Ankle & Foot – Joint Clinic Paarl

Gout of the foot

Daan Botes — Sun, 20 Sep 2020 14:42:11 +0000

Gout of the foot is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint. Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours. The joint at the base of the big toe is affected in about half of cases. It may also result in tophi, kidney stones, or kidney damage.

Gout is due to persistently elevated levels of uric acid in the blood. This occurs from a combination of diet, other health problems, and genetic factors. At high levels, uric acid crystallizes and the crystals deposit in joints, tendons, and surrounding tissues, resulting in an attack of gout.

Gout occurs more commonly in those who regularly drink beer or sugar-sweetened beverages or who eat foods that are high in purines such as liver, shellfish, or anchovies, or are overweight. Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint. Blood uric acid levels may be normal during an attack.

Tarsal Tunnel Syndrome

Saltlicker — Thu, 23 Jul 2020 15:43:48 +0000

Tarsal tunnel syndrome (TTS), is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle). The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two (medial and lateral plantar nerves) continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.

Patients with TTS typically complain of numbness in the foot radiating to the big toe and the first three toes, pain, burning, electrical sensations, and tingling over the base of the foot and the heel. Depending on the area of entrapment, other areas can be affected. If the entrapment is high, the entire foot can be affected as varying branches of the tibial nerve can become involved. Ankle pain is also present in patients who have high level entrapments. Inflammation or swelling can occur within this tunnel for a number of reasons.

The flexor retinaculum has a limited ability to stretch, so increased pressure will eventually cause compression on the nerve within the tunnel. As pressure increases on the nerves, the blood flow decreases. Nerves respond with altered sensations like tingling and numbness. Fluid collects in the foot when standing and walking and this makes the condition worse. As small muscles lose their nerve supply they can create a cramping feeling.

Plantar Fasciitis

Saltlicker — Thu, 23 Jul 2020 15:43:34 +0000

Plantar fasciitis is a disorder of the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually, and it affects both feet in about one-third of cases.

The cause of plantar fasciitis is not entirely clear. Risk factors include overuse, such as from long periods of standing, an increase in exercise, and obesity. It is also associated with inward rolling of the foot, a tight Achilles tendon, and a sedentary lifestyle. It is unclear if heel spurs have a role in causing plantar fasciitis even though they are commonly present in people who have the condition.

Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. Since inflammation plays either a lesser or no role, a review proposed it be renamed plantar fasciosis. The presentation of the symptoms is generally the basis for diagnosis; with ultrasound sometimes being useful if there is uncertainty. Other conditions with similar symptoms include osteoarthritis, ankylosing spondylitis, heel pad syndrome, and reactive arthritis.

Lisfranc Fracture

Saltlicker — Thu, 23 Jul 2020 15:43:20 +0000

A Lisfranc fracture, also known as Lisfranc injury, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus.

The midfoot consists of five bones that form the arches of the foot (the cuboid, navicular, and three cuneiform bones) and their articulations with the bases of the five metatarsal bones, and these articulations are damaged in a Lisfranc injury. Such injuries typically involve the ligaments between the medial cuneiform bone and the bases of the second and third metatarsal bones, and each of these ligaments is called Lisfranc ligament.

Lisfranc injuries are caused when excessive kinetic energy is applied either directly or indirectly to the midfoot and are often seen in traffic collisions or industrial accidents. Direct Lisfranc injuries are usually caused by a crush injury, such as a heavy object falling onto the midfoot, or the foot being run over by a car or truck, or someone landing on the foot after a fall from a significant height.

Indirect Lisfranc injuries are caused by a sudden rotational force on a plantar flexed (downward pointing) forefoot. Examples of this type of trauma include a rider falling from a horse but the foot remaining trapped in the stirrup, or a person falling forward after stepping into a storm drain.

In athletic trauma, Lisfranc injuries occur commonly in activities such as windsurfing, kitesurfing, wakeboarding, or snowboarding (where appliance bindings pass directly over the metatarsals). American football players occasionally acquire this injury, and it most often occurs when the athlete’s foot is plantar flexed and another player lands on the heel. This can also be seen in pivoting athletic positions such as a baseball catcher or a ballerina spinning.

Talus Fracture

Saltlicker — Thu, 23 Jul 2020 15:43:06 +0000

A talus fracture is a broken ankle bone. The talus (/ˈteɪləs/; Latin for ankle), talus bone, astragalus /əˈstræɡələs/, or ankle bone is one of the group of foot bones known as the tarsus. The tarsus forms the lower part of the ankle joint. It transmits the entire weight of the body from the lower legs to the foot.

The talus has joints with the two bones of the lower leg, the tibia and thinner fibula. These leg bones have two prominences (the lateral and medial malleoli) that articulate with the talus. At the foot end, within the tarsus, the talus articulates with the calcaneus (heel bone) below, and with the curved navicular bone in front; together, these foot articulations form the ball-and-socket-shaped talocalcaneonavicular joint.

The talus is the second largest of the tarsal bones; it is also one of the bones in the human body with the highest percentage of its surface area covered by articular cartilage. It is also unusual in that it has a retrograde blood supply, i.e. arterial blood enters the bone at the distal end.

In humans, no muscles attach to the talus, unlike most bones, and its position therefore depends on the position of the neighbouring bones.

Claw Toe and Hammer Toe

Saltlicker — Thu, 23 Jul 2020 15:42:52 +0000

Claw Toe and Hammer Toe deformities are conditions that are usually caused by wearing shoes that are too tight resulting in toes being bent into odd positions.

A Hammer toe or contracted toe is a deformity of the muscles and ligaments of the proximal interphalangeal joint of the second, third, fourth, or fifth toe causing it to be bent, resembling a hammer. In the early stage a flexible hammertoe is movable at the joints; a rigid hammertoe joint cannot be moved and usually requires surgery.

Mallet toe is a similar condition affecting the distal interphalangeal joint. Claw toe is another similar condition, with dorsiflexion of the proximal phalanx on the lesser metatarsophalangeal joint, combined with flexion of both the proximal and distal interphalangeal joints. Claw toe can affect the second, third, fourth, or fifth toes.

Cavovarus Deformity

Saltlicker — Thu, 23 Jul 2020 15:42:37 +0000

Cavovarus Deformity, also known as high arch, is a human foot type in which the sole of the foot is distinctly hollow when bearing weight. That is, there is a fixed plantar flexion of the foot. A high arch is the opposite of a flat foot and is somewhat less common.

People suffering from cavovarus deformity sometimes—though not always—have difficulty finding shoes that fit and may require support in their shoes. Children with high arches who have difficulty walking may wear specially-designed insoles, which are available in various sizes and can be made to order.

Individuals that suffer from cavovarus deformity frequently report foot pain, which can lead to a significant limitation in function. The range of complaints reported in the literature include metatarsalgia, pain under the first metatarsal, plantar fasciitis, painful callosities, ankle arthritis, and Achilles tendonitis.

There are many other symptoms believed to be related to the cavus foot. These include shoe-fitting problems, lateral ankle instability, lower limb stress fractures, knee pain, iliotibial band friction syndrome, back pain and tripping.

Foot pain in people suffering from cavovarus deformity may result from abnormal plantar pressure loading because, structurally, the cavoid foot is regarded as being rigid and non-shock absorbent and having reduced ground contact area. There have previously been reports of an association between excessive plantar pressure and foot pathology in people with pes cavus.

Bunions

Saltlicker — Thu, 23 Jul 2020 15:42:20 +0000

Bunions, also known as hallux valgus, is a deformity of the joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complications may include bursitis or arthritis.

The exact cause is unclear. Proposed factors include wearing overly tight shoes, high-heeled shoes, family history, and rheumatoid arthritis. Diagnosis is generally based on symptoms and supported by X-rays. A similar condition of the little toe is referred to as a bunionette.

Foot and Ankle Arthritis

Saltlicker — Thu, 23 Jul 2020 15:42:02 +0000

Foot and Ankle Arthritis is the inflammation of one or more of your joints of the foot, ankle or both. This inflammation can cause pain and stiffness resulting in trouble walking.

The most common foot joints that arthritis affects are:

The joint where the ankle and shinbone meet.
The 3 joints of the foot that involve the heel bone, the inner mid-foot bone, and the outer mid-foot bone.
The joint of the big toe and foot bone.

Arch Pain

Saltlicker — Thu, 23 Jul 2020 15:41:44 +0000

Arch pain (medically known as plantar pain) is a broad term many people use to describe pain in the muscles, tendons, ligaments, bones, or nerves on the bottom of the foot. All these components are connected to the bottom of the foot; therefore, damage to any one of these can cause pain on the bottom of the foot.