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Bunions are bony protrusions located at the base of the big toe that develop when the toe is slanted inward or overlaps the next toe. They can be very painful. Bunions form when the movement of the big toe influences the angle of the bones in the foot. The changes gradually develop into the characteristic bump, which over time becomes more and more noticeable.

Causes
Contributing factors may include excessive foot pronation, wearing tight and pointed-toe shoes, and occasionally trauma. Joint misalignment causes osteoarthritis with cartilage erosion and exostosis formation, resulting in joint motion being limited (hallux limitus) or eliminated (hallux rigidus). In late stages, synovitis occurs, causing joint swelling. In reaction to pressure from tight shoes, an adventitious bursa can develop medial to the joint prominence, which can become painful, swollen, and inflamed.

Symptoms
Redness, swelling, or pain along the inside margin of the foot just behind the great toe. Moderate to severe discomfort at the bunion when wearing shoes, particularly if tight fitting. A painful callus may develop over the bunion. Sometimes a painful corn on the adjacent sides of the first and second toes. Irritation if there is overlapping of the first and second toes. Arthritis may cause stiffness and discomfort in the joint between the great toe and the first metatarsal. There may be a fluid filled cyst or bursa between the skin and the "bunion bone". Skin over the bunion may break down causing an ulceration, which can become infected.

Diagnosis
A doctor can very often diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot. In some cases, arthritis may also be seen.

Non Surgical Treatment
There are many treatment options for bunions and they will vary with the type and severity of each bunion and will also depend on what is causing the symptoms. Bunions are almost always progressive and tend to get larger and more painful with time, how fast this happens may be a function of the fit of the footwear. The initial goal of treatment options is to relieve pressure on the bunion and any symptoms that may be present and to halt or slow the progression of the joint deformity. There is no effective may be "get rid off" a bunion without surgery. There are a number of things that individuals and Podiatrists can do to help the symptoms and slow (if not halt) progression.

Surgical Treatment
In 2010, the National Institute for Health and Care Excellence (NICE) published guidance about a minimally invasive surgical procedure to treat bunions. The aim of the procedure is to repair the tilting of the big toe. The technique can be carried out under a local anaesthetic or a general anaesthetic, using X-rays or an endoscope for guidance. The type of endoscope used will be a long, thin, rigid tube with a light source and video camera at one end. One or more incisions will be made near the big toe so that bone-cutting instruments can be inserted. These will be used to remove the bunion and to divide one or more bones located at the front of the foot. Wires, screws or plates will be used to keep the divided bones in place. After the procedure, you may need to wear a plaster cast or dressing to keep your foot in the correct position until the bones have healed. You may be given a special surgical shoe that enables you to walk on your heel. As the procedure is relatively new, there's little in the way of reliable evidence regarding its safety or effectiveness. ]]> https://ameblo.jp/keithkaminska/entry-12040195265.html Thu, 18 Jun 2015 05:58:20 +0900 Overview
A bunion is an enlargement of ?the metatarsophalangeal (MTP) joint?, this is the big toe?s base joint that forms when the bone or tissue moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. The MTP joint, which carries lots of weight, is stiff and sore, making even the wearing of shoes difficult or impossible. It also causes swelling of the feet to occur. Hammer toes are also associated with the formation of bunions.

Causes
Bunions are not inherited, but do tend to run in families. What is inherited is the poor or faulty foot type, that mechanically can lead to the instability around the joint that will eventually lead to bunions, how soon, how quickly and how bad they are or become is assumed to be very dependant on the footwear. A number of other factors are known to play a role in the cause of bunions and hallux valgus. Bunions can follow foot injuries and develop in those with neuromuscular problems. Those with flat feet or pronated feet appear to be more prone to the instability about the joint and have a higher incidence of bunions. Some activities (eg ballet dancing) puts added pressure on the joint and may increase the chance of bunions developing.

Symptoms
Since the pain from a bunion is always aggravated by shoe wear, the symptoms will often depend on the type and size of shoes worn. The perception of pain or discomfort that people experience is quite varied. There are some individuals who have small bunions that are very uncomfortable. This limits their ability to wear shoes comfortably. On the other hand, some individuals may have quite significant deformities that are annoying but do not limit their activities in anyway.

Diagnosis
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.

Non Surgical Treatment
If you suspect a bunion, it is essential that you confirm your suspicions by consulting with a podiatric physician. Don?t try to treat the problem yourself, even by using conservative measures. Many conditions have similar symptoms, and only a professional can tell the difference. Once a diagnosis is obtained, it is essential to begin treatment immediately. Your podiatric physician will advise you on the most effective means. If caught early enough, good foot care, shoes that fit properly, and/or orthoses may eliminate the need for any further intervention. Certain over-the-counter remedies, such as felt or foam pads, applied to specific areas of the foot to relieve pressure and friction, will protect the bunion. Elevating the foot and icing the area for 20 minutes an hour may help to relieve pain.

Surgical Treatment
Surgery is a last option for those with advanced and painful bunions that do not respond to any other treatment. The surgical operation to correct the deformity from a bunion is called a bunionectomy, which typically involves removing bony growth of the bunion, re-positioning ligaments and tendons, and realigning the bones of the toe joint. Surgery is usually a day procedure performed with a local anaesthetic. The bones may be stabilised in their new position with screws or pins. Hardware may even include absorbable pins that are broken down by the body after a few months. You can expect a 6 - 8 week recovery period during which crutches are usually required. Surgery is often successful but sometimes the big toe moves back to its previous deviated position. Proper footwear and orthotics reduces the chances of surgical failure. ]]> https://ameblo.jp/keithkaminska/entry-12036735395.html Tue, 09 Jun 2015 06:37:58 +0900 Overview
Your foot has an incredible design. All of the parts fit together in such a way as to be flexible and moveable while still being very strong. One of the important parts of the foot is your arch. Located in the middle of your foot, it is slightly raised off the ground and helps you absorb the impact of every step. Sometimes, however, it can ache and make walking or standing around very uncomfortable.

Causes
Arch pain is most often caused by plantar fasciitis, which can affect the heel, arch, or both. Plantar fasciitis treatment is the same, regardless of the location of foot pain (see above). For persistent plantar fasciitis, an injection with a mixture of a steroid and local anesthetic can be helpful. Fallen arches or flat feet occur when the arches of the feet flatten out (often when standing or walking), causing foot pain and other problems. Flat feet can be treated with shoe inserts (orthotics), shoe adjustments, rest/ice, using a walking cane or brace, or physical therapy. Occasionally, surgery is necessary.

Symptoms
People suffering from pain in the arch sometimes complain of burning or soreness on the foot sole, which is worse in the morning and after physical activity. There may also be some tenderness when pressure is applied to the sole of the foot or heel. In addition to this, patients tend to complain of more pain when they stand on tiptoe.

Diagnosis
Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.

Non Surgical Treatment
Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and chronic pain. Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia. Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive-it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.

Surgical Treatment
In cases where cast immobilization, orthoses and shoe therapy have failed, surgery is the next alternative. The goal of surgery and non-surgical treatment is to eliminate pain, stop progression of the deformity and improve mobility of the patient. Opinions vary as to the best surgical treatment for adult acquired flatfoot. Procedures commonly used to correct the condition include tendon debridement, tendon transfers, osteotomies (cutting and repositioning of bone) and joint fusions.

Stretching Exercises
Try these simple stretches to assist with relieving pain in your arches. (Note: Stretch slowly and gently. You should feel a moderate pull on the muscle and tendon but no pain. If these stretches are painful, stop and seek further advice from a health professional). STRETCH ONE. Stand at arm?s length from a wall with one foot in front of the other, forward knee bent. Keeping your back leg straight and back heel on the floor, lean into the wall until you feel a stretch in your calf. STRETCH TWO. This time, bend your back leg slightly, and lean into the wall. You should feel a stretch in the lower part of your calf. Hold each stretch for 20 seconds and repeat on each leg, a few times daily. ]]> https://ameblo.jp/keithkaminska/entry-12033977154.html Tue, 02 Jun 2015 08:07:28 +0900 Overview
Adults with an acquired flatfoot deformity may present not with foot deformity but almost uniformly with medial foot pain and decreased function of the affected foot (for a list of causes of an acquired flatfoot deformity in adults. Patients whose acquired flatfoot is associated with a more generalised medical problem tend to receive their diagnosis and are referred appropriately. However, in patients whose ?adult acquired flatfoot deformity? is a result of damage to the structures supporting the medial longitudinal arch, the diagnosis is often not made early. These patients are often otherwise healthier and tend to be relatively more affected by the loss of function resulting from an acquired flatfoot deformity. The most common cause of an acquired flatfoot deformity in an otherwise healthy adult is dysfunction of the tibialis posterior tendon, and this review provides an outline to its diagnosis and treatment.

Causes
Adult flatfoot typically occurs very gradually. If often develops in an obese person who already has somewhat flat feet. As the person ages, the tendons and ligaments that support the foot begin to lose their strength and elasticity.

Symptoms
In many cases, adult flatfoot causes no pain or problems. In others, pain may be severe. Many people experience aching pain in the heel and arch and swelling along the inner side of the foot.

Diagnosis
In diagnosing flatfoot, the foot & Ankle surgeon examines the foot and observes how it looks when you stand and sit. Weight bearing x-rays are used to determine the severity of the disorder. Advanced imaging, such as magnetic resonance imaging (MRI) and computed tomography (CAT or CT) scans may be used to assess different ligaments, tendons and joint/cartilage damage. The foot & Ankle Institute has three extremity MRI?s on site at our Des Plaines, Highland Park, and Lincoln Park locations. These extremity MRI?s only take about 30 minutes for the study and only requires the patient put their foot into a painless machine avoiding the uncomfortable Claustrophobia that some MRI devices create.

Non surgical Treatment
Options range from shoe inserts, orthotics, bracing and physical therapy for elderly and/or inactive patients to reconstructive surgical procedures in those wishing to remain more active. These treatments restore proper function and alignment of the foot by replacing the damaged muscle tendon unit with an undamaged, available and expendable one, lengthening the contracted Achilles tendon and realigning the Os Calcis, or heel bone, while preserving the joints of the hindfoot. If this condition is not recognized before it reaches advanced stages, a fusion of the hindfoot or even the ankle is necessary. Typically this is necessary in elderly individuals with advanced cases that cannot be improved with bracing.

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. Symptomatic flexible flatfoot conditions are common entities in both the adolescent and adult populations. Ligamentous laxity and equinus play a significant role in most adolescent deformities. Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult acquired flatfoot. One should consider surgical treatment for patients who have failed nonoperative therapy and have advancing symptoms and deformities that significantly interfere with the functional demands of daily life. Isolated Joint Fusion. This technique is used for well reducible flat foot by limiting motion at one or two joints that are usually arthritic. The Evans Anterior Calcaneal Osteotomy. This is indicated for late stage II adult acquired flatfoot and the flexible adolescent flatfoot. This procedure will address midtarsal instability, restore the medial longitudinal arch and reduce mild hind foot valgus. The Posterior Calcaneal Displacement Osteotomy (PCDO). This technique is indicated for late stage I and early stage II PTTD with reducible Calcaneal valgus. This is often combined with a tendon transfer. A PCDO is also indicated as an adjunctive procedure in the surgical reconstruction of the severe flexible adolescent flatfoot. Soft tissue procedure. On their own these are not very effective but in conjunction with an osseous procedure, soft tissue procedures can produce good outcome. Common ones are tendon and capsular repair, tendon lengthening and transfer procedures. Flat foot correction requires lengthy post operative period and a lot of patience. Your foot may need surgery but you might simply not have the time or endurance to go through the rehab phase of this type of surgery. We will discuss these and type of procedures necessary for your surgery in length before we go further with any type of intervention. ]]> https://ameblo.jp/keithkaminska/entry-12017543829.html Wed, 22 Apr 2015 20:38:26 +0900