Bunions: Cause & Treatments

Bunions are bony humps that form at the base of the big toe. When this happens, the big toe will curve towards the other toes and cause the base of the toe to push towards the first metatarsal bone. It usually occurs at a joint and the entire body weight will be acting on it. This will result in tremendous pain and discomfort.

Causes

As we grow and develop, more pressure is acting on the foot due to the need to support the body’s entire weight. Therefore, it gets worse as age increases. Bunions is hereditary and will run in the family due to the fact that foot type and shape is hereditary. In some cases, bunions will develop with existing medical conditions such as arthritis. Women are also at a higher risk of suffering from bunions due to the fact that most women wear tight and ill-fitting high heeled shoes, pushing the foot bone into awkward positions for long periods of time.

Non-surgical treatment

Non-surgical is targeted to reduce pressure on the big toe and provide pain relief.

  • Wearing wide and comfortable shoes with sufficient space for toes to wriggle. The insoles should also provide good arch support.
  • Custom made orthotics will help to distribute the body’s weight equally throughout the foot and reduce any unnecessary pressure acting on the big toe.
  • Pain relief medication will provide instant pain relief for patients and bring down the swelling.
  • Ice is a cheap and effective method to reduce swelling and provide pain relief.

Surgical treatment

If non-surgical treatment does not provide adequate pain relief, daily activities such as walking can be severely hindered. In such cases, surgery may be the only option left. The main aim of bunion surgery is to straighten the curved toe bone and provide pain relief.

  • Bunionectomy is a bunion specific surgery and involves removal of part of the affected metatarsal head.
  • Osteotomy involves the cutting of bones located in the toe to prevent bone spurs from sticking out and re-alignment the soft tissues around the toe joint.
  • Resection arthroplasty is reserved for more serious cases and involve the removal of bone located at the end of the first metatarsal joining the metatarsophalangeal joint.

As the saying goes, prevention is better than cure. A good pair of footwear is often all that is needed to prevent one from getting bunions. Selecting a pair of functional shoes over one that is aesthetically pleasing is a much sensible choice.

Femur Shaft Fractures (Broken Thighbone): Cause & Treatments

Our femur is the strongest and longest bone in our body. Due to the high strength, an extremely large force is necessary to cause any fracture. These situations can include a high speed car crash and this is the most common reason for such fracture. A force that is beyond the normal limits of the femur will result in a fracture. The long and straight part of the femur is called the femoral shaft and when there is a break along the femoral shaft fracture, it is known as a femoral shaft fracture.

Causes of a femoral shaft fracture

Femoral shaft fractures usually occur in young people due to the type of activities they engage in. Most youngsters engage in high impact activities such as wakeboarding, football and racing. The most common reason is an automobile accident resulting in a car crash. Other less common causes can be an accidental fall from a certain height or even a simple fall in people of a higher age group. This is due to their weakened bones or existing medical conditions such as osteoporosis.

Treatment

Non-surgical treatment

Non-surgical treatment is meant for patients who do not have a displaced femoral shaft fracture. In cases like this, treatment will involve the usage of walking aids such as crutches or walker with the foot in a protective brace or splint for a period of time. However, most femoral shaft fractures will require surgery to properly heal.

Surgical treatment

Surgical treatment is needed for those who have displaced femoral shaft fractures and this will usually involve the realignment of the bones. Metal pins and screws will be placed into the bones located above and below the fracture site to properly hold the bone in the proper position to facilitate healing. It is a temporary treatment and will provide adequate stability until the patient is ready for stage 2 of the surgery – intramedullary nailing. A metal rod will be inserted into the marrow canal of the femur to hold it in its proper position. It is then screwed to the bone at both ends. The bone fragments will also be cleaned and joined together with the femur using screws and metal plates.

Patients suffering from a femur fracture should seek prompt medical attention as ignoring such symptoms will cause more damages to the femur and prevent healing of the fracture altogether, leading to a lifetime of instability and pain.

 

Morton’s Neuroma: Symptoms & Treatment

Morton’s neuroma is a medical condition affecting one of the many nerves running between the metatarsals in our foot. Metatarsals are one of the many bones found in the foot. The other bones are the tarsal bones and phalanges with metatarsals being the longest ones. There are a total of five metatarsal bones and the first is the largest and the smallest is the last.

Morton’s neuroma is named after a doctor who first described this condition in 1876 – Dr Morton. It affects the plantar digital nerves running between the metatarsals and usually affects the third and fourth bone. It may also affect the second and third metatarsal bones but this is less common and rarely affects the first and second and fourth and fifth.

Patients suffering from Morton’s neuroma often complain of pain that starts in the ball of the foot all the way to the affected toes. Some patients however will brush it away as toe pain. In some cases, a stinging sensation might also be felt in the toe. The pain will also be felt at the sides of the affected toes. For example, if the third and fourth metatarsal bones are affected, pain will be felt at the right side of the fourth toe and all the way to the left side of the third tone. Symptoms are intensified if patients wear high heel shoes requiring them to walk on their toes and will often go after periods of rest.

Some patients require simple non-surgical treatments while some may need surgery:

Non-surgical treatments

  • Footwear adjustment might be all that is needed for some patients. This include wearing wide feet shoes to allow room for toes to wriggle, avoiding high heel shoes and having orthotic pads fitted into the shoe.
  • Cryotherapy uses extreme cold to destroy neuroma tissues. Through the use of liquid nitrogen, it effectively shrink tissues and inhibit blood flow to the abnormal tissues.
  • Steroid injections will deliver a burst anti-inflammatory medication directly to the area
  • Sclerosant injections delivers a mixture of alcohol and local anaesthesia to shrink blood vessels and some doctors compare the effectiveness of it to surgery

If non-surgical treatment does not help, surgery will be required. The main purpose of surgery is to make space for the affected nerves due to decompression. The surgeon will make a small incision at the top or sole of the affected foot to relieve the internal pressure. The success rates of surgery is high and long term complications are not common.

 

Lisfranc (Midfoot) Injury: Cause & Treatments

Lisfranc or midfoot injuries are often the results of broken bones in the midfoot or torn ligaments. Lisfranc injuries can vary from complex to simple depending on the number of joints and bones that are involved. Many patients often mistaken their midfoot injury to that of a simple sprain. As a result, many choose to self-medicate with pain relief cream. However, Lisfranc injury is not as simple as it seems and may even require surgery in some cases.

Located in the midfoot are clusters of small bones forming an arch at the top of the foot. There are five long metatarsal bones extending to the tones and ligaments and tendons hold the bones in place. However, there are no connective tissues holding the first metatarsal to the second metatarsal.

Lisfranc injuries can occur due to either direct or indirect trauma. Direct trauma is often result of an external force striking the foot while an indirect trauma occurs due to a force transferring to the stationary foot that deforms the foot. The foot is a smart system that is divided into three different sections namely the hindfoot, midfoot and forefoot. The role of the midfoot is to translate force and provide rotational stability and it is the keystone for plantar flexion and dorsiflexion. Therefore with a lack of dorsal support, the load acting on the foot is sufficient to cause dorsal displacement, leading to broken bones and/or ligaments.

The earlier a Lisfranc joint injury is diagnosed, the better it is for both patient and doctor. An initial clinical evaluation involving radiographs such as x-rays and MRI will be performed to indicate the probability of a mild, moderate or complex sprain. If diastasis is not present, immobilisation will be needed. This will include the usage of an immobilisation cast for a period of four to six weeks followed by limited movements. After six weeks, rehabilitation exercises need to start immediately. This is due to the bone being a piezoelectric material and will resorb after periods of inactivity.

If surgery is needed, it will be performed within 24 hours of the injury or after 10 days to allow for the drainage of bodily fluid due to swelling. Kirshner wires will be used to fix the bones together and bone fragments will be removed. After surgery, patients need to be immobilised in a cast for up to 12 weeks with minimal movements.

Some people will no longer be able to return to pre-injury levels of activity after a midfoot injury despite advancement in medical technology.

 

Arthritis of the Hand: Symptoms & Treatment

Arthritis is the generic name for inflammation in the joints. It can take many different form and the most common one is osteoarthritis. Osteoarthritis is the medical condition when the protective cushioning known as the cartilage is worn out due to wear and tear. It usually happens in areas such as the hand. In this article, we will look at some of the symptoms and treatment for hand arthritis.

Pain

Pain is the most straightforward symptom for any kind of medical conditions. In the initial stages of hand arthritis, the surrounding area will start to have a burning sensation especially after periods of long usage. This pain can be immediate or delayed. As wear and tear of the cartilage continue to take place, the pain will start to be more intense and the frequency increases. After long periods of rest such as after waking up in the morning, the pain can be quite unbearable and the ability to sense changes in weather also appears. Simple activities such as carrying a grocery bag or opening a can be difficult to accomplish.

Crepitation

After some time, there will be sensations of crepitation. This is due to the damaged cartilage rubbing against each other to create a grinding effect. If the hand arthritis affects the hand ligaments, the ligaments and tendons may start to become loose, creating a sense of instability.

Swelling

Swelling occurs due to an excess of body fluid accumulated in the hand. This is due to the body’s natural defence mechanism sensing that something is wrong. As a result, the white blood cells start to destroy the damaged cartilage, secreting a lot of fluid as a result. This will result in pain and tenderness in the hand.

 

Treatment is classified into non-surgical and surgical methods. In non-surgical treatment, the doctor will prescribe medication to stop the inflammation such as acetaminophen and ibuprofen. These medication can only treat the symptom but cannot repair the damaged cartilage. To counter this, glucosamine and chondroitin may also be prescribed as supplements.

If non-surgical treatment fails to produce good results, surgery will be necessary. The most common form of surgery is finger joint replacement. The replacement materials are biocompatiable and possesses weightbearing capabilities such as ceramics. This will help to restore function to the hand and improve the quality of life.

Cartilage do not self-regenerate and this is why joint replacement is the most viable option up to date.

Bennett Fracture: Cause & Treatments

A Bennett fracture happens when the bone located at the base of the thumb dislocates and breaks. It can be due to a sudden trauma during high impact sports or accidents. A Bennett fracture will result in swelling of the thumb, pain and the inability to use the thumb. In this article, we will look at the causes and treatments for Bennett fractures.

Causes

The causes of a Bennett’s fracture can differ. However, it happens when the metacarpal bone located in the arm fractures and breaks. This can be due to any kind of forces that will result in a huge impact sufficient to break it.

Treatments

Treatment is classified into non-surgical and surgical. For minor cases where the bones are not misaligned, non-surgical will be more than sufficient. The initial stages of treatment will involve the famous RICE therapy – Rest, Ice, Compression and Elevation. Resting involves immobilising the injured hand and preventing any stresses on it. During this period, the patient is not allowed to participate in any activities. Several times a day, the injured thumb will need to be iced in order to bring down the swelling. To prevent swelling and loss of blood, compression finger sleeves may be worn. This will also help to retain body heat and enhance blood circulation. Lastly, the injured thumb needs to be elevated above the heart to drain away excess blood. Bracing and casting may be required depending on the activity level of individual patients.

Surgical treatment is also classified into invasive and minimally invasive. In minimally invasive surgery, a surgical wire will be inserted through a small incision aided by cameras. However, this method is highly dependent on the stability of the injury and the alignment of the metacarpal bone. If the bones fragments are scattered, an invasive surgery will need to be carried out in order to remove these bone fragments. A small screw will be used to hold the fragments together until they heal on their own. One popular surgical treatment is the Kirschner wire fixation. The K-wires are made up of surgical grade stainless steel and are temporary fixation tools. The pins are drilled into the bones and act as an anchor point for skeletal traction.

Unlike other injuries, Bennett’s fracture cannot really be prevented due to the various uses of the hand and the fingers. However, this fracture can be avoided to a certain extent using medical tapes to tape the thumb and index finger together.

 

 

 

Hamstring Muscle Injuries: Cause & Treatments

Hamstring injuries are a common occurrence in athletes. They are usually known as “pulled hamstring”. Sports requiring frequent sprinting such as soccer, rugby and basketball poses a higher risk of a hamstring injury. Hamstring injuries happen when the muscle location at the back of the thigh is injured in the form of a strain. Fortunately, this type of injury respond well to nonsurgical treatment. In this article, we will look at the causes and treatment methods for a pulled hamstring.

The main cause of a hamstring injury is due to overloading of the hamstring muscle. The hamstring is a tendon which is essentially a thick bundle of fibers. During a normal scenario, the tendon contracts and shortens and expands and extends. In unusual situations, this tendon contracts and extend due to the presence of an additional load or strain. When this situation happens, the hamstring is pulled, resulting in a hamstring muscle injury.

Treatment will vary depending on the severity of the injury. Most hamstring injuries can recover with nonsurgical treatment. The first treatment administered will be the RICE protocol – Rest, Ice, Compression and Elevation. Resting involves the usage of walking aids such as crutches to avoid placing weight on the injured leg. During this period, the patient is not allowed to participate in any activities. Several times a day, the injured leg needs to be iced in order to bring down the swelling. To prevent swelling and loss of blood, compression garments will need to be worn. This will also help to retain body heat and enhance blood circulation. Lastly, the injured leg needs to be elevated above the heart to drain away excess blood. Once pain and swelling has subsided, a series of physical therapy sessions will be planned for in order to regain strength and range of motion to slowly help return back to sports.

If nonsurgical treatment does not help, surgery will be required. This is usually for cases where the hamstring tendon has been completely torn from the bone. To repair the torn tendon, the hamstring muscle must be located and placed back to its original location. Due to this injury, the body naturally forms scar tissues at the injury site and this must be removed as well. After that, the tendon will be reattached back using biodegradable sutures. This is followed by an intense rehabilitation period lasting at least 3 months.

Patients with hamstring injuries are able to fully recover after completing their rehabilitation plan. Most are able to return back to their pre-injury level and enjoy their favorite sport.

 

Adult Forearm Fractures: Cause & Treatments

Our forearm is connected by two bones, the radius and ulna. In an event of a forearm fracture, both of the bones are often broken. The location of the fracture can be in several areas. It can appear at the wrist area, middle of forearm or nearer to the elbow. The main function of the forearm is to facilitate rotation of the wrist. This rotation movement allows us to turn our palms upwards or downwards. A forearm fracture will severely limit the amount of work we can do.

Causes

Fractures are usually caused by a sudden stress acting on it that is beyond the usual limit. In the case of forearm fractures, there are 3 main situations that can cause such an injury – a sudden blow to the forearm, a sudden compression to the forearm or over rotation of the forearm. The ulna is the bone that is often broken by the above scenarios. Twisting fractures can also occur due to high impact sports or fall from heights landing on an outstretched arm. There will also be damages and injuries to the soft tissues such as the muscles and tendons.

Treatment

Non-surgical

The first step would be a first aid evaluation by a medical professional. The fractured arm will be immobilized using a splint or sling. An isolated fracture can be easily treated using this method and it will heal on its own. Realignment surgery is not necessary if there are no mis-aligned bones or protruding bones.

Surgical – Internal fixation

In serious cases, surgery will be required in order to promote healing and recovery. A fixation surgery will be carried out to realign and fix the fracture bones together. The bones will be connected using metal plates and screws and this will allow early recovery of movement, reducing the chances of bone resorption. A cast is required after surgery as well to add weight to the bone.

Surgical – External fixation

In cases where there is the presence of open wounds or damages to the skin, internal fixation is not recommended due to the chances of further injuries. Thus, external fixation is preferred. As the name suggests, external fixation involves fixing screws on the outside of the body. Screws will be attached around the fracture site using a metal bar. This metal bar acts as a stabilizing frame to hold the bone in proper position until it heals on its own.

Olecranon Fractures: Treatment & Management

Our elbow is a complex hinge joint made up of three different bones. It can also perform various functions. The elbow is able to bend and straighten up, rotate and turning up and down. When you try to bend your elbow, the sharp tip protruding out is called the olecranon. Olecranon fractures are injuries that affect the particular bone.

Treatment

After a patient suffers from an Olecranon fracture, the first thing a doctor will administer is ice and pain relief medication followed by elbow immobilization. The doctor will then determine if surgery is required depending on the extent of the fracture.

Nonsurgical treatment

Patients who do not have a severe fracture will not be required to undergo surgery. Nonsurgical treatment is fairly straightforward. The patient will need to immobilize the fractured elbow using a splint or sling during the healing process. The patient will also need to visit the hospital once a week for X-ray imaging to monitor the healing process. If there are no protruding bone fragments, movement will resume after a month. During the healing process, a physiotherapist will be assigned to teach basic strengthening exercises. If the fracture shifts during this process, the patient will eventually surgery to piece the bones together.

Surgical treatment

Surgery will be needed for patients who have serious fractures such as an open fracture or displaced fracture. In a displaced fracture, the fracture is out of place. This is due to the strong attachment of the bicep muscles to the olecranon. Once the fracture is out of place, the elbow will be unable to straighten at all. An open fracture on the other hand means that the bone fragments have cut the skin, leading to an increased risk of infection. This is a much more serious condition and patients will be administered with antibiotics and tetanus shot. An incision will be made at the back of the elbow where the surgeon will piece the bone fragments together again. Large pieces of bones may be joined together using pins, wires, screws or plates and these metal implants can be permanent or biodegradable.

Management

Following surgery, rehabilitation will be required in order to regain the elbow to its previous condition. As the healing process is lengthy, bone resorption could have taken place. As such, the region is much weaker. A physiotherapist will thus concentrate on regaining bone mass and muscular strength in the elbow.

Scoliosis: Symptoms & Treatments

Our spine is the structure that gives our body its shape and provide support to it. The entire spinal column consists of multiple small bones stacked together. The spine is designed to be curved naturally although it looks straight when it is viewed from the front. In fact, there are two S-curves at the spine. Scoliosis is a medical problem arising from the abnormal curvature of the spine. Patients who suffer from scoliosis have got spine that looks curved even when viewed from the front. Research has shown that scoliosis are more prevalent in females than males and affects 3 out of 1000 people.

As mentioned above, patients with scoliosis have an abnormal curvature of their spine. As such, this is the most common and obvious symptom. The curving of the spine occurs at an extremely slow pace and thus is easy to miss out until it really becomes severe. The easiest way to be spotted with it is during periodic medical examinations during primary and secondary school. In some patients, scoliosis may also cause their head to the slanted to one side or one of the shoulder to be slightly higher than the other side. In serious cases, the heart and lungs cannot work efficiently and this will lead to the shortness of breath and chest pains.

Treatment of scoliosis really depends on how severe it is towards the patient. Treatment is classified into 3 general groups: observation, bracing and surgery. In patients with mild symptom, they will only be observed for a period of time to spot any changes of the curve getting worse.

Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve stays below 25 degrees, no other treatment is needed. You may return to see the doctor every three to four months to check for any worsening of the curve. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. If the curve is between 25-40 degrees and you are still growing, a brace may be recommended. Bracing is not recommended for people who have finished growing. If the curve is greater than 40 degrees, then surgery may be recommended.

Although there is currently no cure for scoliosis, there are good treatment methods that are effective. As the saying goes, prevention is always better than cure.