FOOT PAIN AND PHYSIOTHERAPY

FOOT PAIN

Foot is the terminal portion of our limbs which bears weight and helps in movements. Most people ignore about foot care and its problems which leads serious complications and will suffer alot in future .Even the foot like the rest of the body feel effects of age. Muscle tissue thins out, the long nerves that supply them don't send electrical messages properly as they did earlier, leads to loss of sensation. The fat pads lies under the heel and the ball of the foot get thinner and provides less cushioning. In diabetic people serious complications may result if there is no proper care and some times may lead to amputations also if the foot disease is not healed. 

Types of Foot Problems occurs most commonly are

1.PLANTAR FASCITIS: Plantar fascia is a softtissue in the foot , due to repeated stress of weight bearing, jumping, hopping, runing results in plantarfascitis. Pain and inflammation felt over the inner aspect of the foot or at the weight bearing areas. 

2.BUNIONS: Bony growth at the base of the big toe.

3.HAMMER TOES: Fixed bend (Flexed) deformity at joints of the toes.

4.CALLUSES & CORNS:Skin on the toes become yellowish and thickened.

5.HALLUX VALGUS:Lateral deviation of the big toe usually occurs due to wearing of high heels     with pointed shoes.

6.HALLUX RIGIDUS:Stiff big toe due to arthritis at joints of big toe

7. TOE NAIL PROBLEMS: Ingrown thickened and discoloured nails. 

8.ARCH PAIN: Occurs due to loss of arches in the foot or sometimes when there is increase in the arch of the foot.

9.ACHILLES TENDONITIS: Swelling or inflammation in the tendon that connects heel bone to calf muscle.

10.TARSAL TUNNEL SYNDROME:Pinched nerve disorder results in pain, burning sensation, paraesthesia in the toes and sole of foot.

11. DIABETIC FOOT: In diabetic people Foot ulcers difficult to heal and  loss of sensations. 
12.CALCANEAL SPUR: Continues overstrain of the softtissue in th foot results in stripping of bone covering at the calcaneal bone, to fill this gap a bony spur will form and results in pain.
13.METATARSALGIA:Wearing high heels cause constant strain over the forefoot leads to Metatarsalagia.

CARE FOR FOOT

Wearing proper shoes

Avoid standing and walking for long time period

Reduce your body weight

Avoid walking with bare foot especially diabetic people.
Avoid wearing high heels
Avoid straining activites

PHYSIOTHERAPY TREATMENT: 

For pain and relaxation take the following treatments.
Ultrasound treatment
Interferential therapy
TENS and 
Foot Massage
Faradic foot bath 
Re-education of walking with proper shoe wedge,pad or metatarsal bar. 
For Swelling:  cryotherapy with leg elevation. 
Hot packs/ Ice massage 
To reduce edema and to improve circulation speedy ankle and toe movements are very helpful.

Try these exercises and relaxation measures when your feet are beaten.

Achilles tendon and plantar fascia stretch

Loop a towel around the ball of your foot and pull your toes towards your body, keeping your knee straight.Hold for 30 seconds.Repeat 3 times on each foot.

 Plantar fascia stretch

Sit down and rest the arch of your foot on a round object.Roll the arch in all directions for a few minutes.Repeat this exercise at least twice daily.

Towel pickup

Sit down with a towel on the floor in front of you.

Keeping your heel on the ground, pick up the towel by scrunching it between your toes.

Repeat 10–20 times. As you improve, add a small weight such as a tin of beans to the towel.

Sitting plantar fascia stretch

Sit down and cross one foot over your other knee.Grab the base of your toes and pull them back towards your body until you feel a comfortable stretch.Hold for 15–20 seconds.
Repeat 3 times.

Wall push

a) Facing a wall, put both hands on the wall at shoulder height and place one foot in front of the other.The front foot should be approximately 30 cm (12 inches) from the wall.With the front knee bent and the back knee straight, bend the front knee towards the wall until the calf in your back leg feels tight. Relax and repeat 10 times.

b) Repeat a) but bring the back foot forward a little so that the back knee is slightly bent.

Repeat 10 times.

  

Toe grip (to strengthen the foot muscles to improve balance): Drop a sock on the floor and use your toes to grip and lift it off the floor. Hold for 10 seconds, then release. Repeat five times with each foot.

Toe extension (to strengthen and support the muscles, which in turn will protect the bones of the feet): Wrap an elastic band around all five toes. Expand your toes and hold for five seconds and release. Repeat five times on each foot.

Calf raises (to strengthen the feet and the calves and improve balance): Stand near a counter or a doorway and hold on lightly for balance. Balance on one foot and rise up onto your toes. Hold for 10 seconds, then lower. Repeat 10 times on each foot.

Calf stretch (to keep the Achilles tendons and the plantar fasciae from getting tight): Sit with one leg stretched out in front of you and wrap a towel around the ball of the foot. Pull the towel back gently until you feel a stretch in the arch of the foot and the calf. Hold for 10 seconds; release. Repeat five times on each leg.

    

Consult Your doctor before starting the exercise program.

GERIATRIC ASSESSMENT AND SENIOR FALL PREVENTION TIPS

      

       GERIATRICS is a branch of medicine dealing with the physiological changes of ageing and the diagnosis and treatment of diseases affecting the aged which helps in raising standarad living lengthens life expectancy and increase the proportion of aged persons in the society.                                                                       

   The Geriatric Assessment

   Medical Screening and Assessment

              

  Medical screening and assessment by doctors and 

  Physical therapists for prevention of falls in older persons:

  Each person should be asked whether he/she has fall in the 

  past year if so, about the frequency and circumstances 

  of falls. Did they faced any experience of difficulties with 

  walking / balance.Anyone who has had a fall should be 

  evaluated for gait and balance.Anyone who has problems 

  in standarad gait and balance tests should be 

  given comprehensive assessment.

                                                         

   Focused History

 a)History of falls:Causes of the fall,frequency,symptoms at time of fall,injuries,  other consequences.

 b) Medication review

 c)History of relevant risk factors : Acute/chronic health problems 

  

   Physical Examination

a) Detailed assessment of gait, balance, and mobility levels and

    Lower extremity joint function. 

b) Neurological function: cognitive evaluation, lower extremity 

    Peripheral nerves, Proprioception, reflexes, co ordination.

c) Muscle strength (lower extremities)

d) Cardiovascular status: Heart Rate,

                                           Postural pulse

                                           Blood pressure

                                           Rhythm

                                          

e)Respiratory status

f) Assessment of visual acuity & Hearing

g) Examination of the feet and footwear

h) Nutritional Assessment   

 Functional Assessment 

 a) Assessment of activities of daily living (ADL) skills including use 

     of adaptive equipment 

 b) Assessment of the individual’s perceived functional ability and fear related to falling 

 Environmental Assessment This assessment includes home safety                        

         

 SENIOR FALL CAUSES & PREVENTION TIPS                                  

Falls are the leading cause of injury death in Older Adults and       

20-30% who fall suffer from moderate to severe injuries such as  

Lacerations, hip fractures, or head traumas.

Because of these injuries it makes them difficult to move  

  around and live independently and some are becoming 

bedridden and leads to risk of early death.

Fall Fear- Many people who fall & not injured developing a fear 

of falling & due to this they are reducing body mobility 

which leads to loss of physical strength and they are 

   increasing their actual risk of falling.

Falls are more in women than men because early osteoporosis 

in women,decrease bone density causes falls and resultant injuries.

 Repeated Falls:who fall earlier will fall again within six months

 to one year.

                    

MAJOR RISK FACTORS F FALLS AND PREVENTION TIPS

OSTEOPOROSIS means decrease in the bone density where the bones become weak and less resistant to stress and more prone to the fractures. Commonly seen in the menopause women. 

Prevention TIPS: Encourage calcium rich foods like milk, fish, selected vegetables such as broccoli, soyabeans and almonds. Meet your dietician for proper planning of your diet.Take doctors advice and give them calcium supplements if needed. Sufficient vitamin D is needed for the absorption of this calcium in to the bloodstream. We can get vitamin D naturally through sunlight but some older adults needed supplement. Weight bearing exercises are good to follow regularly. Please take your doctor advice before taking the supplements/ exercises.        

                  

VISION PROBLEMS Age related vision diseases leads to impaired vision which makes them to move difficulty in their homes or any shopping malls, can increase the Risk of falling.

Prevention Tips: Regular checkups by ophthalmologist. Use balance  aiding objects like Grab bars and handrails. Add contrasting colour on first and last steps to identify change of level. If they wear then clean them to improve visibility.

MEDICATIONS like Antidepressants , sedatives or any Antipsychotic drugs can contribute to the falls by reducing mental alertness, worsening the balance and the gait and causing drops in systolic blood pressure while standing. 

Prevention Tips: First make a note on side effects of medicines you are taking and talk to your doctor about the dosage of medicine. Use walking aids while using medicines that affect balance. Limit intake of alcohol as it may interact with medications.

                  

 ENVIRONMENTAL HAZARDS in the home also one of 

      the cause for falls 

  Prevention Tips:  Asses your house to identify any fall hazards by room by room. Then do home modification if needed which includes ramps,handrails,lifts, stair glides, roll in showers, grab bars, easy to reach kitchen work and storage areas , daily used things should be placed at lower case shelves so that they can easily reachable. Bathroom or bedroom should be reachable easily without climibing stairs. Place a lamp close to the bed where its easy to reach the things they want to use. Give some assistive equipment if needed like power wheel chair, power seat lift chairs. Give them any emergency alarms which are coming in the way of watch or pendent they can easily wear it, if they need anything they will press the button which automatically dials on. 

 LACK OF PHYSICAL ACTIVITY which results in the decreased balance,flexibility and the strength, poor muscle tone. 

 Prevention Tips: Encourage them to do exercises for atleast alternate days for 15 to 20 minutes.Let them go for a  group walking and swimming where they enjoy. Tell them to wear supportive shoes with low heels/ rubber soles.

  

Physiotherapist will train them to do daily activites in a safe 

manner such as reaching and bending activites and how to raise 

from bed to chair and from chair to stand  or else transfer to an 

wheel chair.

Physiotherapist will plan your exercise programme according to 

your health issues or medical problems in order to improve 

 balance, flexibility and muscle strengthening.

Strengthening exercises

Balance training

Co ordination exercises

Flexibility exercises

Weight bearing exercises

Breathing exercises to improve lung function

Endurance exercises

Stability ball exercises for hips

Joint Mobility exercises like Pendular exercises to shoulder

Squeeze ball exercises for wrist

Neck isometric exercises

Back strengthening exercises

Treadmill training

Aerobics

Yoga

   Start exercises at a low intensity and slowly work your way up to harder.Always consult a doctor before starting an exercise program. 

                                              

                             

IMPORTANCE OF PARENTS AND THERAPIES IN TREATING AUTISTIC CHILD

Autism is not a disease it’s a  

variation in functioning.

Autism is a Neuro developmental disorder where there is a problem with the communication and social interaction and restricted interest and Repetitive behaviour. It occurs 3-4 times more in boys than girls. Parents will notice signs in first  2-3 years of child’s life and some children reach their milestones normally and then worsen. Autism affects information processing in the brain & don’t know why this is occurring in the brain. Research is going on this. 

CAUSES: There is no specific cause but some Combination of Genetic & Environmental factors involved.

RISK FACTORS: Some infections like Rubella during pregnancy & Alcohol consumption during pregnancy.

There is no known treatment for this to cure. 

Early speech or behavioural interventions can help children with autism to gain self care, social and communication skills. Not all but some children are successful to live independently. This is because of combination of treatments or therapies.

Some Medicines used to treat problems associated with ASD like Psychoactive drugs or Anticonvulsants but there is no known medication to cure ASD symptoms and some medications have adverse effects or undesired harmful effects on body also. 

Autistic child improvement is majorly depend on family along with the therapies.

Patience & Tolerance of parents play major role. For making their child independent

So Just teach &teach &teach until they learn things. No one will learn things without proper and continues teaching.

Don’t think THEY CAN’T AND THEY WON’T, THEY CAN AND THEY WILL do and participate in all activities if there is proper training. 

Spend more time with your kid and take them to new places every time & educate them how to move along through various circumstances. 

Some parents depend more on Therapist / Therapy treatments and they won't give training in the house. Remember Every kid first learn all milestones from parents only at home even you and Me learn everything  First from Parents only, so Learn how to train your child from Therapist and later do the same at home. May be he won’t pay interest first but after few days may be he can. 

Fear by seeing crowd and my child start crying many parents will say this it happens because they are unfamiliar with the things in the crowd so they may feel fear by seeing new people, new smell, and new sound. So make them familiar by Taking them to near parks or malls and let them  play with other kids,  if they are not playing make them to play or otherwise let them move in the crowd,  so that they learn new things like hearing new sounds , new voices and will smell fresh air or any spray of perfume and he may feel the things by touch and their brain will  learn new things and he may  lose his fear and familiar with the things around him. 

Some parents with their wrong perception and because of their busy life they are making children to stay at home after therapy treatments. Then there is no use of therapies please spend more time to make your child independent. 

Some parents may GO TO DEPRESSION and think that after Therapy training also there will be no improvement  and its waste to take the therapy its waste of time and money . SLOW AND STEADY will win the race be patient and train them maximum, one day you will see the change for sure. There are many success stories of Autistic kids so why can’t you be the success parent. Don’t lose your hope until you succeed.

THERAPY TREATMENTS Give them proper therapy treatments which include Behavioural therapy, Occupational therapy, Speech therapy, Changes in the diet pattern and PHYSIOTHERAPY.

PHYSIOTHERAPY ROLE:

Physiotherapist will assess the child’s overall motor functioning, identify the underlying difficulties, and provide an intervention program to help to improve these difficulties and subsequently the child’s overall functioning. Physiotherapy intervention plan include:

• Specific exercises or activities for muscle strength, posture, endurance, motor planning and balance reactions

• Sensory feedback strategies to improve a child’s awareness of their body posture and movements

• Recommendations for taping, orthotics, and/or other bracing or positioning strategies and equipment to enhance the child’s body alignment, posture and body awareness during functional or physical activities

• Recommendations and support to participate in community based physical activity programs that will support their physical skills and endurance

TIPS FOR EXERCISES:

• When teaching a child with autism a new exercise, it’s important to do so in a calm and supportive environment. 

• Use positive reinforcement such as “You’re doing a great job!” 

• Also use verbal or hands-on cues to help guide them through the movements and decrease the chances of them getting frustrated and upset.

• Start slow and monitor for signs of fatigue such as shortness or breath, muscle cramps, or dizziness.

• Ensure the child is well hydrated and rested before exercising.

• It’s best to start at a low intensity and slowly work your way up to harder, more vigorous sessions.

Autistic child need multi-disciplinary team, Working together with occupational therapist, speech therapist and psychologists, dietician, physiotherapist , most importantly parents and family members can make a childs overall fuction independent and improves their quality of Life.

Note:Always consult a doctor before starting an exercise program with a child with autism