“Friend looks head to head and enemy at feet ..”
Our feet are the most important part that carries our weight, which some proudly display, some lamented when hidden in shoes during the winter and come to light in summer with open slippers, which complement our beauty.
In healthy individuals with foot structure; Three points are used in contact with the ground. The heel, thumb and little finger comb bone end parts transfer our body weight to the floor. In the foot architecture, the comb in the front and two arches on our longitudinal sole serve as a shock absorbing spring.
While both arches are supported by the common beam of the muscles on the soles of the foot, the spinning wheel mechanism distributes the loads between 3 points without injury, so that our weight-bearing feet can resist the loads.
While the middle long arc distributes the load to three points between the heel and the anterior arc, it can reduce the riding force by one tenth as a lever. While a healthy foot structure is like this, when the arc disappears in the flat sole, the outer muscles of the foot have to work harder to balance this structure. Therefore, long walking and running fast on flat soles becomes difficult.
For whatever reason, when the load distribution is disrupted, calluses, protrusions in the bones that touch the ground or adhere to the beams, deterioration and erosion in the joints begin to occur. Foot problems can be examined in three areas.
Back foot problems (Heel pain, bone spurs around the heel, Achilles problems)
Midfoot (Plantar fascia problems = heel spur ?, sinus tarsi syndrome, nerve traps)
Forefoot problems: Metatarsalgia, Thumb problems, Morton’s neuroma, hammer finger, tailor’s finger,
Hindfoot and Heel
Is the heel spur real?
This diagnosis, which alternates between medical reality and urban legend, divided medical professionals all over the world. The common view of both sides is the presence of ossification at the attachment site of the combined tendon to the heel bone. Is their point of departure the bone problem? Is it resolved by eliminating the causing tendon discomfort. This difference of opinion has also led to heel support and treatment options for them.
From simple to complex diagnosis and treatment methods, if the problematic area is not relieved with arch reinforcements, heel supports, and ESWT (External Shock Wave therapy) methods do not help, we can endoscopically shave the combined tendon. The permanent solution can be completed with post-surgical rehabilitation.
Heel Cushion Syndrome
This situation, which decreases in a few minutes, gives the feeling of walking on a thorny road in the morning; It is caused by the rupture of the natural fat pad wall that surrounds our heel and absorbs the shock on the floor. Challenge with a simple Heel cup with a patient rehabilitation
It will disappear automatically.
Heel Spurs- Bursitis (Calcaneal Bursitis)
Bone Spurs (Haglund deformity)
Bursitis, which develops due to the pressure of hard and narrow shoes on the Achilles beam, is the healing tissue caused by the irritation of the bone and the side of the Achilles facing the bone surface. If not treated well, it can become ossified and horned. Comfortable slippers worn on summer days are a great opportunity for treatment. If it is not possible to disintegrate this tissue from the outside like ESWT treatment, it is possible to remove this hard tissue in front of the tendon by closed surgery with ankle arthroscopy.
Achilles tendinitis
Although it does not seem directly related to the mechanics of the foot, it is very difficult to solve this situation caused by excessive strain without correcting the foot arch. Apart from rest and medical treatment, the heel of the foot that will trigger this situation should be corrected with varus insoles, which pushes the heel outward (flat foot, valgus) or disrupts the inward alignment, and plantar fascia tension should be reduced. If Achilles tendinitis is not treated well, it can result in breakouts. ESWT can be effective. When medical treatment is insufficient, radiofrequency can be applied with tenoscopy.
Peroneal Tendinitis
Back foot heel is one of the causes of pain. Just like Achilles, it occurs after foot mechanics deterioration and excessive strain. Occurs frequently in ankle fractures, in cases of malunion.
Outsole wedges relax in medical treatment. ESWT is useless in this region. Ankle arthroscopy gives extremely good results in resistant cases.
Midfoot
Plantar Fasciitis
Our tendon, which adheres to the heel of the foot, adheres to the heel where all the inner muscles of the foot are strengthened, and the spinning wheel acts as a force arm in walking mechanics.
The injury of this structure, which is extremely important in gait mechanics, becomes chronic when it is not supported with the right insoles and its alignment is not regulated, causing the other structures of the foot to become open to load and injured. ESWT can support healing by increasing regeneration in complaints that are not reduced by choosing the right shoes and insoles. Injection treatments are successful. Tenoscopy and endoscopic debridement of the plantar fascia are among the surgical options.
Sinus Tarsi Syndrome
It includes the discomfort of the joint between the two bones that make up the heel that increases with pressure, which gives a feeling of fullness and swelling in the foot.
It is frequently injured after foot sprains and strains. It may progress with the involvement of the joint surfaces between the two bones or with joint inflammation due to purely mechanical reasons. If the insoles do not decrease with intra-articular injection and drug treatment, if intra-articular problems are revealed in radiology, we apply sinus tarsi arthroscopy.
Foot Trap Neuropathies
Tarsal Tunnel
It is the compression of the tibial nerve, which goes to the sole of the foot, without giving the plantar branch or after narrowing the space between the muscles and tendons. It is characterized by heel pain, burning in the sole and numbness in the big toe. EMG test is negative in half of the patients. Treatment is surgical release, cortisone injection can be tried.
Dorsal Nerve Compression
It is the result of compression of the nerve that goes to the toes on the back of the foot. It may be characterized by numb pain and burning in the second and third fingers.
It is common in dancers and runners who wear tight strappy shoes.
Treatment is surgical loosening if the injection does not respond.
Forefoot Problems
Metatarsalji
It is one of the most common foot ailments. The metatarsal region is the area formed by the metatarsal bones. A similar dome of the foot is also present here, this time along the toes. Its deterioration causes “Splay Foot” discomfort and is one of the causes of forefoot metatarsalgia.
Injury of the foot nerves and their healing in the form of knots, “Morton’s neuroma”, which is characterized by numbness in the fingers and pain in the form of pressing on a pebble, or phantom nerve injury is another cause of foot pain that is very difficult to diagnose. In this case, the treatment is surgery and the nerve node is removed.
We frequently use metatarsal pad supports in the treatment of metatarsalgias, and patients benefit from appropriate support insoles after foot analysis.
Thumb deformities (Hallux Valgus, Bursitis)
The presence of deformity and bone protrusions in the big toe is the fearful dream of many people who care about aesthetics. In particular, mistakes made in surgical treatments and failures that lead to long plaster treatments cause patients to avoid surgery and to be exposed to complex treatments from simple preventive solutions.
Not every bone protrusion is Hallux Valgus
It is very important to correctly define haluk valgus, which has become an urban legend.
First of all, it is a complex condition in which the toe turns inward (pronation) along with the outward orientation of the thumb, and the inner muscles of the feet are shortened.
If you have a scalloped foot and the comb bone is directed inward, this is another situation that we call metatarsus primus varus, which is another condition that should be corrected near the completion of the bone development that occurs in puberty or even congenital.
If there is no rotation of the metacarpal bone in our thumb, shortening of the ligaments, and no outward curvature of the finger, our bony prominence may be a simple bursitis. The treatment of this condition, which we can describe as a bunion, is simple bursectomy.
Contrary to what is known, bone protrusion is not removed during surgery. Rather, it is to harmonize the joint and provide the alignment. After this procedure, the joint should work and be able to press without pain. After the correct surgery, patients can walk with or without a cast within 3 weeks and return to their normal lives.
Articular Cartilage Problems
Our finger joints can suffer from cartilage injuries, just like knees and large joints. In this case, there may be swelling and pain in the joint. A painless joint can be achieved when the problem on the joint surface is resolved by arthroscopy or small joint surgery.
Hammer Finger Deformity
Clawing may occur in people who wear loose shoes or move their toes forward when there is no foot box support. It can also occur in certain neurological diseases. This is a condition that should be known to people who want to get rid of bursitis and calluses on their toes during pedicure, and if splint and band treatments do not benefit, it can be surgically corrected.
Tailor’s Finger
It occurs as a result of forcing the little finger inward on the comb bone, especially in people sitting under their feet. Over time, the bunion becomes painful in the form of bone protrusion. Surgical treatment is required if it is not corrected with splints with early intervention.