What Is Mortons Neuroma

Overview

interdigital neuromaMorton’s neuroma is the common name given to the nerve irritation that is found in the ball of the foot that may or may not be accompanied by an inter-metatarsal bursae (a bursa-neuromal complex). It is often associated with inflammation or degeneration and often occurs with constant pressure or irritation of the nerve from the surrounding bony structures or local bursas (fluid filled sacs). Morton’s Neuroma can cause symptoms such as a sharp pain, burning even a lack of feeling in the ball of the foot and associated toes.

Causes

Although in many areas of medicine, it?s easy to pinpoint the exact source of a problem (the way a specific germ causes a certain illness with recognizable symptoms), neuromas are harder to categorize. While there isn?t really one exact cause, podiatric physicians tend to agree that a neuroma can occur in response to the irritation of a nerve by one or more factors. Abnormality in foot function or foot mechanics: In other words, a foot that doesn?t move the way science thinks it should. In general, this means a pronated foot (one with an excessive rolling motion when the patient is walking, running or doing any kind of activity), because it causes excessive strain on the nerve. If you are not certain whether or not this is a problem for you, ask your podiatric physician, who will be able to examine your feet, as well as the wear pattern on your shoe, and give you an answer. Foot mechanics, and problems with them, tend to run in families, so if you know that a relative has had foot pain similar to yours, be sure to mention it.

Symptoms

What are the symptoms of Morton?s neuroma? A sharp or stinging pain between the toes when standing or walking. Pain in the forefoot between the toes. Swelling between the toes. Tingling (?pins and needles?) and numbness. Feeling like there is a ?bunched up sock? or a pebble or marble under the ball of the foot.

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests or imaging studies may be performed. The best time to see your foot and ankle surgeon is early in the development of symptoms. Early diagnosis of a Morton?s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.

Non Surgical Treatment

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

Surgical Treatment

About one person in four will not require any surgery for Morton’s neuroma and their symptoms can be controlled with footwear modification and steroid/local anaesthetic injections. Of those who choose to have surgery, about three out of four will have good results with relief of their symptoms. Recurrent or persisting (chronic) symptoms can occur after surgery. Sometimes, decompression of the nerve may have been incomplete or the nerve may just remain ‘irritable’. In those who have had cutting out (resection) of the nerve (neurectomy), a recurrent or ‘stump’ neuroma may develop in any nerve tissue that was left behind. This can sometimes be more painful than the original condition.

Prevention

Wearing proper footwear that minimizes compression of the forefoot can help to prevent the development of and aggravation of a Morton’s neuroma.

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Hammer Toes Causes And Cures

Hammer ToeOverview
Hammertoes is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop. Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammer toes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammer toes can become more rigid and will not respond to non-surgical treatment. Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.

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.

Hammer ToeSymptoms
If the toes remain in the hammertoe position for long periods, the tendons on the top of the foot will tighten over time because they are not stretched to their full length. Eventually, the tendons shorten enough that the toe stays bent, even when shoes are not being worn. 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
Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.

Non Surgical Treatment
If the problem is caught in the early stages you can avoid hammer toe surgery. One of the easiest methods of treatment is to manipulate the toe out of a bent position then splint and buddy wrap it alongside it?s larger neighbour. This method of hammer toe taping will help the problem to fix itself. Make sure the toe isn?t resuming its bent shape during the recovery. To alleviate some of the painful symptoms of hammer toe avoid wearing high heels or shoes that cramp or stifle your feet. Choosing a pair of minimalist shoes can be an excellent choice for both foot and postural health. Wearing shoes that give the toes plenty of space and are comfortable lined is also a smart choice. Hammer toe recovery starts be treating the toe respectfully. Soft insoles or protection for the corn can also provide additional assistance.

Surgical Treatment
Surgery to straighten the toe may be needed if an ulcer has formed on either the end or the top surface of the toe. Surgery sometimes involves cutting the tendons that support movement in the toe so that the toe can be straightened. Cutting the tendons, however, takes away the ability to bend the very end of the toe. Another type of surgery combines temporary insertion of a pin or rod into the toe and alteration or repair of the tendons, so that the toe is straightened. After surgery, the deformity rarely recurs.

Hammer ToePrevention
Few people realize that their feet grow over the years: actually, the heel stays the same, but the front of the foot becomes wider and longer. The result, most women wear shoes that fit at the heel but are much too narrow in the front. Buy shoes that fit the longer foot. For two out of three people, one foot is significantly bigger than the other. Have both feet measured whenever you buy shoes. Have your feet measured while you’re standing, and buy shoes that fit the larger foot. Shop at the end of the day, when foot swelling is greatest. No shoe should feel tight. Don’t go by numbers. You may think of yourself as a size 8B, but size varies from shoe to shoe. There is no standardization, so pick the shoes that fit best. Limit high-heel use. These shoes increase pressure on the front of the foot by at least 50 percent, so wear them only for special occasions. Flat shoes are more comfortable than high heels, but they, too, can be hard on your feet, especially if they are thin-soled. Change your shoes. If your shoes are too short or too narrow, get another pair. This is especially important for children going through periods of rapid growth. The toe area should be high enough so that it doesn’t rub against the top of your toes-especially if hammer toes have started to develop.

Physical Therapy After Hammertoe Surgery

Hammer ToeOverview

Hammer toe is defined as a deformity in the toe where part of the toe is permanently bent downward resembling a hammer. Two related conditions are mallet toe and claw toe which effect different toe joints in slightly different ways. The key difference is that Hammer toe tends to effect the middle joint in the toe (note: not the middle toe, the middle toe joint). The disease is usually associated with the second largest toe but can effect the third or fourth toe as well. Mallet toe effects the uppermost toe joint whereas claw toe is caused by the tow being held in a cramped ?claw-like? position.

Causes

Hammertoe commonly develops because of structural changes that take place over time in the muscles and tendons that bend the toes. People with certain medical conditions, such as diabetes, are at risk for developing hammertoe. It can be an inherited condition for some people. Other causes include trauma and wearing shoes that are too tight, narrow, or have high heels. The toe next to the big toe (second toe) is most frequently affected by hammertoe.

Hammer ToeSymptoms

The most obvious symptoms of this injury will be the the middle toe joint is permanently bent at an angle. In the beginning movement may still be possible but as time passes and the injury worsens the toe will be locked in place and possible require hammer toe correction surgery to fix. Another key indicator of hammer toe is that a lump or corn will form on top of the toe. The toe joint will be painful and walking can cause severe discomfort. Occasionally a callus may form on the sole of the injured foot. If you see any of these symptoms together or have been enduring pain for some time, seeing a podiatrist should be your next step.

Diagnosis

The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Non Surgical Treatment

Putting padding between your toes and strapping them in place can help to stop pain caused by the toes rubbing. Custom-made insoles for your shoes will help to take the pressure off any painful areas. Special shoes that are wider and deeper than normal can stop your toes rubbing. However if your pain persists your consultant may recommend an surgery.

Surgical Treatment

Surgery may be the treatment of choice if conservative approaches prove unsuccessful. Usually performed as an outpatient procedure, the specific surgery will depend on the type and extent of injury to the toe. Recovery my take several days or weeks and you may experience some redness, stiffness and swelling of the affected toe. Your physician will recommend taking it easy and to keep your foot elevated Hammer toes while you recover.

What Are Bunions?

Overview
Bunions Callous
Bunion pain can be debilitating and bunion surgery can be a scary decision most people would rather put off. I know. I’ve been there and I’ve learned that IF you know what to expect ahead of time and what questions to ask your doctor, you will lessen your fear, make better decisions, and increase your success with bunion surgery and bunion surgery recovery. No matter how good your podiatrist or bunion surgeon is, the truth is, no one knows exactly what’s right for you except you and that’s what can make your decision so scary. What if the surgery doesn’t really fix the problem, and like others you read about or hear about, you end up worse off than before? It’s not always clear what to do, but with the right information, questions, and support, it can be an easier decision for you.

Causes
Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.
SymptomsBunions may or may not cause symptoms. A frequent symptom is foot pain in the involved area when walking or wearing shoes; rest relieves this pain. A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. Shoe pressure in this area can cause interment pain while the development of arthritis in more severe bunions can lead to chronic pain. Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness. It is important to note that, in postpubertal men and postmenopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.

Diagnosis
Your doctor will be able to diagnose a bunion by asking about your symptoms and examining your feet. You may also have blood tests to rule out any other medical conditions, such as rheumatoid arthritis or gout, although this is rare. Your doctor may refer you to a podiatrist or chiropodist (healthcare professionals who specialise in conditions that affect the feet).

Non Surgical Treatment
Nonsurgical treatments that may relieve the pain and pressure of a bunion include changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes. Padding and taping or splinting. Your doctor can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain. Medications. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) can help you control the pain of a bunion. Cortisone injections also can be helpful. Shoe inserts. Padded shoe inserts can help distribute pressure evenly when you move your feet, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people, although others may require prescription orthotic devices. Applying ice. Icing your bunion after you’ve been on your feet too long can help relieve soreness and inflammation.
Bunions Callous

Surgical Treatment
Surgery is a last option for those with advanced and painful bunions that do not respond to any other treatment. The surgical operation to correct the deformity from a bunion is called a bunionectomy, which typically involves removing bony growth of the bunion, re-positioning ligaments and tendons, and realigning the bones of the toe joint. Surgery is usually a day procedure performed with a local anaesthetic. The bones may be stabilised in their new position with screws or pins. Hardware may even include absorbable pins that are broken down by the body after a few months. You can expect a 6 – 8 week recovery period during which crutches are usually required. Surgery is often successful but sometimes the big toe moves back to its previous deviated position. Proper footwear and orthotics reduces the chances of surgical failure.

Prevention
Shoes that possess tapering toe boxes should be avoided if you have a bunion, as narrow toe boxes will hasten the progression of your bunion deformity. In some cases, conservative measures, including switching to appropriate footwear, may not have the desired effect, and your podiatrist may recommend for you a surgical procedure known as a bunionectomy.

Overpronation Of The Feet

Overview

While a slight amount of pronation is the proper means to absorb shock naturally, too much pronation (over-pronation) can potentially contribute to many maladies, which can sideline a runner. A foot that pronates excessively is one that continues to roll inward past a neutral position after the shock of impact has been absorbed. Uncorrected and repeated, this motion may lead to repetitive stress related injuries of the feet and legs. More times than not, the runner who over-pronates needs a shoe that reduces excess pronation and guides the foot along a neutral path.Pronation

Causes

Abnormal foot biomechanics usually causes over-use type injuries, occurring most frequently in runners. When a neutral foot pronates during walking or running, the lower leg, knee and thigh all rotate internally (medially). When an athlete with an overpronated foot runs, this rotation movement is exaggerated and becomes more marked.

Symptoms

When standing, your heels lean inward. When standing, one or both of your knee caps turn inward. Conditions such as a flat feet or bunions may occur. You develop knee pain when you are active or involved in athletics. The knee pain slowly goes away when you rest. You abnormally wear out the soles and heels of your shoes very quickly.

Diagnosis

People who overpronate have flat feet or collapsed arches. You can tell whether you overpronate by wetting your feet and standing on a dry, flat surface. If your footprint looks complete, you probably overpronate. Another way to determine whether you have this condition is to simply look at your feet when you stand. If there is no arch on the innermost part of your sole, and it touches the floor, you likely overpronate. The only way to truly know for sure, however, is to be properly diagnosed by a foot and ankle specialist.Over Pronation

Non Surgical Treatment

One of the best forms of treatment for over pronation is wearing supportive shoes. Shoes should have ample support and cushioning, particularly through the heel and arch of the foot. Without proper shoes, there may be additional strain on the tissue in the foot, greatly contributing to or causing an occurrence of over pronation. Rarely is surgery considered to relieve the pain and damage that may have resulted from this condition. Orthotic shoe inserts are often the easiest and most effective way to correct pronation.

Surgical Treatment

Calcaneal “Slide” (Sliding Calcaneal Osteotomy) A wedge is cut into the heel bone (calcaneus) and a fixation device (screws, plate) is used to hold the bone in its new position. This is an aggressive option with a prolonged period of non-weightbearing, long recovery times and many potential complications. However, it can and has provided for successful patient outcomes.

Will Severs Disease Have To Have Surgical Procedures?

Overview

Sever?s Disease is one of the most common overuse injuries affecting children during their secondary growth spurts and is described as a self-limiting condition resolving naturally with skeletal maturity 1. It is suggested to be caused by progressive microtrauma to the bone-cartilage interface in the calcaneal apophysis partly due to large traction forces in the Achilles tendon. The current standard treatment consists mainly of rest, and waiting for skeletal maturity.

Causes

The cause of Sever’s disease is not entirely clear. It is most likely due to overuse or repeated minor trauma that happens in a lot of sporting activities – the cartilage join between the two parts of the bone can not take all the shear stress of the activities. Some children seem to be just more prone to it for an unknown reason – combine this with sport, especially if its on a hard surface and the risk of getting it increases. It can be almost epidemic at the start of some sports seasons, especially winter. At the start of winter, the grounds are often harder, but soften later. Children who are heavier are also at greater risk for developing calcaneal apophysitis.

Symptoms

Most children with Sever’s complain of pain in the heel that occurs during or after activity (typically running or jumping) and is usually relieved by rest. The pain may be worse when wearing cleats. Sixty percent of children’s with Sever’s report experiencing pain in both heels.

Diagnosis

You may have pain when your doctor squeezes your heel bone. You may have pain when asked to stand or walk on your toes or on your heels. You may have pain in your heel when your doctor stretches your calf muscles. Your doctor may order x-rays of the injured foot to show an active growth plate.

Non Surgical Treatment

Decreasing or stopping sport is necessary until the pain reduces. Let pain be your guide, as it decreases you can slowly return to all activities. To help settle inflammation use an ice pack or rub an ice cube over the

painful area for 5 minutes daily whilst pain persists. Wearing supportive trainers during the day can help to soften the impact of walking on the heel. Encourage a normal pattern of walking. Complete the stretches below every day and before and after activity until your symptoms settle.

Prevention

Properly stretching to maintain flexibility is effective for preventing Sever’s disease. Stretches should target the calves, heel cords, and hamstrings. Your child should do the appropriate stretches two or three times a day, holding the stretch for about 20 seconds each time. Ask your child’s doctor for specific exercise instructions. Generally, doctors advise stretching both legs, even if the pain is confined to one heel. It’s also helpful to strengthen the shin muscles by having your youngster pull his toes in with a rubber exercise band or a piece of tubing and then stretch them forward. Assist your child in doing 15 repetitions of this exercise, three times a day. Having your child wear shoes with good shock absorbers and avoid running on hard surfaces as much as possible should also help prevent the condition.

Which Are The Major Causes Of Posterior Tibial Tendon Dysfunction ?

Overview
Flatfoot may sound like a characteristic of a certain water animal rather than a human problem. Flatfoot is a condition in which the arch of the foot is fallen and the foot is pointed outward. In contrast to a flatfoot condition that has always been present, this type develops after the skeleton has reached maturity. There are several situations that can result in fallen arches, including fracture, dislocation, tendon laceration, tarsal coalition, and arthritis. One of the most common conditions that can lead to this foot problem is posterior tibial tendon dysfunction. The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot and is crucial in holding up and supporting the arch. An acute injury or overuse can cause this tendon to become inflamed or even torn, and the arch of the foot will slowly fall over time.
Adult Acquired Flat Foot

Causes
Women are affected by Adult Acquired Flatfoot four times more frequently than men. Adult Flatfoot generally occurs in middle to older age people. Most people who acquire the condition already have flat feet. One arch begins to flatten more, then pain and swelling develop on the inside of the ankle. This condition generally affects only one foot. It is unclear why women are affected more often than men. But factors that may increase your risk of Adult Flatfoot include diabetes, hypertension, and obesity.

Symptoms
Patients will usually describe their initial symptoms as “ankle pain”, as the PT Tendon becomes painful around the inside of the ankle joint. The pain will become more intense as the foot flattens out, due to the continued stretching and tearing of the PT Tendon. As the arches continue to fall, and pronation increases, the heel bone (Calcaneus) tilts into a position where it pinches against the ankle bone (Fibula), causing pain on both the inside and outside of the ankle. As the foot spends increased time in a flattened, or deformed position, Arthritis can begin to affect the joints of the foot, causing additional pain.

Diagnosis
Your podiatrist is very familiar with tendons that have just about had enough, and will likely be able to diagnose this condition by performing a physical exam of your foot. He or she will probably examine the area visually and by feel, will inquire about your medical history (including past pain or injuries), and may also observe your feet as you walk. You may also be asked to attempt standing on your toes. This may be done by having you lift your ?good? foot (the one without the complaining tendon) off the ground, standing only on your problem foot. (You may be instructed to place your hands against the wall to help with balance.) Then, your podiatrist will ask you to try to go up on your toes on the bad foot. If you have difficulty doing so, it may indicate a problem with your posterior tibial tendon. Some imaging technology may be used to diagnose this condition, although it?s more likely the doctor will rely primarily on a physical exam. However, he or she may order scans such as an MRI or CT scan to look at your foot?s interior, and X-rays might also be helpful in a diagnosis.

Non surgical Treatment
Depending on the stage of the deformity and patient?s functional goals, various treatment options are available. Some patients improve with conservative care which includes rest and immobilization, shoe modifications, orthoses and bracing, or physical therapy. Surgery might be warranted for advanced stages of the condition. Often a combination of procedures including tendon and muscle augmentation, tendon transfers, realigning of bones or fusion of certain joints might be necessary in more advanced cases. Your doctor will evaluate and recommend an individualized plan of care with your specific needs in mind.
Flat Feet

Surgical Treatment
Surgery is usually performed when non-surgical measures have failed. The goal of surgery is to eliminate pain, stop progression of the deformity and improve a patient?s mobility. More than one technique may be used, and surgery tends to include one or more of the following. The tendon is reconstructed or replaced using another tendon in the foot or ankle The name of the technique depends on the tendon used. Flexor digitorum longus (FDL) transfer. Flexor hallucis longus (FHL) transfer. Tibialis anterior transfer (Cobb procedure). Calcaneal osteotomy – the heel bone may be shifted to bring your heel back under your leg and the position fixed with a screw. Lengthening of the Achilles tendon if it is particularly tight. Repair one of the ligaments under your foot. If you smoke, your surgeon may refuse to operate unless you can refrain from smoking before and during the healing phase of your procedure. Research has proven that smoking delays bone healing significantly.