A Simple Guide to Plantar Fascilitis

A Simple Guide to Plantar Fascilitis
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What is Plantar Fascilitis?
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Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.

It is more common in women.

What are the cause of Plantar Fascilitis?
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The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.

In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.

Both heels can be affected.

What are the symptoms and signs of Plantar Fascilitis?
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Symptoms:

1.Pain in the heel of one or both feet

2.Pain usually is worse in the morning on getting and stepping on the floor.

3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse

4.Pain is described as constant and aching

5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.

Signs:

1.local tenderness in the calcaneal bone area of the heel.

2. Pain is aggravated by direct pressure.

3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.

4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.

A stress fracture may need to be ruled out in chronic cases.


What is the Treatment of Plantar Fascilitis?
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Conservative treatment:
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Initial phase:

1.rest of the heel-avoid jogging or strenous exercises

2.Cold or ice may help reduce inflammation

3.Heel cups, cushions, tapes, pads may help to reduce the pain

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.

7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.

8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.

Mobilisation phase:

Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain

Surgery is usually not indicated in plantar fascilitis.

Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.


What is the prognosis of Plantar Fascilitis?
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Prognosis is usually good although healing is slow and takes up to 1-2 years.


What is the prevention of Plantar Fascilitis?
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Avoid certain weight bearing exercises like jogging or brisk walking

Use heel cups, cushions, tapes, pads in foot wear

Lose Weight

A Simple Guide to Scoliosis

A Simple Guide to Scoliosis
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What is Scoliosis?
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Scoliosis literally means a crooked spine, a lateral curve or angular deviation of one or more of the vertebral segments.
3% of the population have some form of scoliosis.
For many people it's not much of a problem.
For a small number of people, the curve gets worse as they grow.

What is the cause of Scoliosis?
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1.The most common type of scoliosis is called idiopathic(or unknown cause.) scoliosis.
2.Scoliosis can run in families, that is , it may be hereditary.

Who is affected by Scoliosis?
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Scoliosis usually begins at the age of 9-18 years when the bone starts growing during puberty. After this age, the curve usually become permanent as the bone stopped growing.
Scoliosis is more common in girls than boys.

How Do You check for Scoliosis?
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Scoliosis may be easily noticeable.
A curved spine can cause someone's body to tilt to the left or right.
Many children with scoliosis have one shoulder blade that's higher than the other or an uneven waist with a tendency to lean to one side.

During a doctor visit in school, cases of scoliosis are easily detected during examination.
It's an easy test called the forward-bending test.
It involves bending over, with straight knees, and reaching your fingertips toward your feet or the floor. Then the doctor will look at your back to see if your spine curves.

Someone with scoliosis may have a back that curves like an "S" or a "C."
This type of curve may be noticeable to others and can be uncomfortable.

How to decide whether your Scoliosis require Treatment?

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If you have confirmed scoliosis, then the doctor will decide whether treatment is necessary. He may order X-rays of your spine. This will determine the angle of curvature and the severity.
If the curve is mild, you may not need much treatment except for exercises to straighten your back and consistent monitoring of your spine.

If the curve is severe ,an orthopedic surgeon will check on how severe your spine's curve is.

He will looks at your X-rays and measures the spine's curve in degrees.

Someone who has a mild curve may just need regular checkups to make sure the curve isn't getting worse.

Someone with a more severe curve may need to wear a brace or have an operation.

What is the treatment of Scoliosis?
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There are 3 main methods of treatments:

1.Exercises for back and monitoring:
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For mild cases, you may need to do some exercises to help straighten the back such as doing pull ups.

2.Treating With Braces
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The brace for scoliosis is meant to hold the spine in place so the curve doesn't get any worse.
Some braces are made to be worn only at night.
Others are designed to be worn for much of the day.
Most children need to wear their braces at least 20 hours a day, so that means wearing them to school.
As he or she gets older and the spine curvature improve, braces are worn for a shorter peroid daily.

Braces now are lighter, more comfortable, and easier to wear.
There are many different types of braces.
Where the scoliosis is in the lower part of the back, the child often wear a brace called a thoracolumbosacral orthosis or TLSO for short.
This kind of brace comes up under the arms and is more comfortable than the bigger braces.
The two most popular TLSOs are the Boston brace and the Wilmington brace.

3.Treating With Surgery
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Braces often are able to control the curvature.
Some children who have scoliosis eventually need an operation because of the increasing severity of the scoliosis or if a severe scoliosis is detected late.

During the operation, the orthopedic surgeon fuses the bones in the spine together to correct the curve using metal rods, hooks, screws, and wires to hold everything in line until the bones heal.

The operation takes several hours, depending on how big the curve is and how many bones need to be fused.
After the operation,the child can usually go back to school about a month later.
He or she need not wear a brace and can return to some activities in 3 or 4 months, and most normal activities after a year.
Each patient's surgery and recovery might be different, depending on the type of surgery and the patient's age.

With improved treatment, more children with scoliosis can live normal lives.

A Simple Guide to Sinusitis

A Simple Guide to Sinusitis
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What is sinusitis?
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Sinusitis is a condition in which the lining of your sinuses becomes inflamed.

The sinuses are the air chambers in the bone behind your cheeks, eyebrows and jaw.
They produce mucus, a fluid that cleans bacteria and other particles out of the air you breathe. Tiny hairs called cilia sweep mucus out of your sinuses so it can drain out through your nose.
The paranasal sinuses are in direct communication with the nose.
The sinuses are normally sterile.

If the sinus openings may become blocked, the mucus becomes congested in the sinuses, resulting in stagnation of secretion and finally bacterial growth.

What causes sinusitis?
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Anything that causes swelling in your sinuses or keeps the cilia from moving mucus can cause sinusitis.
This can occur because of changes in temperature or air pressure,
Using decongestant nasal sprays too much,
Smoking, and
Swimming or diving.
Some people have growths called polyps that block their sinus passages.
When sinusitis is caused by a bacterial or viral infection, you get a sinus infection.

Sinus infections sometimes occur after you've had a cold.
The cold virus attacks the lining of your sinuses, causing them to swell and become narrow.
Your body responds to the virus by producing more mucus, but it gets blocked in your swollen sinuses.
This built-up mucus makes a good place for bacteria to grow.
The bacteria can cause a sinus infection.

Acute sinusitis is usually bacterial in origin.
Haemophilus influenzae and Streptococcus pneumoniae are the organisms most commonly found in adults.
In children, similar organisms are seen, with the addition of Moraxella catarrhalis.
In older children and young adults, Staphylococcus aureus is an occasional finding.
In systemically impaired hosts, Candida, Aspergillus, and Phycomycetes may be the cause.

Risk factors include the following: diabetes mellitus, cancer, hepatic disease, renal failure, burns, extreme malnutrition, and immunosuppressive diseases.

What are the signs of acute sinusitis?
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Presentation of sinusitis is often nonspecific.

Patients may present with a persistent cold.
A cold that starts to get better and then gets worse may be a sign of acute sinusitis.

Pain or pressure in some areas of the face (forehead, cheeks or between the eyes) is often a sign of blocked sinus drainage and can be a sign of acute sinusitis.

Pain in your forehead that starts when you lean forward can also be a sign.

Other symptoms may include a stuffy nose.

Some patients complain of dental pain or alteration in smell.

Fever is seen in fewer than 2% of individuals with sinusitis.

Facial tenderness to palpation is present.

Complete opacification of sinus on transillumination is present.

An X-ray of the paranasal sinuses usually confirms the presence of sinusitis as opacity in the sinuses.

How is acute sinusitis treated?
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Your doctor may prescribe an antibiotic.
You may take an antibiotic for 10 to 14 days, but you will usually start feeling better a couple of days after you start taking it. It is important to take this medicine exactly as your doctor tells you and to continue taking it until it is gone, even after you're feeling better.

If you have sinus pain or pressure, your doctor may prescribe or recommend a decongestant to help your sinuses drain.

Painkillers may be prescribed if there is severe pain.

How to take care of sinusitis?
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1.Get plenty of rest.

2.Lying down can make your sinuses feel more congested, so try lying on the side that lets you breathe the best.

3.Drink plenty of fluids.

4.Apply moist heat by holding a warm, wet towel against your face or breathing in steam through a cloth or towel.

5.Rinse your sinus passages with a saline solution.

How is chronic sinusitis treated?
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In cases where the acute sinus infection does not cleared or become chronic, a sinus washout may be necessary to remove the mucus stucked in the sinuses.

This involves syringing of antiseptic solution through a hole in the septum separating the maxillary sinuses from the nose.
Sometimes syringing of frontal sinuses can be done through a tube inserted into the sinuses.

In severe case of chronic sinusitis, endoscopy surgery may be done to strip the lining of the maxillary sinuses and clean the cavity of the sinuses.

A new therapy is the use of phage therapy where bacterial viruses are used to cause bacterila lysis in the sinuses.