September Articles 2014

Bunions

The term bunion refers to an enlargement of the base joint of the toe, the connection to the foot. This enlargement may be formed of swollen tissue or a bony growth, and is caused by the shifting of the bones in the big toe inward, toward the other toes of the foot. The area around the base of the big toe may become inflamed, red, and painful.

Genetic factors are important in the formation of bunions – people who get bunions are usually genetically predisposed to this bone displacement, and may cause its onset by wearing improperly fitting shoes, or by running or walking in a way that causes stress to the feet. Another common cause for bunions is wearing high heeled shoes. The weight of the body in these shoes pushes the toes into an unnatural position, possibly causing bone displacement.

A podiatrist who specializes in foot structure and bio-mechanics will be able to quickly diagnose bunions. Bunions must be distinguished from gout or arthritic conditions, so blood tests may be necessary. The podiatrist may order a radiological exam to provide an image of the bone structure. If the x-ray demonstrates an enlargement of the joint near the base of the toe and a shifting toward the smaller toes, this is indicative of a bunion.

Wearing wider shoes can remove the pressure on the bunion and reduce pain. High heeled shoes should be eliminated for a period of time as this type of shoe generally pushes the big toe outward toward the smaller toes. This may be enough to eliminate the pain associated with bunions; however, if pain persists, anti-inflammatory drugs may be prescribed. Severe pain may require an injection of steroids near the bunion. Orthotics for shoes may be prescribed which, by altering the pressure on the foot, can be helpful in reducing pain. These do not correct the problem, but by eliminating the pain, they can provide relief.

For cases that do not respond to these methods of treatment, surgery can be done to reposition the toe. A surgeon may do this by taking out a section of bone, or may rearrange the ligaments and tendons in the toe to help keep it properly aligned. It may be necessary even after surgery to wear more comfortable shoes that do not put undue pressure on the toe as the big toe can easily move back to its orientation toward the smaller toes.

Morton's Neuroma

Morton's neuroma is a painful foot condition that commonly affects the areas between the third and fourth toe and the ball of the foot. Other areas of the foot can also be susceptible to this condition. Morton’s neuroma is caused by an inflamed nerve in the foot that is being squeezed and aggravated by surrounding bones.  Women are more likely than men to have an occurrence of this foot condition. When a person has Morton's neuroma, it can feel as if they are walking on stones or marbles.

There are risk factors that can increase a person's chance of having Morton's neuroma. Ill-fitting high heels or shoes can add pressure to the toe or foot area. Jogging, running and any other sports that involve constant impact to the foot area can make a person more susceptible to this condition. If a person has flat feet, bunions or any other foot deformities, it can put them at a higher risk for developing Morton's neuroma.

There is no one major sign that indicates a person has Morton's neuroma, but rather certain symptoms to look for. A person who has burning in the ball of the foot or tingling and numbness in the toe areas are signs they may have Morton's neuroma. The pain increases greatly when wearing shoes or being active. There usually is little or no pain at night.

If a person suspects that they have this condition, they should visit their doctor. A physician will check for palpable masses between the bones of the foot. A doctor will also apply pressure to the foot or toe area to replicate the pain a person experiences when active. Range of motion tests and X-rays are other options a doctor may offer a patient to rule out other conditions or problems.

Treating Morton's neuroma can be as simple as changing the type of shoes a person wears. Wear wider shoes or flat shoes with a soft sole. Doing this may help reduce the pressure on the nerve that is aggravated. If necessary, a person can have a cortisone injection to help reduce swelling and pain in the foot area.

If these methods don't relieve the symptoms, consulting with an orthopedic surgeon should be the next option. During a consultation, a patient will find out about the treatment methods available for Morton's neuroma. A surgeon can release the tissue around the nerve that is causing this pain, or they can remove a small area of the nerve completely. There is a short recovery time for this type of surgery, and afterward, patients can return to their normal lifestyle.

What Are Ankle/Foot Orthotics?

Orthotics is a medical field concerned with the design, manufacture and use of aids used to support weak limbs or direct the proper function of limbs, in this case the foot and ankle. Ankle-foot orthotics, or AFOs, are braces worn at the ankle that encompass some or all of the foot. Diseases that affect the musculature or weaken the affected area require AFOs to strengthen the muscles or train in the proper direction. Tight muscles that need to be lengthened and loosened also benefit from AFOs.

When we think of diseases that affect the musculature we think of the big boys: muscular dystrophy, cerebral palsy, polio and multiple sclerosis. We rarely think that arthritis and stroke can affect the musculature or that there are some who "toe in". But whatever trauma affects that musculature, there is a way to correct it. The orthosis helps to control range of motion, provide support by stabilizing walk, correct deformities and manage pain load. A podiatrist would be consulted for those who "toe in", for instance, or an arthritis sufferer whose ankles suffer through walking on the job or perhaps a victim of stroke whose musculature is wasting away and requires strength.

Before the advent of modern orthotic devices, it wasn’t uncommon to see polio victims wearing metal braces from mid thigh to the bottom of the foot, or children who "toed in" wearing metal braces around their ankle and foot. However, both designs and materials have improved dramatically, allowing for new levels of comfort, functionality, and appearance. Many orthotics are now made from plastics in the shape of an L and designed to fit inside a corrective shoe. These can be rigid, buckling at the calf and extending the length of the foot to support the ankle. This same design except with a hinged ankle provides support while walking by normalizing the gait. In the past boots lined with leather and fiberboard provided the rigidity needed for correction and support. Now corrective shoes are available with built up soles to correct the gait or manage pain by sharing it with another area when the foot spreads during walking.

The podiatrist would prescribe this orthosis in the rigid L shape because the foot moves on a hinge. If the hinge isn't functioning as intended due to an injury or malformation, the muscles tighten up, thus making it difficult to flex the foot. When we walk, the foot flexes and muscles stretch. This brace or AFO would support the ankle and musculature during flexion of the foot, in much the same way a knee brace works. Corrective shoes are for people whose feet hit the ground backward, causing tight muscles and arch problems. Wedges and rocker bars on the heels correct the step to heel first and rock onto the ball of the foot, resulting in relaxed musculature and strengthened ankles.

Appearance also counts when we consider a particular support device, especially if the item is intended for regular, daily wear. The L shaped orthotic is contoured to the calf and flesh-colored, fitting into a sneaker or dress shoe. As present, corrective shoes are more attractive than past models, enabling patients wear such devices with greater comfort and confidence.

All About Broken Ankles

Broken ankles are a very serious injury which, if not properly treated, can lead to continuous pain and an inability to walk. An ankle is made up of at least three major bones--the tibia, fibula, and talus. The tibia and fibula are the two bones that connect to your knees. They sit directly upon the talus bone, protected by a fibrous membrane that allows slight movement in our ankle joint. When the ankle is broken, it is because the foot rolled under or twisted too far, causing one or more of these three bones to break.

An ankle sprain occurs when ligaments are ripped or torn but no bones were broken. A sprain can be very severe, causing severe bruising of the foot and an inability to hold weight. In the case of broken ankles, the bones broken in this region could be numerous. If a person cannot stand their own weight on their ankle then it is most likely a broken ankle. The best thing to do if you suspect you have a broken ankle is to get an x-ray to determine the severity of the break immediately. The longer you wait to be diagnosed, the longer the healing process will take.

The most common cause of a broken ankle is when the foot has rolled over on itself, usually while engaged in exercise, physical activity, or sports. Another common cause is from a jump of great height. It is most important to seek medical treatment if one suspects they have broken ankles. A doctor can determine if surgery is needed in order to heal correctly. Without medical assistance after such an injury, a person may suffer severe arthritis and pain later in life. In some cases, an operation may be the only option to ensure the ability to walk properly again.

Broken ankles will cause severe pain. It will help to elevate the feet above your head to reduce blood flow to the injured area, as well as applying ice to the ankles to help decrease swelling. If surgery is required, it usually means an ankle cast for at least three months and then rehabilitation. Rehabilitation can be painful, using atrophied muscles and building tendon strength.

It is important to determine if surgery is needed as a broken ankle can become more severe than you realize. If not professionally treated, the broken ankle bones will inhibit your ability to walk properly.

How to Prevent Running Injuries

Many common running injuries are caused by overuse and overtraining. Several common injuries can occur due to running. When the back of the kneecap starts wearing away and starts causing pain in the knee, this is commonly referred to as runner’s knee. Runner’s knee can occur because of decreased strength in the quadricep muscles or shoes that do not offer proper support to the inside of the forefoot. Runner’s knee usually is treated with strengthening exercises focusing on the quad muscle and sports orthotic. To prevent runner’s knee, efforts should be focused on hip strengthening. Physical therapy is also beneficial in helping to learn the best exercises to heal runner’s knee. To prevent runner’s knee, strengthen the quad muscles to keep the kneecap aligned.

Overtraining is one cause of a common running injury called iliotibial band syndrome, which occurs when the iliotibial band gets irritated, causing pain and discomfort to the outside knee area. Another common running injury is known as plantar fasciitis, which occurs when the bone in the foot becomes inflamed and irritated. This injury primarily causes pain in the foot. Causes can include a high arch, incorrect footwear, tight muscles and flat feet. The best way to avoid plantar fasciitis is stretching and proper footwear.

Stress fractures are a common injury for runners. These fractures can occur because of overtraining, lack of calcium or running style. In runners, it is common for stress fractures to occur in several locations including the inner bone of the leg, the thighbone, the bone at the base of the spine and the toe bones in the foot. The best approach to preventing stress fractures are proper footwear maintenance and running on a surface with enough “give” to absorb some of the shock produced during running.

Besides overtraining, other causes of these common running injuries are poorly fitting footwear, irregular biomechanics, and lack of flexibility and strength. The best way to avoid running injuries is to prevent them. Fortunately, each of these common running injuries can be prevented. To avoid running injuries it is highly recommended to wear only footwear that fits properly and that suits your needs. Running shoes are the only protective gear that runners have to safeguard them from injury; therefore, choosing the correct footwear for running is important. It is important, too, to think about other aspects of your running routine like training schedules, flexibility and strengthening, and tailor them to your needs in order to minimize the possibility of injury. Regular stretching before and after running should be considered also when trying to avoid running injuries. Stretching keeps muscles limber resulting in greater flexibility.