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Suffering from Ankle Pain?

Ankle pain is often due to an ankle sprain. A sprain is an injury to the ligaments, which connect bones to one another. In most cases of ankle sprain, the ankle is twisted inward, causing small tears in the ligaments. This makes the ankle unstable. The tearing leads to swelling and bruising, making it difficult to bear weight on the joint.

Once an ankle is sprained, the injury may take a few weeks to many months to fully heal. Often, the injured ankle remains a little weaker and less stable than the uninjured one. A proper recovery program can prevent this problem.

Other structures in the ankle that can be damaged and cause pain are tendons , cartilage, and blood vessels. Adjacent areas can cause pain to be felt in the ankle. Below are the list of ankle problem:

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Bunion and Hallux Rigidis

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What is Bunion and Hallux Rigidis? A bunion or hallux valgus is a prominence on the inner border of the foot effecting the big toe and at the level of the 1st metatarso-phalangeal (MTP) joint. The bunion prominence which is seen and felt on the inner border of the foot is not due to any growth of bone but is due to the 1st metatarsal bone. With a bunion this has become more prominent than normal because the 1st metatarsal has moved away from its immediate neighbour the 2nd metatarsal. This widens the forefoot thus producing the bunion.

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.

What are the causes?
  • Poorly fitted shoes
  • Hereditary
  • Arthitis
What are the treatments? The treatment for a bunion lies between non-operative (conservative) and operative treatment. Conservative treatment for a bunion means either wearing wider fitting shoes or shoes with softer leather or using some form of a spacer between the big toe and 2nd toe (or alternatively some form of splint to keep the great toe away from the 2nd toe). The spacers or splintage may apparently straighten the bunion but they make no difference to the width of the foot, and the splaying of the 1st and 2nd metatarsals which occur with a bunion deformity. Therefore this type of treatment will not improve the main pain in a bunion which occurs due to the width of the forefoot. An arch type support orthotic may be useful if a bunion is associated with a flatter foot. If you have a bunion this is however just one other thing to get into a shoe with an already wide foot.


Foot Deformity

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What is Foot Deformity Surgery? A bunionectomy is a surgical procedure to excise, or remove, a bunion. A bunion is an enlargement of the joint at the base of the big toe and is comprised of bone and soft tissue. It is usually a result of inflammation and irritation from poorly fitting (narrow and tight) shoes in conjunction with an overly mobile first metatarsal joint and over-pronation of the foot. Over time, a painful lump appears at the side of the joint, while the big toe appears to buckle and move sideway towards the second toe. New bone growth can occur in response to the inflammatory process, and a bone spur may develop. Therefore, the development of a bunion may involve soft tissue as well as a hard bone spur. The intense pain makes walking and other activities extremely difficult. Since the involved joint is a significant structure in providing weight-bearing stability, walking on the foot while trying to avoid putting pressure on the painful area can create an unstable gait.

Purpose of Bunionectomy A bunionectomy is performed when conservative means of addressing the problem, including  fitting, wide-toed shoes, a padded cushion against the joint, orthotics, and anti-inflammatory medication, are unsuccessful. As the big toe moves sideways, it can push the second toe sideways as well. This can result in extreme deformity of the foot, and the patient may complain not only of significant pain, but of an inability to find shoes that fit.

How Bunionectomy surgery done Bunions become more common later in life. One reason is that with age the foot spreads and proper alignment is not maintained. In addition, the constant friction of poorly fitting shoes against the big toe joint creates a greater problem over time. Ignoring the problem in its early stages leads to a shifting gait that further aggravates the situation.

Once surgery has been decided on, the extent of the procedure will depend on the degree of deformity that has taken place. There are several different surgical techniques, mostly named after the surgeons who developed them, such as McBride, Chevron, and Keller. The degree and angle of deformity as well as the patient’s age and physical condition play a significant role in the surgeon’s choice of technique, which will determine how much tissue is removed and whether or not bone repositioning will occur. If bone repositioning is done, that part of the surgery is referred to as an osteotomy ( osteo means bone). The type of anesthesia, whether ankle block (the most common, in which the foot is numb but the patient is awake), general, or spinal, will depend on the patient’s condition and the anticipated extent of the surgery. For surgery done on an ambulatory basis, the patient will usually be asked to arrive one to two hours before the surgery and stay for about two to three hours after the procedure. The procedure itself may take about an hour.

The surgeon will make an incision over the swollen area at the first joint of the big toe. The enlarged lump will be removed. The surgeon may need to reposition the alignment of the bones of the big toe. This may require more than one incision. The bone itself may need to be cut. If the joint surfaces have been damaged, the surgeon may hold the bones together with screws, wires, or metal plates. In severe cases, the entire joint may need to be removed and a joint replacement inserted. If pins were used to hold the bones in place during recovery, they will be removed a few weeks later. In some mild cases, it may be sufficient to repair the tendons and ligaments that are pulling the big toe out of alignment. When finished, the surgeon will close the incision with sutures and may apply steri-strips as an added reinforcement. A compression dressing will be wrapped around the surgical wound. This helps to keep the foot in alignment as well as help reduce postoperative swelling.


Ingrown Toe Nail

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What is Ingrown Toe Nail? An ingrown toe nail is a painful condition of the toe. It occurs when a sharp corner of the toenail digs into the skin at the end or side of the toe. Pain and inflammation at the spot where the nail curls into the skin occurs first. The inflamed area then starts to grow extra tissue or drain yellowish fluid.

What are the causes? Ingrown toe nail can be caused by tight-fitting shoes or high heels causing the toes to be compressed together and pressurize the nail to grow abnormally. Improper trimming of toenails can also cause the corners of the nail to dig into the skin. Disorders such as fungal infections of the nail can also cause a thickened or widened toenail to develop.

How to prevent it? The best method of prevention is careful clipping of the toenails. Toenails should be clipped straight across and taking care to keep the end longer than the skin edge. This prevents the corners from digging into the skin. They should not be rounded or cut too short. Wearing well-fitting shoes helps as well.

What are the treatments? Mild ingrown toenails may be treated with conservative measures like warm daily soaks, topical antibiotics, and gently pushing back the piece of overgrown skin away from the nail. More advanced ingrown toenails may require treatment with oral antibiotics. Resistant or recurrent cases of ingrown toenails may require a minor in-office procedure. Surgical procedures aim to remove the embedded nail from the toe tissue.


Plantar Warts

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What is Plantar Warts? Warts are the most common viral infection of the skin. Plantar warts grow on the plantar surface, or the sole, of the foot. They can be found anywhere in this area but tend to produce symptoms in areas of pressure and friction. The virus that causes warts, the human papillomavirus, infects only the superficial layer of skin, producing a thickened callus-like growth that, if located in an areas subjected to pressure, can become quite tender.

The human papilloma virus (HPV) type 1 causes most plantar warts. The virus gains access to the skin through direct contact. It is presumed that inoculation of the skin probably occurs in places likely to be contaminated by others with plantar warts, like communal showers. There are a variety of innate mechanisms that seem to be important in resisting infections. Once infected by HPV, spontaneous resolution seems to depend on the development of immune lymphocytes that destroy the virus-infected cells. It appears that the levels of neutralizing antibodies in the blood induced by vaccination with HPV proteins can protect against certain types of infections

What are the causes?
  • Human papilloma virus (HPV) type 1
What are the treatment? There are many ways to remove plantar warts, such as acid, laser treatment, cryotherapy,curettage and desiccation,oral medication or immunotherapy.


Gout

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What is Gout? Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body, especially the joints. When crystals form in the joints, it causes recurring attacks of joint inflammation (arthritis). Gout is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones(nephrolithiasis)

What are the causes?
  • Intake of alcholic beverages
  • Hereditary
  • Increase in level of uric acid
  • Starvation and dehydration
  • Trauma
What are the treatments? The treatment of an acute attack of gouty arthritis involves measures and medications that reduce inflammation. Preventing future acute gout attacks is equally as important as treating the acute arthritis. Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption, and medications to lower the uric acid level in the blood.

Maintaining adequate fluid intake helps prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney stone formation in patients with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism to cause hyperuricemia. Therefore, alcohol has two major effects that worsen gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, both of which contribute to the precipitation of uric acid crystals in the joints.


Plantar Fasciitis

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What is Plantar Fasciitis? Plantar fasciitis is one of the most common causes of heel pain. It is due to inflammation of a thick band of tissue called the plantar fascia, which runs across the bottom of the foot, connecting the heel bone to the toes.

How is it diagnose? The chief diagnostic sign of these problems is pain in the bottom of the heel or arch when first standing, which gradually improves with walking. This pain may later return with continued walking. The pain usually subsides after a period of rest.

What are the causes? Under normal circumstances, the plantar fascia acts like a shock-absorbing bowstring, supporting the arch of the foot. But when the tension on the bowstring becomes too great, it creates small tears in the fascia. Repetitive stretching and tearing causes the fascia to become irritated or inflamed.

How to prevent it? Maintaining a healthy weight minimizes the stress on the plantar fascia and choosing supportive shoes by avoiding high heels and buy shoes with a low to moderate heel, good arch support and shock absorbency. Do not go barefoot, especially on hard surfaces.

What are the treatments? About 90 percent of people who suffer from plantar fasciitis recover with conservative treatments in just a few months. Anti-inflammatory drugs may ease pain and inflammation, although they do not treat the underlying problem. Shock wave therapy is a good form of treatment for this condition.


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