Efren Southee

Efren Southee

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Fungus Nails - http://kone468.exteen.com/20150101/exercises-for-calluses-of-the-foot. Overview
The sensation of sore, aching feet or arch pain refers to an inflammation and burning sensation at the arch of the foot. This inflammation is due to the excessive stretching of the fibrous tissue located along the bottom surface of the foot, called plantar fascia. Plantar fascitis is the term named after this condition and described as inflammation of the fascia, muscles and ligaments on the bottom of the foot, causing pain in the heel and arch of the foot.
'Foot

Causes
Plantar Fasciitis is commonly the cause of most arch pain. The bands of fibrous tissue in the arches of the feet become inflamed. Plantar Fasciitis is associated with early morning arch pain, from the plantar fascia tightening and contracting during the night when there is no strain on the bands. Arch pain occurs when there are extended periods of standing or walking, resulting in prolonged tension on the plantar fascia which in turn causes inflammation and irritation. While plantar fasciitis normally affects middle aged men and women, younger athletes are affected by arch pain because of the repetitive movement of certain sports, which causes damage to the fibrous tissue.

Symptoms
Intense heel pain, especially first thing in the morning and after a long day. Difficulty walking or standing for long periods without pain. Generally, the sharp pain associated with plantar fasciitis is localized to the heel, but it can spread forward along the arch of the foot and back into the Achilles tendon. While severe cases can result in chronic pain that lasts all day, the most common flare ups occur first thing in the morning, making those first steps out of bed a form of torture, and in the evening after having spent a day on your feet. Overpronation (a foot that naturally turns too far inward), high arches, and flat feet (fallen arches) can all cause similar arch pain. In these cases, however, the pain is more likely to continue throughout the day rather than being worst in the morning.

Diagnosis
In people with flat feet, the instep of the foot comes in contact with the ground when standing. To diagnose the problem, the health care provider will ask you to stand on your toes. If an arch forms,the flat foot is called flexible. You will not need any more tests or treatment. If the arch does not form with toe-standing (called rigid flat feet), or if there is pain, other tests may be needed, including a CT scan to look at the bones in the foot. MRI scan to look at the tendons in the foot. X-ray of the foot.

Non Surgical Treatment
Stretch the fascia. Prop your toes up against a wall, keeping your arch and heel flat so the toes stretch. Hold for a count of 10. Repeat 10 times three or four times per day. Roll a frozen water bottle under the arch. Stretch first then roll out the arch for 10 minutes; you don?t want to stretch the tendon when it?s ice cold. Freeze a golf ball and massage the fascia. Roll the frozen golf ball under the foot, starting from the front and working your way back. Put good pressure on each spot-the medial, center and lateral positions-for 15 seconds before moving to the next area. Then, roll the ball back and forth over the entire foot. Foam roll all muscles on the body above the plantar. Even tight shoulders can cause the condition, as your arm swing can throw off proper hip alignment and footstrike. Bump your arch. Get a commercial insole with an arch bump to push on the plantar and keep it from flexing-it doesn?t matter if you?re an under or overpronator; the plantar needs to be supported and strengthened, Wear the support in all shoes, if possible.
'Pain

Surgical Treatment
In adults, the most common cause of collapse is due to the posterior tibial tendon tear. In such cases, the tendon must be repaired and a second tendon may be added to the posterior tibial tendon for strength and added support. If the foot is found to be very flat, bone realignment procedures or possible bone fusion procedures may be used to realign the foot. If the calf or Achilles tendon are found to be tight, they may be lengthened to allow better motion at the ankle and less arch strain. The forefoot may also be in a poor position and stabilization of the arch may be necessary to increase forefoot contact to the ground.


Prevention
It is possible to prevent arch pain by wearing well-fitting shoes while performing any physical activity. Many times doctors will suggest a therapeutic shoe with a higher heel to relieve the pressure on the achilles tendon and also the arch muscle (plantar fasciitis). People with arch pain suffer from regular flare-ups of pain. However there is no risk to others as this is not a contagious condition.

Stretching Exercises
Ankle evert or strengthening. Lie on your side with your feet hanging off the end of your bed or a weight bench. Bend the toes of the foot that is closer to the ceiling slightly toward your head. This is the starting position. Now raise your toes toward the ceiling while keeping the rest of your leg stationary. Return to the starting position. Reps. 10-15. Now point your toes slightly away from your head. This is the starting position. Raise your toes toward the ceiling. Return to the starting position. Reps. 10-15. Ankle invertor strengthening. Same as above, but do the exercises with the foot that is closer to the floor. Dorsiflexor strengthening. Sit on a desk, table, or counter so that your feet don?t touch the ground. Let your feet dangle comfortably. Bend your foot upward as far as you can comfortably go. Do not let your foot pull inward or outward. Return to the starting position. Reps. 10-15.
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Overview
Sometimes, feet do weird things. For instance, about 10% of the general population?s feet have decided that having an extra bone in the mix is a really great idea. This extra bone (or sometimes a bit of cartilage), is called an accessory navicular. It shows up in a tendon called the posterior tibial tendon (which is a fancy name - but just remember, it helps support the arch of the foot) on the middle of the inside of the foot, just above the arch. This extra little bone is present from birth, so it?s not something that?ll suddenly grow later in life. Now, accessory navicular syndrome is when that extra bone starts causing issues with your shoe-wearing, or even the shape and function of your foot. It?s the syndrome you want to worry about, not necessarily the extra bone itself.

'Accessory

Causes
The syndrome may result from any of the following, previous trauma such as a foot or ankle sprain. Chronic irritation from shoes or other footwear causing friction against the bone. Strain from overuse or excessive activity.

Symptoms
Many people have accessory (?extra?) naviculars (figure 1) - a prominent extra bone extending from the navicular bone. Most accessory naviculars are completely asymptomatic. However, some individuals will develop pain on the inside of their midfoot. Pain may occur from the pressure of the shoe ware against the prominence, irritating either the bone itself or the fibrous junction where the accessory bone meets the regular navicular. Alternatively, the fibrous junction or interface may become painful as a result of tension applied by the posterior tibial tendon through its connection or insertion at that site. Often, individuals will be asymptomatic for years, however, a new pair of shoes or a change in their activity level can cause symptoms. The accessory navicular itself typically develops during adolescence, when the two areas of the navicular bone fail to fuse together.

Diagnosis
Diagnosis is fairly simple based on an examination by your doctor. He or she will palpate the navicular bone, and based on the location of pain will suspect an accessory navicular. The doctor will also observe your gait to see if you are flatfooted. At this point an x-ray will make the definitive diagnosis. Other causes of pain in the same area of the foot would include a fracture of the navicular bone or possibly tendonitis or even a partial tear of the tibialis posterior tendon that inserts into the navicular. In these cases there is usually a history of trauma. People with a naturally "large" navicular bone may also develop a bursitis due to chronic shoe pressure.

Non Surgical Treatment
If symptoms have been aggravated by an increase in activity level, backing off on activities in the short term can be helpful. The foot is subject to a lot of repetitive loading during walking, and therefore minimizing this force will often help symptoms to settle. After symptoms have settled, the activity level can then be gradually increased.

'Accessory

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 Ulcers accessory navicular syndrome, especially for the patients without flatfoot deformity and old sprain injury.
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Overview
The adult acquired flatfoot (AAF) is a progressive, symptomatic (painful) deformity resulting from gradual stretch (attenuation) of the tibialis posterior tendon as well as the ligaments that support the arch of the foot. Although the posterior tibialis tendon plays a significant role, this pathology has recently been recognized as involving failure of other interosseous ligaments, such as the spring ligament. Due to the complexity of this pathology, posterior tibial tendon dysfunction (PTTD) is now referred to as adult acquired flatfoot. Severe flatfoot associated with AAF can lead to other problems, such as plantar fascial tension, tendon pain, rearfoot subluxation, and ankle osteoarthritis.
'Adult

Causes
Causes of an adult acquired flatfoot may include Neuropathic foot (Charcot foot) secondary to Diabetes mellitus, Leprosy, Profound peripheral neuritis of any cause. Degenerative changes in the ankle, talonavicular or tarsometatarsal joints, or both, secondary to Inflammatory arthropathy, Osteoarthropathy, Fractures, Acquired flatfoot resulting from loss of the supporting structures of the medial longitudinal arch. Dysfunction of the tibialis posterior tendon Tear of the spring (calcaneoanvicular) ligament (rare). Tibialis anterior rupture (rare). Painful flatfoot can have other causes, such as tarsal coalition, but as such a patient will not present with a change in the shape of the foot these are not included here.

Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle. Symptoms, which may occur in some persons with flexible flatfoot, include. Pain in the heel, arch, ankle, or along the outside of the foot. 'Turned-in' ankle. Pain associated with a shin splint. General weakness / fatigue in the foot or leg.

Diagnosis
Clinicians need to recognize the early stage of this syndrome which includes pain, swelling, tendonitis and disability. The musculoskeletal portion of the clinical exam can help determine the stage of the disease. It is important to palpate the posterior tibial tendon and test its muscle strength. This is tested by asking patient to plantarflex and invert the foot. Joint range of motion is should be assessed as well. Stiffness of the joints may indicate longstanding disease causing a rigid deformity. A weightbearing examination should be performed as well. A complete absence of the medial longitudinal arch is often seen. In later stages the head of the talus bone projects outward to the point of a large "lump" in the arch. Observing the patient's feet from behind shows a significant valgus rotation of the heel. From behind, the "too many toes" sign may be seen as well. This is when there is abducution of the forefoot in the transverse plane allowing the toes to be seen from behind. Dysfunction of the posterior tibial tendon can be assessed by asking the patient to stand on his/her toes on the affected foot. If they are unable to, this indicates the disease is in a more advanced stage with the tendon possibly completely ruptured.

Non surgical Treatment
Footwear has an important role, and patients should be encouraged to wear flat lace-up shoes, or even lace-up boots, which accommodate orthoses. Stage I patients may be able to manage with an off the shelf orthosis (such as an Orthaheel or Formthotics). They can try a laced canvas ankle brace before moving to a casted orthosis. The various casted, semirigid orthoses support the medial longitudinal arch of the foot and either hold Hallux Limitus the heel in a neutral alignment (stage I) or correct the outward bent heel to a neutral alignment (stage II). This approach is meant to serve several functions: to alleviate stress on the tibialis posterior; to make gait more efficient by holding the hindfoot fixed; and thirdly, to prevent progression of deformity. Devices available to do this are the orthosis of the University of California Biomechanics Laboratory, an ankle foot orthosis, or a removable boot. When this approach has been used, two thirds of patients have good to excellent results.
'Adult

Surgical Treatment
For those patients with PTTD that have severe deformity or have not improved with conservative treatments, surgery may be necessary to return them to daily activity. Surgery for PTTD may include repair of the diseased tendon and possible tendon transfer to a nearby healthy tendon, surgery on the surrounding bones or joints to prevent biomechanical abnormalities that may be a contributing factor or both.}
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Overview
'AchillesThe Achilles tendon is the thickest and strongest tendon in your body, connecting your calf muscles to the back of your heel. Virtually all of the force generated when you ?Contracted Toe off? the ground during running is transmitted by the Achilles, and this force can be as much as three times your body weight. And the faster you run, the more strain you put on the Achilles tendon. As such, it?s prone to injury in many runners, but particularly those who do a lot of fast training, uphill running, or use a forefoot-striking style. Achilles tendon injuries account for 5-12% of all running injuries, and occur disproportionately in men. This may be because of the faster absolute speeds men tend to train at, or may be due to other biomechanical factors.

Causes
Achilles tendonitis is an overuse injury. Too much too soon is the common cause of overuse injuries, however other factors can contribute to developing the condition. An increase in activity, either distance, speed or a sudden change to running up hills. As a rule of thumb distance runners should increase their mileage by no more than 10% per week. A change of footwear or training surface for example suddenly running on soft sand can cause the heel to drop lower than normal making the tendon stretch further than it is used to. Weak calf muscles can tighten or go into partial spasm which again increases the strain on the achilles tendon by shortening the muscle. Running up hills - the achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal. Overpronation or feet which roll in when running can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon. Wearing high heels constantly shortens the tendon and calf muscles. When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an abnormal strain on the tendon.

Symptoms
Mild ache in the back of the lower leg, especially after running. More acute pain may occur after prolonged activity, Tenderness or stiffness in the morning. In most cases the pain associated with Achilles tendinitis is more annoying than debilitating, making sufferers regret activity after the fact, but not keeping them from doing it. More severe pain around the Achilles tendon may be a symptom of a much more serious ruptured tendon.

Diagnosis
If you think you might have Achilles tendonitis, check in with your doctor before it gets any worse. Your doc will ask about the activities you've been doing and will examine your leg, foot, ankle, and knee for range of motion. If your pain is more severe, the doctor may also make sure you haven't ruptured (torn) your Achilles tendon. To check this, the doc might have you lie face down and bend your knee while he or she presses on your calf muscles to see if your foot flexes. Any flexing of the foot means the tendon is at least partly intact. It's possible that the doctor might also order an X-ray or MRI scan of your foot and leg to check for fractures, partial tears of the tendon, or signs of a condition that might get worse. Foot and ankle pain also might be a sign of other overuse injuries that can cause foot and heel pain, like plantar fasciitis and Sever's disease. If you also have any problems like these, they also need to be treated.

Nonsurgical Treatment
Achilles tendonitis will often respond to rest or changes in activity, stretching, or ice after activity. Non-steroidal anti- inflammatory drugs (NSAIDs), such as ibuprofen or naproxen may also help. Physical therapy focusing on stretching and strengthening, massage, alternating hot and cold baths, and ultrasound or sound waves can also help with healing and comfort. The temporary use of a heel lift or the insertion of an arch support, called an orthotic, into the shoe or sneaker can also help. Although seldom necessary, the ankle may be kept in a short leg cast or splint. Surgery is rarely needed but can remove bone spurs or the bony prominence of the heel bone. The injection of corticosteroids such as cortisone into the area of the Achilles tendon is usually avoided because it may cause the tendon to rupture.

'Achilles
Surgical Treatment
Surgery can be done to remove hardened fibrous tissue and repair any small tendon tears as a result of repetitive use injuries. This approach can also be used to help prevent an Achilles tendon rupture. If your Achilles tendon has already ruptured or torn, Achilles tendon surgery can be used to reattach the ends of the torn tendon. This approach is more thorough and definitive compared to non surgical treatment options discussed above. Surgical reattachment of the tendon also minimizes the change of re-rupturing the Achilles tendon.

Prevention
Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon. Gradually increasing your activity level with an appropriate training schedule-building up to a 5K run, for instance, instead of simply tackling the whole course the first day-can also help prevent tendinitis.
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