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Do Hammer Toes Hurt

July 9th, 2015 parašė rochellweser

Hammer ToeOverview
Hammertoe is a condition in which the toes of your feet become contracted into an upside-down “V” shape, causing pain, pressure and, often, corns and calluses. Hammer Toe can develop on any of the toes, but generally affects the middle three toes, most often the second toe. The bones, muscles, ligaments and tendons of your feet normally are well-balanced to distribute your body’s weight while standing, walking and running. When the first and second joints of your toes experience the prolonged stress that develops when the muscles that control them fail to work together properly, the pressure on the tendons that support them can lead to the curling or contraction known as hammertoe.


Causes
Hammertoes are usually structural in nature. Many times this is the foot structure you were born with and other factors have now made it so that symptoms appear. The muscles in your foot may become unbalanced over time, allowing for a deformity of the small bones in each toe. With longstanding deformity the toe may become rigid. Sometimes one toe is longer than another and this causes a buckling of the digit. A hammertoe may also be caused by other foot deformities such as a bunion. Trauma or other surgery of your foot may predispose you to having the condition if your foot structure is altered.

Hammertoe

Symptoms
A toe stuck in an upside-down “V” is probably a hammertoe. Some symptoms are, pain at the top of the bent toe when putting on a shoe. Corns forming on the top of the toe joint. The toe joint swelling and taking on an angry red colour. Difficulty in moving the toe joint and pain when you try to so. Pain on the ball of the foot under the bent toe. Seek medical advice if your feet regularly hurt, you should see a doctor or podiatrist. If you have a hammertoe, you probably need medical attention. Ask your doctor for a referral to a podiatrist or foot surgeon. Act now, before the problem gets worse.


Diagnosis
Hammer toes may be easily detected through observation. The malformation of the person’s toes begin as mild distortions, yet may worsen over time - especially if the factors causing the hammer toes are not eased or removed. If the condition is paid attention to early enough, the person’s toes may not be permanently damaged and may be treated without having to receive surgical intervention. If the person’s toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.


Non Surgical Treatment
There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors. A number of non-surgical measures can be undertaken. Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option. Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels, conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches. Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance. Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe.


Surgical Treatment
Hammer toe can be corrected by surgery if conservative measures fail. Usually, surgery is done on an outpatient basis with a local anesthetic. The actual procedure will depend on the type and extent of the deformity. After the surgery, there may be some stiffness, swelling and redness and the toe may be slightly longer or shorter than before. You will be able to walk, but should not plan any long hikes while the toe heals, and should keep your foot elevated as much as possible.

Hammertoe

Prevention
To help prevent hammertoe, wear roomy, low-heeled shoes that allow plenty of width and length for the toes. The Mayo Clinic recommends wearing shoes that have at least 1/2 inch of space between the shoe and the longest toe.

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Help For Contracted Toes Feet

July 9th, 2015 parašė rochellweser

Hammer ToeOverview
Hammertoe deformities can be painful and unsightly. These toe deformities can be the result of a muscle/tendon imbalance or often the end stage result of some systemic disease such as diabetes or arthritis, especially Rheumatoid arthritis. Hammertoe deformities are progressive and can be prevented.


Causes
Certain risk factors increase your likelihood of developing a hammertoe. These include a family history of hammertoes, wearing tight or pointy-toed shoes, wearing shoes that are too small, having calluses, bunions, or corns (thickened layers of skin caused by prolonged/repeated friction) Wearing shoes that are too small can force the joint of your toes into a dislocated position. This makes it impossible for your muscles to stretch out. Over time, the practice of wearing improperly fitting shoes increases your risk of developing hammertoes, blisters, bunions, and corns.

Hammertoe

Symptoms
A hammertoe causes you discomfort when you walk. It can also cause you pain when trying to stretch or move the affected toe or those around it. Hammertoe symptoms may be mild or severe. Mild Symptoms, a toe that is bent downward, corns or calluses. Severe Symptoms, difficulty walking, the inability to flex your foot or wiggle your toes, claw-like toes. See your doctor or podiatrist right away if you develop any of these symptoms.


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


Non Surgical Treatment
In the earlier stages of hammer toe, when the toes can still be manually straightened, then conservative treatment is appropriate. This means wearing shoes which are a half size bigger than normal and which are not narrow around the toes. Exercises to stretch the toes out and strengthen the muscles under the foot which balances the tightness of the top tendons are important. Padding or corn plasters can be used to ease the discomfort of any associated corns and calluses.


Surgical Treatment
Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammertoes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.

Hammer Toe

Prevention
Although there is little doubt shoes are responsible for causing corns, the size, shape and other characteristics of our feet are hereditary. A severe bunion may cause a hammertoe, as the great toe twists over or under the second toe, causing it to dislocate.

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Tailor’S Bunion Bunionette (The 6th Toe)

June 9th, 2015 parašė rochellweser

Overview
Bunion Pain
Bunions are one of the more serious conditions that can affect foot health. A bunion is actually a bone deformity of the big toe, where the joint at the base and side of the toe is enlarged, forcing the toe out of place. Left untreated, bunions worsen over time. The big toe angles in toward the rest of the toe, and can overlap the third toe (a condition known as Hallux Valgus). Or, it may move toward the second toe and twist or rotate (Hallus Abducto Valgus). Bunions can also lead to deformities like hammertoes. Bunions cause discomfort and pain, because the enlargement constantly rubs against footwear. The skin of the toe becomes red and tender. The larger a bunion grows, the more painful it is to walk. People with bunions can develop thickening skin on the bottom of the foot, bursitis or arthritis, and chronic pain.


Causes
The main cause of bunions is excessive pressure being placed on the front of the foot, and is usually the result of wearing high-heeled shoes with pointed toes. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the United States wear shoes that are too small and that 55 percent of them have bunions. Overall, bunions are nine times more common in women than men. In some cases, bunions are hereditary; they also may be caused by arthritis or polio.


Symptoms
Bunions are readily apparent, you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the Podiatrist may take x-rays to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. There is no clear-cut way to predict how fast a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.


Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.


Non Surgical Treatment
Your podiatrist can recommend exercises, orthoses (special devices inserted into shoes), shoe alterations or night splints (which hold toes straight over night) which may slow the progression of bunions in children. According to experts, ?conservative? measures such as these may help relieve symptoms, though there is no evidence they can correct the underlying deformity. Orthoses are designed to prevent the problem getting worse by decreasing any biomechanical causes of bunions. In other words, if the biomechanical theory is correct (i.e. if your bunions are caused by the way you walk), orthoses may help you walk in a way that doesn?t exacerbate the problem. But it won?t change the already established shape of your foot. For that, you need surgery.
Bunions


Surgical Treatment
If non-surgical treatments have failed to relieve your bunion pain, or when the pain is interfering with your daily activities, contact the Dallas bunion surgery specialists at North Texas Foot & Ankle to discuss surgical options. There are a several ways to perform bunion surgery. The best procedure for one person is not necessarily the best for another. Some procedures allow you to walk much sooner, reducing the need for crutches. Depending on your foot type, the procedure can have a greater risk for return of the bunion deformity. Other procedures may require you to be on crutches for a few weeks - but could offer a better result in the long-term. Learn more about the different types of bunion surgery.


Prevention
A lot of bunion deformities are hereditary so there isn’t much you can do to fully prevent them. Early detection and treatment will go a long way in preventing the growth of the bunion and foot pain. Often times, a good custom orthotic can be very effective in slowing the progression of a bunion, but a podiatrist provides that. Waiting with bunions will worsen the condition and could lead to further complications such as hammertoes or contracted toes. Besides causing deformity, these secondary conditions can eventually cause issues with walking and affect your knees, hip, lower back. There are no lotions over the counter that would be able to actually treat the problem. There are some bunion shields that you can place on the bump to ease symptoms and pressure from shoes. However because this condition is an actual bone deformity, the over the counter option solutions are more like a Band-aid approach.

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Does Pain In The Foot’s Arch Require Surgical Treatments ?

June 2nd, 2015 parašė rochellweser

Overview
The most common causes of arch pain are repetitive activities, such as walking or running too far; jumping; or standing on hard surfaces for long periods of time. Injury, such as tears in the ligament called the plantar fascia. The natural aging process. Biomechanical defects of the foot, or abnormalities we are born with, such as very high or low arches, or pronation (a turning out of the foot, causing us to walk more on the inner border of the foot). Plantar fibromatosis, a benign growth on the ligament that supports the arch.
Pain In Arch


Causes
The plantar fascia is a thick, fibrous band which runs along the sole of the feet. It helps to support the foot arches and transmits forces through the foot as you move. Plantar fasciitis is one of the most common causes of foot arch pain. The most common problem to develop here is plantar fasciitis. If there is too much strain on the plantar fascia (e.g. from long periods on your feet, suddenly increasing activity levels or your foot position is altered), the plantar fascia becomes inflamed and swollen. It is often accompanied by a bone spur, excess growth of the bone which develops due to repeated tension on the area where the plantar fascia attaches to the bone. Plantar fasciitis is one of the most common causes of foot arch pain. It is usually painful after activity or prolonged rest e.g. first thing in the morning. A less common problem with the plantar fascia which casues foot arch pain is plantar fibromatosis. This is when a small nodular growth develops on the plantar fascia, usually in the middle of the foot arch. It often causes pain when walking due to pressure through the lump.


Symptoms
Persistant pain and selling under the ball of the foot and extending towards the toes (most commonly the 2nd). Some swelling may be disable on the top of the foot along with redness. Often a sensation of ‘walking on the bones for the foot’ will be described, and there is a positive Lachman’s test. Often a tear will result in the toes splaying (daylight sign) and clawing.


Diagnosis
The medical practitioner will examine how the muscles of your foot function. These tests may involve holding or moving your foot and ankle against resistance; you may also asked to stand, walk, or even run. Pain caused by movements may indicate the cause of the pain. The nerves in the foot will be tested to make sure no injury has occurred there. An x-ray, MRI, or bone scan of the foot and arch may be taken to determine if there are changes in the makeup of the bone.


Non Surgical Treatment
What remedies work best depends on the source of your pain. Stretches help tightened, overused muscles to relax, and exercises help weakened ones to regain the strength they need to hold your foot in its proper place. Prescription orthotics add extra support and help your arch more efficiently distribute weight. Changing your shoes to ones that better cushion and brace your foot also help. Generally flatfoot pain doesn?t require surgery, unless the problem was caused by a torn tendon. You may then need a procedure to repair the damaged tissue and realign your arch.
Pain In Arch


Surgical Treatment
Tendon transfers: Too much pull of certain muscles and tendons is often the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength. Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws. Calcaneal osteotomy: This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and is often held in place with one or more screws. Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the joint. Clawed toes are a common problem with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes are often temporarily held in place with pins.


Prevention
Maintain a healthy weight, Use insoles to support your arches, Limit how often you wear high heels, Use proper shoes, especially when exercising to evenly distribute weight through your foot.

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Achilles Tendon Partial Tear Exercises

May 6th, 2015 parašė rochellweser

Overview

When the Achilles tendon ruptures. it gets completely torn by a sudden movement of the ankle/leg. It usually occurs in a tendon that is worn out and has weakened over time and then suddenly tears when there is enough force. It typically occurs during recreational sports that involve running, jumping, and pivoting, such as basketball, soccer or racquet sports. It is most often seen in men in their 30s and 40s. Some medications and medical problems can predispose to having an Achilles rupture.


Causes
An Achilles tendon rupture is often caused by overstretching the tendon. This typically occurs during intense physical activity, such as running or playing basketball. Pushing off from the foot while the knee is straight, pivoting, jumping, and running are all movements that can overstretch the Achilles tendon and cause it to rupture. A rupture can also occur as the result of trauma that causes an over-stretching of the tendon, such as suddenly tripping or falling from a significant height. The Achilles tendon is particularly susceptible to injury if it is already weak. Therefore, individuals who have a history of tendinitis or tendinosis are more prone to a tendon rupture. Similarly, individuals who have arthritis and overcompensate for their joint pain by putting more stress on the Achilles tendon may also be more susceptible to an Achilles tendon rupture.


Symptoms
An Achilles tendon rupture is when the tendon that connects the heel bone to the calf muscle tears and the fibers separate. This happens mostly between the ages of 30 and 50, and usually is caused by sports. Symptoms of Achilles tendon rupture include the following. A pop or snap when the tendon tears. Severe pain in back of the ankle, making it nearly impossible to walk. Swelling and discoloration. Tenderness. Inability to rise on toes. A gap in the back of the ankle where the tendons are separated.


Diagnosis
On physical examination the area will appear swollen and ecchymotic, which may inhibit the examiners ability to detect a palpable defect. The patient will be unable to perform a single heel raise. To detect the presence of a complete rupture the Thompson test can be performed. The test is done by placing the patient prone on the examination table with the knee flexed to 90?, which allows gravity and the resting tension of the triceps surae to increase the dorsiflexion at the ankle. The calf muscle is squeezed by the examiner and a lack of planar flexion is noted in positive cases. It is important to note that active plantar flexion may still be present in the face of a complete rupture due to the secondary flexor muscles of the foot. It has been reported that up to 25% of patients may initially be missed in the emergency department due to presence of active plantar flexion and swelling over the Achilles tendon, which makes palpation of a defect difficult.


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).


Surgical Treatment
Debate remains regarding the best form of treatment for a ruptured Achilles tendon. The 2 options are:immobilisation or operation. A recent meta-analysis of scientific studies showed that compared to immobilisation, an operation reduces the risk of re-rupture and allows a quicker return to work. An operation is not without risk and these must be balanced against the benefit of a lower re-rupture rate. Both treatments involve immobilisation for 8 weeks.


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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What Will Be The Signals Of Achilles Tendon Rupture

April 29th, 2015 parašė rochellweser

Overview

An Achilles tendon rupture is when you tear the tissue that connects your calf muscle to your heel bone. Your Achilles tendon is very strong and flexible. It?s at the back of your ankle and connects your calf muscle to the bone in the heel of your foot (calcaneum). If you rupture your Achilles tendon, you can either partially or completely tear the tendon. Most people who injure their Achilles tendon are between 30 and 50 and don?t exercise regularly. It?s more common in men but can affect anyone. It happens most often in the left leg. This may be because most people are right-handed which means that they ?push off? more frequently with the left foot when running.


Causes
Often the individual will feel or hear a pop or a snap when the injury occurs. There is immediate swelling and severe pain in the back of the heel, below the calf where it ruptures. Pain is usually severe enough that it is difficult or impossible to walk or take a step. The individual will not be able to push off or go on their toes.


Symptoms
Symptoms include a sudden sharp pain in the achilles tendon which is often described as if being physically struck by an object or implement. A loud snapping noise or bang may also be heard at the time. A gap of 4 to 5 cm in the tendon can be felt which may be less obvious later as swelling increases. After a short while the athlete may be able to walk again but without the power to push off with the foot. There will be a significant loss of strength in the injured leg and the patient will be unable to stand on tip toes. There may be considerable swelling around the achilles tendon and a positive result for Thompson’s test can help confirm the diagnosis.


Diagnosis
Some patients mistakenly believe the tendon is working if they can push the foot down, however, patients will usually be able to move the foot up and down while sitting because the other surrounding muscles and tendons are still intact. Trying to push up while standing and applying body weight to the foot will reveal the true weakness. Sensation and circulation to the foot and ankle will be normal. In addition, x-rays will be normal unless the Achilles injury involves pulling off (avulsion) of the bone on the calcaneus (heel bone). This is quite rare, occurring in only a small fraction of patients with Achilles injuries. Patients suffering this type of Achilles avulsion injury tend to be older with weaker bone.
Imaging Studies. Plain x-rays will be negative in patients who have suffered an Achilles tendon rupture. The rupture can be seen on ultrasound or MRI. However, these studies are not indicated for acute ruptures unless there is some uncertainty about the diagnosis. For chronic problems of the Achilles or ruptures that are old, an MRI may be very helpful.


Non Surgical Treatment
As debilitating as they can be, the good news is that minor to moderate Achilles tendon injuries should heal on their own. You just need to give them time. To speed the healing, you can try the following. Rest your leg. Avoid putting weight on your leg as best you can. You may need crutches. Ice your leg. To reduce pain and swelling, ice your injury for 20 to 30 minutes, every three to four hours for two to three days, or until the pain is gone. Compress your leg. Use an elastic bandage around the lower leg and ankle to keep down swelling. Elevate your leg. Prop you leg up on a pillow when you’re sitting or lying down. Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve) will help with pain and swelling. However, these drugs have side effects, such as an increased risk of bleeding and ulcers. They should be used only occasionally unless your health care provider says otherwise and should be taken with food. Check with your doctor before taking these if you have any allergies, medical problems or take any other medication. Use a heel lift. Your health care provider may recommend that you wear an insert in your shoe while you recover. It will help protect your Achilles tendon from further stretching. Practice stretching and strengthening exercises as recommended by your health care provider. Usually, these techniques will do the trick. But in severe cases of Achilles tendon injury, you may need a cast for six to 10 weeks or even surgery to repair the tendon or remove excess tissue.


Surgical Treatment
There are two different types of surgeries; open surgery and percutaneous surgery. During an open surgery an incision is made in the back of the leg and the Achilles tendon is stitched together. In a complete or serious rupture the tendon of plantaris or another vestigial muscle is harvested and wrapped around the Achilles tendon, increasing the strength of the repaired tendon. If the tissue quality is poor, e.g. the injury has been neglected, the surgeon might use a reinforcement mesh (collagen, Artelon or other degradable material). In percutaneous surgery, the surgeon makes several small incisions, rather than one large incision, and sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture to let the swelling go down. For sedentary patients and those who have vasculopathy or risks for poor healing, percutaneous surgical repair may be a better treatment choice than open surgical repair.


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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What Is The Cause And Treatment For Posterior Tibial Tendon Dysfunction

April 28th, 2015 parašė rochellweser

Overview
Most flat feet are not painful, particularly those flat feet seen in children. In the adult acquired flatfoot, pain occurs because soft tissues (tendons and ligaments) have been torn. The deformity progresses or worsens because once the vital ligaments and posterior tibial tendon are lost, nothing can take their place to hold up the arch of the foot. The painful, progressive adult acquired flatfoot affects women four times as frequently as men. It occurs in middle to older age people with a mean age of 60 years. Most people who develop the condition already have flat feet. A change occurs in one foot where the arch begins to flatten more than before, with pain and swelling developing on the inside of the ankle. Why this event occurs in some people (female more than male) and only in one foot remains poorly understood. Contributing factors increasing the risk of adult acquired flatfoot are diabetes, hypertension, and obesity.


Causes
Posterior tibial tendon dysfunction is the most common cause of acquired adult flatfoot deformity. There is often no specific event that starts the problem, such as a sudden tendon injury. More commonly, the tendon becomes injured from cumulative wear and tear. Posterior tibial tendon dysfunction occurs more commonly in patients who already have a flat foot for other reasons. As the arch flattens, more stress is placed on the posterior tibial tendon and also on the ligaments on the inside of the foot and ankle. The result is a progressive disorder.


Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle. Symptoms, which may occur in some persons with flexible flatfoot, include. Pain in the heel, arch, ankle, or along the outside of the foot. ?Turned-in? ankle. Pain associated with a shin splint. General weakness / fatigue in the foot or leg.


Diagnosis
There are four stages of adult-acquired flatfoot deformity (AAFD). The severity of the deformity determines your stage. For example, Stage I means there is a flatfoot position but without deformity. Pain and swelling from tendinitis is common in this stage. Stage II there is a change in the foot alignment. This means a deformity is starting to develop. The physician can still move the bones back into place manually (passively). Stage III adult-acquired flatfoot deformity (AAFD) tells us there is a fixed deformity. This means the ankle is stiff or rigid and doesn???t move beyond a neutral (midline) position. Stage IV is characterized by deformity in the foot and the ankle. The deformity may be flexible or fixed. The joints often show signs of degenerative joint disease (arthritis).


Non surgical Treatment
Flatfoot deformity can be treated conservatively or with surgical intervention depending on the severity of the condition. When people notice their arches flattening, they should immediately avoid non-supportive shoes such as flip-flops, sandals or thin-soled tennis shoes. Theses shoes will only worsen the flatfoot deformity and exacerbate arch pain. Next, custom orthotics are essential for people with collapsed arches. Over-the-counter insoles only provide cushion and padding to the arch, whereas custom orthotics are fabricated to specifically fit the patient?s foot and provide support in the arch where the posterior tibial tendon is unable to anymore. Use of custom orthotics in the early phases of flatfoot or PTTD can prevent worsening of symptoms and prevent further attenuation or injury to the posterior tibial tendon. In more severe cases of flatfoot deformity an ankle foot orthosis (AFO) such as a Ritchie brace is needed. This brace provides more support to the arch and hindfoot rather than an orthotic but can be bulky in normal shoegear. Additional treatment along with use of custom orthotics is use of non-steroidal anti-inflammatories (NSAIDS) such as Advil, Motrin, or Ibuprofen which can decrease inflammation to the posterior tibial tendon. If pain is severe, the patient may need to be placed in a below the knee air walker boot for several weeks which will allow the tendon to rest and heal, especially if a posterior tibial tendon tear is noted on MRI.


Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss.

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Labas pasauli!

April 28th, 2015 parašė rochellweser

BLOGas.lt sveikina prisijungus prie blogerių bendruomenės. Tai pirmas tavo įrašas. Gali jį redaguoti arba ištrinti. Sėkmingo bloginimo!

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