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Calcaneal Spur


Overview


Although a heel spur is often thought to be the source of heel pain, it rarely is. When a patient has plantar fasciitis, the plantar fascia pulls on the bottom of the heel bone. Over time this can cause a spur to form. Heels spurs are a very common x-ray finding, and because the heel spur is buried deep in soft tissue and not truly in a weight bearing area, there is often no history of pain. It is important to note that less than one percent of all heel pain is due to a spur. but frequently caused by the plantar fascia pulling on the heel. Once the plantar fasciitis is properly treated, the heel spur could be a distant memory.


Causes


There exists a membrane that covers most of the bone along the heel. When this membrane gets torn repeatedly due to straining of the muscles in the foot, the calcium deposits that lead to heel spurs are more likely to occur.


Calcaneal Spur


Symptoms


The Heel Spur itself is not thought to be painful. Patients who experience pain with Plantar Fasciitis are suffering from inflammation and irritation of the plantar fascia. This the primary cause of pain and not the Heel Spur. Heel Spurs form in some patients who have plantar fasciitis, and tend to occur in patients who have had the problem for a prolonged period of time. While about 70 % of patients with plantar fasciitis have a heel spur, X-rays also show about 50 % of patients with no symptoms of plantar fasciitis also have a heel spur.


Diagnosis


Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts. X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This 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 may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.


Non Surgical Treatment


Podiatric Care for heel spur syndrome may involve keeping the fascia stretched out by performing exercises. Your doctor may also suggest for you to be seen by a physical therapist. You probably will be advised on the best shoes to wear or some inserts for your shoes. Your podiatrist may suggest that a custom made orthotic be made to allow your foot to function in the most ideal way especially if you have excessive pronation. A heel lift may be used if you have a leg length discrepancy. Medical treatment may include anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce the swelling and decrease pain. If a bursitis is present the medication may greatly improve the symptoms. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.


Surgical Treatment


Approximately 2% of people with painful heel spurs need surgery, meaning that 98 out of 100 people do well with the non-surgical treatments previously described. However, these treatments can sometimes be rather long and drawn out, and may become considerably expensive. Surgery should be considered when conservative treatment is unable to control and prevent the pain. If the pain goes away for a while, and continues to come back off and on, despite conservative treatments, surgery should be considered. If the pain really never goes away, but reaches a plateau, beyond which it does not improve despite conservative treatments, surgery should be considered. If the pain requires three or more injections of "cortisone" into the heel within a twelve month period, surgery should be considered.


Prevention


Prevention of heel spur syndrome may be best by finding a good supportive shoe. Never go barefoot or wear a flat soled shoe. There are many over the counter arch supports that give increased support for your feet. Usually when there is excessive pronation the Achilles Tendon contracts or becomes shortened over time since it is not being used fully. The shortened Achilles Tendon is called an equinus deformity. By keeping this tendon stretched it may decrease some of the tension in the foot. Some theories believe the Achilles Tendon and plantar fascia is continuous. Before you get up from rest, stretch out your Achilles and the plantar fascia. You may attempt to spell the alphabet with your foot and ankle, use a towel against pressure on your foot, or roll a can of soup or sodapop on the ground. Ice may work well at the times of severe pain. For a chronic pain, or longer lasting pain heat therapy may improve the condition.
Admin · 71 vistas · Escribir un comentario
27 Sep 2015
Posterior Calcaneal Spur


Overview


A heel spur is caused by the displacement of calcium on the bone that forms on the underside of the heel, it may be one small bony protrusion or a collection of tiny, irregularly shaped growths on the bone of the heel, which is called the calcaneum. Heel spurs are sometimes painful, described as a knife digging into the heel and other times, a heel spur goes unnoticed and is only detected by an X-ray.


Causes


There exists a membrane that covers most of the bone along the heel. When this membrane gets torn repeatedly due to straining of the muscles in the foot, the calcium deposits that lead to heel spurs are more likely to occur.


Heel Spur


Symptoms


Most people think that a bone "spur" is sharp and produces pain by pressing on tissue, when in fact, these bony growths are usually smooth and flat. Although they rarely cause pain on their own, bone spurs in the feet can lead to callus formation as tissue builds up to provide added cushion over the area of stress. Over time, wear and tear on joints may cause these spurs to compress neighboring ligaments, tendons or nerves, thus injuring tissue and causing swelling, pain and tearing.


Diagnosis


A heel spur is often seen on X-ray as a bony protrusion, which can vary in size. However, because a Heel Spur only indicates increased load on the plantar fascia, and not pain, an ultra sound may be required to assess other actual cause of the heel pain such and may include checking to see if the plantar fascia is inflamed or degenerated.


Non Surgical Treatment


Bone spurs rarely require treatment unless they are causing frequent pain or damaging other tissues. Because heel spurs and plantar fasciitis are so closely related, they are usually treated the same way. Symptomatic treatment involves rest, especially from the activity that is contributing to the condition and making symptoms worse (although this may not be easy to discover, as problems can manifest several hours or days after the harmful activity has occurred). If you identify the offending activity, ice is recommended immediately following it. Stretching of the calf muscles after a short warm up is also a good idea and can be helpful. Stretching exercises that gently lengthen the calm muscle will relax the tissue surrounding the heel and should be done several times a day, especially in the morning and after prolonged sitting.


Surgical Treatment


Sometimes bone spurs can be surgically removed or an operation to loosen the fascia, called a plantar fascia release can be performed. This surgery is about 80 percent effective in the small group of individuals who do not have relief with conservative treatment, but symptoms may return if preventative measures (wearing proper footwear, shoe inserts, stretching, etc) are not maintained.
Admin · 44 vistas · Escribir un comentario
26 Sep 2015
Overview


Heel pain can also be caused due a condition called Bursitis which is constant irritation of the heel's natural cushion (bursa). This can lead to additional pain at the back of the heel when the ankle is moved and there may be swelling on both sides of the Achilles tendon. Useful treatments for Heel bursitis are anti-inflammatory medications such as aspirin and Ibuprofen gel/tablets. Cold ice-pack compresses can be useful in reducing any swelling. In conjunction to these treatments it is important to stabalise and protect the heel. Gel heel pads will help to let the inflamed bursa settle down, however in severe chronic cases sometimes the use of Cortisone injections may be indicated.


Causes


Repetitive, vigorous movement, strenuous and unaccustomed activities that put pressure on a joint, or a blow or other injury can bring on bursitis. The cause can vary depending on where the bursitis occurs. In the shoulder, for example, it can be brought on by excessive strain, such as from serving in tennis. Kneeling on a hard floor can cause bursitis of the knee, and similarly, repeatedly resting the elbow on a hard surface (such as a desk) can cause bursitis in that joint. Arthritis, gout, and certain infections can also contribute to the problem. Bursitis, in fact, may signal the onset of arthritis. While getting older isn't a cause of bursitis, older people, especially older athletes, are more likely to develop the condition.


Symptoms


Patients with this condition typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone. Pain is typically experienced during activities requiring strong or repetitive calf contractions (often involving end of range ankle movements) such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially whilst wearing excessively tight shoes). Often pain may be worse with rest after these activities (especially that night or the following morning). The pain associated with this condition may 'warm up' with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles region.


Diagnosis


The doctor will discuss your symptoms and visually assess the bones and soft tissue in your foot. If a soft tissue injury is suspected, an MRI will likely be done to view where and how much the damage is in your ankle. An x-ray may be recommended to rule out a bone spur or other foreign body as the cause of your ankle pain. As the subcutaneous bursa is close to the surface of the skin, it is more susceptible to septic, or infectious, bursitis caused by a cut or scrape at the back of the heel. Septic bursitis required antibiotics to get rid of the infection. Your doctor will be able to determine whether there is an infection or not by drawing a small sample of the bursa fluid with a needle.


Non Surgical Treatment


With posterior Achilles tendon bursitis, treatment is aimed at reducing the inflammation and adjusting the foot's position in the shoe to relieve pressure and motion on the back of the heel. Foam rubber or felt heel pads can be placed in the shoe to eliminate pressure by elevating the heel. Placing protective gel padding over the painful bursa or stretching the back part of the shoe and placing padding around the inflamed bursa may help. Sometimes a special shoe, such as a running shoe designed to stabilize the midsole heel, devices placed in the shoe (orthoses), or both can help to control abnormal foot and heel motion contributing to the posterior heel irritation. Other shoes have padding that reduces irritation to the posterior heel and Achilles tendon.


Surgical Treatment


Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.
Admin · 53 vistas · Escribir un comentario
24 Agos 2015
Hammer ToeOverview


A Hammer toe occurs from a muscle and ligament imbalance around the toe joint which causes the middle joint of the toe to bend and become stuck in this position. The most common complaint with hammertoes is rubbing and irritation on the top of the bent toe. Toes that may curl rather than buckle, most commonly the baby toe, are also considered hammertoes. It can happen to any toe. Women are more likely to get pain associated with hammertoes than men because of shoe gear. Hammertoes can be a serious problem in people with diabetes or poor circulation. People with these conditions should see a doctor at the first sign of foot trouble.


Causes


While ill-fitting shoes may contribute to a hammertoe, shoes don't actually cause it, Hammertoes occur by the pull and stretch of the tendon. One tendon gets a more mechanical advantage over the other and allows the deformity to occur. Not surprisingly, wearing shoes that are too tight can make a hammertoe worse. If you're fond of narrow, pointy-toed shoes or high-heeled pumps, keep in mind you're squeezing those toes and tendons, which may aggravate hammertoes.


HammertoeSymptoms


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.


Diagnosis


The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.


Non Surgical Treatment


Changing the type of footwear worn is a very important step in the treatment of hammer toes. When choosing a Hammer toe shoe, make sure the toe box (toe area) is high and broad, and can accommodate the hammer toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes. Other conservative treatments include using forefoot products designed to relieve hammer toes, such as hammer toe crests and hammer toe splints. These devices will help hold down the hammer toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.


Surgical Treatment


Surgical Options: Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammer toes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatrist.


HammertoePrevention


If you notice signs of hammertoes in your feet, try some of these suggestions. Look for shoes with flat heels and plenty of space to allow your toes to stretch and spread. We're proud to say that all of our shoes at Soft Star feature these qualities. If you're unwilling to give up your heels, at least try to minimize how much you wear them. Instead of wearing heels every day, is it possible to save them for more special occasions? Giving your feet a break from time to time can do wonders. Practice picking up a towel by grabbing it with your toes. You can also try picking up small objects, such as dice. Doing this several times a day can help stretch and strengthen your toe muscles. Show Your Feet Some Love. Getting a foot massage and stretching your calves can help loosen muscles and improve circulation.
Admin · 110 vistas · Escribir un comentario
16 Agos 2015
HammertoeOverview


What Is A Hammer toe? A hammer toe, or claw toe, describes a condition where the toe(s) become buckled, contracted or crooked. The toe could even cross over an adjacent toe, which is called a cross over toe. Any of the toes may be affected, but the 2nd and 5th toe are most commonly involved.


Causes


Hammertoe commonly develops because of structural changes that take place over time in the muscles and tendons that bend the toes. People with certain medical conditions, such as diabetes, are at risk for developing hammertoe. It can be an inherited condition for some people. Other causes include trauma and wearing shoes that are too tight, narrow, or have high heels. The toe next to the big toe (second toe) is most frequently affected by hammertoe.


HammertoeSymptoms


Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most common at the level of the affected joint due to continuous friction of the deformity against your shoes.


Diagnosis


Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.


Non Surgical Treatment


There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors. A number of non-surgical measures can be undertaken. Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option. Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels, conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches. Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance. Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe.


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 hammertoes 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.


HammertoePrevention


You can avoid many foot, heel and ankle problems with shoes that fit properly. See your doctor if you have foot pain that's persistent and that affects your ability to walk properly and carry out other motions with your foot. Also, see your doctor if one or more of your toes has developed a clenched or claw-like appearance.
Admin · 91 vistas · Escribir un comentario
26 Jun 2015

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