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Aiko Vancil

Common Foot Problems

Right Accessory Navicular Excision

Overview

For most people with an accessory navicular, the extra bone does not cause any problems and most are unaware of its presence. But certain activities or circumstances may cause the extra bone or the tibialis posterior tendon that contains it to grow irritated. This is called accessory navicular syndrome, and its possible causes include sprains, overuse, or wearing shoes that constantly rub against the bone. Individuals who have a collapsed arch (commonly known as flat feet) may be at greater risk of accessory navicular syndrome, assuming they have the extra bone, because of the added daily trauma placed on the tibialis posterior tendon.

Accessory Navicular

Causes

This painful foot condition is caused by an extra bone in the foot called the accessory navicular. Only about 10% of people have this bone (4 to 21%), and not all of them will develop any symptoms. The navicular bone is one of the normal tarsal bones of the foot. It is located on the inside of the foot, at the arch.

Symptoms

Symptoms of this syndrome would include redness, swelling and tenderness over the navicular bone. The navicular bone is located on the inside of the foot approximately midway between the ankle bone and big toe joint. It will tend to be worse after activity and can be aggravated by those that wear very dressy shoes as opposed to casual shoes like sneakers. In other words, the flatter or less supportive the shoe, the greater the chance for pain.

Diagnosis

The diagnosis begins with a complete history and physical examination by your surgeon. Usually the condition is suggested by the history and the tenderness over the area of the navicular. X-rays will usually be required to allow the surgeon see the accessory navicular. Generally no other tests are required.

Non Surgical Treatment

Most cases of accessory navicular syndrome may be treated conservatively with some sort of immobilization. This should allow the fibrous tissue between the two bones to heal. If a patient is extremely flat footed (pronated) then I lean more towards an orthotic than a boot as my main goal is to keep the patient's foot from flattening out too much and thus reduce the strain on the two bones. Supplementation with ice, oral anti-inflammatory medication. If the patient is athletic sometimes we can keep them active with an orthotic, but other times they have to give up their sport for a period of time to allow the condition to heal.

Accessory Navicular Syndrome

Surgical Treatment

Surgery may be an option if non-surgical treatment does not decrease the symptoms of accessory navicular syndrome. Since this bone is not needed for the foot to function normally, Your surgeon may remove the accessory navicular, reshape the area, and repair the posterior tibial tendon for improved function.
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Foot Accessory Navicular Excision

Overview

In an ideal situation, the navicular bone and the accessory bone will fuse together to form one bone. The problem that occurs is that sometimes the two bones do not fuse together and the patient is left with what is known as a fibrous union or basically a non solid union of bone to bone. This fibrous union is more like scar tissue and in theory can cause pain when excessive strain is placed upon it.

Accessory Navicular Syndrome

Causes

It is commonly believed that the posterior tibial tendon loses its vector of pull to heighten the arch. As the posterior muscle contracts, the tendon is no longer pulling straight up on the navicular but must course around the prominence of bone and first pull medially before pulling upward. In addition, the enlarged bones may irritate and damage the insertional area of the posterior tibial tendon, making it less functional. Therefore, the presence of the accessory navicular bone does contribute to posterior tibial dysfunction.

Symptoms

Symptoms of this syndrome would include redness, swelling and tenderness over the navicular bone. The navicular bone is located on the inside of the foot approximately midway between the ankle bone and big toe joint. It will tend to be worse after activity and can be aggravated by those that wear very dressy shoes as opposed to casual shoes like sneakers. In other words, the flatter or less supportive the shoe, the greater the chance for pain.

Diagnosis

To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or swelling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion, and the way the patient walks may also be evaluated. X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluate the condition.

Non Surgical Treatment

The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms. Custom orthotic devices that fit into the shoe provide support for the arch, and may play a role in preventing future symptoms. Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear. When this happens, non-surgical approaches are usually repeated.

Accessory Navicular

Surgical Treatment

Surgical treatment of the accessory navicular syndrome with simple excision has the advantages of less invasive to the posterior tibial tenden and the medial longitudinal arch of the foot, shorter time of immobilization of the foot and stay in hospital, small incision and good clinical results. This procedure is one of the best selective treatments for the accessory navicular syndrome, especially for the patients without flatfoot deformity and old sprain injury.
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The Best Solution To Leg Length Discrepancy Are Shoe Lifts

There are two different kinds of leg length discrepancies, congenital and acquired. Congenital means you are born with it. One leg is anatomically shorter compared to the other. As a result of developmental periods of aging, the brain senses the walking pattern and identifies some difference. The entire body typically adapts by tilting one shoulder over to the "short" side. A difference of less than a quarter inch isn't very uncommon, demand Shoe Lifts to compensate and typically won't have a profound effect over a lifetime.

Leg Length Discrepancy Shoe Lift

Leg length inequality goes mainly undiscovered on a daily basis, however this condition is simply solved, and can eliminate quite a few cases of back ache.

Therapy for leg length inequality commonly involves Shoe Lifts. Many are very inexpensive, ordinarily priced at under twenty dollars, compared to a custom orthotic of $200 if not more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Back pain is the most widespread health problem affecting people today. Around 80 million people experience back pain at some stage in their life. It is a problem which costs businesses millions every year because of lost time and productivity. Fresh and better treatment solutions are constantly sought after in the hope of decreasing the economical influence this condition causes.

Leg Length Discrepancy Shoe Lifts

Men and women from all corners of the earth experience foot ache due to leg length discrepancy. In a lot of these situations Shoe Lifts can be of beneficial. The lifts are capable of decreasing any discomfort in the feet. Shoe Lifts are recommended by many specialist orthopaedic doctors.

To be able to support the human body in a well balanced manner, feet have got a crucial task to play. Inspite of that, it can be the most neglected zone of the human body. Many people have flat-feet meaning there may be unequal force placed on the feet. This causes other body parts like knees, ankles and backs to be impacted too. Shoe Lifts make sure that correct posture and balance are restored.

Have I Got Heel Spur

Calcaneal Spur

Overview

Bone spurs usually form around joints that have arthritis, in the vertebrae of the spine, and on the heel. When they form on the heel, they may form on the back of the heel but usually form on the bottom of the heel. Of course, this is where all of the body weight comes down with each step. Spurs on the bottom of the heel are usually most painful the first few steps out of bed each morning. The pain may lessen somewhat after walking for a few minutes, but may be intense again after sitting for a half hour or so, such as after lunch. The pain usually gets worse throughout the day as you are up on your feet more. Often the pain feels like a nail being driven through the heel into the ankle and leg.

Causes

Some causes of heel spurs include abnormal or lopsided walking, which places excessive stress on the heel bone, ligaments and nerves Running, jogging or jumping, especially on hard surfaces. Poorly fitted or badly worn shoes, especially those lacking appropriate arch support, excess weight and obesity.

Calcaneal Spur

Symptoms

Most heel spurs cause no symptoms and may go undetected for years. If they cause no pain or discomfort, they require no treatment. Occasionally, a bone spur will break off from the larger bone, becoming a ?loose body?, floating in a joint or embedding itself in the lining of the joint. This can cause pain and intermittent locking of the joint. In the case of heel spurs, sharp pain and discomfort is felt on the bottom of the foot or heel.

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 (inflammation of the plantar fascia) are usually controlled with conservative treatment. Early intervention includes stretching the calf muscles while avoiding reinjury to the plantar fascia. Decreasing or changing activities, losing excess weight, and improving the fit of shoes are all important measures to decrease foot pain. Modification of footwear includes well-padded shoes with a raised heel and better arch support. Shoe inserts recommended by a healthcare professional are often very helpful when used with exercises to increase the strength of the foot muscles and arch. The inserts prevent excessive pronation and continued tearing of the plantar fascia.

Surgical Treatment

When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide pain relief and restore mobility. The type of procedure used is based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. The procedure may also include removal of heel spurs.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don't underestimate your body's need for rest and good nutrition. If obese, lose weight.
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What Is The Best Solution For Calcaneal Spur

Heel Spur

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

There exists a membrane that covers most of the bone along the heel. When this membrane gets torn repeatedly due to straining of the muscles in the foot, the calcium deposits that lead to heel spurs are more likely to occur.

Posterior Calcaneal Spur

Symptoms

Heel spurs are most noticeable in the morning when stepping out of bed. It can be described as sharp isolated pain directly below the heel. If left untreated heel spurs can grow and become problematic long-term.

Diagnosis

A thorough history and physical exam is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.

Non Surgical Treatment

The heel pain associated with heel spurs and plantar fasciitis may not respond well to rest. If you walk after a night's sleep, the pain may feel worse as the plantar fascia suddenly elongates, which stretches and pulls on the heel. The pain often decreases the more you walk. But you may feel a recurrence of pain after either prolonged rest or extensive walking. If you have heel pain that persists for more than one month, consult a health care provider. He or she may recommend conservative treatments such as stretching exercises, shoe recommendations, taping or strapping to rest stressed muscles and tendons, shoe inserts or orthotic devices, physical therapy. Heel pain may respond to treatment with over-the-counter medications such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). In many cases, a functional orthotic device can correct the causes of heel and arch pain such as biomechanical imbalances. In some cases, injection with a corticosteroid may be done to relieve inflammation in the area.

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.

Prevention

You can prevent heel spurs by wearing well-fitting shoes with shock-absorbent soles, rigid shanks, and supportive heel counters; choosing appropriate shoes for each physical activity; warming up and doing stretching exercises before each activity; and pacing yourself during the activities. Avoid wearing shoes with excessive wear on the heels and soles. If you are overweight, losing weight may also help prevent heel spurs.

Bursitis Of The Foot Inflammed Joints

Overview

Achilles tendon bursitis is inflammation of the fluid-filled sac (bursa) located either between the skin of the back of the heel and the Achilles tendon (posterior Achilles tendon bursitis) or in front of the attachment of the Achilles tendon to the heel bone (anterior Achilles tendon bursitis, retrocalcaneal bursitis). Typical symptoms include swelling and warmth and a tender spot at the back of the heel. The diagnosis is based on symptoms, an examination, and sometimes x-rays. Treatment is aimed at relieving the inflammation and, depending on the location of the Achilles tendon bursitis, eliminating the pressure on the back of the heel. The Achilles tendon is the tendon that attaches the calf muscles to the heel bone. Posterior Achilles tendon bursitis is often associated with formation of a bone prominence called Haglund deformity or ?pump bump? on the heel bone. Anterior Achilles tendon bursitis is also called Albert disease or retromalleolar bursitis.

Causes

Certain medical conditions and medications suppress people's immune systems and make them more susceptible to septic bursitis. For example, people with cancer, HIV/AIDS, lupus, alcoholism, chronic obstructive pulmonary disease (COPD), and diabetes may be more likely to get septic bursitis. History of inflammation of the bursa. Patients who have had bursitis in the past have an increased chance of getting it again. There may be more than one reason why the retrocalcaneal bursa is inflamed. In these cases, treatment should address all of the causes.

Symptoms

The following are the most common symptoms of bursitis. However, each individual may experience symptoms differently. Bursitis can cause pain, localized tenderness, and limited motion. Swelling and redness may occur if the inflamed bursa is close to the surface (superficial). Chronic bursitis may involve repeated attacks of pain, swelling, and tenderness, which may lead to the deterioration of muscles and a limited range of motion. The symptoms of bursitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Diagnosis

Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis but may be requested to check for any underlying health conditions that may have triggered the bursitis.

Non Surgical Treatment

Surgery should always be the last option. We believe that biologic treatments that preserve normal anatomy are very helpful, particularly for runner, athletes, and active professionals with buy schedules. All non-surgical approaches attempt to calm down the inflammation of the bursa and Achilles tendon. They do not address the bony bump, but they can substantially reduce and shrink the inflamed soft tissue. Some non-surgical treatments include Oral Anti-inflammatory Medications. NSAID's (non-steroidal anti-inflammatory medications) such as Motrin, Aleve, and Steroids (like prednisone) may help control the pain and stop the inflammation. Topical Anti-inflammatory Medications. NSAID's in cream or lotion form may be applied directly to the inflamed area. With these, there is no concern for stomach upset or other problems associated with oral medication. Ice. Ice can applied be applied right to the red, inflamed area and help calm it down. Try applying a podiatrist-approved ice pack to the affected area for 20 minutes of each hour. Just make sure you don't put ice directly against the skin. Exercises. Stretching exercises may relieve some of the tension in the Achilles tendon that started the problem. If you have Equinus Deformity (or a tight heel cord) this is critical to prevent it from coming back again. Heel lifts. Heel lifts placed inside the shoe can decrease the pressure on the Achilles tendon. Remember, pressure and friction cause the bump to become inflamed. Heel pads. Placing gel padding to cushion the Achilles tendon (at the back of the heel) can also help reduce irritation from shoes. Shoe modification. Wearing open-backed shoes, or shoes that have soft backs. This will also help stop the irritation. Physical therapy. Physical therapy, such as ultrasound, massage and stretching can all reduce the inflammation without surgery. Orthotic devices. Custom arch supports known as foot orthotics control abnormal motion in the foot that can allow the heel to tilt over and rub against the heel counter. Orthotics can decrease symptoms and help prevent it from happening again. Immobilization. In some cases, a walking cast boot or plaster/fiberglass cast is necessary to take pressure off the bursa and tendon, while allowing the area to calm down. ESWT. Extra-corporeal Shock Wave Therapy uses high energy sound waves to break up diseased tissue in the bursa and Achilles tendon and stimulate your own bodies healing processes to repair the diseased area. It may be done in the office or in a an outpatient surgery center. There is no incision and no stitches with ESWT. PRP. Platelet Rich Plasma (PRP) is a therapeutic injection. A small sample of blood is drawn from the patient and the healing factors found in the platelets are concentrated in a centrifuge. By injecting the concentrated solution right into the damaged Achilles tendon, a powerful healing can be stimulated. This can be done in the office. No hospital or surgery required.

Surgical Treatment

Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.
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Rigid Hammertoes Surgery

HammertoeOverview

Hammer toes deformities can be painful and unsightly. These toe deformities can be the result of a muscle/tendon imbalance or often the end stage result of some systemic disease such as diabetes or arthritis, especially Rheumatoid arthritis. Hammertoe deformities are progressive and can be prevented.

Causes

The APMA says that hammertoe can result from a muscle imbalance in the foot that puts undue pressure on the joints, ultimately causing deformity. Inherited factors can contribute to the likelihood of developing hammertoe. Arthritis, stroke or nerve damage from diabetes or toe injuries such as jamming or breaking a toe can affect muscle balance in the foot, leading to hammertoe. The Mayo Clinic says that wearing improper shoes often causes hammertoe. Shoes that squeeze the toes, such as those with a tight toe box or with heels higher than two inches, can put too much pressure on the toe joints.

Hammer ToeSymptoms

A hammertoe causes you discomfort when you walk. It can also hammertoes cause you pain when trying to stretch or move the affected toe or those around it. Hammertoe symptoms may be mild or severe. Mild Symptoms, a toe that is bent downward, corns or calluses. Severe Symptoms, difficulty walking, the inability to flex your foot or wiggle your toes, claw-like toes. See your doctor or podiatrist right away if you develop any of these symptoms.

Diagnosis

Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.

Non Surgical Treatment

Your doctor will decide what type of hammertoe you have and rule out other medical conditions. Treatment may range from more appropriate footgear to periodic trimming and padding of the corn. Cortisone injections may be indicated if a bursitis is present. Antibiotics may be utilized in the presence of infection. Removable accommodative pads may be made for you.

Surgical Treatment

Curative treatment of hammertoes varies depending upon the severity of the deformity. When the hammertoe is flexible, a simple tendon release in the toe works well. The recovery is rapid often requiring nothing more that a single stitch and a Band-Aid. Of course if several toes are done at the same time, the recovery make take a bit longer.
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