FAQ Category: Foot

Tendonitis of any tendon is generally treated the same way. The goal is to reduce the inflammation (swelling) and pain, so you can start using your foot again.

Traditional treatments include medications that reduce the swelling and pain (anti-inflammatories), exercises of physiotherapy, or special equipment (orthotics) to left the heel from being flat on the ground. If these treatments don’t work, surgery may be the next step. However, new treatments using shockwave therapy are showing promise in treating tendon injuries.

Chronic Achilles’ tendinopathy can be very difficult to treat successfully. Experts advise starting with a program of conservative care. This begins with antiinflammatory medications. Even though there is no active inflammation, for some reason these drugs do seem to help.

A course of physical therapy can be very helpful along with the medications. The therapist will use heat modalities such as ultrasound and manual therapy to realign the tendon fibers. This can help promote healing.

There have been some studies suggesting that a program of eccentric loading exercises work well for Achilles’ tendinopathy. But other studies have not confirmed these results. If you want to try this idea, the therapist can show you how to do these exercises.

The basic idea is to start with the foot in a neutral position and slowly lengthen the muscle. The program is gradually increased until you can do three sets of 15 repetitions.

Other forms of treatment may include special insoles in your shoes to place your foot in good alignment for healing. Shock-wave therapy has also been tried with good success for some people. A special device is used to apply a pulse through the skin to the injured tendon. Low-energy shock waves therapy brings blood to the area. Pain or nerve endings are blocked and soft tissue healing is enhanced.

Most of these treatment ideas require an initial assessment and program set up. Once you get started, you may only need occasional monitoring. For faster results it’s a good idea to have an individualized program. This will allow you to ask questions and help keep you on track, too.

The Achilles’ tendon refers to the junction of the gastrocnemius and soleus (calf muscles) to the bone. The muscles gradually turn into tendon and a strong band of connective tissue that inserts into the bone.

Tendinopathy is the medical term for injury, pathologic change, or damage to a tendon. There may be a thickening of the tissue or irregular tendon structure. With Achilles’ tendinopathy, there is usually swelling, tenderness or pain, and decreased function of the Achilles’ tendon.

Sometimes this condition is referred to insertional Achilles tendinopathy. The pain and tenderness occur right at the point where the tendon inserts into the bone. When the main body of the tendon is tender, it is called paratendinopathy.

The diagnosis of Achilles’ tendinopathy is usually made by examination and imaging studies. Plain X-rays and ultrasound pictures help rule out other conditions such as bursitis or bone spurs.

Tendon stiffness after injury can be difficult to change. Even after a program of successful rehab, many people report continued tendon stiffness.

Studies on the effects of stretching on stiffness have mixed results. In some studies, there was no change in tendon stiffness after six weeks of stretching. Different types of stretching have been investigated. These include static, ballistic, passive, and eccentric. No study has been done to compare each type of stretching.

When looking at each type of stretching individually, ballistic stretching seems to be able to decrease Achilles’ tendon stiffness the most. Ballistic stretching bounces into or out of a stretched position.

The stretched muscles act as a spring for motion. This type of bouncing is not usually advised. For example, it is not a good idea to bounce down repeatedly to touch your toes.

However a quick movement involving prestretching of the calf muscle and the attached Achilles’ tendon may be an exception. This type of movement activates the stretch-shortening cycle of the muscle-tendon unit. With this type of exercise, proprioceptors (receptors to define when and how the muscle or joint is moving) help increase muscle recruitment over a short period of time.

Ask your rehab coach how to use these exercises to decrease stiffness without increasing muscle bulk and tension. A new form of exercise called plyometrics may help reduce your stiffness. Plyometrics is a type of exercise training designed to produce fast, powerful movements. With a little practice you will be able to incorporate this technique into your rehab program.

Many studies have confirmed that eccentric training is the way to go when trying to rehab an Achilles’ tendon injury. Eccentric training is a way to mechanically load the calf muscle resulting in active lengthening of the muscle and tendon.

To do this, stand on a stair step as if going up the stairs. Place your weight on the leg you want to exercise. Your weight should be on the ball of the foot. Lower the heel below the level of the forefoot. Do this in a slow, controlled way. Go to the point of maximum stretch on the calf muscles.

Move the heel down in six seconds. Then use the other leg to return to the starting position. Repeat this exercise 15 times. Do three sets of these 15 repetitions. Rest at least 20 seconds between each set of 15.

It usually takes six weeks for full recovery of the tendon. Some people continue to carry out this program to prevent reinjury. There’s no proof yet that eccentric heel drop exercises prevent injuries but it is possible. Future studies may shed some light on the merit of this training for injury prevention.

Probably less painful than the toe is right now. Swelling and fluid that builds up inside the joint can cause a tremendous amount of pain. Pressure on the local nerves and blood vessels can cause a throbbing, aching toe.

Many patients like yourself feel desperate for relief from the pain and discomfort. Draining the fluid seems like a good idea until you have time to think about it. But the physician uses a numbing agent such as lidocaine. Lidocaine is a novacaine derivative.

Even before the doctor starts moving the painful toe to find the joint, an injection of this local anesthetic is given. Once the toe is numb, the procedure can be done with no further discomfort to the patient. Usually, pain relief occurs once the fluid is drained. You may have a day or two of residual tenderness or soreness.

Physicians are trained in specific techniques such as aspiration and injection of gouty toes. Aspiration refers to drawing fluid out of a joint or space.

Knowledge of the anatomy is required. When swelling covers the surface, the normal, uninvolved foot can be used as a guide. The doctor palpates (feels) the surface of the normal side and compares it to the swollen toe.

A slight downward pull on the toe can help option up the joint space. Using just the right angle, the needle is inserted and advanced carefully into the joint. The physician is careful to avoid local nerves, blood vessels, and tendons.

Sometimes a bone spur gets in the way and the needle must be pulled out a little. Then it is reinserted using a slightly different angle. The physician is prepared for such events. In the hands of a trained and experienced clinician, this procedure is both safe and effective.

There may be a specific reason your surgeon had in mind when offering this advice. You would have to ask him or her that question directly. In general, there has been much debate over the best treatment approach to use with Achilles’ tendon ruptures.

Studies have been done to compare the results in patients treated with and without surgery. Patients who have surgery tend to get their motion back sooner. This seems to make a differrence with better results.

Recently, researchers in New Zealand compared two groups of patients with acute Achilles’ tendon rupture. All were treated within 10 days of their injury. One group was put in a plaster cast for 10 days. When the cast was taken off, movement and weight-bearing were gradually started.

In the second group, surgery was done to suture the torn tendon back together. A special cast was applied right after surgery and kept on for 10 days. This cast allowed the ankle to move from a neutral position down toward a toes-pointed position.

When patients in both groups were taken out of the casts, motion was started. Each patient completed a set of range of motion exercises once every hour. At the end of six weeks, the patients were allowed to put some weight on the injured foot.

They found that both groups had equal return of ankle motion. It didn’t matter if they had surgery or not. The real difference was the use of early, carefully controlled motion after the injury. With the increased risk of infection and complications from any surgery, a nonoperative approach is always preferred whenever possible.

Some tendons do have some ability to heal themselves. Many times patients with Achilles’ tendon ruptures are put in a cast for a short time. They are given advice about limiting motion and weight-bearing until it heals fully.

Studies show that patients who have surgery to repair the tendon injury may recover faster. But is it because they had surgery or some other factor? Scientists from New Zealand my have that answer for us.

They compared patients with an acute (within 10 days) Achilles’ tendon rupture. Half the patients had surgery. They wore a special brace afterwards. The other half were put in a different type of cast for a short time (without surgery first).

Both groups followed an early exercise program. Rehab was gradually progressed until full motion and strength was achieved. It turns out that the groups had equal results. The surgery group did not improve faster or better than the nonoperative group.

In cases where the surgically repaired tendon re-ruptured, a second or revision operation was advised. Early motion appears to be helpful for healing in tendon injuries. When repair is combined with motion, results are good to excellent for most patients.

Your symptoms of burning and numbness point to a possible nerve problem. Pain, numbness, and weakness are other common symptoms observed with nerve involvement.

The fact that you still have some sensation suggests there may be some pressure or irritation on the nerve(s) to the feet. The specific nerve impaired can be determined by the location of your symptoms.

You may have a condition called tarsal tunnel syndrome (TTS). Pain around the ankle along with pain, numbness, or tingling along the bottom of the foot suggest compression of the tibial nerve.

Other causes of these type of symptoms include hypothyroidism, diabetes, rheumatoid arthritis, or amyloidosis (a connective tissue disorder). A separate disorder that can cause burning pain of the feet is restless legs syndrome (RLS).

You’ll need to see a medical doctor to get a proper diagnosis. Early diagnosis of such problems can prevent more serious complications later. It may be a simple problem, easily solved.

You’ll need to see a medical doctor to get a proper diagnosis. Early diagnosis of such problems can prevent more serious complications later. It may be a simple problem, easily solved.

The too many toes sign refers to a position of the foot that allows the examiner to see all four toes when looking at the foot from behind. With a normal, neutral alignment of the ankle, only the baby (or fifth) toe is usually seen.

Too many toes is a sign that the arch of the foot is dropped down toward the floor. The forefoot is moved away from the big toe. This position is called forefoot abduction. Abduction means away from the midline.

At the same time, the hindfoot (where the Achilles’ tendon inserts along the heel bone) angles inward toward the other foot. This is called hindfoot valgus. This position makes it difficult for the person to lift the heel off the floor and rise up on the toes.

The cause of this change in normal alignment of the foot and ankle is usually damage to the soft tissue from an ankle sprain that hasn’t healed properly.

If one tendon pulls strongly but is unopposed by a weak or injured tendon, then the nearby ligaments are over stretched. The arch drops and over time these other changes take place.

There are a wide range of causes for numbness in the foot or feet. The elliptical trainer requires foot contact for much longer periods of time than some other forms of exercise. You might not experience this symptom when using a recumbent bike or treadmill.

Numbness, tingling, and loss of sensation in the feet can be a serious condition. Tissue injury leading to ulceration are concerns for anyone with diabetes or other chronic conditions causing nerve damage in the feet.

Since the symptom is only present on one side, it suggests a possible problem with foot alignment. Flat feet or unsupported high arches can cause the heads of the metatarsal bones to drop down. Without the necessary support, this could be enough to put pressure on nerves in the forefoot. The result can be numbness such as you are describing.

Proper shoewear may be important. A shoe that gives good support and fits correctly may be the first step. Too much room in the box of the shoe (where the toes are located) may cause shifting of the foot forward with each stride. This type of pressure can cause problems.

You can also try insoles to support the arch and/or forefoot. If the condition gets worse or is not helped by these measures, then it may be a good idea to have an orthopedist or podiatrist examine your foot. An accurate diagnosis can help in protecting your feet from further injury.

Standard surgical treatment for Achilles’ rupture requires six to eight weeks in a short leg case. A full follow-up rehab program may take another four to six months. A long period of time immobilized is needed to avoid re-rupture of the healing tendon.

Some researchers are trying to modify the surgical technique. This along with changes in post-operative treatment may bring about a faster recovery time. These changes may help athletes like your daughter. High level and recreational athletes can return to sports sooner.

For example, different methods of suturing the Achilles’ tendon have been reported. Adjusting the length of the repaired tendon is also being investigated. With these changes, patients have been able to exchange a short leg cast for a hinged brace. Weight-bearing as early as the second week is possible with the brace. This is compared to six to eight weeks in a cast before full weight-bearing is allowed.

For years, surgeons around the world have used a standard operation to repair an acute Achilles’ tendon rupture. This procedure uses stitches called Kessler sutures. The operation must be followed by nonweight-bearing and limited range of motion. The patient must carry out this protocol for at least four to six weeks.

But several studies using modified suturing and surgical techniques have been reported. Using more stitches gives a stronger repair. It also allows for faster recovery. Earlier motion and full weight-bearing are possible much sooner than with the Kessler sutures.

Much of this new research is being done in Japan. The latest study reported accelerated results using a method that can adjust the tension on the tendon using a Tsuge suture at one end and a single knot at the other. Your exchange student may have benefitted from the expertise at one of these centers.

The condition you have called Achilles’ tendinopathy is characterized by a painful thickness in the mid-portion of the Achilles’ tendon. If this problem has been present for more than three months, then it is considered a chronic problem.

Ultrasound studies show that thickening of the tendon and irregularities in the tendon are seen with a tendinopathy. The most commonly prescribed treatment is with eccentric exercise. The muscle is put in a shortened position and then lengthened.

The reason these exercises work still isn’t entirely clear. It’s possible the action of the muscle helps break adhesions. Adhesions are places where tiny bits of the tendon fibers have gotten stuck together. If the fibers don’t glide smoothly during motion, they get bunched up and form a lump. Exercise may also help improve blood flow to the area, which helps restore normal cell structure and function.

In the case of the Achilles’ tendon, the patient starts in a position raised up on toes. Then the foot is lowered to a position with the heel below the toes. This can be done best while standing on a stair facing the stair case as if walking up the stairs. The toes and ball of the foot are on the stair, the heel is not supported by the surface.

Although this exercise is recommended for Achilles’ tendinopathy, the best progression of exercise is unknown. Some experts advise doing the exercises everyday for 12 weeks. The exercises should be done while wearing a stable, supportive shoe.

The exercises are carried out with the knee straight. Then the same set of exercises are repeated with the knee slightly bent. Later, weight can be added by wearing a back pack with increasing weights added inside.

Yes, there are toe joint replacements for the big toe, particularly if the pain is caused by severe osteoarthritis. Right now, however, the results of the replacement don’t seem to be comparable to the results of a surgery called arthrodesis, a fusion of the bones in the toe.

In a recent study, researchers found that patients who had the joint fusion experienced fewer complications and less pain than did those who had the replacement.

When someone has a bone fusion of any bones, the bones are literally fused together so they cannot bend or move. The surgery, called arthrodesis is done when the cartilage, the tissue in the joints that help them move smoothly, is severely damaged.

To do a fusion, the surgeon uses pins or screws to fasten the bones together. The effect, after surgery, is the toe can’t bend as it used to. It should, however, reduce the pain, making walking easier.

Your mother may have to be careful choosing the style of shoe she wants to wear. Because of the inability for the toe to bend, styles like high heels won’t be possible. She may also have to adapt her walking gait a bit to accomodate the fact that the toe doesn’t bend with the step.

There may be some truth that shoe wear can contribute to bunions. This deformity is referred to as hallux valgus in medical terminology.

The true cause of this problem still remains a topic of debate. Early on there was a theory that hypermobility of the joint at the base of the big toe was the problem. Hypermobility refers to increased motion or movement in a joint.

But studies have not been able to show this is true. The next theory tested was that decreased ankle motion and flat feet contributed to the development of bunions. This hasn’t been proven either.

Scientists have X-rayed and measured bone and joint angles looking for an anatomical explanation. Others have looked for imbalances in the surrounding soft tissues such as the muscles, tendons, and ligaments as a possible cause of the problem.

It’s likely there are multiple factors for each patient with this deformity. There may be a genetic component. Shoe wear may add to the speed at which the deformity progresses and the degree or severity of deformity. More study is needed to answer the question more fully.

Recurrence of hallux valgus deformities (the medical term for bunions) is not uncommon after surgery. But it doesn’t happen to everyone.

Doctors aren’t sure why this happens. Instability occurs at the metatarsocuneiform joint contributing to recurrence. This joint is located where the long bone of the first toe (the metatarsal bone) meets the cuneiform bone in the midfoot. Some experts think the joint must be fused during surgery to avoid this problem.

Several studies support the theory that low recurrence rates are linked with the type of corrective operation done. Proximal osteotomy of the first metatarsal is the recommended treatment. Osteotomy refers to removing a wedge of bone to help bring the joint into a more neutral position.

At the same time, realignment of the soft tissues around the joint must be done. Muscle, tendon, and ligaments may be released to decrease the uneven pull on the joint. In some cases, it may be necessary to remove the joint capsule as well.

There’s no guarantee that these measures will prevent recurrence of the deformity. There may be other factors at play that we don’t know about yet. Reported results are good using this surgical approach with low recurrence rates.

Problems in the feet and especially the toenails of patients with diabetes are common. It’s a common misconception that there’s nothing that can be done about it.

You are wise to be cautious. Wounds can be very slow to heal in these patients. The risk of infection is always a concern. Improper foot and nail care can lead to severe disability. Reduced sensation, limited mobility, and poor vision are three main reasons older adults stop caring for their feet.

Correcting toenail disease is important. The best approach may be to seek the professional opinion and services of a podiatrist. A podiatrist is trained to care for problems of this type in the feet.

It may be necessary to take your mother to the foot specialist on a monthly basis. Many times insurance and Medicare will pay for these services. If they don’t, the cost of this appointment compared to even one day’s hospitalization makes it well worth the cash outlay.