Disorders of the Foot
CONTENTS
The heel spur plantar fasciitis
What is it?
plug or S calcaneal fibular is a exostoses, which is a benign lesion of bone in the bottom of the heel.
It 's easier to be formed at the medial heel rather than the side.
The heel spur itself is not painful, just like the osteophytes that form in arthritic joints, also its development is very slow, at least a decade.
exostoses This is caused by inflammation of the insertion of the plantar fascia on the heel (enthesopathy) resulting in deposit of calcium salts.
in the long term accumulation of salts of calcium oxide in the heel leads to the formation of heel spurs.
causes inflammation of the plantar fascia can be Rheumatology: rheumatoid arthritis, gout, etc. or postural: claw foot, flat, hindfoot valgus.
Patients who showed up in clinic with the diagnosis of heel spurs were adults and all wore protective footwear work, as even the shoe can cause the heel spur.
Not all of my patients who are suffering from overweight, statistically only 40%, but almost everyone worked up.
Many athletes are due to heel to heel spurs, especially those who practice athletics, football, basketball, tennis.
What are the symptoms?
Many therapists make the mistake of attributing to every problem of foot or heel spurs, convinced that the pain can be caused only by a deformation Anatomically, however often not the case, for example, may be a bursitis or fasciitis.
La Spina is a bone formation with pointing fingers, is usually located in the inferomedial part of the heel, the pain is felt in this area and type of point.
During the day, most patients suffering from falling out of bed in the morning, after sitting for a long time or in the evening after walking very far or have been standing.
The pain is felt as a thick intense that forces you to limp, but in about half an hour gone, to retake the end of a day's work.
The safety shoes, with heels or elegant can intensify the symptoms.
It should be noted that many people have the heel spur, but are asymptomatic, it is estimated a rate of around 30%.
How is it diagnosed?
Radiograph of a foot with osteoporosis and visible heel spur on the heel.
To arrive at a correct diagnosis is necessary to address a doctor who will perform a history and a clinical examination for signs and symptoms.
The doctor may prescribe laboratory examinations, X-ray, usually under load because it is able to detect the presence of a heel spur.
An MRI or ultrasound may give a more thorough because they show any bruising, swelling, or thickening of the plantar fascia injury.
What is the best treatment?
E 'should pleasure, especially for sports which tend to aggravate the inflammation.
To eliminate the pain the best treatment is a series of 1-MHz ultrasound because they penetrate deeper than 3 MHz, as well as stretching exercises.
Some specialists (orthopedists and physiatrists) suggest to perform the ultrasound underwater.
To prevent recurrence need to change the shoes that caused the formation of the spur or insert orthotics that support the longitudinal time to correct over-pronation of the foot.
Usually after a cycle treatment of the symptoms do not recur, but in most cases require some strong sessions of ESWT performed with special machines that do not break the spur, but cause angiogenesis and micro-haemorrhages, which greatly improve or resolve the situation.
Alternatively, you can proceed with an infiltration of cortisone-based drugs, even though there may be side effects such as the weakening of the soft tissue under the heel.
may help weight loss in obese subjects, while the heel is of little relevance soft to absorb the impact.
Surgery osteotomy with removal of heel spurs is the last option is for the risks posed by the limited prospects for recovery.
What is this?
runs along the inside of the foot longitudinal time supporting it.
The Plantar fasciitis is inflammation of the origin of the arcuate ligament (enthesitis), can avvernire to repetitive microtrauma or overuse.
The causes of this disease may be the retraction of the Achilles tendon or anatomical abnormalities such as flat feet or cable, hindfoot valgus and pronated foot.
If the support of the foot is not corrected can cause abnormal tension on the plantar fascia predispondendola all'entesite.
Many athletes suffer from fasciitis, especially those who practice athletics, football, tennis and basketball.
It 's more likely that they suffer from an amateur to a professional for both footwear for speed in the race, in fact running slow can cause inflammation of the plantar aponeurosis.
Those most affected are adults who are overweight and sports.
What are the signs and symptoms?
The pain you feel supporting your weight or during the movement of dorsiflexion of the foot.
There is in the medial heel region, but in severe cases can go before up to the toes.
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muscles of the foot where you see the plantar fascia. |
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In the first phase of training top athletes experience pain, but symptoms tend to regress after a few minutes.
adults or elderly people report that the worst moments are when you wake up or after they have been sitting a long time, then over time the pain decreases until it disappears.
Generally, symptoms recur in the evening and after much work on their feet.
In the second phase, the pain increases in intensity and extends the time to subside, you need half an hour of waking or the beginning of training, then the attiivtà sport becomes increasingly difficult.
down stairs is often difficult because it remains fixed on the foot stretches the plantar fascia.
In sitting or lying position you do not feel the symptoms.
E ', formation of an edema of the calcaneus.
How is it diagnosed?
The general practitioner or specialist (orthopedist or physiatrist) collect the patient's history, look for the symptomatic area with finger pressure, the currency movements and pain during walking, also head the length of the triceps Musola Sural (calf).
Then you check any anatomical abnormalities such as flat feet, pronated or cable.
Among the causes of plantar fasciitis for the sport are the shoes as well as an athletic misconduct.
In the differential diagnosis must take into account other conditions that may give similar results as heel spurs, bursitis sottocalcaneare, the abductor nerve entrapment of the fifth finger, gout (if the pain is bilateral) and a fracture.
Laboratory tests that take place are the X-ray to rule out fractures, testing for rheumatic diseases such as gout and electromyography, which highlights the possible entrapment of a nerve.
Diagnostic imaging can not, however, replace a thorough clinical examination by a doctor.
What is the best treatment?
For sports is important to rest, if you continue to train and compete is likely to worsen the situation.
There are several effective natural therapies for pain, the CO2 laser, ultrasound therapy and Tecar mode resistive solve almost all cases.
E 'is essential to avoid relapses, as often fasciitis is often caused by anatomical alterations: foot valgus, varus or pronated, we recommend a customized insole to correct the foot support.
Who suffers from foot pain changes the way of walking or limping supporting the weight only on the outside, this can lead to tensions in other parts of the body and cause knee pain, hip and back pain, then the problem needs to be addressed as soon as possible.
The use of a shank support soft cushions on the ground is generally not curative.
At night, the foot remains in a position of plantar flexion, and the triceps surae (calf) and remain in the plantar fascia shortening and the patient accuses a sharp pain in the morning, some specialists recommend a nighttime brace that keeps the foot in dorsiflexion.
During the day, you must run the stretching of the gastrocnemius and soleus because of the retraction of these muscles is one of the causes of inflammation.
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If these therapies were not success, there are two possibilities:
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Shock waves with the lithotripter, very painful, but effective, not all hospitals to have and you should consult the structures that have the most powerful machines to do therapy useless. Hospital Santa Maria di Reggio Emilia has provided an excellent product.
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The surgical option is very risky and there are many drawbacks, it also can not be decisive, so you should wait a year after onset of symptoms and seek at least an orthopedic specialist on the foot.
Those most affected are usually aged over 40 years and are female because it is a disease linked to the type of footwear.
In principle consists of a lateral deviation out of the distal first metatarsal angle, which causes a of the big toe toward the second toe, it follows that the two bones are no longer aligned as they should and is often associated with deformities of the fingers.
The forefoot opening "fan" inward, forming a medial prominence of the foot called the Onion or Nocetta.
As the knee, the foot can also have a valgus deviation, ie the first metatarsal bone is tilted in the direction of the foot and big toe and second toe distal to the approaches.
The hallux valgus, over 30 °, is accompanied by a rotation of the phalanx and first metatarsal.
What are the causes?
Inheritance is the main cause of hallux valgus, every person with this defect usually has at least one parent or grandparent with the same deformity.
The sesamoid bones are two very small, almost circular in shape (a hexagon) in the distal region and plantar first metatarsal which are the most important foothold forefoot
The dislocation of these bones in intermetatarsal space involves a radical anatomical and biomechanical, because these bones to give insertion short hallux flexors and hallux all'Abduttore .
due cause there are several theories of hallux valgus, flat feet, Egyptian (ie the big toe longer than second finger) and pronated are factors that play a key role in the initiation of this process.
Shoes are an important element in the hallux valgus acquired, if a bit narrow in the outer fingers to push the central and high heels aggravate the situation by increasing the pressure.
The tight shoe and the heel is not really the cause of the deformity can be the element that causes the symptoms because the pressure and friction with the onion cause inflammation, bursitis, and then pain.
The bunion may also be the result of arthritis, neuromuscular disease, an infectious process or trauma.
What are the symptoms?
The main symptom is pain around mmin with shoes and with the pressure.
The site of pain is initially on Nocetta inflamed, can then expand on the sole of the foot.
Another thing I noticed was the least stable in conditions such as poor balance on the boards overhead.
I've seen women who have a severe bunion, which overlaps the second toe, or pushing the second toe on the third, which does not experience pain.
How is it diagnosed?
The bunion is visible to naked eye, if the patient decided to undergo surgery is necessary X-rays showing the position of the bones and the angle of valgus.
Hallux Valgus work after three weeks of rest, the big toe is in line with the first metatrso.
This photo is taken first Tecar to make a week of therapy, the patient must use special shoes and unable to drive.
In these two images we see the same foot (left) after you have made for a week Tecar a session of therapy per day, five sessions has achieved a significant improvement in terms of swelling and pain, patient is now able to wear normal shoes and lead.
Note that the other foot (right) was made 6 months before and is now fully recovered.
What is the treatment?
In the initial stages, ie when the pain is intermittent, inflammation of the onion generally responds well to conservative treatment with physical therapy, the CO2 laser has been successful in a few sessions.
When the pain is constant and Nocetta but also involves the forefoot, the patient may decide to intervene surgically.
There are several surgical techniques for the surgery, the orthopedist will examine the subject, age, if you have flat feet, sports, etc. may be practiced. On the basis of this will advise the most suitable method.
This is done as an outpatient, patients often go home the same day, walking with crutches, have to wait at least a day before placing the foot on the ground.
In the first month, the foot is swollen and will require very large shoes.
The pain will improve slowly, but in the early days will not be able to take long walks, it is advisable to keep the raised foot resting on a stool and moving his fingers.
I got good results with physical therapy (CO2 Laser, and Ultrasound Tecar) for pain and deflate the foot.
The Metatarsalgia
Metatarsalgia means pain in the heel of the foot at the metatarsal bones.
This syndrome may be accompanied by some strains such as hallux valgus, hammer toes or the foot flat, but often appears in people with normal feet.
The metatarsalgia can have different origins: anatomical, biomechanical and secondary education.
Metatarsalgia anatomical-biomechanical
It 'possible that weighs heavy on a small area of \u200b\u200bthe forefoot because the metatarsals have a different length and are tilted abnormally, this leads the formation of a callus in the anterior region of the foot in addition to severe pain.
The anatomical changes can result traumatic events, dall'alluce valgus or arthritis of the sesamoid bones.
Another cause of metatarsalgia is dehydration and loss of elasticity of the adipose tissue that is located in the arch of the foot and acts as a cushion during deambulazione.Per avoid the pain of metatarsalgia, the affected person look for more support on the toes, over the years this can lead to deformities of the jaw or hammer toes.
Metatarsalgia Secondary
The metatarsalgia can also result from systemic diseases like diabetes that can lead to ulceration of the foot, rheumatic diseases such as gout or rheumatoid arthritis, vascular diseases or infections (septic arthritis).
should not be the confonedere with Morton's neuroma metatarsalgia which consists of a digital nerve degeneration and is a benign disease that causes pain in the intermetatarsal space between the third and fourth metatarsal.
What are the symptoms?
The patient usually reports a sharp pain in the forefoot, generally under the tree, but can also occur in the dorsal region of the foot.
The symptoms worsen while walking and at the end of a workday standing, but when you are sitting or lying down does not fastidio.Il pain is very intense, then the patient tries to mitigate it by supporting or incorrectly loading the weight on the leg, the long-term position the unit may give other symptoms such as back pain.
the metatarsalgia How is it diagnosed?
To get the correct diagnosis of metatarsalgia is a careful clinical examination performed by a doctor will check on history reasoned that after the patient's symptoms and signs, in this case will of callousness.
instrumental examinations which may be used are:
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radiograph to show anatomical or biomechanical abnormalities.
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If the doctor suspects a Morton's neuroma prescribe an ultrasound, the fact sheet shows only the bones and then to see the soft tissue is need the ultrasound examination.
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baropodometry This is a test that takes place in the foot cam on a platform connected to a computer that measures the load distribution in the two plants of the foot. From these data shows a possible imbalance in the support of the weight which can be seen at a anatomic-biomechanical metatarsalgia.
What is the best treatment?
Sportsmen affected by this painful syndrome will be granted a period of rest or replace running with other activities (swimming, cycling).
To eliminate the pain usually recommend physical therapy (CO2 laser, ultrasonic immersion.) Or manual therapies to eliminate the tensions that cause a bad support.
until it is resolved entirely metatarsalgia is necessary to use wide shoes that do not have a strong external pressure on the metatarsals, possibly combined with an orthotic insole that distributes body weight evenly on all the metatarsals.
In most cases difficult not respond to treatment after at least six months may consider surgery, but not always decisive, then you should consult a good orthopedic patient who will be able to explain the benefits and possible risks.
