strongest muscle tendon complex of the body appreciated as the Achilles tendon. There are multiple ligamentous attachments to this bone that maintain the stability and structure of the foot and ankle. Interestingly, with its significant need for weightbearing load, it is not terribly well designed structurally to do this. It has a thin cortical shell with significant medullary space and we frequently correlate this to almost like an egg with a hard shell and soft yolk in the middle. Fractures of this bone can become challenges depending on the mechanism of injury as well as the anatomic involvement. Broadly speaking we can speak of fractures that involve the complex joint surfaces and those fractures that do not. Not knowing the type of fracture that you have suffered makes it difficult to tell you whether surgery is indicated or not. Fractures that do not involve the articular surface and are considered nondisplaced body type fractures frequently do not require any surgery and heal quite readily given the nature of the bone. Those fractures that we refer to as intra-articular or joint involving that cause displacement and compression of the heel bone remain somewhat controversial in their treatment. For years, a conservative approach was considered given potential wound healing complications associated with surgical exposure. More recently, with an
evolution of surgical techniques, there has been greater interest in recommendation for anatomic reduction of these fractures to restore the gross normal anatomy of the heel bone speaking of its height with in length. Fractures that do involve the subtalar joint surfaces do have high risk for posttraumatic arthritis that may produce prolonged disability and require ultimately surgical fusion of this joint. Given the challenging nature of these fractures and the risk for long-term disability, these do require evaluation by a specialist well-versed in their management. If you have any concerns regarding your healing and treatment recommendations, I would highly encourage a second confirmatory opinion.
Clinical history is critical to assisting in what may be the potential cause. Frequently asymmetric or single leg swelling is representative of a local process of the extremity. When there is bilateral (both limb) involvement, this more than likely represents a systemic or generalized process. It is also critical to understand whether there is associated pain with the presentation. Painful peripheral swelling of joints can represent rheumatic processes. It is also extremely important to identify how long the swelling persists and what is done to relieve the presentation. Given you describe yourself as an 18-year-old girl who appears to be healthy and active as this presentation is developing after running or workout sessions, then the more likely factors appear to revolve around musculoskeletal disorders. Medical evaluation should include basic laboratory studies, radiographs of the ankles and a good physical examination of the involved anatomy with subsequent studies as required to determine the cause of this presentation.
be most appropriate to seek medical evaluation and a determination as to the potential cause for these complaints. Plantar fasciitis is a readily treated disorder with appropriate stretching, shoe and activity modification, heel lift or supportive over-the-counter insole and will improve. Unfortunately arthritic disorders are more challenging and may require greater and more prolonged management in order to achieve an improved pain and functional state.
attachments to the talus which is the bone that resides within the ankle mortise and as a result the stability of this joint complex is based on bony architecture and surrounding ligamentous support. Clearly exercise is critical for good health to include cardiovascular, musculoskeletal and even mental but we must be cautious and understand the limits of our body and appreciate the activity and its pressure that it is exerting through the skeletal system. I have frequently advised patients with notably
higher BMI to begin with appropriate dietary restriction under physician guidance and begin weight loss in this fashion prior to engaging in high intensity activities in an effort to further lose weight through caloric burn. Alternative exercises that do not put excessive pressure on the lower extremity joints to include use of a stationary bike, aquatic exercise are a great initial means to do this. As body mass improves with weight loss then increased exertional activities such as higher intensity walking and running can be initiated with reduced risk of injury.
toe randomly is most suggestive of some type of peripheral nerve process.
More than likely it is local and effects one of the cutaneous or skin
nerves in the area. Given that you do not describe any radiating
presentation to involve other parts and it is quite limited in its area of
involvement this appears to be a benign focal irritation. Since you do not
describe any type of overlying skin eruption or rash, I do not believe
there is any type of skin disorder that may similarly present with this
type of feeling. I do not believe any formal evaluation or treatment is
required other than observation. Clearly if symptoms become more constant
and begin to involve a greater area of the foot this would warrant some
type of medical evaluation. There are systemic causes for what we
described as peripheral neuropathy to include diabetes and other metabolic
disorders, nutritional vitamin deficiencies, metal toxicities, traumatic or
entrapment and many that are simply idiopathic, we simply do not know the
cause. Best recommendation at this time is to simply keep a close eye on
the process and make sure there is no appreciated worsening.
the big toe. These can include musculoskeletal problems, vascular and
neurologic. From a musculoskeletal consideration one would have to consider
arthritic processes that cause joint pain. This may have resulted from old
trauma, repetitive mechanical injury or systemic cause for arthritis.
Vascular complications can include arterial insufficiency. Unfortunately
tobacco misuse has caused identified diseases of the peripheral arterial
system which can cause insufficiency and secondary pain. We also frequently
appreciate this in our diabetic population as this disease also impacts
peripheral circulation.Finally nerve processes can also produce chronic
pain. There are many reasons for peripheral neuropathy to include the
previously mentioned diabetes. There can also be nerve compression and
previous nerve injury. Regardless, if this pain is chronic and has not
found to improve on a timely basis or in fact has been worsening, it would
be best advised to seek specialty medical care in order to have a good
examination to include potential x-rays and other necessary laboratory
studies to better understand why he may be suffering from this discomfort.
readily identified by the consumer (patient) and achieve satisfactory results with an off-the-shelf insert. These conditions include flat feet, plantar fasciitis (heel pain), arch pain/fatigue and metatarsalgia (pain in the ball of the foot). There are many products that can be purchased at local retail stores that will provide similar benefit to that of a custom foot orthosis without the cost in handling these presentations.
It is a frustrating disorder and unfortunately no definitive treatment to guarantee return of your normal nail appearance.