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Sep292015

What Are The Primary Causes Of Calcaneal Spur

Posterior Calcaneal Spur


Overview


Heel spurs are small lumps of excess bone that grow and stick out on the calcaneus, aka heel bone. They usually develop in response to friction, tightness, inflammation or injury when the body lays down extra layers of bone to try and protect itself. There are two areas where heel bone spurs tend to develop. At the back of the heel: these are usually due to conditions such as Achilles tendonitis, tight calf muscles or wearing tight footwear. These are known as posterior calcaneal spurs. Underneath the heel: these are usually due to conditions such as plantar fasciitis, muscle imbalance or altered foot biomechanics. These are known as inferior calcaneal spurs.


Causes


These bony protrusions are commonly found in association with a condition called Plantar Fasciitis. Plantar Fasciitis occurs when the plantar fascia ligament, which spans the arch of the foot, becomes stressed, torn and inflamed. Misalignment and excessive movement of the plantar fascia ligament is most typically the result of an abnormal walking gait. The ligament is designed to stretch with the bounce of each step you take, but if it stretches too much, the resulting small tears and inflammation can cause mild to extreme discomfort. At the same time, it is believed that heel spurs are formed as the body attempts to provide some additional support to the over-stretched ligament. In other words, calcium builds up as a prop to the plantar fascia.


Calcaneal Spur


Symptoms


The following symptoms are typical of heel spur. Stabbing pain when treading on the area affected. Dull, irregularly occurring pains in the heel area also without exerting pressure (e.g. in a reclining position) Pain when taking the first steps in the morning (after lying or sitting down for an extended period, especially in the morning) Occasional swelling in the ankle area. For the lower heel spur, extreme sensitivity at the tendon attachment (laterally in the lower heel area) For the upper heel spur, extreme pressure sensitivity of the Achilles tendon, primarily at approximately ankle height.


Diagnosis


A thorough medical history and physical exam by a physician is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.


Non Surgical Treatment


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


Surgical Treatment


In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.

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Sep252015

Identifying Calcaneal Spur

Heel Spur


Overview


A heel spur is a pointed bony outgrowth of the bone of the heel (the calcaneus bone). Heel spurs under the sole of the foot (plantar area) are associated with plantar fasciitis. Heel spurs and plantar fasciitis can occur alone or be related to underlying diseases. Heel spurs and plantar fasciitis are treated by measures that decrease the associated inflammation and avoid reinjury.


Causes


A major cause of heel spur pain comes from the development of new fibrous tissue around the bony spur, which acts as a cushion over the area of stress. As this tissue grows, a callus forms and takes up even more space than the heel spur, leading to less space for the thick surrounding network of tendons, nerves, ligaments and supporting tissue. These important structures in the foot have limited space because of calcium or tissue buildup, which leads to swelling and redness of the foot, and a deep throbbing pain worsened with exercise.


Heel Spur


Symptoms


Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain, especially while walking, jogging, or running, if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning, a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.


Diagnosis


Your doctor will discuss your medical history and will examine your foot and heel for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray or blood tests (to rule out diseases or infections) may be requested.


Non Surgical Treatment


Common and effective treatments for Heel Spurs include: Stretching exercises, changing to specific shoes, taping or strapping to rest stressed muscles and tendons, custom orthotic devices and physiotherapy. There are many things you can do to treat heel spurs. You should stretch the muscles and ligaments around the area regularly and ensure you are wearing the right footwear for your feet. There are also tapes and straps that you can apply to the muscles and tendons around the area. For more severe cases, custom orthotics may be the way to go along with aggressive physiotherapy. To treat the pain, over the counter NSAIDs (anti-inflammatory medications) is recommended, but use with caution as prolonged use can lead to the development of ulcers. It is therefore best to apply a topical treatment such as Zax?s Original Heelspur Cream, which contains natural ingredients proven to reduce pain and inflammation. More severe forms of the condition may require corticosteroid injections or surgical procedures, but these are very rare cases. Still, should pain become worse and persist, you should consult with your doctor.


Surgical Treatment


More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

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Agos232015

Apparent Symptoms Of Bursitis Of The Foot

Overview


You might be suffering from Achilles bursitis if you have sharp pain at the back of your heel. You have lump on the back of your heel. You have loss of range of motion walking and the pressure for shoes causes you to limp and you have weakness in your leg. You have warmth, redness and swelling on the heel. If any of those statements are true for you or you're suffering from on-going pain in your heel then you might have an injury called "retrocalcaneal bursitis". Many people don't know that Achilles bursitis is a very real injury affecting the bursa sac in your ankle. It can happen to anyone who regularly puts stress with repetitive movements as part of your job, sports related activities, acute trama to the ankle/foot and/or aging weakness the tissue around the ankle and the bursa.


Causes


Overtraining in a runner (eg, excessive increases in miles or intensity). Tight or poorly fitting shoes that, because of a restrictive heel counter, exert excessive pressure on the posterior heel and ankle


Haglund deformity, causing impingement between the increased posterior superior calcaneal prominence and the Achilles tendon during dorsiflexion. More recent research suggests that a misaligned subtalar joint axis (measured in terms of joint inclination and deviation) in relation to the Achilles tendon can result in an asymmetrical force load on the tendon, disrupting normal biomechanics. This altered joint axis is associated with an increased risk for Achilles pathologies, including bursitis.


Symptoms


The following are the most common symptoms of bursitis. However, each individual may experience symptoms differently. Bursitis can cause pain, localized tenderness, and limited motion. Swelling and redness may occur if the inflamed bursa is close to the surface (superficial). Chronic bursitis may involve repeated attacks of pain, swelling, and tenderness, which may lead to the deterioration of muscles and a limited range of motion. The symptoms of bursitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.


Diagnosis


Before making a diagnosis of retrocalcaneal bursitis, a doctor must rule out other possible problems, such as arthritis, a fracture or tumor. A doctor also will try to determine if the Achilles tendon itself is a source of pain. To make a diagnosis, a doctor will use some or all of the diagnostic tools below Patient interview. A doctor will ask a patient about medical history, and to describe the onset of his or her symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask patients what types of shoes they wear and what they do for exercise. A patient's reported symptoms are important to diagnosis and treatment. The doctor will also ask what home treatments have helped the condition. Physical exam. A doctor will examine the patient's foot, noting swelling, tenderness and pain points, and range of motion. The doctor also may ask the patient to point and flex the feet and stand on his or her toes.


Non Surgical Treatment


The initial course of treatment for this problem, after the usual ice and ibuprofen/aspirin routine or course, is to change footwear, especially if the onset of the problem was coincidental with a new pair of shoes. If this fails, a small heel lift (no more than ??) in both shoes may provide enough biomechanical adjustment to relieve the stress and/or friction over the area. If there is still no improvement, complete rest from running is probably advised, along with a professional consultation.


Surgical Treatment


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


Prevention


After taking a history and performing a physical examination, your physician may order x-rays to rule out other disorders. Your doctor may administer injections of corticosteroids and a local anesthetic to reduce swelling and ease pain. Also, to reduce swelling, your physician may draw excess fluid from the bursa with a syringe and then tightly wrap and compress the joint with an elastic bandage. In severe, persistent cases surgery to remove the bursa may be necessary. For infectious bursitis, antibiotics will be prescribed.

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Agos142015

Hammer Toe Caused By Bunion

Hammer ToeOverview


hammertoes is a painful deformity wherein a toe bends unnaturally and becomes clawlike. This happens because the tendons of the toe contract abnormally, forcing the toe to bend downward and the middle joint of the toe to protrude upward. Although any toe may be affected, hammertoe usually affects the second toe. The toe assumes a clawlike position and cannot be straightened out. When someone with hammertoe wears shoes, the toe is constantly rubbed, so walking may become especially painful if a callus on the sole of the foot hammertoe or a corn on the top of a toe develops.


Causes


The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people. Hammertoes may be aggravated by shoes that don?t fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.


HammertoeSymptoms


The most obvious sign of hammertoes are bent toes, other symptoms may include pain and stiffness during movement of the toe. Painful corns on the tops of the toe or toes from rubbing against the top of the shoe's toe box. Painful calluses on the bottoms of the toe or toes. Pain on the bottom of the ball of the foot. Redness and swelling at the joints.


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


In the earlier stages of hammer toe, when the toes can still be manually straightened, then conservative treatment is appropriate. This means wearing shoes which are a half size bigger than normal and which are not narrow around the toes. Exercises to stretch the toes out and strengthen the muscles under the foot which balances the tightness of the top tendons are important. Padding or corn plasters can be used to ease the discomfort of any associated corns and calluses.


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.

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Jun232015

Hammertoes

Hammer ToeOverview


There are two types of Hammer toes, Flexible hammertoes. If the toe still can be moved at the joint, it's a flexible hammertoe. That's good, because this is an earlier, milder form of the problem. There may be several treatment options. Rigid hammertoes. If the tendons in the toe become rigid, they press the joint out of alignment. At this stage, the toe can't be moved. It usually means that surgery is needed.


Causes


Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problem (e.g., a bunion can force the big toe to turn inward and push the other toes). It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot-Marie-Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich's ataxia.


HammertoeSymptoms


Signs and symptoms of hammertoe and mallet toe may include a hammer-like or claw-like appearance of a toe. In mallet toe, a deformity at the end of the toe, giving the toe a mallet-like appearance. Pain and difficulty moving the toe. Corns and calluses resulting from the toe rubbing against the inside of your footwear. Both hammertoe and mallet toe can cause pain with walking and other foot movements.


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


Try to find shoes that are soft, roomy, and comfortable and avoid tight shoes or shoes with high heels. A shoe repair shop may be able to stretch a small pocket in regular shoes to make room for the hammertoe. Have a professional pedicure. Sometimes a skilled manicurist can file down a painful corn. Follow your healthcare provider's instructions. Ask your provider what activities you should avoid and when you can return to your normal activities, how to take care of yourself at home, what symptoms or problems you should watch for and what to do if you have them. Make sure you know when you should come back for a checkup.


Surgical Treatment


he basis for hammer toe surgery most often involves removing s portion of bone within the toe, to reduce the joint contracture. Depending on the direction the toe is deviated, soft tissue procedures may be necessary along with pinning the toe with a surgical wire.


hammertoe class='alignleft' style='float:left;margin-right:10px;' src='http://www.perthfootcentre.com.au/wp-content/uploads/2015/04/ingrown-toe-nail.jpg' width='253' alt='Hammer Toe'/>Prevention


These tips may help you buy the right shoes. Buy shoes at the end of the day. Your feet are smaller in the morning and swell throughout the day. Don't assume your shoe size hasn't changed. As you age, your shoe size may change, especially the width. Measure both feet and buy for the larger foot. Ask for just the right fit. A shoe repair store can stretch shoes in tight spots.

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