Monthly Archives: September 2014

Hallux Limitus / Rigidus – stiff big toe

Summary

  • Hallux rigidus/limitusis a disorder of the joint (form of degenerative arthritis)located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe.

How did I get this?

  • History of trauma in the feet.
  • Faulty foot function.
  • History of arthritis.
  • Family history is a risk factor.

What can I do about it?

  • Rest from activities affecting the joint.
  • Stop wearing high heeled shoes.
  • Applying ice packs reduce inflammation for short period of time.
  • Contrast bath using alternating cold and hot water (30 seconds each for five minutes) to reduce inflammation.
  • Short term use of anti-inflammatory drugs such as ibuprofen to reduce pain and inflammation.

What help can I get for this?

  • A podiatrist may provide shoe modifications, padding, or orthoics.
  • An orthopaedic foot surgeon may assist with removing bony lumps or fusing the joint.

When will it get better?

  • It depends on severity, patient activity and expectation as well as the particular treatment used. Podiatry and activity modification can provide fast relief, along with appropriate footwear.

Freibergs Disease – metatarsal pain

Summary

  • Freiberg’s disease is a relatively uncommon disorder that affects the joints of metatarsals (the bones that extend from the arch of your foot to your toes).
  • The disease is associated with the gradual collapse or disintegration of the joint surfaces between the metatarsals as well as the formation of abnormal joint tissue. Symptoms include chronic history of forefoot pain, foot stiffness, and walking with a limp.

How did I get this?

  • The specific events or factors that cause Freiberg’s disease are not completely understood.
  • However, there are several risk factors for the disease, which include age and gender (Freiberg’s disease occurs most often in female adolescents and young women, although the disease can occur in any person at any age), excessively long metatarsals, and foot trauma.

What can I do about it?

  • Freiberg’s disease may be asymptomatic or it may heal without treatment. But if symptoms are present, the following will be beneficial:
  • Rest the metatarsal joints allowing the joint Inflammation and irritation to go away.
  • Nonsteroidal anti-inflammatory drugs (NSAIDS) are used commonly for pain.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may advise comfort shoes with metatarsal pad to help offload the area and for protection, and a camwalker boot for protected weight bearing for a period of two to six weeks to allow the symptoms to settle.
  • Foot and ankle surgeon for surgical treatment if the nonoperative intervention fails to control the symptoms.

When will it get better?

  • Fortunately, the outcomes of both non-operative and operative management are good to excellent and most patients are able to return to previous activity.

Cuboid Dysfunction Pain

Summary

  • The Cuboid is a square shaped bone which lies between your heel and the 5th metatarsal.
  • Cuboid dysfunction pain can result if this bone and the surrounding joints are subject to repeated trauma and cause intermittent pain.

How did I get this?

  • The way that you walk, or if you have a high arched, or excessively flat foot can cause cuboid dysfunction. There is not usually a specific injury. The joints around the cuboid become inflamed and cause the pain.

What can I do about it?

  • Rest, ice packs, and soft cushioning footwear may be helpful.
  • Short term antiinflammatory drugs such as ibuprofen may relieve symptoms.

What help can I get for this?

  • A podiatrist will assist with footwear advice or modification, strapping, padding, orthotics, or joint mobilisation.

When will it get better?

  • With the correct support and reduction in activity you can expect an improvement over 6-8 weeks.

Acute Compartment Syndrome

Summary

  • It is a condition where there is excessive pressure in the muscle compartment of the foot following fracture or injury. This can lead to tissue damage and requires immediate emergency attention. The pain is generally far in excess of what would be expected.

How did I get this?

  • If there is fracture or injury in the foot, there can be swelling which compresses the muscle compartment and may lead to severe pain, swelling and tissue damage.

What can I do about it?

  • Rest the area affected.
  • Elevate the feet above the heart to promote blood flow and aid in the inflammation.
  • Seek emergency medical attention.

What help can I get for this?

  • See your podiatrist or doctor without delay.
  • Will usually result in hospital admission and surgery.

When will it get better?

  • Conservative treatment options have not been shown to be effective for this condition.
  • Surgical intervention to relieve the pressure will be a better option for better and fast healing.

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Achilles Tendinopathy

Summary

  • Achilles Tendinopathy is a condition where there is pain, swelling, stiffness, and weakness in your Achilles tendon.
  • It is caused by repeated tiny injuries in this area.
  • Pain develops gradually especially in the morning upon waking up but is worse during rest after exercise.

How did I get this?

  • Achilles tendon is important part of your leg which is found behind and above your heel. It joins the heel bone to your calf muscles. This helps to bend your foot downwards at the ankle. Overuse of tendons, wearing inappropriate footwear during exercise, poor flexibility, and increased intensity of exercise can result to injury in your Achilles tendon. Other causes include arthritis and long-term use of some antibiotics (e.g. Ciprofloxacin).

What can I do about it?

  • Rest and avoid strenuous exercise (such as running). As you improve, you can restart exercise gradually.
  • Cold compress (ice pack) will help to decrease swelling and control the pain.
  • Compression using bandage can also minimize pain and aid in reducing the inflammation.
  • Elevate the injured area above the heart while sitting.
  • For prevention, make sure you stretch before and after exercise.
  • Short term use of anti-inflammatory drugs can be helpful to decrease the pain.

What help can I get for this?

  • A podiatrist for special heel pads to wear in the shoes for cushion and support, and a program of special exercises for the strengthening of the injured tendons.
  • Footwear advice or modification and possible orthoses to relieve strain on the Achilles tendon.
  • A surgeon, if symptoms do not improve after 3 to 6 months, might proceed with surgical repair of the tendons.

When will it get better?

  • Symptoms usually clear within 3 to 6 months of starting nonsurgical treatment (as described above). The earlier the diagnosis and treatment, the better the outcome.

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Accessory Navicular

Summary

  • Accessory Navicular is a condition where the Navicular bone has developed in two pieces.
  • You have a painful lump on the inside of your foot, usually aggravated by shoes rubbing on it.
  • It can be difficult to walk far, or on uneven surfaces, and climbing stairs or ladders is a real pain.
  • Your ski boots or hiking boots are killing you.

How did I get this?

  • The accessory navicular is an extra bone in your foot, of which there can be many in addition to the 26 bones we usually expect to find there. It is thought to develop in teenage years as your skeleton hardens and finishes growing.
  • This can become painful due to irritation from footwear, unusually high levels of activity, or recent weight gain.

What can I do about it?

  • Wearing shoes that do not irritate the area is the first step. You can add padding around the area or inside your shoe. Reduce your activity so that the bone is not irritated. Lose weight to reduce the stress on the bone.

What help can I get for this?

  • A podiatrist can help with footwear advice or padding for the lump. You may also get some relief by using orthotics which are designed to reduce the stress on the bone.
  • A surgeon can remove the bone, but only after all other options have been tried. Surgery can take 9-12 months to recover fully.

When will it get better?

  • After pressure and stress are reduced on the bone you should start to feel relief quickly.
  • Continued use of appropriate footwear and padding or support should result in more prolonged improvement.

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Turf Toe

Summary

  • It is simply a sprain of the ligaments around the big toe joint. It’s a condition that’s caused by jamming the big toe or repeatedly pushing off the big toe forcefully as in running and jumping. The most common symptoms of turf toe include pain, swelling, and limited joint movement at the base of one big toe. The symptoms develop slowly and gradually get worse over time if it’s caused by repetitive injury. If it’s caused by a sudden forceful motion, the injury can be painful immediately and worsen within 24 hours. Sometimes when the injury occurs, a “pop” can be felt. Usually the entire joint is involved, and toe movement is limited.

How did I get this?

  • The name “turf toe” comes from the fact that this injury is especially common among athletes who play on artificial turf. When playing sports on artificial turf the foot can stick to the hard surface, resulting in jamming of the big toe joint. There has also been some indication that less-supportive flexible shoes worn on artificial turf are also to blame.

What can I do about it?

  • Initial treatments include rest, ice, compression, and elevation. (RICE), as well as a change to less-flexible footwear.
  • Podiatry consultation for further management.

What help can I get for this?

  • Podiatrist may use measures to limit great toe motion such as stiff soled shoes, or a cam walker to protect the injured tissue while it heals.
  • Podiatrist may consider taping the big toe and using a Morton’s extension splint may be beneficial in protecting the toe.
  • Orthopaedic surgeon for surgical correction if nonoperative approach does not work with the symptoms.

When will it get better?

  • In many cases, if adequate compliance is achieved, conservatively and surgically treated patients can return to their preinjury level of function. However, some disability is possible with either form of treatment.

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Tarsal Tunnel Syndrome

Summary

  • The tarsal tunnel is located inside the ankle next to the ankle bones. Its job is to protect veins, arteries, tendons and nerves. When this tibial nerve is squeezed, or compressed, it results in a condition called tarsal tunnel syndrome (TTS). Many patients experience a tingling or burning sensation inside the ankle or in the sole of the foot while others experience pain in the ankle, heel, toes, arch, and even up the calf.

How did I get this?

  • There is no one specific cause for tarsal tunnel syndrome, but inflammation is the most recognized reason for TTS. Since the tibial nerve is encased in the tarsal tunnel, anything that takes up extra room like inflammation causes swelling in the tissues and puts pressure on the nerve.

What can I do about it?

  • Rest may be suggested to control the symptoms initially.
  • Ice or heat treatment.
  • Activity modification.
  • Anti-inflammatory medications help reduce the inflammation and swelling of the tissues around the tibial nerve.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may prescribe padding or strapping, specialized orthotics to relieve the symptoms, and give footwear advice.
  • Orthopedic surgeon for surgical management if nonoperative approach fails.
  • Physical therapy for specialized strengthening exercise for up to eight weeks after surgery.

When will it get better?

  • An improvement in your symptoms may take about 2-3 months.
  • Surgery causes release of pressure on the nerve, so by the time the sutures are removed you may already have had relief of your symptoms.

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Tarsal Coalition

Summary

  • A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet. While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to 16. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life. Symptoms include Pain (mild to severe) when walking or standing, tired or fatigued legs, muscle spasms in the leg causing the foot to turn outward when walking, flatfoot (in one or both feet), walking with a limp, and stiffness of the foot and ankle.

How did I get this?

  • Most often, tarsal coalition occurs during foetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.

What can I do about it?

  • Rest from activities that cause the pain.
  • Short term nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be helpful in reducing the pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe orthotic devices for distributing weight away from the joint, limiting motion at the joint and relieving pain. Footwear modification such as a stiff rocker sole may be effective.
  • Podiatrist may consider immobilization to give the affected area a rest. The foot is placed in a cam walker, and crutches may be used to avoid placing weight on the foot.
  • Your doctor may give steroid injections to reduce the inflammation and pain.
  • Foot and ankle surgeon for surgical management if symptoms are not adequately relieved with nonsurgical treatment.

When will it get better?

  • Treatment by a podiatrist may result in symptom relief within 6-8 weeks.
  • Depending upon the type and location of your surgery, a cast will be required for a period of time to protect the surgical site and prevent you from putting weight on the foot. Although it may take several months to fully recover, most patients have pain relief and improved motion after surgery.

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Stress Fracture

Summary

  • Stress Fracture occurs when excessive repetitive force is applied to a localized area of bone. Activities such as walking, running, and repeated jumping can subject the bones of the foot to large forces that often lead to microscopic cracks in the bone.

How did I get this?

  • Generally, it is repetitive stress (i.e. running, marching, sport etc.) although some bone diseases can pre-dispose to thin bones which therefore fracture more easily. In people with osteoporosis (thinning of the bone) there is an increased risk of stress fracture.

What can I do about it?

  • Rest the area and stop sporting activity.
  • Wear good fitting shoes with adequate support and cushioning.
  • Avoid high heels.
  • You can try a protective pad.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may advise appropriate shoes, consider prescribing orthotics, consider immobilisation, and advise on surgery.

When will it get better?

  • In the majority of cases, conservative care allows the bone to heal and normal activity can then be resumed. Surgery is sometimes necessary to stabilise the fracture site which allows longer time to resume activity.

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