The hip is made of two iliac or innominate bones called strongly welded together if the front and back by the sacrum.

It says that the iliac bone is flat, and it articulates with the sacrum, which runs a wedge between the two iliac. The union of these is the pelvic girdle, where organs are housed very important to our lives.

As interesting details we named the acetabulum, which is a cavity esfererica for the accommodation of the femoral head to fiormar the hip joint.
Hip Biomechanics

The hip joint is a very strong ball and socket joint coaptation. It has a smaller range of motion in relation to the shoulder joint, but has a greater stability.

AXIS OF MOVEMENT

1. transverse axis: located in a frontal plane movements are performed flexion-extension
2. Anteroposterior axis: situated in a sagittal plane are made of abduction-adduction movements
3. Vertical axis: allows the movements of external rotation, internal rotation.

FLEX

The hip flexion is the movement that carries the anterior thigh to meet the trunk. The hip flexion is closely related to the attitude of the knee, we thus:

* Active flexion with the knee extended: 90 º
* Active flexion with the knee flexed 120 °
* Passive flexion with the knee flexed 140 º
* Passive flexion with the knee extended: less than before.

The knee flexion, the hamstring muscles relax, allowing more flexion of the hip.

In passive flexion of both hip joints with flexion of the knees, the anterior of the muscles provides a broad contact with the trunk, as the bending of the coxofemoral added backward tilt of the pelvis by straightening lumbar lordosis.

EXTENSION

The extension leads to the lower level behind the front.

The breadth of the extent of the hip is much smaller than the bending and which is limited by tension developed by the iliofemoral ligament.

Active extension. Less comprehensive than the passive:

1. With the knee extended: 20 º
2. With the knee flexed: 10 °, this is because the hamstrings lose their effectiveness as hip extensors have used a substantial part of its force of contraction in flexion of the knee.
3. Passive extension: 20 º, takes place one foot forward, bending the body forward while the other remains motionless.

You can achieve significant increases in amplitude with the practice of proper exercises.

ADDUCTION

The pure adduct does not exist. There, on adduction, when starting from a position of abduction lead to the leg inward.

There adduction combined with hip extension and adduction combined with hip flexion.

In all combined adduction, the maximum amplitude of adduction is 30 º

The sitting position with legs crossed over each other, is formed by ballot box associated with a flexion adduction and external rotation. In this position, hip stability is minimal.

ABDUCTION

Abduction leads to the lower outward direction and away from the plane of symmetry of the body.

The abduction of hip abduction is accompanied by equal and the other automatic.

When we take the maximum abduction, the angle of the lower extremities is 90 °, from which it follows that the maximum amplitude of hip abduction is 45 degrees.

Damage to cartilage may occur as a result of trauma to the knee or wear and tear on the joints. There are some people with damaged articular cartilage who display few symptoms and do not develop osteoarthritis but until they are older. Although symptoms may not appear until later in life, articular cartilage problems are very common. When the gliding of the articular surface of the joint is lost due to defects of the content is developed abnormal friction that leads to greater wear of the cartilage. This leads to the development of osteoarthritis of the knee becomes painful.

The development of osteoarthritis depends on several factors:

1. Patient age at onset of the degeneration
2. Patient’s activity level and weight
3. The presence of lesions of the anterior cruciate ligament and meniscus

What is the articular cartilage and what to do?

There are two types of human knee cartilage:

1. Fibrocartilage is commonly known as meniscus.
2. The articular cartilage. This cartilage is bright, white that covers the ends of the surfaces of most bones. Articular cartilage protects the ends of bones in joints and allows slippage of them in gently with less friction. It also helps to spread the loads applied to the joints. This is only a few mm thick and has no blood supply to facilitate the healing process. Therefore, if it breaks, there is little ability to heal.

What is an articular cartilage injury?

An injury to the articular cartilage (chondral lesion) may occur as a result of a pivot or twist on a bent knee, similar to the movement that can cause a meniscal tear. Damage can also result from a direct blow to the knee. Chondral injuries may accompany an injury to a ligament, including the anterior cruciate ligament. Small pieces of articular cartilage may break off and float around the knee as loose bodies, causing locking of the joint and / or swelling. Most of the time, there is no clear history of a single lesion. The patient’s condition may in fact be the result of a series of minor injuries that have occurred over time. Articular cartilage also wears down with use as with the elderly.

The cartilage damage is classified from mild to severe, and all grades can have characteristics of osteoarthritis or arthritis wear.

Cartilage damage rating:

1. Grade I: The cartilage swells and softens. This is the first form of damage.
2. Grade II and III: As the condition worsens, the cartilage can become cracked (looks grated). The degree of injury depends on the size of the area involved and affected cartilage thickness.
3. Grade IV – The cartilage has worn away completely, leaving the bone exposed from small areas at a generalized form. When the areas involved are large, pain usually becomes more severe, causing a limitation in the activity.

What are the signs and symptoms of an articular cartilage injury?

The symptoms of an articular cartilage injury is not as obvious as a torn meniscus or ligament.

1. Intermittent Swelling: Sometimes the only symptom. The loose fragments of cartilage floating in the knee can cause swelling.
2. Pain: Pain may occur with prolonged walking or climbing stairs.
3. Loss of stability: The knee may become unstable when walking.
4. Block: loose cartilage fragments floating within the knee can be trapped when the knee is flexed causing the blockage of this.
5. Noise: The knee may crackle or make noise during movement, especially if it is the cartilage of the patella which is damaged.

How do you diagnose articular cartilage damage?

It can be difficult to diagnose articular cartilage injury. Physical examination may show swelling of the knee, but the test may be normal.
X-rays may be normal in most cases because only the bone is visible on X-rays. When the loss of cartilage is advanced there is a decrease in space between two bone surfaces. Loose bone fragments can be detected in a condition called osteochondritis dissecans (OCD), in which a piece of bone between the articular cartilage.

MRI can reveal the different changes in the cartilage, from early stages of cartilage disease, such as softening, to complete loss of this or osteochondral loose fragments.

Diagnosing articular cartilage damage is more reliable with an arthroscopic exam. In this procedure, a tiny fiberoptic lens inserted into the joint with fully observed inside the knee.

How is articular cartilage injury?

Nonsurgical Treatment

Articular cartilage degeneration is often treated without surgery. Some of the measures that the doctor may recommend are:

1. Weight loss.
2. Exercises to strengthen the muscles around the joint.
3. Templates walked to cushion the shock.
4. Changes in physical activity.
5. Injections of hyaluronic acid to improve lubrication and reduce friction.

The doctor will usually prescribe drugs to treat the symptoms of the patient and observe the progress. Although there are medications that can treat symptoms associated with articular cartilage damage, there are no drugs that can repair or promote new cartilage growth.

Surgical treatment

In the past 10 years, there have been many interesting advances in the surgical treatment of articular cartilage defects. The most commonly used treatment involves shaving the affected cartilage using an arthroscopic procedure. However, important research in this field of medicine has led to the development of several new techniques to tackle this difficult problem.

Factors influencing the choice of procedure include:

1. The size of the defect.
2. The location of the defect in the knee.
3. The age and weight of the patient.
4. Activity level and activity of the patient wishes in your future.
5. The patient’s motivation and ability to participate in postoperative rehabilitation.
6. The alignment of the limb of the patient: Are the knees or legs bowed out of the patient?

A simple way to make a diagnosis by coaches

The patella is the largest of the sesamoid bones (developed within a tendon) of the human body. It is located on the femoral condyles. It is vital to achieve the last degrees of extension and hyperextension of the knee. Improves the lever because it raises the point farthest from the quadriceps.

The patella pathologies generally occur very slowly and the signs can be very nonspecific, difficult to diagnose and can be shared with other diseases. Sometimes become evident with widespread pain, when you make certain efforts or adopting unusual positions, such as climbing stairs, squatting or perform full knee flexion.

The idea is to examine the athlete or trainee to present these signs, to get an idea prior to diagnosis of a health professional, and we can do this in two ways:
- Stopping it, with legs together, to observe the alignment of the legs and swivels, so you’ll get important information to know if the bearings are converging or diverging, or if we have an individual with “genuvalgo” or “genuvaro.”

The change in patellar position may be of muscular origin or external rotation or anteversion of the femoral neck. Whatever the origin, the most important thing is to maintain very strong vastus medialis, or retrieval in case of weakness or atrophy, for a good knee function. As we know, to work the vastus we do it especially in the last 30 degrees of knee extension and slight external rotation of the foot.

- The second way to assess patellar pain the individual is sleeping. We took the top edge of the patella and quadriceps ask a contraction, ruling out a problem we can detect synovitis patellae. Another maneuver is to push from the inside of the kneecap outward as the athlete bend the knee pain is present we have a patellar problem.

There is a simple way to know if this person has a tendency to dislocate the patella. It should draw two lines to get an angle (Q). The first line will be from the head of the femur to the center of the patella, the second from the same point to the anterior tibial tuberosity. Q If this angle exceeds 15 degrees, there is a tendency to dislocation.

Other dislocations are likely causes, patella alta, valgus deviation, muscle imbalance, surgical sequelae, hypotrophy or flattening of the lateral condyle of the femur, patella girl or deterioration, etc. For this reason it will be vital to strengthen the quadriceps for its containment, and above all, as mentioned earlier the vastus medialis, as almost all these cases generate an external dislocation, and this muscle will be responsible for aligning and maintaining the bone .
Successive dislocations generate a disease of the patella, called chondro malacia, and finally with the passage of time increases the possibility of the occurrence of osteoarthritis.

Remember that surgery should be implemented in the worst of circumstances, and immobilization in very acute cases.

In general, damage to the ligaments of the knee are common sports-related injuries.

Arthroscopy is the use of cameras and instruments on the end of long narrow tubes to correct Problems in the knee. The tubes are insert into the knee-through small incisions.

Knee surgery is Performed in the Following Cases:

* When a disc ruptures in the knee (meniscus)
* When a Damaged knee bone (patella or patella)
* When a ligament is Damaged
* Flammability or Damaged joint lining (synovium)

Treatment of Spinal Fractures from Osteoporosis

The treatment with vertebroplasty for vertebral fractures caused by osteoporosis has proven effective, with less pain in 90% of cases and effects that have been proven durable over time, as is clear from the experience of the Fundación Jiménez Diaz. In fact, both Dr. Antonio Pérez Higueras, Chief of Neuroradiology, and Dr. Luis Alvarez Galovich specialist Spine Surgery Department of Orthopaedics and Traumatology, have reported the results obtained in the FJD, with more experience 300 interventions in the last six years, at various conferences and national and international meetings.

It was precisely in 1995, when the Fundación Jiménez Díaz, in the service of Neuroradiology, headed by Dr. Antonio Pérez Higueras, began the realization of the technique of “hardening” of the affected vertebral bodies. This technique produces an almost immediate relief of discomfort and allows patients to return to their daily activities. This procedure, known as minimally invasive vertebroplasty is performed under sedation and local anesthesia. Usually requires an inflow of 24 hours, but sometimes can be performed as outpatient surgery without income.

The technique basically involves placing a tube inside the vertebral body through which the injection is made of cement. The cannula is placed under radiological control and then slowly injected biological cement that sets in 15-20 minutes, strengthening the bone.

A growing problem

We must remember that osteoporosis is the most common metabolic bone disease that affects more than 30% of the female population above 65 years of age.

Moreover, forecasts indicate that its incidence is expected to quadruple the worldwide population over the next 50 years. Vertebral fractures are common and cause severe pain and continued producing a major constraint to the development of people’s daily activities. In general, treatment with rest, analgesics and the use of external media is effective in most cases. But in some patients the pain is persistent and very disabling as it requires the use of narcotics. In these cases where you should indicate the performance of this technique.

Spondylolisthesis is a spinal condition in which one vertebra slips forward over the vertebra below. Degenerative spondylolisthesis usually occurs in the lumbar spine, especially at L4-L5. It is the result of degenerative changes in the vertebral structure that causes the joints between the vertebrae to slip forward. This type of spondylolisthesis is most common among older female patients, usually over 60 years.

Symptoms

Symptoms of spondylolisthesis may include the following:
* Pain, especially after exercise, lower back, thighs and / or legs, radiating into the buttocks and / or to the legs (sciatica)
* Muscle spasms
* Weakness of legs
* Hamstring Tightness
* Irregular gait or limp

Some people with spondylolisthesis have no symptoms and do not discover the illness until they see the doctor for another health problem. However, the vertebral body slipping forward in severe cases of degenerative spondylolisthesis often leads to spinal stenosis, nerve compression, pain and neurological injury.

What causes degenerative spondylolisthesis?

Degenerative spondylolisthesis is usually the result of age and wear on the spine that causes spinal component failure. It is different from isthmic spondylolisthesis that does not involve a defect. Spinal stenosis tends to occur in the early stages of degenerative spondylolisthesis.

Diagnosis

Correct diagnosis is obviously essential. Dr. Lonner uses the latest diagnostic technologies, combined with medical examinations by experts to make sure an accurate diagnosis. Diagnostic tools include:

* Medical history. It will ask about your symptoms, their severity, and treatments tested.
* Physical examination. Will be checked carefully to determine if there are limitations of movement, balance problems, pain, loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological damage.
* Diagnostic tests. Usually we start with X-rays that allow us to rule out other problems such as tumors and infections. You may also use a CT scan or an MRI to confirm the diagnosis. In some patients using a myelogram, which is a test that involves the use of a liquid dye is injected into the spinal column to show the degree of compression of the nerves, the sliding of the affected vertebrae, and abnormal movements .

Classification of Spondylolisthesis

There are several ways to “grade” the degree of slippage ranging from mild to most severe. Discuss with you the extent of your spondylolisthesis.

In general, most physicians use the Meyerding Rating System for classifying slips. This system is relatively easy to understand. Landslides are classified based on the percentage in which a vertebral body has slipped forward over the vertebral body below. Thus a Grade I slip indicates that 1-24% of the vertebral body has slipped forward over the vertebral body below. Grade II indicates a 25-49% slip. Grade III indicates a 50-74% slip and Grade IV indicates a shift of 75% -99%. If the body completely slips contact with the body below it, is classified as a Grade V slip, known as spondyloptosis.

Non-Surgical Treatment

In most cases of isthmic spondylolisthesis (especially Grades I and II) treatment consists of temporary bed rest, restriction of the activities that caused the onset of symptoms, pain medications and anti-inflammatory steroid-anesthetic injections, Physical and / or spinal bracing.

Degenerative spondylolisthesis can be progressive – meaning the damage will continue to worsen as time passes. In addition, degenerative spondylolisthesis can cause spinal stenosis, a narrowing of the spinal canal and compression of the spinal cord. If spinal stenosis is severe, and all non-surgical treatments have failed, surgery may be necessary.

Surgical Treatment

Surgery is rarely necessary, unless the case is severe (usually Grade III or greater), neurological damage has occurred, the pain is disabling, or that all options have failed nonsurgical treatment.

The most common surgical procedure used to treat spondylolisthesis is called a laminectomy and fusion. In this procedure widens the spinal canal by removing or trimming the laminae (roof) of the vertebra. This is done to create a larger space for the nerves and relieve pressure on the spinal cord. It may be necessary for the surgeon to fuse vertebrae. If a merger may be necessary to implement various devices (like screws or interbody cages) to reinforce the merger and support the spine unstable.

Case Example of Degenerative Spondylolisthesis
This 58 year old woman had degenerative spondylolisthesis at the level of L4 / 5, as seen on radiography and magnetic resonance above. He had difficulty walking certain distances and back and leg pain. She was treated with laminectomy and fusion with instrumentation (see the article on PLIF, ALIF and TLIF for details of the procedure.)

Conclusion

Most people will have some degenerative changes in the spine as they age. However, severe spondylolisthesis only affects a small percentage of the population. Overall, most degenerative disorders of the spine can be treated successfully using non-surgical methods. In Scoliosis Associates will work closely with you to find the best treatment for you and help you regain an active lifestyle.

The backbone or vertebral column consists of 24 individual bones called vertebrae, which are spliced on top of each other to form a flexible column that is the mainstay of the body. The vertebrae are divided by their location in cervical, lumbar, thoracic and sacral.

Inside the column running a major spinal cord called neural structure that contains thousands of nerves that come out of it to each body part to take, receive and convey information from different parts of the body to the brain and vice versa.

The vertebrae are separated by soft discs of cartilage, called intervertebral disks, which consist of a fibrous ring that binds together the vertebrae and inside, this ring nucleus pulposus has a soft consistency, similar to a jelly. These disks act as shock absorbers to protect the vertebrae from each other when there is some movement and help her back to bend, twist and rotate.

The strongest support for the column are the muscles of the stomach and back as well as many ligaments that go from top to bottom in the back.

The spine, neck and back allow us to walk, sit, stand, run, and in order to make any movement of the limbs, so it is very important to take care of injuries as they generally are complicated in their treatment.

While most back and neck pain are caused by bad posture also another reason that generates and affects other body parts such as limbs: are disc herniations that are causing more or less than 80% of pain in the lumbar region.

A herniated disc occurs when one or more of the cartilage disks are out of place and put pressure on nearby nerves, causing intense pain. A hernia means that the outer layers of the pad is broken partially or completely, allowing a shift away from internal fragment of the disc compressing the nerves inside the column.

This problem usually starts between 20 and 30 years, when the fibrous ring undergoes a process of degeneration that causes the disc to flatten and lose their elasticity, which can sometimes lead to a fissure, which increases more than 30 to 50 years, giving rise the hernias. The same degenerative process occurs in the nucleus pulposus causing decay and escape from their normal place.

The output of the nucleus of place is going to develop a herniated disc, which will compress the nerve roots from the spinal cord, which is housed within the spine. Depending on the location and type of hernia is that it will exhibit the symptoms in each person.

If the hernia occurs in the cervical vertebrae, the affected parts are the arms and hands and if it occurs in the lumbar vertebrae, the affected party will be from the waist down.

There are several reasons why the cartilage that lies between the vertebrae out of place:
- For a fall or an accident.
- For great efforts repeated back, in some types of work.
- For some sudden and harsh action such as lifting heavy objects improperly or twisting violently.
- Spontaneously, without a definite cause.

The tarsus is the back foot and a half, is formed by the bones that lie behind the metatarsals. These bones are: the calcaneus (heel bone), talus (the bone that articulates with the tibia that this form the ankle), the navicular, cuboid and three wedges. When an overload of the joints between these bones to develop osteoarthritis, which is not only premature aging of the cartilage covering the bone.

Causes

Osteoarthritis of these joints is increased by the overload due to certain deformities (pes planus, pes cavus, etc …) for obesity, and type some rheumatic diseases that directly attack the joints. When fractures occur affect the joints or bone deformities may also cause premature degeneration of cartilage.

Essentially increasing pain when walking. The initial pain may be felt in the tendons of the dorsum of the foot and then deeper and can be seen in the bone. Osteoarthrosis in advanced stages produce a thickening of the bone near the joint that will be highlighted as deformities and “packages” hard (osteophytes) below the skin.

Treatment

It is important to emphasize avoiding overloading, treating obesity. It must, likewise avoid walking over uneven ground. Download templates can help in the treatment of pain. When the source of pain are tendinitis, common in this type of foot, can be treated by rest and anti-inflammatory. The surgery is performed in cases that do not improve with the measures described above, in it attempts to fuse the joints affected by arthritis for the pain.

WHAT IS IT?

It is a lump interdigital nerve of the foot. Interdigital nerves are in the sole. When you are under the principles of the metatarsals are split into two beams, one in the direction of each finger. Morton’s neuroma occurs in the 2nd and 3rd interdigital nerves. It is what is known as 2 and 3 spaces. Usually radiates to the 2nd or 3rd finger. This is often the only symptom.

SEE WHY THE NEUROMA?

There is usually a bad metatarsal support, so that the nerve becomes trapped between the floor and the metatarsal intermetatarsal ligament that is closing the roof space.

How is it diagnosed?

1. Clinical Examination
2. Ultrasound
3. RNM

THIS IS HOW?

1. Injections:

At first it may be an effective treatment that resolves the problem, sometimes permanently. However if one does not work with recommend not insist.

2. Orthotics:

It is also an effective method that can solve the problem. Since the origin is frequently a bad foot support, it makes sense to respond to treatment with templates. We recommend the use of orthotics if we have obtained a good result in leakage. Also recommended for after the surgery. Our choice for the soft template Morton, Denis type with retrocapital handrail.

3. Surgery:

Until recently the only question raised by the Morton’s Neuroma Surgery was: When we operate and if the incision had to be made via plantar or dorsal. Endoscopic Surgery Today has given us an outstanding choice.

WHEN WE TEST?

Basically when we have exhausted conservative treatment (injections, templates, etc …)

Should we removed the NEUROMA?

Endoscopic Surgery Today gives us the opportunity to NOT remove the neuroma. Obviously it is better does not remove the neuroma if possible.

WHAT ARE THE CONSEQUENCES to remove the neuroma?

For many years we have performed this surgery and, thankfully, we have cured the immense majority of our patients. Yet it is an aggressive surgery that involves a major plantar or dorsal scar, a certain loss of sensibility in the fingers and often can cause residual pain at the scar. The recovery time is much slower when you cut the root of the neuroma. The patient begins to wear normal shoes after a month postop. With endoscopy, the patient begins to walk the same day and the week and you can use a sports type soft shoes.

WHAT IS THE PERCENTAGE OF SUCCESSFUL SURGERY Morton’s neuroma?

In 80% of patients achieved cure without sequelae of the disease. When it does not we can resort to traditional surgery to remove the neuroma. In no case may worsen the disease Endoscopy.

COMPLICATIONS OF ENDOSCOPY

In itself it has more complications than the other surgeries, in no event may worsen the patient’s clinical picture. We could say that the worst thing that could happen is that the neuroma was not solved and the patients require open surgery to remove it. Nevertheless, endoscopy is a procedure so little aggressive than the vast majority of patients accept without thinking too much this small possibility.

SURGICAL TECHNIQUE: WHAT SHOULD I KNOW?

1. OUTPATIENT PROCEDURE: This surgery outpatient practice, because we do Suvee general anesthesia and its duration (operating time) is about 15 minutes. The patient should be in the hospital 1 hour before, as in all outpatient procedures, and after surgery will last for about an hour in the recovery room.

2. RESTART ambulation (walking): After this time you can start walking with the help of a special shoe heel invested.

3. FIRST WEEK: The patient can walk with the inverted heel shoe. The pain is minimal. If you have severe pain must warn it is not normal. It is normal for a small spot of blood. Despite this abuse and should not recommend a little rest.

4. SECOND WEEK: We took the points and allow comfortable shoes to walk using a sporting or similar type.

5. THIRD AND FOURTH WEEKS: The discomfort will gradually disappear. Some patients report a small area of sensitivity to plant a little upset that used to annoy.

6. DOLORES WASTE: With Morton’s Neuroma surgery, either open or closed, we can only hope to solve the pain from the disease.

If we consider that the neuroma appears, inter alia, by poor foot support, all the trouble of this fact with the exception of reference, may persist, it means metatarsal pain, bursitis, etc …
The doctor should lose a bit of time explaining to the patient that is to be expected from endoscopy or open surgery.

It is a deformity of the toe or big toe “of the foot that does not maintain normal alignment gradually moving out, even to be available over the fingers.

- Causes:

There are several factors that influence its appearance and development is one of the most important long-term use of inappropriate footwear, narrow toe and high heel -. It is therefore a much more frequent in women than in men. At other times there is a familial predisposition for the disease, especially if they have mothers. Other times it is due to congenital defects in the shape of the foot and less inflammatory diseases such as rheumatoid arthritis. In many cases, is due to the sum of several factors.

Usually bilateral but may affect more than one foot to another and though, more often is the development in adulthood may also have juvenile cases.

- Clinical Manifestations:

* At first, cause pain, deformity and only the difficulty of finding suitable footwear.
* Over time will produce an osteoarthritis and dislocation of the joint with destruction of the same, which is painful and very disabling. Also in the inner neighbor by friction with the shoe, they become inflamed and very painful callus that prevents footwear.

- Diagnosis:

The simple assessment by the physician and the realization of a simple radiographic study is sufficient for diagnosis.

- Treatment:

* The best treatment is prevention by avoiding the use of inappropriate footwear. In early forms can be applied for daytime use braces and / or night only in early cases and with continued use can prevent the progression of the deformity.
* Sometimes it is also recommended the use of templates and custom-made orthopedic shoes
* Finally, if advanced and painful deformities surgery is recommended, with multiple techniques depending on the degree of injury and patient age.

Hammer Toes

This is a deformity of the fingers, usually affecting several simultaneously, and that too often accompanies the hallux valgus, in this case only usually affects the second toe – the toe adjacent to -. Only appears in the last four fingers, first finger or thumb does not suffer this problem.

It produces an excessive extension of the root joint of the finger and also excessive flexion of the joint below, creating a prominence at the top of the finger, which makes protruding above the rest.

- Causes:

Many times it is due to the manner of the fingers, longer than usual, with the use of short shoes that force the fingers to bend. Sometimes accompanying the bunion deformity often forming an association. In other cases there are inflammatory diseases that may be the cause.

- Clinical Manifestations:

Usually affect both feet, can seat one or more fingers. At first I only produce visible deformity, which disappears if it is not the foot. Over time, they become stiff and painful calluses appear prominently in the area by rubbing with the footwear.

- Treatment:

Its appearance is connected with high narrow tip shoes to avoid.
If the finger has a flexible deformity braces can be used to try to correct them.
If they are stiff and painful the only solution is surgery.

Claw Toes

It is a deformity that can affect all the fingers but less frequently to the big toe. Instead of supporting the entire surface of the fingers, the support is made only on the extreme end of the finger, which takes the form of a claw, hence the name.

- Causes:

Usually accompanies cavus although they may appear isolated. Almost always affect all fingers simultaneously, except the fat, which is much rarer.

- Clinical Manifestations:

In addition to the visible deformity, the fundamental problem is the appearance of painful calluses from rubbing of footwear in the top of the fingers.

- Treatment:

Using wide-toed shoes and high. In very painful surgery.

Recommended footwear

The use of inappropriate footwear may promote the development of many painful foot deformities. A shoe right from childhood is the best prevention of these problems.

* The sole should be leather for its flexibility, the soles of rubber or plastic is discouraged by its rigidity.
* The toe should be broad in width and height to accommodate the fingers without compressing or limiting their mobility.
* The counter should not prevent the movement of the ankle or be very rigid.
* In the women’s footwear is preferred shoe covering the instep to leave it exposed. The heel should be above 2cm. below and 6 cm. high.

Recommendations Template

* The templates should always be prescribed by a doctor after the diagnosis of a particular foot problem in an individual patient and must be performed individually for each person.
* The use of standard templates does not usually give good results, you may even aggravate the problem.
* Templates must be used with any shoe and fit properly in the shoe so they do not make your foot is narrow in the shoe or that it is so large that it can move within it.
* Must clog and weigh as much for ease of use and be washable.