Magnesium And Gout: Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendon dysfunction (PTTD), also called posterior tibial tendonitis, is one of the leading causes of acquired flatfoot in adults. The onset of PTTD may be slow and progressive or abrupt. An abrupt beginning is typically linked to some form of trauma, whether it be simple (stepping down off a curb or ladder) or severe (falling from a height or vehicle accident). PTTD is hardly ever seen in children and increases in frequency as we grow old.
Myerson, M.S. Adult purchased flatfoot deformity. J. Bone and Joint Surgery. 78-A;780, 1996 Johnson, K.A., Tibialis posterior tendon rupture. Clin. Orthop. 177:140-147, 1983
Treatment of Posterior Tibial Tendons Dysfunction and Posterior Tibial Tendonitis
Treatment for PTTD is dependant upon the clinical stage and the health status of the patient. It is important to recognize that PTTD is a mechanical problem that needs a mechanical solution. This means that treating PTTD with medication on your own is fraught with failure. Timely introduction of some form of physical support is imperative.
Stage I May Respond to Rest, Such as a Walking Throw
Pain and inflammation may be controlled with anti-inflammatory medications. It is important to make certain that Stage I patients realize that the use of shoes with additional arch support and also heel elevation, for the rest of their lives, will be crucial. Arch support, whether constructed into the shoe or added as an orthotic, helps support the posterior tibial tendon and decrease its' function. Elevation of the heel, reduces equinus, one of the most significant contributing factors to PTTD. If Stage I patients come back to low heels without arch support, PTTD may recur.
Dairy products have high level of body fat and thus must not be taken in excessive quantities. Milk, ice cream, cheese and butter are responsible for gout symptoms, given that they have a lot of of fat.
Stage III Tendon status Severe degeneration with likely rupture Clinical findings Rigid flatfoot along with inability to raise up on toes X-ray/MRI MRI shows tear in tendon. X-ray noting abduction of forefoot, collapse of talo-navicular joint.
- Drinking a lot of water, six or more glasses a day, will help the body in order to excrete more uric acid.
- Water also decreases the chances of getting kidney stones.
- Diet Fruits Eat fresh fruits, especially citrus fruit fruits.
- Drink one or more of the following three times each day: orange juice, fresh lemonade and grapefruit juice.
- You may also eat the fruits if you prefer.
- Drink the juice or consume the fruits first thing to get the vitamins working in your system.
- Mix oil of wintergreen, chloroform and massaging alcohol in the ratio of 1:3:12.
- Once the mixture is prepared, rub it on the affected area.
- Symptoms of Gout: - Indigestion Excessive consumption of salty, sour, hot, hot, oily foods.
- Consumption of Fish.
- Consuming horse gram, urad dal.
Maintaining a proper weight and getting regular exercise cuts down on the risk and severity of gout attacks.
- Stage II Tendon status Attenuated with possible partial or complete break Clinical findings Pain in arch.
- Unable to raise on toes.
- A lot of toes sign present X-ray/MRI MRI notes tear in muscle.
- X-ray noting abduction of forefoot, collapse of talo-navicular joint
Conditions that may resemble PTTD include tarsal tunnel syndrome, tibial stress fractures, posterior tibial tendons rupture, flexor hallucis longus tendonitis, gout, arthritis of the subtalar joint or a fracture of the posterior process of the actual talus.
Stage III patients require stabilization of the rearfoot with procedures that fuse the primary joints of the arch and feet. These procedures are salvage procedures and require prolonged casting and disability following surgery. A common procedure for Stage III is called triple arthrodesis which is a technique used to fuse the actual subtalar joint, the talo-navicular joint as well as the calcaneal cuboid joint.
Two Tbsp of Water, Add One Tbsp Fresh Limejuice
Have this twice a day -in the morning and at night. In a pint of warm water, mix juice of three lemons and three tablespoons Epsom salts. Take one tsp of the mixture in the morning and one in the evening.
Advanced cases of PTTD, in addition to the pain of the tendon itself, pain will also be noted at the sinus tarsi. The sinus tarsi refers to a small tunnel or divot on the outside of the ankle that can actually be felt. This tunnel is the entry to the subtalar joint. The subtalar joint is the joint that controls the side to side motion of the foot, motion that would occur with uneven surfaces or sloped hills. As PTTD progresses and the ability of the posterior tibial tendon to support the arch becomes reduced, the arch will collapse overloading the subtalar joint. As a result, there is increased pressure put on the joint floors of the lateral aspect of the subtalar joint, resulting in soreness.
Osteo-arthritis Gout Ankylosing spondylitis Tennis elbow Frozen shoulder Cervical spondylitis Fibrositis Read more on Rheumatism as well as Home Remedies for Rheumatism. Also visit on Singapore Journey InformationCauses of Rheumatism.
- Immediately treating gout won't allow it to get worse.
- All of us will now go over treatment, and natural remedies for gout in more detail.
- An effective way to treat rheumatism would be to have 1 or 2 tsp of raw potato juice before meals.
- Mix 1 tablespoon of cod liver oil in a glass of orange juice.
- Whip as well as drink this juice before going to bed.
Poisoning of blood with acid wastes Physically stressful work Damp weather conditioner Acid-alkaline imbalance (Acidosis) Home Remedy for Rheumatism
- A glass of warm water, dissolve 2 tsp each of apple cider vinegar and honey.
- Have this mixture once or twice a day.
- Mix carrot juice and lemon juice in equal proportions.
- Have a large spoonful of the concoction, everyday, to cure rheumatism.
- Celery is helpful in curing rheumatism.
- You can either use it as a condiment or a fluid extract. 5 to 10 drops of this fluid should be mixed with a glass of hot water.
- Have this decoction before meals.
Natural Treatments for Gout:
Alternative therapies are popular among people with gout. However, if they are used, they should complement and not substitute conventional care. There is very little evidence right now that shows alternative therapies are effective for gout. Below are a few natural remedies that are commonly used.
- Eating generous amounts of other fruits and vegetables helps keep uric acid crystals in solution.
- Eat foods high in potassium, as mentioned above.
Author's Biography Mary Watson, the well known author writes on gout problem and Buy Colcrys. He regularly writes for http://www.colchicine.ca/.
Biomechanics: The function of the posterior tibial tendon would be to plantarflex the foot at the toe away phase of the gait cycle and to stabilize the medial arch.
Pain on the medial ankle with weight bearing Inability to boost up on the toes without pain Too many toes sign
- Symptoms: The symptoms of phase I PTTD include a dull ache of the medial arch.
- The pain become worse with activity, better on days with limited time on the feet.
- Extensive activity may result in a partial rupture of the tendon, moving to stage II.
There have been many proposed explanations for PTTD over time since this condition was first described by Kulkowski in The most contemporary explanation refers to an area of hypovascularity (limited blood flow) in the tendon just below the ankle. Tendon comes most of its' nutritional support from synovial fluid produced by the particular outer lining of the tendon. Really small blood vessels also permeate the muscle sheath to arrive at muscle. This makes all tendon notoriously slow to recover. In the case of the posterior tibial tendon, this problem is exacerbated by a distinct part of poor blood flow hypovascularity). This area is located in the posterior tibial tendon just below or distal to the inside ankle bone (medial malleolus).
- The green stalk of rhubarb is effective in curing rheumatism.
- Crush this with equal amounts of sugar.
- Possess a tsp of this mixture three or four times everyday.
- A quarter of cranberry juice, dissolve 4 tsp blackstrap molasses.
- Drink one glass of the juice everyday, for curing rheumatism.
- Myerson, M.S., Corrigan, J.
- Treatment of posterior tibial tendons dysfunction with flexor digitorum longus tendon transfer and calcaneal osteotomy.
- Orthopedics 19:383-388, 1996
Lateral Subtalar Joint (Outside of the Ankle) Pain
A common test to evaluate PTTD may be the 'too many toes sign'. The too many toes sign' is a test used to calculate abduction deviation away from the midline of the body) of the forefoot. With damage to the rear tibial tendon, the forefoot will abduct or transfer in relationship to the rest of the foot. In the event of PTTD, if the foot is viewed from guiding, the toes appear as 'too many' on the outside of the foot due to abduction of the forefoot.
Equinus is Also a Contributing Factor to PTTD
Equinus is the term used to describe the ability or lack of ability to dorsiflex the feet at the ankle (move the toes toward you). Equinus is usually due to tightness in the calf muscle, also known as the gastroc-soleal complex (a combination of the gastrocnemius and soleus muscles). Equinus may also be due to a bony block in the front of the ankle. The presence of equinus makes the rear tibial muscle to accept additional insert during gait.
- Stage II signs and symptoms are seen with more regularity.
- Pain is present at the onset of weight bearing.
- Some limitation of a chance to raise up on the toes will be present.
Food an Excellent Source of Purine Content
Any kind of food that is high in purine level, are to be strictly prevented. Seafood, fish, pork, poultry or beef are a few of such foods. Meat from certain organs of animals can be held responsible for gout. Liver, brains, kidneys, have got high purine content. Hence the consumption of meat needs to be reduced as much as possible. Broths or fish roe, can cause gout as well, since they have meat as their main ingredient.
Foods in Order to Avoid
Avoid eating meat and fish, caffeinated beverages, sugar, white bread and pasta, alcohol and pickled or even very salty foods. All of these foods are acidic and, while they don't cause your rheumatism to be able to get worse, may inhibit the work with the healthy foods in the rheumatism diet. The fewer acidic foods you take in, the more likely the alkaline foods can flush away the toxins causing rheumatoid pain instead of the acids in the foods you've just eaten.
Gout is undoubtedly one of the most common and painful ailments that affects mankind. It is a result of accumulation of uric acid in the form of crystals in joints and tissues. It starts from the major portions of the body like the big toe and then start spreading throughout. The enhancement of the uric acid level is mainly a result of eating food items high in protein or even fat content. To take care of gout efficiently there are a many food products that are to be able to be avoided. This article aims at throwing a little light on these products.
- Most patients might complain, that is all the scrumptious food items are tagged forbidden for them, how would they be able to appreciate life?
- It is also true that the food items mentioned are some of the most common ones.
- However, if one wishes to be able to remove gout looking at the roots, these are a few safety measures that he has to follow.
- For veggies that do not result in gout one would need to check out the gourmet section of the shops.
- And, as said earlier fresh and natural food are a lot more beneficial and hygienic than processed food.
- Why should one take a risk having junk food, when there is no guarantee that no harmful component has been used in it.
- Peel some potatoes.
- Wash 30 grams of this peeling in half a liter of water.
- Strain the decoction and have it three or four times daily.
- This is an effective way to treat rheumatism.
Consuming Half a Dozen Walnuts Everyday is Helpful in Treating Rheumatism
However, make sure you chew them properly. In a bucket of warm water, add some rosemary oil. Dip the affected area in this water. This would provide relief from the pain and treat the inflammation as well.
Vegetables are often known for their medicinal values. But veggies like mushroom, lentils, spinach, peas, beans, cauliflowers, as well as asparagus cause gout. The addition of butter to these vegetables just instigates their adverse effects.
PTTD is a condition that increases in frequency with age and the prevalence of poor health indicators such as diabetes and obesity. As a result, many patients with PTTD are bad surgical candidates for correction of PTTD. Prosthetics such as an ankle foot orthotic (AFO), Arizona Brace or other bracing may be very helpful to control the symptoms of PTTD. Anatomy:
- Avoid foods with high levels of purines.
- As we mentioned before, foods with high purine levels include shellfish, alcohol, organ meats, creamy sauces, dried peas, etc.
- Having sex helps prevent men from getting gout.
- It seems that increased sexual activity reduces uric acid levels in fertile men.
- No matter how hard it seems to prevent junk and prepared foods, one must actually avoid them.
- Most manufacturers used yeast in processed food.
- Some also use certain chemical substances which are normally not tested regarding gout.
- The consumption of these ingredients is definitely going to have adverse effects on gout sufferers.
- However, it is always a good idea for any person to have real food; it is more useful for one who has gout.
- It is upon themselves to check on any further enhancement in the level of uric acid in their body.
- One must have small quantities of food and must make sure that the overall usage is kept low.
Tendon is also the majority of susceptible to fatigue and failure at an area in which the tendon changes direction. As the posterior tibial tendon descends the leg and comes to the inside of the ankle, the tendon follows a well defined groove in the back of the tibia (bone of the lining of the ankle). The tendon then takes a dramatic turn towards the arch of the foot. If the muscle is placed into a situation where significant load is applied to the foot, the tendon responds by pulling up as the load of the body (in addition to be able to gravity) pushes down. At the location where the tendon alterations course, the tibia acts as a wedge and may utilize enough force to actually damage or rupture the tendon.
Surgical procedures that focus on primary repair of the posterior tibial tendon have been very unsuccessful. This is due to the fact that tendon heals slowly following damage and cannot be relied upon as a sole solution for PTTD cases. Surgical success is usually attained simply by stabilization with the rearfoot subtalar joint) which significantly reduces the work done by the rear tibial tendon.
Foods known to reduce the occurrence of gout include: dairy, foods high in potassium, black cherry juice, blueberries and lemon juice.
- Stage III signs and symptoms are severe with an inability to complete most normal daily activities such as laundry or going to the store.
- Collapse of the medial arch will be obvious.
- Abduction of the forefoot will show 'too many toes sign'.
Yeast and Candida Products
Yeast or yeast by products is also to be struck off from the diet list. They also act in catalyzing gout effects. Any kind of alcohol, even if it is just beer are in order to avoided as well. the reason behind this being that yeast is a main ingredient in them.
- Include foods rich in calcium, magnesium and vitamin C in the diet.
- This would help in treating rheumatism.
- Extract a cup of bitter gourd juice.
- Mix it with a tsp of honey.
- Daily dose of this, for three months, would be helpful in treating rheumatism.
- Stage I Tendon status Attenuated (lengthened) with tendonitis but absolutely no rupture Clinical findings Palpable pain in the medial arch.
- Foot is supple, flexible with a lot of toes indicator X-ray/MRI Mild to moderate tenosynovitis on MRI, no X-ray changes
About the Actual Author:Jeffrey a
Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.
- Additional contributing factor to the onset of PTTD may include hypertension, diabetes, peripheral neuropathy, smoking or arthritis.
- The progression of PTTD might result in tendonitis, partial tears of the tendon or complete tendons rupture.
- Many types have been developed to describe PTTD.
- The group as described by Johnson and Strom is most commonly used today.
The characteristic finding of PTTD include; Loss of medial arch height Edema (swelling) of the medial ankle Loss of the ability to resist force in order to abduct or push the foot out from the midline of the body.
Rheumatism is Not a Single Disease
It pertains to a whole range of conditions, which cause pain. These conditions affect the joints, the muscles and the ligaments. Rheumatism is more common among the middle aged and elderly people. The exact cause of most types of rheumatism is not known. Exposure to wet and cold may aggravate the pain. There are many forms of rheumatism, and also some of the most common kinds are:
The posterior tibial tendons is the extension of the posterior tibial muscle that lies deep to the calf. The origin of the posterior tibial muscle is the posterior aspect of both the tibia and fibula and the interosseus membrane. The insertion of the posterior tibial muscle is the medial navicular where the tendon divides into nine different insertion web site on the bottom of the foot.
- Read more about Rheumatism and Home remedies for Rheumatism.
- Also visit on Singapore Travel InformationCauses of Rheumatism
Stage II patients, or Stage I patients that do not respond to rest and assistance, require surgical correction to stabilize the subtalar joint prior to further damage to the posterior tibial tendon. Subtalar arthroeresis is a procedure used to strengthen the subtalar joint. Arthroeresis is a term that means the motion of the joint is blocked without fusion. Subtalar arthroeresis can only be used in cases of Stage I or II where mild to be able to moderate deformation of the arch has occurred and MRI findings show the muscle to be only partially ruptured. Subtalar arthroeresis is typically performed in conjunction with an Achilles tendon lengthening procedure to improve equinus. These methods require casting for a period of weeks following the method.
- Additional references include;
- Cantanzariti, A.R., Lee, M.S., Mendicino, R.W.
- Posterior Calcaneal Displacement Osteotomy with regard to Adult Acquired Flatfoot.
- J. of Foot and Ankle Surgery. 39-1: 2-14, 2000
Alcohol. Consuming opposite foods. Lack of sleep. Obesity. Sedentary work Causes of Gout: - Gout is brought on by high blood levels of uric acid that crystallize and form painful deposits in the joints. Traditional thinking tells us that gout is the result of excessive amounts of alcohol, protein, heavy foods, coffee and soft drinks in your diet. These foods cause uric acid levels to increase. Other foods that increase uric acid are anchovies, asparagus, legumes, mushrooms, meat, organ meat, and also shellfish. Reduction in consumption of these foods is very often successful in reducing or eliminating gout.
For people with gout the uric acid degree in the blood is so high that uric acid crystals form and put in joints and other tissues. This will cause the joint cellular lining to become inflamed, resultant in sudden and severe attacks of pain, softness, redness and warmth. Either way, gout treatment options may include medication to lower the uric acid level or perhaps a special gout diet to be able to decrease the amount of purine ingested.
- Take the actual falconoid quercetin - see below under Folk Remedies.
- This should be part of your permanent gout-prevention diet.
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