What Exactly Are Hallux Valgus?


Overview
Bunion Pain
A bunion, (medical term: hallux abductovalgus) is a condition resulting in boney prominence at the inside of the foot at the big toe joint. A bunion occurs when the big toe begins to deviate toward the second toe. The biggest misconception is that bunions occur from an overgrowth of bone. While that may be true in very few people, the bunion really represents a dislocation of the big toe joint as it bulges against the skin.

Causes
While there isn?t really one exact cause of bunions, podiatric physicians tend to agree that a bunion is formed when the normal mechanics of the foot are disrupted. This can happen in any number of ways. Abnormality in foot function or foot mechanics. In general, this means a pronated foot (one with an excessive rolling to the outside when the patient is walking, running or doing any kind of activity), a flat foot or low-arched foot. This is probably the most common cause, and it?s where the idea of heredity comes into play. Foot mechanics, and problems with them, tend to run in families. The good news is that there are orthoses and corrective shoes that can effectively alleviate these and other disturbances to foot mechanics, before they contribute to bunions. A podiatric physician can prescribe the best corrective footwear and shoe inserts for all activities, work, exercise, play, walking, shopping and more, based on an analysis of the patient?s foot and his or her lifestyle.
SymptomsBunions are an often painful condition that may become even more painful as extra bone and a fluid-filled sac grow at the base of your big toe. Some of the most frequently experienced signs and symptoms associated with bunions, besides pain, include redness in your affected area. Blistering over your bunion. Callus formation around your bunion. Bursitis. Nerve damage (numbness and/or sharp pains) in your involved area. Bunions may also cause pain within and below your first metatarsophalangeal, or MTP, joint. Your bunion may become further dislocated and unstable as it progresses and may overload your adjacent joints.

Diagnosis
Physical examination typically reveals a prominence on the inside (medial) aspect of the forefoot. This represents the bony prominence associated with the great toe joint ( the medial aspect of the first metatarsal head). The great toe is deviated to the outside (laterally) and often rotated slightly. This produces uncovering of the joint at the base of the big toe (first metatarsophalangeal joint subluxation). In mild and moderate bunions, this joint may be repositioned back to a neutral position (reduced) on physical examination. With increased deformity or arthritic changes in the first MTP joint, this joint cannot be fully reduced. Patients may also have a callus at the base of their second toe under their second metatarsal head in the sole of the forefoot. Bunions are often associated with a long second toe.

Non Surgical Treatment
You can buy orthotics over the counter from pharmacies, or they can be custom-made by a podiatrist to fit your feet. Whether you need to buy an over-the-counter orthotic or have one specially made will depend on your individual circumstances and the severity of your bunion. You can also use special bunion splints, worn over the top of your foot and your big toe to help straighten its alignment. Splints are available for both daytime and night-time use. However, there's little evidence that splints are effective. Toe spacers are also available, which can help reduce the pain caused by bunions. However, toe spacers or orthotics may be of limited use because they often compete with the bunion for the already limited space in the shoe. If your toe joint is painful and swollen, applying an ice pack to the affected area several times a day can help to relieve the pain and inflammation. Never apply ice directly to your skin. Wrap it in a cloth or tea towel. A bag of frozen vegetables makes a good ice pack. It's recommended that you wear flat or low-heeled, wide-fitting shoes if you have a bunion. Shoes made from soft leather are ideal because they'll relieve any pressure on the bunion. Avoid narrow or slip-on shoes. High heels can also make your bunion worse by putting excessive pressure on your toes.
Bunion Pain

Surgical Treatment
Bunions can cause pain and difficulty wearing certain shoes. When simple treatments don't relieve your symptoms, surgery may be considered for treatment of the bunion. What are the signs that surgery may be the right treatment for your bunion? In general, surgery is recommended only when pain from the bunion prevents a patient from wearing normal shoes. There is a common misconception that surgical treatments for a bunion are better and quicker than non-surgical treatments. Unfortunately, patients who rush into surgery may have unrealistic expectations, and may be unsatisfied with surgery.

The Treatments And Causes Of Overpronation Of The Feet

Overview


Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person's arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, potentially causing severe discomfort and leading to other foot problems.Over Pronation


Causes


During our development, the muscles, ligaments, and other soft tissue structures that hold our bones together at the joints become looser than normal. When the bones are not held tightly in place, the joints are not aligned properly, and the foot gradually turns outward at the ankle, causing the inner ankle bone to appear more prominent. The foot moves in this direction because it is the path of least resistance. It is more difficult for the foot to move in the opposite direction (this is called supination). As we develop, the muscles and ligaments accommodate to this abnormal alignment. By the time growth is complete, the pronated foot is: abnormally flexible, flat, and its outer border appears raised so that as you step down you do not come down equally across the entire foot; instead, you come down mostly on the inner border of the foot. Normal aging will produce further laxity of our muscles that causes the pronation to become gradually worse.


Symptoms


Eventually, over-pronation can lead to a full list of maladies including flat feet, plantar fasciitis, plantar fibroma, neuromas, heel spurs, shin splints, ankle sprains, bunions, hammertoes, calluses, and pain in the arches, knee, hip and lower back. But it doesn?t have to go that far, because there are steps we can take to correct the over-pronation. In the vast majority of cases, we?ll prescribe custom foot orthotics, which will realign your ankles, redistribute the weight, support the arch and reduce the twisting. Many orthotics will fit snugly into your normal shoes. Although we?ll also take a look at the type of shoes you wear to see if they are contributing to the problem.


Diagnosis


To easily get an idea of whether a person overpronates, look at the position and condition of certain structures in the feet and ankles when he/she stands still. When performing weight-bearing activities like walking or running, muscles and other soft tissue structures work to control gravity's effect and ground reaction forces to the joints. If the muscles of the leg, pelvis, and feet are working correctly, then the joints in these areas such as the knees, hips, and ankles will experience less stress. However, if the muscles and other soft tissues are not working efficiently, then structural changes and clues in the feet are visible and indicate habitual overpronation.Over Pronation


Non Surgical Treatment


Side Step with Opposite Reach. This exercise is designed to load the "bungee cord system" of the gluteal muscle and its opposite, latissimus dorsi muscle to keep the foot from overpronating. Because the opposite arm swings across the front leg when walking, this exercise creates tension in the muscles all the way from the front foot, across the back of the hips and back, to the fingers of the opposite hand. Movement Directions. Stand with left foot on top of the dome of the BT. (Note: For added balance, the right foot can tap on the ground, if needed). Reach right leg out to the side of the BT, and tap the ground while squatting down on the left side and reaching right arm across the left knee. Push down with left big toe while squatting. This activates the arch of the left foot and strengthens all the stabilizing muscles on the left side of the lower body. Return to starting position. Perform 8 to 10 repetitions on each leg.


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.

Will Severs Disease Always Call For Surgical Treatment?

Overview


Sever's disease is an overuse syndrome involving an immature part of the skeleton. Pain goes away when the overuse is over, or when the growing is done. Hence, the disease is self-limited, in that the pain goes away eventually when growth in the heel bone is complete at about age 13. Even if the child is hurting, as long as he can tolerate it, he may continue to take part in sports. No long term disability is expected from this problem.


Causes


The condition generally occurs in active children at early adolescence during rapid growth periods as the heel bone can grow faster than the leg muscles causing them to become tight and overstretched. Sever?s disease most often caused by inadequate footwear, playing sport on hard surfaces, calf tightness and biomechanical problems.


Symptoms


Severs causes swelling, pain and tenderness over the back of the heel. Your child may walk with a limp. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. The swelling increases and is painful when touched or knocked. It commonly affects boys who are having a growth spurt during their pre-teen or teenage years. One or both knees may be affected.


Diagnosis


Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.


Non Surgical Treatment


Most patients with Sever?s Disease can be treated with a self-guided home exercise program. Your healthcare provider will discuss with you if a prescription for formal physical therapy is indicated instead of a self-directed home or school exercise program. Rest (protection of the heel). Ice (Ice 20 minutes at a time, 2-3 times a day). Gel heel pads / inserts. Anti-inflammatory medication. Well cushioned pair of shoes. Brace (Cheetah) *Generally given for those who cannot wear shoes during their sport. Low impact aerobic training such as walking, riding a bike, elliptical or swimming. Home exercise program focusing on increasing the flexibility of the heel cord and calf muscle.


Prevention


Perform a well rounded dynamic warm up before activity. Perform a good static stretching routine after activity. Increase core strength. Perform exercises that emphasize active lengthening of the calf muscles. Use proper footwear. Avoid excessive running or jumping on hard surfaces like concrete by using better surfaces such as asphalt, gymnasium floors or grass.

The Treatments And Causes

Overview


This condition is a progressive collapse of the tendons and ligaments that hold up the foot?s arch. This condition most commonly affects women. It typically occurs in only one foot, but in some cases, both feet are afflicted.Acquired Flat Feet






Causes


The cause of posterior tibial tendon insufficiency is not completely understood. The condition commonly does not start from one acute trauma but is a process of gradual degeneration of the soft tissues supporting the medial (inner) side of the foot. It is most often associated with a foot that started out somewhat flat or pronated (rolled inward). This type of foot places more stress on the medial soft tissue structures, which include the posterior tibial tendon and ligaments on the inner side of the foot. Children nearly fully grown can end up with flat feet, the majority of which are no problem. However, if the deformity is severe enough it can cause significant functional limitations at that age and later on if soft tissue failure occurs. Also, young adults with normally aligned feet can acutely injure their posterior tibial tendon from a trauma and not develop deformity. The degenerative condition in patients beyond their twenties is different from the acute injuries in young patients or adolescent deformities, where progression of deformity is likely to occur.






Symptoms


Symptoms shift around a bit, depending on what stage of PTTD you?re in. For instance, you?re likely to start off with tendonitis, or inflammation of the posterior tibial tendon. This will make the area around the inside of your ankle and possibly into your arch swollen, reddened, warm to the touch, and painful. Inflammation may actually last throughout the stages of PTTD. The ankle will also begin to roll towards the inside of the foot (pronate), your heel may tilt, and you may experience some pain in your leg (e.g. shin splints). As the condition progresses, the toes and foot begin to turn outward, so that when you look at your foot from the back (or have a friend look for you, because-hey-that can be kind of a difficult


maneuver to pull off) more toes than usual will be visible on the outside (i.e. the side with the pinky toe). At this stage, the foot?s still going to be flexible, although it will likely have flattened somewhat due to the lack of support from the posterior tibial tendon. You may also find it difficult to stand on your toes. Finally, you may reach a stage in which your feet are inflexibly flat. At this point, you may experience pain below your ankle on the outside of your foot, and you might even develop arthritis in the ankle.






Diagnosis


Looking at the patient when they stand will usually demonstrate a flatfoot deformity (marked flattening of the medial longitudinal arch). The front part of the foot (forefoot) is often splayed out to the side. This leads to the presence of a ?too many toes? sign. This sign is present when the toes can be seen from directly behind the patient. The gait is often somewhat flatfooted as the patient has the dysfunctional posterior tibial tendon can no longer stabilize the arch of the foot. The physician?s touch will often demonstrate tenderness and sometimes swelling over the inside of the ankle just below the bony prominence (the medial malleolus). There may also be pain in the outside aspect of the ankle. This pain originates from impingement or compression of two tendons between the outside ankle bone (fibula) and the heel bone (calcaneus) when the patient is standing.






Non surgical Treatment


Because of the progressive nature of PTTD, early treatment is critical. If treated soon enough, symptoms may resolve without the need for surgery and progression of the condition can be stopped. If left untreated, PTTD may create an extremely flat foot, painful arthritis in the foot and ankle, and will limit your ability to walk, run, and other activities. Your podiatrist may recommend one or more of these non-surgical treatments to manage your PTTD. 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. Immobilization. A short-leg cast or boot may be worn to immobilize the foot and allow the tendon to heal. Physical therapy. Ultrasound therapy and stretching exercises may help rehabilitate the tendon and muscle following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may recommend changes in your footwear.


Adult Acquired Flat Foot






Surgical Treatment


A new type of surgery has been developed in which surgeons can re-construct the flat foot deformity and also the deltoid ligament using a tendon called the peroneus longus. A person is able to function fully without use of the peroneus longus but they can also be taken from deceased donors if needed. The new surgery was performed on four men and one woman. An improved alignment of the ankle was still evident nine years later, and all had good mobility 8 to 10 years after the surgery. None had developed arthritis.

What's The Main Cause Of Achilles Tendon Pain ?

Overview


Achilles TendonYour Achilles tendon is located at the back of your foot, just above your heel. It connects your heel to the two muscles of your calf and helps your foot push forward every time you take a step. If the tendon becomes swollen or irritated due to overuse, it can lead to the painful condition called Achilles tendonitis. If Achilles tendonitis goes untreated, it can become a chronic (ongoing) condition that makes just walking around almost impossible. Achilles tendonitis is a very common running injury. But it can also affect basketball players, dancers, or people who put a lot of repeated stress on their feet. It can be very painful.


Causes


The majority of Achilles tendon injuries are due to overuse injuries. Other factors that lead to Achilles tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics, a short Achilles tendon, direct trauma (injury) to the tendon, training errors and heel bone deformity. There is significant evidence that people with feet that role in excessively (over-pronate) are at greater risk for developing Achilles tendinitis. The increased pronation puts additional stress on the tendon, therefore, placing it at greater risk for injury.


Symptoms


The pain associated with Achilles tendonitis can come on gradually or be caused by some type of leg or foot trauma. The pain can be a shooting, burning, or a dull ache. You can experience the pain at either the insertion point on the back of the heel or upwards on the Achilles tendon within a few inches. Swelling is also common along the area with the pain. The onset of discomfort at the insertion can cause a bump to occur called a Haglund's deformities or Pump bump. This can be inflammation in the bursa sac that surrounds the insertion of the Achilles tendon, scar tissue from continuous tares of the tendon, or even some calcium buildup. In this situation the wearing of closed back shoes could irritate the bump. In the event of a rupture, which is rare, the foot will not be able to go through the final stage of push off causing instability. Finally, you may experience discomfort, even cramping in the calf muscle.


Diagnosis


If you think you have Achilles tendinitis, make an appointment to see your doctor. The doctor will ask you questions about your recent activity and look for signs. The foot not flexing when the calf muscle is pressed ( if Achilles ruptures or tears in half). Swelling on the back of the foot. Pain in the back of the foot. Limited range of motion in ankle. An X-ray or MRI scan can check for tendinitis.


Nonsurgical Treatment


The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naprosyn, can reduce pain and swelling. Physical therapy and the use of an orthosis (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have failed, surgery may be recommended to remove and repair the damaged tissue.


Achilles Tendonitis


Surgical Treatment


There are two types of Achilles repair surgery for tendonitis (inflammation of the Achilles Tendon), if nonsurgical treatments aren't effective. Gastrocnemius recession - The orthopaedic surgeon lengthens the calf muscles to reduce stress on your Achilles tendon. D?bridement and repair - During this procedure, the surgeon removes the damaged part of the Achilles tendon and repairs the remaining tendon with sutures or stitches. Debridement is done when the tendon has less than 50% damage.


Prevention


A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load compared to running without orthotics. This study indicates that foot orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,
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