Do you have a long second toe? Some people believe that having a second toe longer than the first is an indication for having a high IQ. Unfortunately, while no evidence supports this theory, an extended second digit CAN predispose an individual to a painful alternative-Predislocation syndrome.
Predislocation syndrome is a common condition that can affect all of your toes-regardless of their length. It most often occurs in healthy individuals between 30 and 50 years old, and it most frequently affects the second toe. While individuals may have slightly increased their level of physical activity recently, they usually have no history of accidents or trauma. The onset can be sudden or gradual, and usually comes on with swelling, tenderness, or pain on the underside of the closest portion of the toe-near where it bends. It may feel like you are walking on a lump or bruise, and the toe will likely be bent upwards- though it is rare to find a corn on top of the toe which is common in other conditions. People usually experience pain when walking barefoot, and commonly walk on the outside of their foot to favor the painful toe.
So what exactly is Predislocation syndrome? Your toes move by bending at the joints between the many small bones in your toes. To accomplish this, complex cooperation is required between the muscles and tendons in your feet and lower legs. In Predislocation syndrome, some of the tissue which holds down and facilitates this motion is torn. Unfortunately, as the situation progresses, these forces can become unbalanced, and the toe can eventually be pulled out of alignment. This is not only painful, but it causes a huge disruption to your active and healthy lifestyle.
Podiatrists can quickly and accurately identify this condition with the right diagnostic techniques. Fortunately, conservative treatment-when applied appropriately-can bring relief in the majority of cases. These measures may include pads, splints, oral steroids, ultrasounds, etc. In more serious cases-such as those in which the toe becomes dislocated-surgical procedures are available. The primary goals of surgery are to repair or realign the tissues in order to bring the toe back to a normal, functional position. Your podiatric physician can help you determine your best treatment option.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://yourfeetfixer.com
Showing posts with label pain. Show all posts
Showing posts with label pain. Show all posts
Tuesday, May 5, 2009
Monday, April 27, 2009
Nerve Entrapments: More than a feeling
If you stop to think about it, the functions that your feet play on a daily basis are pretty amazing. Along with walking, your feet are able to judge position, perform complex maneuvers, and balance your weight in the first place. In order to complete these actions, your feet and lower legs are equipped with a sophisticated complex of nerves. As you might suspect, when one or more of these nerves become entrapped, you’ll probably feel it!
There are many causes of nerve entrapments. They may be congenital or due to impingements from the surrounding tissues such as scars, cysts, or fatty tumors. Other causes may include fractures, poor casting techniques, or infectious and metabolic processes such as diabetes, rheumatoid arthritis, and thyroid problems. The symptoms usually include pain at rest which is aggravated by active motion. People will often have an abnormal or unpleasant numbness which feels like a “prickly”, “stinging”, or “burning” sensation. They may also notice an increased sensitivity to normal touch or pain. If the entrapment goes on long enough, eventually the individual may experience muscle wasting and weakness.
Since pinched nerves can easily be confused with other etiologies, it’s a good idea to visit your podiatrist in order to confirm the diagnosis. He or she can rule out other serious problems such as peripheral vascular disease, muscle tendon injuries, or even spinal cord lesions. If it is indeed an entrapped nerve, your podiatrist can identify and localize the nerve, as well as decide on the most appropriate treatment.
Treatments almost always begin conservatively. Sometimes, removing pressure such as shoelaces that are too tight is a simple fix. Patients may also receive standard pain medications or be treated with orthotics, splints, or casts to prevent the aggravating motion. Sometimes, periodic injections with a local anesthetic plus a steroid are utilized. This is usually required less than three times a year. Physical therapy and other modalities are also available. If these treatments prove ineffective, surgery is certainly a viable option depending on your situation. The goal is usually to open up some space, release the surrounding structures, and adjust the nerve’s position.
While trapped nerves can show up in a variety of patterns-with muscular or sensory loss on almost any part of the foot and lower leg- thankfully, there are many treatment options available to address this condition.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://yourfeetfixer.com
There are many causes of nerve entrapments. They may be congenital or due to impingements from the surrounding tissues such as scars, cysts, or fatty tumors. Other causes may include fractures, poor casting techniques, or infectious and metabolic processes such as diabetes, rheumatoid arthritis, and thyroid problems. The symptoms usually include pain at rest which is aggravated by active motion. People will often have an abnormal or unpleasant numbness which feels like a “prickly”, “stinging”, or “burning” sensation. They may also notice an increased sensitivity to normal touch or pain. If the entrapment goes on long enough, eventually the individual may experience muscle wasting and weakness.
Since pinched nerves can easily be confused with other etiologies, it’s a good idea to visit your podiatrist in order to confirm the diagnosis. He or she can rule out other serious problems such as peripheral vascular disease, muscle tendon injuries, or even spinal cord lesions. If it is indeed an entrapped nerve, your podiatrist can identify and localize the nerve, as well as decide on the most appropriate treatment.
Treatments almost always begin conservatively. Sometimes, removing pressure such as shoelaces that are too tight is a simple fix. Patients may also receive standard pain medications or be treated with orthotics, splints, or casts to prevent the aggravating motion. Sometimes, periodic injections with a local anesthetic plus a steroid are utilized. This is usually required less than three times a year. Physical therapy and other modalities are also available. If these treatments prove ineffective, surgery is certainly a viable option depending on your situation. The goal is usually to open up some space, release the surrounding structures, and adjust the nerve’s position.
While trapped nerves can show up in a variety of patterns-with muscular or sensory loss on almost any part of the foot and lower leg- thankfully, there are many treatment options available to address this condition.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://yourfeetfixer.com
Tuesday, March 10, 2009
Common Pain in the ball of the foot
Neuroma
Description
A neuroma is the swelling of nerve that is a result of a compression or trauma. They are often described as nerve tumors. However, they are not in the purest sense a tumor. They are a swelling within the nerve that may result in permanent nerve damage. The most common site for a neuroma is on the ball of the foot. The most common cause of neuroma in ball of the foot is the abnormal movement of the long bones behind the toes called metatarsal bones. A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a "Y" and enter the toes. It is in this area the nerve gets pinched and swells, forming the neuroma. Burning pain, tingling, and numbness in one or two of the toes is a common symptom. Sometimes this pain can become so severe, it can bring tears to a patient's eyes. Removing the shoe and rubbing the ball of the foot helps to ease the pain. As the nerve swells, it can be felt as a popping sensation when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve. When the neuroma is present in the space between the third and fourth toes, it is called a Morton's Neuroma. This is the most common area for a neuroma to form. Another common area is between the second and third toes. Neuromas can occur in one or both of these areas and in one or both feet at the same time. Neuromas are very rare in the spaces between the big toe and second toe, and between the fourth and fifth toes. Neuromas have been identified in the heel area, resulting in heel pain.
A puncture wound or laceration that injures a nerve can cause a neuroma. These are called traumatic Neuromas. Neuromas can also result following a surgery that may result in the cutting of a nerve.
Diagnosis
The diagnosis of Neuromas is made by a physical exam and a thorough history of the patient's complaint. Conditions that mimic the pain associated with Neuromas are stress fracture of the metatarsals, inflammation of the tendons in the bottom of the toes, arthritis of the joint between the metatarsal bone and the toe, or nerve compression or nerve damage further up on the foot, ankle, knee, hip, or back. X-rays are generally taken to rule out a possible stress fracture or arthritis. Because nerve tissue is not seen on an x-ray, the x-ray will not show the neuroma. A skilled foot specialist will be able to actually feel the neuroma on his exam of the foot. Special studies such as MRI and CT Scan have little value in the diagnosis of a neuroma. However, ultra sound testing has been shown to be very effective in diagnosing neuromas. Neurological testing such as neuro sensory motor testing is also helpful in diagnosing a neuroma. If the doctor on his exam cannot feel the neuroma, and if the patient's symptoms are not what is commonly seen, then nerve compression at another level should be suspected. In this instance, one area to be examined is the ankle.
Just below the ankle bone on the inside of the ankle, a large nerve passes into the foot. At this level, the nerve can become inflamed. This condition is called Tarsal Tunnel Syndrome. Generally, there is not pain at this site of the inflamed nerve at the inside of the ankle. Pain may instead be experienced in the bottom of the foot or in the toes. This can be a difficult diagnosis to make in certain circumstances. Neuromas, however, occur more commonly than Tarsal Tunnel Syndrome.
Treatment
Treatment for the neuroma consists of cortisone injections, orthotics, chemical destruction of the nerve, or surgery. Cortisone injections are generally used as an initial form of treatment. Cortisone is useful when injected around the nerve, because it can shrink the swelling of the nerve. This relieves the pressure on the nerve. Up to three cortisone injections can be given over a twelve-month period. Cortisone may provide relief for many months, but is often not a cure for the condition. The abnormal movements of the metatarsal bones continue to aggravate the condition over a period of time.
To address the abnormal movement of the metatarsal bones, a functional foot orthotic can be used. These devices are custom-made inserts for the shoes that correct abnormal function of the foot. The combination treatment of cortisone injections and orthotics can be a very successful form of treatment. If, however, there is significant damage to the nerve, then failure to this treatment can occur. When there is permanent nerve damage, the patient is left with three choices: live with the pain, chemical destruction of the nerve, or surgical removal of the nerve.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://yourfeetfixer.com
Description
A neuroma is the swelling of nerve that is a result of a compression or trauma. They are often described as nerve tumors. However, they are not in the purest sense a tumor. They are a swelling within the nerve that may result in permanent nerve damage. The most common site for a neuroma is on the ball of the foot. The most common cause of neuroma in ball of the foot is the abnormal movement of the long bones behind the toes called metatarsal bones. A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a "Y" and enter the toes. It is in this area the nerve gets pinched and swells, forming the neuroma. Burning pain, tingling, and numbness in one or two of the toes is a common symptom. Sometimes this pain can become so severe, it can bring tears to a patient's eyes. Removing the shoe and rubbing the ball of the foot helps to ease the pain. As the nerve swells, it can be felt as a popping sensation when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve. When the neuroma is present in the space between the third and fourth toes, it is called a Morton's Neuroma. This is the most common area for a neuroma to form. Another common area is between the second and third toes. Neuromas can occur in one or both of these areas and in one or both feet at the same time. Neuromas are very rare in the spaces between the big toe and second toe, and between the fourth and fifth toes. Neuromas have been identified in the heel area, resulting in heel pain.
A puncture wound or laceration that injures a nerve can cause a neuroma. These are called traumatic Neuromas. Neuromas can also result following a surgery that may result in the cutting of a nerve.
Diagnosis
The diagnosis of Neuromas is made by a physical exam and a thorough history of the patient's complaint. Conditions that mimic the pain associated with Neuromas are stress fracture of the metatarsals, inflammation of the tendons in the bottom of the toes, arthritis of the joint between the metatarsal bone and the toe, or nerve compression or nerve damage further up on the foot, ankle, knee, hip, or back. X-rays are generally taken to rule out a possible stress fracture or arthritis. Because nerve tissue is not seen on an x-ray, the x-ray will not show the neuroma. A skilled foot specialist will be able to actually feel the neuroma on his exam of the foot. Special studies such as MRI and CT Scan have little value in the diagnosis of a neuroma. However, ultra sound testing has been shown to be very effective in diagnosing neuromas. Neurological testing such as neuro sensory motor testing is also helpful in diagnosing a neuroma. If the doctor on his exam cannot feel the neuroma, and if the patient's symptoms are not what is commonly seen, then nerve compression at another level should be suspected. In this instance, one area to be examined is the ankle.
Just below the ankle bone on the inside of the ankle, a large nerve passes into the foot. At this level, the nerve can become inflamed. This condition is called Tarsal Tunnel Syndrome. Generally, there is not pain at this site of the inflamed nerve at the inside of the ankle. Pain may instead be experienced in the bottom of the foot or in the toes. This can be a difficult diagnosis to make in certain circumstances. Neuromas, however, occur more commonly than Tarsal Tunnel Syndrome.
Treatment
Treatment for the neuroma consists of cortisone injections, orthotics, chemical destruction of the nerve, or surgery. Cortisone injections are generally used as an initial form of treatment. Cortisone is useful when injected around the nerve, because it can shrink the swelling of the nerve. This relieves the pressure on the nerve. Up to three cortisone injections can be given over a twelve-month period. Cortisone may provide relief for many months, but is often not a cure for the condition. The abnormal movements of the metatarsal bones continue to aggravate the condition over a period of time.
To address the abnormal movement of the metatarsal bones, a functional foot orthotic can be used. These devices are custom-made inserts for the shoes that correct abnormal function of the foot. The combination treatment of cortisone injections and orthotics can be a very successful form of treatment. If, however, there is significant damage to the nerve, then failure to this treatment can occur. When there is permanent nerve damage, the patient is left with three choices: live with the pain, chemical destruction of the nerve, or surgical removal of the nerve.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://yourfeetfixer.com
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