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Hammer Toe Fusion Implants

August 20, 2015
Hammer ToeOverview

A hammertoes is a misshapen second, third, or fourth toe. The toe bends up at the middle joint. The toe becomes a hammertoe because a muscle in the toe isn?t working properly or is too weak, increasing pressure on the tendons and the toe joints. Muscles normally work in twos to bend and straighten toes. If the toe stays bent too long, a hammertoe develops. Ill-fitting shoes, arthritis, heredity, even an injury, can cause the hammertoe to form. To add insult to injury, corns and calluses are common on top of hammertoes because the toe is rubbing against the shoe.

Causes

Hammertoe commonly develops because of structural changes that take place over time in the muscles and tendons that bend the toes. People with certain medical conditions, such as diabetes, are at risk for developing hammertoe. It can be an inherited condition for some people. Other causes include trauma and wearing shoes that are too tight, narrow, or have high heels. The toe next to the big toe (second toe) is most frequently affected by hammertoe.

HammertoeSymptoms

Symptoms include sharp pain in the middle of the toe and difficulty straightening the toe. People with hammertoe may also develop blisters, which are fluid-filled pockets of skin, because the bent toe is likely to rub against the inside of a shoe. This increased friction may also lead to calluses, which are areas of thickened skin, and corns, which are hard lumps that may form on or between toes. Symptoms may be minor at first, but they can worsen over time.

Diagnosis

Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.

Non Surgical Treatment

Your doctor may prescribe some toe exercises that you can do at Hammer toes home to stretch and strengthen the muscles. For example, you can gently stretch the toes manually. You can use your toes to pick things up off the floor. While you watch television or read, you can put a towel flat under your feet and use your toes to crumple it. Finally, your doctor may recommend that you use commercially available straps, cushions or nonmedicated corn pads to relieve symptoms. If you have diabetes, poor circulation or a lack of feeling in your feet, talk to your doctor before attempting any self-treatment.

Surgical Treatment

Hammer toe can be corrected by surgery if conservative measures fail. Usually, surgery is done on an outpatient basis with a local anesthetic. The actual procedure will depend on the type and extent of the deformity. After the surgery, there may be some stiffness, swelling and redness and the toe may be slightly longer or shorter than before. You will be able to walk, but should not plan any long hikes while the toe heals, and should keep your foot elevated as much as possible.

Hammer ToePrevention

Prevention of a hammertoe can be difficult as symptoms do not arise until the problem exists. Wearing shoes that have extra room in the toes may eliminate the problem or slow down the deformity from getting worse. Sometimes surgery is recommended for the condition. If the area is irritated with redness, swelling, and pain some ice and anti-inflammatory medications may be helpful. The best prevention may be to get advice from your podiatrist.

Foot Bunions And Corns

June 7, 2015
Overview
Bunions Bunions are a common problem that most individuals experience as a painful swelling or a bony protuberance at the inner base of the big toe. This condition is the result of a malalignment of the first toe. These can be hereditary or secondary to wearing high-heeled or narrow toe-box shoes.
Causes
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.
Symptoms
Bunions typically start out as a mild bump or outward bending of the big toe. Bunions at this stage are usually only a concern of appearance at this stage, and at this point they often don't hurt much. Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the big toe gradually pull it farther and farther towards the second toe. Sometimes patients will find their first and second toes begin to press together too much, and they'll often get a painful corn between those toes. As the bunion progresses, the big toe may begin to ride on top of the second toe, or vice versa, creating a second deformity. Others will develop bump pain at the site of the bony enlargement on the side of the foot. A painful bursa may develop at that site. This is particularly true in tight shoes. Many patients also develop a painful callus beneath the foot. Capsulitis and other types of metatarsalgia may develop in the joints beneath these calluses, particularly in the second and third metatarsophalangeal joints (the joints in the ball of the foot). Over time, with the toe held in a crooked position for enough time, arthritis develops in the big toe joint. This will usually result in decreased range of motion of that joint (a condition known as "Hallux Limitis"), which as a result, often causes the patient to changes in the way a patient walks. Often the patient walks in an "out-toed", or duck-like, fashion, which very frequently causes secondary pain in the legs, knee, hip, and low back.
Diagnosis
Orthopaedic surgeons diagnose bunions on the basis of physical examination and weight bearing x-rays. Two angles are assessed, the intermetatarsal angle, that is between the first and second metatarsals (the bones that lead up to the base of the toes). If this angle exceeds 9? (the angle found in the healthy foot) it is abnormal and referred to as metatarsus primus varus. the hallux valgus angle, that is, the angle of the big toe as it drifts toward the small toe. An angle that exceeds 15? is considered to be a sign of pathology.
Non Surgical Treatment
You can buy orthotics over the counter from pharmacies, or they can be custom-made by a podiatrist to fit your feet. Whether you need to buy an over-the-counter orthotic or have one specially made will depend on your individual circumstances and the severity of your bunion. You can also use special bunion splints, worn over the top of your foot and your big toe to help straighten its alignment. Splints are available for both daytime and night-time use. However, there's little evidence that splints are effective. Toe spacers are also available, which can help reduce the pain caused by bunions. However, toe spacers or orthotics may be of limited use because they often compete with the bunion for the already limited space in the shoe. If your toe joint is painful and swollen, applying an ice pack to the affected area several times a day can help to relieve the pain and inflammation. Never apply ice directly to your skin. Wrap it in a cloth or tea towel. A bag of frozen vegetables makes a good ice pack. It's recommended that you wear flat or low-heeled, wide-fitting shoes if you have a bunion. Shoes made from soft leather are ideal because they'll relieve any pressure on the bunion. Avoid narrow or slip-on shoes. High heels can also make your bunion worse by putting excessive pressure on your toes. Bunions
Surgical Treatment
Surgery isn't recommended unless a bunion causes you frequent pain. A bunionectomy, like other types of surgery, is not without risk. Additionally, you may still have pain or you could develop a new bunion in your big toe joint after surgery. Consider trying conservative treatment before having a bunionectomy.If you have an underlying mechanical fault,surgery will only correct the aesthetical nature of your bunion for a short period.So therefore surgery is not recommended.

Severs Disease Therapy

May 15, 2015
Overview

Sever?s disease is particularly prevalent among active children between ages 8 and 15. Young boys and girls who play soccer and other sports in which footwear is inappropriate-i.e. too narrow in the toe box, too rigid, etc. are most commonly affected. Sever?s disease usually appears during the adolescent growth spurt-the 2-year period in early puberty where children grow the quickest. The adolescent growth spurt occurs between the ages of 8 and 13 in girls and 10 and 15 in boys. Teenagers over 15 years old rarely experience this heel problem, as heel bone growth is usually complete by this age. Sever?s disease usually self-resolves within 6 months of onset, though it can last longer.

Causes

Your child is most at risk for this condition when he or she is in the early part of the growth spurt in early puberty. Sever's disease is most common in physically active girls 8 years to 10 years of age and in physically active boys 10 years to 12 years of age. Soccer players and gymnasts often get Sever's disease, but children who do any running or jumping activity may also be at an increased risk. Sever's disease rarely occurs in older teenagers because the back of the heel has typically finished growing by 15 years of age.

Symptoms

The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the tendo-achilles inserts into the calcaneus (heel bone), and is tender to deep pressure at that site. Walking on his toes relieves the pain.

Diagnosis

Children or adolescents who are experiencing pain and discomfort in their feet should be evaluated by a physician. In some cases, no imaging tests are needed to diagnose Sever?s disease. A podiatrist or other healthcare professional may choose to order an x-ray or imaging study, however, to ensure that there is no other cause for the pain, such as a fracture. Sever?s disease will not show any findings on an x-ray because it affects cartilage.

Non Surgical Treatment

Traditional treatment involved simply telling children that they can?t play sport for a year. This is not popular for children or parents and abstaining from sport leads to other problems when wanting to return. Treatments focus on improving foot and lower limb function with footwear selection, heel raises, calf stretching, prescription orthoses, run technique training and training modifications. This results in a reduced load through the growth plate and the child can perform more activity before the growth plate becomes inflamed. Rest will always reduce the Sever?s disease symptoms, however this is always the last option.

Recovery

One of the most important things to know about Sever's disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever's disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away.

Partial Achilles Tendon Rupture Symptoms

May 5, 2015
Overview
Achilles Tendonitis The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone. However, this tendon is also the most common site of rupture or tendonitis, an inflammation of the tendon due to overuse. Achilles tendon rupture is a partial or complete tear of the Achilles tendon. It comes on suddenly, sometimes with a popping sound, and can be debilitating. A full rupture is more severe, but less common, than a partial rupture. A full rupture splits the Achilles tendon so that it no longer connects the calf muscle to the heel: the calf muscle can no longer cause the foot to ?push off?, so normal walking is impossible. If it is a full rupture, then lightly pinching the Achilles tendon with the forefinger and thumb will reveal a gap in the Achilles tendon. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden stretching, such as sprinting and racquet sports. Partial Achilles tendon tears are also common among middle and long distance runners.
Causes
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Rupture usually occurs in the section of the tendon located within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section may be predisposed to rupture because it gets less blood flow, which also may impair its ability to heal. Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include increasing the intensity of sports participation, especially in sports that involve jumping, falling from a height, stepping into a hole.
Symptoms
A sudden and severe pain may be felt at the back of the ankle or calf, often described as "being hit by a rock or shot" or "like someone stepped onto the back of my ankle." The sound of a loud pop or snap may be reported. A gap or depression may be felt and seen in the tendon about 2 inches above the heel bone. Initial pain, swelling, and stiffness may be followed by bruising and weakness. The pain may decrease quickly, and smaller tendons may retain the ability to point the toes. Without the Achilles tendon, though, this would be very difficult. Standing on tiptoe and pushing off when walking will be impossible. A complete tear is more common than a partial tear.
Diagnosis
Your doctor will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your doctor may ask you to do a series of movements or exercises to see how well you can move your lower leg. He or she may also examine your leg, heel and ankle and may squeeze your calf muscle to check the movement of your foot. You may need to have further tests to confirm if your tendon is torn, which may include the following. An ultrasound scan. This uses sound waves to produce an image of the inside of your leg. An MRI scan. This uses magnets and radio waves to produce images of the inside of your leg.
Non Surgical Treatment
To give the best prospects for recovery it is important to treat an Achilles' tendon rupture as soon as possible. If a complete rupture is treated early the gap between the two ends of the tendon will be minimised. This can avoid the need for an operation or tendon graft. There are two forms of treatment available for an Achilles' tendon rupture; conservative treatment and surgery. Conservative treatment will involve the affected leg being placed in a cast and series of braces with the foot pointing down to allow the two ends of the tendon to knit together naturally. Achilles Tendon
Surgical Treatment
Surgery may be indicated directly following injury rather than conservative care. Repair of an achilles tendon rupture is greatly varied for each clinical situation. There may be a direct repair of the ends of the tendon with suture, or possibly a tendon graft used to augment the tendon. Post-operatively, the period of immobilization will depend on the size of the defect that was repaired and how it was completed. Usually the immobilization is between 6-10 weeks. This repair may allow for a complete return to normal function, but in many instances the healing is complicated with adhesions and a partial loss of range of motion. There may be a continued soft tissue defect noted and a permanent or prolonged swelling.
Prevention
To reduce your chance of developing Achilles tendon problems, follow the following tips. Stretch and strengthen calf muscles. Stretch your calf to the point at which you feel a noticeable pull but not pain. Don't bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury. Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill running and jumping activities. Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training and wear well-fitting athletic shoes with proper cushioning in the heels. Increase training intensity slowly. Achilles tendon injuries commonly occur after abruptly increasing training intensity. Increase the distance, duration and frequency of your training by no more than 10 percent each week.

Functional Leg Length Discrepancy Way Of Measuring

April 27, 2015
Overview

Leg shortening is employed when LLD is severe and when a patient has already reached skeletal maturity. The actual surgery is called an osteotomy , which entails the removal of a small section of bone in the tibia (shinbone) and sometimes the fibula as well, resulting in the loss of around an inch in total height. Leg lengthening is a difficult third option that has traditionally had a high complication rate. Recently, results have improved somewhat with the emergence of a technique known as callotasis , in which only the outer portion of the bone (the cortex ) is cut, (i.e. a corticotomy ). This allows the bone to be more easily lengthened by an external fixation device that is attached to either side of the cut bone with pins through the skin. The ?ex-fix,' as it is sometimes called, is gradually adjusted by an orthopaedic surgeon, and healing can occur at the same time that the leg is being distracted , or lengthened over time. Unlike epiphysiodesis, leg lengthening procedures can be performed at almost any skeletal or chronological age.Leg Length Discrepancy

Causes

The causes of LLD are many, including a previous injury, bone infection, bone diseases (dysplasias), inflammation (arthritis) and neurologic conditions. Previously broken bones may cause LLD by healing in a shortened position, especially if the bone was broken in many pieces (comminuted) or if skin and muscle tissue around the bone were severely injured and exposed (open fracture). Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. Also, a break in a child?s bone through a growth center (located near the ends of the bone) may cause slower growth, resulting in a shorter extremity. Bone infections that occur in children while they are growing may cause a significant LLD, especially during infancy. Bone diseases may cause LLD, as well; examples are neurofibromatosis, multiple hereditary exostoses and Ollier disease. Inflammation of joints during growth may cause unequal extremity length. One example is juvenile rheumatoid arthritis. Osteoarthritis, the joint degeneration that occurs in adults, very rarely causes a significant LLD.

Symptoms

Children whose limbs vary in length often experience difficulty using their arms or legs. They might have difficulty walking or using both arms to engage in everyday activities.

Diagnosis

The evaluation of leg length discrepancy typically involves sequential x-rays to measure the exact discrepancy, while following its progression. In addition, an x-ray of the wrist allows us to more carefully age your child. Skeletal age and chronological age do not necessarily equal each other and frequently a child's bone age will be significantly different than his or her stated age. Your child's physician can establish a treatment plan once all the facts are known: the bone age, the exact amount of discrepancy, and the cause, if it can be identified.

Non Surgical Treatment

You may be prescribed a heel lift, which will equal out your leg length and decrease stress on your low back and legs. If it?s your pelvis causing the leg length discrepancy, then your physical therapist could use your muscles to realign your pelvis and then strengthen your core/abdominal region to minimize the risk of such malalignment happening again. If you think that one leg may be longer than the other and it is causing you to have pain or you are just curious, then make an appointment with a physical therapist.

LLD Insoles

Surgical Treatment

Large leg length inequalities can be treated by staged lengthenings or by simultaneous ipsilateral femoral and tibial lengthenings. Additionally, lengthenings can be combined with appropriately timed epiphysiodesis in an effort to produce leg length equality. Staged lengthenings are often used for congenital deficiencies such as fibular hemimelia, in which 15 cm or more may be needed to produce leg length equality. We typically plan for the final lengthening to be completed by age 13 or 14 years, and allow at least 3 years between lengthenings. Lengthening of both the tibia and femur simultaneously requires aggressive therapy and treatment of soft tissue contractures. Curran et al[57] reported the need for surgical release of soft tissue contractures in 3 of 8 patients treated with simultaneous ipsilateral femoral and tibial lengthenings. Lengthening over an IM nail can be done in an effort to decrease the amount of time the fixator needs to be worn and to prevent angular malalignment. This technique requires that the patient be skeletally mature and it carries a higher risk of osteomyelitis (up to 15%). Additionally, if premature consolidation occurs, a repeat corticotomy is more difficult.

Does Adult Aquired Flat Foot Necessitate Surgery ?

April 24, 2015
Overview
Adults with an acquired flatfoot deformity may present not with foot deformity but almost uniformly with medial foot pain and decreased function of the affected foot (for a list of causes of an acquired flatfoot deformity in adults. Patients whose acquired flatfoot is associated with a more generalised medical problem tend to receive their diagnosis and are referred appropriately. However, in patients whose ?adult acquired flatfoot deformity? is a result of damage to the structures supporting the medial longitudinal arch, the diagnosis is often not made early. These patients are often otherwise healthier and tend to be relatively more affected by the loss of function resulting from an acquired flatfoot deformity. The most common cause of an acquired flatfoot deformity in an otherwise healthy adult is dysfunction of the tibialis posterior tendon, and this review provides an outline to its diagnosis and treatment. Adult Acquired Flat Foot
Causes
Many health conditions can create a painful flatfoot, an injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.
Symptoms
Many patients with this condition have no pain or symptoms. When problems do arise, the good news is that acquired flatfoot treatment is often very effective. Initially, it will be important to rest and avoid activities that worsen the pain.
Diagnosis
Although you can do the "wet test" at home, a thorough examination by a doctor will be needed to identify why the flatfoot developed. Possible causes include a congenital abnormality, a bone fracture or dislocation, a torn or stretched tendon, arthritis or neurologic weakness. For example, an inability to rise up on your toes while standing on the affected foot may indicate damage to the posterior tibial tendon (PTT), which supports the heel and forms the arch. If "too many toes" show on the outside of your foot when the doctor views you from the rear, your shinbone (tibia) may be sliding off the anklebone (talus), another indicator of damage to the PTT. Be sure to wear your regular shoes to the examination. An irregular wear pattern on the bottom of the shoe is another indicator of acquired adult flatfoot. Your physician may request X-rays to see how the bones of your feet are aligned. Muscle and tendon strength are tested by asking you to move the foot while the doctor holds it.
Non surgical Treatment
Treatment will vary depending on the degree of your symptoms. Generally, we would use a combination of rest, immobilization, orthotics, braces, and physical therapy to start. The goal is to keep swelling and inflammation under control and limit the stress on the tendon while it heals. Avoidance of activities that stress the tendon will be necessary. Once the tendon heals and you resume activity, physical therapy will further strengthen the injured tendon and help restore flexibility. Surgery may be necessary if the tendon is torn or does not respond to these conservative treatment methods. Your posterior tibial tendon is vital for normal walking. When it is injured in any way, you risk losing independence and mobility. Keep your foot health a top priority and address any pain or problems quickly. Even minor symptoms could progress into chronic problems, so don?t ignore your foot pain. Flat Feet
Surgical Treatment
A new type of surgery has been developed in which surgeons can re-construct the flat foot deformity and also the deltoid ligament using a tendon called the peroneus longus. A person is able to function fully without use of the peroneus longus but they can also be taken from deceased donors if needed. The new surgery was performed on four men and one woman. An improved alignment of the ankle was still evident nine years later, and all had good mobility 8 to 10 years after the surgery. None had developed arthritis.

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