Physiotherapy For Bursitis Of The Feet
Overview
Bursas are small fluid containing sacs, that are situated between areas of high friction such as bone against the floor (heel) and bone against other soft tissue structures like tendons, skin and or muscle. The bursa job is to act as a shock absorber, and to allow stress free movement between the above noted structures. Bursitis is a swellinginflammation of the bursa sac, due to constant micro trauma or overuse. In the foot Abnormal Pronation, most often caused by Morton?s Toe.
Causes
High impact activity, such as running. Trauma to the heel such as jumping from a height. Increase in training levels. Lack of shock absorbency in the trainers worn. Worn running shoes. Poor biomechanics. Loss of the fat pad under the heel. Increase in weight.
Symptoms
Nagging ache and swelling in or around a joint. Painful and restricted movement in the affected joint. Pain radiating into the neck or arms when bursitis strikes the shoulder (the most common site). Fever, when associated with an infection.
Diagnosis
A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose a retrocalcaneal bursitis. Diagnosis may be confirmed with an ultrasound investigation, MRI or CT scan.
Non Surgical Treatment
Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce the swelling in the bursa. An injection may be used for both diagnosis and for treatment. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and ankle to ensure no other problems exist in this area. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure especially if you have excessive pronation. Sometimes patients are sent to Physical Therapy for treatment as well. To aid in relief of pressure points, some simple padding techniques can be utilized. Most all patients respond to these conservative measures once the area of irritation is removed.
Surgical Treatment
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.
Bursas are small fluid containing sacs, that are situated between areas of high friction such as bone against the floor (heel) and bone against other soft tissue structures like tendons, skin and or muscle. The bursa job is to act as a shock absorber, and to allow stress free movement between the above noted structures. Bursitis is a swellinginflammation of the bursa sac, due to constant micro trauma or overuse. In the foot Abnormal Pronation, most often caused by Morton?s Toe.
Causes
High impact activity, such as running. Trauma to the heel such as jumping from a height. Increase in training levels. Lack of shock absorbency in the trainers worn. Worn running shoes. Poor biomechanics. Loss of the fat pad under the heel. Increase in weight.
Symptoms
Nagging ache and swelling in or around a joint. Painful and restricted movement in the affected joint. Pain radiating into the neck or arms when bursitis strikes the shoulder (the most common site). Fever, when associated with an infection.
Diagnosis
A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose a retrocalcaneal bursitis. Diagnosis may be confirmed with an ultrasound investigation, MRI or CT scan.
Non Surgical Treatment
Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce the swelling in the bursa. An injection may be used for both diagnosis and for treatment. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and ankle to ensure no other problems exist in this area. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure especially if you have excessive pronation. Sometimes patients are sent to Physical Therapy for treatment as well. To aid in relief of pressure points, some simple padding techniques can be utilized. Most all patients respond to these conservative measures once the area of irritation is removed.
Surgical Treatment
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.
Hammer Toe Correction
Overview
The 2nd toe is the most common digit to develop a hammertoes deformity. Second toe hammer toes commonly result from an elongated 2nd metatarsal and from pressure due to an excessively abducted great toe (hallux valgus deformity) causing a bunion. Unusually long toes often develop hammer toe deformities. Painful corns often develop in hammer toe deformity, particularly of the 5th toe. Reactive adventitial bursas often develop beneath corns, which may become inflamed.
Causes
The muscles of each toe work in pairs. When the toe muscles get out of balance, a hammer toe can form. Muscle imbalance puts a lot of pressure on the toe's tendons and joints. This pressure forces the toe into a hammerhead shape. How do the toe muscles get out of balance? There are three main reasons. Your genes, you may have inherited a tendency to develop hammer toes because your foot is slightly unstable - such as a flat foot. But high-arched feet can also get hammer toes. Arthritis. Injury to the toe: ill-fitting shoes are the main culprits of this cause. If shoes are too tight, too short, or too pointy, they push the toes out of balance. Pointy, high-heeled shoes put particularly severe pressure on the toes.
Symptoms
Hammertoe and mallet toe feature an abnormal bend in the joints of one or more of your toes. Moving the affected toe may be difficult or painful. Corns and calluses can result from the toe rubbing against the inside of your shoes. See your doctor if you have persistent foot pain that affects your ability to walk properly.
Diagnosis
Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.
Non Surgical Treatment
Your doctor may prescribe some toe exercises that you can do at home to stretch and strengthen the muscles. For example, you can gently stretch the toes manually. You can use your toes to pick things up off the floor. While you watch television or read, you can put a towel flat under your feet and use your toes to crumple it. Finally, your doctor may recommend that you use commercially available straps, cushions or nonmedicated corn pads to relieve symptoms. If you have diabetes, poor circulation or a lack of feeling in your feet, talk to your doctor before attempting any self-treatment.
Surgical Treatment
Curative treatment of hammertoes varies depending upon the severity of the deformity. When the hammertoe Hammer toe is flexible, a simple tendon release in the toe works well. The recovery is rapid often requiring nothing more that a single stitch and a Band-Aid. Of course if several toes are done at the same time, the recovery make take a bit longer.
How To Treat Foot Bunions
Overview
The term hallux valgus actually describes what happens to the big toe. Hallux is the medical term for big toe, and valgus is an anatomic term that means the deformity goes in a direction away from the midline of the body. So in hallux valgus the big toe begins to point towards the outside of the foot. As this condition worsens, other changes occur in the foot that increase the problem. One of those changes is that the bone just above the big toe, the first metatarsal, usually develops too much of an angle in the other direction. This condition is called metatarsus primus varus. Metatarsus primus means first metatarsal, and varus is the medical term that means the deformity goes in a direction towards the midline of the body. This creates a situation where the first metatarsal and the big toe now form an angle with the point sticking out at the inside edge of the ball of the foot. The bunion that develops is actually a response to the pressure from the shoe on the point of this angle. At first the bump is made up of irritated, swollen tissue that is constantly caught between the shoe and the bone beneath the skin. As time goes on, the constant pressure may cause the bone to thicken as well, creating an even larger lump to rub against the shoe.
Causes
There is no single cause of hallux valgus. It most commonly runs in families but may skip generations. High heel, pointed toe shoes are not the primary cause of the hallux valgus but they do cause it to be painful. Pressure from shoes may cause bunions, corns and calluses to develop where there is hallux valgus deformity.
Symptoms
Bunions are readily apparent, you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the Podiatrist may take x-rays to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. There is no clear-cut way to predict how fast a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.
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. 
Surgical Treatment
Surgical techniques can now not only move the wayward bones into proper alignment but also slide the first metatarsal downwards so that its head is pushed into a normal position. In its proper position, the metatarsal bone can help prevent the over-pronation that caused the formation of the bunion. Combined with proper orthotic devices, this type of surgery has provided excellent results.
Prevention
Wear insoles and well-fitting shoes to help slow down the progression of bunions and alleviate discomfort. Cushioning can also help alleviate discomfort. Consider wearing shoes with a wide toe box so they don't crowd your toes. Children can also develop bunions and should wear properly fitting shoes as their feet are still developing.
The Facts About Over-Pronation Of The Feet
Overview
Pronation is the term used to describe a natural movement of the foot when walking. When the gait is normal, the heel strikes the ground first. As weight is transferred forward, the arch of the foot flattens and the foot rolls slightly inwards. Body weight is then placed on the ball of the foot and toes, and the foot straightens and turns outwards as the toes push off. Overpronation occurs when the foot rolls inward too far. This causes all the muscles and tendons of the lower leg to twist excessively. Regular overpronation is believed to contribute to the development of many knee, lower leg and foot injuries such as heel spurs, plantar fasciitis, tendinitis and bunions. It is thought that as much as 60% of the population may overpronate.
Causes
Generally fallen arches are a condition inherited from one or both parents. In addition, age, obesity, and pregnancy cause our arches to collapse. Being in a job that requires long hours of standing and/or walking (e.g. teaching, retail, hospitality, building etc) contributes to this condition, especially when standing on hard surfaces like concrete floors. Last, but not least unsupportive footwear makes our feet roll in more than they should.
Symptoms
Overpronation can lead to injuries and pain in the foot, ankle, knee, or hip. Overpronation puts extra stress on all the bones in the feet. The repeated stress on the knees, shins, thighs, and pelvis puts additional stress on the muscles, tendons, and ligaments of the lower leg. This can put the knee, hip, and back out of alignment, and it can become very painful.
Diagnosis
One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).
Non Surgical Treatment
Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.
Prevention
Many of the prevention methods for overpronation orthotics, for example, can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.
Pronation is the term used to describe a natural movement of the foot when walking. When the gait is normal, the heel strikes the ground first. As weight is transferred forward, the arch of the foot flattens and the foot rolls slightly inwards. Body weight is then placed on the ball of the foot and toes, and the foot straightens and turns outwards as the toes push off. Overpronation occurs when the foot rolls inward too far. This causes all the muscles and tendons of the lower leg to twist excessively. Regular overpronation is believed to contribute to the development of many knee, lower leg and foot injuries such as heel spurs, plantar fasciitis, tendinitis and bunions. It is thought that as much as 60% of the population may overpronate.
Causes
Generally fallen arches are a condition inherited from one or both parents. In addition, age, obesity, and pregnancy cause our arches to collapse. Being in a job that requires long hours of standing and/or walking (e.g. teaching, retail, hospitality, building etc) contributes to this condition, especially when standing on hard surfaces like concrete floors. Last, but not least unsupportive footwear makes our feet roll in more than they should.
Symptoms
Overpronation can lead to injuries and pain in the foot, ankle, knee, or hip. Overpronation puts extra stress on all the bones in the feet. The repeated stress on the knees, shins, thighs, and pelvis puts additional stress on the muscles, tendons, and ligaments of the lower leg. This can put the knee, hip, and back out of alignment, and it can become very painful.
Diagnosis
One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).
Non Surgical Treatment
Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.
Prevention
Many of the prevention methods for overpronation orthotics, for example, can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.
Can I Take Care Of Calcaneal Apophysitis At Home ?
Overview
Sever's disease (calcaneal apophysitis) is a common cause of heel pain, particularly in physically active young people who are about to begin puberty. The cause is uncertain, but it is thought that the long calf bones of the leg grow faster than the surrounding muscle and soft tissue, causing the Achilles tendon to pull uncomfortably tight.
Causes
Contraction of the calf muscles along with the rapid growth of the leg bone (tibia), decreases ankle motion and increases strain on the heel area. This puts strain on the Achilles tendon. Injury results from repetitive pulling through the heel bone by the Achilles and the traction forces from the plantar fascia.
Symptoms
Symptoms include heel pain related to sports activities and worsen after those sport and exercise activities. However, some children who are not in a sport may also get this if they are physically active. If you notice that your child is ?walking on their toes? this is a sign of possible heel pain. The pain is usually on the back of the heel, the sides of the heel, the bottom of the heel, or a combination of all of these. We typically don't see swelling with this, however if pressure is applied to the sides of the heel pain may be reported. Sometimes the pain is so bad the child will have to limp, or take a break from sports activity either for a few days or few months.
Diagnosis
Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
The doctor will talk with you about the best treatment plan for your child. As instructed, your child will Ice the heel 3-4 times a day for 15-20 minutes at a time. Use an ice pack or bag of frozen peas, or something similar. Never put ice directly on your child's skin. A thin cloth or towel should be between your child?s skin and the ice pack. Take anti-inflammatory medication, such as ibuprofen, as directed. Decrease the amount of running and jumping he or she does. Stretch the heels and calves, as instructed by the doctor. Regular stretching can help prevent Sever?s from coming back. Use a ?heel cup? or a cushioned shoe insert that takes pressure off the heel. In some cases, a cast is placed on the foot and worn for several weeks.
Prevention
To reduce the risk of heel pain or sore heels from Sever?s Disease. Only wear properly fitting shoes. A lace up shoe with a firm heel counter. Stretch calf and foot before exercising or playing sports. Properly taping the foot provides excellent protection and immediate pain relief. Wear shoe inserts or an over-the-counter orthotic. If the problem persists, consult your foot doctor.
Sever's disease (calcaneal apophysitis) is a common cause of heel pain, particularly in physically active young people who are about to begin puberty. The cause is uncertain, but it is thought that the long calf bones of the leg grow faster than the surrounding muscle and soft tissue, causing the Achilles tendon to pull uncomfortably tight.
Causes
Contraction of the calf muscles along with the rapid growth of the leg bone (tibia), decreases ankle motion and increases strain on the heel area. This puts strain on the Achilles tendon. Injury results from repetitive pulling through the heel bone by the Achilles and the traction forces from the plantar fascia.
Symptoms
Symptoms include heel pain related to sports activities and worsen after those sport and exercise activities. However, some children who are not in a sport may also get this if they are physically active. If you notice that your child is ?walking on their toes? this is a sign of possible heel pain. The pain is usually on the back of the heel, the sides of the heel, the bottom of the heel, or a combination of all of these. We typically don't see swelling with this, however if pressure is applied to the sides of the heel pain may be reported. Sometimes the pain is so bad the child will have to limp, or take a break from sports activity either for a few days or few months.
Diagnosis
Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
The doctor will talk with you about the best treatment plan for your child. As instructed, your child will Ice the heel 3-4 times a day for 15-20 minutes at a time. Use an ice pack or bag of frozen peas, or something similar. Never put ice directly on your child's skin. A thin cloth or towel should be between your child?s skin and the ice pack. Take anti-inflammatory medication, such as ibuprofen, as directed. Decrease the amount of running and jumping he or she does. Stretch the heels and calves, as instructed by the doctor. Regular stretching can help prevent Sever?s from coming back. Use a ?heel cup? or a cushioned shoe insert that takes pressure off the heel. In some cases, a cast is placed on the foot and worn for several weeks.
Prevention
To reduce the risk of heel pain or sore heels from Sever?s Disease. Only wear properly fitting shoes. A lace up shoe with a firm heel counter. Stretch calf and foot before exercising or playing sports. Properly taping the foot provides excellent protection and immediate pain relief. Wear shoe inserts or an over-the-counter orthotic. If the problem persists, consult your foot doctor.
Will Adult Aquired Flat Feet Need To Have Surgical Teatment ?
Overview
Adult-Acquired Flat Foot Deformity (AAFFD) is most commonly caused by a progressive degeneration of the tendon (tibialis posterior) that supports the arch of the foot. As the tendon ages or is subjected to repetitive trauma, it stretches out over time, the natural arch of the foot becomes less pronounced and the foot gradually flattens out. Although it is uncertain why this occurs, the problem is seen equally among men and women - at an increasing frequency with age. Occasionally, a patient will experience a traumatic form of the condition as a result of a fall from a height or abnormal landing during aerial sports such as gymnastics or basketball. 
Causes
There are numerous causes of acquired Adult Flatfoot, including, trauma, fracture, dislocation, tendon rupture/partial rupture or inflammation of the tendons, tarsal coalition, arthritis, neuroarthropathy and neurologic weakness. The most common cause of acquired Adult Flatfoot is due to overuse of a tendon on the inside of the ankle called the posterior tibial tendon. This is classed as - posterior tibial tendon dysfunction. What are the causes of Adult Acquired flat foot? Trauma, Fracture or dislocation. Tendon rupture, partial tear or inflammation. Tarsal Coalition. Arthritis. Neuroarthropathy. Neurological weakness.
Symptoms
Your feet tire easily or become painful with prolonged standing. It's difficult to move your heel or midfoot around, or to stand on your toes. Your foot aches, particularly in the heel or arch area, with swelling along the inner side. Pain in your feet reduces your ability to participate in sports. You've been diagnosed with rheumatoid arthritis; about half of all people with rheumatoid arthritis will develop a progressive flatfoot deformity.
Diagnosis
Posterior Tibial Tendon Dysfunction is diagnosed with careful clinical observation of the patient?s gait (walking), range of motion testing for the foot and ankle joints, and diagnostic imaging. People with flatfoot deformity walk with the heel angled outward, also called over-pronation. Although it is normal for the arch to impact the ground for shock absorption, people with PTTD have an arch that fully collapses to the ground and does not reform an arch during the entire gait period. After evaluating the ambulation pattern, the foot and ankle range of motion should be tested. Usually the affected foot will have decreased motion to the ankle joint and the hindfoot. Muscle strength may also be weaker as well. An easy test to perform for PTTD is the single heel raise where the patient is asked to raise up on the ball of his or her effected foot. A normal foot type can lift up on the toes without pain and the heel will invert slightly once the person has fully raised the heel up during the test. In early phases of PTTD the patient may be able to lift up the heel but the heel will not invert. An elongated or torn posterior tibial tendon, which is a mid to late finding of PTTD, will prohibit the patient from fully rising up on the heel and will cause intense pain to the arch. Finally diagnostic imaging, although used alone cannot diagnose PTTD, can provide additional information for an accurate diagnosis of flatfoot deformity. Xrays of the foot can show the practitioner important angular relationships of the hindfoot and forefoot which help diagnose flatfoot deformity. Most of the time, an MRI is not needed to diagnose PTTD but is a tool that should be considered in advanced cases of flatfoot deformity. If a partial tear of the posterior tibial tendon is of concern, then an MRI can show the anatomic location of the tear and the extensiveness of the injury.
Non surgical Treatment
Treatment will vary depending on the degree of your symptoms. Generally, we would use a combination of rest, immobilization, orthotics, braces, and physical therapy to start. The goal is to keep swelling and inflammation under control and limit the stress on the tendon while it heals. Avoidance of activities that stress the tendon will be necessary. Once the tendon heals and you resume activity, physical therapy will further strengthen the injured tendon and help restore flexibility. Surgery may be necessary if the tendon is torn or does not respond to these conservative treatment methods. Your posterior tibial tendon is vital for normal walking. When it is injured in any way, you risk losing independence and mobility. Keep your foot health a top priority and address any pain or problems quickly. Even minor symptoms could progress into chronic problems, so don?t ignore your foot pain. 
Surgical Treatment
If conservative treatment fails to provide relief of pain and disability then surgery is considered. Numerous factors determine whether a patient is a surgical candidate. They include age, obesity, diabetes, vascular status, and the ability to be compliant with post-operative care. Surgery usually requires a prolonged period of nonweightbearing immobilization. Total recovery ranges from 3 months to one year. Clinical, x-ray, and MRI examination are all used to select the appropriate surgical procedure.
Everything You Want To Know Concerning Pain In The Arch
Overview
A fallen arch or flatfoot is known medically as pes planus. The foot loses the gently curving arch on the inner side of the sole, just in front of the heel. If this arch is flattened only when standing and returns when the foot is lifted off the ground, the condition is called flexible pes planus or flexible flatfoot. If the arch disappears in both foot positions, standing and elevated, the condition is called rigid pes planus or rigid flatfoot.
Causes
The more common specific causes of arch pain (arch strain) tend to be Plantar fasciitis (strain of the plantar fascia - a strong ligament that supports the arch. Foot strain from a pronated / flat foot or high arched foot. Osteoarthritis of the joints in the mid-foot. Poor or improper footwear (high heels or athletic shotes). Tarsal tunnel syndrome (a pinched nerve at the ankle that refers to pain in the arch). There are two arches in each foot. The longitudinal arch runs the length of your foot, and the transverse arch runs across the width of your foot. The arches are made up of ligaments, which keep the bones of your foot in place. Arch pain can occur in one or both arches, but occurs most commonly in the longitudinal arch. If this arch pain (arch strain) 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 and seek a proper consultation.
Symptoms
Arch pain symptoms could include any of the following, a dull, constant ache if the ligaments have been stretched, swelling or tenderness in the foot, redness or bruising in the event of a more serious injury, difficulty putting weight on the foot, sharp pain when the foot is turned or manipulated, tenderness when pressure is applied. Because the arch of the foot is such a complex structure, arch pain could be an indicator of several different types of injuries. Chronic illnesses such as arthritis could also cause arch pain, and depending on the cause or source of your pain, you may experience discomfort in a variety of different areas. Ask a doctor if you believe you may have injured your foot arch.
Diagnosis
A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to "raise up on the tip toes" of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet, the symptomatic and asymptomatic - will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.
Non Surgical Treatment
Treatment isn't usually needed for flat feet because the condition doesn't usually cause any significant problems. Aching feet can often be relieved by wearing supportive shoes that fit properly. You may need to wear shoes that are wider than normal. If your feet overpronate, you may need to wear a special insole (an orthotic) inside your shoes to stop your feet rolling inwards when you walk or run. These will usually need to be made and fitted by a podiatrist.
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
Foot and ankle injuries are common in sports, especially running, tennis and soccer. But sports enthusiasts can decrease the risk of injury by taking some precautions. Lightly stretch or better yet, do a slow jog for two to three minutes to warm up the muscles. Don't force the stretch with a "bouncing motion." The amount of time spent on the activity should be increased gradually over a period of weeks to build both muscle strength and mobility. Cross training by participating in different activities can help build the muscles. People whose feet pronate or who have low arches should choose shoes that provide support in both the front of the shoe and under the arch. The heel and heel counter (back of the shoe) should be very stable. Those with a stiffer foot or high arches should choose shoes with more cushion and a softer platform. Use sport-specific shoes. Cross training shoes are an overall good choice; however, it is best to use shoes designed for the sport.
Stretching Exercises
Calf Stretching in Bed. As you may already know, the first few steps out of bed in the morning can be the worst of the day. Those first few steps can be enough to reaggravate your condition putting you into a cycle of inflammation and pain. The best way to help break that cycle is to stretch your calf before taking those first steps in the morning. When the muscles in your calf are tight, they pull on the heel bone, making your plantar fascia very taut and prone to injury. To help loosen those muscles, take a towel or belt and loop it around the ball of your foot. Keeping your leg straight, gently pull towards your body until you feel a stretch in the lower part of your leg. Hold that for 30 seconds and repeat up to 5 times before taking your first step out of bed. Plantar Fascia Stretching. Loosening up the tissues that are irritated probably makes sense to you, but you may not know how to do so. Luckily, there?s a very simple way. All you have to do is pull your toes up with your hand until you feel a stretch along the ball of your foot. You may feel the stretch anywhere from the ball of your foot to your heel. Holding this position for 30 seconds a few times can make a world of difference in your pain levels. Calf Stretching. I know, it probably seems like overkill, but stretching out the muscles in the lower leg is an integral step to recovery. There are two main muscles in the lower leg that attach to the heel, so we?ll work on stretching them both out. Stand against a wall and slide one leg back, pushing the heel down towards the floor (first picture). When you feel a stretch in the lower part of your leg, hold it for 30 seconds. After those 30 seconds are up, bend your knees until a deeper stretch is felt a bit lower in the leg (second photo). Again, hold this stretch for 30 seconds and repeat this until you?ve done it 3 times on each leg. Who doesn?t love a good massage? I suppose you could pay for someone to rub out the tissues in the bottom of your foot, but if you?re looking for a cheaper alternative, look no further than the humble tennis ball. Placing a tennis ball on the ground and gently rolling it under foot for a few minutes can help loosen up your plantar fascia, making it much less likely to become irritated. Put enough pressure on the ball to get a deep massage. You may feel some soreness, but back off if you feel any pain.Tennis Ball Massage While using the tennis ball is great for keeping things loose, sometimes it?s worth doing some icing at the same time for some inflammation control. Freezing a water bottle and rolling it under your foot for 10 minutes at the end of the day can be a very effective way to keep inflammation in check while staying loose. It might not be the most comfortable thing in the world, but ?Brrr? is better than ?Ouch? any day. One thing to keep in mind is that while these tips have been proven to work, they?re not an instant fix. It can take a few weeks of consistency with them before your pain levels begin to change. If you?re not seeing any improvement after making an honest effort, it may be time to look into some different treatment methods with your doctor such as formal PT, orthotics, a weight-loss plan, or others.
A fallen arch or flatfoot is known medically as pes planus. The foot loses the gently curving arch on the inner side of the sole, just in front of the heel. If this arch is flattened only when standing and returns when the foot is lifted off the ground, the condition is called flexible pes planus or flexible flatfoot. If the arch disappears in both foot positions, standing and elevated, the condition is called rigid pes planus or rigid flatfoot.
Causes
The more common specific causes of arch pain (arch strain) tend to be Plantar fasciitis (strain of the plantar fascia - a strong ligament that supports the arch. Foot strain from a pronated / flat foot or high arched foot. Osteoarthritis of the joints in the mid-foot. Poor or improper footwear (high heels or athletic shotes). Tarsal tunnel syndrome (a pinched nerve at the ankle that refers to pain in the arch). There are two arches in each foot. The longitudinal arch runs the length of your foot, and the transverse arch runs across the width of your foot. The arches are made up of ligaments, which keep the bones of your foot in place. Arch pain can occur in one or both arches, but occurs most commonly in the longitudinal arch. If this arch pain (arch strain) 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 and seek a proper consultation.
Symptoms
Arch pain symptoms could include any of the following, a dull, constant ache if the ligaments have been stretched, swelling or tenderness in the foot, redness or bruising in the event of a more serious injury, difficulty putting weight on the foot, sharp pain when the foot is turned or manipulated, tenderness when pressure is applied. Because the arch of the foot is such a complex structure, arch pain could be an indicator of several different types of injuries. Chronic illnesses such as arthritis could also cause arch pain, and depending on the cause or source of your pain, you may experience discomfort in a variety of different areas. Ask a doctor if you believe you may have injured your foot arch.
Diagnosis
A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to "raise up on the tip toes" of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet, the symptomatic and asymptomatic - will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.
Non Surgical Treatment
Treatment isn't usually needed for flat feet because the condition doesn't usually cause any significant problems. Aching feet can often be relieved by wearing supportive shoes that fit properly. You may need to wear shoes that are wider than normal. If your feet overpronate, you may need to wear a special insole (an orthotic) inside your shoes to stop your feet rolling inwards when you walk or run. These will usually need to be made and fitted by a podiatrist.
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
Foot and ankle injuries are common in sports, especially running, tennis and soccer. But sports enthusiasts can decrease the risk of injury by taking some precautions. Lightly stretch or better yet, do a slow jog for two to three minutes to warm up the muscles. Don't force the stretch with a "bouncing motion." The amount of time spent on the activity should be increased gradually over a period of weeks to build both muscle strength and mobility. Cross training by participating in different activities can help build the muscles. People whose feet pronate or who have low arches should choose shoes that provide support in both the front of the shoe and under the arch. The heel and heel counter (back of the shoe) should be very stable. Those with a stiffer foot or high arches should choose shoes with more cushion and a softer platform. Use sport-specific shoes. Cross training shoes are an overall good choice; however, it is best to use shoes designed for the sport.
Stretching Exercises
Calf Stretching in Bed. As you may already know, the first few steps out of bed in the morning can be the worst of the day. Those first few steps can be enough to reaggravate your condition putting you into a cycle of inflammation and pain. The best way to help break that cycle is to stretch your calf before taking those first steps in the morning. When the muscles in your calf are tight, they pull on the heel bone, making your plantar fascia very taut and prone to injury. To help loosen those muscles, take a towel or belt and loop it around the ball of your foot. Keeping your leg straight, gently pull towards your body until you feel a stretch in the lower part of your leg. Hold that for 30 seconds and repeat up to 5 times before taking your first step out of bed. Plantar Fascia Stretching. Loosening up the tissues that are irritated probably makes sense to you, but you may not know how to do so. Luckily, there?s a very simple way. All you have to do is pull your toes up with your hand until you feel a stretch along the ball of your foot. You may feel the stretch anywhere from the ball of your foot to your heel. Holding this position for 30 seconds a few times can make a world of difference in your pain levels. Calf Stretching. I know, it probably seems like overkill, but stretching out the muscles in the lower leg is an integral step to recovery. There are two main muscles in the lower leg that attach to the heel, so we?ll work on stretching them both out. Stand against a wall and slide one leg back, pushing the heel down towards the floor (first picture). When you feel a stretch in the lower part of your leg, hold it for 30 seconds. After those 30 seconds are up, bend your knees until a deeper stretch is felt a bit lower in the leg (second photo). Again, hold this stretch for 30 seconds and repeat this until you?ve done it 3 times on each leg. Who doesn?t love a good massage? I suppose you could pay for someone to rub out the tissues in the bottom of your foot, but if you?re looking for a cheaper alternative, look no further than the humble tennis ball. Placing a tennis ball on the ground and gently rolling it under foot for a few minutes can help loosen up your plantar fascia, making it much less likely to become irritated. Put enough pressure on the ball to get a deep massage. You may feel some soreness, but back off if you feel any pain.Tennis Ball Massage While using the tennis ball is great for keeping things loose, sometimes it?s worth doing some icing at the same time for some inflammation control. Freezing a water bottle and rolling it under your foot for 10 minutes at the end of the day can be a very effective way to keep inflammation in check while staying loose. It might not be the most comfortable thing in the world, but ?Brrr? is better than ?Ouch? any day. One thing to keep in mind is that while these tips have been proven to work, they?re not an instant fix. It can take a few weeks of consistency with them before your pain levels begin to change. If you?re not seeing any improvement after making an honest effort, it may be time to look into some different treatment methods with your doctor such as formal PT, orthotics, a weight-loss plan, or others.
