While deformities of the lesser toes (all toes other than the big toe) can be very painful, there are numerous surgical and nonsurgical treatments for these conditions that are usually quite effective. A literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) shows that because lesser toe deformities are often treatable, and can be symptoms of other conditions, early assessment and treatment by an orthopedic surgeon is important.
“Toe pain can limit a person’s quality of life,” says Khalid Shirzad, MD, an orthopedic surgeon at Northwest Orthopedic Specialists, P.S., Spokane, Wash., and lead author of the review. “When it hurts to walk, that person will start decreasing time spent on activities they enjoy. If the initial problem is not treated, it may lead to further issues such as skin infections, deformities, and muscular problems.”
Lesser toes are important in walking, especially when pushing off with the foot towards the next step, bearing the majority of the weighted pressure in support of the big toe and the ball of the foot. A variety of causes can lead to lesser toe deformities, such as:
•Improper footwear, such as shoes with pointed toes or tight toe-boxes;
•Neuromuscular and metabolic diseases, such as cerebral palsy, multiple sclerosis, or rheumatoid arthritis; or
The most common lesser toe deformities include: hammer toes, claw toes, mallet toes, curly toes, crossover toes, and bunions. In all of these conditions, the toe is bent, curled, or misaligned in a way that makes normal walking painful. Symptoms, in addition to pain, also include redness, swelling, and sores or calluses where the bent toe rubs against the inside of a shoe.
Dr. Shirzad also notes that while diabetes isn’t a direct cause of lesser toe deformities, diabetic patients with neuropathy may not notice when a toe has become painful. They, and others with reduced sensation in their extremities, should be especially aware of any injury or changes in their toes.
Lesser toe deformities can often be treated nonsurgically, but if the patient doesn’t respond well to those treatments, surgery is also an effective option. Nonsurgical treatments can include pads or gel sleeves to reduce pressure on the toe joint; or wraps, tape, or shoe inserts designed to guide the toes into a proper alignment. Surgery may involve reconstruction of the soft tissues, bones, or a combination of both.
While some causes of lesser toe deformities are not preventable, one of the most common causes is footwear. Shoes that don’t fit well are responsible for many toe deformities as well as other foot problems.
“The most important thing the public should take from this is to be conscious of your footwear,” Dr. Shirzad says. “Well-fitted shoes that do not pinch the foot or constrict the toes can prevent many toe deformities.”
The above post is reprinted from materials provided by American Academy of Orthopaedic Surgeons.
If you often find yourself running after a bus, escaping a burning building or taking part in competitive athletics in high-heeled footwear, you may be storing up knee problems for later in life, according to a study published this month in the International Journal of Biomedical Engineering and Technology.
9 out of 10 wearers of high-heels report associated soreness, fatigue, numbness and bunions when wearing such footwear. Despite this, the wearing of high-heels apparently represents an ongoing fashion statement. It gives the wearer a shorter stride, a purportedly more graceful gait and a superficial “shaping” of the leg towards the slender. It is perhaps no surprise then that given the perception of increased attractiveness and an apparent boost to self-confidence that high-heeled footwear remains popular despite the pain.
Now, Yaodong Gu, Yan Zhang and Wenwen Shen of the Faculty of Sports Science, at Ningbo University, in Zhejiang, China, have demonstrated that there are additional long-term risks for wearers of high-heels who find themselves regularly having to run.
The team measured the hip and ankle movements in young women running in different types of footwear — flat shoes heel (15 mm heel), low heel (45 mm) and high heels (70 mm). The team observed an increased motion of range of knee abduction-adduction and hip flexion-extension while the volunteers where running in high heels. This, they explain, could induce high loading forces on knee joints. Moreover, they observed a decrease in ankle movement and inversion while running that correlated with heel height, which would be linked to a greater risk of sprain. The researchers suggest that the higher the heel the greater the risk of an ankle sprain if running.
Perhaps more worrying than an ankle sprain in the long-term is that their findings suggest that the regular use of high-heeled footwear may contribute to osteoarthritis of the knee joints. The greater movement and force focused on the knees while running in such footwear being the major risk factor. Although the team studied only a small group of women aged 21-25 years in laboratory conditions, it is likely that other people wearing heeled footwear would be exposed to the same risks of injury and joint wear and tear.
The above post is reprinted from materials provided by Inderscience Publishers. Note: Materials may be edited for content and length.
1.Yaodong Gu, Yan Zhang and Wenwen Shen. Lower extremities kinematics variety of young women jogging with different heel height. Int. J. Biomedical Engineering and Technology, October 2013
Knee Pain Advice
For patients with severe knee pain, supervised exercise therapy is more effective at reducing pain and improving function than usual care, finds a study published on bmj.com.
Patellofemoral pain syndrome is a condition in which pain occurs at the front of the knee during or after exercise and is a common reason to visit the doctor. Women are more likely to be affected than men, and symptoms usually start during adolescence when participation in sporting activities is high.
General advice is to rest during periods of pain and to avoid pain provoking activities. This “wait and see” approach is considered usual care.
A recent study reported only limited evidence for the effectiveness of exercise therapy with respect to pain reduction, while there is conflicting evidence with respect to functional improvement.
So researchers based in the Netherlands investigated the effectiveness of supervised exercise therapy compared with usual care in 131 patients aged between 14 and 40 years with patellofemoral pain syndrome.
A total of 131 participants were included in the study, 65 to a supervised exercise program (intervention group) and 66 to usual care (control group). Both groups received similar written information about the syndrome and similar instructions for home exercises, as well as advice to refrain from painful activities.
Patients rated their recovery, pain at rest, pain on activity, and function scores at the start of the study and again at three and 12 months.
After three months, the intervention group reported significantly less pain and better function than the control group. At 12 months, the intervention group continued to show better outcomes than the control group with regard to pain at rest and pain on activity, but not function.
A higher proportion of patients in the exercise group than in the control group reported recovery (42% v 35% at three months and 62% v 51% at 12 months), but these results were not significantly different between the two groups.
This study provides evidence that supervised exercise therapy for patellofemoral pain syndrome in general practice is more effective than usual care for pain at rest, pain on activity, and function at three and 12 months, say the authors. However, supervised exercise therapy had no effect on perceived recovery.
Further research is needed to understand how exercise therapy results in better outcome, they conclude.
The first time I ever suffered a genuine “back spasm” was a day I will never forget. I was in a car park, sitting in the car, and I bent down sideways to pick up my wallet from the floor on the passenger side (trunk in flexion and rotation). Whilst I was in this position I sneezed and felt this almighty thump in my back like someone had shot me with a bazooka. I was stuck in that position for a good 5 minutes. Sweet relief only came with a cocktail of pain killers – Valium, Tramadol and Voltaren.
We often see clients who present to the clinic with acute onset of back pain associated with a degree of protective muscle spasm. Genuine back spasms are an example of common low back disorders, along with the more frequent lumbar spine disc injuries, facet joint sprains and rib joint sprains. A muscle spasm can be defined as an acute onset of uncontrolled and involuntary muscle contraction. Most of us may be familiar with the sensation of muscle cramps such as the calves and hamstrings that usually accompany fatigue in the affected muscles. These types of cramps (a form of spasm) are usually caused by fatigue related dehydration and/or electrolyte imbalance. These can be quite debilitating and painful and usually resolve with aggressive stretching and rehydration and are short term.
Back muscle spasms are rarely this type of phenomenon. Back spasms are more often caused by a sudden ill directed movement that causes a muscle to spasm. For example, if someone is bent over and sneezes, they may cause a sudden spasm in a thoracic muscle that “locks” the back up. Or the person may attempt to lift a heavy weight (gym or occupation) and they may feel a muscle spasm. Golfers often complain of acute back spasms following big tee shots with driving woods, due to the sudden forceful muscle contraction involved in rotating the spine.
Often the spasm is a warning sign that something under the surface is waiting to become problematic. For example, if someone sprains a facet joint or tweaks a disc, often the muscles in the back area will spasm as a protective mechanism. The common muscles to spasm are the quadrutus lumborum (QL) and the thoracic paraspinals. Red flag symptoms such as bladder and bowel problems or neurological sensations down the leg such as numbness, pins and needles and weakness are usually indications something much more sinister is happening at the spine level. The spasm is purely a warning sign. In these instances, a thorough workup is needed involving doctors, radiology and the like.
If the spasm is a true and genuine spasm caused by the uncontrolled contraction of the muscle, then there are number of things the therapist can do to relieve the spasm. Primarily, if the spasm is debilitating they may need referral to a doctor to obtain some muscle relaxants and/or anti-inflammatory medication. These can be quite effective in dulling the spasm very quickly. The more therapist orientated interventions are directed at relieving the spasm via gentle soft tissue massage to “work out” the spasm. This is particularly useful on muscles such as the QL in the case of low back spasm or the paraspinals and QL in the case of rib joint sprains.
The Side Lie Stretch can help alleviate the spasm. A safe stretch for the QL is the side lie stretch. Lie on the affected side and bend the knees and hips up. Prop up on the elbow and slowly let the body sink in towards the floor to create lateral flexion of the trunk. This can be held for 5-10 minutes and is quite safe to do even in the case of an acute and painful spasm.