The Flatfoot (Latin pes planus) Is in the final stage (contracted), a pathological distortion of the Foot bones, Where the arch is depressed and rests the entire foot surface, even without exposure to the substrate.

Causes for the emergence of a valgus or flatfoot, for example, a weakness of the sinews or excess weight. An early form of flatfoot is the Flat feetIn which the longitudinal arch lowered.

A flat foot is heralded by severe foot pain in the metatarsal bones. Since the foot when walking the steps to cushion can no longer hurt every step. In the growth phase of the - then mostly still loose - flatfoot is painless.

Treatment

In children and young people trying to get along at first without an orthopedic device. It is recommended that Fußgymnastik and barefoot.

That Footwear the feet should be enough space and not press. The Orthopedist is the patients with flat feet orthopedic footwear to prescribe it then on to the recipe Orthopedic shoemaker can make their choice according to his wishes can. Also inserts Custom gain immediate relief.

In appropriate cases, the flat foot can be surgically corrected. This is basically a triangular wedge from the sawed , which is oriented perpendicular to the longitudinal axis of the foot and shows with its base on the sole of the foot out. If you then after removal of the wedge, the remaining bone surfaces, and each is surgically stabilized by screws or plate, resulting directly a longitudinal arch.

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Than Foldable base (Valgus) Is called a pathological deformity of the foot, with a reduction in the medial (inner) border of the foot and an increase in the lateral (outer) border of the foot.

Stages of development and prevention

The Foldaway Base frequently occurs in conjunction with the Valgus or Flatfoot on. The infant is physiologically in a certain period, a Foldable base, ie the norm. At age 8 to 10 years of child's so far but should be strengthened, that the foot is no longer or only minimal kinking inside. If this is not the case, as soon as possible to begin Fußgymnastik. Also Barefoot on uneven natural surfaces has a positive effect on the stabilization of the foot.

Pain occurs mainly at the inner ankle and Innenlängsgewölbe (because very often there is also a cut of it) on. The ankle pain after the leg side runs high. The inner ankle comes out strong, a shift in the lower ankle is present, with the heel bone deviates outward.

Causes

A Foldable base can be acquired or congenital in the course of life. Acquired cracked feet can be due to a flat foot, trauma, spastic paralysis, A Infection and from Rheumatism, Overload or damage to fragile ligaments Obesity be with angular deformity of the legs.

Emergence of the foot bend

The talus head, due to overuse of the feet in relation to the muscle (usually in childhood), pressed down and moved medially. This falls into the heel bone Pronation. Thus, the inner ankle appears stronger, and the ankle bone is clearly visible beneath the inner ankle (this "double ankle") is the most visible sign of recognition for the Foldaway Base. Due to the changed position of the ankle bone in the ankle mortise, the foot is replaced by an inclined position against the leg

Treatment

Foldable base stands in conjunction with a flat foot, one can achieve in school and additional patients with advanced insoles or gymnastik quite a normalization of the foot. In severe cases, Nancy Hilton-or Ringorthesen may be required.

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The Heberden's node, Named after the London Doctor William Heberden (1710-1801), is a Idiopathic Osteoarthritis the digital distal (distal interphalangeal, DIP) with the formation of Heberden nodes. The disease is largely genetic, but also hormonal.

Clinical picture

Are characterized by the Heberden nodes. These are two-humped, cartilaginous-bony growths on the extensor side of the base of the Fingerendglieder. They are often locally-accompanied by substantial inflammatory and destructive phenomena: Gelenkverplumpung and deviation from the Thumbpage, pain, loss of power, restriction of movement.

The Heberden's arthritis often affects the interphalangeal joints of Forefinger and Hypothenar. Often, the finger middle joints (proximal interphalangeal, PIP; Bouchard-Arthrose) - Then as a Heberden-Bouchard-Arthrose known - and Carpometacarpal joint (→ RhizarthrosisSurprised). Are also affected other joints or spine, is called a Polyarthrosis.

Epidemiology

The Heberden's arthritis affects about ten times more often women than men. Usually the disease begins in the Menopause. Of 100,000 women aged between 50 and 59 will suffer an estimated 190 to a hand osteoarthritis, of 100,000 men the same age group, only 27 are affected.

Diagnosis

It is a so-called View Diagnostics. The presence of Heberden nodes is characteristic, but one X-rayImage is not further testing is usually necessary. Prior to such Radiosynoviorthesis is usually a Bone scan made.

The Heberden's node must differential mainly by the rheumatoid arthritis be demarcated. In addition to the clinical picture and the X-ray image of the hands can in rare cases, certain blood tests and possibly a three-phase skeletalScintigram necessary. Other considerations include the GoutArthropathy and Psoriatic arthritis.

Therapy

For therapy, painkillers (to beAnalgesics) CortisoneInjections into the joint, surgical procedures (especially the stiff joints, Arthrodesis) And the Radiosynoviorthesis used. Also coming Physiotherapy, Occupational Therapy, Physical Therapy (especially cold application) and X-raylovely irradiation is used.

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The Madelung deformity (after the German surgeon Otto Wilhelm Madelung) Is a growth disorder of the Forearm, Which is associated with a characteristic deformity. According to him the Madelungsche Handdeformität and Madelungsche fat neck have been appointed.

Etiology

It is a DysostosisCaused by a disturbed process of endochondral ossification is conditioned. In the course of the growth occurs at a lag of distal Radius--Metaphysis. This makes the Ulna longer than the radius. Gender relations between women and men is about 4:1.

Clinical Presentation

The ulna extends to the Dorsal of Wrist apparent. This leads to the so-called Bayonet deformity the Hand. The bayonet deformity can also healed in malposition of the distal Radius Fractures result (Differential Diagnosis).

In the Madelung deformity is restricted the mobility of the wrist. The Dorsiflexion and Abduction ulnar be hampered by bony inhibition. There are usually no Pain. Typical is the early development of a Hangelenks -Osteoarthritis.

Therapy

The therapy should be considered at a perceived as a debilitating restriction of movement and is operating normally. Either the ulna can be shortened (Shortening) Or the radius by a Osteotomy be extended. The aim is to rectify the difference in length and improved functionality.

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Ankylosis, or Anchylosis  is a acerbity of a joint, the aftereffect of abrasion or disease. The acerbity may be complete or fractional and may be due to deepening of the tendinous or able-bodied structures alfresco the collective or of the tissues of the collective itself. Noma - a addle ache still boundless a part of angular accouchement active on the borders of the Sahara arid - can could cause ankylosis of the bone and mandible, impairing the adeptness to allege and eat.

When the structures alfresco the collective are affected, the appellation "false" ankylosis has been acclimated in animosity to "true" ankylosis, in which the ache is aural the joint. If deepening has acquired the joint-ends of the basic to be alloyed calm the ankylosis is termed osseous or complete. Excision of a absolutely ankylosed accept or bend may restore chargeless advancement and account to the limb. "Ankylosis" is aswell acclimated as an anatomical term, basic getting said to ankylose (or anchylose) when, from getting originally distinct, they coalesce, or become so abutting calm that no motion can yield abode amid them.

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The Achondroplasia (also Chondrodysplasia or Chondrodystrophia fetalis known) is one of many Mammals - Including humans - frequent MutationThat the growth of Skeletal system concerns. It is a smaller part autosomal--dominant inherited () about 20%, produced far greater part, however, by Mutation, Which increases the probability of occurrence especially with the age of the biological father. The shortened legs of some breeds, such as Dachshund and Basset Hound are the result of a targeted selection for achondroplasia, the Malformation is part of the Breed standards.

Frequency

One of 40,000 babies is born with achondroplasia.

Causes

Achondroplasia is the result of a Point mutation in Fibroblast growth factor receptor gene FGFR-3 These autosomal dominant Mutation leads to a disruption of Cartilage formationAnd the bone growth zone (Epiphyseal) Is premature ossification, leading to the reduction of longitudinal growth especially of the arms and legs (Extremities) Leads (Endochondral Ossification).

About 80% of cases by Mutations conditioned. The cause is present in 96% of cases, G (1138) A point mutation in the FGFR-3. It is here at position 380, the Amino Glycine through Arginine replaced. In 3% of the cases can be a G (show 1138) C point mutation at the Glycine through Glutamine is replaced. Embryo with homozygous Mutation (both the paternal and maternal variant of the gene are altered) are not viable and die in the womb (utero).

Common symptoms of mutation

The results in achondroplasia DISPROPORTIONATE Stature. As the unusual formation of cartilage, particularly in the Bones , proper development can not be possible, are greatly reduced Extremities characteristic. Linear growth is impaired by contrast, almost normal growth in thickness.

Other symptoms in people affected are:

• relatively short fingers
• increasing the distance between the 3rd and 4 Finger (Trident hand)
• relatively short neck and large head with bulging forehead and unusual skull base
• narrow face with Saddle nose
• often hollow cross (Lordosis) Or a Kyphosis
• congenital weakness of the entire spinal canal
• often Bowlegged or X-Legs
• frequent Otitis (due to constricted Eustachian tube)
• characteristic skin folds (the skin is too much) for the shortened limbs
• Hydrocephalus

Therapy

The therapy is based on the symptoms. For functional disability through the leg axis and spinal position as well as incipient paralysis decompression and stabilization procedures on the can Spine be made. Studies Growth hormone therapy (GH) Were performed, the results are still pending, because the people involved have not yet reached adulthood. Surgical leg lengthening with length win up to 20 cm is possible.

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The Achilles tendon rupture (ASR) is the rupture of the Achilles tendon. They usually only occurs on predamages by excess and stress. A rupture can be treated surgically or with a firm bandage or conservative treatment.

Anatomical-Physiological Basis

The Achilles Tendon - Tendo calcaneus (Achilles) - is supposedly the strongest tendon in the human body. She sits at the calcaneal tubercle (tuberosity of the calcaneus) and united as a tendon of the calf muscle (triceps surae), the terminal tendons of the three calf muscles.


She's grown loads of 60-100 N / mm ², equivalent to 80 mm ² a carrying capacity of up to 800 kilograms. A sudden rupture of the Achilles tendon strain of the triceps surae therefore usually occurs only when predamages by an over-and stress. The tendon undergoes again and again minor injuries that disrupt the blood supply to the tissues and thus lead to the degeneration of the tissue .These changes are affecting the most in the range 2-6 cm above the insertion of (so-called "Achilles waist"), where the tendon is supplied at the worst, and is also where most of the crack .The tendon then breaks suddenly with a loud noise peitschenknallähnlichen. The plantar is then only a very limited extent. In the Achilles tendon (Achilles tendon) is usually a sudden transection of the Achilles tendon. Rarely occurs with notice of the Achilles tendon, such as Achilles tendon pain or irritation. Consequently, physically active people are often disproportionately affected by an Achilles tendon injury. It shows a cluster of physically active men aged 30 to 50 years. A rare cause is taking a different antibiotic, the group of gyrase inhibitors, levofloxacin, for example. The elderly and patients taking corticosteroids, are at greater risk.

Diagnosis

Clinically, there is usually a palpable gap), most commonly a few centimeters above the insertion of the heel bone (calcaneus). Occasionally, the area is swollen and bloodshot. Walking on tiptoe is not possible anymore. With complete rupture of the Thompson test is positive, the patient lies on his stomach, his feet hanging over. Now, if the calf muscle of both sides pressed together, so it usually comes to plantar flexion, but not in an Achilles tendon rupture. In the ultrasound, the distance between the two tendons can be determined, and whether a complete or partial rupture.

Treatment

In principle, this can be done conservatively or surgically with a crack.

Treatment without surgery (conservative)

The foot is immobilized by a firm bandage (eg plaster, special shoe orthosis). The healing progress will be monitored (eg ultrasound). The foot is immobilized only here for about 1 week in 20 ° equinus. This is followed by the supply with a special shoe with a heel lift for approximately 6 weeks. A conservative method is especially useful in patients at increased surgical risk.

Surgical treatment

Both open surgery and minimally invasive surgery to be performed in either local anesthesia, regional anesthesia or general anesthesia (general anesthesia). By a tourniquet on the thigh, the blood supply for the duration of the surgery can be prevented (tourniquet) to reduce blood loss and improve the data in the operational area.

• Open surgery: The cracked and auseinandergewichenen tendon are exposed and a suture and / or gluing reunited. In old tendon tear or heavy wear on the skin or muscle tendon must sometimes part of Nachbarsehnen structures to reinforce the Achilles tendon and Achilles tendon to bridge used to be broken) (tendon with a plastic interposition). In the rare bony avulsion of the tendon directly from the heel bone, the bone piece is screwed together with the re-attached tendon calcaneal tuberosity.
• Minimally invasive surgery: In contrast to open surgery does not expose the surgical field, but the torn tendon ends are sought through small skin incisions and back together again. A small cross section at the level of the rupture to allow for an approximation of the torn tendon to

Depending on the operative findings, the insertion may be a wound drainage tube for the suction of wound exudate and blood is required.
Even after surgical treatment or care is immobilization of the leg for several weeks is required. The foot is to relieve the early tendon fixed in equinus (about 30 ° to 40 °) and then returned slowly over weeks into its normal position. Close monitoring by a physician weiterbehandelnden are required.

Rehabilitation

The tendon is restrained by both approaches usually in a leg cast for 6 weeks or in a special boot (industrial-made orthotics from different manufacturers). Subsequently a gradual phased rehabilitation program. During this time the foot is in equinus (held approximately 10 ° to 20 °), which can be gradually reduced after each treatment. Especially in the to 10 Week is the danger of another crack high. Loose jogging on level ground can usually be started after about 4 to 6 months. The Achilles tendon healed achieved - as all the other torn tendons, too never recover full load capacity. It lies at an optimal course of about 80 to 90% of the healthy tendon. Nevertheless, in the best case will again be fully sports - including competitive sport – run.

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