Thursday, 10 September 2015

Metatarsalgia


METATARSALGIA

 Metatarsalgia is described as excessive pain which occurs over the toes & forefoot.
Most commonly, the first metatarsal head is affected- the ball of the foot just behind the big toe. In the foot there are small toe nerves between the metatarsal bones. When the head of one metatarsal bone is pressed against another, the small nerve is caught between them & start to become inflamed, thus causing metatarsalgia.

These can cause metatarsalgia or Contribute:
  • Ill fitting footwears- Footwears that is tight around the toes or has high heels that can add pressure on the ball of the foot as it is forced into tight space.
  • Overweight- Overweight people may suffer this pain as the excess weight can strain on the foot.
  • Age- As a person ages several degenerative changes occur in the body, one such is reduced shock absorption. Metatarsalgia can subsequently develop as the foot has less protection from the strain of impact & load.
  • High Impact Exercise- People who run or play high impact sport are at risk of metatarsalgia. When we running our feet absorb large amounts of force.

  • Shapes of the foot & toes- Having a high arch in your foot or a second toe longer than the big toe can add to the pressure on the metatarsals.
  • Stress fractures- These are small breaks in the toe bones or metatarsals. They can cause pain when weight is put on the foot- the individual compensates by changing the way they put weight on his/her foot.
Medical conditions that can cause Metatarsalgia:
  • Bunion- this is a painful swollen bump that occurs at the base of the big toe.
  • Rheumatoid Arthritis- swelled joints in the foot can cause metatarsalgia.
  • Morton's Neuroma- is entrapment & irritation of the inter digital nerve which passes between 3rd & 4th metatarsal bones.
  • Diabetes- the small nerves in the foot can become irritated, thus causing metatarsalgia. 
Common symptoms of metatarsalgia:
  • A burning pain
  • Sharp aching
  • Pain in the ball of the foot.
  • Pain increases when walk bare feet.
  • Pain that worsens when standing or moving around but decreases at rest.
Treatment:
  • Apply ice pack to the area approximately 15-20 minutes 2-3 times a day. Wrap ice in something to protect your skin from direct contact to ice.
  • Avoid high impact sports & exercise that puts pressure on the feet. Try something lighter on the feet i.e. Cycling or swimming.
  • Try to keep pressure off the feet, when resting try putting your feet up.
  • Be sure to exercise your ankle & keep stretching the Achilles tendon.
  • Use fitted insoles (Orthotics) as these will reallocate pressure or reduce pressure, improve foot function & guard the ball your foot.
  • Change to better fitting flat headed shoes.

HIGH ARCH

High Arch

High Arch

Pes cavus foot type is the complete opposite pattern to that of flat feet. People with pes cavus foot type have well defined & deep arch. The only areas of contact with the ground are the heel & forefoot.
Arch Patterns
Consequently these people have a tendency of bearing more weight on forefoot. As mentioned earlier the arch pattern influences gait pattern. As a result these people load on the outer border of foot while walking as there is no contact on the inner side of the foot with the ground, which is termed as "SUPINATOR". 
people with high arch are more susceptible to develop knee problems owing to hard heel strike which causes excessive pressure to act 
on the heel & knee.
Deviations












Most common problem faced by people with high arch are:

INGROWING TOE NAIL


INGROWING TOENAIL



An in grown toe nail is curved on either of the edges/borders and pierces the surrounding skin. The in-growing nail usually irritates the skin due to continuous pressure and often results in pain, redness, swelling and inflammation over the surrounding healthy tissue. If left unattended it has a potential of developing infection.

Causes:
 Skin and Nail Conditions: Few percentage of population has a natural tendency to attain skin infection which recurs even after treatment. Overtime these infections start affecting the nail which starts to grow abnormally.
     


Improper type and size of footwear:
The most common notion we follow while buying any footwear
in comfort, a factor which is highly subjective and hence land
up buying incorrect type of footwear. There are two impor-
tant factors which should be considered while buying foot-
wear—Foot length and Width. Mostly people tend to
buy shoes which are too short, tapering from front or ill fitting.
     
Faulty Foot Alignment: Faulty foot alignment like flat feet, week transverse arch & high arch can lead to excessive fore foot pressure which can results in ingrowing toenail.

Trauma: Occasionally in-growing results due to any injury/trauma to the nail such as an object falling over the toe, stubbing of toe or being involved in repeated activity which puts an impact on the toes such as running or kicking.
        
     


Inappropriate trimming: The most common cause of in-growing is incorrect trimming of toe nail. Some people tend to cut their nail too shirt so that when it starts to grow it begins to pierce the surrounding skin.



           Treatment:

  •  In case of infection, the most essential step is to control the ongoing infection. Once the infection is under control then further debridement of the in-growing can be carried out. It requires a team effort of a Dermatologist and Podiatrist.
  • Using appropriately sized shoes is an important long term treatment plan. It is advisable to use correct offloading orthotic device to avoid recurrence of the situation.
  • Proper and timely trimming of toe nail is another important management aspect. The correct method is to trim the nail in a straight and clean cut. Avoid curving on the edges as it invariably results in in-growing.

Morton's Neuroma


Neuroma is a term used to describe the enlargement or thickening of the tissue that surrounds the nerve. Morton's neuroma is entrapment & irritation of the interdigital nerve which passes between 3rd & 4th metatarsal bones. Hence it is also termed as intermetatarsal neuroma.

SIGNS & SYMPTOMS:
  • Pain on weight bearing - a shooting pain affecting the contiguous halves of two toes. Sometimes there may be a dull pain rather than a sharp one. 
  • Burning
  • Numbness
  • Paresthesia - tingling, pricking, or numbness with no apparent long-term physical effect. Commonly known as pins-and-needles.
  • A sensation that something is inside the ball of the foot
Causes:
  • High-heeled shoes - especially those over 2 inches (5cm), or a pointed or tight toe box which
    squash the toes together. This is probably why the condition is much more common in females than in males.
  • High-arched foot.
  • Flat feet.
  • A bunion.
  • Hammer toe.
  • Some high-impact sporting activities.
  • Injuries - an injury or other type of trauma to the foot may lead to a neuroma.


Treatment:
  • Resting the foot.
  • Using an ice pack on the affected area.
  • Changing footwear- wearing shoe according to foot size like wide shoes & or no heeled shoes.
  • Orthotic correction (Arch support)-  The arch support of the foot, removing pressure from the nerve. The doctor may recommend a custom-made, individually designed shoe-insert, molded to fit the contours of the patient's foot. 
  • Modifying activities - avoiding activities which put repetitive pressure on the neuroma until the condition improves.
  • Body weight management - if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with foot problems, such as flat feet, who successfully lose weight experience considerable improvement of symptoms.




Thursday, 4 June 2015

ARE YOU BEING GYM SMART??? CHECK FOR YOURSELF…..

                       
 

People of 21st century seem to have been swept away by the maddening wave of being Healthy and Fit. It is no longer impossible to don the physique of your favorite actor or actress. This is the prime reason for us noticing a vast number of people with their gym gears on and hitting the gym-to be healthier and fitter.

But is it really so? Are all these people fit in the true sense? More often than not these fitness freaks are seen complaining of muscle cramps, shoulder pain, neck pain, low back strain, muscle overload and hoards of other injuries. All of these problems not only become a barrier for you in achieving your target but also de-motivate you. Exercise is a science. In each exercise you have to be aware of your posture, movement, strength, speed and repetition. Improper application of any of these variables can be harmful and instead of making you fit, it will deteriorate your physical condition. Epidemiological studies conclude a rapid increase in the number of injuries caused due to improper fitness training in the recent years. This directs us to the purpose of this article-To orient fitness seekers on being completely fit and how to prevent them from being a victim of injuries related to fitness training.

PREREQUISITES

Before you get all zest up and impatient to hit the gym you should get to know the prerequisites of starting with the actual workout. 
The degree of movement available at all joints is majorly dependant on the strength & flexibility of muscles, stability of ligaments and integrity of joints. So before you start, knowing these factors will aid your programme and help you work on any factor which is lacking short.

Shoes
Wearing appropriate shoes plays a pivotal role in imparting stability. In most of the
weight bearing and cardio exercises most of the body’s stability comes from the feet and core. Hence if the shoe provides with a good grip and is inflexible you need not worry about being unstable and can direct your attention to the target area. 70% people wear wrong size & type shoes. One essential point to keep in mind is that if you experience any pain or discomfort either around the feet, ankle, knees it is quite possible that your incorrect pattern of shoes are the culprit.
   
  Physiological Well Being
Scientifically speaking there are no two people with the same physiology. Various factors have a play in making up our physiology such as gender, age, nutritional status, metabolism, hormone level and most importantly any diagnosed medical condition. If you plan your workout with these factors in perspective it will give way to germane results.

  
IT’S ALL ABOUT THE BASICS-COMMON GROUND FACTORS THAT WE OVERLOOK.

1. Inadequate Warm Up and Cool Down: It's always a smart idea to incorporate adequate warm up & cool down. Warm up is the preparatory phase for exercising. It functions by increasing the blood flow subsequently increasing the oxygen supply which in turn increases speed & force of muscle contraction. All these factors prepare the various body systems for the upcoming activity in a safe & gradual manner. IN opposition, cooling down has the effect of returning the blood back to the heart rather than allowing it to pool in the exercised muscles which helps in returning the heart rate back to normal. In addition it helps in reducing lactic acid levels & ensures that the vital organs continue to receive a sufficient supply of blood & oxygen at the end.

2. Being over zealous: Being enthusiastic to exercise & to reach your goal is a positive attitude. But don't let it get the best of you as with all the adrenaline pumping through your vein you tend to ignore your limitations. This is possible by letting your system adapt to the challenge progressively & not forcing the change upon a system which is not prepared to handle it. So take your eyes off the heavier weights or kilometers indicator on the cardio machine & give time. Judge for yourself- Are you there yet?

3. Lifting too much or too little: Either of these extreme measures aren't going to fetch you desired results. Keep aside the condescending attitude & lower down the weights if you need to. Instead it would be wiser to increase the number of repetitions or set with the same amount of weights. This will prevent your muscle fibers from undue overload. On the contrary if you are lifting light weights, you might as well put them aside as they will prove to be nothing more than a wasted. So the ney is to strike the right balance between doing what you are capable of & loading the muscles with right amount of weight.

4. Improper management of rest interval: While it is important to allot a stipulated amount of time for various exercises it is also important to know when to stop & take adequate rest in between. Instead of taking longer or shorter breaks change the tempo of your exercise for better results. For instance, while doing Biceps curls lower the weight slowly (enhanced eccentric load) and lift it with a strong and controlled contraction (concentric load). This is very motivating as you can see your muscle working and will help you pump your guns without unprecedented damage.

5. Improper management of exercise and diet: It is popularly known that if you are working your calories off to get those cuts
& abs without following a designed diet plan, you are wasting your time. Diet & exercise are two sides of the same coin. So let your exercise regimen to be aided by your diet plan. Apart from this remember to keep yourself adequately hydrated at all times. Avoid working out on an empty stomach or heavy meals.
          


MOST POPULAR GYM EXERCISES AND MOST REGULAR BLUNDERS
     
     1. LATERAL PULL DOWNS
As we all know this exercise is designed to work the muscles situated over the lateral side of your back (Latissimus Dorsii).
The Blunder Approach: This movement requires excellent shoulder joint mobility, maintaining a straight spine and activation of core for stability.  Most of the people pull the barbell down the back of their head and keep their backs either too hunched or hyperextend from the low back while pulling the bar down. Consequently the load is not directed to the Lats and results in trick movements leading in Rotator cuff injury, Trapezius spasm, lower back & neck strain and Shoulder impingement syndrome.

The Correct Approach: If done correctly this exercise can prove to be a great way to

develop your back muscles. Place your hands slightly beyond shoulder width distance and instead of pulling the bar behind your head pull it in front of your head. Make sure you lean back a little from your back while maintaining an erect spine and using your core muscles for stabilizing your body. Concentrate on pinching your shoulder blades together and take care to avoid pulling the bar beyond the level of your collar bone. Maintain the contraction while the bar moves up and fight the momentum while leaving the bar. 

2. SQUATS
Squats are the pinnacle of lower body strength. In addition if done correctly squats also help to workout core muscles, arm muscles, low back muscles and with more repetition act as cardio exercise and aid in weight loss. But it is easily possible to goof up while doing squats.

Stand straight with your feet shoulder width apart with the knee pointing straight ahead. Bend your knee, keep the spine neutral and mimic the action of trying to sit in a chair. Take precaution to not let your knee cross over your toes and try making an angle of 90 degrees with your knee. Make sure you keep your chest up and don’t hunch your upper back. If you are lifting weights then roll your shoulders back before lifting. Practice this movement facing the mirror in the front and side view.

 3. DEAD LIFTS
This is the most effective manner of getting a strong and stable lower back along with the added bonus of working the core. Any form of exercises which requires core activation is great as all the movements of arms and legs can be carried out effectively if the core is active and working.
Set the bar over your mid-foot with the feet at shoulder width distance and pass your hand over the bar maintaining them at the same distance. Do not let your back hunch or hyper extend as either of the positions exert great stress on the disc and its structures when your lift weights. Drag the bar up just grazing your shin and squeeze your gluteal and thigh muscles while lifting up. When lowering the weight down the quintessential point is to bend from your hips rather than from your knee. If you bend from the knee the bar might hit or roll over your knees and land down over your forefoot instead of the midfoot. This will alter the mechanics and make lifting the weight up more strenuous for your back. 


4.     BICEPS CURLS
Mention of this exercise may have you raising your eyebrows and has you wondering who would go wrong while doing this simple exercise but a considerable number of people fail to execute this exercise correctly.
A major misconception that people have is that it’s good to lift heavier weights. This
transfers all the weight over to your chest and other shoulder muscles which are definitely not the target muscles. Instead pay attention to the form, direction and precision of your movement. Lift manageable weights with more reps; it will pay you greater dividends. Improper execution of this exercise can lead to Biceps tendinitis.
Adopt a posture with your spine straight with a slight bend in your knee. Roll your shoulders back and lift by using your upper arms strength in a straight line and lower down with a slow and steady pace.


5. CRUNCHES
Crunches are the most incorrectly and over performed exercises. It’s a trend to complete a 100 or 150 crunch challenge but what you forget in the process is that it’s the quality of exercise that matters and not always the quantity.
Begin with lying on the ground/mat with a neutral spine and relaxed neck. Cross your hands over the back of your head in order to support your neck slightly with your hands. Make sure you don’t hunch your upper back or bring your elbows close to each other. Lift up using your abdominals by imagining someone is punching you in the stomach. Slowly lower down your back. The commonest mistake people make is to strain their neck while lifting up. This is because they fail to connect with the muscle they have to work and instead of contracting their abdominals they lift up with their neck.


Apart from this there are numerous exercises where you can go wrong. Hence we conclude that if you carry out exercises with a scientific approach you can keep uninvited injuries at bay and focus on gain not pain. Another important fact to remember is that if you develop any injury, you should immediately visit an expert in exercise science - A Physiotherapist.


We have become tech smart, book smart & street smart, it’s time to become gym smart…

Wednesday, 15 April 2015

HEEL PAIN


If you are waking up with acute pain at your heel, then mostly you are suffering from plantar fasciitis. This is one of the most common foot problems. Many times pain is very severe & disabling.

What is plantar fasciitis?


Plantar Fasciitis (plantar fasciosis) is inflammation of the plantar fascia. The planar fascia is a strong bowstring like ligament that runs from the calcaneus (Heel Bone) to the tip of the foot. When the plantar fascia is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long period of rest. If inflammation persists for longer duration it can lead to calcaneal spur.


Causes: Plantar Fasciitis is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel. Still following factors play important role in increasing severity of plantar fasciitis.


  1. Arch Type: Flat feet, High arch or in between.
  2. Footwear: Wearing too flat or too high heel footwear.
  3. Lifestyle: Continuous standing, walking  or running.
  4. Body weight: Overweight results in more stress on platar fascia.
  5. Osteoporosis: Weak bones will aggravate pain.




Symptoms
  • Pain at the heel when standing.
  • Throbbing or piercing type of pain.
  • Pain in the first few steps in the morning after a period of inactivity.
  • Pain while walking barefoot, on toes or while climbing stairs.
  • Tenderness along the inferior surface of the heel


Causes: Plantar Fasciitis is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel. Still following factors play important role in increasing severity of plantar fasciitis.

Treatment:
  • Rest: Temporary rest is important to allow plantar fascia to heal
  • Cold pack: Helps to reduce inflammation. Recommended 3-4 times a day, 20 minutes each time (Not recommended for diabetic patient)
  • Taping
  • Right orthotics: To support your plantar fascia & correct your faulty alignment
  • Supportive shoes: Orthotics with proper supportive shoe gives long term relief
  • Exercises: Generally higher arched feet require a strict stretching program and flat feet require a gradual strengthening program and more support.  One should not do stretching in acute pain.
What to avoid:


  1. Barefeet walking on hard surfaces 
  2. Wearing too flat or too high heeled footwear
  3. Heel Cushions: Silicone or foam heel cushions commonly available from pharmacies do nothing to actually cure this condition and at best provide temporary comfort.

Success Story- Click this link 

For more details visit- www.vcarerehab.in

LET'S TAKE UP THE CHALLENGE OF KIDS FITNESS...


More Attentive for Gadgets

Kids of the modern era face several health issues owing to the growing interest in technology and its smart gadgets. Most of the kids are seen with their heads buried behind computers, smart phones or playing digital games.


This has led to a decline in the overall physical activity of kids. It’s general knowledge that there is direct proportion between reduced physical activity and increase in weight, which has led to increase incidence of childhood obesity. 

In addition, reduced physical activity may lead to decreased muscle tone & strength, ligament laxity, poor reflexes, core muscle weakness, improper posture, poor balance, altered gait mechanics and reduced activity endurance. Apart from these physical changes they develop several behavioral issues such as aggressiveness, hostility, reduced social and self awareness, and increase in frustration.


It is essential to start interventions at an early stage when the child is still developing. Once this development is complete the changes that have already manifested cannot be reverted to normal. Many parents popularly believe that if they indulge their kids in sports, swimming, karate etc it will help in keeping their child active. But the child needs to be physically fit before participating in such challenging activities. The ideal way to tackle this problem is through physical exercise. But it is practically not possible to make kids follow an exercise programme regularly, as it is dull and boring for them. Therefore the more practical approach is to engage the child in a structured, tailor made, fun filled and interactive activity based programme which will focus on dealing with their specific problems. This will not only improve their physical fitness but will also enhance their performance in the sport or activity of their choice and help them to excel. Moreover it will help in reducing the risk of serious injuries in future.
Assessment

The first step towards this intervention is a detailed and exclusive assessment. The assessment should 
  • Assessment of Muscle tone.
  • Assessment of Muscular imbalance.
  • Assessment of Posture.
  •  Assessment of Balance & Co-ordination.
  •  Gait Analysis.
  •  Foot screening (foot alignment).





The data thus obtained will help in determining the target areas and aid in the treatment approach. As mentioned earlier the treatment will be tailor made and focus on improving the problems identified and also improve endurance and agility.


                         This is the time to understand that our modern lifestyle is taking a huge toll on physical health of our young generation. Structured activity based programme can prevent lots of future musculoskeletal complications. It is imperative that we provide our kids with a strong foundation so that they can successfully reach new heights without the fear of falling….
Play Of Joy
                                                            -Dr. Sarika Jambhulkar & Dr. Vilas Jambhulkar


                                                                       http://vcarerehab.in/