Thursday, 15 April 2021

SUCCESS STORY OF FLAT FEET WITH RHEUMATOID ARTHRITIS

 



The degree of freedom for the podiatry in rheumatoid arthritis is very restricted. As podiatry approach in R.A. is mainly to reduce foot-related pain, maintain/improve foot function and so mobility while protecting skin and other tissues from damage. Pain & swelling is main causes of restrictions.

Finely tuned podiatry intervention can give dramatic results in long run. Check out the images.
60 years old Lady with RA & pain 😔mostly at right foot.
Drastic relief in foot pain in a month with customization in STRIVE orthotic footwear. But the real treat is visible correction in her foot deformities within two years.(P.S. RA deformities are progressive means worsen day by day)
Good changes can happen at any age....!
Happy to see smile on her face.



Wednesday, 13 January 2021

Plantar fasciitis (Heel Pain)


Plantar fasciitis (Heel Pain)


Is the inflammation of the plantar fascia caused due to repetitive stress applied to it.

It is usually common in active individual, obese, runners or athletes, people who spend most of their day on foot.
The pain is usually characterized by piercing or searing type of heel pain that appears in the first few steps in the morning or after a period of inactivity.
Patient may present with tenderness around the medial calcaneal tuberosity at the plantar aponeurosis.
Pain increases when walking barefoot on toes or while climbing stairs.

Patho-physiology

As the term implies plantar fasciitis is the inflammation of the plantar fascia however in all the samples reviewed there is no evidence of inflammation histologically.
However research shows that plantar fascia is a degenerative condition, hence it is better to be  called “fasciosis” than fasciitis.1

Biomechanics of the foot during gait

There are 6 phases of gait cycle : heel contact, weight acceptance, mid stance, push off , propulsion and toe off phase. Foot goes for supination during heel contact phase followed by pronation in weight acceptance phase, in order to maintain contact with the surface. From the mid stance to the toe off phase the foot goes for supination thus making the foot as a rigid lever which is necessary for the propulsion of the foot.

Plantar fascia plays a very important role in maintaining this arch during the gait cycle of the foot. Because if plantar fascia fails to work effectively the medial arch arch would disrupt and the force required to control supination and pronation would be altered. Hence plantar fascia plays a very important role in control of supination and pronation of the foot during gait cycle.

Evidence based therapy for plantar fasciitis

  • Cryotherapy or NSAIDS – Not much effective in the treatment of plantar fascia, however it provides only temporary pain relief.
  •  Taping – No studies have proved the effectiveness of taping.
  •  Shoe inserts-  a study was done to compare the effectiveness of the custom made orthotics and prefabricated shoe inserts with stretching. It was found that prefabricated shoe inserts with stretching showed more effect than custom made orthotics.
  •  Stretching – A study shows plantar fascia stretch alone more effective than combined stretch of calf muscle and Achilles tendon.
  •  Night splints – limited evidence suggesting the effectiveness of night splints.
  •  Extra-corporeal shock-wave therapy – No evidence supporting the effectiveness of Extra-corporeal shock wave therapy for reducing night pain and resting pain in short term.
  • Corticosteroid injection – According to Cochraine review Steroid iontophersis injecton improved only short term outcomes.2
As mentioned earlier the arch of the foot is very important to maintain stability on the surface when walking or standing. Overpronation or underpronation can have direct influence on the effective working of plantar fascia.

Overpronated foot

Overpronation of the foot is caused due to muscle weakness, tightness in the heel cord and abnormal structure of the foot. Proximal muscles such as gluteus medius, gluteus minimus, tensor fascia latae or quadriceps can contribute to the pronation of the foot. These proximal muscles help in assisting lower extremity response during gait, hence weakness of these muscles will transmit greater shock to the supporting foot structures and decreased pronation control.
Heel cord assist in dorsiflexion of the foot during gait, hence tightness in the heel cord limits the ability to dorsiflex the ankle at heel strike phase of the gait thus making the foot to over pronate more at the midtarsal joints in order to make contact with the surface of the ground.
Structural deformities include excessive sub-talar or forefoot varus.
Treatments for overpronated foot include strengthening of the weak muscles, stretching of the calf muscles, and using appropriate shoes with sufficient toe box and firm ankle grip to control the movement of the ankle within the shoes. Insoles made of polyurethane and ethyl vinyl acetate also enhances shoe support.3

Underpronated foot (Supination)

Supinated foot which is caused due to factors such as increased muscle tightness, decreased mobility within the joints and decreased plantar fascia extensibility.
Highy arched or cavus foot will have limited joint mobility to distribute the force during weight acceptance phase. Hence when foot does not pronate during weight acceptance phase, it indirectly applies a lot of tension force to  the insertion of plantar fascia at the medial tubercle of calcaneum.
Treatment for supinated foot include Stretching of calf muscles, mobilization of joints and increase plantar fascia extensibility. Appropriate shoe wear with ethyl vinyl acetate midsole provides appropriate space for the rearfoot and forefoot to move , offers much shock absorption.
Silicone heel pad can further enhance shock absorption.3

By Dr. Liana Thomas (PT)

Reference –

  1. Plantar fasciitis  A degenerative process without Inflammation (Harvey Lemont et al.)
  2. Plantar fasciitis (Charles Cole, Craig Seto et al.)
  3. Plantar faciitis and the Windlass mechanism : A Biomechanical Link to clinical practice (Lori   A. Bolgia et al. )



Saturday, 24 March 2018

SUCCESS STORY OF METATARSALGIA


Metatarsalgia is condition which results in pain & inflammation under forefoot. Following case study of Metatarsalgia show how altered Biomechanics can create various injuries.

30 years old female patient came with complaints of pain under left forefoot since four weeks. She
has started learning SALSA recently, pain aggravates after dancing.
She used wear high heel footwear for office.

Bio-Mechanical Assessment-
  • Medial Arch- Flat both sides
  • Subtalar Joint- Over pronated
  • Transverse Arch- Reduced
  • Calcaneus- Eversion
  • Knee- Valgus
  • Left Knee higher than right
  • Spine- Sway back posture, mild scoliosis at lumbar level with convexity right side.
  • 1st Ray- Hyper mobile
  • Foot Size- US 10 Medium
Strive Ibiza
Gait-
  • Heel Strike- Medial
  • Mid Stance- Over-pronation at subtalar Joint
Orthotic Correction-
  • Prescribed Strive orthotic footwear with metatarsal pad.
  • Advised to avoid high heel foot wear.
Physical Therapy intervention-
  • Exercise prescribed for scoliosis
Bio-Fashion
Follow up (after 3 weeks)
Pain is disappeared. comfortable with correction. 
Considering her demand of wearing high heels advised to wear platform heels instead of pencil heels but occasionally.
Given Bio Fashion insole in high heel footwear's. Advised to walk minimal in high heels.




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Saturday, 27 January 2018

SUCCESS STORY OF RECURRENT CORN 1

SUCCESS STORY OF RECURRENT CORN

25 Years old young man working in restaurant as a manager came with complaints of three painful recurrent corns since 3 years. He needs to stand a lot as he was floor manager in five star hotel. He needs to stand at least 6-8 hours every day.

ASSESSMENT REVEALS:
  • Excessive forefoot pressure.
  • Medial Arch- Pronounced Bilaterally
  • Transverse arch- Reduced Bilaterally
  • Subtalar Joint- Supinates statically & dynamically
  • Corns- Three corns at 1st, 3rd & 5th Metatarsal heads
FOOT SIZE
  • Right- 8 Wide to Extra-wide
  • Left- 7 Extrawide
DIAGNOSIS- Corns with Pes Cavus foot type

CLINICAL REASONING:

Following are the reasons for corns in this case,
  • Week Transverse arch had increased fore foot pressure.
  • Both the foot sizes are different (Left foot is smaller than right)
He was wearing US 9 size shoes which was medium width. Left foot was sliding more inside the shoes resulted in more friction & corns.

Bio-Orthotic
TREATMENT & ADVISE:
  • Treatment started with targeting to offload the corn area.
  • Prescribed ready to wear orthotic footwear with metatarsal; raise for home wear.
  • Given Medium Density prefabricated custom orthotics (Bio-Advance insole) to use in his formal shoes.
Follow Up: After 15 Days
Corns are not hurting anymore when he wears corrections. Also recommended wide width formal shoes.
After three months corns healed completely.
After five months: even marks of the corn disappear.
TESTIMONIAL
"I came to V-Care Clinic about year back. In lot of pain & frustration ailing with three corns in my left sole. I had consulted with three doctors, endless trial & errors done. One of doctor even advised for surgery. One day magically I came across V-Care clinic on Google. After few hours of research on Podiatry. I decided very apprehensively to visit.
The first visit was what changed everything!!
The analysis & prescription of my problem by Dr. Sarika & Dr. Vilas was amazing. I am sure Sherlock Homes would be surprised. The warmth & the dedication is second to none. The meticulous explanation of the problem & its cure is commendable. I wish the V-Care team all the best & hope their quest of relieving people from pain goes on forever.
I cannot express my gratitude in words to Dr. Sarika & Dr. Vilas" 
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Saturday, 30 December 2017

SUCCESS STORY OF HEEL PAIN

Success Story of Heel Pain (Plantar Fasciitis)


53 year old female patient came with complaints in right foot.
Pain was worst in morning & aggravates by standing & walking for longer duration.
Professor by profession; standing for longer is the demand of occupation.

She has already consulted with many doctors. Tried medication & therapy but no long term relief. "Medicines will help to reduce the symptoms (pain & discomfort) which will help temporarily in this cases. Long term help will be to find out the root cause & manage it better way."
She was allergic to few anti-inflammatory medicines.

Bio-Mechanical Examination-

Static Examination:

  • Transverse Arch- Reduced Bilaterally
  • Medial Arch- Pronounced Bilaterally
  • Sub-talar Joint- Supinated Bilaterally (More on right side compare to left side)
  • Knee- Genu valgus (Right knee is slightly lower than left knee)
  • Calf & Hamstring muscles was moderately tight bilaterally.

Dynamic Examination:

  • Gait Pattern- Poor heel to toe pattern
  • Heel Strike- Lateral heel strike bilaterally
  • Stance Phase- Supinated at sub-talar joint bilaterally
  • Toe Off- From the 2nd Meatatarso-phalangeal joint bilaterally

Foot Size:

  • Right Foot- US 5 1/2 wide
  • Left Foot- US 6 wide

Investigations:

  • X-rays reveals Calcaneal spur right side.

Diagnosis:

  • Right Calcaneal Spur
"Root cause of her right heel pain was stiffness of plantar fascia due to her high arch foot type. This resulted in spur formation at its origin.This spur developed because of repetitive pull of the plantar fascia which lies underneath of our foot sole. Appropriate arch support will stop this pulling of ligament will help her eventually."

For more details watch this video (Click the link)- Heel Pain diagnosis & Treatment
Or to read click this link- Heel Pain



Treatment & Advice:

  1. Cold Pack 3-4 times a day 20 minutes each time
  2. Prescribed Strive ready to wear orthotic footwear.
  • Follow up: After 2 week
  1. 80-90% pain relief
  2. Prescribed wide width sport shoe US 6 1/2 wide
  3. Bio-Advance Orthotic medium density insole along with lateral raise
  4. Customized exercise regime was given.

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Thursday, 14 December 2017

SUCCESS STORY OF FLAT FEET WITH POSTERIOR TIBIAL TENDON DYSFUNCTION



CASE STUDY: FLAT FEET WITH POSTERIOR TIBIALTENDON DYSFUNCTION (PTTD)

41 year old female complaints pain & swelling at inner side of left ankle since a year. Pain was gradually increased. Initially it use to hurt on prolong standing & walking eventually pain got worst. Now not even able walk few steps also.

On Examination:
  • Swelling was present around left navicular area
  • Grade III tenderness at the navicular area
Biomechanical Assessment:
Static-
  • Clawing of toes left side
  • Medial Arch- Flat Bilaterlly (Flat Feet)
  • Transvrse arch reduced
  • Subtalar joint- Overpronation bilatrally more on lfert side
     
  • Navicular drop- Present bilaterally
  • Navicular drift- Present bilaterally
  • Calcaneum (Posterior view)- Eversion bilaterally more on left side
  • Knee- Valgus
Gait Assessment:
  • Gait Pattern- Poor heel to pattern
  • Heel Strike- Medial heel strike
  • Stance Phase- Overpronation at the sub-talar joint bilaterally
  • Limp on left side

Treatment & Advice:
Advice-
Bio-Advance

  • Complete rest for one week with cold pack 4 time a day over affected area for 20 min. each time.
Orthotic correction to improve lower limb biomechnical alignment-
  • Advised to wear sport shoes (Even indoor) with firm heel counter (Stable Shoes) few days as concidering her pain & sevirity of flat feet.
  • Prescribed Bio-Advanced medium density orthotic insole in her shoes & also to reduce stress on Tibialis posterior muscle tendon.

1st Follow up after two week
  • Demarkeble changes seen. More than 50% of pain was reduced.
  • Added correction in orthotics to further enhance arch support.
  • Advised to continue with cold pack. 
2 nd Follow up after one month
Strive

  • This time 90% pain reduced.
  • Now slight discomfirt only after long stand or walk.
  • Adviced Strive orthotic footwear for short distance (Near by) & continue the sports shoes for out door.
  • Exercises for strengthening tibialis posterior muscle.
3rd Follow up after 2 months
No pain & Adviced to continue with orthotics



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