Types of Sesamoid Injuries In The Foot

Sesamoids in the foot are two pea-shaped bones beneath the big toe joint found in the ball of the foot. Joint with tendons, the sesamoids act as pulleys to facilitate movement of the big toe. When walking, running and jumping, sesamoids help the big toe push off and bear weight for the big toe bone when the foot hits the ground.

Causes

The damage of a sesamoid injury could affect the bones, tendons and the surrounding tissue. Risk of a sesamoid injury is increased with activities that place extra pressure on the foot such as soccer, ballet, tennis and basketball. Wearing ill-fitting shoes and high-heels bring additional strain to the joints and could also cause injury to the area.

 

Types

Turf Toe

This sesamoid injury involves a sprain of ligaments around the big toe joint. It happens when the foot is bent too far forward, causing a hyperextension of the joint. Usually, it is a result of a sudden impact when engaging in sports. Patient might hear a “pop” sound when it happens, followed by a sharp pain and swelling.

Fracture

A fracture happens when the bone is broken. There are two types of sesamoid bone fractures.

Acute Fracture:

An acute fracture occurs when a direct blow causes a break in the sesamoid bone. Pain and swelling would be immediate.

Chronic Fracture:

It is a chronic fracture when repetitive stress causes a hairline break in the sesamoid bone. Patient would feel constant pain in the ball of the foot. With rest, the pain can be alleviated. But once activity resumes, the pain would recur and get aggravated.

Sesamoiditis

Caused by increased pressure to the sesamoids, this injury is an overuse injury that produces a dull, longstanding pain beneath the big joint toe where the sesamoid bones are. Both the bones and joint tendons are inflamed. The pain recurs upon activity and wearing inappropriate shoes.

 

Treatment

Treatments for sesamoid injuries are generally non-surgical. Only if the injury does not show any significant improvement with non-operative treatment, surgery would be considered. Depending on the severity of the injury, one or more of these conservative methods may be used.

  • Cast immobilization
  • Physical therapy
  • Orthoses
  • Padding of insoles or taping of toe joint
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Types Of Intoeing

Intoeing typically occurs in infants and children under the age of 10. The appearance of the condition is apparent with the toes pointing inwards instead of straight ahead, thus commonly referred as “pigeon-toed”. Some infants are born with it, caused by the position in the womb. Others gradually develop it or the intoeing becomes noticeable after they started walking.

Usually, children outgrow intoeing. Their feet would straighten out as their legs grow longer without the use of casts, braces and surgery. Intoeing does not cause any pain or trouble in learning to walk. Only in severe cases that patients would trip and stumble often as a result of the conflicting directions that the feet are pointing.

Intoeing should not be confused with Hammertoes, which is a more severe deformity of the second, third or forth toe. It got its name from the way the middle joint of the toe is bent downwards like a hammer. While intoeing does not affect the child’s daily functions and would naturally correct itself over time, hammertoes causes pain, growth of corns and calluses, discomfort in wearing regular shoes, muscle imbalance, and these symptoms would worsen if left untreated. Surgery may even be required if it is diagnosed late.

To know the cause of intoeing, patient has to be diagnosed with the specific type of intoeing.

Metatarsus Adductus

This is a common birth defect in which the middle of the foot to the toes are turned inwards. Most of the time, it gets better after a few months. But if the condition persists, casts and special shoes would usually correct the alignment without the need for surgery.

Tibial Torsion

Because of the position in the womb, tibial torsion may occur even before the infant is born. The tibia, or lower leg, is bent inwards, making the feet twist inwards as well. Special shoes and therapy would not help but it usually goes away after the tibia grows longer. But if it does not get better even up to 8 years old and it affects the walking drastically, surgery may be required.

Femoral Anteversion

This occurs when the thighbone is turned inwards and may not be noticeable until the child is about 5 years old. As with tibial torsion, special shoes and therapy would not help but the condition improves with age. If walking is affected and causing significant tripping, surgery may be considered with the prerequisite that the child is at least older than 9 years old.

Causes & Treatments For Metatarsalgia (Forefoot Pain)

Patients with metatarsalgia experience pain and inflammation in the ball of the foot. It is an overuse injury usually occurring in athletes that do high-impact sports like track and field, tennis and soccer. These activities require heavy uses of the forefoot, thus subjecting to a high risk of the injury.

 

Symptoms

The pain does not happen immediately but gradually increases over a span of a few months. Left untreated, the pain would be aggravated with more walking and running. Sometimes, bursitis may also develop along with metatarsalgia.

Patients would feel a sharp, aching or burning pain in the ball of the foot likened to stepping on sharp pebbles. This follows with a numb, tingling sensation in the toes. You would notice that a callus, or hardened skin, is developed. Often diagnosed as a symptom to other problems, metatarsalgia usually comes with other forms of injuries.

 

Causes

Excessive side-to-side movement required by certain sports is one of the causes of metatarsalgia. However, this is not just a sports injury. Those with tight Achilles tendon, weak toe muscles, or wearing ill-fitting shoes over long periods of time can also cause the injury. Most often, it occurs with a combination of factors. These are some other possible factors:

  • High foot arch
  • Obesity
  • Compensating for previous foot injuries
  • Morton’s neuroma

 

Treatment

Non-Surgical:

The first course of treatment would be the RICE (Rest, Ice, Compression, Elevation). Patient should not put any weight on the foot at this point. It is advisable to get a professional to assist with proper stretching exercises to strengthen the foot and restore motion. Special footwear that has stiff soles and padding are also recommended to support the foot.

Surgical:

The doctor may recommend shaving the callus, but this method is just a temporary relief of pain. There is also a risk of bleeding from excessive debridement and the use of acids and chemicals. The callus is merely a reaction to the pressure on the foot that causes the pain. More importantly, the cause of the callus has to be determined to know the appropriate treatment for the long-term. Only in severe cases, the metatarsal bones may need to be surgically realigned.

 

Recovery

The goal of therapy is to subside the inflammation and relief the pressure. One or more of these measures may be recommended to assist the recovery process:

  • ROM exercises
  • Swimming
  • Self-mobilization exercises
  • Using an orthotic device
  • Shoe modification with an orthotic support

What Is Progressive Flatfoot? Signs, Causes & Treatment

Another name for progressive flatfoot is Posterior Tibial Tendon Dysfunction. The posterior tibial tendon is found in the calf down to the inside of the ankle to the middle section of the foot. It is responsible for holding up the arch of the foot and gives us support when walking. Progressive flatfoot happens when the tendon becomes inflamed, stretched or torn, causing the arch to collapse.

Not to be confused with plantar fasciitis, which is the inflammation of the plantar fascia, causing the bottom of the foot to hurt and swell. While progressive flatfoot is an injury to the tendon, plantar fasciitis is a strain to the ligament.

Signs

Patients with progressive flatfoot will experience pain on the inner side of the ankle. The arch of the foot is now flat and pain gradually develops on the outer side of the ankle as well. Patients may be unable to or experience difficulty in supporting their weight on their toes.

Causes

Progressive flatfoot is often caused by trauma to the ankle from sports or outdoor activities such as soccer, running and hiking. The posterior tibial tendon is overstretched, resulting in inflammation. This condition can also happen to patients with an abnormality of the tendon, usually women over the age of 50. Obese and diabetic patients are also at higher risk for this injury.

Treatment

Treatment is important to prevent chronic pain or even disability. If left unattended, the tendon would stiffen up and it might be difficult to walk or wear shoes. Arthritis would develop in the hind foot and the pain would spread to other parts of the ankle.

Non-Surgical Treatment:

If the condition is mild, patient would be wearing a cast or brace for 6-8 weeks to prevent the foot from weight bearing. At this point, anti-inflammatory drugs and plenty of rest are needed to recover. Patient would need to wear a shoe insert to support the arch after the cast is removed.

Surgical Treatment:

For more severe cases or if the condition does not get better with non-surgical treatment, the doctor would recommend surgery. The surgical procedure may include cleaning away inflamed tissue, changing the alignment of the heel bone, repairing the damaged tendon, recreating the arch of the foot or joining two bones together to stabilize the hind foot.

Pilon Fracture: Causes, Symptoms & Treatments

Pilon fractures occur at the lower end of the tibia, or the shinbone, where the part of the bone near the ankle bears the most weight. The smaller calf bone on the lateral side of the tibia, the fibula, most often is broken as well following the fracture.

Usually occurring in adults aged 30-40s, this injury is rare, consisting of only 7% of tibia fractures. It may be difficult to treat and complications after treatment are common.

Causes

Pilon fractures are usually resulted from high-impact falls or car accidents. Airbags in cars can save a person’s life but not protect the legs. Thus in a collision, survivors may sustain pilon fractures and usually other forms of injuries.

Symptoms

Patients would feel severe pain with swelling and bruising. Walking is impossible or extremely difficult. Bearing weight on the injured foot at this point would cause the bones and soft tissue to be further damaged. The ankle would also have a deformed appearance because of the displaced bones.

Diagnosis

It is important to inform your doctor the way that you got yourself hurt to gauge the severity of the injury. Your doctor may do an X-ray, radiograph, CT scan or 3D CAT scan to fully evaluate the fracture. Whether surgery is opted for also depends on the patient’s health condition. Let your doctor know about your medical history to avoid the risk of aggravating your health issues.

Treatments

The decision to go for surgery depends on the extent of the displacement. Most pilon fractures require surgery. If the bones are minimally displaced, nonsurgical treatment might be possible.

Nonsurgical:

Cast immobilization is used for fractures with bone pieces still aligned and stable. Patients with health problems or do not need to do a lot of walking may also be recommended nonsurgical treatment. Cast has to be worn for 6 weeks and replaced with a brace after. It is recommended to not bear weight on the injured foot for 12 weeks.

There might be a chance that patient is left with a deformed-looking ankle after the fracture heals. Improper care during the recovery process or complications cause incomplete alignment. If the shape of the joints is not fully restored, patient is at a high risk of developing arthritis.

Surgical:

Metal implants such as plates and screws are used in open reduction and internal fixation to hold the bones back in place. However, if the swelling and blisters are too severe, an external fixator may be applied first to stabilize the bones and allow soft tissue to heal before the surgery can take place to reduce the risk of infection.

Full recovery typically takes 3-6 months with regular follow-ups. Physical activity should be kept to the minimal during this period to prevent jeopardizing the healing process. It is not uncommon that patients may take up to 12 months to fully recover and regularly experience stiffness, swelling and aches even after recovery. Physiotherapy might be needed for patients that take longer to heal.

All About Charcot Arthropathy

Charcot arthropathy, also known as Charcot foot and ankle, is a condition that weakens the bones of the foot, causing an eventual fracture or dislocation and collapse of the mid-foot arch.

Causes and Symptoms

This condition often develops from neuropathy. Because of the loss or diminished sensation in the foot, patients do not detect the swelling, warmth and pain caused by Charcot arthropathy, thus continuously bearing weight on it and aggravating the injury. Neuropathic patients with a tight Achilles tendon are at an even greater risk to develop Charcot arthropathy.

Patients with diabetes, leprosy and syphilis are some of those with a higher tendency to develop Charcot arthropathy because of the neuropathy caused by those illnesses. Additionally, their slow rate of healing might not compensate fast enough for the amount of trauma impacted on the weakened joints from their body weight. It is important to check for redness and swelling or the abnormal appearance of the rocker-bottom foot.

Diagnosis

These are the different types of scans and tests that may be done on the injury to determine the severity and rule out other conditions.

  • X-Ray
  • Bone Scan
  • MRI
  • Radiography
  • Doppler Ultrasonography
  • Lumbar Puncture
  • Bone Probing
  • Portable Infrared Dermal Thermometry
  • Joint Aspiration
  • Synovial Biopsy

Treatments

Non-Surgical:

Most cases of Charcot arthropathy can be treated without surgery. Immobilization is most effectively done with a cast on for 3-6 months and regularly checked and replaced every 1-2 weeks. A splint, braces or orthoses are other options but the healing period might be longer. A non-weight bearing (NWB) condition is ideal for the injury to heal faster and prevent further damage.

After the initial healing stage is stabilized and the cast is remove, it is recommended to wear custom footwear with special shoe inserts to prevent recurrence and ulcers. Protection to both feet is important as the other foot has a high likelihood to develop Charcot arthropathy as well. As such, physical activity that might bring trauma to the feet has to be minimized.

Surgical:

If the ankle sustains displaced fractures, an open reduction and internal fixation (ORIF) is needed. An even more severe injury would require a correction of deformity or ostectomy. Usually amputation is not necessary unless ulcers are developed. There is a chance of recovery by draining the infection and maintenance of fixation, but if the infection could not be contained, amputation is the last resort.

Recovery

Typically, it takes up to 1-2 years before the injury is fully recovered. However, a regular lifelong follow-up is required to ensure that symptoms do not recur.

Adult Acquired Flatfoot: Cause, Symptoms and Treatment

Adult acquired flatfoot deformity (AAFD) is not present at birth and only acquired during adulthood between 40-60 years of age. Usually caused by damage to the posterior tibial tendon, the arch of the foot gradually collapses as the tendon gets inflamed or torn.

Causes

There are a few categories of people more likely to develop AAFD – Women over 40, diabetic patients, obese people and patients with hypertension. Such conditions provide a higher risk to overstretch or rupture the posterior tibial tendon, leading to AAFD.

Other causes of AAFD are rheumatoid arthritis, bone fracture or dislocation. These conditions cause the tendon to be weaker and subject to impairment. Those with flatfoot since birth are also more prone to AAFD later in life.


Symptoms

One or more of these symptoms may be experienced depending on the cause of the AAFD.

  • The foot is angled in an awkward position. One way to check is to view from the back of the foot. For a normal foot, only the fourth and fifth toes can be seen from the back. If the big toe can be seen, chances are AAFD has developed.
  • Pain and swelling along the inner side of the foot causing difficulty to tiptoe.
  • Aggravated pain from long periods of standing or walking, or from high intensity physical activities.
  • Pain in the anklebone that feels like arthritis.
  • Numbness and tingling on the top of the foot and in the toes caused by bony bumps developed from old injuries.
  • Diabetic patients may only notice the swelling but not feel any pain due to their impairment of sensation.

 

Treatment

Most cases of AAFD can be treated without surgery. If the condition is not improved after nonsurgical treatments, surgery is needed to realign the foot.

Nonsurgical:

  • Shoe modification may help for mild conditions. A shoe insert or customized shoes that give arch support can be easily purchased from stores.
  • Customized braces and foot orthoses are fit tightly around the leg to prevent it from moving in certain angles and correct the alignment of the foot.
  • Physiotherapy helps to strengthen leg muscles and guide foot movements.


Surgical:

Depending on the type and severity of deformity, one or a combination of these procedures might be used if nonsurgical treatments show no improvement.

  • Repairing of the posterior tibial tendon and removing inflammatory tissue.
  • Tendon transfer if the posterior tibial tendon is badly damaged.
  • Bone surgery is done to recreate the arch and realign the bones, which are then held in place with screws and plates.