The document discusses several common foot conditions including bunions, bursitis, osteomalacia, osteoporosis, rickets, and osteoarthritis. It describes the symptoms, causes, treatments, and results of treatment for each condition. For bunions specifically, it notes the main symptom is a bulge at the base of the big toe. Causes include ill-fitting shoes and genetics. Treatment may include rest, pads, splints, anti-inflammatory drugs, cortisone injections, and sometimes surgery to realign the toe.

1. Pathology I Alyssa, Kayla, Manny, Ashley, & Kylie Group 4

2. Osteoarthritis Most common joint disorder Significant in those over 60 (25% of woman and 15% of men) Also known as degenerative arthritis or DJD

3. Osteoartritis a. Causes: Cumulative wear and tear on joint surfaces May be gene linked to disease Cushioning cartilage between bones wears away in joints As it worsens, cartilage flakes off and eventually disappears and bone rubs on bone Ligaments and muscles around joints loosen and become weak May be linked to aging Those overweight are more susceptible Long- term overuse b. Symptoms: Over time, pain becomes present when at rest Joint swelling Muscle weakness around arthritic joints Joint movement causes cracking, swelling or warmth Limited range in motion c. Treatment: Depends on which joint is affected Over the counter pain relievers (Tylenol, Aspirin) Food supplements  glucosamine and chondroitin Doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or Celebrex Corticosteroid injections into the affected joint Exercise Applying heat and cold Watching weight Physical therapy Braces and splints Surgery may be needed d. Results of Treatment: Corticosteroid injections  relief only for few weeks Most treatments only last temporarily Surgery can create great improvement

4. Rheumatoid Arthritis Inflammatory condition Affects other organs of body Three times more common in females vs. males Affects roughly 2.5% of population Considered an autoimmune disease Can happen at any age

5. Rheumatoid Arthritis a. Causes: Exact cause is unknown Most commonly affected  wrists, fingers, knees, feet, and ankles Infection, hormones, viruses, bacteria and genes may have affect Misdirected immune systems attacks the body’s tissues and organs Smoking tobacco increases risk b. Symptoms: Beings gradually with: Fatigue Loss of appetite Stiffness (morning time or after inactivity) Muscle aches (widespread) Weakness Low-grade fever Joints become red, swollen, tender (painful) c. Treatment: Lifelong treatment Disease modifying antirheumatic drugs (DMARDs) Aspirin Nonsteroidal anti-inflammatory drugs (NSAIDs) Corticosteroids Certain white blood cell modulators to help inflammation Tumor necrosis factor (TNF) inhibitors to help inflammation Surgery (synovectomy and total joint replacements) Physical therapy/ Occupational therapy d. Results of Treatment: Surgery can relieve joint pain and improve joint function Medications are more short term relief Therapy can be big help for pain Can stop damage to joints Most treatments will improve function of joints and joint pain

6. Osteomalacia Osteomalacia is the softening of the bones due to a lack of vitamin D or a problem with the body’s ability to break down and use this vitamin. (above) “AP Radiograph. X-linked hypophosphatemic osteomalacia. Patent sacroiliac joints, dense bones, and bowed femora in X-linked hypophosphatemic osteomalacia.” (Courtesy of Professor J. E. Adams, FRCR, Manchester University, England.)

7. Osteomalacia Symptoms: Bone Fractures that happen with very little injury Muscle Weakness Widespread bone pain, especially in the hips More General Symptoms: Abnormal heart rhythm Numbness of arms and legs Numbness around the mouth Spasms of hands or feet b. Causes: Not enough vitamin D in the diet Not enough exposure to sunlight, which produces vitamin D in the body Reduction of vitamin D by means of: use of very strong sunscreen; limited exposure of the body to sunlight; short days of sunlight; smog; not drinking milk Conditions that may cause Osteomalacia: Cancer Hereditary or acquired disorders of vitamin D metabolism Kidney failure Liver disease c. Treatment: Vitamin D, calcium, and phosphorus supplements taken by mouth Regular blood tests may be needed to monitor blood levels of phosphorus and calcium in persons with certain underlying conditions Moderate exposure to sunlight d. Results of Treatment: Improvement from symptoms can be seen within a few weeks in certain people with vitamin D deficiency disorders. Complete healing with supplement treatment takes place in 6 months.

8. Rickets Rickets is a disorder caused by a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones in children.

9. Rickets Symptoms: Bone pain or tenderness of arms, legs, pelvis, and spine. Dental Deformities -Delayed formation of teeth -Decreased muscle tone (loss of muscle strength) -Defects in the structure of teeth, holes in enamel -Increased cavities in the teeth -Progressive weakness Impaired growth Increased bone fractures Muscle cramps Short stature (adults less than 5 feet tall) Skeletal Deformities Asymmetrical or odd-shaped skull Bowlegs Bumps in the ribcage Breastbone pushed forward Pelvic deformities Spine deformities b. Causes: Vitamin D helps maintain control of levels of calcium and phosphate in the body. When levels of calcium and phosphate are low in the bloodstream, the body produces hormones that release the needed calcium and phosphate from the bones. This process leaves the bones soft and weak. A lack of vitamin D may occur when individuals: -live in climates with little exposure to sunlight -must stay indoors -work indoors during daylight hours -are lactose intolerant (have trouble digesting milk products) -do not drink milk products -follow a vegetarian diet c. Treatment: After a physical exam, bone x-ray, or blood work revealing the lack of these minerals, dietary sources of vitamin D such as fish, liver, and processed milk may help bring levels of vitamin D up in the bloodstream. Exposure to a moderate amount of sunlight is also encouraged. If the problem of Rickets is mainly metabolic, supplements of calcium, phosphorus, and vitamin D may be prescribed. d. Results of Treatment: After treatment strength of the muscles should resume in the body. If Rickets is treated when the child is very young, any skeletal deformities will most likely improve and disappear over time. But if Rickets is treated at a later time when the child has stopped growing, most deformities are permanent.

10. Bursitis Bursitis is an inflammation of a bursa. A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The major bursas are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.

11. Bursitis a . Symptoms: -Pain that increases with movement of joint -Tenderness of joint -Limited movement in the affected areas -Swelling and redness in affected areas b. Causes: by trauma, infection, and crystal deposits More specifically factors include: -Overuse or injury to the joint areas from playing or working -Incorrect posture at work or rest, or poor conditioning before exercise or playing sports -An abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a particular joint) that stresses soft tissue structures. -Sometimes in association with other diseases or conditions, such as rheumatoid arthritis, gout, tuberculosis or psoriatic arthritis -Staphylococcal or other (bacterial) infection Treatment Results after Treatment

12. Bunion A bunion is an enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes caused by ill-fitting shoes, congenital causes, or injuries.

13. Bunion a. Symptoms: The dominant symptom of a bunion is a big bulging bump on the inside of the base of the big toe. Other symptoms include swelling, soreness and redness around the big toe joint, a tough callus at the bottom of the big toe, and persistent or intermittent pain. (A frequent symptom is pain in the involved area when walking or wearing shoes that is relieved by resting). A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. b. Causes: -High-heeled or ill-fitting shoes -Inherited foot type; flat feet -Foot injuries -Deformities present at birth (congenital) -Tight-fitting shoes -Bursitis -Neurological conditions -Excessive ligamentous flexibility -Abnormal bone structure -Biomechanical abnormality c. Treatment: Bunion Surgery For those whose bunions cause persisting pain, a surgical operation is considered. Surgical procedures can correct deformity and relieve pain leading to improved function. These procedures typically involve removing the bony growth of the bunion while realigning the big toe. Surgery is often, but not always, successful, and failure to relieve pain can result from the big toe moving back to its deviated position before the operation. Proper footwear and activity restrictions can reduce the chances of surgical failure.

14. Bunion Treatment c. Treatment (cont.) Resting the foot by avoiding excessive walking and wearing loose (wider) shoes or sandals can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that tug the big toe outward. Anti-inflammation medications, such as aspirin, ibuprofen and naproxen, can help to ease inflammation as well as pain. Local cold pack application is sometimes helpful as well. To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes given. A bunion splint, usually worn at night, can provide further relief. Depending on the structure of the foot, custom insoles might add further support and repositioning. Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone. Any signs of skin breakdown or infection can require antibiotics. When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care. Repair of the Tendons and Ligaments Around the Big Toe These tissues may be too tight on one side and too loose on the other, creating an imbalance that causes the big toe to drift toward the others. Often combined with an osteotomy, this procedure shortens the loose tissues and lengthens the tight ones. Arthrodesis: Removal of the damaged joint surfaces, followed by the insertion of screws, wires, or plates to hold the surfaces together until it heals. Used for patients with severe bunions, severe arthritis, and when other procedures have failed. Resection Arthroplasty : Removal of the damaged portion of the joint, used mainly for patients who are older, have had previous bunion surgery, or have severe arthritis. This creates a flexible "scar" joint. Osteotomy: The surgical cutting and realignment of the joint. Your orthopaedic surgeon will choose the procedure best suited to your condition. Exostectomy : Removal of the bump on the toe joint; used only for an enlargement of the bone with no drifting of the big toe. This procedure is seldom used because it rarely corrects the cause of the bunion.

15. Bunion (Results after Treatment) d. Results after surgery: Though uncommon, complications can occur following bunion surgery. Contact your orthopedic surgeon if: Your dressing loosens, comes off or gets wet. Your dressing is moistened with blood or drainage. You develop side effects from postoperative medications. Also, call your orthopedic surgeon immediately if you notice any of the following warning signs of infection: Fever. Chills. Persistent warmth or redness around the dressing. Increased or persistent pain. Significant swelling in the calf above the treated foot. Recovery after surgery Dressing Care Wear a special postoperative surgical shoe or cast to protect the foot. The sutures will be removed about two weeks after surgery, but the foot will require continued support from dressings or a brace for six to eight weeks. Interference with proper healing could cause a recurrence of the bunion. Be sure to place a plastic bag over the foot while showering.

16. Herniated Disk A Herniated Disk is a painful rupture of the fibrocartilage of the disc between spinal vertebrae; occurs most often in the lumbar region a. Symptoms: (depends on the exact location) Local Pain The Pain is usually worse when you’re standing, and is relieved when lying down. b. Causes: Aging Degeneration of the disk Injury to the spine Obesity (pressure on the spine) Lifting heavy objects Sudden twisting c. Treatment: 6 to 10 months of Physical Therapy Surgery maybe recommended. Pain medications Steroid Injections d. Results of Treatment: Over a long period of time, herniated disks can be healed.