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Heel Spur Symtoms

September 28, 2015
Calcaneal Spur

Overview

A heel spur also known as a calcaneal spur, is a pointed bony outgrowth of the heel bone (calcaneus). Heel spurs do not always cause pain and often are discovered incidentally on X-rays taken for other problems. Heel spurs can occur at the back of the heel and also under the heel bone on the sole of the foot, where they may be associated with the painful foot condition plantar fasciitis.

Causes

Heel spurs can be caused by several things. Anything that can cause the body to rebuild itself can lead to a bone spur. A heel spur is a natural reaction of the body to correct a weakness by building extra bone. One of the most common causes for the development of heel spurs is the wearing of shoes that are too tight. That?s why more women suffer from heel spurs more than men. Athletes who tend to stress their feet a lot, people are overweight who have more pressure on their lower extremities and the elderly also tend to suffer more from heel spurs.

Calcaneal Spur

Symptoms

Bone spurs may cause sudden, severe pain when putting weight on the affected foot. Individuals may try to walk on their toes or ball of the foot to avoid painful pressure on the heel spur. This compensation during walking or running can cause additional problems in the ankle, knee, hip, or back.

Diagnosis

Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.

Non Surgical Treatment

By reducing excessive motion and controlling and supporting the foot during physical activities an orthotic can help to limit how far the plantar fascia is pulled or torn away from the heel. A Heel Spur pad can be offered- which is a pad designed to take pressure off the spur. If the problem persists, consult your foot doctor.

Surgical Treatment

Almost 90% of the people suffering from heel spur get better with nonsurgical treatments. However, if the conservative treatments do not help you and you still have pain even after 9 to 12 months, your doctor may advise surgery for treating heel spur. The surgery helps in reducing the pain and improving your mobility. Some of the surgical techniques used by doctors are release of the plantar fascia. Removal of a spur. Before the surgery, the doctor will go for some pre-surgical tests and exams. After the operation, you will need to follow some specific recommendations which may include elevation of the foot, waiting time only after which you can put weight on the foot etc.

Prevention

To prevent this condition, wearing shoes with proper arches and support is very important. Proper stretching is always a necessity, especially when there is an increase in activities or a change in running technique. It is not recommended to attempt working through the pain, as this can change a mild case of heel spurs and plantar fascitis into a long lasting and painful episode of this condition.

Tips To Treat Heel Spur

September 25, 2015
Heel Spur

Overview

A calcaneal spur (or heel spur) is a small osteophyte (bone spur) located on the calcaneus (heel bone). Calcaneal spurs are typically detected by a radiological examination (X-ray). When a foot bone is exposed to constant stress, calcium deposits build up on the bottom of the heel bone. Generally, this has no effect on a person's daily life. However, repeated damage can cause these deposits to pile up on each other,causing a spur-shaped deformity, called a calcaneal (or heel) spur. Obese people, flatfooted people, and women who constantly wear high-heeled shoes are most susceptible to heel spurs. An inferior calcaneal spur is located on the inferior aspect of the calcaneus and is typically a response to plantar fasciitis over a period, but may also be associated with ankylosing spondylitis (typically in children). A posterior calcaneal spur develops on the back of the heel at the insertion of the Achilles tendon. An inferior calcaneal spur consists of a calcification of the calcaneus, which lies superior to the plantar fascia at the insertion of the plantar fascia. A posterior calcaneal spur is often large and palpable through the skin and may need to be removed as part of the treatment of insertional Achilles tendonitis. These are also generally visible to the naked eye.

Causes

A bone spur forms as the body tries to repair itself by building extra bone. It generally forms in response to pressure, rubbing, or stress that continues over a long period of time. Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the ends of the bones within joints breaks down and eventually wears away (osteoarthritis). Bone spurs due to aging are especially common in the joints of the spine and feet.

Calcaneal Spur

Symptoms

Heel spurs are most noticeable in the morning when stepping out of bed. It can be described as sharp isolated pain directly below the heel. If left untreated heel spurs can grow and become problematic long-term.

Diagnosis

A Heel Spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone. The plantar fascia is the thick, connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. In other words, tremendous stress is placed on the plantar fascia.

Non Surgical Treatment

Heel spurs can be solved with simple solutions that do not involve surgery. Avoiding extended periods of activity such as running, sports and walking. Applying ice directly to the heel for 5 minutes at a time. This helps soothe and reduce inflammation. Lose weight to reduce stress on your heels. A series of simple exercises. Inexpensive orthotic shoe inserts. The best way to treat heel spurs is by treating the underlying cause of the problem. This involves correcting the dynamics of your foot motion with orthotic insoles.

Surgical Treatment

Surgery, which is a more radical treatment, can be a permanent correction to remove the spur itself. If your doctor believes that surgery is indicated, he will recommend an operation - but only after establishing that less drastic methods of treatment are not successful.

Prevention

Choose new shoes that are the right size. Have your foot measured when you go to the shoe store instead of taking a guess about the size. Also, try on shoes at the end of the day or after a workout, when your feet are at their largest. To ensure a good fit, wear the same type of socks or nylons that you would normally wear with the type of shoe that you are trying on.

Bursitis Of The Feet

August 23, 2015
Overview

Do you experience pain at the back of your heel? Is the back of your heel red and swollen? And you were told that it might Achilles Tendonitis? But so far treatment for Achilles Tendonitis does not seem to be working? You might be suffering instead from Retrocalcaneal Bursitis.

Causes

If the posterior-superior portion of the heel has an abnormally large bony prominence protruding from it (called a Haglund's Deformity), in some instances it may rub against the Achilles Tendon. When this occurs, the bursa between the bone and the tendon will become inflamed, swollen, and painful. This condition is called Retrocalcaneal Bursitis. The presence of a Haglund's Deformity does not insure that these problems will occur. In order for these problems to occur, the heel and foot must be tilted in such a way as to actually force this bony prominence into the bursa and tendon.

Symptoms

Symptoms include pain at the back of the heel, especially when running uphill or on soft surfaces. There will be tenderness and swelling at the back of the heel which may make it difficult to wear certain shoes. When pressing in with the fingers both sides are the back of the heel a spongy resistance may be felt.

Diagnosis

Like all other forms of bursitis, initially the physician will take down the history of symptoms experienced by the patient, this will be followed by a detailed physical examination which involves checking for inflammation signs like pain, redness, and warmth of the heel area. The physician might examine further by moving the ankle a little to determine the exact location of pain. Further diagnostic tests including x-ray, bone scans, and MRI scan might be suggested if required.

Non Surgical Treatment

Treatment is primarily comprised of relief from the painful activity (running). It is important that shoes do not pinch the heel. If satisfactory progress is not made during the rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the bursa. Injections should be performed under ultrasound guidance to ensure optimal effect and reduce the risk of injecting into the Achilles itself. If progress is not made neither through rehabilitation nor medicinal treatment, surgical treatment can be attempted.

Surgical Treatment

Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.

Treatment For Hammer Toes Without Surgery

June 23, 2015
Hammer ToeOverview

When a person has hammertoe, the end of their toe bends downward and the middle joint curls up. Eventually, the toe gets stuck in a stiff, claw-like position. When the inside of your shoe rubs against a hammer toe, corns, blisters or calluses may form on top of the toe or on the bottom of your foot. This can make walking painful. You may also have pain in the joint where your big toe joins your foot. Hammer toe usually affects a person?s second toe (the toe next to the big toe), but it can affect other toes too.

Causes

Shoes that narrow toward the toe force the smaller toes into a bent upward position. This makes the toes rub against the inside of the shoe, and creates corns and calluses, aggravating the toes further. If the shoes have a high heel, the feet are forced forward and down, squeezing the toes against the front of the shoe, which increases the pressure on the toes and makes them bend further. Eventually, the toe muscles become unable to straighten the toe.

HammertoeSymptoms

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

Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

Non Surgical Treatment

People with a hammer toe benefit from wearing shoes in which the toe box is made of a flexible material and is wide enough and high enough to provide adequate room for the toes. High-heeled shoes should be avoided, because they tend to force the toes into a narrow, flat toe box. A doctor may recommend an insert (orthotic) for the shoe to help reduce friction and pressure on the hammer toe. Wearing properly fitted shoes may reduce pain and inflammation. It may also prevent ulcers from developing and help existing ulcers heal. However, the hammer toe does not disappear.

Surgical Treatment

For severe hammer toe, you will need an operation to straighten the joint. The surgery often involves cutting or moving tendons and ligaments. Sometimes the bones on each side of the joint need to be connected (fused) together. Most of the time, you will Hammer toe go home on the same day as the surgery. The toe may still be stiff afterward, and it may be shorter. If the condition is treated early, you can often avoid surgery. Treatment will reduce pain and walking difficulty.

HammertoePrevention

wear sensible shoes. Here are some tips. Most people have one foot that's bigger than the other. Fit your shoes to the bigger foot. Buy your shoes at the end of the day as your feet tend to swell a bit and you will get a better sense of fit. When you buy your shoes, wear the sock that you will be using when wearing that shoe - wear a sports sock when buyingtrainers, for example. As you get older, your feet get bigger. Get your feet measured every time you buy shoes. Don't go by shoe sizes. Shoe sizes vary among manufacturers; a shoe is the right size only when it fits comfortably. The ball of your foot should fit into the widest part of the shoe. A shoe should be sturdy so that it only bends in the ball of the foot, exactly where your big toes bend. Any shoe that can be bent anywhere along the sole or twisted side to side is generally too flimsy. There should be at least 1.5 cm between the tip of your longest toe and the front of the shoe. Never buy shoes that feel tight and expect them to stretch with wearing. If you have prominent areas on your feet such as hammer toes and bunions, avoid shoes with a lot of stitching or multiple pieces of fabric, as these stitched areas tend not to stretch to accommodate various toe deformities. Your shoes shouldn't ride up and down on your heel as you walk. The higher the heel, the less safe the shoe. Check children's shoes regularly.

What Is Over-Pronation

June 6, 2015
Overview

Excessive pronation hampers our natural walking pattern, causing an imbalance and leading to wear and tear in other parts of the body, with every step we take! Whether you have a true flat foot or suffer from over-pronation in both cases your poor walking pattern may contribute to a range of different complaints. Especially with age, poor alignment of the feet will cause very common conditions such as heel pain or knee Pain.Foot Pronation

Causes

It is important to identify the cause of overpronation in order to determine the best treatment methods to adopt. Not all treatments and preventative measures will work equally well for everyone, and there may be a little trial and error involved to get the best treatment. A trip to a podiatrist or a sports therapist will help you to establish the cause of overpronation, and they will be able to tell you the best treatments based on your specific degree of overpronation and the cause. Overpronation has many causes, with the most common reasons for excessive pronation listed, low arches, flexible flat feet, fallen arches, gait abnormalities, abnormal bone structure, abnormal musculature, bunions, corns and calluses.

Symptoms

In addition to problems overpronation causes in the feet, it can also create issues in the calf muscles and lower legs. The calf muscles, which attach to the heel via the Achilles tendon, can become twisted and irritated as a result of the heel rolling excessively toward the midline of the body. Over time this can lead to inflexibility of the calf muscles and the Achilles tendon, which will likely lead to another common problem in the foot and ankle complex, the inability to dorsiflex. As such, overpronation is intrinsically linked to the inability to dorsiflex.

Diagnosis

To easily get an idea of whether a person overpronates, look at the position and condition of certain structures in the feet and ankles when he/she stands still. When performing weight-bearing activities like walking or running, muscles and other soft tissue structures work to control gravity's effect and ground reaction forces to the joints. If the muscles of the leg, pelvis, and feet are working correctly, then the joints in these areas such as the knees, hips, and ankles will experience less stress. However, if the muscles and other soft tissues are not working efficiently, then structural changes and clues in the feet are visible and indicate habitual overpronation.Foot Pronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improper fitting footwear can lead to additional problems of the foot.

Prevention

With every step we take, we place at least half of our body weight on each foot (as we walk faster, or run, we can exert more than twice our body weight on each foot). As this amount of weight is applied to each foot there is a significant shock passed on to our body. Custom-made orthotics will absorb some of this shock, helping to protect our feet, ankles, knees, hips, and lower back.

Rehab For Calcaneal Apophysitis

May 14, 2015
Overview

Sever?s disease is similar to Osgood-Schlatter disease of the knee in that they both involve a partial detachment or tearing of the tendon from the bone. The difference is location: Osgood-Schlatter occurs at the knee, and Sever?s occurs at the ankle. In Sever?s disease, which usually occurs in children from the ages of 8 to 14, the Achilles tendon begins to tear away from its insertion into the calcaneus or heel bone. This injury can be very painful and affect highly active to somewhat inactive children. Symptoms include pain that increases with activity, localized pain in the back of the foot, tenderness to the touch, and swelling. Treatment includes rest, ice, compression, elevation, and nonsteroidal anti-inflammatory medication as necessary.

Causes

Sever?s disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season. Children who are going through adolescence are also at risk of getting it because the heel bone grows quicker than the leg. Too much weight bearing on the heel can also cause it, as can excessive traction since the bones and tendons are still developing. It occurs more commonly in children who over-pronate, and involves both heels in more than half of patients.

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

Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.

Non Surgical Treatment

Treatment may consist of one or more of the following, Elevating the heel, Stretching hamstring and calf muscles 2-3 times daily, Using R.I.C.E. (Rest, Ice, Compression, Elevation), Foot orthotics, Medication, Physical therapy, Icing daily (morning), Heating therapy, Open back shoe are best and avoid high heel shoe. The Strickland Protocol has shown a positive response in patients with a mean return to sport in less than 3 weeks.

Exercise

The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Calf Stretch with Towel. Begin this exercise with a resistance band around your foot and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free. Once you can perform 20 repetitions consistently without pain, the exercise can be progressed by gradually increasing the resistance of the band provided there is no increase in symptoms. Bridging. Begin this exercise lying on your back in the position demonstrated. Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.

Leg Length Discrepancy Shoe Wear Pattern

April 29, 2015
Overview

Differences of an inch-and-a-half to two inches may require epiphysiodesis (adjusting the growth of the longer side) or acute shortening of the other side. Differences greater than 2.5 inches usually require a lengthening procedure. The short bone is cut and an external device is applied. Gradual lengthening is done over months to allow the muscles and nerves accommodate the new length.Leg Length Discrepancy

Causes

The causes of LLD may be divided into those that shorten a limb versus those that lengthen a limb, or they may be classified as affecting the length versus the rate of growth in a limb. For example, a fracture that heals poorly may shorten a leg slightly, but does not affect its growth rate. Radiation, on the other hand, can affect a leg's long-term ability to expand, but does not acutely affect its length. Causes that shorten the leg are more common than those that lengthen it and include congenital growth deficiencies (seen in hemiatrophy and skeletal dysplasias ), infections that infiltrate the epiphysis (e.g. osteomyelitis ), tumors, fractures that occur through the growth plate or have overriding ends, Legg-Calve-Perthes disease, slipped capital femoral epiphysis (SCFE), and radiation. Lengthening can result from unique conditions, such as hemihypertrophy , in which one or more structures on one side of the body become larger than the other side, vascular malformations or tumors (such as hemangioma ), which cause blood flow on one side to exceed that of the other, Wilm's tumor (of the kidney), septic arthritis, healed fractures, or orthopaedic surgery. Leg length discrepancy may arise from a problem in almost any portion of the femur or tibia. For example, fractures can occur at virtually all levels of the two bones. Fractures or other problems of the fibula do not lead to LLD, as long as the more central, weight-bearing tibia is unaffected. Because many cases of LLD are due to decreased rate of growth, the femoral or tibial epiphyses are commonly affected regions.

Symptoms

Back pain along with pain in the foot, knee, leg and hip on one side of the body are the main complaints. There may also be limping or head bop down on the short side or uneven arm swinging. The knee bend, hip or shoulder may be down on one side, and there may be uneven wear to the soles of shoes (usually more on the longer side).

Diagnosis

There are several orthopedic tests that are used, but they are rudimentary and have some degree of error. Even using a tape measure with specific anatomic landmarks has its errors. Most leg length differences can be seen with a well trained eye, but I always recommend what is called a scanagram, or a x-ray bone length study (see picture above). This test will give a precise measurement in millimeters of the length difference.

Non Surgical Treatment

Internal heel lifts: Putting a simple heel lift inside the shoe or onto a foot orthotic has the advantage of being transferable to many pairs of shoes. It is also aesthetically more pleasing as the lift remains hidden from view. However, there is a limit as to how high the lift can be before affecting shoe fit. Dress shoes will usually only accommodate small lifts (1/8"1/4") before the heel starts to piston out of the shoe. Sneakers and workboots may allow higher lifts, e.g., up to 1/2", before heel slippage problems arise. External heel lifts: If a lift of greater than 1/2" is required, you should consider adding to the outsole of the shoe. In this way, the shoe fit remains good. Although some patients may worry about the cosmetics of the shoe, it does ensure better overall function. Nowadays with the development of synthetic foams and crepes, such lifts do not have to be as heavy as the cork buildups of the past. External buildups are not transferable and they will wear down over time, so the patient will need to be vigilant in having them repaired. On ladies' high-heel shoes, it may be possible to lower one heel and thereby correct the imbalance.

Leg Length

Surgical Treatment

Many people undergo surgery for various reasons - arthritis, knee replacement, hip replacement, even back surgery. However, the underlying cause of leg length inequality still remains. So after expensive and painful surgery, follow by time-consuming and painful rehab, the true culprit still remains. Resuming normal activities only continues to place undue stress on the already overloaded side. Sadly so, years down the road more surgeries are recommended for other joints that now endure the excessive forces.

Causes And Treatment

April 20, 2015
Overview
Adult-acquired flatfoot or collapsed arch occurs because the large tendon on the inside of the ankle - the posterior tibial tendon - becomes stretched out and no longer supports the foot?s arch. In many cases, the condition worsens and and the tendon thickens, becoming painful, especially during activities. Flatfoot or collapsed arch is also known as posterior tibial tendon dysfunction. This condition is different than having flat feet since birth (known as congenital flatfoot), although sometimes these patients develop similar symptoms and require similar treatments. Flat Foot
Causes
There are numerous causes of acquired Adult Flatfoot, including, trauma, fracture, dislocation, tendon rupture/partial rupture or inflammation of the tendons, tarsal coalition, arthritis, neuroarthropathy and neurologic weakness. The most common cause of acquired Adult Flatfoot is due to overuse of a tendon on the inside of the ankle called the posterior tibial tendon. This is classed as - posterior tibial tendon dysfunction. What are the causes of Adult Acquired flat foot? Trauma, Fracture or dislocation. Tendon rupture, partial tear or inflammation. Tarsal Coalition. Arthritis. Neuroarthropathy. Neurological weakness.
Symptoms
At first you may notice pain and swelling along the medial (big toe) side of the foot. This is where the posterior tibialis tendon travels from the back of the leg under the medial ankle bone to the foot. As the condition gets worse, tendon failure occurs and the pain gets worse. Some patients experience pain along the lateral (outside) edge of the foot, too. You may find that your feet hurt at the end of the day or after long periods of standing. Some people with this condition have trouble rising up on their toes. They may be unable to participate fully in sports or other recreational activities.
Diagnosis
First, both feet should be examined with the patient standing and the entire lower extremity visible. The foot should be inspected from above as well as from behind the patient, as valgus angulation of the hindfoot is best appreciated when the foot is viewed from behind. Johnson described the so-called more-toes sign: with more advanced deformity and abduction of the forefoot, more of the lateral toes become visible when the foot is viewed from behind. The single-limb heel-rise test is an excellent determinant of the function of the posterior tibial tendon. The patient is asked to attempt to rise onto the ball of one foot while the other foot is suspended off the floor. Under normal circumstances, the posterior tibial muscle, which inverts and stabilizes the hindfoot, is activated as the patient begins to rise onto the forefoot. The gastrocnemius-soleus muscle group then elevates the calcaneus, and the heel-rise is accomplished. With dysfunction of the posterior tibial tendon, however, inversion of the heel is weak, and either the heel remains in valgus or the patient is unable to rise onto the forefoot. If the patient can do a single-limb heel-rise, the limb may be stressed further by asking the patient to perform this maneuver repetitively.
Non surgical Treatment
Conservative treatment is indicated for nearly all patients initially before surgical management is considered. The key factors in determining appropriate treatment are whether acute inflammation and whether the foot deformity is flexible or fixed. However, the ultimate treatment is often determined by the patients, most of whom are women aged 40 or older. Compliance can be a problem, especially in stages I and II. It helps to emphasise to the patients that tibialis posterior dysfunction is a progressive and chronic condition and that several fittings and a trial of several different orthoses or treatments are often needed before a tolerable treatment is found. Acquired Flat Feet
Surgical Treatment
Surgical treatment should be considered when all other conservative treatment has failed. Surgery options for flatfoot reconstruction depend on the severity of the flatfoot. Surgery for a flexible flatfoot deformity (flatfoot without arthritis to the foot joints) involves advancing the posterior tibial tendon under the arch to provide more support and decrease elongation of the tendon as well as addressing the hindfoot eversion with a osteotomy to the calcaneus (surgical cut in the heel bone). Additionally, the Achilles tendon may need to be lengthened because of the compensatory contracture of the Achilles tendon with flatfoot deformity. Flatfoot deformity with arthritic changes to the foot is considered a rigid flatfoot. Correction of a rigid flatfoot deformity usually involves surgical fusion of the hindfoot joints. This is a reconstructive procedure which allows the surgeon to re-position the foot into a normal position. Although the procedure should be considered for advanced PTTD, it has many complications and should be discussed at length with your doctor.

Does Adult Aquired Flat Foot Call For Surgery Teatment ?

April 19, 2015
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. Flat Foot
Causes
As discussed above, many health conditions can create a painful flatfoot. Damage to the posterior tibial tendon is the most common cause of AAFD. The posterior tibial tendon is one of the most important tendons of the leg. It starts at a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inside of the foot. The main function of this tendon is to hold up the arch and support your foot when you walk. If the tendon becomes inflamed or torn, the arch will slowly collapse. Women and people over 40 are more likely to develop problems with the posterior tibial tendon. Other risk factors include obesity, diabetes, and hypertension. Having flat feet since childhood increases the risk of developing a tear in the posterior tibial tendon. In addition, people who are involved in high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Inflammatory arthritis, such as rheumatoid arthritis, can cause a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the foot to change shape and become flat. The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch.
Symptoms
As different types of flatfoot have different causes, the associated symptoms can be different for different people. Some generalized symptoms are listed. Pain along the course of the posterior tibial tendon which lies on the inside of the foot and ankle. This can be associated with swelling on the inside of the ankle. Pain that is worse with activity. High intensity or impact activities, such as running and jumping, can be very difficult. Some patients can have difficulty walking or even standing for long periods of time and may experience pain at the inside of the ankle and in the arch of the foot. Feeling like one is ?dragging their foot.? When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain in the bones and tendons in the outside of the ankle joint. Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot. These make shoe wear very difficult. Sometimes, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes. Diabetic patients may not experience pain if they have damage to their nerves. They may only notice swelling or a large bump on the bottom of the foot. The large bump can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoe wear is not used.
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
Conservative (nonoperative) care is advised at first. A simple modification to your shoe may be all that???s needed. Sometimes purchasing shoes with a good arch support is sufficient. For other patients, an off-the-shelf (prefabricated) shoe insert works well. The orthotic is designed specifically to position your foot in good alignment. Like the shoe insert, the orthotic fits inside the shoe. These work well for mild deformity or symptoms. Over-the-counter pain relievers or antiinflammatory drugs such as ibuprofen may be helpful. If symptoms are very severe, a removable boot or cast may be used to rest, support, and stabilize the foot and ankle while still allowing function. Patients with longer duration of symptoms or greater deformity may need a customized brace. The brace provides support and limits ankle motion. After several months, the brace is replaced with a foot orthotic. A physical therapy program of exercise to stretch and strengthen the foot and leg muscles is important. The therapist will also show you how to improve motor control and proprioception (joint sense of position). These added features help prevent and reduce injuries. Acquired Flat Foot
Surgical Treatment
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical treatment may include repairing the tendon, tendon transfers, realigning the bones of the foot, joint fusions, or both. Dr. Piccarelli will determine the best approach for your specific case. A variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, or insertion of implant devices. Whether you have flexible flatfoot or PTTD, to select the procedure or combination of procedures for your particular case, Dr. Piccarelli will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

Posterior Tibial Tendon Dysfunction Surgery Prognosis

April 17, 2015
Overview
Posterior Tibial Tendon Dysfunction (PTTD) is a painful flatfoot condition that affects adults, primarily over the age of 50. Also known as Adult Acquired Flatfoot, this issue affects women more than men and is linked to obesity, hypertension and diabetes. Most people with PTTD have had flat feet all of their lives. Then, for reasons not fully understood, one foot starts to become painful and more deformed. Adult Acquired Flat Feet
Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
Symptoms
Not everyone with adult flatfoot has problems with pain. Those who do usually experience it around the ankle or in the heel. The pain is usually worse with activity, like walking or standing for extended periods. Sometimes, if the condition develops from arthritis in the foot, bony spurs along the top and side of the foot develop and make wearing shoes more painful. Diabetic patients need to watch for swelling or large lumps in the feet, as they may not notice any pain. They are also at higher risk for developing significant deformities from their flatfoot.
Diagnosis
Diagnostic testing is often used to diagnose the condition and help determine the stage of the disease. The most common test done in the office setting are weightbearing X-rays of the foot and ankle. These assess joint alignment and osteoarthritis. If tendon tearing or rupture is suspected, the gold standard test would be MRI. The MRI is used to check the tendon, surrounding ligament structures and the midfoot and hindfoot joints. An MRI is essential if surgery is being considered.
Non surgical Treatment
A patient who has acute tenosynovitis has pain and swelling along the medial aspect of the ankle. The patient is able to perform a single-limb heel-rise test but has pain when doing so. Inversion of the foot against resistance is painful but still strong. The patient should be managed with rest, the administration of appropriate anti-inflammatory medication, and immobilization. The injection of corticosteroids is not recommended. Immobilization with either a rigid below-the-knee cast or a removable cast or boot may be used to prevent overuse and subsequent rupture of the tendon. A removable stirrup-brace is not initially sufficient as it does not limit motion in the sagittal plane, a component of the pathological process. The patient should be permitted to walk while wearing the cast or boot during the six to eight-week period of immobilization. At the end of that time, a decision must be made regarding the need for additional treatment. If there has been marked improvement, the patient may begin wearing a stiff-soled shoe with a medial heel-and-sole wedge to invert the hindfoot. If there has been only mild or moderate improvement, a longer period in the cast or boot may be tried. Acquired Flat Feet
Surgical Treatment
Good to excellent results for more than 80% of patients have been reported at five years' follow up for the surgical interventions recommended below. However, the postoperative recovery is a lengthy process, and most surgical procedures require patients to wear a plaster cast for two to three months. Although many patients report that their function is well improved by six months, in our experience a year is required to recover truly and gain full functional improvement after the surgery. Clearly, some patients are not candidates for such major reconstructive surgery.

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