Jean Mcmanis

Foot Pain In Diabetics

What Can You Do About Fallen Arches?

Overview

Acquired Flat Foot

Fallen arches is a common term used to describe a flatfoot condition that develops during adulthood. This should not be confused with other causes of flatfoot that may develop during childhood or adolescence. Most cases of ?fallen arches? develop when the main arch-supporting tendon (the posterior tibial tendon) becomes weakened or injured, causing the arch to gradually become lower. With time, the shape of the foot changes and secondary symptoms start to appear. Common problems associated with fallen arches include plantar fasciitis, tendonitis, increased fatigue, and arthritis of the foot and ankle.

Causes

A Rigid Flat Foot may be congenital, where the arch never develops when growing. A Rigid Flat Foot can also be acquired due to disease processes involving inflammatory arthritis, neurological conditions such as Charcot neuro-arthropathy or trauma. A Flexible Flat Foot (fallen arches) may also be congenital where excessive pronation occurs for shock absorption. In some cases this condition may be the result of neurological disease or injury involving muscle weakness, hyper-mobile joints or ligament laxity. These conditions may allow for excessive pronation causing the arch to fall when weight bearing or during activity. Both of these foot types can result in posture mal-alignment involving the lower back, hips, knees and feet which may result in pain in those areas.

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

If you notice that your feet are flat, but you?re not really experiencing any pain, then you?re probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it?s better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that?s certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor?s own in-person examination.

arch support plantar fasciitis

Non Surgical Treatment

Flexible flat feet that are painless do not require treatment. If you have pain due to flexible flat feet, an orthotic (arch-supporting insert in the shoe) can bring relief. With the increased interest in running, many shoe stores carry shoes for normal feet and pronated feet. The shoes designed for pronated feet make long distance running easier and less tiring because they correct for the abnormality. Rigid or painful flat feet require evaluation by a health care provider. The treatment depends on the cause of the flat feet. For tarsal coalition, treatment starts with rest and possibly a cast. If this fails to improve the pain, surgery may be necessary. For problems with the posterior tibial tendon, treatment may start with rest, anti-inflammatory medications, and shoe inserts or ankle braces. In more advanced cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints of the foot into a corrected position. Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.

Surgical Treatment

Acquired Flat Feet

Since there are many different causes of flatfoot, the types of flatfoot reconstruction surgery are best categorized by the conditions. Posterior tibial tendon dysfunction. In this condition, the tendon connecting the calf muscle to the inner foot is torn or inflamed. Once the tendon is damaged it no longer can serve its main function of supporting the arch of the foot. Flatfoot is the main result of this type of condition and can be treated by the following flatfoot reconstruction surgeries. Lengthening of the Achilles tendon. Otherwise known as gastrocnemius recession, this procedure is used to lengthen the calf muscles in the leg. This surgery treats flatfoot and prevents it from returning in the future. This procedure is often combined with other surgeries to correct posterior tibial tendon dysfunction. Cleaning the tendon. Also known as tenosynovectomy, this procedure is used in the earlier and less severe stages of posterior tibial tendon dysfunction. It is performed before the arch collapses and while the tendon is only mildly affected. The inflamed tissue is cleaned away and removed from the remaining healthy tendon. Tendon transfer. This procedure is done to correct flatfoot and reform the lost arch in the foot. During the procedure, the diseased tendon is removed and replaced by tendon from another area of the foot. If the tendon is only partially damaged, the inflamed part is cleaned and removed then attached to a new tendon. Cutting and shifting bones. Also called an osteotomy, this procedure consists of cutting and reconstructing bones in the foot to reconstruct the arch. The heel bone and the midfoot are most likely reshaped to achieve this desired result. A bone graft may be used to fuse the bones or to lengthen the outside of the foot. Temporary instrumentation such as screws and plates can also be used to hold the bones together while they heal.

Prevention

Orthotic inserts, either prescribed or bought over the counter, can help keep the arches fixed into position, but always wear them as although they support, they don?t strengthen, which is why some experts reccomend avoiding them. Gait analysis at a run specialist can help to diagnose overpronation and flat feet. Most brands produce shoes that will give support and help to limit the negative effects of a poor gait on the rest of the body. Barefoot exercises, such as standing on a towel and making fists with the toes, can help to strengthen the arches. Start easy and build up the reps to avoid cramping. Short barefoot running sessions can help take pressure off the arches by using the natural elasticity of the foot?s tendons to take impact and build strength to help prevent flat feet. These should be done on grass for only a few minutes at a time.

Leg Length Discrepancy Running

Overview

Shortening techniques can be used after skeletal maturity to achieve leg length equality. Shortening can be done in the proximal femur using a blade plate or hip screw, in the mid-diaphysis of the femur using a closed intramedullary (IM) technique, or in the tibia. Shortening is an accurate technique and involves a much shorter convalescence than lengthening techniques. Quadriceps weakness may occur with femoral shortenings, especially if a mid-diaphyseal shortening of greater than 10% is done. If the femoral shortening is done proximally, no significant weakness should result. Tibial shortening can be done, but there may be a residual bulkiness to the leg, and risks of nonunion and compartment syndrome are higher. If a tibial shortening is done, shortening over an IM nail and prophylactic compartment release are recommended. We limit the use of shortenings to 4 to 5 cm leg length inequality in patients who are skeletally mature.Leg Length Discrepancy

Causes

An anatomical short leg is due to several orthopedic or medical condition mechanisms. Often, one leg simply stops growing before the other one does and is called ?congenital?. We often see mother-daughters or father-sons who exhibit virtually the same degree of shortness on the same side. Often it is not known why this occurs, but it seems to account for approximately 25% of the population demonstrating a true LLD. Other causes of a true LLD include trauma or broken bones, surgical repair, joint replacement, radiation exposure, tumors or Legg-Calves-Perthes disease.

Symptoms

As patients develop LLD, they will naturally and even unknowingly attempt to compensate for the difference between their two legs by either bending the longer leg excessively or standing on the toes of the short leg. When walking, they are forced to step down on one side and thrust upwards on the other side, which leads to a gait pattern with an abnormal up and down motion. For many patients, especially adolescents, the appearance of their gait may be more personally troublesome than any symptoms that arise or any true functional deficiency. Over time, standing on one's toes can create a contracture at the ankle, in which the calf muscle becomes abnormally contracted, a condition that can help an LLD patient with walking, but may later require surgical repair. If substantial enough, LLD left untreated can contribute to other serious orthopaedic problems, such as degenerative arthritis, scoliosis, or lower back pain. However, with proper treatment, children with leg length discrepancy generally do quite well, without lingering functional or cosmetic deficiencies.

Diagnosis

The doctor carefully examines the child. He or she checks to be sure the legs are actually different lengths. This is because problems with the hip (such as a loose joint) or back (scoliosis) can make the child appear to have one shorter leg, even though the legs are the same length. An X-ray of the child?s legs is taken. During the X-ray, a long ruler is put in the image so an accurate measurement of each leg bone can be taken. If an underlying cause of the discrepancy is suspected, tests are done to rule it out.

Non Surgical Treatment

Treatment of leg length inequality involves many different approaches, such as orthotics, epiphysiodesis, shortening, and lengthening, which can be used alone or combined in an effort to achieve equalization of leg lengths. Leg length inequality of 2 cm or less is usually not a functional problem. Often, leg length can be equalized with a shoe lift, which usually corrects about two thirds of the leg length inequality. Up to 1 cm can be inserted in the shoe. For larger leg length inequalities, the shoe must be built up. This needs to be done for every shoe worn, thus limiting the type of shoe that the patient can wear. Leg length inequalities beyond 5 cm are difficult to treat with a shoe lift. The shoe looks unsightly, and often the patient complains of instability with such a large lift. A foot-in-foot prosthesis can be used for larger leg length inequalities. This is often done as a temporizing measure for young children with significant leg length inequalities. The prosthesis is bulky, and a fixed equinus contracture may result.

Leg Length Discrepancy

shoe lifts for height

Surgical Treatment

Surgeries for LLD are designed to do one of three general things ? shorten the long leg, stop or slow the growth of the longer or more rapidly growing leg, or lengthen the short leg. Stopping the growth of the longer leg is the most commonly utilized of the three approaches and involves an operation known as an epiphysiodesis , in which the growth plate of either the lower femur or upper tibia is visualized in the operating room using fluoroscopy (a type of real-time radiographic imaging) and ablated , which involves drilling into the region several times, such that the tissue is no longer capable of bone growth. Because the epiphyseal growth capabilities cannot be restored following the surgery, proper timing is crucial. Usually the operation is planned for the last 2 to 3 years of growth and has excellent results, with children leaving the hospital within a few days with good mobility. However, it is only appropriate for LLD of under 5cm.

What Are The Causes Of Heel Discomfort

Overview

Painful Heel

The plantar fascia is a broad fan shaped strap of strong body tissue which stretches from the bottom of the heel bone to the ball of the foot. It helps to hold the foot bones and joints in place. When it is over stressed (over stretched) typical symptoms occur. The heels hurt most of all first thing in the morning or after a period of rest. The heels are also very sore after standing for a long time.

Causes

Some of the many causes of heel pain can include abnormal walking style (gait), such as rolling the feet inwards. Obesity. Ill-fitting shoes. Standing, running or jumping on hard surfaces. Injury to the heel, such as stress fractures. Bursitis (inflammation of a bursa, bursae are small sacs that contain fluid to lubricate moving parts, such as joints and muscles). Neuroma (nerve enlargement). Certain disorders, including diabetes and arthritis.

Symptoms

The heel can be painful in many different ways, depending on the cause. Plantar fasciitis commonly causes intense heel pain along the bottom of the foot during the first few steps after getting out of bed in the morning. This heel pain often goes away once you start to walk around, but it may return in the late afternoon or evening. Although X-ray evidence suggests that about 10% of the general population has heels spurs, many of these people do not have any symptoms. In others, heel spurs cause pain and tenderness on the undersurface of the heel that worsen over several months. In a child, this condition causes pain and tenderness at the lower back portion of the heel. The affected heel is often sore to the touch but not obviously swollen. Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down. Pump bump, this condition causes a painful enlargement at the back of the heel, especially when wearing shoes that press against the back of the heel. Heel bruises, like bruises elsewhere in the body, may cause pain, mild swelling, soreness and a black-and-blue discoloration of the skin. Achilles tendonitis, this condition causes pain at the back of the heel where the Achilles tendon attaches to the heel. The pain typically becomes worse if you exercise or play sports, and it often is followed by soreness, stiffness and mild swelling. A trapped nerve can cause pain, numbness or tingling almost anywhere at the back, inside or undersurface of the heel. In addition, there are often other symptoms, such as swelling or discoloration - if the trapped nerve was caused by a sprain, fracture or other injury.

Diagnosis

The diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. Pain can be referred to the heel and foot from other areas of the body such as the low back, hip, knee, and/or ankle. Special tests to challenge these areas are performed to help confirm the problem is truly coming from the plantar fascia. An X-ray may be ordered to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation. Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter's syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.

Non Surgical Treatment

Rest until there is no more pain. This is the most important element of treatment as continuing to walk or run on the injured foot will not allow the injury to heal. Wear soft trainers with lots of cushioning or pad the heel of shoes with shock absorbing insoles or heel pads. These should be worn in both shoes, even if only one heel is bruised. Wearing a raise in only one shoe causes a leg length difference which can cause other problems. Replace running shoes if they are old. A running shoe is designed to last for around 400 miles of running. After this the mid soles are weakened through use.

Surgical Treatment

At most 95% of heel pain can be treated without surgery. A very low percentage of people really need to have surgery on the heel. It is a biomechanical problem and it?s very imperative that you not only get evaluated, but receive care immediately. Having heel pain is like having a problem with your eyes; as you would get glasses to correct your eyes, you should look into orthotics to correct your foot. Orthotics are sort of like glasses for the feet. They correct and realign the foot to put them into neutral or normal position to really prevent heel pain, and many other foot issues. Whether it be bunions, hammertoes, neuromas, or even ankle instability, a custom orthotic is something worth considering.

heel spur surgery

Prevention

Foot Pain

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don?t underestimate your body's need for rest and good nutrition. If obese, lose weight.

Managing Mortons Neuroma

Overview

plantar neuromaMorton neuromas are focal areas of symptomatic perineural fibrosis around a plantar digital nerve of the foot. The abnormality is non-neoplastic and does not represent a true neuroma. It may more correctly be known as Morton?s metatarsalgia. The condition is thought to be due to chronic entrapment of the nerve by the intermetatarsal ligament. It most often occurs in middle-aged individuals and is many times more common in women than men. Approximately 30% of asymptomatic middle-aged persons have the radiological pathologic findings of a Morton?s neuroma.

Causes

The exact cause is unknown. Doctors believe the following may play a role in the development of this condition. Wearing tight shoes and high heels. Abnormal positioning of toes. Flat feet. Forefoot problems, including bunions and hammer toes. High foot arches. Morton neuroma is more common in women than in men.

Symptoms

A Morton's neuroma causes a "burning" sharp pain and numbness on the bottom of the foot in the involved area, and this pain and numbness can radiate to the nearby toes. The pain is usually increased by walking or when the ball of the foot is squeezed together and decreased with massaging. It may force a person to stop walking or to limp from the pain.

Diagnosis

The clinical symptoms should quickly lead your doctor to suspect a neuroma. When examined, the doctor may feel a "click" which is known as Mulder's sign. There may be tenderness in the interspace. The metatarsal bones will also be examined both clinically (and often with an xray). Tenderness at one of the metatarsal bones can suggest an overstress reaction (pre-stress fracture or stress fracture) in the bone. An ultrasound scan can confirm the diagnosis and is a less expensive and at this time, at least as sensitive a test as an MRI. An x-ray does not show neuromas, but can be useful to "rule out" other causes of the pain.

Non Surgical Treatment

The first step in treating Morton's Neuroma is to select proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating and relieving the pain. The next step in treatment is to use an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure, and relieve the pain caused by the neuroma.

If problem persists, consult your foot doctor.plantar neuroma

Surgical Treatment

For severe or persistent pain, you may need surgery to remove the neuroma. Once the nerve is gone, you permanently lose feeling in the affected area. One alternative to surgery is to undergo neurolysis injections. These use chemical agents to block pain signals. Another alternative is to take a prescription pain reliever that alleviates nerve pain.

The Best Solution To Leg Length Discrepancy Is Shoe Lifts

There are actually two different types of leg length discrepancies, congenital and acquired. Congenital means that you are born with it. One leg is structurally shorter in comparison to the other. Through developmental periods of aging, the brain senses the stride pattern and identifies some variance. The entire body typically adapts by tilting one shoulder over to the "short" side. A difference of under a quarter inch isn't blatantly abnormal, require Shoe Lifts to compensate and normally doesn't have a serious effect over a lifetime.

Leg Length Discrepancy Shoe Lift

Leg length inequality goes typically undiscovered on a daily basis, yet this issue is easily remedied, and can reduce a number of incidents of back discomfort.

Therapy for leg length inequality usually consists of Shoe Lifts . These are low cost, frequently costing below twenty dollars, compared to a custom orthotic of $200 if not more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Low back pain is easily the most common condition afflicting men and women today. Over 80 million men and women experience back pain at some point in their life. It is a problem that costs businesses huge amounts of money annually on account of lost time and production. Innovative and better treatment methods are always sought after in the hope of lowering economic influence this condition causes.

Shoe Lift

Men and women from all corners of the world suffer the pain of foot ache as a result of leg length discrepancy. In a lot of these cases Shoe Lifts are usually of very beneficial. The lifts are capable of decreasing any discomfort in the feet. Shoe Lifts are recommended by many specialist orthopaedic practitioners".

So that they can support the body in a nicely balanced manner, feet have got a very important part to play. Irrespective of that, it can be the most neglected zone in the human body. Some people have flat-feet which means there is unequal force placed on the feet. This will cause other parts of the body such as knees, ankles and backs to be impacted too. Shoe Lifts guarantee that appropriate posture and balance are restored.

Shoe Lifts For Leg Length Discrepancy

There are not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital means you are born with it. One leg is structurally shorter than the other. As a result of developmental stages of aging, the human brain picks up on the walking pattern and identifies some variation. The body typically adapts by tilting one shoulder to the "short" side. A difference of under a quarter inch is not blatantly excessive, demand Shoe Lifts to compensate and commonly does not have a serious effect over a lifetime.

Leg Length Discrepancy Shoe Lift

Leg length inequality goes mainly undiagnosed on a daily basis, yet this problem is easily fixed, and can eradicate numerous instances of low back pain.

Therapy for leg length inequality usually involves Shoe Lifts. They are very reasonably priced, usually costing less than twenty dollars, in comparison to a custom orthotic of $200 or more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Back pain is easily the most common condition impacting men and women today. Around 80 million people have problems with back pain at some stage in their life. It is a problem which costs companies millions of dollars year after year as a result of time lost and productivity. New and more effective treatment solutions are constantly sought after in the hope of decreasing the economic influence this issue causes.

Leg Length Discrepancy Shoe Lifts

People from all corners of the world experience foot ache as a result of leg length discrepancy. In these cases Shoe Lifts might be of very beneficial. The lifts are capable of relieving any pain in the feet. Shoe Lifts are recommended by countless skilled orthopaedic doctors.

So as to support the body in a well-balanced fashion, your feet have got a significant job to play. In spite of that, it is sometimes the most overlooked region of the human body. Many people have flat-feet meaning there is unequal force placed on the feet. This will cause other parts of the body including knees, ankles and backs to be impacted too. Shoe Lifts make sure that correct posture and balance are restored.

The Answer To Leg Length Discrepancy Is Shoe Lifts

There are two different types of leg length discrepancies, congenital and acquired. Congenital means you are born with it. One leg is anatomically shorter in comparison to the other. As a result of developmental stages of aging, the human brain picks up on the walking pattern and identifies some difference. The entire body usually adapts by tilting one shoulder over to the "short" side. A difference of under a quarter inch isn't really uncommon, does not need Shoe Lifts to compensate and generally does not have a serious effect over a lifetime.

Shoe Lifts

Leg length inequality goes largely undiagnosed on a daily basis, yet this condition is easily remedied, and can reduce many cases of back discomfort.

Treatment for leg length inequality commonly consists of Shoe Lifts. These are generally low-priced, typically costing less than twenty dollars, compared to a custom orthotic of $200 or maybe more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Lower back pain is the most prevalent health problem afflicting people today. Over 80 million people suffer from back pain at some point in their life. It is a problem that costs companies millions annually because of time lost and production. Fresh and superior treatment solutions are always sought after in the hope of lowering economic impact this issue causes.

Leg Length Discrepancy Shoe Lift

People from all corners of the world suffer from foot ache due to leg length discrepancy. In these types of situations Shoe Lifts might be of very helpful. The lifts are capable of alleviating any discomfort and pain in the feet. Shoe Lifts are recommended by many professional orthopaedic practitioners".

So as to support the human body in a well balanced manner, the feet have a very important part to play. Inspite of that, it can be the most overlooked area in the body. Many people have flat-feet which means there is unequal force placed on the feet. This will cause other parts of the body including knees, ankles and backs to be impacted too. Shoe Lifts guarantee that correct posture and balance are restored.