What Causes Mortons Neuroma

Overview

intermetatarsal neuromaMorton?s Neuroma is a pain condition that affects your feet and toes. If you are suffering from Morton?s Neuroma, a growth of tissue has developed over one of the nerves running from your feet into your toes. This growth can cause inflammation and pain whenever you use your foot. A type of benign tumor, Morton?s Neuroma typically develops in the space between the third and fourth toes, although it can also form between the second and third toes. When you walk, the bones and ligaments in the top of your foot press down on this growth, causing pressure and pain.

Causes

Morton’s neuroma may be the result of irritation, pressure or injury. In some cases its cause is unknown. In the majority of cases only one nerve is affected. Having both feet affected is extremely rare. A high percentage of patients with Morton’s neuroma are women who wear high-heeled or narrow shoes. Patients with Morton’s neuroma may need to change their footwear, take painkillers or steroid injections, while others may require surgery to either remove the affected nerve or release the pressure on it.

Symptoms

The symptoms of Morton?s Neuroma tend to come and go over time. They are typically exacerbated by physical activity or by wearing certain shoes. Morton?s Neuroma symptoms include sharp pain in the ball of the foot, pain radiating to the tips of the toes, burning pain in the second, third, or fourth toes, numbness in the toes, sensation of a lump between the toes.

Diagnosis

During the examination, your physician will feel for a palpable mass or a “click” between the bones. He or she will put pressure on the spaces between the toe bones to try to replicate the pain and look for calluses or evidence of stress fractures in the bones that might be the cause of the pain. Range of motion tests will rule out arthritis or joint inflammations. X-rays may be required to rule out a stress fracture or arthritis of the joints that join the toes to the foot.

Non Surgical Treatment

Common treatments involve wearing different shoes or using arch supports. Resting the foot, massaging the toes and using an ice pack may work for some people. A GP or a podiatrist (foot specialist) may also recommend anti-inflammatory painkillers or a course of steroid injections. Numbing injections, in which alcohol and a local anaesthetic are injected into the affected area of the foot, may also be effective. In extreme cases, when the condition does not respond to treatment, day case surgery may be needed.plantar neuroma

Surgical Treatment

When conservative measures are unsuccessful, surgery can be a good choice in the treatment of Morton’s neuroma. The operation for Morton’s neuroma does not require an overnight hospital stay. The anesthetic used is an ankle block, which completely numbs the foot during the surgery. The physician removes the neuroma from an incision made on the top of the foot between the involved metatarsal heads. The nerve to the interspace is exposed and cut next to the metatarsal heads.

Prevention

Although the exact causes of neuromas are not completely known, the following preventive steps may help. Make sure your exercise shoes have enough room in the front part of the shoe and that your toes are not excessively compressed. Wear shoes with adequate padding in the ball of the foot. Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).

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Causes Hammertoe Deformity

HammertoeOverview
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 Hammertoe 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
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.

Hammer ToeSymptoms
The most obvious symptom of hammertoe is the bent, hammer-like or claw-like appearance of one or more of your toes. Typically, the proximal joint of a toe will be bending upward and the distal joint will be bending downward. In some cases, both joints may bend downward, causing the toes to curl under the foot. In the variation of mallet toe, only the distal joint bends downward. Other symptoms may include Pain and stiffness during movement of the toe, Painful corns on the tops of the toe or toes from rubbing against the top of the shoe’s toe box, Painful calluses on the bottoms of the toe or toes, Pain on the bottom of the ball of the foot, Redness and swelling at the joints. If you have any of these symptoms, especially the hammer shape, pain or stiffness in a toe or toes, you should consider consulting your physician. Even if you’re not significantly bothered by some of these symptoms, the severity of a hammertoe can become worse over time and should be treated as soon as possible. Up to a point hammertoes can be treated without surgery and should be taken care of before they pass that point. After that, surgery may be the only solution.

Diagnosis
A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.

Non Surgical Treatment
Often padding and taping are the first steps in a treatment plan. Padding the hammer toe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain. Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity. Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammer toe deformity.

Surgical Treatment
Surgery is the approach that is often necessary to correct hammertoe that fails to respond to nonsurgical management. Surgery is appropriate when the muscles and tendons involved in a hammertoe problem have become so tight that the joints are rigid, misaligned and unmovable. There are a number of surgical techniques for dealing with the complex range of joint, bone, muscle, tendon and ligament abnormalities that define each hammertoe’s make-up. To correct a hammertoe deformity, the surgeon’s goal is to restore the normal alignment of the toe joint, relieving the pressure that led to the hammertoe’s development (this should also relieve the pain, as well). To do this, he or she may remove part of the boney structure that creates a prominence at the top of the joint. Tighten or loosen the muscles, tendons and ligaments around the toe joints. Realign the toe bones by cutting one or more and shifting their position, realigning muscles, tendons and ligaments accordingly. Use screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.

Hammer Toe Symptoms

Hammer ToeOverview

The term hammertoes describes three unique contracture deformities of the toes. The deformities differ by the location of contracture in each joint of the toe. The three deformities include hammer toe, claw toe and mallet toe. Hammer toes may be flexible or rigid. Hammer toes are most common on the lesser toes (2-5) and may affect one or more toes simultaneously. Hallux malleus is the term used to described a hammer toe of the great toe. Hallux malleus is often found as an isolated foot problem. Hammer toes are found equally in men and women. The onset of hammer toes is between the ages of 30 and 80 years of age.

Causes

People who have a high-arched feet have an increased chance of hammer toes hammertoes occurring. Also, patients with bunion deformities notice the second toe elevating and becoming hammered to make room for the big toe that is moving toward it. Some patients damage the ligament that holds the toe in place at the bottom of the joint that connects the toe and foot. When this ligament (plantar plate) is disrupted or torn, the toe floats upward at this joint. Hammer toes also occur in women wearing ill-fitting shoes or high heels, and children wearing shoes they have outgrown.

HammertoeSymptoms

At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you’re not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses.

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

Putting padding between your toes and strapping them in place can help to stop pain caused by the toes rubbing. Custom-made insoles for your shoes will help to take the pressure off any painful areas. Special shoes that are wider and deeper than normal can stop your toes rubbing. However if your pain persists your consultant may recommend an surgery.

Surgical Treatment

Surgery to correct for a hammertoe may be performed as a day procedure. There are several different types of procedures that can be used depending on the foot structure and if the deformity is flexible or rigid.

HammertoePrevention

Custom orthotics paired with a well made shoe can prevent the progression and development of hammertoes. Wearing proper-fitting shoes and custom orthotic devices can provide the support patients need to address muscle/tendon dysfunction. It can also support end stage diseases that result in hammertoe deformities by re-balancing the foot and ankle and controlling the deforming forces.

What Is Overpronation Of The Feet

Overview

Pronation is a normal motion that our feet make as they walk. With each step, the heel touches the ground first, then the foot rolls forward to the toes, causing the ankle to roll inward slightly and the arch to flatten out. That?s normal. But when that rolling inward becomes more pronounced, that?s over-pronation, which is a big problem. You can usually see over-pronation by looking at the back of the leg and foot. The Achilles tendon normally runs straight down from the leg to the foot, hitting the floor at a perpendicular angle. In feet that over-pronate, the Achilles tendon will be at a slight angle to the ground and the ankle bone will appear more prominent than usual.Over Pronation

Causes

There are many possible causes for overpronation, but researchers have not yet determined one underlying cause. Hintermann states, Compensatory overpronation may occur for anatomical reasons, such as a tibia vara of 10 degrees or more, forefoot varus, leg length discrepancy, ligamentous laxity, or because of muscular weakness or tightness in the gastrocnemius and soleus muscles. Pronation can be influenced by sources outside of the body as well. Shoes have been shown to significantly influence pronation. Hintermann states that the same person can have different amounts of pronation just by using different running shoes. It is easily possible that the maximal ankle joint eversion movement is 31 degrees for one and 12 degrees for another running shoe.

Symptoms

Over-pronation is a condition where the arch flattens out which makes the feet roll inward while walking. This condition is also known as flat feet. It imposes extreme additional stresses on the plantar fascia, a fibrous band of tissue which connects the heel to the forefoot. Over-pronation makes walking a painful experience because of the additional strain on the calves, heel and/or back. Treatment for over-pronation involves the use of specially-made orthotics which offers arch support and medial rear foot posting as corrective measures.

Diagnosis

Your healthcare provider will ask about your symptoms, medical history, and activities and examine your feet. Your provider may watch you walk or run. Check the motion of your feet when they strike the ground. Look at your athletic shoes to see if they show an abnormal pattern of wear.Over-Pronation

Non Surgical Treatment

An overpronator is a person who overpronates, meaning that when walking or running their feet tend to roll inwards to an excessive degree. Overpronation involves excessive flattening of the arches of the feet, with the roll seeing the push off take place from the inside edge of the foot and the big toe. When this happens, the muscles and ligaments in the feet are placed under excessive strain, which can lead to pain and premature fatigue of the foot. Overpronation is most commonly experienced in people who have flat feet or fallen arches.

Prevention

Massage and stretch the calves to increase dorsiflexion at the foot/ankle. Dorsiflexion is the bending at the ankle. By improving the dorsiflexion, one will have more flexibility at the ankle, which will allow the foot to over-pronate less. Massage the IT Band with a foam roller or tennis ball to quiet down the tightness throughout this part of the leg. The IT Band attaches from the glute maximus and runs down the side of the leg into the knee area. When the IT Band is tight it will accelerate the force of the leg moving inward, which will cause the foot to move inward as well. It is often that tightness through the IT Band that promotes over-pronation. Decreasing over-pronation, which is very prominent in runners, will help add endurance, speed and efficiency to your run and ultimately place less stress on your body.

The Way To Spot Calcaneal Apophysitis?

Overview

Although the name might sound pretty frightening, Sever’s disease is really a common heel injury that occurs in kids. It can be painful, but is only temporary and has no long-term effects. Calcaneal apophysitis is a painful inflammation of the heel?s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop. Calcaneal apophysitis is also called Sever?s disease, although it is not a true ?disease.? It is the most common cause of heel pain in children, and can occur in one or both feet. Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn?t improve in this manner. In fact, walking typically makes the pain worse.

Causes

Sever’s disease can result from standing too long, which puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel. Although Sever’s disease can occur in any child, these conditions increase the chances of it happening. Pronated foot (a foot that rolls in at the ankle when walking), which causes tightness and twisting of the Achilles tendon, thus increasing its pull on the heel’s growth plate, flat or high arch, which affects the angle of the heel within the foot, causing tightness and shortening of the Achilles tendon, short leg syndrome (one leg is shorter than the other), which causes the foot on the short leg to bend downward to reach the ground, pulling on the Achilles tendon, overweight or obesity, which puts weight-related pressure on the growth plate

Symptoms

Activity-related pain that occurs on the back of the heel, where the Achilles tendon attaches on to the heel bone. Tenderness, pain & swelling on the heel bone. Difficulty walking or walking with a limp or on tiptoes.

Diagnosis

Children or adolescents who are experiencing pain and discomfort in their feet should be evaluated by a physician. In some cases, no imaging tests are needed to diagnose Sever?s disease. A podiatrist or other healthcare professional may choose to order an x-ray or imaging study, however, to ensure that there is no other cause for the pain, such as a fracture. Sever?s disease will not show any findings on an x-ray because it affects cartilage.

Non Surgical Treatment

Treatment includes modifying activities and resting to reduce pain and inflammation and take pressure off the growth center. Ice can also be very helpful in relieving symptoms, as well as anti-inflammatory medication. A physical therapy program should be initiated to stretch tight calf muscles and strengthen the ankle muscles to relieve tension on the growth center. Shoes with padded heel surfaces and good arch support can decrease pain. Cleats may need to be avoided for some time to help reduce symptoms. The doctor may also recommend gel heel cups or supportive shoe inserts.

Posterior Tibial Tendon Dysfunction Causes

Overview
One in four adults in the U.S. has adult acquired flatfoot deformity, which may begin during childhood or be acquired with age. The foot may be flat all the time or may lose its arch when the person stands. The most common and serious cause of flat foot is Posterior Tibial Tendon Dysfunction, in which the main tendon that supports the arch gradually weakens.
Acquired Flat Foot

Causes
Women are affected by Adult Acquired Flatfoot four times more frequently than men. Adult Flatfoot generally occurs in middle to older age people. Most people who acquire the condition already have flat feet. One arch begins to flatten more, then pain and swelling develop on the inside of the ankle. This condition generally affects only one foot. It is unclear why women are affected more often than men. But factors that may increase your risk of Adult Flatfoot include diabetes, hypertension, and obesity.

Symptoms
As different types of flatfoot have different causes, the associated symptoms can be different for different people. Some generalized symptoms are listed. Pain along the course of the posterior tibial tendon which lies on the inside of the foot and ankle. This can be associated with swelling on the inside of the ankle. Pain that is worse with activity. High intensity or impact activities, such as running and jumping, can be very difficult. Some patients can have difficulty walking or even standing for long periods of time and may experience pain at the inside of the ankle and in the arch of the foot. Feeling like one is ?dragging their foot.? When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain in the bones and tendons in the outside of the ankle joint. Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot. These make shoe wear very difficult. Sometimes, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes. Diabetic patients may not experience pain if they have damage to their nerves. They may only notice swelling or a large bump on the bottom of the foot. The large bump can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoe wear is not used.

Diagnosis
In the early stages of dysfunction of the posterior tibial tendon, most of the discomfort is located medially along the course of the tendon and the patient reports fatigue and aching on the plantar-medial aspect of the foot and ankle. Swelling is common if the dysfunction is associated with tenosynovitis. As dysfunction of the tendon progresses, maximum pain occurs laterally in the sinus tarsi because of impingement of the fibula against the calcaneus. With increasing deformity, patients report that the shape of the foot changes and that it becomes increasingly difficult to wear shoes. Many patients no longer report pain in the medial part of the foot and ankle after a complete rupture of the posterior tibial tendon has occurred; instead, the pain is located laterally. If a fixed deformity has not occurred, the patient may report that standing or walking with the hindfoot slightly inverted alleviates the lateral impingement and relieves the pain in the lateral part of the foot.

Non surgical Treatment
Treatment will vary depending on the degree of your symptoms. Generally, we would use a combination of rest, immobilization, orthotics, braces, and physical therapy to start. The goal is to keep swelling and inflammation under control and limit the stress on the tendon while it heals. Avoidance of activities that stress the tendon will be necessary. Once the tendon heals and you resume activity, physical therapy will further strengthen the injured tendon and help restore flexibility. Surgery may be necessary if the tendon is torn or does not respond to these conservative treatment methods. Your posterior tibial tendon is vital for normal walking. When it is injured in any way, you risk losing independence and mobility. Keep your foot health a top priority and address any pain or problems quickly. Even minor symptoms could progress into chronic problems, so don?t ignore your foot pain.
Adult Acquired Flat Feet

Surgical Treatment
For patients with a more severe deformity, or significant symptoms that do not respond to conservative treatment, surgery may be necessary. There are several procedures available depending on the nature of your condition. Ligament and muscle lengthening, removal of inflamed tendon lining, transferring of a nearby tendon to re-establish an arch, and bone realignment and fusion are examples of surgical options to help with a painful flatfoot condition. Surgery can be avoided when symptoms are addressed early. If you are feeling ankle pain or notice any warmth, redness or swelling in your foot, contact us immediately. We can create a tailored treatment plan to resolve your symptoms and prevent future problems.