FAQ Category: Foot

Bunions can get pretty ugly — and not just because they look funny. But because with the big toe angled so oddly, the foot loses the normal function of that joint and changes how a person walks. They can also be very painful.

What is a bunion anyway? That bony knob sticking out from the big toe is caused by a change in the alignment of the first metatarsal and the hallux. The first metatarsal is the bone inside the big toe. The hallux is the bone in your foot that connects to the first metatarsal. The joint where these two bones meet is called the first metatarsophalangeal joint or MTP joint.

As the hallux shifts away from the foot (a movement called abduction), the first metatarsal adducts (moves toward the other toes). The result is a disruption of the metatarsophalangeal (MTP) joint. Swelling around the joint develops and forms the deformity you see on the outside of the foot that’s called a bunion. Once the shift begins, it seems there’s no stopping it without surgery.

No one knows exactly why this shift gets started. There have been many theories and experts agree that it’s probably multifactorial. In other words, there are many things combined together to cause this foot deformity. Some of those things include environment (shoe wear), genetics (family history), and anatomy.

It’s possible that the use of a shoe insert called an orthotic to support the arch early on may prevent this unsightly deformity. At least that’s what a group of physical therapists at the University of Minnesota Medical School are proposing. If that’s true, it will be the first treatment discovered to affect bunions in any way other than surgery. And that would be good news for bunion sufferers!

This group of therapists took a look at the arch of the foot and suggested that a flattening of the arch may be at fault. If you look at the alignment of the foot arch from the front of the foot, it’s easy to see how a change in the tilt of the arch can change pressure placed on the big toe. Collapse of the arch while standing up on the foot in a weight-bearing (load) position may set up a chain of events that ultimately leads to hallux valgus (the medical term for bunions).

The shape of the arch of the foot affects the axis of the first metatarsal (big toe). As the arch drops down, the first metatarsal axis becomes more vertical (aligned up and down). Shifting of the hallux and first metatarsal occur and that affects the joint axis, too. Pressure on and stretching of the ligaments and cartilage around the joint further weaken the support of the bony structures.

With the right kind of support, the metatarsal axis can be oriented more toward the horizontal (straight across from side to side). In this way, the arch can help support the weight of the body without collapsing, shifting the arch, and altering the alignment of the foot. A shift in one arch affects joint axis, bones, ligaments, alignment, and so on.

In 1998, researchers received the Nobel Prize in medicine for their discovery of a molecule called nitric oxide. This molecule is made up of one nitrogen (N) and one oxygen (O) atom. It is present in all mammals, including humans. It is NOT the same as nitrous oxide (N2O), the laughing gas used by dentists.

Nitric oxide does many, many things in the body. For example, it acts like teflon in the blood vessels. It keeps the blood moving smoothly and prevents plaque build-up that causes atherosclerosis. It helps with long-term memory, sexual function, nerve transmission, and boosts the immune system function. Scientists have since discovered that it also plays a role in wound healing for fractures and tendon damage.

The word anodyne is a Greek word for pain reliever. It has been used to name a device that increases nitric oxide formation in the body for healing and recovery. Anodyne Therapy is infrared light therapy device used to increase circulation and reduce pain, stiffness and muscle spasm. It has been approved by the Food and Drug Administration (FDA) as a way to temporarily achieve these results.

The treatment is delivered via pads that are applied to the skin of the affected body part. The light energy helps increase blood flow thereby delivering healing cells and nutrients to the injured site. The idea behind the treatment is to increase circulation to the area to promote a healing response.

The treatment has been used for nerve damage, poor circulation, tendon problems, stress fractures, pressure ulcers, bursitis, arthritis, and many other chronic conditions. There have been variety of scientific journals and articles published on Anodyne and its benefits. It is a fairly new area of research. Results of studies published have not been analyzed yet to formulate an overall assessment of its effectiveness for these various conditions.

There may be several factors at play here. First, let’s take a look at the tendon problem itself. Scientists have indeed shown that chronic, painful tendon problems are not associated with inflammation. When tissue samples are studied under the microscope, there are NO inflammatory cells.

There probably was an inflammatory response when the injury first occurred. The initial acute phase is often one of inflammation and repair. But with chronic overuse and excessive mechanical load, the tenocytes (tendon cells) start to degenerate or break down. A pain response is initiated by the body to let you know there is a problem and to do something about it.

The steroid injection may be effective strictly from the placebo effect that is present with any treatment. And that refers to the fact that the patient is expecting the treatment to work, so it does. The brain and body respond with a new, improved healing response that is more successful than the previous strategy.

Secondly, the injection includes both the steroidal antiinflammatory but also an anesthetic or numbing agent. By stopping the pain signals being sent to the brain, the patient gets some pain relief.

But in the final analysis, we simply don’t know exactly why steroid injections work for a noninflammatory condition. And since they aren’t effective for everyone, there must be some individual factors that influence the treatment that haven’t been uncovered yet.

The first thing to do, is let your surgeon in on your secret. He or she will keep your confidence. You can treat the appointment as a routine follow-up while still getting the help you need. The physician will assess what might be causing the swelling and treat you accordingly. You may need some medication. Sometimes exercise is needed to get the fluids moving from the feet back into the main circulation.

There are therapists who specialize in a type of massage designed to help move lymph fluid and reduce swelling any where in the body. Lymph is the fluid found between the cells of the human body. It flows through the entire body through special lymph vessels and filters out toxins or waste products from cellular metabolism.

After any kind of surgery (and especially surgery on both sides of the body), fluid can build up. Microscopic damage can occur to the lymph vessels during surgery slowing down the regular flow of lymph fluid. Decreased movement and inactivity add to the problem. The lymph system doesn’t have a pump of its own like the heart, which pumps blood through the blood vessels. Instead, the lymph fluid moves in response to muscular contractions. Since physical activity and exercise is often limited after bilateral bunionectomies, this type of swelling called lymphedema can develop.

The lymphedema specialist will use very gentle hand movements over the skin to get the lymph fluid draining again properly and move any areas where it has pooled (such as in the feet and ankles. Ask your doctor to refer you to a lymphedema specialist. Early intervention can help clear up the problem quickly and keep the swelling from becoming a chronic, lifelong problem. This type of swelling can occur after any surgery and should not be viewed as the result of making a choice that was right for you. What’s important is that you get the care you need when you need it.

Physical therapy has been shown effective following many types of orthopedic surgeries (e.g., joint replacements, ligament reconstruction, bone fractures). A recent study from Gait Analysis Laboratory at the Foot and Ankle Center in Vienna, Austria showed how function can improve with rehab after forefoot surgery like bunionectomies.

A bunion deformity is referred to in medical terms as hallux valgus. Surgery to restore a more normal alignment of the toe is called a bunionectomy. The surgeon removes a pie-shaped piece of bone from one side of the big toe and wedges it on the other side of the joint to straighten it out. But studies have shown that even when the X-ray shows a surgical success, the patient may not resume a normal gait (walking) pattern. There is a tendency to shift the weight while walking away from the first toe to avoid pain and stay off the surgical site.

What can be done to help patients recover fully after surgery for hallux valgus? Physical therapists have demonstrated through this study that a multimodal rehabilitation program can help restore more normal weight-bearing and walking patterns. Physical therapy began four weeks after surgery with leg elevation, lymphatic drainage, gait training, manual therapy, and strengthening exercises. Manual therapy included release techniques for the muscles of the foot and lower leg as well as manipulations of the big toe, forefoot, and ankle. Specific training exercises to restore normal walking patterns were also part of the rehab program. Everyone had four sessions (once a week for four weeks) and did a home program of daily exercises as well.

Post-rehab testing showed marked improvement in function and motion along with a decrease in the maximum force placed on the first toe. Total motion did not change significantly but dorsiflexion of the big toe improved by five degrees. Dorsiflexion describes the movement of the big toe needed to push off from the ground to move forward.

Analysis of the plantar pressure patterns (weight and load placed through the foot) from before to after surgery showed improvement. This suggests improved function of the big toe in pushing off while walking. This particular finding helps support the benefit of physical therapy intervention after bunionectomy surgery. Although there wasn’t a control group in this study (i.e., patients who had the surgery but did not have rehab), other before and after studies using plantar pressure data have not shown this type of change.

So there is some evidence that physical therapy can benefit patients who have had a bunionectomy. A short program of manual therapy, supervised exercises, and a follow-up home program may be all that’s needed to get patients back on track with normal movement patterns. That’s an important step in preventing uneven weight-bearing patterns that can lead to arthritis.

Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead.

Cortisone is an antiinflammatory that can weaken the collagen fibers that make up the plantar fascial ligament and underlying bone. Experts who have conducted studies in this area advise against the use of steroid injections for plantar fasciitis and/or plantar fascia ruptures. The first thing that is usually recommended is activity restriction. If you are a runner or athlete, you will be asked to reduce your activity — maybe even stop running and jumping.

X-rays are usually taken to see if there has been any additional damage to the calcaneal (heel) bone. Without the protective fibrous sheath of the plantar fascia, load transmitted through the foot is not evenly distributed or transmitted through the calcaneus (heel). Instead, the load on the calcaneus can increase the stress to the breaking point. A calcaneal stress fracture may be the result. Stress fracture means there’s a tiny crack in the bone but the bone has not separated.

Treatment is more likely centered around taking weight off the foot using a cast or other immobilizer. When the pain and swelling have gone done, you might be placed in a rigid-sole shoe. A program of muscle strengthening begins when the immobilizer is removed. Regular weight-bearing activities are gradually added in over a period of weeks to months. The length of time this takes depends on how severe the injury was in the first place.

Surgery remains a last resort when all attempts at nonoperative care have failed. Almost one-third of all patients with chronic tendinopathies end up having surgery. This is true despite the fact that there is no evidence to support this approach or show which surgical procedure works best.

Surgical options include removing scar tissue and adhesions, repairing tendon tears, removing areas of obvious tendon degeneration, and tenotomy (cutting the tendon). If a large portion of the tendon is removed, it may be necessary to transfer a tendon from some other area of the body to the affected site. Surgical options vary according to which tendon is the problem.

Rehab may still be the answer if you have not tried eccentric exercise. No one knows for sure why this technique works (and it doesn’t seem to help all tendon problems), but the Achilles tendon responds well in many cases. A physical therapist can instruct you in the proper technique, but here’s the basic exercise.

Stand on a stair (facing the stair as if going up stairs) with just the toes in contact with the stair. Start in a position up on raised toes on the involved leg (shortened or contracted calf muscle), then slowly lower the heel down past the edge of the stair. The knee is kept straight throughout the first set of exercises. The exercise is repeated keeping the knee bent throughout the raising and lowering motion.

It is suggested that you do three sets of 15 repetitions, twice a day. Repeat daily for 12 weeks. It takes some time and dedication, but the results can be well worth it.

You really need to see a physician to make the diagnosis. Any time symptoms are present bilaterally (both sides), there could be a systemic problem unrelated to your running schedule. For example, rheumatoid arthritis (which is a systemic problem affecting more than just the joints) can be the underlying problem.

In particular, Reiter’s syndrome, a sexually transmitted disease can cause bilateral symptoms. Usually, with Reiter’s syndrome, there is a triad of other symptoms including skin rash, kidney infection, and conjunctivitis (painful, inflammation of the eye).

There are other causes of heel pain to be investigated. Soft tissue structures such as the Achilles tendon, plantar fascia along the bottom of the foot, and even the bursa (round fluid-filled cushions between the muscles/tendons and bones) can cause heel pain when inflamed. Usually, the person experiences any one of these problems just on one side of the body, but bilateral symptoms are possible.

How can the orthopedic surgeon tell what’s causing the heel pain? Location of symptoms is the first place to start. The examiner will also ask the patient what makes it better or worse, and what structures hurt when pressed or palpated. The presence of any visible changes (e.g., skin thickening, bony bump, swelling around the Achilles) will be noted. X-rays can help show areas of calcification (bone build-up from a pump bump) or bone breakdown around the area of a bone bump from chronic inflammation (bursitis).

Treatment always depends on the underlying cause of heel pain. That’s why a careful diagnostic sorting process is important and an understanding of what each condition is and how it presents clinically. Imaging tests start with X-rays. MRIs may be ordered when there is suspicion of plantar fascia rupture or calcaneal fracture.

Studies show that some motor vehicle accidents are more traumatic because of the higher impact. Not only are the bones broken, but the soft tissues around the bones are often torn as well. In your case, it might also have to do with the fact that you fell from a step stool rather than off a high ladder or rooftop. Accidents from greater heights can also create greater trauma at the point of impact.

Your surgeon is probably aware of a recent study that showed the mechanism of injury (car accident versus a fall) did seem to make a difference in the final outcomes of surgery for calanceal fractures. The calcaneus is your heel bone. The patients in the study were all 18 or older and had a displaced calcaneal fracture. Displaced means the bone was fractured and the bones had separated and moved apart at the fracture line.

Those who were injured in a car accident seemed to have worse results when compared with patients who had fallen. The reasons for this weren’t obvious but the authors of the study made some suggestions that might help explain the differences. They said the first possibility for these differences is that motor vehicle accidents cause more soft tissue damage along with the fracture than falls from heights. This is especially true when the fall isn’t from a high ladder but rather, a low stool as in your case.

Their study was based on the results of three questionnaires given to their patients years after surgery was done. But the surveys didn’t ask any questions about additional injuries present at the time of the surgery. The second explanation may be that car accidents are higher-energy accidents compared with falls. The calcaneal fractures from car accidents might have caused more bone fragments or there could have been fractures of other bones in the ankle besides the calcaneus.

There are any number of explanations as to why the surgeon might have said this about you. When you go in for a follow-up appointment, consider asking him or her what was meant by that statement as it applies to you. There may be a different reason than those that we can offer you based on reported studies.

The demands of your job (climbing ladders, walking on uneven or slanted rooftops) create a unique challenge to recovery from an injury of this type. If you needed surgery, that suggests the fracture was displaced (bones separated) and/or comminuted (many bone fragments).

Recovery often depends on your age, general health, use of tobacco products, and psychosocial factors such as motivation to return-to-work. Studies show that traumatic injuries are slower to heal in patients who have diabetes, heart disease, and/or who smoke or use other tobacco products. Older adults tend to heal more slowly. Good nutrition is also important in healing from musculoskeletal injuries.

Studies show a high rate of complications following surgery for calcaneal fractures. Patients often develop infections, poor wound healing and/or experience disabling pain requiring additional surgery. Sometimes the surgeon has to remove the hardware (plates, screws, wires) that is holding the bone fragments together.

In other cases, it may become necessary to fuse the ankle, a procedure called arthrodesis. Pain and ankle instability are the two major reasons for ankle fusion. With a fusion, walking on the rooftops of homes and buildings would be a much greater challenge. If you did have Worker’s Compensation status, ankle fusion would be enough to claim a disability.

Your surgeon will be able to give you some predictions based on the individual factors and variables discussed here. A recent study from Duke University Medical Center reported excellent long-term results following surgery for displaced calcaneal injuries. The majority of their 73 patients (82 per cent) went back to work (though they did not report specific job types). Only three per cent required fusion later.

Better understanding of this injury and the surgical procedure along with improved surgical technique mean improved outcomes for patients today with this injury.

Hallux valgus (bunions) is a condition that affects the joint at the base of the big toe. The bunion actually refers to the bump that grows on the side of the first metatarsophalangeal (MTP) joint.

In reality, the condition is much more complex than a simple bump on the side of the toe. Interestingly, this condition almost never occurs in cultures that do not wear shoes. Pointed shoes, such as high heels and cowboy boots, can contribute to the development of hallux valgus. Wide shoes, with plenty of room for the toes, lessen the chances of developing the deformity and help reduce the irritation on the bunion if you already have one.

Unfortunately, recurrence of this problem is considered a common complication of the surgery. But new research indicates that this may not be absolutely true if the surgeon is careful to pay special attention to one particular area: the sesamoid bones.

The sesamoids are two tiny, pea-sized bones that sit just under the main joint of the big toe. They are embedded in the soft tissues and play an important role in how the foot and big toe work. If the sesamoid bones are not properly realigned after bunion surgery (called a bunionectomy), patients are at a greater risk of recurrence of the bunion deformity.

How can this be avoided? Surgeons investigating the matter suggest that complete complete reduction of the sesamoid bones is necessary and possible with improved surgical technique. Reduction means these two little bones are placed back in their normal, neutral position under the joint of the big toe. If that’s not the case, then the surgery must be modified until they are in the necessary alignment.

The surgeon may have to go back and release other soft tissue structures, including the capsule (fibrous soft tissue) surrounding the joint. X-rays must be taken during the operatino to confirm proper alignment before closing up the surgical incision.

Let your surgeon know of your concerns and ask some questions about how you can avoid recurrence of the problem. Sometimes people look for others who have had excellent results in their geographical area in order to find the surgeon that’s best for them. Look for patients who have a good to excellent result that is still satisfactory one to five years later.

Bunions. They are more than just ugly toes. The medical term is hallux valgus. Hallux refers to the big toe. Valgus describes the awkward angle that forms as the base of the metatarsal bone drifts away from the rest of the foot. Surgery for the deformity is more than just for cosmetic reasons. Hallux valgus can be very painful and disabling.

What causes them? Narrow, pointy shoes has been suggested as a potential cause. Reducing pressure from shoes rubbing against the misaligned bones is a definite part of why these deformities develop. But since not everyone who wears high heels or cowboy boots develops bunions, there must be other factors at play. Scientists are still looking at various possibilities to help us find better ways to prevent the problem.

Surgeons are also aware that there’s an unacceptable rate of recurrence of this problem after surgery to correct it. Why is that? We’re not sure but we may have a piece of the puzzle. In a recent study, surgeons from Japan have discovered that the position of the sesamoid bones is an important part of the problem.

The sesamoids are two tiny, pea-sized bones that sit just under the main joint of the big toe. They are embedded in the soft tissues and play an important role in how the foot and big toe work. If the sesamoid bones are not properly realigned after bunion surgery (called a bunionectomy), the deformity we call bunion is more likely to come back.

It’s possible that these bones shifted after surgery, pulling the muscles, tendons, ligaments, and bones back out of place. If these bones aren’t lined up exactly where they belong, the correction might not hold. Surgeons from Japan showed how this happens in a study of women with known hallux valgus compared with a similar group who did not have this deformity. When it was all said and done, they suggested closer attention by the surgeon to the position of the sesamoid bones. They must be put back in their proper place under the big toe to recreate normal foot biomechanics and avoid recurrence.

Tendon disorders of the foot and ankle come in all sizes and shapes. There are overuse injuries, tendinosis, paratenonitis, bursitis, and both acute and chronic Achilles tendon ruptures.

Tendinosis is degeneration of the tendon without inflammation. It is caused by microtrauma or aging leading to thickening of the tendon. Bursitis, a painful inflammation of the retrocalcaneal bursa is caused by compression of the bursa located between the Achilles tendon and the calcaneus (heel bone). A bursa is a round or oval pad that reduces friction between two areas that rub together. This condition occurs most often in uphill runners.

Paratenonitis refers to inflammation of the paratenon, which is a thin membrane around the tendon. The paratenon helps the tendon glide up and down smoothly as the Achilles tendon contracts and relaxes to move the foot and ankle up and down. It is a common problem in middle- and long-distance runners.

Paratenonitis can be treated with physical therapy and other nonoperative methods first before considering surgery. Ice therapy or other modalities are used to get control of the pain and swelling. The therapist will help correct training errors and problems with limb alignment, improve flexibility, and teach eccentric stretching/strengthening exercises.

Steroid injections aren’t used because they can weaken the tendon structure and lead to tendon rupture. But many patients are helped by nonsteroidal antiinflammatory drugs. When surgery is advised, it’s for chronic problems that just won’t clear up with conservative care. The surgeon removes any adhesions or thickened areas of the paratenon.

Your uncertainty and indecision is no surprise. Despite the fact that every year, many people (athletes and nonathletes alike) injure their Achilles tendons, the best way to treat these injuries is still up in the air.

Tendon ruptures are handled according to the age of the patient, activity level, and patient/surgeon preference. There is no agreement yet as to the optimal treatment of acute tendon ruptures. Published studies so far show there are fewer reruptures after surgery, improved strength, and faster return to sports for affected athletes.

For patients with acute tendon ruptures who don’t want surgery, conservative care continues to be used successfully by many people. Treatment begins with a cast that places the foot and ankle in slight plantar flexion (toes pointed down). After four weeks, the patient is recast or put in an ankle immobilizer in the neutral position. Rehab and a gradual return to activities follows cast or splint removal.

In the case of chronic Achilles tendon rupture, MRIs may be needed to show the extent of damage. Although the patient may have weakness and a limp, pain and swelling aren’t always present and other tests used for acute tendon rupture are negative. MRIs give the additional information needed to make a treatment decision. Surgery is usually the only way to restore function in the young, athletic or older, active adult. The operation is a bit more tricky than with acute (fresh) ruptures.

By the time the patient has surgery, many weeks have passed by from the acute injury. That means the torn tendon has retracted (snapped back) away from the bone where it originally inserted. And the body has laid down scar tissue to try and heal itself. The surgeon will have to remove the scar tissue, pull the tendon back down and reconstruct the tendon-muscle unit. How this is done depends on how much distance must be made up between the tendon and insertion point on the bone.

There’s no doubt that Achilles tendon injuries are fairly common. But high-quality studies with conclusions about the best way to treat them are just lacking right now. Information on surgical techniques isn’t the only area where questions exist. There really isn’t much evidence to support
one form of conservative care over another. Successful sports rehab treatment protocols is another area where future research is needed to help guide the management of Achilles tendon injuries, especially for competitive athletes.

Plantar fasciitis, the inflammation and pain of the plantar fascia can make walking extremely difficult, especially first thing in the morning. The plantar fascia is the band of tissue that connects your heel to your toes and causes sharp heel pain when it acts up. More women get it than men and it seems to be more common between the ages of 40 and 60 years old.
– Participating in exercises that stress your heel and foot, such as long distance running, dance aerobics, and ballet.
– Being obese puts a tremendous amount of stress on your foot and the plantar fascia.
– Certain professions, like nurses, who do a lot of walking or cashiers, who do a lot of standing, help contribute to plantar fasciitis.
– Foot problems, such as flat feet or high arches.
– Footwear such as high heels put a tremendous amount of stress on your Achilles tendon, which in turn will pull on the plantar fascia. Ill-fitting shoes or ones that don’t properly absorb the shock of your steps don’t help either.

Plantar fasciitis is a condition that results in pain because the plantar fascia, a thick band of tissue that runs across the bottom of your foot, has become irritated and inflamed.

One thing that helps relieve the pain of plantar fasciitis is stretching and gentle movement. When you’re sleeping at night, your foot is in a relaxed position and doesn’t pull or stretch on the heel. So, when you wake up, the area is tight and painful. It’s said that the most painful time for plantar fasciitis is your first steps out of bed, or if you’ve begun to walk after a long period of inactivity.

You might not realize it, but a fracture of the long bone in the foot to the little toe can be a very serious injury. It’s called a fifth metatarsal fracture and it’s most often seen in athletes. What makes this such a problematic injury?

Disruption to any part of the anatomy such as the bones, ligaments, joint capsule, blood supply to the area, and nerves controlling sensation can lead to poor recovery. In fact, the risk of nonunion and even refracture after successful union is a reality for many athletes.

Wherever the fracture occurs, the patient usually has pain, swelling, and can’t put weight on that foot. The type and severity of the break can make a difference. Treatment of some kind is needed. Usually, the individual can’t keep walking on it and expect it to heal. The more displaced or separated the broken parts are, the greater likelihood that surgery will be needed to repair the damage.

If the broken ends of the base fracture are less than two millimeters apart, then the patient can use a cast boot, walking cast, or even a hard-sole shoe to protect the bone while it heals. Patients should expect about a six weeks period of time before healing is complete. This can take longer if there has been any damage to the ligaments, blood vessels, or nerves.

More severe fractures or fractures that don’t heal with conservative (nonoperative) care require surgery. An incision is made directly over the bone. The surgeon is careful to avoid the nerves in that area while aligning the bone and holding it together with screws. This procedure is called an open reduction and fixation.

If your player has not had an orthopedic evaluation, a visit to the orthopedic surgeon is needed. If she is being treated by a surgeon but without the expected results, then it’s probably time for a follow-up visit. The earlier problems are recognized, the better her chances are for getting proper treatment and an improved outcome.

Fractures of the fifth metatarsal bone can be very complex and a challenge to treat. They don’t always heal well. If the ends of the bone pull apart, getting them back together and keeping them there while healing takes place isn’t always a straightforward and easy task.

Postoperative recovery can take quite awhile (weeks to months). Treatment may occur in a series of steps. First, a weight bearing cast boot is placed on the ankle and foot. The patient wears it for the first two to three weeks. Once pain has been controlled, then a motion-controlled athletic shoe is worn for another three to six weeks.

A physical therapist sees the patient early on to begin rehab. The goal is to return the patient to his or her previous level of activity as soon as possible. For the athlete, this would be a return to sports participation at a level equal to (or better than) before the fracture.

But there are still many unknowns about treating fifth metatarsal fractures. Future studies are needed to identify which patients need surgery and when (how soon). Results may vary with different types of fixation devices.

Research to show which implants to use with each fracture type would be helpful. And finally, studies are needed to develop evidence-based guidelines on when it’s safe to resume normal activities — or for the athlete, when returning to sports is possible.

High heels may look great on some women, but like everything, they should be used in moderation. Not only can high heels cause foot problems, such as corns, calluses, hammertoes, and arthritis, they can cause back problems, not to mention the pain from a sprained or broken ankle. Researchers have also made a link between long-term high heel wear and osteoarthritis of the knee.

Doctors use terms that originate from Latin because it was considered to be a universal language of study. It helps to keep things consistent because different languages would translate terms into different things. This could cause confusion.

Hallux means your big toe. So both hallux valgus and hallux rigidus have something to do with your big toe. Hallux valgus is a bunion. A bunion happens when the joint of your big toe moves out of place, outward, and your big toe starts to turn in towards the other toes. As the lump grows, it can become more painful.

Hallux rigidus is a condition where the joint in the big toe begins to be stiff, or rigid. As the disorder worsens, it becomes more difficult to bend the toe as you would when you’re taking a step.