Treatment Of Bursitis Of The Foot
Overview
The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The Achilles is attached to the heel bone (calcaneus). At the heel bone there is a bursa in front of the Achilles anchor point (bursae tendinis Achilles), as well as behind (bursae subcutanea calcanei). The bursa reduce the pressure against the heel bone.
Causes
Bursitis, tendinitis, and other soft tissue rheumatic syndromes typically result from one or more factors. These include: Play or work activities that cause overuse or injury to the joint areas Incorrect posture Stress on the soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint) Other diseases or conditions (rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction) Infection.
Symptoms
Pain or tenderness at the back of the heel around the Achilles region. Increased pain during activities with strong, repetitive calf contractions, walking (uphill), stair climbing, running, jumping. Pain may be worse with rest after activity (that night or the next morning) or at the beginning of the excercise. Pain when wearing shoes and the heel is getting rubbed. Bump forming on the back of the heel. Limping. Stiffness. Decreased range of motion. Redness and warmth (if the bursa gets infected).
Diagnosis
Like all other forms of bursitis, initially the physician will take down the history of symptoms experienced by the patient, this will be followed by a detailed physical examination which involves checking for inflammation signs like pain, redness, and warmth of the heel area. The physician might examine further by moving the ankle a little to determine the exact location of pain. Further diagnostic tests including x-ray, bone scans, and MRI scan might be suggested if required.
Non Surgical Treatment
It is important to treat bursitis in the early stages to reduce the symptoms, minimize damage and maintain motion and strength in your foot. Resting your ankle, using proper cushioning, wearing comfortable footwear and reducing any activities that add pressure on your bursa will help to reduce your pain and bursitis inflammation.
Surgical Treatment
Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to remove the inflamed bursa.
The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The Achilles is attached to the heel bone (calcaneus). At the heel bone there is a bursa in front of the Achilles anchor point (bursae tendinis Achilles), as well as behind (bursae subcutanea calcanei). The bursa reduce the pressure against the heel bone.
Causes
Bursitis, tendinitis, and other soft tissue rheumatic syndromes typically result from one or more factors. These include: Play or work activities that cause overuse or injury to the joint areas Incorrect posture Stress on the soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint) Other diseases or conditions (rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction) Infection.
Symptoms
Pain or tenderness at the back of the heel around the Achilles region. Increased pain during activities with strong, repetitive calf contractions, walking (uphill), stair climbing, running, jumping. Pain may be worse with rest after activity (that night or the next morning) or at the beginning of the excercise. Pain when wearing shoes and the heel is getting rubbed. Bump forming on the back of the heel. Limping. Stiffness. Decreased range of motion. Redness and warmth (if the bursa gets infected).
Diagnosis
Like all other forms of bursitis, initially the physician will take down the history of symptoms experienced by the patient, this will be followed by a detailed physical examination which involves checking for inflammation signs like pain, redness, and warmth of the heel area. The physician might examine further by moving the ankle a little to determine the exact location of pain. Further diagnostic tests including x-ray, bone scans, and MRI scan might be suggested if required.
Non Surgical Treatment
It is important to treat bursitis in the early stages to reduce the symptoms, minimize damage and maintain motion and strength in your foot. Resting your ankle, using proper cushioning, wearing comfortable footwear and reducing any activities that add pressure on your bursa will help to reduce your pain and bursitis inflammation.
Surgical Treatment
Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to remove the inflamed bursa.
Hammer Toe Signs Symptoms
Overview
A hammertoes can be flexible or rigid. Hammertoes often start out flexible and become rigid over time as your toe becomes accustomed to its crooked position. Flexible hammertoes are less serious than rigid hammertoes, as they can be easily diagnosed and treated in their initial stages. Flexible hammertoes are named as such because your affected toe still possesses some degree of movement.
Causes
Hammertoes are more commonly seen in women than men, due to the shoe styles women frequently wear: shoes with tight toe boxes and high heels. Genetics plays a role in some cases of hammertoes, as does trauma, infection, arthritis, and certain neurological and muscle disorders. But most cases of contracted toes are associated with various biomechanical abnormalities of the feet, such as flat feet and feet with abnormally high arches. These biomechanical abnormalities cause the muscles and tendons to be used excessively or improperly, which deforms the toes over time.
Symptoms
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
Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.
Non Surgical Treatment
Prescription strength medicines to decrease pain and inflammation. Physical Therapy. To strengthen poorly functioning muscles and stretch tight muscles that may be exacerbating the toes. Special ultrasound techniques may reduce inflammation. Custom Foot Orthotics. An orthotic with an exact mold of your foot to better align and support the foot to ease current discomfort and prevent future progression. Toe Splints or Pads. Specific pads may prevent pressure and physical irritation in shoes. Toe splints and toe spacers physically realign the toes and can lessen pain and halt or stall hammer toe progression. Cortisone injections are strong anti-inflammatory agents to decrease pain, and swelling directly at the toe region. Injections only treat the symptoms, and in some cases used in caution (and sparingly) they can weaken supporting ligaments of the toe(s).
Surgical Treatment
The technique the surgeon applies during the surgery depends on how much flexibility the person's affected toes still retain. If some flexibility has still been preserved in their affected toes, the hammer toes might be corrected through making a small incision into the toe so the surgeon can manipulate the tendon that is forcing the person's toes into a curved position. If, however, the person's toes have become completely rigid, the surgeon might have to do more than re-aligning the person's tendons. Some pieces of bone may have to be removed so the person's toe has the ability to straighten out. If this is the case, some pins are attached onto the person's foot afterwards to fix their bones into place while the injured tissue heals.
Prevention
The best first step you can take is to evaluate your shoe choices. Ditch any shoes that aren?t serving your feet well. Shoes that crowd the front of your foot, especially around your toes, aggravate the existing condition and can also cause the condition hammertoes to develop. If you suspect the development of hammertoe, you may also try using protective pads to prevent irritation and the development of corns. Custom orthotics to correct muscle imbalances in your feet may also help prevent hammertoe.
Could Hammer Toe Contribute To Unbalance
Overview
A Hammer toes is a toe that tends to remain bent at the middle joint in a claw-like position. There are 2 types of hammer toe. Flexible hammer toe, can be straightened by hand. Rigid hammer toe, cannot be pulled straight and can be extremely painful. The position of the toe can also lead to corns or calluses. These may also be painful. Hammer toe may be present at birth or develop later in life due to tendons that have tightened, causing the toe's joints to curl downward. Occasionally, all toes may be bent. This may be due to problems with the peripheral nerves or the spinal cord.
Causes
Wearing ill-fitting shoes is probably the main cause of hammer toe. As the toe bends, tendons add to the problem by contracting in such a way that the bending is reinforced to the point of becoming permanent. In some cases, tendons that are abnormal to begin with may start the bending process.
Symptoms
The most obvious symptom of hammertoe is the bent, hammer-like or claw-like appearance of one or more of your toes. Typically, the proximal joint of a toe will be bending upward and the distal joint will be bending downward. In some cases, both joints may bend downward, causing the toes to curl under the foot. In the variation of mallet toe, only the distal joint bends downward. Other symptoms may include Pain and stiffness during movement of the toe, Painful corns on the tops of the toe or toes from rubbing against the top of the shoe's toe box, Painful calluses on the bottoms of the toe or toes, Pain on the bottom of the ball of the foot, Redness and swelling at the joints. If you have any of these symptoms, especially the hammer shape, pain or stiffness in a toe or toes, you should consider consulting your physician. Even if you're not significantly bothered by some of these symptoms, the severity of a hammertoe can become worse over time and should be treated as soon as possible. Up to a point hammertoes can be treated without surgery and should be taken care of before they pass that point. After that, surgery may be the only solution.
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
Surgical correction is needed to bring the toe into a corrected position and increase its function. Correction of the hammer toes is a simple outpatient surgery, with limited downtime. The best option is to fuse the deformed and contracted toe into a straight position. This limits the need for future surgery and deformity return. A new pin that absorbs in the bone or small screw is used by the Foot and Ankle Institute to avoid the need for a metal pin protruding from the toe during recovery. Although the absorbable pin is not for everyone, it is Hammer toe much more comfortable than the pin protruding from the end of the toe. In certain cases, a removal of a small area of bone in the deformity area will decrease pain and limit the need for a surgical waiting period that is found with fusions. Although the toe is not as stable as with a fusion, in certain cases, an arthroplasty is the best option.
What Is Tailor'S Bunion?
Overview
In medical terms, a bunion, or hallux valgus, is a bony bump that forms around the joint at the base of your big toe. This joint is one of the most important parts of your foot, bearing most of your body weight. The bony bump is caused by the head of the first metatarsal bone (the long bone) behind the big toe angling out from the foot. This causes the joint to swell, pushing the big toe in towards the adjacent toes. The result is pain on the side of your foot, arch pain, and discomfort throughout the adjacent toes as well.
Causes
Bunions are most often caused by faulty foot mechanics. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity progressively worse. That means you may experience symptoms sooner.
Symptoms
Signs and symptoms of a bunion include the base of the big toe is swollen and sticks out. The big toe is often bent towards the other toes, and sometimes the second toe is pushed to overlap the third toe. Skin around the big toe joint is red and sore. Thickened skin at the base of the big toe. Pain in the big toe or foot. Wearing shoes is painful. Pain or difficulty when walking.
Diagnosis
Your doctor will be able to diagnose a bunion by asking about your symptoms and examining your feet. You may also have blood tests to rule out any other medical conditions, such as rheumatoid arthritis or gout, although this is rare. Your doctor may refer you to a podiatrist or chiropodist (healthcare professionals who specialise in conditions that affect the feet).
Non Surgical Treatment
You can try over-the-counter remedies like pads to stop them rubbing, or take painkillers such as paracetamol or ibuprofen if they play up. Devices that fit into your shoe, called orthotics, or splints that you wear at night, can slow the progression of bunions. If these don't help and the bunion is causing a painful and substantial deformity that?s seriously limiting your footwear, your GP will probably refer you to see a podiatrist, medical professionals who specialise in feet. They can give further advice about non-invasive treatments and also refer you for an operation, either with a podiatric or orthopaedic (bone) surgeon, ultimately the only thing that can correct the gnarly blighters. You can visit a podiatrist privately, which will cost anything from ?140-?200. But Mike O?Neill, spokesperson for the Society of Podiatrists and Chiropodists, suggest always going via your GP, who will know the best qualified. Such is the complexity of the bone structure of the foot, there are more than 130 different surgical procedures for bunions. One person?s op may be very different from another?s, so be wary of sounding out a friend about theirs. 
Surgical Treatment
Surgery should only be considered for bunions that are painful, not for correction of the cosmetic appearance! The primary indication for operative intervention should be pain that is not relieved by appropriate non-operative management. Although symptom-free bunions can slowly increase in size over time surgical treatment is not recommended unless significant pain symptoms develop. The prolonged recovery time associated with most bunion operations, combined with the potential for complications means that patients should be extremely cautious of undergoing bunion surgery for purely cosmetic reasons.
Study Overpronation
Overview
Pronation is the natural act of the body spreading the impact of walking, jogging or running throughout the foot evenly. As the foot strikes the ground, the ankle naturally rolls inward absorbing the shock of the ground and mobilizing to the terrain. Overpronation is when the ankle of the foot rolls in past its normal 15? of inward rotation. The cause of this could be many things such as foot type, biomechanics, or compensation strategies. People with flat feet often, although not always, overpronate.
Causes
Generally fallen arches are a condition inherited from one or both parents. In addition, age, obesity, and pregnancy cause our arches to collapse. Being in a job that requires long hours of standing and/or walking (e.g. teaching, retail, hospitality, building etc) contributes to this condition, especially when standing on hard surfaces like concrete floors. Last, but not least unsupportive footwear makes our feet roll in more than they should.
Symptoms
Eventually, over-pronation can lead to a full list of maladies including flat feet, plantar fasciitis, plantar fibroma, neuromas, heel spurs, shin splints, ankle sprains, bunions, hammertoes, calluses, and pain in the arches, knee, hip and lower back. But it doesn?t have to go that far, because there are steps we can take to correct the over-pronation. In the vast majority of cases, we?ll prescribe custom foot orthotics, which will realign your ankles, redistribute the weight, support the arch and reduce the twisting. Many orthotics will fit snugly into your normal shoes. Although we?ll also take a look at the type of shoes you wear to see if they are contributing to the problem.
Diagnosis
One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).
Non Surgical Treatment
Side Step with Opposite Reach. This exercise is designed to load the "bungee cord system" of the gluteal muscle and its opposite, latissimus dorsi muscle to keep the foot from overpronating. Because the opposite arm swings across the front leg when walking, this exercise creates tension in the muscles all the way from the front foot, across the back of the hips and back, to the fingers of the opposite hand. Movement Directions. Stand with left foot on top of the dome of the BT. (Note: For added balance, the right foot can tap on the ground, if needed). Reach right leg out to the side of the BT, and tap the ground while squatting down on the left side and reaching right arm across the left knee. Push down with left big toe while squatting. This activates the arch of the left foot and strengthens all the stabilizing muscles on the left side of the lower body. Return to starting position. Perform 8 to 10 repetitions on each leg.
Prevention
Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity or sport. Without a proper warm up the muscles and tendons around your feet, ankles and lower legs will be tight and stiff. There will be limited blood flow to the lower legs, which will result in a lack of oxygen and nutrients for those muscles. Click here for a detailed explanation of how, why and when to perform your warm up. Secondly, flexible muscles are extremely important in the prevention of most ankle and lower leg injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of motion. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.
Pronation is the natural act of the body spreading the impact of walking, jogging or running throughout the foot evenly. As the foot strikes the ground, the ankle naturally rolls inward absorbing the shock of the ground and mobilizing to the terrain. Overpronation is when the ankle of the foot rolls in past its normal 15? of inward rotation. The cause of this could be many things such as foot type, biomechanics, or compensation strategies. People with flat feet often, although not always, overpronate.
Causes
Generally fallen arches are a condition inherited from one or both parents. In addition, age, obesity, and pregnancy cause our arches to collapse. Being in a job that requires long hours of standing and/or walking (e.g. teaching, retail, hospitality, building etc) contributes to this condition, especially when standing on hard surfaces like concrete floors. Last, but not least unsupportive footwear makes our feet roll in more than they should.
Symptoms
Eventually, over-pronation can lead to a full list of maladies including flat feet, plantar fasciitis, plantar fibroma, neuromas, heel spurs, shin splints, ankle sprains, bunions, hammertoes, calluses, and pain in the arches, knee, hip and lower back. But it doesn?t have to go that far, because there are steps we can take to correct the over-pronation. In the vast majority of cases, we?ll prescribe custom foot orthotics, which will realign your ankles, redistribute the weight, support the arch and reduce the twisting. Many orthotics will fit snugly into your normal shoes. Although we?ll also take a look at the type of shoes you wear to see if they are contributing to the problem.
Diagnosis
One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).
Non Surgical Treatment
Side Step with Opposite Reach. This exercise is designed to load the "bungee cord system" of the gluteal muscle and its opposite, latissimus dorsi muscle to keep the foot from overpronating. Because the opposite arm swings across the front leg when walking, this exercise creates tension in the muscles all the way from the front foot, across the back of the hips and back, to the fingers of the opposite hand. Movement Directions. Stand with left foot on top of the dome of the BT. (Note: For added balance, the right foot can tap on the ground, if needed). Reach right leg out to the side of the BT, and tap the ground while squatting down on the left side and reaching right arm across the left knee. Push down with left big toe while squatting. This activates the arch of the left foot and strengthens all the stabilizing muscles on the left side of the lower body. Return to starting position. Perform 8 to 10 repetitions on each leg.
Prevention
Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity or sport. Without a proper warm up the muscles and tendons around your feet, ankles and lower legs will be tight and stiff. There will be limited blood flow to the lower legs, which will result in a lack of oxygen and nutrients for those muscles. Click here for a detailed explanation of how, why and when to perform your warm up. Secondly, flexible muscles are extremely important in the prevention of most ankle and lower leg injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of motion. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.
What Are The Causes Of Severs Disease?
Overview
Sever?s disease is a heel problem that is the most common cause of heel pain that commonly occurs in children. It is caused by repetitive use and overuse of the heel while it is still growing, therefore is more common in active children and teenagers. Despite the name, Sever?s Disease like Osgood- Schlatter disease is caused by overuse and is not a disease.
Causes
Sever's disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. Boys, 10 to 12 years old.
Symptoms
The symptoms include pain, tenderness, swelling or redness in the heel, and they might have difficulty walking or putting pressure on the heel. If you notice that your child suddenly starts walking around on their toes because their heels hurt, that?s a dead giveaway. Kids who play sports might also complain of foot pain after a game or practice. As they grow, the muscles and tendons will catch up and eventually the pressure will subside along with the pain. But in the meantime, it can become very uncomfortable.
Diagnosis
A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.
Non Surgical Treatment
Treatment of Severs disease usually involves a combination of an accurate analysis of your child?s gait, muscles, tendons, ligaments and joints is a crucial first step. Specific stretching and strengthening exercises often make up part of the treatment. Anti-inflammatory measures such as ice baths after exercise can be helpful in the short term. Footwear review, assessment and advice is important. Orthotic devices are often needed to firstly control any abnormal traction or tension on the heel growth plate and, secondly, too unload the ground reaction forces on the heel bone. Podiatry Care has podiatrists with specific paediatric training enabling them to utilise treatment options to relieve heel pain in children very quickly. If your child is struggling to play sport, see a Podiatry Care podiatrist near you. In severe cases modification to activity levels may be required. Treatment of Severs disease does NOT require surgery. This foot condition responds very well to conservative treatment.
Sever?s disease is a heel problem that is the most common cause of heel pain that commonly occurs in children. It is caused by repetitive use and overuse of the heel while it is still growing, therefore is more common in active children and teenagers. Despite the name, Sever?s Disease like Osgood- Schlatter disease is caused by overuse and is not a disease.
Causes
Sever's disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. Boys, 10 to 12 years old.
Symptoms
The symptoms include pain, tenderness, swelling or redness in the heel, and they might have difficulty walking or putting pressure on the heel. If you notice that your child suddenly starts walking around on their toes because their heels hurt, that?s a dead giveaway. Kids who play sports might also complain of foot pain after a game or practice. As they grow, the muscles and tendons will catch up and eventually the pressure will subside along with the pain. But in the meantime, it can become very uncomfortable.
Diagnosis
A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.
Non Surgical Treatment
Treatment of Severs disease usually involves a combination of an accurate analysis of your child?s gait, muscles, tendons, ligaments and joints is a crucial first step. Specific stretching and strengthening exercises often make up part of the treatment. Anti-inflammatory measures such as ice baths after exercise can be helpful in the short term. Footwear review, assessment and advice is important. Orthotic devices are often needed to firstly control any abnormal traction or tension on the heel growth plate and, secondly, too unload the ground reaction forces on the heel bone. Podiatry Care has podiatrists with specific paediatric training enabling them to utilise treatment options to relieve heel pain in children very quickly. If your child is struggling to play sport, see a Podiatry Care podiatrist near you. In severe cases modification to activity levels may be required. Treatment of Severs disease does NOT require surgery. This foot condition responds very well to conservative treatment.
Posterior Tibial Tendon Dysfunction Orthotic Treatment
Overview
Adult-Acquired Flat Foot Deformity (AAFFD) is most commonly caused by a progressive degeneration of the tendon (tibialis posterior) that supports the arch of the foot. As the tendon ages or is subjected to repetitive trauma, it stretches out over time, the natural arch of the foot becomes less pronounced and the foot gradually flattens out. Although it is uncertain why this occurs, the problem is seen equally among men and women - at an increasing frequency with age. Occasionally, a patient will experience a traumatic form of the condition as a result of a fall from a height or abnormal landing during aerial sports such as gymnastics or basketball. 
Causes
Flat feet causes greater pressure on the posterior tibial tendon than normal. As the person with flat feet ages, the muscles, tendons and ligaments weaken. Blood supplies diminish as arteries narrow. These conditions are magnified for obese patients because of their increased weight and atherosclerosis. Finally, the tendon gives out or tears. Most of the time, this is a slow process. Once the posterior tibial tendon and ligaments stretch, body weight causes the bones of the arch to move out of position. The foot rotates inward (pronation), the heel bone is tilted to the inside, and the arch appears collapsed. In some cases, the deformity progresses until the foot dislocates outward from the ankle joint.
Symptoms
Patients will usually describe their initial symptoms as "ankle pain", as the PT Tendon becomes painful around the inside of the ankle joint. The pain will become more intense as the foot flattens out, due to the continued stretching and tearing of the PT Tendon. As the arches continue to fall, and pronation increases, the heel bone (Calcaneus) tilts into a position where it pinches against the ankle bone (Fibula), causing pain on both the inside and outside of the ankle. As the foot spends increased time in a flattened, or deformed position, Arthritis can begin to affect the joints of the foot, causing additional pain.
Diagnosis
In the early stages of dysfunction of the posterior tibial tendon, most of the discomfort is located medially along the course of the tendon and the patient reports fatigue and aching on the plantar-medial aspect of the foot and ankle. Swelling is common if the dysfunction is associated with tenosynovitis. As dysfunction of the tendon progresses, maximum pain occurs laterally in the sinus tarsi because of impingement of the fibula against the calcaneus. With increasing deformity, patients report that the shape of the foot changes and that it becomes increasingly difficult to wear shoes. Many patients no longer report pain in the medial part of the foot and ankle after a complete rupture of the posterior tibial tendon has occurred; instead, the pain is located laterally. If a fixed deformity has not occurred, the patient may report that standing or walking with the hindfoot slightly inverted alleviates the lateral impingement and relieves the pain in the lateral part of the foot.
Non surgical Treatment
The adult acquired flatfoot is best treated early. Accurate assessment by your doctor will determine which treatment is suitable for you. Reduce your level of activity and follow the RICE regime. R - rest as often as you are able. Refrain from activity that will worsen your condition, such as sports and walking. I - ice, apply to the affected area, ensure you protect the area from frostbite by applying a towel over the foot before using the ice pack. C - compression, a Tubigrip or elasticated support bandage may be applied to relieve symptoms and ease pain and discomfort. E - elevate the affected foot to reduce painful swelling. You will be prescribed pain relief in the form of non-steroidal antiinflammatory medications (if you do not suffer with allergies or are asthmatic). Immobilisation of your affected foot - this will involve you having a below the knee cast for four to eight weeks. In certain circumstances it is possible for you to have a removable boot instead of a cast. A member of the foot and ankle team will advise as to whether this option is suitable for you. Footwear is important - it is advisable to wear flat sturdy lace-up shoes, for example, trainers or boots. This will not only support your foot, but will also accommodate orthoses (shoe inserts). 
Surgical Treatment
Surgical treatment should be considered when all other conservative treatment has failed. Surgery options for flatfoot reconstruction depend on the severity of the flatfoot. Surgery for a flexible flatfoot deformity (flatfoot without arthritis to the foot joints) involves advancing the posterior tibial tendon under the arch to provide more support and decrease elongation of the tendon as well as addressing the hindfoot eversion with a osteotomy to the calcaneus (surgical cut in the heel bone). Additionally, the Achilles tendon may need to be lengthened because of the compensatory contracture of the Achilles tendon with flatfoot deformity. Flatfoot deformity with arthritic changes to the foot is considered a rigid flatfoot. Correction of a rigid flatfoot deformity usually involves surgical fusion of the hindfoot joints. This is a reconstructive procedure which allows the surgeon to re-position the foot into a normal position. Although the procedure should be considered for advanced PTTD, it has many complications and should be discussed at length with your doctor.
