Achilles tendonitis is characterized by pain and swelling in the Achilles tendon. Non-Insertional Achilles tendonitis (occurring above the insertion) is often associated with an increase in activity level and tends to occur in patients in their 30s and 40s. Treatment is usually non-operative and includes an initial period where the symptoms are allowed to settle, followed by a gradual return to activity. Treatment includes: avoiding aggravating activities; use of a slight heel lift inside the shoe; wearing a shoe with a heel to off-load the tendon; anti-inflammatory medications (if tolerated); and exercises designed to both stretch and strengthen the Achilles tendon
A bunion (a.k.a Hallux Valgus) is a common foot condition associated with a prominent bump on the inside of the forefoot (see Figure 1). The word bunion originates from the Latin root for the word "turnip." Bunions can lead to discomfort over the prominence, especially if patients wear tight fitting shoes. It is common for bunions to run in a family and gradually worsen over time. The vast majority of bunions can be managed successfully with basic non-operative treatment. Surgery is reserved for patients who have persistent symptoms in spite of appropriate non-operative treatment.
Clubfoot is a foot deformity in newborns where the foot is rotated inwards (varus) and downwards (equinus) (Figure 1). The vast majority of clubfoot deformities are congenital in nature, and therefore acquired during development in the uterus and not through heredity. It occurs in approximately 1 in 1000 births and is bilateral about 50% of the time. A small percentage are related to a genetic or chromosomal abnormality and these deformities tend to be stiffer with more resistance to standard treatment.
Claw toes can develop in many people as they age, and can make fitting into restrictive shoes uncomfortable. This condition can create symptoms in one or all of three places: On the top of the toes if they rub against the shoes. On the tips of the toes if they jam into the soles of the shoes . At the base of the toes (metatarsophalangeal (MTP) joints) as they become subluxed (displaced partially out of joint)
Some children will develop a pronounced flatfoot deformity (Figure 1). Usually this deformity does not create symptoms, although some children may complain of an ache in their arch or their calf muscles with increased activity. In most instances, the flatfoot deformity is flexible and is due to a tight outer calf muscle. Treatment of flexible feet is almost always non-surgical and includes calf stretching, activity modification, and comfortable shoes often consisting of a slight heel.
Plantar fasciitis is the most common cause of heel pain. Pain from plantar fasciitis is often most noticeable during the first few steps after getting out of bed in the morning. The plantar fascia is a thick band of tissue in the sole of the foot. Microtearing at the origin of the plantar fascia on the heel bone (calcaneus) can occur with repetitive loading. This microtearing leads to an inflammatory response (healing response) which produces the pain. Risk factors for plantar fasciitis include: excessive standing, increased body weight, increasing age, a change in activity level, and a stiff calf muscle. Plantar fasciitis can be managed non-operatively in the vast majority of patients. The main components of an effective non-operative treatment program are: calf stretching with the knee straight, plantar fascia stretching, activity modification (to avoid precipitating activities), and comfort shoe wear.
Rheumatoid Arthritis (RA) is an autoimmune condition that affects the joints and causes swelling of the joint lining (synovium). Though this condition can involve any joint, it most commonly affects the small joints of the hands and feet. For example, RA can occur in the hindfoot or forefoot. Rheumatoid Arthritis is a condition that often requires the specialized care of a rheumatologist. It is unknown how one develops this condition, but research is currently being done on the subject. Family history often plays a role and it has been suggested that climate may also be a factor. Rheumatoid Arthritis is more common in women in their thirties and forties, and symptoms tend to increase with age. Some patients are referred for surgery in addition to other treatments.
Pain on the bottom of the foot at the base of the great toe is characteristic of sesamoiditis. Symptoms usually originate from excessive, repetitive loading to this area of the foot. Often patients will have a higher arched foot. Treatment involves avoiding activities that aggravate symptoms; inserts that offload the involved area, comfortable supportive shoes, anti-inflammatory medications if tolerated, and possibly corticosteroid injections. Patience is required as it often takes time to successfully manage the symptoms of sesamoiditis.
Stress Fractures occur when excessive repetitive force is applied to a localized area of bone. Activities such as walking, running, and repeated jumping can subject the bones of the foot to large forces, often leading to microscopic cracks in the bone, called “microfractures.” Normally, the body is able to sufficiently heal these microfractures, leading to a stronger bone able to accommodate these higher forces in the future. However, when the rate of loading on the foot is such that the body’s healing response cannot keep up, a stress reaction can develop. Eventually, if the forces continue, the bone structure can fail and a stress fracture will occur. An individual’s lack of sufficient biology to heal microfractures (i.e., low calcium, vitamin D, or thyroid hormone) can also contribute or lead to stress fractures.
The Achilles tendons are thick and powerful bands of fibrous tissue. They connect your calf muscles to your heel bones. The tendons help you walk, run and jump. And that means they are under a lot of stress, making injuries to the Achilles tendons common.
This deformity affects the joint at the base of the big toe. It is a bony bump beneath the skin on the inner side of the foot. A bunion starts small, but over time it can grow to become very large. Bunions are more common in women.
This condition is a deformity in which a toe bends downward at the middle joint. The second toe is the one most likely to be affected, but this deformity can occur in other toes as well. Sometimes, more than one toe is affected.
This is a collapse of your foot's arch. It happens over time, usually in just one foot but sometimes in both. As your arch collapses, the bones of your foot may gradually shift out of alignment. This can cause pain and other problems.
This condition is a thickening of the nerve sheath that surrounds a nerve in the ball of the foot. It most commonly develops between the third and fourth toes. It also commonly occurs between the second and third toes.
Plantar fasciitis is an irritation of the plantar fascia. This thick band of connective tissue travels across the bottom of the foot between the toes and the heel. It supports the foot's natural arch. It stretches and becomes taut whenever the foot bears weight.
Rheumatoid arthritis (we call it "RA") is a chronic disease. It affects joints throughout your body. It commonly starts in your hands or feet. For many people, it causes problems in the feet and ankles.
This condition is an irritation of the sesamoid bones, which are located within the tendons that slide along either side of the bottom of the big toe. The sesamoid bones, each about the size of a kernel of corn, provide leverage for the tendons that control the big toe.
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