The disorders that develop in feet, which are probably the most ill-treated organs in human body, tend to progress over time. In treatment of these disorders, which arise from causes such as physical inactivity, wrong choice of shoes and genetic factors, the last resort is surgery.
Foot disorders are conditions that develop in the parts of the body which bear the whole weight of a person, and can reduce the life quality to a great extent. Developing due to a wide range of reasons such as sports injuries, wrong choice of shoes and lack of exercise, foot and ankle disorders require various treatments. Stating that the procedures applied in the past do not have much of a place in current treatment protocols and that patient-friendly methods are now more prominent, Associate Professor Barış Kocaoğlu, an orthopedist/traumatologist at Acıbadem Kadıköy Hospital, has shared with us information on the most common foot and ankle disorders and the treatment methods for these.
ANKLE LIGAMENT INJURIES
Most of the trauma cases that turn up at emergency departments consist of ankle ligament injury cases. These injuries usually occur during sports activities in young people and due to accidents such as falling or twisting an ankle.
Symptoms: The symptoms are generally pain and swelling in feet.
Treatment methods: Following a physical examination, the patient undergoes radiography (x-ray) in case of tenderness in the bones. Unless there is a fracture, the patient is required not to stand or walk on the injured foot for only a few days. The foot in question is also braced with plastic or bandaged. It is also required for the foot to be kept in a position raised higher than the level of the heart and an ice pack to be applied for a period of twenty minutes every two or three hours in order to reduce edema. Nonsteroidal painkillers and gels are also used for treatment. After pain management, the patient becomes able to stand with the help of crutches. The complaints arising from symptoms are eliminated in one or two weeks. In the event that the ankle pain continues despite all treatments, the patient undergoes MRI due to the possibility of damage to the cartilage. In case there is any damage present, the patient is monitored closely or an arthroscopic procedure is performed. If the patient experiences recurrent ankle ligament injuries or pain due to twisting or if the specialist feels a looseness during physical examination, ligament reconstruction surgery comes to the fore. This procedure, which is performed through closed surgery methods, involves replacement of the damaged ligaments with synthetic ligaments. There is no need for any plaster casts after the operation and the patient becomes able to stand on his foot. After use of a walking boot and management of the pain, the patient becomes able to walk in one or two weeks.
ACHILLES TENDON DISORDERS
This tendon has a slightly different structure than those of other tendons in the body. Since it lacks the synovial sheath that supplies blood, it is possible for thinning or degeneration to occur in the Achilles tendon after age 40 or 50. These are common in people who are overweight, as well as those who perform certain activities repeatedly and those who get injured frequently.
Symptoms: These disorders most commonly develop around the tendon and the attachment points of the tendon. For instance, the patient starts to experience pain in his heel, particularly the upper part of his heel and the Achilles tendon, which is in the back of the foot. The pain, which tends to be very severe in the morning while becoming more tolerable in the following hours of the day, is the most important indication of chronic inflammation.
Treatment methods: Physical examination reveals a bulge the size of an olive which indicates degeneration in the Achilles tendon. The possibility of a cyst or inflammatory reaction is assessed via MRI. Unless there are cysts or inflammatory reactions, eccentric strengthening exercises are performed. The patients are taught how to do these exercise by physiotherapists. Patients whose condition does not respond to the exercises can receive stem cell or PRP (Platelet-Rich Plasma) treatments for purposes of supplying the area with blood. Unless there are any improvements in the tendon, the degenerated tissues in the area are eliminated through closed surgery methods and with cameras of 1 to 3 mm size that magnify the area by 10 to 12 times. The patient becomes able to walk with a walking boot after the operation and can wear normal shoes once three or four weeks have passed.
20 to 25% of patients who apply to the department have heel spur. The most common reasons for degeneration in the bottom of the feet are wrong choice of shoes, excessive weight, standing for long hours and physical inactivity.
Symptoms: The condition emerges with symptoms similar to those of Achilles tendon pain. If left untreated for years, chronic inflammatory reactions develop. Patients feel a stabbing pain on taking their first step in the morning.
Treatment methods: Since there is inflammation in the heel, gels or painkillers have no effect on the condition. Diagnosis involves examination of the plantar fascia with MRI. In order to eliminate the condition, which manifests itself in the form of a bony protrusion in the thick band of connective tissue in the foot, requires blood supply to the area. The success rate for treatment of the condition with exercises that stretch soles of the feet and use of cortisone injections at the early stage varies between 80 to 90%. Patients on whom these are not successful undergo procedures such as stretching treatments, cold therapy and ultrasound treatments. Specialists can also inflict artificial injury on the affected area in order to stimulate the body to supply blood to it for repair purposes. This involves use of an ESWT (Extracorporeal Shock Wave Therapy) device that applies shock waves to the tendon. The treatment alleviates the condition of 60 to 70% of patient who receive it for 6 months, once a week for five minutes. Patients who do not respond to any of these treatment methods, who comprise 15% of the total population of those with heel spurs, receive PRP treatment. The last resort is elimination of the heel spurs through closed surgery, which involves entry into the heel with a camera of 2,5 mm size. During the operation, the connective tissue is loosened. In two to three months, all of the pain experienced by the patient disappears. The rate of success for this treatment is 90 to 95%.
PROTECT THE HEALTH OF YOUR FEET WITH THESE THREE STEPS
- Keep in mind that your feet bear the whole weight of your body and make sure to keep your weight under control.
- When choosing shoes, prioritize foot health. Change shoes frequently.
Strengthen your ankles by exercising for 30 to 60 minutes on three days a week.
HALLUX VALGUS (DEFORMITY OF THE GREAT TOE/BUNION)
One of the most common conditions that develop in feet is deformity of the great toe. This problem, which manifests itself in two different ways, is encountered 10 times more in women. It appears in the form of great toe curvature during childhood, particularly at ages 12 and 13. Since patients during childhood are still growing, they do not go under any surgical procedures but are required to do protective exercises. Patients who reach the age of 17 or 18, however, are recommended to undergo surgery. The group of patients who are adults consist of people who have used bad shoes that are too tight for many years and spent a great amount of time on their feet. It is even possible to encounters cases in which the great toe develops a deformity overnight. 30 to 40% of people with a family history of this deformity develop hallux valgus themselves.
Treatment methods: There is no preventive treatment for the condition. Toe separators and corrector toe bandages are only useful in stopping pain. When radiography indicates that the deformity has exceeded a certain level, specialists decide on surgery. The rasping method, which entails a high risk of recurrence, is not used for hallux valgus surgery. Hallux valgus surgery involves realigning of the bone to be normal through sliding. The bone is fixed in place with small screws and any part of the bone which might be extra is removed. Use of special shoes or plaster casts, which used to be required in the past, is no longer necessary. Following surgery, patients become able to wear sports shoes after three weeks and normal shoes after one and a half months.
HAMMER TOE DEFORMITY
Another problem that arises from wrong choice of shoes is hammer toe deformity. This condition most commonly develops in cases where the little toe is longer than the toe next to it. Since the part of a shoe in which the little toe is placed is a narrow one, the longer toe is forced to curl. The toe develops a deformity when left in the same position continuously.
Treatment methods: In deformities arising from excessively long toes, it is possible to tape the long toe to remain straight. When patients wear their shoes with their toe taped, slight deformities are prevented from progressing further. However, advanced cases require outpatient surgery. This involves local anesthesia on the foot and pinning of the joint in the curled toe with a wire. The wire is removed during the third week following the operation and the patient becomes able to return to his daily life.