{"id":100,"date":"2013-10-14T02:47:30","date_gmt":"2013-10-14T02:47:30","guid":{"rendered":"http:\/\/footdetox.org\/pads\/?p=100"},"modified":"2013-10-29T02:48:46","modified_gmt":"2013-10-29T02:48:46","slug":"common-problems-in-the-adult-foot","status":"publish","type":"post","link":"https:\/\/footdetox.org\/pads\/common-problems-in-the-adult-foot\/","title":{"rendered":"Common Problems in the Adult Foot"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"500\" height=\"281\" src=\"http:\/\/www.youtube.com\/embed\/sPbChtApxIw?feature=oembed\" frameborder=\"0\" allowfullscreen><\/iframe><\/p>\n<p style=\"text-align: left;\" align=\"center\">My name is Rick Laughlin, and I work in orthopedic surgery.\u00a0 I\u2019m on the faculty of the medical school, and our practice is spread out throughout the city.\u00a0 Most our hospital work is in Miami Valley Hospital downtown.<\/p>\n<p>Just to give you a little bit of the history of the building, the medical school here\u2019s been for around 30 years, and they used to have a practice planned out here in the building that\u2019s become the new medical school.\u00a0 That\u2019s that white building, or some of you may have read the paper.\u00a0 That\u2019s White Hall.\u00a0 That used to be a practice facility.\u00a0 So, for a period of time, we didn\u2019t have any place to see outpatients here on campus.\u00a0 This building\u2019s a product of about seven to eight years of planning, and we\u2019ve had the advantage of learning what we learned from the old building of what worked and what didn\u2019t.\u00a0 I think the exciting thing about this building is we have merged together several departments so we can provide a lot of services.\u00a0 The genesis of much of it was driven by the athletic training department.<\/p>\n<p>The athletic trainers needed much more space so we were able to combine our rehab facilities and physical therapy with the athletic trainers\u2019.\u00a0 So, that\u2019s on the first floor, and we think we\u2019ll be able to provide a great service in rehab for the same people that are rehabbing the varsity athletes will be working on our patient population.\u00a0 We think we can all learn quite a bit from each other.<\/p>\n<p>We moved into the building last July.\u00a0 As we\u2019ve gotten in and figured out where everything is, we\u2019re going to start some educational sessions that we could present to the community.\u00a0 This is the first one of these presentations.\u00a0 We hope to do this on a regular basis and provide educational material to the surrounding community.\u00a0\u00a0 I really appreciate you all coming out and welcome.\u00a0 The presentation is a general presentation, and if any of you have any questions, certainly feel free to ask them along the way.\u00a0 So, we\u2019ll get started.<\/p>\n<p>We\u2019re going to talk about just a few things that are very common problems in the foot and ankle.\u00a0 My practice focuses on foot and ankle reconstruction, and there\u2019s a lot of problems.\u00a0 I think when people think of foot and ankle problems, you easily focus on the toes.\u00a0 Everybody knows about bunions and hammertoes and things like that, but there\u2019s a lot of problems around the back part of the foot or around the ankle that oftentimes go undiagnosed.\u00a0 They can be cause for a lot of problems and pain, and a lot of times, people just live with it.\u00a0 There are things you can do for it that are better.<\/p>\n<p>The things we\u2019re going to talk about tonight are flatfoot (one of the more common problems), Achilles tendon problem, and also peroneal tendon problems.\u00a0 These are all tendons that cross the ankle.\u00a0 Oftentimes, a lot of problems in orthopedics and soft tissues start becoming symptomatic around middle age.\u00a0 Usually around the time that we turn 40, 45, many of our tendons don\u2019t repair themselves as well.\u00a0 So, get wear and tear problems with some of the tendons, and I\u2019m sure a lot of you have heard about the rotator cuff.\u00a0 A lot of the arthritis-type problems start becoming more commonly presented at that time.\u00a0 We\u2019re going to go over some of the tendon problems of the foot.<\/p>\n<p>In flatfoot, there\u2019s a lot of different reasons why people have flatfoot.\u00a0 Sometimes people are just born with it.\u00a0 That\u2019s just the way the structure of your bones are.\u00a0 This is something that comes about quite commonly.\u00a0 It\u2019s really common in middle-aged women, probably easily 10-to-1, as far as women to men.\u00a0 The posterior tibial tendon is a tendon that\u2019s right on the inside of the foot.\u00a0 It goes right around the inside of the ankle.\u00a0 It\u2019s on the big toe side of the foot, and what it does is helps support your arch.\u00a0 So, when you walk and the heel hits the ground as you try and walk over your foot and push off, the posterior tibial tendon\u2019s what stabilizes the back of your foot and allows the push off like that.\u00a0 So, when that tendon fails, your arch starts to collapse.<\/p>\n<p>You can see in the foot here, the foot starts going out to the side.\u00a0 See, this is the normal foot.\u00a0 This, you can see is a little bit out to the side, and you can see the lateral toe more.\u00a0 It\u2019s a physical exam sign, one of the things that we teach the medical students and residents.\u00a0 That\u2019s called \u201ctoo many toes sign\u201d.\u00a0 That means when you look at it from the back, the foot is abducted, and you see all their lateral toes.\u00a0 It should be more like this guy.\u00a0 You can barely see the fifth toe.\u00a0 When you go home tonight, you can look at your husband or your wife.\u00a0 Look at them from the back and see if they have the right number of toes.<\/p>\n<p>The typical history is oftentimes people may have long standing history of flatfeet.\u00a0 They\u2019re usually flexible though.\u00a0 Some people have flatfeet where they\u2019re real stiff, and no matter what you do, you can\u2019t push them back under.\u00a0 Oftentimes, these are flexible, and usually the pain, again, is on the inside of the ankle.\u00a0 It\u2019s not something that tends to get better.\u00a0 Some things in the body have the ability to heal.\u00a0 This particular tendon, when it fails, it typically doesn\u2019t heal.\u00a0 It continues to stretch out, and when it stretches out, it\u2019s like a rope that\u2019s got too much slack in it.\u00a0 If the rope\u2019s got a lot of slack it in, you pull it, and nothing happens.\u00a0 That\u2019s basically what happens to your foot, and it changes the way you walk.<\/p>\n<p>Oftentimes, people may have a bit of a flatfoot, and they may not have pain.\u00a0 They may have what seems like a minor sprain (you step off a curb).\u00a0 It\u2019s like the straw that breaks the camel\u2019s back, and then the tendon fails.\u00a0 You get swelling around your ankle.\u00a0 Your arch collapses.\u00a0 Then, you\u2019ll notice the asymmetric progression.\u00a0 So, one foot gets more flat than the other.\u00a0 As you get out of the shower, as you look down at your feet, one is more flat, and the toes go out to the side.<\/p>\n<p>So, physical exam.\u00a0 Again, we talked about this a little bit before.\u00a0 See how it heels out to the side?\u00a0 Usually, you\u2019re tender right on the inside of the big toe side of the foot, right around your ankle.\u00a0 The other thing that you find is commonly when we examine you, we ask you to raise up on your toes.\u00a0 As you raise up on your toes, you should see your heel invert, and again, that\u2019s testing the function of that tendon.\u00a0 Usually, once you get a foot like this, if you notice when this person stands on their left foot, they can\u2019t raise up on their toes independently.\u00a0 That\u2019s what that tendon does.\u00a0 So, there\u2019s the heel raise.\u00a0 Again, you can see, as he goes up, his heels go in a little bit.<\/p>\n<p>So, people who have that, you can see, have their toes to the side.\u00a0 You can see the big toe on the other side.\u00a0 So, when that tendon doesn\u2019t work, you get chronic swelling around the ankle.\u00a0 People notice that they\u2019re weaker as far as with their push-off, and it\u2019s usually an activity-related pain.<\/p>\n<p>Usually all you need is an X-ray.\u00a0 I think one thing that\u2019s common (and I don\u2019t mean to make this an economics talk) but I know many of you have to start watching how you spend your healthcare money.\u00a0 This is not a condition that requires MRI.\u00a0 To get a diagnosis, you just need a physical exam, and MRIs are ordered a lot for a lot of problems.\u00a0 In the foot and ankle, there\u2019s a few things where they\u2019re helpful, but for the most part, usually, you don\u2019t need an MRI to make a diagnosis.\u00a0 So, MRIs are extremely helpful in the shoulders and knees and backs, but in foot, they\u2019re not all the helpful in making a diagnosis.\u00a0 So, if someone orders an MRI of your foot, ask them if you really need it that much, especially if you\u2019re paying for it out of your health savings account.<\/p>\n<p>So, what we look for on the X-ray, you just need an X-ray with you standing.\u00a0 This is your tibia, here there\u2019s your calcaneus. Then you\u2019re looking at your medial arch.\u00a0 These bones should all line up pretty well.\u00a0 You can see on this side the difference is you\u2019ve got a sag.\u00a0 So, what your posterior tibial tendon does, it comes down here, and it attaches right here to the bone.\u00a0 So, when it\u2019s not working anymore, these bones start to sag.\u00a0 Then, you get the deformity.<\/p>\n<p>So, these are just some of the structures that give way to the posterior tibial tendon.\u00a0 The spring ligament is a ligament on the bottom of the foot that helps support the arch.\u00a0 Then, the deltoid ligament is the medial ligament of the ankle, and that helps keep the heels centered under the leg.\u00a0 This is what you get abduction through the forefoot.\u00a0 The hindfoot valgus, that refers to the angulation of the heel.\u00a0 The medial side or the big to side is very mobile so you can move it up and down, wherever you want. One of the ways they describe it to the patient is you think of your foot as a three-legged stool. You have three legs.\u00a0 Your heel is one.\u00a0 Then, your big toe side is one.\u00a0 The small toe side is the other.\u00a0 When one of those legs give out, meaning the medial side, the three-legged stool stars leaning over to the side, and that\u2019s what happens with your foot.<\/p>\n<p>We divide it into stages so it\u2019s a very simple classification.\u00a0 Stage 1 means there\u2019s no deformity.\u00a0 It\u2019s just the tendon.\u00a0 It\u2019s swollen, but your arch hasn\u2019t collapsed yet.\u00a0 This is where you want to catch people because a lot of times if you get them in some type of brace or arch support that protects the tendon, and then you do some physical therapy.\u00a0 Over 50%, usually 60-70%, their symptoms will go away, and they may not need anything else done.\u00a0 So, usually you don\u2019t need surgery at this stage, and honestly, I rarely see people at this stage.\u00a0 I think usually the just don\u2019t get a diagnosis, and they haven\u2019t noticed any deformities.\u00a0 They\u2019re either seeing family physician, taking some Motrin\u00ae, or doing the simpler thing so oftentimes they don\u2019t see them at this stage.<\/p>\n<p>Stage 2 is when you\u2019re starting to get a deformity, but it\u2019s flexible.\u00a0 So, you could put a brace on those people, and you can push it back into the alignment it needs to be.\u00a0 There are lots of different kinds of braces.\u00a0 That\u2019s just one type of brace.\u00a0 We can make some of the braces cosmetic so they fit inside your shoe, but when you are wearing a braces, you\u2019re going to have certain shoe restrictions.\u00a0 These things don\u2019t fit in any type of shoe.\u00a0 You\u2019re going to wear athletic shoe or walking shoe with it.<\/p>\n<p>Again, for the pain and swelling or the acute phases, we usually help mobilize it with a brace.\u00a0 Then, you get some type of physical therapy.\u00a0 The hard thing to explain to people is you do that to take care of the symptoms, but the tendon typically doesn\u2019t heel.\u00a0 So, if the tendon gets stretched out, it\u2019s not going heel and go back to its normal length and support your arch.\u00a0 So, what you\u2019re trying to accomplish with the brace is prevent the deformity from getting any worse and to take care of the symptoms or support your tendon enough so the pain goes away.\u00a0 It won\u2019t typically control your deformity.\u00a0 When you put the brace on, you\u2019re trying to prevent the tendon from elongating and the arch from collapsing more.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>My name is Rick Laughlin, and I work in orthopedic surgery.\u00a0 I\u2019m on the faculty of the medical school, and our practice is spread out throughout the city.\u00a0 Most our hospital work is in Miami Valley Hospital downtown. Just to give you a little bit of the history of the building, the medical school here\u2019s [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/100"}],"collection":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/comments?post=100"}],"version-history":[{"count":1,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/100\/revisions"}],"predecessor-version":[{"id":101,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/100\/revisions\/101"}],"wp:attachment":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/media?parent=100"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/categories?post=100"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/tags?post=100"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<!-- WP Super Cache is installed but broken. 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