Overview
There are many different causes of and treatments for flat foot. The most important part of treatment is determining the exact flat foot type on an individual basis, and doing so early on. The main objective is to become educated on the potential problems, so that you can stop them before they start. Conservative treatment is often successful if initiated early. The old adage "a stitch in time saves nine" definitely applies to the human body, hopefully more figuratively than literally. Do not ignore what your common sense and your body are telling you. Yes, you can live without an arch, but never neglect a symptomatic foot. If you neglect your feet, they will make you pay with every literal step you take. Causes Factors that increase your chance of flat feet include family history, diseases that cause muscle or nerve damage, such as peripheral neuropathy, diabetes, cerebral palsy, spina bifida, or muscular dystrophy. Foot injuries. Conditions of the feet that can injure foot tissue such as osteoarthritis. Conditions present at birth, such as excess laxity of joint capsules and ligaments, such as Ehlers-Danlos syndrome. Obesity. Symptoms Structural problems in your feet like fallen arches can alter your walking pattern, running pattern and cause pain throughout your body. Clear and accurate assessment of the mechanics of your lower limbs is key to understanding the profound effect that subtle faults in your foot, ankle, knee and hip alignment can cause. Diagnosis People who have flat feet without signs or symptoms that bother them do not generally have to see a doctor or podiatrist about them. However, if any of the following occur, you should see your GP or a podiatrist. The fallen arches (flat feet) have developed recently. You experience pain in your feet, ankles or lower limbs. Your unpleasant symptoms do not improve with supportive, well-fitted shoes. Either or both feet are becoming flatter. Your feet feel rigid (stiff). Your feet feel heavy and unwieldy. Most qualified health care professionals can diagnose flat feet just by watching the patient stand, walk and examining his/her feet. A doctor will also look at the patient's medical history. The feet will be observed from the front and back. The patient may be asked to stand on tip-toe while the doctor examines the shape and functioning of each foot. In some cases the physician may order an X-ray, CT (computed tomography) scan, or MRI (magnetic resonance imaging) scan. pes planus radiology Non Surgical Treatment Some patients with flat feet may automatically align their limbs in such a way that unpleasant symptoms never develop. In such cases treatment is not usually required. Pain in the foot that is caused by flat feet may be alleviated if the patient wears supportive well-fitted shoes. Some patients say that symptoms improve with extra-wide fitting shoes. Fitted insoles or orthotics (custom-designed arch supports) may relieve pressure from the arch and reduce pain if the patient's feet roll or over-pronate. The benefits of an orthotic only exist while it is being worn. Patients with tendonitis of the posterior tibial tendon may benefit if a wedge is inserted along the inside edge of the orthotic - this takes some of the load off the tendon tissue. Wearing an ankle brace may help patients with posterior tibial tendinitis, until the inflammation comes down. Rest, doctors may advise some patients to rest and avoid activities which may make the foot (feet) feel worse, until the foot (feet) feels better. A combination of an insole and some kind of painkiller may help patients with a ruptured tendon, as well as those with arthritis. Patients with a ruptured tendon or arthritis who find insoles with painkillers ineffective may require surgical intervention. Patients, usually children, whose bones did not or are not developing properly, resulting in flat feet from birth, may require surgical intervention to separate fused bones (rare). Bodyweight management, if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with flat feet who successfully lose weight experience considerable improvement of symptoms. Surgical Treatment A combination of surgical procedures can be used to reconstruct the flatfoot. Generally, these procedures can be separated into those that correct deformities of the bones and those that repair ligaments and tendons. Your orthopaedic surgeon will choose the proper combination of procedures for your foot. Surgery of the foot can be performed under regional anesthesia, which is numbing the foot and ankle with a nerve or spinal block, or general anesthesia, which may require a breathing tube. A nerve block is often placed behind the knee to reduce pain after surgery. Overview
Heel pain is one of the most common conditions to affect the foot. It is usually felt as an intense pain when the affected heel is used. The pain is usually worse when you get out of bed in the morning or after a long period of activity. In most cases, only one heel is affected. After walking, the pain usually improves. However, it is common for it to be painful when you first take a step after a period of rest. The pain often worsens by the end of the day. Most cases of heel pain are caused by damage and thickening of the plantar fascia. Sometimes, the surrounding tissue and the heel bone also become inflamed (swollen). Causes he most common cause of heel pain is over pronation, this is when your foot rotates in too much as you walk. You really need to treat the underlying cause of the heel pain as soon as possible to prevent any further damage to the plantar fascia. Excessive load on the foot from obesity is a major cause of plantar fasciitis. Which is why this condition is common in middle aged and over weight adults. A sudden increase in weight, such as pregnancy can also lead to plantar fascitis. A sudden increase in walking or a sporting activity can also be a contributing factor. A classic example of when this condition can develop is when a post man has returned to work after a period away from the job. Tight plantar fascia (this is often caused by tight calf muscles). Excessive flattening of the arch on weight bearing i.e. flat feet. People with flat feet are more at risk of developing this condition. Biomechanical problems (walking abnormalities) is a major cause of plantar fasciitis. Different types of arthritis can also lead to this condition, such as osteoarthritis and rheumatoid arthritis. Symptoms Symptoms may also include swelling that is quite tender to the touch. Standing, walking and constrictive shoe wear typically aggravate symptoms. Many patients with this problem are middle-aged and may be slightly overweight. Another group of patients who suffer from this condition are young, active runners. Diagnosis Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans. Non Surgical Treatment Recommended treatments, heel Spurs: cushioning for the heel is of little value. Your chiropodist/podiatrist may initially apply padding and strapping to alter the direction of stretch of the ligament. This is often successful at reducing the tenderness in the short term. Your chiropodist/podiatrist may suggest a course of deep heat therapy to stimulate the healing processes, allowing damage to respond and heal faster. In the long term, your chiropodist/podiatrist may prescribe special insoles (orthoses) to help the feet to function more effectively, thereby reducing strain on the ligaments and making any recurrence less likely. If pain from heel spurs continues, you may be referred to your GP who can prescribe an oral non-steroidal anti-inflammatory. Alternatively, localised hydrocortisone injection treatment may be given by your GP or an appropriate chiropodist/podiatrist. If pain persists, surgery may be considered. Heel Bursitis: in most cases, attention to the cause of any rubbing, and appropriate padding and strapping by your chiropodist/podiatrist will allow the inflammation to settle. If infection is present, your chiropodist/podiatrist will refer you to your GP for antibiotics. Heel Bumps: adjustments to footwear is often enough to make them comfortable. A leather heel counter and wearing boots may help. However, if pain persists, surgery may be necessary. Surgical Treatment Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day. heel cushion silicone Prevention Heel pain is commonly caused from shoes that do not fit properly. In addition, shoes need to have ample cushioning and support, particularly through the heel, ball of the foot, and arch. Shoes should also be replaced if they become too worn. One sure sign of wear and tear is overly worn areas of a shoe's insoles. If the heel or ball of the foot is particularly worn, damage could easily occur since the bottom of the foot is not getting the cushioning it needs. Overview
leg length discrepancy can be present from birth (congenital) or acquired (a result of an injury, infection or tumor). Some of the conditions that can cause limb problems in a child or young adult include congenital conditions present from birth. Osteogenesis imperfecta,. Bow legs. Knock knees. Neurofibromatosis. Arthritis. Infections of the bones and tumors. Injuries involving the growth center of the bone. There may also be deformities that are a result of the soft tissues and not the bones, such as with arthrogryposis and burns. 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 Often there are few or no symptoms prior to the age of 25-35. The most common symptom is chronic lower back pain, but also is frequently middle and upper back pain. Same-sided and repeated injury or pain to the hip, knee and/or ankle is also a hallmark of a long-standing untreated LLD. It is not uncommon to have buttock or radiating hip pain that is non-dermatomal (not from a disc) and tends to go away when lying down. Diagnosis Asymmetry is a clue that a LLD is present. The center of gravity will shift to the short limb side and patients will try to compensate, displaying indications such as pelvic tilt, lumbar scoliosis, knee flexion, or unilateral foot pronation. Asking simple questions such as, "Do you favor one leg over the other?" or, "Do you find it uncomfortable to stand?" may also provide some valuable information. Performing a gait analysis will yield some clues as to how the patient compensates during ambulation. Using plantar pressure plates can indicate load pressure differences between the feet. It is helpful if the gait analysis can be video-recorded and played back in slow motion to catch the subtle aspects of movement. Non Surgical Treatment After the leg length discrepancy has been identified it can be categorized in as structural or functional and appropriate remedial action can be instigated. This may involve heel lifters or orthotics being used to level up the difference. The treatment of LLD depends on the symptoms being experienced. Where the body is naturally compensating for the LLD (and the patient is in no discomfort), further rectifying action may cause adverse effects to the biomechanical mechanism of the body causing further injury. In cases of functional asymmetry regular orthotics can be used to correct the geometry of the foot and ground contact. In structural asymmetry cases heel lifts may be used to compensate for the anatomic discrepancy. increase height quickly Surgical Treatment Surgical treatments vary in complexity. Sometimes the goal of surgery is to stop the growth of the longer limb. Other times, surgeons work to lengthen the shorter limb. Orthopedic surgeons may treat children who have limb-length conditions with one or a combination of these surgical techniques. Bone resection. An operation to remove a section of bone, evening out the limbs in teens or adults who are no longer growing. Epiphyseal stapling. An operation to slow the rate of growth of the longer limb by inserting staples into the growth plate, then removing them when the desired result is achieved. Epiphysiodesis. An operation to slow the rate of growth of the longer limb by creating a permanent bony ridge near the growth plate. Limb lengthening. A procedure (also called distraction osteogenesis or the Ilizarov procedure) that involves attaching an internal or external fixator to a limb and gradually pulling apart bone segments to grow new bone between them. There are several ways your doctor can predict the final LLD, and thus the timing of the surgery. The easiest way is the so-called Australian method, popularised by Dr. Malcolm Menelaus, an Australian orthopedic surgeon. According to this method, growth in girls is estimated to stop at age 14, and in boys at age 16 years. The femur grows at the rate of 10 mm. a year, and the upper tibia at the rate of 6 mm. a year. Using simple arithmetic, one can get a fairly good prediction of future growth. This of course, is an average, and the patient may be an average. To cut down the risk of this, the doctor usually measures leg length using special X-ray technique (called a Scanogram) on three occasions over at least one year duration to estimate growth per year. He may also do an X-ray of the left hand to estimate the bone age (which in some cases may differ from chronological age) by comparing it with an atlas of bone age. In most cases, however, the bone age and chronological age are quite close. Another method of predicting final LLD is by using Anderson and Green?s remaining growth charts. This is a very cumbersome method, but was till the 1970?s, the only method of predicting remaining growth. More recently, however, a much more convenient method of predicting LLD was discovered by Dr. Colin Moseley from Montreal. His technique of using straight line graphs to plot growth of leg lengths is now the most widely used method of predicting leg length discrepancy. Whatever method your doctor uses, over a period of one or two years, once he has a good idea of the final LLD, he can then formulate a plan to equalize leg lengths. Epiphyseodesis is usually done in the last 2 to 3 years of growth, giving a maximum correction of about 5 cm. Leg lengthening can be done at any age, and can give corrections of 5 to10 cm., or more. Overview
A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton?s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. ?Intermetatarsal? describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot. MortonThe thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage. Causes The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon. Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour. Symptoms Patients with neuroma may develop pain on the bottom of the forefoot, most commonly under the 3rd and 4th toes, though any toe may be affected. The pain may be dull and mild or severe and sharp. The toes may feel ?numb? as times, especially the area between the 3rd and 4th toes. A classic complaint is that patients feel as if they are ?walking on a stone or pebble? and/or ?feel as if the sock is rolled up in the shoe.? Pain is often worse when walking barefoot. Diagnosis Podiatrists conduct a physical examination and may order imaging tests, such as x-ray or MRI scan to diagnose Morton's neuroma. Conservative treatment options include custom-fitted orthotics, medication, and/or alcohol injections designed to harden the nerve. However, most patients with Morton's neuroma need minor surgery. Non Surgical Treatment Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment. Wear shoes with thick, shock-absorbent soles, as well as proper insoles that are designed to keep excessive pressure off of the foot. High-heeled shoes over two inches tall should be avoided whenever possible because they place undue strain on the forefoot. Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort. Use over-the-counter shoe pads. These pads can relieve pressure around the affected area. Surgical Treatment Interdigital neurectomy (removal of the diseased nerve) in right hands, should give satisfactory results almost all the time. Some of the reasons behind failure is when not enough nerve is dissected, mistakes in initial diagnosis, or bad handling of adjacent nerves, tendons and joint capsules during the operation. It is very common and acceptable to have some numbness in the area where the nerve used to be. This never causes any discomfort and often gets better in few years. It is crucial to address the biomechanical pathologies underlying the impingement of the nerve during and after the surgery. There are actually two different kinds of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is structurally shorter than the other. As a result of developmental periods of aging, the human brain senses the walking pattern and recognizes some variance. The entire body typically adapts by tilting one shoulder to the "short" side. A difference of under a quarter inch is not grossly uncommon, require Shoe Lifts to compensate and usually does not have a serious effect over a lifetime.
Leg length inequality goes mainly undiscovered on a daily basis, yet this problem is very easily solved, and can eliminate many instances of upper back pain. Treatment for leg length inequality usually consists of Shoe Lifts. These are generally low cost, ordinarily priced at below twenty dollars, compared to a custom orthotic of $200 or maybe more. 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 the most widespread health problem affecting men and women today. Around 80 million men and women experience back pain at some stage in their life. It's a problem that costs companies millions of dollars year after year as a result of lost time and productivity. Fresh and better treatment methods are continually sought after in the hope of minimizing the economical influence this issue causes. Men and women from all corners of the world experience foot ache as a result of leg length discrepancy. In these types of situations Shoe Lifts can be of very beneficial. The lifts are capable of alleviating any discomfort and pain in the feet. Shoe Lifts are recommended by countless experienced orthopaedic orthopedists. So that they can support the body in a well balanced manner, your feet have a very important function to play. Inspite of that, it can be the most overlooked zone in the human body. Some people have flat-feet which means there is unequal force exerted on the feet. This will cause other areas of the body such as knees, ankles and backs to be affected too. Shoe Lifts ensure that ideal posture and balance are restored. There are actually not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital indicates you are born with it. One leg is anatomically shorter compared to the other. Through developmental phases of aging, the brain senses the step pattern and recognizes some difference. Our bodies typically adapts by tilting one shoulder to the "short" side. A difference of under a quarter inch is not really irregular, demand Shoe Lifts to compensate and usually does not have a profound effect over a lifetime.
Leg length inequality goes mainly undiscovered on a daily basis, yet this issue is easily fixed, and can eliminate many instances of lumbar pain. Treatment for leg length inequality commonly involves Shoe Lifts. Many are cost-effective, normally costing less than twenty dollars, in comparison to a custom orthotic of $200 or more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position. Chronic back pain is easily the most common condition affecting people today. Over 80 million people experience back pain at some point in their life. It is a problem that costs businesses huge amounts of money yearly due to time lost and output. Fresh and more effective treatment methods are constantly sought after in the hope of decreasing the economical impact this condition causes. People from all corners of the world suffer the pain of foot ache as a result of leg length discrepancy. In most of these situations Shoe Lifts are usually of very helpful. The lifts are capable of alleviating any pain in the feet. Shoe Lifts are recommended by countless skilled orthopaedic physicians. In order to support the human body in a well balanced manner, feet have got a vital job to play. In spite of that, it is often the most overlooked region of the human body. Many people have flat-feet meaning there may be unequal force placed on the feet. This will cause other areas of the body such as knees, ankles and backs to be affected too. Shoe Lifts ensure that appropriate posture and balance are restored. There are not one but two different types of leg length discrepancies, congenital and acquired. Congenital means that you are born with it. One leg is structurally shorter in comparison to the other. As a result of developmental stages of aging, the human brain senses the gait pattern and identifies some variation. Your body usually adapts by tilting one shoulder to the "short" side. A difference of less than a quarter inch is not grossly abnormal, require Shoe Lifts to compensate and typically won't have a serious effect over a lifetime.
Leg length inequality goes largely undiscovered on a daily basis, however this issue is simply solved, and can eradicate a number of cases of low back pain. Treatment for leg length inequality usually consists of Shoe Lifts. These are generally affordable, frequently priced at under twenty dollars, compared to a custom orthotic of $200 if not more. 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. Back ache is the most widespread ailment impacting people today. Over 80 million men and women are afflicted by back pain at some stage in their life. It is a problem that costs businesses huge amounts of money every year because of lost time and productivity. Fresh and better treatment methods are continually sought after in the hope of minimizing the economical impact this condition causes. People from all corners of the world suffer the pain of foot ache as a result of leg length discrepancy. In a lot of these situations Shoe Lifts might be of very beneficial. The lifts are capable of relieving any discomfort and pain in the feet. Shoe Lifts are recommended by numerous experienced orthopaedic practitioners". So that they can support the body in a nicely balanced manner, your feet have got a vital part to play. Inspite of that, it can be the most overlooked region of the human body. Some people have flat-feet which means there may be unequal force placed on the feet. This will cause other areas of the body like knees, ankles and backs to be impacted too. Shoe Lifts guarantee that suitable posture and balance are restored. There are actually two different types of leg length discrepancies, congenital and acquired. Congenital indicates you are born with it. One leg is structurally shorter than the other. As a result of developmental stages of aging, the human brain picks up on the step pattern and recognizes some variation. Your body usually adapts by tilting one shoulder over to the "short" side. A difference of less than a quarter inch is not very irregular, demand Shoe Lifts to compensate and typically doesn't have a serious effect over a lifetime.
Leg length inequality goes typically undiscovered on a daily basis, however this issue is simply fixed, and can eradicate many instances of back problems. Therapy for leg length inequality commonly consists of Shoe Lifts. Many are economical, normally being less than twenty dollars, compared to a custom orthotic of $200 and up. 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. Lower back pain is the most prevalent condition afflicting men and women today. Over 80 million men and women experience back pain at some point in their life. It is a problem that costs companies vast amounts of money year after year because of time lost and production. Innovative and better treatment methods are always sought after in the hope of minimizing the economic influence this issue causes. People from all corners of the world experience foot ache as a result of leg length discrepancy. In a lot of these situations Shoe Lifts are usually of beneficial. The lifts are capable of eliminating any discomfort in the feet. Shoe Lifts are recommended by countless specialist orthopaedic doctors. So that they can support the body in a well-balanced manner, the feet have a very important job to play. Despite that, it is sometimes the most neglected area of the human body. Many people have flat-feet meaning there is unequal force placed on the feet. This causes other areas of the body including knees, ankles and backs to be affected too. Shoe Lifts ensure that appropriate posture and balance are restored. Overview
A hammer toe can be defined as a condition that causes your toe to bend downward instead of pointing forward. While it can occur on any toe on your foot, it usually affects the second or third toe. If your baby toe curls instead of buckling, it is also considered a hammer toe. There are two types of hammer toes. If your toes still can move around at the joint, then it is considered a flexible hammer toe. It is a milder form of the condition and there are more treatment options. The other type is called a rigid hammertoe, which occurs when the tendons in your toe become so rigid that they push your toe joint out of alignment, and it cannot move at all. Typically, you will need surgery to fix it. 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. Other causes include genes. Some people are born with hammertoe, bunions. These knobby bumps sometimes develop at the side of the big toe. This can make the big toe bend toward the other toes. The big toe can then overlap and crowd the smaller toes. Arthritis in a toe joint can lead to hammertoe. Symptoms The symptoms of hammertoe include a curling toe, pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward. Thickening of the skin above or below the affected toe with the formation of corns or calluses. Difficulty finding shoes that fit well. In its early stages, hammertoe is not obvious. Frequently, hammertoe does not cause any symptoms except for the claw-like toe shape. 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 medical and family history. Non Surgical Treatment Wear wide shoes with plenty of room in the toes and resilient soles. Avoid wearing shoes with pointed toes. Commercially available felt pads or cushions may ease pressure from the shoe on the toe. Toe caps (small, padded sleeves that fit around the tip of the toe) may relieve the pain of hammer toe. Do toe exercises, to help toe muscles become stronger and more flexible. Arch supports or an orthotic shoe insert prescribed by your doctor or podiatrist may help to redistribute weight on the foot. These devices do not cure the problem but may ease the symptoms of either hammer toe or mallet toe. Surgical Treatment Surgery is used when other types of treatment fail to relieve symptoms or for advanced cases of hammertoe. There are several types of surgeries to treat hammertoe. A small piece of bone may Hammer toe be removed from the joint (arthroplasty). The toe joint may be fused to straighten it (arthrodesis). Surgical hardware, such as a pin, may be used to hold the bones in place while they heal. Other types of surgery involve removing skin (wedging) or correcting muscles and tendons to balance the joint. Prevention How can I prevent hammer toe? Avoid wearing shoes that are narrow or don?t fit well. Also, don?t wear heels higher than 2 inches. Instead, choose shoes with a wide toe box that give you ? inch between the end of your longest toe and the inside tip of the shoe. Check often to make sure your child?s shoes fit, especially when he or she is having a growth spurt.
Overview
The Achilles tendon is the tough sinew that attaches the calf muscle to the back of the calcaneus, or heel bone. It is also known as the tendo calcaneus or the tendo Achilles and happens to be one of the longest tendons in the body. An Achilles tendon rupture occurs when the Achilles tendon is partially or completely broken or torn. The average age of patients who suffer Achilles tendon ruptures is 30 to 40 years. The male-to-female ratio is nearly 20 to 1. Causes People who commonly fall victim to Achilles rupture or tear include recreational athletes, people of old age, individuals with previous Achilles tendon tears or ruptures, previous tendon injections or quinolone use, extreme changes in training intensity or activity level, and participation in a new activity. Most cases of Achilles tendon rupture are traumatic sports injuries. The average age of patients is 29-40 years with a male-to-female ratio of nearly 20:1. Fluoroquinolone antibiotics, such as ciprofloxacin, and glucocorticoids have been linked with an increased risk of Achilles tendon rupture. Direct steroid injections into the tendon have also been linked to rupture. Quinolone has been associated with Achilles tendinitis and Achilles tendon ruptures for some time. Quinolones are antibacterial agents that act at the level of DNA by inhibiting DNA Gyrase. DNA Gyrase is an enzyme used to unwind double stranded DNA which is essential to DNA Replication. Quinolone is specialized in the fact that it can attack bacterial DNA and prevent them from replicating by this process, and are frequently prescribed to the elderly. Approximately 2% to 6% of all elderly people over the age of 60 who have had Achilles ruptures can be attributed to the use of quinolones. Symptoms A sudden and severe pain may be felt at the back of the ankle or calf, often described as "being hit by a rock or shot" or "like someone stepped onto the back of my ankle." The sound of a loud pop or snap may be reported. A gap or depression may be felt and seen in the tendon about 2 inches above the heel bone. Initial pain, swelling, and stiffness may be followed by bruising and weakness. The pain may decrease quickly, and smaller tendons may retain the ability to point the toes. Without the Achilles tendon, though, this would be very difficult. Standing on tiptoe and pushing off when walking will be impossible. A complete tear is more common than a partial tear. Diagnosis Diagnosis of Achilles tendon rupture is not difficult. Usually, the diagnosis is obvious after examination of the ankle and performing some easy foot maneuvers (such as attempting to stand on the toes). When an Achilles tendon rupture occurs, there is often clinical confirmation of tenderness and bruising around the heel. A gap is felt when the finger is passed over the heel area, where the rupture has developed. All individuals with a full-blown rupture of the tendon are unable to stand on their toes. There is no blood work required in making a diagnosis of Achilles tendon rupture. The following are three common radiological tests to make a diagnosis of Achilles tendon rupture. Plain X-rays of the foot may reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification. Ultrasound is the next most commonly ordered test to document the injury and size of the tear. For a partial tear of the Achilles tendon, the diagnosis is not always obvious on a physical exam and hence an ultrasound is ordered. This painless procedure can make a diagnosis of partial/full Achilles tendon rupture rapidly. Ultrasound is a relatively inexpensive, fast, and reliable test. MRI is often ordered when diagnosis of tendon rupture is not obvious on ultrasound or a complex injury is suspected. MRI is an excellent imaging test to assess for presence of any soft-tissue trauma or fluid collection. More importantly, MRI can help detect presence of tendon thickening, bursitis, and partial tendon rupture. However, MRI is expensive and is not useful if there is any bone damage. Non Surgical Treatment Pain medicines can help decrease pain and swelling. A cast may be needed for 2 months or more. Your foot will be positioned in the cast with your toes pointing slightly down. Your caregiver will change your cast and your foot position several times while the tendon heals. Do not move or put weight on your foot until your caregiver tells you it is okay. A leg brace or splint may be needed to help keep your foot from moving while your tendon heals. Heel lifts are wedges put into your shoe or cast. Heel lifts help decrease pressure and keep your foot in the best position for your tendon to heal. Surgery may be needed if other treatments do not work. The edges of your tendon may need to be stitched back together. You may need a graft to patch the tear. A graft is a piece of another tendon or artificial material. Surgical Treatment A completely ruptured Achilles tendon requires surgery and up to 12 weeks in a cast. Partial tears are sometimes are treated with surgery following by a cast. Because the tendon shortens as it heals, a heel lift is used for 6 months or more after the cast comes off. Physical therapy to regain flexibility and then strength are begun as soon as the cast is off. Prevention Good flexibility of the calf muscles plays an essential role in the prevention of Achilles tendon injuries. It is also important to include balance and stability work as part of the training programme. This should include work for the deep-seated abdominal muscles and for the muscles that control the hip. This might at first appear odd, given the fact that the Achilles are a good distance from these areas, but developing strength and control in this area (core stability) can boost control at the knee and ankle joints. Training errors should be avoided. The volume, intensity and frequency of training should be monitored carefully, and gradually progressed, particularly when introducing new modes of training to the programme. Abrupt changes in training load are the primary cause of Achilles tendinopathy. |
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