Leg Length Discrepancy Surgery Recovery
Overview
Differences between the lengths of the upper and/or lower legs are called leg length discrepancies (LLD). A leg length difference may simply be a mild variation between the two sides of the body. This is not unusual in the general population. For example, one study reported that 32 percent of 600 military recruits had a 1/5 inch to a 3/5 inch difference between the lengths of their legs. This is a normal variation. Greater differences may need treatment because a significant difference can affect a patient's well-being and quality of life.
Causes
A patient?s legs may be different lengths for a number of reasons, including a broken leg bone may heal in a shorter position, particularly if the injury was severe. In children, broken bones may grow faster for a few years after they heal, resulting in one longer leg. If the break was near the growth center, slower growth may ensue. Children, especially infants, who have a bone infection during a growth spurt may have a greater discrepancy. Inflammation of joints, such as juvenile arthritis during growth, may cause unequal leg length. Compensation for spinal or pelvic scoliosis. Bone diseases such as Ollier disease, neurofibromatosis, or multiple hereditary exostoses. Congenital differences.
Symptoms
Often there are few or no symptoms prior to the age of 25-35. The most common symptom is chronic lower back pain, but also is frequently middle and upper back pain. Same-sided and repeated injury or pain to the hip, knee and/or ankle is also a hallmark of a long-standing untreated LLD. It is not uncommon to have buttock or radiating hip pain that is non-dermatomal (not from a disc) and tends to go away when lying down.
Diagnosis
Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.
Non Surgical Treatment
In some circumstances, the physician will recommend a non-surgical form of treatment. Non-surgical treatments include orthotics and prosthetics. Orthotics are a special type of lift placed in or on a shoe that can be used in the treatment of leg length discrepancies between two and six centimeters. In pediatric patients who have large discrepancies and are not good candidates for other treatment forms, prosthetics can be helpful.
how to grow tall after 18
Surgical Treatment
Surgical treatments vary in complexity. Sometimes the goal of surgery is to stop the growth of the longer limb. Other times, surgeons work to lengthen the shorter limb. Orthopedic surgeons may treat children who have limb-length conditions with one or a combination of these surgical techniques. Bone resection. An operation to remove a section of bone, evening out the limbs in teens or adults who are no longer growing. Epiphyseal stapling. An operation to slow the rate of growth of the longer limb by inserting staples into the growth plate, then removing them when the desired result is achieved. Epiphysiodesis. An operation to slow the rate of growth of the longer limb by creating a permanent bony ridge near the growth plate. Limb lengthening. A procedure (also called distraction osteogenesis or the Ilizarov procedure) that involves attaching an internal or external fixator to a limb and gradually pulling apart bone segments to grow new bone between them. There are several ways your doctor can predict the final LLD, and thus the timing of the surgery. The easiest way is the so-called Australian method, popularised by Dr. Malcolm Menelaus, an Australian orthopedic surgeon. According to this method, growth in girls is estimated to stop at age 14, and in boys at age 16 years. The femur grows at the rate of 10 mm. a year, and the upper tibia at the rate of 6 mm. a year. Using simple arithmetic, one can get a fairly good prediction of future growth. This of course, is an average, and the patient may be an average. To cut down the risk of this, the doctor usually measures leg length using special X-ray technique (called a Scanogram) on three occasions over at least one year duration to estimate growth per year. He may also do an X-ray of the left hand to estimate the bone age (which in some cases may differ from chronological age) by comparing it with an atlas of bone age. In most cases, however, the bone age and chronological age are quite close. Another method of predicting final LLD is by using Anderson and Green?s remaining growth charts. This is a very cumbersome method, but was till the 1970?s, the only method of predicting remaining growth. More recently, however, a much more convenient method of predicting LLD was discovered by Dr. Colin Moseley from Montreal. His technique of using straight line graphs to plot growth of leg lengths is now the most widely used method of predicting leg length discrepancy. Whatever method your doctor uses, over a period of one or two years, once he has a good idea of the final LLD, he can then formulate a plan to equalize leg lengths. Epiphyseodesis is usually done in the last 2 to 3 years of growth, giving a maximum correction of about 5 cm. Leg lengthening can be done at any age, and can give corrections of 5 to10 cm., or more.
Differences between the lengths of the upper and/or lower legs are called leg length discrepancies (LLD). A leg length difference may simply be a mild variation between the two sides of the body. This is not unusual in the general population. For example, one study reported that 32 percent of 600 military recruits had a 1/5 inch to a 3/5 inch difference between the lengths of their legs. This is a normal variation. Greater differences may need treatment because a significant difference can affect a patient's well-being and quality of life.
Causes
A patient?s legs may be different lengths for a number of reasons, including a broken leg bone may heal in a shorter position, particularly if the injury was severe. In children, broken bones may grow faster for a few years after they heal, resulting in one longer leg. If the break was near the growth center, slower growth may ensue. Children, especially infants, who have a bone infection during a growth spurt may have a greater discrepancy. Inflammation of joints, such as juvenile arthritis during growth, may cause unequal leg length. Compensation for spinal or pelvic scoliosis. Bone diseases such as Ollier disease, neurofibromatosis, or multiple hereditary exostoses. Congenital differences.
Symptoms
Often there are few or no symptoms prior to the age of 25-35. The most common symptom is chronic lower back pain, but also is frequently middle and upper back pain. Same-sided and repeated injury or pain to the hip, knee and/or ankle is also a hallmark of a long-standing untreated LLD. It is not uncommon to have buttock or radiating hip pain that is non-dermatomal (not from a disc) and tends to go away when lying down.
Diagnosis
Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.
Non Surgical Treatment
In some circumstances, the physician will recommend a non-surgical form of treatment. Non-surgical treatments include orthotics and prosthetics. Orthotics are a special type of lift placed in or on a shoe that can be used in the treatment of leg length discrepancies between two and six centimeters. In pediatric patients who have large discrepancies and are not good candidates for other treatment forms, prosthetics can be helpful.
how to grow tall after 18
Surgical Treatment
Surgical treatments vary in complexity. Sometimes the goal of surgery is to stop the growth of the longer limb. Other times, surgeons work to lengthen the shorter limb. Orthopedic surgeons may treat children who have limb-length conditions with one or a combination of these surgical techniques. Bone resection. An operation to remove a section of bone, evening out the limbs in teens or adults who are no longer growing. Epiphyseal stapling. An operation to slow the rate of growth of the longer limb by inserting staples into the growth plate, then removing them when the desired result is achieved. Epiphysiodesis. An operation to slow the rate of growth of the longer limb by creating a permanent bony ridge near the growth plate. Limb lengthening. A procedure (also called distraction osteogenesis or the Ilizarov procedure) that involves attaching an internal or external fixator to a limb and gradually pulling apart bone segments to grow new bone between them. There are several ways your doctor can predict the final LLD, and thus the timing of the surgery. The easiest way is the so-called Australian method, popularised by Dr. Malcolm Menelaus, an Australian orthopedic surgeon. According to this method, growth in girls is estimated to stop at age 14, and in boys at age 16 years. The femur grows at the rate of 10 mm. a year, and the upper tibia at the rate of 6 mm. a year. Using simple arithmetic, one can get a fairly good prediction of future growth. This of course, is an average, and the patient may be an average. To cut down the risk of this, the doctor usually measures leg length using special X-ray technique (called a Scanogram) on three occasions over at least one year duration to estimate growth per year. He may also do an X-ray of the left hand to estimate the bone age (which in some cases may differ from chronological age) by comparing it with an atlas of bone age. In most cases, however, the bone age and chronological age are quite close. Another method of predicting final LLD is by using Anderson and Green?s remaining growth charts. This is a very cumbersome method, but was till the 1970?s, the only method of predicting remaining growth. More recently, however, a much more convenient method of predicting LLD was discovered by Dr. Colin Moseley from Montreal. His technique of using straight line graphs to plot growth of leg lengths is now the most widely used method of predicting leg length discrepancy. Whatever method your doctor uses, over a period of one or two years, once he has a good idea of the final LLD, he can then formulate a plan to equalize leg lengths. Epiphyseodesis is usually done in the last 2 to 3 years of growth, giving a maximum correction of about 5 cm. Leg lengthening can be done at any age, and can give corrections of 5 to10 cm., or more.
Fighting Fallen Arches
Overview
Fallen arches, flat feet, or Plantar fasciitis can cause pain and discomfort in the legs, feet, ankles, Achilles tendon, hips, and low back. In this video, Ron Vaughn, a sports massage therapist, and Christie Powell, a physical therapist, explain how the feet become pronated (fallen arches) and how some simple at-home exercises can strengthen the arch muscles to allevaite pain and discomfort.
Causes
Fallen arches can be the result of other conditions such as overuse, stretching or tearing of the posterior tibial tendon (which attaches to a bone in the foot and runs up the calf of the lower leg at a tension which pulls up the arch) which reduces its ability to maintain tension in the tendon. Whether or not the condition is caused by overpronation, this is the likely outcome for runners, whose arches are no longer strong enough to take the constant strain of bearing the body?s weight on impact, causing joint, postural and muscular problems.
Symptoms
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.
Diagnosis
It is important for people with foot pain to know if they have flat feet. The following tests can help you determine your arch type. When you get out of a swimming pool, look at your footprint on the concrete. The front of the foot will be joined to the heel by a strip. If your foot is flat, then the strip is the same width as the front of the foot, creating a footprint that looks like a stretched out pancake. With a normal arch, the strip is about half the width of the front of the foot. If you have a high arch, only a thin strip connects the front of the foot with the heel. Put your shoes on a flat table and view them at eye level from behind. See if the sole is worn evenly. A flat foot will cause more wear on the inside of the sole, especially in the heel area. The shoe will easily rock side to side. A flat foot will also cause the upper part of the shoe to lean inward over the sole. Both shoes should wear about the same way. If you have pain in one foot, you should make sure you don't have a fallen arch on that side. There are two good tests you can perform at home to detect this problem. Place your fingertips on a wall that you are directly facing and stand on your tiptoes on one foot. If you can't do it, a fallen arch may be the culprit. Stand with your feet parallel. Have someone stand in back of you and look at your feet from behind. You can also do it yourself if you stand with your back to a mirror. Normally, only the pinky toe is visible from behind. If one foot is flatter than the other, the 4th and sometimes the 3rd toe on that foot can also be seen.
fallen arches support
Non Surgical Treatment
For mild pain or aching, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil, Motrin and others) may be effective. Flexible Flatfoot. When there are no symptoms, treatment is not needed. If a child older than age 3 develops symptoms, the doctor may prescribe a therapeutic shoe insert made from a mold of the child's foot or a corrective shoe. As an alternative, some doctors recommend store-bought arch supports. These appear to work as well as more expensive treatments in many children. With any conservative, nonsurgical treatment, the goal is to relieve pain by supporting the arch and correcting any imbalance in the mechanics of the foot.
Surgical Treatment
Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.
Fallen arches, flat feet, or Plantar fasciitis can cause pain and discomfort in the legs, feet, ankles, Achilles tendon, hips, and low back. In this video, Ron Vaughn, a sports massage therapist, and Christie Powell, a physical therapist, explain how the feet become pronated (fallen arches) and how some simple at-home exercises can strengthen the arch muscles to allevaite pain and discomfort.
Causes
Fallen arches can be the result of other conditions such as overuse, stretching or tearing of the posterior tibial tendon (which attaches to a bone in the foot and runs up the calf of the lower leg at a tension which pulls up the arch) which reduces its ability to maintain tension in the tendon. Whether or not the condition is caused by overpronation, this is the likely outcome for runners, whose arches are no longer strong enough to take the constant strain of bearing the body?s weight on impact, causing joint, postural and muscular problems.
Symptoms
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.
Diagnosis
It is important for people with foot pain to know if they have flat feet. The following tests can help you determine your arch type. When you get out of a swimming pool, look at your footprint on the concrete. The front of the foot will be joined to the heel by a strip. If your foot is flat, then the strip is the same width as the front of the foot, creating a footprint that looks like a stretched out pancake. With a normal arch, the strip is about half the width of the front of the foot. If you have a high arch, only a thin strip connects the front of the foot with the heel. Put your shoes on a flat table and view them at eye level from behind. See if the sole is worn evenly. A flat foot will cause more wear on the inside of the sole, especially in the heel area. The shoe will easily rock side to side. A flat foot will also cause the upper part of the shoe to lean inward over the sole. Both shoes should wear about the same way. If you have pain in one foot, you should make sure you don't have a fallen arch on that side. There are two good tests you can perform at home to detect this problem. Place your fingertips on a wall that you are directly facing and stand on your tiptoes on one foot. If you can't do it, a fallen arch may be the culprit. Stand with your feet parallel. Have someone stand in back of you and look at your feet from behind. You can also do it yourself if you stand with your back to a mirror. Normally, only the pinky toe is visible from behind. If one foot is flatter than the other, the 4th and sometimes the 3rd toe on that foot can also be seen.
fallen arches support
Non Surgical Treatment
For mild pain or aching, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil, Motrin and others) may be effective. Flexible Flatfoot. When there are no symptoms, treatment is not needed. If a child older than age 3 develops symptoms, the doctor may prescribe a therapeutic shoe insert made from a mold of the child's foot or a corrective shoe. As an alternative, some doctors recommend store-bought arch supports. These appear to work as well as more expensive treatments in many children. With any conservative, nonsurgical treatment, the goal is to relieve pain by supporting the arch and correcting any imbalance in the mechanics of the foot.
Surgical Treatment
Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.
Everything You Will Need To Know About Heel Soreness
Overview
Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone. Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term). There are 26 bones in the human foot, of which the heel (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running. Consequently, the heel is vulnerable to damage, and ultimately pain.
Causes
Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern. As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation-excessive inward motion-can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Symptoms
Sever?s Disease. This is a condition that occurs in 10 - 15 year old children, predominantly boys and is associated with running and repetitive jumping. It is also associated with flimsy footwear that kids may wear. It occurs when the Achilles tendon continually pulls on the apophysis of the calcaneum and does not allow for it to fuse with the body of the calcaneum. Calcaneal enthesopathy. This occurs when there is repetitive trauma at the attachment of the Achilles tendon, resulting in a spur from the calcaneum up into the Achilles tendon. It is usually visualized on x-ray and may be tender if there is an associated bursitis or tendonitis. "Pump Bump". Also known as Haglund?s Deformity, this is a bony enlargement that exists on the back of the heel - usually related to a congenital abnormality or with chronic bursitis, causing a thickening. There may have already been trauma or pressure from footwear. Treatment is usually protection of the bump and correct footwear. Associated with a symmetrical swelling at the base of the Achilles tendon. It is usually related to repetitive trauma or inappropriate footwear. It is often red and hot in the early stages. Treatment is usually to correct the footwear, provide padding and treat the local symptoms e.g. ice, rest, physiotherapy and cortisone injection. Fat Pad Syndrome. Direct contact with the base of the heel may result in trauma to the fat pad. Related to obesity, training on hard surfaces, uneven grounds, poor shoes especially overlarge shoes which can cause shearing forces on the heel. These conditions are renowned for taking a long time to recover - usually many months.
Diagnosis
A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.
Non Surgical Treatment
If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches, padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia. Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain. Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal. Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients. Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
Surgical Treatment
It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.
heel pad anatomy
Prevention
Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.
Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone. Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term). There are 26 bones in the human foot, of which the heel (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running. Consequently, the heel is vulnerable to damage, and ultimately pain.
Causes
Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern. As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation-excessive inward motion-can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Symptoms
Sever?s Disease. This is a condition that occurs in 10 - 15 year old children, predominantly boys and is associated with running and repetitive jumping. It is also associated with flimsy footwear that kids may wear. It occurs when the Achilles tendon continually pulls on the apophysis of the calcaneum and does not allow for it to fuse with the body of the calcaneum. Calcaneal enthesopathy. This occurs when there is repetitive trauma at the attachment of the Achilles tendon, resulting in a spur from the calcaneum up into the Achilles tendon. It is usually visualized on x-ray and may be tender if there is an associated bursitis or tendonitis. "Pump Bump". Also known as Haglund?s Deformity, this is a bony enlargement that exists on the back of the heel - usually related to a congenital abnormality or with chronic bursitis, causing a thickening. There may have already been trauma or pressure from footwear. Treatment is usually protection of the bump and correct footwear. Associated with a symmetrical swelling at the base of the Achilles tendon. It is usually related to repetitive trauma or inappropriate footwear. It is often red and hot in the early stages. Treatment is usually to correct the footwear, provide padding and treat the local symptoms e.g. ice, rest, physiotherapy and cortisone injection. Fat Pad Syndrome. Direct contact with the base of the heel may result in trauma to the fat pad. Related to obesity, training on hard surfaces, uneven grounds, poor shoes especially overlarge shoes which can cause shearing forces on the heel. These conditions are renowned for taking a long time to recover - usually many months.
Diagnosis
A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.
Non Surgical Treatment
If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches, padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia. Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain. Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal. Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients. Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
Surgical Treatment
It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.
heel pad anatomy
Prevention
Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.
Mortons Neuroma An Overview
Overview
Morton's neuroma is named after Dr Morton who first described this condition in 1876. It is sometimes called Morton's metatarsalgia or interdigital neuroma. It is a condition that affects one of the common plantar digital nerves that run between the long bones (metatarsals) in the foot. It most commonly affects the nerve between the third and fourth metatarsal bones, causing pain and numbness in the third and fourth toes. It can also affect the nerve between the second and third metatarsal bones, causing symptoms in the second and third toes. Morton's neuroma rarely affects the nerve between the first and second, or between the fourth and fifth, metatarsal bones. It tends to affect only one foot. It is rare to get two neuromas at the same time in the same foot.
Causes
Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the nerve running between the metatarsal heads. This chronic pinching can make the nerve sheath enlarge. As it enlarges it than becomes more squeezed and increasingly troublesome. Tight shoes, shoes with little room for the forefoot, pointy toeboxes can all make this problem more painful. Walking barefoot may also be painful, since the foot may be functioning in an over-pronated position.
Symptoms
Feelings of numbness, tingling or tenderness in the ball of the foot (the area just behind the base of the toes) are some of the first signs of a condition known as Morton?s Neuroma. However, the condition is somewhat unpredictable, and symptoms may vary from patient to patient. Generally, however, the discomfort gets worse rather than better, and the patient may feel pain or a burning sensation that radiates out to the toes. Eventually, wearing shoes becomes uncomfortable (or even unbearable), and the patient may complain that the feeling is similar to that of having a stone bruise, or walking on a marble or pebble constantly, even though no there is no trauma to the skin, and no visible bump or lump on the sole of the foot.
Diagnosis
Patients with classic Morton?s neuroma symptoms will have pain with pressure at the base of the involved toes (either between the 2nd and 3rd toes, or between the 3rd and 4th toes). In addition, squeezing the front of the foot together can exacerbate symptoms. As well, they may have numbness on the sides of one toe and the adjacent toe as this corresponds with the distribution of the involved nerve.
Non Surgical Treatment
Treatment for Morton?s neuroma will depend on how long you've had the condition and its severity. Simple non-surgical treatments are effective for some people. Others may need surgery. If Morton's neuroma is diagnosed early, treatment will aim to reduce the pressure on the affected nerve. This is usually the nerve between the third and fourth toe bones (metatarsals). Your GP or podiatrist (foot specialist) may recommend changing the type of shoes you usually wear, shoes with a wider toe area may help ease the pressure on the nerve in your foot. Using orthotic devices, such as a support for the arch of your foot to help relieve the pressure on the nerve. Anti-inflammatory painkillers or a course of steroid injections into the affected area of your foot may help ease the pain and inflammation. Alcohol and local anaesthetic is injected into your foot using ultrasound for guidance, studies have shown that this type of treatment is effective. Resting your foot and massaging your toes may also help to relieve the pain. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.
Surgical Treatment
Surgery for Morton's neuroma is usually a treatment of last resort. It may be recommended if you have severe pain in your foot or if non-surgical treatments haven't worked. Surgery is usually carried out under local anaesthetic, on an outpatient basis, which means you won't need to stay in hospital overnight. The operation can take up to 30 minutes. The surgeon will make a small incision, either on the top of your foot or on the sole. They may try to increase the space around the nerve (nerve decompression) by removing some of the surrounding tissue, or they may remove the nerve completely (nerve resection). If the nerve is removed, the area between your toes may be permanently numb. After the procedure you'll need to wear a special protective shoe until the affected area has healed sufficiently to wear normal footwear. It can take up to four weeks to make a full recovery. Most people (about 75%) who have surgery to treat Morton's neuroma have positive results and their painful symptoms are relieved.
Morton's neuroma is named after Dr Morton who first described this condition in 1876. It is sometimes called Morton's metatarsalgia or interdigital neuroma. It is a condition that affects one of the common plantar digital nerves that run between the long bones (metatarsals) in the foot. It most commonly affects the nerve between the third and fourth metatarsal bones, causing pain and numbness in the third and fourth toes. It can also affect the nerve between the second and third metatarsal bones, causing symptoms in the second and third toes. Morton's neuroma rarely affects the nerve between the first and second, or between the fourth and fifth, metatarsal bones. It tends to affect only one foot. It is rare to get two neuromas at the same time in the same foot.Causes
Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the nerve running between the metatarsal heads. This chronic pinching can make the nerve sheath enlarge. As it enlarges it than becomes more squeezed and increasingly troublesome. Tight shoes, shoes with little room for the forefoot, pointy toeboxes can all make this problem more painful. Walking barefoot may also be painful, since the foot may be functioning in an over-pronated position.
Symptoms
Feelings of numbness, tingling or tenderness in the ball of the foot (the area just behind the base of the toes) are some of the first signs of a condition known as Morton?s Neuroma. However, the condition is somewhat unpredictable, and symptoms may vary from patient to patient. Generally, however, the discomfort gets worse rather than better, and the patient may feel pain or a burning sensation that radiates out to the toes. Eventually, wearing shoes becomes uncomfortable (or even unbearable), and the patient may complain that the feeling is similar to that of having a stone bruise, or walking on a marble or pebble constantly, even though no there is no trauma to the skin, and no visible bump or lump on the sole of the foot.
Diagnosis
Patients with classic Morton?s neuroma symptoms will have pain with pressure at the base of the involved toes (either between the 2nd and 3rd toes, or between the 3rd and 4th toes). In addition, squeezing the front of the foot together can exacerbate symptoms. As well, they may have numbness on the sides of one toe and the adjacent toe as this corresponds with the distribution of the involved nerve.
Non Surgical Treatment
Treatment for Morton?s neuroma will depend on how long you've had the condition and its severity. Simple non-surgical treatments are effective for some people. Others may need surgery. If Morton's neuroma is diagnosed early, treatment will aim to reduce the pressure on the affected nerve. This is usually the nerve between the third and fourth toe bones (metatarsals). Your GP or podiatrist (foot specialist) may recommend changing the type of shoes you usually wear, shoes with a wider toe area may help ease the pressure on the nerve in your foot. Using orthotic devices, such as a support for the arch of your foot to help relieve the pressure on the nerve. Anti-inflammatory painkillers or a course of steroid injections into the affected area of your foot may help ease the pain and inflammation. Alcohol and local anaesthetic is injected into your foot using ultrasound for guidance, studies have shown that this type of treatment is effective. Resting your foot and massaging your toes may also help to relieve the pain. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.
Surgical Treatment
Surgery for Morton's neuroma is usually a treatment of last resort. It may be recommended if you have severe pain in your foot or if non-surgical treatments haven't worked. Surgery is usually carried out under local anaesthetic, on an outpatient basis, which means you won't need to stay in hospital overnight. The operation can take up to 30 minutes. The surgeon will make a small incision, either on the top of your foot or on the sole. They may try to increase the space around the nerve (nerve decompression) by removing some of the surrounding tissue, or they may remove the nerve completely (nerve resection). If the nerve is removed, the area between your toes may be permanently numb. After the procedure you'll need to wear a special protective shoe until the affected area has healed sufficiently to wear normal footwear. It can take up to four weeks to make a full recovery. Most people (about 75%) who have surgery to treat Morton's neuroma have positive results and their painful symptoms are relieved.
Leg Length Discrepancy And Shoe Lifts
There are actually two different types of leg length discrepancies, congenital and acquired. Congenital implies that you are born with it. One leg is anatomically shorter than the other. Through developmental phases of aging, the brain senses the walking pattern and identifies some variance. The body typically adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch isn't blatantly excessive, doesn't need Shoe Lifts to compensate and typically won't have a profound effect over a lifetime.
Leg length inequality goes mainly undiagnosed on a daily basis, yet this problem is simply solved, and can reduce numerous instances of back problems.
Treatment for leg length inequality usually involves Shoe Lifts. These are cost-effective, typically priced at under twenty dollars, in comparison to a custom orthotic of $200 or even more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.
Mid back pain is the most common condition impacting men and women today. Over 80 million men and women experience back pain at some point in their life. It's a problem that costs companies huge amounts of money year after year on account of time lost and production. Fresh and better treatment solutions are continually sought after in the hope of lowering economical influence this issue causes.
People from all corners of the earth suffer from foot ache due to leg length discrepancy. In these types of cases Shoe Lifts are usually of very useful. The lifts are capable of decreasing any discomfort in the feet. Shoe Lifts are recommended by many experienced orthopaedic practitioners".
To be able to support the body in a balanced manner, your feet have a significant job to play. Irrespective of that, it's often the most overlooked area of the body. Some people have flat-feet which means there is unequal force exerted on the feet. This causes other parts of the body such as knees, ankles and backs to be impacted too. Shoe Lifts ensure that appropriate posture and balance are restored.
Leg length inequality goes mainly undiagnosed on a daily basis, yet this problem is simply solved, and can reduce numerous instances of back problems.
Treatment for leg length inequality usually involves Shoe Lifts. These are cost-effective, typically priced at under twenty dollars, in comparison to a custom orthotic of $200 or even more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.
Mid back pain is the most common condition impacting men and women today. Over 80 million men and women experience back pain at some point in their life. It's a problem that costs companies huge amounts of money year after year on account of time lost and production. Fresh and better treatment solutions are continually sought after in the hope of lowering economical influence this issue causes.
People from all corners of the earth suffer from foot ache due to leg length discrepancy. In these types of cases Shoe Lifts are usually of very useful. The lifts are capable of decreasing any discomfort in the feet. Shoe Lifts are recommended by many experienced orthopaedic practitioners".
To be able to support the body in a balanced manner, your feet have a significant job to play. Irrespective of that, it's often the most overlooked area of the body. Some people have flat-feet which means there is unequal force exerted on the feet. This causes other parts of the body such as knees, ankles and backs to be impacted too. Shoe Lifts ensure that appropriate posture and balance are restored.
Why Shoe Lifts Are The Solution To Leg Length Imbalances
There are actually not one but two different types of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is anatomically shorter than the other. Through developmental stages of aging, the brain senses the walking pattern and identifies some variation. The body usually adapts by tilting one shoulder to the "short" side. A difference of less than a quarter inch is not blatantly excessive, demand Shoe Lifts to compensate and typically does not have a profound effect over a lifetime.
Leg length inequality goes mainly undiagnosed on a daily basis, however this problem is very easily solved, and can reduce quite a few instances of back discomfort.
Therapy for leg length inequality usually consists of Shoe Lifts. They are very reasonably priced, regularly being less than twenty dollars, in comparison to a custom orthotic of $200 or maybe more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.
Mid back pain is easily the most common health problem affecting men and women today. Over 80 million men and women have problems with back pain at some stage in their life. It's a problem which costs businesses millions annually as a result of time lost and productivity. New and superior treatment methods are continually sought after in the hope of minimizing the economic influence this condition causes.
People from all corners of the earth experience foot ache as a result of leg length discrepancy. In most of these situations Shoe Lifts might be of worthwhile. The lifts are capable of decreasing any discomfort and pain in the feet. Shoe Lifts are recommended by countless specialist orthopaedic practitioners".
To be able to support the human body in a healthy and balanced manner, feet have got a very important function to play. Irrespective of that, it is sometimes the most overlooked region of the human body. Some people have flat-feet meaning there may be unequal force placed on the feet. This will cause other body parts such as knees, ankles and backs to be affected too. Shoe Lifts ensure that proper posture and balance are restored.
Leg length inequality goes mainly undiagnosed on a daily basis, however this problem is very easily solved, and can reduce quite a few instances of back discomfort.
Therapy for leg length inequality usually consists of Shoe Lifts. They are very reasonably priced, regularly being less than twenty dollars, in comparison to a custom orthotic of $200 or maybe more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.
Mid back pain is easily the most common health problem affecting men and women today. Over 80 million men and women have problems with back pain at some stage in their life. It's a problem which costs businesses millions annually as a result of time lost and productivity. New and superior treatment methods are continually sought after in the hope of minimizing the economic influence this condition causes.
People from all corners of the earth experience foot ache as a result of leg length discrepancy. In most of these situations Shoe Lifts might be of worthwhile. The lifts are capable of decreasing any discomfort and pain in the feet. Shoe Lifts are recommended by countless specialist orthopaedic practitioners".
To be able to support the human body in a healthy and balanced manner, feet have got a very important function to play. Irrespective of that, it is sometimes the most overlooked region of the human body. Some people have flat-feet meaning there may be unequal force placed on the feet. This will cause other body parts such as knees, ankles and backs to be affected too. Shoe Lifts ensure that proper posture and balance are restored.
For Leg Length Discrepancy Chiropodists Prefer Shoe Lifts
There are two unique variations of leg length discrepancies, congenital and acquired. Congenital implies you are born with it. One leg is anatomically shorter compared to the other. As a result of developmental periods of aging, the human brain picks up on the gait pattern and identifies some difference. Our bodies typically adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch isn't blatantly irregular, does not need Shoe Lifts to compensate and commonly doesn't have a serious effect over a lifetime.
Leg length inequality goes typically undiscovered on a daily basis, yet this problem is very easily corrected, and can reduce quite a few cases of back problems.
Therapy for leg length inequality commonly consists of Shoe Lifts. These are generally low cost, generally being below twenty dollars, compared to a custom orthotic of $200 or higher. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.
Back ache is the most common ailment impacting men and women today. Over 80 million people suffer from back pain at some point in their life. It is a problem which costs businesses vast amounts of money each year on account of lost time and production. New and improved treatment methods are continually sought after in the hope of reducing the economical influence this condition causes.
Men and women from all corners of the earth suffer from foot ache due to leg length discrepancy. In a lot of these situations Shoe Lifts might be of very beneficial. The lifts are capable of decreasing any discomfort and pain in the feet. Shoe Lifts are recommended by countless certified orthopaedic orthopedists.
So that you can support the body in a healthy and balanced fashion, your feet have got a critical task to play. Despite that, it can be the most overlooked zone in the body. Many people have flat-feet meaning there may be unequal force exerted on the feet. This causes other areas of the body such as knees, ankles and backs to be affected too. Shoe Lifts ensure that proper posture and balance are restored.
Leg length inequality goes typically undiscovered on a daily basis, yet this problem is very easily corrected, and can reduce quite a few cases of back problems.
Therapy for leg length inequality commonly consists of Shoe Lifts. These are generally low cost, generally being below twenty dollars, compared to a custom orthotic of $200 or higher. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.
Back ache is the most common ailment impacting men and women today. Over 80 million people suffer from back pain at some point in their life. It is a problem which costs businesses vast amounts of money each year on account of lost time and production. New and improved treatment methods are continually sought after in the hope of reducing the economical influence this condition causes.
Men and women from all corners of the earth suffer from foot ache due to leg length discrepancy. In a lot of these situations Shoe Lifts might be of very beneficial. The lifts are capable of decreasing any discomfort and pain in the feet. Shoe Lifts are recommended by countless certified orthopaedic orthopedists.
So that you can support the body in a healthy and balanced fashion, your feet have got a critical task to play. Despite that, it can be the most overlooked zone in the body. Many people have flat-feet meaning there may be unequal force exerted on the feet. This causes other areas of the body such as knees, ankles and backs to be affected too. Shoe Lifts ensure that proper posture and balance are restored.
