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Treatment Of Bursitis Of The Foot

Overview

There are about 160 bursae in the human body. These little, fluid-filled sacs cushion pressure and lubricate points between our bones, tendons, and muscles near our joints. The bursae are lined with synovial cells. Synovial cells produce a lubricant that reduces friction. This cushioning and lubrication allows our joints to move easily. When a person has bursitis, inflammation of the bursa, movement or pressure is painful. Overuse, injury and sometimes an infection from gout or rheumatoid arthritis may cause bursitis.

Causes

The swelling is the result of the blockage of blood, tissue fluids and circulation in the heel because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating, blood and fluids back up behind the injured heel, causing pain, inflammation, lumps and swelling.

Symptoms

Below is a list of common signs and symptoms of retrocalcaneal bursitis. Recognizing and treating symptoms early can prevent retrocalcaneal bursitis from becoming chronic. Swelling. The retrocalcaneal bursa is located behind the Achilles tendon, just above where the tendon attaches to the heel bone. When the bursa is inflamed it will cause visible soft tissue swelling near the top of the heel bone. It is worth noting that bursitis of the retroachilles bursa, which is located between the Achilles tendon and skin, can manifest slightly differently: swelling may be more distinct, appearing as a hard lump behind the heel. Retroachilles bursitis is also more likely than retrocalcaneal bursitis to cause the skin at the back of the heel to turn red.

Diagnosis

On physical examination, patients have tenderness at the site of the inflamed bursa. If the bursa is superficial, physical examination findings are significant for localized tenderness, warmth, edema, and erythema of the skin. Reduced active range of motion with preserved passive range of motion is suggestive of bursitis, but the differential diagnosis includes tendinitis and muscle injury. A decrease in both active and passive range of motion is more suggestive of other musculoskeletal disorders. In patients with chronic bursitis, the affected limb may show disuse atrophy and weakness. Tendons may also be weakened and tender.

Non Surgical Treatment

Treatment consists of anti-inflammatory therapy with the use of ice, short term non steroidal therapy including ibuprofen and naproxen and selective use of cortisone injections. Cortisone injections have been shown to be a highly effective anti-inflammatory measure for relieving foot and ankle pain. Care must always be taken by the physician to insure that the injection is administered into the bursal sac and not the Achilles tendon which can cause tendon injury. Treatment also consists of the use of heel lifts or the temporary use of a shoe with a low heel. The heel lift decreases the mechanical load on the Achilles tendon. Gentle stretching of the Achilles tendon, the possible use of a splint that is worn at night as well as physical therapy as directed by your physician can be employed. Temporary activity limitations for fitness must be incorporated into the treatment plan. Any weight bearing activity for exercise that actively lifts your heel off of the ground including running, walking stair stepper will interfere with effective conservative care. Low impact activity including biking and pool tend to be safe exercises during your recovery.

Surgical Treatment

Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).

Prevention

After taking a history and performing a physical examination, your physician may order x-rays to rule out other disorders. Your doctor may administer injections of corticosteroids and a local anesthetic to reduce swelling and ease pain. Also, to reduce swelling, your physician may draw excess fluid from the bursa with a syringe and then tightly wrap and compress the joint with an elastic bandage. In severe, persistent cases surgery to remove the bursa may be necessary. For infectious bursitis, antibiotics will be prescribed.

Hammertoe Pain

HammertoeOverview

Hammer toes are usually not a serious condition, but can become painful as the bent joint rubs against the inside of the shoe, causing irritation, corns, or calluses on the top of the middle joint or the tip of the toe. A hammertoe may also cause occasional shooting pains throughout the toes or elsewhere in the foot. A hammertoe has a kink or contracture in its second joint--called the proximal interphalangeal joint--that causes the toe to bend upward in the middle, giving it a hammer-like appearance. The raised part of the toe often rubs on shoes, leading to the formation of corns or calluses. Usually hammertoe affects the smaller toes, causing pain and interfering with the ability to walk normally.

Causes

Your toe contains two joints that allow it to bend at the middle and bottom. A hammertoe occurs when the middle joint becomes dislocated. Common causes of this joint dislocation include a toe injury, arthritis, a high foot arch, wearing shoes that don?t fit properly, tightened ligaments or tendons in the foot, pressure from a bunion (when your big toe points inward toward your second toe) Spinal cord or peripheral nerve damage may cause all of your toes to curl downward.

Hammer ToeSymptoms

A hammertoe may be present but not always painful unless irritated by shoes. One may have enlarged toe joints with some thickened skin and no redness or swelling. However, if shoes create pressure on the joint, the pain will usually range from pinching and squeezing to sharp and burning. In long standing conditions, the dislocated joints can cause the pain of arthritis.

Diagnosis

Hammer toes may be easily detected through observation. The malformation of the person's toes begin as mild distortions, yet may worsen over time - especially if the factors causing the hammer toes are not eased or removed. If the condition is paid attention to early enough, the person's toes may not be permanently damaged and may be treated hammertoe without having to receive surgical intervention. If the person's toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.

Non Surgical Treatment

A person with hammer toes will be asked to practice some exercises for their toes to regain average structure and movement. The exercises usually involve stretching and strengthening their toes. The person may attempt to pick things up off the floor using only their toes. They may also stretch their toes on a regular basis by hand to ease them into straightening out. Another example of a physical exercise specifically for a person's toes involves crumpling a towel with the toes. The towel can lie underneath the person's feet and the person can use their toes to scrunch up the towel as they perform simple tasks such as reading a book or watching television.

Surgical Treatment

If you are unable to flex your toe, surgery is the only option to restore movement. Surgery is used to reposition the toe, remove deformed or injured bone, and realign your tendons. Surgery is normally done on an outpatient basis, so you can return home on the day of your surgery.

Hammer ToePrevention

There should be at least one-half inch between the tip of your longest toe and the front of the shoe. Never buy shoes that feel tight and expect them to stretch with wearing. If you have prominent areas on your feet such as hammertoes and bunions, avoid shoes with a lot of stitching or multiple pieces of fabric, as these stitched areas tend not to stretch to accommodate various toe deformities.

How To Fix Hammer Toes Without Surgery

Hammer ToeOverview

A hammertoe is a toe that is bent because of a weakened muscle. The weakened muscle makes the tendons (tissues that connect muscles to bone) shorter, causing the toes to curl under the feet. Hammertoes can run in families. They can also be caused by shoes that are too short. Hammertoes can cause problems with walking and can lead to other foot problems, such as blisters, calluses, and sores. Splinting and corrective footwear can help in treating hammertoes. In severe Hammer toes cases, surgery to straighten the toe may be necessary.

Causes

The APMA says that hammertoe can result from a muscle imbalance in the foot that puts undue pressure on the joints, ultimately causing deformity. Inherited factors can contribute to the likelihood of developing hammertoe. Arthritis, stroke or nerve damage from diabetes or toe injuries such as jamming or breaking a toe can affect muscle balance in the foot, leading to hammertoe. The Mayo Clinic says that wearing improper shoes often causes hammertoe. Shoes that squeeze the toes, such as those with a tight toe box or with heels higher than two inches, can put too much pressure on the toe joints.

HammertoeSymptoms

People with a hammer toe will often find that a corn or callus will develop on the top of the toe, where it rubs against the top of the footwear. This can be painful when pressure is applied or when anything rubs on it. The affected joint may also be painful and appear swollen.

Diagnosis

First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.

Non Surgical Treatment

Wear sensible shoes. If you don?t want to have surgery to fix your hammertoe, use non-medicated padding along with proper shoes made with a wider and deeper toe box to accommodate your foot?s shape. Ensuring your shoes have a good arch support can slow the progression of the condition as well. Use a pumice stone. The corn or callus that forms on top of the hammertoe can cause discomfort when you wear shoes. Treat the corn by using a file or pumice stone to reduce its size after a warm bath, then apply emollients to keep the area softened and pliable. Use silicone or moleskin padding on top of the area when wearing shoes. Do foot exercises. Theoretically, exercises like extending, then curling the toes, splaying the toes, and moving the toes individually may help prevent the digital contracture that causes hammertoe. Try these suggestions and see what works best for you.

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.

HammertoePrevention

Wear thick-soled shoes if you walk on hard surfaces on a regular basis. Wear shoes with low heels. Have your feet checked regularly by a podiatrist to ensure that no deformities or conditions are developing. Do stretching exercises daily to strengthen the muscles in your feet.

Over-Pronation Of The Foot What Are The Causes

Overview

Overpronation and underpronation describe general foot movements. These terms do not necessarily describe a medical problem with a foot. For example, you can overpronate and not have any problems or symptoms at all. It is important to have your foot structure and symptoms adequately assessed by your prescribing physician and a qualified practitioner. Once the underlying conditions and mechanical faults are assessed, an appropriate treatment plan including possible orthotic and footwear recommendations can be made.Over Pronation

Causes

There are many biomechanical issues that can contribute to excessive pronation, including weak foot intrinsic muscles, limited ankle dorsiflexion mobility and calf flexibility, weak ankle invertor muscles (e.g. posterior tibialis), weak forefoot evertor muscles (peroneus longus), poor hip strength and control, Anterior pelvic tilting, heel InversionIn a person who overpronates, the heel bone goes into an everted position meaning that it turns out away from the midline of the body. The opposite motion of eversion is inversion. Inversion is a motion that needs to be controlled to prevent the foot from excessively pronating.

Symptoms

Due to the laxity of the soft tissue structures of the foot, and the fact that the joints are not held together properly, the bones of the feet shift. When this occurs, the muscles that attach to these bones must also shift, or twist, in order to attach to these bones. The strongest and most important muscles that attach to our foot bones come from our lower leg. So, as these muscles course down the leg and across the ankle, they must twist to maintain their proper attachments in the foot. This twisting of these muscles will cause shin splints, Achilles Tendonitis, generalized tendonitis, fatigue, muscle aches and pains, cramps, ankle sprains, and loss of muscular efficiency (reducing walking and running speed and endurance). The problems we see in the feet, which are due to over-pronation include bunions, heel spurs, plantar fasciitis, fallen and painful arches, hammertoes, metatarsalgia (ball of foot pain), and calluses.

Diagnosis

Bunions, calluses and crooked toes may indicate alignment problems. So, it is important to ascertain the condition of a client's toes. Check the big toe to determine if the first joint of the toe is swollen, has a callus or bunion, and/or looks as though it abducts (i.e., hallux valgus) rather than pointing straight ahead. Also, look to see if the lesser toes seem to "curl up" (i.e., the person has hammer or claw toes). This may be indicative of damage to, or inflexibility of the plantar fascia caused by excessive flattening of the foot.Pronation

Non Surgical Treatment

When you see the doctor, he or she will likely perform a complete examination of your feet and watch you walk. The doctor will need to take x-rays to determine the cause of your flat feet. In some cases, further imaging may be needed, especially if your symptoms are severe and sudden in nature. Once you are properly diagnosed, your doctor will create an appropriate treatment plan. There are several options to correct overpronation, such as orthotics. In many cases, overpronation can be treated with non-surgical methods and over-the-counter orthotics. In severe cases, however, custom-made orthotics may work better. Orthotics provide arch support and therefore prevent collapse of the arch with weight bearing. They are made of materials such as spongy rubber or hard plastic. Your doctor will also want to examine your footwear to ensure they fit properly and offer enough medial support. Extra support and stability can be achieved with footwear that has a firm heel counter. If you are experiencing pain, you should be able to use over-the-counter pain medications such as ibuprofen to relieve symptoms.

Prevention

Strengthen the glutes to slow down the force of the foot moving too far inward. Most individuals who over-pronate have weak glute muscles and strengthening this area is a must. A simple exercise to strengthen glutes is lateral tube walking across a field/court/room. Place a lateral stretch band around your ankles and move your leg sideways while keeping your feet forward.

Coping With Severs Disease

Overview

The muscle group at the back of the lower leg is commonly called the calf. The calf comprises of 2 major muscles (known as the gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon. In people who have not yet reached skeletal maturity, a growth plate exists where the Achilles tendon inserts into the heel bone. This growth plate is primarily comprised of cartilage. Every time the calf contracts, it pulls on the Achilles tendon which in turn pulls on the heel's growth plate. When this tension is too forceful or repetitive, irritation to the growth plate may occur resulting in pain and sometimes an increased bony prominence at the back of the heel. This condition is called Severs disease. Severs disease is typically seen in children or adolescents during periods of rapid growth. This is because muscles and tendons become tighter as bones become longer. As a result, more tension is placed on the heel's growth plate.

Causes

The calcaneal apophysis develops as an independent center of ossification (possibly multiple). It appears in boys aged 9-10 years and fuses by age 17 years, it appears in girls at slightly younger ages. During the rapid growth surrounding puberty, the apophyseal line appears to be weakened further because of increased fragile calcified cartilage. Microfractures are believed to occur because of shear stress leading to the normal progression of fracture healing. This theory explains the clinical picture and the radiographic appearance of resorption, fragmentation, and increased sclerosis leading to eventual union. The radiographs showing fragmentation of the apophysis are not diagnostic, because multiple centers of ossification may exist in the normal apophysis, as noted. However, the degree of involvement in children displaying the clinical symptoms of Sever disease appears to be more pronounced. In a study of 56 male students from a soccer academy, of whom 28 had Sever disease and 28 were healthy control subjects, findings suggested that higher heel plantar pressures under dynamic and static conditions were associated with Sever disease, though it was not established whether the elevated pressures predisposed to or resulted from the disease. Gastrocnemius ankle equinus also appeared to be a predisposing factor.

Symptoms

Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next morning after sport.

Diagnosis

In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.

Non Surgical Treatment

Treatment depends on the severity of the condition, but may include relative rest and modified activity, a physiotherapist can help work out what, and how much, activity to undertake. Cold packs, apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking. Shoe inserts, small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term. Medication, pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor). Anti-inflammatory creams are also an effective management tool. Splinting or casting, in severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare. Time, generally the pain will ease in one to two weeks, although there may be flare-ups from time to time. Correction of any biomechanical issues, a physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition. Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Prevention

Once your child?s growth spurt ends, and she's reached full size, her Sever?s disease won?t return. Until then, the condition can happen again if your child stays very active. Some simple steps can help prevent it. Have your child. Wear supportive, shock-absorbing shoes. Stretch her calves, heels, and hamstrings. Not overdo it. Warn against over-training, and suggest plenty of rest, especially if she begins to feel pain in her heel. Try to avoid lots of running and pounding on hard surfaces. If she?s overweight, help her lose those extra pounds, which can increase pressure on her heels.

Achilles Rupture The Facts

Overview
Achilles Tendon The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. Although the Achilles tendon can withstand great stresses from running and jumping, it is vulnerable to injury. A rupture of the tendon is a tearing and separation of the tendon fibers so that the tendon can no longer perform its normal function.

Causes
Inflammation/strain of the tendon is usually caused by overuse, for example, frequent jumping in volleyball, netball or basketball. It is often also caused by a sudden increase in certain types of training, such as hill sprinting or track running, particularly when running in spikes. Tendinopathy can also be associated with ageing. Our ability to regenerate damaged tissue decreases as we age and the quality of the tendon deteriorates. However, the better news is that sensible training can actually strengthen all our soft tissue (tendons, ligaments and muscle). Tightness in the calf muscles will demand greater flexibility of the tendon, which inevitably results in overuse and injury. Biomechanically, the tightness can reduce the range of dorsiflexion (toe up position) in the ankle, which increases the amount and duration of pronation. This problem is known as overpronation.* This reduces the ability of the foot to become a rigid lever at push off and places more lateral and linear forces through the tendon. This imbalance can translate into altered rotation of the tibia (shin bone) at the knee joint and, in turn, produce compensatory rotation at the hip joint with subsequent injuries to the shin, knee and hip. Pronation is part of the natural movement of the subtalar joint in the foot. It allows ?eversion? (turning the sole outwards), dorsiflexion and abduction (pointing the toes out to the side). Pronation is a normal part of the gait cycle, when walking and running, and it helps to provide shock absorption in the foot. When pronation is excessive, the foot has a tendency to roll inward more than normally acceptable. One sign of overpronation is greater wear on the inside of your running shoes than on the midsole. Lack of stability around the ankle joint can also be a contributory factor, as recurrent ankle sprains appear to be associated with a high incidence of Achilles tendonopathy. Wearing shoes that don?t fit or support the foot properly can be a major contributing cause of Achilles tendon injury.

Symptoms
Many people say that a ruptured Achilles feels like ?being shot in the heel?, if you can imagine how enjoyable that feels. You may hear a snap sound or feel a sudden sharp pain when the tendon tears. After a few moments, the pain settles and the back of the lower leg aches. You can walk and bear weight, but you may find it difficult to point the foot downward or push off the ground on the affected side. You will be unable to stand on tiptoe. Bruising and swelling are likely, and persistent pain will be present. Similar symptoms may be caused by an inflamed Achilles tendon (Achilles tendonitis), a torn calf muscle, arthritis of the ankle, or deep vein thrombosis in the calf, so an MRI or ultrasound scan will likely be used to diagnose your condition.

Diagnosis
To diagnose an Achilles tendon injury, your health care provider will give you a thorough physical exam. He or she may want to see you walk or run to look for problems that might have contributed to your Achilles tendon injury.

Non Surgical Treatment
Not every torn Achilles tendon needs an operation. Recent studies have shown that even a conservative treatment, i.e. immobilizingt the leg can lead to satisfactory healing successes. This requires, however, that the patient is fitted with a cast (immobilization splint) and/or a special boot for a period of approximately 6 - 8 weeks. After that, the boot must be worn during the day for about two more weeks. An intensive physiotherapy will start after about six weeks to train the calf muscles so that the initial coordination can be restored. Running training on flat ground can be started again after another 10 - 12 weeks. Studies show that the danger of a recurring torn tendon is higher after a conservative treatment opposed to an operative treatment. Depending on the type of treatment, about 10 - 15 percent of those affected can expect at some point to again suffer from a tear of the Achilles tendon. Moreover, in the non-operated cases, we see more often a significant permanent weakness of the footprint, particularly restricting the ability to participate in sports. Achilles Tendinitis

Surgical Treatment
Operative treatment of Achilles tendon ruptures involves opening the skin and identifying the torn tendon. This is then sutured together to create a stable construct. This can be performed through a standard Achilles tendon repair technique or through a mini-incision technique (to read about the different types of techniques, look under ?Procedure? in Achilles Tendon Repair). By suturing the torn tendon ends together, they maintain continuity and can be mobilized more quickly. However, it is critical to understand that the return to normal activities must wait until adequate healing of the tendon has occurred. The potential advantages of an open repair of the Achilles tendon include, faster recovery, this means that patients will lose less strength. Early Range of Motion. They are able to move the ankle earlier so it is easier to regain motion. Lower Re-rupture Rate. The re-rupture rate may be significantly lower in operatively treated patients (2-5%) compared to patients treated non-operatively (8-15%). The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a wound-healing problem which could lead to a deep infection that is difficult to eradicate, or a painful scar.

Prevention
There are things you can do to help prevent an Achilles tendon injury. You should try the following. Cut down on uphill running. Wear shoes with good support that fit well. Always increase the intensity of your physical activity slowly. Stop exercising if you feel pain or tightness in the back of your calf or heel.

Leg Length Discrepancy Symptoms

Overview

Every person?s body is unique and will show different symptoms due to a short leg. Athletes are able to distinguish the negative effects of a leg length that is just 3 mm shorter then the other. A whole host of negative effects can occur to the body that can create chronic pain and may necessitate surgical interventions. The effect of a short leg can be seen almost everywhere in the body.Leg Length Discrepancy

Causes

The causes of LLD may be divided into those that shorten a limb versus those that lengthen a limb, or they may be classified as affecting the length versus the rate of growth in a limb. For example, a fracture that heals poorly may shorten a leg slightly, but does not affect its growth rate. Radiation, on the other hand, can affect a leg's long-term ability to expand, but does not acutely affect its length. Causes that shorten the leg are more common than those that lengthen it and include congenital growth deficiencies (seen in hemiatrophy and skeletal dysplasias ), infections that infiltrate the epiphysis (e.g. osteomyelitis ), tumors, fractures that occur through the growth plate or have overriding ends, Legg-Calve-Perthes disease, slipped capital femoral epiphysis (SCFE), and radiation. Lengthening can result from unique conditions, such as hemihypertrophy , in which one or more structures on one side of the body become larger than the other side, vascular malformations or tumors (such as hemangioma ), which cause blood flow on one side to exceed that of the other, Wilm's tumor (of the kidney), septic arthritis, healed fractures, or orthopaedic surgery. Leg length discrepancy may arise from a problem in almost any portion of the femur or tibia. For example, fractures can occur at virtually all levels of the two bones. Fractures or other problems of the fibula do not lead to LLD, as long as the more central, weight-bearing tibia is unaffected. Because many cases of LLD are due to decreased rate of growth, the femoral or tibial epiphyses are commonly affected regions.

Symptoms

Many people walk around with LLD?s of up to 2 cm. and not even know it. However, discrepancies above 2 cm. becomes more noticeable, and a slight limp is present. But even up to 3 cm. a small lift compensates very well, and many patients are quite happy with this arrangement. Beyond 3 cm. however, the limp is quite pronounced, and medical care is often sought at that point. Walking with a short leg gait is not only unsightly, but increases energy expenditure during ambulation. It could also put more stress on the long leg, and causes functional scoliosis. Where the discrepancy is more severe, walking becomes grotesque or virtually impossible.

Diagnosis

The doctor carefully examines the child. He or she checks to be sure the legs are actually different lengths. This is because problems with the hip (such as a loose joint) or back (scoliosis) can make the child appear to have one shorter leg, even though the legs are the same length. An X-ray of the child?s legs is taken. During the X-ray, a long ruler is put in the image so an accurate measurement of each leg bone can be taken. If an underlying cause of the discrepancy is suspected, tests are done to rule it out.

Non Surgical Treatment

Heel lifts Raise the heel on the shorter leg. It is applied either to the heel of the custom orthotic or to the inside of the shoe under the insole at the heel. Generally if the discrepancy is greater than 3/8 of an inch, the modification is applied externally on the footwear. Custom made orthotics help to provide proper support and alignment to the foot, controlling conditions such as over pronation. Orthopedic Footwear, properly fitted, to which a lift might be applied inside or out.

LLD Insoles

Surgical Treatment

The type of surgery depends on the type of problem. Outpatient procedures may be used to alter the growth of the limb. This is often done through small incisions. If an outpatient procedure is done, your child can continue with most regular activities. Other times, surgery may be very involved and require the use of an external device that is attached to the limb with pins and wires. This device may be left on for months to correct the deformity or lengthen the leg. If this type of surgery is required, your child will be making weekly visits to Cincinnati Children's.