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Overview
A Hammer toes is a deformity of the second, third or fourth toes in which the main toe joint is bent upward like a claw. Initially, hammertoes are flexible and can be corrected with simple measures. Left untreated, they can become fixed and require surgery. Hammertoe results from shoes that don?t fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and can?t stretch out.

Causes
Hammertoe has three main culprits: tight shoes, trauma, and nerve injuries or disorders. When toes are crowded in shoes that are too tight and narrow, they are unable to rest flat, and this curled toe position may become permanent even when you aren't wearing shoes due to the tendons of the toe permanently tightening. When the tendons are held in one position for too long, the muscles tighten and eventually become unable to stretch back out. A similar situation may result when tendons are injured due to trauma, such as a stubbed, jammed, or broken toe.

Symptoms
The middle joint of the toe is bent. The end part of the toe bends down into a claw-like deformity. At first, you may be able to move and straighten the toe. Over time, you will no longer be able to move the toe. It will be painful. A corn often forms on the top of the toe. A callus is found on the sole of the foot. Walking or wearing shoes can be painful.

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
Mild hammer toe in children can be treated by manipulating and splinting the affected toe. The following changes in footwear may help relieve symptoms. Wear the right size shoes or shoes with wide toe boxes for comfort, and to avoid making hammer toe worse. Avoid high heels as much as possible. Wear soft insoles to relieve pressure on the toe. Protect the joint that is sticking out with corn pads or felt pads. A foot doctor can make foot devices called hammer toe regulators or straighteners for you, or you can buy them at the store. Exercises may be helpful. You can try gentle stretching exercises if the toe is not already in a fixed position. PIcking up a towel with your toes can help stretch and straighten the small muscles in the foot.

Surgical Treatment
For severe hammer toe, you will need an operation to straighten the joint. The surgery often involves cutting or moving tendons and ligaments. Sometimes the bones on each side of the joint need to be connected (fused) together. Most of the time, you will go home on the same day as the surgery. The toe may still be stiff afterward, and it may be shorter. If the condition is treated early, you can often avoid surgery. Treatment will reduce pain and walking difficulty.

Overview
A Hammer toes is a deformity that causes your toe to bend or curl downward instead of pointing forward. This deformity can affect any toe on your foot; however, it most often affects the second toe or third toe. Although a hammertoe may be present at birth, it usually develops over time due to wearing ill-fitting shoes or arthritis. In most cases, a hammertoe is treatable.

Causes
The constant pressure a woman's foot receives in high-heeled shoes due to the force of gravity causes their feet to naturally slide down and press on the lowest point of the shoe so they are not able to receive enough space and stretch out. The result is an eventual distortion of the woman's toes. The deformity comes as a result of the shortening of muscles inside the toes because the toes become used to being in a bent position, prompting the muscles to fail to extend any further and become tightened and curbed. At first, toes may still be stretched out if poor footwear is not being worn, yet if the habit is persistent...the person's toes will eventually become used to the position they are constantly in and muscle fibers inside them will harden and refuse to stretch.

Symptoms
Well-developed hammertoes are distinctive due to the abnormal bent shape of the toe. However, there are many other common symptoms. Some symptoms may be present before the toe becomes overly bent or fixed in the contracted position. Often, before the toe becomes permanently contracted, there will be pain or irritation over the top of the toe, particularly over the joint. The symptoms are pronounced while wearing shoes due to the top of the toe rubbing against the upper portion of the shoe. Often, there is a significant amount of friction between the toe and the shoe or between the toe and the toes on either side of it. The corns may be soft or hard, depending on their location and age. The affected toe may also appear red with irritated skin. In more severe cases, blisters or open sores may form. Those with diabetes should take extra care if they develop any of these symptoms, as they could lead to further complications.

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
Wear sensible shoes. If you don?t want to have surgery to fix your hammertoe, use non-medicated padding along with proper shoes made with a wider and deeper toe box to accommodate your foot?s shape. Ensuring your shoes have a good arch support can slow the progression of the condition as well. Use a pumice stone. The corn or callus that forms on top of the hammertoe can cause discomfort when you wear shoes. Treat the corn by using a file or pumice stone to reduce its size after a warm bath, then apply emollients to keep the area softened and pliable. Use silicone or moleskin padding on top of the area when wearing shoes. Do foot exercises. Theoretically, exercises like extending, then curling the toes, splaying the toes, and moving the toes individually may help prevent the digital contracture that causes hammertoe. Try these suggestions and see what works best for you.

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
Although these following preventative tips may be able to reverse a painful bunion or hammertoe deformity, they are more effective when applied to young people, and are less effective the longer a person has progressed with their bunion or hammertoe deformity. This is because the joints in our bodies get used to the positions they are most frequently held in, and our feet are no different, with our 12 to 15 hours a day in restrictive footwear, with tapering toeboxes, heel elevation, and toespring.

Overview

A foot bunion is when the big toe gradually deviates inwards towards the second toe and in severe cases may even start to cross over the top or underneath. As the top of the toe moves inwards, the base of the toe (the knuckle part), pushes outwards producing the characteristic lump on outer side of the big toe. The medical term for a foot bunion at the big toe is a hallux abducto valgus, or hallux valgus. ?Hallux? means big toe, ?abducto? means to move away from the midline and ?valgus? refers to the abnormal angle of the toe. Foot bunions can also occur in the little toe, where they are known as a bunionette, but these are much less common.

Causes
By far the most common cause of bunions is the prolonged wearing of poorly fitting shoes, usually shoes with a narrow, pointed toe box that squeezes the toes into an unnatural position. Bunions also may be caused by arthritis or polio. Heredity often plays a role in bunion formation. But these causes account for only a small percentage of bunions. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions. Not surprisingly, bunions are nine times more common in women than men.
SymptomsIt is unusual to have much bunion or hallux valgus pain when out of shoe wear or at rest. There are exceptions to this and in particular if symptoms have been ignored during the day and the bunion has become very painful during the day then some symptoms may be present at night. The pain from the region of the great toe at rest or at night is however more often a symptom of an arthritic big toe (hallux rigidus) rather than a straightforward bunion. To confuse matters these two conditions can sometimes coexist. Bunion or hallux valgus pain is most often present when walking in enclosed shoes. There may be little bunion pain in sandals or barefoot. It is unusual to have much bunion pain when not putting weight on the foot or at night. If there is bunion pain at rest or at night then there may also be arthritic change within the toe.

Diagnosis
Although bunions are usually obvious from the pain and unusual shape of the toe, further investigation is often advisable. Your doctor will usually send you for X-rays to determine the extent of the deformity. Blood tests may be advised to see if some type of arthritis could be causing the pain. Based on this evaluation, your doctor can determine whether you need orthopaedic shoes, medication, surgery or other treatment.

Non Surgical Treatment
Wearing good footwear does not cure the deformity but may ease symptoms of pain and discomfort. Ideally, get footwear advice from a person qualified to diagnose and treat foot disorders (podiatrist - previously called a chiropodist). Advice may include wear shoes, trainers or slippers that fit well and are roomy. Don't wear high-heeled, pointed or tight shoes. You might find that shoes with laces or straps are best, as they can be adjusted to the width of your foot. Padding over the bunion may help, as may ice packs. Devices which help to straighten the toe (orthoses) are still occasionally recommended, although trials investigating their use have not found them much better than no treatment at all. Painkillers such as paracetamol or ibuprofen may ease any pain. If the bunion (hallux valgus) develops as part of an arthritis then other medication may be advised. A course of antibiotics may be needed if the skin and tissues over the deformity become infected.


Surgical Treatment
If bunions are causing severe foot pain or inflammation and swelling that limits daily activities and doesn't improve with rest, medication and comfortable shoes, surgery may be required. More than 100 surgical options are available for painful bunions. Some realign the foot's anatomy by cutting notches from the metatarsal bone or the bone of the big toe. The bones can then grow back without the slant that promotes bunion growth. The operation is usually done on an outpatient basis, but afterward, you probably will have to stay off your feet for a few weeks. Recovery takes about six weeks. Surgery is not recommended for a bunion that doesn't cause pain.

Prevention
Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunion problems can be managed without surgery. In general, bunions that are not painful do not need surgical correction. For this reason, orthopaedic surgeons do not recommend "preventive" surgery for bunions that do not hurt; with proper preventive care, they may never become a problem.

Overview

The Achilles tendon connects the muscles in the back of your calf to your heel bone. There are two basic variations of Achilles injuries. Achilles tendonitis, and a complete tear. It?s important to know whether the Achilles is torn or not, because the treatment is very different, a torn Achilles may require surgery. Achilles tendonitis probably means rehab and rest. While tendonitis is a gradual onset of pain that tends to get worse with more activity, an Achilles tear is a sudden injury, and it feels as if you were hit or kicked in the back of the ankle. A tear usually affects your ability to walk properly. Because an Achilles tendon rupture can impair your ability to walk, it?s common to seek immediate treatment. You may also need to consult with doctors specializing in sports medicine or orthopaedic surgery.

Causes
An Achilles tendon injury might be caused by several factors. Overuse. Stepping up your level of physical activity too quickly. Wearing high heels, which increases the stress on the tendon. Problems with the feet, an Achilles tendon injury can result from flat feet, also known as fallen arches or overpronation. In this condition, the impact of a step causes the arch of your foot to collapse, stretching the muscles and tendons. Muscles or tendons in the leg that are too tight. Achilles tendon injuries are common in people who participate in the following sports. Running. Gymnastics. Dance. Football. Baseball. Softball. Basketball. Tennis. Volleyball. You are more likely to tear an Achilles tendon when you start moving suddenly. For instance, a sprinter might get one at the start of a race. The abrupt tensing of the muscle can be too much for the tendon to handle. Men older than age 30 are particularly prone to Achilles tendon injuries.

Symptoms
Tendon strain or tendon inflammation (tendonitis) can occur from tendon injury or overuse and can lead to a rupture. Call your doctor if you have signs of minor tendon problems. Minor tenderness and possible swelling increases with activity. There is usually no specific event causing sudden pain and no obvious gap in the tendon. You can still walk or stand on your toes. Acute calf pain and swelling can indicate a tear or partial tear of the Achilles tendon where it meets the calf muscle. You may still be able to use that foot to walk, but you will need to see a specialist such as an orthopedic surgeon. Surgery is not usually done for partial tears. Sometimes special heel pads or orthotics in your shoes may help. Follow up with your doctor to check for tendonitis or strain before resuming activity, because both can increase the risk of tendon rupture. Any acute injury causing pain, swelling, and difficulty with weight-bearing activities such as standing and walking may indicate you have a tear in your Achilles tendon. Seek prompt medical attention from your doctor or emergency department. Do not delay! Early treatment results in better outcome. If you have any question or uncertainty, get it checked.

Diagnosis
The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson?s test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.

Non Surgical Treatment
The treatments of Achilles tendonitis include resting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling Achilles tendonitis. In patients who have more significant symptoms, a period of immobilization can help. Either a removable walking boot or a cast can allow the inflamed tendon to cool down quickly. A heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic and work shoes. Applying ice to the area of inflammation can help stimulate blood flow to the area and relieve the pain associated with inflammation. Apply ice several times a day, including after exercise. The pain and swelling most commonly associated with Achilles tendonitis can be improved with non-steroidal, anti-inflammatory medications (NSAIDs) which include Celebrex?, Advil?, Motrin?, Naprosyn?. Be sure to consult your physician before starting any medications. Physical therapists can help formulate a stretching and rehabilitation program to improve flexibility of the Achilles tendon. Cortisone injections should not be used for Achilles tendonitis. Studies have shown an increased incidence of Achilles tendon rupture after cortisone injections.


Surgical Treatment
Surgical repair is a common method of treatment of acute Achilles rupture in North America because, despite a higher risk of overall complications, it has been believed to offer a reduced risk of rerupture. However, more recent trials, particularly those using functional bracing with early range of motion, have challenged this belief. The aim of this meta-analysis was to compare surgical treatment and conservative treatment with regard to the rerupture rate, the overall rate of other complications, return to work, calf circumference, and functional outcomes, as well as to examine the effects of early range of motion on the rerupture rate.

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.

Overview
Another common term for this condition is Posterior Tibial Tendon Dysfunction (PTTD). There is a cause-effect relationship between pronation, flatfoot deformity and subsequent tenosynovitis of the posterior tibial tendon. Mechanical irritation of the tendon may lead to synovitis, partial tearing and eventually full rupture of the tendon. Other structures, including ligaments and the plantar fascia, have also been shown to contribute to the arch collapsing. As the deformity progresses, these structures have been shown to attenuate and rupture as well. In later stages, subluxation of various joints lead to a valgus rearfoot and transverse plane deformity of the forefoot. These deformities can become fixed and irreducible as significant osteoarthritis sets in.


Causes
Several risk factors are associated with PTT dysfunction, including high blood pressure, obesity, diabetes, previous ankle surgery or trauma and exposure to steroids. A person who suspects that they are suffering from PTT dysfunction should seek medical attention earlier rather than later. It is much easier to treat early and avoid a collapsed arch than it is to repair one. When the pain first happens and there is no significant flatfoot deformity, initial treatments include rest, oral anti-inflammatory medications and, depending on the severity, a special boot or brace.

Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.

Diagnosis
There are four stages of adult-acquired flatfoot deformity (AAFD). The severity of the deformity determines your stage. For example, Stage I means there is a flatfoot position but without deformity. Pain and swelling from tendinitis is common in this stage. Stage II there is a change in the foot alignment. This means a deformity is starting to develop. The physician can still move the bones back into place manually (passively). Stage III adult-acquired flatfoot deformity (AAFD) tells us there is a fixed deformity. This means the ankle is stiff or rigid and doesn???t move beyond a neutral (midline) position. Stage IV is characterized by deformity in the foot and the ankle. The deformity may be flexible or fixed. The joints often show signs of degenerative joint disease (arthritis).

Non surgical Treatment
Initial treatment for most patients consists of rest and anti-inflammatory medications. This will help reduce the swelling and pain associated with the condition. The long term treatment for the problem usually involves custom made orthotics and supportive shoe gear to prevent further breakdown of the foot. ESWT(extracorporeal shock wave therapy) is a novel treatment which uses sound wave technology to stimulate blood flow to the tendon to accelerate the healing process. This can help lead to a more rapid return to normal activities for most patients. If treatment is initiated early in the process, most patients can experience a return to normal activities without the need for surgery.


Surgical Treatment
Good to excellent results for more than 80% of patients have been reported at five years' follow up for the surgical interventions recommended below. However, the postoperative recovery is a lengthy process, and most surgical procedures require patients to wear a plaster cast for two to three months. Although many patients report that their function is well improved by six months, in our experience a year is required to recover truly and gain full functional improvement after the surgery. Clearly, some patients are not candidates for such major reconstructive surgery.