If you were to tell a friend that you were having trouble with your “sesamoids”, you’d probably get a funny look or a blank stare in response. While knee problems or a broken collar bone (for example) are rather easy for people to identify with, sesamoid complications are more obscure and not as easily recognized. Nevertheless, issues involving the sesamoids can cause big problems for people and lead to severe pain and irritation underneath the big toe. The name may sound funny, but the symptoms in question are definitely not!
So what exactly is a “sesamoid” anyway? Glad you asked! In order to wiggle our toes or perform any other critical toe motions, our feet contain tendons which run along the tops and bottoms of our toes. When these tendons are shortened, are toes are able to move up or down according to our needs. Anyway, as you might have assumed, the big toe is very important. Over 50% of our body weight is transferred through the ball of the foot and into the big toe during normal walking and other activities. “Sesamoids” are small, rounded, and independent bones which are located in pairs on the underside of each ‘ball’ region of the foot just behind the big toe. About the size of jelly beans, they work almost like a pulley to increase the force of the major tendon which runs between them and out to the end of the big toe. They also help to absorb and transmit pressure and to reduce friction in the area.
Like any bones, the sesamoids in particular are susceptible to disease, possible infections, and fractures especially given their location in such a pressure-prone area of the body. Repetitive motions such as walking on a treadmill with inappropriate shoes or sporting injuries may contribute to complications. Generally, people will have pain, tenderness, swelling, and possible numbness in the area. These symptoms are often exacerbated by climbing stairs, exercising, or other activities which stress the area by forcing the big toe to bend upwards. Consequently, people will often times begin to shift weight to the outer borders of their feet in order to walk in such a way that they off-load the tender inner area behind the big toe.
Symptoms of this nature certainly warrant examination by your podiatrist. He or she will typically order some specific X-rays to isolate the injury and rule our arthritis, nerve damage, or any other potential diagnoses. Because the ball of the foot is such a critical joint, it contains many structures and thus many potential problems! Once sesamoid pathology is determined, the nature of it as well as treatment options can be discussed between you and your podiatrist. Nonsurgical possibilities may include special casts, boots, and padding as well as steroid injections, off-loading, and other modalities. Surgical options might entail bone-grafting, procedures to raise the ball of the foot, and even excision or removal of one of the sesamoids. It all depends on the unique nature of your condition.
Ideally, your sesamoid bones should work for you and not against you. When this is not the case, thankfully, quality help is available.
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 swelling. Show all posts
Showing posts with label swelling. Show all posts
Friday, October 16, 2009
Tuesday, May 5, 2009
Sore Second Toe
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
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
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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