Author Archives: susanfegarly

Coping with Mortons Neuroma

Overview

Morton neuromaMorton neuroma (interdigital neuroma), first described in 1876, is a perineural fibrosis and nerve degeneration of the common digital nerve. Morton neuroma, or Morton’s neuroma, is not a true neuroma, although it results in neuropathic pain in the distribution of the interdigital nerve secondary to repetitive irritation of the nerve. The most frequent location is between the third and fourth metatarsals (third webspace). Other, less common locations are between the second and third metatarsals (second webspace) and, rarely, between the first and second (first webspace) or fourth and fifth (fourth webspace) metatarsals.

Causes

Poorly fitted footwear can be a cause. Shoes that have a tight and narrow toe box can cause the never to become entrapped causing the pain. High heeled shoes abnormally place the metatarsals under extreme pressure which can cause Morton?s Neuroma. In cases of abnormal pronation, there can be significant motion between the 3rd and 4th metatarsals which can cause an irritation to the nerve that runs between them. This inflammation causes the pain.

Symptoms

Symptoms include: pain on weight bearing, frequently after only a short time. The nature of the pain varies widely among individuals. Some people experience shooting pain affecting the contiguous halves of two toes. Others describe a feeling like having a pebble in their shoe or walking on razor blades. Burning, numbness, and paresthesia may also be experienced. Morton’s neuroma lesions have been found using MRI in patients without symptoms.

Diagnosis

The clinical symptoms should quickly lead your doctor to suspect a neuroma. When examined, the doctor may feel a “click” which is known as Mulder’s sign. There may be tenderness in the interspace. The metatarsal bones will also be examined both clinically (and often with an xray). Tenderness at one of the metatarsal bones can suggest an overstress reaction (pre-stress fracture or stress fracture) in the bone. An ultrasound scan can confirm the diagnosis and is a less expensive and at this time, at least as sensitive a test as an MRI. An x-ray does not show neuromas, but can be useful to “rule out” other causes of the pain.

Non Surgical Treatment

Nonsurgical treatment is tried first. Your doctor may recommend any of the following. Padding and taping the toe area, shoe inserts, changes to footwear, for example wearing shoes with wider toe boxes or flat heels, Anti-inflammatory medicines taken by mouth or injected into the toe area, nerve blocking medicines injected into the toe area, other painkillers, physical therapy. Anti-inflammatories and painkillers are not recommended for long-term treatment. In some cases, surgery is needed to remove the thickened tissue and inflammed nerve. This helps relieve pain and improve foot function. Numbness after surgery is permanent.Morton neuroma

Surgical Treatment

Recently, an increasing number of procedures are being performed at specialist centers under radiological or ultrasound guidance. Recent studies have shown excellent results for the treatment of Morton’s neuroma with ultrasound guided steroid injections, ultrasound guided sclerosing alcohol injections, ultrasound guided radiofrequency ablation and ultrasound guided cryo-ablation.

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Shoe Lifts The Ideal Solution To Leg Length Imbalances

There are actually two different kinds of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is structurally shorter compared to the other. As a result of developmental stages of aging, the human brain senses the walking pattern and recognizes some variance. The human body usually adapts by dipping one shoulder to the “short” side. A difference of less than a quarter inch isn’t very excessive, demand Shoe Lifts to compensate and in most cases doesn’t have a profound effect over a lifetime.

Shoe Lift

Leg length inequality goes typically undiscovered on a daily basis, yet this problem is easily remedied, and can eliminate many cases of lumbar pain.

Therapy for leg length inequality commonly involves Shoe Lifts. Many are cost-effective, generally being less than twenty dollars, compared to a custom orthotic of $200 or higher. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Lumbar pain is the most widespread condition affecting people today. Over 80 million men and women are afflicted by back pain at some point in their life. It’s a problem which costs companies huge amounts of money year after year on account of time lost and output. New and improved treatment solutions are continually sought after in the hope of reducing the economical influence this condition causes.

Shoe Lift

People from all corners of the world experience foot ache as a result of leg length discrepancy. In a lot of these cases Shoe Lifts are usually of very helpful. The lifts are capable of reducing any discomfort in the feet. Shoe Lifts are recommended by countless expert orthopaedic practitioners”.

In order to support the human body in a well balanced fashion, your feet have got a critical function to play. Inspite of that, it can be the most neglected region in the body. Some people have flat-feet which means there may be unequal force exerted on the feet. This will cause other body parts including knees, ankles and backs to be impacted too. Shoe Lifts ensure that the right posture and balance are restored.

What May Cause Calcaneal Spur

Heel Spur

Overview

Approximately 10 per cent of the population may have heel spurs without any heel pain. Whilst recent research has raised the question of whether or not heel spurs are the result of the body trying to increase its base of support, heel spurs are still considered to be the result from strain on the muscles of the foot (in particular the plantar fascia). This may result from a biomechanical imbalance, such as over pronation.

Causes

When a patient has plantar fasciitis, the plantar fascia becomes inflamed and degenerative (worn out)–these abnormalities can make normal activities quite painful. Symptoms typically worsen early in the morning after sleep. At that time, the plantar fascia is tight so even simple movements stretch the contracted plantar fascia. As you begin to loosen the plantar fascia, the pain usually subsides, but often returns with prolonged standing or walking.

Posterior Calcaneal Spur

Symptoms

More often than not, heel spurs have no signs or symptoms, and you don?t feel any pain. This is because heel spurs aren?t pointy or sharp pieces of bone, contrary to common belief. Heel spurs don?t cut tissue every time movement occurs; they?re actually deposits of calcium on bone set in place by the body?s normal bone-forming mechanisms. This means they?re smooth and flat, just like all other bones. Because there?s already tissue present at the site of a heel spur, sometimes that area and the surrounding tissue get inflamed, leading to a number of symptoms, such as chronic heel pain that occurs when jogging or walking.

Diagnosis

Diagnosis of a heel spur can be done with an x-ray, which will be able to reveal the bony spur. Normally, it occurs where the plantar fascia connects to the heel bone. When the plantar fascia ligament is pulled excessively it begins to pull away from the heel bone. When this excessive pulling occurs, it causes the body to respond by depositing calcium in the injured area, resulting in the formation of the bone spur. The Plantar fascia ligament is a fibrous band of connective tissue running between the heel bone and the ball of the foot. This structure maintains the arch of the foot and distributes weight along the foot as we walk. However, due to the stress that this ligament must endure, it can easily become damaged which commonly occurs along with heel spurs.

Non Surgical Treatment

Conventional treatment for heel spurs typically includes rest, stretching exercises, icing and anti-inflammatory medications. Many people find it difficult to go through the day without some sort of routine activity or exercise, and this prolongs the heel spur and forces people to rely on anti-inflammatory medications for a longer period of time. This can be detrimental due to the many side effects of these medications, including gastrointestinal problems like leaky gut, bleeding and ulcer symptoms.

Surgical Treatment

When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide pain relief and restore mobility. The type of procedure used is based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. The procedure may also include removal of heel spurs.

What Are The Symptoms Of Inferior Calcaneal Spur

Posterior Calcaneal Spur

Overview

Bone spurs including heel spurs occur as a natural response of the body to wear and tear. Heel spur in particular, can cause pain when it rubs against soft tissues including the Achilles tendon. When that happens movement can become restricted. Spurs can also appear in other joint areas such as under the toenail where it would lead to pain and nail deformation.

Causes

Everyone can be affected by heel spurs, however, certain groups of people have an increased risk. For example, Plantar Fasciitis is a common running injury. People who walk a lot are much more likely to have heel spurs or people who play golf or play tennis. Over-weight people are also more at risk for heel bone spurs as our feet are not designed to carry around extra weight. As a result the ligaments under the foot are placed under constant stress, which inevitably will lead to foot problems.

Inferior Calcaneal Spur

Symptoms

Although it may take years to become a problem, once it appears, it may cause considerable suffering. Because of proximity to the tendons, the spur is a source of continuous painful aching. The sensation has been described as “a toothache in the foot.” When you place your weight on the heel, the pain can be sufficient to immobilize you.

Diagnosis

The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.

Non Surgical Treatment

There are many temporary solutions to resolve the pain associated with irritation to the plantar ligaments. Common recommendations are ice and anti-inflammatory medications or even cortisone injections, however none of these solve the fundamental problem. To permanently resolve heel spurs you need to support and restrict the movement of the plantar ligaments. Flexible shoes will aggravate and often contribute to heel spurs. We recommend a RIGID orthotic that extends from the metatarsal heads to the heel to resolve heel spurs.

Surgical Treatment

In some cases, heel spurs are removed by surgery after an X-ray. While the surgery is typically effective, it?s a timely and expensive procedure. Even after surgery, heel spurs can re-form if the patient continues the lifestyle that led to the problem. These reasons are why most people who develop painful heel spurs begin looking for natural remedies for joint and bone pain. Surgery isn?t required to cure a heel spur. In fact, more than 90 percent of people get better with nonsurgical treatments. If nonsurgical methods fail to treat symptoms of heel spurs after 12 months, surgery may be necessary to alleviate pain and restore mobility.

What Can Cause Bursitis Of The Feet?

Overview

Retrocalcaneal bursitis is the painful inflammation and swelling of the retrocalcaneal bursa that is situated between the calcaneus (heel bone) and the Achilles tendon. A bursa is a small fluid filled sac that forms around joints in areas where there is a lot of friction between muscles, tendons and outcrops of bone. The bursae position themselves in between the tendon or muscle and the bone, buffering any friction from movement. To picture a bursa imagine it as a very small water filled balloon that sits in places where things rub against each other, such as in between a tendon and a bone, to provide a soft smooth cushion for the tendon to pass over painlessly. The covering of the bursa also acts as a lubricant and aids the tendon?s movement. It is estimated that there is over 150 bursae in your body which protect the joint and tendons from wear. They are all very small and unnoticeable until they become swollen and painful with bursitis.

Causes

The following are some of the more common causes for heel bursitis. Overuse (common in runners and athletes). Running with the wrong footwear. A sudden impact to the foot. Repetitive stress. Underlying inflammatory condition (such as osteoarthritis).

Symptoms

Symptoms of Achilles bursitis are often mistaken for Achilles tendinitis because of the location of the pain at the back of the heel. When you suffer from Achilles bursitis you will experience some or all of the following symptoms which are most noticeable when you begin activity after resting. High heels can add pressure on the retrocalcaneal bursa, subcutaneous calcaneal bursa, and Achilles tendon.

Diagnosis

The diagnosis is based on the symptoms and an examination. For anterior Achilles tendon bursitis, doctors use x-rays to rule out a fracture of the heel bone or damage to the heel bone caused by rheumatoid arthritis or other inflammatory arthritis.

Non Surgical Treatment

Relieving the symptoms of bursitis initially focuses on taking the pressure off the bursa. This can be done with proper cushioning, inserts, or footwear but may require surgery if it is a bone formation problem (i.e. Huglund’s Deformity). If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and prescribe antibiotics to treat the infection.

Surgical Treatment

Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.

Is Hammertoe Surgery Painful

HammertoeOverview

A hammer toe can be defined as a condition that causes your toe to bend downward instead of pointing forward. While it can occur on any toe on your foot, it usually affects the second or third toe. If your baby toe curls instead of buckling, it is also considered a hammer toe. There are two types of hammer toes. If your toes still can move around at the joint, then it is considered a flexible hammer toe. It is a milder form of the condition and there are more treatment options. The other type is called a rigid hammertoes, which occurs when the tendons in your toe become so rigid that they push your toe joint out of alignment, and it cannot move at all. Typically, you will need surgery to fix it.

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 Hammer toe high heels or tight shoes that crowd the toes and don?t allow them to lie flat. Aging.

HammertoeSymptoms

Hammer, claw, and mallet toes can cause discomfort and pain and may make it hard to walk. Shoes may rub on your toes, causing pain, blisters, calluses or corns, or sores. Sores can become infected and lead to cellulitis or osteomyelitis, especially if you have diabetes or peripheral arterial disease. If you have one of these health problems and sores develop, contact your doctor.

Diagnosis

Hammer toes may be easily detected through observation. The malformation of the person’s toes begin as mild distortions, yet may worsen over time – especially if the factors causing the hammer toes are not eased or removed. If the condition is paid attention to early enough, the person’s toes may not be permanently damaged and may be treated without having to receive surgical intervention. If the person’s toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.

Non Surgical Treatment

Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than your longest toe. For many people, the second toe is longer than the big toe.) Avoid wearing tight, narrow, high-heeled shoes. You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. Or, a shoe repair shop may be able to stretch the toe box so that it bulges out around the toe. Sandals may help, as long as they do not pinch or rub other areas of the foot.

Surgical Treatment

In advanced cases in which the toe has become stiff and permanently bent, the toe can be straightened with surgery. One type of surgery involves removing a small section of the toe bone to allow the toe to lie flat. Surgery for hammertoe usually is classified as a cosmetic procedure. Cosmetic foot surgeries sometimes result in complications such as pain or numbness, so it’s better to treat the problem with a shoe that fits properly.

Contracted Toe Surgical Treatments

<img hammertoe class=’alignleft’ style=’float:right;margin-right:10px;’ src=’http://adambudgen.co.uk/uploads/images/Claw_Toe_and_Hammer_Toe.jpg&#8217; width=’254′ alt=’Hammer Toe’/>Overview

A Hammer toes is a deformity of the second, third or fourth toes in which the main toe joint is bent upward like a claw. Initially, hammertoes are flexible and can be corrected with simple measures. Left untreated, they can become fixed and require surgery. Hammertoe results from shoes that don?t fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and can?t stretch out.

Causes

If a foot is flat (pes planus, pronated), the flexor muscles on the bottom of the foot can overpower the others because a flatfoot is longer than a foot with a normal arch. When the foot flattens and lengthens, greater than normal tension is exerted on the flexor muscles in the toes. The toes are not strong enough to resist this tension and they may be overpowered, resulting in a contracture of the toe, or a bending down of the toe at the first toe joint (the proximal interphalangeal joint) which results in a hammertoe. If a foot has a high arch (pes cavus, supinated), the extensor muscles on the top of the foot can overpower the muscles on the bottom of the foot because the high arch weakens the flexor muscles. This allows the extensor muscles to exert greater than normal tension on the toes. The toes are not strong enough to resist this tension and they may be overpowered, resulting in a contracture of the toe, or a bending down of the toe at the first toe joint (the proximal interphalangeal joint) which results in a hammertoe.

Hammer ToeSymptoms

The most common symptoms of hammertoes include. The toe is bent upward at the middle toe joint, so that the top of this joint rubs against the top of the shoe. The remainder of the toe is bent downward. Pain upon pressure at the top of the bent toe from footwear. The formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe. This occurs because the contracted digit puts pressure on the metatarsal head creating callouse and pressure on the ball of the foot.

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

Conservative treatment is the first choice, often starting with a change of shoes to ones that have soft, larger toe spaces. Toe exercises may be prescribed to stretch and strengthen the toe muscles. Over-the-counter straps, cushions or non-medicated corn pads may be recommended to help relieve your symptoms.

Surgical Treatment

Probably the most frequent procedure performed is one called a Post or an Arthroplasty. In this case a small piece of bone is removed from the joint to straighten the toe. The toe is shortened somewhat, but there is still motion within the toe post-operatively. In other cases, an Arthrodesis is performed. This involves fusing the abnormally-contracted joint. The Taylor procedure fuses only the first joint in the toe, whereas the Lambrinudi procedure fuses both joints within the toe. Toes which have had these procedures are usually perfectly straight, but they take longer to heal and don’t bend afterwards. A Hibbs procedure is a transfer of the toe’s long extensor tendon to the top of the metatarsal bone. The idea of this procedure is to remove the deforming cause of the hammertoes (in this case, extensor substitution), but to preserve the tendon’s function in dorsifexing the foot by reattaching it to the metatarsals. Fortunately, the Gotch (or Gotch and Kreuz) procedure–the removal of the base of the toe where it attaches to the foot, is done less frequently than in years past. The problem with this procedure is that it doesn’t address the problem at the level of the deformity, and it causes the toe to become destabilized, often resulting in a toe that has contracted up and back onto the top of the foot. You can even have an Implant Arthroplasty procedure, where a small, false joint is inserted into place. There are several other procedures, as well.

Hammer ToePrevention

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