Hammer Toes Causes Symptoms
HammertoeOverview


A Hammer toe is a term that is commonly used to describe any type of toe deformity. It is a common problem that may or may not be a problem. What does a hammer toe look like? In a hammertoe the deformity usually exists in one toe (at the proximal inter phalangeal joint) - the base of the toe points upward and the end of the toe points down.


Causes


Essentially, hammertoes are caused by an abnormal interworking of the bones, muscles, ligaments and tendons that comprise your feet. When muscles fail to work in a balanced manner, the toe joints can bend to form the hammertoe shape. If they remain in this position for an extended period, the muscles and tendons supporting them tighten and remain in that position. A common factor in development of hammertoe is wearing shoes that squeeze the toes or high heels that jam the toes into the front of the shoe. Most likely due to these factors, hammertoe occurs much more frequently in women than in men.


HammertoeSymptoms


The symptoms of hammertoe are progressive, meaning that they get worse over time. Hammertoe causes the middle joint on the second, third, fourth, or fifth toes to bend. The affected toe may be painful or irritated, especially when you wear shoes. Areas of thickened skin (corns) may develop between, on top of, or at the end of your toes. Thickened skin (calluses) may also appear on the bottom of your toe or the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear.


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 hammertoe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).


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 splinting the toe to keep it straight and to stretch the tendons of the foot. Using over-the-counter pads, cushions or straps to decrease discomfort Exercising the toes to relax the foot tendons (a session with a physical therapist may help you get started with foot exercises) Wearing shoes that fit properly and allow toes plenty of room to stretch out.


Surgical Treatment


Hammer toe can be corrected by surgery if conservative measures fail. Usually, surgery is done on hammertoes an outpatient basis with a local anesthetic. The actual procedure will depend on the type and extent of the deformity. After the surgery, there may be some stiffness, swelling and redness and the toe may be slightly longer or shorter than before. You will be able to walk, but should not plan any long hikes while the toe heals, and should keep your foot elevated as much as possible.
What Are Hallux Valgus?

Overview
Bunion Pain
A bunion develops when the joint at the base of the big toe becomes swollen and most likely painful. The American Academy of Orthopaedic Surgeons suggests these ways to ease bunion pain. Make sure shoes fit properly and comfortably, and mold to the shape of your feet. Opt for shoes with a soft sole, wide toe box and wide instep. Avoid heels of more than 2 1/4 inches, those that are too tight, and shoes with pointy, narrow toes. To accommodate a bunion, wear shoes that are a bit big, or have your shoes professionally stretched. Place a protective cushioned pad over the bunion.

Causes
Perhaps the most frequent cause of bunion development is the wearing of shoes with tight, pointed toes, or with high heels that shift all of your body's weight onto your toes and also jam your toes into your shoes' toe boxes. It's estimated that more than 50 percent of women have bunions caused by high-heel shoes, and that nine out of 10 people who develop bunions are women. Bunions can also develop on your little toes, in which case they are called bunionettes or tailor's bunions.
SymptomsSymptoms of a bunion include irritated skin, sensitivity to touch, and pain when walking or running. Since the bunion may grow so prominent as to affect the shape of the foot, shoes may no longer fit properly, and blisters may form at the site of friction and pressure. Bunions may grow so large that an individual must wear shoes that are a larger size than they would otherwise wear. If the bunion becomes a severe case, walking may become difficult.

Diagnosis
A doctor can very often diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot. In some cases, arthritis may also be seen.

Non Surgical Treatment
Early treatment of bunions is centered on providing symptomatic relief. Switching to a shoe with a rounder, deeper toe box and made of a softer more pliable leather will often provide immediate relief. The use of pads and cushions to reduce the pressure over the bone can also be helpful for mild bunion deformities. Functional foot orthotics, by controlling abnormal pronation, reduces the deforming forces leading to bunions in the first place. These may help reduce pain in mild bunion deformities and slow the progression of the deformity. When these conservative measures fail to provided adequate relief, surgical correction is indicated.
Bunions

Surgical Treatment
Surgery may be recommended for some bunions, but only when symptoms are severe enough to warrant such intervention. Surgery for a bunion, called a bunionectomy, is done in hospital usually under general anaesthesia. The surgeon can often realign the bone behind the big toe by cutting the ligaments at the joint. For a severe bunion, you may need to have the bone cut in a technique called an osteotomy. Wires or screws may be inserted to keep the bones in line, and excess bone may be shaved off or removed. Potential complications of surgery include recurrence of the bunion, inadequate correction, overcorrection (the toe now points inwards), continued pain, and limited movement of the big toe.

Prevention
Shop for shoes that possess a removable liner, or insole, and stand on the liner after you have removed it from your shoe. This is an effective method to see if your shoe is wide enough in the forefoot to accommodate your bunion. If your bunion and forefoot are wider than the insole, your shoe will squeeze and constrict your bunion and create the symptoms that define this health problem. The insole should also be wide enough to fully accommodate your big toe when it points outward, away from your other toes.
Post Achilles Tendon Surgery Recovery

Overview
Achilles Tendonitis
The Achilles tendon is an important part of the leg. It is located just behind and above the heel. It joins the heel bone to the calf muscles. Its function is to help in bending the foot downwards at the ankle (this movement is called plantar flexion by doctors). If the Achilles tendon is torn, this is called an Achilles tendon rupture. The tear may be either partial or complete. In a partial tear, the tendon is partly torn but still joined to the calf muscle. With complete tears, the tendon is completely torn so that the connection between the calf muscles and the ankle bone is lost.

Causes
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Rupture usually occurs in the section of the tendon located within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section may be predisposed to rupture because it gets less blood flow, which also may impair its ability to heal. Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include increasing the intensity of sports participation, especially in sports that involve jumping, falling from a height, stepping into a hole.

Symptoms
You may notice the symptoms come on suddenly during a sporting activity or injury. You might hear a snap or feel a sudden sharp pain when the tendon is torn. The sharp pain usually settles quickly, although there may be some aching at the back of the lower leg. After the injury, the usual symptoms are as follows. A flat-footed type of walk. You can walk and bear weight, but cannot push off the ground properly on the side where the tendon is ruptured. Inability to stand on tiptoe. If the tendon is completely torn, you may feel a gap just above the back of the heel. However, if there is bruising then the swelling may disguise the gap. If you suspect an Achilles tendon rupture, it is best to see a doctor urgently, because the tendon heals better if treated sooner rather than later.

Diagnosis
The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor's examination. The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson's test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.

Non Surgical Treatment
There is no definitive protocol for conservative management. Traditionally, conservative treatment involved immobilisation in a cast or boot, with initial non-weight bearing. Recently, good results have been achieved with functional bracing and early mobilisation, and it is common to be immediately weight-bearing in an orthotic. Conservative management reduces the chance of complications, such as infection. There is a risk the tendon can heal too long and more slowly.
Achilles Tendinitis

Surgical Treatment
While it is possible to treat an Achilles tendon rupture without surgery, this is not ideal since the maximum strength of the muscle and tendon rarely returns. The reason is the ends of the tendon are ruptured in a very irregular manner, almost like the ends of a paint brush. As soon as the tendon ruptures, the calf muscle (gastrocnemius muscle) continues to pull on the tendon and the end of the ruptured tendon pulls back into the leg, which is called retraction. Once the tendon retracts, it is never possible to get sufficient strength back without surgery, because the muscle no longer functions at the correct biomechanical length and is now stretched out. There are patients for whom surgery cannot be performed, in particular, due to existing medical conditions that may add to potential for complications following surgery. For these patients, a specially designed boot that positions the foot correctly and takes the pressure and tension off the muscle and tendon is used. Most importantly, a cast is never used because it causes permanent shrinkage (atrophy) of the calf muscle. The special boot permits pressure on the foot with walking. The boot also has a hinge to permit movement of the ankle. Many studies of Achilles tendon ruptures have shown that this movement of the foot in the boot while walking is ideal for tendon healing. If surgery is not recommended, it is essential to obtain special tests to check that the ends of the tendon are lying next to each other so that healing can occur. The best test to do this is an ultrasound and not an MRI.

Prevention
The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain ankle flexibility. Problems with foot mechanics can also lead to Achilles tendonitis. This can often be treated with devices inserted into the shoes such as heel cups, arch supports, and custom orthotics.
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