Chinese foot binding is an old method used in China to bind the foot of girls and keep them bound so that the foot would not grow in size. This Chinese foot binding was that the small foot in Chinese culture was considered more erotic and a higher price could be obtained for a bride with a smaller foot. The foot binding practice has not been used in several generations, but there are still some older Chinese female still alive that were subjected to what really was a torture.
Posterior tibial tendonitis is a problem that is more common in athlete who spend more time on their forefoot (eg tennis; basketball; runners who forefoot strike). The discomfort of posterior tibial tendonitis usually occurs around the medial or inside ankle bone and sometimes down into the arch of the foot. The treatment of posterior tibial tendonitis is to alter the training routine in the athlete to within tolerance levels and use modalities to reduce the load in the tendon such as strapping and foot orthotics.
The Austin bunionectomy is probably the most common procedure used for treating bunions associated with hallux valgus. The Austin Bunionectomy is a combination procedure that involves the removal of the lump of the bunion and a wedge osteotomy of the first metatarsal to alter the alignment of the bone. Additionally, the Austin Bunionectomy also involves some soft tissue work around the first metatarsophalangeal joint to alter the pull of the tendons. A screw fixation is needed for the Austin Bunionectomy.
Toe walking is common in kids and can be insignificant or it can be of great importance. Many kids just like to walk around on their toes and have a full range of ankle joint motion so they can get the heel down to the ground and have no underlying problems causing the toe walking. However, in some kids the toe walking can be a sign of and underlying neurological problem (eg cerebral palsy) or behavioural problem (eg Autism). For that reason toe walking needs to be taken very seriously and thoroughly investigated to rule out any of those underlying causes. If there is no underlying problem, then the child will generally stop toe walking in due course.
We have been seeing more of the condition ‘TOFP’ (top of foot pain) as it has become known around the barefoot running community. This top of foot pain is a common injury in the barefoot or minimalist runner which is someone unusual given all the claims made that running this way is supposed to reduce injury. A cursory look at any number of the barefoot or minimalist running website and you see plenty of runners asking about this injury. The basic problem in this top of foot pain is that with the forefoot landing the dorsiflexion forces on the forefoot are too high and there is some jamming of the bones ad joints on the dorsum of the foot. The best way to manage this is to get back to heel striking so the forces causing it are not so high.
Baxters nerve entrapment is a problem that occurs at the heel and can often be misdiagnosed as plantar fasciitis. Complicating this is that he inflammation associated with plantar fasciitis can actually cause the Baxters neuritis! Differentiating between the two is important so that the treatment can be better directed. Plantar fasciitis is more painful in the morning compared to the Baxters neuropathy. The pain of a Baxters nerve entrapment tends to radiate more than the pain from plantar fasciitis. A unique feature of Baxters is that that those with it tend to have a problem abducting the little toe, however so do a lot of people so it is not that accurate.
The high arched or pes cavus foot provides challenges in clinical practice. The first thing that needs to be established is the cause of the pes cavus. Neurological causes need to be ruled out initially as this condition can be first sign of several different problems. The treatment of pes cavus will depend on the cause of any symptoms. The pain in pes cavus can be from pressure on the metatarsal heads, so accommodative type foot orthotics are often needed. If the pain is in the arch or heel, then more supportive foot orthotics are indicated. If the pain is further up the lower limb, functional foot orthotics may be needed to change the function of the foot. If the pain is on top of the foot, then footwear advice is often needed. If all else fails then pes cavus surgery is indicated.
The Ponsetti method for clubfoot is becoming the most popular method for treating clubfoot. It is a manipulative technique that does not need surgery. Gradual corrections are achieved through gentle manipulation and then plaster casts are applied to maintain that correction. This is repeated regularly for several months in the infant to achieve full correction of the deformity. A lot of research now supports the Ponsetti method for clubfoot.
I just noticed several questions being asked in some online forums about pitted keratolysis (see: pitted keratolysis). Pitted keratolysis is a condition that affects the soles of the feet. It mostly happens in those who sweat more especially if they wear closed in footwear. It is caused by corynebacteria infection that develops in the moist environment. It affects either the forefoot or the heel or both and appears as white with areas of punched-out pits or small cavities. They look a lot worse when the foot is wet. The primary treatment for pitted keratolysis is to deal with the hyperhidrosis or sweaty foot first. Occasionally a topical antibiotic, either topical or oral is needed if control of the hyperhidrosis is not successful in the treatment of pitted keratolysis.
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The Weil Osteotomy is a common surgical procedure for problems in the forefoot such as plantar corns and calluses, plantarflexed metatarsals and problems commonly lumped under the term ‘metatarsalgia’. While the Weil Osteotomy is commonly used, it is also controversial and opinions are clearly divided on its usefulness. There have been a couple of online polls about this. Podiatry Online TV has some video clips on the Weil Osteotomy.
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When we are first developing before birth, the foot is just a lump of cartilage. Inside that cartilage the individual bone develop separate from each other and the joints between them develop, so at birth we should have all the bones well on their way to being developed and the joint form. Sometimes a joint or joints between bones does not form and are joined by a bridge or cartilage. This is called a tarsal coalition. There are several types of tarsal coalitions, depending on which bones are involved. Two common one are the talocalcaneal coalition and the calcaneonavicular coalition. Initially these tend not to cause any problems as the cartilage is very flexible, but at the child gets older, they can become symptomatic as the bone becomes more developed. Foot orthotics can be used to restrict movement of the bones to help the symptoms. In most cases of tarsal coaltions a surgical removal of the bridge of bone connecting the bones across the joint can be helpful.
Smelly feet are an embarrassing problem. The actually odour of smelly feet is due to the action of bacteria on sweat, so the two logical ways to treat this problems are to get rid of the sweat and get rid of the bacteria. There are a number of strategies to get rid of sweat, such as going barefoot as much as possible, using socks, insoles and powders that can absorb the sweat. There are a number of medications that can be used to help try up the sweat and work on the bacteria that break down the fatty acids. There is no magic secret sauce for smelly feet or foot odour, it’s just a lot of ongoing hard work to keep the sweat and bacteria under control.
A key diagnostic feature of navicular stress fractures is tenderness at the so-called “n spot”. This is an spot on the proximal dorsal portion of the navicular bone. When the thumb is pressed into this area, the tenderness is felt. This is an important physical finding of a navicular stress fracture. This should be confirmed with an x-ray (or MRI). Tenderness at the n-spot is also used to monitor progress. Many of these navicular stress fractures are placed in a weight bearing cast or walking splint until that tenderness subsides.
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Hallux rigidus is a big toe joint that does not move. Invariably this is due to osteoarthritis in the joint that has progressed to the stage that the joint hardly moves. Hallux rigidus makes not only the joint painful, but as the joint is not moving properly, other joints get forced to move at a time when they should not be moving. These compensation in other joints can also be painful. The big toe joint is so important for forward motion as this is the joint that the body pivots forward over the foot when the foot is in the ground. The treatment for hallux rigidus is to somehow restore that motion, which in a joint with osteoarthritis is not really possible. The only options are to add some sort of rocker to the shoe, so the foot can pivot forward over the rocker and not need to use the joint. The other option for hallux rigidus is surgical, in which the joint is either fused or replaced with a spacer so there is still some movement.
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Questions keep being asked in all sorts of forums about the MBT Shoes (MBT Shoes, do they Work?; Do MBT shoes Work). MBT stands for Masai Barefoot Technology and the shoes are designed to mimic the gait of the Masai tribe from Africa, who have a very upright posture and do not develop any postural or low back problems. The shoe is designed to help people with these problem A number of studies have shown the biomechanical effects of the shoes, but very limited studies have shown the effects on outcomes. The shoes certainly do help some people with these problems and do not help others, and the evidence provide little guidance. When MBT shoes first came on the market they claimed to cure everything including cellulite. It was this cellulite claims that got them labels as ‘snake oil’. That claim has now been removed from the website. From what I have observed a key principle in using MBT shoes is the correct use of them and there are videos to aid that.
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