Hammer Toe Repair Surgery

Hammer ToeOverview
What Is A Hammer toes? A hammer toe, or claw toe, describes a condition where the toe(s) become buckled, contracted or crooked. The toe could even cross over an adjacent toe, which is called a cross over toe. Any of the toes may be affected, but the 2nd and 5th toe are most commonly involved.

Causes
Hammer toe results from shoes that don't fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out. Shoes that narrow toward the toe may make your forefoot look smaller. But they also push the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles become unable to straighten the toe, even when there is no confining shoe. Hammertoe

Symptoms
Well-developed hammertoes are distinctive due to the abnormal bent shape of the toe. However, there are many other common symptoms. Some symptoms may be present before the toe becomes overly bent or fixed in the contracted position. Often, before the toe becomes permanently contracted, there will be pain or irritation over the top of the toe, particularly over the joint. The symptoms are pronounced while wearing shoes due to the top of the toe rubbing against the upper portion of the shoe. Often, there is a significant amount of friction between the toe and the shoe or between the toe and the toes on either side of it. The corns may be soft or hard, depending on their location and age. The affected toe may also appear red with irritated skin. In more severe cases, blisters or open sores may form. Those with diabetes should take extra care if they develop any of these symptoms, as they could lead to further complications.

Diagnosis
The earlier a hammertoe is diagnosed, the better 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
If your toe is still flexible, your doctor may recommend that you change to roomier and more comfortable footwear and that you wear shoe inserts (orthotics) or pads. Wearing inserts or pads can reposition your toe and relieve pressure and pain. In addition, your doctor may suggest exercises to stretch and strengthen your toe muscles. These may include picking up marbles or a thin towel off the floor with your toes.

Surgical Treatment
Surgery to correct for a hammertoe may be performed as an outpatient procedure at a hospital, surgery center, or in the office of your podiatrist. There are multiple procedures that can be used depending on your individual foot structure and whether the deformity is flexible or rigid. There may be a surgical cut in the bone to get rid of an exostosis, or a joint may be completely removed to allow the toe to lay straight. Hammer Toe

Prevention
Few people realize that their feet grow over the years: actually, the heel stays the same, but the front of the foot becomes wider and longer. The result, most women wear shoes that fit at the heel but are much too narrow in the front. Buy shoes that fit the longer foot. For two out of three people, one foot is significantly bigger than the other. Have both feet measured whenever you buy shoes. Have your feet measured while you're standing, and buy shoes that fit the larger foot. Shop at the end of the day, when foot swelling is greatest. No shoe should feel tight. Don't go by numbers. You may think of yourself as a size 8B, but size varies from shoe to shoe. There is no standardization, so pick the shoes that fit best. Limit high-heel use. These shoes increase pressure on the front of the foot by at least 50 percent, so wear them only for special occasions. Flat shoes are more comfortable than high heels, but they, too, can be hard on your feet, especially if they are thin-soled. Change your shoes. If your shoes are too short or too narrow, get another pair. This is especially important for children going through periods of rapid growth. The toe area should be high enough so that it doesn't rub against the top of your toes-especially if hammer toes have started to develop.

The Facts Concerning Over-Pronation Of The Foot

Overview

Overpronation is a term which is used more and more frequently by runners and exercisers these days, but what is overpronation and is it bad? Overpronation is excessive pronation of the feet when walking and running, and it can place people at risk of developing foot problems. Knowing the degree to which you pronate is important in order to select the correct footwear and exercise shoes. If you pronate excessively you could be placing an excessive strain on your feet, however overpronators can also place an excessive strain on the ankles, legs, knees, hips and lower back. Runners often claim to be an overpronator or even an underpronator or supinator. These terms may very well be viewed in a negative light when they really are not a problem at all. On the other hand people may be overpronators and not even know about it and could be at a high risk of developing a musculoskeletal problem.Overpronation

Causes

Over-pronation has different causes. Obesity, pregnancy, age or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Over-pronation is also very common with athletes, especially runners and most of them nowadays use orthotics inside their shoes. Over-pronation affects millions of people and contributes to a range of common complaints including sore, aching feet, ball of foot pain, heel Pain, achilles tendonitis, bunions, shin pain, tired, aching legs, knee pain and lower back pain. The most effective treatment solution for over-pronation is wearing an orthotic shoe insert. Orthotics correct over-pronation, thereby providing natural, lasting pain relief from many common biomechanical complaints.

Symptoms

Because overpronation affects the entire lower leg, many injuries and conditions may develop and eventually cause problems not only in the leg and foot, but also the knee, hips and lower back. Pain often begins in the arch of the foot or the ankle. Blisters may develop on the instep, or on the inside edge of the heels. As overpronation continues and problems develop, pain will be felt elsewhere, depending on the injury.

Diagnosis

So, how can you tell if you have overpronation, or abnormal motion in your feet, and what plantar fasciitis treatment will work to correct it? Look at your feet. While standing, do you clearly see the arch on the inside of your foot? If not, and if the innermost part of your sole touches the floor, then your feet are overpronated. Look at your (running/walking) shoes. If your shoes are more worn on the inside of the sole in particular, then pronation may be a problem for you. Use the wet foot test. Wet your feet and walk along a section of pavement, then look at the footprints you leave behind. A normal foot will leave a print of the heel connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you?re feet are pronated there may be little distinction between the rear and forefoot.Over Pronation

Non Surgical Treatment

If you overpronate, you should talk with a foot and ankle specialist, especially if symptoms have not developed yet. Questions you may want to ask your doctor include what are the best running shoes on the market? Where can I find those shoes? If over-the-counter orthotics don?t work, how long should I wait before contacting you for custom-made orthotics? On my next visit, what type of diagnostic testing should I expect? If I limit the amount of time I spend running, will my overpronation symptoms disappear? What additional treatment options can we try?

Surgical Treatment

Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.

An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.
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Am I Able To Treat Severs Disease At Home ?

Overview

Sever?s Disease (calcaneal aphophysitis) is not really a disease, but more a repetitious strain injury. This is the most common cause of kids heel pain seen at Podiatry Care. Active children in football, soccer, basketball, netball and tennis with this type of foot pain complain of pain in the region of the heel bone particularly after exercise. In severe cases, children will complain of pain during exercise as well. It is a frequent cause of heel pain in children, particularly in the very active child. It is most often seen in children between the ages of 8 to 15 years as the growth plate is not fully developed or calcified at this time.

Causes

The spontaneous development of pain in children generally indicates some form of injury to the growth plate of a growing bone. This can occur without a specific memorable event. When pain occurs in the heel of a child the most likely cause is due to injury of the growth plate in the heel bone. This is called Sever's disease. A condition that may mimic Seiver's disease is Achilles tendonitis. Achilles tendonitis is 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. It is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats seem to aggravate the condition. It is believed that the condition is due to an underlying mechanical problem with the way the foot functions.

Symptoms

Symptoms of calcaneal apophysitis may include Pain in the back or bottom of the heel, Limping, Walking on toes, Difficulty running, jumping, or participating in usual activities or sports, Pain when the sides of the heel are squeezed.

Diagnosis

In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.

Non Surgical Treatment

Stretching programs. Strengthening exercises. Exercise and training modification. Orthotic therapy. In rare cases, where fragmentation of the apophysis exists and pain fails to subside with traditional treatments then immobilization of the foot and ankle with a short leg pneumatic walker(walking cast) is indicated.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
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Which Are The Key Causes Of Posterior Tibial Tendon Dysfunction (PTTD) ?

Overview
Originally known as posterior tibial tendon dysfunction or insufficiency, adult-acquired flatfoot deformity encompasses a wide range of deformities. These deformities vary in location, severity, and rate of progression. Establishing a diagnosis as early as possible is one of the most important factors in treatment. Prompt early, aggressive nonsurgical management is important. A patient in whom such treatment fails should strongly consider surgical correction to avoid worsening of the deformity. In all four stages of deformity, the goal of surgery is to achieve proper alignment and maintain as much flexibility as possible in the foot and ankle complex. However, controversy remains as to how to manage flexible deformities, especially those that are severe. Acquired Flat Feet

Causes
There are multiple factors contributing to the development of this problem. Damage to the nerves, ligaments, and/or tendons of the foot can cause subluxation (partial dislocation) of the subtalar or talonavicular joints. Bone fracture is a possible cause. The resulting joint deformity from any of these problems can lead to adult-acquired flatfoot deformity. Dysfunction of the posterior tibial tendon has always been linked with adult-acquired flatfoot deformity (AAFD). The loss of active and passive pull of the tendon alters the normal biomechanics of the foot and ankle. The reasons for this can be many and varied as well. Diabetes, high blood pressure, and prolonged use of steroids are some of the more common causes of adult-acquired flatfoot deformity (AAFD) brought on by impairment of the posterior tibialis tendon. Overstretching or rupture of the tendon results in tendon and muscle imbalance in the foot leading to adult-acquired flatfoot deformity (AAFD). Rheumatoid arthritis is one of the more common causes. About half of all adults with this type of arthritis will develop adult flatfoot deformity over time. In such cases, the condition is gradual and progressive. Obesity has been linked with this condition. Loss of blood supply for any reason in the area of the posterior tibialis tendon is another factor. Other possible causes include bone fracture or dislocation, a torn or stretched tendon, or a neurologic condition causing weakness.

Symptoms
In many cases, adult flatfoot causes no pain or problems. In others, pain may be severe. Many people experience aching pain in the heel and arch and swelling along the inner side of the foot.

Diagnosis
Posterior Tibial Tendon Dysfunction is diagnosed with careful clinical observation of the patient?s gait (walking), range of motion testing for the foot and ankle joints, and diagnostic imaging. People with flatfoot deformity walk with the heel angled outward, also called over-pronation. Although it is normal for the arch to impact the ground for shock absorption, people with PTTD have an arch that fully collapses to the ground and does not reform an arch during the entire gait period. After evaluating the ambulation pattern, the foot and ankle range of motion should be tested. Usually the affected foot will have decreased motion to the ankle joint and the hindfoot. Muscle strength may also be weaker as well. An easy test to perform for PTTD is the single heel raise where the patient is asked to raise up on the ball of his or her effected foot. A normal foot type can lift up on the toes without pain and the heel will invert slightly once the person has fully raised the heel up during the test. In early phases of PTTD the patient may be able to lift up the heel but the heel will not invert. An elongated or torn posterior tibial tendon, which is a mid to late finding of PTTD, will prohibit the patient from fully rising up on the heel and will cause intense pain to the arch. Finally diagnostic imaging, although used alone cannot diagnose PTTD, can provide additional information for an accurate diagnosis of flatfoot deformity. Xrays of the foot can show the practitioner important angular relationships of the hindfoot and forefoot which help diagnose flatfoot deformity. Most of the time, an MRI is not needed to diagnose PTTD but is a tool that should be considered in advanced cases of flatfoot deformity. If a partial tear of the posterior tibial tendon is of concern, then an MRI can show the anatomic location of the tear and the extensiveness of the injury.

Non surgical Treatment
Treating PTTD is almost always easier the earlier you catch it. So, the first step in treatment is to see your doctor as soon as you begin experiencing painful symptoms. However, once your condition has been diagnosed, your podiatrist will likely try to give the upset tendon a bit of a break so it?ll calm down and stop being so painful. This can often be accomplished by immobilizing the foot using tape and padding, braces, or casts, depending on what your podiatrist believes will work best for you, and depending on the severity of your condition. You may also be instructed to reduce inflammation by applying ice to the area (usually 40 minutes on and 20 minutes off, with a thin towel between you and the ice). Or, you might take anti-inflammatory medications like ibuprofen (steroidal anti-inflammatory meds are actually likely to make this problem worse, and are not usually recommended in treating PTTD), or use ultrasound therapy. Once the inflammation has gone down a bit, your podiatrist may recommend using orthotics (prescription shoe inserts) to support your damaged arch. Ankle braces can also be helpful. Adult Acquired Flat Foot

Surgical Treatment
If initial conservative therapy of posterior tibial tendon insufficiency fails, surgical treatment is considered. Operative treatment of stage 1 disease involves release of the tendon sheath, tenosynovectomy, debridement of the tendon with excision of flap tears, and repair of longitudinal tears. A short-leg walking cast is worn for 3 weeks postoperatively. Teasdall and Johnson reported complete relief of pain in 74% of 14 patients undergoing this treatment regimen for stage 1 disease. Surgical debridement of tenosynovitis in early stages is believed to possibly prevent progression of disease to later stages of dysfunction.

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