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Treatment is possible with ice, cold compression therapy, wearing heel pads to reduce the strain on the tendon, and an exercise routine designed to strengthen the tendon (see eccentric strengthening, above). Some people have reported vast improvement after applying light to medium compression around ankles and lower calf by wearing elastic bandages throughout the day. Using these elastic bandages while sleeping can reduce morning stiffness but care must be taken to apply very light compression during sleep. Compression can inhibit healing by hindering circulation. Seeing a professional for treatment as soon as possible is important, because this injury can lead to an Achilles tendon rupture with continued overuse. Other treatments may include non-steroidal anti-inflammatory drugs, such as ibuprofen, ultrasound therapy, manual therapy techniques, a rehabilitation program, and in rare cases, application of a plaster cast. Steroid injection is sometimes used, but must be done after very careful, expert consideration because it can increase the risk of tendon rupture. There has recently been some interest in the use of autologous blood injections; however the results have not been highly encouraging and there is little evidence for their use.
More specialised therapies include prolotherapy (sclerosant injection into the neovascularity) and extracorporeal shockwave therapy may have some additional benefit. However, the evidence is limited.
Typical treatments include rest, ice, strengthening and gradually returning to activity. Rest and ice work to allow the tibia to recover from sudden, high levels of stress and reduce inflammation and pain levels. It is important to significantly reduce any pain or swelling before returning to activity. Strengthening exercises should be performed after pain has subsided, on lower leg and hip muscles. Individuals should gradually return to activity, beginning with a short and low intensity level. Over multiple weeks, they can slowly work up to normal activity level. It is important to decrease activity level if any pain returns. Individuals should consider running on other surfaces besides asphalt, such as grass, to decrease the amount of force the lower leg must absorb. Orthoses and insoles help to offset biomechanical irregularities, like pronation, and help to support the arch of the foot. Other conservative interventions include footwear refitting, orthotics, manual therapy, balance training (e.g. using a balance board), cortisone injections, and calcium and vitamin D supplementation.
Less common forms of treatment for more severe cases of shin splints include extracorporeal shockwave therapy (ESWT) and surgery. Surgery is only performed in extreme cases where more conservative options have been tried for at least a year. However, surgery does not guarantee 100% recovery.
Ice is often used to reduce swelling in cycles of 15–20 minutes on and 20–30 minutes off. Icing an ankle too long can cause cold injuries, indicated if the area turns white.
In uncomplicated lateral ankle sprains, swelling of the soft tissue can be prevented with compression around both malleoli, elevation of the injured ankle higher than the heart, and pain-free exercises.
An orthopedic walking boot is often used for the treatment of a sprained ankle injury. Braces and crutches are also used to help alleviate the pain so the injured ankle can heal as quickly and painlessly as possible.
Although found to be less effective than casts, compression bandages are used to provide support and compression for sprained ankles. Wrapping is started at the ball of the foot and slowly continued up to the base of the calf muscle, which pushes the swelling up toward the center of the body so that it does not gather in the foot.
Deteriorating changes start to appear with age, but attempting to slow down these changes is key in the prevention of Achilles tendinitis. Performing consistent physical activity will improve the elasticity and strength of the tendon, which will assist in resisting the forces that are applied.
It is essential to stretch and warm-up before beginning an exercise session in order to prepare and protect the tendon for work. Warm-ups enhance the tendon's capability of being stretched, further aiding in protection from injury. Prevention of recurrence includes following appropriate exercise habits and wearing low-heeled shoes. In the case of incorrect foot alignment, orthotics can be used as a preventative way to properly position the feet. Footwear that is specialized to provide shock-absorption can be utilized to defend the longevity of the tendon. Achilles tendon injuries can be the result of exceeding the tendon's capabilities for loading, therefore it is important to gradually adapt to exercise if someone is inexperienced, sedentary, or is an athlete who is not progressing at a steady rate.
Preventive exercises are aimed at strengthening the gastrocnemius and soleus muscles, typically by eccentric strengthening exercises. This eccentric training method is especially important for individuals with chronic Achilles tendinosis which is classified as the degeneration of collagen fibers. Eccentric exercises improve the tensile strength of the tendon and lengthen the muscle-tendon junction, decreasing the amount of strain experienced with ankle joint movements. These involve repetitions of slowly raising and lowering the body while standing on the affected leg, using the opposite arm to assist balance and support if necessary, and starting with the heel in a hyperextended position. (Hyperextension is typically achieved by balancing the forefoot on the edge of a step, a thick book, or a barbell weight. so that the point of the heel is a couple of inches below the forefoot.)
Early stages may be treated conservatively using the R.I.C.E methods.
1. Rest
2. Ice
3. Compression
4. Elevation
Exercises involving eccentric muscle contractions of the quadriceps on a decline board are strongly supported by extant literature. A physical therapist may also recommend specific exercises and stretches to strengthen the muscles and tendons, eg. cycling or swimming. Use of a strap for jumper's knee and suspension inlays for shoes may also reduce the problems.
Should this fail, autologous blood injection, or platelet-rich plasma injection may be performed and is typically successful though not as successful as high volume saline injection (Crisp "et al."). Uncommonly it may require surgery to remove myxoid degeneration in the tendon. This is reserved for patients with debilitating pain for 6–12 months despite conservative measures. Novel treatment modalities targeting the abnormal blood vessel growth which occurs in the condition are currently being investigated.
New research shows that knee operations in most cases have no better effects than exercise programs, and that most knee operations thus can be avoided.
Initial treatment commonly consists of rest, icing, compression and elevation (which is often referred to by the mnemonic RICE or sometimes PRICE with P being "protection"). These are recommended by physicians for the treatment of soft tissue damage, and sprained ankles are one of the most common soft tissue injuries. RICE helps limit the amount of swelling to the area, and "facilitates venous and lymphatic drainage".
Treatment of ankle fractures is dictated by the stability of the ankle joint. Certain fractures patterns are deemed stable, and may be treated similar to ankle sprains. All other types require surgery, most often an open reduction and internal fixation (ORIF), which is usually performed with permanently implanted metal hardware that holds the bones in place while the natural healing process occurs. A cast or splint will be required to immobilize the ankle following surgery.
In children recovery may be faster with an ankle brace rather than a full cast in those with otherwise stable fractures.
Treatments typically include rest, manipulation, strengthening of tibialis anterior, tibialis posterior, peroneus and short toe flexors, casting with a walker boot, corticosteroid and anesthetic injections, hot wax baths, wrapping, compression hose, and orthotics. Medications may include various anti-inflammatories such as Anaprox, or other medications such as Ultracet, Neurontin and Lyrica. Lidocaine patches are also a treatment that helps some patients.
This method should be used within the first 48–72 hours after the injury in order to speed up the recovery process.
Heat: Applying heat to the injured area can cause blood flow and swelling to increase.
Alcohol: Alcohol can inhibit your ability to feel if your injury is becoming more aggravated, as well as increase blood flow and swelling.
Re-injury: Avoid any activities that could aggravate the injury and cause further damage.
Massage: Massaging an injured area can promote blood flow and swelling, and ultimately do more damage if done too early.
Aside from surgery, there are a few options for handling an accessory navicular bone that has become symptomatic. This includes immobilization, icing, medicating, physical therapy, and orthotic devices. Immobilizing involves placing the foot and ankle in a cast or removable walking boot. This alleviates stressors on the foot and can decrease inflammation. Icing will help reduce swelling and inflammation. Medication involves usage of nonsteroidal anti-inflammatory drugs, or steroids (taken orally or injected) to decrease inflammation. Physical therapy can be prescribed in order to strengthen the muscles and help decrease inflammation. Physical therapy can also help prevent the symptoms from returning. Orthotic devices (arch support devices that fit in a shoe) can help prevent future symptoms. Occasionally, the orthotic device will dig into the edge of the accessory navicular and cause discomfort. For this reason, the orthotic devices made for the patient should be carefully constructed.
There are multiple ways that tarsal tunnel can be treated and the pain can be reduced. The initial treatment, whether it be conservative or surgical, depends on the severity of the tarsal tunnel and how much pain the patient is in. There was a study done that treated patients diagnosed with tarsal tunnel syndrome with a conservative approach. Meaning that the program these patients were participated in consisted of physiotherapy exercises and orthopedic shoe inserts in addition to that program. There were fourteen patients that had supplementary tibial nerve mobilization exercises. They were instructed to sit on the edge of a table in a slumped position, have their ankle taken into dorsiflexion and ankle eversion then the knee was extended and flexed to obtain the optimal tibial nerve mobilization. Patients in both groups showed positive progress from both programs. The medial calcaneal, medial plantar and lateral plantar nerve areas all had a reduction in pain after successful nonoperative or conservative treatment. There is also the option of localized steroid or cortisone injection that may reduce the inflammation in the area, therefore relieving pain. Or just a simple reduction in the patient’s weight to reduce the pressure in the area.
The treatment of Pilon fractures depends on the extent of the injury. This includes the involvement of other bones such as the fibula and the talus, involvement of soft tissue, and the fracture pattern. Treatment strategies and fixation methods used include internal and external fixation, as well as staged approaches, with the aim of reducing the fracture, reconstructing the involved bones and restoration of articular surface congruence, with minimal insult to soft tissues. Appropriate wound management is important to reduce the high rate of infectious complications and secondary wound healing problems associated with open Pilon fractures. Vacuum-assisted wound closure therapy and using a "staged protocol" (awaiting soft-tissue recovery before extensive reconstructive efforts) may play a positive role.
The RICE method is an effective procedure used in the initial treatment of a soft tissue injury.
Rest: It is suggested that you take a break from the activity that caused the injury in order to give the injury time to heal.
Ice: The injury should be iced on and off in 20 minute intervals, avoiding direct contact of the ice with the skin.
Compression: Bandaging the injury will compress it, and prevent any further bleeding or swelling from occurring.
Elevation: Elevating the injury above the heart while resting will aid in the reduction of swelling.
Nonsurgical treatment of tibia shaft fractures is now limited to closed, stable, isolated, minimally displaced fractures caused by a low-energy mechanism of injury. This treatment consists of application of a long-leg cast.
Surgical treatment is only initiated if there is severe pain, as the available operations can be difficult. Otherwise, high arches may be handled with care and proper treatment.
Suggested conservative management of patients with painful pes cavus typically involves strategies to reduce and redistribute plantar pressure loading with the use of foot orthoses and specialised cushioned footwear. Other non-surgical rehabilitation approaches include stretching and strengthening of tight and weak muscles, debridement of plantar callosities, osseous mobilization, massage, chiropractic manipulation of the foot and ankle, and strategies to improve balance. There are also numerous surgical approaches described in the literature that are aimed at correcting the deformity and rebalancing the foot. Surgical procedures fall into three main groups:
1. soft-tissue procedures (e.g. plantar fascia release, Achilles tendon lengthening, tendon transfer);
2. osteotomy (e.g. metatarsal, midfoot or calcaneal);
3. bone-stabilising procedures (e.g. triple arthrodesis).
Non-surgical treatment is for extra-articular fractures and Sanders Type I intra-articular fractures, provided that the calcaneal weight-bearing surface and foot function are not compromised. Physicians may choose to perform closed reduction with or without fixation (casting), or fixation alone (without reduction), depending on the individual case. Recommendations include no weight-bearing for a few weeks followed by range-of-motion exercises and progressive weight bearing for a period of 2–3 months.
Displaced intra-articular fractures require surgical intervention within 3 weeks of fracture, before bone consolidation has occurred. Conservative surgery consists of closed reduction with percutaneous fixation. This technique is associated with less wound complications, better soft tissue healing (because of less soft tissue manipulati) and decreased intraoperative time. However, this procedure has increased risk of inadequate calcaneal bone fixation, compared to open procedures. Currently, open reduction with internal fixation (ORIF) is usually the preferred surgical approach when dealing with displaced intra-articular fractures. Newer, more innovative surgical techniques and equipment have decreased the incidence of intra- and post-operative complications.
Surgical treatment is typically indicated for high-energy trauma fractures. Intramedullary nailing is a common technique, but external fixation may have equivalent outcomes.
The first phase of the rehabilitation after surgery includes keeping the foot elevated and iced for the first 2 days after the operation. After those 2 days, using crutches or a wheelchair in which there is no weight applied to the affected foot is recommended to getting around. If no operation was performed, the foot should be submitted to frequent range of motion exercises. The second phase occurs 6 weeks after and consists of keeping the foot elevated and iced while resting and performing exercises in which only slight weight is applied to the affected area for the next two weeks, others recommend six weeks of this phase. In this phase, range of motion exercises should be implemented if surgery was needed for the fracture. The third and final phase of rehabilitation of calcaneal fractures is to allow the full body weight to be used and use crutches or a cane if needed, between 13 weeks to a year the patient is allowed to resume normal activities.
Risk factors for developing shin splints include:
- Excessive pronation at subtalar joint
- Excessively tight calf muscles (which can cause excessive pronation)
- Engaging the medial shin muscle in excessive amounts of eccentric muscle activity
- Undertaking high-impact exercises on hard, noncompliant surfaces (ex: running on asphalt or concrete)
- Smoking and low fitness level
While medial tibial stress syndrome is the most common form of shin splints, compartment syndrome and stress fractures are also common forms of shin splints. Females are 1.5 to 3.5 times more likely to progress to stress fractures from shin splints. This is due in part to females having a higher incidence of diminished bone density and osteoporosis.
For idiopathic toe walking in young children, doctors may prefer to watch and wait: the child may "outgrow" the condition. If there is a reduction in the child's range of motion, there are several options.
- Wearing a brace or splint either during the day, night or both which limits the ability of the child to walk on their toes and stretches the Achilles tendon. One type of brace used is an AFO (ankle-foot orthosis).
- Serial casting where the foot is cast with the tendon stretched, and the cast is changed weekly with progressive stretching. However, these casts may not be changed weekly and instead every 2-3 weeks.
- Botox therapy is used to paralyze the calf muscles to reduce the opposition of the muscles to stretching the Achilles tendon, usually together with serial casting or splinting.
- If conservative measures fail to correct the toe walking after about 12–24 months, surgical lengthening of the tendon is an option. The surgery is typically done under full anesthesia but if there are no issues, the child is released the same day. After the surgery, a below-the-knee walking cast is worn for six weeks and then an AFO is worn to protect the tendon for several months.
For toe walking which results from more serious neuro-muscular conditions, additional specialists may need to be consulted.
Surgical repair using open reduction and internal fixation is generally required, and because there is no lateral restraint of the foot, the ankle cannot bear any weight while the bone knits. This typically takes six weeks in an otherwise healthy person, but can take as much as twelve weeks. Non-surgical treatment may sometimes be considered in cases where the patient has significant health problems or where the risk of surgery may be too great.
Once the process is recognized, it should be treated via the VIPs — vascular management, infection management and prevention, and pressure relief. Aggressively pursuing these three strategies will progress the healing trajectory of the wound. Pressure relief (off-loading) and immobilization with total contact casting (TCC) are critical to helping ward off further joint destruction.
TCC involves encasing the patient’s complete foot, including toes, and the lower leg in a specialist cast that redistributes weight and pressure in the lower leg and foot during everyday movements. This redistributes pressure from the foot into the leg, which is more able to bear weight, to protect the wound, letting it regenerate tissue and heal. TCC also keeps the ankle from rotating during walking, which prevents shearing and twisting forces that can further damage the wound. TCC aids maintenance of quality of life by helping patients to remain mobile.
There are two scenarios in which the use of TCC is appropriate for managing neuropathic arthropathy (Charcot foot), according to the American Orthopaedic Foot and Ankle Society. First, during the initial treatment, when the breakdown is occurring, and the foot is exhibiting edema and erythema; the patient should not bear weight on the foot, and TCC can be used to control and support the foot. Second, when the foot has become deformed and ulceration has occurred; TCC can be used to stabilize and support the foot, and to help move the wound toward healing.
Walking braces controlled by pneumatics are also used. Surgical correction of a joint is rarely successful in the long-term in these patients. However, off-loading alone does not translate to optimal outcomes without appropriate management of vascular disease and/or infection. Duration and aggressiveness of offloading (non-weight-bearing vs. weight-bearing, non-removable vs. removable device) should be guided by clinical assessment of healing of neuropathic arthropathy based on edema, erythema, and skin temperature changes. It can take 6–9 months for the edema and erythema of the affected joint to recede.
Surgical treatment will often be required, usually an Open Reduction Internal Fixation. This involves the surgical reduction, or realignment, of the fracture followed by the implementation of surgical implants to aid in the healing of the fracture.
According to some studies, patients with bimalleolar fractures had significantly worse function in the ankle one year after surgical treatment. After recovering fully from their fractures, the majority of patients experience little to mild pain and have few restrictions in functionality.
In some cases, foot diseases and painful conditions can be treated. Synovium hydrates the cartilage in the heal and can bring pain relief quickly. Synovium gel looks as well as strongly smells like urine, straying some consumers away. However this only occurs after expiration. Blood thinners can also work however are deemed as bad relievers by medical practitioners due to the fact that they can contribute to headaches and in some cases increase foot pain afterwards.
The underlying disorder must be treated. For example, if a spinal disc herniation in the low back is impinging on the nerve that goes to the leg and causing symptoms of foot drop, then the herniated disc should be treated. If the foot drop is the result of a peripheral nerve injury, a window for recovery of 18 months to 2 years is often advised. If it is apparent that no recovery of nerve function takes place, surgical intervention to repair or graft the nerve can be considered, although results from this type of intervention are mixed.
Non-surgical treatments for spinal stenosis include a suitable exercise program developed by a physical therapist, activity modification (avoiding activities that cause advanced symptoms of spinal stenosis), epidural injections, and anti-inflammatory medications like ibuprofen or aspirin. If necessary, a decompression surgery that is minimally destructive of normal structures may be used to treat spinal stenosis.
Non-surgical treatments for this condition are very similar to the non-surgical methods described above for spinal stenosis. Spinal fusion surgery may be required to treat this condition, with many patients improving their function and experiencing less pain.
Nearly half of all vertebral fractures occur without any significant back pain. If pain medication, progressive activity, or a brace or support does not help with the fracture, two minimally invasive procedures - vertebroplasty or kyphoplasty - may be options.
Ankles can be stabilized by lightweight orthoses, available in molded plastics as well as softer materials that use elastic properties to prevent foot drop. Additionally, shoes can be fitted with traditional spring-loaded braces to prevent foot drop while walking. Regular exercise is usually prescribed.
Functional electrical stimulation (FES) is a technique that uses electrical currents to activate nerves innervating extremities affected by paralysis resulting from spinal cord injury (SCI), head injury, stroke and other neurological disorders. FES is primarily used to restore function in people with disabilities. It is sometimes referred to as Neuromuscular electrical stimulation (NMES)
The latest treatments include stimulation of the peroneal nerve, which lifts the foot when you step. Many stroke and multiple sclerosis patients with foot drop have had success with it. Often, individuals with foot drop prefer to use a compensatory technique like steppage gait or hip hiking as opposed to a brace or splint.
Treatment for some can be as easy as an underside "L" shaped foot-up ankle support (ankle-foot orthoses). Another method uses a cuff placed around the patient's ankle, and a topside spring and hook installed under the shoelaces. The hook connects to the ankle cuff and lifts the shoe up when the patient walks.