Posts for: September, 2016
Equinus is a condition in which the upward bending motion of the ankle is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. People with equinus develop ways to compensate for their limited ankle motion which often leads to other foot problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot.
There are several possible causes for the limited range of ankle motion. Often it is due to tightness in the Achilles tendon or calf muscles (soleus and/or gastrocnemius muscles). In some patients, this is an inherited trait. In other patients acquire the tightness through situations that keep the foot pointing downward for extended periods - such as being in a cast or frequently wearing high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause tightness. Sometimes equinus is related to a bone blocking the ankle motion. Less often, it is caused by spasms in the calf muscle. These spasms may be signs of an underlying neurologic disorder, such as cerebral palsy.
Depending on how a patient compensates for the inability to bend the ankle properly, a variety of foot conditions can develop, including: plantar fasciitis, calf cramping, Achilles tendonitis, metatarsalgia, flat foot, arthritis of the midfoot, bunions, hammertoes, ankle pain, or shin splints.
Treatment options include strategies aimed at relieving the symptoms and conditions associated with equinus. In addition, the patient is treated for the equinus itself through one or more of the following options: calf-stretching exercises, night splints, heel lifts, or orthotic devices.
Rheumatoid Arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints. RA causes inflammation in the synovium (lining) of joints, most often in the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability.
When joints become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, cause swelling and damage to the joint’s cartilage and bones. Foot problems caused by RA most commonly occur in the forefoot, although it can also affect other areas of the foot and ankle. Deformities and conditions associated with RA may include: rheumatoid nodules, dislocated toes, hammertoes, bunions, heel pain, Achilles tendonitis, flatfoot, and ankle pain.
RA is usually diagnosed prior to visiting a foot and ankle surgeon; however, a podiatrist may be the first to diagnose RA. It is diagnosed on the basis of a clinical examination as well as blood tests. While the treatment of RA focuses on the medication prescribed by a patient’s rheumatologist, there are various options for treatment plans aimed at relieving the pain of RA-related foot problems. The plan may include one or more of the following options: orthotic devices to give proper support, accommodative shoeing to relieve pressure points, steroid injections to reduce inflammation, and surgery as a last resort to correct any deformities associated with RA.