How to Treat Bunions

Bunions

What is it?
A bunion is an enlargement of the joint at the base of the big toe and is almost always accompanied with a hallux valgus, that is the deviation of the big toe to rewards the lesser toes. The enlargement of the joint creates problems with pain in the joint and pressure on the enlarged joint from the footwear. This can be due to an arthritis in the joint because of the deviation and the pressure from footwear can cause a bursitis swelling and pain. There is often corns on the adjacent toes. The most common cause of bunions is generally considered a combination of genetics, forefoot biomechanics combined with inadequate fitting footwear. Lots of questions get asked online about bunions and lots of different answers get given.

How to manage it?
As the pain from bunions is from two sources a different strategy is needed to manage it.

If the pain is due to the arthritis type symptoms inside the joint then the approach to this is generally the use of medication for pain relief and exercises to keep the joint mobile.

If the pain is due to pressure from the shoes on the enlarged joint then the approach is to use better fitting footwear and to use doughnut like pads to keep the pressure off the joint.

There is no way to make a bunion go away without surgery, all that can be done conservatively is to manage the symptoms using the two approaches outlined above. Generally this will be successful.

When to see the doctor?
It will be necessary to see the doctor for bunions if the Conservative self managed measures are not successful, in which case better advice can be given on how to self manage the problem. The other reason to see the doctor is that if these conservative measures are not successful or if you need surgery. Surgery is the only way to remove a bunion. There is also a high possibility that a bunion can occur after the surgery if the factors that cause the bunion, such as poor fitting shoes, are not addressed.

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An Abductory Twist

What is it?
An abductory twist, also sometimes called a medial heel whip is a sudden abduction or medial ‘whip’ of the heel just as the heel comes off the ground during gait. The cause is generally considered to be a foot that is overpronating when the leg is rotating in the opposite direction. These opposing motions continue to oppose each other until the weight comes of the heel and friction then can not stop the foot pronating it. There is also some thought that it could be due to a weakness of the adductor muscles in the hip.

How to manage it?
It is managed by managing the underlying cause of the overpronation and exercises to strengthen the hip adductor muscles.

When to see the doctor?
When the self managed treatment of the overpronation are failing to help. You will need to be assessed fro the exact cause that is underpinning it and a plan put in place to manage it.

Resources:
http://www.podiatryonline.tv/abductory-twist.htm
http://www.podiatryfaq.com/abductory-twist/

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Overpronation

What is it?
Overpronation is a problem that occurs when the ankle rolls inwards and the arch of the foot flattens. It is widely known in the running community and is widely assumed to be associated with a number of different running injuries, though there is a lot of debate about that. Overpronation has also been the basis in which running shoes are often used, though there is a lot of debate about that as well! Overpronation is not always a problem and there is a lot of misunderstanding about it. It can be associated with an abductory twist.

How to manage it?
As overpronation is not always a problem it does not always need treating. If it is contributing to a problem that you have, then yes it needs treating. The problem with overpronation is that there are many different casues, so there are many different treatments. The first line approach is to use supportive shoes and inserts.

When to see the doctor?
If that does not help, then you really need to see someone who knows enough about pverpronation to determine the casue, so can advise the appropriate treatment. Fpr some people it is muscle strengthening; for others it is foot orthotics; for others it is strecthing; and for others it is a more minimalist approach to running. To blindly apply one treatment ahead of another without determining the cause is just plain silly.

Resources:
http://podiatric.blogspot.com/2011/12/overpronation-in-runners.html
http://www.therunninginjury.com/my-advice-if-you-overpronat/22/
http://www.runresearchjunkie.com/the-nonsensical-understanding-of-overpronation/
http://www.ipodiatry.net/overpronation/
http://www.itsafootcaptain.com/pronation-mythology/

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Do Toning Shoes Help?

toning1
What are they?
Toning shoes area class of footwear that is what is considered unstable. They have designs in the sole that creates an environment in which the muscles of the foot and leg work harder and changes the alignment of the posture. The extra effort from the muscles is claimed to give an extra tone up, which is how the shoes got there name. The change in alignment also is claimed to help with some postural alignment problems. There is a lot of marketing hype associated with these shoes which is not supported by the scientific evidence.

Do they help?
The problem with toning shoes is that they help some people and do not help other people. Some people can walk fine in them, others fall over in them! They are more likely to help people with arthritis of the big toe joint than other problems. Some of the companies claim they help plantar fasciitis, but some people get plantar fasciitis using these shoes.

It is difficult to give clear advice on this. It is going to have to be a matter of trial and error to see if they can help your foot problem or not. If you want to try them, then the key os to use them only in small amounts initially and build up the use of them gradually.

For more, see:
PodoPaedia
Toning Shoes Today
Foot Info
Toning Shoes Market
Professor

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Achilles Tendon Rupture


What is it?
This occurs when the Achilles tendon tears, most often during sport when the knee is extended and the ankle dorsiflexes. The load during this can be too high for the tendon to take and it then tears. You know when it is happened as there is a gap in the tendon and you can’t raise up on your toes when standing.

How to manage it?
Put ice on it and get to the doctor. There is nothing you can do yourself!

What will the doctor do?
They will do one of two things. It will either be put in a cast or walking brace or it will be operated on. All the research has shown that the outcomes of the two methods are exactly the same, so it probably does not matter which methods is used.

Further information.
Also see: PodiaPaedia.

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Peroneal Tendonitis

Peroneal tendonitis is an overuse injury that happens in athletes. It can be a very persistent problem if not managed properly. The function of the peroneal muscles on the outside of the leg function to support the function of the foot on the ground and stop the foot from supinating or rolling outward at the ankle joint. This means that peroneal tendonitis is more common in those that want to roll outwards more at the ankle joint such as those with a higher arch profile. The symptoms tend to be in the tendons just about or just below the outer ankle bone (lateral malleolus). Only sometimes is there any swelling in the early stages.

How to manage peroneal tendonitis:
First the running has to be modified to reduce activity levels to a level that can be tolerated. Another activity such as swimming and cycling can be substituted to maintain fitness. ICE and other physical therapies can be used after the activity. The key to managing peorneal tendonitis is to use a lateral heel wedge, probably made of a rubber, in the shoe that is higher on the outside to stop the foot from wanting to roll outwards. This means that the peroneal muscles do not have to work as hard.

When to see the doctor:
When the above does not help, see the doctor.

References:
Podiatry Update | Clinical Boot Camp | Podiatry TV | Foot Info | Run Research Junkie

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Kohlers Disease

Kohlers disease is a problem if the growing navicular bone in the feet of children. It is due to an interruption of the blood supply to the bone. As the bone is at the top of the arch of the foot, it takes considerable load during walking so this disruption to the blood supply leads to a softening and deformity in the bone. The most common age of onset is around 5 years of age and it presents with pain over the top of the arch, sometimes with some swelling and it may lead to a limp.

What to do for it?
Don’t do anything, go to the doctor.

Resources:
Podiatry Arena

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Cracked Heels

What are they?
Cracked heels occur when the thick and dry skin around the edges of the heel splits. This will not heal as that skin is dead. The split in the skin will then try and tear the skin below which can become painful and bleed. The main risk factors for this problem are the thick dry skin that can build up around the heel; being overweight; and wearing shoes that are not closed in around the heel.

How to manage them?
The best way to manage these cracked heels is to remove the thick skin around the heels and keep it down. This is not easy to do and can be done with a heel file. This has to be done carefully if there is an active split present. After that, if there is a painful active crack present, and then use tape to hold the edges together. Leave the tape in place for at least several days so it can heel. Every time you walk on the crack without the tape, the split just opens up again. Once that has healed, the efforts to keep the thick and dry skin have to be kept down. This means the regular use of a file and the regular application of an emollient cream to soften the skin. The use of shoes that have a closed in heel needs to be worn to help keep the skin from splitting. This is not a ‘one off’ treatment and these strategies have to be kept up on a regular basis.

When to see the doctor?
You will need to see a skilled podiatrist then the above self-care strategies do not work. They will be able to meticulously remove all the dry and hard shin, so that the self-care plan has the best chance to work. They may also use heel cups in the worse cases to help prevent the cracks from happening.

Further information
ePodiatry

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The Circulation Booster

Circulation BoosterWhat is it?
The Circulation Booster is a product marketed with claims that it can boost the circulation to the foot and lower limb.

How does it work?
When we walk, the muscles in the leg contract. This contraction compresses the veins in the legs to help pump the blood back to the heart. This is good, healthy and how it is supposed to work. The Circulation Booster works by electrically stimulating the muscles to contract when you are sitting. This theoretically should help get the blood back to the heart.

Does it Work?
The research done on the Circulation Booster has shown that it does and can help the venous return and swelling around the ankle. It does not improve the arterial circulation or that circulation concerned with getting blood down to the foot and lower limb.

My Advice
You are better off going for a walk rather than sit there and have the muscles electrically stimulated. The walking will have the same effect at making the muscles contract to help return the blood back to the heart. The walking will also help the arterial circulation and be a lot better for you for a whole lot of other health reasons.

More Information:
Circulation Boosters: Good or Bad?

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Hallux Rigidus

What is hallux rigidus?

Hallux rigidus is a problem with their being no motion available at the big toe joint. We need that joint to pivot forward over, so if that joint does not move there is going to be a problem with walking. The restriction in motion will put strains on some of the other joints and alter the way that you walk. This can cause problems in other areas. The most common cause of hallux rigidus is osteoarthritis in the joint or some trauma that has damaged the joint. A hallux limitus is when the range of motion is restricted but the joint is not rigid. Both generally have a lump above the big toe joint.

How to treat hallux rigidus?

Once you have developed hallux rigidus there is very little that you can actually do. There is no way to restore the range of motion to the joint. Continuing to walk on it may be causing symptoms in other joints so a restriction in activity may be warranted. It is possible to try a toning shoe that has a rocker on the bottom on the bottom and this will make walking easier. Stretching and mobilization exercises may be helpful if there is some pain in the joint and motion is still possible.

When to see the doctor?

There are two options available to manage hallux rigidus

  1. A rocker may be placed on the outside of the shoe to make walking easier
  2. A spacer can be surgically placed in the joint to increase the range of motion

For a hallux limitus, there are come another surgical options that can be used to increase the range of motion and injection theapry can be used to help if the joint is painful.

Further Information:
Podiatry TV

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