There are not one but two different kinds of leg length discrepancies, congenital and acquired. Congenital implies that you are born with it. One leg is anatomically shorter than the other. As a result of developmental phases of aging, the human brain senses the walking pattern and recognizes some variance. The human body usually adapts by tilting one shoulder over to the "short" side. A difference of under a quarter inch isn't very abnormal, does not need Shoe Lifts to compensate and generally does not have a serious effect over a lifetime.

Shoe Lifts

Leg length inequality goes typically undiagnosed on a daily basis, yet this issue is simply solved, and can eradicate quite a few instances of chronic back pain.

Treatment for leg length inequality usually consists of Shoe Lifts. Many are economical, generally priced at less than twenty dollars, compared to a custom orthotic of $200 and up. 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.

Low back pain is the most prevalent health problem affecting people today. Over 80 million men and women experience back pain at some point in their life. It is a problem which costs businesses huge amounts of money yearly because of lost time and productivity. Innovative and better treatment solutions are always sought after in the hope of reducing the economic influence this condition causes.

Leg Length Discrepancy Shoe Lifts

People from all corners of the world suffer from foot ache as a result of leg length discrepancy. In a lot of these cases Shoe Lifts can be of very beneficial. The lifts are capable of eliminating any discomfort in the feet. Shoe Lifts are recommended by numerous professional orthopaedic doctors.

In order to support the human body in a healthy and balanced fashion, the feet have got a crucial job to play. Despite that, it is sometimes the most neglected zone of the human body. Some people have flat-feet which means there may be unequal force exerted on the feet. This will cause other body parts like knees, ankles and backs to be impacted too. Shoe Lifts guarantee that proper posture and balance are restored.
HammertoeOverview

A Hammer toes is a deformity of the second, third or fourth toes in which the main toe joint is bent upward like a claw. Initially, hammertoes are flexible and hammertoe can be corrected with simple measures. Left untreated, they can become fixed and require surgery. Hammertoe results from shoes that don?t fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and can?t stretch out.

Causes

Factors that may increase you risk of hammertoe and mallet toe include age. The risk of hammertoe and mallet toe increases with age. Your sex. Women are much more likely to develop hammertoe or mallet toe than are men. Toe length. If your second toe is longer than your big toe, it's at higher risk of hammertoe or mallet toe.

Hammer ToeSymptoms

People with a hammer toe will often find that a corn or callus will develop on the top of the toe, where it rubs against the top of the footwear. This can be painful when pressure is applied or when anything rubs on it. The affected joint may also be painful and appear swollen.

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. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).

Non Surgical Treatment

Treatment options for a hammertoe are based on the severity of the condition. A hammertoe caused by inappropriate footwear can be corrected by wearing properly fitting shoes. If a high arch caused the condition, wearing toe pads or insoles in your shoes can help. These pads work by shifting your toe?s position, which relieves pain and corrects the appearance of your toe.

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.

Overview
Bunions Hard Skin
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
A true bunion or hallux valgus results from a drifting inwards of the big toe metatarsal from its normal position closer to the second metatarsal. The bunion is the head of this first metatarsal which produces the prominence on the inner side of the now wider foot. Tendons run circumferentially around the metatarsal and toe. They both move and stabilise the toe under normal circumstances. In a bunion or hallux valgus, with the shift/displacement of the first metatarsal these tendons no longer lie in the correct axis and in fact act as a deforming force, contributing to the bunion condition.
SymptomsIf a foot bunion is developing, you may experience some of these symptoms. Bulge or bump on the outside of the base of your big toe. Swelling. Redness. Soreness. Thickening of the skin in that location. Corns or calluses. Limited movement of your big toe. Persistent or periodic pain. The pain you experience may be mild or severe. It may become increasingly difficult to walk in your normal shoes. The pressure on your other toes can cause your toenails to grow inward or your smaller toes to become bent.

Diagnosis
The doctor considers a bunion as a possible diagnosis when noting the symptoms described above. The anatomy of the foot, including joint and foot function, is assessed during the examination. Radiographs (X-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes when taken in a standing position.

Non Surgical Treatment
Long-term treatment of bunions must be directed towards re-balancing the foot, so that we no longer walk with our weight forced on to the inner border of the foot. This is accomplished by controlling and reducing pronation with the use of a high quality arch support or custom made orthotics. These devices comfortably re-balance the feet and overcome pronation. This reduces the abnormal weight forces on the big toe and its metatarsal head, allowing the feet to function normally. As a result, the deformity should not worsen, and the pain should gradually subside. If the foot is not re-balanced, the deformity and pain will become worse.
Bunion Pain

Surgical Treatment
If conservative treatment doesn't provide relief from your symptoms, you may need surgery. The goal of bunion surgery is to relieve discomfort by returning your toe to the correct position. There are a number of surgical procedures for bunions, and no one technique is best for every problem. Surgical procedures for bunions might involve removing the swollen tissue from around your big toe joint. Straightening your big toe by removing part of the bone. Realigning the long bone between the back part of your foot and your big toe, to straighten out the abnormal angle in your big toe joint. Joining the bones of your affected joint permanently. It's possible you may be able to walk on your foot immediately after a bunion procedure. However, full recovery can take weeks to months. To prevent a recurrence, you'll need to wear proper shoes after recovery. It's unlikely that you'll be able to wear narrower shoes after surgery. Surgery isn't recommended unless a bunion causes you frequent pain or interferes with your daily activities. Talk to your doctor about what you can expect after bunion surgery.

Prevention
To help prevent bunions be sure your shoes don't cramp or irritate your toes. Choose shoes with a wide toe box - there should be space between the tip of your longest toe and the end of the shoe. Your shoes should conform to the shape of your feet without squeezing or pressing any part of your foot. Avoid pointy-toed shoes.
Overview

Overpronation is the most common abnormality found in the foot, and for this reason, is the most studied. The term that most people attribute to overpronation is ?flat feet.? Pronation is the rolling in of the foot and the collapse of the arch. Every person pronates to some extent and this is a necessary moment in the normal walking cycle as it allows the forefoot to make complete contact with the ground. A foot that overpronates acts like a loose bag of bones during the walking cycle. This makes this type of foot very flexible but inefficient. The foot has to work much harder to propel the body, fatiguing easily and placing mechanical stresses on the lower body. We like to use the analogy of digging a hole in the dirt. Overpronating feet are like using a broom to dig the hole. It won?t break down quickly, but you will be digging for a very long time, or until eventually wear and tear will take effect. Wouldn?t you rather have a shovel to work with. This is in essence what an orthotic can do for your feet. This is why orthotics have become an evidence based treatment for so many foot ailments, as they can effectively manage overpronation.Overpronation is when a person pronates too much and for too long. This places excess stress on the tendons and ligaments in the foot and ankle.Over Pronation

Causes

There is a relationship between biomechanics and injury that is specific to each body part. Overall though, poor mechanics will either increase the landing forces acting on the body or increase the work to be done by the muscles. Both increase the stress, which, depending on the individual and the amount of running can become excessive and cause injury.

Symptoms

Common conditions that develop with prolonged overpronation typically include plantar fasciitis, achilles tendonitis, shin splints, posterior tibial stress syndrome and even IT band syndrome. With long term neglect you may see the development of bunyons, foot deformities and early onset of hip and knee arthritis.

Diagnosis

Look at the wear on your shoes and especially running trainers; if you overpronate it's likely the inside of your shoe will be worn down (or seem crushed if they're soft shoes) from the extra strain.Foot Pronation

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.

Surgical Treatment

HyProCure implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.
Overview

Sever's disease is a disorder of the growth plate of the calcaneus. Symptoms most often occur at the posterior (back of the heel) aspect of the growth plate but sometimes are experienced at the plantar aspect below the heel. The Achilles tendon attaches to the posterior aspect of the growth plate and the plantar fascia takes part of its origin from the plantar aspect. Sever?s disease occurs more often in boys than girls. The age of onset is usually between 8 to 12 years. Sever?s disease is believed to be caused by overuse. On x-ray the growth center first appears in girls between the ages of 4 to 6 years and boys aged 7 to 8 years. The centers fuse to the primary ossification center of the calcaneus in girls at approximately ages 12 to 14 on boys at ages 15 to 17.

Causes

The calcaneal apophysis develops as an independent center of ossification (possibly multiple). It appears in boys aged 9-10 years and fuses by age 17 years, it appears in girls at slightly younger ages. During the rapid growth surrounding puberty, the apophyseal line appears to be weakened further because of increased fragile calcified cartilage. Microfractures are believed to occur because of shear stress leading to the normal progression of fracture healing. This theory explains the clinical picture and the radiographic appearance of resorption, fragmentation, and increased sclerosis leading to eventual union. The radiographs showing fragmentation of the apophysis are not diagnostic, because multiple centers of ossification may exist in the normal apophysis, as noted. However, the degree of involvement in children displaying the clinical symptoms of Sever disease appears to be more pronounced. In a study of 56 male students from a soccer academy, of whom 28 had Sever disease and 28 were healthy control subjects, findings suggested that higher heel plantar pressures under dynamic and static conditions were associated with Sever disease, though it was not established whether the elevated pressures predisposed to or resulted from the disease. Gastrocnemius ankle equinus also appeared to be a predisposing factor.

Symptoms

Unilateral or bilateral heel pain. Heel pain during physical exercise, especially activities that require running or jumping or are high impact. Pain is often worse after exercise. A tender swelling or bulge on the heel that is painful on touch. Limping. Calf muscle stiffness first thing in the morning.

Diagnosis

Radiography. Most of the time radiographs are not helpful because the calcaneal apophysis is frequently fragmented and dense in normal children. But they can be used to exclude other traumas. Ultrasonography. could show the fragmentation of secondary nucleus of ossification of the calcaneus in severs?s disease. This is a safe diagnostic tool since there is no radiation. This diagnostic tool can also be used to exclude Achilles tendinitis and/or retrocalcaneal bursitis.

Non Surgical Treatment

Initially, Sever?s Disease is treated with rest, anti-inflammatory medication and softer shoes. Ice followed by heat is a common practice and heel cup orthotics have worked wonders for our young patients in the past. It can take anywhere from a few weeks to a year for these growth plates to naturally close - at which point Sever?s Disease disappears. Even though the condition does heal on its own, athletes are encouraged to seek treatment, rather than push through the pain. Simply ?dealing with it? and continuing to play sports despite the injury could lead to an impaired gait, a strained hip or a knee injury. Stretches to strengthen the leg muscles, leg compression wraps and over-the-counter acetaminophen or ibuprofen are also recommended treatments. In very rare cases, a podiatrist may recommend wearing a cast for two to twelve weeks.

Recovery

It may take several weeks or months for the pain to completely stop. In most cases severs disease goes away on its own with a little rest and time. However if you ignore the pain and play through it, the condition may get worse and may be more difficult to treat. When the pain is completely gone, you can slowly return to your previous level of activity. With future growth spurts the pain may return therefore keep up with the stretches and follow the advice given.
Overview

Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.Acquired Flat Foot




Causes

Flat footedness, most people who develop the condition already have flat feet. With overuse or continuous loading, a change occurs where the arch begins to flatten more than before, with pain and swelling developing on the inside of the ankle. Inadequate support from footwear may occasionally be a contributing factor. Trauma or injury, occasionally this condition may be due to fracture, sprain or direct blow to the tendon. Age, the risk of developing Posterior Tibial Tendon Dysfunction increases with age and research has suggested that middle aged women are more commonly affected. Other possible contributing factors - being overweight and inflammatory arthritis.




Symptoms

Often, this condition is only present in one foot, but it can affect both. Adult acquired flatfoot symptoms vary, but can swelling of the foot's inner side and aching heel and arch pain. Some patients experience no pain, but others may experience severe pain. Symptoms may increase during long periods of standing, resulting in fatigue. Symptoms may change over time as the condition worsens. The pain may move to the foot's outer side, and some patients may develop arthritis in the ankle and foot.




Diagnosis

It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal" treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.




Non surgical Treatment

Orthoses (insoles, functional orthoses, ankle supports, braces, ankle foot orthoses (AFOs)) - are usually custom-made to increase the functional stability of the foot and improve the mechanical properties of the tendon as well as reducing the actual degree of strain on the tendon. This reduces pain and inflammation. Physiotherapy - exercises and physiotherapy are often used to increase mobility, strengthen the tendon itself, stretch your Achilles tendon as well as reduce pain. Once the tendon has been stretched (stage one), the heel starts rolling outwards. Total immobilisation in a cast may help the symptoms to subside and prevent progression of the deformity in a smaller percentage of patients. Long-term use of orthoses may help stop progression of the deformity and reduce pain without surgery. Non-surgical treatment is unlikely to prevent progression to stage three and four but may be chosen by some patients who either are unsuitable for surgery or prefer not to have surgery.

Acquired Flat Foot




Surgical Treatment

The indications for surgery are persistent pain and/or significant deformity. Sometimes the foot just feels weak and the assessment of deformity is best done by a foot and ankle specialist. If surgery is appropriate, a combination of soft tissue and bony procedures may be considered to correct alignment and support the medial arch, taking strain off failing ligaments. Depending upon the tissues involved and extent of deformity, the foot and ankle specialist will determine the necessary combination of procedures. Surgical procedures may include a medial slide calcaneal osteotomy to correct position of the heel, a lateral column lengthening to correct position in the midfoot and a medial cuneiform osteotomy or first metatarsal-tarsal fusion to correct elevation of the medial forefoot. The posterior tibial tendon may be reconstructed with a tendon transfer. In severe cases (stage III), the reconstruction may include fusion of the hind foot,, resulting in stiffness of the hind foot but the desired pain relief. In the most severe stage (stage IV), the deltoid ligament on the inside of the ankle fails, resulting in the deformity in the ankle. This deformity over time can result in arthritis in the ankle.
Overview

Achilles TendonThe Achilles tendon, which connects the calf muscles to the heel bone, can withstand significant pressure from physical activities. Achilles tendinitis is estimated to account for approximately 11 percent of all running injuries, as the Achilles tendon provides the momentum to push off to walk or run. Achilles tendinitis, also called Achilles tendinopathy, results from overuse, injury or disease of the Achilles tendon, which causes the area to become inflamed. There are two types of Achilles tendinitis: Non-insertional Achilles Tendinitis - Fibers that are located in the middle portion of the tendon began to develop small tears that cause swelling and thickening. This type of tendinitis is usually found in younger people who are very active. Insertional Achilles Tendinitis - Develops where the tendon attaches to the heel bone in the lower part of the heel. Extra bone growth also called bone spurs form because of this tendinitis and can affect patients at any time, even if they are not active.

Causes

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including a bone spur that has developed where the tendon attaches to the heel bone, Sudden increase in the amount or intensity of exercise activity-for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance, Tight calf muscles, Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon, Bone spur-Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.

Symptoms

Most cases of Achilles tendonitis start out slowly, with very little pain, and then grow worse over time. Some of the more common symptoms include mild pain or an ache above the heel and in the lower leg, especially after running or doing other physical activities, pain that gets worse when walking uphill, climbing stairs, or taking part in intense or prolonged exercise, stiffness and tenderness in the heel, especially in the morning, that gradually goes away, swelling or hard knots of tissue in the Achilles tendon, a creaking or crackling sound when moving the ankle or pressing on the Achilles tendon, weakness in the affected leg.

Diagnosis

If you think you might have Achilles tendonitis, check in with your doctor before it gets any worse. Your doc will ask about the activities you've been doing and will examine your leg, foot, ankle, and knee for range of motion. If your pain is more severe, the doctor may also make sure you haven't ruptured (torn) your Achilles tendon. To check this, the doc might have you lie face down and bend your knee while he or she presses on your calf muscles to see if your foot flexes. Any flexing of the foot means the tendon is at least partly intact. It's possible that the doctor might also order an X-ray or MRI scan of your foot and leg to check for fractures, partial tears of the tendon, or signs of a condition that might get worse. Foot and ankle pain also might be a sign of other overuse injuries that can cause foot and heel pain, like plantar fasciitis and Sever's disease. If you also have any problems like these, they also need to be treated.

Nonsurgical Treatment

See your doctor or sports physiotherapist for further advice. You may be prescribed anti-inflammatory medicine and a rehabilitation programme. Sometimes, the ankle may be put into a walking boot or cast to immobilise the ankle in the short term. Gentle calf stretching is the first stage of rehabilitation. Don?t stretch to the point of pain. Strengthening the Achilles tendon is the second stage. Your doctor or sports physiotherapist will be able to advise you on exercises for this. Special exercises called eccentric calf raises, that contract the calf muscle as it is lengthening (during the lowering part of the movement), are the standard exercise used in the rehabilitation of Achilles tendon injuries. Sometimes a heel raise or orthotics may be useful. As symptoms resolve, resume normal weight-bearing activities gradually. Avoid running until all tenderness has gone. Swimming or cycling in low gear are good replacement activities.

Achilles Tendon

Surgical Treatment

Occasionally, conservative management of Achilles tendon conditions fails. This failure is more common in older male patients and those with longstanding symptoms, those who persist in full training despite symptoms or those who have uncorrected predisposing factors. In these cases, surgery may be indicated. It should be remembered, however, that the rehabilitation program, particularly for severe Achilles tendon injuries, is a slow, lengthy program. Surgery is only indicated when there is failure to progress in the rehabilitation program. Surgery should not be considered unless at least six months of appropriate conservative management has failed to lead to improvement.

Prevention

While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you're just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don't support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.
Overview

Achilles TendinitisThe Achilles tendon attaches your calf muscles to your heel. You use this tendon to jump, walk, run, and stand on the balls of your feet. Continuous, intense physical activity, like running and jumping, can cause inflammation of the Achilles. This is known as Achilles tendonitis (also spelled tendinitis). Achilles tendonitis can often be treated at home using simple strategies. However, if home treatment doesn?t work, it is important to see a doctor. If your tendonitis gets worse, it can lead to a tendon tear. You may need medication to ease the pain or a surgical repair.

Causes

Tendinitis can result from an injury or over-use. Improper stretching prior to exertion or incorrect form during physical activity can also contribute to the development of tendinitis. Some people, including those with ?flat feet,? tight tendons or arthritis, are particularly prone to tendinitis.

Symptoms

Symptoms of Achilles tendinitis and tendinosis include recurring localized heel pain, sometimes severe, along the achilles tendon during or after exercise. Pain often begins after exercise and gradually worsens. Morning tenderness or stiffness about an inch and a half above the point where the Achilles tendon is attached to the heel bone. Sluggishness in your leg. Mild to severe swelling. Stiffness that generally diminishes as the tendon warms up with use.

Diagnosis

In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient?s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays or other imaging modalities.

Nonsurgical Treatment

Treatment will focus on relieving the pain and preventing further injury. Your podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area for a period of time. (Often, a couple of weeks are needed for the tendon to heal.) Medication can help too. Your podiatrist may recommend or prescribe oral medication.

Achilles Tendonitis

Surgical Treatment

In most surgeries, damaged tissue is cleaned out before surgeons make the necessary repairs. However, a new minimally-invasive surgery to repair a torn Achilles tendon actually uses the damaged tissue to help repair the tear. The percutaneous Achilles repair system, or PARS technique, enables surgeons to better repair a torn Achilles tendon through a smaller incision. This procedure was recently performed at Houston Methodist Hospital to treat an NFL cornerback, getting him back on field for this season.

Prevention

So what are some of the things you can do to help prevent Achilles Tendinitis? Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Balancing Exercises, Any activity that challenges your ability to balance, and keep your balance, will help what's called proprioception, your body's ability to know where its limbs are at any given time. Plyometric Training, Plyometric drills include jumping, skipping, bounding, and hopping type activities. These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint. Footwear, Be aware of the importance of good footwear. A good pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion. Cool Down properly, Just as important as warming up, a proper cool down will not only help speed recovery, but gives your body time to make the transition from exercise to rest. Rest, as most cases of Achilles tendinitis are caused by overuse, rest is probably the single biggest factor in preventing Achilles injury. Avoid over training, get plenty of rest; and prevent Achilles tendinitis.
Overview

Achilles Tendon

An Achilles tendon rupture is when you tear the tissue that connects your calf muscle to your heel bone. Your Achilles tendon is very strong and flexible. It?s at the back of your ankle and connects your calf muscle to the bone in the heel of your foot (calcaneum). If you rupture your Achilles tendon, you can either partially or completely tear the tendon. Most people who injure their Achilles tendon are between 30 and 50 and don?t exercise regularly. It?s more common in men but can affect anyone. It happens most often in the left leg. This may be because most people are right-handed which means that they ?push off? more frequently with the left foot when running.




Causes

The Achilles tendon is most commonly injured by sudden plantarflexion or dorsiflexion of the ankle, or by forced dorsiflexion of the ankle outside its normal range of motion. Other mechanisms by which the Achilles can be torn involve sudden direct trauma to the tendon, or sudden activation of the Achilles after atrophy from prolonged periods of inactivity. Some other common tears can occur from overuse while participating in intense sports. Twisting or jerking motions can also contribute to injury. Fluoroquinolone antibiotics, famously ciprofloxacin, are known to increase the risk of tendon rupture, particularly achilles.




Symptoms

An Achilles tendon rupture is when the tendon that connects the heel bone to the calf muscle tears and the fibers separate. This happens mostly between the ages of 30 and 50, and usually is caused by sports. Symptoms of Achilles tendon rupture include the following. A pop or snap when the tendon tears. Severe pain in back of the ankle, making it nearly impossible to walk. Swelling and discoloration. Tenderness. Inability to rise on toes. A gap in the back of the ankle where the tendons are separated.




Diagnosis

On physical examination the area will appear swollen and ecchymotic, which may inhibit the examiners ability to detect a palpable defect. The patient will be unable to perform a single heel raise. To detect the presence of a complete rupture the Thompson test can be performed. The test is done by placing the patient prone on the examination table with the knee flexed to 90?, which allows gravity and the resting tension of the triceps surae to increase the dorsiflexion at the ankle. The calf muscle is squeezed by the examiner and a lack of planar flexion is noted in positive cases. It is important to note that active plantar flexion may still be present in the face of a complete rupture due to the secondary flexor muscles of the foot. It has been reported that up to 25% of patients may initially be missed in the emergency department due to presence of active plantar flexion and swelling over the Achilles tendon, which makes palpation of a defect difficult.




Non Surgical Treatment

Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome.

Achilles Tendon




Surgical Treatment

Surgery may be indicated directly following injury rather than conservative care. Repair of an achilles tendon rupture is greatly varied for each clinical situation. There may be a direct repair of the ends of the tendon with suture, or possibly a tendon graft used to augment the tendon. Post-operatively, the period of immobilization will depend on the size of the defect that was repaired and how it was completed. Usually the immobilization is between 6-10 weeks. This repair may allow for a complete return to normal function, but in many instances the healing is complicated with adhesions and a partial loss of range of motion. There may be a continued soft tissue defect noted and a permanent or prolonged swelling.




Prevention

Good flexibility of the calf muscles plays an essential role in the prevention of Achilles tendon injuries. It is also important to include balance and stability work as part of the training programme. This should include work for the deep-seated abdominal muscles and for the muscles that control the hip. This might at first appear odd, given the fact that the Achilles are a good distance from these areas, but developing strength and control in this area (core stability) can boost control at the knee and ankle joints. Training errors should be avoided. The volume, intensity and frequency of training should be monitored carefully, and gradually progressed, particularly when introducing new modes of training to the programme. Abrupt changes in training load are the primary cause of Achilles tendinopathy.
Overview

Achilles TendinitisAchilles Tendonitis is a term that commonly refers to an inflammation of the Achilles tendon or its covering. It is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action. Most experts now use the term Achilles tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendonitis out of habit.

Causes

Tendinitis can result from an injury or over-use. Improper stretching prior to exertion or incorrect form during physical activity can also contribute to the development of tendinitis. Some people, including those with ?flat feet,? tight tendons or arthritis, are particularly prone to tendinitis.

Symptoms

Paratenonitis presents in younger people. Symptoms start gradually and spontaneously. Aching and burning pain is noted especially with morning activity. It may improve slightly with initial activity, but becomes worse with further activity. It is aggravated by exercise. Over time less exercise is required to cause the pain. The Achilles tendon is often enlarged, warm and tender approximately 1 to 4 inches above its heel insertion. Sometimes friction is noted with gentle palpation of the tendon during ankle motion. Tendinosis presents similarly but typically in middle-aged people. If severe pain and limited walking ability are present, it may indicate a partial tear of the tendon.

Diagnosis

A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.

Nonsurgical Treatment

The first thing to do is to cut back your training. If you are working out twice a day, change to once a day and take one or two days off per week. If you are working out every day cut back to every other day and decrease your mileage. Training modification is essential to treatment of this potentially long lasting problem. You should also cut back on hill work and speed work. Post running ice may also help. Be sure to avoid excessive stretching. The first phase of healing should be accompanied by relative rest, which doesn't necessarily mean stopping running, but as I am emphasizing, a cut back in training. If this does not help quickly, consider the use of a 1/4 inch heel lift can also help. Do not start worrying if you will become dependent on this, concentrate on getting rid of the pain. Don't walk barefoot around your house, avoid excessively flat shoes, such as "sneakers", tennis shoes, cross trainers, etc. In office treatment would initially consist of the use of the physical therapy modalities of electrical stimulation, (HVGS, high voltage galvanic stimulation), and ultrasound. Your sports medicine physician should also carefully check your shoes. A heel lift can also be used and control of excessive pronation by taping can also be incorporated into a program of achilles tendonitis rehabilitation therapy. Orthotics with a small heel lift are often helpful.

Achilles Tendonitis

Surgical Treatment

Surgery usually isn't needed to treat Achilles tendinopathy. But in rare cases, someone might consider surgery when rubbing between the tendon and the tissue covering the tendon (tendon sheath) causes the sheath to become thick and fibrous. Surgery can be done to remove the fibrous tissue and repair any small tendon tears. This may also help prevent an Achilles tendon rupture.

Prevention

A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load compared to running without orthotics. This study indicates that foot orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,
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