Karyn Hurm

Foot Conditions

Leg Length Discrepancy Gait

Overview

Neuromuscular. Muscle imbalance causing different pull on pelvis (anterior superior Ilium or posterior inferior ilium). Muscle tightness/shortness especially piriformis (which lead to an external rotation of the femur thus shortening of the leg) and QL (raising ipsilateral iliac crest). Genu recurvatum, valgus, varus. Asymmetrical fallen arches or over pronation. Polio, Cerebral palsy. Trauma. Fracture. Injury epiphyseal plate. Iatrogenic (such as hip or knee surgery). Idiopathic. Hip disorder (such Legg-Perthes-Calve? or Slipped capital femoral epiphysis). Advanced degenerative changes.Leg Length Discrepancy

Causes

Leg discrepancy can develop from a medical issue in any portion of the femur or tibia. One leg may lengthen, but leg shortening is much more common. Factors that can cause leg length discrepancy include inherited growth deficiencies. Infections. A bone infection can cause delayed growth in the affected limb. Injury. If your child breaks a leg, it may be shorter once it heals. This is most likely to happen if the fracture or break was complicated, an open fracture, or an injury that affected the growth plate near the end of the bone. Alternatively, a break can cause bones to grow faster after healing, making a leg longer. Tumors. Legg-Calve-Perthes disease. This is a condition that affects the ball (femoral head) of the hip joint. The femoral head may be friable and damage easily, sometimes leading to shortening of the thigh bone. Hemihypertrophy. In children with this condition, one side of the body grows more quickly than the other. Vascular malformations. These are abnormal clusters of veins and arteries that can form close to the bone and stimulate growth. Juvenile arthritis. Inflammation from arthritis can stimulate growth in the affected leg and cause discrepancy.

Symptoms

Many people walk around with LLD?s of up to 2 cm. and not even know it. However, discrepancies above 2 cm. becomes more noticeable, and a slight limp is present. But even up to 3 cm. a small lift compensates very well, and many patients are quite happy with this arrangement. Beyond 3 cm. however, the limp is quite pronounced, and medical care is often sought at that point. Walking with a short leg gait is not only unsightly, but increases energy expenditure during ambulation. It could also put more stress on the long leg, and causes functional scoliosis. Where the discrepancy is more severe, walking becomes grotesque or virtually impossible.

Diagnosis

A systematic and well organized approach should be used in the diagnosis of LLD to ensure all relevant factors are considered and no clues are overlooked which could explain the difference. To determine the asymmetry a patient should be evaluated whilst standing and walking. During the process special care should be used to note the extent of pelvic shift from side to side and deviation along the plane of the front or leading leg as well as the traverse deviation of the back leg and abnormal curvature of the spine. Dynamic gait analysis should be conducted during waling where observation of movement on the sagittal, frontal and transverse planes should be noted. Also observe head, neck and shoulder movements for any tilting.

Non Surgical Treatment

To begin a path torwards a balanced foundation and reduce pain from leg length discrepancy, ask your doctor about these Functional Orthotics and procedures. Functional Orthotics have been shown to specifically reduce pain from leg length inequality, support all three arches of the foot to create a balanced foundation, maximize shock absorption, add extra propulsion, and supply more stability, enable posture correction and long-term preventive protection. Will improve prolonged effectiveness of chiropractic adjustments. Shoe or heel Lifts, Correct the deficiencies that causes imbalances in the body.

Leg Length Discrepancy

what shoes make you taller

Surgical Treatment

Surgical treatments vary in complexity. Sometimes the goal of surgery is to stop the growth of the longer limb. Other times, surgeons work to lengthen the shorter limb. Orthopedic surgeons may treat children who have limb-length conditions with one or a combination of these surgical techniques. Bone resection. An operation to remove a section of bone, evening out the limbs in teens or adults who are no longer growing. Epiphyseal stapling. An operation to slow the rate of growth of the longer limb by inserting staples into the growth plate, then removing them when the desired result is achieved. Epiphysiodesis. An operation to slow the rate of growth of the longer limb by creating a permanent bony ridge near the growth plate. Limb lengthening. A procedure (also called distraction osteogenesis or the Ilizarov procedure) that involves attaching an internal or external fixator to a limb and gradually pulling apart bone segments to grow new bone between them. There are several ways your doctor can predict the final LLD, and thus the timing of the surgery. The easiest way is the so-called Australian method, popularised by Dr. Malcolm Menelaus, an Australian orthopedic surgeon. According to this method, growth in girls is estimated to stop at age 14, and in boys at age 16 years. The femur grows at the rate of 10 mm. a year, and the upper tibia at the rate of 6 mm. a year. Using simple arithmetic, one can get a fairly good prediction of future growth. This of course, is an average, and the patient may be an average. To cut down the risk of this, the doctor usually measures leg length using special X-ray technique (called a Scanogram) on three occasions over at least one year duration to estimate growth per year. He may also do an X-ray of the left hand to estimate the bone age (which in some cases may differ from chronological age) by comparing it with an atlas of bone age. In most cases, however, the bone age and chronological age are quite close. Another method of predicting final LLD is by using Anderson and Green?s remaining growth charts. This is a very cumbersome method, but was till the 1970?s, the only method of predicting remaining growth. More recently, however, a much more convenient method of predicting LLD was discovered by Dr. Colin Moseley from Montreal. His technique of using straight line graphs to plot growth of leg lengths is now the most widely used method of predicting leg length discrepancy. Whatever method your doctor uses, over a period of one or two years, once he has a good idea of the final LLD, he can then formulate a plan to equalize leg lengths. Epiphyseodesis is usually done in the last 2 to 3 years of growth, giving a maximum correction of about 5 cm. Leg lengthening can be done at any age, and can give corrections of 5 to10 cm., or more.
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What Are Fallen Arches

Overview

Acquired Flat Foot

flat foot, condition of the human foot in which the entire sole rests on the ground when the person is standing. When the foot muscles are weakened or the ligaments are strained and stretched, the arch lowers, so that instead of the natural curved contour, there is flattening of the entire sole. Sometimes no discomfort accompanies flat foot. However, fallen arches may cause disalignment of other foot structures so that there is pain not only in the arch area but also in the calf muscles and sometimes as far up as the lower back; the discomfort is increased by prolonged standing. Flat foot may be inherited or may be caused by rickets, obesity, metabolic disorder, debilitating disease, or faulty footwear. Treatment and exercise directed by an orthopedic physician are sometimes advisable. Arch supports or other devices to be worn inside the shoe are often prescribed.

Causes

Inflammatory arthritis, such as rheumatoid arthritis, can cause a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the foot to change shape and become flat. The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch. An injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity. People with diabetes or with a nerve problem that limits normal feeling in the feet, can have arch collapse. This type of arch collapse is typically more severe than that seen in patients with normal feeling in their feet. This is because patients do not feel pain as the arch collapses. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate, without the patient feeling any pain. This may result in a severely deformed foot that is very challenging to correct with surgery. Special shoes or braces are the best method for dealing with this problem.

Symptoms

Some people have fallen arches, and they aren?t even aware of it, fallen arches are sometimes asymptomatic and do not always cause pain. However, for others, the following symptoms may be present. Foot pain, particularly in the arches or heels, leg or back pain, feet feel tired quickly, swelling in the feet and difficulty moving the feet.

Diagnosis

People who have flat feet without signs or symptoms that bother them do not generally have to see a doctor or podiatrist about them. However, if any of the following occur, you should see your GP or a podiatrist. The fallen arches (flat feet) have developed recently. You experience pain in your feet, ankles or lower limbs. Your unpleasant symptoms do not improve with supportive, well-fitted shoes. Either or both feet are becoming flatter. Your feet feel rigid (stiff). Your feet feel heavy and unwieldy. Most qualified health care professionals can diagnose flat feet just by watching the patient stand, walk and examining his/her feet. A doctor will also look at the patient's medical history. The feet will be observed from the front and back. The patient may be asked to stand on tip-toe while the doctor examines the shape and functioning of each foot. In some cases the physician may order an X-ray, CT (computed tomography) scan, or MRI (magnetic resonance imaging) scan.

What does it mean when you have flat feet?

Non Surgical Treatment

Switch activities for a little while. If you?re a super athlete, you don?t want to hear that you need to take a break, but there?s no way around it. You need to lay off the high impact sports like basketball, tennis and running. Don?t panic-there?s no shortage of alternatives. Find a high school track that?s open to the public and try going for a run. Many athletic programs use spongy synthetic materials to pave tracks instead of concrete. This is much easier on all the joints and tendons, not only in your feet but your legs and ankles. You can also try running on dirt trails or stable grassy areas. Take up swimming for a little while. This is actually an ideal activity for your arches. The buoyancy of water takes weight off our feet, but still allows for aerobic activity. Many gyms and activity centers also offer various water sport classes. In no time flat, you?ll be on your way to healthier feet.

Surgical Treatment

Adult Acquired Flat Feet

Since there are many different causes of flatfoot, the types of flatfoot reconstruction surgery are best categorized by the conditions. Posterior tibial tendon dysfunction. In this condition, the tendon connecting the calf muscle to the inner foot is torn or inflamed. Once the tendon is damaged it no longer can serve its main function of supporting the arch of the foot. Flatfoot is the main result of this type of condition and can be treated by the following flatfoot reconstruction surgeries. Lengthening of the Achilles tendon. Otherwise known as gastrocnemius recession, this procedure is used to lengthen the calf muscles in the leg. This surgery treats flatfoot and prevents it from returning in the future. This procedure is often combined with other surgeries to correct posterior tibial tendon dysfunction. Cleaning the tendon. Also known as tenosynovectomy, this procedure is used in the earlier and less severe stages of posterior tibial tendon dysfunction. It is performed before the arch collapses and while the tendon is only mildly affected. The inflamed tissue is cleaned away and removed from the remaining healthy tendon. Tendon transfer. This procedure is done to correct flatfoot and reform the lost arch in the foot. During the procedure, the diseased tendon is removed and replaced by tendon from another area of the foot. If the tendon is only partially damaged, the inflamed part is cleaned and removed then attached to a new tendon. Cutting and shifting bones. Also called an osteotomy, this procedure consists of cutting and reconstructing bones in the foot to reconstruct the arch. The heel bone and the midfoot are most likely reshaped to achieve this desired result. A bone graft may be used to fuse the bones or to lengthen the outside of the foot. Temporary instrumentation such as screws and plates can also be used to hold the bones together while they heal.

After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.
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What Causes Heel Pain

Overview

Feet Pain

Your foot is made up of 26 bones, 33 joints, and more than 100 tendons. The heel is the largest bone in your foot. If you overuse or injure your heel, you may experience heel pain. This can range from mild to disabling. In many cases, if you have heel pain, you will need a doctor to diagnose the cause.

Causes

The plantar fascia spans the long arch of the foot from the heel to the base of the toes, where it blends with the soft tissues, then anchoring to the base of the toes. Plantar Fascia. The plantar fascia is a common cause of heel pain. As the bony attachment at the heel is considered the plantar fascia?s ?weak spot?, the patient will present with pain at the heel, mainly on the inside. The most common predisposing factor to this condition is the pronating (flattening feet) - 52% - whilst there is also some evidence that a very high arch, in a rigid foot (pes cavus), also was reasonably common - 42%.

Symptoms

Symptoms may also include swelling that is quite tender to the touch. Standing, walking and constrictive shoe wear typically aggravate symptoms. Many patients with this problem are middle-aged and may be slightly overweight. Another group of patients who suffer from this condition are young, active runners.

Diagnosis

A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.

Non Surgical Treatment

As heel pain is basically a stress problem in the tissues of the heel, the main treatment is to reduce stress. Your doctor will advise you about weight loss and appropriate footwear. A soft heel pad is useful to wear in your shoe to act as a shock-absorber when you walk. If you have a stiff ankle or tight Achilles tendon a physiotherapist can advise on exercises for these. Stretching the Achilles tendon and plantar fascia is very effective general treatment for many patients. If you have a high-arched or flat foot, a podiatrist may advise an insole to reduce stress. Simple pain-killers such as paracetamol or anti-inflammatory medicines can help reduce the pain. Ask advice from your doctor or pharmacist before taking anti-inflammatory medicines as they can have troublesome side-effects in some people. The simple measures above will help the majority of people with heel pain. If the pain continues, a splint to wear on your ankle at night to prevent your Achilles tendon tightening up while you are asleep is often very effective in improving the severe pain that many people get first thing in the morning and breaking the cycle of pain. Your GP or an orthopaedic foot and ankle surgeon or rheumatologist may inject some steroid into the attachment of the plantar fascia to damp down the inflammation. These measures will reduce the pain in most people who are not helped by simple treatment. If you still have pain after one or two injections, your doctor may want to investigate your problem a bit further. If no other medical problem or cause of stress in your heel is found, a number of other treatments can be tried. Further physiotherapy, wearing a plaster cast to rest the inflamed tissues, pain control treatments such as transcutaneous nerve stimulation (TENS) or acupuncture. Only if all non-surgical treatments fail would an operation be considered.

Surgical Treatment

Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

Where is a heel spur located?

Prevention

Painful Heel

You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.
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Working with Mortons Neuroma

Overview

MortonMorton's neuroma is a swollen, inflamed nerve in the foot.Morton's neuroma causes a "burning" sharp pain on the bottom of the foot. Treatments for Morton's neuroma include resting the foot, better-fitting shoes, anti-inflammation medications, ice packs, and operation. A neuroma is growth (benign tumor) that arises in nerve cells. A Morton's neuroma is a swollen, inflamed nerve located between the bones at the ball of the foot. The most common location of a Morton's neuroma is in either the second or the third spacing from the base of the big toe.

Causes

Morton's Neuroma is a foot condition caused from an abnormal function of the foot that leads to bones squeezing a nerve usually between the 3rd and 4th metatarsal heads. Symptoms of Morton's Neuroma often occur during or after you have been placing significant pressure on the forefoot area, while walking, standing, jumping, or sprinting. This condition can also be caused by footwear selection. Footwear with pointed toes and/or high heels can often lead to a neuroma. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain.

Symptoms

Symptoms include tingling in the space between the third and fourth toes, toe cramping, a sharp, shooting, or burning pain in the ball of the foot and sometimes toes, pain that increases when wearing shoes or pressing on the area, pain that gets worse over time. In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton neuroma, but treatment is similar.

Diagnosis

If you suspect Morton?s Neuroma, it is essential that you confirm your suspicions by consulting with a podiatric physician. Don?t wait for the symptoms to go away for good (even if they tend to come and go). Also, remember that many conditions have similar symptoms, and only a professional can tell the difference.

Non Surgical Treatment

Once a diagnosis is obtained, it is essential to begin treatment immediately. Your podiatric physician will advise you on the most effective means. If caught early enough, good foot care, shoes that fit properly, and/or orthoses may eliminate the need for any further intervention. Other conservative measures might include oral non-steroidal anti-inflammatory medication (NSAIDS), physical therapy, ultrasound or other non-invasive measures. If that doesn?t work, your podiatric physician might use injectable steroids, and/or a local anesthetic around the neuroma to reduce inflammation and pain. Many patients report relief after these measures are taken.Morton

Surgical Treatment

Recently, an increasing number of procedures are being performed at specialist centers under radiological or ultrasound guidance. Recent studies have shown excellent results for the treatment of Morton's neuroma with ultrasound guided steroid injections, ultrasound guided sclerosing alcohol injections, ultrasound guided radiofrequency ablation and ultrasound guided cryo-ablation.

Prevention

Women, particularly those who wear tight shoes, are at greatest risk for Morton?s neuroma. The best way to prevent the condition is to wear shoes with wide toe boxes. Tight, pointed shoes squeeze bones, ligaments, muscles and nerves. High heels may worsen the problem by shifting your weight forward. Over time, this combination can cause the nerves to swell and become painful.
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Are Shoe Lifts The Ideal Solution To Leg Length Discrepancy

There are two different types of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is anatomically shorter than the other. Through developmental periods of aging, the brain senses the step pattern and identifies some variance. Our bodies typically adapts by tilting one shoulder to the "short" side. A difference of less than a quarter inch isn't really irregular, require Shoe Lifts to compensate and ordinarily does not have a profound effect over a lifetime.

Leg Length Discrepancy Shoe Lifts

Leg length inequality goes typically undiscovered on a daily basis, yet this condition is easily solved, and can eliminate a number of incidents of back ache.

Therapy for leg length inequality typically involves Shoe Lifts. These are low cost, often priced at under twenty dollars, in comparison to a custom orthotic of $200 or maybe more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Lumbar pain is the most prevalent ailment affecting men and women today. Around 80 million men and women are affected by back pain at some stage in their life. It's a problem which costs companies huge amounts of money year after year as a result of time lost and output. Fresh and improved treatment solutions are continually sought after in the hope of minimizing the economical influence this condition causes.

Shoe Lifts

People from all corners of the earth suffer the pain of foot ache due to leg length discrepancy. In these cases Shoe Lifts can be of very useful. The lifts are capable of relieving any pain and discomfort in the feet. Shoe Lifts are recommended by many specialist orthopaedic physicians.

To be able to support the human body in a nicely balanced fashion, your feet have got a critical function to play. Despite that, it is often the most overlooked zone in the body. Many people have flat-feet which means there is unequal force placed on the feet. This will cause other body parts like knees, ankles and backs to be impacted too. Shoe Lifts guarantee that correct posture and balance are restored.

Shoe Lifts For Leg Length Discrepancy

There are not one but two different types of leg length discrepancies, congenital and acquired. Congenital means you are born with it. One leg is anatomically shorter than the other. Through developmental periods of aging, the brain picks up on the walking pattern and recognizes some difference. The entire body usually adapts by dipping one shoulder over to the "short" side. A difference of under a quarter inch is not grossly abnormal, doesn't need Shoe Lifts to compensate and usually does not have a profound effect over a lifetime.

Leg Length Discrepancy Shoe Lift

Leg length inequality goes largely undiscovered on a daily basis, yet this condition is easily solved, and can eradicate numerous instances of chronic back pain.

Therapy for leg length inequality usually consists of Shoe Lifts. These are generally economical, generally priced at under twenty dollars, compared to a custom orthotic of $200 or maybe more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Low back pain is easily the most widespread ailment affecting people today. Over 80 million people experience back pain at some stage in their life. It is a problem which costs employers huge amounts of money yearly on account of lost time and productivity. Fresh and better treatment solutions are always sought after in the hope of reducing the economic impact this condition causes.

Shoe Lifts

People from all corners of the world suffer from foot ache due to leg length discrepancy. In a lot of these cases Shoe Lifts can be of beneficial. The lifts are capable of relieving any discomfort and pain in the feet. Shoe Lifts are recommended by many expert orthopaedic doctors.

To be able to support the human body in a well-balanced manner, your feet have a vital part to play. Irrespective of that, it is sometimes the most neglected area in the human body. Many people have flat-feet which means there is unequal force placed on the feet. This causes other parts of the body like knees, ankles and backs to be affected too. Shoe Lifts make sure that appropriate posture and balance are restored.
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How Shoe Lifts Treat Leg Length Discrepancy

There are two unique variations of leg length discrepancies, congenital and acquired. Congenital implies you are born with it. One leg is structurally shorter compared to the other. As a result of developmental stages of aging, the human brain senses the step pattern and recognizes some variation. The human body typically adapts by dipping one shoulder to the "short" side. A difference of less than a quarter inch isn't blatantly abnormal, require Shoe Lifts to compensate and usually does not have a serious effect over a lifetime.

Shoe Lifts

Leg length inequality goes mainly undiagnosed on a daily basis, yet this issue is easily remedied, and can eradicate quite a few cases of lower back pain.

Treatment for leg length inequality typically involves Shoe Lifts. These are low cost, ordinarily priced at below twenty dollars, in comparison to a custom orthotic of $200 if not more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Mid back pain is easily the most common health problem afflicting men and women today. Over 80 million people have problems with back pain at some point in their life. It is a problem which costs businesses huge amounts of money year after year on account of lost time and output. Innovative and superior treatment methods are always sought after in the hope of minimizing the economic impact this issue causes.

Leg Length Discrepancy Shoe Lifts

People from all corners of the earth experience foot ache due to leg length discrepancy. In a lot of these cases Shoe Lifts are usually of very useful. The lifts are capable of alleviating any discomfort and pain in the feet. Shoe Lifts are recommended by many qualified orthopaedic doctors.

To be able to support the human body in a nicely balanced manner, the feet have a very important role to play. Irrespective of that, it's often the most overlooked zone in the body. Some people have flat-feet which means there may be unequal force exerted on the feet. This causes other body parts such as knees, ankles and backs to be affected too. Shoe Lifts guarantee that correct posture and balance are restored.