Tue

14

Apr

2015

What Are The Main Causes Of Adult Aquired Flat Foot ?

Overview
This condition is characterized by a progressive flattening or falling of the arch. It is often referred to as posterior tibial tendon dysfunction (PTTD) and is becoming a more commonly recognized foot problem. Since the condition develops over time, it is typically diagnosed in adulthood. It usually only develops in one foot although it can affect both. Since it is progressive, it is common for symptoms to worsen, especially when it is not treated early. The posterior tibial tendon attaches to the bones on the inside of your foot and is vital to the support structure within the foot. With PTTD, changes in the tendon impair its ability to function normally. The result is less support for the arch, which in turn causes it to fall or flatten. A flattening arch can cause the heel to shift out of alignment, the forefoot to rotate outward, the heel cord to tighten, and possible deformity of the foot. Common symptoms include pain along the inside of the ankle, swelling, an inward rolling of the ankle, pain that is worse with activity, and joint pain as arthritis sets in. Acquired Flat Foot

Causes
Many health conditions can create a painful flatfoot, an injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.

Symptoms
Pain and swelling behind the inside of your ankle and along your instep. You may be tender behind the inner ankle where the posterior tibial tendon courses and occasionally get burning, shooting, tingling or stabbing pain as a result of inflammation of the nerve inside the tarsal tunnel. Difficulty walking, the inability to walk long distances and a generalised ache while walking even short distances. This may probably become more pronounced at the end of each day. Change in foot shape, sometimes your tendon stretches out, this is due to weakening of the tendon and ligaments. When this occurs, the arch in your foot flattens and a flatfoot deformity occurs, presenting a change in foot shape. Inability to tip-toe, a way of diagnosing Posterior Tibial Tendon Dysfunction is difficulty or inability to ?heel rise? (stand on your toes on one foot). Your tibialis posterior tendon enables you to perform this manoeuvre effectively. You may also experience pain upon attempting to perform a heel rise.

Diagnosis
In the early stages of dysfunction of the posterior tibial tendon, most of the discomfort is located medially along the course of the tendon and the patient reports fatigue and aching on the plantar-medial aspect of the foot and ankle. Swelling is common if the dysfunction is associated with tenosynovitis. As dysfunction of the tendon progresses, maximum pain occurs laterally in the sinus tarsi because of impingement of the fibula against the calcaneus. With increasing deformity, patients report that the shape of the foot changes and that it becomes increasingly difficult to wear shoes. Many patients no longer report pain in the medial part of the foot and ankle after a complete rupture of the posterior tibial tendon has occurred; instead, the pain is located laterally. If a fixed deformity has not occurred, the patient may report that standing or walking with the hindfoot slightly inverted alleviates the lateral impingement and relieves the pain in the lateral part of the foot.

Non surgical Treatment
Nonoperative treatment of posterior tibial tendon dysfunction can be successful with the Arizona AFO brace, particularly when treatment is initiated in the early stages of the disease. This mandates that the orthopedist has a high index of suspicion when evaluating patients to make an accurate diagnosis. Although there is a role for surgical management of acquired flat feet, a well-fitted, custom-molded leather and polypropylene orthosis can be effective at relieving symptoms and either obviating or delaying any surgical intervention. In today's climate of patient satisfaction directed health care, a less invasive treatment modality that relieves pain may prove to be more valuable than similar pain relief that is obtained after surgery. Questions regarding the long-term results of bracing remain unanswered. Future studies are needed to determine if disease progression and arthrosis occur despite symptomatic relief with a brace. Furthermore, age- and disease stage-matched control groups who are randomized to undergo surgery or bracing are necessary to compare these different treatment modalities. Adult Acquired Flat Feet

Surgical Treatment
When conservative care fails to control symptoms and/or deformity, then surgery may be needed. The goal of surgical treatment is to obtain good alignment while keeping the foot and ankle as flexible as possible. The most common procedures used with this condition include arthrodesis (fusion), osteotomy (cutting out a wedge-shaped piece of bone), and lateral column lengthening. Lateral column lengthening involves the use of a bone graft at the calcaneocuboid joint. This procedure helps restore the medial longitudinal arch (arch along the inside of the foot). A torn tendon or spring ligament will be repaired or reconstructed. Other surgical options include tendon shortening or lengthening. Or the surgeon may move one or more tendons. This procedure is called a tendon transfer. Tendon transfer uses another tendon to help the posterior tibial tendon function more effectively. A tendon transfer is designed to change the force and angle of pull on the bones of the arch. It's not clear yet from research evidence which surgical procedure works best for this condition. A combination of surgical treatments may be needed. It may depend on your age, type and severity of deformity and symptoms, and your desired level of daily activity.

Sun

15

Mar

2015

The Treatment And Cause

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.Flat Feet




Causes

Adult flatfoot typically occurs very gradually. If often develops in an obese person who already has somewhat flat feet. As the person ages, the tendons and ligaments that support the foot begin to lose their strength and elasticity.




Symptoms

Often, this condition is only present in one foot, but it can affect both. Adult acquired flatfoot symptoms vary, but can swelling of the foot's inner side and aching heel and arch pain. Some patients experience no pain, but others may experience severe pain. Symptoms may increase during long periods of standing, resulting in fatigue. Symptoms may change over time as the condition worsens. The pain may move to the foot's outer side, and some patients may develop arthritis in the ankle and foot.




Diagnosis

Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course. Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is available. Check the anterior tibial tendon for size and strength.




Non surgical Treatment

What are the treatment options? In early stages an orthotic that caters for a medially deviated subtalar joint ac-cess. Examples of these are the RX skive, Medafeet MOSI device. Customised de-vices with a Kirby skive or MOSI adaptation will provide greater control than a prefabricated device. If the condition develops further a UCBL orthotic or an AFO (ankle foot orthotic) could be necessary for greater control. Various different forms of surgery are available depending upon the root cause of the issue and severity.

Adult Acquired Flat Foot




Surgical Treatment

Surgery should only be done if the pain does not get better after a few months of conservative treatment. The type of surgery depends on the stage of the PTTD disease. It it also dictated by where tendonitis is located and how much the tendon is damaged. Surgical reconstruction can be extremely complex. Some of the common surgeries include. Tenosynovectomy, removing the inflamed tendon sheath around the PTT. Tendon Transfer, to augment the function of the diseased posterior tibial tendon with a neighbouring tendon. Calcaneo-osteotomy, sometimes the heel bone needs to be corrected to get a better heel bone alignment. Fusion of the Joints, if osteoarthritis of the foot has set in, fusion of the joints may be necessary.
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Wed

04

Mar

2015

Coping With Achilles Tendinitis

Overview

Achilles TendonitisA tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon. Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts. Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.

Causes

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time. Health professionals may use different terms to describe a tendon injury. You may hear, Tendonitis (or Tendinitis): This actually means "inflammation of the tendon," but inflammation is rarely the cause of your tendon pain.

Symptoms

People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.

Diagnosis

A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs, calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not be visible on MRI. It depends upon the severity of the condition.

Nonsurgical Treatment

The latest studies on Achilles tendonitis recommend a treatment plan that incorporates the following three components. Treatment of the inflammation. Strengthening of the muscles that make up the Achilles tendon using eccentric exercise. These are a very specific type of exercise that has been shown in multiple studies to be a critical component of recovering from Achilles tendonitis. Biomechanical control (the use of orthotics and proper shoes). Shockwave therapy.

Achilles Tendon

Surgical Treatment

In cases of severe, long-term Achilles tendonitis the sheath may become thick and fibrous. In these cases surgery may be recommended. Surgery aims to remove the fibrous tissue and repair any tears in the tendon. A cast or splint will be required after the operation and a recovery program including physiotherapy, specific exercises and a gradual return to activity will be planned.

Prevention

If you're just getting started with your training, be sure to stretch after running, and start slowly, increasing your mileage by no more than 10% per week. Strengthen your calf muscles with exercises such as toe raises. Work low-impact cross-training activities, such as cycling and swimming, into your training.
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Sat

17

Jan

2015

What Triggers Pain In The Heel To Appear

Feet Pain

Overview

Heel pain is most commonly caused by plantar fasciitis, which is the swelling of the tissue that connects the heel bone to the toes at the bottom part of the foot, also known as the plantar fascia. Plantar fasciitis is often described as sharp pain in the middle of the heel, which is typically worse after periods of rest when fascia contracts. The pain usually becomes more bearable as the muscles loosen up during the low-impact walking, but can return even worse after extended periods of walking or standing. The plantar fascia serves as a shock absorber and supports the foot’s arch. Too much tension on the plantar fascia can cause inflammation and swelling. Fortunately in most cases, plantar fasciitis treatment is fairly conservative. Plantar fasciitis exercises, medications and orthotics are usually all that’s needed to manage the pain. Most severe cases may require surgery.




Causes

Plantar fasciitis is caused by drastic or sudden increases in mileage, poor foot structure, and inappropriate running shoes, which can overload the plantar fascia, the connective tissue that runs from the heel to the base of the toes. The plantar fascia may look like a series of fat rubber bands, but it's made of collagen, a rigid protein that's not very stretchy. The stress of overuse, overpronation, or overused shoes can rip tiny tears in it, causing pain and inflammation, a.k.a. plantar fasciitis.




Symptoms

The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel. This develops gradually over time. It usually affects just one foot, but can affect both feet. Some people describe the pain as dull, while others experience a sharp pain, and some feel a burning or ache on the bottom of the foot extending outward from the heel. The pain is usually worse in the morning when you take your first steps out of bed, or if you’ve been sitting or lying down for a while. Climbing stairs can be very difficult due to the heel stiffness. After prolonged activity, the pain can flare-up due to increased inflammation. Pain is not usually felt during the activity, but rather just after stopping.




Diagnosis

Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.




Non Surgical Treatment

Treatments you can do at home include rest. Try to avoid activities that put stress on your feet. This can be hard, especially if your job involves being on your feet for hours at a time, but giving your feet as much rest as possible is the first step in reducing the pain of plantar fasciitis. Use ice or a cold compress to reduce pain and inflammation. Do this three or four times a day for about 20 minutes at a time until the pain goes away. Take anti-inflammatory medications. Painkillers such as ibuprofen or acetaminophen can help relieve pain and reduce inflammation in the affected area. Your doctor may also prescribe a medication called a corticosteroid to help treat severe pain. Exercise your feet and calves. When the pain is gone, do calf and foot stretches and leg exercises to make your legs as strong and flexible as possible. This can help you avoid getting plantar fasciitis again. Ask your coach, athletic trainer, or a physical therapist to show you some leg exercises. Rolling a tennis ball under your foot can massage the area and help the injury heal. Talk to your doctor about shoe inserts or night splints. Shoe inserts can give your feet added support to aid in the healing process. Night splints keep your calf muscles gently flexed, helping to keep your plantar fascia from tightening up overnight. Have a trainer or sports injury professional show you how to tape your foot. A proper taping job allows your plantar fascia to get more rest. You should tape your foot each time you exercise until the pain is completely gone. For people who get repeated sports injuries, it can help to see a sports medicine specialist. These experts are trained in evaluating things like an athlete's running style, jumping stance, or other key moves. They can teach you how to make the most of your body's strengths and compensate for any weaknesses. Once you're healed, look for the silver lining in your bench time. You may find that what you learn from having an injury leads you to play a better game than ever before.

Heel Discomfort




Surgical Treatment

Surgery is not a common treatment for this condition. Approximately 5% of people with plantar fasciitis require surgery if non-surgical methods do not help to relieve pain within a year. The surgical procedure involves making an incision in the plantar fascia in order to decrease the tension of the ligament. Potential risks of this surgical procedure include irritation of the nerves around the heel, continued plantar fasciitis, heel or foot pain, infection, flattening of the arch, problems relating to the anesthetic.

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Tue

13

Jan

2015

What Is Heel Pain

Plantar Fasciitis

Overview

The plantar fascia acts like a bowstring and supports the arch and several muscles inside the foot. When there is increased stress on the arch, microscopic tears can occur within the plantar fascia, usually at its attachment on the heel. This results in inflammation and pain with standing and walking and sometimes at rest.




Causes

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.




Symptoms

If you are concerned that you may have developed this syndrome, review this list of symptoms to see if they match with your experience. Aching, sharp or burning pain in the sole of your foot, often centering in the heel area. Foot pain that occurs as soon as you step out of bed or get to your feet after prolonged periods of sitting. Pain that may decrease eventually after you've been on your feet for awhile, only to return later in the day. Sudden heel pain or pain that builds gradually. Foot pain that has lasted for more than a few days, or which you experience periodically over the course of months or years. Pain in just one foot, though it is possible to have Plantar Fasciitis affect both feet. Swelling, redness, or feelings of heat in the heel area. Limping.




Diagnosis

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.




Non Surgical Treatment

Conservative treatment is almost always successful, given enough time. Traditional treatment often includes, rest, NSAIDs, and new shoes or heel inserts. Some doctors also recommend avoiding walking bare-footed. This means you’d have to wear your shoes as soon as you wake up. Certain foot and calf exercises are often prescribed to slowly build strength in the ligaments and muscles that support the arch of the foot. While traditional treatment usually relieves pain, it can last from several months to 2 years before symptoms get better. On average, non-Airrosti patients tend to get better in about 9 months.

Heel Pain




Surgical Treatment

Surgery is rarely used in the treatment of plantar fasciitis. However it may be recommended when conservative treatment has been tried for several months but does not bring adequate relief of symptoms. Surgery usually involves the partial release of the plantar fascia from the heel bone. In approximately 75% of cases symptoms are fully resolved within six months. In a small percentage of cases, symptoms may take up to 12 months to fully resolve.




Prevention

Warm up properly. This means not only stretching prior to a given athletic event, but a gradual rather than sudden increase in volume and intensity over the course of the training season. A frequent cause of plantar fasciitis is a sudden increase of activity without suitable preparation. Avoid activities that cause pain. Running on steep terrain, excessively hard or soft ground, etc can cause unnatural biomechanical strain to the foot, resulting in pain. This is generally a sign of stress leading to injury and should be curtailed or discontinued. Shoes, arch support. Athletic demands placed on the feet, particularly during running events, are extreme. Injury results when supportive structures in the foot have been taxed beyond their recovery capacity. Full support of the feet in well-fitting footwear reduces the likelihood of injury. Rest and rehabilitation. Probably the most important curative therapy for cases of plantar fasciitis is thorough rest. The injured athlete must be prepared to wait out the necessary healing phase, avoiding temptation to return prematurely to athletic activity. Strengthening exercises. Below are two simple strength exercises to help condition the muscles, tendons and joints around the foot and ankle. Plantar Rolling, Place a small tin can or tennis ball under the arch of the affected foot. Slowly move the foot back and forth allowing the tin can or tennis ball to roll around under the arch. This activity will help to stretch, strengthen and massage the affected area. Toe Walking, Stand upright in bare feet and rise up onto the toes and front of the foot. Balance in this position and walk forward in slow, small steps. Maintain an upright, balanced posture, staying as high as possible with each step. Complete three sets of the exercise, with a short break in between sets, for a total of 20 meters.
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