Bursitis Of The Foot Bursa Removal Complications

Overview

A Bursa is a small fluid filled sac that forms in areas of extra rubbing and friction. They are usually present with a bone deformity as the bone is pressed against other structures like a tendon or against the ground as you walk. The bursa acts as a shock absorber and is a way for your body to protect you from damage. When this bursa or sac like structure becomes swollen and inflammed it is called bursitis. The bursa may be anatomical meaning normally present, or it may be adventitious meaning, only present because of a problem. Many bursa are present and do not cause pain.

Causes

A bursa acts as a cushion and lubricant between tendons or muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel. It is where the large Achilles tendon connects the calf muscles to the heel bone. Repeated or too much use of the ankle can cause this bursa to become irritated and inflamed. Possible causes are too much walking, running, or jumping. This condition is usually linked to Achilles tendinitis. Sometimes retrocalcaneal bursitis may be mistaken for Achilles tendinitis. Risks for this condition include starting an aggressive workout schedule, or suddenly increasing activity level without the right conditioning.

Symptoms

Symptoms include pain at the back of the heel, especially when running uphill or on soft surfaces. There will be tenderness and swelling at the back of the heel which may make it difficult to wear certain shoes. When pressing in with the fingers both sides are the back of the heel a spongy resistance may be felt.

Diagnosis

Obtaining a detailed history from the patient is important in diagnosing calcaneal bursitis. The following complaints (which the physician should ask about during the subjective examination) are commonly reported by patients.

Other inquiries that the physician should make include the following. The clinician should ask about the patient's customary footwear (whether, for example, it includes high-heeled shoes or tight-fitting athletic shoes). The patient should be asked specifically about any recent change in footwear, such as whether he/she is wearing new athletic shoes or whether the patient has made a transition from flat shoes to high heels or vice versa. Individuals who have been accustomed to wearing high-heeled shoes on a long-term basis may find that switching to flat shoes causes increased stretch and irritation of the Achilles tendon and the associated bursae. The specifics of a patient's activity level should be ascertained, including how far the patient runs and, in particular, whether the individual is running with greater intensity than before or has increased the distance being run. The history of any known or suspected underlying rheumatologic conditions, such as gout, rheumatoid arthritis, or seronegative spondyloarthropathies, should be obtained.

Non Surgical Treatment

So what can you do to alleviate this type of pain in the foot? If the bursitis pain is occurring on the toes, bunion or back of the heel area the smart money would be on eliminating the shoes that seem to aggravate the condition. Eliminating these shoes may not in itself clear up the problem but you can be sure that if you continue to wear the offending shoes nothing you or your doctor do will permanently ?fix? the problem. A recurring theme that I use throughout this site that if you put an abnormally shaped foot in a dressy shoe it is literally the same as trying to put a square peg in a round hole, it will not fit. OK, so you threw away those dressy shoes and the foot still hurts, now what? Depending on the severity of the pain, over the counter anti-inflammatory medication may do the trick. The key here is to take the medication on an ongoing basis, according to the directions on the package to build up therapeutic blood levels. Assuming you can tolerate this type of medication, along with alternative treatments you can try). take the medication for 10-14 days. Stop if the symptoms have not dramatically improved. Icing the area during this period may also help reduce the symptoms.

Surgical Treatment

Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.

Prevention

Once your pain and inflammation is gone, you can prevent retrocalcaneal bursitis deformity by wearing the best shoes for your foot type. You should high-heels and pumps if possible. Wear orthotics (custom arch supports) or over-the-counter orthotic devices. Perform frequent Achilles tendon stretching exercises to prevent it from becoming tight agian. Avoiding running uphill when training. Try to run on softer surfaces and avoid concrete.

Hammer Toe Cure

HammertoeOverview

A hammertoe is a toe that tends to remain bent at the middle joint in a claw-like position. There are 2 types of hammer toe. Flexible hammer toe, can be straightened by hand. Rigid hammer toe, cannot be pulled straight and can be extremely painful. The position of the toe can also lead to corns or calluses. These may also be painful. Hammer toe may be present at birth or develop later in life due to tendons that have tightened, causing the toe's joints to curl downward. Occasionally, all toes may be bent. This may be due to problems with the peripheral nerves or the spinal cord.

Causes

Some causes of hammertoe are shoes that are too tight or short, shoes with high heels, injury, Diseases that affect the nerves and muscles, such as arthritis and diabetes. When shoes do not fit well, over time the pressure of the shoes pushes the toes into a bent position. After a while, the muscles become unable to straighten the toe, even when you are not wearing shoes. Similarly, when there is damage or disease of the nerves or muscles in the toes, the toe may rest in the bent position until the tendons become permanently shortened and the toe hammertoes becomes a rigid hammertoe. The risk of developing a hammertoe increases with age. Women are much more likely to develop a hammertoe than men.

Hammer ToeSymptoms

The symptoms of a hammer toe include the following. Pain at the top of the bent toe upon pressure from footwear. Formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.

Diagnosis

Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.

Non Surgical Treatment

Early on, when a hammertoe first starts and is still flexible, here are some ways it might be treated. Your healthcare provider may splint or tape the toe into the correct, normal position. You can use your fingers to stretch your toes and toe joints toward a more normal position. Exercise your toes by trying to pick up marbles with them or by wadding up a towel on the floor with your toes. Padding may be used to change where your weight falls when you walk on the foot.

Surgical Treatment

There are generally two methods surgeons use to correct hammer toes, they are joint resection (arthroplasty) or bone mending (fusion), and the location where this is performed on the toe depends on where the toe is buckled. Its important to recognize that most of the surgical work involved the joints of the toe, not the joint of the ball of the foot. Sometimes a toe relocation procedure is needed when the joint of the ball of the foot is malaligned (subluxed or dislocated).

How To Help Hammertoe Pain

HammertoeOverview

A Hammer toes is a toe that is bent because of a muscle imbalance around the toe joints. The imbalance causes the toe to bend at one or more joints, pushing the middle of the toe upward in a claw-like position. If you notice hammertoe such changes, it is important to seek proper treatment. Hammer toes never get better without some type of intervention and the sooner it is treated, the better the outcome.

Causes

While there are a number of causes, there aren't many specific risk factors for hammertoes, women tend to get these problems more than men, but they occur without rhyme or reason. Diabetics, however, are more likely to get a hammertoe if they have underlying nerve damage in the toes and feet.

Hammer ToeSymptoms

People with a hammer toe will often find that a corn or callus will develop on the top of the toe, where it rubs against the top of the footwear. This can be painful when pressure is applied or when anything rubs on it. The affected joint may also be painful and appear swollen.

Diagnosis

The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Non Surgical Treatment

Treating hammertoe involves straightening the toe, making tendons in the toes flexible again, and preventing the problem from returning. Some simple treatments include Soaking your feet every day in warm water, then stretching your toes and ankles by pointing your toes. Using over-the-counter pads, cushions or straps to decrease discomfort. Splinting the toe to keep it straight and to stretch the tendons of the foot. Exercising the toes to relax the foot tendons (a session with a physical therapist may help you get started with foot exercises). One simple exercise is to place a small towel on the floor and then pick it up using only your toes. You also can grasp at carpet with your toes or curl your toes up and down repeatedly. Wearing shoes that fit properly and give toes plenty of room to stretch out.

Surgical Treatment

Surgical Options: Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammer toes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatrist.

Do Bunions Have To Have Surgery

Overview
Bunions The classic bunion is a bump on the side of the great toe joint. This bump represents an actual deviation of the 1st metatarsal. In addition, there is also deviation of the great toe toward the second toe. In severe cases, the great toe can either lie above or below the second toe.

Causes
Bunions tend to run in families, but that does not mean that if you have a bunion, your children will inevitably have one too. The connection may be that bunions are a bit commoner in people with unusually flexible joints, and this can be hereditary. They are also commoner in women than in men. Bunions do occur in cultures in which shoes are not worn, but much less commonly. Shoes which squeeze the big toe or do not fit properly, or have an excessively high heel, may worsen the deformity, particularly in people who are at higher risk anyway.

Symptoms
Just because you have a bunion does not mean you will necessarily have pain. There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Symptoms for a bunion may include pain on the inside of your foot at the big toe joint, swelling on the inside of your foot at the big toe joint, appearance of a "bump" on the inside edge of your foot. The big toe rolling over to one side. Redness on the inside of your foot at the big toe joint. Numbness or burning in the big toe (hallux). Decreased motion at the big toe joint. Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint. Pain while wearing shoes - especially shoes too narrow or with high heels. Joint pain during activities. Other conditions which may appear with bunions include Corns in between the big toe and second toe. Callous formation on the side or bottom of the big toe or big toe joint. Callous under the second toe joint. Pain in the second toe joint.

Diagnosis
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.

Non Surgical Treatment
If abnormal pronation is identified and corrected early, the formation of a bunion can be prevented. However, if the bunion has already developed and cannot be tolerated by the patient, surgery is necessary. Amputation of the big toe ceased to be a treatment for bunions many generations ago, but only in the past few years have surgical procedures been developed to incorporate the realignment of the bone with the correction of the abnormal motion that led to deformity. Bunions

Surgical Treatment
If your bunion has progressed to the point where you have difficulty walking, or experience pain despite accommodating shoes, you may need surgery. Bunion surgery realigns bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position. Orthopedic surgeons have several techniques to ease your pain. Many bunion surgeries are done on a same-day basis, requiring no hospital stay, using an ankle-block anesthesia. A long recovery is common and may include persistent swelling and stiffness.

Know About Overpronation Of The Foot

Overview

Pronation occurs at the joint below the ankle, the subtalar joint. It describes the inward rolling motion of the foot just after it lands on the ground. This moment is called initial contact, which is part of the stance phase of the gait cycle. Urthotic Insoles are designed today specifically for different pronation patterns. When you pick your next pair of insoles, your pronation type is a very important factor in your choice.Foot Pronation

Causes

There may be several possible causes of over pronation. The condition may begin as early as birth. However, there are several more common explanations for the condition. First, wear and tear on the muscles throughout the foot, either from aging or repetitive strain, causes the muscles to weaken, thereby causing the foot to turn excessively inward. Also, standing or walking on high heels for an extended period of time also places strain and pressure on the foot which can weaken the tissue. Lastly, shoes play a very common factor in the development of over pronation. Shoes that fail to provide adequate support through the arch commonly lead to over pronation.

Symptoms

It is important to note that pronation is not wrong or bad for you. In fact, our feet need to pronate and supinate to achieve proper gait. Pronation (rolling inwards) absorbs shock and supination (rolling outwards) propels our feet forward. It is our body?s natural shock-absorbing mechanism. The problem is over-pronation i.e. the pronation movement goes too deep and lasts for too long, which hinders the foot from recovering and supinating. With every step, excess pronation impedes your natural walking pattern, causing an imbalance in the body and consequent excessive wear and tear in joints, muscles and ligaments. Some common complaints associated with over-pronation include Heel Pain (Plantar Fasciitis) ,Ball of foot pain, Achilles Tendonitis, Shin splints, Knee Pain, Lower Back Pain.

Diagnosis

Pronounced wear on the instep side of shoe heels can indicate overpronation, however it's best to get an accurate assessment. Footbalance retailers offer a free foot analysis to check for overpronation and help you learn more about your feet.Over Pronation

Non Surgical Treatment

Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.

Surgical Treatment

Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.

Does Severs Disease Often Necessitate Surgical Treatment?

Overview

Pain in the heel of a child's foot, typically brought on by some form of injury or trauma, is sometimes Sever's Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon may contribute to Sever's Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger children and is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats are also known to aggravate the condition. Treatment includes calf muscle stretching exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.

Causes

Severs disease is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter as they cannot keep up with the bone growth. The point at which the achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble (a lot like osgood schlatters disease of the knee). Tight calf muscles may contribute as the range of motion at the ankle is reduced resulting in more strain on the achilles tendon. Sever's disease is the second most common injury of this type which is known as an apophysitis.

Symptoms

The most prominent symptom of Sever?s disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever?s disease is primarily clinical.

Diagnosis

Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.

Non Surgical Treatment

Orthotics, The orthotics prescribed are made to align the foot in its correct foot posture. This will reduce stress and force at the site of the growth plate of the heel bone. Rest and Ice the heel 20 minutes before and after sporting activity. Calf muscle stretching exercises.

Arch Pain Causes Symptoms And Treatment

Overview

Plantar fasciitis is a common and often persistent kind of repetitive strain injury afflicting runners, walkers and hikers, and nearly anyone who stands for a living, cashiers, for instance. It causes mainly foot arch pain and/or heel pain. Morning foot pain is a signature symptom. Plantar fasciitis is not the same thing as heel spurs and flat feet, but they are related and often confused. Most people recover from plantar fasciitis with a little rest, arch support (regular shoe inserts or just comfy shoes), and stretching, but not everyone. Severe cases can stop you in your tracks, undermine your fitness and general health, and drag on for years.

Pain In Arch

Causes

There are a number of other medical conditions that can cause foot arch pain such as diabetes, arthritis and obesity. These can affect the position and strength of the bones, muscles, ligaments and tendons, leading to bottom of foot pain. It sounds simple but footwear plays an important role in how our feet feel. Foot arch pain is commonly caused by ill-fitting shoes, especially ones with little arch support or that are too tight. Footwear is particularly important if you are going to be spending long periods on your feet or for sporting activities such as running. Shoes should be supportive, comfortable, cushioned, provide the appropriate level of arch support and be the correct width.

Symptoms

Arch pain symptoms could include any of the following, a dull, constant ache if the ligaments have been stretched, swelling or tenderness in the foot, redness or bruising in the event of a more serious injury, difficulty putting weight on the foot, sharp pain when the foot is turned or manipulated, tenderness when pressure is applied. Because the arch of the foot is such a complex structure, arch pain could be an indicator of several different types of injuries. Chronic illnesses such as arthritis could also cause arch pain, and depending on the cause or source of your pain, you may experience discomfort in a variety of different areas. Ask a doctor if you believe you may have injured your foot arch.

Diagnosis

The doctor will examine your feet for foot flexibility and range of motion and feel for any tenderness or bony abnormalities. Depending on the results of this physical examination, foot X-rays may be recommended. X-rays are always performed in a young child with rigid flatfeet and in an adult with acquired flatfeet due to trauma.

Non Surgical Treatment

If it is flat feet, then you'd seek professional advice and maybe need orthotics, or arch supports to prevent the pressures and to stop the pain. One of the other reasons you can get pain in this area of the foot is plantar fasciitis. The plantar fascia is a membrane that is inside of the skin and attaches to the heel bone here. It divides into three bands that go out of the foot here: the outer band, the central band, and the medial band here. Often, from impact, you get an inflammation of that attachment to the heel bone and this can often spread up the medial band and this is another way of getting pain in that arch. Now, the way to treat that is also using arch supports but also heel cushions, better soled shoes to prevent the pressure. These things normally disappear after a year, 18 months. Plantar fasciitis is easier to treat because it's not a long term problem. If you do need arch support, something like this would be very good for both problems.

Pain In Arch

Surgical Treatment

As with most surgeries, patients and physicians should consider the surgery only after other, less invasive treatments have proven unproductive. Indications for surgery include Pain. Inability to function. Failure to improve after a six-month course of specific, directed physical therapy. Failure to improve after using arch supports, orthotics, or ankle and foot bracing. Once patients are at that point, the good news is that the procedure has considerably better outcomes than more traditional flat foot surgery. In the past, surgeons would realign and fuse the three hind joints, which would cause patients to lose motion, leaving them with a significantly stiff hind foot, With these newer procedures, if the foot is still flexible, surgeons can realign it and usually restore a close-to-normal or functional range of motion in the joints.

Prevention

To prevent arch pain, it is important to build up slowly to your exercise routine while wearing arch supports inside training shoes. By undertaking these simple measures you can prevent the discomfort of arch pain which can otherwise linger for many months. While you allow the foot to recover, it will help to undertake low impact exercises (such as swimming or water aerobics).

Stretching Exercises

Point your toes. To ease foot pain and aching in your feet, lift one foot and roll it downward until the toes are pointed toward the ground. Then flex your foot. Repeat using the other foot. This exercise will help stretch out all the small muscles that are on the bottom of your feet, which can help relieve aching and improve blood circulation. Raise your heels. This exercise is good for relieving toe cramps caused by standing for hours in constricting shoes, says Kurtz. Bonus: It can also strengthen calf muscles and make them look more defined. Stand up and lift your heels so that you are standing on the balls of your feet. Hold for 10 seconds. Repeat 10 times. Squeeze your toes. To strengthen the toes and help alleviate foot pain from hammertoes (when a toe resembles a claw), separate your toes using corks or foam toe separators and then squeeze your toes together for five seconds. Repeat 10 times. Roll a ball. Want to create an instant massage for the bottom of your feet? Roll a golf ball or tennis ball under the ball of your foot. Apply light pressure for about two minutes. This exercise can be helpful for arch pain, cramps, and heel pain from plantar fasciitis. Stretch standing up. A weight-bearing, runners-type stretch can be helpful for foot pain in the arch. Stand up and place your toes against a wall; lean forward a little until you feel your arch stretch. Repeat using the other foot. Stretch sitting down. Sit barefoot and cross your left leg so that your ankle rests on your right thigh. Then hold your toes and bend them back toward your shin, stretching the band of tissue connecting the bottom of the heel to the ball. A University of Rochester study found that people living with plantar fasciitis had a 75 percent chance of having no pain within three to six months of performing this stretch three times daily. Give yourself a foot massage. Nothing spells pain relief like a good foot rub. Use the following technique recommended by Rhonda Crockett, a licensed massage therapist at Ohio State University?s Center for Integrative Medicine in Columbus. Start with your toes, using your thumb to massage them in circular motions. Then move to the arch under your foot and gradually work your way down to the heel, applying pressure with your fingers and palm of your hand. Use lotion to allow your hand to move smoothly over your foot. Relax in a warm bath with Epsom salts. The combination of warm water and Epsom salts will give you a double dose of pain relief and relaxation. Magnesium sulfate, the key compound in Epsom salts, has been found to relax muscles, reduce pain, and sedate the nervous system. Plus, warm water helps improve circulation in the feet and relieve muscle pain. Crockett recommends adding two cups of Epsom salts to a warm bath and soaking for 20 minutes.