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カテゴリ未分類

2015.07.11
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カテゴリ:カテゴリ未分類

Overview
Hammer toes are usually not a serious condition, but can become painful as the bent joint rubs against the inside of the shoe, causing irritation, corns, or calluses on the top of the middle joint or the tip of the toe. A Hammer Toe may also cause occasional shooting pains throughout the toes or elsewhere in the foot. A hammertoe has a kink or contracture in its second joint--called the proximal interphalangeal joint--that causes the toe to bend upward in the middle, giving it a hammer-like appearance. The raised part of the toe often rubs on shoes, leading to the formation of corns or calluses. Usually hammertoe affects the smaller toes, causing pain and interfering with the ability to walk normally.

Causes
Hammertoes are more commonly seen in women than men, due to the shoe styles women frequently wear: shoes with tight toe boxes and high heels. Genetics plays a role in some cases of hammertoes, as does trauma, infection, arthritis, and certain neurological and muscle disorders. But most cases of contracted toes are associated with various biomechanical abnormalities of the feet, such as flat feet and feet with abnormally high arches. These biomechanical abnormalities cause the muscles and tendons to be used excessively or improperly, which deforms the toes over time.

Symptoms
Pain upon pressure at the top of the bent toe from footwear. The formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.

Diagnosis
Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.

Non Surgical Treatment
Treating hammertoe involves straightening the toe, making tendons in the toes flexible again, and preventing the problem from returning. Some simple treatments include splinting the toe to keep it straight and to stretch the tendons of the foot. Using over-the-counter pads, cushions or straps to decrease discomfort Exercising the toes to relax the foot tendons (a session with a physical therapist may help you get started with foot exercises) Wearing shoes that fit properly and allow toes plenty of room to stretch out.

Surgical Treatment
he basis for hammer toe surgery most often involves removing s portion of bone within the toe, to reduce the joint contracture. Depending on the direction the toe is deviated, soft tissue procedures may be necessary along with pinning the toe with a surgical wire.






最終更新日  2015.07.11 21:01:48
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カテゴリ:カテゴリ未分類

Overview
Hammer toes is a condition which causes one or more of the smaller toes to become bent upwards. The toe can be straightened but if ignored may become a permanent deformity. Each of the 4 smaller toes consist of 3 bones called phalanges, forming two interphalangeal joints. The toe bends at the proximal or first interphalangeal joint. Initially it can be straightened, but if left untreated, this can become a permanent deformity.

Causes
Those fashionable shoes. Women tend to cram their feet into too-narrow, ill-fitting shoes with little to no arch support. That?s why we see more hammertoes in women than men. Pointy, high-heeled shoes put severe pressure on the toes and their joints, and they typically have little to no arch support. Neuromuscular diseases can contribute to the development of hammertoe, too. People with diabetes can be at increased risk for complications from a hammertoe. In diabetics, if a toe has a corn or other ulceration, it indicates there is too much pressure on the toes. In those with poor blood flow or neuropathy, these lesions can get infected and lead to the loss of a toe or foot unless shoes are modified.

Symptoms
People with a hammer toe will often find that a corn or callus will develop on the top of the toe, where it rubs against the top of the footwear. This can be painful when pressure is applied or when anything rubs on it. The affected joint may also be painful and appear swollen.

Diagnosis
The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.

Non Surgical Treatment
If you have hammer toe, avoiding tight shoes and high heels may provide relief. Initial (non-surgical) treatment for hammer toe involves wearing shoes with plenty of room in the toe area. Shoes should be at least one-half inch longer than the longest toe. Stretching and strengthening exercises for the toes (such as picking up items with the toes or stretching the toes by hand) are also recommended. Sometimes orthopedists recommend special pads, cushions, or slings to help relieve the pain of hammer toe.

Surgical Treatment
In advanced cases in which the toe has become stiff and permanently bent, the toe can be straightened with surgery. One type of surgery involves removing a small section of the toe bone to allow the toe to lie flat. Surgery for hammertoe usually is classified as a cosmetic procedure. Cosmetic foot surgeries sometimes result in complications such as pain or numbness, so it's better to treat the problem with a shoe that fits properly.






最終更新日  2015.07.11 07:38:53
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2015.06.28
カテゴリ:カテゴリ未分類

Overview
A Hammer Toe is the result of deformed toe joints, tight tendons that attach to the toe, and misaligned toe bones. The usual appearance of a hammertoe is a toe bent upward at the middle toe joint, so that the top of this joint rubs against the top of the shoe. The remainder of the toe is bent downward so that, instead of the entire toe bearing weight, only the tip of the toe bears weight. Pain can occur on the top of the toe, the tip of the toe, or in both areas.

Causes
While most cases of hammertoes are caused by an underlying muscle imbalance, it may develop as a result of several different causes, including arthritis, a hereditary condition, an injury, or ill-fitting shoes. In some cases, patients develop hammertoes after wearing shoes or stockings that are too tight for long periods of time. These patients usually develop hammertoes in both feet.

Symptoms
Common reasons patients seek treatment for toe problems are toe pain on the knuckle. Thick toe calluses. Interference with walking/activities. Difficulty fitting shoes. Worsening toe deformity. Pain at the ball of the foot. Unsightly appearance. Toe deformities (contractures) come in varying degrees of severity, from slight to severe. The can be present in conjunction with a bunion, and develop onto a severe disfiguring foot deformity. Advanced cases, the toe can dislocate on top of the foot. Depending on your overall health, symptoms and severity of the hammer toe, the condition may be treated conservatively and/or with surgery.

Diagnosis
Hammer toes may be easily detected through observation. The malformation of the person's toes begin as mild distortions, yet may worsen over time - especially if the factors causing the hammer toes are not eased or removed. If the condition is paid attention to early enough, the person's toes may not be permanently damaged and may be treated without having to receive surgical intervention. If the person's toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.

Non Surgical Treatment
There are many non-surgical treatments to help relieve symptoms of hammertoe. The first step for many people is wearing the right size and type of shoe. Low-heeled shoes with a boxy or roomy toe area are helpful. Cushioned insoles, customized orthopedic inserts, and pads can provided relief as well. Splints or straps may be used to help correct toe position. Your doctor may show you toe stretches and exercises to perform. Your doctor can safely remove corns and calluses. You should not try to remove them at home.

Surgical Treatment
The technique the surgeon applies during the surgery depends on how much flexibility the person's affected toes still retain. If some flexibility has still been preserved in their affected toes, the hammer toes might be corrected through making a small incision into the toe so the surgeon can manipulate the tendon that is forcing the person's toes into a curved position. If, however, the person's toes have become completely rigid, the surgeon might have to do more than re-aligning the person's tendons. Some pieces of bone may have to be removed so the person's toe has the ability to straighten out. If this is the case, some pins are attached onto the person's foot afterwards to fix their bones into place while the injured tissue heals. Following the surgical procedure, the person might have to deal with some stiffness and swelling as they pursue their recovery process. The person should also expect the toes that have been corrected to appear different following the surgery. For example; the person's toes may appear longer or shorter than they were before. The person will be advised not to pursue too much physical activity that involves their feet for some time to give their injury from surgery enough time to heal properly.






最終更新日  2015.06.29 01:14:09
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2015.06.19
カテゴリ:カテゴリ未分類

Overview

Bunions involve boney prominences and repositioning of the joints at the base of the big toes. Bunions most commonly affect the inner foot at the base of the big toe but also can affect the outside of the foot at the base of the little toe, referred to as a bunionette or tailor's bunion. Bunions most commonly affect women. Bunions may or may not cause symptoms. Treatment of bunions can include rest, icing, alteration offootwear, foot supports (orthotics), medications, steroid injections, and or surgery.

Causes
Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.
SymptomsThe most obvious symptoms of a bunion are. Pain in the area of the MTP joint, the joint where your big toe connects to your foot. Bending of the big toe in towards the other toes. An enlarged bump of bone or tissue at the MTP joint. Each symptom can range in degree from small to severe. Sometimes the pain can be sufficient to make it difficult to walk in normal shoes. Other symptoms may include. Swelling and inflammation of the skin around the MTP joint. Thickening of the skin in the area of the joint. Restricted motion in your big toe. Pressure from the inward bending of your big toe can affect your other toes, leading to corns on your smaller toes. Ingrown toenails on the smaller toes. Development of hammertoes in the other toes. Calluses on the bottom of your foot. If you have any of these symptoms, especially pain, displacement of your big toe or development of a bulge, you should consider consulting your physician. Even if you're not significantly bothered by some of these symptoms, bunions tend to continue getting bigger and more serious over time and should be taken care of before they do so.

Diagnosis
Most patients are diagnosed to have bunions from clinical history and examination. However, in some cases, X-rays will be performed to determine the extent of damage to the joint. Furthermore, it will enable the treating doctor to decide on the best course of management of the patient.

Non Surgical Treatment
Wear comfortable shoes that don't squeeze your toes together. Sandals are ideal in warm weather. Cushioning the bunion with a donut-shaped bunion pad sold at drugstores can prevent any direct rubbing against your shoes. Have your shoes stretched to give your foot more room or consider switching to footwear customized to relieve pressure on the affected area. Soak your foot in warm water to help lessen the pain after a day on your feet. Apply ice packs several times a day to reduce swelling of painful and inflamed bunions. Take aspirin or ibuprofen for the inflammation and pain, and try supplementing with anti-inflammatory herbs such as ginger and turmeric (these work more slowly than the drugs). See a podiatrist for specially fitted shoes or orthotic devices that may help. Sometimes, surgery is necessary. Seek a second opinion before scheduling any operation.


Surgical Treatment
Surgery takes place either under local or general anaesthetic and takes about one hour. After surgery you will have either a plaster cast or special dressing on the foot and you will be given a special walking shoe and crutches to use the first few days/weeks. Recovery usually takes approximately 6-8 weeks but swelling often lasts longer and it may take a few months before you are able to wear normal shoes again. Full recovery can take up to a year. Bunion surgery is successful in approximately 85% of cases, but it is vital not to go back to wearing ill-fitting shoes else the problem is likely to return.






最終更新日  2015.06.19 16:51:39
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2015.06.04
カテゴリ:カテゴリ未分類

Overview

A bunion develops when the joint at the base of the big toe becomes swollen and most likely painful. The American Academy of Orthopaedic Surgeons suggests these ways to ease bunion pain. Make sure shoes fit properly and comfortably, and mold to the shape of your feet. Opt for shoes with a soft sole, wide toe box and wide instep. Avoid heels of more than 2 1/4 inches, those that are too tight, and shoes with pointy, narrow toes. To accommodate a bunion, wear shoes that are a bit big, or have your shoes professionally stretched. Place a protective cushioned pad over the bunion.

Causes
Women are particularly at risk for bunions, as high heels may help aggravate the condition. Bunions may also be caused when bursal sacs, sacs that absorb friction and lubricate the many tendons, bones muscles of the body, in the foot become inflamed or swollen. Bunions may also be prompted by the metatarsal bone, the bone that runs from the heel to the toe of the foot, with one metatarsal bone leading to each toe, of the big toe enlarging or deviating slightly to the outside of the foot.
SymptomsSymptoms, which occur at the site of the bunion, may include pain or soreness, inflammation and redness, a burning sensation, possible numbness. Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

Diagnosis
X-rays are the best way to determine the amount of deformity of the MTP joint. Blood work may be required to rule out other diseases that may be associated with bunions such as rheumatoid arthritis. Other tests such as bone scans or MRI's are not usually required.

Non Surgical Treatment
The treatment of bunions should be individualized because the degree of deformity is not always consistent with the degree of pain. The most important first step in the treatment (and prevention) of bunions is to wear properly fitted shoes, with a low heel and adequate room in the toe area. Further treatment may include relative rest and icing to decrease pain around the MTP joint, medications to reduce inflammation and pain, stretching and strengthening exercises and shoe orthotics. If the above measures are not successful, surgery may be required.


Surgical Treatment
Research shows that 85% of people who have bunion corrections are satisfied with the results. However, a number of problems can arise. The big toe is usually stiffer than before. For most people this does not matter, but for athletes or dancers it is very important. As mentioned before, the big toe is slightly weaker with a bunion, and this transfers weight onto the ball of the foot. After bunion surgery, this transfer of weight can increase. Therefore, if you have pain under the ball of the foot ("metatarsalgia") it may be worse after bunion surgery, and it may also develop for the first time. Careful surgical technique can reduce this risk, but it cannot avoid it completely. Most people who develop metatarsalgia are comfortable with a simple insole in the shoe but occasionally surgery is required. In some people the big toe slowly tilts back toward the original position and occasionally this is bad enough to need to have the operation redone. On the other hand, the toe can tilt the other way, though much more rarely. Again, occasionally this is bad enough to need to have the operation redone. Infections in the wound, plaster problems and minor damage to the nerves of the toe can occur in any foot surgery. Usually these are minor problems that get better quickly. This may sound like a lot of possible problems, but in fact most people do not get them and are satisfied with their bunion surgery. However, this may help you to see how important it is to have any bunion surgery carried out by a properly trained and experienced foot and ankle surgeon.

Prevention
To minimize the chance of developing bunions, never force your feet into shoes that don?t fit. Choose a shoe that conforms to the shape of your foot. Opt for shoes with wider insteps, broad toes, and soft soles. Shoes that are short, tight, or sharply pointed should be avoided.






最終更新日  2015.06.04 16:48:37
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2015.05.04
カテゴリ:カテゴリ未分類

Overview

The Achilles tendon, or calcaneal tendon, is a large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus). Sometimes called the heel cord, it is the largest tendon in the human body. When the calf muscles contract, the Achilles tendon is tightened, pulling the heel. This allows you to point your foot and stand on tiptoe. It is vital to such activities as walking, running, and jumping. A complete tear through the tendon, which usually occurs about 2 inches above the heel bone, is called an Achilles tendon rupture.

Causes
The Achilles tendon is most commonly injured by sudden plantarflexion or dorsiflexion of the ankle, or by forced dorsiflexion of the ankle outside its normal range of motion. Other mechanisms by which the Achilles can be torn involve sudden direct trauma to the tendon, or sudden activation of the Achilles after atrophy from prolonged periods of inactivity. Some other common tears can occur from overuse while participating in intense sports. Twisting or jerking motions can also contribute to injury. Fluoroquinolone antibiotics, famously ciprofloxacin, are known to increase the risk of tendon rupture, particularly achilles.

Symptoms
An Achilles tendon rupture is when the tendon that connects the heel bone to the calf muscle tears and the fibers separate. This happens mostly between the ages of 30 and 50, and usually is caused by sports. Symptoms of Achilles tendon rupture include the following. A pop or snap when the tendon tears. Severe pain in back of the ankle, making it nearly impossible to walk. Swelling and discoloration. Tenderness. Inability to rise on toes. A gap in the back of the ankle where the tendons are separated.

Diagnosis
Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor will gently squeeze the calf muscles, if the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.

Non Surgical Treatment
Medical therapy for a patient with an Achilles tendon rupture consists of rest, pain control, serial casting, and rehabilitation to maximize function. Ongoing debate surrounds the issue of whether medical or surgical therapy is more appropriate for this injury. Conservative management of Achilles tendinosis and paratenonitis includes the following. Physical therapy. Eccentric exercises are the cornerstone of strengthening treatment, with most patients achieving 60-90% pain relief. Orthotic therapy in Achilles tendinosis consists of the use of heel lifts. Nonsteroidal anti-inflammatory drugs (NSAIDs). Tendinosis tends to be less responsive than paratenonitis to NSAIDs. Steroid injections. Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture. Vessel sclerosis. Platelet-rich plasma injections. Nitric oxide. Shock-wave therapy.


Surgical Treatment
Immediate surgical repair of the tendon is indicated in complete tears. Delaying surgery can lead to shortening of the tendon, formation of scar tissue and decreased blood flow, which can lead to a poor outcome. Following surgery your ankle will be put in an immobilizing device and you will be instructed to use crutches to limit weight bearing and protect the joint. Over the next 2-4 weeks weight bearing will be increased and physical therapy will be initiated. The surgeon will determine the physical therapy timeline and program. Physical Therapy, Treatment will emphasize gradual weaning off the immobilizing device, increased weight bearing, restoration of ankle range of motion and strengthening of the lower leg muscles. It is important that the physician and therapist communicate during the early stages and progress your program based on the principles of healing so as not to compromise the Achilles tendon. Patient will be progressed to more functional activities as normal ankle range of motion and strength is restored.






最終更新日  2015.05.05 03:13:46
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2015.04.28
カテゴリ:カテゴリ未分類

Overview
Adult acquired flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common-partial or total collapse (loss) of the arch. Other characteristics shared by most types of flatfoot include ?Toe drift,? where the toes and front part of the foot point outward. The heel tilts toward the outside and the ankle appears to turn in. A short Achilles tendon or calf muscle, which causes the heel to lift off the ground earlier when walking and may act as a deforming force. In addition, other deformities such bunions and hammertoes can occur and cause pain in people with flexible flatfoot. Health problems such as rheumatoid arthritis, diabetes and obesity can increase the risk of developing flatfoot and may (or may not) make it more difficult to treat. This article provides a brief overview of the problems that can result in AAFD. Further details regarding the most common conditions that cause an acquired flatfoot and their treatment options are provided in separate articles. Links to those articles are provided.


Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Symptoms
Some symptoms of adult acquired flat foot are pain along the inside of the foot and ankle, pain that increases with activity, and difficulty walking for long periods of time. You may experience difficulty standing, pain on the outside of the ankle, and bony bumps on the top of the foot and inside the foot. You may also have numbness and tingling of the feet and toes (may result from large bone spurs putting pressure on nerves), swelling, a large bump on the sole of the foot and/or an ulcer (in diabetic patients). Diabetic patients should wear a properly fitting diabetic shoe wear to prevent these complications from happening.

Diagnosis
Observe forefoot to hindfoot alignment. Do this with the patient sitting and the heel in neutral, and also with the patient standing. I like to put blocks under the forefoot with the heel in neutral to see how much forefoot correction is necessary to help hold the hindfoot position. One last note is to check all joints for stiffness. In cases of prolonged PTTD or coalition, rigid deformity is present and one must carefully check the joints of the midfoot and hindfoot for stiffness and arthritis in the surgical pre-planning.

Non surgical Treatment
It is imperative that you seek treatment should you notice any symptoms of a falling arch or PTTD. Due to the progressive nature of this condition, your foot will have a much higher chance of staying strong and healthy with early treatment. When pain first appears, your doctor will evaluate your foot to confirm a flatfoot diagnosis and begin an appropriate treatment plan. This may involve rest, anti-inflammatory medications, shoe modifications, physical therapy, orthotics and a possible boot or brace. When treatment can be applied at the beginning, symptoms can most often be resolved without the need for surgery.


Surgical Treatment
Flatfoot reconstruction (osteotomy). This is often recommended for flexible flatfoot condition. Flatfoot reconstruction involves cutting and shifting the heel bone into a more neutral position, transferring the tendon used to flex the lesser toes (all but the big toe) to strengthen the posterior tibial tendon, and lengthening the calf muscle. Fusion (also known as triple arthrodesis). Fusion involves fusing, or making stiff, three joints in the back of the foot the subtalar, talonavicular, and calcaneocuboid joints, to realign the foot and give it a more natural shape. Pins or screws hold the area in place until it heals. Fusion is often recommended for a rigid flatfoot deformity or evidence of arthritis. Both of these surgeries can provide excellent pain relief and correction.






最終更新日  2015.04.28 14:25:36
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