Cheryll Siemering

Effective Facts Related To Feet

Are Bunions And Corns The Same Thing

Overview
Bunions Hallux Abducto Valgus, commonly called bunion, is a bony deformity affecting the angle of the joint at the base of the big toe. Some medical professionals believe that the condition is solely due to ill-fitting footwear, while others believe it is a genetic structural defect that can be exacerbated by shoes. Despite the varying opinions, the reality is that it is probably a combination of both factors. A bunion forms when pressure is applied to the side of the big toe, causing it to become inflamed and painful. The joint then protrudes, effectively making the foot wider. The second toe might then become displaced, which can cause a multitude of other issues like corn and callus development. The bunion joint will have a reduced range of motion and often ends up arthritic. The condition usually develops later in life.

Causes
No one single cause has been proven. There are a number of causes, and though shoes can exacerbate the problem, bunions do occur in societies that don?t wear them. We walk on the same type of ground all the time, whereas the human foot was actually designed to adapt to varying terrains. In a sense, a bunion is a type of repetitive strain injury. And like repetitive strain injury, some people are more prone to it than others. One theory, though it remains unproven, is that bunions are caused by one or both of the following. Because the foot wasn?t designed to constantly walk on a level surface, the ball of the big toe is slightly lower than the ball of the rest of your foot. When your foot meets the ground, the ball of the big toe is pushed up, and the big toe joint can?t bend as well as it was designed to. In order for the big toe joint to bend fully as you walk, your foot rolls slightly over to the side (this is also why people with hallux valgus often get hard skin). Also, if your midtarsal joint tends to move from side to side more than it does up and down, the arch in your foot collapses as your foot rolls in. This also makes you more prone to developing bunions. Such problems can be exacerbated by tight footwear. Slip-on shoes can make matters worse. Because they have to be tighter to stay on your feet, you automatically have less room for your toes. And with nothing to hold your foot in place, your toes often slide to the end where they?re exposed to lots of pressure. Likewise, high heels throw more weight onto the ball of the foot, putting your toes under further pressure. If you haven?t got a bunion by adulthood and you later develop one, there could be some underlying arthritis.

Symptoms
Patients with bunions will often display pain over the prominent bump on the inside of their forefoot (the medial eminence?). However, they may also have pain under the ball of the foot (under the area near the base of the second toe). Symptoms can vary in severity from none at all to severe discomfort aggravated by standing and walking. There is no direct correlation between the size of the bunion and the patient?s symptoms. Some patients with severe bunion deformities have minimal symptoms, while patients with mild bunion deformities may have significant symptoms. Symptoms are often exacerbated by restrictive shoe wear, particularly shoes with a narrow toe box or an uncomfortable, stiff, restraining upper.

Diagnosis
Bunions are readily apparent, you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the Podiatrist may arrange for x-rays to be taken to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. There is no clear-cut way to predict how fast a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.

Non Surgical Treatment
Bunions are progressive problems, meaning they tend to get worse over time. Sometimes severe-looking bunions don't hurt much, and sometimes relatively modest-looking bunions hurt a great deal. Thus, treatment varies depending upon a patient's symptoms. You can often improve the discomfort of bump pain by a change to more proper shoes. Alternatively, alterations to existing shoes may improve pain associated with bunions. Accommodative padding, shields and various over-the-counter and custom-made orthopaedic appliances can also alleviate bunion pain. Anti-inflammatory medications, steroid injections, physiotherapy, massage, stretching, acupuncture and other conservative treatment options may be recommended by your podiatric physician to calm down an acutely painful bunion. Long term, orthoses (orthotics) can address many of the mechanical causes of a bunion. Thus, while orthoses don't actually correct a bunion deformity, if properly designed and made, they can slow the progression of bunions. They can also be made to redistribute weight away from pain in the ball of the foot, which often accompanies bunion development. Padding, latex moulds and other accommodative devices may also be effective. While they don't correct the misalignment in the bones, they may alleviate pain. Often, though, when conservative measures fail to alleviate pain associated with the bunion, when you start to limit the types of activities you perform, when it's difficult to find comfortable shoes, and when arthritis changes how you walk, surgery may be the best alternative. Bunions

Surgical Treatment
When these above measures no longer help to relieve the pain in the big toe, surgery to correct the bunion deformity is considered. Numerous surgical procedures have been recommended for bunions. What is most critical is that the type of deformity is carefully evaluated, because one bunion surgery cannot be used for all types of bunions. If the big toe joint is rotated out of place, the joint must be rotated back in place for the procedure to work. Conversely, a bunion can occur with the big toe still ?in place.? If surgery is considered, the bunion must be corrected with the toe joint left in its current position. In other words, one type of bunion repair does not work for everyone. In all types of bunion repairs, ligaments and tendons (soft tissues) around the big toe joint are reconstructed, to allow the toe to be straightened. Most bunion procedures also require cutting the metatarsal bone, which is then fixed with metal screws to hold the bone in position until it heals. It usually takes 2 to 4 months to fully recover from bunion surgery, which is why it is always the last course of treatment.

Partial Achilles Tendon Tear Surgery

Overview
Achilles Tendinitis An Achilles tendon rupture is a tear in the strong fibrous cord that connects the muscles in the back of your calf to your heel bone. The tendon can rupture partially or completely. Your Achilles tendon is the largest tendon in the body and plays a critical role. In fact, you rely on it every time you move your foot. The tendon helps you point your foot down, rise on your toes and push off as you walk. An Achilles tendon rupture is a serious injury. If you suspect you have torn your Achilles - especially if you hear a pop or snap in your heel and cannot walk properly - seek medical attention immediately.

Causes
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot, for example, in football, running, basketball, diving, and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much. The Achilles tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position, this movement stretches the tendon. Another possible injury is a deep cut at the back of the ankle, which might go into the tendon. Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are corticosteroid medication (such as prednisolone), mainly if it is used as long-term treatment rather than a short course. Corticosteroid injection near the Achilles tendon. Certain rare medical conditions, such as Cushing?s syndrome, where the body makes too much of its own corticosteroid hormones. Increasing age. Tendonitis (inflammation) of the Achilles tendon. Other medical conditions which can make the tendon more prone to rupture, for example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE) - lupus. Certain antibiotic medicines may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low, and mainly applies if you are also taking corticosteroid medication or are over the age of about 60.

Symptoms
Ankle pain and swelling or feeling like the ankle has ?given out? after falling or stumbling. A loud audible pop when the ankle is injured. Patients may have a history of prior ankle pain or Achilles tendonitis, and may be active in sports. Swelling, tenderness and possible discoloration or ecchymosis in the Achilles tendon region. Indentation above the injured tendon where the torn tendon may be present. Difficulty moving around or walking. Individual has difficulty or is unable to move their ankle with full range of motion. MRI can confirm disruption or tear in the tendon. Inability to lift the toes.

Diagnosis
The diagnosis of an Achilles tendon rupture can be made easily by an orthopedic surgeon. The defect in the tendon is easy to see and to palpate. No x-ray, MRI or other tests are necessary.

Non Surgical Treatment
Your doctor will advise you exactly when to start your home physical therapy program, what exercises to do, how much, and for how long to continue them. Alphabet Range of Motion exercises. Typically, the first exercise to be started (once out of a non-removable cast). While holding your knee and leg still (or cross your leg), you simply write the letters of the alphabet in an imaginary fashion while moving your foot and ankle (pretend that the tip of your toe is the tip of a pencil). Motion the capital letter A, then B, then C, all the way through Z. Do this exercise three times per day (or as your doctor advises). Freeze a paper cup with water, and then use the ice to massage the tendon area as deeply as tolerated. The massage helps to reduce the residual inflammation and helps to reduce the scarring and bulkiness of the tendon at the injury site. Do the ice massage for 15-20 minutes, three times per day (or as your doctor advises). Calf Strength exercises. This exercise is typically delayed and not used in the initial stages of rehabilitation, begin only when your doctor advises. This exercise is typically done while standing on just the foot of the injured side. Sometimes, the doctor will advise you to start with standing on both feet. Stand on a step with your forefoot on the step and your heel off the step. The heel and forefoot should be level (neither on your tip toes nor with your heel down). Lower your heel very slowly as low as it will go, then rise back up to the level starting position, again very slowly. This is not a fast exercise. Repeat the exercise as tolerated. The number of repetitions may be very limited at first. Progress the number of repetitions as tolerated. Do this exercise one to two times per day (or as your doctor advises). Achilles Tendonitis

Surgical Treatment
Operative treatment involves a 6cm incision along the inner side of the tendon. The torn ends are then strongly stitched together with the correct tension. After the operation a below knee half cast is applied for 2 weeks. At 2 weeks a brace will be applied that will allow you to move the foot and fully weight-bear for a further 6 weeks. After this you will need physiotherapy. Surgery carries the general risks of any operation but the risk of re-rupture is greatly reduced to 2%. The best form of treatment is controversial with good results being obtained by both methods but surgery is generally recommended for patients under 60 years of age who are fit and active with an intra-substance tear.