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July 04 2017

heavenlyquantit2

What Can You Do About Fallen Arches?

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Flat Foot

Your foot arch is your natural shock absorption system. Nature designed it so that when you put your body weight over your feet the shock is absorbed by this mechanism in order to alleviate the impact (and subsequent injuries) that would otherwise hit your feet, ankles, knees and hips. A flat foot is the most visible sign of overpronation, meaning that your arch collapses during the impact on the ground. As a consequence, your ankle twists inward and your knees overcompensates. Flat feet are a particular concern for runners, as during the running gait the arch is supposed to support on average 3 times their body weight.

Causes

Most cases of flatfeet are simply the result of normal development. When that is not the case, the condition can be caused by a number of factors, including the following, Age, disease, injury, obesity or being overweight, physical abnormality, pregnancy. Flattened arches in adults may result from the stresses of aging, weight gain, and the temporary increase in elastin (protein in connective tissue) due to pregnancy. In some cases, flatfeet are caused by a physical abnormality, such as tarsal coalition (two or more bones in the foot that have grown together) or accessory navicular (an extra bone along the side of the foot). The effects of diseases such as diabetes and rheumatoid arthritis can lead to flatfeet. An injury (e.g., bone fracture, dislocation, sprain or tear in any of the tendons and ligaments in the foot and leg) also can cause flatfeet.

Symptoms

Not everyone who has flat feet experiences symptoms. Others, however, feel persistent pain in their feet and wearing shoes can prove additionally painful. Others only feel symptoms when they walk more than normal, go jogging or participate in a sport that involves running or kicking.

Diagnosis

It is important for people with foot pain to know if they have flat feet. The following tests can help you determine your arch type. When you get out of a swimming pool, look at your footprint on the concrete. The front of the foot will be joined to the heel by a strip. If your foot is flat, then the strip is the same width as the front of the foot, creating a footprint that looks like a stretched out pancake. With a normal arch, the strip is about half the width of the front of the foot. If you have a high arch, only a thin strip connects the front of the foot with the heel. Put your shoes on a flat table and view them at eye level from behind. See if the sole is worn evenly. A flat foot will cause more wear on the inside of the sole, especially in the heel area. The shoe will easily rock side to side. A flat foot will also cause the upper part of the shoe to lean inward over the sole. Both shoes should wear about the same way. If you have pain in one foot, you should make sure you don't have a fallen arch on that side. There are two good tests you can perform at home to detect this problem. Place your fingertips on a wall that you are directly facing and stand on your tiptoes on one foot. If you can't do it, a fallen arch may be the culprit. Stand with your feet parallel. Have someone stand in back of you and look at your feet from behind. You can also do it yourself if you stand with your back to a mirror. Normally, only the pinky toe is visible from behind. If one foot is flatter than the other, the 4th and sometimes the 3rd toe on that foot can also be seen.

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Non Surgical Treatment

If your condition is bothersome, try elevating your feet and using ice on the arches to reduce swelling. Your podiatrist can recommend several orthotic aids and inserts to strengthen the tendons of your foot. He can also demonstrate stretching exercises or refer you to physical therapy to get those tendons back into shape. If the symptoms of fallen arches are painful and troubling, he may recommend a steroid injection to relieve inflammation and pain. And in some instances, he may determine that surgery is necessary.

Surgical Treatment

Flat Feet

A combination of surgical procedures can be used to reconstruct the flatfoot. Generally, these procedures can be separated into those that correct deformities of the bones and those that repair ligaments and tendons. Your orthopaedic surgeon will choose the proper combination of procedures for your foot. Surgery of the foot can be performed under regional anesthesia, which is numbing the foot and ankle with a nerve or spinal block, or general anesthesia, which may require a breathing tube. A nerve block is often placed behind the knee to reduce pain after surgery.

June 29 2017

heavenlyquantit2

Treatment For Leg Length Discrepancy After Hip Replacement

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Leg shortening is employed when LLD is severe and when a patient has already reached skeletal maturity. The actual surgery is called an osteotomy , which entails the removal of a small section of bone in the tibia (shinbone) and sometimes the fibula as well, resulting in the loss of around an inch in total height. Leg lengthening is a difficult third option that has traditionally had a high complication rate. Recently, results have improved somewhat with the emergence of a technique known as callotasis , in which only the outer portion of the bone (the cortex ) is cut, (i.e. a corticotomy ). This allows the bone to be more easily lengthened by an external fixation device that is attached to either side of the cut bone with pins through the skin. The ?ex-fix,' as it is sometimes called, is gradually adjusted by an orthopaedic surgeon, and healing can occur at the same time that the leg is being distracted , or lengthened over time. Unlike epiphysiodesis, leg lengthening procedures can be performed at almost any skeletal or chronological age.Leg Length Discrepancy

Causes

Leg discrepancy can develop from a medical issue in any portion of the femur or tibia. One leg may lengthen, but leg shortening is much more common. Factors that can cause leg length discrepancy include inherited growth deficiencies. Infections. A bone infection can cause delayed growth in the affected limb. Injury. If your child breaks a leg, it may be shorter once it heals. This is most likely to happen if the fracture or break was complicated, an open fracture, or an injury that affected the growth plate near the end of the bone. Alternatively, a break can cause bones to grow faster after healing, making a leg longer. Tumors. Legg-Calve-Perthes disease. This is a condition that affects the ball (femoral head) of the hip joint. The femoral head may be friable and damage easily, sometimes leading to shortening of the thigh bone. Hemihypertrophy. In children with this condition, one side of the body grows more quickly than the other. Vascular malformations. These are abnormal clusters of veins and arteries that can form close to the bone and stimulate growth. Juvenile arthritis. Inflammation from arthritis can stimulate growth in the affected leg and cause discrepancy.

Symptoms

The most common symptom of all forms of LLD is chronic backache. In structural LLD the sufferer may also experience arthritis within the knee and hip are, flank pain, plantar fasciitis and metatarsalgia all on the side that is longer. Functional LLD sufferers will see similar conditions on the shorter side.

Diagnosis

The most accurate method to identify leg (limb) length inequality (discrepancy) is through radiography. It?s also the best way to differentiate an anatomical from a functional limb length inequality. Radiography, A single exposure of the standing subject, imaging the entire lower extremity. Limitations are an inherent inaccuracy in patients with hip or knee flexion contracture and the technique is subject to a magnification error. Computed Tomography (CT-scan), It has no greater accuracy compared to the standard radiography. The increased cost for CT-scan may not be justified, unless a contracture of the knee or hip has been identified or radiation exposure must be minimized. However, radiography has to be performed by a specialist, takes more time and is costly. It should only be used when accuracy is critical. Therefore two general clinical methods were developed for assessing LLI. Direct methods involve measuring limb length with a tape measure between 2 defined points, in stand. Two common points are the anterior iliac spine and the medial malleolus or the anterior inferior iliac spine and lateral malleolus. Be careful, however, because there is a great deal of criticism and debate surrounds the accuracy of tape measure methods. If you choose for this method, keep following topics and possible errors in mind. Always use the mean of at least 2 or 3 measures. If possible, compare measures between 2 or more clinicians. Iliac asymmetries may mask or accentuate a limb length inequality. Unilateral deviations in the long axis of the lower limb (eg. Genu varum,?) may mask or accentuate a limb length inequality. Asymmetrical position of the umbilicus. Joint contractures. Indirect methods. Palpation of bony landmarks, most commonly the iliac crests or anterior iliac spines, in stand. These methods consist in detecting if bony landmarks are at (horizontal) level or if limb length inequality is present. Palpation and visual estimation of the iliac crest (or SIAS) in combination with the use of blocks or book pages of known thickness under the shorter limb to adjust the level of the iliac crests (or SIAS) appears to be the best (most accurate and precise) clinical method to asses limb inequality. You should keep in mind that asymmetric pelvic rotations in planes other than the frontal plane may be associated with limb length inequality. A review of the literature suggest, therefore, that the greater trochanter major and as many pelvic landmarks should be palpated and compared (left trochanter with right trochanter) when the block correction method is used.

Non Surgical Treatment

Whether or not treatment should be pursued depends on the amount of discrepancy. In general, no treatment (other than a heel life, if desired) should be considered for discrepancies under two centimeters. If the discrepancy measures between two and five centimeters, one might consider a procedure to equalize leg length. Usually, this would involve closure of the growth plate on the long side, thereby allowing the short side to catch up; shortening the long leg; or possibly lengthening the short leg.

LLD Shoe Inserts

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Surgical Treatment

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

June 26 2017

heavenlyquantit2

True Vs Apparent Leg Length Discrepancy

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Surgery is another option. In some cases the longer extremity can be shortened, but a major shortening may weaken the muscles of the extremity. In growing children, lower extremities can also be equalized by a surgical procedure that stops the growth at one or two sites of the longer extremity, while leaving the remaining growth undisturbed. Your physician can tell you how much equalization can be attained by surgically halting one or more growth centers. The procedure is performed under X-ray control through very small incisions in the knee area. This procedure will not cause an immediate correction in length. Instead, the LLD will gradually decrease as the opposite extremity continues to grow and "catch up." Timing of the procedure is critical; the goal is to attain equal length of the extremities at skeletal maturity, usually in the mid- to late teens. Disadvantages of this option include the possibility of slight over-correction or under-correction of the LLD and the patient?s adult height will be less than if the shorter extremity had been lengthened. Correction of significant LLDs by this method may make a patient?s body look slightly disproportionate because of the shorter legs.Leg Length Discrepancy

Causes

The causes of LLD are many, including a previous injury, bone infection, bone diseases (dysplasias), inflammation (arthritis) and neurologic conditions. Previously broken bones may cause LLD by healing in a shortened position, especially if the bone was broken in many pieces (comminuted) or if skin and muscle tissue around the bone were severely injured and exposed (open fracture). Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. Also, a break in a child?s bone through a growth center (located near the ends of the bone) may cause slower growth, resulting in a shorter extremity. Bone infections that occur in children while they are growing may cause a significant LLD, especially during infancy. Bone diseases may cause LLD, as well; examples are neurofibromatosis, multiple hereditary exostoses and Ollier disease. Inflammation of joints during growth may cause unequal extremity length. One example is juvenile rheumatoid arthritis. Osteoarthritis, the joint degeneration that occurs in adults, very rarely causes a significant LLD.

Symptoms

Often there are few or no symptoms prior to the age of 25-35. The most common symptom is chronic lower back pain, but also is frequently middle and upper back pain. Same-sided and repeated injury or pain to the hip, knee and/or ankle is also a hallmark of a long-standing untreated LLD. It is not uncommon to have buttock or radiating hip pain that is non-dermatomal (not from a disc) and tends to go away when lying down.

Diagnosis

A qualified musculoskeletal expert will first take a medical history and conduct a physical exam. Other tests may include X-rays, MRI, or CT scan to diagnose the root cause.

Non Surgical Treatment

The key to treatment of LLD in a child is to predict what the discrepancy is at maturity. If it is predicted to be less than 2 cm., no treatment is needed. Limb length discrepancies of up to 2 or 2.5 cm. can be compensated very well with a lift in the shoe. Beyond 2.5 cm., it becomes increasingly difficult to compensate with a left in the insole. Building up the shoe becomes uncosmetic and cumbersome, and some other way of compensating for the discrepancy becomes necessary. The treatment of LLD is long-term treatment, and involves the physician and patient?s family working together as a team. The family needs to weigh the various options available. If leg lengthening is decided on, the family needs to understand the commitment necessary to see it through. The treatment takes 6 months to a year for completion, and complications can happen. But when it works, the results are gratifying.

Leg Length Discrepancy

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Surgical Treatment

Surgical options in leg length discrepancy treatment include procedures to lengthen the shorter leg, or shorten the longer leg. Your child's physician will choose the safest and most effective method based on the aforementioned factors. No matter the surgical procedure performed, physical therapy will be required after surgery in order to stretch muscles and help support the flexibility of the surrounding joints. Surgical shortening is safer than surgical lengthening and has fewer complications. Surgical procedures to shorten one leg include removing part of a bone, called a bone resection. They can also include epiphysiodesis or epiphyseal stapling, where the growth plate in a bone is tethered or stapled. This slows the rate of growth in the surgical leg.

June 01 2017

heavenlyquantit2

Managing Mortons Neuroma

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plantar neuromaA Morton?s Neuroma is actually incorrectly termed, with the name suggesting it is a tumour or growth. Rather than a true neuroma it is actually what is called a perineural fibrosis, which means that over time the sheath surrounding the nerve becomes irritated, inflamed, and forms a thickened scar tissue.

Causes

Inappropriate footwear is one of the principle causes of Morton?s neuroma. Toe spring and tapering toe boxes are the most problematic shoe design features that contribute to this health problem. Morton?s neuroma occurs when one of your nerves is stretched and pinched, which happens with great frequency in people who wear shoes incorporating these design features. A professional shoe fitting should always be sought if you are struggling with neuroma-related symptoms.

Symptoms

Many patients describe the sensation as a burning pain in the ball of the foot that often radiates to the toes. Initially, the pain may become much more apparent when the person wears tight, narrow or high-heeled shoes, or engages in activities which place pressure on the foot. Eventually, symptoms may be continuous and last for days, and even weeks. MRI (magnetic resonance imaging) scans have revealed Morton's neuroma lesions in patients who had no symptoms at all. Symptoms can become so disrupting that many affected individuals become anxious about walking, or even placing their foot on the ground.

Diagnosis

The most common condition misdiagnosed as Morton's neuroma is metatarsophalangeal (MTP) joint synovitis. When pain occurs in the third interspace, the clinician may misdiagnose the condition as Morton's neuroma instead of MTP synovitis, which may manifest very much like Morton's neuroma. MTP synovitis is distinguished from Morton's neuroma by subtle swelling around the joint, pain localized mainly within the joint, and pain with forced toe flexion. Palpation of the MTP joint is performed best with a pinching maneuver from the dorsal and plantar aspects of the joint to elicit tenderness of the joint. Other conditions often misdiagnosed as Morton's neuroma include the following. Stress fracture of the neck of the metatarsal. Rheumatoid arthritis and other systemic arthritic conditions. Hammertoe. Metatarsalgia (ie, plantar tenderness over the metatarsal head) Less common conditions that have overlapping symptoms with Morton's neuroma include the following. Neoplasms. Metatarsal head osteonecrosis. Freiburg. steochondrosis. Ganglion cysts. Intermetatarsal bursal fluid collections. True neuromas.

Non Surgical Treatment

Simple treatments may be all that are needed for some people with a Morton's neuroma. They include the following. Footwear adjustments including avoidance of high-heeled and narrow shoes and having special orthotic pads and devices fitted into your shoes. Calf-stretching exercises may also be taught to help relieve the pressure on your foot. Steroid or local anaesthetic injections (or a combination of both) into the affected area of the foot may be needed if the simple footwear changes do not fully relieve symptoms. However, the footwear modification measures should still be continued. Sclerosant injections involve the injection of alcohol and local anaesthetic into the affected nerve under the guidance of an ultrasound scan. Some studies have shown this to be as effective as surgery.plantar neuroma

Surgical Treatment

Surgery for neuroma most often involves removing affected nerve in the ball of the foot. An incision is made on the top of the foot and the nerve is carefully removed. Surgeon must remove the nerve far enough back so that the nerve doesn?t continue to become impinged at the ball of the foot. Alternatitvely, another type of surgery involves releasing a tight ligament that encases the nerve. Recovery after Morton?s neuroma (neurectomy) surgery is generally quick. Typically patients are walking on the operated foot in a post-surgical shoe for 2 - 4 weeks, depending on healing. Return to shoes is 2-6 weeks after the surgery. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.

June 12 2015

heavenlyquantit2

What Exactly Are Bunions?

Overview
Bunions callous The classic bunion is a bump on the side of the great toe joint. This bump represents an actual deviation of the 1st metatarsal. In addition, there is also deviation of the great toe toward the second toe. In severe cases, the great toe can either lie above or below the second toe.

Causes
Bunions are most often caused by faulty mechanics of the foot. The deformity runs in families, but it is the foot type that is hereditary, not the bunion.Certain foot types make a person prone to developing a bunion. Injury can be a cause, especially if just one foot is involved. Although wearing shoes that crowd the toes won?t actually cause bunions in the first place, it can make the deformity progressively worse. That means you may expererince symptoms sooner.

Symptoms
The symptoms of a bunion include pain, swelling, and redness over the bony bump on the inside of the foot. It can become painful to walk, because the big toe bends every time you take a step. Shoes can become painful to wear, especially ones that are even a little bit tight. Usually, bunions become more painful as they get larger. In severe cases, you can develop arthritis in the big toe as a result of the bunion. However, a bunion that is not painful does not need surgical treatment, even a large one.

Diagnosis
People with bunions may be concerned about the changing appearance of their feet, but it is usually the pain caused by the condition that leads them to consult their doctor. The doctor will evaluate any symptoms experienced and examine the affected foot for joint enlargement, tissue swelling and/or tenderness. They will also assess any risk factors for the condition and will ask about family history. An x-ray of the foot is usually recommended so that the alignment of big toe joint can be assessed. This would also allow any other conditions that may be affecting the joint, such as arthritis, to be seen.

Non Surgical Treatment
Bunions can be treated conservatively (without surgery) using simple measures such as well-fitting shoes, orthoses simple painkillers and padding. Physiotherapy can help improve associated muscle imbalances. Such measures will not correct or even stop the deformity but they can help with symptoms. When non-surgical treatments prove insufficient, surgery can relieve your pain, correct any related foot deformity and help you resume your normal activities. Bunions callous

Surgical Treatment
If your bunion has progressed to the point where you have difficulty walking, or experience pain despite accommodating shoes, you may need surgery. Bunion surgery realigns bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position. Orthopedic surgeons have several techniques to ease your pain. Many bunion surgeries are done on a same-day basis, requiring no hospital stay, using an ankle-block anesthesia. A long recovery is common and may include persistent swelling and stiffness.

Prevention
To minimize the chance of developing bunions, never force your feet into shoes that don?t fit. Choose a shoe that conforms to the shape of your foot. Opt for shoes with wider insteps, broad toes, and soft soles. Shoes that are short, tight, or sharply pointed should be avoided.
Tags: Bunions
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