Cristin Boniello
Warning Signs Of Bursitis Of The Foot
Overview


Retrocalcaneal bursitis is sometimes difficult to differentiate from Achilles tendinitis, at least symptomatically. Both are most uncomfortable during the push-off phase of gait, are most severely painful in the morning and with walking after sitting for a period of time, and generally worsen with activity. Most practitioners make the distinction between the two simply on the basis of location of pain and tenderness. Generally, Achilles tendinitis is felt an inch or two higher than this form of bursitis.


Causes


Bursitis can develop for several reasons, including repetitively engaging in the same motion, or example, lifting objects above your head for work. Putting a lot of pressure on a bursa for an extended period of time. Leaning on your elbows or kneeling (for example, to lay carpet) can cause bursitis in the elbows or knees. If you sit for long periods of time, especially on hard surfaces, you may develop bursitis in your hip. Wearing shoes with a stiff back that rubs against the back of the ankle can cause Achilles tendon bursitis. Trauma. The bursae at the knee and elbow are close to the surface of the skin, and if you fall directly on your elbow or the knee, you can rupture, injure or puncture a bursa. Infection. Known as septic bursitis, it?s the result of bacteria infecting a bursa. It can occur from an infection traveling from another site or following an accident that ruptures the bursa. Even scraping the skin on your elbow or getting a mosquito bite that breaks the skin near the olecranon bursa (near the elbow) can lead to bursitis. Other joint disorders, such as rheumatoid arthritis, osteoarthritis and gout, or health conditions.


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


Bursitis is usually diagnosed after a careful physical examination and a full review of your medical history. If you garden and spend a lot of time on your knees, or if you have rheumatoid arthritis, tell your doctor, this information can be very helpful. During the physical exam, he or she will press on different spots around the joint that hurts. The goal is to locate the specific bursa that is causing the problem. The doctor will also test your range of motion in the affected joint. Other tests usually aren?t required to diagnose bursitis, but your doctor may suggest an MRI, X-ray or ultrasound to rule out other potential causes of pain.


Non Surgical Treatment


Orthotics may assist heel bursitis by providing stability to the heel, reduce any foot functioning abnormalities and provide extra support for the feet. The orthotic achieves this by maintaining correct foot posture, therefore facilitating normal functioning of the Achilles tendon. Icing the back of the heel post activity for temporary relief. Non-steroidal anti-inflammatory medication such as ibuprofen can reduce inflammation of the bursa. Stretching of the calf muscle may reduce the pulling on the heel by the Achilles tendon. Shoes that have an elevated heel may reduce pulling on the heel from the Achilles tendon. Resting the painful heel may reduce inflammation and pain. Surgical removal of the painful bursa is a last resort treatment when all other treatments have failed.


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.
Hammer Toe Caused By Bunion
Hammer ToeOverview


What are hammertoes, mallet toes and claw toes? Often the words are used interchangeably to mean an abnormally contracted toe like the drawing above. Technically speaking, a "hammertoe" is the name for a toe that is contracted at the first toe joint. If it's contracted at the second toe joint it is called a "mallet toe". IIf a toe is contracted at both toe joints, it is called a "claw toe". Each of these conditions can be quite uncomfortable and are cosmetically unappealing.


Causes


A person may be born with hammer toe or may develop it from wearing short, narrow shoes. Hammer toe can occur in children who outgrow shoes rapidly. Sometimes hammer toe is genetic and is caused by a nerve disorder in the foot. High heeled shoes are can also cause hammer toe. The reason for this is that the toes are not only bunched up, but the weight of the body is pushing them forward even further.


HammertoeSymptoms


Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most common at the level of the affected joint due to continuous friction of the deformity against your shoes.


Diagnosis


First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.


Non Surgical Treatment


Inserts in your shoes can be used to help relieve pressure on the toes from the deformity. Splints/Straps. These can be used to help re-align and stretch your toes and correct the muscle imbalance and tendon shortening. One of the most common types are toe stretchers like the yogatoe. Chiropody. A chiropodist can remove calluses or corns, areas of hard skin that have formed to make the foot more comfortable.Steroid injections can help to reduce pain and inflammation.


Surgical Treatment


In advanced cases in which the toe has become stiff and permanently bent, the toe can be straightened with surgery. One type of surgery involves removing a small section of the toe bone to allow the toe to lie flat. Surgery for hammertoe usually is classified as a cosmetic procedure. Cosmetic foot surgeries sometimes result in complications such as pain or numbness, so it's better to treat the problem with a shoe that fits properly.


HammertoePrevention


Avoid wearing shoes that are too short or narrow. Check children's shoe sizes often, especially during periods of fast growth. If you have hammer toe, call for an appointment with your health care provider. If you develop thick blisters or corns on your toes, if your pain gets worse, if you have difficulty walking call for Hammer toes an appointment with your health care provider.
Hammer Toes Causes
HammertoeOverview


A hammertoe can be flexible or rigid. Hammertoes often start out flexible and become rigid over time as your toe becomes accustomed to its crooked position. Flexible hammertoes are less serious than rigid hammertoes, as they can be easily diagnosed and treated in their initial stages. Flexible hammertoes are named as such because your affected toe still possesses some degree of movement.


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 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


Common reasons patients seek treatment for toe problems are toe pain on the knuckle. Thick toe calluses. Interference with walking/activities. Difficulty fitting shoes. Worsening toe deformity. Pain at the ball of the foot. Unsightly appearance. Toe deformities (contractures) come in varying degrees of severity, from slight to severe. The can be present in conjunction with a bunion, and develop onto a severe disfiguring foot deformity. Advanced cases, the toe can dislocate on top of the foot. Depending on your overall health, symptoms and severity of the hammer toe, the condition may be treated conservatively and/or with surgery.


Diagnosis


Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoes hammertoe.


Non Surgical Treatment


Symptoms of hammer toe might be helped through corn pads or cushions to alleviate them. If the person's hammer toes were caused by an underlying disease, the person should ask for their doctor's advice prior to performing any exercises without consent. It is also important for a person with hammer toes to remember that they must not attempt to treat or remove corns by themselves. If open cuts result from attempts to remove them, an infection becomes a very real possibility. People who experience diabetes or conditions that lead to poor circulation in their feet need to be especially careful.


Surgical Treatment


Joint resection procedures involves removing part of one of the two small joints of the toe directly underneath where the digit is crooked. The purpose is to make room for the toe to be re-positioned flat or straight. Because hammer toes become rigid or fixed with time, removing the joint becomes the only option when the knuckle is stiff. Its important to understand that this procedure does not involve the joint of the ball of the foot, rather the a small joint of the toe. Medical terminology for this procedure is called a proximal interphalangeal joint arthroplasty or a distal interphalangeal joint arthroplasty, with the latter involving the joint closer to the tip of the toe.
Home Treatment For Bunions

Overview
Bunions Hard Skin
A bunion is enlargement of bone or tissue that develops at the joint that connects your big toe to your foot. The bones, muscles, ligaments and tendons of your feet normally are well-balanced to distribute your body's weight while standing, walking and running. When the joint, called the metatarsophalangeal joint, or MTP joint, experiences abnormal, prolonged stress in terms of weight distribution or squeezing of the toes within the shoe, the result can be the deformity called a bunion. Generally, a bunion develops when, as a response to prolonged stress, your big toe begins bending toward your foot's smaller toes and puts pressure on your MTP joint, forcing it to bulge outward (the term "bunion" comes from the Latin word for "enlargement"). There is no "standard" bunion, however, but rather a complex range of joint, bone and tendon abnormalities that can cause variation in each bunion's make-up.

Causes
While the precise cause is not known, there seem to be inherited (genetic) factors that lead to abnormal foot function like overpronation that can predispose to the development of bunions. This is especially common when bunions occur in younger individuals. This abnormal biomechanics can lead to instability of the metatarsal phalangeal joint and muscle imbalance resulting in the deformity. Although shoe gear doesn't directly cause a bunion, it can certainly make the bunion painful and swollen. Other less common causes of bunion deformities include trauma (sprains, fractures, and nerve injuries), neuromuscular disorders (polio or Charcot-Marie-Tooth disease) and limb-length discrepancies (one leg shorter than the other) where the longer leg develops the bunion.
SymptomsThe most common symptoms associated with this condition are pain on the side of the foot just behind the great toe. A red painful bump is usually present. Pain is usually brought on with walking or sports. Shoes don't cause bunions but will typically aggravate them. Stiff leather shoes or shoes with a tapered toe box are the prime offenders. This is why bunion pain is most common in women whose shoes have a pointed toe box. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the 1st and 2nd toe from the pressure the toes rubbing against each other.

Diagnosis
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.

Non Surgical Treatment
You can buy orthotics over the counter from pharmacies, or they can be custom-made by a podiatrist to fit your feet. Whether you need to buy an over-the-counter orthotic or have one specially made will depend on your individual circumstances and the severity of your bunion. You can also use special bunion splints, worn over the top of your foot and your big toe to help straighten its alignment. Splints are available for both daytime and night-time use. However, there's little evidence that splints are effective. Toe spacers are also available, which can help reduce the pain caused by bunions. However, toe spacers or orthotics may be of limited use because they often compete with the bunion for the already limited space in the shoe. If your toe joint is painful and swollen, applying an ice pack to the affected area several times a day can help to relieve the pain and inflammation. Never apply ice directly to your skin. Wrap it in a cloth or tea towel. A bag of frozen vegetables makes a good ice pack. It's recommended that you wear flat or low-heeled, wide-fitting shoes if you have a bunion. Shoes made from soft leather are ideal because they'll relieve any pressure on the bunion. Avoid narrow or slip-on shoes. High heels can also make your bunion worse by putting excessive pressure on your toes.
Bunions Hard Skin

Surgical Treatment
The surgical treatment will vary depending on x-ray analysis and severity of the deformity. Most bunion surgeries focus on realigning the bony deformities of the bunion/big toe joint. At Accent on Feet we practice Ambulatory foot surgery for bunion correction. This method allows for faster healing, lower risk and preferred cosmetic result over traditional hospital surgery. All surgical procedures are performed in the office using local anesthesia (freezing). All patients walk immediately.
Do You Know The Principal Reasons Behind Over-Pronation
Overview


Excessive pronation is a common fault that occurs with the dynamic structure of the foot. Some degree of pronation is necessary for shock absorption. Excessive pronation, or collapsing of the arch, limits the foot?s ability to efficiently support the weight of the body. The altered position of the foot and ankle complex that occurs with high degrees of pronation also forces the rest of the lower body out of alignment. This can cause mechanical problems in muscles and joints traveling all the way up to the back. Arch strengthening is a vital part of maintaining healthy feet.Overpronation


Causes


Although there are many factors that can contribute to the development of these conditions, improper biomechanics of the body plays a large and detrimental role in the process. Of the many biomechanical elements involved, foot and ankle function perhaps contribute the most to these aches and pains.


Symptoms


In addition to problems overpronation causes in the feet, it can also create issues in the calf muscles and lower legs. The calf muscles, which attach to the heel via the Achilles tendon, can become twisted and irritated as a result of the heel rolling excessively toward the midline of the body. Over time this can lead to inflexibility of the calf muscles and the Achilles tendon, which will likely lead to another common problem in the foot and ankle complex, the inability to dorsiflex. As such, overpronation is intrinsically linked to the inability to dorsiflex.


Diagnosis


The best way to discover whether you have a normal gait, or if you overpronate, is to visit a specialty run shop, an exercise physiologist, a podiatrist or a physical therapist who specializes in working with athletes. A professional can analyze your gait, by watching you either walk or run, preferably on a treadmill. Some facilities can videotape your gait, then analyze the movement of your feet in slow-motion. Another (and less costly) way is to look at the bottom of an older pair of run shoes. Check the wear pattern. A person with a normal gait will generally see wear evenly across the heel and front of the shoe. A person who overpronates will likely see more wear on the OUTside of the heel and more wear on the INside of the forefoot (at the ball). A person who supinates will see wear all along the outer edges of the shoe. You can also learn about your gait by looking at your arches. Look at the shape your wet feet leave on a piece of paper or a flat walking surface.Foot Pronation


Non Surgical Treatment


Not all over pronation is treated. Although, when it appears to be a causitive factor that is contributing to pain,or development of structural deformities, there are various degrees of treatment.In some cases specific shoes may be all that is required. In other cases, paddings or strapping, are prescribed and where necessary orthotic therapy. A podiatric assesment would be advised to asses this.


Prevention


Duck stance: Stand with your heels together and feet turned out. Tighten the buttock muscles, slightly tilt your pelvis forwards and try to rotate your legs outwards. You should feel your arches rising while you do this exercise.


Calf stretch:Stand facing a wall and place hands on it for support. Lean forwards until stretch is felt in the calves. Hold for 30 seconds. Bend at knees and hold for a further 30 seconds. Repeat 5 times.


Golf ball:While drawing your toes upwards towards your shins, roll a golf ball under the foot between 30 and 60 seconds. If you find a painful point, keep rolling the ball on that spot for 10 seconds.


Big toe push: Stand with your ankles in a neutral position (without rolling the foot inwards). Push down with your big toe but do not let the ankle roll inwards or the arch collapse. Hold for 5 seconds. Repeat 10 times. Build up to longer times and fewer repetitions.


Ankle strengthener: Place a ball between your foot and a wall. Sitting down and keeping your toes pointed upwards, press the outside of the foot against the ball, as though pushing it into the wall. Hold for 5 seconds and repeat 10 times.


Arch strengthener: Stand on one foot on the floor. The movements needed to remain balanced will strengthen the arch. When you are able to balance for 30 seconds, start doing this exercise using a wobble board.