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June 25 2015

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Hammer Toe Causes And Treatments

HammertoeOverview

A Hammer toes is commonly mistaken as any type of toe deformity. The terms claw toe, or mallet toe, although technically different than a hammer toe, are commonly referred as such. The toe may be flexible with movement at the joints, or it may be rigid, especially if it has been present for a long time. With a true hammertoe the deformity exists at the proximal interphalangeal joint only.

Causes

Hammertoes are most common in women, and a big part of this is poor shoe choices, which are a big factor in the development of many foot problems. Tight toe boxes and high heels are the biggest culprits. Genetics certainly hammertoe plays a role in some cases of hammertoes, as does trauma, infection, arthritis, and certain neurological and muscle disorders. But most cases of contracted toes are associated with various biomechanical abnormalities in how a patient walks. This causes the muscles and tendons to be used excessively or improperly, which deforms the toes over time.

Hammer ToeSymptoms

Pain on the bottom of your foot, especially under the ball of your foot, is one of the most common symptoms associated with hammertoes. Other common signs and symptoms of hammertoes include pain at the top of your bent toe from footwear pressure. Corns on the top of your bent toe. Redness and swelling in your affected area. Decreased joint range of motion in your affected toe joints.

Diagnosis

Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.

Non Surgical Treatment

The most common treatment is to wear more comfortable shoes. When choosing a shoe, make sure the toe area is high and broad and has enough room for hammer toes. If there is chronic pain, surgery may be needed to correct a malalignment. Surgical treatments are aimed at loosening up the contracted toe joints to allow them to align properly. Other types of treatment are products designed to relieve hammer toes, such as hammer toe crests and hammer toe splints. These devices will help hold down the hammer toe and provide relief to the forefoot. Gel toe shields and gel toe caps can also be used. Gel toe shields and toe caps will help eliminate friction between the shoe and the toe, while providing comfort and lubrication.

Surgical Treatment

he basis for hammer toe surgery most often involves removing s portion of bone within the toe, to reduce the joint contracture. Depending on the direction the toe is deviated, soft tissue procedures may be necessary along with pinning the toe with a surgical wire.

HammertoePrevention

There are several things you can do to help prevent hammer toes from forming or progressing. Wear supportive shoes to help prevent deformities. Hammer toes are often related to faulty foot mechanics, especially foot flattening. Wear custom orthotics prescribed by your podiatrist. Orthotics may slow the progression or prevent the development of hammer toes. Avoid shoes with narrow or pointed toe boxes that can compress the toes.
Tags: Hammer Toes
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How To Fix Hammer Toes Without Surgery

HammertoeOverview

A Hammer toe is a toe that is bent because of a muscle imbalance around the toe joints. The imbalance causes the toe to bend at one or more joints, pushing the middle of the toe upward in a claw-like position. If you notice such changes, it is important to seek proper treatment. Hammer toes never get better without some type of intervention and the sooner it is treated, the better the outcome.

Causes

Poorly fitting shoes and muscle imbalances are the most common causes of hammertoe. When shoes are too narrow or do not accommodate the shape and size of your feet, they often contort the position of your toes. Choosing a shoe that fits is very important when it comes to avoiding foot problems like bunions or hammertoe. Having your toes bent for an extended period of time in a shoe that is too narrow or small forces your toes to adapt to the cramped space. With time, the muscles in your feet become accustomed to holding the flexed position of your toes, making it harder, or even impossible to straighten them.

Hammer ToeSymptoms

Common symptoms of hammertoes include pain or irritation of the affected toe when wearing shoes. corns and calluses (a buildup of skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location. Inflammation, redness, or a burning sensation. Contracture of the toe. In more severe cases of hammertoe, open sores may form.

Diagnosis

Your doctor is very likely to be able to diagnose your hammertoe simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate your gait as you walk and the types of shoes hammertoe you wear. You'll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to better define your deformity.

Non Surgical Treatment

Conservative treatment is the first choice, often starting with a change of shoes to ones that have soft, larger toe spaces. Toe exercises may be prescribed to stretch and strengthen the toe muscles. Over-the-counter straps, cushions or non-medicated corn pads may be recommended to help relieve your symptoms.

Surgical Treatment

If pinning the toe is not required during the procedure, then the surgery could be preformed in the doctor's office under a local anesthesia. Some patients prefer the comfort of sedation during the surgery and if this is the case or if a pin must be placed, then the surgery could be preformed in an outpatient surgery center.

Hammer ToePrevention

In addition to wearing proper shoes and socks, walking often and properly can prevent foot injury and pain. The head should be erect, the back straight, and the arms relaxed and swinging freely at the side. Step out on the heel, move forward with the weight on the outside of the foot, and complete the step by pushing off the big toe. Exercises specifically for the toe and feet are easy to perform and help strengthen them and keep them flexible. Helpful exercises include the following. Raise and curl the toes 10 times, holding each position for a count of five. Put a rubber band around both big toes and pull the feet away from each other. Count to five. Repeat 10 times. Pick up a towel with the toes. Repeat five times. Pump the foot up and down to stretch the calf and shin muscles. Perform for 2 or 3 minutes.
Tags: Hammer Toe

June 12 2015

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How To Treat Tailor'S Bunion Without Surgery

Overview
Bunions hard skin Bunions are a common problem that most people experience as a bony protuberance at the base of the big toe. A bunion, however, is more complicated than simply a bump on the foot. When a patient has a bunion, the big toe angles in towards the other toes, a condition called hallux valgus. Bunions are most common in women. The skin over your big toe may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful. Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. If this condition gets severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis. Bunions tend to get progressively worse over time without treatment.

Causes
Bunions are a common problem experienced mostly by women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot. It is important for men and women to realize that wearing dress shoes and boots, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.

Symptoms
Just because you have a bunion does not mean you have to have pain. There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Symptoms for a bunion may include pain on the inside of your foot at the big toe joint. Swelling on the inside of your foot at the big toe joint. Redness on the inside of your foot at the big toe joint. Numbness or burning in the big toe (hallux). Decreased motion at the big toe joint. Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint. Pain while wearing shoes, especially shoes too narrow or with high heels. Joint pain during activities. Other conditions which may appear with bunions include corns in between the big toe and second toe. Callous formation on the side or bottom of the big toe or big toe joint. Callous under the second toe joint. Pain in the second toe joint.

Diagnosis
People with bunions may be concerned about the changing appearance of their feet, but it is usually the pain caused by the condition that leads them to consult their doctor. The doctor will evaluate any symptoms experienced and examine the affected foot for joint enlargement, tissue swelling and/or tenderness. They will also assess any risk factors for the condition and will ask about family history. An x-ray of the foot is usually recommended so that the alignment of big toe joint can be assessed. This would also allow any other conditions that may be affecting the joint, such as arthritis, to be seen.

Non Surgical Treatment
This is probably the most important step. Wearing the right footwear can help reduce stress on a minor deformity and reduce the likelihood of it progressing. Recommendations are that the forefoot easily fits within the width of the shoe and there is adequate cushioning and arch support. Soft materials such as smooth leather, suede or fabric will also help to reduce irritation to the area. The podiatrist plays an invaluable role in managing patients with bunions. This is because they can offer a number of options to the patient that can help relieve pain and reduce the severity of the deformity. They can also reduce pressure on skin lesions that develop as a result of the biomechanical changes. Podiatrists can prescribe customised orthotic devices that help reduce the stress on a bunion and control biomechanical factors which cause them. These may be used in conjunction with bunion splints or cushions to further offload the area. Evidence has shown a significant reduction in pain with the use of customized orthotic devices. Bunions callous

Surgical Treatment
When the pain of a bunion interferes with daily activities, and conservative treatment has been completed it's time to discuss surgical options. Foot Mechanics has excellent relationships with many Orthopaedic Surgeons, who are the specialists who perform bunion surgery. Because bunions are caused by faulty foot mechanics surgery can improve the look of your feet by removing the ?bump? but if the underlying mechanics are not addressed then the bunion is likely to return. For this reason orthotics are used post-surgery to prevent the return of bunions.

Prevention
Shop for shoes that possess a removable liner, or insole, and stand on the liner after you have removed it from your shoe. This is an effective method to see if your shoe is wide enough in the forefoot to accommodate your bunion. If your bunion and forefoot are wider than the insole, your shoe will squeeze and constrict your bunion and create the symptoms that define this health problem. The insole should also be wide enough to fully accommodate your big toe when it points outward, away from your other toes.
Tags: Bunions

May 31 2015

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Over-Pronation Of The Foot What Are The Symptoms

Overview

Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person?s arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, possibly causing severe discomfort and leading to other foot problems.Over-Pronation

Causes

For those not familiar with the term pronation, you might be familiar with terms related to shoes and pronation such as ?motion control?, ?stability,? and ?neutral cushioned.? The terms motion control and stability are typically associated with the word ?over-pronation? or a foot that is supposedly pronating too much and needs correction. According to the running shoe industry, ?over-pronation? is a biomechanical affliction evident when the foot and or ankle rolls inward past the vertical line created by your leg when standing.

Symptoms

Symptoms can manifest in many different ways. The associated conditions depend on the individual lifestyle of each patient. Here is a list of some of the conditions associated with Over Pronation. Hallux Abducto Valgus (bunions). Hallux Rigidus (stiff 1st toe). Arch Pain. Heel Pain (plantar fascitis). Metatarsalgia (ball of the foot pain). Ankle sprains. Shin Splints. Achilles Tendonitis. Osteochondrosis. Knee Pain. Corns & Calluses. Flat Feet. Hammer Toes.

Diagnosis

So, how can you tell if you have overpronation, or abnormal motion in your feet, and what plantar fasciitis treatment will work to correct it? Look at your feet. While standing, do you clearly see the arch on the inside of your foot? If not, and if the innermost part of your sole touches the floor, then your feet are overpronated. Look at your (running/walking) shoes. If your shoes are more worn on the inside of the sole in particular, then pronation may be a problem for you. Use the wet foot test. Wet your feet and walk along a section of pavement, then look at the footprints you leave behind. A normal foot will leave a print of the heel connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you?re feet are pronated there may be little distinction between the rear and forefoot.Over-Pronation

Non Surgical Treatment

If you overpronate, you should talk with a foot and ankle specialist, especially if symptoms have not developed yet. Questions you may want to ask your doctor include what are the best running shoes on the market? Where can I find those shoes? If over-the-counter orthotics don?t work, how long should I wait before contacting you for custom-made orthotics? On my next visit, what type of diagnostic testing should I expect? If I limit the amount of time I spend running, will my overpronation symptoms disappear? What additional treatment options can we try?

Surgical Treatment

Hyperpronation can only be properly corrected by internally stabilizing the ankle bone on the hindfoot bones. Several options are available. Extra-Osseous TaloTarsal Stabilization (EOTTS) There are two types of EOTTS procedures. Both are minimally invasive with no cutting or screwing into bone, and therefore have relatively short recovery times. Both are fully reversible should complications arise, such as intolerance to the correction or prolonged pain. However, the risks/benefits and potential candidates vary. Subtalar Arthroereisis. An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer. HyProCure Implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.

May 20 2015

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What Is Severs Disease?

Overview

Another name for Sever?s Disease is calcaneal apophysitis. The heel bone is called the calcaneus. Sever?s Disease is heel pain thought to be caused by inflammation around the growth plate in the calcaneus (apophysis). It is most likely due to repetitive overuse during sports and exercise, which causes increased strain on the heel growth plate. Sever?s Disease won?t cause long-term damage or arthritis. Sever?s Disease is often associated with tight heel tendons. It most commonly affects physically active children who are between the ages of 8, 14 years old, such as soccer players and gymnasts.

Causes

The most common of the Sever?s disease causes is when the heel bone grows more rapidly than the muscles and tendons in the leg. The muscles and tendons become tight and put additional stress on the growth plate in the heel. When this happens, the growth plate begins to swell, becomes tender, and the child will essentially begin to feel one or more Sever?s disease symptoms. It can occur in any child as they grow, but there are some common Sever?s disease causes and risk factors that make a child more prone to the condition. They include participation in sports and other activities that put pressure on the heel, such as basketball, track, and gymnastics. A pronated foot, which makes the Achilles tendon tight, increasing the strain on the growth plate of the heel. An arch that is flat or high, affecting the angle of the heel. Short leg syndrome, when one leg is shorter than the other, causing the shorter leg to pull more on the Achilles tendon in order to reach the ground. Obesity puts extra weight on the growth plate, which can cause it to swell.

Symptoms

Sever?s disease is a clinical diagnosis based on the youth?s presenting symptoms, rather than on diagnostic tests. While x-rays may be ordered in the process of diagnosing the disease, they are used primarily to rule out bone fractures or other bone abnormalities, rather than to confirm the disease. Common Characteristics of Sever?s Disease include Posterior inferior heel pain. Pain is usually absent when waking in the morning. Increased pain with weight bearing, running, or jumping (or activity-related pain). Area often feels stiff or inflexible. Youth may limp at the end of physical activity. Tenderness at the insertion of the tendons. Limited ankle dorsiflexion range that is secondary to tightness of the Achilles tendon. Activity or sport practices on hard surfaces can also contribute to pain, as well as poor quality shoes, worn out shoes, or the wrong shoes for the sport. Typically, the pain from this disease gradually resolves with rest.

Diagnosis

Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.

Non Surgical Treatment

The treatment of Sever's disease depends upon the severity of symptoms experienced by the patient. Care is initiated with a simple program of stretching and heel elevation to weaken the force applied to the calcaneus by the Achilles tendon. If stretches and heel elevation are unsuccessful in controlling the symptoms of Sever's disease, children should be removed from sports and placed on restricted activities. Mild Symptoms. Wear a 3/8 heel lift at all times (not just during physical activity). It is important to use a firm lift and not a soft heel pad. Calf stretches 6/day for 60 seconds each. Calf stretches are best accomplished by standing with the toes on the edge of a stretching block. Moderate Symptoms. Follow the directions for minor symptoms and decrease activity including elimination of any athletic activity. In addition to stretching by day, a night stretching splint can be worn while sleeping. Severe Symptoms. Follow the directions for mild and moderate symptoms. Children should be removed from sports activities such as football, basketball, soccer or gym class. A below knee walking cast with a heel lift or in severe cases, non-weight bearing fiberglass cast, may be indicated for 4-6 weeks. The cast should be applied in a mildly plantar flexed position. Cam Walkers should not be used for Sever's Disease unless they have a built in heel lift.

Prevention

Sever's disease may be prevented by maintaining good joint and muscle flexibility in the years leading up to, and during, their growth spurts (eg girls 8 to 10, boys 10 to 12). Foot arch problems such as flat feet should be addressed after the age of five if they don't appear to be self-correcting. If you are concerned, please ask your health practitioner. The most important factor is the amount of weight-bearing exercise your child is currently performing.

April 16 2015

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Does Posterior Tibial Tendon Dysfunction Require Surgical Teatment ?

Overview
Posterior tibial tendon insufficiency (also called posterior tibial tendon dysfunction or adult acquired flatfoot) has been named literally after failure of the posterior tibial tendon. However, the condition is caused not only by the progressive failure of the posterior tibial tendon; it is also failure of associated ligaments and joints on the inner side of the ankle and foot. This results in collapse of the arch of the foot, along with the deformity which most often becomes the debilitating problem in its later stages. While at the beginning the common symptom is pain over the tendon in the inner part of the hindfoot and midfoot, later on it is the deformity that can threaten a person?s ability to walk. Just as the tendon degenerates and loses its function, other soft tissue on the same inner side of the foot - namely the ligaments - degenerate and fail. Ligaments are responsible for holding bones in place, and when they fail, bones shift to places where they shouldn?t; deformity is the result. The deformity causes malalignment, leading to more stress and failure of the ligaments. Acquired flat foot

Causes
Posterior tibial tendon dysfunction is the most common cause of acquired adult flatfoot deformity. There is often no specific event that starts the problem, such as a sudden tendon injury. More commonly, the tendon becomes injured from cumulative wear and tear. Posterior tibial tendon dysfunction occurs more commonly in patients who already have a flat foot for other reasons. As the arch flattens, more stress is placed on the posterior tibial tendon and also on the ligaments on the inside of the foot and ankle. The result is a progressive disorder.

Symptoms
Initially, flatfoot deformity may not present with any symptoms. However, overtime as the tendon continues to function in an abnormal position, people with fallen arches will begin to have throbbing or sharp pain along the inside of the arch. Once the tendon and soft tissue around it elongates, there is no strengthening exercises or mechanism to shorten the tendon back to a normal position. Flatfoot can also occur in one or both feet. If the arch starts to slowly collapse in one foot and not the other, posterior tibial dysfunction (PTTD) is the most likely cause. People with flatfoot may only have pain with certain activities such as running or exercise in the early phase of PTTD. Pain may start from the arch and continue towards the inside part of the foot and ankle where the tendon courses from the leg. Redness, swelling and increased warmth may also occur. Later signs of PTTD include pain on the outside of the foot from the arch collapsing and impinging other joints. Arthritic symptoms such as painful, swollen joints in the foot and ankle may occur later as well due to the increased stress on the joints from working in an abnormal position for a long period of time.

Diagnosis
Posterior Tibial Tendon Dysfunction is diagnosed with careful clinical observation of the patient?s gait (walking), range of motion testing for the foot and ankle joints, and diagnostic imaging. People with flatfoot deformity walk with the heel angled outward, also called over-pronation. Although it is normal for the arch to impact the ground for shock absorption, people with PTTD have an arch that fully collapses to the ground and does not reform an arch during the entire gait period. After evaluating the ambulation pattern, the foot and ankle range of motion should be tested. Usually the affected foot will have decreased motion to the ankle joint and the hindfoot. Muscle strength may also be weaker as well. An easy test to perform for PTTD is the single heel raise where the patient is asked to raise up on the ball of his or her effected foot. A normal foot type can lift up on the toes without pain and the heel will invert slightly once the person has fully raised the heel up during the test. In early phases of PTTD the patient may be able to lift up the heel but the heel will not invert. An elongated or torn posterior tibial tendon, which is a mid to late finding of PTTD, will prohibit the patient from fully rising up on the heel and will cause intense pain to the arch. Finally diagnostic imaging, although used alone cannot diagnose PTTD, can provide additional information for an accurate diagnosis of flatfoot deformity. Xrays of the foot can show the practitioner important angular relationships of the hindfoot and forefoot which help diagnose flatfoot deformity. Most of the time, an MRI is not needed to diagnose PTTD but is a tool that should be considered in advanced cases of flatfoot deformity. If a partial tear of the posterior tibial tendon is of concern, then an MRI can show the anatomic location of the tear and the extensiveness of the injury.

Non surgical Treatment
Get treated early. There is no recommended home treatment. While in stage one of the deformity, rest, a cast, and anti-inflammatory therapy can help you find relief. This treatment is followed by creating custom-molded foot orthoses and orthopedic footwear. These customized items are critical in maintaining the stability of the foot and ankle. Once the tendon has stretched and deformity is visible, the chances of success for non-surgical treatment are significantly lower. In a small percentage of patients, total immobilization may arrest the progression of the deformity. A long-term brace known as an ankle foot orthosis is required to keep the deformity from progressing. The Richie Brace, a type of ankle foot orthosis, shows significant success as a treatment for stage two posterior tibial dysfunction. It is a sport-style brace connected to a custom corrected foot orthodic that fits into most lace-up footwear (including athletic shoes). It is also light weight and more cosmetically appealing than traditionally prescribed ankle foot orthosis. The Arizona Brace, California Brace or Gauntlet Brace may also be recommended depending on your needs. Adult acquired flat feet

Surgical Treatment
Surgical intervention for adult acquired flatfoot is appropriate when there is pain and swelling, and the patient notices that one foot looks different than the other because the arch is collapsing. As many as three in four adults with flat feet eventually need surgery, and it?s better to have the joint preservation procedure done before your arch totally collapses. In most cases, early and appropriate surgical treatment is successful in stabilizing the condition.

March 12 2015

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The Cause For Adult Aquired Flat Foot

Overview

Posterior Tibial Tendon Dysfunction (PTTD) is a painful flatfoot condition that affects adults, primarily over the age of 50. Also known as Adult Acquired Flatfoot, this issue affects women more than men and is linked to obesity, hypertension and diabetes. Most people with PTTD have had flat feet all of their lives. Then, for reasons not fully understood, one foot starts to become painful and more deformed.Acquired Flat Foot



Causes

Many health conditions can create a painful flatfoot, an injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.



Symptoms

Patients will usually describe their initial symptoms as "ankle pain", as the PT Tendon becomes painful around the inside of the ankle joint. The pain will become more intense as the foot flattens out, due to the continued stretching and tearing of the PT Tendon. As the arches continue to fall, and pronation increases, the heel bone (Calcaneus) tilts into a position where it pinches against the ankle bone (Fibula), causing pain on both the inside and outside of the ankle. As the foot spends increased time in a flattened, or deformed position, Arthritis can begin to affect the joints of the foot, causing additional pain.



Diagnosis

Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon, the tendon which is primarily responsible for supporting the arch structure of the foot.



Non surgical Treatment

Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted.

Flat Feet



Surgical Treatment

Until recently, operative treatment was indicated for most patients with stage 2 deformities. However, with the use of potentially effective nonoperative management , operative treatment is now indicated for those patients that have failed nonoperative management. The principles of operative treatment of stage 2 deformities include transferring another tendon to help serve the role of the dysfunctional posterior tibial tendon (usually the flexor hallucis longus is transferred). Restoring the shape and alignment of the foot. This moves the weight bearing axis back to the center of the ankle. Changing the shape of the foot can be achieved by one or more of the following procedures. Cutting the heel bone and shifting it to the inside (Medializing calcaneal osteotomy). Lateral column lengthening restores the arch and overall alignment of the foot. Medial column stabilization. This stiffens the ray of the big toe to better support the arch. Lengthening of the Achilles tendon or Gastrocnemius. This will allow the ankle to move adequately once the alignment of the foot is corrected. Stage 3 acquired adult flatfoot deformity is treated operatively with a hindfoot fusion (arthrodesis). This is done with either a double or triple arthrodesis - fusion of two or three of the joints in hindfoot through which the deformity occurs. It is important when a hindfoot arthrodesis is performed that it be done in such a way that the underlying foot deformity is corrected first. Simply fusing the hindfoot joints in place is no longer acceptable.

March 06 2015

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What Will Cause Achilles Tendon Pain ?

Overview

Achilles TendonitisThe Achilles tendon is the thickest and strongest tendon in your body, connecting your calf muscles to the back of your heel. Virtually all of the force generated when you ?toe off? the ground during running is transmitted by the Achilles, and this force can be as much as three times your body weight. And the faster you run, the more strain you put on the Achilles tendon. As such, it?s prone to injury in many runners, but particularly those who do a lot of fast training, uphill running, or use a forefoot-striking style. Achilles tendon injuries account for 5-12% of all running injuries, and occur disproportionately in men. This may be because of the faster absolute speeds men tend to train at, or may be due to other biomechanical factors.

Causes

The cause of paratenonitis is not well understood although there is a correlation with a recent increase in the intensity of running or jumping workouts. It can be associated with repetitive activities which overload the tendon structure, postural problems such as flatfoot or high-arched foot, or footwear and training issues such as running on uneven or excessively hard ground or running on slanted surfaces. Tendinosis is also associated with the aging process.

Symptoms

Achilles tendonitis is an injury that occurs when your Achilles tendon -- the large band of tissues connecting the muscles in the back of your lower leg to your heel bone -- becomes inflamed or irritated. The signs and symptoms of Achilles tendonitis often develop gradually. You'll feel pain and stiffness in your Achilles, especially when you first get out of bed. The pain lessens as you warm up, and may even disappear as you continue running. Once you stop, the pain returns and may feel even worse. You may also notice a crackling or creaking sound when you touch or move your Achilles tendon.

Diagnosis

Your physiotherapist or sports doctor can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests. Achilles tendons will often have a painful and prominent lump within the tendon. Further investigations include US scan or MRI. X-rays are of little use in the diagnosis.

Nonsurgical Treatment

Treating Achilles tendinitis rarely requires much professional intervention. Ease the pain with OTC pain killers. Stretch and strengthen the Achilles tendon. Stop the condition from happening again. Doctors treating Achilles tendinitis will recommend the following options for accomplishing this. Pain Killers - Generally ibuprofen (Advil) or naproxen (Aleve) will ease the mild pain. Physical Therapy, Stretches and exercises devised to lengthen and strengthen the Achilles tendon will help reduce pain and prevent future recurrence. Orthopedic Supports, Heel-elevating insoles or other orthotic devices can reduce the strain on the Achilles tendon, helping ease the inflammation and pain.

Achilles Tendinitis

Surgical Treatment

Many people don't realize that Achilles tendon surgery can be very traumatic to your body. The type of trauma you experience after surgery can be compared to what you go through when you first injured your Achilles tendon. During the first 24 to 72 hours after the surgery your ankle will be tender, swollen and very painful. Your leg will be weak and unstable making it impossible for you to put weight on your leg without some kind of help. This is why your doctor or surgeon will have you outfitted for a cast, ankle brace and/or crutches before the procedure. When you are relying on a cast/brace and crutches your Achilles tendon is less likely to be as active as it once was. This is usually why atrophy (loss) of your lower leg muscles (specifically your calf muscle) happens. In general, more than 80%* of people who undergo surgery for an injured Achilles Tendon are able to return to their active lifestyle. In order to avoid re-injury, it is important to commit to a regular conservative therapy routine.

Prevention

By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.

January 18 2015

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What Causes Heel Pain

Plantar Fascia

Overview

Plantar Fasciitis is a chronic pain in the heel that can just appear from nowhere but it is actually a long standing mechanical condition caused by prolonged stress on your foot. In most cases Plantar Fasciitis is a common, but very treatable, mechanical condition of the foot and responds positively to orthotics. A heel pain caused by prolonged stress on a ligament like structure in the arch that is very important in weigh-bearing activities. The tissue becomes damaged and needs to be helped to repair in order for the pain to go or subside to a manageable level. Orthotics for your feet can achieve this necessary healing for pain relief. It can be very painful, and even debilitating for sufferers.



Causes

A number of factors can contribute to plantar fasciitis. While men can get plantar fasciitis, it is more common in women. You're also more likely to have this condition as you age or if you are overweight. Take up a new form of exercise or suddenly increase the intensity of your exercise. Are on your feet for several hours each day. Have other medical conditions such as rheumatoid arthritis or lupus (systemic lupus erythematosus). Tend to wear high-heeled shoes, and then switch abruptly to flat shoes. Wear shoes that are worn out with weak arch supports and thin soles. Have flat feet or an unusually high arch. Have legs of uneven lengths or an abnormal walk or foot position. Have tight achilles tendons, or ‘heel cords’.



Symptoms

Plantar fasciitis sufferers feel a sharp stab or deep ache in the middle of the heel or along the arch. Another sign is the morning hobble from the foot trying to heal itself in a contracted position overnight. Taking that first step causes sudden strain on the bottom of the foot. The pain can recur after long spells of sitting, but it tends to fade during a run, once the area is warmed up.



Diagnosis

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose plantar fasciitis. Occasionally, further investigations such as an X-ray, ultrasound or MRI may be required to assist with diagnosis and assess the severity of the condition.



Non Surgical Treatment

No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better. Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces. To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). Do toe stretches camera.gif, calf stretches camera.gif and towel stretches camera.gif several times a day, especially when you first get up in the morning. (For towel stretches, you pull on both ends of a rolled towel that you place under the ball of your foot.) Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts. Use them in both shoes, even if only one foot hurts. If these treatments do not help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid) in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months. Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few weeks. But it may take time for the pain to go away completely. It may take a few months to a year. Stay with your treatment. If you don't, you may have constant pain when you stand or walk. The sooner you start treatment, the sooner your feet will stop hurting.

Heel Discomfort



Surgical Treatment

Surgery should be reserved for patients who have made every effort to fully participate in conservative treatments, but continue to have pain from plantar fasciitis. Patients should fit the following criteria. Symptoms for at least 9 months of treatment. Participation in daily treatments (exercises, stretches, etc.). If you fit these criteria, then surgery may be an option in the treatment of your plantar fasciitis. Unfortunately, surgery for treatment of plantar fasciitis is not as predictable as a surgeon might like. For example, surgeons can reliably predict that patients with severe knee arthritis will do well after knee replacement surgery about 95% of the time. Those are very good results. Unfortunately, the same is not true of patients with plantar fasciitis.

January 16 2015

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What Can Cause Painful Heel And Ways To Remedy It

Plantar Fascitis

Overview

Plantar fasciitis is a poorly understood condition. There is little consensus among medical professionals about what causes the problem, and no treatments have been reliably proven to treat it. A number of theories exists for why plantar fasciitis develops, but the ineffectiveness of conventional treatments suggests something is missing. The plantar fascia is a band of connective tissue that runs along the underside of the foot from the heel to the toes. The fascia helps maintain the integrity of the arch, provides shock absorption, and plays an important role in the normal mechanical function of the foot.



Causes

This is a problem of either extreme, so people with high arches or those that have very flat feet are at risk of developing pain in this region. This is because of the relative stress the plantar fascia is put under. In people with excessive pronation, the plantar fascia is put under too much stretch, as their range flattens and strains it. People with a stiff, supinated (high-arched) foot lack the flexibility to appropriately shock absorb, so this too puts extra strain on the plantar fascia. Clinically, we see more people presenting with plantar fascia pain who have excessive pronation than those with stiff, supinated feet. But while the foot type is the biggest risk factor for plantar fasciitis, the whole leg from the pelvis down can affect how the foot hits the ground. A thorough biomechanical assessment will determine where in the kinetic chain things have gone wrong to cause the overload.



Symptoms

You'll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting. Your heel pain will be worse with the first steps and improves with activity as it warms up. As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage your are in using the following guidelines. No Heel Pain, Normal! Heel pain after exercise. Heel pain before and after exercise. Heel pain before, during and after exercise. Heel pain all the time. Including at rest! This symptom progression is consistent with the four stages of a typical overuse injury. Ultimately, further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone it is known as heel spurs, which have a longer rehabilitation period.



Diagnosis

Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot, this could be a sign of nerve damage in your feet and legs (peripheral neuropathy) your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel, this could be a sign of arthritis. Possible further tests may include blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.



Non Surgical Treatment

In many instances, plantar fasciitis can be treated with home care. Changing your physical activities, resting the foot, and applying ice to the area are common remedies. Taking over the counter medications such as ibuprofen or acetaminophen can help reduce pain and inflammation that may have developed. An orthotic device placed in your shoes can also significantly help to reduce pain. In addition, orthotics can also help promote healing to reverse plantar fasciitis. If pain from plantar fasciitis continues despite conservative treatments, you may need to visit a doctor or podiatrist. It's important to seek medical advice before heel pain and damage becomes worse. If the condition is allowed to worsen, more serious or invasive forms of treatment may be required to stop pain. A visit to a doctor may reveal other conditions affecting the foot as well, such as Achilles tendonitis, heel spurs, or other heel pain conditions. An x-ray may also be taken, which can reveal the presence of a heel spur. In rare cases surgery may be required to release tension on the plantar fascia, or to remove a portion of a heel spur. But again, most heel pain conditions can be resolved using conservative treatment.

Feet Pain



Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.

January 12 2015

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What Leads To Heel Discomfort To Flare Up

Pain At The Heel

Overview

The plantar fascia is a band of connective tissue on the bottom of the foot that helps form the arch of the foot. Acute injury or cumulative trauma to the plantar fascia can be a cause of inflammation and heel pain. This is called plantar fasciitis.



Causes

The cause of plantar fasciitis is poorly understood and is thought to likely have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot. Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is actually due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. Due to this shift in thought about the underlying mechanisms in plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis. The structural breakdown of the plantar fascia is believed to be the result of repetitive microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers. Disruptions in the plantar fascia’s normal mechanical movement during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by placing excess strain on the calcaneal tuberosity.



Symptoms

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually worst with the first few steps after awakening, although it can also be triggered by long periods of standing or getting up from a seated position.



Diagnosis

X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more rare problems, stress fractures, bone tumors-are contributing to your heel pain.



Non Surgical Treatment

If conservative treatments fail, and the symptoms of plantar fasciitis have not been relieved, the doctor may recommend one of the following treatments. Cortisone, or corticosteroids, is medications that reduce inflammation. Cortisone is usually mixed with local anesthetics and injected into the plantar fascia where it attaches to the heel bone. In many cases this reduces the inflammation present and allows the plantar fascia to begin healing. Local injections of corticosteroids may provide temporary or permanent relief. Recurrence of symptoms may be lessened by combining steroid injections with other forms of treatment such as orthotics, changes in shoe gear, weight loss, stretching exercises, and rest. Repeated cortisone injections may result in rupture of the plantar fascia, thinning of the heel's fat pad, and other tissue changes. Extracorporeal Shock Wave Therapy (ESWT) devices generate pulses of high-pressure sound that travel through the skin. For reasons that are not fully understood, soft tissue and bone that are subjected to these pulses of high-pressure energy heal back stronger. There is both a high-energy and low-energy form of ESWT; and both forms of shock wave therapy can be used in the treatment of plantar fasciitis. Research studies indicate ESWT is a safe and effective treatment option for plantar fasciitis. The recovery period is shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.

Feet Pain



Surgical Treatment

Most practitioners agree that treatment for plantar fasciitis is a slow process. Most cases resolve within a year. If these more conservative measures don't provide relief after this time, your doctor may suggest other treatment. In such cases, or if your heel pain is truly debilitating and interfering with normal activity, your doctor may discuss surgical options with you. The most common surgery for plantar fasciitis is called a plantar fascia release and involves releasing a portion of the plantar fascia from the heel bone. A plantar fascia release can be performed through a regular incision or as endoscopic surgery, where a tiny incision allows a miniature scope to be inserted and surgery to be performed. About one in 20 patients with plantar fasciitis will need surgery. As with any surgery, there is still some chance that you will continue to have pain afterwards.



Stretching Exercises

Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch. Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.

January 09 2015

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What Is Pain At The Heel

Painful Heel

Overview

Plantar fasciitis is thickening of the plantar fascia, a band of tissue running underneath the sole of the foot. The thickening can be due to recent damage or injury, or can be because of an accumulation of smaller injuries over the years. Plantar fasciitis can be painful.



Causes

Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if your feet roll inward too much when you walk ( excessive pronation ). You have high arches or flat feet. You walk, stand, or run for long periods of time, especially on hard surfaces. You are overweight. You wear shoes that don't fit well or are worn out. You have tight Achilles tendons or calf muscles.



Symptoms

The most common symptoms of plantar fasciitis include pain on the bottom of the foot near the heel, pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking. Greater pain after (not during) exercise or activity.



Diagnosis

Your doctor will ask you about the kind of pain you're having, when it occurs and how long you've had it. If you have pain in your heel when you stand up for the first time in the morning, you may have plantar fasciitis. Most people with plantar fasciitis say the pain is like a knife or a pin sticking into the bottom of the foot. After you've been standing for a while, the pain becomes more like a dull ache. If you sit down for any length of time, the sharp pain will come back when you stand up again.



Non Surgical Treatment

Many types of treatment have been used to combat plantar fasciitis, including injections, anti-inflammatory medications, orthotics, taping, manipulation, night splinting, and instrument-assisted soft-tissue manipulation (IASTM). IASTM begins with heat, followed by stretching. Stretching may be enhanced by applying ice to the plantar fascia. These stretches should be performed several times per day, with the calf in the stretched position. IASTM uses stainless-steel instruments to effectively access small areas of the foot. IASTM is believed to cause a secondary trauma to injured soft tissues as part of the healing process. Therapeutic modalities such as low-level laser, ultrasound, and electrical muscular stimulation may be effective in the reduction of pain and inflammation. Low Dye strapping or taping of the foot is an essential part of successful treatment of plantar fasciitis. Extracorporeal shock-wave therapy (ESWT) was introduced with great promise at one time. Recent studies have reported less favorable results. Some report no effect. Previous local steroid injection may actually have a negative effect on results from ESWT.

Pain On The Heel



Surgical Treatment

The most common surgical procedure for plantar fasciitis is plantar fascia release. It involves surgical removal of a part from the plantar fascia ligament which will relieve the inflammation and reduce the tension. Plantar fascia release is either an open surgery or endoscopic surgery (insertion of special surgical instruments through small incisions). While both methods are performed under local anesthesia the open procedure may take more time to recover. Other surgical procedures can be used as well but they are rarely an option. Complications of plantar fasciitis surgery are rare but they are not impossible. All types of plantar fasciitis surgery pose a risk of infection, nerve damage, and anesthesia related complications including systemic toxicity, and persistence or worsening of heel pain.

January 06 2015

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Symptoms Of Joint Pain in the Foot

If your Back Pain feels like a bruise or a dull ache, you may have metatarsalgia People with metatarsalgia will often find that the pain is aggravated by walking in bare feet and on hard floor surfaces. Pain in the ball of your foot can stem from several causes. Ball of foot pain is the pain felt in the ball of foot region. Metatarsalgia is a condition characterized by having pain in ball of foot. The average adult takes about 9,000 steps per day.

TOE CONDITIONS: Ingrown toenails, blood accumulation under the nail plate (subungual hematoma), corns and calluses are all often seen as a result of playing baseball. It is important that good foot hygiene be practiced with washing between the toes and drying the feet well after bathing. Topical antifungals work well to treat athletes foot. ORTHOPEDIC INJURIES: Most orthopedic baseball foot and ankle injuries are acute or sudden. If an individuals foot or ankle is injured, seek immediate evaluation with one of our doctors. If your athlete has a baseball related injury, call our specialists at Advanced Foot and Ankle Center in McKinney and Prosper Texas at 972-542-2155. However, toe numbness and pain occurring together is one such problem that you cannot afford to ignore. Common symptoms are flat feet knee problems , burning sensation, numbness.

Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

The spur occurs where the plantar fascia attaches, and the pain in that area is really due to the plantar fascia attachment being irritated. However, there are many people with heel spurs who have no symptoms at all. Haglund's deformity is a bony growth on the back of the heel bone, which then irritates the bursa and the skin lying behind the heel bone. Achilles tendinopathy is degeneration of the tendon that connects your calf muscles to your heel bone. Stress fractures are common in military training.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

Went to Podiatrist after receiving pain pills to move, got MRI and he told me I have severe tear in plantor faciitis tendon. Have swelling or what I call a fatty feeling, as I have always had on ball of foot below left most two toes. And it seems to feel a little more fatty since I walked for the first time today after putting on a good pair of ankle boots. Any idea what the fatty feeling is on ball of foot. Lastly, I took the boot off at my stairs into my house 2 days ago and took a step using ball of left foot and it did not pop.

November 21 2014

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Caring For Your Feet As You Age

A bunionette is similar to a bunion, but it develops on the outside of the foot. Kate Middleton is barely seen out in public engagements without her trusty nude LK Bennett high heels on. When she made a pre-Olympic visit to a judo center however, she gamely kicked off her heels to step on the mat. Pain is a symptom common to many foot conditions, and pain medications are a good solution for most types of foot pain.

Podiatrists treat bunions, hammertoes, and all sources of toe and forefoot pain more than any other condition, save for heal pain and nail disease. There can be many complex mechanical causes for these conditions, as genetics has only an initial role in most cases of bunions and other toe and foot deformities. These conditions are successfully treated all day long by podiatrists, and should be the obvious first choice in care when foot pain develops. Sprains are a common injury, and often occur in the evenings or weekends after most medical practices are closed. It is very appropriate to present to an urgent care center or emergency room for serious foot and ankle sprains to ensure there is no fracture. These products can burn your skin.

Below is a series of questions that podiatrists commonly ask in order to find the source of the pain and how to better treat it. Patients should think about some of the answers to the following questions before and during the appointment in order to better assist the podiatrist in finding the source of the problem. Aside from treating the source of the problem, the podiatrist may offer treatment that can alleviate pain. Josie, now 2 years old, still has some health conditions and has had several close calls in her young life.

Continue to the next page to get tips on treating calluses - a foot condition almost everyone experiences at one time or another. Foot Injuries : Find out how to avoid unpleasant injuries to your feet, or at least reduce pain and prevent infection after they occur, with these simple suggestions. How to Care for Your Feet : Learn how to keep your feet - and yourself - healthy and happy with these tips on caring for your feet, including selecting the right shoes. For ladies that love to wear high heel footwear, the physics are immutable.

A lot of professionals believe that common physical activity may be the answer to gout. You'll want to have an expert to look at the concerns with your feet. The feet might be experiencing pain for a lot of numerous reasons. The deep tissue massage is ideal for people experiencing chronic muscle pain on their upper and lower back, legs, and shoulders. A deep tissue massage frees our muscles of toxin build-up that is usually the main cause of pain and muscle immobility. Some massage therapists call it pressure therapy” since it involves applying pressure to specific points on the foot. A foot massage is a very relaxing way of addressing problems with your body's internal organs. A trained massage therapist can also put pressure on different meridians or energy lines on the sole and side of the feet to determine the cause of illness. A sports massage is ideal of active individuals that are engaged in sports or intensive work-outs. However, they may be contagious for weeks after symptoms go away.

Since plantar fascia gets tightened while one is asleep, the sudden movement causes stretching of the ligament as one takes the first few steps. While structural foot abnormalities such as high arches or fallen arches can make one more susceptible to plantar fasciitis, wearing old worn-out shoes can also cause stress to the plantar fascia. Those suffering from plantar fasciitis are also at an increased risk of developing heel spurs. Heel spurs, also known as osteophytes, are abnormal bony outgrowths that may develop along the edges of the heel bone. Heel spurs form when the plantar fascia starts pulling at the heel bone or gets torn due to excessive stress. If the heel spurs start impinging on any of the surrounding nerves or the tissues, one is likely to suffer from pain. Plantar fasciitis and heel spurs surely affect one's ability to move about freely. This is the best way to support the arch of the foot. Pain then sets in and you may need surgery.

Avoid sharing personal items like towels, footwear and clothes with other people. Podiatry is a branch of medicine that is focused on the study, diagnosis and ultimately, the treatment of disorders that occur on the foot, ankle or lower leg. Podiatrists are able to easily identify, diagnose and treat a foot related problem that a person is suffering from. You can also prevent foot problems by some exercising and stretching.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

March 25 2014

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March 24 2014

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March 21 2014

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Complaints: Protecting Pennsylvanians - Pennsylvania Office of Attorney General




Complaints: Protecting Pennsylvanians - Pennsylvania Office of Attorney General

INSURANCE FRAUD REFERRALS

We receive referrals from a number of different sources: the insurance industry, businesses, employees, concerned citizens and other state or law enforcement agencies. If you suspect someone is committing insurance fraud, you are encouraged to submit an Insurance Fraud Referral Form.

INSURANCE INDUSTRY should use one of the following:
Instructions for Insurance Industry FormAdobe AcrobatINSURANCE INDUSTRY Printable Referral FormAdobe AcrobatINSURANCE INDUSTRY Online Referral Form
PRIVATE CITIZENSshould use one of the following:
Instructions for Private Citizen FormAdobe AcrobatPRIVATE CITIZEN Printable Referral FormAdobe AcrobatPRIVATE CITIZEN Online Referral Form
Or you may request a form by contacting:

PA Office of Attorney General
Insurance Fraud Section
16th Floor, Strawberry Square
Harrisburg PA 17120
(717) 787-0272 (phone)

March 19 2014

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List of Six Feet Under episodes - Wikipedia, the free encyclopedia




List of Six Feet Under episodes - Wikipedia, the free encyclopedia

Six Feet Under, an American television drama series created by Alan Ball, premiered on the premium cable network HBO in the United States on June 3, 2001 and ended its original run of five seasons and 63 episodes on August 21, 2005.[1] The series chronicles the Fisher family of funeral directors who struggle with relationships and their own personal demons while trying to maintain a small funeral home. All five seasons are available on DVD in individual box sets and in a collected volume.

Contents1 Series overview2 Episode list2.1 Season 1 (2001)2.2 Season 2 (2002)2.3 Season 3 (2003)2.4 Season 4 (2004)2.5 Season 5 (2005)3 References4 External links
Series overview[edit]SeasonEpisodesOriginally airedDVD release datesSeason premiereSeason finaleRegion 1Region 2Region 4113June 3, 2001August 19, 2001February 4, 2003[2]July 7, 2003[3]February 11, 2004[4]213March 3, 2002June 2, 2002July 6, 2004[2]June 21, 2004[5]July 14, 2004[6]313March 2, 2003June 1, 2003May 17, 2005[2]April 4, 2005[7]May 11, 2005[8]412June 13, 2004September 12, 2004August 23, 2005[2]May 9, 2005[9]November 16, 2005[10]512June 6, 2005August 21, 2005March 28, 2006[2]April 10, 2006[11]October 14, 2006[12]
Episode list[edit]
Season 1 (2001)[edit]No. in
seriesNo. in
seasonTitleDirected byWritten byOriginal air date11"Pilot"Alan BallAlan BallJune 3, 2001 (2001-06-03)On Christmas Eve 2000, patriarch Nathaniel Fisher (Richard Jenkins), owner of Fisher & Sons Funeral Home, is hit by a bus while driving his brand new hearse. His passing throws his immediate family into emotional chaos as they attempt to deal with their grief. Nathaniel's death casts a pall over the return of his older son Nate (Peter Krause), who was hoping for a relaxing vacation before returning to his home in Seattle. On the flight, he meets and later has sex with Brenda Chenowith (Rachel Griffiths). Dutiful son David (Michael C. Hall) is struggling to keep his true sexual identity and his new boyfriend Keith (Mathew St. Patrick) from his family. Matriarch Ruth (Frances Conroy) has her own secrets to keep, while youngest child and only daughter Claire (Lauren Ambrose) has her first taste of crystal meth before finding out about Nathaniel's death and must now go through the experience while tweaking. Meanwhile, Nathaniel's spectre repeatedly appears to each member of his family and forces them to face their own anxieties about life and death. 22"The Will"Miguel ArtetaChristian WilliamsJune 10, 2001 (2001-06-10)Chandler Swanson, the inventor of a large-scale pyramid scheme, is killed when he hits his head on the bottom of the pool. His young widow is shocked to learn that her husband's business was actually a scam and that she has inherited massive debts. Meanwhile, the reading of Nathaniel's will drives a wedge between Nate and David when he leaves them each half of the business. Claire, angry that she must either go to college or wait until she is twenty-five to get her inheritance, starts getting closer to Gabe (Eric Balfour), the boy who got her high the night Nathaniel died and they have a close encounter involving Gabe's toe. Ruth goes on a hiking trip with her boyfriend Hiram (Ed Begley, Jr.) and decides that from now on, she does not want to be involved with the family business, leaving all the responsibility to the brothers. David reconnects with his ex-fiancee Jennifer while pushing Keith away. Brenda helps both Nate and David deal with their grief and reconnect with each other in a surprising way. 33"The Foot"John PattersonBruce Eric KaplanJune 17, 2001 (2001-06-17)Thomas Alfredo Romano is cut into pieces and killed when the dough mixer he is cleaning is accidentally turned on. Nate persuades the others to sell Fisher and Sons to a large chain, Kroehner International, but Nathaniel's presence gives him second thoughts. Claire is humiliated when her car is vandalized at school with phrases like "toe slut" and "this little piggy lover". She takes her revenge by stealing one of Romano's severed feet and putting it in Gabe's locker. Nate must make a choice between taking the money and running from the business he hates and fears, or staying and using his gifts to help people. He and David decide to turn down Kroehner, but their refusal has serious consequences when the large corporation plans to open a cheap cremation house just across the street. Ruth decides to have a little fun and ends up losing $25,000 betting on horse races. The family discovers that Claire stole Romano's foot and events take a surprising turn when Kroehner's new property catches on fire. 44"Familia"Lisa CholodenkoLaurence AndriesJune 24, 2001 (2001-06-24)A gang member, Manuel "Paco" Bolin, is shot to death by a rival gang and Fisher & Sons arranges his funeral, but Nate and David have to turn to Federico (Freddy Rodriguez), their restorative artist, to help with the interference of gang leader Powerful. Meanwhile, Nate and Brenda are questioned over the fire, but Nate is more suspicious of Claire, given her recent behavior. Ruth hosts a dinner to meet Brenda, but walks in on her and Nate in a compromising position. The police rule the fire was started by "causes unknown", letting Fisher & Sons off the hook. An incident involving Keith forces David to confront his self-loathing, and David is antagonized by the spectre of Manuel about his "run-and-hide" attitude toward life. 55"An Open Book"Kathy BatesAlan BallJuly 1, 2001 (2001-07-01)Viveca St. John (Veronica Hart), a famous porn star, is electrocuted in her bath tub, bringing much needed business to Fisher & Sons, but her less than conventional circle of friends makes for an interesting funeral and shocks Ruth. Elsewhere, David is invited to be a deacon at his mother's church and this causes problems with Keith, who wants David to keep coming to church with him. Nate is introduced to Brenda's psychiatrist parents Margaret and Bernard (Joanna Cassidy and Robert Foxworth), who reveal a few of Brenda's darker secrets. Acting on the advice of Claire's guidance counselor, Ruth tries to form a closer relationship with her daughter, which does not go as planned. David comes out to Nate, but when he refuses to let Keith come to church with him, Keith accuses him of being a coward and breaks up with him and David later denies his sexuality to his brother. Nate meets Brenda's brother Billy (Jeremy Sisto), who is unstable and suffers from bipolar disorder. 66"The Room"Rodrigo Garc?aChristian TaylorJuly 8, 2001 (2001-07-08)Mildred "Hattie" Jones dies in her sleep, leaving her husband to arrange the funeral. Nate discovers some irregularities on the Fisher & Sons books, and discovers that Nathaniel used to trade funeral services for favors, such as getting marijuana from a local businesswoman and renting a room above an Indian restaurant, leading Nate to ponder just how well he really knew his father. Claire takes an interest in Billy, but when he later rejects her, she takes little comfort from Brenda's kind words. Tracy, a woman who has been aggressively pursuing David, makes him realize how lonely he is without Keith and he takes to trolling gay bars for companionship. Mr. Jones himself dies at his wife's side after her viewing and Ruth reignites her romantic relationship with Hiram the hairdresser. 77"Brotherhood"Jim McBrideChristian WilliamsJuly 15, 2001 (2001-07-15)A young veteran, Victor Kovitch, dies from supposed Gulf War syndrome and his brother Paul, who refuses a military service because he and Victor were fighting the Army for compensation, arranges the funeral. Nate soon discovers that Victor loved the Army and wanted a military burial but had never wanted to cause trouble with his brother. Nate and Brenda plan a trip away for the weekend, but their plans are interrupted by Billy, who is having an emotional crisis. David interviews a progressive priest for a position at the church, which forces him to consider his own place within the congregation. Ruth brings her boyfriend Hiram over for dinner and introduces him to the family, and takes a job working for Nikolai (Ed O'Ross) at his flower shop. Fisher & Sons holds a funeral for Victor without Paul's permission but Nate manages to convince Paul to give his brother the funeral he really wanted. 88"Crossroads"Allen CoulterLaurence AndriesJuly 22, 2001 (2001-07-22)It's a dry season in the funeral business for the Fisher family, and Rico takes the opportunity to test his skills and his income by freelancing with Kroehner. Business is so slow that Nate and David rent out their slumber room to a seniors' dance class, and David finds a short-term, drug-laced romance in the class' young male dance instructor. Nate is angered to discover Brenda's Australian friend is staying at her home and sleeping in her bed. He gets high and blows up at Brenda but the two later apologize for their erratic behaviors toward one another. Claire gets herself kicked out of a school trip after the leader finds marijuana in her bag. She befriends a classmate, Parker, and learns that people are not always what they seem. Ruth finds herself torn between the comfort that Hiram offers her and the spirit of adventure she finds in Nikolai. 99"Life's Too Short"Jeremy PodeswaChristian TaylorJuly 29, 2001 (2001-07-29)When Gabriel's six-year-old brother dies of a self-inflicted gunshot wound, Claire finds herself softening toward her ex-boyfriend. David hits the dance clubs with his new lover and discovers the joys of ecstasy--as does his mother, Ruth, when she takes the pills that David left in the aspirin bottle. David ends his relationship with his lover when he tries to coax him into a threesome. He later runs into Keith and his new boyfriend at a club. While under the influence of ecstasy, Ruth dreams of reuniting with her husband, Nathaniel. Brenda comes up with a scheme to improve Nate's management abilities by taking a whirlwind tour of some rival funeral homes after he flunks the funeral director's exam. 1010"The New Person"Kathy BatesBruce Eric KaplanAugust 5, 2001 (2001-08-05)The Fishers need to replace Rico and they hire outstanding but outspoken embalmer, Angela (Illeana Douglas). Brenda and Nate's relationship faces a mounting crisis when her brother, Billy, includes in his art exhibit a portrait of an unsuspecting Nate urinating against a wall. Finding Billy off his "meds" one time too many, Brenda's parents think he should be sent away for treatment. David orchestrates a meeting with his ex-boyfriend, Keith, which ends with David coming on to and being rejected by Keith, who is seeing someone new. Claire finds herself enmeshed in a deep relationship with Gabe, but it may be shallower than she thinks when he lies to her about going to visit his father, who Claire later finds out died when Gabe was four. David fires Angela for breaking one of his mother's wine glasses, and on her way out, Angela reveals to Ruth that her son is gay. Nate tracks down Rico, and he agrees to return to Fisher and Sons temporarily because of his new-found unhappiness at Kroehner. He also informs Nate that Kroehner set the house across the street on fire in order to collect insurance money, and they are not through with their take-down of Fisher & Sons. 1111"The Trip"Michael EnglerRick ClevelandAugust 12, 2001 (2001-08-12)David, Nate and Brenda attend a funeral directors' conference in Las Vegas where David successfully speaks on the role of independent funeral homes as he faced the "suits" from Kroehner. David's fellow funeral director friends pay for a female stripper to give David a lap dance, and he is forced to reveal that he is gay. He calls a male prostitute and is later arrested for having sex in public. David calls Keith to bail him out of jail. Keith is able to have the charges dropped, but he is disappointed that David was having unprotected sex with a prostitute. Brenda and Nate are disturbed to discover that Brenda's psychotic brother, Billy, followed them and broke into their hotel room to photograph them naked and asleep in bed. Meanwhile, Rico has rejoined the firm and faces a tough emotional challenge with his first client, a three-week old infant who died of SIDS, which causes him to worry about the impending birth of his own child. Ruth attends a class to make her flower arranging less funereal after a suggestion from Nikolai. Claire finds out that Gabe overdosed on heroin and visits him in a hospital. The episode ends with Claire and Gabe professing their love for one another and the birth of Rico and Vanessa's son, Agosto. 1212"A Private Life"Rodrigo Garc?aKate RobinAugust 19, 2001 (2001-08-19)The homophobic killing of a young man forces David to re-examine his lifestyle and his family relationships. Brenda is trying her best to break from her brother, Billy. Nate goes to pick up a body when in reality, Billy had lured him there, where he displays pictures of himself kissing Nate's sister, Claire, and of Nate and Brenda having sex. He threatens Nate with a knife, but Nate is able to escape. Brenda then breaks up with Nate, telling him she needs space. Later, Billy breaks into Brenda's home, showing her that he has removed his tattoo on his lower back of the name "Isabel" by cutting off his own skin. He tries to remove Brenda's matching tattoo, but she is able to knock him unconscious and call an ambulance. She decides to have Billy committed, and she and Nate reunite. Ruth suspects that David is gay. She asks Robbie, her homosexual co-worker, how he came out to his mother, and he tells her that it is not her business. Eventually, David comes out to an accepting Ruth and a disgusted Rico. At the funeral, Keith is on patrol to protect the family from homophobic rioters. David assaults one of the rioters in retaliation, and Keith covers for him. Claire is concerned that Gabe's overdosed was not accidental and is concerned for his well-being. 1313"Knock, Knock"Alan BallAlan BallAugust 19, 2001 (2001-08-19)Tracy Blair arranges a funeral for her aunt; Federico holds a christening party for his son Augusto at the Fisher residence. Brenda visits her brother Billy in the mental hospital.
Season 2 (2002)[edit]No. in
seriesNo. in
seasonTitleDirected byWritten byOriginal air date141"In the Game"Rodrigo Garc?aAlan BallMarch 3, 2002 (2002-03-03)Ruth holds a special dinner in David's honor. Federico's sister-in-law arranges a funeral for a young actress. 152"Out, Out Brief Candle"Kathy BatesLaurence AndriesMarch 10, 2002 (2002-03-10)A college football player dies of heat stroke. Nate battles with keeping his arteriovenous malformation (AVM) secret. Brenda has dinner with an old friend. The Fishers make an investment on a casket wall to raise profits, much to the chagrin of Rico. 163"The Plan"Rose TrocheKate RobinMarch 17, 2002 (2002-03-17)The funeral for a psychic's husband raises many interesting questions. Ruth attends a self-help seminar. As Mrs. Piper transitions her husband into the afterlife, Nathaniel questions his sons on where he may be. 174"Driving Mr. Mossback"Michael CuestaRick ClevelandMarch 24, 2002 (2002-03-24)Nate and Claire travel to Seattle to retrieve a body. David babysits for Keith's niece. Ruth makes amends with people from her past. 185"The Invisible Woman"Jeremy PodeswaBruce Eric KaplanMarch 31, 2002 (2002-03-31)Ruth takes an interest in a woman who died without family or friends. Brenda begins writing a novel. 196"In Place of Anger"Michael EnglerChristian TaylorApril 7, 2002 (2002-04-07)Ruth's sister Sarah visits causing much pain and closure. The Fishers are visited for a second time by Mitzi Dalton-Huntley. 207"Back to the Garden"Dan AttiasJill SolowayApril 14, 2002 (2002-04-14)A Jewish funeral leads Nate to question the Jewish point of view on death with a female rabbi. Claire visits Aunt Sarah. David begins seeing Keith again. 218"It's the Most Wonderful Time of the Year"Alan TaylorScott BuckApril 21, 2002 (2002-04-21)Christmas signals the one year anniversary of Nathaniel's death, causing everyone to reminisce. Margaret has a special present for Brenda. Nikolai is beaten and mugged on Christmas Eve and Claire brings her new boyfriend to dinner. 229"Someone Else's Eyes"Michael CuestaAlan BallApril 28, 2002 (2002-04-28)Nate gets a shocking surprise from Lisa. Keith checks up on Karla. Nikolai continues to recuperate at the Fisher's. Claire is asked to help Billy with a project. 2310"The Secret"Alan PoulBruce Eric KaplanMay 5, 2002 (2002-05-05)Karla has a secret that will affect her relationship with Keith and David. Brenda attends a lifestyle party with Melissa. Claire illegally takes portraits of the deceased for a school project, which her brothers soon learn about. 2411"The Liar and the Whore"Miguel ArtetaRick ClevelandMay 12, 2002 (2002-05-12)Vanessa loses her job after being negligent. A lawsuit from a previous client turns out beneficial. Rabbi Ari recommends Nate and Brenda be honest with each other before moving forward with marriage. 2512"I'll Take You"Michael EnglerJill SolowayMay 19, 2002 (2002-05-19)David and Keith greet a social worker. Federico unexpectedly gains an inheritance. Brenda's parents renew their wedding vows. Nate discovers Brenda's infidelity. 2613"The Last Time"Alan BallKate RobinJune 2, 2002 (2002-06-02)Fisher & Sons has an unannounced inspection which turns out positively for Federico. Nate undergoes surgery for his AVM as his family anxiously await the outcome.
Season 3 (2003)[edit]No. in
seriesNo. in
seasonTitleDirected byWritten byOriginal air date271"Perfect Circles"Rodrigo Garc?aAlan BallMarch 2, 2003 (2003-03-02)A year after the events of the previous episode, Nate has recovered from the operation and is married happily with Lisa and their daughter Maya; Fisher & Sons is now Fisher & Diaz; David and Keith attend couples' counseling; Ruth becomes obsessed with her granddaughter; and Claire is at college and believes the work is pointless. 282"You Never Know"Michael CuestaScott BuckMarch 9, 2003 (2003-03-09)David and Rico are at odds over the death of a telemarketer; Lisa and Nate hold a dinner for David and Keith. 293"The Eye Inside"Michael EnglerKate RobinMarch 16, 2003 (2003-03-16)David and Keith go on a much needed vacation; Ruth has fun at the mall with Bettina; Claire breaks up with Phil. 304"Nobody Sleeps"Alan PoulRick Cleveland and Alan BallMarch 23, 2003 (2003-03-23)A man arranges an operatic tribute for his lover; Lisa arranges a birthday dinner for Ruth. David yearns for the closeness a deceased client had with his lover in his relationship with Keith. 315"The Trap"Jeremy PodeswaBruce Eric KaplanMarch 30, 2003 (2003-03-30)Ruth sets ground rules for a new live-in apprentice Arthur; Brenda returns to apologize to Nate; David encounters a face from his past. 326"Making Love Work"Kathy BatesJill SolowayApril 6, 2003 (2003-04-06)Nate and Lisa take Maya camping; Ruth enjoys spending time with new friend, Arthur; Claire and David talk about sexuality. 337"Timing & Space"Nicole HolofcenerCraig WrightApril 13, 2003 (2003-04-13)Brenda's father dies and Nate attends the funeral to Lisa's chagrin; David and Keith attend a brunch; Claire spends a lot of time with Russell. 348"Tears, Bones and Desire"Dan AttiasNancy OliverApril 20, 2003 (2003-04-20)Fisher & Diaz plays home to a deceased patriarch's children and several wives; Keith gets his revenge on David's friends. Lisa becomes increasingly curious to learn about the details of Nate's break-up with Brenda 359"The Opening"Karen MoncrieffKate RobinApril 27, 2003 (2003-04-27)Claire, Russell and Billy display their art at an alumni show; Ruth gets close with Arthur; David and Keith set ground rules on threesomes. Nate and Lisa unexpectedly meet up with Brenda at the art show. 3610"Everyone Leaves"Dan MinahanScott BuckMay 4, 2003 (2003-05-04)Keith confronts his father after his aunt's funeral; Lisa travels to her sister's to give herself and Nate much needed relief; Claire gets a confession from Russell and later discusses her flawed relationships with her mother. 3711"Death Works Overtime"Dan AttiasRick ClevelandMay 11, 2003 (2003-05-11)Fisher & Diaz brims with activity after receiving a trio of unrelated deaths; Ruth stays optimistic on Lisa's whereabouts. Claire is visited by Russell who begs for forgiveness and later finds out important information about her health. 3812"Twilight"Kathy BatesCraig WrightMay 18, 2003 (2003-05-18)A funeral for a serial killer causes Nate to ponder many scenarios about Lisa as he temporarily finds relief with the killer's daughter; Claire has an abortion. Ruth and George take their relationship to the next level. Tensions between David and Keith come to a head. 3913"I'm Sorry, I'm Lost"Alan BallJill SolowayJune 1, 2003 (2003-06-01)Ruth shocks the family with unexpected news; Nate gets unwanted news about Lisa; Brenda goes on a date with a neighbor; David reunites with Keith and Claire meets up with familiar faces during a visit to the afterlife.
Season 4 (2004)[edit]No. in
seriesNo. in
seasonTitleDirected byWritten byOriginal air date401"Falling into Place"Michael CuestaCraig WrightJune 13, 2004 (2004-06-13)Nate is at odds with Lisa's family; David and Keith look for ways to start over; Claire reunites with Russell. 412"In Case of Rapture"Dan AttiasRick ClevelandJune 20, 2004 (2004-06-20)George's routines irk Arthur; Brenda slowly plans her relationship with Joe; Keith begins a new job. Diaz has a fling. 423"Parallel Play"Jeremy PodeswaJill SolowayJune 27, 2004 (2004-06-27)The Fishers hold a yard sale; David gives Arthur more responsibility. Nate warms up to a divorcee at Maya's Mommy and Me class. 434"Can I Come Up Now?"Dan MinahanAlan BallJuly 11, 2004 (2004-07-11)David's ex-fianc?e asks him to arrange her father's funeral. Nate has a psychic rendezvous. Ruth discovers the identity of George's stalker. 445"That's My Dog"Alan PoulScott BuckJuly 18, 2004 (2004-07-18)David is taken for a ride by a hitchhiker; Nate attends a bereavement support group; Ruth plays matchmaker to George's son. 456"Terror Starts at Home"Miguel ArtetaKate RobinJuly 25, 2004 (2004-07-25)Ruth throws a birthday dinner for David who is struggling in the aftermath of his carjacking; Claire gets "closer" with some friends; Vanessa begins to suspect Rico's infidelity. 467"The Dare"Peter WebberBruce Eric KaplanAugust 1, 2004 (2004-08-01)Ruth overhears a conversation between two of George's ex-wives. Keith comes out to his co-worker buddy; Vanessa follows Federico to Sophia's house. 478"Coming and Going"Dan AttiasNancy OliverAugust 8, 2004 (2004-08-08)Rico and Ruth come to melting points in their marriages. Claire gets comfortable with Edie. Keith finds solace away from David. Joe catches Brenda having sex with Nate. 489"Grinding the Corn"Alan CasoRick ClevelandAugust 15, 2004 (2004-08-15)Ruth and Bettina travel to Mexico. David experiences worse side effects of post-traumatic stress disorder. Claire achieves her first orgasm with the help of classmate Jimmy by performing a coital alignment technique (grinding the corn). 4910"The Black Forest"Peter CareJill Soloway & Craig WrightAugust 22, 2004 (2004-08-22)Nate, Brenda, and Maya attend a memorial service for Lisa in Idaho. Claire comes to final blows with Edie at Jimmy's party. Ruth reconciles with George. 5011"Bomb Shelter"Nicole HolofcenerScott BuckAugust 29, 2004 (2004-08-29)George becomes increasingly paranoid about Armageddon and discovers the family's bomb shelter. Ruth wants to attend a sex workshop. David and Keith face a lawsuit. Barb confronts Nate about "Lisa's" ashes. 5112"Untitled"Alan BallNancy OliverSeptember 12, 2004 (2004-09-12)Ruth discovers another secret about George during a lunch with his daughter; David confronts his carjacker. Claire sacrifices her friendships for fame at an art show. Nate confronts Barb and Hoyt after David receives a message from Michaela.
Season 5 (2005)[edit]No. in
seriesNo. in
seasonTitleDirected byWritten byOriginal air date521"A Coat of White Primer"Rodrigo Garc?aKate RobinJune 6, 2005 (2005-06-06)Nate and Brenda prepare for a big day; Ruth is far from ecstatic on George's return home; David and Keith consider being parents. 532"Dancing for Me"Dan AttiasScott BuckJune 13, 2005 (2005-06-13)Nate hangs with friends from high school; Brenda starts her internship; Maggie gives Ruth much needed relief. 543"Hold My Hand"Jeremy PodeswaNancy OliverJune 20, 2005 (2005-06-20)Claire is seduced by Billy's newfound lust for life; George is haunted by visions from his mother's death. Ruth and Claire are at odds over Claire's inheritance money and lifestyle. 554"Time Flies"Alan PoulCraig WrightJune 27, 2005 (2005-06-27)Brenda has surprises for Nate on his 40th birthday; David and Keith "propose" to Mary, a surrogate. 565"Eat a Peach"Dan MinahanRick ClevelandJuly 4, 2005 (2005-07-04)Ruth finds a way to relax without George; David and Keith consider adopting a child named Anthony; Nate and Brenda consider giving Maya a coherent narrative. 576"The Rainbow of Her Reasons"Mary HarronJill SolowayJuly 10, 2005 (2005-07-10)Ruth is delighted when her sister Sarah visits but she brings bad news with her; David and Keith begin experiencing difficulties on how to discipline their new foster children; Nate muses on the loss of his first love. Vanessa hires a nanny. 587"The Silence"Joshua MarstonBruce Eric KaplanJuly 17, 2005 (2005-07-17)David and Keith struggle to create boundaries for their new sons. Brenda and Nate receive some ambiguous news; Ruth fills her schedule with activities. 598"Singing for Our Lives"Matt ShakmanScott BuckJuly 24, 2005 (2005-07-24)When David attempts to make a bid on a crematorium, Federico refuses and pushes for another employee. Brenda receives information from her doctor. Nate begins attending Quaker services with Maggie, to the chagrin of Brenda. Ruth goes to see her ex-boyfriend, Hiram. 609"Ecotone"Dan MinahanNancy OliverJuly 31, 2005 (2005-07-31)After suffering a massive stroke, Nate is taken to the hospital. As Nate undergoes surgery, tension ensues between Maggie and Brenda in the waiting room. Elsewhere, Ruth is still camping in the wilderness with Hiram and is completely oblivious to what is happening with her family in L.A. Nate dies from his stroke. 6110"All Alone"Adam DavidsonKate RobinAugust 7, 2005 (2005-08-07)Nate's funeral divides the family; David deals with being left in charge of the family business, Keith makes an embarrassing discovery on the job; Brenda is challenged by Nate, and makes a painful decision about what to do with Maya; Maggie gets a door shut in her face. 6211"Static"Michael CuestaCraig WrightAugust 14, 2005 (2005-08-14)As David's fears take over, Keith tries to protect him - and the boys; visions of Nate compel Brenda to make a decision about her relationship with Billy, who is supporting her; George wants to help Ruth with Maya. Claire's grief begins to cause her to drink heavily and hallucinate while at Nate's gravesite. Rico pushes for a talk about the business. 6312"Everyone's Waiting"Alan BallAlan BallAugust 21, 2005 (2005-08-21)David finally embraces his demons; Nathaniel Sr. talks to his younger son; Brenda delivers early and fights Nate's negativity; Margaret is impressed to see Olivier's nurturing side; Rico and Vanessa celebrate an investment; the family toast Nate's memory at a farewell dinner for Claire; Claire's departure reveals what's to come for her family members and herself.
References[edit]^ "Shows A-Z - six feet under on hbo". The Futon Critic. Retrieved October 12, 2012. ^ a b c d e "Six Feet Under (2001)". TVShowsOnDVD. Retrieved October 12, 2012. ^ "Six Feet Under : Complete HBO Season 1". Amazon.co.uk. Retrieved October 12, 2012. ^ "Six Feet Under - The Complete 1st Season (4 Disc Set)". EzyDVD. Retrieved October 12, 2012. ^ "Six Feet Under : Complete HBO Season 2". Amazon.co.uk. Retrieved October 12, 2012. ^ "Six Feet Under - The Complete 2nd Season (5 Disc Set)". EzyDVD. Retrieved October 12, 2012. ^ "Six Feet Under : Complete HBO Season 3". Amazon.co.uk. Retrieved October 12, 2012. ^ "Six Feet Under - The Complete 3rd Season (5 Disc Set)". EzyDVD. Retrieved October 12, 2012. ^ "Six Feet Under : Complete HBO Season 4". Amazon.co.uk. Retrieved October 12, 2012. ^ "Six Feet Under - The Complete 4th Season (5 Disc Set)". EzyDVD. Retrieved October 12, 2012. ^ "Six Feet Under Season 5 (R2) in April - Artwork Updated". The Digital Fix. March 1, 2006. Retrieved October 12, 2012. ^ "Six Feet Under - The Complete 5th Season (5 Disc Set)". EzyDVD. Retrieved October 12, 2012.
External links[edit]Episode guide at HBO.comList of Six Feet Under episodes at the Internet Movie DatabaseList of Six Feet Under episodes at TV.comvteSix Feet UnderAwards and NominationsAlan BallQuotesCharactersNate FisherDavid FisherBrenda ChenowithEpisodes"Pilot""The Plan""Everyone's Waiting"Seasons12345OtherSoundtrack2nd Soundtrack


March 18 2014

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Ossification of bones of the Foot | Professional Health Systems




Ossification of bones of the Foot | Professional Health Systems



The tarsal. bones are each ossified from a single center, excepting the calcaneus, which has an epiphysis for its posterior aspect. The centers make their appearance as follows : in the calcaneus, at the sixth month of fetal life in the talus, about the seventh month ; in the cuboid at the ninth month: in the lateral cuneiform; during the first year ; in the medial cuneiform, during the third year ; in the intermediate cuneiform and navicular, during the fourth year. The epiphysis for the posterior surface of the calcaneus begins to ossify between the sixth and tenth years; and unites with the rest of the bone soon after puberty. The posterior tubercle of the talus is sometimes ossified from an independent center; and may remain connected to the rest of the bone by cartilage. It is then named the ostrigonum.


Figure 500
Ossification projection for bones of the foot - Figure 500
The metatarsal bones are each ossified from two centers : a primary center for the shaft, and a secondary or epiphyseal center for the base or proximal end of the first, and for the head or distal end of each of the other four. Ossification begins in the middle of the shaft about the eighth or ninth week of fetal life. The epiphysis for the base of the first metatarsal appears about the third year ; those for the heads of the other metatarsals between the third and fourth years ; all unite with the shafts between the seventeenth. and twentieth years. An epiphysis is frequently present on the tubercle of the base of the fifth metatarsal bone (Holland).'

The phalanges are each ossified from two centers : a primary one for the shaft and an epiphysis for the base. The primary centers for the distal phalanges appear about the eighth week of fetal life : those for the proximal phalange between the twelfth and sixteenth weeks, and those for the intermediate phalanges after the sixteenth week (that for the phalanx of the fifth toe does not usually appear until after birth). The epiphyseal centers appear between the third and sixth years and unite with the shafts about the seventeenth or eighteenth year.





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March 16 2014

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Bunion Surgery, Treatment, Home Remedies, Symptoms - MedicineNet




Bunion Surgery, Treatment, Home Remedies, Symptoms - MedicineNet

All of the women in my family have horrible bunions. Are there any exercises that can ward off or help bunions?
Author: Richard Weil, MEd, CDE
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

A bunion is an irregular bony prominence (a bump) on the joint where yourbig toe meets the main bones of your foot. The bunion causes the end of thebig toe to bend toward the other toes and crowd them, while the bone at thebase of the toe where it meets the foot moves outward beyond the normallimits of where the bone should be. Pain is caused by inflammation and thebone pressing against the shoe. Bunions are more common in women, as youreport, and are caused by a number of reasons, including shoes that are tootight, years of abnormal motion (like dancers on point), poor footmechanics, bone deformities, flat feet, and arthritis.

Treatment usually includes shoes with a roomy toe box (you should be ableto wiggle your toes; the toe box should be wide enough to accommodate thebony prominence), padding, over-the-counterarch supports, orthotics, andtaping by a physical therapist or doctor. Surgery is an option whenconservative treatment fails and you have chronic pain.
Learn exercises to treat and prevent bunions >>


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