Tumblelog by Soup.io
Newer posts are loading.
You are at the newest post.
Click here to check if anything new just came in.

September 25 2015

cody2rogers44

What Can Induce Calcaneal Spur

Inferior Calcaneal Spur

Overview

Heel spurs, pointed, bony outgrowths of the heel, are caused by localized soft tissue inflammation and can be located at the back of the heel or under the heel, beneath the sole of the foot. Plantar fascitis is associated with inflammation caused by heel spurs on the soles of the feet. Both conditions are treated with ice application and anti-inflammatory medications. Orthotics may also provide some relief.

Causes

Causes for heel spurs (and related plantar fasciitis) include increase or change in activity, lack of arch support or poor shoe choice, injury, inflexibility in Achilles tendon and calf muscles, and spending hours daily on the feet. Also, arthritis from aging is often a common cause of bone loss and natural cushioning under the heel. Tarsal tunnel syndrome can also be to blame. Ultimately, in the United States, the most likely cause of this pain is being overweight. With more than 60% of the nation obese or morbidly obese, foot pain related to excessive weight is most likely. Dietary changes are most likely to cause long-term relief for bone spurs and plantar fasciitis.

Inferior Calcaneal Spur

Symptoms

You'll typically first notice early heel spur pain under your heel in the morning or after resting. Your heel pain will be worse with the first steps and improves with activity as it warms up. When you palpate the tender area you may feel a tender bony lump. As your plantar fasciitis deteriorates and your heel spur grows, the pain will be present more often.

Diagnosis

Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products such as Advil or Ibuprofin are helpful in eradicating the pain. Pain creams, such as Neuro-eze, BioFreeze & Boswella Cream can help to relieve pain and help increase circulation.

Non Surgical Treatment

If pain and other symptoms of inflammation-redness, swelling, heat-persist, you should limit normal daily activities and contact a doctor of podiatric medicine. The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments. A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery. Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Surgical Treatment

Usually, heel spurs are curable with conservative treatment. If not, heel spurs are curable with surgery, although there is the possibility of them growing back. About 10% of those who continue to see a physician for plantar fascitis have it for more than a year. If there is limited success after approximately one year of conservative treatment, patients are often advised to have surgery.

Prevention

Heel spurs and plantar fasciitis can only be prevented by treating any underlying associated inflammatory disease.

August 26 2015

cody2rogers44

Organic Treatment For Bursitis Foot

Overview

Bursitis is the inflammation of a bursa within the body. A bursa is a fluid-filled sac that cushions some of the major joints, allowing bones, gliding muscles, and tissues to exist together without harming each other. It aids in reducing the friction between bones and the soft tissues above it. Though there are bursae all over the body, the main ones are located in the knee, elbow, shoulder, hip, and heel. These are also the ones that are the most often injured. Still, however, when you hear the word ?bursitis?, the person is usually referring to their shoulder, but it could also refer to any of the preceding areas--such as the second most common one, the hip.

Causes

A rapid increase in physical activity levels or thinning of the heel?s protective fat pad are factors that may contribute to infracalcaneal bursitis. Other possible causes of infracalcaneal bursitis include blunt force trauma, acute or chronic infection, and arthritic conditions. The following factors may increase your risk of experiencing bursitis, including infracalcaneal bursitis. Participating in contact sports. Having a previous history of bursitis in any joint. Poor conditioning. Exposure to cold weather. Heel striking when running, especially in conventional running shoes with heel elevation.

Symptoms

Pain at the back of the heel, especially when running uphill. Pain may get worse when rising on the toes (standing on tiptoes). Tenderness at the back of heel. Swelling at the back of heel.

Diagnosis

Diagnosis of heel bursitis can be made by your health practitioner and is based on the following. Assessing the location of the pain by palpating the back of the heel. Assessment of any inflammation at the back of the heel. Assessment of biomechanics and foot function. Ultrasound or MRI can reveal inflammation of the retro calcaneal bursa.

Non Surgical Treatment

Your health care provider may recommend the following treatments. Avoid activities that cause pain. Ice the heel several times a day. Take nonsteroidal anti-inflammatory medications (for example, ibuprofen). Try over-the-counter or custom heel wedges to help decrease the stress on the heel. Try ultrasound treatment during physical therapy to reduce inflammation. Use physical therapy to improve flexibility and strength around the ankle, which can help the bursitis improve and prevent it from coming back. If these treatments don't work, your health care provider may inject a small amount of steroids into the bursa. After the injection, you should avoid stretching the tendon too much because it can break open (rupture). If the condition is connected with Achilles tendinitis, casting the ankle for several weeks to keep it from moving can be effective. Very rarely, surgery may be needed to remove the inflamed bursa.

Surgical Treatment

Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.

Prevention

You can help to prevent heel pain and bursitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.

June 27 2015

cody2rogers44

Hammer Toe Caused By Running

HammertoeOverview

hammertoe is a condition which causes one or more of the smaller toes to become bent upwards. The toe can be straightened but if ignored may become a permanent deformity. Each of the 4 smaller toes consist of 3 bones called phalanges, forming two interphalangeal joints. The toe bends at the proximal or first interphalangeal joint. Initially it can be straightened, but if left untreated, this can become a permanent deformity.

Causes

Wearing shoes that squeeze the toes or high heels that jam the toes into the front of the shoe. Other causes or factors in the development of hammertoes can include an injury such as badly stubbing your toe, arthritis and nerve and muscle damage from diseases such as diabetes. And, hammertoes tend to run in families, although it is more likely the faulty foot mechanics that lead to hammertoes that are inherited, not the hammertoes themselves. Hammertoe generally affect the smaller toes of the foot, especially the second toe, which for many people is the longest toe. It's uncommon for the big toe to be bent this way.

HammertoeSymptoms

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

First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.

Non Surgical Treatment

The most common treatment is to wear more comfortable shoes. When choosing a shoe, make sure the toe area is high and broad and has enough room for hammer toes. If there is chronic pain, surgery may be needed to correct a malalignment. Surgical treatments are aimed at loosening up the contracted toe joints to allow them to align properly. Other types of treatment are products designed to relieve hammer toes, such as hammer toe crests and hammer toe splints. These devices will help hold down the hammer toe and provide relief to the forefoot. Gel toe shields and gel toe caps can also be used. Gel toe shields and toe caps will help eliminate friction between the shoe and the toe, while providing comfort and lubrication.

Surgical Treatment

If pinning the toe is not required during the procedure, then the surgery could be preformed in the doctor's office under a local anesthesia. Some patients prefer the comfort hammertoes of sedation during the surgery and if this is the case or if a pin must be placed, then the surgery could be preformed in an outpatient surgery center.

HammertoePrevention

The easiest way to avoid hammertoe is to wear shoes that fit properly. Orthopaedic surgeons and podiatrists recommend shoes that have roomy toe boxes, which give the toes plenty of space to flex. Shoes that fit well should also cushion the arch in the middle of the foot. This helps to distribute the weight of the body evenly across the bones and joints of the foot. The size and shape of a foot can change with age, and many people inadvertently wear the wrong size shoe. Podiatrists recommend having your feet measured regularly to ensure that your shoes fit properly.
Tags: Hammer Toe
cody2rogers44

Do I Need To Have A Hammer Toe Operation

Hammer ToeOverview

If the joint on one of your toes, usually the toe next to the big toe or the smallest toe, points upward rather than lying flat, you might have a Hammer toe. The condition is actually a deformity that happens when one of the toe muscles becomes weak and puts pressure on the toe?s tendons and joints. This pressure forces the toe to become misshapen and stick up at the joint. Also, there?s frequently a corn or callus on top of the deformed toe. This outgrowth can cause pain when it rubs against the shoe.

Causes

The APMA says that hammertoe can result from a muscle imbalance hammertoes in the foot that puts undue pressure on the joints, ultimately causing deformity. Inherited factors can contribute to the likelihood of developing hammertoe. Arthritis, stroke or nerve damage from diabetes or toe injuries such as jamming or breaking a toe can affect muscle balance in the foot, leading to hammertoe. The Mayo Clinic says that wearing improper shoes often causes hammertoe. Shoes that squeeze the toes, such as those with a tight toe box or with heels higher than two inches, can put too much pressure on the toe joints.

Hammer ToeSymptoms

Hammertoe and mallet toe feature an abnormal bend in the joints of one or more of your toes. Moving the affected toe may be difficult or painful. Corns and calluses can result from the toe rubbing against the inside of your shoes. See your doctor if you have persistent foot pain that affects your ability to walk properly.

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

If your hammertoe problem is diagnosed as flexible hammertoe, there are a number of nonsurgical treatments that may be able to straighten out your toe or toes and return them to their proper alignment. Padding and Taping. Your physician may pad the boney top-part of your hammertoe as a means of relieving pain, and may tape your toes as a way to change their position, correct the muscle imbalance and relieve the pressure that led to the hammertoe's development. Medication. Anti-inflammatory drugs such as aspirin and ibuprofen can help deal with inflammation, swelling and pain caused by your hammertoe. Cortisone injections may be prescribed for the same purpose. If your hammertoe is a consequence of arthritis, your physician may prescribe medications for that.

Surgical Treatment

Any surgery must be carefully considered and approached in a serious manner, as any procedure is serious for the patient. But in most cases the procedure is relatively straight forward. The surgery can be done using local anesthetic and does not require hospitalization. The patient goes home in a special post-operative shoe or a regular sandal, and in most cases can walk immediately. That's not to say that the patient is walking or functioning normally immediately after the procedure. The patient must take some time off work to rest the foot and allow it to heal.
Tags: Hammertoe

June 12 2015

cody2rogers44

What Are The Symptoms Of Hallux Valgus?

Overview
Bunions hard skin A bunion is a firm, painful bump that forms over a bony bulge at the base of the big toe. In most cases, the big toe joint also is enlarged and has degenerative arthritis. The toe also may be pushed toward the second toe (hallux valgus). Bunions tend to be inherited, but they also are common in the following groups. Women who wear high heels. People who wear shoes that are too narrow or too pointed. People with flatfeet. All of these situations force the big toe to drift toward the little toes, and this can cause bunions to form.

Causes
Women traditionally have a higher rate of bunions, which is to be expected, since it is they who have traditionally worn shoes with high heels, a narrow toe box, or whatever fashion dictates from year to year. However, men can suffer from bunions as well, as can anyone for whom the right (or wrong) conditions exist, poor foot mechanics, improper footwear, occupational hazards, health and genetic predisposition. Finally, bunions have long been a condition associated with the elderly, and although they often appear in conjunction with inflammatory joint diseases such as arthritis (which is often associated with age), they can strike at any point in life, including adolescence.

Symptoms
The major symptom of bunions is a hard bump on the outside edge of the foot or at the base of the big toe. Redness, pain and swelling surrounding or at the MTP joint can also occur.

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

Non Surgical Treatment
Padding with a number of different materials (eg felt) to reduce pressure on the painful prominence of the bunion. Physical therapy can be used to help with the symptoms and improve the range of motion (this is particularly helpful if the pain is coming from inside the joint, rather than from shoe pressure). Manipulation of the joint can be used to help with this (manipulation will never correct the alignment of the joint). Any corns and calluses that are causing symptoms should be treated. The correct fitting of footwear is essential for anyone who is serious about doing something about their bunions and hallux valgus. It may be possible to have your shoes stretched over the area of the bunion to also relieve pressure. Foot orthotics may be useful in helping with the instability about the joint. They may be more helpful if there are other symptoms in the foot as well, as their use in "treating" bunions is controversial. They may play a role in slowing progression and in the prevention of bunions developing again after surgical correction. Exercises can be important in maintaining the mobility of the joint in those with bunions, this is especially important for the arthritic type pains that may be originating from inside the joint and for the prevention of these painful symptoms in the future. Bunions callous

Surgical Treatment
Procedures are designed and chosen to correct a variety of pathologies that may be associated with the bunion. For instance, procedures may address some combination of removing the abnormal bony enlargement of the first metatarsal, realigning the first metatarsal bone relative to the adjacent metatarsal bone, straightening the great toe relative to the first metatarsal and adjacent toes, realigning the cartilagenous surfaces of the great toe joint, addressing arthritic changes associated with the great toe joint, repositioning the sesamoid bones beneath the first metatarsal bone, shortening, lengthening, raising, or lowering the first metatarsal bone, and correcting any abnormal bowing or misalignment within the great toe. Connecting two parallel long bones side by side by Syndesmosis Procedure. At present there are many different bunion surgeries for different effects. The age, health, lifestyle and activity level of the patient may also play a role in the choice of procedure. Traditional bunion surgery can be performed under local, spinal or general anesthetic. In the case of laser surgery, a narcotic analgesic is typically used.[5] The trend has moved strongly toward using the less invasive local anesthesia over the years. A patient can expect a 6- to 8-week recovery period during which crutches are usually required for aid in mobility. An orthopedic cast is much less common today as newer, more stable procedures and better forms of fixation (stabilizing the bone with screws and other hardware) are used. Hardware may even include absorbable pins that perform their function and are then broken down by the body over the course of months.

Prevention
There are some steps that may help prevent, or at least slow, the progression of bunions. Avoid shoes with a narrow toe box. If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics from your podiatrist. See your podiatrist at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression.
Tags: Bunions

June 05 2015

cody2rogers44

Will Over-Pronation Of The Feet Have To Have Surgical Procedures

Overview

Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person?s arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, possibly causing severe discomfort and leading to other foot problems.Pronation

Causes

Generally fallen arches are a condition inherited from one or both parents. In addition, age, obesity, and pregnancy cause our arches to collapse. Being in a job that requires long hours of standing and/or walking (e.g. teaching, retail, hospitality, building etc) contributes to this condition, especially when standing on hard surfaces like concrete floors. Last, but not least unsupportive footwear makes our feet roll in more than they should.

Symptoms

With over pronation, sufferers are most likely to experience pain through the arch of the foot. A lack of stability is also a common complaint. Over pronation also causes the foot to turn outward during movement at the ankle, causing sufferers to walk along the inner portion of the foot. This not only can deliver serious pain through the heel and ankle, but it can also be the cause of pain in the knees or lower back as well. This condition also causes the arch to sink which places stress on the bones, ligaments, and tendons throughout the foot. This may yield other common conditions of foot pain such as plantar fasciitis and heel spurs.

Diagnosis

Look at your soles of your footwear: Your sneaker/shoes will display heavy wear marks on the outside portion of the heel and the inside portion above the arch up to the top of the big toe on the sole. The "wet-foot" test is another assessment. Dip the bottom of your foot in water and step on to a piece of paper (brown paper bag works well). Look at the shape of your foot. If you have a lot of trouble creating an arch, you likely overpronate. An evaluation from a professional could verify your foot type.Pronation

Non Surgical Treatment

Treatment with orthotics will provide the required arch support to effectively reduce excessive pronation and restore the foot and its posture to the right biomechanical position. It should be ensured that footwear has sufficient support, for example, shoes should have a firm heel counter to provide adequate control.

Surgical Treatment

The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.

May 22 2015

cody2rogers44

Severs Disease Physical Rehabilitation

Overview

Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the bone and is characterized by pain in the heel of a child's foot, typically brought on by some form of injury or trauma. This condition is most common in children ages 10 to 15 and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate the condition. The disease mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on the growth plate of the heel bone (calcaneus). Treatment includes cutting back on sports activities, calf muscle stretching exercises, heel cushions in the shoes, icing, and/or anti-inflammatory medications.

Causes

There are many contributing factors that cause strain across the growth plate, making your child prone to developing Sever?s disease. These include repeated minor trauma to the growth plate from running or jumping sports, tight calf or hamstring muscles, rapid growth spurts can lead to the leg muscles becoming tight, increasing tension on the growth plate, tight Achilles tendon, the Achilles tendon attaches to the back of the heel adjacent to the growth plate, poor foot posture, may increase the strain on the growth plate, footwear with a very low heel pitch (eg soccer boots), unsupportive or unstable footwear with poor shock absorption at the heel, running or playing sport on hard surfaces.

Symptoms

Symptoms of Sever?s disease, mostly pain at the back of heel, usually occur during and after sporting activity, and usually disappear with rest. In some cases, children may find it difficult to place pressure on their heels, and begin walking on their toes to gain relief. For some children, the heel pain will persist until the next morning, causing some stiffness or hobbling on first arising. Some children may experience mild swelling at the back of the heel.

Diagnosis

Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.

Non Surgical Treatment

Orthotics or special shoe inserts can also be used to cushion the heel and reduce pain. Physical Therapy. If avoiding physical activities fails to clear up Sever?s disease Genesis Orthopedics & Sports Medicine may proceed with physical therapy. Physical therapy strengthens the muscles and tendons in the heel, releasing pressure and eventually reducing pain.

May 04 2015

cody2rogers44

What Are Primary Causes And Signs Or Symptoms Of A Ruptured Achilles Tendon?

Overview
Achilles tendon A rupture of the Achilles tendon is one of the more common types of tendon ruptures. As the largest tendon in the human body, the Achilles tendon is very important to one?s balance and stability. Patients who suffer an Achilles tendon rupture experience severe pain and often require Achilles tendon surgery to repair the damage. There are also less invasive methods of Achilles tendon treatment including, icing, anti-inflammatory medications, rehabilitation, taping or bracing, sports massages and more. Achilles tendon recovery is dependent on the health of the patient, and the severity of the injury.

Causes
The exact cause of Achilles tendon ruptures is hard to say. It can happen suddenly, without warning, or following an Achilles tendonitis . It seems that weak calf muscles may contribute to problems. If the muscles are weak and become fatigued, they may tighten and shorten. Overuse can also be a problem by leading to muscle fatigue . The more fatigued the calf muscles are, the shorter and tighter they will become. This tightness can increase the stress on the Achilles tendon and result in a rupture. Additionally, an imbalance of strength of the anterior lower leg muscles and the posterior lower leg muscles may also put an athlete at risk for an injury to the Achilles tendon. An Achilles tendon rupture is more likely when the force on the tendon is greater than the strength of the tendon. If the foot is dorsiflexed while the lower leg moves forward and the calf muscles contract, a rupture may occur. Most ruptures happen during a forceful stretch of the tendon while the calf muscles contract. Other factors that may increase the risk of Achilles tendon rupture include. Tight calf muscles and/or Achilles tendon. Change in running surface eg: from grass to concrete. Incorrect or poor footwear. A change of footwear eg: from heeled to flat shoes. It is thought that some medical conditions, such as gout, tuberculosis and systemic lupus erythematosus, may increase the risk of Achilles tendon rupture.

Symptoms
Typically patients present with sudden onset of pain and swelling in the achilles region, often accompanied by a audible snap during forceful dorsiflexion of the foot. A classic example is that of an unfit 'weekend warrior' playing squash. If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance.

Diagnosis
It is usually possible to detect a complete rupture of the Achilles tendon on the history and examination. A gap may be felt in the tendon, usually 4-5cm above the heel bone. This is the normal site of injury and is called an intra-substance tear. The tear can occur higher up about 10cm above the insertion into the heel at the site where the muscles join the tendon, this is known as a musculo-tendinous tear. A special test will be performed which involves squeezing the calf. Normally if the Achilles tendon is intact this causes the foot to point downwards but if it is ruptured it causes no movement. To confirm the diagnosis and the exact site of the rupture it may be necessary to perform an Ultra-sound or MRI scan.

Non Surgical Treatment
Achilles tendon rupture is treated using non surgical method or surgical method. Non surgical treatment involves wearing a cast or special brace which is changed after some period of time to bring the tendon back to its normal length. Along with cast or brace, physical therapy may be recommended to improve the strength and flexibility of leg muscles and Achilles tendon. Achilles tendinitis

Surgical Treatment
Surgical repair is a common method of treatment of acute Achilles rupture in North America because, despite a higher risk of overall complications, it has been believed to offer a reduced risk of rerupture. However, more recent trials, particularly those using functional bracing with early range of motion, have challenged this belief. The aim of this meta-analysis was to compare surgical treatment and conservative treatment with regard to the rerupture rate, the overall rate of other complications, return to work, calf circumference, and functional outcomes, as well as to examine the effects of early range of motion on the rerupture rate.

April 26 2015

cody2rogers44

Posterior Tibial Tendon Dysfunction Orthotics

Overview
Adult-acquired flatfoot (AAF) is the term used to describe the progressive deformity of the foot and ankle that, in its later stages, results in collapsed and badly deformed feet. Although the condition has been described and written about since the 1980s, AAF is not a widely used acronym within the O&P community-even though orthotists and pedorthists easily recognize the signs of the condition because they treat them on an almost daily basis. AAF is caused by a loss of the dynamic and static support structures of the medial longitudinal arch, resulting in an incrementally worsening planovalgus deformity associated with posterior tibial (PT) tendinitis. Over the past 30 years, researchers have attempted to understand and explain the gradual yet significant deterioration that can occur in foot structure, which ultimately leads to painful and debilitating conditions-a progression that is currently classified into four stages. What begins as a predisposition to flatfoot can progress to a collapsed arch, and then to the more severe posterior tibial tendon dysfunction (PTTD). Left untreated, the PT tendon can rupture, and the patient may then require a rigid AFO or an arthrodesis fixation surgery to stabilize the foot in order to remain capable of walking pain free. Acquired flat feet

Causes
The cause of posterior tibial tendon insufficiency is not completely understood. The condition commonly does not start from one acute trauma but is a process of gradual degeneration of the soft tissues supporting the medial (inner) side of the foot. It is most often associated with a foot that started out somewhat flat or pronated (rolled inward). This type of foot places more stress on the medial soft tissue structures, which include the posterior tibial tendon and ligaments on the inner side of the foot. Children nearly fully grown can end up with flat feet, the majority of which are no problem. However, if the deformity is severe enough it can cause significant functional limitations at that age and later on if soft tissue failure occurs. Also, young adults with normally aligned feet can acutely injure their posterior tibial tendon from a trauma and not develop deformity. The degenerative condition in patients beyond their twenties is different from the acute injuries in young patients or adolescent deformities, where progression of deformity is likely to occur.

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
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
There are many non-surgical options for the flatfoot. Orthotics, non-custom braces, shoe gear changes and custom braces are all options for treatment. A course of physical therapy may be prescribed if tendon inflammation is part of the problem. Many people are successfully treated with non-surgical alternatives. Adult 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. Your foot and ankle surgeon will determine the best approach for you.
Older posts are this way If this message doesn't go away, click anywhere on the page to continue loading posts.
Could not load more posts
Maybe Soup is currently being updated? I'll try again automatically in a few seconds...
Just a second, loading more posts...
You've reached the end.

Don't be the product, buy the product!

Schweinderl