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Flexible Hammertoes Treatment

2015-07-11

HammertoeOverview
There are two main types of Hammer toes. Hammertoes can be flexible, which means that you can still move the toe a bit - these are easier to treat with stretching, wider shoes and in some cases, toe splints. Rigid hammertoes occur when the foot condition has persisted for so long without treatment that the tendons become too rigid to be stretched back to normal. Rigid hammertoes are more common in people with arthritis. This foot condition usually needs to be treated with surgery.


Causes
Your shoes, your genetic predisposition, an underlying medical condition or all of these can make you susceptible to developing one of these deformities of the toes. The genes your parents gave you. When it comes to genetics, the foot type you?re born with predisposes you to developing this type of joint deformity over a lifetime. For many, a flat flexible foot leads to hammertoes as the foot tries to stabilize against a flattening arch. Those with high arches can also form hammertoes as the extensor tendons overpower the flexors.

Hammer Toe

Symptoms
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
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.


Non Surgical Treatment
Early on, when a hammertoe first starts and is still flexible, here are some ways it might be treated. Your healthcare provider may splint or tape the toe into the correct, normal position. You can use your fingers to stretch your toes and toe joints toward a more normal position. Exercise your toes by trying to pick up marbles with them or by wadding up a towel on the floor with your toes. Padding may be used to change where your weight falls when you walk on the foot.


Surgical Treatment
Surgery may not help how your foot looks. And your toe problems may also come back after surgery. This is more likely if you keep wearing the kinds of shoes that cause toe problems. Your expectations will play a large role in how you feel about the results of surgery. If you are only having surgery to improve the way your foot looks, you may not be happy with how it turns out.

Hammertoe

Prevention
Preventing foot problems, including hammertoes, is often a matter of wearing the right shoes and taking care of your feet. Check your feet regularly for problems. This is especially true if you have diabetes or any other medical condition that causes poor circulation or numbness in your toes. If you do, check feet daily so that problems can be caught early on.

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Contracted Toes

2015-07-11

Hammer ToeOverview
When a person has Hammertoes, the end of their toe bends downward and the middle joint curls up. Eventually, the toe gets stuck in a stiff, claw-like position. When the inside of your shoe rubs against a hammer toe, corns, blisters or calluses may form on top of the toe or on the bottom of your foot. This can make walking painful. You may also have pain in the joint where your big toe joins your foot. Hammer toe usually affects a person?s second toe (the toe next to the big toe), but it can affect other toes too.


Causes
If a foot is flat (pes planus, pronated), the flexor muscles on the bottom of the foot can overpower the others because a flatfoot is longer than a foot with a normal arch. When the foot flattens and lengthens, greater than normal tension is exerted on the flexor muscles in the toes. The toes are not strong enough to resist this tension and they may be overpowered, resulting in a contracture of the toe, or a bending down of the toe at the first toe joint (the proximal interphalangeal joint) which results in a hammertoe. If a foot has a high arch (pes cavus, supinated), the extensor muscles on the top of the foot can overpower the muscles on the bottom of the foot because the high arch weakens the flexor muscles. This allows the extensor muscles to exert greater than normal tension on the toes. The toes are not strong enough to resist this tension and they may be overpowered, resulting in a contracture of the toe, or a bending down of the toe at the first toe joint (the proximal interphalangeal joint) which results in a hammertoe.

Hammertoe

Symptoms
A hammer toe may be painful, especially when irritated by a shoe. All four toe conditions may cause cramps in the toes, foot and leg due to the abnormal function of the tendons in the foot. If a mallet toe has occurred, you are likely to suffer from a corn at the end of the toe. A hammertoe may cause a corn on the top of the toe. Infections and ulcers can also occur. In severe cases a mallet toe, trigger toe, claw toe or a hammer toe may create a downward pressure on the foot, which can result in hard skin and corns on the soles of the feet.


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
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
If pinning the toe is not required during the procedure, then the surgery could be preformed in the doctor’s office under a local anesthesia. Some patients prefer the comfort of sedation during the surgery and if this is the case or if a pin must be placed, then the surgery could be preformed in an outpatient surgery center.

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Do Bunions Call For Surgery

2015-06-04

Overview
Bunion Pain
When your big toe is angled towards the second toe, the deformity is called a bunion (hallux valgus). This causes a bump on the side at the base of the big toe. In addition there is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful. Sometimes a fluid-filled sac (bursa) develops over the joint.


Causes
Wearing footwear that is too tight or causing the toes to be squeezed together are the most commonly blamed factor for the cause of bunions and hallux valgus and is undoubtedly the main contributing factor. This probably is the reason for the higher prevalence of bunions among women. However, studies of some indigenous populations that never wear footwear, show that they also get bunions but they are very uncommon. As they do get bunions, factors other than footwear must play a role in the cause, even though footwear is the main culprit for providing the pressure that causes the symptoms.


Symptoms
The main problem is usually the pressure of the shoe over the bony prominence, which causes discomfort or pain. Sometimes the skin over the lump becomes red, blistered or infected. The foot may become so broad that it is difficult to get wide enough shoes. The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place so it presses on the shoe. Also, the big toe does not work as well with a bunion, and the other toes have to take more of the weight of the body as you walk. This can cause pain under the ball of the foot (”metatarsalgia”). Sometimes arthritis develops in the deformed joint, causing pain in the joint.


Diagnosis
Your family doctor or chiropodist /podiatrist can identify a bunion simply by examining your foot. During the exam, your big toe will be moved up and down to determine if your range of motion is limited. You will be examined for signs of redness or swelling and be questioned about your history of pain. A foot x-ray can show an abnormal angle between the big toe and the foot. In some cases, arthritis may also be seen. A X-ray of your foot may help identify the cause of the bunion and rate its severity.


Non Surgical Treatment
Getting rid of a Bunion is almost impossible without surgery. Foot and toe exercises can help. Foam pads can reduce the pressure on the joint. Ice packs and anti-inflammatory medication can help reduce swelling. The progress of a Bunion can be slowed or even halted, especially if it is caused by ill-fitting footwear. Of course the best course of action is to not wear pointy-toed high-heel shoes to begin with. But if you have worn improper footwear and now want to stop the progress of Bunions.
Bunions


Surgical Treatment
Pain is the commonest indication for bunion surgery. You may also notice redness and inflammation and usually this means that the bunion has progressed to a point that it will not respond to simple modification in shoe wear. Eventually that major joint of the big toe will become stiff and this makes it difficult for activities such as climbing stairs and sports.


Prevention
To help prevent bunions be sure your shoes don’t cramp or irritate your toes. Choose shoes with a wide toe box - there should be space between the tip of your longest toe and the end of the shoe. Your shoes should conform to the shape of your feet without squeezing or pressing any part of your foot. Avoid pointy-toed shoes.

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Achilles Tendon Rupture Boot Treatment

2015-05-08

Overview

Achilles Tendon Rupture Surgery is a surgical procedure is used to repair a ruptured Achilles tendon. There are two types of surgery an open surgery and a percutaneous surgery, in both cases the surgeon sews the tendon back together through the incision helping the tendon to heal properly and restore function to the foot and ankle. If the injury or rupture has caused severe swelling the surgery may be delayed for a short period of time to allow the swelling to go down.


Causes
The exact cause of Achilles tendon ruptures is hard to say. It can happen suddenly, without warning, or following an Achilles tendonitis . It seems that weak calf muscles may contribute to problems. If the muscles are weak and become fatigued, they may tighten and shorten. Overuse can also be a problem by leading to muscle fatigue . The more fatigued the calf muscles are, the shorter and tighter they will become. This tightness can increase the stress on the Achilles tendon and result in a rupture. Additionally, an imbalance of strength of the anterior lower leg muscles and the posterior lower leg muscles may also put an athlete at risk for an injury to the Achilles tendon. An Achilles tendon rupture is more likely when the force on the tendon is greater than the strength of the tendon. If the foot is dorsiflexed while the lower leg moves forward and the calf muscles contract, a rupture may occur. Most ruptures happen during a forceful stretch of the tendon while the calf muscles contract. Other factors that may increase the risk of Achilles tendon rupture include. Tight calf muscles and/or Achilles tendon. Change in running surface eg: from grass to concrete. Incorrect or poor footwear. A change of footwear eg: from heeled to flat shoes. It is thought that some medical conditions, such as gout, tuberculosis and systemic lupus erythematosus, may increase the risk of Achilles tendon rupture.


Symptoms
Patients often describe a feeling of being kicked or hit with a baseball bat in the back of the heel during athletic activity. They are unable to continue the activity and have an extreme loss of strength with the inability to effectively walk. On physical examination there is often a defect that can be felt in the tendon just above the heel. A diagnosis of an Achilles tendon rupture is commonly made on physical exam. An MRI may be ordered to confirm the suspicion of a tear or to determine the extent of the tear.


Diagnosis
During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if a complete rupture has occurred. Achilles tendon rupture can be diagnosed reliably with clinical examination, but if there?s a question about the extent of your Achilles tendon injury then your doctor may order a magnetic resonance imaging (MRI) scan.


Non Surgical Treatment
A medical professional will take MRI scans to confirm the diagnosis and indicate the extent of the injury. Sometimes the leg is put in a cast and allowed to heal without surgery. This is generally not the preferred method, particularly for young active people. Surgery is the most common treatment for an achilles tendon rupture.


Surgical Treatment
Operative treatment of Achilles tendon ruptures involves opening the skin and identifying the torn tendon. This is then sutured together to create a stable construct. This can be performed through a standard Achilles tendon repair technique or through a mini-incision technique (to read about the different types of techniques, look under ?Procedure? in Achilles Tendon Repair). By suturing the torn tendon ends together, they maintain continuity and can be mobilized more quickly. However, it is critical to understand that the return to normal activities must wait until adequate healing of the tendon has occurred. The potential advantages of an open repair of the Achilles tendon include, faster recovery, this means that patients will lose less strength. Early Range of Motion. They are able to move the ankle earlier so it is easier to regain motion. Lower Re-rupture Rate. The re-rupture rate may be significantly lower in operatively treated patients (2-5%) compared to patients treated non-operatively (8-15%). The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a wound-healing problem which could lead to a deep infection that is difficult to eradicate, or a painful scar.

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Labas pasauli!

2015-05-08

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