A stasis ulcer, also sometime referred to as venous or varicose, is a wound that occurs when a valve in a vein fails to function correctly. They are most common in the lower extremities and can be a source of extreme pain. There are several methods used to treat the condition. However, it is known to be an especially problematic issue, as it commonly returns in the same location in many afflicted patients.
This type of skin lesion happens most often in the lower part of the legs, on the sides rather than the front or back. It occurs due to something called a venous insufficiency, which is when blood does not return to the heart in the way that it should. Instead, it backs up and pools in the vein. It causes itchy, red skin over the affected area, followed by swelling. Eventually, the fluid accumulation causes an open sore.
Stasis ulcers are caused by poor blood circulation, valve failure, or a combination of both. For some people, this can happen for reasons unknown. However, there are several risk factors that may increase the chances of developing the condition. Among them are obesity, smoking, jobs that require long periods of sitting or standing, or an overall lack of physical activity.
When the first signs of swelling or itchy red tissue are noticed, it’s important to call a doctor immediately. Smaller lesions are easier to heal than larger ones, so a faster response will improve the chances of proper healing. The open wound will be treated by keeping it clean and covered with a proper dressing. Petroleum jelly may help to keep the dressing from sticking. After the initial sore is healed, it’s essential to try to reduce the chance of recurrence. Most doctors recommend compression stockings which should only be taken off to sleep and bathe.
These types of open wounds on the legs not only cause severe pain, but also pose a serious infection risk for patients who suffer from them. Those afflicted will need to follow up with medical professionals for regular reviews of their skin condition in order to monitor closely for any new lesions. Since almost 50% of patients see a recurrence within five years of initial onset, they must work together with doctors to catch and treat new lesions quickly for proper healing.
March 26, 2014
There are several factors that determine whether or not a person will develop bunions, or hallux valgus, in his or her lifetime. Regardless of why they develop, most people who suffer from the condition do find them to be painful. For those prone to developing this type of foot issue, there are several different methods used for prevention and treatment, as well as various ways to deal with the discomfort associated with the bump on the side of the foot.
A hallux valgus is a bump of bone on the metatarsal that develops at the base joint of the big toe, on the inside of the foot. It grows bigger over time, and this growth pushes the big toe inward toward, causing it to rub against the second toe and also changing the shape of the foot. The area around the bump may become swollen and sore, causing pain with walking and other daily activities.
Several factors determine whether one is prone to the condition. People whose gait rolls the foot inward instead of out tend to develop the bony bumps more frequently. Those with a foot shape that places a lot of pressure on the joint of the big toe are also likely to develop them. Women are more likely than men to suffer from the condition due to wearing shoes with high heels, which leave their toes constricted for long periods, again placing pressure on the big toe.
Those seeking treatment for the condition and the associated pain should see a podiatrist. If the condition exists but isn’t causing any discomfort, it may not be necessary to do any treatment at all. If the foot is sore and impeding daily activities, the podiatrist may suggest one or more approaches to the problem. First, the doctor could suggest wearing wide shoes with plenty of room for the toes. They should also have a supportive sole. She may also suggest custom orthotics or a splint for additional support and lifestyle changes including complete avoidance of narrow shoes and high heels. Anti-inflammatory medications and ice can be used to treat pain and swelling. Some have found success with ultrasound therapy. In rare cases, surgery is an option.
For many people, bunions are a painful fact of life. If you know that you’re prone to the condition, you can do your best to avoid discomfort by choosing footwear with a wide toe box and supportive sole. For those already dealing with the issue, combat soreness with anti-inflammatory medications and ice for swelling. At the current time, these are the best methods available for coping with the often chronic condition.
February 25, 2014
Pain in the calf can occur for several reasons. There are two different muscles located in the back of the lower leg, and each may suffer injury. Additionally, cramps may occur for reasons other than acute injury. While in most cases the cause is minor and treatable, there are times that discomfort in the back of lower leg area is a sign of a bigger underlying problem.
The calves are made up of two muscles. The first and larger is the gastrocnemius, which is divided into two parts, called the medial and lateral heads. The second is smaller and flat and lies under the gastrocnemius. This is called the soleus. They taper together and merge at the bottom of the calf. Connective tissue then joins them with the Achilles tendon, which connects to the heel bone, called the calcaneus. The plantaris attaches nearby and is often grouped with the gastrocnemius and soleus.
Many common conditions are known to cause pain in the calves. A calf strain, for example, can occur quite easily in sports or even from a bad landing in a slip and fall accident. A more severe injury is a complete tear, or muscle rupture. Knee injuries that cause an uneven gait could lead to soreness in the calves over time, as well. On top of these injuries, vigorous physical activity can also lead to cramping, lasting from a few seconds to up to fifteen minutes or more at a time.
More dangerously, discomfort of unknown cause in the calves could be a sign of a bigger underlying problem. It may be a sign of a blood clot in the deep vessels of the back of leg area, partially blocking circulation. It may cause part of the leg to swell, or feel like a bruise. This is called a deep vein thrombosis, and it must be treated by a doctor. Rarely, it’s possible that a tumor, called a sarcoma, may form. If not caught by a doctor and treated with appropriate therapy, medications, and surgery if necessary, it may spread to the lymph nodes.
Most average, active people will suffer only minor cramps and strains of the calves in their lives, the kind easily healed with rest. However, there are several more serious conditions and injuries that can cause discomfort to the lower portion of the leg. In some cases, it’s a symptom of a bigger underlying problem. It’s important to always take painful sensations in the calves seriously and bring them up with a doctor.
January 28, 2014
Morton’s neuroma is a painful affliction involving the nerves leading to the toes. It can cause pain, burning, or numbness to the toes, along with a feeling like having a rock in the shoe. It affects women more often than men, due to the fact that it develops frequently in those who wear high heels and similar shoes. Various treatments are available and some are very simple. However, surgery is necessaryin some cases.
With this condition, there are no visible symptoms that appear on the foot itself. Rather, those developing the affliction will feel discomfort similar to having a pebble lodged in the shoe, or pain that radiates forward from the ball of the foot. This can be in the form of cramps or burning. As with any painful condition, it’s necessary to seek a doctor’s advice if the pain doesn’t clear up within a few days.
At an appointment, a doctor will perform a differential diagnosis by first checking for any signs of trauma to the foot. He will ask about recent injuries or accidents. Give information about daily routines and activities, including fitness and recreational sports that may cause repetitive motion damage. X-ray and MRI may be used both to rule out injury and to look for abnormalities in the soft tissue. While electromyography cannot diagnose a neuroma, it may be used to eliminate conditions that present with similar symptoms. A physical examination may reveal a clicking between the 3rd and 4th toes. This is characteristic of Morton’s neuroma.
There are several treatment options for Morton’s neuroma. For less severe cases, conservation options will be the first course of action. This includes a change in shoes away from high heels. Shoes should allow the wearer to stand in flat feet, rather than applying pressure to the ball of the foot. Arch supports to make shoes fit correctly are an option, and may be custom made. Medications can be prescribed to treat the associated pain, and some people also experience a measure of relief from physical therapy. In severe cases, surgery to decompress the pressure on the nerve or even to remove the nerve entirely is necessary.
While this neuroma can be caused by the repetitive force and pressure of some sports, the majority of those afflicted are women who wear high heels frequently The solution may be as simple as switching footwear to a pair that allows for flat feet. In some cases, though, a doctor’s advice calls for surgery to undo the painful pressure on the nerve between the 3rd and 4th toes.
January 2, 2014
Hallux rigidus is an arthritic condition that affects the metatarsophalangeal joint, or MTP. This is the junction located at the base of the big toe, the most common site of arthritis in the foot. Men and women affected by the condition find that this toe becomes stiff and swollen, making walking difficult. Pain radiates throughout the toe and the rest of the foot with each step.
The cartilage that protects the toe’s joints wears away over time and bone spurs, also known as osteophytes, begin to form. These spurs decrease range of motion and can make it impossible to bend the toe while walking. As joint space diminishes, the level of pain increases due to extreme inflammation of surrounding tissues. As the condition gradually develops, the patient may experience discomfort in the ankles and knees as well. Specialized shoes and insoles can help patients cope with aching and swelling, relieving pressure and providing needed support. Because of the amount of pressure they apply to the toes and ball of the foot, high heels are strongly discouraged.
Individuals aged thirty to sixty are at the highest risk of developing hallux rigidus. Your doctor can perform an exam and x-rays to determine if the anatomy of your feet lends itself to arthritis and related conditions. If you do receive a positive diagnosis, your doctor will likely prescribe medications to decrease inflammation and pain. Resting the affected foot and applying ice regularly will also help with discomfort and swelling.
In cases of hallux rigidus in which conservative measures fail to make a noticeable difference, surgery may be deemed necessary. There are three types of surgery commonly recommended for patients whose condition has not been improved by nonsurgical methods. Cheilectomy involves removal of any existent osteophytes and a portion of the bone itself to increase joint space. Though the recovery time may consist of a few months and ample rest, the majority of patients find that the procedure provides long-term relief from pain, swelling and stiffness.
For severe cases, particularly in the elderly, arthrodesis or arthroplasty may be the best options for surgical treatment. Arthrodesis involves the fusion of the bones with either a plate, pins or screws. In an arthroplasty, an artificial joint is placed after the damaged surfaces are surgically removed. This procedure is best suited for patients who do not exert an inordinate amount of stress or pressure on the feet.
December 4, 2013
Avascular necrosis, or AVN, is a disease in which cell death occurs due to loss of blood supply. Without an adequate supply of blood, tissue dies and bone collapses. If this occurs in the knee, the joint may be destroyed.
AVN, sometimes called osteonecrosis, may happen in any bone, but is particularly common in joints like the hip, shoulder, and knee. It usually affects the end of a long bone, such as the medial femoral condyle or lateral femoral condyle, which are the two projections making up the lower end of the femur. It may affect one or more joints at the same time. It’s not limited to men or women, young or elderly; however it affects women more so than men and occurs more frequently after the age of sixty.
While avascular necrosis is understood, the exact cause is unknown. In some cases, it’s idiopathic, with no underlying cause found. In other cases, it’s associated with medical conditions like high blood pressure, lupus, sickle cell anemia, or chemotherapy. For some people, AVN may set in possibly because of past traumas, like fractures at the joint. Other risk factors include alcoholism, fat buildup in the bone, long term steroid use, and exposure to high underwater pressures.
In the early stages, many have no symptoms of AVN. Over time, there may be pain with activity as necrosis worsens. Eventually, pain will be constant, even at night, and may be accompanied by swelling. If there have been no fractures or other trauma, this may seem sudden. It’s important to see a doctor as soon as possible, because osteonecrosis has to be treated early to gain the best possible outcome.
While a physical exam and x-rays may be used, an MRI will give the best look at small changes in the surfaces of the joint that may indicate the presence of osteonecrosis. Once confirmed, in addition to treating any underlying disease, nonsurgical options and medications are usually the first course of treatment. Anti-inflammatory medications could be used to help treat pain and swelling. Physical therapy may be recommended to maintain range of motion. In severe cases, surgery and joint replacement are necessary.
While there are several risk factors for osteonecrosis of the knee, very few are controllable. Additionally, the condition may exist for quite some time before symptoms appear. Any suspicious, sudden, or severe joint discomfort should be brought up with a doctor as soon as possible. To avoid major surgery and possible joint replacement, this disease has to be treated early.
November 5, 2013
The anterior cruciate ligament, or ACL, is one of the four major ligaments that makes up the knee. A tear to this ligament is one of the most common knee injuries, with more than 100,000 occurring each year in the US alone. Women are more likely to tear the ACL than men. The most common treatment is surgery, especially for those who plan to return to high intensity sports.
The anterior cruciate ligament connects between the femur and the tibia. Its primary function is to provide stability to the joint. Injury to the ligament will result in pain, instability, and a loss of mobility. It requires immediate medical attention from a doctor. An untreated injury will not only result in difficult walking, but also leads to an increased risk of developing osteoarthritis due to the abnormal movement of bones damaging the tissues that usually cushion the joint.
Injury to the ACL often occurs during high intensity sports. It’s especially common when the foot is planted and there’s a blow to the joint. Also, any movement that inadvertently causes the knee to move in two directions at once is a common cause, like sudden changes in direction when running, or hard landings when jumping. Pain is the first symptom, and it’s not unusual to feel or even hear a pop when the injury occurs.
A doctor will conduct an exam to determine the severity of the injury. With a sprain injury, there are three grades. In grade 1, there is mild stretching, but function is maintained. Grade 2 is also referred to as a partial tear and involves significant stretching of the ligament. In the case of grade 3, a complete tear, the ACL is severed completely and the joint is unstable.
For older patients or those with an extremely low activity level, nonsurgical options for recovery may be considered. However, the anterior cruciate ligament will not heal without surgery. To fully stabilize the joint, the torn area must be replaced with a tissue graft. This method is usually successful, but requires many months to recover while the graft fully grows in. A brace to stabilize the leg will be worn for weeks to months, followed with physical therapy. Those involved in high intensity sports should expect at least six full months of recovery time.
An injury to the anterior cruciate ligament is serious and painful. It jeopardizes the stability of the joint and causes pain, difficult walking, and if untreated, brings an increased risk of developing osteoarthritis. Even after graft surgery, it takes many months to recover.
October 9, 2013
Plantar fasciitis is a condition that involves the inflammation of the plantar fascia, the network of connective tissue located in the sole of the foot. The condition occurs when the tendons and ligaments that connect the toes and heel are placed under an inordinate amount of stress or strain. The result is an acute stabbing pain that typically affects the patient most severely first thing in the morning, though discomfort may persist throughout the day.
Causes and Risk Factors
One of the most common causes of plantar fasciitis is overuse or overexertion of the vital band of tissues within the foot’s arch. It is often seen in runners, particularly those who have flat feet or often run on uneven surfaces. Other sports and recreational activities that involve regular, stressful impact to the feet may result in the development of the condition as well. These include baseball, dancing, football, soccer and hurdling.
Women who are pregnant may experience the sudden, sharp pains associated with plantar fasciitis toward the end of their pregnancy, only to find that the symptoms vanish shortly after delivery. This is due in part to the hormone-induced stretching of ligaments throughout the body as it prepares for childbirth. People who are overweight and over the age of 40 are also at a higher risk for developing the condition.
Complications of Plantar Fasciitis
Though primarily affecting the feet, plantar fasciitis can lead to pain in other parts of the body. Discomfort and stiffness in the knees and back occur when the body attempts to overcompensate for the foot’s weakness, placing more strain on other joints. If the condition affects only one of the feet, as is typically the case, symptoms in other areas will present themselves on the same side of the body as the foot in question.
One of the most frequently reported complications of plantar fasciitis is the development of heel spurs. Fortunately, this problem and the condition that causes it are generally treated with noninvasive methods.
Treatment for Plantar Fasciitis and Heel Spurs
Treatment can begin as soon as a definitive diagnosis has been given. Home treatment includes a variety of methods, including massage, specialized stretches, the use of night splints, the application of ice to the affected area and over-the-counter anti-inflammatory medications. Your doctor will likely recommend that you engage in regular physical therapy to aid in the healing process and may suggest the use of cortisone injections. If, after 12 months of this kind of care has not remedied the condition, surgery may be considered. Your doctor will refer you to a licensed podiatrist for further evaluation. Recovery time after surgery is dramatically diminished when the patient takes advantage of physical therapy during healing.
September 13, 2013
A slip and fall accident leading to a fracture in one of the hips is a dangerous health risks facing the elderly community. Often requiring surgery or a total replacement, the rehabilitation from such an injury is long and not always successful. A quick education on the causes, treatments, and prevention of these fractures is provided below.
About: The hip joint is where the femur connects to the pelvis. The place where the bones connect is called the acetabulum. It’s a ball and socket joint. The hips themselves are comprised of three different bones – the ilium, ischium, and pubis – which are fused together in adults. However, the term “hip fracture” actually refers to a break in the end of the femur that connects to the pelvis.
Causes: When the head of the femur breaks in a normal person, it is almost always due to a high impact trauma, like a car accident. However, in the vast majority of cases, the break happens in someone experiencing bone fragility. Fragile bones could be caused by a number of conditions or diseases, such as cancer, osteoporosis, and, rarely, infection. Since older adults are prone to osteoporosis causing weak bones, they are most at risk, especially due to an elevated chance of falls.
Treatments: After an examination and x-ray to determine which of the several different types of breaks has occurred, most fractures of the hip will be treated with surgery. The surgery generally will include an orthosis. Some solutions include the placement of metal screws and plates, while others call for a total replacement. The surgery is extremely taxing, especially on elderly patients. Extreme pain and aching are common, and movement is limited by both. Nonsurgical options are extremely few.
Prevention: To prevent a fracture of the top of the femur, it’s extremely important for the elderly to avoid slips and falls. Wear stable shoes and make sure that any dangers like loose rugs or leaks are removed or repaired to keep a safe home. A diet rich in calcium along with vitamins will help prevent weak bones, though it’s most important to be vigilant to avoid slips. After a break, prevent re-injury by following up with all prescribed physical therapy and engage in gentle weight bearing exercises regularly.
Fractures to the hips are all too common in the older population, and unfortunately, this type of injury often ends up being fatal. That’s why education about the risks and careful prevention are the most important factor – chances of rehabilitation are best when the injury never occurs in the first place.
August 15, 2013
Pseudarthrosis is a condition that occurs when a fracture does not heal in the amount of time expected, and there is no chance of the bones uniting without some kind of further intervention. It happens when the bones move out of position, preventing the union that would allow for healing. Nonunions lasting nine months or longer will result in a diagnosis of this condition.
There are several different factors that can cause pseudarthrosis or make a person more susceptible to the painful condition. Age is a factor – older adults are more likely to suffer from nonunions. Poor nutrition may also play a role in these factors, as do habits such as consumption of alcohol and smoking. Those afflicted with metabolic disorders such as hyperparathyroidism are also at higher risk. Additionally, weakened muscles around the site of the injury, infection, and inadequate blood supply to the area all also may contribute to the extended healing time or failure to heal.
There are two different types of classifications of pseudarthrosis – avascular and hypervascular nonunions. Both types of this condition require medical intervention to achieve complete healing. In the past, doctors used electrical stimulus to help promote the growth of new bone cells to keep the bones from shifting further out of position, in an immobilization from within technique.
Recently, more advanced but invasive techniques have been very successful. Bone grafting is a popular choice. Donor material is used to stimulate cartilage formation, with then calcifies solidly, instead of in a soft scar tissue form. Fixation is a second option, where rods, screws, and plates for immobilization are used to stabilize the fracture. As these are surgical procedures, there is always a risk of infection for anyone, especially those with a low or suppressed immune system, who also happen to be among those who may be more at risk for pseudarthrosis in the first place.
Though usually found in older people, the unhealed fractures – or nonunions – known as pseudarthrosis are a painful affliction that can strike nearly anyone. Advances in treatment options such as cartilage formation and internal immobilization provide excellent treatment options but unfortunate dearth of prevention options other than good nutrition and an avoidance of risk factors like smoking and alcohol.
July 16, 2013