Therapy For Severs Disease
Overview
Calcaneal apophysitis (Sever?s disease) is the most common cause of heel pain in young athletes. Calcaneal apophysitis is a painful inflammation of the heel?s calcaneal apophysis growth plate, believed to be caused by repetitive microtrauma from the pull of the Achilles tendon on the apophysis. Patients with calcaneal apophysitis may have activity-related pain in the posterior aspect of the heel. 60 percent of patients report bilateral pain. This condition is usually treated conservatively with stretching and arch supports. The young athlete should be able to return to normal activities as the pain decreases. Calcaneal apophysitis (Sever?s Disease) may last for months. Increasing pain, despite measures listed below, warrants a return visit to the physician.
Causes
The cause of the pain in Severs disease is thought to be the tractional forces applied to the growth plate of the heel bone by the Achilles tendon at the rear of the heel bone and the plantar fascia just beneath the heel bone. This pulling force by the Achilles tendon on the growth plate is often aggravated by tight calf muscles and excessively pronated feet (i.e. feet that ?roll in? too far).
Symptoms
The patient complains of activity related pain that usually settles with rest. On Examination the heel bone - or calcaneum - is tender on one or both sides. The gastrocnemius and soleus muscles (calf muscles) may be tight and bending of the ankle might be limited because of that. Foot pronation (rolling in) often exacerbates the problem. There is rarely anything to see and with no redness or swelling and a pain that comes and goes mum and dad often wait before seeking advice on this condition. The pain may come on partway through a game and get worse or come at the end of the game. Initially pain will be related only to activity but as it gets worse the soreness will still be there the next morning and the child might limp on first getting up.
Diagnosis
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot.
Non Surgical Treatment
If your child lets you know that his heels are hurting, schedule a doctor's appointment. Your family doctor may or may not refer you to a podiatrist. Treatment for Sever's Disease typically consists of one or more of the following steps. Reducing physical activity. Because Sever's Disease appears to be most common in athletic children, reducing exercise periods will relieve pressure on the heel bones, thereby reducing pain. Your doctor may recommend that your child take a complete break from athletic activity for a set amount of time. Icing the heel bones can help to lower both inflammation and pain levels. Use a cold pack or wrap ice in a towel and apply it to the heels. A new exercise regimen that involves simple stretches designed to lengthen the calf muscles and tendons. Your doctor may prescribe the use of orthotic shoe inserts that will assist your child in maintaining a good level of physical activity. HTP Heel Seats may be an excellent option and have been purchased by many parents as an effective aide for children suffering from Sever's Disease. Read about HTP Heel Seats here and ask your doctor if they are right for your child's unique case. In extreme cases, a doctor may recommend a plaster cast or boot, but typically only if other less cumbersome solutions fail to reduce pain. Some doctors may prescribe anti-inflammatory medications. Never give these to a child yourself, without first seeking a doctor's advice. Some medications carry the risk of serious side effects for children. Only give medications if specifically prescribed your child's physician.
Recovery
One of the most important things to know about Sever's disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever's disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away. Although Sever's disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child's growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.
Calcaneal apophysitis (Sever?s disease) is the most common cause of heel pain in young athletes. Calcaneal apophysitis is a painful inflammation of the heel?s calcaneal apophysis growth plate, believed to be caused by repetitive microtrauma from the pull of the Achilles tendon on the apophysis. Patients with calcaneal apophysitis may have activity-related pain in the posterior aspect of the heel. 60 percent of patients report bilateral pain. This condition is usually treated conservatively with stretching and arch supports. The young athlete should be able to return to normal activities as the pain decreases. Calcaneal apophysitis (Sever?s Disease) may last for months. Increasing pain, despite measures listed below, warrants a return visit to the physician.
Causes
The cause of the pain in Severs disease is thought to be the tractional forces applied to the growth plate of the heel bone by the Achilles tendon at the rear of the heel bone and the plantar fascia just beneath the heel bone. This pulling force by the Achilles tendon on the growth plate is often aggravated by tight calf muscles and excessively pronated feet (i.e. feet that ?roll in? too far).
Symptoms
The patient complains of activity related pain that usually settles with rest. On Examination the heel bone - or calcaneum - is tender on one or both sides. The gastrocnemius and soleus muscles (calf muscles) may be tight and bending of the ankle might be limited because of that. Foot pronation (rolling in) often exacerbates the problem. There is rarely anything to see and with no redness or swelling and a pain that comes and goes mum and dad often wait before seeking advice on this condition. The pain may come on partway through a game and get worse or come at the end of the game. Initially pain will be related only to activity but as it gets worse the soreness will still be there the next morning and the child might limp on first getting up.
Diagnosis
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot.
Non Surgical Treatment
If your child lets you know that his heels are hurting, schedule a doctor's appointment. Your family doctor may or may not refer you to a podiatrist. Treatment for Sever's Disease typically consists of one or more of the following steps. Reducing physical activity. Because Sever's Disease appears to be most common in athletic children, reducing exercise periods will relieve pressure on the heel bones, thereby reducing pain. Your doctor may recommend that your child take a complete break from athletic activity for a set amount of time. Icing the heel bones can help to lower both inflammation and pain levels. Use a cold pack or wrap ice in a towel and apply it to the heels. A new exercise regimen that involves simple stretches designed to lengthen the calf muscles and tendons. Your doctor may prescribe the use of orthotic shoe inserts that will assist your child in maintaining a good level of physical activity. HTP Heel Seats may be an excellent option and have been purchased by many parents as an effective aide for children suffering from Sever's Disease. Read about HTP Heel Seats here and ask your doctor if they are right for your child's unique case. In extreme cases, a doctor may recommend a plaster cast or boot, but typically only if other less cumbersome solutions fail to reduce pain. Some doctors may prescribe anti-inflammatory medications. Never give these to a child yourself, without first seeking a doctor's advice. Some medications carry the risk of serious side effects for children. Only give medications if specifically prescribed your child's physician.
Recovery
One of the most important things to know about Sever's disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever's disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away. Although Sever's disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child's growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.
What Will Be The Causes And Signs Or Symptoms Of Achilles Tendon Rupture
Overview
The Achilles tendon is a conjoined tendon composed of the gastrocnemius and soleus muscles with occasional contribution from the plantaris muscle, and it inserts on the calcaneal tuberosity. The plantaris muscle is absent in 6% to 8% of individuals. The Achilles tendon is approximately 15-cm long and is the largest and strongest tendon in the human body. The tendon spirals approximately 90? from its origin to its insertion and this twisting produces an area of stress approximately 2- to 5-cm proximal to its insertion. The tendon has no true synovial sheath; instead it is wrapped in a paratenon. The Achilles tendon experiences the highest loads of any tendon in the body, and bears tensile loads up to 10 times body weight during athletic activities. The tendon most commonly ruptures in a region 2- to 6-cm proximal to its insertion.
Causes
The Achilles tendon is a strong bands of fibrous connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel bone, producing movement. The Achilles tendon ruptures because the load applied to it is greater than the tendon's ability to withstand that load. This usually occurs as a result of a sudden, quick movement where there is a forceful stretch of the tendon or a contraction of the muscles eg: jumping, sprinting, or pushing off to serve in tennis. This occurs most often in sports that require a lot of stopping and starting (acceleration-deceleration sports) such as tennis, basketball, netball and squash. The Achilles tendon is on average 15cm in length. Most ruptures occur 2-6cm above where the tendon inserts into the heel bone. This is the narrowest portion of the Achilles tendon and is also the area with the poorest blood supply. achilles tendon rupture is most common when the muscles and tendon have not been adequately stretched and warmed up prior to exercise, or when the muscles are fatigued. the Achilles tendon has a poor blood supply, which makes it susceptible to injury and slow to heal after injury. During exercise the amount of blood able to travel to the tendon is decreased, further increasing the risk of rupture. Most experts agree that there are no warning signs of an impending rupture. However, frequent episodes of Achilles tendonitis (tendon inflammation) can weaken the tendon and make it more susceptible to rupture.
Symptoms
You may notice the symptoms come on suddenly during a sporting activity or injury. You might hear a snap or feel a sudden sharp pain when the tendon is torn. The sharp pain usually settles quickly, although there may be some aching at the back of the lower leg. After the injury, the usual symptoms are a flat-footed type of walk. You can walk and bear weight, but cannot push off the ground properly on the side where the tendon is ruptured. Inability to stand on tiptoe. If the tendon is completely torn, you may feel a gap just above the back of the heel. However, if there is bruising then the swelling may disguise the gap. If you suspect an Achilles tendon rupture, it is best to see a doctor urgently, because the tendon heals better if treated sooner rather than later. A person with a ruptured Achilles tendon may experience one or more of the following. Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf, often subsiding into a dull ache. A popping or snapping sensation. Swelling on the back of the leg between the heel and the calf. Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes.
Diagnosis
A consultation and physical exam with a qualified musculoskeletal expert is the first step. X-ray or MRI scanning may be required for a diagnosis. Once a rupture is diagnosed it should be treated to prevent loss of strength and inadequate healing.
Non Surgical Treatment
The treatments of Achilles tendonitis include resting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling Achilles tendonitis. In patients who have more significant symptoms, a period of immobilization can help. Either a removable walking boot or a cast can allow the inflamed tendon to cool down quickly. A heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic and work shoes. Applying ice to the area of inflammation can help stimulate blood flow to the area and relieve the pain associated with inflammation. Apply ice several times a day, including after exercise. The pain and swelling most commonly associated with Achilles tendonitis can be improved with non-steroidal, anti-inflammatory medications (NSAIDs) which include Celebrex?, Advil?, Motrin?, Naprosyn?. Be sure to consult your physician before starting any medications. Physical therapists can help formulate a stretching and rehabilitation program to improve flexibility of the Achilles tendon. Cortisone injections should not be used for Achilles tendonitis. Studies have shown an increased incidence of Achilles tendon rupture after cortisone injections. 
Surgical Treatment
Immediate surgical repair of the tendon is indicated in complete tears. Delaying surgery can lead to shortening of the tendon, formation of scar tissue and decreased blood flow, which can lead to a poor outcome. Following surgery your ankle will be put in an immobilizing device and you will be instructed to use crutches to limit weight bearing and protect the joint. Over the next 2-4 weeks weight bearing will be increased and physical therapy will be initiated. The surgeon will determine the physical therapy timeline and program. Physical Therapy, Treatment will emphasize gradual weaning off the immobilizing device, increased weight bearing, restoration of ankle range of motion and strengthening of the lower leg muscles. It is important that the physician and therapist communicate during the early stages and progress your program based on the principles of healing so as not to compromise the Achilles tendon. Patient will be progressed to more functional activities as normal ankle range of motion and strength is restored.
Prevention
Prevention centers on appropriate daily Achilles stretching and pre-activity warm-up. Maintain a continuous level of activity in your sport or work up gradually to full participation if you have been out of the sport for a period of time. Good overall muscle conditioning helps maintain a healthy tendon.
Best Surgery For Flat Feet In Adults
Overview
For many adults, years of wear and tear on the feet can lead to a gradual and potentially debilitating collapse of the arch. However, a new treatment approach based on early surgical intervention is achieving a high rate of longterm success. Based on results of clinical studies of adults with flat feet, we now believe that reconstructive surgery in the early stages of the condition can prevent complications later on. Left untreated, the arch eventually will collapse, causing debilitating arthritis in the foot and ankle. At this end stage, surgical fusions are often required to stabilize the foot. 
Causes
The most common cause of acquired adult flatfoot is posterior tibial tendon dysfunction. What causes adult acquired flat foot? Fracture or dislocation. Tendon laceration. Tarsal Coalition. Arthritis. Neuroarthropathy. Neurological weakness.
Symptoms
Not everyone with adult flatfoot has problems with pain. Those who do usually experience it around the ankle or in the heel. The pain is usually worse with activity, like walking or standing for extended periods. Sometimes, if the condition develops from arthritis in the foot, bony spurs along the top and side of the foot develop and make wearing shoes more painful. Diabetic patients need to watch for swelling or large lumps in the feet, as they may not notice any pain. They are also at higher risk for developing significant deformities from their flatfoot.
Diagnosis
The diagnosis of posterior tibial tendon dysfunction and AAFD is usually made from a combination of symptoms, physical exam and x-ray imaging. The location of pain, shape of the foot, flexibility of the hindfoot joints and gait all may help your physician make the diagnosis and also assess how advanced the problem is.
Non surgical Treatment
Conservative (nonoperative) care is advised at first. A simple modification to your shoe may be all that???s needed. Sometimes purchasing shoes with a good arch support is sufficient. For other patients, an off-the-shelf (prefabricated) shoe insert works well. The orthotic is designed specifically to position your foot in good alignment. Like the shoe insert, the orthotic fits inside the shoe. These work well for mild deformity or symptoms. Over-the-counter pain relievers or antiinflammatory drugs such as ibuprofen may be helpful. If symptoms are very severe, a removable boot or cast may be used to rest, support, and stabilize the foot and ankle while still allowing function. Patients with longer duration of symptoms or greater deformity may need a customized brace. The brace provides support and limits ankle motion. After several months, the brace is replaced with a foot orthotic. A physical therapy program of exercise to stretch and strengthen the foot and leg muscles is important. The therapist will also show you how to improve motor control and proprioception (joint sense of position). These added features help prevent and reduce injuries. 
Surgical Treatment
When conservative care fails to control symptoms and/or deformity, then surgery may be needed. The goal of surgical treatment is to obtain good alignment while keeping the foot and ankle as flexible as possible. The most common procedures used with this condition include arthrodesis (fusion), osteotomy (cutting out a wedge-shaped piece of bone), and lateral column lengthening. Lateral column lengthening involves the use of a bone graft at the calcaneocuboid joint. This procedure helps restore the medial longitudinal arch (arch along the inside of the foot). A torn tendon or spring ligament will be repaired or reconstructed. Other surgical options include tendon shortening or lengthening. Or the surgeon may move one or more tendons. This procedure is called a tendon transfer. Tendon transfer uses another tendon to help the posterior tibial tendon function more effectively. A tendon transfer is designed to change the force and angle of pull on the bones of the arch. It's not clear yet from research evidence which surgical procedure works best for this condition. A combination of surgical treatments may be needed. It may depend on your age, type and severity of deformity and symptoms, and your desired level of daily activity.
