Exercise And Myositis Ossification

DESCRIPTION :

Myositis ossificans (MO) occurs when bone or bone-like tissue grows where it’s not supposed to. It most commonly happens in your muscle after an injury — like when you get hit hard in the thigh during a soccer game or maybe after a car or bicycle accident.Myositis ossificans comprises two syndromes characterized by heterotopic ossification (calcification) of muscle.About 80 percent of the time, these bony growths develop in the muscles of your thigh or upper arm.

CLASSIFICATION

strenghening ex

In the first, and by far most common type, nonhereditary myositis ossificans, calcifications occur at the site of injured muscle, most commonly in the arms or in the quadriceps of the thighs.
The term myositis ossificans traumatica is sometimes used when the condition is due to trauma. Also known as Myositis ossificans circumscripta is another synonym of myositis ossificans traumatica refers to the new extraosseous bone that appears after trauma.
The second condition, myositis ossificans progressiva (also referred to as fibrodysplasia ossificans progressiva) is an inherited affliction, autosomal dominant pattern, in which the ossification can occur without injury, and typically grows in a predictable pattern. Although this disorder can be passed to offspring by those afflicted with FOP, it is also classified as nonhereditary, as it is most often attributed to a spontaneous genetic mutation upon conception.

CAUSES

icing
Ice Pack Applied in Painful Area

Myositis ossificans usually occurs where a person has experienced a single traumatic injury, such as sustaining a hit while playing football or soccer that causes a deep muscle bruise.

It can also happen when there is a repetitive injury to the same area, such as in the thighs of horseback riders.

Sports injuries or accidents usually initiate MO. Adolescents and young adults in their 20s are most likely to develop MO. It’s rare for children age of 10 and under to get the condition. People who have paraplegia are also prone to develope MO, but usually with no evidence of trauma.

SIGNS & SYMPTOMS

Unlike other typical muscle strains or injuries, people with myositis ossificans may notice that their pain worsens with time instead of getting better.
Someone with this condition may also notice changes in the affected muscle, including:

Warmth
Swelling
A lump or bump
Decreased range of motion
Tenderness

DIAGNOSIS

If it has been at least 2–3 weeks since the pain or other symptoms started, the doctor may order some imaging tests to look for evidence of bone growth in the soft tissue.
Your doctor may also order other imaging tests. These may include a diagnostic ultrasound, MRI, CT, or bone scan.

X-ray: It can be difficult to diagnose myositis ossificans in the early stages with just an X-ray. Most X-rays will not show up any abnormalities in the first 2–3 weeks following the injury but will show changes after 3–4 weeks.

Ultrasound: Ultrasounds use sound waves to look at the soft tissues. They are one early diagnostic test that can be used to look for the changes associated with myositis ossificans. Ultrasonography depends on the ability of the person reading the scans, so many doctors do not often recommend it as the first test.

CT scan: Doctors can usually see the early development of bone tissue in soft tissues. However, it is not 100 percent reliable, and if a doctor suspects that someone has myositis ossificans, they may carry out additional testing to make the diagnosis.

Magnetic resonance imaging (MRI): An MRI is a preferred method of looking at soft tissue growths. A doctor may still order additional tests to compare and confirm a diagnosis.

A biopsy of the growth may also be taken and evaluated in a lab.

 

MANAGEMENT :

laser therapy
Physiotherapy Treatment

Rest
Immobilization
Anti-inflammatory drugs
physiotherapy management
surgical debridement

Myositis ossificans usually resolves on its own.You may be able to prevent MO by properly taking care of your injury in the first two weeks. You can reduce inflammation by immobilizing the affected muscle with slight compression, icing, and elevation.

Rest: You don’t have to just lie there, but don’t stress the muscle too much.
Ice: Apply for 15 to 20 minutes at a time.
Compression: Wrap an elastic bandage firmly around your injury to minimize swelling and keep the area stable.
Elevation: Raise your injured limb above the level of your heart to help drain excess fluid from the area.
Non-painful stretching and strengthening: Gently stretch the affected muscle and start doing strengthening exercises when your doctor says it’s OK. Don’t perform any movements to the point of pain.

Medications and orthotics

You can take nonsteroidal anti-inflammatory drugs like ibuprofen (Advil) or naproxen (Aleve) to reduce pain and swelling. Topical treatments like Biofreeze or Tiger Balm can also helps to ease pain.

When your pain and movement allow you to get back to sports, wear some padding or other protection on the injured muscle to prevent additional damage.

Physiotherapy management of myositis ossificans includes

Rest

Icing the injury

Pulsed Ultra sound and phonophoresis

Maintain available range of motion but avoid stretching and massage, until maturation.
Passive range of motion and mobilization: This is when a person or machine moves your body parts for you.
Active range of motion and mobilization: This is when you use your own strength to move your body parts.

Iontophoresis with 2 % acetic acid solution.

Extra corporeal shock wave therapy

Surgical Management

Growth should not be removed in premature stage as it will likely reoccur. The ossification becomes exuberant, infiltrates beyond the original site, and compresses the soft tissues around beyond hope of repair. When after serial x-rays the mass is dense, well delineated, and at a stand still, it may be safely removed. It may be possible to prevent myositis by aspirating the original haematoma.

PREVENTION

While it can be difficult to predict who will get myositis ossificans, it is important to treat every injury promptly using the R.I.C.E. method. This is:

Rest
Ice
Compression
Elevation

An athlete who sustains an injury may need to leave the game or event, especially if there is significant swelling or bruising.

Gentle stretching and range of motion exercises are also essential after an injury; myositis ossificans is more likely to affect a muscle that is not being used.

Doing too much too soon can worsen MO. But not working to recover your range of motion when the doctor says it’s safe may make your pain and stiffness last longer.

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Frankele’s Co-Ordination Exercise in Ataxia :

 

FRENKLE ‘S CO-ORDINATION EXERCISE FOR CEREBELLER ATAXIA

CEREBELLUM
Cerebellum And Brain 

Definition of coordination Exercises:

It is the ability to execute smooth, accurate, controlled motor responses (optimal interaction of muscle function).

Coordination is the ability to select the right muscle at the right time with proper intensity to achieve proper action.
Coordinated movement is characterized by appropriate speed, distance, direction, timing and muscular tension.
It is the process that results in activation of motor units of multiple muscles with simultaneous inhibition of all other muscles in order to carry out a desired activity

Importance of the cerebellum in coordination ;

The cerebellum is the primary center in the brain for coordination of movement.

Components of coordinated movement:

Volition: is the ability to initiate,maintain or stop an activity or motion.
Perception:in tact proprioception and subcortical centres to integrate motor impulses and the sensory feedback. When proprioception is affected it is compensated with visual feedback.
Engramformation:is the neurologica lmuscular activity developed in the extrapyramidal system. Research proved that high repetitions of precise performance must be performed in order to develop an engram
.
Types of coordination:

1) Fine motor skills:

Require coordinated movement of small muscles (hands, face).
Examples: include writing, drawing, buttoning a shirt, blowing bubbles

2) Gross motor skills:

Require coordinated movement of large muscles or groups of muscles (trunk, extremities).
Examples: include walking, running, lifting activities.

3)Hand-eye skills:

The ability of the visual system to coordinate visual information. Received and then control or direct the hands in the accomplishment of a task .
Examples : include catching a ball,sewing,computer mouse use.

Causes of coordination impairments , Causes of Ataxia

Degeneration, damage or loss of nerve cells in the cerebellum, which is that part of the brain that controls muscle coordination, causes ataxia. The cerebellum comprises of two small ball-shaped folded tissues present at the base of the brain near the brainstem. Diseases which damage the spinal cord and peripheral nerves which connect the cerebellum to the muscles can also cause ataxia
.
Other causes of ataxia include:

Stroke is a condition where the blood supply to a part of the brain gets severely diminished or interrupted, which deprives the brain tissue of oxygen and other nutrients resulting in death of brain cells.

Trauma or injury to the head, which causes damage to the brain or spinal cord, can cause sudden-onset ataxia (acute cerebellar ataxia).

Chickenpox can result in a complication in the form of Ataxia; although this is not common. Ataxia can appear during the healing stages of the infection and persist for days to weeks and gradually resolve over the time.

Transient ischemic attack (TIA) is caused by a temporary reduction in blood supply to a part of the brain. Majority of the TIAs last only for a few minutes. Some of the symptoms of TIA include ataxia, which is temporary.

Multiple sclerosis is a chronic, potentially debilitating medical condition, which affects the central nervous system.

Cerebral palsy consists of a group of disorders, which occurs as a result of damage to a child’s brain during its early development. It can be before, during or shortly after birth. It affects the ability to coordinate movements of the body.

Paraneoplastic syndromes are rare, degenerative disorders, which are triggered by the response of the immune system to a tumor or neoplasm. This tumor is commonly in the lungs, ovaries, lymph nodes or breast. Patient can experience ataxia many months or years before cancer is actually diagnosed.

Toxic reaction to some medications can also cause ataxia. Medicines, especially barbiturates and certain sedatives, like benzodiazepine, can cause ataxia as a side effect. Other things, which could cause toxic reactions, are heavy metal poisoning, alcohol and drug intoxication and solvent poisoning.

Any type of growth on the brain, either cancerous or noncancerous, can damage cerebellum and cause ataxia.

Deficiency of vitamin E or B-12 can also lead to ataxia.

No specific cause can be found for some adults who develop sporadic ataxia, also known as sporadic degenerative ataxia, which can be of many types, such as multiple system atrophy which is a progressive and degenerative disorder.
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test UL
Finger to Nose Test

Examples of coordination tests:

1) In the upper limb:

A) Finger-to-nose test

The shoulder is abducted to 90o with the elbow extended, the patient is asked to bring tip of the index finger to the tip of nose.Finger to therapist finger: the patient and the therapist site opposite to each other, the therapist index finger is held in front of the patient, the patient is asked to touch the tip of the index finger to the therapist index finger.

B) Finger-to-finger test

Both shoulders are abducted to bring both the elbow extended, the patient is asked to bring both the hand toward the midline and approximate the index finger from opposing hand

C) Finger-to-doctor’s finger test

the patient alternately touch the tip of the nose and the tip of the therapist’s finger with the index finger.

D) Adiadokokinesia or dysdiadokokinesia:

The patient asked to do rapidly alternating movement e.g. forearm supination and pronation, hand tapping.

E) Rebound phenomena:

The patient with his elbow fixed, flex it against resistance. When the resistance is suddenly released the patient’s forearm flies upward and may hit his face or shoulder.

F) Buttoning and unbuttoning test.

In any of the previous tests, we may find:

Intention tremors and Decomposition of movements
Dysmetria: in the form of hypermetria or hypometria

2) In the lower limb

A) Heel-to-knee test

heel to shin test
Heel To Knee Test in Lower Limb

B) Walking along a straight line. Foot close to foot:In case of cerebellar lesion, there is deviation of gait

C) Rom-berg test: Ask the patient to stand with heels together. Swaying or loss of balance occurs while his eyes are open or closed.

General principles of coordination exercises involve:

Constant repetition of a few motor activities
Use of sensory cues (tactile, visual,proprioceptive) to enhance motor performance
Increase of speed of the activity over time
Activities are broken down into components that are simple enough to be performed correctly.
Assistance is provided when ever necessary.
The patient there fore should have a short rest after two or three repetitions,to avoid fatigue.
High repetition of precise performance must be performed for the engram to form.
When ever a new movement is trained, various inputs are given, like instruction(auditory), sensory stimulation(touch) ,or positions in which the patient can view the movement (visual stimulation) to enhance motor performance.

Therapeutic exercises used to improve coordination:

Frenkel’s exercises
Proprioceptive Neuromuscular Facilitation
Neurophysiological Basis of Developmental techniques
Sensory Integrative Therapy

FRENKEL’S CO-ORDINATION EXERCISES:

hand eye coordination
Co-ordination Exercise

Frenkel aimed at establishing voluntary control of movement by the use of any part of the sensory mechanism which remained intact, notably sight, sound and touch, to compensate for the loss of kinaesthetic sensation.

The process of learning this alternative method of control is similar to that required to learn any new exercise,

the essentials being: Concentration of the attention, Precision and Repetition

The ultimate aim is to establish control of movement so that the patient is able and confident in his ability to carry out these activities which are essential for independence in everyday life.

They are a system of slow repetitious exercises. They increase in difficulty over the time of the program. The patient watches his hand or arm movements (for example) and corrects them as needed.

Although the technique is simple, needs virtually no exercise equipment, and can be done on one’s own, concentration and some degree of perseverance is required. Research has shown that 20,000 to 30,000 repetitions may be required to produce results. A simple calculation will show that this can be achieved by doing 60 repetitions every hour for six weeks in a 16-hour daily waking period. The repetitions will take just a few minutes every hour.

The brain as a whole learns to compensate for motor deficits in the cerebellum (or the spinal cord where applicable). If the ataxia affects say, head movements, the patient can use a mirror or combination of mirrors to watch their own head movements.

History

Best Physiotherapy Exercises for In-Coordination–Frenkel’s Exercises :

Frenkel Exercises are a series of motions of increasing difficulty performed by ataxic patients to facilitate the restoration of coordination. Frenkel’s exercises are used to bring back the rhythmic, smooth and coordinated movements.

 

Dr. H S Frenkel was a physician from Switzerland who aimed at establishing voluntary control of movement by the use of any part of the sensory mechanism which remained intact, notably sight, sound and touch, to compensate for the loss of kinaesthetic sensation.

Frenkel Exercises were originally developed in 1889 to treat patients of tabes dorsalis and problems of sensory ataxia owing to loss of proprioception. These exercises have been applied in the treatment of individuals with ataxia, in particular cerebellar ataxia. The exercises are performed in supine, sitting, standing and walking. Each activity is performed slowly with the patient using vision to carefully guide correct movement. These exercises require a high degree of mental concentration and effort. For those patients with the prerequisite abilities, they may be helpful in regaining control of movement through cognitive compensation strategies. Patients with partial sensation can progress to practicing exercises with eyes closed. The main principles of Frenkel exercises are the following:

Concentration or attention
Precision
Repetition

This program consists of a planned series of exercises designed to help patient compensate for the inability to tell where the arms and legs are- in space without looking.

1. Exercises are designed primarily for coordination; they are not intended for strengthening.
2. Commands should be given in an event, slow voice; the exercises should be done to counting.
3. It is important that the area is well lit and that patients are positioned so that they can watch the movement of their legs.
4. Avoid fatigue. Perform each exercise not more than four times. Rest between each exercise.
5. Exercises should be done within normal range of motion to avoid over-stretching of muscles.
6. The ?rst simple exercises should be adequately performed before progressing to more dif?cult patterns.

General Instructions for frenkel exercises

Exercises can be performed with the part supported or unsupported, unilaterally or bilaterally.
They should be practiced as smooth, timed movements, performed at a slow, even tempo by counting out loud.
Consistency of performance is stressed and a specified target can be used to determine range.
Four basic positions are used: lying, sitting, standing and walking.
The exercises progress from postures of greatest stability (lying, sitting) to postures of greatest challenge (standing, walking).
As voluntary control improves, the exercises progress to stopping and starting on command, increasing the range and performing the same exercises with eyes closed.
Concentration and repetition are the keys to success.

Frenkel exercises for lower limb

Exercises for the legs in lying

Flex and extend one leg by the heel sliding down a straight line on the table.
Abduct and adduct hip smoothly with knee bent and heel on the table.
Abduct and adduct leg with knee and hip extended by sliding the whole leg on the table.
Flex and extend hip and knee with heel off the table.
Flex and extend both the legs together with the heel sliding on the table.
Flex one leg while extending the other.
Flex and extend one leg while taking the other leg into abduction and adduction.
Heel of one limb to opposite leg (toes, ankle, shin, patella).
Heel of one limb to opposite knee, sliding down crest of tibia to ankle.

Whether the patient slides the heels or lifts it off the bed he has to touch it to the marks indicated by the patient on the plinth. The patient may also be told to place the heel of one leg on various points of the opposite leg under the guidance of the therapist.
Exercises for the legs in Sitting

One leg is stretched to slide the heel to a position indicated by a mark on the floor.
The alternate leg is lifted to place the heel on the marked point.
From stride sitting posture patient is asked to stand and then sit.
Rise and sit with knees together.
Sitting hip abduction and adduction.

Exercises for the legs in Standing

In stride standing weight is transferred from one foot to other.
Place foot forward and backward on a straight line.
Walk along a winding strip.
Walk between two parallel lines
Walk sideways by placing feet on the marked point.
Walk and turn around
Walk and change direction to avoid obstacles.

 

Frenkel exercises for upper limb :

Similar exercises can be devised for the upper limb wherein the patient may be directed to place the hand on the various points marked on the table or wall board to improve coordination of all the movements in the upper limb.
Some examples of Frankel exercises of upper limb in sitting position

Have patient sit in front of a table and place a number of objects on the table. The patient then touches each object with the right hand and then the left hand.
The patient flexes the right shoulder to 90 degree with elbow and wrist extended. The patient then takes his or her right index finger and touches the tip of his or her nose. This exercise is then repeated with the left hand. The exercise is performed alternating right and left index finger.
The patient taps bilateral hands on bilateral thighs while alternating palmer and dorsal surfaces as fast as possible.

Certain diversional activities such as building with toy bricks or drawing on a black board, buttoning, combing, writing, typing are some of the activities that also improves the coordination.

 

Oral SubMucous Fibrosis And Exercise :

ORAL SUB MUCOUS FIBROSIS :

DEFINATION:

SMF2
Patient With SMF

Oral submucous fibrosis is characterized as the unending, tricky ailment influencing the oral pit and here and there pharynx, albeit at times went before or potentially connected with vesicle arrangement and is constantly connected with juxtaepithelial fiery response took after by fibro versatile changes in the lamina propria with epithelial decay prompting firmness of oral pit prompting trismus and powerlessness to eat.

Oral submucous fibrosis is an interminable crippling and an all around perceived possibly threatening condition related with areca nut biting, an element of betel quid and is pervasive in South Asian populace. Pathogenesis isn’t yet settled however is accepted to be because of multifactorial causes; consequently the treatment of oral submucous fibrosis proposes a noteworthy test for oral doctors.

ETIOLOGY AND PATHOPHYSIOLOGY:

The pathogenesis of the illness isn’t entrenched, however the reason for OSF is accepted to be multifactorial.

Various variables may trigger the infection procedure by causing a juxtaepithelial fiery response in the oral mucosa. Components incorporate are areca nut biting, ingestion of chilies, hereditary and immunologic procedures, wholesome inadequacies and different variables.

Areca Nut (Betel Nut) Chewing:

The areca nut segment of betel quid assumes a noteworthy part in the pathogenesis of OSF 15. Betel nut is much of the time utilized as a psychotropic and antihelminthic operator and utilized as an after feast digestant which is taken to ease stomach inconvenience.

Smoking and liquor utilization alone, propensities basic to areca nut chewers, have been found to have no impact in the advancement of OSF. The most grounded confirm in regards to the etiology of OSF is with the propensity for areca nut biting.

Areca nut shape might be accessible in thefollowing structure:

Supari + Tobacco

Supari + Pan+ Tobacco

Supari + Pan + Pan masala

Skillet Parag/Pan masala

Supari + Pan + Lime

Supari-Roasted/Raw Areca nut

Part of areca nut in pathogenesis of OSF:

Arecoline, a dynamic alkaloid found in betel nuts. Animates fibroblasts to build creation of collagen by 150%.

To lift the mRNA and protein articulation of cystatin C, a nonglycosylated fundamental protein reliably up-directed the assortment of fibrotic illnesses, in a measurement subordinate way in people with OSF.

Areca nuts have likewise been appeared to have a high copper substance, and biting areca nuts for 5-30 minutes altogether increments solvent copper levels in oral liquids. This expanded level of solvent copper underpins the speculation as a starting element in people with OSF.

Healthful Deficiencies:

Press insufficiency frailty, vitamin B complex inadequacy and lack of healthy sustenance are advancing variables that unsettle the repair of the excited oral mucosa, prompting damaged recuperating and resultant scarring.

The resultant atrophic oral mucosa is more defenseless to the impacts of chilies and betel nuts. Mucosal changes like those in vitamin B and iron insufficiency are found in oral sub mucosal fibrosis.

Chillies:

The part of chillies ingestion in the pathogenesis of OSF is disputable.

A touchiness response to chilies is accepted to add to OSF.

Hereditary and Immunologic Processes:

A hereditary segment is thought to be engaged with OSF Patients with expanded recurrence of HLA-A10, HLA-B7, and HLA-DR3.

ExerciseinSMF
Measurement Of Mouth Opening

Phases OF OSF:

Stage 1:

Stomatitis incorporates erythematous mucosa, vesicles, mucosal ulcers, melanotic mucosal pigmentation, and mucosal petechia.

Stage 2:

Fibrosis happens in cracked vesicles and ulcers when they mend, which is the sign of this stage.

Early sores show whitening of the oral mucosa.

More established sores incorporate vertical and round unmistakable sinewy groups in the buccal mucosa and around the mouth opening or lips, bringing about a mottled, marble like appearance of the mucosa in view of the vertical, thick, stringy groups running in a whitening mucosa. Particular discoveries incorporate the accompanying:

Decrease of the mouth opening (trismus).

Solid and little tongue.

Whitened and rough floor of the mouth.

Fibrotic and depigmented gingiva.

Rubbery delicate sense of taste with diminished portability.

Whitened and atrophic tonsils.

Contracted budlike uvula.

Sinking of the cheeks, not comparable with age or nutritious status.

Stage 3:

Screech of OSF are as per the following:

Leukoplakia is precancerous and is found in over 25% of people with OSF.

Discourse and hearing deficiencies may happen in view of inclusion of the tongue and the eustachian tubes.

Manifestations:

Xerostomia.

Intermittent ulceration.

Torment in the ear or deafness.

Nasal pitch of voice.

Confinement of the development of the delicate sense of taste.

Diminishing and hardening of the lips.

Pigmentation of the oral mucosa.

Dryness of the mouth and consuming sensation.

Diminished mouth opening and tongue bulge.

CAUSES:

Immunological ailments.

Outrageous climatic conditions.

Delayed insufficiency to iron and vitamins in the eating regimen.

DIFFERENTIAL DIAGNOSIS:

Oral appearances of scleroderma

Oral appearances of Plummer Vinson disorder (Iron lack Anemia).

Examination:

Finish Hemogram

Toludine blue test

Biopsy :- Incisional biopsy

Immunofluorescent test:

a) Direct b) Indirect

Administration AND PREVENTION:

The treatment of patients with OSF relies upon the level of clinical contribution. On the off chance that the malady is identified at a beginning period, suspension of the propensity is adequate. Most patients with OSMF give moderateto-serious arranging. Direct to-serious arranging of OSF is irreversible. Medicinal treatment is symptomatic and gone for enhancing mouth developments.

Not to devour areca nut and other incessant aggravation, for example, hot and zesty sustenance including chiles.

Guidance green verdant vegetables.

Organization of Vit. A, B complex and high protein consume less calories.

Organization of Antoxid OD for 6 – two months.

Organization of Lycored OD for 6 two months.

Keeping up legitimate oral cleanliness.

Supplementing the eating regimen with nourishments rich in vitamins A, B complex, and C and iron.

Swearing off hot liquids like tea, espresso.

Swearing off liquor.

Utilizing a dental specialist to round off sharp teeth and concentrate third molars.

SURGICAL MANAGEMENT:

Surgical treatment is shown in patients with extreme conditions. These incorporate:-

Basic extraction of the stringy groups: Excision can bring about contracture of the tissue and intensification of the condition.

Split-thickness skin joining following respective temporalis myotomy or coronoidectomy: Trismus related with OSF might be because of changes in the temporalis ligament auxiliary to OSF; subsequently, skin unions may assuage.

Nasolabial folds and lingual pedicle folds: Surgery performed just in patients with OSF in whom the tongue isn’t included.

PHYSIOTHERAPY MANAGEMENT:

smf3
Exercise In Oral Sub Mucous Fibrosis

Muscle extending practices for the mouth might be useful to anticipate advance restrictions of mouth opening strong mouth opening has been attempted with mouth choke and non-cyclic surgical screw.

Diathermy: Microwave diathermy appear to be better than short wave, in light of the fact that specific warming of juxtaepitheliel connective tissue is conceivable it acts by physio fibrinolysis of groups.

Ultrasound: Ultra sound selectivity bring the temperature up in some all around aggregated territories. Ultrasound turns out to be an effective profound warming methodology.

Hallux Valgus Deformity And Treatment :

INTRODUCATION:-

Hallux-Valgus-Bunion
Hallux Valgus Deformity

Hallux valgus is a progressive foot deformity in which the first metatarsophalangeal (MTP) joint is affected and is often accompanied by significant functional disability and foot pain.

CAUSES:-

Hallux-valgus-Klinik-stadien-der-fehlstellung-im-vergleich
Foot Deformity- Hallux Valgus

Bunions are a widespread foot ailment that can be caused by a number of factors including genetics
Excess weight gain,
Activity level, and
Ill-fitting shoes.
Other less common causes of bunions include trauma to the
MTP joint (sprains, fractures, and nerve injuries),
Neuromuscular disorders,
Limb-length discrepancies.
Some studies report that bunions tend to occur ten times more frequently in women than in men, primarily as the result of wearing narrow, pointy, tight fitting, and/or high-heeled shoes over a significant period of time. Repetitive stresses to the foot can also cause bunions.

SYMPTOMS:-
Your big toe points toward your second toe, or your second toe overlaps your big toe
A prominent bump on the inside of the MTP or big toe joint
Pain on the inside of your foot at the big toe joint when wearing any kind of shoe
Pain each time the big toe flexes when walking
Redness, swelling , or thickening of the skin on the inside of the big toe joint

DIAGNOSIS:-

VyharovnmeQqirmYORcb.g_m
Hallux Valgus Angle Measurement

Radiographic exmatination show the angle formed between longitudinal bisection of the 1st Metatarsal and proximal phalanx.
A big toe position with an angle of up to 10° is still considered normal.
A minor hallux valgus defect is 16-20°.
A moderate hallux valgus deformity has a deviation of 16-40°.
A severe hallux valgus deformity has a deviation of over 40°.
Magnetic resonance imaging (MRI) will detect cartilage damage, trapped soft tissue and bone damage.

PHYSIOTHERAPY TREATMENT:-

images
Splinting In Hallux Valgus

Adjusted footwear with wider and deeper tip
Increase extension of MTP joint
Relieve weight-bearing stresses (orthosis)
Sesamoid Mobilization:The physical therapist performs grade III joint mobilizations on the medial and lateral sesamoid of the affected first MPJ. One thumb is placed on the proximal aspect of the sesamoid and is used to apply a force from proximal to distal that causes the sesamoid to reach the end range of motion (distal glides). These are performed with large-amplitude rhythmic oscillations. No greater than 20° of movement of the MPJ should be allowed during the technique.

indexngh
Strenthening Exercise In Hallux Valgus

Strengthening of peroneus longus
Electrotherapy Modalities – Ultrasound, ice, electrical stimulation, MTJ mobilizations and exercises. This is more effective than physical therapy alone. The combination will result in a increase in ROM of the MTP joint, strength and function, and also a decrease in pain .
Pain is the main reason that patients seek treatment for a bunion. Inflammation is best eased using ice therapy, techniques (e.g. soft tissue massage, acupuncture, unloading taping techniques) or exercises that unload the inflamed structures. Anti-inflammatory medications may help. Orthotics can also be used to offload the bunion.

For Restoring the Normal Joint Of Motion –

images jgh
Gripping Muscle Of Foot Active Exercise

Joint mobilisation (abduction and flexion) and alignment techniques (between the first and the second metatarsal)
Massage
Muscle and joint stretches
Taping
Bunion splint or orthotics
bunion stretch and soft tissue release.

For Strenghting Of Muscles –
Towel curls The patient spreads out a small towel on the floor, curling his/her toes around it and pulling the towel towards them.
The ends of the band are either held by an assistant or secured against an immovable object (e.g. a table leg). The patient then dorsiflexes the ankle, pulling “towards their nose,” working against the resistance of the band.

 

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