Hammer Toes Definition
Overview
Hammer toes are classified based on the mobility of the toe joints. There are two types. Flexible and rigid. In a flexible hammertoe, the joint has the Hammer toes ability to move. This type of hammer toe can be straightened manually. A rigid hammer toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.
Causes
Hammertoe is caused when muscles fail to work in a balanced manner and the toe joints bend to form the hammertoe shape. If they remain in this position, the muscles and tendons supporting them tighten and stay that way. Causes of hammertoe can include squeezing into a too-small or ill-fitting shoe or wearing high heels that jam your toes into a tight toe box. An injury such as badly stubbing your toe. Arthritis. Nerve and muscle damage from diseases such as diabetes,
Symptoms
At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses.
Diagnosis
A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.
Non Surgical Treatment
What will a doctor do? Treat any foot complaints such as corns, calluses by periodically reducing the lesion and applying appropriate pads and dressings. Recommend the silicone toe prop. If an infection is present, then anti-septic dressings, antibiotics and pads to redistribute pressure away from the lesion may be necessary. In the case of a mallet toe, trigger toe or claw toe. If a corn occurs at the end of the toe, a silicone or leather prop may be used to straighten the toe. In a hammertoe deformity, a silicone prop to redistribute pressure away from a corn may be necessary. The doctor may give footwear advice. In severe cases, corrective surgery may be necessary. The doctor may recommend orthosis to correct a mechanical complaint of the foot, such as 3/4 length silicone insoles.
Surgical Treatment
Surgery to correct for a hammertoe may be performed as a day procedure. There are several different types of procedures that can be used depending on the foot structure and if the deformity is flexible or rigid.
Prevention
The best treatment is good prevention! Hammertoe can be prevented by wearing shoes with ample toe room, avoiding high heels, and wearing adjustable shoes to assure a looser fit. When buying shoes, shop at the end of the day when your feet are swollen from daily activity, try both shoes on to confirm they fit properly, and if necessary, visit a shoe repair store to see if they can stretch your shoes for a better fit.
Discover More About Overpronation Of The Feet
Overview
Overpronation is a term which is used more and more frequently by runners and exercisers these days, but what is overpronation and is it bad? Overpronation is excessive pronation of the feet when walking and running, and it can place people at risk of developing foot problems. Knowing the degree to which you pronate is important in order to select the correct footwear and exercise shoes. If you pronate excessively you could be placing an excessive strain on your feet, however overpronators can also place an excessive strain on the ankles, legs, knees, hips and lower back. Runners often claim to be an overpronator or even an underpronator or supinator. These terms may very well be viewed in a negative light when they really are not a problem at all. On the other hand people may be overpronators and not even know about it and could be at a high risk of developing a musculoskeletal problem.
Causes
Over-pronation may happen because the tissue that attaches to your foot bones is loose. You may be born with this problem or it may result from injuries or overuse, like from too much running.
Symptoms
People with overpronation may suffer from pain in the knees, hips, and low back. Overpronation itself does not necessarily cause any other symptoms but is a contributing factor of many foot conditions such as Plantar Facsiitis, Heel Spur Syndrome, Posterior Tibialis Tendon Rupture or Tendonitis, Hallux Valgus, Bunion Deformities, Metatarsalgia, Hallux Limitus or Hallux Rigidus, Hammer Toes, and Morton?s Neuroma.
Diagnosis
Your healthcare provider will ask about your symptoms, medical history, and activities and examine your feet. Your provider may watch you walk or run. Check the motion of your feet when they strike the ground. Look at your athletic shoes to see if they show an abnormal pattern of wear.
Non Surgical Treatment
Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion, and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body. When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.
Surgical Treatment
Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.
Overpronation is a term which is used more and more frequently by runners and exercisers these days, but what is overpronation and is it bad? Overpronation is excessive pronation of the feet when walking and running, and it can place people at risk of developing foot problems. Knowing the degree to which you pronate is important in order to select the correct footwear and exercise shoes. If you pronate excessively you could be placing an excessive strain on your feet, however overpronators can also place an excessive strain on the ankles, legs, knees, hips and lower back. Runners often claim to be an overpronator or even an underpronator or supinator. These terms may very well be viewed in a negative light when they really are not a problem at all. On the other hand people may be overpronators and not even know about it and could be at a high risk of developing a musculoskeletal problem.
Causes
Over-pronation may happen because the tissue that attaches to your foot bones is loose. You may be born with this problem or it may result from injuries or overuse, like from too much running.
Symptoms
People with overpronation may suffer from pain in the knees, hips, and low back. Overpronation itself does not necessarily cause any other symptoms but is a contributing factor of many foot conditions such as Plantar Facsiitis, Heel Spur Syndrome, Posterior Tibialis Tendon Rupture or Tendonitis, Hallux Valgus, Bunion Deformities, Metatarsalgia, Hallux Limitus or Hallux Rigidus, Hammer Toes, and Morton?s Neuroma.
Diagnosis
Your healthcare provider will ask about your symptoms, medical history, and activities and examine your feet. Your provider may watch you walk or run. Check the motion of your feet when they strike the ground. Look at your athletic shoes to see if they show an abnormal pattern of wear.
Non Surgical Treatment
Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion, and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body. When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.
Surgical Treatment
Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.
Rehab For Severs Disease
Overview
Sever's disease, also called calcaneal apophysitis, is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow. Sever's disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever's disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone. Sever's disease is similar to Osgood-Schlatter disease, a condition that affects the bones in the knees.
Causes
Sever's disease is caused by repetitive tension and/or pressure on the growth center of the heel. Running and jumping place a large amount of pressure on the heels and can cause pain. Children with Sever's may limp or have an altered gait due to the pain. Risk factors for Sever's include tight calf muscles, weak ankle muscles, and alignment abnormalities at the foot and ankle. Sever's can also result from wearing shoes without sufficient heel padding or arch support.
Symptoms
Adolescents suffering from Sever?s disease usually complain of pain at the back of their heel which is often worse after exercising. It is most common between the ages of 10-12 in boys and 8-10 in girls due to the rapid growth spurts that occur during this time. It can however happen anytime up until the age of 15. Whilst most people present with pain worse in one foot, it is very common to have symptoms in both feet.
Diagnosis
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.
Non Surgical Treatment
If your child lets you know that his heels are hurting, schedule a doctor's appointment. Your family doctor may or may not refer you to a podiatrist. Treatment for Sever's Disease typically consists of one or more of the following steps. Reducing physical activity. Because Sever's Disease appears to be most common in athletic children, reducing exercise periods will relieve pressure on the heel bones, thereby reducing pain. Your doctor may recommend that your child take a complete break from athletic activity for a set amount of time. Icing the heel bones can help to lower both inflammation and pain levels. Use a cold pack or wrap ice in a towel and apply it to the heels. A new exercise regimen that involves simple stretches designed to lengthen the calf muscles and tendons. Your doctor may prescribe the use of orthotic shoe inserts that will assist your child in maintaining a good level of physical activity. HTP Heel Seats may be an excellent option and have been purchased by many parents as an effective aide for children suffering from Sever's Disease. Read about HTP Heel Seats here and ask your doctor if they are right for your child's unique case. In extreme cases, a doctor may recommend a plaster cast or boot, but typically only if other less cumbersome solutions fail to reduce pain. Some doctors may prescribe anti-inflammatory medications. Never give these to a child yourself, without first seeking a doctor's advice. Some medications carry the risk of serious side effects for children. Only give medications if specifically prescribed your child's physician.
Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
Sever's disease, also called calcaneal apophysitis, is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow. Sever's disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever's disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone. Sever's disease is similar to Osgood-Schlatter disease, a condition that affects the bones in the knees.
Causes
Sever's disease is caused by repetitive tension and/or pressure on the growth center of the heel. Running and jumping place a large amount of pressure on the heels and can cause pain. Children with Sever's may limp or have an altered gait due to the pain. Risk factors for Sever's include tight calf muscles, weak ankle muscles, and alignment abnormalities at the foot and ankle. Sever's can also result from wearing shoes without sufficient heel padding or arch support.
Symptoms
Adolescents suffering from Sever?s disease usually complain of pain at the back of their heel which is often worse after exercising. It is most common between the ages of 10-12 in boys and 8-10 in girls due to the rapid growth spurts that occur during this time. It can however happen anytime up until the age of 15. Whilst most people present with pain worse in one foot, it is very common to have symptoms in both feet.
Diagnosis
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.
Non Surgical Treatment
If your child lets you know that his heels are hurting, schedule a doctor's appointment. Your family doctor may or may not refer you to a podiatrist. Treatment for Sever's Disease typically consists of one or more of the following steps. Reducing physical activity. Because Sever's Disease appears to be most common in athletic children, reducing exercise periods will relieve pressure on the heel bones, thereby reducing pain. Your doctor may recommend that your child take a complete break from athletic activity for a set amount of time. Icing the heel bones can help to lower both inflammation and pain levels. Use a cold pack or wrap ice in a towel and apply it to the heels. A new exercise regimen that involves simple stretches designed to lengthen the calf muscles and tendons. Your doctor may prescribe the use of orthotic shoe inserts that will assist your child in maintaining a good level of physical activity. HTP Heel Seats may be an excellent option and have been purchased by many parents as an effective aide for children suffering from Sever's Disease. Read about HTP Heel Seats here and ask your doctor if they are right for your child's unique case. In extreme cases, a doctor may recommend a plaster cast or boot, but typically only if other less cumbersome solutions fail to reduce pain. Some doctors may prescribe anti-inflammatory medications. Never give these to a child yourself, without first seeking a doctor's advice. Some medications carry the risk of serious side effects for children. Only give medications if specifically prescribed your child's physician.
Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
Posterior Tibial Tendon Dysfunction Surgery Recovery Time
Overview
Adult Acquired Flatfoot (Posterior Tibial Tendon Dysfunction) is a painful, progressive deformity in adults. It results from a gradual stretch (attenuation) of the tibialis posterior tendon and the ligaments that support your foot?s arch. This stretching causes the tendon to lose strength and function. Many people have flat feet and do not experience pain. However, pain occurs with Adult Acquired Flatfoot because the tendons and ligaments have been torn. Once the vital ligaments and posterior tibial tendon are lost, there is no longer anything holding the arch of the foot in place. 
Causes
The posterior tibial tendon, which connects the bones inside the foot to the calf, is responsible for supporting the foot during movement and holding up the arch. Gradual stretching and tearing of the posterior tibial tendon can cause failure of the ligaments in the arch. Without support, the bones in the feet fall out of normal position, rolling the foot inward. The foot's arch will collapse completely over time, resulting in adult acquired flatfoot. The ligaments and tendons holding up the arch can lose elasticity and strength as a result of aging. Obesity, diabetes, and hypertension can increase the risk of developing this condition. Adult acquired flatfoot is seen more often in women than in men and in those 40 or older.
Symptoms
The types of symptoms that may indicate Adult-Acquired Flat Foot Deformity include foot pain that worsens over time, loss of the arch, abnormal shoe wear (excessive wearing on the inner side of shoe from walking on the inner side of the foot) and an awkward appearance of the foot and ankle (when viewed from behind, heel and toes appear to go out to the side). It is important that we help individuals recognize the early symptoms of this condition, as there are many treatment options, depending upon the severity, the age of the patient, and the desired activity levels.
Diagnosis
Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course. Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is available. Check the anterior tibial tendon for size and strength.
Non surgical Treatment
Treatment depends very much upon a patient?s symptoms, functional goals, degree and specifics of deformity, and the presence of arthritis. Some patients get better without surgery. Rest and immobilization, orthotics, braces and physical therapy all may be appropriate. With early-stage disease that involves pain along the tendon, immobilization with a boot for a period of time can relieve stress on the tendon and reduce the inflammation and pain. Once these symptoms have resolved, patients are often transitioned into an orthotic that supports the inside aspect of the hindfoot. For patients with more significant deformity, a larger ankle brace may be necessary. 
Surgical Treatment
The indications for surgery are persistent pain and/or significant deformity. Sometimes the foot just feels weak and the assessment of deformity is best done by a foot and ankle specialist. If surgery is appropriate, a combination of soft tissue and bony procedures may be considered to correct alignment and support the medial arch, taking strain off failing ligaments. Depending upon the tissues involved and extent of deformity, the foot and ankle specialist will determine the necessary combination of procedures. Surgical procedures may include a medial slide calcaneal osteotomy to correct position of the heel, a lateral column lengthening to correct position in the midfoot and a medial cuneiform osteotomy or first metatarsal-tarsal fusion to correct elevation of the medial forefoot. The posterior tibial tendon may be reconstructed with a tendon transfer. In severe cases (stage III), the reconstruction may include fusion of the hind foot,, resulting in stiffness of the hind foot but the desired pain relief. In the most severe stage (stage IV), the deltoid ligament on the inside of the ankle fails, resulting in the deformity in the ankle. This deformity over time can result in arthritis in the ankle.
Flat Feet In Adults (Adult Aquired FlatFoot)
Overview
The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot. PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn't treated early.
Causes
The posterior tibial tendon, which connects the bones inside the foot to the calf, is responsible for supporting the foot during movement and holding up the arch. Gradual stretching and tearing of the posterior tibial tendon can cause failure of the ligaments in the arch. Without support, the bones in the feet fall out of normal position, rolling the foot inward. The foot's arch will collapse completely over time, resulting in adult acquired flatfoot. The ligaments and tendons holding up the arch can lose elasticity and strength as a result of aging. Obesity, diabetes, and hypertension can increase the risk of developing this condition. Adult acquired flatfoot is seen more often in women than in men and in those 40 or older.
Symptoms
Many patients with this condition have no pain or symptoms. When problems do arise, the good news is that acquired flatfoot treatment is often very effective. Initially, it will be important to rest and avoid activities that worsen the pain.
Diagnosis
The diagnosis of posterior tibial tendon dysfunction and AAFD is usually made from a combination of symptoms, physical exam and x-ray imaging. The location of pain, shape of the foot, flexibility of the hindfoot joints and gait all may help your physician make the diagnosis and also assess how advanced the problem is.
Non surgical Treatment
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support.
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.
The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot. PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn't treated early.
Causes
The posterior tibial tendon, which connects the bones inside the foot to the calf, is responsible for supporting the foot during movement and holding up the arch. Gradual stretching and tearing of the posterior tibial tendon can cause failure of the ligaments in the arch. Without support, the bones in the feet fall out of normal position, rolling the foot inward. The foot's arch will collapse completely over time, resulting in adult acquired flatfoot. The ligaments and tendons holding up the arch can lose elasticity and strength as a result of aging. Obesity, diabetes, and hypertension can increase the risk of developing this condition. Adult acquired flatfoot is seen more often in women than in men and in those 40 or older.
Symptoms
Many patients with this condition have no pain or symptoms. When problems do arise, the good news is that acquired flatfoot treatment is often very effective. Initially, it will be important to rest and avoid activities that worsen the pain.
Diagnosis
The diagnosis of posterior tibial tendon dysfunction and AAFD is usually made from a combination of symptoms, physical exam and x-ray imaging. The location of pain, shape of the foot, flexibility of the hindfoot joints and gait all may help your physician make the diagnosis and also assess how advanced the problem is.
Non surgical Treatment
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support.
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.
All The Things You Want To Know About Achilles Tendinitis
Overview
Achilles tendonitis is an inflammation of the Achilles tendon, which attaches the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Pain can be felt on the back of the heel at the attachment of the tendon, along the length of the tendon, or at the base of the calf where the tendon attaches to the muscle. Swelling is not always present with this injury, but it may occur in severe cases.
Causes
Like any muscle or tendon in the body, the older we get, the more likely we are to sustain an injury. So middle-aged men and women are most at risk, with a slightly higher risk factor attributed to males. Those who participate in more intense athletic activities like high impact sports (tennis, running, basketball) are most susceptible to the injury. Certain underlying medical conditions can also be a contributing factor. Diabetics are more at risk of suffering from Achilles Tendinitis, as are those who are not in great physical shape. Some antibiotics, particularly fluoroquinolones can make one more likely to suffer a strained Achilles Tendon.
Symptoms
Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.
Diagnosis
A doctor or professional therapist will confirm a diagnosis, identify and correct possible causes, apply treatment and prescribe eccentric rehabilitation exercises. An MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis. Gait analysis along with a physical assessment will identify any possible biomechanical factors such as over pronation which may have contributed to the achilles tendonitis and training methods will be considered. Biomechanical problems can be corrected with the use of orthotic inserts and selection of correct footwear.
Nonsurgical Treatment
NSAIDS like ibuprofen are often prescribed to help manage the pain and inflammation. Steroids are often recommended when patients do not respond to NSAID treatment. They are often most effective when injected directly into the inflamed and swollen area. Physiotherapy is a great way to stretch and strengthen the Achilles tendon. A good physical therapist will also teach the patient techniques which give better foot support during exercise (taping, wrapping, etc?). Orthotics, assistive devices and insoles can be used to cushion and cradle the arch of the foot during the healing process. Shock Wave Therapy. This is the newest form of treatment and uses concentrated sound waves to stimulate healing in the affected area. This form of treatment is reserved for heel pain that is unresponsive to other forms of treatment.
Surgical Treatment
Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from the transferred tendon.
Prevention
Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.
Achilles tendonitis is an inflammation of the Achilles tendon, which attaches the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Pain can be felt on the back of the heel at the attachment of the tendon, along the length of the tendon, or at the base of the calf where the tendon attaches to the muscle. Swelling is not always present with this injury, but it may occur in severe cases.
Causes
Like any muscle or tendon in the body, the older we get, the more likely we are to sustain an injury. So middle-aged men and women are most at risk, with a slightly higher risk factor attributed to males. Those who participate in more intense athletic activities like high impact sports (tennis, running, basketball) are most susceptible to the injury. Certain underlying medical conditions can also be a contributing factor. Diabetics are more at risk of suffering from Achilles Tendinitis, as are those who are not in great physical shape. Some antibiotics, particularly fluoroquinolones can make one more likely to suffer a strained Achilles Tendon.
Symptoms
Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.
Diagnosis
A doctor or professional therapist will confirm a diagnosis, identify and correct possible causes, apply treatment and prescribe eccentric rehabilitation exercises. An MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis. Gait analysis along with a physical assessment will identify any possible biomechanical factors such as over pronation which may have contributed to the achilles tendonitis and training methods will be considered. Biomechanical problems can be corrected with the use of orthotic inserts and selection of correct footwear.
Nonsurgical Treatment
NSAIDS like ibuprofen are often prescribed to help manage the pain and inflammation. Steroids are often recommended when patients do not respond to NSAID treatment. They are often most effective when injected directly into the inflamed and swollen area. Physiotherapy is a great way to stretch and strengthen the Achilles tendon. A good physical therapist will also teach the patient techniques which give better foot support during exercise (taping, wrapping, etc?). Orthotics, assistive devices and insoles can be used to cushion and cradle the arch of the foot during the healing process. Shock Wave Therapy. This is the newest form of treatment and uses concentrated sound waves to stimulate healing in the affected area. This form of treatment is reserved for heel pain that is unresponsive to other forms of treatment.
Surgical Treatment
Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from the transferred tendon.
Prevention
Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.
What Is Heel Pain
Overview
The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot. Through overuse the fascia can become inflamed and painful at its attachment to the heel bone or calcaneus. The condition is traditionally thought to be inflammation, however this is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain is thought to be degeneration of the collagen fibres close to the attachment to the heel bone.
Causes
Far and away the most common cause of plantar fasciitis in an athlete is faulty biomechanics of the foot or leg. Faulty biomechanics causes the foot to sustain increased or prolonged stresses over and above those of routine ground contacts. Throughout the phase of ground contact, the foot assumes several mechanical positions to dissipate shock while at the same time placing the foot in the best position to deliver ground forces. With heel landing the foot is supinated (ankle rolled out). At mid-stance the foot is pronated (ankle rolled in). The foot is supinated again with toe-off. The supination of the foot at heel strike and toe-off makes the foot a rigid lever. At heel strike the shock of ground contact is transferred to the powerful quads. During toe-off forward motion is created by contraction of the gastroc complex plantar flexing the rigid lever of the foot pushing the body forward.
Symptoms
You'll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting. Your heel pain will be worse with the first steps and improves with activity as it warms up. As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage your are in using the following guidelines. No Heel Pain, Normal! Heel pain after exercise. Heel pain before and after exercise. Heel pain before, during and after exercise. Heel pain all the time. Including at rest! This symptom progression is consistent with the four stages of a typical overuse injury. Ultimately, further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone it is known as heel spurs, which have a longer rehabilitation period.
Diagnosis
Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.
Non Surgical Treatment
About 80% of plantar fasciitis cases resolve spontaneously by 12 months; 5% of patients end up undergoing surgery for plantar fascia release because all conservative measures have failed. For athletes in particular, the slow resolution of plantar fasciitis can be a highly frustrating problem. These individuals should be cautioned not to expect overnight resolution, especially if they have more chronic pain or if they continue their activities. . Generally, the pain resolves with conservative treatment. Although no mortality is associated with this condition, significant morbidity may occur. Patients may experience progressive plantar pain, leading to limping (antalgic gait) and restriction of activities such as walking and running. In addition, changes in weight-bearing patterns resulting from the foot pain may lead to associated secondary injury to the hip and knee joints.
Surgical Treatment
Surgery may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone; this is called a plantar fascia release. It may also involve removal of a spur on the calcaneum if one is present. Surgery is not always successful. It can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.
Prevention
The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise or walk a lot or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet. You should also avoid repeated jarring to the heel. Keep a healthy weight. Do your leg and foot stretching exercises regularly.
