What Is Mortons Neuroma

Overview

Morton’s metatarsalgia is a condition associated with a painful neuroma* on the digital nerve causing pain in the foot. Charcterised by perineural fibrosis and nerve degeneration due to repetitive irritation, is thought to be due to irritation of the digital nerve caused by repeated trauma, ischemia or entrapment of the nerve, occurs most frequently in women aged 40-50 who wear high-heeled, pointed-toe shoes. The neuroma occurs at the level of the metatarsal necks. The common digital nerve to the third/fourth metatarsal spaces is most often affected, although other interspaces can be involved.

Causes

A Morton’s Neuroma is not a true neuroma, which is a tumor that is generally benign. Rather, it is an enlargement of the nerve where it goes between the metatarsal bones of the foot. Because the nerve no longer fits between the gap, the pressure causes pain and sometimes numbness. This enlargement of the nerve is often an inflammation due to irritation. If the forefoot becomes compressed due to shoes that are too narrow, the nerve becomes damaged and inflamed. This inflammation means the nerve no longer fits in the space between the bones, creating further irritation and more inflammation. If this vicious circle can be broken, the problem may be resolved. However, in some situations the nerve can have fibrous tissues formed around it, which may require the destruction of the nerve or surgical removal.

Symptoms

The symptoms of a Morton’s neuroma are classic in nature. The patient complains of a burning , tingling, slightly numb feeling (dysesthesias) which radiates out to the toes on either side of the interspace that is involved. For instance, a Morton’s neuroma of the third interspace will result in pain between the third and fourth toes, and a neuroma in the second interspace will cause pain between the second and third toes. The symptoms are usually aggravated by wearing shoes, particularly those with high heels. Symptoms are relieved by walking in flat, wide shoes or going barefoot. Rarely will the patient experience pain when sitting or laying down.

Diagnosis

There is a special orthopedic test called the Morton’s test that is often used to evaluate the likelihood of plantar nerve compression. For this test, the client is supine on the treatment table. The practitioner grasps the client’s forefoot from both sides and applies moderate pressure, squeezing the metatarsal heads together. If this action reproduces the client’s symptoms (primarily sharp, shooting pain into the toes, especially the third and fourth), Morton’s neuroma may exist.

Non Surgical Treatment

Treatments may include rehabilitation measures to reduce nerve Irritation. Switching to low-heeled, wide-toed shoes with good arch support. Wearing padding in the shoes and/or between the toes. Wearing shoe inserts to correct a mechanical abnormality of the foot. Having ultrasound, electrical stimulation, whirlpool, and massage done on the foot. The foot may be injected with corticosteroids mixed with a local anesthetic in order to reduce pain. Relief may be only temporary, however, if the mechanical irritation is not also corrected. Injections with other types of medications such as alcohol, phenol, or vitamin B12 are sometimes used.

Surgical Treatment

Operative treatment of Morton?s neuroma should be entertained only after failure of non-operative management. Standard operative treatment involves identifying the nerve and cutting (resecting) it proximal to the point where it is irritated/injured. This is usually done through an incision on the top (dorsal) aspect of the foot, although an incision on the sole (plantar) aspect of the foot can be used. Some physicians will attempt to treat Morton?s neuroma by releasing the intermetatarsal ligament, and freeing the nerve of local scar tissue. This may also be beneficial.

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What Is The Best Remedy For Calcaneal Spur

Overview

Heel spur is a thorn-like, bony protrusion of the heel bone, which can become inflamed through irritation, thus causing pain. A heel spur forms at the tendon attachments on the muscles of the heel bone as a result of micro-injuries to the tissue caused by overstraining. As part of the healing process for these micro-injuries, the body stores bone material in the tendon attachments as a repair mechanism. Heel spurs can develop over a very long period without causing major complaints. However, irritation of the area surrounding the ossified tendon attachment can cause inflammations. Left untreated, the inflammations can in turn lead to increased ossification and thus to permanent degradation with a risk of chronic manifestation. The normal rolling procedure that we all use when walking is then frequently no longer possible.

Causes

The plantar fascia is a big strong ligament on the bottom of the foot, starting at the bottom of the heel bone and running into the ball of the foot. As the arch of the foot becomes weak, it sags slightly with each step and this causes the plantar fascia to tug and pull at the heel bone with each step. Over a period of time, a spur forms where this big strong ligament tugs and pulls at the heel bone. Soon, inflammation (swelling) starts around this spur and the pain becomes almost unbearable. (Sometimes heel spurs may be present without being painful if no inflammation is present).

Symptoms

Heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain. Your heel pain may be worse in the morning when you first wake up or during certain activities.

Diagnosis

Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products such as Advil or Ibuprofin are helpful in eradicating the pain. Pain creams, such as Neuro-eze, BioFreeze & Boswella Cream can help to relieve pain and help increase circulation.

Non Surgical Treatment

Elevation of the affected foot and leg at rest may diminish the pain. Applying gentle heat to the painful area may ease the pain by dilating local blood vessels. One also can protect the heel by placing a foam rubber pad in the heel of the shoe. A pad about one-half inch thick will raise the heel, shift the weight of the body forward, and protect the irritated muscles attached to the heel bone. The same effect can be achieved by using adhesive tape to turn the foot inward. Additional treatment may consist of a number of physical therapies, such as diathermy, ultrasound waves and whirlpool baths.

Surgical Treatment

Surgery involves releasing a part of the plantar fascia from its insertion in the heel bone, as well as removing the spur. Many times during the procedure, pinched nerves (neuromas), adding to the pain, are found and removed. Often, an inflamed sac of fluid call an accessory or adventitious bursa is found under the heel spur, and it is removed as well. Postoperative recovery is usually a slipper cast and minimal weight bearing for a period of 3-4 weeks. On some occasions, a removable short-leg walking boot is used or a below knee cast applied.

Posterior Calcaneal Spur Causes

Overview

Heel spurs are new bone that forms in response to stress to the heel. They serve to protect the bone against the development of microfractures. Spurs start out as cartilage and progress to solid bone. They are present in about 50 percent of the population, yet not everyone has heel pain- that’s the first clue that heel spurs don’t always cause heel pain.

Causes

Heel spurs develop as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia pulls away from the heel. This stretching of the plantar fascia is usually the result of over-pronation (flat feet), but people with unusually high arches (pes cavus) can also develop heel spurs. Women have a significantly higher incidence of heel spurs due to the types of footwear often worn on a regular basis.

Symptoms

Heel spurs often do not show any symptoms. If you have intermittent or chronic pain when you walk, run or jog, it may be heel spur. There will be inflammation the point where spur formation happens. The pain is caused by soft tissue injury in the heel. Patients often describe the pain as a pin or knife sticking to the heel. The pain is more specially in the morning when the patient stands up for the first time.

Diagnosis

A Heel Spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone. The plantar fascia is the thick, connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. In other words, tremendous stress is placed on the plantar fascia.

Non Surgical Treatment

Heel spurs and plantar fascitis are usually controlled with conservative treatment. Early intervention includes stretching the calf muscles while avoiding re-injuring the plantar fascia. Decreasing or changing activities, losing excess weight, and improving the proper fitting of shoes are all important measures to decrease this common source of foot pain. Modification of footwear includes shoes with a raised heel and better arch support. Shoe orthotics recommended by a healthcare professional are often very helpful in conjunction with exercises to increase strength of the foot muscles and arch. The orthotic prevents excess pronation and lengthening of the plantar fascia and continued tearing of this structure. To aid in this reduction of inflammation, applying ice for 10-15 minutes after activities and use of anti-inflammatory medication can be helpful. Physical therapy can be beneficial with the use of heat modalities, such as ultrasound that creates a deep heat and reduces inflammation. If the pain caused by inflammation is constant, keeping the foot raised above the heart and/or compressed by wrapping with an ace bandage will help. Corticosteroid injections are also frequently used to reduce pain and inflammation. Taping can help speed the healing process by protecting the fascia from reinjury, especially during stretching and walking.

Surgical Treatment

Though conservative treatments for heel spurs work most of the time, there are some cases where we need to take your treatment to the next level. Luckily, with today?s technologies, you can still often avoid surgery. Some of the advanced technologies to treat a Heel Spur are Platelet Rich Plasma Therapy. Platelet Rich Plasma Therapy (also known as PRP) is one of several regenerative medicine techniques that University Foot and Ankle Institute has helped bring to foot and ankle care. This amazing in-office procedure allows the growth factors in the blood to be used to actually begin the healing process again long after your body has given up on healing the area. Heel Pain Shockwave Therapy. Shockwave therapy is a non-invasive procedure done in the office that allows for new blood to get to the region of fascia damage and help with healing. Results have been excellent with more than 70 percent of patients getting relief with only one treatment. Topaz for Heal Spurs and pain. Another minimally invasive technology technique is called Coblation Surgery using a Topaz probe. This minimally invasive procedure involves controlled heating of multiple tiny needles that are inserted through the skin and into the plantar fascia. This process, like PRP and Shockwave therapy, irritates the fascia enough to turn a chronic problem back into an acute problem, greatly increasing the chances of healing. Heel Spur Surgery. Endoscopic Plantar Fasciotomy is one surgical procedure that we consider to release the tight fascia. University Foot and Ankle Institute has perfected an endoscopic (camera guided) approach for fascia release to allow rapid healing and limited downtime with minimal pain.

Prevention

In order to prevent heel spurs, it?s important that you pay attention to the physical activities you engage in. Running or jogging on hard surfaces, such as cement or blacktop, is typical for competitive runners, but doing this for too long without breaks can lead to heel spurs and foot pain. Likewise, the shoes you wear can make a big difference in whether or not you develop heel spurs. Have your shoes and feet checked regularly by our Dallas podiatrist to ensure that you are wearing the proper equipment for the activities. Regular checkups with a foot and ankle specialist can help avoid the development of heel spurs.

How Can You Treat Bursitis Of The Foot

Overview

Bursitis is defined as inflammation of a bursa. Humans have approximately 160 bursae. These are saclike structures between skin and bone or between tendons, ligaments, and bone. The bursae are lined by synovial tissue, which produces fluid that lubricates and reduces friction between these structures.

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

Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down.

Diagnosis

Careful examination by your physician or physiotherapist can determine if the inflammation is from the Achilles tendon or from the retrocalcaneal bursa. Tenderness due to insertional Achilles tendinitis is normally located slightly more distal where the tendon inserts into the back of the heel, whereas tenderness caused by the retrocalcaneal bursa is normally palpable at the sides of the distal Achilles tendon. Diagnosis can be confirmed with an ultrasound investigation, MRI or CT scan.

Non Surgical Treatment

During the initial acute phase of the condition, patients should apply ice to the back of the heel for 15 to 20 minutes and follow the R.I.C.E.R regime. Avoid activities that cause pain. Gradual progressive stretching of the calf muscle and Achilles tendon is also advocated. Changing the footwear. Wearing an open-backed shoe may help relieve pressure on the affected region. For those whose symptoms were caused by a sudden change from wearing high-heeled shoes to flat shoes, the temporary use of footwear with a heel height in between may be helpful. Inserting a heel cup in the shoe may help to raise the inflamed region slightly above the shoe?s restricting heel counter and relieve the pain. It is advisable to also insert the heel cup into the other shoe to avoid any leg-leg discrepancies that can lead to other problems. Training frequency and intensity should be gradually progressed with adequate rest between trainings.

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.

Hammertoe Repair Implant

Overview

Hammer, mallet, and claw toes have distinctive differences that can assist you in determining what kind of toe problem you are dealing with. All three conditions deal with toes that are curved into abnormal positions, which possibly look strange and may cause pain. Typically, the big toe is not affected by these problems. A Hammer toe tends to bend downward at the center of a toe joint. It generally affects your second toe. The affliction causes the center of your toe to rise and is often accompanied with a bony lump.

Causes

Though hammer toes are principally hereditary, several other factors can contribute to the deformity. Most prevalent is an imbalance of the muscles and tendons that control the motion of the toe. When the tendon that pulls the toe upward is not as strong as the one that pulls it downward there is a disparity of power. This forces the toe to buckle and gradually become deformed. If the it persists, the toe can become rigid and harder to correct.

Symptoms

Hammer, claw, and mallet toes can cause discomfort and pain and may make it hard to walk. Shoes may rub on your toes, causing pain, blisters, calluses or corns, or sores. Sores can become infected and lead to cellulitis or osteomyelitis, especially if you have diabetes or peripheral arterial disease. If you have one of these health problems and sores develop, contact your doctor.

Diagnosis

The earlier a hammertoe is diagnosed, the better Hammer toes the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.

Non Surgical Treatment

Hammertoes that are not painful (asymptomatic) and still flexible may not require treatment. In mild cases, open-toed, low-heeled, or wider shoes and foam or moleskin pads can provide symptomatic relief by reducing pressure. Taping (strapping) the affected toe can help to reduce deformity and pain. Physical therapy to instruct patients in exercises that passively stretch tight structures and strengthen weak foot intrinsic muscles is also helpful with mild cases. Periodic trimming (debridement) of corns (clavi, helomata) by a podiatrist can provide temporary relief. Corticosteroid injections are often very effective in reducing pain.

Surgical Treatment

Surgery is used when other types of treatment fail to relieve symptoms or for advanced cases of hammertoe. There are several types of surgeries to treat hammertoe. A small piece of bone may be removed from the joint (arthroplasty). The toe joint may be fused to straighten it (arthrodesis). Surgical hardware, such as a pin, may be used to hold the bones in place while they heal. Other types of surgery involve removing skin (wedging) or correcting muscles and tendons to balance the joint.

Prevention

There are several things you can do to help prevent hammer toes from forming or progressing. Wear supportive shoes to help prevent deformities. Hammer toes are often related to faulty foot mechanics, especially foot flattening. Wear custom orthotics prescribed by your podiatrist. Orthotics may slow the progression or prevent the development of hammer toes. Avoid shoes with narrow or pointed toe boxes that can compress the toes.

Chiropractic Method For Hammer Toes

Overview

A hammertoes occurs when the joint of the toes curl down. The reason they curl abnormally is due to a muscle imbalance which results in the tendons becoming unnaturally tight. They are due to Heredity, improper shoes, and Arthritis. There are two types of hammer toes, flexible or rigid. These classification are based on the mobility of the toe joints. A flexible hammer toe is one with a flexible toe joint that allows it to be straightend with your finger. In time a flexible joint may turn into a rigid hammer toe. Normally flexible hammer toes are much less painful than rigid hammer toes. A rigid hammer toe is one with a rigid toe joint, one that is not moveable with your finger. These rigid toe joints can be very painful and limit the ability to move.

Causes

Hammer toes are most frequently caused by a muscle – tendon imbalance in the foot, and are seen both in adults and children. Foot muscles work in pairs to straighten and bend the toes. If your foot has a biomechanical defect, the muscles tighten and the tendons shorten. Eventually, the toe muscles can?t straighten the toe, even when barefoot. Contributing factors are poor choices in footwear, arthritis, or trauma.

Symptoms

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

Your doctor is very likely to be able to diagnose your hammertoe simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate your gait as you walk and the types of shoes you wear. You’ll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to better define your deformity.

Non Surgical Treatment

Apply a commercial, non-medicated hammer toe pad around the bony prominence of the hammer toe to decrease pressure on the area. Wear a shoe with a deep toe box. If the hammer toe becomes inflamed and painful, apply ice packs several times a day to reduce swelling. Avoid heels more than two inches tall. A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit Hammer toe to your podiatrist can be arranged. While this treatment will make the hammer toe feel better, it is important to remember that it does not cure the condition. A trip to the podiatrist’s office will be necessary to repair the toe to allow for normal foot function. Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.

Surgical Treatment

Extreme occurrences of hammer toe may call for surgery. Your surgeon will decide which form of surgery will best suit your case. Often, the surgeon may have to cut or remove a tendon or ligament. Depending on the severity of your condition, the bones on both sides of the joint afflicted may need to be fused together. The good news is you can probably have your surgery and be released to go home in one day. You will probably experience some stiffness in your toe, but it might last for a short period, then your long-term pain will be eliminated.

How To Diagnose Bunions

Overview

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. The big toe may turn toward the second toe. The tissues around the joint may be swollen and tender. A bony bump at the base of the little toe is called a bunionette or tailor’s bunion. The little toe also bends inward, and the joint swells or enlarges.

Causes
With prolonged wearing of constraining footwear your toes will adapt to the new position and lead to the deformity we know as a foot bunion. Footwear is not the only cause of a bunion. Injuries to the foot can also be a factor in developing a bunion. Poor foot arch control leading to flat feet or foot overpronation does make you biomechanically susceptible to foot bunions. A family history of bunions also increases your likelihood of developing bunions. Many people who have a bunion have a combination of factors that makes them susceptible to having this condition. For example, if you are a women over the age of forty with a family history of bunions, and often wear high-heeled shoes, you would be considered highly likely to develop a bunion.
SymptomsSymptoms, which occur at the site of the bunion, may include pain or soreness, inflammation and redness, a burning sensation, possible numbness. Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

Diagnosis
People with bunions may be concerned about the changing appearance of their feet, but it is usually the pain caused by the condition that leads them to consult their doctor. The doctor will evaluate any symptoms experienced and examine the affected foot for joint enlargement, tissue swelling and/or tenderness. They will also assess any risk factors for the condition and will ask about family history. An x-ray of the foot is usually recommended so that the alignment of big toe joint can be assessed. This would also allow any other conditions that may be affecting the joint, such as arthritis, to be seen.

Non Surgical Treatment
Treatment options are based on the severity of the deformity and symptoms. Nonsurgical treatments usually are enough to relieve the pain and pressure on the big toe. Your doctor may tell you to start wearing roomy, comfortable shoes and use toe padding or a special corrective device that slips into your shoes to push the big toe back into its proper position. To help relieve pain, you can take over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others). Whirlpool baths also may help to ease discomfort.

Surgical Treatment
Bunion surgery is most often performed as an out-patient, this means you go home that same day. It will likely be done at a hospital or out-patient (ambulatory) surgery center. The anesthetic choices with bunion surgery are local with sedation, spinal or general anesthesia. You wouldn?t expect that a small bunion would be treated exactly the same as a large one. Over the years, surgeons have developed dozens of methods to surgically correct bunions. But don?t worry because only a handful of methods are used today. With most bunion surgeries today, the procedure involves a combination of soft-tissue rebalancing of ligaments and tendons as well as bone work to re-align the foot structure. You may have heard people say they had their ?bunion shaved.? In most cases, the surgery often involves much more than simply shaving the bunion. The shaving part of the procedure is called an ?exostectomy? and often performed in conjunction with other methods.