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
Sometimes inflammation is a good thing. If we are ill or injured, the immune system dispatches white blood cells to fight the infection. Once we are well again, the inflamed area returns to normal.
At times, the immune system becomes confused and attacks healthy tissues. The result is autoimmune diseases like certain types of arthritis.
Another type of problem occurs when the whole body suffers low levels of inflammation. This chronic condition has been linked to heart disease, increased risk of stroke, cognitive issues, pain, and overall poor health.
If you suspect you suffer from this condition, your doctor can order simple blood tests to measure your c-reactive protein. Increased levels of c-reactive protein support a diagnosis of inflammatory disease.
Chronic inflammatory problems are caused by several factors including the typical American diet, high levels of stress, lack of exercise and sleep deprivation. Therefore, the best way to treat this disease is to modify your lifestyle.
Avoid Processed Foods
Processed foods are often high in omega-6 which can act as an irritant to the body. They also tend to contain high levels of trans fat and sugar. You don’t have to give up all your favorite treats, but try to work some healthy foods like leafy green vegetables and fresh seafood into your diet. Instead of salt, use herbs for seasoning. These interventions will help calm your immune response and reduce inflammation.
Choose Your Oils Carefully
Polyunsaturated oils like grape seed, cottonseed, corn and sunflower can contribute to inflammatory disease. Instead, try alternatives like macadamia nut oil or extra virgin olive oil.
Maintain a Healthy Weight
Having a large gut can lead to a condition called insulin resistance, often a precursor of diabetes. Bring your weight under control with measures like regular exercise and reducing intake of sugar or refined sugars.
Get Some Sleep the Natural Way
If you have trouble sleeping at night, evaluate your bedtime routine to make sure you’re practicing good sleep hygiene. Go to bed and get up at the same time, even on weekends. Avoid using your bedroom for any activities besides sleep and sex. Don’t do a strenuous workout or eat a heavy meal immediately before bedtime, and avoid caffeine after mid-afternoon. If you still have trouble with insomnia, a visit to your doctor may be in order where a different method of treatment may be utilized.
Chronic body inflammation is a serious problem that can have profound negative effects on your health. The good news is that the more healthy choices you make, the less you will have to worry about your body’s inflammatory response.
June 19, 2013
Prepatellar bursitis is one of the most common causes of pain and swelling in the kneecap area. It is also called housemaid’s knee, because the cause of this condition is a repetitive kneeling position, such as one a housemaid might take up to clean floors. The condition is not limited by job type – sufferers may include hobby gardeners that live in a location such as San Diego or elsewhere in the United States, athletes who participate in contact sports, or victims of motor vehicle accidents as well, to name a few.
There are thin sacks of lubricating fluid in the knee joints, known as bursa sacks. These bursa sacks are present in the knee to lubricate the joint and reduce the damaging effects of friction on the kneecap, bones and tendons. When the sacks become irritated and inflamed, the condition is known as prepatellar bursitis. The symptoms of the condition include both pain and swelling in the kneecap area, as well as a limited range of motion of the knee due to those symptoms. It can occur in one or both knees simultaneously.
The prevention and treatment of this bursitis can be difficult, depending on job type, since the first step is to try to avoid the aggravating activity. For those with jobs that require a lot of time spent kneeling or down on the knees, this may prove to be difficult, as it is not easy to change behavior associated with a career, even for medical reasons. Those suffering from prepatellar bursitis reasons unrelated to job type are advised to avoid kneeling when possible. Secondly, standard RICE protocol – rest, ice, compression, elevation – is usually recommended and successful for relief of pain and swelling in standard cases. Warm baths or warm compression may help some sufferers as well during flare ups.
In extreme cases, a doctor may need to aspirate or excise the gathered fluid. If a doctor chooses to aspirate the fluid on the knees, the procedure can be performed in office. If fluid continues to gather and symptoms remain severe, a doctor may choose to operate and remove the bursa sack, especially if it has become infected in a condition known as infected bursitis. This simple surgery would be performed in an operating room, and typically has a quick recovery time.
While prepatellar bursitis is an unpleasant condition, it is far from uncommon and most symptoms can be easily treated at home by following the advice of a doctor closely. Remember to avoid aggravating the condition and change behavior that requires extended time spent on the affected knee or knees. Lastly, the RICE protocol will provide comfort during flare ups, while a doctor can monitor any need for further treatment.
May 21, 2013
The Google Dictionary defines pain as “physical suffering or discomfort caused by an illness or injury.”
There are many different kinds of pain. It can be sharp, dull, cramping, heavy or tingling. Even numbness can be perceived as a sort of pain. Discomfort can also be acute, lasting only a short time, or chronic, lasting long after the original injury is healed.
The most common type of pain is probably nociceptive pain which occurs when nerve endings are hurt or irritated. Nociceptive pain warns us when our tissues are being damaged and gives us a chance to pull away to minimize the injury. It can usually be controlled with medications, and it only lasts for a limited time. There are several different types of nociceptive pain.
Somatic pain is caused by an injury to the body’s tissues. It fades away as the injury heals. If pain relief is needed, somatic pain can respond well to over the counter or prescription analgesics.
Visceral pain is another type of nociceptive pain, but it comes from the internal organs like the liver or intestines. It is usually experienced as an aching or squeezing feeling, and it comes from pressure in and around the organs. Because there are so many organs in the abdominal cavity, the cause of visceral pain may be difficult to pinpoint. One example of visceral pain is inflammatory bowel disease.
Inflammatory pain occurs as the result of the body’s response to tissue damage. When a part of the body is being damaged or injured, the body’s immune system sends cells to repair the damage. Sometimes, as in the case of osteoarthritis of the knees or other joints, the damage isn’t so easily repaired so the area can remain inflamed.
Sometimes the cytokines which help control communication between cells in the immune system pass on incorrect information and the cells become confused and attack healthy tissue. This is called an autoimmune disease. A common example is rheumatoid arthritis.
Neuropathic pain occurs when the nervous system malfunctions. It may be described as sharp, shocking, or shooting. Neuropathic pain does not typically respond well to standard pain medications. A spinal cord injury is a good example of neuropathic pain. It is caused by abnormal signals from damaged nerves and is usually felt at or below the level of injury.
In central sensitization, neurons become super sensitive to sensory input, for instance, a light touch on the cheek may feel like a slap across the face, or warm water may feel like scalding or freezing water.
There are many different kinds of pain people may experience. Some are easily treated, while others are not. The more scientists learn about the different kinds of pain the human body is capable of feeling, the more they will be able to do to ease discomfort and end suffering.
April 23, 2013
Central sensitization occurs when the nervous system maintains a state of high sensitivity or reactivity. This reactivity causes pain hypersensitivity so that even a light bump, touch or movement may cause great discomfort.
The body’s chief mechanism for experiencing pain is through the peripheral nervous system, or the PNS. When it encounters a noxious stimulus, the PNS sends signals along various pathways to the spinal cord. Nociceptors are the neurons that detect noxious stimuli and pass along a signal via the dorsal root ganglia; providing a message that something is wrong and instruct the body to stop or pull away from whatever is causing it.
Development of Central Sensitization
Sometimes, something goes awry with pain signals that causes changes in the brain to occur. In this case, even after the painful stimulus is removed and the wound is healed, the brain continues to interpret discomfort. Scientists first linked this condition to injuries of the brain or a part of the spinal cord called the dorsal horn.
They soon realized, however, that there were many other predisposing factors that had nothing to do with the nerves or with injury to the central nervous system, or CNS. Some of these predisposing factors include fibromyalgia, osteoarthritis, certain musculoskeletal conditions or injuries, and mood issues such as depression and anxiety.
Genetic factors may also play a part in the development of central sensitization. People with a low pain threshold, for instance, may be more likely to develop the condition than people with a normal or high tolerance.
Researchers also theorize that an absence of inflammatory mediators may play a part in the development and maintenance of the condition.
Interestingly, the nervous system usually remains intact with no lesions to the neurons that show reactivity.
Central Sensitization Managed
People with this condition may lead a difficult life, both because they must deal with chronic pain and because they are often faced with the emotional experience of having loved ones or doctors who don’t believe the it is real.
Treatments for this condition include analgesics – medicines that help provide relief and work to calm the CNS, light aerobic exercise routines, and psychotherapy to learn methods for coping with a chronic and potentially debilitating illness.
Patients may also be referred to multidisciplinary treatment centers where they can receive a variety of interventions aimed at reducing discomfort and helping them enjoy as normal a life as possible.
March 19, 2013