Working with Mortons Neuroma

Overview

intermetatarsal neuromaNeuromas are generally benign or non-cancerous growths of nerve tissue, developing in various parts of the body. Morton?s Neuromas are confined to the nerves of the foot, most commonly, between the third and fourth toes. The condition involves a thickening of the tissue around one of the digital nerves leading to the toes and does not qualify as an actual tumor. The affliction causes a sharp, burning pain, usually in the region of the ball of the foot. A patient?s toes may also sting, burn or exhibit numbness. Often, the symptoms have been likened to ?walking on a marble.?

Causes

The exact cause of Morton?s neuroma is not known, but the choice of footwear seems be a factor. Wearing high heels (shoes with heels over 2 inches) can put extra pressure on the balls of the feet. Wearing tight or pointed toed shoes may squeeze the toes together or otherwise constrict their movement. For that reason, women are about 8 to 10 times more likely to develop Morton?s neuroma compared with men. People who are born with flat feet, high arches, or an abnormal position of the toes are more prone to developing Morton?s neuroma. This may be due to instability around the toe joints. Certain conditions that develop over time, such as bunions or hammer toes, are also associated with Morton?s neuroma. Some sports that involve running, including tennis and other racquet sports, can also increase the chance of developing Morton?s neuroma due to trauma or injury to the foot.

Symptoms

A Morton’s neuroma causes a “burning” sharp pain and numbness on the bottom of the foot in the involved area, and this pain and numbness can radiate to the nearby toes. The pain is usually increased by walking or when the ball of the foot is squeezed together and decreased with massaging. It may force a person to stop walking or to limp from the pain.

Diagnosis

In some cases your doctor will be able to feel the Morton’s as a swelling in the middle of your foot. However they may also suggest an X-ray or a blood test – this is normally to rule our other causes of the pain such as arthritis. The most accurate way to diagnose Morton?s itself is with magnetic resonance imaging (MRI) or ultrasound.

Non Surgical Treatment

Relief of symptoms can often start by having a good pair of well fitting shoes fitted to your feet ensuring that the shoes don’t squeeze your foot together. Once footwear is addressed patients may require a small pre-metatarsal pad to be positioned onto the insole of the shoe to help lift and separate the bones in the forefoot to alleviate the pressure on the nerve. If the patients foot structure and mechanics is found to be a contributing cause, a custom made orthotic is usually the most convenient and effective way to manage the problem. Sometimes an injection of local anaesthetic and steroid is recommended to assist in settling acute symptoms.Morton neuroma

Surgical Treatment

If conservative treatments haven’t helped, your doctor might suggest injections. Some people are helped by the injection of steroids into the painful area. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.

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Hammer Toe Pain Through The Night

Hammer ToeOverview
The smallest four toes of each foot have three bony segments connected by two joints, just as the fingers do. Hammertoes is a deformity in which one or more of the small toes develops a bend at the joint between the first and second segments so that the tip of the toe turns downward, making it looks like a hammer or claw. The second toe is affected most often.

Causes
The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people. Hammertoes may be aggravated by shoes that don?t fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.

Hammer ToeSymptoms
Here is a look at some of the symptoms hammertoe can cause. They include hammer-like or claw-like appearance of the toe. Pain when walking or moving the foot. Difficulty moving the toe. Corns may form on top of the toe. Callus may form on the sole of the foot. During the initial stages, you may be able to manually straighten your toe. This is called a flexible hammertoe. But as time passes, the toe will not move as easily and will continue to look like a hammer. Pressure and irritation over the joint can cause a blister to develop and become a corn over time. These corns have the potential to become infected and cause additional symptoms such as redness, bleeding, and difficulty wearing shoes and socks. Corns are the main cause of pain when hammertoes are developing.

Diagnosis
Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.

Non Surgical Treatment
For hammertoes that are still flexible, a podiatrist might recommend padding or taping the toes to relieve pain and orthotic inserts for shoes to minimize pressure and keep the toe properly aligned. Anti-inflammatory drugs or corticosteroid injections can relieve pain and inflammation. For more advanced cases of hammertoe, a podiatrist might recommend a surgical procedure to cut the tendon, allowing the toe to straighten. For hammertoes that have become rigid, a more complicated surgery might be needed, during which the podiatrist removes part of the bone at the deformed joint to allow it to straighten.

Surgical Treatment
he basis for hammer toe surgery most often involves removing s portion of bone within the toe, to reduce the joint contracture. Depending on the direction the toe is deviated, soft tissue procedures may be necessary along with pinning the toe with a surgical wire.

Hammer ToePrevention
Be good to your feet, because they carry you. They are designed to last a lifetime, but that doesn?t mean they don?t need some love and care as well as some basic maintenance. Check your feet regularly for problems. This is especially true if you have diabetes or any other medical condition that causes poor circulation or numbness in your toes. If you do, check your feet every day so problems can be caught early on. Good circulation is essential. When you’re sitting down, put your feet up. If you’ve been sitting for a while, stretch your legs and feet. Give yourself a foot massage, or ask someone you love for a foot massage. A warm foot bath is also a good idea.

Could Hammertoes Cause Numbness

Hammer ToeOverview

Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning as it should. A hammertoes occurs when the joint at the end of the toe cannot straighten. Excessive rubbing of the hammer toe against the top of the shoe can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe causing pressure and discomfort.

Causes

Hammer toe usually affects the second toe. However, it may also affect the other toes. The toe moves into a claw-like position. The most common cause of hammer toe is wearing short, narrow shoes that are too tight. The toe is forced into a bent position. Muscles and tendons in the toe tighten and become shorter. Hammer toe is more likely to occur in women who wear shoes that do not fit well or have high heels and children who keep wearing shoes they have outgrown. The condition may be present at birth (congenital) or develop over time. In rare cases, all of the toes are affected. This may be caused by a problem with the nerves or spinal cord.

HammertoeSymptoms

The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes. There may be a bursa under the corn or instead of a corn, depending on the pressure. Most of the symptoms are due to pressure from footwear on the toe. There may Hammer toes be a callus under the metatarsal head at the base of the toe. Initially a hammer toe is usually flexible, but when longstanding it becomes more rigid.

Diagnosis

Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.

Non Surgical Treatment

In the early stages, the deformities from mallet toe, claw toe and hammertoe can be corrected. But if treatment is delayed too long, permanent stiffness can ensue which can only be corrected by surgery. The most effective treatment options are good fitting footwear. Shoes with a wide toebox will be more comfortable and will reduce the tension on the muscles and friction on the toes. Avoid high heels as they push your feet forwards to the front of the shoes. This increases the pressure on the toes, forcing them to bend more than usual. Shoes should ideally be half an inch longer than your longest toe. Exercises to strengthen and stretch the muscles can be really helpful. Simple things like trying to pick marbles up with your feet or scrunching up a towel underneath your foot can work well.

Surgical Treatment

Surgical Options: Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammer toes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatrist.

Hammer ToePrevention

wear sensible shoes. Here are some tips. Most people have one foot that’s bigger than the other. Fit your shoes to the bigger foot. Buy your shoes at the end of the day as your feet tend to swell a bit and you will get a better sense of fit. When you buy your shoes, wear the sock that you will be using when wearing that shoe – wear a sports sock when buyingtrainers, for example. As you get older, your feet get bigger. Get your feet measured every time you buy shoes. Don’t go by shoe sizes. Shoe sizes vary among manufacturers; a shoe is the right size only when it fits comfortably. The ball of your foot should fit into the widest part of the shoe. A shoe should be sturdy so that it only bends in the ball of the foot, exactly where your big toes bend. Any shoe that can be bent anywhere along the sole or twisted side to side is generally too flimsy. There should be at least 1.5 cm between the tip of your longest toe and the front of the shoe. Never buy shoes that feel tight and expect them to stretch with wearing. If you have prominent areas on your feet such as hammer toes and bunions, avoid shoes with a lot of stitching or multiple pieces of fabric, as these stitched areas tend not to stretch to accommodate various toe deformities. Your shoes shouldn’t ride up and down on your heel as you walk. The higher the heel, the less safe the shoe. Check children’s shoes regularly.

Hammer Toe Genetic Causes

Hammer ToeOverview

Hammer, mallet, and claw toes have distinctive differences that can assist you in determining what kind of toe problem you are dealing with. All three conditions deal with toes that are curved into abnormal positions, which possibly Hammer toe look strange and may cause pain. Typically, the big toe is not affected by these problems. A hammertoes tends to bend downward at the center of a toe joint. It generally affects your second toe. The affliction causes the center of your toe to rise and is often accompanied with a bony lump.

Causes

The muscles of each toe work in pairs. When the toe muscles get out of balance, a hammertoe can form. Muscle imbalance puts a lot of pressure on the toe’s tendons and joints. This pressure forces the toe into a hammerhead shape. How do the toe muscles get out of balance? There are three main reasons. Genes. you may have inherited a tendency to develop hammertoes because your feet are somewhat unstable, they may be flat or have a high arch. Arthritis. Injury to the toe, ill-fitting shoes are the main culprits. If shoes are too tight, too short, or too pointy, they push the toes out of balance. Pointy, high-heeled shoes put particularly severe pressure on the toes.

HammertoeSymptoms

The most obvious symptoms of this injury will be the the middle toe joint is permanently bent at an angle. In the beginning movement may still be possible but as time passes and the injury worsens the toe will be locked in place and possible require hammer toe correction surgery to fix. Another key indicator of hammer toe is that a lump or corn will form on top of the toe. The toe joint will be painful and walking can cause severe discomfort. Occasionally a callus may form on the sole of the injured foot. If you see any of these symptoms together or have been enduring pain for some time, seeing a podiatrist should be your next step.

Diagnosis

The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.

Non Surgical Treatment

Padding and Taping. Often this is the first step in a treatment plan. Padding the hammertoe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain. Medication. Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity. Orthotic Devices. Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammertoe deformity.

Surgical Treatment

Sometimes, if the deformity is severe enough or surgical modification is needed, the toe bones may be fused so that the toe does not bend. Buried wires are used to allow for the fusion to heal, and they remain in place after healing. Your skin is closed with fine sutures, which are typically removed seven to ten days after surgery. A dressing is used to help keep your toes in their new position. Dressings should not get wet or be removed. After surgery, your doctor may prescribe pain relievers, typically for the initial four to seven days. Most people heal completely within one month of surgery, with few complications, if any. Crutches or a cane may be needed to help you keep weight off your affected foot, depending on the procedure. Occasionally, patients receive a special post-op shoe or a walking boot that is to be worn during the healing process. Most people are able to shower normally after surgery, but must protect the dressing from getting wet. Many patients are allowed to resume driving within one week after the procedure, but care needs to be taken.

HammertoePrevention

Good circulation is essential. When you’re sitting down, put your feet up. If you’ve been sitting for a while, stretch your legs and feet. Give yourself a foot massage or trade foot massages with someone you love. A warm foot bath is also a good idea. Most people have one foot that’s bigger than the other. Fit your shoes to the bigger foot. Buy shoes at the end of the day, as feet tend to swell a bit and you will get a better sense of fit. When buying shoes, wear the socks that you will be using when wearing that shoe. For example, wear an athletic sock when buying athletic shoes and a dress sock when purchasing dress shoes. If the shoe does not feel good at the time of purchase, then it will never feel good.

What Are The Treatment Methods For Bunions?

Overview
Bunions Callous
A bunion is a very common foot deformity that develops over the first metatarsal phalageal joint of the big toe of the foot. The joint that joins the big toe to the foot is called the first MTP joint. When it becomes prominent and the big toe starts to become crooked this is known as a bunion. The term referring to deformity of the big toe as it becomes crooked is called Hallux Valgus. It is the bump itself that is known as the bunion. When it gets red and swollen over the bunion because it gets sore this is usually due to an inflamed soft tissue over the underlying bone.

Causes
Bunions are caused by a combination of factors, including a familial predisposition, and wearing high-heeled shoes that are tight and narrow at the front. Most bunions occur in women. Sometimes other foot problems accompany bunions, including calluses and hammertoes (angling downward of the lesser toes).
SymptomsBunions typically start out as a mild bump or outward bending of the big toe. Bunions at this stage are usually only a concern of appearance at this stage, and at this point they often don’t hurt much. Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the big toe gradually pull it farther and farther towards the second toe. Sometimes patients will find their first and second toes begin to press together too much, and they’ll often get a painful corn between those toes. As the bunion progresses, the big toe may begin to ride on top of the second toe, or vice versa, creating a second deformity. Others will develop bump pain at the site of the bony enlargement on the side of the foot. A painful bursa may develop at that site. This is particularly true in tight shoes. Many patients also develop a painful callus beneath the foot. Capsulitis and other types of metatarsalgia may develop in the joints beneath these calluses, particularly in the second and third metatarsophalangeal joints (the joints in the ball of the foot). Over time, with the toe held in a crooked position for enough time, arthritis develops in the big toe joint. This will usually result in decreased range of motion of that joint (a condition known as “Hallux Limitis”), which as a result, often causes the patient to changes in the way a patient walks. Often the patient walks in an “out-toed”, or duck-like, fashion, which very frequently causes secondary pain in the legs, knee, hip, and low back.

Diagnosis
A thorough medical history and physical exam by a physician is necessary for the proper diagnosis of bunions and other foot conditions. X-rays can help confirm the diagnosis by showing the bone displacement, joint swelling, and, in some cases, the overgrowth of bone that characterizes bunions. Doctors also will consider the possibility that the joint pain is caused by or complicated by Arthritis, which causes destruction of the cartilage of the joint. Gout, which causes the accumulation of uric acid crystals in the joint. Tiny fractures of a bone in the foot or stress fractures. Infection. Your doctor may order additional tests to rule out these possibilities.

Non Surgical Treatment
The first step in the treatment of Bunions, Corns, and Calluses is determining what is causing the problem. Check with your family doctor or Podiatrist (foot doctor) to find the best solution for your ailment. You can reduce the risk of Bunions, Corns, and Calluses by following these simple instructions. Wear properly-fitting footwear, socks, and stockings (not too tight or too loose). Wear footwear with a wide toe box (toe area). Wear footwear or arch supports which provide proper support, weight distribution, and shock absorption. Maintain a healthy weight. For early-stage Bunions, soaking your feet in warm water can provide temporary relief.
Bunions Callous

Surgical Treatment
Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

Prevention
Proper footwear may prevent bunions. Wear roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint. Medicine will not prevent or cure bunions.

Will Overpronation Of The Feet Need An Operation

Overview

Overpronation represents a dysfunction in the biomechanics of the body, and it is not a disease. Occasionally it may make your feet ache, but it need not be that much of a problem. If you wear comfortable shoes for overpronation such as stability shoes or motion control shoes for running, that is all that is needed in most cases to prevent foot problems from developing. If you overpronate to a high degree, you may need orthopaedic devices for your shoes which will ensure the maximum amount of correction.Foot Pronation

Causes

Over-pronation has different causes. Obesity, pregnancy, age or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Over-pronation is also very common with athletes, especially runners and most of them nowadays use orthotics inside their shoes. Over-pronation affects millions of people and contributes to a range of common complaints including sore, aching feet, ball of foot pain, heel Pain, achilles tendonitis, bunions, shin pain, tired, aching legs, knee pain and lower back pain. The most effective treatment solution for over-pronation is wearing an orthotic shoe insert. Orthotics correct over-pronation, thereby providing natural, lasting pain relief from many common biomechanical complaints.

Symptoms

If you overpronate, your symptoms may include discomfort in the arch and sole of foot, your foot may appear to turn outward at the ankle, your shoes wear down faster on the medial (inner) side of your shoes. Pain in ankle, shins, knees, or hips, especially when walking or running are classic symptoms of overpronation. Overpronation can lead to additional problems with your feet, ankles, and knees. Runners in particular find that overpronation can lead to shin splints, tarsal tunnel syndrome, plantar fasciitis, compartment syndrome, achilles tendonitis, bunions or hallux valgus, patello-femoral pain syndrome, heel spurs, metatarsalgia.

Diagnosis

You can test for pronation by looking at the leg and foot from the back. Normally you can see the Achilles Tendon run straight down the leg into the heel. If the foot is pronated, the tendon will run straight down the leg, but when it lies on the heel it will twist outward. This makes the inner ankle bone much more prominent than the outer ankle bone.Over Pronation

Non Surgical Treatment

Although there is no actual cure for over-pronation it is possible to correct or at least reduce this problem. In order to restore our normal foot function an ‘orthotic’ or orthotic insole device is placed inside the shoes. Orthotics are designed to realign the foot and ankle bones to their natural position. This in turn restores our normal foot function and it helps alleviate not only foot problems but also ailments in other parts of the body i.e. the legs, knees and lower back. In addition to wearing an orthotic, it is recommended to wear supportive shoes, like good quality athletic footwear with a firm heel counter and sufficient flexibility in the forefoot area.

Prevention

Pronation forces us to bear most of our weight on the inner border of our feet. Custom-made orthotics gently redistributes the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist out at the ankle, but will strike the ground normally when the orthotics is used. This action of the custom-made orthotics will help to prevent shin splints, ankle sprains, knee and hip pain, lower back pain, nerve entrapments, tendonitis, muscle aches, bunions, generalized fatigue, hammer toes, and calluses.

Could I Cure Severs Disease At Home ?

Overview

During AGS, and in specific reference to Sever?s disease, the heel bone grows faster than the Achilles tendon, resulting in an extremely tight Achilles tendon. Because the foot is one of the first parts of the body to grow to full size, and because the heel is not a very flexible area, it is especially susceptible to injury. The Achilles tendon (also called the heel cord) is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress (such as impact activities) on the tight Achilles tendon causes the tendon to pull on and damage the growth plate in the heel, resulting in swelling, tenderness, and pain.

Causes

Inflammation occurs at the insertion of the achilles tendon into the back of the heel due to a number of reasons. One or several of the following may cause the initiation of Sever?s disease. Rapid growth spurt. Tight calf muscles. Change in footwear (soccer boots / athletic shoes no heel). Excessive rolling in of feet. Poor warm up routine. Remember this condition usually settles as the growth plate fuses within 6-12 months.

Symptoms

This syndrome can occur unilaterally or bilaterally. The incidence of bilaterally is approximately 60%. Common signs and symptoms include posterior inferior heel pain (over the medial and lateral surface of the bone). Pain is usually absent when the child gets up in the morning. Increased pain with weight bearing, running or jumping (= activity-related pain). The area often feels stiff. The child may limp at the end of physical activity. Tenderness at the insertion of the tendons (= an avascular necrosis of the arthropathy). Limited ankle dorsiflexion range secondary to tightness of the Achilles tendon. Hard surfaces and poor-quality or worn-out athletic shoes contribute to increased symptoms. The pain gradually resolves with rest. Reliability or validity of methods used to obtain the ankle joint dorsiflexion or biomechanical malalignment data are not commented upon, thus reducing the quality of the data. Although pain and limping are mentioned as symptomatic traits, there have been no attempts to quantify the pain or its effect on the individual.

Diagnosis

A Podiatrist can easily evaluate your child?s foot, lower limbs and muscular flexibility, to identify if a problem exists. If a problem is identified, a simple treatment plan is put in place. Initial treatment may involve using temporary padding and strapping to control motion or to cushion the painful area and based on the success of this treatment, a long-term treatment plan will be put in place. This long-term treatment plan may or may not involve Foot Supports, Heel Raises, muscle stretching and or strengthening.

Non Surgical Treatment

Treatment depends on the severity of the condition, but may include relative rest and modified activity, a physiotherapist can help work out what, and how much, activity to undertake. Cold packs, apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking. Shoe inserts, small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term. Medication, pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor). Anti-inflammatory creams are also an effective management tool. Splinting or casting, in severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare. Time, generally the pain will ease in one to two weeks, although there may be flare-ups from time to time. Correction of any biomechanical issues, a physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition. Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Recovery

One of the most important things to know about Sever’s disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever’s disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away.