shoes, orthoses, splinting and/or immobilization form the cornerstone for successful functional management of plantar fasciitis.When you take the overuse nature of plantar fasciitis into account and attempt to re-establish the windlass mechanism of the foot, there is an enhanced potential for success. Unfortunately, too little attention has been directed to appropriately managing the shoes worn during treatment for plantar fasciitis. Emphasising motion control and stability type athletic shoes (that provide a firm heel cup, instep rigidity, longitudinal integrity and a well-integrated shoe upper) can help decrease excess eccentric tissue strain. The shoe also serves as a vital and functional link between an orthotic and the foot. Orthoses have long been considered to be a reliable method for treating plantar fasciitis. Considerable debate has been waged over the benefits of over-the-counter (OTC), prefabricated and prescription foot and/or ankle orthoses. Heel cushions, heel cups and cushioning pads appear to provide immediate pain relief for many people who have plantar fasciitis.This relief is frequently short-lived and requires other treatment modalities for success.Neutral position taping and strapping of the foot provides temporary symptomatic relief of pain caused by plantar fasciitis. Although the functional benefits are temporary and likely do not last longer than 10 minutes with exercise, the soft tissue compression and symptomatic relief afforded by the strapping can last for nearly a week.

Surgical Treatment

With the advancements in technology and treatments, if you do need to have surgery for the heel, it is very minimal incision that?s done. And the nice thing is your recovery period is short and you should be able to bear weight right after the surgery. This means you can get back to your weekly routine in just a few weeks. Recovery is a lot different than it used to be and a lot of it is because of doing a minimal incision and decreasing trauma to soft tissues, as well as even the bone. So if you need surgery, then your recovery period is pretty quick.

how to add a strap to high heels

Prevention

Feet Pain

Wear properly fitting shoes. Place insoles or inserts in your shoes to help control abnormal foot motion. Maintain a healthy weight. Exercise and do foot stretches as they have been shown to decrease the incidence of heel pain.
grotesquesuburb53

Leg Length Discrepancy Running

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If one of your child's legs is longer than the other leg, he or she has a common problem known as leg length discrepancy. A typical difference in leg length can be anywhere from one centimeter, which usually does not cause any problems, to more than six centimeters. The greater the discrepancy, the more your child must compensate his or her normal posture and walking pattern in day to day life, which can lead to a variety of symptoms, such as functional scoliosis, hip, knee and ankle problems.Leg Length Discrepancy

Causes

From an anatomical stand point, the LLD could have been from hereditary, broken bones, diseases and joint replacements. Functional LLD can be from over pronating, knee deformities, tight calves and hamstrings, weak IT band, curvature in the spine and many other such muscular/skeletal issues.

Symptoms

The most common symptom of all forms of LLD is chronic backache. In structural LLD the sufferer may also experience arthritis within the knee and hip are, flank pain, plantar fasciitis and metatarsalgia all on the side that is longer. Functional LLD sufferers will see similar conditions on the shorter side.

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 most common solution to rectify the difference in your leg lengths is to compensate for the short fall in your shortest leg, thereby making both of your legs structurally the same length. Surgery is a drastic option and extremely rare, mainly because the results are not guaranteed aswell as the risks associated with surgery, not to mention the inconvenience of waiting until your broken bones are healed. Instead, orthopediatrician's will almost always advise on the use of "heel lifts for leg length discrepancy". These are a quick, simple and costs effective solution. They sit under your heel, inside your shoe and elevate your shorter leg by the same amount as the discrepancy. Most heel lifts are adjustable and come in a range of sizes. Such lifts can instantly correct a leg length discrepancy and prevent the cause of associate risks.

Leg Length Discrepancy Insoles

what is a shoe lift?

Surgical Treatment

Surgery is another option. In some cases the longer extremity can be shortened, but a major shortening may weaken the muscles of the extremity. In growing children, lower extremities can also be equalized by a surgical procedure that stops the growth at one or two sites of the longer extremity, while leaving the remaining growth undisturbed. Your physician can tell you how much equalization can be attained by surgically halting one or more growth centers. The procedure is performed under X-ray control through very small incisions in the knee area. This procedure will not cause an immediate correction in length. Instead, the LLD will gradually decrease as the opposite extremity continues to grow and "catch up." Timing of the procedure is critical; the goal is to attain equal length of the extremities at skeletal maturity, usually in the mid- to late teens. Disadvantages of this option include the possibility of slight over-correction or under-correction of the LLD and the patient?s adult height will be less than if the shorter extremity had been lengthened. Correction of significant LLDs by this method may make a patient?s body look slightly disproportionate because of the shorter legs.

May 29 2017

grotesquesuburb53

What Is Mortons Neuroma

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plantar neuromaPatients with Morton?s neuroma present with pain in the forefoot, particularly in the ?ball? of the foot. However, not all pain in the forefoot is a Morton?s neuroma. In fact, most chronic pain in the forefoot is NOT the result of a Morton?s neuroma, but rather is from metatarsalgia - inflammation (synovitis) of the ?toe/foot? joints. The symptoms from Morton?s neuroma are due to irritation to the small digital nerves, as they pass across the sole of the foot and into the toes. Therefore, with a true Morton?s neuroma, it is not uncommon to have nerve-type symptoms, which can include numbness or a burning sensation extending into the toes. There are several interdigital nerves in the forefoot. The most common nerve to develop into a neuroma is between the 3rd and 4th toes. With a true neuroma, the pain should be isolated to just one or two toes.

Causes

There are orthoses and corrective shoes that can effectively alleviate disturbances to foot mechanics. A podiatric physician can prescribe the best corrective footwear and shoe inserts for all activities, work, exercise, play, walking, shopping and more, based on an analysis of the patient?s foot and his or her lifestyle. Improper footwear. Podiatric physicians have long believed that constricting, narrow, poor-fitting shoes with a tight or pointed toe box tend to compress the end of the foot, leading to abnormal motion of the foot and to excessive pressure in the area of the nerve. High-heeled shoes are a particular culprit here, since they put pressure on the area around wearer?s toes and the ball of the foot.

Symptoms

There may be pain at the end of the push-off phase when walking or running, and this pain is generally worse when the client is wearing shoes as opposed to being barefoot. Clients may also report a relief of symptoms by massaging the foot, which may spread the metatarsal heads and mobilize the entrapped nerve.

Diagnosis

Metatarsal bones will be examined clinically, and often an x-ray will be taken to assess the particular case and ensure against other conditions, including fracture. When the foot is examined by a doctor, he may feel a characteristic ?click,? referred to as Mulder?s sign, and the interspaces between toe bones will often be tender. The doctor may put pressure on these areas to localize the site of pain and test for other conditions, including calluses or stress fractures. Range of motion tests will also be applied to rule out arthritis or joint inflammations. X-rays may be required to ensure there are no stress fractures or arthritis within the joints that join the toes to the foot. Tenderness in one or more metatarsal bones may imply a pre-stress fracture or stress-fracture. An ultrasound scan may be used to confirm diagnosis of Morton?s Neuroma, as x-ray will not detect the condition, (but can confirm that the bones are uninjured).

Non Surgical Treatment

Initial treatment for Morton?s Neuroma may include non-prescription anti-inflammatory medications to reduce pain and swelling. These may consist of standard analgesics such as aspirin and ibuprofen (Advil, Motrin, others). Massaging the painful region three times daily with ice. Change of footwear. Avoid tight shoes, high heels or any footwear that seems to irritate the condition. Low heeled shoes with softer soles are preferable. Arch supports and foot pads to help reduce pressure on the nerve. In some cases, a physician may prescribe a customized shoe insert, molded to fit the contours of the patient?s foot. Reducing activities causing stress to the foot, including jogging, dancing, aerobic activity or any high impact movements of the foot. Injections of a corticosteroid medication to reduce the swelling and inflammation of the nerve and reduce pain. Occasionally other substances may be injected in order to ?ablate? the Neuroma. (The overuse of injected steroids is to be avoided however, as side effects, including weight gain and high blood pressure can result.)Morton neuroma

Surgical Treatment

When conservative measures are unsuccessful, surgery can be a good choice in the treatment of Morton's neuroma. The operation for Morton's neuroma does not require an overnight hospital stay. The anesthetic used is an ankle block, which completely numbs the foot during the surgery. The physician removes the neuroma from an incision made on the top of the foot between the involved metatarsal heads. The nerve to the interspace is exposed and cut next to the metatarsal heads.

Prevention

Wearing shoes that fit properly and that have plenty of room in the toe area may help prevent Morton's neuroma.

July 01 2015

grotesquesuburb53

Treatment For Hammer Toes Without Surgery

HammertoeOverview

A Hammer toe is a toe that tends to remain bent at the middle joint in a claw-like position. There are 2 types of hammer toe. Flexible hammer toe, can be straightened by hand. Rigid hammer toe, cannot be pulled straight and can be extremely painful. The position of the toe can also lead to corns or calluses. These may also be painful. Hammer toe may be present at birth or develop later in life due to tendons that have tightened, causing the toe's joints to curl downward. Occasionally, all toes may be bent. This may be due to problems with the peripheral nerves or the spinal cord.

Causes

It is possible to be born with a hammer toe, however many people develop the deformity later in life. Common causes include tightened tendons that cause the toe to curl downward. Nerve injuries or problems with the spinal cord. Stubbing, jamming or breaking a toe. Having a stroke. Being a diabetic. Having a second toe that is longer than the big toe. Wearing high heels or tight shoes that crowd the toes and don?t allow them to lie flat. Aging.

HammertoeSymptoms

A hammertoe may be present but not always painful unless irritated by shoes. One may have enlarged toe joints with some thickened skin and no redness or swelling. However, if shoes create pressure on the joint, the pain will usually range from pinching and squeezing to sharp and burning. In long standing conditions, the dislocated joints can cause the pain of arthritis.

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

Try to find shoes that are soft, roomy, and comfortable and avoid tight shoes or shoes with high heels. A shoe repair shop may be able to stretch a small pocket in regular shoes to make room for the hammertoe. Have a professional pedicure. Sometimes a skilled manicurist can file down a painful corn. Follow your healthcare provider's instructions. Ask your provider what activities you should avoid and when you can return to your normal activities, how to take care of yourself at home, what symptoms or problems you should watch for and what to do if you have them. Make sure you know when you should come back for a checkup.

Surgical Treatment

he basis for hammer toe surgery most often involves removing s portion of bone within the toe, to reduce the joint contracture. Depending on the direction the toe is deviated, soft tissue procedures may be necessary along with pinning the toe with a surgical Hammer toes wire.
Tags: Hammer Toe

June 27 2015

grotesquesuburb53

Hammer Toe Cause & Treatment

HammertoeOverview

What are hammertoes, mallet toes and claw toes? Often the words are used interchangeably to mean an abnormally contracted toe like the drawing above. Technically speaking, a "Hammer toe" is the name for a toe that is contracted at the first toe joint. If it's contracted at the second toe joint it is called a "mallet toe". IIf a toe is contracted at both toe joints, it is called a "claw toe". Each of these conditions can be quite uncomfortable and are cosmetically unappealing.

Causes

Most hammertoes are caused by wearing ill-fitting, tight or high-heeled shoes over a long period of time. Shoes that don't fit well can crowd the toes, putting pressure on the middle toes and causing them to curl downward. The condition may be more likely when the second toe is longer than the first toe or when the arch of the foot is flat. Hammertoe can also be present at birth (congenital). Hammertoe also can be caused by a bunion, which is the knobby bump that sometimes develops at the side of the big toe. A bunion causes the big toe to bend toward the other toes. The big toe can then overlap and crowd the smaller toes. Occasionally, a hammertoe is inherited or caused by arthritis in the toe joint.

Hammer ToeSymptoms

Pain upon pressure at the top of the bent toe from footwear. The formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.

Diagnosis

The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your hammertoes medical and family history.

Non Surgical Treatment

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

Surgical Treatment

Sometimes when the joints are removed the two bones become one as they are fused in a straightened position. Many times one toe will be longer than another and a piece of bone is removed to bring the toes in a more normal length in relation to each other. Sometimes tendons will be lengthened, or soft tissue around the joints will be cut or rebalanced to fix the deformity. Angular corrections may also be needed. The surgeon may place fixation in your foot as it heals which may include a pin, or wires.
Tags: Hammer Toes

June 02 2015

grotesquesuburb53

Over-Pronation Cause And Treatment

Overview

Overpronation is the most common abnormality found in the foot, and for this reason, is the most studied. The term that most people attribute to overpronation is ?flat feet.? Pronation is the rolling in of the foot and the collapse of the arch. Every person pronates to some extent and this is a necessary moment in the normal walking cycle as it allows the forefoot to make complete contact with the ground. A foot that overpronates acts like a loose bag of bones during the walking cycle. This makes this type of foot very flexible but inefficient. The foot has to work much harder to propel the body, fatiguing easily and placing mechanical stresses on the lower body. We like to use the analogy of digging a hole in the dirt. Overpronating feet are like using a broom to dig the hole. It won?t break down quickly, but you will be digging for a very long time, or until eventually wear and tear will take effect. Wouldn?t you rather have a shovel to work with. This is in essence what an orthotic can do for your feet. This is why orthotics have become an evidence based treatment for so many foot ailments, as they can effectively manage overpronation.Overpronation is when a person pronates too much and for too long. This places excess stress on the tendons and ligaments in the foot and ankle.Foot Pronation

Causes

There has been some speculation as to whether arch height has an effect on pronation. After conducting a study at the Rose-Hulman Institute of Technology, Maggie Boozer suggests that people with higher arches tend to pronate to a greater degree. However, the generally accepted view by professionals is that the most pronation is present in those with lower arch heights. To complicate matters, one study done by Hylton Menz at the University of Western Sydney-Macarthur suggests that the methods for measuring arch height and determining whether someone is ?flat-footed? or ?high-arched? are unreliable. He says, ?For this reason, studies investigating the relationship between static arch height motion of the rearfoot have consistently found that such a classification system is a poor predictor of dynamic rearfoot function.

Symptoms

Overpronation can be a contributing factor in other lower extremity disorders, such as foot pain, plantar fasciitis, ankle injuries, medial tibial stress syndrome (shin splints), periostitis, stress fractures and myofascial trigger points. Overpronation increases the degree of internal tibial rotation, thereby contributing to various knee disorders such as meniscal injury or ligament sprains. The effects of the postural deviation are exaggerated in athletes due to the increase in foot strikes while running and the greater impact load experienced. When running, three to four times the body weight is experienced with each foot strike.2 If overpronation exists, the shock force is not adequately absorbed by the foot and is transmitted further up the kinetic chain.

Diagnosis

If you have flat feet or low arches, chances are you overpronate. Although not always the case, the lower your arches the greater the overpronate. Stand on a hard surface (in front of a mirror if you need to) and look at your feet, flat feet or low arches are easy to spot. If your feet look flatter than a pancake, have a look at your ankles and see if they seem collapsed or straight. If they are, you're overpronating.Overpronation

Non Surgical Treatment

When you see the doctor, he or she will likely perform a complete examination of your feet and watch you walk. The doctor will need to take x-rays to determine the cause of your flat feet. In some cases, further imaging may be needed, especially if your symptoms are severe and sudden in nature. Once you are properly diagnosed, your doctor will create an appropriate treatment plan. There are several options to correct overpronation, such as orthotics. In many cases, overpronation can be treated with non-surgical methods and over-the-counter orthotics. In severe cases, however, custom-made orthotics may work better. Orthotics provide arch support and therefore prevent collapse of the arch with weight bearing. They are made of materials such as spongy rubber or hard plastic. Your doctor will also want to examine your footwear to ensure they fit properly and offer enough medial support. Extra support and stability can be achieved with footwear that has a firm heel counter. If you are experiencing pain, you should be able to use over-the-counter pain medications such as ibuprofen to relieve symptoms.

Prevention

Pronation forces us to bear most of our weight on the inner border of our feet. Custom-made orthotics gently redistributes the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist out at the ankle, but will strike the ground normally when the orthotics is used. This action of the custom-made orthotics will help to prevent shin splints, ankle sprains, knee and hip pain, lower back pain, nerve entrapments, tendonitis, muscle aches, bunions, generalized fatigue, hammer toes, and calluses.

May 17 2015

grotesquesuburb53

Calcaneal Apophysitis Physiotherapy

Overview

Sever's disease or Calcaneal apophysitis is a condition that affects children between the ages of 10 and 13 years. It is characterized by pain in one or both heels with walking. During this phase of life, growth of the bone is taking place at a faster rate than the tendons. Hence there is a relative shortening of the heel-cord compared to the leg bones. As a result, the tension the heel-cord applies to the heel bone at its insertion is very great. Moreover, the heel cord is attached to a portion of the calcaneus (heel bone) that is still immature, consisting of a mixture of bone and growing cartilage, called the calcaneal apophysis, which is prone to injury. Compounding to this is the fact that all these changes are happening in a very active child, prone to overuse. The end result is therefore an overuse syndrome of injury and inflammation at the heel where the heel cord (Achilles Tendonitis) inserts into the heel bone (Calcaneal apophysitis).

Causes

The most common of the Sever?s disease causes is when the heel bone grows more rapidly than the muscles and tendons in the leg. The muscles and tendons become tight and put additional stress on the growth plate in the heel. When this happens, the growth plate begins to swell, becomes tender, and the child will essentially begin to feel one or more Sever?s disease symptoms. It can occur in any child as they grow, but there are some common Sever?s disease causes and risk factors that make a child more prone to the condition. They include participation in sports and other activities that put pressure on the heel, such as basketball, track, and gymnastics. A pronated foot, which makes the Achilles tendon tight, increasing the strain on the growth plate of the heel. An arch that is flat or high, affecting the angle of the heel. Short leg syndrome, when one leg is shorter than the other, causing the shorter leg to pull more on the Achilles tendon in order to reach the ground. Obesity puts extra weight on the growth plate, which can cause it to swell.

Symptoms

Sever?s disease is more common in boys. They tend to have later growth spurts and typically get the condition between the ages of 10 and 15. In girls, it usually happens between 8 and 13. Symptoms can include pain, swelling, or redness in one or both heels, tenderness and tightness in the back of the heel that feels worse when the area is squeezed. Heel pain that gets worse after running or jumping, and feels better after rest. The pain may be especially bad at the beginning of a sports season or when wearing hard, stiff shoes like soccer cleats. Trouble walking. Walking or running with a limp or on tip toes.

Diagnosis

Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.

Non Surgical Treatment

If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position. If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. 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.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

April 16 2015

grotesquesuburb53

What Can Cause Posterior Tibial Tendon Dysfunction ?

Overview
The posterior tibialis muscle originates on the bones of the leg (tibia and fibula). This muscle then passes behind the medial (inside) aspect of the ankle and attaches to the medial midfoot as the posterior tibial tendon. The posterior tibial tendon serves to invert (roll inward) the foot and maintain the arch of the foot. This tendon plays a central role in maintaining the normal alignment of the foot and also in enabling normal gait (walking). In addition to tendons running across the ankle and foot joints, a number of ligaments span and stabilize these joints. The ligaments at the medial ankle can become stretched and contribute to the progressive flattening of the arch. Several muscles and tendons around the ankle and foot act to counter-balance the action of the posterior tibial tendon. Under normal circumstances, the result is a balanced ankle and foot with normal motion. When the posterior tibial tendon fails, the other muscles and tendons become relatively over-powering. These muscles then contribute to the progressive deformity seen with this disorder. Adult acquired flat feet

Causes
Rheumatoid arthritis This type of arthritis attacks the cartilage in the foot, leading to pain and flat feet. It is caused by auto-immune disease, where the body?s immune system attacks its own tissues. Diabetes. Having diabetes can cause nerve damage and affect the feeling in your feet and cause arch collapse. Bones can also fracture but some patients may not feel any pain due to the nerve damage. Obesity and/or hypertension (high blood pressure) This increases your risk of tendon damage and resulting flat foot.

Symptoms
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on the affected side.

Diagnosis
In the early stages of dysfunction of the posterior tibial tendon, most of the discomfort is located medially along the course of the tendon and the patient reports fatigue and aching on the plantar-medial aspect of the foot and ankle. Swelling is common if the dysfunction is associated with tenosynovitis. As dysfunction of the tendon progresses, maximum pain occurs laterally in the sinus tarsi because of impingement of the fibula against the calcaneus. With increasing deformity, patients report that the shape of the foot changes and that it becomes increasingly difficult to wear shoes. Many patients no longer report pain in the medial part of the foot and ankle after a complete rupture of the posterior tibial tendon has occurred; instead, the pain is located laterally. If a fixed deformity has not occurred, the patient may report that standing or walking with the hindfoot slightly inverted alleviates the lateral impingement and relieves the pain in the lateral part of the foot.

Non surgical Treatment
Conservative treatment is indicated for nearly all patients initially before surgical management is considered. The key factors in determining appropriate treatment are whether acute inflammation and whether the foot deformity is flexible or fixed. However, the ultimate treatment is often determined by the patients, most of whom are women aged 40 or older. Compliance can be a problem, especially in stages I and II. It helps to emphasise to the patients that tibialis posterior dysfunction is a progressive and chronic condition and that several fittings and a trial of several different orthoses or treatments are often needed before a tolerable treatment is found. Acquired flat foot

Surgical Treatment
If initial conservative therapy of posterior tibial tendon insufficiency fails, surgical treatment is considered. Operative treatment of stage 1 disease involves release of the tendon sheath, tenosynovectomy, debridement of the tendon with excision of flap tears, and repair of longitudinal tears. A short-leg walking cast is worn for 3 weeks postoperatively. Teasdall and Johnson reported complete relief of pain in 74% of 14 patients undergoing this treatment regimen for stage 1 disease. Surgical debridement of tenosynovitis in early stages is believed to possibly prevent progression of disease to later stages of dysfunction.

March 29 2015

grotesquesuburb53

All You Ought To Know About Heel Discomfort

Overview

Pain On The Heel

Does your heel feel painful when you get up from bed every morning, or when you get up after sitting down for a long period of time? If you often experience this sort of pain, known as first step pain, you could be suffering from plantar fasciitis (pronounced fash-ee-eye-tus), an inflammation of the plantar fascia, or the band of muscle under the foot. Plantar fasciitis is the most common cause of Heel Pain.

Causes

Pain in the foot can be due to a problem in any part of the foot. Bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or skin can be the source of foot pain. The cause of foot pain can be narrowed down by location and by considering some of the most common causes of foot pain. Plantar fasciitis is the most common cause of heel pain. The plantar fascia, a band of tough tissue connecting the heel bone to the toes, becomes irritated or inflamed. Heel pain, worst in the morning when getting out of bed, is the most common symptom. Arch pain may also be present.

Symptoms

See your doctor immediately if you have Severe pain and swelling near your heel. Inability to bend your foot downward, rise on your toes or walk normally. Heel pain with fever, numbness or tingling in your heel. Severe heel pain immediately after an injury. Schedule an office visit if you have. Heel pain that continues when you're not walking or standing. Heel pain that lasts more than a few weeks, even after you've tried rest, ice and other home treatments.

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

Clinical trials are underway investigating the use of radiofrequency to treat plantar fasciitis. It is a simple, noninvasive form of treatment. It allows for rapid recovery and pain relief within seven to 10 days. The radio waves promote angiogenesis (formation of new blood vessels) in the area. Once again, increasing blood flow to the damaged tissue encourages a healing response. Antiinflammatory medications are sometimes used to decrease the inflammation in the fascia and reduce your pain. Studies show that just as many people get better with antiinflammatories as those who don't have any improvement. Since these medications are rarely used alone, it's difficult to judge their true effectiveness. A cortisone injection into the area of the fascia may be used but has not been proven effective. Studies show better results when ultrasound is used to improve the accuracy of needle placement. Cortisone should be used sparingly since it may cause rupture of the plantar fascia and fat pad degeneration and atrophy, making the problem worse. Botulinum toxin A otherwise known as BOTOX has been used to treat plantar fasciitis. The chemical is injected into the area and causes paralysis of the muscles. BOTOX has direct analgesic (pain relieving) and antiinflammatory effects. In studies so far, there haven't been any side effects of this treatment.

Surgical Treatment

With the advancements in technology and treatments, if you do need to have surgery for the heel, it is very minimal incision that?s done. And the nice thing is your recovery period is short and you should be able to bear weight right after the surgery. This means you can get back to your weekly routine in just a few weeks. Recovery is a lot different than it used to be and a lot of it is because of doing a minimal incision and decreasing trauma to soft tissues, as well as even the bone. So if you need surgery, then your recovery period is pretty quick.

Prevention

Heel Pain

Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.
Tags: Heel Pain

March 05 2015

grotesquesuburb53

Living With Achilles Tendon Pain

Overview

Achilles TendonitisThe Achilles tendon attaches the calf muscle to the heel bone. Jumping, climbing and strenuous exercise can strain the tendon and calf muscle, which can cause the type of inflammation known as tendinitis. This injury can be mild enough that it can be treated by over-the-counter medications or so severe that it must be repaired surgically. Chronic tendinitis can cause microscopic tears in the muscle which can weaken the tendon and increase the risk for tear or rupture. Symptoms usually include pain and swelling near the ankle. Pain may lead to weakness in the area that increases with walking and running. Stiffness in the tendon may be worse in the morning.

Causes

Achilles tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptoms. In many people who have developed achilles tendonitis, chronic shortening of the gastroc-soleus muscle complex is the reason that home remedies and anti-inflammatory medications fail. In these instances the muscle itself becomes shortened and creates a constant stress at the tendon?s attachment. Like a green branch that is slowly bent, eventually it begins to breakdown. Over a prolonged period the tendon becomes inflamed, and in the worst cases, appears swollen and thickened. In certain circumstances attempts to heal have failed and the body?s inability to heal the tissue results in degenerative changes known as achilles tendonosis. Anti-inflammatory medication, stretching and ice may only provide temporary relief, because they address the inflammation but not the root cause.

Symptoms

Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning. The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.

Diagnosis

A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.

Nonsurgical Treatment

Self-care strategies include the following steps, often known by the acronym R.I.C.E, Rest. You may need to avoid exercise for several days or switch to an activity that doesn't strain the Achilles tendon, such as swimming. In severe cases, you may need to wear a walking boot and use crutches. Ice. To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain. Compression. Wraps or compressive elastic bandages can help reduce swelling and reduce movement of the tendon. Elevation. Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot elevated at night.

Achilles Tendonitis

Surgical Treatment

Mini-Open Achilles Tendon Repair. During a mini-open Achilles tendon repair surgery, 2 to 8 small stab incisions are made to pull the edges of the tendon tear together and suture the torn edges to repair the damage. During this procedure the surgeon will make one 3 to 4 cm long incision on the back of your ankle and 2 to 4 smaller vertical incisions around the long incision. These smaller veritical incisions are made with a pair of surgical scissors and are commonly referred to as "stab incisions". Once the incisions are opened up, the surgeon will place precise sutures with non-absorbable stitches to strengthen the damaged Achilles tendon tissue. This suturing technique reduces the amount of scar tissue on the tendon after surgery and provides better surface healing of the skin. Unlike the traditional method of an open surgery, this procedure has less risks and complications involved. To learn about all risks you may face be sure to speak to your doctor.

Prevention

So what are some of the things you can do to help prevent Achilles Tendinitis? Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Balancing Exercises, Any activity that challenges your ability to balance, and keep your balance, will help what's called proprioception, your body's ability to know where its limbs are at any given time. Plyometric Training, Plyometric drills include jumping, skipping, bounding, and hopping type activities. These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint. Footwear, Be aware of the importance of good footwear. A good pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion. Cool Down properly, Just as important as warming up, a proper cool down will not only help speed recovery, but gives your body time to make the transition from exercise to rest. Rest, as most cases of Achilles tendinitis are caused by overuse, rest is probably the single biggest factor in preventing Achilles injury. Avoid over training, get plenty of rest; and prevent Achilles tendinitis.

February 24 2015

grotesquesuburb53

Achilles Tendinitis The Facts

Overview

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

Causes

Unusual use or overuse of the lower leg muscles and Achilles tendon is usually the cause of Achilles tendinitis. Repetitive jumping, kicking, and sprinting can lead to Achilles tendinitis in both recreational and competitive athletes. Runners, dancers, and athletes over age 65 are especially at risk. Sudden increases in training or competition can also inflame your Achilles tendon. For example, adding hills, stair-climbing, or sprinting to your running workout puts extra stress on your Achilles tendon. Improper technique during training can also strain the tendon. Intense running or jumping without stretching and strengthening your lower leg muscles can put you at risk regardless of your age or fitness level. Running on tight, exhausted, or fatigued calf muscles can put added stress on your Achilles tendon, as your tendon may not be ready to quickly start a workout after a period of inactivity. Direct blows or other injuries to the ankle, foot, or lower leg may pull your Achilles tendon too far and stretch the tissue. A hard contraction of the calf muscles, such as can happen when you push for the final sprint in a race, can strain the tendon. People whose feet roll inward, a condition called overpronation, are particularly at risk. Sometimes, shoes with too much heel cushioning put extra strain on the Achilles tendon.

Symptoms

In most cases, symptoms of Achilles tendonitis, also sometimes called Achilles tendinitis, develop gradually. Pain may be mild at first and worsen with continued activity. Repeated or continued stress on the Achilles tendon increases inflammation and may cause it to rupture. Partial or complete rupture results in traumatic damage and severe pain, making walking virtually impossible and requiring a long recovery period. Patients with tendinosis may experience a sensation of fullness in the back of the lower leg or develop a hard knot of tissue (nodule).

Diagnosis

During the physical exam, your doctor will gently press on the affected area to determine the location of pain, tenderness or swelling. He or she will also evaluate the flexibility, alignment, range of motion and reflexes of your foot and ankle. Your doctor may order one or more of the following tests to assess your condition, X-rays. While X-rays can't visualize soft tissues such as tendons, they may help rule out other conditions that can cause similar symptoms. Ultrasound. This device uses sound waves to visualize soft tissues like tendons. Ultrasound can also produce real-time images of the Achilles tendon in motion. Magnetic resonance imaging (MRI). Using radio waves and a very strong magnet, MRI machines can produce very detailed images of the Achilles tendon.

Nonsurgical Treatment

NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions. Steroid injections. Steroids decrease pain and swelling. After you get this shot, you may feel like your Achilles tendon is healed. Do not return to your regular exercise until your caregiver says it is okay. You could make the tendinitis worse, or even tear the tendon. Surgery. If your tendinitis does not heal with other treatments, you may need surgery. Surgery may be done to repair a tear in the tendon, or to remove parts of the tendon. The most important way to manage Achilles tendinitis is to rest. Rest decreases swelling and keeps your tendinitis from getting worse. You may feel pain when you begin to run or exercise. The pain usually goes away as your muscles warm up, but it may come back. Your caregiver may tell you to stop your usual training or exercise activities. He may give you other exercises to do until your Achilles tendon heals. Ice decreases swelling and pain. Put ice in a plastic bag. Cover it with a towel. Put this on your Achilles tendon for 15 to 20 minutes, 3 to 4 times each day. Do this for 2 to 3 days or until the pain goes away. After 2 or 3 days, you may use heat to decrease pain and stiffness. Use a hot water bottle, heating pad, whirlpool, or warm compress. To make a compress, soak a clean washcloth in warm water. Wring out the extra water and put it on your Achilles tendon 15 to 20 minutes, 3 to 4 times each day. Stretching and making the muscles stronger may help decrease stress on your Achilles tendon. Physical therapists can teach you exercises and treatments to help your tendinitis heal faster. You may need to wear inserts in your shoes. You may need to wrap tape around your heel and back of the leg. You may need to wear a cast, brace, or support boot.

Achilles Tendon

Surgical Treatment

Surgery is considered when non-operative measures fail. Patient compliance and postoperative management is an important aspect of the operative management to prevent ankle stiffness or recurrence of the symptoms. Surgery usually requires a removal of the damaged tissue (debridement) and meticulous repair of the tendon. Post-operative immobilization is required, followed by gradual range of motion and strengthening exercises start. It may require 6 months for the full recovery. Some known complication are recurrence, stiffness of the ankle and deep vein thrombosis.

Prevention

There are several things you can do to reduce the risk of Achilles tendinitis, warm up every time before you exercise or play a sport. Switch up your exercises. Slowly increase the length and intensity of your workouts. Keep your muscles active and stay in shape all year-round. When you see symptoms of Achilles tendinitis, stop whatever activity you are doing and rest.

February 21 2015

grotesquesuburb53

Achilles Tendon Rupture How Would I Know I Suffered One?

Overview

Achilles Tendon

A rupture of the Achilles tendon means that there has been either a complete, or partial, tear of the tendon which connects the calf muscles to the heel bone. Usually this occurs just above insertion on the heel bone, although it can happen anywhere along the course of the tendon.



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

Typically patients present with sudden onset of pain and swelling in the achilles region, often accompanied by a audible snap during forceful dorsiflexion of the foot. A classic example is that of an unfit 'weekend warrior' playing squash. If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance.



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

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 Tendonitis



Surgical Treatment

Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient?s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient. Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weight bearing. Complications such as incision-healing difficulties re-rupture of the tendon, or nerve pain can arise after surgery.



Prevention

The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain ankle flexibility. Problems with foot mechanics can also lead to Achilles tendonitis. This can often be treated with devices inserted into the shoes such as heel cups, arch supports, and custom orthotics.
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