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Aug252015

Bursitis Of The Foot

Overview


During contraction of the calf muscle, tension is placed through the Achilles tendon and this rubs against the retrocalcaneal bursa. Compressive forces and friction may also be placed on the retrocalcaneal bursa during certain ankle movements or by wearing excessively tight shoes. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. This condition is known as retrocalcaneal bursitis.


Causes


Repetitive overuse injury of the ankle during long periods of running and or walking. Tight shoes. The heel counter of the shoe constantly rubbing against the back of the heel. Wearing shoes with a low cut heel counter. Abnormal foot mechanics (abnormal pronation). Poor flexibility. Inappropriate training.


Symptoms


Your feet are extremely resilient and are designed to stand up to the pressures of day-to-day living. In some cases, though, foot structures may break down when subjected to chronic stress associated with prolonged periods of weight-bearing activity on concrete, asphalt, or other hard surfaces (especially when your footwear does not allow for appropriate weight distribution). Foot problems, including infracalcaneal bursitis, are often exacerbated by poorly designed footwear, and pressure, impact, and shear forces can damage your feet over time. Bursal sacs are intended to minimize this damage, but sometimes the bursa itself becomes inflamed.


Diagnosis


When you suspect you have retrocalcaneal bursitis, your foot doctor will begin by taking a complete history of the condition. A physical exam will also be performed. X-rays are usually taken on the first visit as well to determine the shape of the heel bone, joint alignment in the rearfoot, and to look for calcium deposits in the Achilles tendon. The history, exam and x-rays may sufficient for your foot surgeon to get an idea of the treatment that will be required. In some cases, it may be necessary to get an ultrasound or MRI to further evaluate the Achilles tendon or its associated bursa. While calcium deposits can show up on xray, the inflammation in the tendon and bursa will show up much better on ultrasound and MRI. The results of these tests can usually be explained on the first visit. You can then have a full understanding of how the problem started, what you can do to treat prevent it from getting worse/ You will also know which treatment will be most helpful in making your heel pain go away.


Non Surgical Treatment


The following exercises are commonly prescribed to patients with retrocalcaneal bursitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2, 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in a circle as large as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free.


Surgical Treatment


Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.

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Aug252015

Apparent Symptoms Of Bursitis Of The Feet

Overview


Heel Bursitis is a condition where one of the bursae at the back of the heel becomes swollen, inflamed and painful. A bursa is a fluid filled sac that cushions muscles, tendons and joints. There are 3 main types of bursitis associated with heel bursitis. These include Retro-calcaneal bursitis, Achilles bursitis, and Sub-calcaneal bursitis. The locations of the 3 bursae are: the insertion point of the Achilles tendon at the back of the heel (retro-calcaneal bursa), between the Achilles tendon and the skin at the back of the heel (Achilles bursa), and the bottom of the heel (sub-calcaneal bursa).


Causes


High impact activity, such as running. Trauma to the heel such as jumping from a height. Increase in training levels. Lack of shock absorbency in the trainers worn. Worn running shoes. Poor biomechanics. Loss of the fat pad under the heel. Increase in weight.


Symptoms


Pain or tenderness at the back of the heel around the Achilles region. Increased pain during activities with strong, repetitive calf contractions, walking (uphill), stair climbing, running, jumping. Pain may be worse with rest after activity (that night or the next morning) or at the beginning of the excercise. Pain when wearing shoes and the heel is getting rubbed. Bump forming on the back of the heel. Limping. Stiffness. Decreased range of motion. Redness and warmth (if the bursa gets infected).


Diagnosis


In addition to a complete medical history and physical examination, diagnostic procedures for bursitis may include the following. X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. Ultrasound. A diagnostic technique that uses high-frequency sound waves to create an image of the internal organs. Aspiration. A procedure that involves removal of fluid from the swollen bursa to exclude infection or gout as causes of bursitis. Blood tests. Lab tests that are done to confirm or eliminate other conditions.


Non Surgical Treatment


Cold compresses can help reduce the initial swelling and pain in acute (short-term but severe) soft tissue conditions. Cold therapy is usually most effective during the first 48 hours after swelling begins. Guidelines for cold therapy include. Use a cold gel pack, a bag filled with ice cubes, or even a bag of frozen vegetables. Wrap the pack in a towel if the cold temperature is too painful. Place the cold pack over the area for 20 minutes, three to four times a day. Rub an ice cube over smaller painful areas for a short time. After 48 hours, or for chronic (long-term) pain, dry or moist heat may be more helpful than cold compresses. Follow these guidelines. Use a hot pack, a heating pad, or a damp towel heated in the microwave (make sure it's not too hot or it may burn your skin). Place a hot pack over the painful area for 15-20 minutes, three to four times a day. Never use analgesic creams or rubs with heat packs because the combination could severely burn your skin. Take a warm shower or bath.


Surgical Treatment


Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to remove the inflamed bursa.


Prevention


Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.

Admin · 131 views · Leave a comment