There is surgery for it. \u00a0Oftentimes, before you get to the surgery, the take-home point or the most important thing to do is maintain the flexibility of your foot.\u00a0 Usually when I see people in stage 2, I tell them it\u2019s important to keep the range of motion of your foot.\u00a0 If you can keep the flexibility of your foot, then it\u2019s easy to put a brace or arch support in, and a lot of times, your symptoms will be okay.\u00a0 You start getting a lot of symptoms as your foot collapses, and you start getting a foot deformity where you cannot bring your foot back into the normal alignment for you to walk on it. Usually, as you start getting stiffer, you have more symptoms.\u00a0 So, in stage 2, one of the first things I do with people is send them to physical therapy.\u00a0 Physical therapy works hard on their range of motion, trying to get their flexibility back.<\/p>\n
Then, depending on how their symptoms respond to that and some do not really want to wear brace long term, there is surgery to reconstruct the tendon. There\u2019s different kinds of surgery, and I\u2019m not going to go into too much detail as to what the surgery is.\u00a0 The part of the surgery that people have to realize is that it\u2019s not just a surgery where you go in and get fixed, and a week later you\u2019re good.\u00a0 It\u2019s a surgery that reconstructs your arch. \u00a0For me, this is like doing a knee replacement or a hip replacement.\u00a0 It\u2019s a surgery that you come in the hospital for.\u00a0 Usually, people stay in the hospital one night, and there is a recovery time involved with it.<\/p>\n
You can either try to preserve the joint or preserve the motion in the joint where we do osteotomy where you cut some of the bones and re-align them.\u00a0 Then, you fix and repair the tendon, and you transfer another tendon to augment it.\u00a0 That generally works pretty well in younger people who have flexible feet.<\/p>\n
As you get stiffer, if the foot is not passibly correctible, we start getting our correction by fusing some of the joints.\u00a0 So, we\u2019ll go in through the joints, put the bones back where they belong, usually put some screws in to hold it. \u00a0Then, we\u2019ll let those joints fuse.\u00a0 Your foot\u2019s straight, still works where it up and down, but you lose some of the side-to-side motion.\u00a0 So, we do those in people that become stiff and can\u2019t get their motion back.<\/p>\n
This is just an example of one of the ones with the osteotomy.\u00a0 So, this shows, in the X-ray, the medial column of the foot\u2019s been stabilized with some screws.\u00a0 Then, we cut the heel bone, shifted it over, and fixed that with some screws.\u00a0 Again, what you\u2019re doing is re-aligning the arch, and what you can\u2019t see is what we did with the tendon.\u00a0 The tendon, we fixed, which is right along here.\u00a0 It attaches on this bone, and once you make a new tendon, the soft tissues will help support the arch.<\/p>\n
Then, in the fusions, you see a bunch of screws in this, but basically, we go through these joints.\u00a0 The joints had collapsed through the subtalar joint, talonavicular joint.\u00a0 Once those collapse, you go in through the joints, you bring the heel back under the talus and line up the medial column.\u00a0 You scrape the joints out, you put screws in them, and it stays straight.\u00a0 That\u2019s a good way for correcting deformity.\u00a0 You do lose a little bit of the side-to-side motion of your foot.<\/p>\n
So, that\u2019s flatfoot or posterior tibial disease in a nutshell.\u00a0 Does anybody have any questions about that?\u00a0 Yes?<\/p>\n
[18:16]<\/p>\n
I think it\u2019s really important to keep your calves well-stretched out.\u00a0 So, when you go walking or work out or things like that, every day you should work out your calves.\u00a0 Certain people are more prone to it, people who have a lot of ligamentous laxity. Maintaining the side-to-side range of motion in your feet is important.\u00a0 There\u2019s not a lot of evidence to show that arch support makes a difference or prevents it, but I don\u2019t know that that means they don\u2019t work.\u00a0 I just think we haven\u2019t done the study well enough or you need a lot of people to show these make a difference, but arch supports intuitively help.\u00a0 Probably the most important thing is keeping the mobility of your foot, supporting your arch, stretching the calves out, keeping your weight down helps.\u00a0 Some people, again, there is a genetic component to it.\u00a0 When you see patients, it\u2019s amazing.\u00a0 You\u2019ll see people who have arthritis in their shoulders, hips, and knees, and they\u2019re just genetically predisposed.\u00a0 I think that\u2019s the same way with tendons.\u00a0 It\u2019s really common to see both shoulders done, or they get this on both sides.\u00a0 So, I think there\u2019s a little bit of a genetic component that you really can\u2019t change much.<\/p>\n
Did you have a question over there?<\/p>\n
[19:58]<\/p>\n
I think it\u2019s very common.\u00a0 I think it\u2019s oftentimes undiagnosed so we see it\u2019s much more common in women.\u00a0 Usually, the typical age is probably 50 to 65, and typically, a lot of people just have a swollen ankle that hurts.\u00a0 I see people who have had sorts of testing.\u00a0 I\u2019ll see people tested for blood clots.\u00a0 They get nerve test.\u00a0 They get tested for all sorts of things, and I usually don\u2019t see them.\u00a0 I usually don\u2019t see them until they start developing a deformity, but it\u2019s diagnosed usually by a physical exam.\u00a0 Again, it presents in the middle age and is much more common in women.<\/p>\n
Yes?<\/p>\n
[20:57]<\/p>\n
No, venous insufficiency just relates to the blood flow out of the feet, and it doesn\u2019t really have much to do with the ligaments or the bones or the musculoskeletal problem.\u00a0 That\u2019s more of a vascular problem, but that\u2019s a really common of swelling around the ankles.\u00a0 I think a lot of times people present with a lot of swelling around the ankles, and people say just that.\u00a0 They say you have varicose veins or bad circulation in their legs, and there\u2019s not much to do for it.\u00a0 Usually, that doesn\u2019t hurt a lot.\u00a0 If you have pain that you can localize to one part of your foot that should tip you off that it\u2019s more than venous insufficiency.\u00a0 Now, you can have both.<\/p>\n
Yes?<\/p>\n
[21:56]<\/p>\n
I think it contributes to your balance.\u00a0 It\u2019s kind of like the chicken or the egg. I think when you have this, you don\u2019t have as good a balance.<\/p>\n
Yes?<\/p>\n
[22:15]<\/p>\n
I don\u2019t know that they\u2019re really preventative.\u00a0 I think they can make the condition not affect you as much, but again, I think there are some genetic factors and factors that have to do with the structure of your foot that make you more prone to get tendon failures. Just like people with fair skin are more like to get a sunburn, there\u2019s people that have tendons and the way that they\u2019re foot is that they\u2019re more likely to have this.<\/p>\n
Yes?<\/p>\n
[22:57]<\/p>\n
It depends on what operation you have so usually I tell people, \u201cMy main goal in your surgery is to have your foot straight, have it fit in a shoe, have you off pain medicine, and if you need an arch support, it\u2019s just one of the over-the-counter ones like Dr. Scholl\u2019s.\u201d\u00a0 Those are usually my goals of the surgery, but generally, especially if you do the fusion, you take away some of the side-to-side motion of your foot.\u00a0 Some people don\u2019t notice is that much because by the time they get the surgery, they\u2019ve already lost that motion.\u00a0 So, what you\u2019re doing is you\u2019re restoring the alignment of their foot, and if you differentiate the foot from ankle, what you\u2019re trying to do is line the foot up in the best possible mechanical alignment so your ankle joint doesn\u2019t wear out.<\/p>\n
Another application I see fairly commonly is people who have knee replacements.\u00a0 If you have knock knees, you bend like this for a long time, and then they replace your knee.\u00a0 They straighten out your knee, and this puts more stress on your foot.\u00a0 Sometimes, your foot didn\u2019t really hurt before, but now it hurts because the alignment in your knee is different.\u00a0 The emphasis is restoring the alignment so that it\u2019s in the best mechanical position so that it will last the longest.<\/p>\n
Yes?<\/p>\n
[24:43]<\/p>\n
So, the question was, \u201cIf the tendon is injured does it ever go back to normal?\u201d\u00a0 I think there\u2019s two ways to look at it.\u00a0 If you\u2019re young and you have a normal foot and you have an injury, oftentimes, that may calm.\u00a0 If the tendon stretches out and degenerates, usually no matter what you do, the tendon is not going to heal.\u00a0 So, every once in a while I get someone who\u2019s younger and has an acute injury and you diagnose a posterior tibial tear.\u00a0 Even in those cases, you rarely just repair it.\u00a0 You usually augment it with something.<\/p>\n
Yes, sir?<\/p>\n
[25:45]<\/p>\n
He asked if you see the condition in runners.\u00a0 It\u2019s probably not as much.\u00a0 It\u2019s much more common in the sedentary, middle aged females, but runners can certainly get tendonitis of their posterior tibial tendon.\u00a0 Again, runners, depending on how serious they are, they will usually do stretching, keep their feet mobile, and you can usually get it to calm down with arch support.<\/p>\n
Okay, so we\u2019ll go on to Achilles tendinosis.\u00a0 Everybody knows where your Achilles tendon is?\u00a0 It\u2019s on the back of your ankle and inserts on the back of your heel.\u00a0 There\u2019s two areas that get involved.\u00a0 One is where the Achilles attaches to your heel bone or your calcaneus.\u00a0 That\u2019s, by far, the most common type of tendinopathy.\u00a0 The other one is up in the mid portion of the tendon.\u00a0 That is more commonly seen in the active people.\u00a0 That\u2019s more common in the runners.<\/p>\n
The nice thing about the foot and ankle is that it\u2019s very superficial and it\u2019s right under the skin.\u00a0 Usually, if you know the anatomy and you can poke around and figure out what hurts, you can usually figure out what the problem is.\u00a0 Again, it\u2019s usually tender where it attached to the bone.\u00a0 Oftentimes, this is not one where you need an MRI scan.\u00a0 Usually, you just get a plain X-ray, and the most you\u2019ll on an X-ray is the heel bone here.\u00a0 You\u2019ll see calcification going up into the tendon bone.\u00a0 That\u2019s typically what people refer to as a bone spur.\u00a0 What a bone spur really is it\u2019s where the tendon attaches to the bone, you have these microinjuries.\u00a0 It\u2019s wearing out, and your body\u2019s trying to make it heal.\u00a0 As your tries to heal it, it lays down calcium, and you get the bony overgrowth or what you feel is a spur.<\/p>\n
A lot of times, what you\u2019ll actually feel on your heel is soft tissue swelling.\u00a0 You could really have a big bump on the back of your heel, and you\u2019d think it\u2019s all this bony spur.\u00a0 Usually, it\u2019s just soft tissue, and the spur usually isn\u2019t that big.<\/p>\n
So, in this, again, most of these first approaches is non-surgical.\u00a0 So, we do a lot of physical therapy with the foot.\u00a0 You want to modify what your activities are. \u00a0Usually, any anti-inflammatories like Motrin\u00ae or Aleve\u00ae.\u00a0 Putting a heel lift into your shoe changes the movement of the muscle so sometimes that will relieve some pain.\u00a0 For people who a bump on their heel, it raises your foot up in the show so the back of the shoe just hits you in a different spot.\u00a0 Sometimes that will give you relief, but we do a lot of stretching.\u00a0 You can get a pad, these gel pads, you can buy that.\u00a0 It\u2019s like a sock with a little gel sock in it.\u00a0 You pull it on, and it has padding on the back of your heel so that your shoe doesn\u2019t rub against it.<\/p>\n","protected":false},"excerpt":{"rendered":"
There is surgery for it. \u00a0Oftentimes, before you get to the surgery, the take-home point or the most important thing to do is maintain the flexibility of your foot.\u00a0 Usually when I see people in stage 2, I tell them it\u2019s important to keep the range of motion of your foot.\u00a0 If you can keep […]<\/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\/102"}],"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=102"}],"version-history":[{"count":1,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/102\/revisions"}],"predecessor-version":[{"id":103,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/102\/revisions\/103"}],"wp:attachment":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/media?parent=102"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/categories?post=102"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/tags?post=102"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}