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Foot Pain Relief

Tips On How To Diagnose Pes Planus

Overview

Adult Acquired Flat Feet

The medical term for fallen arches is pes planus. Pes planus can occur from birth and is not always a medical problem (pathologic). It can also occur over time from degeneration of the cartilage and ligaments that support the arch of the foot. It is especially important for persons with pes planus that is caused by degeneration to use comfortable footwear.

Causes

The most common acquired flat foot in adults is due to Posterior Tibial Tendon Dysfunction. This develops with repetitive stress on the main supporting tendon of the arch over a long period of time. As the body ages, ligaments and muscles can weaken, leaving the job of supporting the arch all to this tendon. The tendon cannot hold all the weight for long, and it gradually gives out, leading to a progressively lower arch. This form of flat foot is often accompanied by pain radiating behind the ankle, consistent with the course of the posterior tibial tendon. Compounding matters is the fact that the human foot was not originally designed to withstand the types of terrain and forces it is subjected to today. Nowhere in nature do you see the flat hard surfaces that we so commonly walk on in present times. Walking on this type of surface continuously puts unnatural stress on the arch. The fact that the average American is overweight does not help the arch much either-obesity is a leading cause of flat feet as the arch collapses under the excessive bodyweight. Furthermore, the average life span has increased dramatically in the last century, meaning that not only does the arch deal with heavy weight on hard flat ground, but also must now do so for longer periods of time. These are all reasons to take extra care of our feet now in order to prevent problems later.

Symptoms

Not everyone who has flat feet experiences symptoms. Others, however, feel persistent pain in their feet and wearing shoes can prove additionally painful. Others only feel symptoms when they walk more than normal, go jogging or participate in a sport that involves running or kicking.

Diagnosis

Flat feet are easy to identify while standing or walking. When someone with flat feet stands, their inner foot or arch flattens and their foot may roll over to the inner side. This is known as overpronation. To see whether your foot overpronates, stand on tiptoes or push your big toe back as far as possible. If the arch of your foot doesn't appear, your foot is likely to overpronate when you walk or run. It can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.

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Non Surgical Treatment

Treatment of flat feet by a fully educated, trained, and licensed podiatrist should be sought if the previously mentioned pain in the foot or knee areas start to surface and becomes a painful problem. Depending on the cause and exact type of the condition, a variety of forms of treatment may be prescribed. Verification of the exact cause and type of flat feet that each individual has, should only be handled by a professional podiatrist. Often times, the actual treatment method will include some form of arch support or light gymnastic style exercise. In rare cases, something more involved may be necessary, but only your skilled podiatrist would be able to accurately make that determination. If you suffer from flat feet, plantar fasciitis, or any other form of problematic foot condition, we encourage you to contact a foot clinic today and potentially rid yourself of that problem in virtually no time at all.

Surgical Treatment

Flat Feet

Common indications for surgery are cerebral palsy with an equinovalgus foot, to prevent progression and breakdown of the midfoot. Rigid and painful Pes Planus. To prevent progression, eg with a Charcot joint. Tibialis posterior dysfunction, where non-surgical treatment is unsuccessful. Possible surgical procedures include Achilles tendon lengthening. Calcaneal osteotomy, to re-align the hindfoot. Reconstruction of the tibialis posterior tendon. For severe midfoot collapse of the arch, triple arthrodesis may be indicated.
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Leg Length Discrepancy And Surgical Operations

Overview

Leg length difference (LLD) is primarily when the hips are not level, causing a limp from side to side. Most practitioners divide LLD into anatomical or functional. Anatomical is when there is a true difference in the length of the tibia/fibula or the femur bone, or both. While functional LLD are either the shortening or lengthening of a limb, secondary to joint contracture or muscle imbalances.Leg Length Discrepancy

Causes

Limb-length conditions can result from congenital disorders of the bones, muscles or joints, disuse or overuse of the bones, muscles or joints caused by illness or disease, diseases, such as bone cancer, Issues of the spine, shoulder or hip, traumatic injuries, such as severe fractures that damage growth plates.

Symptoms

The most common symptom of all forms of LLD is chronic backache. In structural LLD the sufferer may also experience arthritis within the knee and hip are, flank pain, plantar fasciitis and metatarsalgia all on the side that is longer. Functional LLD sufferers will see similar conditions on the shorter side.

Diagnosis

Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.

Non Surgical Treatment

The way in which we would treat a LLD would depend on whether we have an anatomical or functional difference. To determine which one is causing the LLD you will need to get your legs measured. This is the easiest way to determine if it is anatomical or functional. With a functional LLD we must first determine the cause and treat the cause. Should the cause be one that is not correctable then we may need to treat the LLD as if it were an anatomical or may have to treat the opposite leg to improve one's gait. As for the anatomical LLD, we may start off with a heel lift only in the shoe and follow up to see if we will need to put the lift full sole on the bottom of the shoe. This is determined by the affects that a heel lift in one shoe may have on that knee. Should the LLD be more than 1/4 inch we usually recommend starting between 1/8 inch to 1/4 inch less than the actual amount and let the body adjust to the change and then raise up to the measured amount later.

Leg Length Discrepancy

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Surgical Treatment

Surgical lengthening of the shorter extremity (upper or lower) is another treatment option. The bone is lengthened by surgically applying an external fixator to the extremity in the operating room. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins or both. A small crack is made in the bone and tension is created by the frame when it is "distracted" by the patient or family member who turns an affixed dial several times daily. The lengthening process begins approximately five to ten days after surgery. The bone may lengthen one millimeter per day, or approximately one inch per month. Lengthening may be slower in adults overall and in a bone that has been previously injured or undergone prior surgery. Bones in patients with potential blood vessel abnormalities (i.e., cigarette smokers) may also lengthen more slowly. The external fixator is worn until the bone is strong enough to support the patient safely, approximately three months per inch of lengthening. This may vary, however, due to factors such as age, health, smoking, participation in rehabilitation, etc. Risks of this procedure include infection at the site of wires and pins, stiffness of the adjacent joints and slight over or under correction of the bone?s length. Lengthening requires regular follow up visits to the physician?s office, meticulous hygiene of the pins and wires, diligent adjustment of the frame several times daily and rehabilitation as prescribed by your physician.

Everything It Is Best To Know About

Overview

Heel Pain

As anyone who has ever had foot pain can tell you, when your feet hurt, you hurt all over. ?The feet are the foundation of our ?building,? or body,? says Craig Gastwirth, a podiatrist at Podiatry Examiners of Michigan in Detroit. ?If there?s a problem with that foundation, everything else - knees, hips and back - is thrown off.? Heel pain, typically caused by plantar fasciitis, is the No. 1 reason people visit a podiatrist, says Dr. Gastwirth. Plantar fasciitis, inflammation of a thick band of connective tissue called the plantar fascia, which runs along the sole from the bottom of the heel bone to the toes, can feel like the arch of the foot is tearing.

Causes

Heel pain has a number of causes that are typically associated with overuse of the heel bone. You can strain your heel by pounding your feet on hard surfaces, being overweight, or wearing shoes that do not fit properly. These strains can irritate the heel?s bones, muscles, or tendons. Other common causes of heel pain include the following. Heel Spurs. Heel spurs develop when the lining that covers the heel is continuously stretched. When this occurs, pieces of the lining may break off. Heel spurs typically develop in athletes who frequently run or jog. They are also common in people who are obese. Plantar Fasciitis. Plantar fasciitis develops when the tissue connecting the heel to the ball of the foot becomes inflamed. Plantar fasciitis also occurs in athletes who frequently run or jog. It can also result from wearing shoes that do not fit properly. Excessive Pronation. Excessive pronation occurs when the ligaments and tendons at the back of the heel are stretched too much. This condition can occur when injuries to the back, hips, or knees change the way you walk. Achilles Tendinitis. Achilles tendinitis can occur when the Achilles tendon, which runs along the back of the heel, becomes inflamed. This condition is common in people with active lifestyles who frequently run and jog, professional athletes and dancers.

Symptoms

The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they?ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

Non Surgical Treatment

Recommended treatments, heel Spurs: cushioning for the heel is of little value. Your chiropodist/podiatrist may initially apply padding and strapping to alter the direction of stretch of the ligament. This is often successful at reducing the tenderness in the short term. Your chiropodist/podiatrist may suggest a course of deep heat therapy to stimulate the healing processes, allowing damage to respond and heal faster. In the long term, your chiropodist/podiatrist may prescribe special insoles (orthoses) to help the feet to function more effectively, thereby reducing strain on the ligaments and making any recurrence less likely. If pain from heel spurs continues, you may be referred to your GP who can prescribe an oral non-steroidal anti-inflammatory. Alternatively, localised hydrocortisone injection treatment may be given by your GP or an appropriate chiropodist/podiatrist. If pain persists, surgery may be considered. Heel Bursitis: in most cases, attention to the cause of any rubbing, and appropriate padding and strapping by your chiropodist/podiatrist will allow the inflammation to settle. If infection is present, your chiropodist/podiatrist will refer you to your GP for antibiotics. Heel Bumps: adjustments to footwear is often enough to make them comfortable. A leather heel counter and wearing boots may help. However, if pain persists, surgery may be necessary.

Surgical Treatment

Only a relatively few cases of heel pain require surgery. If required, surgery is usually for the removal of a spur, but also may involve release of the plantar fascia, removal of a bursa, or a removal of a neuroma or other soft-tissue growth.

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Prevention

Heel Discomfort

You can try to avoid the things that cause heel pain to start avoid becoming overweight, where your job allows, minimise the shock to your feet from constant pounding on hard surfaces, reduce the shocks on your heel by choosing footwear with some padding or shock-absorbing material in the heel, if you have high-arched feet or flat feet a moulded insole in your shoe may reduce the stresses on your feet, if you have an injury to your ankle or foot, make sure you exercise afterwards to get back as much movement as possible to reduce the stresses on your foot and your heel in particular, If you start to get heel pain, doing the above things may enable the natural healing process to get underway and the pain to improve.
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Leg Length Discrepancy Surgery Cost

Overview

Surgical treatments vary in complexity. Sometimes the goal of surgery is to stop the growth of the longer limb. Other times, surgeons work to lengthen the shorter limb. Orthopedic surgeons may treat children who have limb-length conditions with one or a combination of these surgical techniques. Bone resection. An operation to remove a section of bone, evening out the limbs in teens or adults who are no longer growing. Epiphyseal stapling. An operation to slow the rate of growth of the longer limb by inserting staples into the growth plate, then removing them when the desired result is achieved. Epiphysiodesis. An operation to slow the rate of growth of the longer limb by creating a permanent bony ridge near the growth plate. Limb lengthening. A procedure (also called distraction osteogenesis or the Ilizarov procedure) that involves attaching an internal or external fixator to a limb and gradually pulling apart bone segments to grow new bone between them. There are several ways your doctor can predict the final LLD, and thus the timing of the surgery. The easiest way is the so-called Australian method, popularised by Dr. Malcolm Menelaus, an Australian orthopedic surgeon. According to this method, growth in girls is estimated to stop at age 14, and in boys at age 16 years. The femur grows at the rate of 10 mm. a year, and the upper tibia at the rate of 6 mm. a year. Using simple arithmetic, one can get a fairly good prediction of future growth. This of course, is an average, and the patient may be an average. To cut down the risk of this, the doctor usually measures leg length using special X-ray technique (called a Scanogram) on three occasions over at least one year duration to estimate growth per year. He may also do an X-ray of the left hand to estimate the bone age (which in some cases may differ from chronological age) by comparing it with an atlas of bone age. In most cases, however, the bone age and chronological age are quite close. Another method of predicting final LLD is by using Anderson and Green?s remaining growth charts. This is a very cumbersome method, but was till the 1970?s, the only method of predicting remaining growth. More recently, however, a much more convenient method of predicting LLD was discovered by Dr. Colin Moseley from Montreal. His technique of using straight line graphs to plot growth of leg lengths is now the most widely used method of predicting leg length discrepancy. Whatever method your doctor uses, over a period of one or two years, once he has a good idea of the final LLD, he can then formulate a plan to equalize leg lengths. Epiphyseodesis is usually done in the last 2 to 3 years of growth, giving a maximum correction of about 5 cm. Leg lengthening can be done at any age, and can give corrections of 5 to10 cm., or more.Leg Length Discrepancy

Causes

A number of causes may lead to leg length discrepancy in children. Differences in leg length frequently follow fractures in the lower extremities in children due to over or under stimulation of the growth plates in the broken leg. Leg length discrepancy may also be caused by a congenital abnormality associated with a condition called hemihypertrophy. Or it may result from neuromuscular diseases such as polio and cerebral palsy. Many times, no cause can be identified. A small leg length discrepancy of a quarter of an inch or less is quite common in the general population and of no clinical significance. Larger leg length discrepancies become more significant. The long-term consequences of a short leg may include knee pain, back pain, and abnormal gait or limp.

Symptoms

The symptoms of limb deformity can range from a mild difference in the appearance of a leg or arm to major loss of function of the use of an extremity. For instance, you may notice that your child has a significant limp. If there is deformity in the extremity, the patient may develop arthritis as he or she gets older, especially if the lower extremities are involved. Patients often present due to the appearance of the extremity (it looks different from the other side).

Diagnosis

A doctor will generally take a detailed medical history of both the patient and family, including asking about recent injuries or illnesses. He or she will carefully examine the patient, observing how he or she moves and stands. If necessary, an orthopedic surgeon will order X-ray, bone age determinations and computed tomography (CT) scans or magnetic resonance imaging (MRI).

Non Surgical Treatment

Internal heel lifts: Putting a simple heel lift inside the shoe or onto a foot orthotic has the advantage of being transferable to many pairs of shoes. It is also aesthetically more pleasing as the lift remains hidden from view. However, there is a limit as to how high the lift can be before affecting shoe fit. Dress shoes will usually only accommodate small lifts (1/8"1/4") before the heel starts to piston out of the shoe. Sneakers and workboots may allow higher lifts, e.g., up to 1/2", before heel slippage problems arise. External heel lifts: If a lift of greater than 1/2" is required, you should consider adding to the outsole of the shoe. In this way, the shoe fit remains good. Although some patients may worry about the cosmetics of the shoe, it does ensure better overall function. Nowadays with the development of synthetic foams and crepes, such lifts do not have to be as heavy as the cork buildups of the past. External buildups are not transferable and they will wear down over time, so the patient will need to be vigilant in having them repaired. On ladies' high-heel shoes, it may be possible to lower one heel and thereby correct the imbalance.

Leg Length

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Surgical Treatment

Large leg length inequalities can be treated by staged lengthenings or by simultaneous ipsilateral femoral and tibial lengthenings. Additionally, lengthenings can be combined with appropriately timed epiphysiodesis in an effort to produce leg length equality. Staged lengthenings are often used for congenital deficiencies such as fibular hemimelia, in which 15 cm or more may be needed to produce leg length equality. We typically plan for the final lengthening to be completed by age 13 or 14 years, and allow at least 3 years between lengthenings. Lengthening of both the tibia and femur simultaneously requires aggressive therapy and treatment of soft tissue contractures. Curran et al[57] reported the need for surgical release of soft tissue contractures in 3 of 8 patients treated with simultaneous ipsilateral femoral and tibial lengthenings. Lengthening over an IM nail can be done in an effort to decrease the amount of time the fixator needs to be worn and to prevent angular malalignment. This technique requires that the patient be skeletally mature and it carries a higher risk of osteomyelitis (up to 15%). Additionally, if premature consolidation occurs, a repeat corticotomy is more difficult.
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What Causes Mortons Neuroma

Overview

MortonMorton neuromas are focal areas of symptomatic perineural fibrosis around a plantar digital nerve of the foot. The abnormality is non-neoplastic and does not represent a true neuroma. It may more correctly be known as Morton?s metatarsalgia. The condition is thought to be due to chronic entrapment of the nerve by the intermetatarsal ligament. It most often occurs in middle-aged individuals and is many times more common in women than men. Approximately 30% of asymptomatic middle-aged persons have the radiological pathologic findings of a Morton?s neuroma.

Causes

Morton's neuroma may be the result of irritation, pressure or injury. In some cases its cause is unknown. In the majority of cases only one nerve is affected. Having both feet affected is extremely rare. A high percentage of patients with Morton's neuroma are women who wear high-heeled or narrow shoes. Patients with Morton's neuroma may need to change their footwear, take painkillers or steroid injections, while others may require surgery to either remove the affected nerve or release the pressure on it.

Symptoms

A Morton's neuroma usually causes burning pain, numbness or tingling at the base of the third, fourth or second toes. Pain also can spread from the ball of the foot out to the tips of the toes. In some cases, there also is the sensation of a lump, a fold of sock or a "hot pebble" between the toes. Typically, the pain of a Morton's neuroma is relieved temporarily by taking off your shoes, flexing your toes and rubbing your feet. Symptoms may be aggravated by standing for prolonged periods or by wearing high heels or shoes with a narrow toe box.

Diagnosis

Your doctor will suspect that you have a Morton's neuroma based on the nature and location of your foot pain. He or she may ask questions about your shoes - what type of shoes you usually wear and whether these shoes have narrow toes or high heels. To rule out other causes of foot pain, your doctor may ask questions about your medical history, especially any history of arthritis, nerve and muscle problems or previous injury to your foot or leg.

Non Surgical Treatment

Treaments may include wearing wider shoes to reduce the squeezing force on the foot. Adding a specially made padding to shoes to offload the pressure on the ball of the foot (called a metatarsal dome) Addressing the foot and lower limb biomechanics. This involves looking at foot stability and if needed prescribing an orthotic device to correct your foot position. Anesthetic & Cortisone injections. This is done when the above treatments are insufficient. The trauma is sometimes so great that conservative treatment cannot control the inflammation or cause of the pain. A series of injections are performed to control the inflammation or to temporarily settle the nerve. An ultrasound and cortisone injection can be prescribed by your podiatrist.Morton neuroma

Surgical Treatment

Surgery to remove the neuroma may be recommended if more conservative treatment does not solve the problem. While surgery usually relieves or completely removes the symptoms, it often leaves a permanent numb feeling at the site of the neuroma.
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How Shoe Lifts Overcome Leg Length Imbalances

There are two different kinds of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is anatomically shorter in comparison to the other. As a result of developmental periods of aging, the human brain senses the stride pattern and identifies some variation. The body typically adapts by tilting one shoulder to the "short" side. A difference of under a quarter inch isn't very irregular, require Shoe Lifts to compensate and normally doesn't have a profound effect over a lifetime.

Leg Length Discrepancy Shoe Lifts

Leg length inequality goes largely undiagnosed on a daily basis, however this condition is easily fixed, and can reduce many incidents of back discomfort.

Therapy for leg length inequality typically involves Shoe Lifts. They are economical, usually costing less than twenty dollars, compared to a custom orthotic of $200 and up. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Back ache is the most prevalent health problem afflicting people today. Around 80 million people experience back pain at some stage in their life. It is a problem that costs businesses huge amounts of money every year due to time lost and production. New and superior treatment methods are always sought after in the hope of decreasing the economic influence this issue causes.

Leg Length Discrepancy Shoe Lifts

Men and women from all corners of the world suffer the pain of foot ache as a result of leg length discrepancy. In most of these cases Shoe Lifts might be of beneficial. The lifts are capable of relieving any discomfort and pain in the feet. Shoe Lifts are recommended by many experienced orthopaedic physicians.

To be able to support the body in a healthy and balanced manner, feet have a critical part to play. Irrespective of that, it is often the most neglected zone of the body. Some people have flat-feet which means there is unequal force exerted on the feet. This will cause other body parts like knees, ankles and backs to be impacted too. Shoe Lifts guarantee that ideal posture and balance are restored.

Shoe Lifts The Podiatrists Option For Leg Length Difference

There are two different types of leg length discrepancies, congenital and acquired. Congenital means you are born with it. One leg is anatomically shorter in comparison to the other. As a result of developmental stages of aging, the human brain picks up on the stride pattern and identifies some difference. Our bodies typically adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch isn't grossly excessive, demand Shoe Lifts to compensate and commonly does not have a profound effect over a lifetime.

Shoe Lifts

Leg length inequality goes mainly undiscovered on a daily basis, however this condition is very easily fixed, and can eliminate many cases of back discomfort.

Treatment for leg length inequality usually consists of Shoe Lifts. These are low-priced, commonly priced at below twenty dollars, in comparison to a custom orthotic of $200 if not more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Lumbar pain is easily the most prevalent health problem affecting people today. Around 80 million men and women experience back pain at some stage in their life. It's a problem that costs businesses vast amounts of money each year because of lost time and productivity. New and better treatment methods are continually sought after in the hope of lowering economic influence this condition causes.

Leg Length Discrepancy Shoe Lift

People from all corners of the world suffer from foot ache as a result of leg length discrepancy. In these cases Shoe Lifts are usually of beneficial. The lifts are capable of easing any discomfort in the feet. Shoe Lifts are recommended by countless expert orthopaedic orthopedists.

To be able to support the body in a well-balanced fashion, your feet have got a vital job to play. In spite of that, it is sometimes the most neglected zone of the human body. Some people have flat-feet meaning there is unequal force placed on the feet. This will cause other parts of the body such as knees, ankles and backs to be impacted too. Shoe Lifts ensure that appropriate posture and balance are restored.