Addressing Mortons Neuroma

Overview

interdigital neuromaA neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton?s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. ?Intermetatarsal? describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot. MortonThe thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Causes

The exact cause of Morton’s neuroma is not known. However, it is thought to develop as a result of long-standing (chronic) stress and irritation of a plantar digital nerve. There are a number of things that are thought to contribute to this. Some thickening (fibrosis) and swelling may then develop around a part of the nerve. This can look like a neuroma and can lead to compression of the nerve. Sometimes, other problems can contribute to the compression of the nerve. These include the growth of a fatty lump (called a lipoma) and also the formation of a fluid-filled sac that can form around a joint (a bursa). Also, inflammation in the joints in the foot next to one of the digital nerves can sometimes cause irritation of the nerve and lead to the symptoms of Morton’s neuroma.

Symptoms

Patients will complain of numbness, a ?pins and needles? type of tingling and loss of sensation in the toes. Burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. Night pain is rare. There may also be numbness in the toes, or an unpleasant feeling in the toes. Runners may feel pain as they push off from the starting block. High-heeled shoes, which put the foot in a similar position to the push-off, can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve.

Diagnosis

X-rays of your affected foot will not show a neuroma, as neuromas are made up of soft tissue. X-rays may be helpful, however, in helping rule in osteoarthritis or a stress fracture as the cause of your symptoms. Ultrasonography and MRI are sometimes used to help diagnose neuromas, although they are often ineffective. The clinical diagnosis by a foot care expert with experience treating this health problem is usually the most effective way to diagnose neuromas. Your podiatrist will attempt to duplicate your neuroma symptoms by pressing on the involved nerve at various points, and he or she may try to cause a clicking of your nerve that indicates nerve enlargement.

Non Surgical Treatment

If your Morton’s neuroma is painful, your doctor usually will begin treatment with conservative therapies, including a switch to shoes with low heels, wide toes and good arch support. Padding techniques, including metatarsal pads or toe crest pads. Shoe inserts (orthotics) to help correct any mechanical imbalance in the foot. Anti-inflammatory medication, such as ibuprofen (Advil, Motrin and other brand names) or naproxen (Aleve, Naprosyn and other brand names) A local injection of anesthetic and corticosteroid medication into the affected area. Inflamed or injured nerves can take months to improve, even after the underlying problem has been corrected.Morton neuroma

Surgical Treatment

Surgery to remove the neuroma may be recommended if more conservative treatment does not solve the problem. While surgery usually relieves or completely removes the symptoms, it often leaves a permanent numb feeling at the site of the neuroma.

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Inferior Calcaneal Spur Treatment

Posterior Calcaneal Spur

Overview

A heel spur is an overgrowth of bone that resembles a hook on the bottom of the foot. It is a reaction to stress placed on the thick connective tissue on the bottom of the foot (plantar fascia) that helps maintain the arches of the foot. Over-stress can stem from improper support of the feet. A heel spur is often accompanied by a bursitis that is a major contributor to pain.

Causes

One frequent cause of heel spurs is an abnormal motion and mal-alignment of the foot called pronation. For the foot to function properly, a certain degree of pronation is required. This motion is defined as an inward action of the foot, with dropping of the inside arch as one plants the heel and advances the weight distribution to the toes during walking. When foot pronation becomes extreme from the foot turning in and dropping beyond the normal limit, a condition known as excessive pronation creates a mechanical problem in the foot. In some cases the sole or bottom of the foot flattens and becomes unstable because of this excess pronation, especially during critical times of walking and athletic activities. The portion of the plantar fascia attached into the heel bone or calcaneous begins to stretch and pull away from the heel bone.

Posterior Calcaneal Spur

Symptoms

Bone spurs may cause sudden, severe pain when putting weight on the affected foot. Individuals may try to walk on their toes or ball of the foot to avoid painful pressure on the heel spur. This compensation during walking or running can cause additional problems in the ankle, knee, hip, or back.

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

The majority of heel spurs are treated with non-surgical interventions. These can relieve pain, but may take from about 3 months to up to a year for symptoms to resolve. Rest, icing, and over-the-counter anti-inflammatory or prescription medications can help ease symptoms. Cortisone injections may also be used. Physical therapists may instruct you to perform stretching exercises to help relax the tissues in the heel. Your doctor may recommend custom orthotics or shoe inserts to position and cushion your heel. Night splints can help position the heel and arch of the foot while you sleep. Some doctors may recommend extracorporeal shock wave therapy (ESWT). This treatment uses energy pulses to start the repair process in the heel tissues. ESWT is recommend when other non-surgical treatments have failed.

Surgical Treatment

When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide relief of pain 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. Depending on the presence of excess bony build up, the procedure may or may not include removal of heel spurs. Similar to other surgical interventions, there are various modifications and surgical enhancements regarding surgery of the heel.

What Causes Bursitis Of The Feet?

Overview

Achilles tendon bursitis occurs mainly in young women but can develop in men. Walking in a way that repeatedly presses the soft tissue behind the heel against the stiff back support of a shoe can cause or aggravate the bursitis. Shoes that taper sharply inward toward the posterior heel (such as high-heeled shoes) can cause irritating pressure that leads to the development of this bursitis. Normally, only one bursa is in the heel, between the Achilles tendon and the heel bone (calcaneus). This bursa may become inflamed, swollen, and painful, resulting in anterior Achilles tendon bursitis. Abnormal pressure and foot dysfunction can cause a protective bursa to form between the Achilles tendon and the skin. This bursa may also become inflamed, swollen, and painful, resulting in posterior Achilles tendon bursitis. Any condition that puts extra strain on the Achilles tendon can cause anterior Achilles tendon bursitis. Injuries to the heel and diseases such as rheumatoid arthritis can also cause it.

Causes

Bursitis, tendinitis, and other soft tissue rheumatic syndromes typically result from one or more factors. These include: Play or work activities that cause overuse or injury to the joint areas Incorrect posture Stress on the soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint) Other diseases or conditions (rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction) Infection.

Symptoms

Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise the arm out from the side of the body. Putting on a jacket or combing the hair becomes a troublesome activity. In acute bursitis symptoms appear suddenly, with chronic bursitis, pain, tenderness, and limited movement reappear after exercise or strain.

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

The patient with retrocalcaneal bursitis should be instructed to apply ice to the posterior heel and ankle in the acute period of the bursitis. Icing can be performed several times a day, for 15-20 minutes each. Some clinicians also advocate the use of contrast baths. Gradual progressive stretching of the Achilles tendon may help relieve impingement on the subtendinous bursa and can be performed in the following manner. Stand in front of a wall, with the affected foot flat on the floor. Lean forward toward the wall until a gentle stretching is felt within the ipsilateral Achilles tendon. Maintain the stretch for 20-60 seconds and then relax. Perform the stretches with the knee extended and then again with the knee flexed. To maximize the benefit of the stretching program, repeat the above steps for several stretches per set, several times daily. Avoid ballistic (ie, abrupt, jerking) stretches. Other treatment options are microcurrent therapy and corticosteriod injection into the retrocalcaneal bursa. If conservation treatment fails then surgery is indicated.

Surgical Treatment

Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).

Prevention

It isn’t always possible to avoid the sudden blow, bump, or fall that may produce bursitis. But you can protect your body with measures similar to those that protect you from other kinds of overuse injuries, such as tendinitis. Keep yourself in good shape. Strengthening and flexibility exercises tone muscles that support joints and help increase joint mobility. Don?t push yourself too hard (or too long). If you?re engaged in physical labor, pace yourself and take frequent breaks. If you?re beginning a new exercise program or a new sport, work up gradually to higher levels of fitness. And anytime you?re in pain, stop. Work on technique. Make sure your technique is correct if you play tennis, golf, or any sport that may strain your shoulder. Watch out for ?elbow-itis.? If you habitually lean on your elbow at your work desk, this may be a sign that your chair is uncomfortable or the wrong height. Try to arrange your work space so that you don?t have to lean on your elbow to read, write, or view your computer screen. Take knee precautions. If you have a task that calls for lots of kneeling (for example, refinishing or waxing a floor), cushion your knees, change position frequently, and take breaks. Wear the right shoes. High-heeled or ill-fitting shoes cause bunions, and tight shoes can also cause bursitis in the heel. Problems in the feet can also affect the hips. In particular, the tendons and bursae in the hips can be put under excessive strain by worn-down heels. Buy shoes that fit and keep them in good repair. Never wear a shoe that?s too short or narrow. Women should save their high heels for special occasions only. Avoid staying in only one position for too long. Get up and walk around for a while or change positions frequently.

Hammertoe

Hammer ToeOverview

The hammertoes condition is usually irreversible, but often its progression can be slowed or halted. You should visit a Podiatrist if the toe becomes painful and you have difficulty walking. A Podiatrist will be able to provide advice and treatment including padding the bony top-part of your hammertoe to relieve pain or to tape your toes as a way to change their position. Podiatrists have an important role to play in preventing and managing foot problems. Prompt action is important. Problems which are left without assessment or treatment may result in major health risks.

Causes

Flat feet can result in hammertoes, this is due to poor mechanics off the foot. High arched feet can also result in buckling toes. A major cause is in hereditary, all the toe conditions mentioned could be acquired due in hereditary factors. Bunions are a major cause of hammertoes. Claw toes are usually the result of a shoe that is too short. For many people, the second toe is actually longer than the great toe, and if shoes are sized to fit the great toe, the second (and maybe even the third toe) will have to bend to fit into the shoe. Shoes that are pointed make matters even worse. Combine pointed shoes with high heels, the foot is under similar pressure as if it was constantly being pushed downhill into a wall. Rheumatoid arthritis can also lead to bunions, which in turn can lead to hammer toes.

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

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 Hammer toe 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

Often padding and taping are the first steps in a treatment plan. Padding the hammer toe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain. Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity. Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammer toe deformity.

Surgical Treatment

Joint resection procedures involves removing part of one of the two small joints of the toe directly underneath where the digit is crooked. The purpose is to make room for the toe to be re-positioned flat or straight. Because hammer toes become rigid or fixed with time, removing the joint becomes the only option when the knuckle is stiff. Its important to understand that this procedure does not involve the joint of the ball of the foot, rather the a small joint of the toe. Medical terminology for this procedure is called a proximal interphalangeal joint arthroplasty or a distal interphalangeal joint arthroplasty, with the latter involving the joint closer to the tip of the toe.

Dealing With Bunions

Overview
Bunion Pain
The best thing to say about the natural history of bunions is that they are unpredictable. This is both in terms of whether the bunion deformity will progress, and also whether the bunion will become painful (if it is not already painful). It would probably however be true to say that once a previously painfree bunion has started to become painful it is not common for the bunion to go back to being entirely pain-free.

Causes
Bunions result from the long bone in the foot (metatarsal) and the big-toe bone becoming misaligned. The causes are likely to be a combination of genetics, wearing ill-fitting shoes, and the way that we walk or run. Arthritis sufferers are also prone to bunions.
SymptomsBunions are an often painful condition that may become even more painful as extra bone and a fluid-filled sac grow at the base of your big toe. Some of the most frequently experienced signs and symptoms associated with bunions, besides pain, include redness in your affected area. Blistering over your bunion. Callus formation around your bunion. Bursitis. Nerve damage (numbness and/or sharp pains) in your involved area. Bunions may also cause pain within and below your first metatarsophalangeal, or MTP, joint. Your bunion may become further dislocated and unstable as it progresses and may overload your adjacent joints.

Diagnosis
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.

Non Surgical Treatment
The non-invasive treatments for bunions are many and include changes in footwear, icing the sore area, over the counter pain medications, orthotic shoe inserts, and weight management. If these conservative measures fail to arrest your pain and discomfort, your foot and ankle surgeon may recommend a bunionectomy or similar surgical procedure, depending on your condition.
Bunions Callous

Surgical Treatment
Bunion surgery is most often done on an outpatient or day-surgery basis, usually with a local anesthetic technique called an ankle block. The surgery typically takes an hour or two to perform. Following your surgery, you will stay in the Recovery Room for several hours while the anesthetic wears off. For your safety, you will be required to have someone to drive you home. You should keep in mind that any surgery carries with it very small-but-possible risks of complications such as allergic reaction to anesthesia, bleeding and infection.

How Can I Tell If I’Ve Got Over-Pronation

Overview

Over pronation of the foot is commonly referred to as “flat feet.” Many middle-aged men and women suffer from over pronation over time and as a result of wearing poor-fitting shoes, continuing with repetitive exercising habits, or walking in high heels for long periods over several years. Regular speed-walkers often experience over pronation as well as a result of this activity.Pronation

Causes

Flat feet don’t automatically mean you have a problem. The problem can be divided into a flexible flat foot or rigid flat foot. The rigid flat foot is one that does not change shape when the foot becomes weight bearing. i.e. it does not go through the excessive motion of pronation. Generally speaking this foot does not provide too many problems. The flexible flat foot is the type that when it becomes weight bearing the foot and ankle tends to roll in (pronates) too far. This type of person will often say I have great arches but when I stand up much of this arch disappears as the foot excessively pronates When the foot is excessively pronating and causing problems like sore ankles, feet or knees when standing or exercising then arch support is extremely important to restore the foot structure.

Symptoms

If ignored, overpronation can lead to complications such as hammer toes, corns and calluses, shin splints, hallux rigidus and many more foot and lower leg problems. Hammer toes appear when the toes are placed under too much pressure and the ligaments and muscles in the toes begin to reduce in size, leading to the curvature of the toes and making them look like little hammers. Overpronators can develop hammertoes if they don?t wear an appropriate pair of shoes. Corns and calluses also appear as a result of overpronation. They form in response to excess pressure, and overpronators may find that they have excessive hard skin on the balls of the feet and inside edge of the big toe. It is the body?s way of protecting against excessive forces and friction. They can be painful.

Diagnosis

Bunions, calluses and crooked toes may indicate alignment problems. So, it is important to ascertain the condition of a client’s toes. Check the big toe to determine if the first joint of the toe is swollen, has a callus or bunion, and/or looks as though it abducts (i.e., hallux valgus) rather than pointing straight ahead. Also, look to see if the lesser toes seem to “curl up” (i.e., the person has hammer or claw toes). This may be indicative of damage to, or inflexibility of the plantar fascia caused by excessive flattening of the foot.Foot Pronation

Non Surgical Treatment

Flat feet and fallen arches can be treated effectively by wearing an orthotic insert in your shoes. Orthotics can be custom-made and prescribed by your foot specialist (podiatrist), or you can use a so called pre-made foot orthotic. Most people do not require expensive custom-made orthotics to combat excess pronation, unless they have a specific medical foot condition. Footlogics orthotic insoles were developed to correct excess pronation, thereby providing sustainable, long-lasting pain relief to many aches and pains in a natural way. Footlogics Comfort, Casual and Sports are products which promote excellent biomechanical control of the foot.

Prevention

Pronation forces us to bear most of our weight on the inner border of our feet. Custom-made orthotics gently redistributes the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist out at the ankle, but will strike the ground normally when the orthotics is used. This action of the custom-made orthotics will help to prevent shin splints, ankle sprains, knee and hip pain, lower back pain, nerve entrapments, tendonitis, muscle aches, bunions, generalized fatigue, hammer toes, and calluses.

What Would Cause Severs Disease?

Overview

When recurring heel pain occurs in children, it is usually due to Sever’s Disease, while adult heel pain is usually due to heel spurs, plantar fasciitis, or retrocalcaneal bursitis (Haglund’s Deformity). Calcaneus is the anatomical name of the heel bone. Sever’s Disease or Calcaneal Apophysitis is an inflammation of the growth plate located at the posterior aspect (back) of the heel.

Causes

There are usually two root causes of Sever?s disease that we?ve found that effect young athletes. Arches are not supported causing a dysfunctional run, jump, and landing. The calves (gastrocnemius and soleus muscles) are overworked, tight, and do not allow proper movement of foot which puts extreme pressure on the Achilles? tendon, in turn irritating the growth plate in the heel.

Symptoms

The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A child with Sever?s may also have these common problems, Heel pain with limping, especially after running. Difficulty walking, Discomfort or stiffness in the feet upon awaking. Swelling and redness in the heel, Symptoms are usually worse during or after activity and get better with rest.

Diagnosis

Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.

Non Surgical Treatment

Stretching programs. Strengthening exercises. Exercise and training modification. Orthotic therapy. In rare cases, where fragmentation of the apophysis exists and pain fails to subside with traditional treatments then immobilization of the foot and ankle with a short leg pneumatic walker(walking cast) is indicated.