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2015.07.11
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カテゴリ:カテゴリ未分類

Overview
Hammer Toe (hammertoe) is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, into an upward position, causing it to resemble a hammer (sometimes decribed as ?curled toes?). Left untreated, hammer toes can become inflexible and require surgery. Toes which take on a curled appearance are hammer toes. Mallet toe is a similar condition, but affects the upper joint of a toe.

Causes
As described above, the main reason people develop hammertoes is improper footwear, or footwear that is too short for the toes. Shoes that do not allow our toes to lie flat are the biggest cause of hammertoes, though there are others, including genetics, injury or trauma in which the toe is jammed or broken. Diseases that affect the nerves and muscles, such as arthritis. Abnormal foot mechanics due to nerve or muscle damage, causing an imbalance of the flexor and extensor tendons of the toe. Systematic diseases such as arthritis can also lead to problems such as hammertoe. Some people are born with hammertoes, while others are more prone to developing the condition due to genetics. If you have ever broken a toe, you know there is not much that can be done for it. It is one of the only bones in the body that heals without the use of a cast. A broken toe may be splinted, however, which may help prevent a hammertoe from forming.

Symptoms
Some people never have troubles with hammer toes. In fact, some people don't even know they have them. They can become uncomfortable, especially while wearing shoes. Many people who develop symptoms with hammer toes will develop corns, blisters and pain on the top of the toe, where it rubs against the shoe or between the toes, where it rubs against the adjacent toe. You can also develop calluses on the balls of the feet, as well as cramping, aching and an overall fatigue in the foot and leg.

Diagnosis
Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.

Non Surgical Treatment
Early on, when a hammertoe first starts and is still flexible, here are some ways it might be treated. Your healthcare provider may splint or tape the toe into the correct, normal position. You can use your fingers to stretch your toes and toe joints toward a more normal position. Exercise your toes by trying to pick up marbles with them or by wadding up a towel on the floor with your toes. Padding may be used to change where your weight falls when you walk on the foot.

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.

Prevention
Few people realize that their feet grow over the years: actually, the heel stays the same, but the front of the foot becomes wider and longer. The result, most women wear shoes that fit at the heel but are much too narrow in the front. Buy shoes that fit the longer foot. For two out of three people, one foot is significantly bigger than the other. Have both feet measured whenever you buy shoes. Have your feet measured while you're standing, and buy shoes that fit the larger foot. Shop at the end of the day, when foot swelling is greatest. No shoe should feel tight. Don't go by numbers. You may think of yourself as a size 8B, but size varies from shoe to shoe. There is no standardization, so pick the shoes that fit best. Limit high-heel use. These shoes increase pressure on the front of the foot by at least 50 percent, so wear them only for special occasions. Flat shoes are more comfortable than high heels, but they, too, can be hard on your feet, especially if they are thin-soled. Change your shoes. If your shoes are too short or too narrow, get another pair. This is especially important for children going through periods of rapid growth. The toe area should be high enough so that it doesn't rub against the top of your toes-especially if hammer toes have started to develop.






最終更新日  2015.07.11 11:51:41
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2015.07.09
カテゴリ:カテゴリ未分類

Overview
Hammertoes are quite common and may range from mild to severe. A Hammer Toe is a contracture, or bending, of one or more toes, usually due to an imbalance between the muscles or tendons on the top and bottom of the toes. Over time, the affected toes lose flexibility, becoming rigid and fixed in a contracted position. The abnormal bend positions the knuckle of the toe upward, causing it to push against the top of the shoe leading to additional problems. The condition usually becomes progressively worse if not treated.

Causes
Hammertoe is caused when muscles fail to work in a balanced manner and the toe joints bend to form the hammertoe shape. If they remain in this position, the muscles and tendons supporting them tighten and stay that way. Causes of hammertoe can include squeezing into a too-small or ill-fitting shoe or wearing high heels that jam your toes into a tight toe box. An injury such as badly stubbing your toe. Arthritis. Nerve and muscle damage from diseases such as diabetes,

Symptoms
The most obvious symptoms of this injury will be the the middle toe joint is permanently bent at an angle. In the beginning movement may still be possible but as time passes and the injury worsens the toe will be locked in place and possible require hammer toe correction surgery to fix. Another key indicator of hammer toe is that a lump or corn will form on top of the toe. The toe joint will be painful and walking can cause severe discomfort. Occasionally a callus may form on the sole of the injured foot. If you see any of these symptoms together or have been enduring pain for some time, seeing a podiatrist should be your next step.

Diagnosis
The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Non Surgical Treatment
Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce this swelling. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot, check for fractures and determine the cause. The podiatrist may see you to take care of any corns that develop due to the bone deformities. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure. Padding techniques may be used to straighten the toe if the deformity is flexible, or pads may be used to lessen the pressure on the area of the corn or ulcer. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.

Surgical Treatment
Treatment of a severe hammertoe that has become rigid includes surgery. What is done during the surgery depends on how misshapen and inflexible the toe is. The surgeon may make a cut over your toe and release the tendon by cutting the tendon away from the bone. The surgeon may remove a small piece of bone from the toe. The surgeon may realign the tendons to reposition your toe or fasten the bones with pins. Sometimes the surgeon may have to join the bones in the toe. In this case, you will no longer be able to bend the toe, but the toe will be flat.

Prevention
To help prevent hammertoe, wear roomy, low-heeled shoes that allow plenty of width and length for the toes. The Mayo Clinic recommends wearing shoes that have at least 1/2 inch of space between the shoe and the longest toe.






最終更新日  2015.07.09 19:36:25
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2015.06.15
カテゴリ:カテゴリ未分類

Overview

A bunion (Hallux Abducto Valgus) is sometimes described as a bump on the side of the big toe. However, the visible bump actually reflects changes in the bony framework in the front part of the foot. Instead of pointing straight ahead, the big toe leans towards the second toe, throwing the bones out of alignment and producing the ?bump? of the bunion. Bunions are a progressive disorder and gradually change the angle of the bones in your foot over the years. Symptoms usually occur in the later stages. The skin over the base of your big toe may become red and tender, and make wearing shoes painful. The bigger the bunion gets, the more it hurts to walk. Pressure from your big toe can force your second toe out of alignment, sometimes overlapping your third toe. Severe bunions can make it difficult to walk and you may develop arthritis.

Causes
The main cause of bunions is excessive pressure being placed on the front of the foot, and is usually the result of wearing high-heeled shoes with pointed toes. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the United States wear shoes that are too small and that 55 percent of them have bunions. Overall, bunions are nine times more common in women than men. In some cases, bunions are hereditary; they also may be caused by arthritis or polio.
SymptomsBunions may or may not cause symptoms. A frequent symptom is foot pain in the involved area when walking or wearing shoes that is relieved by resting. A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. This leads to intermittent or chronic pain at the base of the big toe. Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness. It is important to note that, in post-pubertal men and post-menopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.

Diagnosis
Generally, observation is adequate to diagnose a bunion, as the bump is obvious on the side of the foot or base of the big toe. However, your physician may order X-rays that will show the extent of the deformity of the foot.

Non Surgical Treatment
A range of treatments is available for bunions, including painkillers, modifying footwear, orthotics, such as insoles, bunion pads and toe spacers. Surgery may be considered if a person's symptoms are severe and do not respond to non-surgical treatment. The type of surgery used will depend on the level of deformity, the severity of any other associated symptoms, the patient's age and any other associated medical conditions. Bunion surgery is usually effective, with up to 85% of cases resulting in improvement to symptoms. However, the deformity can sometimes return after bunion surgery.


Surgical Treatment
Surgical options, such as a bunionectomy, can remove the bunion and realign the toe. There are several types of surgeries to fix the bunion. The type of bunion you have along with other factors such as the degree of severity and underlying cause of the bunion will determine which approach would be most beneficial for you.

Prevention
The best way to prevent a bunion is to be proactive in the truest sense of the word. Go over your risk factors. If you know that you pronate or have any problem with the mechanics of your foot, talk with a podiatric physician about the correct types of shoes and/or orthoses for you. If you are not sure whether you have such a problem, the podiatric professional can analyze your foot, your stride and the wear pattern of your shoes, and give you an honest evaluation. Has anyone in your family complained of bunions? Does your job involve a lot of standing, walking or other stress on your feet or toes? Do you exercise? If so, what kind of shoes do you wear for sports? For work? For school? Do you ever feel pain in your toes, or have you noticed a pronounced or increased redness on your big toe, or on the other side of your foot, near your little toe? Make sure you let the doctor know. Keep track of whether any relatives have suffered from arthritis or other joint problems, as well as anything else that might be relevant to your podiatric health. If you?ve suffered sports injuries previously, let the doctor know about that, too. In other words, try to give your health care professional the most honest and thorough background you can, so that he or she can make the best evaluation possible.






最終更新日  2015.06.15 12:19:49
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2015.06.12
カテゴリ:カテゴリ未分類

Overview

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe ( metatarsophalangeal joint ). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallux Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe.

Causes
Bunions are among the most common problems of the foot. They are several possible reasons a bunion may develop, though a biomechanical abnormality (improper function of the foot) is the most common cause. In an unstable flat foot, for example, a muscular imbalance often develops that, over time, causes bunions. Bunions tend to run in families, and most podiatrists believe that genetic factors play a role in predisposing some people to develop bunions. Poor shoes, like high heels and pointed toe boxes--exacerbate the condition by speeding up the development of bunions, and by making bunions more painful. Poor shoe choices is at least one of the reasons bunions are much more common in women than men.
SymptomsPatients with bunions will often display pain over the prominent bump on the inside of their forefoot (the medial eminence?). However, they may also have pain under the ball of the foot (under the area near the base of the second toe). Symptoms can vary in severity from none at all to severe discomfort aggravated by standing and walking. There is no direct correlation between the size of the bunion and the patient?s symptoms. Some patients with severe bunion deformities have minimal symptoms, while patients with mild bunion deformities may have significant symptoms. Symptoms are often exacerbated by restrictive shoe wear, particularly shoes with a narrow toe box or an uncomfortable, stiff, restraining upper.

Diagnosis
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.

Non Surgical Treatment
Pain is the main reason that you seek treatment for bunion. Analgesics may help. Inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Anti-inflammatory medications may help. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and orthotics to off-load the bunion. As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal toe and foot joint range of motion and muscle length. Treatment may include joint mobilisation and alignment techniques, massage, muscle and joint stretches, taping, a bunion splint or orthotic. Your physiotherapist is an expert in the techniques that will work best for you. Your foot posture muscles are vital to correct the biomechanics that causing your bunion to deteriorate. Your physiotherapist will assess your foot posture muscles and prescribe the best exercises for you specific to your needs. During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their feet that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity. Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals. Bunions will deform further with no attention. Plus, the bunion pain associated does have a tendency to return. The main reason is biomechanical. In addition to your muscle control, your physiotherapist will assess your foot biomechanics and may recommend either a temporary off-the shelf orthotic or refer you to a podiatrist for custom made orthotics. You should avoid wearing high heel shoes and shoes with tight or angular toe boxes. Your physiotherapist will guide you.


Surgical Treatment
Bunion surgery is both an art and a science, and it should always be performed by a healthcare professional who understands the multifaceted mechanics of your first MTP and its surrounding structures. Bunion surgery involves more than just removing the bump at the base of your big toe, and it is best followed up with supportive therapies to prevent a recurrence of your health problem.






最終更新日  2015.06.12 23:27:51
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2015.06.02
カテゴリ:カテゴリ未分類

Overview
Pes planus is the scientific term that describes low arch or "flat" feet. As podiatric physicians, we are very interested not only in structure but also in function of the feet. While very few people have 20-20 vision, it is also true that very few people have perfect arch structure. High and low arch feet are just the two ends of the spectrum of foot structure. The more deviation from what is considered perfect, the worse the function becomes. We describe deviation from "the ideal" as imbalance in structure. It is the imbalance in structure that leads to abnormal function. Abnormal function causes pain and/or deformity. Deformity can manifest itself in a variety of foot problems such as bunions or hammertoes. Likewise, pain can manifest itself in a variety of ways such as heel pain ( plantar fasciitis or heel spur), corns or calluses, metatarsalgia or pain in the ball of the foot ( neuromas, stress fractures, or tendonitis), or even in pediatric problems. Invariably, we can treat most foot imbalance or biomechanical insufficiencies with orthotic therapy.


Causes
Arch pain can be caused by several different factors. Tight calf muscles combined with repeated arch collapse on weight bearing, is the most common cause of arch pain.This can then often lead to a condition called plantar fasciitis, which is an inflammation of the connective tissue that connects the heel with the ball of the foot. When the connective tissue in the bottom of the feet gets stretched out too much, plantar fasciitis can result. The inflammation resulting from plantar fasciitis can result in arch pain. Arch pain caused by plantar fasciitis is often worst after long periods of rest, like when you first wake up in the morning. This is because the plantar fascia tightens when you are off your feet. When you wake up in the morning and start walking around, the plantar fascia stretches out again.

Symptoms
Pain and tenderness associated with plantar fascia strains are usually felt on the bottom of the foot and may manifest either as a specific or general area of tenderness. Plantar fascia pain may be increased or decreased by stretching of the arch. Generally, in mild cases of plantar fasciitis, the pain will decrease as the soft tissues of the foot "warm up"; however, pain may increase as use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed. A more specific pain (point tenderness) is an indicator that something is wrong in that specific area. Pain with movement of the affected area is also an indicator of the particular body part affected.

Diagnosis
In people with flat feet, the instep of the foot comes in contact with the ground when standing. To diagnose the problem, the health care provider will ask you to stand on your toes. If an arch forms,the flat foot is called flexible. You will not need any more tests or treatment. If the arch does not form with toe-standing (called rigid flat feet), or if there is pain, other tests may be needed, including a CT scan to look at the bones in the foot. MRI scan to look at the tendons in the foot. X-ray of the foot.

Non Surgical Treatment
Changes in shoes to include more supportive sport shoes or walking shoes that have a softer footbed. Oral anti-inflammatories including over-the-counter medications such as Brufen can help acute flare ups. Prescription strength anti-inflammatories prescribed by your GP or doctor. Prescription Transdermal Verapamil gel, which can reduce scar tissue. Anti-inflammatory injections (cortisone-type medications) into the mass and surrounding areas to decrease the inflammation. Stretching exercises, this may worsen the problem as it stretches the area of tear. Massage including tennis ball orfrozen water bottle massage of the arch - as with stretching this may worsen the problem. Taping or strapping of the foot, arch or ankle to reduce the pressure on the plantar fascia. Long term conservative treatment should include custom moulded functional orthotics. The orthotics should have an accommodation for the plantar fibroma, this is probably the best conservative treatment for plantar fibroma.


Surgical Treatment
The procedure involves cutting and shifting the bone, and then performing a tendon transfer. First, the surgeon performs a calcaneal osteotomy, cutting the heel bone and shifting it into the correct position. Second, the surgeon transfers the tendon. Reroute the flexor digitorum to replace the troublesome posterior tibial tendon. Finally, the surgeon typically performs one or more fine-tuning procedures that address the patient?s specific foot deformity. Often, the surgeon will lengthen the Achilles tendon because it is common for the mispositioned foot to cause the Achilles to tighten. Occasionally, to increase the arch, the surgeon performs another osteotomy of one of the bones of the midfoot. Occasionally, to point the foot in a straightforward direction, the surgeon performs another osteotomy of the outside portion of the calcaneus.


Prevention
Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.






最終更新日  2015.06.02 08:01:23
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2015.05.09
カテゴリ:カテゴリ未分類

Overview
Plantar fasciitis is a common and often persistent kind of repetitive strain injury afflicting runners, walkers and hikers, and nearly anyone who stands for a living, cashiers, for instance. It causes mainly foot arch pain and/or heel pain. Morning foot pain is a signature symptom. Plantar fasciitis is not the same thing as heel spurs and flat feet, but they are related and often confused. Most people recover from plantar fasciitis with a little rest, arch support (regular shoe inserts or just comfy shoes), and stretching, but not everyone. Severe cases can stop you in your tracks, undermine your fitness and general health, and drag on for years.


Causes
Tarsal Tunnel Syndrome develops when there is compression on the tibial nerve as it passes through the tarsal tunnel on the inner side of the ankle bone (medial malleolus). It can cause pain on bottom of foot as well as pins and needles. Numbness in the heel can often extend down to the big toe and adjacent three toes. In addition, it may also produce hot and cold sensations along the bottom of the foot. Tarsal Tunnel Syndrome is caused by anything which occupies space in the tarsal tunnel including cysts, ganglions, bone spurs, swelling from ankle injuries or tumours. Treatment aims to reduce the foot arch pain and usually consists of rest, strengthening and stretching exercises, compression bandages and steroid injections. If the pain in bottom of foot persists, surgery may be required.

Symptoms
Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. The condition is diagnosed with the classic symptoms of pain well focused deep in the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking. Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. It is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.

Diagnosis
The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise.

Non Surgical Treatment
Posterior tibial tendon dysfunction is a common cause of fallen arches in adults. The tendon runs along the bottom of the foot and up the back of the ankle, connecting to the tibialis posterior muscle in the calf. The posterior tibial tendon is an important support for the foot arch. Overuse, inflammation and tears of the tendon may cause progressive foot and ankle pain and the development of flat feet. The American College of Foot and Ankle Surgeons states that an ankle brace, leg cast or removable boot may be used to temporarily immobilize the posterior tibial tendon, facilitating healing. Physical therapy typically follows immobilization to strengthen the foot and restore normal foot structure and function.


Surgical Treatment
In rare cases, surgery may be needed if a child has flat feet caused by a problem they're born with (a congenital abnormality). The foot may need to be straightened or the bones may need to be separated if they're fused together. Painkillers and insoles are the first treatment options for flat feet that are caused by a joint problem, such as arthritis or a torn tendon. However, surgery may be recommended if the injury or condition is severely affecting your feet. Where flat feet are caused by a condition that affects the nervous system, special shoes, insoles, or supportive foot or leg braces may be needed. Again, in severe cases, an operation may be needed to straighten the feet.


Stretching Exercises
Massage therapy is a great way to loosen muscles and help improve mobility in in your feet. As many people with foot pain have discovered, tight muscles in your legs or back can lead to tense foot muscles. All those muscles are connected, so tension in your back can cause tension in your legs which can pull the tendons in your feet and cause stiffness and pain. Getting acupuncture or a professional full body massage are probably the best ways to deal with this, but there are also some simple tricks you can do at home to help keep muscles limber. These are great for loosening up and improving circulation, both before and after exercise. Place a tennis ball under the arch of your bare foot and roll it around, stretching the muscles in your foot and promoting blood flow. You can also roll the ball under your calves and upper legs to work out stiffness and knots. If you feel the tennis ball is too easy, try a lacrosse ball for deeper massaging. This is also demonstrated in the exercise video above. Use a foam roller, those big overpriced rolls of foam that are now available in every department and sporting goods store are fantastic for self-massage (why a roll of foam costs $30 is beyond us, but they do work wonders-our advice is to not waste money on the more expensive fancy grooved ones because even the simplest rollers work great). The exercises you can do with foam rollers seem to be endless, and there are literally hundreds of free videos online showing how to use them to massage every part of your body. Here's one we picked out that specifically targets foot and leg muscles related to arches and plantar fasciitis.






最終更新日  2015.05.09 18:48:44
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2015.05.06
カテゴリ:カテゴリ未分類

Overview

The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. Although the Achilles tendon can withstand great stresses from running and jumping, it is vulnerable to injury. A rupture of the tendon is a tearing and separation of the tendon fibers so that the tendon can no longer perform its normal function.

Causes
The Achilles tendon usually ruptures as a result of a sudden forceful contraction of the calf muscles. Activities such as jumping, lunging, or sprinting can cause undue stress on the Achilles tendon and cause it to rupture. Often there is a background of Achilles tendinitis. Direct trauma to the area, poor flexibility or weakness of the calf muscles or of the Achilles tendon and increasing age are some of the other factors that are associated with an Achilles tendon rupture.

Symptoms
A sudden and severe pain may be felt at the back of the ankle or calf, often described as "being hit by a rock or shot" or "like someone stepped onto the back of my ankle." The sound of a loud pop or snap may be reported. A gap or depression may be felt and seen in the tendon about 2 inches above the heel bone. Initial pain, swelling, and stiffness may be followed by bruising and weakness. The pain may decrease quickly, and smaller tendons may retain the ability to point the toes. Without the Achilles tendon, though, this would be very difficult. Standing on tiptoe and pushing off when walking will be impossible. A complete tear is more common than a partial tear.

Diagnosis
Some patients mistakenly believe the tendon is working if they can push the foot down, however, patients will usually be able to move the foot up and down while sitting because the other surrounding muscles and tendons are still intact. Trying to push up while standing and applying body weight to the foot will reveal the true weakness. Sensation and circulation to the foot and ankle will be normal. In addition, x-rays will be normal unless the Achilles injury involves pulling off (avulsion) of the bone on the calcaneus (heel bone). This is quite rare, occurring in only a small fraction of patients with Achilles injuries. Patients suffering this type of Achilles avulsion injury tend to be older with weaker bone.
Imaging Studies. Plain x-rays will be negative in patients who have suffered an Achilles tendon rupture. The rupture can be seen on ultrasound or MRI. However, these studies are not indicated for acute ruptures unless there is some uncertainty about the diagnosis. For chronic problems of the Achilles or ruptures that are old, an MRI may be very helpful.

Non Surgical Treatment
Non-surgical treatment typically involves wearing a brace or cast for the first six weeks following the injury to allow time for the ends of the torn tendon to reattach on their own. Over-the-counter medications, such as ibuprofen or aspirin, may be taken during this time to reduce pain and swelling. Once the tendon has reattached, physical therapy will be needed to strengthen the muscles and tendon. A full recovery is usually made within four to six months.


Surgical Treatment
There are two types of surgery to repair a ruptured Achilles tendon. In open surgery, the surgeon makes a single large incision in the back of the leg. In percutaneous surgery, the surgeon makes several small incisions rather than one large incision. In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture, to let the swelling go down.

Prevention
The following can significantly reduce the risk of Achilles tendon rupture. Adequate stretching and warming up prior to exercising. If playing a seasonal sport, undertake preparatory exercises to build strength and endurance before the sporting season commences. Maintain a healthy body weight. This will reduce the load on the tendon and muscles. Use footwear appropriate for the sport or exercise being undertaken. Exercise within fitness limits and follow a sensible exercise programme. Increase exercise gradually and avoid unfamiliar strenuous exercise. Gradual ?warm down? after exercising.






最終更新日  2015.05.07 00:52:54
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2015.04.22
カテゴリ:カテゴリ未分類

Overview
There are four stages of posterior tibial tendon dysfunction. In the first stage the posterior tibial tendon is inflamed but has normal strength. There is little to no change in the arch of the foot. In stage two the tendon is partially torn or shows degenerative changes and as a result loses strength. There is considerable flattening of the arch without arthritic changes in the foot. Stage three results when the posterior tibial tendon is torn and not functioning. As a result the arch is completely collapsed with arthritic changes in the foot. Stage four is identical to stage three except that the ankle joint also becomes arthritic.


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
The symptom most often associated with AAF is PTTD, but it is important to see this only as a single step along a broader continuum. The most important function of the PT tendon is to work in synergy with the peroneus longus to stabilize the midtarsal joint (MTJ). When the PT muscle contracts and acts concentrically, it inverts the foot, thereby raising the medial arch. When stretched under tension, acting eccentrically, its function can be seen as a pronation retarder. The integrity of the PT tendon and muscle is crucial to the proper function of the foot, but it is far from the lone actor in maintaining the arch. There is a vital codependence on a host of other muscles and ligaments that when disrupted leads to an almost predictable loss in foot architecture and subsequent pathology.

Diagnosis
Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon, the tendon which is primarily responsible for supporting the arch structure of the foot.

Non surgical Treatment
The adult acquired flatfoot is best treated early. There is no recommended home treatment other than the general avoidance of prolonged weightbearing in non-supportive footwear until the patient can be seen in the office of the foot and ankle specialist. In Stage I, the inflammation and tendon injury will respond to rest, protected ambulation in a cast, as well as anti-inflammatory therapy. Follow-up treatment with custom-molded foot orthoses and properly designed athletic or orthopedic footwear are critical to maintain stability of the foot and ankle after initial symptoms have been calmed. Once the tendon has been stretched, the foot will become deformed and visibly rolled into a pronated position at the ankle. Non-surgical treatment has a significantly lower chance of success. Total immobilization in a cast or Camwalker may calm down symptoms and arrest progression of the deformity in a smaller percentage of patients. Usually, long-term use of a brace known as an ankle foot orthosis is required to stop progression of the deformity without surgery. A new ankle foot orthosis known as the Richie Brace, offered by PAL Health Systems, has proven to show significant success in treating Stage II posterior tibial dysfunction and the adult acquired flatfoot. This is a sport-style brace connected to a custom corrected foot orthotic device that fits well into most forms of lace-up footwear, including athletic shoes. The brace is light weight and far more cosmetically appealing than the traditional ankle foot orthosis previously prescribed.


Surgical Treatment
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.






最終更新日  2015.04.22 19:12:06
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