Will Severs Disease Need To Have Surgical Procedures?

posted on 23 May 2015 02:28 by hallowedsalvati42
Overview

Sever?s Disease is one of the most common overuse injuries affecting children during their secondary growth spurts and is described as a self-limiting condition resolving naturally with skeletal maturity 1. It is suggested to be caused by progressive microtrauma to the bone-cartilage interface in the calcaneal apophysis partly due to large traction forces in the Achilles tendon. The current standard treatment consists mainly of rest, and waiting for skeletal maturity.

Causes

Sever's Disease typically affects boys and girls between 8-15 years of age. Risk factors include. Athletic activity that involves heel contact with hard surfaces, as in gymnastics, track, soccer, basketball, ice skating, ballet and aerobics. The wearing of ill-fitting shoes. Well-made shoes that fit properly are a must for every child. Prolonged periods of standing. If a child complains of heel pain after choir practice, doing dishes, standing in lines or other activities that put pressure on the heel bones, pay attention.

Symptoms

Sever's disease causes pain and tenderness in the back and bottom of the heel when walking or standing, and the heel is painful when touched. It can occur in one or both feet.

Diagnosis

In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.

Non Surgical Treatment

Treatment may consist of one or more of the following, Elevating the heel, Stretching hamstring and calf muscles 2-3 times daily, Using R.I.C.E. (Rest, Ice, Compression, Elevation), Foot orthotics, Medication, Physical therapy, Icing daily (morning), Heating therapy, Open back shoe are best and avoid high heel shoe. The Strickland Protocol has shown a positive response in patients with a mean return to sport in less than 3 weeks.

Exercise

Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.

Achilles Tendon Rupture Fiction

posted on 01 May 2015 11:08 by hallowedsalvati42
Overview
Achilles Tendonitis Achilles tendon rupture is when the achilles tendon breaks. The achilles is the most commonly injured tendon. Rupture can occur while performing actions requiring explosive acceleration, such as pushing off or jumping. The male to female ratio for Achilles tendon rupture varies between 7:1 and 4:1 across various studies.

Causes
Often the individual will feel or hear a pop or a snap when the injury occurs. There is immediate swelling and severe pain in the back of the heel, below the calf where it ruptures. Pain is usually severe enough that it is difficult or impossible to walk or take a step. The individual will not be able to push off or go on their toes.

Symptoms
The classic sign of an Achilles' tendon rupture is a short sharp pain in the Achilles' area, which is sometimes accompanied by a snapping sound as the tendon ruptures. The pain usually subsides relatively quickly into an aching sensation. Other signs that are likely to be present subsequent to a rupture are the inability to stand on tiptoe, inability to push the foot off the ground properly resulting in a flat footed walk. With complete tears it may be possible to feel the two ends of tendon where it has snapped, however swelling to the area may mean this is impossible.

Diagnosis
Your caregiver will ask what you were doing at the time of your injury. You may need any of the following. A calf-squeeze test is used to check for movement. You will lie on your stomach on a table or bed with your feet hanging over the edge. Your caregiver will squeeze the lower part of each calf. If your foot or ankle do not move, the tendon is torn. An x-ray will show swelling or any broken bones. An ultrasound uses sound waves to show pictures of your tendon on a monitor. An ultrasound may show a tear in the tendon. An MRI takes pictures of your tendon to show damage. You may be given dye to help the tendon show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the caregiver if you have any metal in or on your body.

Non Surgical Treatment
The other option is to allow your tendon to heal without surgery. In this case, you also need to wear a cast, splint, walking boot, or brace for 6-8 weeks. You also may have different exercises to do. If you are less active or have a chronic illness that prevents surgery, this option may be better for you. Achilles Tendon

Surgical Treatment
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient?s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient. Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weight bearing. Complications such as incision-healing difficulties re-rupture of the tendon, or nerve pain can arise after surgery.

Acquired Flat Foot Tibialis Posterior Stretch

posted on 20 Apr 2015 04:33 by hallowedsalvati42
Overview
Tendons do a lot of work. In fact, a great deal of what happens when you walk can be related to tendons tugging and pulling in appropriate ways in their proper places. With this in mind, it?s hardly surprising that on occasion, (probably because we too often forget to send them ?Thank you? cards), tendons may decide that they?ve had it. They may buck their responsibilities, shirk their work, and in all other ways cease to function properly. And that may mean bad news for you. Take the posterior tibial tendon: it runs from the bottom of the calf, goes right under that bump on the inside of the ankle (the medial malleolus) and ends up attaching itself to a bone on the inside of the middle of your foot (the navicular bone). It?s the main tendon that keeps the arch of your foot in place, and it helps a bunch in walking, too. Over time, though, we tend to put a lot of stress on this faithful tendon, especially if we?ve put on extra weight, or do a lot of activities that stress it out, walking, running, hiking, or climbing stairs. Sometimes athletes (who do a lot of that walking and running stuff) may put so much stress on the tendon that it tears suddenly. But for many of us, damage may take place gradually (i.e. the tendon stretches out) until the tendon tells us that it flat out quits. (It sometimes doesn?t even give two weeks notice.) In short, you may develop posterior tibial tendon dysfunction (PTTD). Adult Acquired Flat Foot

Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Symptoms
At first you may notice pain and swelling along the medial (big toe) side of the foot. This is where the posterior tibialis tendon travels from the back of the leg under the medial ankle bone to the foot. As the condition gets worse, tendon failure occurs and the pain gets worse. Some patients experience pain along the lateral (outside) edge of the foot, too. You may find that your feet hurt at the end of the day or after long periods of standing. Some people with this condition have trouble rising up on their toes. They may be unable to participate fully in sports or other recreational activities.

Diagnosis
Looking at the patient when they stand will usually demonstrate a flatfoot deformity (marked flattening of the medial longitudinal arch). The front part of the foot (forefoot) is often splayed out to the side. This leads to the presence of a ?too many toes? sign. This sign is present when the toes can be seen from directly behind the patient. The gait is often somewhat flatfooted as the patient has the dysfunctional posterior tibial tendon can no longer stabilize the arch of the foot. The physician?s touch will often demonstrate tenderness and sometimes swelling over the inside of the ankle just below the bony prominence (the medial malleolus). There may also be pain in the outside aspect of the ankle. This pain originates from impingement or compression of two tendons between the outside ankle bone (fibula) and the heel bone (calcaneus) when the patient is standing.

Non surgical Treatment
Medical or nonoperative therapy for posterior tibial tendon dysfunction involves rest, immobilization, nonsteroidal anti-inflammatory medication, physical therapy, orthotics, and bracing. This treatment is especially attractive for patients who are elderly, who place low demands on the tendon, and who may have underlying medical problems that preclude operative intervention. During stage 1 posterior tibial tendon dysfunction, pain, rather than deformity, predominates. Cast immobilization is indicated for acute tenosynovitis of the posterior tibial tendon or for patients whose main presenting feature is chronic pain along the tendon sheath. A well-molded short leg walking cast or removable cast boot should be used for 6-8 weeks. Weight bearing is permitted if the patient is able to ambulate without pain. If improvement is noted, the patient then may be placed in custom full-length semirigid orthotics. The patient may then be referred to physical therapy for stretching of the Achilles tendon and strengthening of the posterior tibial tendon. Steroid injection into the posterior tibial tendon sheath is not recommended due to the possibility of causing a tendon rupture. In stage 2 dysfunction, a painful flexible deformity develops, and more control of hindfoot motion is required. In these cases, a rigid University of California at Berkley (UCBL) orthosis or short articulated ankle-foot orthosis (AFO) is indicated. Once a rigid flatfoot deformity develops, as in stage 3 or 4, bracing is extended above the ankle with a molded AFO, double upright brace, or patellar-tendon-bearing brace. The goals of this treatment are to accommodate the deformity, prevent or slow further collapse, and improve walking ability by transferring load to the proximal leg away from the collapsed medial midfoot and heel. Adult Acquired Flat Foot

Surgical Treatment
Until recently, operative treatment was indicated for most patients with stage 2 deformities. However, with the use of potentially effective nonoperative management , operative treatment is now indicated for those patients that have failed nonoperative management. The principles of operative treatment of stage 2 deformities include transferring another tendon to help serve the role of the dysfunctional posterior tibial tendon (usually the flexor hallucis longus is transferred). Restoring the shape and alignment of the foot. This moves the weight bearing axis back to the center of the ankle. Changing the shape of the foot can be achieved by one or more of the following procedures. Cutting the heel bone and shifting it to the inside (Medializing calcaneal osteotomy). Lateral column lengthening restores the arch and overall alignment of the foot. Medial column stabilization. This stiffens the ray of the big toe to better support the arch. Lengthening of the Achilles tendon or Gastrocnemius. This will allow the ankle to move adequately once the alignment of the foot is corrected. Stage 3 acquired adult flatfoot deformity is treated operatively with a hindfoot fusion (arthrodesis). This is done with either a double or triple arthrodesis - fusion of two or three of the joints in hindfoot through which the deformity occurs. It is important when a hindfoot arthrodesis is performed that it be done in such a way that the underlying foot deformity is corrected first. Simply fusing the hindfoot joints in place is no longer acceptable.
Tags: adult, aquired, flat, foot