Freiberg's Disease

Freiberg's Disease is a painful condition that affects the second metatarsal head. This is the bony knuckle in the ball of the foot behind the second toe. It can also affect the third and fourth metatarsal bones, but they are less commonly affected.
More than 80% of cases are females, and most of those are women up to the age of 20 years. Children who are athletes are often most commonly affected, especially those who are on their toes a lot in sprinting or jumping. The primary complaint is often vague forefoot pain, worsened by activity and weight-bearing and relieved with rest.

Freiberg's Disease occurs in children when there is a disruption of blood flow to the tip of the bone because of excessive pressure. It happens at the site of the growth plate, which closes in adolescence and therefore does not affect adults. In some cases a mechanical cause is thought to be the reason for the condition. A traumatic event, such as a heavy blow, or several small incidents can also cause Freiberg's Disease.
Freiberg's Infarction is the term applied when it occurs to children. Infarct means tissue death because of lack of blood. It is likely the excessive pressure causes a small fracture to occur within the cartilage growth plate that is between the long shaft of the metatarsal bone and the head, cutting off the blood flow. On an x-ray the area will be transparent as calcium leaves the bone, which will collapse on itself. The process takes about a year and when it is complete, the bone will be denser and whiter. An x-ray will also show the flattening of the rounded tip of the metatarsal bone and thickening of the shaft.
Freigberg's Infraction is applied to adults where the x-rays are similar. Most people have two or three arteries supplying blood to the area, but some have only one artery, making possible bone death. In others, the first metatarsal does not function properly and shuns its share of the body weight over the second, third, and fourth bones.
Treatment includes examination of the foot, which should show the area to be swollen, stiff, and painful. To find the tender spot, the podiatrist will flex the toe back as far as possible to expose the end of the metatarsal as well as the bottom surface. Treatment will focus on reducing the pressure on the second metatarsal head, by deflecting the pressure away from the area, causing the first metatarsal to take its share of the weight.
If your child has Freiberg's Disease, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Kohler's Disease In the Foot

Kohler's Disease is a rare bone disorder of the foot found in children between the ages of 6 and 9, affecting boys more than girls. It was first described in 1908 by Alban Kohler a German radiologist.
It is caused when the navicular bone temporarily loses its blood supply and as a result, the tissue in the bone dies and the bone collapses.
Symptoms include pain and swelling in the middle of the foot and usually a limp. Patients who limp tend to put increased weight on the lateral side of their foot. They may also experience tenderness over the navicular and pain over the apex.
In February 2010 the Journal of the American Medical Association reported that Egyptian boy king Tutankhamun may have died from complications of the disease along with malaria.
Your podiatrist will take an X-ray of the affected foot to diagnose the disease. The affected foot will have a sclerotic and flattened navicular bone.
When treated, this disease has no long term affects, but rarely it can return in adults. Treatment includes resting the affected foot, taking pain relievers, and avoiding putting pressure on the foot. In severe cases, the patient wears a cast, worn between 6 and 8 weeks. After the cast is removed, arch supports are worn for about 6 months. Children may benefit from moderate exercise and physical therapy. Children who follow the prescribed treatment will heal quickly. Kohler's Disease may persist for some time, but most cases are resolved within two years.
If your child has Kohler's Disease, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Adult Cavovarus Foot

Adult cavovarus foot is the result of an imbalance of muscle forces, usually from motor sensory neuropathies. It is seldom seen at birth, but the deformity becomes apparent as the child, or the deformity grows. Other causes include cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot.
In this foot deformity, the strong peroneus longus and tibialis posterior muscles cause the hindfoot varus and forefoot varus (pronated) position. Hindfoot varus causes overload of the border of the foot, which results in ankle instability, stress fractures, and peroneal tendonitis. In overloaded joints, degenerative arthritis can develop. Claw toes may also be a symptom of this deformity.
Your podiatrist will do a gait examination, which allows for the planning of tendon transfers to correct the stance and swing-phrase deficits. They will also inspect the forefoot and hindfoot to determine the need for soft-tissue release and osteotomy. The Coleman block test assesses the cause of hindfoot varus.
Oddly enough, prolonged use of orthotics and supportive shoes can result in muscle imbalance, creating the deformity and causing irreversible damage to the tendons and joints. Your doctor will have to rebalance the tendons to avoid deterioration of the foot. Muscle imbalance can be rectified by tendon transfer, corrective osteotomy, and fusion.
If you have cavovarus foot, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Hitchhiker's Toe

"Hit the road, Jack, and don't you come back no more no more..."
Hitchhikers are often seen on major state roads, giving the old thumbs up gesture, an indication that they're looking for a ride. But did you ever see a hitchhiker giving the old big toe up gesture???
Hitchhiker's toe resembles the thumb of a hitchhiker, due to the hyperextension of the extensor hallucis longus muscle. This involuntary position is also called striated toe.

A patient often develops the hyperextension of hitchhiker's toe from spasticity,  which is caused by brain injuries, like a stroke, neurological condition, or spinal cord injury. Some toes are painful because of an altered gait or shoe fitting issues. This issue is also commonly found with other neurological conditions; drop foot and equino varus deformity are also common with hitchhiker's toe.
Symptoms include the first toe pulling up instead of lying down as it should, pain due to pulling on the muscle, and pain or callusing on the toe where it hits the shoe. The patient should look out for when the foot moves into the varus position, the aftereffects of a stroke or other neurological condition, or recovery from spine surgery or injury.
Causes of this deformity include stroke, cerebral palsy, physical trauma, such as a spinal cord injury, and
other neurological disorders.
The goal of treatment is to restore balance and support in the foot, since the big toe bears a great deal of our body's weight. An lower and thinner orthotic may be created to support the longitudinal and metatarsal, and bracing may be necessary to relax the toe. The patient should avoid flip-flops, except those approved by the American Podiatric Medical Association, high heels, and going barefoot. Physical therapy may be prescribed to regain strength in the toe.
If you have hitchhiker's toe, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Metatarsus Adductus in Children

Metatarsus adductus, or metatarsus varus, is a common foot deformity present at birth that causes the front half of the foot to turn inward. This condition can be flexible, meaning the foot can be straightened by hand, or non-flexible, meaning the foot cannot be straightened by hand.

The cause of metatarsus adductus is not known and occurs in one out of every 1,000 or 2,000 live births, affecting boys and girls evenly. Causal factors include a family history of metatarsus adductus, the position of the baby in the uterus, especially with breech babies, and the sleeping position of the baby (babies sleeping on their stomach sometimes increase the tendency to turn their feet outward).
Babies born with metatarsus adductus may be at an increased risk of having a related hip condition called developmental dysplasia of the hip (DDH). DDH is when the hip joint slips in and out of its socket, because the socket is too shallow to keep the joint intact.
Diagnosis is through a physical examination, where the doctor will ask if any other family members have metatarsus adductus. X-rays are taken in cases of non-flexible metatarsus adductus.
Infants with metatarsus adductus have high arches and the big toe has a wide separation from the second toe and deviates inward. Flexible metatarsus adductus is diagnosed when the heel and forefoot can be aligned with each other with gentle pressure on the forefoot while holding the heel steady. If the heel is difficult to align with the heel, it is considered non-flexible, or stiff foot.
Treatment for metatarsus adductus is based on:

• Your child's age, overall health, and medical history
• Extent of the deformity
• Your child's tolerance for certain medications, procedures, or therapies
• Expectations of the course of treatment
• Your opinion or preference

The goal of treatment is to straighten the position of the forefoot and heel. There are various options, including:

• Observation for those with flexible forefoot
• Stretching or passive manipulation exercises
• Casts
• Surgery

Metatarsus adductus may suddenly resolve itself without any medical intervention.
Your doctor will instruct you in passive manipulation exercises on their feet while diaper changing and will recommend changing their sleeping position.
In rare cases where stretching and manipulation exercises do not work, long leg casts will be applied. Casts are used to stretch the soft tissues of the forefoot and are changed every one to two weeks. If the foot responds to casting, straight cast shoes will be prescribed to hold the forefoot in place. This cast is made without a curve in the bottom of the foot. Infants with very severe metatarsus adductus will require surgery to release the forefoot joints.
With treatment, this condition can be resolved and the child can live without pain in their foot.
If your child is born with metatarsus adductus and has foot deformities, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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