Post-Tib Tendonitis: Orthopedic Treatment

by Administrator 30. June 2017 01:26

 A tendon is a soft tissue structure that connects the muscles to the bones. The posterior tibial tendon is found on the inner side of the foot near the ankle and it connects the calf muscle to the ankle. It is a an important tendon in the leg as it supports the foot while walking and hold up the foot arch. Stress caused to this particular tendon is known as the Post-Tib Tendonitis. Stress may be in the form of inflammation or tearing of this tendon. It may result in loss of foot stability and collapse of the foot arch.


  • Presence of over-pronation feet causes damage to the posterior tibial tendon
  • Overuse of the muscles in the feet leads to damage of the tendon resulting in this condition
  • A fall on the foot that may cause severe injury
  • Playing high impact sports such as basketball, tennis may tear or stretch the tendon


  • Development of over pronated feet as the tendon cannot support the foot arch
  • Pain
  • Growth or heel spurs
  • Pain is aggravated while walking, running, weight bearing
  • Pain and swelling may occur periodically in the initial stages but becomes permanent as the condition aggravates
  • The heel bone may shift  to a new position as the foot arch collapses and cause change in shape of the foot
  • The foot is visibly deformed with a tilted heel and inward bent foot
  • If the foot of the patient is observed from behind in a standing position, many toes are visible which indicates over pronation
  • The calf muscles may be tight


  • The details of the patient’s medical history, symptoms and mode of injury may be taken into account
  • The foot may be moved, palpated and observed for visible signs of the condition, loss of flexibility and other symptoms
  • Single limb heel test - The patient may be asked to stand on one leg and raise the heel. Inability to do so indicates tendonitis
  • Range of motion of the foot
  • X-ray imaging may be required
  • MRI, CT scan and ultrasound tests may be needed


  • Rest your feet adequately and avoid weight bearing as well as any physical activity that causes pain for a few days
  • Shoe inserts and orthotic devices  can be used to provide better protection, shock absorption and reduce the stress on the post tibial tendon or the plantar fascia
  • The exercise should be varied so that the same part and muscles of the foot is not strained every time
  • Ice packs can be applied 4-5 times a day to reduce swelling
  • Pain killers and anti-inflammatory medicines may be prescribed
  • The leg may be immobilized in a cast or a boot for 6-8 weeks
  • An ankle brace to correct the flat foot deformity
  • Steroids may be injected into the affected joint
  • Physical therapy may be helpful
  • Surgical lengthening of the calf muscles
  • Surgical removal of the damaged tendon
  • Surgical repair of the torn tendon
  • Arthrodesis or surgical fusion of the joints may be done to treat Flat Foot and Arthritis

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Overlapping Toes: Causes, Symptoms And Treatment

by Administrator 7. March 2017 14:19

Overlapping Toes refers to a foot deformity that occurs when one of the toes overrides the adjacent toe. The condition commonly affects the fifth and the second toe. Overlapping is generally detected at the time of birth or during early infancy. As the person ages, the deformity tends to become more rigid.

Overlapping Toes may occur at any time in life and is more common in women than men.


  • Genetic traits passed on from the parents to the child
  • Congenital – it is believed that the position of the fetus in the womb is such in some cases that the foot gets cramped resulting in this deformity at the time of birth
  • Wearing pointed, high heeled shoes for a long time
  • Tightness in tendon or ligament that pulls the bone of the toe
  • Faulty foot biomechanics- fallen arches or high arched, both can result in Overlapping Toes
  • Bunions on the big toe may result in overlapping of the second toe as the former tends to bend against it
  • If the second toe is the longest amongst the others, it may tend to overlap
  • Hammer Toes
  • Joint injuries or displacements may alter the position of the bones


  • Visibly deformed toes
  • Formation of painful calluses over the time
  • Swelling and pain in the toes as they rub against the shoes
  • Corn formation or hardening of the skin on the toes due to constant friction
  • Change in gait
  • In case the fifth toe overrides the fourth one, a small Bunion may be formed on its outer side


  • Analysis of the patient’s medical and family history besides taking note of the symptoms reported
  • X-ray imaging of the foot to study bone structure
  • MRI scan may be used to analyze the position and structure of tendons and ligaments that support the foot
  • Palpation and observation may be applied to assess condition of the affected toe


  • Passive techniques may be used in case of infants to treat the condition
  • Taping of the toes using special adhesive tapes to hold the affected toe in place. This may be applied for 6-12 weeks depending on the case
  • In severe cases, surgical release of the affected tendon or ligament may be performed
  • A pin may be surgically inserted to reposition the toe. It may be kept for a few weeks and then removed. The patient may be required to wear a cast or a special boot during this period
  • A splint may be used to secure the toe post-surgery
  • Use of shoes with soft shoes soles may be recommended
  • Use of orthotic devises such as shoe inserts may help to distribute body weight equally by rectifying the fallen or high arches

Visit the foot and ankle specialists at OrthoTexas for complete treatment of Overlapping Toes. For an appointment with the orthopedic doctors in Denton, TX, call at (940) 382 - 1577.

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Chronic Shoulder Instability: Orthopedic Denton

by Administrator 18. January 2017 18:40

The shoulder is one of the most mobile joints of the body which is made up of three main bones, the upper arm bone (humerus), shoulder blade (scapula) and collar bone (clavicle). However, the extensive range of motion of the joint makes it prone to injuries and instability. The upper end of the humerus fits into a cavity within the shoulder blade known as glenoid. It is held in place by strong ligament structures but an external trauma or overuse may push the humeral head out of the socket, leaving the joint unstable. Once it occurs, the shoulder tends to become susceptible to repeated incidences of injury. This condition is medically termed as Chronic Shoulder Instability. It may lead to partial or complete displacement of the humeral head.


  • Injury or trauma- A sudden injury to the shoulder or arm may push the humerus out of the glenoid. This occurs as a result of damage to the ligaments, tendons and cartilage structures that support the bones. Weak connective tissues make the joint prone to repeated episodes of instability
  • Bankart Lesion-  Damage to the cartilage lining between the humeral head and glenoid may make the shoulder unstable
  • Stress caused due to activities that require repeated overhead movement of the arm, such as swimming, playing tennis, painting etc., may loosen the ligaments
  • Inherent weakness of the muscles and soft tissue structures that support the shoulder joint. They tend to suffer from multi-directional instability and the bone may slip out from the glenoid in different directions
  • Double jointed- Excessive flexibility of the shoulder joint may also increase the risk of instability


  • Pain in the upper arm, neck and shoulder
  • Weakness
  • Feeling that the shoulder may give away
  • Frequent subluxations may occur


  • Patient’s medical history and shoulder injuries may be taken into consideration by the orthopedic doctor
  • The patient may be asked to move the arm in different directions to check for the range of motion
  • X-ray imaging may be conducted to assess the extent of damage to the joint
  • MRI scan may be required to study the condition of the soft tissue structures


Chronic Shoulder Instability can be treated through conservative methods initially but if the symptoms do not subside or the condition weakens, surgery may be required. Treatment may include the following:

  • Some lifestyle changes and modification of the daily activities may be suggested to relieve the symptoms. Any task that requires overhead movement of the arm should be avoided
  • Physical therapy program may be initiated to increase the strength of the supporting muscles in the joint.
  • A sling may be worn to provide support to the joint and allow the bone to get back to its original position
  • Non-steroidal anti-inflammatory medicines may also be prescribed by the orthopedic doctor
  • In severe cases, cortisone injections may be administered directly into the joint
  • Surgical repair of weak or torn ligaments and reattaching them to the bone to increase stability
  • Arthroscopic surgery may be performed to remove damaged cartilage and any loose fragments within the joint

OrthoTexas provides effective treatment for Chronic Shoulder Instability and other medical conditions. To schedule an appointment with the orthopedic doctors in Denton, TX, you can call at (940) 382-1577.

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Haglund’s Deformity: Causes, Symptoms And Treatment

by Administrator 20. December 2016 09:02

Haglund's Deformity, also known as Mulholland Deformity or Pump Bump, refers to the abnormal growth in the bony structure behind the heel bone. The condition eventually causes the bursae (located between this bone and Achilles tendon) to become irritated and swollen. Haglund’s Deformity can affect any person although it is more commonly observed in women.


  • Prolonged wearing of hard shoes with a closed back that rubs against the heel bone
  • Genetic deformity in the shape or structure of the heel bone
  • Presence of a high-arched foot
  • Tightness of the Achilles tendon
  • Unusual gait such as walking on the outer side of the heel
  • Running on hard surfaces
  • Excess body weight can stress the heel bone and the tendons
  • Past injuries to the foot or heel


  • Visible outgrowth of the bone behind the heel
  • Considerable pain while walking or wearing shoes
  • The back of the heel feels swollen and tender when touched
  • Redness
  • Tightness in the heel or at the back of the foot while moving


  • Clinical evaluation of the affected foot
  • X-ray imaging may be required to analyze changes in foot structure
  • Analysis of the patient’s gait
  • The symptoms reported by the patient, daily activities as well as type of shoes worn may be taken into consideration to establish the cause and diagnosis


Non-surgical Treatment

  • Using customized orthotic supports may allow even distribution of pressure on the foot and prevent the bone from rubbing
  • Non-steroidal anti-inflammatory medicines may be prescribed by the doctor
  • Use of heel pads may be recommended to prevent pressurizing the heel
  • Ice packs may be help to reduce swelling
  • Wearing open shoes may help to reduce pain while walking
  • In severe cases, an immobilizing boot or temporary cast may be recommended

Surgical Treatment

If the Achilles tendon is tight or damaged, surgery may be required to reduce the pressure on the joint. During the procedure, the orthopedic doctor removes the outgrowth and smoothens the bone.

Post-surgery, the patient may be recommended to wear soft padded shoes and use crutches to prevent weight bearing.

For complete treatment of Haglund's Deformity, visit the orthopedic foot doctors at OrthoTexas. To schedule an appointment, call at (940) 382-1577.

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Lumbar Herniated Disc: Orthopedic Denton

by Administrator 11. November 2016 05:52

The lumbar spine refers to the lower back which is made up of 5 small bones called vertebrae. A fibrous pad called the intervertebral disc is stacked between each vertebra to absorb all the external shocks on the spine.
The disc is divided into two main parts- the outer ring and inner ring. The outer called the annulus fibrosus holds a gel like substance called the nucleus pulposus. A break or a crack in this outer ring causes the inner gel (nucleus pulposus) to flow out of the disc space. This condition is termed as Lumbar Herniated Disc. It can compress the small nerve roots that emerge out of the intervertebral joints. It may causes many other problems and can be physically limiting.


  • Lack of physical activity or sitting for longer durations may weaken the vertebrae
  • Poor posture is responsible for over stressing the lumbar spine and can lead to uneven distribution of weight on the lower extremities
  • As a person ages, the body undergoes natural wear and tear which affects the vertebral bones as well as the discs that support them. The discs tend to dry out or become thin with time
  • A diet deficient in calcium and minerals leads to loss of bone mass in the spine
  • Being overweight can increase the risk of Lumber Herniated Disc
  • Driving for long hours at a stretch can also lead to the condition
  • Men are genetically pre disposed to develop the condition
  • Activities that involve a lot of bending, twisting and lifting weights can be a causative factor


  • Some people may not experience any symptoms and yet have a Herniated Disc. In others, the following symptoms may be observed.
  • Muscle spasms and cramps  
  • Pain in the lower back and legs is a characteristic symptom of Lumbar Herniated Disc. The pain may vary from a dull ache to severe sharp pain which tends to intensify when the patient coughs, bends or sneezes
  • In extreme cases, loss of bowel and bladder control may be experienced
  • In case of nerve pinching, the patient may experience a sharp shooting pain that radiates from the lower back to one side of the leg
  • Weakness or instability may be felt in the legs and thighs
  • Some patients may feel a tingling or pricking sensation in the legs or feet. Numbness may also occur


  • A detailed physical examination is conducted to check for the symptoms
  • X-ray may be done to diagnose changes in the structure of the spine and disc spaces
  • Neurological tests may be required to assess the loss of sensory capabilities
  • The medical and family history of the patient may be analyzed
  • CT scan and MRI can help to reveal the condition and position of the vertebrae as well as damage to the soft tissue structures
  • Myelogram, a dye-induced CT scan, may be required for a detailed view of the spine


Lumbar Herniated Disc can be treated by non-surgical as well as surgical methods depending on the level of the damage, patient’s age and existing health condition. Treatment may include:

  • Cryotherapy: Application of ice packs at regular intervals for a couple of days can help to relieve pain. 
  • Medications: Anti-inflammatory medicines and muscle relaxants may be prescribed by the doctor to relieve the symptoms. Corticosteroids may be injected directly into the affected lumbar region in case of severe pain or muscle spasms.  
  • Heat therapy: It may be a good option to relax the muscles and improve the flow of blood to the affected part of the spine
  • Surgery: If the patient does not respond to conservative methods, surgery may be required. Discectomy may be performed to remove the affected spinal vertebrae or the damaged part of the disc 
  • Physical therapy: A physical therapy program may be recommended post-surgery to help the patient regain flexibility and strength.

We, at OrthoTexas, provide effective treatment for Lumbar Herniated Disc. To schedule an appointment with the orthopedic surgeons in Plano, TX, you can call at (972) 985-1072.

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Tarsal Coalition: North Texas Orthopedic

by Administrator 28. January 2014 05:20

Tarsal Coalition is a medical condition associated with the bones of the foot. This condition generally develops when the bones of the rear foot gets fused together causing intense pain and discomfort. Tarsal coalition is primarily considered as an inherited condition and can be easily found in children and adolescents. When not treated in time, tarsal coalition can also lead to flat feet.

Read on to know more about Tarsal Coalition:

Causes: Listed below are a few causes and risk factors of tarsal coalition:

  • Genetics: There is growing evidence suggesting the association between tarsal coalition and genetics. According to orthopedic doctors, people with a family history of tarsal coalition are more susceptible of developing this condition. In some patients, this condition is present at the time of birth, while in others it may develop later in life.
  • Medical conditions: It has been proven that people with medical conditions like arthritis, infections, trauma and abnormal bone growth are more prone to tarsal coalition.
  • Other conditions: Sometimes abnormal motion or physical activities involving stress on foot joints may also lead to this condition.

Following are the early and late symptoms of tarsal coalition:

  • Intense pain on the outside and top of the foot
  • Stiffness in the foot
  • Chronic pain and stiffness in the ankle
  • Muscle spasms in the leg
  • Fatigues legs
  • Inflexibility of the foot
  • Limited range of motion
  • Affected foot appears flattened
  • Irritation in the tendon on the outside of foot

It is vital to consult an orthopedic doctor, if the aforementioned symptoms are noticed. The doctors are more likely to conduct physical examination to determine the accurate cause of symptoms. They may also perform imaging tests like X-Ray, MRI and CT to rule out other foot related medical conditions.

The most often recommended treatments for tarsal coalition include:

  • Medication and orthotics: The doctors may prescribe you oral anti-inflammatory medication to reduce pain and inflammation. They may also recommend the use of foot orthotics to maintain the stability of the foot joint. Protective pad may also be prescribed to prevent the irritation from the shoes.
  • Physical therapy: The doctors may also refer you to a physical therapist to help you regain the muscle strength and motion through exercises. The therapists may recommend you a range of foot strengthening, stretching and motion exercises to improve the muscle flexibility.
  • Surgery: In severe cases, tarsal coalition surgery may be recommended by the doctors.

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Degenerative Bone and Joint Problems

by Administrator 16. October 2013 14:16

Aging has a direct impact on the bones, muscles, and joints, leading to changes in gait and posture, along with other degenerative problems. Aging results in a decrease in bone density, especially in post-menopausal women. This is caused by a decrease in the level of calcium and other minerals in the body. Another major degenerative change in the musculoskeletal system is a decrease in the fluid in joints, which causes the cartilage to rub together and erode, causing complications like osteoarthritis. A problem commonly experienced in the shoulder is the deposition of minerals around the joint, leading to restricted movement.

Bones are more prone to breaks and fractures in the elderly, which can lead to a loss of mobility. The fragility of the bones, combined with gait changes, loss of balance, reduced reflexes, and instability lead to an increased risk of injury in the elderly. It is also common for people to experience activity intolerance with age, owing to the increase in muscle weakness and fatigue. The elderly also commonly experience complications like fasciculations (involuntary movements) and paresthesias (abnormal sensations). The doctors at OrthoTexas, Denton TX provide state-of-art treatment options for degenerative joint and bone disorders.

The diagnosis of these disorders is carried out by various techniques depending on the symptoms being experienced. The first step in the diagnosis is assessing the clinical history of the patient, including the family history and any other medical problems the patient might have. The doctor then assesses the patient’s reflexes and general health through a physical examination. Diagnostic techniques like X-rays, Magnetic Resonance Imaging, and a possible joint aspiration are then carried out to determine the disorder, the extent of damage caused, and the possible treatment options.

Most successful treatment programs for degenerative joint and bone disorders include a combination of medication, physical therapy, lifestyle modifications, pain relief techniques, and rest. In some cases, it might be necessary to perform surgery.

Degenerative disorders of the bones and joints can be prevented by adopting a moderate exercise program to maintain strength, flexibility, and balance. Women should be especially careful to include sufficient amounts of Calcium and Vitamin D in their diets as they age.

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