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What Is Pes Planus?

3/31/2015

Overview

Acquired Flat Feet

When standing, most people have a gap under the arch of their foot. Flat feet, or pes planus is the term used to describe collapsed arches, meaning that the entire sole of the foot rests partially or completely on the ground. A simple way to check to see if you have flat feet is to wet your feet and step onto a dry, flat surface. Step away from your footprint; if you see a complete footprint, you more than likely have flat feet. If you only see toes, the pads of your feet, and your heels, you probably do not have flat feet. People who have flat feet usually roll their feet over to the inner side when they walk. The feet may even appear to point outward because of this movement. In most cases, the condition cannot be prevented.

Causes

Fallen arches in adults are caused by several things. Below are some of the most common causes. Abnormalities present from birth. Torn or stretched tendons (resulting from foot injuries or foot strains). Inflammation or damage of the PTT (posterior tibial tendon). The PTT is responsible for connecting the middle of the arch to the ankle and lower leg. Dislocated or broken bones (also as a result of injury). Health problems like rheumatoid arthritis. Nerve problems. Other factors like diabetes, obesity, aging and pregnancy (these factors are known to increase the risk of fallen arches).

Symptoms

A significant number of people with fallen arches (flat feet) experience no pain and have no problems. Some, however, may experience pain in their feet, especially when the connecting ligaments and muscles are strained. The leg joints may also be affected, resulting in pain. If the ankles turn inwards because of flat feet the most likely affected areas will be the feet, ankles and knees. Some people have flat feet because of a developmental fault during childhood, while others may find that the problem develops as they age, or after a pregnancy. There are some simple devices which may prevent the complications of flat feet.

Diagnosis

Diagnosis of flat feet or fallen arches can be made by your health practitioner and is based on the following. Clinical assessment involving visual gait assessment, as well as biomechanical assessment. A detailed family and medical history. A pain history assessment determining the location of painful symptoms. Physical palpation of the feet and painful areas. Imaging such as MRI or x-ray can be used by your practitioner to assist in the diagnosis.

Non Surgical Treatment

The treatment your podiatrist recommends will depend upon the trouble and pain you?re experiencing. Custom shoe inserts (orthotics) are most often recommended and are quite effective. Stretching exercises to loosen and strengthen the supporting tendons may also be recommended. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may recommend an ankle brace or a custom orthotic device that fits into your shoe to support the arch. A short-leg cast or boot may be worn to immobilize the foot and allow the tendon to heal. Ultrasound therapy and stretching exercises may help rehabilitate the tendon and muscle following immobilization. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Your foot and ankle surgeon may recommend changes in your footwear.

Surgical Treatment

Flat Foot

Procedures may include the following. Fusing foot or ankle bones together (arthrodesis). Removing bones or bony growths, also called spurs (excision). Cutting or changing the shape of the bone (osteotomy). Cleaning the tendons' protective coverings (synovectomy). Adding tendon from other parts of your body to tendons in your foot to help balance the "pull" of the tendons and form an arch (tendon transfer). Grafting bone to your foot to make the arch rise more naturally (lateral column lengthening).

Learn How To Combat Pes Planus

3/31/2015

Overview

Acquired Flat Feet

Flat feet are a common problem. They can easily be identified by even non-trained individuals as the appearance is quite clear. On the inside of the foot should be a nice curvature which raises the inner foot up off the floor. If the foot touches the floor consistently from heel to toes then the foot is considered flat.

Causes

Most commonly fallen arches in adulthood can arise due to Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon plays a pivotal role in holding up the arch of the foot, damage to this tendon results in the arch collapsing. Another cause of acquired flat feet in adulthood may be due to Rheumatoid arthritis as this disease attacks the bone, cartilage and ligaments in the foot causing it to change shape and flatten. Injury to the ligament, fracture and/or dislocation of the bones in the mid foot can all lead to a flat foot deformity. Adult acquired flat fleet can also arise in people who have diabetes or a neurological condition which limits normal feeling in the foot, the muscles in feet switch off, the tendons and ligaments weaken, and the arch eventually collapses.

Symptoms

A symptom is something the patient feels and reports, while a sign is something other people, including the doctor may detect. An example of a symptom may be pain in the ankle, while a sign may be a swelling. Symptoms may vary and generally depend on the severity of the condition. Some have an uneven distribution of bodyweight and find that the heel of their shoes wears out more rapidly and more on one side than the other. The most common signs or symptoms of flat feet are pain in the ankle (inner side), there may also be swelling of the foot in general, swelling in the arch of the foot, the calf, knee, the hip, the back, the general lower leg area. People with flat feet may also experience stiffness in one or both feet. One or both feet may be flat on the ground (either no arch, or very slight arch). Shoes may wear unevenly.

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.

Non Surgical Treatment

Get shoes made for walking or running. One way to support your arch is to wear good-quality running or walking shoes, says Dr. Gastwirth. "These shoes generally provide good support to the foot." Add support. The top-of-the-line arch support is an orthotic insole, which may cost $900 or more and must be custom-made. "But many people with sore arches will get relief with over-the-counter arch supports for about $10," suggests Judith Smith, M.D., assistant professor of orthopedic surgery at Emory University School of Medicine in Atlanta. "The thing to remember about arch supports is that your shoe must have enough depth to accommodate them. Otherwise, you'll get a lot of rubbing on the top of your foot, or your heel will come out of the shoe." Most mens shoes are deep enough to accommodate the insoles; women should take their shoes with them to the drugstore when buying the insoles to ensure a good fit. If your heels are high, keep them wide. High heels may be your Achilles' heel--especially if you wear them constantly. "Flatter shoes are no doubt better," says Dr. Sanfilippo. Flat heels help prevent fallen arches and are kinder to your feet if fallen arches have already occurred. "If you must wear high heels, choose styles with a wide heel. Stay away from stiletto heels."

Surgical Treatment

Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.

Prevention

Strap the arches into the anatomically correct positions with athletic tape and leave them like this for some time. If the fallen arches are an issue with the muscular structure, this may give the muscles an opportunity to strengthen. This is definitely not a fallen arches cure all the time but it can help prevent it more times than not. Ask a doctor or physical therapists to show you how to do this taping. Find shoes that fit. This may require that you get your foot measured and molded to ensure that the shoe will fit. Shoes that are too big, too tight or too short, may not directly cause the fallen arches, but they can assist with the damage to the area. These shoes should have thick cushioning inside and have plenty of room for your toes. Walk without shoes as much as possible. Shoes directly assist with weakening and distorting the arches of the feet so going without shoes can actually help strengthen your arches and prevent fallen arches. Walking on hard and bumpy surfaces barefooted makes the muscles in your feet strengthen in order to prevent injury. It is a coping mechanism by your body. Insert heel cups or insoles into the shoes that you wear the most. Many people wear uncomfortable shoes to work and these are the same shoes that cause their arches the most problems. Inserting the heel cups and insoles into these shoes can prevent fallen arches from occurring. Many people place these inserts into all their shoes to ensure support. Ask a medical professional, either your doctor or a physical therapist, about daily foot exercises that may keep the arches stronger than normal. Many times, you can find exercises and stretches on the Internet on various websites. Curling your toes tightly and rotating your feet will help strengthen your longitudinal arches. Relax your feet and shake them for a minute or so before you do any arch exercises. This will loosen the muscles in your feet that stay tight due to normal daily activities. Wear rigid soled sandals whenever possible to provide a strong support for your arches. Wooden soled sandals are the best ones if available. Walk or jog on concrete as much as you can. This will create a sturdy support for your arches. Running or walking in sandy areas or even on a treadmill, does not give rigid support. Instead, these surfaces absorb the step, offering no support for arches.

After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or non-union (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.

Does Pain In The Arch Require Surgical Procedures ?

3/30/2015

Overview

Most flat feet are not painful, particularly those flat feet seen in children. In the adult acquired flatfoot, pain occurs because soft tissues (tendons and ligaments) have been torn. The deformity progresses or worsens because once the vital ligaments and posterior tibial tendon are lost, nothing can take their place to hold up the arch of the foot. The painful, progressive adult acquired flatfoot affects women four times as frequently as men. It occurs in middle to older age people with a mean age of 60 years. Most people who develop the condition already have flat feet. A change occurs in one foot where the arch begins to flatten more than before, with pain and swelling developing on the inside of the ankle. Why this event occurs in some people (female more than male) and only in one foot remains poorly understood. Contributing factors increasing the risk of adult acquired flatfoot are diabetes, hypertension, and obesity.

Causes

There are many different factors that can cause arch pain. A structural imbalance or an injury to the foot can often be the direct cause. However, most frequently the cause is a common condition called plantar fasciitis. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Excessive stretching of the plantar fascia, usually due to over-pronation (flat feet), causes plantar fasciitis. The inflammation caused by the plantar fascia being stretched away from the heel often leads to pain in the heel and arch areas. The pain is often extreme in the morning when an individual first gets out of bed or after a prolonged period of rest. If this condition is left untreated and strain on the longitudinal arch continues, a bony protrusion may develop, known as a heel spur. It is important to treat the condition promptly before it worsens.

Symptoms

The foot of a newborn with congenital vertical talus typically has a convex rocker-bottom shape. This is sometimes combined with an actual fold in the middle of the foot. The rare person who is diagnosed at an older age often has a "peg-leg" gait, poor balance and heavy calluses on the soles where the arch would normally be. If a child with congenital vertical talus has a genetic disorder, additional symptoms often are seen in other parts of the body.

Diagnosis

The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise.

Non Surgical Treatment

For mild pain or aching, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil, Motrin and others) may be effective. When there are no symptoms, treatment is not needed. If a child older than age 3 develops symptoms, the doctor may prescribe a therapeutic shoe insert made from a mold of the child's foot or a corrective shoe. As an alternative, some doctors recommend store-bought arch supports. These appear to work as well as more expensive treatments in many children. With any conservative, nonsurgical treatment, the goal is to relieve pain by supporting the arch and correcting any imbalance in the mechanics of the foot. Surgery is typically offered as a last resort in people with significant pain that is resistant to other therapies.

Pain In Arch

Surgical Treatment

There are two types of bone procedure for flat feet, those where bone cuts and bone grafts are used to alter the alignment by avoiding any joint structures, or joint invasive procedures (called fusions or arthrodeses) that remove a joint to reshape the foot. With joint fusion procedures, there are those procedures that involve non-essential joints of the foot versus those that involve essential joints. All bone procedures have their place in flat foot surgery, and Dr. Blitz carefully evaluates each foot to preserve as much motion and function while obtaining proper and adequate alignment. In many cases a flat foot reconstruction involves both soft tissue procedures and bone procedures to rebuild and restore the arch. There are several joints in the arch of the foot that can collapse - and these joints are non-essential joints of the foot. This does not mean that they do not have a purpose, but rather become inefficient is providing a stable platform for function. As such, locking these non-essential non-functioning joints into place is commonly recommended. These joints are fused together with screws and/or plates. A heel bone that is no longer in proper position and pushed outwards away from the foot can be corrected with a bone cut and realignment procedure, so long as the displacement is not too significant. A benefit of this surgery is that it keeps the back portion of the foot mobile, and helps the surrounding tendons work for efficiently in maintaining the arch. In certain flat feet, the foot is deviated outwards and away from the midline of the body. Sometimes, this is due to the outer portion of the foot being shorter than the inner portion. Here bone graft can be added to the outer edge of the foot to lengthen the foot to swing the foot over into a corrected position. This procedure is most commonly performed in children and young adults. A bone graft is inserted into the top part of the arch to realign a component of the flat foot, medically known as forefoot varus or medial column elevatus. The back part of the foot (called the rearfoot complex) can be the cause (or source) of the flat foot or the simply affected by the flat foot foot. In simple terms, the back part of the foot can be made to flatten out due to arch problems - and vica versa for that matter. Dr. Blitz specifically identifies the cause of the flat foot as this will determine the best treatment plan, as each flat foot needs to be evaluated individually. The rearfoot is made up of three joints, and depending on the extent and most importantly the rigidity of these joints, they may require fusion to restore alignment. When all three joints require fusion - this call is a triple arthrodesis. For completeness, isolated fusion of any of the three joints can be performed (such as subtalar joint arthrodesis, talonavicular arthrodesis, and calcaneaocuboid joint arthrodesis). The medical decision making for isolated fusions is beyond the scope this article, but Dr. Blitz tries to avoid any rearfoot fusion for flexible feet because these are joints are essential joints of the foot, especially in younger people. Those in severe cases, it may be advantageous to provide re-alignment.

Prevention

Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.

Pain In The Arches Cause And Effect

3/29/2015

Overview

The arch of the foot is a collection of bones, ligaments, tendons, and muscles that are constructed to allow your foot to bear the weight of your body safely. These tissues and bones of your arch are in constant motion as you walk and run, absorbing impacts that might otherwise injure you. The arch of your foot has its limits, however, and arch pain can be a sign that you?ve passed those limits and injured yourself. Pay close attention to any pain you are feeling in your foot. What may seem at first to be simple soreness from being on your feet all day could be a sign of a more serious stress injury or repeated motion injury. Arch pain could also be a result of a fall or impact injury, so be sure to seek proper treatment.

Causes

There are several reasons why arch pain develops. Sometimes it?s due to a condition known as plantar fasciitis, in which the plantar fascia (the band of tissue that runs along the bottom of your foot from your heel to your toes) becomes inflamed after excessive stress. Heel pain results from this inflammation. Sometimes the pain is due to extensive time spent on your feet. Many people feel pain on the arch of their feet after a long workday, while others overuse their feet exercising or playing sports. A foot deformity, such as hammertoe or clubfoot, can also cause this pain. Medical conditions such as diabetes or obesity can put additional stress on your feet, thereby causing arch pain. Your footwear is also important. Shoes should support all parts of your foot, especially the bottom. This is very important if you spend excessive time on your feet, if your obese, if your pregnant, or if you engage in sport-related activities. Injuries to any of the twenty-six bones, thirty-three joints and over 100 muscles, tendons and ligaments in the feet can also cause arch pain. Because the foot is such a complex structure, it?s important to see a podiatrist at the first sign of symptoms.

Symptoms

Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).

Diagnosis

In people with flat feet, the instep of the foot comes in contact with the ground when standing. To diagnose the problem, the health care provider will ask you to stand on your toes. If an arch forms,the flat foot is called flexible. You will not need any more tests or treatment. If the arch does not form with toe-standing (called rigid flat feet), or if there is pain, other tests may be needed, including a CT scan to look at the bones in the foot. MRI scan to look at the tendons in the foot. X-ray of the foot.

Non Surgical Treatment

The treatment of a rigid flatfoot depends on its cause. Congenital vertical talus. Your doctor may suggest a trial of serial casting. The foot is placed in a cast and the cast is changed frequently to reposition the foot gradually. However, this generally has a low success rate. Most people ultimately need surgery to correct the problem. Tarsal coalition. Treatment depends on your age, extent of bone fusion and severity of symptoms. For milder cases, your doctor may recommend nonsurgical treatment with shoe inserts, wrapping of the foot with supportive straps or temporarily immobilizing the foot in a cast. For more severe cases, surgery is necessary to relieve pain and improve the flexibility of the foot. Lateral subtalar dislocation. The goal is to move the dislocated bone back into place as soon as possible. If there is no open wound, the doctor may push the bone back into proper alignment without making an incision. Anesthesia is usually given before this treatment. Once this is accomplished, a short leg cast must be worn for about four weeks to help stabilize the joint permanently. About 15% to 20% of people with lateral subtalar dislocation must be treated with surgery to reposition the dislocated bone.

Arch Pain

Surgical Treatment

Surgery may be necessary in situations where the symptoms are likely to get worse over time, or when pain and instability cannot be corrected with external orthopedic devices. There are many types of surgical procedures, including cavus foot reconstruction, which can be performed to correct the foot and the ankle and restore function and muscle balance.

Prevention

To prevent arch pain, it is important to build up slowly to your exercise routine while wearing arch supports inside training shoes. By undertaking these simple measures you can prevent the discomfort of arch pain which can otherwise linger for many months. While you allow the foot to recover, it will help to undertake low impact exercises (such as swimming or water aerobics).

Adult Aquired FlatFoot

3/27/2015

Overview

Adult acquired flatfoot can be a progressive disorder which involves the compromise involving soft tissue supports in the medial arch. the situation mostly affects middle outdated females and it is seen as a lowering in the arch, turning out in the forefoot, and a sideways angulation of the heel. You can easily find five stages in the disorder that will gets progressively disabling. the end stage could potentially compromise your ankle joint together with all the joints in the hindfoot.

Adult Acquired Flat Feet

Causes

Women are affected through Adult Acquired Flatfoot 4 times more frequently when compared with men. Adult Flatfoot typically occurs in center in order to older get older people. The Majority Of individuals who acquire the situation curently have flat feet. one arch begins to flatten more, then pain as well as swelling develop on the inside in the ankle. This situation generally affects just one foot. The idea is unclear why ladies are generally affected more often than men. However elements that may increase your risk of Adult Flatfoot include diabetes, hypertension, and also obesity.

Symptoms

Symptoms are minor and might even go unnoticed, Pain dominates, as opposed to deformity. Minor swelling could become noticeable across the length of the particular tendon. Pain as well as swelling over the course of the tendon. Noticeable decline in arch height. Aduction with the forefoot in rearfoot. Subluxed tali as well as navicular joints. Deformation at this point is even now flexible. Considerable deformity along with weakness. Significant pain. Arthritic changes inside the tarsal joints. Deformation as associated with this point is actually rigid.

Diagnosis

Starting in the knee down, examine for any bowing in the tibia. The tibial varum will trigger increased medial strain around the foot and ankle. This may be important to contemplate throughout surgical planning. Verify the actual gastrocnemius muscle mass along with Achilles complex by method of a new straight as well as bent knee examine for equinus. When the particular selection of motion improves to a minimal of neutral with bent knee testing of the Achilles complex, one may think regarding a gastrocnemius recession. If the particular Achilles complex is actually nevertheless tight with bent knee testing, an Achilles lengthening could end up being necessary. check the particular posterior tibial muscle alongside its entire course. Palpate the actual muscle as well as observe the tendon pertaining to power with a plantarflexion and inversion tension test. check the particular flexor muscles with regard to strength to become able to discover if a sufficient transfer tendon will be available. check your anterior tibial tendon pertaining to dimension and strength.

Non surgical Treatment

Because in the progressive nature associated with PTTD, early treatment method is actually advised. In the event that handled early enough, your signs and symptoms may resolve without having the requirement for surgery along with progression of your issue may be arrested. Throughout contrast, untreated PTTD could depart anyone having an extremely flat foot, painful arthritis inside the foot as well as ankle, as well as growing limitations about walking, running, or other activities. Throughout many cases regarding PTTD, treatment may start out with non-surgical approaches in which may include. Orthotic devices or bracing. To Always Be Able To give your own arch your assistance it needs, your current foot and also ankle surgeon could supply you by getting an ankle brace or possibly a custom orthotic device that fits in in order to the shoe. Immobilization. Sometimes a short-leg cast or even boot will be worn to immobilize the actual foot and permit the particular tendon to heal, or perhaps a person could have to entirely stay away from all weight-bearing for a while. Physical therapy. Ultrasound therapy as well as exercises could aid rehabilitate the tendon as well as muscle mass following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), for example ibuprofen, assist decrease the anguish and also inflammation. Shoe modifications. your foot and ankle surgeon could advise changes to create together together with your shoes and could supply unique inserts designed to boost arch support.

Adult Acquired Flat Foot

Surgical Treatment

For patients having a more severe deformity, or even significant signs as well as symptoms that do not react to conservative treatment, surgery may be necessary. You will find a number of procedures available depending about the naturel of one's condition. Ligament as well as muscle mass lengthening, removal of inflamed tendon lining, transferring of the close by tendon for you to re-establish an arch, and also bone realignment along with fusion are examples associated with surgical choices to assist having a painful flatfoot condition. Surgery could be avoided when symptoms are usually addressed early. In your event that you're sensation ankle pain or perhaps notice just about any warmth, redness as well as swelling within your foot, contact us immediately. We could create a tailored treatment method program to solve your signs and symptoms along with prevent long term problems.

The Causes And Also Treatment

3/26/2015

Overview

There are usually a few some other items that can weaken your tendon (and thus move in which quitting occasion a little closer). Females are generally far more most likely as compared to men for you to develop this condition, also it may take location across the exact same moment as menopause (around age 60 as well as so). Steroid use (not often illegal-this might originate from having cortisone shots inside the area) and smoking could also improve the chance with regard to developing PTTD, since steroids tend to weaken tendons. The history of injury within the area, arthritis, or even an already flat foot might also actually push the particular tendon to always be able to declare, ?That?s the final straw!? (Silly tendon. Because if it even understands what straw is.)

Acquired Flat Foot

Causes

There are generally multiple elements contributing for the development of this problem. Damage towards the nerves, ligaments, and/or tendons in the foot could cause subluxation (partial dislocation) in the subtalar as well as talonavicular joints. Bone fracture is a possible cause. the resulting joint deformity from any of these issues can lead to adult-acquired flatfoot deformity. Dysfunction with the posterior tibial tendon offers often been linked along with adult-acquired flatfoot deformity (AAFD). The Actual loss of active and also passive pull with the tendon alters the particular typical biomechanics with the foot and ankle. The Particular causes of this can end up being many along with varied as well. Diabetes, high blood pressure, and also prolonged use regarding steroids tend to be some involving the more common causes of adult-acquired flatfoot deformity (AAFD) brought upon by simply impairment in the posterior tibialis tendon. Overstretching or even rupture of the tendon brings about tendon as well as muscle mass imbalance inside the foot leading to adult-acquired flatfoot deformity (AAFD). Rheumatoid arthritis can be one of the greater widespread causes. Regarding 50 % of just about all adults with this particular kind involving arthritis will develop adult flatfoot deformity over time. Within such cases, the particular situation will be gradual along with progressive. Weight Problems has been linked with this particular condition. Loss regarding blood supply for practically any cause within the location in the posterior tibialis tendon is an additional factor. Various Other possible leads to contain bone fracture as well as dislocation, a new torn or perhaps stretched tendon, or even a neurologic condition causing weakness.

Symptoms

Pain as well as swelling at the particular rear of the within of your ankle and also together your current instep. An Individual might always be tender powering the particular inner ankle where the posterior tibial tendon programs and also sometimes get burning, shooting, tingling or perhaps stabbing pain as a consequence of inflammation with the nerve inside the particular tarsal tunnel. Problems walking, the particular inability simply for you to walk long mileage plus a generalised ache whilst strolling even short distances. This specific may most likely turn out for you to be more pronounced following each day. Adjust in foot shape, sometimes your current tendon stretches out, this truly is thanks to weakening in the tendon as well as ligaments. When this occurs, the arch in your foot flattens along using a flatfoot deformity occurs, presenting a new change in foot shape. Inability to tip-toe, any way of diagnosing Posterior Tibial Tendon Dysfunction can be trouble or perhaps inability to end up being able to ?heel rise? (stand on your toes using one foot). Your Current tibialis posterior tendon enables you for you to definitely perform this manoeuvre effectively. A Person might also encounter pain upon attempting to do the heel rise.

Diagnosis

Although you'll end up being in a new position to do the "wet test" at home, a comprehensive examination by a physician is going to be necessary to recognize why your flatfoot developed. Feasible leads to incorporate a congenital abnormality, a bone fracture or perhaps dislocation, a torn or stretched tendon, arthritis or even neurologic weakness. for example, an inability to rise on your toes whilst standing on the affected foot could indicate damage to the posterior tibial tendon (PTT), which supports the heel as well as types your arch. In the particular event that "too many toes" show around the outside of one's foot if the physician views anyone from the rear, your own shinbone (tibia) might end up being sliding off your anklebone (talus), an additional indicator of harm to the PTT. Always Be positive in order to put on your own standard shoes towards the examination. An irregular put on pattern on the bottom in the shoe is yet another indicator of acquired adult flatfoot. your physician may request X-rays to observe how the particular bones of your feet tend to be aligned. muscle and also tendon power are usually tested simply by asking to move your foot even although the doctor holds it.

Non surgical Treatment

Nonoperative remedy regarding posterior tibial tendon dysfunction may be successful with just about all the Arizona AFO brace, specially when treatment method will be initiated inside the first stages with the disease. This kind of mandates the orthopedist has a high index involving suspicion when evaluating patients to create a precise diagnosis. Though there's a role pertaining to surgical management regarding acquired flat feet, a new well-fitted, custom-molded leather along with polypropylene orthosis could be successful in relieving symptoms and also either obviating or perhaps delaying virtually any surgical intervention. Inside today's climate regarding patient fulfillment directed well being care, a new less invasive treatment modality in which relieves pain might prove to become more valuable when compared with similar pain relief that is obtained following surgery. Concerns relating to the long-term outcomes involving bracing remain unanswered. future studies tend to be required to see whether disease progression and also arthrosis occur despite symptomatic relief with a brace. Furthermore, age- along with disease stage-matched control teams who're randomized for you to undergo surgery or bracing are generally required to compare these different therapy modalities.

Flat Foot

Surgical Treatment

In your event that conservative treatment fails surgical intervention is actually offered. for any Stage 1 deformity the posterior tibial tendon tenosynovectomy (debridement of the tendon) or primary repair may always be indicated. Regarding Stage two any combination of Achilles lengthening along with bone cuts, calcaneal osteotomies, as well as tendon transfers is common. Stage 2 versatile PTTD may always be the most frequent stage patients existing together with pertaining to treatment. Within Stage three as well as 4 PTTD isolated fusions, locking a pair of or perhaps more joints together, maybe indicated. Most therapy is dependent on the stage and also severity from presentation with almost all the goals and activity amount individual inside mind. treatment can be customized towards the individual affected person needs.

Achilles Tendon Rupture

3/22/2015

Overview
Achilles Tendonitis

The Achilles tendon is the largest and most vulnerable tendon in the body. It joins the gastrocnemius (calf) and the soleus muscles of the lower leg to heel of the foot. The gastrocnemius muscle crosses the knee, the ankle, and the subtalar joints and can create stress and tension in the Achilles tendon . Tendons are strong, but not very flexible so they can only so far before they get inflammed and tear or rupture.

Causes
A rupture occurs when a patient overstretches the Achilles tendon, an act which causes it to tear partially or completely. Achilles tendon ruptures can occur during athletic play or any time the tendon is stretched in an unexpected way.

Symptoms
Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel. An inability to bend your foot downward or "push off" the injured leg when you walk. An inability to stand up on your toes on the injured leg. A popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward.

Diagnosis
A physician usually can make this diagnosis with a good physical examination and history. X-rays usually are not taken. A simple test of squeezing the calf muscles while lying on your stomach should indicate if the tendon is still connected (the foot should point). This test isolates the connection between the calf muscle and tendon and eliminates other tendons that may still allow weak movement. A word of caution, Achilles tendon rupture is often misdiagnosed as a strain or minor tendon injury. Swelling and the continuing ability to weakly point your toes can confuse the diagnosis. Ultrasound and MRI are tests that can assist in difficult diagnosis. Depending on the degree of injury, these tests can also assist in determining which treatment may be best.

Non Surgical Treatment
Two treatment options are casting or surgery. If an Achilles tendon rupture is untreated then it may not heal properly and could lead to loss of strength. Decisions about treatment options should be made on an individual basis. Non-surgical management traditionally is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. The goal of casting is to allow the tendon to slowly heal over time. The foot and ankle are positioned to bring the torn ends of the tendon close together. Casting or bracing for up to 12 weeks or more may be necessary. This method can be effective and avoids some risks, such as infection, associated with surgery. However, the likelihood of re-rupture may be higher with a non-surgical approach and recovery can take longer.

Surgical Treatment
There are two types of surgery to repair a ruptured Achilles tendon. In open surgery, the surgeon makes a single large incision in the back of the leg. In percutaneous surgery, the surgeon makes several small incisions rather than one large incision. In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture, to let the swelling go down.