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Mar212015

The Cause And Treatment For Adult Aquired FlatFoot

Overview


A painful flat foot, or adult acquired flatfoot deformity, is a progressive collapsing of the arch of the foot that occurs as the posterior tibial tendon becomes insufficient due to various factors. Early stages may present with only pain along the posterior tibial tendon whereas advanced deformity usually results in arthritis and rigidity of the rearfoot and ankle.Flat Feet






Causes


As the name suggests, adult-acquired flatfoot occurs once musculoskeletal maturity is reached, and it can present for a number of reasons, though one stands out among the others. While fractures, dislocations, tendon lacerations, and other such traumatic events do contribute to adult-acquired flatfoot as a significant lower extremity disorder, as mentioned above, damage to the posterior tibial tendon is most often at the heart of adult-acquired flatfoot. One study further elaborates on the matter by concluding that ?60% of patients [presenting with posterior tibial tendon damage and adult-acquired flatfoot] were obese or had diabetes mellitus, hypertension, previous surgery or trauma to the medial foot, or treatment with steroids?.






Symptoms


Posterior tibial tendon insufficiency is divided into stages by most foot and ankle specialists. In stage I, there is pain along the posterior tibial tendon without deformity or collapse of the arch. The patient has the somewhat flat or normal-appearing foot they have always had. In stage II, deformity from the condition has started to occur, resulting in some collapse of the arch, which may or may not be noticeable. The patient may feel it as a weakness in the arch. Many patients initially present in stage II, as the ligament failure can occur at the same time as the tendon failure and therefore deformity can already be occurring as the tendon is becoming symptomatic. In stage III, the deformity has progressed to the extent where the foot becomes fixed (rigid) in its deformed position. Finally, in stage IV, deformity occurs at the ankle in addition to the deformity in the foot.






Diagnosis


Observation by a skilled foot clinician and a hands-on evaluation of the foot and ankle is the most accurate diagnostic technique. Your Dallas foot doctor may have you do a walking examination (the most reliable way to check for the deformity). During walking, the affected foot appears more pronated and deformed. Your podiatrist may do muscle testing to look for strength deficiencies. During a single foot raise test, the foot doctor will ask you to rise up on the tip of your toes while keeping your unaffected foot off the ground. If your posterior tendon has been attenuated or ruptured, you will be unable to lift your heel off the floor. In less severe cases, it is possible to rise onto your toes, but your heel will not invert normally. X-rays are not always helpful as a diagnostic tool for Adult Flatfoot because both feet will generally demonstrate a deformity. MRI (magnetic resonance imaging) may show tendon injury and inflammation, but can?t always be relied on for a complete diagnosis. In most cases, a MRI is not necessary to diagnose a posterior tibial tendon injury. An ultrasound may also be used to confirm the deformity, but is usually not required for an initial diagnosis.






Non surgical Treatment


Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support.


Adult Acquired Flat Foot






Surgical Treatment


A new type of surgery has been developed in which surgeons can re-construct the flat foot deformity and also the deltoid ligament using a tendon called the peroneus longus. A person is able to function fully without use of the peroneus longus but they can also be taken from deceased donors if needed. The new surgery was performed on four men and one woman. An improved alignment of the ankle was still evident nine years later, and all had good mobility 8 to 10 years after the surgery. None had developed arthritis.

Admin · 5082 views · Leave a comment
Mar142015

Do I Suffer Adult Aquired Flat Foot (AAF)?

Overview


PTTD is a common condition treated by foot and ankle specialists. Although there is a role for surgical treatment of PTTD, conservative care often can prevent or delay surgical intervention. Decreasing inflammation and stabilizing the affected joints associated with the posterior tibial tendon can decrease pain and increase functional levels. With many different modalities available, aggressive nonoperative methods should be considered in the treatment of PTTD, including early immobilization, the use of long-term bracing, physical therapy, and anti-inflammatory medications. If these methods fail, proper evaluation and work-up for surgical intervention should be employed.Adult Acquired Flat Feet






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


Patients will usually describe their initial symptoms as "ankle pain", as the PT Tendon becomes painful around the inside of the ankle joint. The pain will become more intense as the foot flattens out, due to the continued stretching and tearing of the PT Tendon. As the arches continue to fall, and pronation increases, the heel bone (Calcaneus) tilts into a position where it pinches against the ankle bone (Fibula), causing pain on both the inside and outside of the ankle. As the foot spends increased time in a flattened, or deformed position, Arthritis can begin to affect the joints of the foot, causing additional pain.






Diagnosis


Observe forefoot to hindfoot alignment. Do this with the patient sitting and the heel in neutral, and also with the patient standing. I like to put blocks under the forefoot with the heel in neutral to see how much forefoot correction is necessary to help hold the hindfoot position. One last note is to check all joints for stiffness. In cases of prolonged PTTD or coalition, rigid deformity is present and one must carefully check the joints of the midfoot and hindfoot for stiffness and arthritis in the surgical pre-planning.






Non surgical Treatment


This condition may be treated with conservative methods. These can include orthotic devices, special shoes, and bracing. Physical therapy, rest, ice, and anti-inflammatory medication may be prescribed to help relieve symptoms. If the condition is very severe, surgical treatment may be needed.


Acquired Flat Feet






Surgical Treatment


Many operations are available for the treatment of dysfunction of the posterior tibial tendon after a thorough program of non-operative treatment has failed. The type of operation that is selected is determined by the age, weight, and level of activity of the patient as well as the extent of the deformity. The clinical stages outlined previously are a useful guide to operative care (Table I). In general, the clinician should perform the least invasive procedure that will decrease pain and improve function. One should consider the effects of each procedure, particularly those of arthrodesis, on the function of the rest of the foot and ankle.

Admin · 21269 views · Leave a comment
Mar062015

What Exactly Leads To Tendonitis Of The Achilles ?

Overview


Achilles TendonitisAchilles tendonitis (tendinitis), is a painful and often debilitating inflammation of the Achilles tendon than can progress into degeneration which we call Achilles Tendinosis. The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone (calcaneus), and connects the calf muscles to the heel bone. In most cases, Achilles tendonopathy's are overuse injuries are more common among athletes and people who train heavily, however it can also occur in people who are less active. Achilles Tendonitis can vary in severity from a mild pain in the tendon during a particular activity to more severe cases when any form of activity that puts strain on this ligament, even standing or walking, can cause pain.


Causes


Achilles tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptoms. In many people who have developed achilles tendonitis, chronic shortening of the gastroc-soleus muscle complex is the reason that home remedies and anti-inflammatory medications fail. In these instances the muscle itself becomes shortened and creates a constant stress at the tendon?s attachment. Like a green branch that is slowly bent, eventually it begins to breakdown. Over a prolonged period the tendon becomes inflamed, and in the worst cases, appears swollen and thickened. In certain circumstances attempts to heal have failed and the body?s inability to heal the tissue results in degenerative changes known as achilles tendonosis. Anti-inflammatory medication, stretching and ice may only provide temporary relief, because they address the inflammation but not the root cause.


Symptoms


Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.


Diagnosis


If you think you have Achilles tendinitis, make an appointment to see your doctor. The doctor will ask you questions about your recent activity and look for signs. The foot not flexing when the calf muscle is pressed ( if Achilles ruptures or tears in half). Swelling on the back of the foot. Pain in the back of the foot. Limited range of motion in ankle. An X-ray or MRI scan can check for tendinitis.


Nonsurgical Treatment


Ask your Pharmacist for advice. 1) Your Pharmacy stocks a range of cold packs which may be applied to the area to decrease inflammation. 2) Ask your Pharmacist about a temporary heel raise or pad which can be inserted into footwear to decrease the force absorbed by the tendon when the feet land heavily on the ground. 3) Gently massaging a heat-producing liniment into the calf can help to relieve tension in the muscle which may relieve the symptoms of Achilles Tendinitis. Ask your Pharmacist to recommend the most appropriate type. 4) Gels, sprays or creams which help to reduce inflammation are available and may be applied to the injured area. Ask your Pharmacist for advice. 5) Your Pharmacist can advise you on analgesic, anti-inflammatory medications such as Aspirin which may be of assistance. Aspirin should be avoided in children under the age of 12 and those aged 12 to 15 who have a fever. 6) Strapping the ankle can help restrict movement and minimise further injury. Your Pharmacist stocks a range of athletic strapping tape and ankle guards which may assist your injury.


Achilles Tendinitis


Surgical Treatment


Surgical treatment for tendons that fail to respond to conservative treatment can involve several procedures, all of which are designed to irritate the tendon and initiate a chemically mediated healing response. These procedures range from more simple procedures such as percutaneous tenotomy61 to open procedures and removal of tendon pathology. Percutaneous tenotomy resulted in 75% of patients reporting good or excellent results after 18 months. Open surgery for Achilles tendinopathy has shown that the outcomes are better for those tendons without a focal lesion compared with those with a focal area of tendinopathy.62 At 7 months after surgery, 67% had returned to physical activity, 88% from the no-lesion group and 50% from the group with a focal lesion.


Prevention


Regardless of whether the Achilles injury is insertional or non-insertional, a great method for lessening stress on the Achilles tendon is flexor digitorum longus exercises. This muscle, which originates along the back of the leg and attaches to the tips of the toes, lies deep to the Achilles. It works synergistically with the soleus muscle to decelerate the forward motion of the leg before the heel leaves the ground during propulsion. This significantly lessens strain on the Achilles tendon as it decelerates elongation of the tendon. Many foot surgeons are aware of the connection between flexor digitorum longus and the Achilles tendon-surgical lengthening of the Achilles (which is done to treat certain congenital problems) almost always results in developing hammer toes as flexor digitorum longus attempts to do the job of the recently lengthened tendon. Finally, avoid having cortisone injected into either the bursa or tendon-doing so weakens the tendon as it shifts production of collagen from type one to type three. In a recent study published in the Journal of Bone Joint Surgery(9), cortisone was shown to lower the stress necessary to rupture the Achilles tendon, and was particularly dangerous when done on both sides, as it produced a systemic effect that further weakened the tendon.

Admin · 234 views · Leave a comment
Mar042015

Working with With Achilles Tendinitis Pain And discomfort

Overview


Achilles TendonitisAchilles tendinitis is an overuse injury of the Achilles (uh-KIL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that?s Achilles tendinitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture. Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It?s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends. Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor?s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.


Causes


The two most common causes of Achilles tendonitis are Lack of flexibility and Overpronation. Other factors associated with Achilles tendonitis are recent changes in footwear, and changes in exercise training schedules. Often long distance runners will have symptoms of Achilles tendonitis after increasing their mileage or increasing the amount of hill training they are doing. As people age, tendons, like other tissues in the body, become less flexible, more rigid, and more susceptible to injury. Therefore, middle-age recreational athletes are most susceptible to Achilles tendonitis.


Symptoms


The pain associated with Achilles tendonitis can come on gradually or be caused by some type of leg or foot trauma. The pain can be a shooting, burning, or a dull ache. You can experience the pain at either the insertion point on the back of the heel or upwards on the Achilles tendon within a few inches. Swelling is also common along the area with the pain. The onset of discomfort at the insertion can cause a bump to occur called a Haglund's deformities or Pump bump. This can be inflammation in the bursa sac that surrounds the insertion of the Achilles tendon, scar tissue from continuous tares of the tendon, or even some calcium buildup. In this situation the wearing of closed back shoes could irritate the bump. In the event of a rupture, which is rare, the foot will not be able to go through the final stage of push off causing instability. Finally, you may experience discomfort, even cramping in the calf muscle.


Diagnosis


The diagnosis is made via discussion with your doctor and physical examination. Typically, imaging studies are not needed to make the diagnosis. However, in some cases, an ultrasound is useful in looking for evidence of degenerative changes in the tendon and to rule out tendon rupture. An MRI can be used for similar purposes, as well. Your physician will determine whether or not further studies are necessary.


Nonsurgical Treatment


Ask your Pharmacist for advice. 1) Your Pharmacy stocks a range of cold packs which may be applied to the area to decrease inflammation. 2) Ask your Pharmacist about a temporary heel raise or pad which can be inserted into footwear to decrease the force absorbed by the tendon when the feet land heavily on the ground. 3) Gently massaging a heat-producing liniment into the calf can help to relieve tension in the muscle which may relieve the symptoms of Achilles Tendinitis. Ask your Pharmacist to recommend the most appropriate type. 4) Gels, sprays or creams which help to reduce inflammation are available and may be applied to the injured area. Ask your Pharmacist for advice. 5) Your Pharmacist can advise you on analgesic, anti-inflammatory medications such as Aspirin which may be of assistance. Aspirin should be avoided in children under the age of 12 and those aged 12 to 15 who have a fever. 6) Strapping the ankle can help restrict movement and minimise further injury. Your Pharmacist stocks a range of athletic strapping tape and ankle guards which may assist your injury.


Achilles Tendonitis


Surgical Treatment


Surgery is considered the last resort. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.


Prevention


By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.

Admin · 543 views · Leave a comment