Therapy And Severs Disease

Overview


Severs? disease usually presents with pain in either one or both of a sufferer?s heels. The area can be sore or tender, particularly first thing in the morning or after squeezing. Because the pain is focussed on the heel, an important part of the foot that makes contact with the ground through virtually all movement, sufferers often have to limp to alleviate their discomfort. The pain of Severs? disease is at its worst after any exertion that involves contact between a heel and the ground, particularly strenuous exercise like running or sport. The condition is caused by the wear and tear of structures in the heel, most significantly the heel bone and any attached tendons. Severs? disease is prevalent in young children who are extremely active, particularly as the heel and its attached tendons are still growing in the age group the condition most commonly affects (7-14).


Causes


The condition is thought to result from repetitive microtrauma to growth plates of the calcaneus. Although some of the recent articles says, there is no evidence to support that weight and activity levels are risk factors for Sever's disease. High plantar foot pressures are associated with Sever's disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever's disease.


Symptoms


The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the tendo-Achilles inserts into the calcaneus, and is tender to deep pressure at that site. Walking on his toes relieves the pain.


Diagnosis


This condition is self limiting, it will go away when the two parts of bony growth join together, this is natural. Unfortunately, Sever's disease can be very painful and limit sport activity of the child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever's disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join, usually around the age of 16 years. There are no known long term complications associated with Sever's disease.


Non Surgical Treatment


Home treatment consists of calf muscle stretching exercises, heel cushions in the shoes, and/or oral anti-inflammatory medications like Tylenol or Advil. Icing the area may provide some temporary relief. If the condition persists the child should be evaluated by a podiatrist for abnormal foot function. In severe cases a below the knee walking cast may be required. Treatment may require the use of custom-made shoe inserts called orthotics. Orthotics work by correcting foot function and will fit into most normal shoes and athletic cleats.


Prevention


The old adage, "An once of prevention is worth a pound of cure," is most appropriate when trying to prevent the effects of Sever's Disease. If this condition is not prevented, or treated in its earliest stages, it may cause the child to stop certain sports activities until the growth plate has fused and matured (this usually occurs around the age of 16 years old). Long Term Treatment and Prevention must be directed towards protecting the growth plate at the back of the heel during a child's growing years. Being aware of the following best does this. If the child is very active in sports that require repetitive and exertive activities, then the parents must be vigilant when it comes to the child's gait, watching to see if he or she is limping, walking on their toes, or complaining of heel pain when weight-bearing. These may be "early warning signs" of Sever's Disease. Along with these signs, if your child has any of the Predisposing Hereditary Factors listed above, the chances of Sever's Disease occurring increased.

Arch Pain Work Outs

Overview


The arch of the foot is a very complex structure, consisting of multiple bones and ligaments. Most causes of arch pain are related to the anatomy of the arch and the types of physical activity that you perform. For example, a classic set up for arch pain is people who engage in lots of high impact exercise (such as running) while wearing a type of athletic shoe that does not properly support their type of foot arch. If you notice that the twinges of pain you have are most commonly associated with or immediately after exercise, you might want to visit a good athletic shoe store to make sure you are wearing the right kind of shoe. Another cause of arch pain is plantar fasciitis. The plantar fascia is a tough tissue structure that holds the bottom part of the arch in place. The fascia often becomes inflamed and sore, usually as a result of repetitive motion (for example, very common in those who stand on their feet for work). The pain is often noticeable first thing in the morning and worse with activity. In addition to wearing good arch supports and taking anti-inflammatory medications, stretching exercises are often a part of the treatment. You should see your primary care doctor to determine what is the best treatment for you.


Foot Arch Pain


Causes


Training on improper, hard and/or irregular surfaces as well as excessive track work in spiked shoes, or steep hill running, can stress the plantar fascia past its limits of elasticity, leading to injury. Finally, failure in the early season to warm up gradually gives the athlete insufficient time for the structures of the foot to re-acclimate and return to a proper fitness level for intensive exercise. Such unprepared and repeated trauma causes microscopic tearing, which may only be detected once full-blown plantar fasciitis and accompanying pain and debilitation have resulted.


Symptoms


Symptoms include pain which is often described as a burning pain radiating into the arch of the foot, heel and sometimes the toes. Pins and needles or numbness may be felt in the sole of the foot. Pain may be worse when running or when standing for long periods of time and often worse at night. The area under the medial malleolus on the inside of the ankle may be tender to touch.


Diagnosis


Diagnosis of a plantar plate tear can often be challenging due to the complex nature of the anatomy of the foot. Careful history taking and an examination of the area of pain is required to determine the extent and cause of the tear. If necessary, further investigations such as x-rays or diagnostic ultrasound may be ordered by your podiatrist to help evaluate the severity of the problem.


Non Surgical Treatment


Treatment of plantar fasciitis is sometimes a drawn out and frustrating process. A program of rehabilitation should be undertaken with the help of someone qualified and knowledgeable about the affliction. Typically, plantar fasciitis will require at least six weeks and up to six months of conservative care to be fully remedied. Should such efforts not provide relief to the athlete, more aggressive measures including surgery may be considered. The initial goals of physical therapy should be to increase the passive flexion of the foot and improve flexibility in the foot and ankle, eventually leading to a full return to normal function. Prolonged inactivity in vigorous sports is often the price to be paid for thorough recovery. Half measures can lead to a chronic condition, in some cases severely limiting athletic ability.


Foot Arch Pain


Surgical Treatment


Patients with adult acquired flatfoot are advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot, meaning you will be on crutches for two months. The bottom line is: Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.


Prevention


People who run regularly should replace shoes every six months, more frequently if an avid runner. Avoid running or stepping on uneven surfaces. Try to be careful on rocky terrain or hills with loose gravel. Holes, tree stumps and roots are problems if you are trail running. If you have problems with the lower legs, a dirt road is softer than asphalt, which is softer than concrete. Try to pick a good surface if possible. However, if you're racing, be sure to train on the surface you'll eventually run on. Be careful running too many hills. Running uphill is a great workout, but make sure you gradually build this up to avoid injuries. Be careful when running downhill too fast, which can often lead to more injuries than running uphills. Prevent recurrent injuries. Athletes who have experienced ankle injuries previously may benefit from using a brace or tape to prevent recurrent ankle injuries.


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.

Ruptured Achilles Tendon Facts Not Popular Misconceptions




Overview
Achilles Tendonitis
Achilles tendon rupture is most common in people aged 30-50. Patients may describe the injury as feeling or hearing a snap or bang, or as feeling they have been shot in the back of the leg. On examination, patients will have reduced plantarflexion and a positive Thompson test. Surgery is associated with a lower risk of re-rupture and a greater likelihood of returning to sporting activity. Conservative management reduces the chance of complications.

Causes
The tendon is susceptible to injury and can rupture during vigorous activities such as running and jumping. Rupture can also occur as a result of gradual wear. After becoming chronically weakened, it can rupture during non-stress activities like walking.

Symptoms
Symptoms of an Achilles tendon injury are as follows. Pain along the back of your foot and above your heel, especially when stretching your ankle or standing on your toes; with tendinitis, pain may be mild and worsen gradually. If you rupture the tendon, pain can be abrupt and severe. Tenderness. Swelling. Stiffness. Hearing a snapping or popping noise during the injury. Difficulty flexing your foot or pointing your toes (in complete tears of the tendon).

Diagnosis
Most Achilles tendon ruptures occur in people between 30 and 50 years old and such injuries are often sport-related. If you suspect an Achilles injury, it is best to apply ice, elevate the leg, and see a specialist. One of the first things the doctor will do is evaluate your leg and ankle for swelling and discoloration. You may feel tenderness and the doctor may detect a gap where the ends of the tendon are separated. In addition to X-rays, the calf squeeze, or Thompson test, will be performed to confirm an Achilles tendon rupture. With your knee bent, the doctor will squeeze the muscles of your calf and if your tendon is intact the foot and ankle will automatically flex downward. In the case of a ruptured Achilles there will be no movement in the foot and ankle during the test.

Non Surgical Treatment
Once a diagnosis of Achilles tendon rupture has been confirmed, a referral to an orthopaedic specialist for treatment will be recommended. Treatment for an Achilles tendon rupture aims to facilitate the torn ends of the tendon healing back together again. Treatment may be non-surgical (conservative) or surgical. Factors such as the site and extent of the rupture, the time since the rupture occurred and the preferences of the specialist and patient will be considered when deciding which treatment will be undertaken. Some cases of rupture that have not responded well to non-surgical treatment may require surgery at a later stage. The doctor will immobilise the ankle in a cast or a special hinged splint (known as a ?moon boot?) with the foot in a toes-pointed position. The cast or splint will stay in place for 6 - 8 weeks. The cast will be checked and may be changed during this time.
Achilles Tendon

Surgical Treatment
While it is possible to treat an Achilles tendon rupture without surgery, this is not ideal since the maximum strength of the muscle and tendon rarely returns. The reason is the ends of the tendon are ruptured in a very irregular manner, almost like the ends of a paint brush. As soon as the tendon ruptures, the calf muscle (gastrocnemius muscle) continues to pull on the tendon and the end of the ruptured tendon pulls back into the leg, which is called retraction. Once the tendon retracts, it is never possible to get sufficient strength back without surgery, because the muscle no longer functions at the correct biomechanical length and is now stretched out. There are patients for whom surgery cannot be performed, in particular, due to existing medical conditions that may add to potential for complications following surgery. For these patients, a specially designed boot that positions the foot correctly and takes the pressure and tension off the muscle and tendon is used. Most importantly, a cast is never used because it causes permanent shrinkage (atrophy) of the calf muscle. The special boot permits pressure on the foot with walking. The boot also has a hinge to permit movement of the ankle. Many studies of Achilles tendon ruptures have shown that this movement of the foot in the boot while walking is ideal for tendon healing. If surgery is not recommended, it is essential to obtain special tests to check that the ends of the tendon are lying next to each other so that healing can occur. The best test to do this is an ultrasound and not an MRI.

Prevention
To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before any participating in any activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.
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Farrah Parrillo

Author:Farrah Parrillo
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