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Pes Planus Explained

7/2/2017

 
Overview

Adult Acquired Flat Foot

Flexible flatfeet are considered normal in young children because babies are not born with a normal arch. The arch may not form fully until sometime between ages 7 and 10. Even in adulthood, 15% to 25% of people have flexible flatfeet. Most of these people never develop symptoms. In many adults who have had flexible flatfeet since childhood, the missing arch is an inherited condition related to a general looseness of ligaments. These people usually have extremely flexible, very mobile joints throughout the body, not only in the feet. Flatfeet also can develop during adulthood. Causes include joint disease, such as rheumatoid arthritis, and disorders of nerve function (neuropathy). Unlike a flexible flatfoot, a rigid flatfoot is often the result of a significant problem affecting the structure or alignment of the bones that make up the foot's arch. Some common causes of rigid flatfeet include. Congenital vertical talus. In this condition, there is no arch because the foot bones are not aligned properly. In some cases, there is a reverse curve (rocker-bottom foot, in which the shape is like the bottom rails of a rocking chair) in place of the normal arch. Congenital vertical talus is a rare condition present at birth. It often is associated with a genetic disorder, such as Down syndrome, or other congenital disorders. The cause is unknown in up to half of cases. Tarsal coalition (peroneal spastic flatfoot). In this inherited condition, two or more of the foot bones are fused together, interfering with the flexibility of the foot and eliminating the normal arch. A rare condition, it often affects several generations of the same family. Lateral subtalar dislocation. Sometimes called an acquired flatfoot, it occurs in someone who originally had a normal foot arch. In a lateral subtalar dislocation, there is a dislocation of the talus bone, located within the arch of the foot. The dislocated talus bone slips out of place, drops downward and sideways and collapses the arch. It usually occurs suddenly because of a high-impact injury related to a fall from a height, a motor vehicle accident or participation in sports, and it may be associated with fractures or other injuries.

Causes

Flat feet can be caused by injury, aging, and weight gain. They can cause pain in the feet and may lead to pain in other parts of the body such as the ankles, knees, or hips. For this reason, it behooves us to treat fallen arches. The question becomes how to do so.

Symptoms

Most patients who suffer from flat feet or fallen arches often do not complain of any symptoms whatsoever. However, on some occasions, patients may find that their feet are fatigued fairly easily and following activity on long periods of standing may have a painful foot or arch. On occasions, swelling may be seen on the inner aspect of the foot and performing certain movements may be painful and difficult. Some patients who have flat feet may find that their feet tend to roll in (over-pronate) a lot more when they walk and run. As a result, they may experience damage to the ankle joint and the Achilles tendon, as well as excessive shoe wear.

Diagnosis

Podiatrists are trained in expertly assessing flat feet and identifying different risk factors and the causes for it. Initial assessment will begin with a detailed history attempting to find out if any underlying illness has resulted in this. A detailed clinical examination normally follows. The patient may be asked to perform certain movements such as walking or standing on their toes to assess the function of the foot. Footwear will also be analysed to see if there has been excessive wear or if they are contributing to the pronation of the foot. To assess the structure of the foot further, the podiatrist may perform certain x-rays to get a detailed idea of the way the bones are arranged and how the muscle tissues may be affecting them. It also helps assess any potential birth defects in a bit more detail.

pes cavus

Non Surgical Treatment

Flexible flat feet that are painless do not require treatment. If you have pain due to flexible flat feet, an orthotic (arch-supporting insert in the shoe) can bring relief. With the increased interest in running, many shoe stores carry shoes for normal feet and pronated feet. The shoes designed for pronated feet make long distance running easier and less tiring because they correct for the abnormality. Rigid or painful flat feet require evaluation by a health care provider. The treatment depends on the cause of the flat feet. For tarsal coalition, treatment starts with rest and possibly a cast. If this fails to improve the pain, surgery may be necessary. For problems with the posterior tibial tendon, treatment may start with rest, anti-inflammatory medications, and shoe inserts or ankle braces. In more advanced cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints of the foot into a corrected position. Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.

Surgical Treatment

Acquired Flat Foot

Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.

Leg Length Discrepancy Workouts

6/29/2017

 
Overview

Shortening techniques can be used after skeletal maturity to achieve leg length equality. Shortening can be done in the proximal femur using a blade plate or hip screw, in the mid-diaphysis of the femur using a closed intramedullary (IM) technique, or in the tibia. Shortening is an accurate technique and involves a much shorter convalescence than lengthening techniques. Quadriceps weakness may occur with femoral shortenings, especially if a mid-diaphyseal shortening of greater than 10% is done. If the femoral shortening is done proximally, no significant weakness should result. Tibial shortening can be done, but there may be a residual bulkiness to the leg, and risks of nonunion and compartment syndrome are higher. If a tibial shortening is done, shortening over an IM nail and prophylactic compartment release are recommended. We limit the use of shortenings to 4 to 5 cm leg length inequality in patients who are skeletally mature.Leg Length Discrepancy

Causes

Sometimes the cause of LLD is unknown, yet the pattern or combination of conditions is consistent with a certain abnormality. Examples include underdevelopment of the inner or outer side of the leg (hemimelias) or (partial) inhibition of growth of one side of the body of unknown cause (hemihypertrophy). These conditions are present at birth, but the limb length difference may be too small to be detected. As the child grows, the LLD increases and becomes more noticeable. In hemimelia, one of the two bones between the knee and the ankle (tibia or fibula) is abnormally short. There also may be associated foot or knee abnormalities. Hemihypertrophy or hemiatrophy are rare conditions in which there is a difference in length of both the arm and leg on only one side of the body. There may also be a difference between the two sides of the face. Sometimes no cause can be found. This type of limb length is called idiopathic. While there is a cause, it cannot be determined using currect diagnostic methods.

Symptoms

The effects vary from patient to patient, depending on the cause of the discrepancy and the magnitude of the difference. Differences of 3 1/2 to 4 percent of the total length of the lower extremity (4 cm or 1 2/3 inches in an average adult), including the thigh, lower leg and foot, may cause noticeable abnormalities while walking and require more effort to walk. Differences between the lengths of the upper extremities cause few problems unless the difference is so great that it becomes difficult to hold objects or perform chores with both hands. You and your physician can decide what is right for you after discussing the causes, treatment options and risks and benefits of limb lengthening, including no treatment at all. Although an LLD may be detected on a screening examination for curvature of the spine (scoliosis), LLD does not cause scoliosis. There is controversy about the effect of LLD on the spine. Some studies indicate that people with an LLD have a greater incidence of low back pain and an increased susceptibility to injuries, but other studies refute this relationship.

Diagnosis

Limb length discrepancy can be measured by a physician during a physical examination and through X-rays. Usually, the physician measures the level of the hips when the child is standing barefoot. A series of measured wooden blocks may be placed under the short leg until the hips are level. If the physician believes a more precise measurement is needed, he or she may use X-rays. In growing children, a physician may repeat the physical examination and X-rays every six months to a year to see if the limb length discrepancy has increased or remained unchanged. A limb length discrepancy may be detected on a screening examination for curvature of the spine (scoliosis). But limb length discrepancy does not cause scoliosis.

Non Surgical Treatment

You may be prescribed a heel lift, which will equal out your leg length and decrease stress on your low back and legs. If it?s your pelvis causing the leg length discrepancy, then your physical therapist could use your muscles to realign your pelvis and then strengthen your core/abdominal region to minimize the risk of such malalignment happening again. If you think that one leg may be longer than the other and it is causing you to have pain or you are just curious, then make an appointment with a physical therapist.

LLL Shoe Insoles

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Surgical Treatment

Your child will be given general anesthetic. We cut the bone and insert metal pins above and below the cut. A metal frame is attached to the pins to support the leg. Over weeks and months, the metal device is adjusted to gradually pull the bone apart to create space between the ends of the bones. New bone forms to fill in the space, extending the length of the bone. Once the lengthening process is completed and the bones have healed, your child will require one more short operation to remove the lengthening device. We will see your child regularly to monitor the leg and adjust the metal lengthening device. We may also refer your child to a physical therapist to ensure that he or she stays mobile and has full range of motion in the leg. Typically, it takes a month of healing for every centimeter that the leg is lengthened.

What Are The Major Causes Of Heel Serious Pain

6/28/2017

 
Overview

Heel Pain

Many types of heel pain are simply the result of overuse injuries and can easily be avoided. Follow these tips to reduce your chances of heel pain. Wear properly fitting shoes with good arch support. Replace them regularly. Stretch your feet, ankles, and legs before and after you exercise. Avoid walking barefoot on hard surfaces. If your feet hurt, stop what you?re doing. No pain is normal. Keep your weight under control, being overweight or obese can be a significant contributor to heel pain.

Causes

One of the most common heel pain causes is a condition called plantar fasciitis. The tendons, ligaments, muscles, and joints in the feet all work together to allow you to move your feet to walk or run. When the plantar fascia, or the arch of the foot, is overused or injured, pain is felt in the heel. The most common heel pain causes include plantar fasciitis, Achilles tendonitis, Bursitis, Fibromyalgia, Bone fracture, Heel spurs, Arthritis, Tarsal tunnel syndrome, Sever?s Disease.

Symptoms

See your doctor as soon as possible if you experience severe pain accompanied by swelling near your heel. There is numbness or tingling in the heel, as well as pain and fever. There is pain in your heel as well as fever. You are unable to walk normally. You cannot bend your foot downwards. You cannot stand with the backs of the feet raised (you cannot rise onto your toes). You should arrange to see a doctor if the heel pain has persisted for more than one week. There is still heel pain when you are not standing or walking.

Diagnosis

Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.

Non Surgical Treatment

When consulting a doctor about heel pain, a patient can expect to be questioned about their level of pain, how long they?ve been experiencing it, and which activities aggravate or alleviate the condition. The doctor may order x-rays, a physical therapy regimen, or refer the afflicted individual to an orthopedic specialist for further examination. The doctor may attempt to recreate conditions that cause the heel pain to flare up in order to study reaction and cause in the patient, but this will be temporary and the doctor will stop this test at the request of the patient. A patient with heel pain may also be fitted with special inserts for their shoes to help correct arch and heel problems that cause pain. Heel problems can range from the mildly irritating to the nearly devastating, but proper prevention in care will help keep each step pain free. Advanced orthopedics, pain management, and technologically-honed surgical techniques ensure that no patient needs to suffer with the discomfort of heel pain and the restrictions it imposes on an active lifestyle.

Surgical Treatment

Surgery to correct heel pain is generally only recommended if orthotic treatment has failed. There are some exceptions to this course of treatment and it is up to you and your doctor to determine the most appropriate course of treatment. Following surgical treatment to correct heel pain the patient will generally have to continue the use of orthotics. The surgery does not correct the cause of the heel pain. The surgery will eliminate the pain but the process that caused the pain will continue without the use of orthotics. If orthotics have been prescribed prior to surgery they generally do not have to be remade.

deelsonheels

Prevention

Feet Pain

Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.

Diagnosing Mortons Neuroma

5/31/2017

 
Overview

plantar neuromaSome sources claim that entrapment of the plantar nerve because of compression between the metatarsal heads, as originally proposed by Morton, is highly unlikely, because the plantar nerve is on the plantar side of the transverse metatarsal ligament and thus does not come in contact with the metatarsal heads. It is more likely that the transverse metatarsal ligament is the cause of the entrapment. Despite the name, the condition was first correctly described by a chiropodist named Durlacher, and although it is labeled a "neuroma", many sources do not consider it a true tumor, but rather a perineural fibroma (fibrous tissue formation around nerve tissue).

Causes

A Morton's neuroma commonly occurs due to repetitive weight bearing activity (such as walking or running) particularly when combined with tight fitting shoes or excessive pronation of the feet (i.e. "flat-feet"). The condition is also more common in patients with an unstable forefoot allowing excessive movement between the metatarsal bones. A Morton's neuroma can also occur due to certain foot deformities, trauma to the foot, or the presence of a ganglion or inflamed bursa in the region which may place compressive forces on the nerve.

Symptoms

A Morton's neuroma usually causes burning pain, numbness or tingling at the base of the third, fourth or second toes. Pain also can spread from the ball of the foot out to the tips of the toes. In some cases, there also is the sensation of a lump, a fold of sock or a "hot pebble" between the toes. Typically, the pain of a Morton's neuroma is relieved temporarily by taking off your shoes, flexing your toes and rubbing your feet. Symptoms may be aggravated by standing for prolonged periods or by wearing high heels or shoes with a narrow toe box.

Diagnosis

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a Morton's neuroma. Investigations such as an X-ray, ultrasound, MRI, CT scan or bone scan may sometimes be used to assist with diagnosis, assess the severity of the injury and rule out other conditions.

Non Surgical Treatment

The best results are achieved with massage techniques that encourage spreading and mobilizing the metatarsal heads. Metatarsal spreading is one technique that can help reduce the detrimental effects of nerve compression. To perform this technique, pull the metatarsal heads (not just the toes) apart and hold them in this position to help stretch the intrinsic foot muscles and other soft-tissues. When this technique is combined with the use of toe spacers, it will be even more effective.Morton

Surgical Treatment

If your pain continues despite several months of conservative treatment, your doctor may recommend surgery to remove the neuroma or to widen the space through which the affected nerve travels. These types of surgery often are done under local anesthesia. If your doctor removes a portion of the affected nerve along with the neuroma, you may develop permanent numbness between the toes.

Hammertoe Repair Implant

7/10/2015

 
HammertoeOverview
A Hammer Toe is a contracture of the toes as a result of a muscle imbalance between the tendons on the top and the tendons on the bottom of the toe. They can be flexible or rigid in nature. When they are rigid, it is not possible to straighten the toe out by manipulating it. Frequently, they develop corns on the top of the toe as a result of rubbing on the shoe. They may also cause a bothersome callous on the ball of the foot. This occurs as a result of the toe pressing downward on the bone behind the toe. This area then becomes prominent and the pressure of the bone against the ground causes a callous to form.

Causes
It is possible to be born with a hammer toe, however many people develop the deformity later in life. Common causes include tightened tendons that cause the toe to curl downward. Nerve injuries or problems with the spinal cord. Stubbing, jamming or breaking a toe. Having a stroke. Being a diabetic. Having a second toe that is longer than the big toe. Wearing high heels or tight shoes that crowd the toes and don?t allow them to lie flat. Aging. Hammer Toe

Symptoms
Symptoms may include pain in the affected toe or toes when you wear shoes, making it hard or painful to walk. A corn or callus on the top of the joint caused by rubbing against the shoe. Swelling and redness of the skin over the joint. Trouble finding comfortable shoes.

Diagnosis
Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).

Non Surgical Treatment
Early on, when a hammertoe first starts and is still flexible, here are some ways it might be treated. Your healthcare provider may splint or tape the toe into the correct, normal position. You can use your fingers to stretch your toes and toe joints toward a more normal position. Exercise your toes by trying to pick up marbles with them or by wadding up a towel on the floor with your toes. Padding may be used to change where your weight falls when you walk on the foot.

Surgical Treatment
Toes can be surgically realigned and made straight again. They can even be made shorter. The good news is that toes can be corrected. Hammer toe surgery is often synonymous with ?toe shortening?, ?toe job? and/or ?toe augmentation?. Depending on the severity and length of the toe, there are several methods to surgically correct a hammer toe. In general, the surgery involves removing a portion of the bone at the contracted joint, to realign the toe. Hammertoe

Prevention
Early Development. The first year of life is important for foot development. Parents should cover their babies' feet loosely, allowing plenty of opportunity for kicking and exercise. Change the child's position frequently. Children generally start to walk at 10 - 18 months. They should not be forced to start walking early. Wearing just socks or going barefoot indoors helps the foot develop normally and strongly and allows the toes to grasp. Going barefoot outside, however, increases the risk for injury and other conditions, such as plantar warts. Children should wear shoes that are light and flexible, and since their feet tend to perspire, their shoes should be made of materials that breathe. Replace footwear every few months as the child's feet grow. Footwear should never be handed down. Protect children's feet if they participate in high-impact sports.

Treatment For Hammer Toes Pain

6/26/2015

 
HammertoeOverview

There are two main types of Hammer toes. Hammertoes can be flexible, which means that you can still move the toe a bit - these are easier to treat with stretching, wider shoes and in some cases, toe splints. Rigid hammertoes occur when the foot condition has persisted for so long without treatment that the tendons become too rigid to be stretched back to normal. Rigid hammertoes are more common in people with arthritis. This foot condition usually needs to be treated with surgery.

Causes

The cause of hammertoes varies, but causes include genetics, arthritis and injury to the toe. Treatment for hammertoes depends on the severity and can include anti-inflammatory medication, metatarsal pads, foot exercises and better-fitting shoes. If the pain caused by a hammertoe is so severe that wearing a shoe is uncomfortable, surgery may be necessary. Typically this surgery is an outpatient procedure that doesn?t require general anesthesia, though it is an option. Recovery from surgery usually takes a few weeks, and patients are given special shoes to wear.

HammertoeSymptoms

The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes. There may be a bursa under the corn or instead of a corn, depending on the pressure. Most of the symptoms are due to pressure from footwear on the toe. There may be a callus under the metatarsal head at the base of the toe. Initially a hammer toe is usually flexible, but when longstanding it becomes more rigid.

Diagnosis

Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.

Non Surgical Treatment

Symptoms of hammer toe might be helped through corn pads or cushions to alleviate them. If the person's hammer toes were caused by an underlying disease, the person should ask for their doctor's advice prior to performing any exercises without consent. It is also important for a person with hammer toes to remember that they must not attempt to treat or remove corns by themselves. If open cuts result from attempts to remove them, an infection becomes a very real possibility. People who experience diabetes or conditions that lead to poor circulation in their feet need to be especially careful.

Surgical Treatment

Surgical correction is necessary in more severe cases and may consist of removing a bone spur (exostectomy) removing the enlarged bone and straightening the toe (arthroplasty), sometimes with internal fixation using a pin to realign the toe; shortening a long metatarsal bone (osteotomy) fusing the toe joint and then straightening the toe (arthrodesis) or simple tendon lengthening and capsule release in milder, flexible hammertoes (tenotomy and capsulotomy). The procedure chosen depends in part on how flexible the hammertoe is.

HammertoePrevention

The best ways to prevent a hammertoe are. Wear shoes that fit well. Shoes should be one-half inch longer than your longest toe. Shoes should be wide enough and the toe box should be high enough to give the foot room to move. Don?t wear shoes with heels over 2 inches high. If a toe starts to look like a hammertoe, buy shoes that have an extra high toe box. Wear corn pad removers or cushion Hammer toe pads on top of the affected toe. See your healthcare provider any time you have foot pain that does not go away quickly or is more than mild pain. Foot pain is not normal.

What Are The Solutions For Bunions?

6/8/2015

 
Overview
Bunions Hard Skin Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment. A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion?s ?bump.? Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.

Causes
Many problems that occur in the feet are the result of abnormal pressure or rubbing. One way of understanding what happens in the foot due to abnormal pressure is to view the foot simply. Our simple model of a foot is made up of hard bone covered by soft tissue that we then put a shoe on top of. Most of the symptoms that develop over time are because the skin and soft tissue are caught between the hard bone on the inside and the hard shoe on the outside. Any prominence, or bump, in the bone will make the situation even worse over the bump. Skin responds to constant rubbing and pressure by forming a callus. The soft tissues underneath the skin respond to the constant pressure and rubbing by growing thicker. Both the thick callus and the thick soft tissues under the callus are irritated and painful. The answer to decreasing the pain is to remove the pressure. The pressure can be reduced from the outside by changing the pressure from the shoes. The pressure can be reduced from the inside by surgically removing any bony prominence.

Symptoms
Bunions may or may not cause symptoms. A frequent symptom is foot pain in the involved area when walking or wearing shoes; rest relieves this pain. A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. Shoe pressure in this area can cause interment pain while the development of arthritis in more severe bunions can lead to chronic pain. Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness. It is important to note that, in postpubertal men and postmenopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.

Diagnosis
A doctor can very often diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot. In some cases, arthritis may also be seen.

Non Surgical Treatment
Initial treatment of bunions may include wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas) or the use of splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe. For bunions caused by arthritis, medications may help reduce pain and swelling. If nonsurgical treatment fails, your doctor may suggest surgery, which resolves the problem in nearly all persons. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot. Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot. Bunions Callous

Surgical Treatment
Conservative bunion treatment methods help to reduce the symptoms but they cannot undo changes in the bone to fully correct the condition. If the pain becomes severe and it starts to affect your daily life, then foot bunion surgery may be the best option to correct a hallux abducto valgus. There are a number of different surgical options, depending on the severity of the bony deformity. The two most common types of surgery are Osteotomy. This is the most common type pf surgery and involves removing part of the bony lump and realigning the toes. It is also known as a bunionectomy or exostectomy. The ligaments around the big toe may also need realigning and this will be done at the same time if necessary. Fusion.This is where the joint at the base of the big toe (metatarsophalangeal joint) is fused together, known as an arthrodesis. This is only indicated in severe cases or if other treatments have failed as it severely limits the movement of the big toe.

The Causes And Treatment Of Over-Pronation Of The Foot

5/29/2015

 
Overview

To understand "overpronation" it's important to first understand pronation. Pronation is a normal function of the foot. It is the inward motion of the ankle bone and outward motion of the rest of the foot bones, which occurs naturally when the foot hits the ground and weight is applied. Pronation is a good thing; it cushions the foot and the entire body during the walking cycle. It keeps the foot and ankles protected from hard impact and an uneven ground surface. Overpronation occurs when too much pronation is present. In other words, overpronation occurs when the inward motion of the ankle bone is excessive and goes past the healthy point necessary for its intended functions. This excessive motion is caused by a misalignment between the ankle bone and the hindfoot bones. It creates an imbalance of forces and weight distribution in the foot that propagates throughout the entire body. Over time, this functional imbalance causes repetitive damage to joints, ligaments and bone structures. Left untreated, overpronation can lead to foot ailments such as bunions, heel pain (plantar faciitis), hammertoes, etc. Furthermore, the excessive motion in the foot can travel up the body and cause knee, hip and lower back pain.Over Pronation

Causes

During our development, the muscles, ligaments, and other soft tissue structures that hold our bones together at the joints become looser than normal. When the bones are not held tightly in place, the joints are not aligned properly, and the foot gradually turns outward at the ankle, causing the inner ankle bone to appear more prominent. The foot moves in this direction because it is the path of least resistance. It is more difficult for the foot to move in the opposite direction (this is called supination). As we develop, the muscles and ligaments accommodate to this abnormal alignment. By the time growth is complete, the pronated foot is: abnormally flexible, flat, and its outer border appears raised so that as you step down you do not come down equally across the entire foot; instead, you come down mostly on the inner border of the foot. Normal aging will produce further laxity of our muscles that causes the pronation to become gradually worse.

Symptoms

Because overpronation affects the entire lower leg, many injuries and conditions may develop and eventually cause problems not only in the leg and foot, but also the knee, hips and lower back. Pain often begins in the arch of the foot or the ankle. Blisters may develop on the instep, or on the inside edge of the heels. As overpronation continues and problems develop, pain will be felt elsewhere, depending on the injury.

Diagnosis

The best way to discover whether you have a normal gait, or if you overpronate, is to visit a specialty run shop, an exercise physiologist, a podiatrist or a physical therapist who specializes in working with athletes. A professional can analyze your gait, by watching you either walk or run, preferably on a treadmill. Some facilities can videotape your gait, then analyze the movement of your feet in slow-motion. Another (and less costly) way is to look at the bottom of an older pair of run shoes. Check the wear pattern. A person with a normal gait will generally see wear evenly across the heel and front of the shoe. A person who overpronates will likely see more wear on the OUTside of the heel and more wear on the INside of the forefoot (at the ball). A person who supinates will see wear all along the outer edges of the shoe. You can also learn about your gait by looking at your arches. Look at the shape your wet feet leave on a piece of paper or a flat walking surface.Over-Pronation

Non Surgical Treatment

Anti-Pronation Insoles provide a unique foot support system that aligns the lower body. The major cause of foot and leg pain is over pronation (rolling over of the feet) which causes excessive pressure on the muscles, ligaments and bones of the lower body. Running insoles treat the underlying cause of over pronation and prevent future occurrences of the associated foot or leg condition. A project conducted at the NIKE Sport Research Laboratory studied the effects of orthotics on rear foot movement in running. Nine well-trained runners who wore orthotics were chosen as subjects. The results of the study indicated that orthotics reduced rear foot movement by roughly one degree or approximately nine percent of the amount found in runners not using orthotics. The average reduction of the maximum velocity of pronation was fifteen percent. Thus this study indicates that orthotics and insoles control over pronation which will treat and prevent many sporting injuries.

Prevention

Pronation forces us to bear most of our weight on the inner border of our feet. Custom-made orthotics gently redistributes the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist out at the ankle, but will strike the ground normally when the orthotics is used. This action of the custom-made orthotics will help to prevent shin splints, ankle sprains, knee and hip pain, lower back pain, nerve entrapments, tendonitis, muscle aches, bunions, generalized fatigue, hammer toes, and calluses.

How To Spot Severs Disease?

5/23/2015

 
Overview

Sever's Disease is not a disease in the sense of an infection or other chronic pathology but is an injury/irritation of a growth plate. The Calcaneal growth plate or growth plate in the heel bone has attachments from the achilles tendon and the plantar fascia. Pull from either or both of these structures can cause enough motion within the apophysis or growth plate space to create irritation and inflammation which can be quite painful and limiting. This can start when the growth plate is still wide open but is more often seen as the growth plate starts to close further limiting its ability to move with the traction of soft tissue attachments. It was believed by Sever that fractures within the growth plate were the source of the discomfort. When looking at a growth plate that has started to close it can appear to be fragmented into 2 or 3 pieces. It has since been proven that this is the normal appearance of a closing growth plate.

Causes

Heel pain is very common in children due to the fact they are cnstantly growing. In most children, the heel bone (the calcaneus) is not fully developed until the age of 14 or older. Until then, new bone is forming at the growth plate of the foot (the apophysis, located at the back of the heel), an area which is softer than others due to its role in accommodating the growth. Repetitive stress on the growth plate due to walking, running and sports causes inflammation in the heel area. Because the heel's growth plate is sensitive, repeated running and pounding on hard surfaces can result in pediatric heel pain. Children and adolescents who take part in a lot of sport are especially vulnerable. Over-pronation (fallen arches and rolling inwards of the feet) will increase the impact on the growth plate and is therefore a significant cause and a major contributing factor to heel pain in children.

Symptoms

The symptoms include pain, tenderness, swelling or redness in the heel, and they might have difficulty walking or putting pressure on the heel. If you notice that your child suddenly starts walking around on their toes because their heels hurt, that?s a dead giveaway. Kids who play sports might also complain of foot pain after a game or practice. As they grow, the muscles and tendons will catch up and eventually the pressure will subside along with the pain. But in the meantime, it can become very uncomfortable.

Diagnosis

Sever?s disease can be diagnosed based on the symptoms your child has. Your child?s doctor will conduct a physical examination by squeezing different parts of your child?s foot to see if they cause any pain. An X-ray may be used to rule out other problems, such as a broken bone or fracture.

Non Surgical Treatment

Heel pain, unlike the heel spurs, that occur in adults is very uncommon in children. Of those children who do get heel pain, by far the most common cause is a disturbance to the growing area at the back of the heel bone (calcaneus) where the strong achilles tendon attaches to it. This is known as Sever's disease or calcaneal apophysitis (inflammation of the growth plate). It is most common between the ages of 10 to 14 years of age. These are one of several different 'osteochondroses' that can occur in other parts of the body, such as at the knee (Osgood-Schlatters Disease).

Recovery

It may take several weeks or months for the pain to completely stop. In most cases severs disease goes away on its own with a little rest and time. However if you ignore the pain and play through it, the condition may get worse and may be more difficult to treat. When the pain is completely gone, you can slowly return to your previous level of activity. With future growth spurts the pain may return therefore keep up with the stretches and follow the advice given.

Achilles Tendon Rupture Rehab Exercises

4/30/2015

 
Overview
Achilles Tendinitis The Achilles tendon forms a thick band joining your calf muscles to your heel. This tendon can be ruptured with rapid movements such as sprinting, lunging and jumping. There are two ways to treat patients who have ruptured their Achilles tendon, non-operative management in a splint or cast, and surgery. Multiple research studies have shown that both approaches have similar outcomes at one year when rehabilitation is started early. After this injury, dedicated rehabilitation of your core muscles, leg strength, balance and agility are essential for you to return to doing all of your regular activities.

Causes
The most common cause of a ruptured Achilles' tendon is when too much stress is placed through the tendon, particularly when pushing off with the foot. This may happen when playing sports such as football, basketball or tennis where the foot is dorsiflexed or pushed into an upward position during a fall. If the Achilles' tendon is weak, it is prone to rupture. Various factors can cause weakness, including corticosteroid medication and injections, certain diseases caused by hormone imbalance and tendonitis. Old age can also increase the risk of Achilles' tendon rupture.

Symptoms
Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel, an inability to bend your foot downward or "push off" the injured leg when you walk, an inability to stand on your toes on the injured leg, a popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward.

Diagnosis
In order to diagnose Achilles tendon rupture a doctor or physiotherapist will give a full examination of the area and sometimes an X ray is performed in order to confirm the diagnosis. A doctor may also recommend an MRI or CT scan is used to rule out any further injury or complications.

Non Surgical Treatment
There is no definitive protocol for conservative management. Traditionally, conservative treatment involved immobilisation in a cast or boot, with initial non-weight bearing. Recently, good results have been achieved with functional bracing and early mobilisation, and it is common to be immediately weight-bearing in an orthotic. Conservative management reduces the chance of complications, such as infection. There is a risk the tendon can heal too long and more slowly. Achilles Tendinitis

Surgical Treatment
Surgery will involve stitching the two ends of the tendon together, before placing the leg in a cast or brace. The advantage of having an operation is the reduced chance of the rupture reoccurring, however it will involve the risks associated with any surgical procedure, such as infection.
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