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Archive for June, 2015

Contracted Toes

Hammer ToeOverview

Uneven muscle tension results in the distortion of one or several of the small toes. (hammertoes) Pressure points develop at the raised middle joint as well as at the tip of the toe and underneath the metatarsal head. In the beginning, when the misalignment can still be corrected, it often suffices to lengthen the tendon and to cut a notch into the capsule. In a contracted misalignment, part of the middle joint is removed to form a replacement joint. Modern surgical techniques preserve the metatarsophalangeal joint (Weil or Helal osteotomies).

Causes

Hammer toe is often caused by wearing shoes that do not fit properly. If shoes are too small either in length or width, then the hammertoes toes are held in a shortened position for long periods and the muscles eventually shorten and pull the toes into the bent position. Alternatively it can be caused by overactivity in the extensor digitorum dongus muscle (right) and a weakness in the counteracting muscle under the foot, such as flexor digitorum longus. Sometimes it can be a congenital condition, meaning it is present from birth. It is also more common in those with arthritis in the foot or diabetes.

HammertoeSymptoms

Hammer toe is often distinguished by a toe stuck in an upside-down ?V? position, and common symptoms include corns on the top of your toe joint. Pain at the top of a bent toe when you put on your shoes. Pain when moving a toe joint. Pain on the ball of your foot under the bent toe. Corns developing on the top of the toe joint. It is advisable to seek medical advice if your feet hurt on a regular basis. It is imperative to act fast and seek the care of a podiatrist or foot surgeon. By acting quickly, you can prevent your problem from getting worse.

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 If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).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

Wearing proper footwear may ease your foot pain. Low-heeled shoes with a deep toe box and flexible material covering the toes may help. Make sure there’s a half-inch of space between your longest toe and the inside tip of your shoe. Allowing adequate space for your toes will help relieve pressure and pain. Avoid over-the-counter corn-removal products, many of which contain acid that can cause severe skin irritation. It’s also risky to try shaving or cutting an unsightly corn off your toe. Foot wounds can easily get infected, and foot infections are often difficult to treat, especially if you have diabetes or poor circulation.

Surgical Treatment

Sometimes when the joints are removed the two bones become one as they are fused in a straightened position. Many times one toe will be longer than another and a piece of bone is removed to bring the toes in a more normal length in relation to each other. Sometimes tendons will be lengthened, or soft tissue around the joints will be cut or rebalanced to fix the deformity. Angular corrections may also be needed. The surgeon may place fixation in your foot as it heals which may include a pin, or wires.

Hammer ToePrevention

Hammertoe can usually be prevented by wearing shoes that fit properly and give the toes plenty of room. Don?t wear shoes with pointed or narrow toes. Don?t wear shoes that are too tight or short. Don?t wear high-heeled shoes, which can force the toes forward. Choose shoes with wide or boxy toes. Choose shoes that are a half-inch longer than your longest toe. If shoes hurt, don?t wear them.

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How To Help Hammertoe Pain

Hammer ToeOverview

A hammertoes is a misshapen toe. The middle joint of the toe bends up in a way that makes the toe look like it is forming an upside-down V. The bent joint may rub the top of your shoe. Hammertoes can develop on any toe, but they usually happen in the second toe. Claw toes or mallet toes look a lot like hammertoes, but a different joint in the toe is bent. Hammertoes usually are not painful at first. When they begin, they can be pushed down to the correct position. These are called flexible hammertoes. After a while, they will not go back to their normal position, even if pushed with the fingers. These are called rigid hammertoes.

Causes

Shoes that narrow toward the toe force the smaller toes into a bent upward position. This makes the toes rub against the inside of the shoe, and creates corns and calluses, aggravating the toes further. If the shoes have a high heel, the feet are forced forward and down, squeezing the toes against the front of the shoe, which increases the pressure on the toes and makes them Hammer toe bend further. Eventually, the toe muscles become unable to straighten the toe.

HammertoeSymptoms

Symptoms include sharp pain in the middle of the toe and difficulty straightening the toe. People with hammertoe may also develop blisters, which are fluid-filled pockets of skin, because the bent toe is likely to rub against the inside of a shoe. This increased friction may also lead to calluses, which are areas of thickened skin, and corns, which are hard lumps that may form on or between toes. Symptoms may be minor at first, but they can worsen over time.

Diagnosis

Your doctor is very likely to be able to diagnose your hammertoe simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate your gait as you walk and the types of shoes you wear. You’ll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to better define your deformity.

Non Surgical Treatment

Early on, when a hammertoe first starts and is still flexible, here are some ways it might be treated. Your healthcare provider may splint or tape the toe into the correct, normal position. You can use your fingers to stretch your toes and toe joints toward a more normal position. Exercise your toes by trying to pick up marbles with them or by wadding up a towel on the floor with your toes. Padding may be used to change where your weight falls when you walk on the foot.

Surgical Treatment

Surgery involves removing a small section of bone from the affected joint through a procedure called arthroplasty. Arthrodesis may also be performed to treat hammertoes, which involves fusing together one of the joints in the toe in order to keep it straight. This procedure requires the use of a metal pin to hold the toe in position while it heals.

HammertoePrevention

The American Podiatric Medical Association offers the following tips for preventing foot pain. Don’t ignore foot pain, it’s not normal. Inspect feet regularly. Wash feet regularly, especially between the toes, and dry them completely. Trim toenails straight across, but not too short. Make sure shoes fit properly.


Is Over-Pronation

Overview

Feet are supposed to roll inward as a part of every step you take. This helps them to mold to the various terrain that they step on (sand, rocks, various obstacles) without injury. This is called pronation. But, when your feet roll inward excessively, problems often arise. Excessive inward rolling of the feet and ankles is called over-pronation. Sometimes, people who over-pronate are told they have ?flat feet?. The term ?flat feet? can be misleading. When standing, body weight causes the arch of most feet to flatten out somewhat. This does not mean they become flat like pancakes (though some feet do). Instead, the arch shape gets longer and flatter and the arch height gets lower.Over-Pronation

Causes

In adults, the most common reason for the onset of Over-Pronation is a condition known as Post Tibial Tendonitis. This condition develops from repetitive stress on the main supporting tendon (Posterior Tibial Tendon) of the foot arch. As the body ages, ligaments and muscles can weaken. When this occurs the job of providing the majority of the support required by the foot arch is placed upon this tendon. Unfortunately, this tendon cannot bear the weight of this burden for too long. Eventually it fatigues under the added strain and in doing so the foot arch becomes progressively lower over a period of time.

Symptoms

Overpronation causes alterations in proper muscle recruitment patterns leading to tightness in the outside of the ankle (lateral gastrocnemius, soleus, and peroneals). This tightness can lead to weakness in the opposing muscles such as the medial gastrocnemius, anterior tibialis, and posterior tibialis. If these muscles are weak, they will not be able to keep the knee in proper alignment, causing the valgus position. All this tightness and weakness can cause pain within the ankle, calf, and knee region. And it can send imbalance and pain all the way up to the upper back, if deep core strength is lacking and can’t hold the pelvis in neutral.

Diagnosis

Do the wet foot test. Get your feet wet and walk along a paved surface or sand and look at the footprints you leave. If you have neutral feet you will see a print of the heel with a thin strip connecting to your forefoot, but if you’re overpronating your foot print will look a bit like a giant blob with toes.Overpronation

Non Surgical Treatment

Although there is no actual cure for over-pronation it is possible to correct or at least reduce this problem. In order to restore our normal foot function an ‘orthotic’ or orthotic insole device is placed inside the shoes. Orthotics are designed to realign the foot and ankle bones to their natural position. This in turn restores our normal foot function and it helps alleviate not only foot problems but also ailments in other parts of the body i.e. the legs, knees and lower back. In addition to wearing an orthotic, it is recommended to wear supportive shoes, like good quality athletic footwear with a firm heel counter and sufficient flexibility in the forefoot area.

Surgical Treatment

HyProCure implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.


Bunions Triggers Signs And Symptoms And Solutions

Overview
Bunions Callous
The bunion, or hallux valgus, is a condition that affects the bones and joints associated with the great toe. It is one of the most common deformities of the forefoot. The condition develops slowly and results from the gradual dislocation of the joint, usually because of instability during gait. There is a displacement of the first metatarsal bone toward the mid-line of the body, and a simultaneous displacement of the great toe away from the mid-line (and toward the smaller toes). This causes a prominence of bone on the inside (medial) margin of the forefoot, this is termed a bunion. As the deformity progresses, the big toe will shift toward the outside of the foot. In severe cases, the big toe will actually overlap or under lap the second toe. It is often of a hereditary nature, but it is also associated with rheumatoid arthritis and other diseases. There are no exercises, splints or other devices that reliably correct a bunion. Orthotics can sometimes slow or halt the progression by addressing the instability which causes the deformity, but they cannot reduce the deformity.

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.
SymptomsPatients with bunions will often display pain over the prominent bump on the inside of their forefoot (the medial eminence?). However, they may also have pain under the ball of the foot (under the area near the base of the second toe). Symptoms can vary in severity from none at all to severe discomfort aggravated by standing and walking. There is no direct correlation between the size of the bunion and the patient?s symptoms. Some patients with severe bunion deformities have minimal symptoms, while patients with mild bunion deformities may have significant symptoms. Symptoms are often exacerbated by restrictive shoe wear, particularly shoes with a narrow toe box or an uncomfortable, stiff, restraining upper.

Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.

Non Surgical Treatment
There are many treatment options for bunions and they will vary with the type and severity of each bunion and will also depend on what is causing the symptoms. Bunions are almost always progressive and tend to get larger and more painful with time, how fast this happens may be a function of the fit of the footwear. The initial goal of treatment options is to relieve pressure on the bunion and any symptoms that may be present and to halt or slow the progression of the joint deformity. There is no effective may be “get rid off” a bunion without surgery. There are a number of things that individuals and Podiatrists can do to help the symptoms and slow (if not halt) progression.
Bunions Callous

Surgical Treatment
Procedures can range from shaving off excess bone to restructuring and fusing the big toe. For mild conditions, you may simply need the connective tissues holding your big toe to be tightened so they hold the digit in the correct position. More advanced bunions will need more manipulation and involved remedies. Cuts in the bone tissue can help our specialists realign the toe. You may need to have the damaged portion of the joint removed. In severe cases, the joint may be fused to prevent it from moving out of position again. If your bunion created other foot complications, like hammertoes, our specialists may correct those during the procedure as well.

Prevention
The best way to reduce your chances of developing bunions is to wear shoes that fit properly. Shoes that are too tight or have high heels can force your toes together. Bunions are rare in populations that don?t wear shoes. Make sure your shoes are the correct size and that there’s enough room to move your toes freely. It’s best to avoid wearing shoes with high heels or pointed toes.