Hidden Home Exercises

Cure Arthritis Naturally

Beat Arthritis Naturally

Get Instant Access

Even for the general, sedentary, non-sporty population, exercise is an essential part of well-being. Exercise is also the 'drug' prescribed for a number of major health problems such as high blood pressure, heart insufficiency, diabetes, asthma, obesity, osteoporosis, rheumatoid arthritis and multiple sclerosis. Although for each of these disorders there are exercise alternatives that may be prescribed under the close supervision of a specialist doctor, we should be wary of sending unmotivated people to gyms or fitness centres where they feel out of place and uncomfortable. We should not underestimate the negative effects of how modern society has turned many into crisp-eating, soap-watching, coach potatoes.

On the other hand, we should not underestimate the positive effect of everyday activities. For example (and this applies to both sexes), one to two hours of vigorous weekly cleaning of a normal house will force a middle-aged sedentary tr o

CO LU

tr o

Who needs a gym if you have a garden?

Cleaning windows is excellent training for shoulder muscles and posture

Vacuum cleaning is excellent core-stability training

Who needs a gym if you have a garden?

Cleaning windows is excellent training for shoulder muscles and posture

Vacuum cleaning is excellent core-stability training person to use 70 to 80 per cent of their maximal oxygen uptake, equivalent to running for 45 minutes at a good pace. Cleaning windows manually is excellent rotator cuff training after shoulder injuries; vacuum cleaning requires core stability and posture; washing dishes in warm water is excellent for a healed radius fracture. There are many, many other examples: running up and down stairs, standing on one leg on a wobble board while brushing your teeth, stretching out in the shower, cutting the hedges, mowing the lawn, walking or jogging the dog, jumping off the bus one stop away from the office, using stairs instead of lifts. We neglect many of these things (if we can) during the week, then we spend money and energy on a one-hour run on a treadmill and gym training. Who needs a gym if there is a garden to attend to? Who needs exercise if you are running after three small children all day or taking the dog out once a day?

Exercise on prescription is not new. A Swedish doctor who lived in Enkoping in the early twentieth century gave detailed prescriptions: six walks a day around the park, three sit-downs and stand-ups from each of the park benches and so on. In ancient literature, from the Egyptians and Greeks to the Chinese, exercise is named as a basic and essential ingredient of life. If we sit still we die!

Without sounding like an old schoolmarm, I do think we should go back to some of these basic ideas, to avoid further deterioration of sedentary people's fitness levels and help motivate injured athletes by prescribing a balanced diet of alternative exercises.

Fracture of metatarsal bones Hallux rigidus Hallux valgus Morton's neuroma Plantar fasciitis Sesam bone stress fractures Stress fractures of the foot Sub-talar instability and pain Tarsal coalition Turf toe m

INJURIES TO THE ANKLE

Anterior impingement syndrome Cartilage injury of the talus dome Lateral ankle ligament ruptures Multi-ligament ruptures of the ankle Peroneus tendon dislocation Peroneus tendon rupture Posterior impingement of the ankle Syndesmosis ligament rupture Tarsal tunnel syndrome Tibialis posterior syndrome

INJURIES TO THE LOWER LEG

Achilles tendon rupture

Achilles tendinopathy

Achilles tendinosis

Achilles paratenon disorders

Anterior chronic compartment syndrome

Anterior tibia stress fractures

Apophysitis calcaneii

Medial tibia stress syndrome Rupture of the gastrocnemius or soleus muscles Stress fracture of fibula Stress fracture of posterior tibia

Anterior cruciate ligament tear (ACL) Anterior knee pain Cartilage injuries Chondromalacia patella Gout: arthropathies Iliotibial band friction syndrome Lateral collateral ligament tear (LCL) Medial collateral ligament tear (MCL) Medial plica syndrome Meniscus tear Osgood-Schlatter's disease Osteoarthritis

Osteochondritis dissecans (OCD)

Patella dislocation

Patella tendon rupture

Patellar instability or mal-tracking

Patellar tendinosis

Popliteus tenosynovitis

Posterior cruciate ligament tear (PCL)

Posterior lateral corner injuries

Posterior medial corner injuries

Prepatellar bursitis

Rupture of the quadriceps or hamstring muscles Tibial spine avulsion fracture

TJ 70 m

INJURIES TO THE THIGH AND GROIN

Adductor tendonitis/tendinosis Hip joint labral tears Hip joint osteoarthritis Iliopsoas-related groin pain Nerve entrapment causing groin pain Rupture of the rectus femoris muscle Stress fracture of the femur neck Stress fracture of the pelvis Symphysitis

INJURIES TO THE WRIST

Baseball mallet finger Bowler's thumb Carpal tunnel syndrome De Quervain's tenosynovitis Dislocation of finger joint Handlebar palsy Hypothenar syndrome Rugby finger Scaphoid fracture Skier's thumb

Stress fracture of the radial epiphysis Squeaker's wrist

Tenosynovitis of the extensor carpi ulnaris Wartenberg's syndrome

Lateral epicondylitis (tennis elbow) Olecranon bursitis Pronator teres syndrome Radial tunnel syndrome Triceps tendon rupture

INJURIES TO THE SHOULDER

Acromio-clavicular dislocation Anterior shoulder dislocation Biceps tendon rupture Clavicle fracture External impingement Frozen shoulder

Internal impingement syndrome Multi-directional instability Pectoralis muscle rupture Posterior shoulder dislocation Post-traumatic shoulder stiffness Referred pain from the cervical spine Referred pain from the upper back Rotator cuff rupture SLAP tear

Subscapularis tendon rupture Thoraco-scapular muscle insufficiency

INJURIES TO THE ELBOW

Cartilage injury and loose bodies Distal biceps tendon rupture Golfer's elbow

Foot injuries are very common but have been neglected for many years in sports medicine. The developments of podiatry and foot surgery as orthopaedic specialities have dramatically improved our knowledge and the possibility of assisting in the treatment of these sometimes disabling injuries. Foot injuries are common in virtually all sports and at all ages.

The below figures show the anatomical appearances of the foot from different angles with arrows indicating the locations of presenting injury symptoms.

i FOOT INJURIES

Pijn Binnenkant Voet

1. FRACTURE OF METATARSAL BONES

SYMPTOMS There is a sharp localised exercise-induced pain over a metatarsal bone. Most commonly, MT IV or V are affected, often after a previous sprain or after a direct impact injury. AETIOLOGY The injury is either caused by direct impact, for example from football boot studs, or by excessive repetitive stress from forefoot running or jumping, sometimes due to faulty shoes or inlays with the breaking point of the sole over the mid-part of a metatarsal.

Stress Fracture Sporting Example
Fig. 3 MT V stress fractures should be treated with caution, since healing is often prolonged

CLINICAL FINDINGS There is swelling and distinct tenderness on palpation over the fractured metatarsal bone.

INVESTIGATIONS X-ray can be mistaken for normal if the stress fracture is undisplaced until there is o o callus formation, which occurs within a few weeks. MRI shows localised bone oedema very early. CT scans can disclose the fracture line. Displaced fractures, which are rare, are diagnosed directly by X-ray. TREATMENT This depends on the location of the fracture. While MT IV fractures usually heal with the use of non-weight-bearing boots and modifications in training within four to eight weeks, MT V fractures can be hazardous if displaced or unstable, leading to non-union and long-term problems, independent of treatment. Immobilisation in a non-weight-bearing boot or surgery may be indicated. Stress fractures to the first and second metatarsal bones are more uncommon in athletes. REFERRALS Refer to orthopaedic surgeon for consideration of immobilisation or surgery with screw fixation.

EXERCISE PRESCRIPTION Rest will not help so allow all kinds of non-impact sporting activities using well-fitting shoes, non-weight-bearing boots or strapping and avoiding impact. Suggest low-impact activities such as cycling and swimming. EVALUATION OF TREATMENT OUTCOMES Monitor decrease of clinical symptoms and signs and X-ray showing healed fracture. PROGNOSIS Excellent-Good in most cases but may be career-threatening for professional players, due to long healing times.

Fig. 4 Clinical presentation of advanced Hallux Rigidus

SYMPTOMS There is increasing stiffness and exercise-induced pain around MTP I without preceding trauma, usually affecting adult athletes. This condition can be mistaken for 'turf toe', which is common in young footballers. AETIOLOGY The aetiology is unclear but there is a possible genetic predisposition. CLINICAL FINDINGS There is decreased active and passive range of motion, most notably in extension and flexion of the MTP I to the degree that the joint freezes. There is localised swelling, effusion and tenderness on palpation over the MTP I joint. The condition is often bilateral. INVESTIGATIONS X-ray is initially normal. In later stages there is typically a decreased joint space, dorsal exostoses and sub-chondral sclerosis. TREATMENT Initially try individually adapted orthotics combined with stretching of the flexor and extensor muscles of MTP I. NSAID or cortisone injections into MTP I can give short-term relief. Surgery with osteotomy and excision of exostoses may be indicated to increase the mobility of the joint in severe cases but should be performed with caution on athletes since outcomes are sometimes unpredictable. Full weight bearing is usually allowed within six weeks of surgery. REFERRALS Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic surgeon if there are severe or progressive symptoms. EXERCISE PRESCRIPTION Rest will not help, so allow all kinds of sporting activities using well-fitting shoes. If there is pain on impact, suggest cycling, swimming or other low-impact sports as alternatives to running and jumping. DIFFERENTIAL DIAGNOSES Osteoarthritis, which usually does not give the typical stiffness and X-ray appearance; turf toe, which is post-traumatic intra-articular stiffness due to capsule and cartilage damage.

EVALUATION OF TREATMENT OUTCOMES

Monitor decreased clinical symptoms and signs and expect a normal X-ray around 12 weeks from surgery.

PROGNOSIS Good-Fair. Many of these conditions lead to an immovable joint, in the long term preventing running and jumping on the forefoot.

3. HALLUX VALGUS

Ankle Exercises After Surgery
Fig. 5 Clinical presentation of Hallux Valgus before surgery (patient's right foot) and after surgery (left foot)

SYMPTOMS Increasing stiffness, aching pain and typical deformation of MTP I without preceding trauma. Often the symptoms are bilateral. This condition is commonly presented by middle-aged recreational athletes or sedentary people, predominantly female, but it can occur in younger individuals. AETIOLOGY The aetiology is unclear but there is possibly a genetic predisposition to this disease, which causes a typical mal-alignment of MTP I with secondary bursitis and joint degeneration. Asymptomatic hallux valgus does not need treatment.

CLINICAL FINDINGS Hallux valgus is diagnosed when there is more than 10 degrees of malformation, with adducted distal phalanges and localised swelling, redness and tenderness on palpation over the MTP I joint.

INVESTIGATIONS X-ray confirms the diagnosis and indicates the extent of mal-alignment, subluxation and lateralisation of the MTP I joint. Usually there is a degree of osteoarthritis.

TREATMENT Try individually made orthotics in the shoes to support the anterior arch, combined with stretching of the MTP I adductor muscles. NSAID or local cortisone injections can give short-term relief. Surgery with correction of the mal-alignment (osteotomy of the bone and screw fixation in a straight position) is indicated in severe and progressive cases and has excellent outcomes. Full weight bearing is usually allowed at an early stage.

REFERRALS Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic foot surgeon if severe or deteriorating symptoms and severe mal-alignment.

EXERCISE PRESCRIPTION Rest will not help, so allow all kinds of sporting activities using well-fitting shoes. If pain is aggravated on impact suggest cycling, swimming or similar low-impact sports as alternative to running and jumping sports. DIFFERENTIAL DIAGNOSES Osteoarthitis that usually does not give the typical deformation. EVALUATION OF TREATMENT OUTCOMES Monitor the decrease of clinical symptoms and signs, the pain should disappear and a new X-ray should be normal, with healed osteotomy, six to twelve weeks after surgery. The screw that fixes the osteotomy can be removed later if symptoms occur. PROGNOSIS Excellent with appropriate treatment. Untreated hallux valgus can lead to severe mal-alignment, MTP I osteoarthritis and pain. If the bone becomes too osteoporotic, surgery may be difficult.

Hallux Rigidus Sesam
Fig. 6 Morton's Neuroma typically affects the nerve between MTIII and MTIV

SYMPTOMS Sharp radiating exercise-induced pain or dysaestesia between two metatarsal bones, most often between MT III and MT IV, without obvious preceding trauma. There are often bilateral symptoms. Usually it occurs in adults and particularly in middle-aged recreational athletes who wear tight shoes. AETIOLOGY This syndrome is caused by entrapment of an inter-digital nerve between two metatarsal bones arising from a local neuroma or synovitis. CLINICAL FINDINGS There is distinct tenderness on palpation and a positive Tinel's sign. Squeeze test is positive. Squeezing the toes together while holding the metatarsals parallel causes a typical local sharp pain reaction.

INVESTIGATIONS Injection of 1-2 ml of local anaesthetic around the tender spot gives immediate pain relief. MRI can confirm the diagnosis and its cause. TREATMENT Initially try orthotics to support and lift the anterior foot arch. NSAID or local cortisone injections can give short-term relief. Surgery for excision of the neuroma is indicated in severe cases and shows excellent outcomes. However, the patient will then lose sensation in the area distal to the neuroma, which could be slightly disabling. Surgery is done as a day case and full weight bearing is often allowed within two to four weeks.

REFERRALS Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic surgeon if the symptoms are severe or progressing. EXERCISE PRESCRIPTION Rest will not help so allow all kinds of sporting activities using well-fitting shoes.

DIFFERENTIAL DIAGNOSES Stress fracture of metatarsal with synovitis.

EVALUATION OF TREATMENT OUTCOMES

Monitor a decrease of clinical symptoms and signs. Tinel's sign and Squeeze test should be negative. PROGNOSIS Good-Fair. The pain, which disappears with treatment, is replaced with lack of sensation, which some athletes retrospectively feel is worse than the initial pain.

5. PLANTAR FASCIITIS

Insertion Plantar Fasciitis
Fig. 7 Palpating the insertion of the plantar fascia while stretching the toe extensors causes sharp localised pain. This is a positive Plantar Fasciitis test

SYMPTOMS There is increasing sharp or aching localised pain around the insertion of the plantar fascia at the anterior inferior part of the calcaneus, without preceding trauma. This condition commonly occurs in middle-aged athletes who run or jump repeatedly on the forefoot but is also common in manual workers who stand on hard surfaces in poor shoes. AETIOLOGY The aetiology is unclear but in the literature a chronic inflammatory process from overuse/stress to the insertion is often suggested. Strangely, when biopsies are taken from operated fasciitis there are no inflammatory cells. The name of this condition could thus be challenged. CLINICAL FINDINGS There is intense localised tenderness on palpation over the insertion, which is aggravated on extension of the plantar fascia by dorsi-flexion of the ankle and the toe extensors. INVESTIGATIONS X-ray often shows a bony spur in chronic cases, which is not correlated to the symptoms but rather indicates a chronic reaction caused by repetitive strain to the insertion.

TREATMENT Initially try orthotics to support the foot arch, which provides improved shock absorption/padding of the insertion area combined with stretching of the plantar fascia. NSAID or local cortisone injections can give short-term relief. Surgery is seldom indicated.

REFERRALS Refer to podiatrist and physiotherapist for mild symptoms and sports physician if the symptoms are severe. EXERCISE PRESCRIPTION Rest will not help so allow all kinds of sporting activities, with well-fitting shoes. If there is pain on impact, suggest low-impact alternatives such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor the decrease of clinical symptoms and signs. Symptoms can last for one to two years. DIFFERENTIAL DIAGNOSES A plantar fascia rupture can give the same symptoms and occur on the same location but with sudden onset and collapse of the foot arch. Ultrasound or MRI can help to differentiate. This condition occurs either while landing from a jump or in a running stride and is often associated with a previous cortisone injection for plantar fasciitis. Tarsal tunnel syndrome can cause radiating pain from nerve branches below the medial malleoli towards the insertion of the plantar fascia. Often the Tinel's sign is positive and local anaesthetic injected around the Tarsal tunnel (not the plantar fascia insertion) immediately relieves symptoms.

PROGNOSIS Excellent but with long duration of symptoms.

Sesam Bone Foot
Fig. 8 Sesam bone fractures are uncommon but very difficult to treat

SYMPTOMS There is gradually increasing exercise-induced pain and swelling around and below MTP I or diffuse pain in the forefoot on forefoot landings and running.

AETIOLOGY This injury is usually caused by excessive direct impact from landing on the forefoot on hard surfaces.

CLINICAL FINDINGS There is distinct tenderness on palpation over the medial or lateral sesam bones during forced dorsi-flexion of toe extensors. Jumping and landing on the forefoot is very painful.

INVESTIGATIONS X-ray is often normal until later stages or if avascular necrosis or sclerosis occurs. MRI may show oedema in and around the sesam bone and occasionally, in late stages, avascular necrosis. CT scans can sometimes show the fracture line.

TREATMENT Initially try orthotics or soft padding to take the load off the sesam bones. NSAID or local cortisone injections can give short-term relief. Surgery for excision of the fractured fragments or of the fractured bone may be necessary. REFERRALS Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic foot surgeon if symptoms become severe.

EXERCISE PRESCRIPTION Rest will not help so allow all kinds of sporting activities using well-fitting shoes and avoiding impact to the forefoot. Suggest low-impact activities such as cycling and swimming. EVALUATION OF TREATMENT OUTCOMES Monitor decrease of clinical symptoms and signs. PROGNOSIS Excellent if treated appropriately but duration of symptoms can be long after surgery.

7. STRESS FRACTURES OF THE FOOT

Fig. 9 Navicular bone stress fractures can be career threatening
Fig. 10 MT V stress fractures should be treated with caution, since healing is often prolonged and this injury often requires surgery

SYMPTOMS There is increasing localised pain over a bony prominence, often with no direct preceding trauma. The start of symptoms can be acute. There is often a history of suddenly increased training intensity or jumping or running on hard surfaces. A number of famous footballers' metatarsal stress fractures have figured in the media over the last few years.

AETIOLOGY A stress fracture is preceded by an imbalance in impact/loading and adaptive bone turnover. 'Too much too soon' is the typical cause in the healthy young athlete; in elderly athletes osteoporosis may play a role; in younger athletes who have been temporarily immobilised inactivity-related osteopenia can play a role. INVESTIGATIONS X-ray confirms the diagnosis around three weeks from onset when there is callus formation. MRI and bone scans pick up this injury within a few days from onset and can be recommended in unclear cases.

TREATMENT Initially modify the training avoiding or decreasing impact to the foot. The location of the stress fracture is important for outcomes. There are a few stress fractures that need to be treated with utmost caution: MT V, the Navicular bone and talus, calcaneus and sesam bone fractures adjacent to MTP I. These may need immobilisation or sometimes surgery. Most other stress fractures, unless with underlying bone problems, will heal within six to twelve weeks by just modifying activities. REFERRALS Refer to podiatrist and physiotherapist for mild symptoms and to orthopaedic foot surgeon if stress fractures on the above locations. EXERCISE PRESCRIPTION Rest will not help so allow all kinds of sporting activities using well-fitting shoes and decrease impact to fractured area. A non-weight-bearing boot can be used temporarily. If there is pain on impact, suggest cycling, water exercises or swimming as alternatives to running and jumping sports.

Fig. 11 A range of boots is commercially available for stability or 'non weight-bearing'

EVALUATION OF TREATMENT OUTCOMES

Monitor the decrease of clinical symptoms and signs and take an X-ray six to twelve weeks after onset to monitor healing. Beware the risk of avascular necrosis or non-union in bones with persistent symptoms. These injuries often require surgery and can be career-threatening. DIFFERENTIAL DIAGNOSES Skeletal tumours often present with resting pain, night pain and general feeling of unease. X-rays usually detect such tumours; osteoporotic fractures or suspected bone tumours should always be referred to an orthopaedic specialist. All stress fractures in anorexic young athletes should be referred to psychologists and other specialists in this condition. Usually an anorexic athlete's stress fractures affect the flat bones (pelvis, spine, etc) first. If there are general signs of infection or previous surgery in the affected area, rule out bone infections, such as osteomyelitis.

PROGNOSIS Excellent in most cases but some cases may be career-threatening with or without surgery.

8. SUB-TALAR INSTABILITY AND PAIN

Fig. 12 Persistent pain in the marked area after previous sprain can be caused by this syndrome

SYMPTOMS There is increasing stiffness or sense of instability combined with diffuse aching pain around and below the talo-tibial ankle joint, often occurring after previous sprain. AETIOLOGY The aetiology is unclear but the trauma may have caused structural damage to the region that can be missed. CLINICAL FINDINGS There is tenderness on palpation over the sub-talar joint (sinus tarsi) during forced inversion. Occasionally there is a combined sub-talar and tibio-talar laxity that makes the diagnosis difficult.

INVESTIGATIONS X-ray is often normal. MRI may show oedema and swelling in the sub-talar joint. TREATMENT Initially try orthotics to support the foot arch. NSAID or local cortisone injections can give short-term relief. Surgery is seldom indicated. REFERRALS Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic surgeon if there are severe or progressing symptoms. EXERCISE PRESCRIPTION Rest will not help so allow all kinds of sporting activities, using well-fitting shoes and avoiding impact. If there is pain on impact suggest non-impact activities such as cycling and swimming as alternatives. EVALUATION OF TREATMENT OUTCOMES Monitor the decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES Tarsal coalition-tumour (X-ray and MRI will differentiate); stress fracture (X-ray and MRI will differentiate); osteomyelitis (signs of infection, fever, positive blood tests for CRP, ESR); OCD (X-ray and MRI will differentiate); osteid osteoma (X-ray and MRI will differentiate).

PROGNOSIS Good-Fair. The symptoms can be prolonged with or without surgery.

Fig. 13 Coalition between two nearby bones in this area can cause pain and stiffness, severely affecting jumping and running

SYMPTOMS There is diffuse exercise-induced aching pain around the sub-talar joint, sometimes after previous sprain.

AETIOLOGY The aetiology is unclear. Sub-talar structures fuse over time by fibrosis or callus formation. CLINICAL FINDINGS There is tenderness on palpation over the sub-talar joint (sinus tarsi), decreased mobility and swelling.

INVESTIGATIONS X-ray may show talo-navicular coalition; talo-calcaneal coalition requires MRI or CT scans.

TREATMENT Initially try orthotics to support the foot arch. NSAID or local cortisone injections can give short-term relief.

REFERRALS Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic surgeon if symptoms are severe. Surgery may involve fusing the joints or excision of fibrosis but is not always successful.

EXERCISE PRESCRIPTION Rest will not help so allow all kinds of sporting activities, using well-fitting shoes and avoiding impact. If there is pain on impact suggest low-impact activities such as cycling and swimming. EVALUATION OF TREATMENT OUTCOMES Monitor the decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES Tumour (X-ray and MRI will differentiate); Stress fracture (X-ray and MRI will differentiate); Sub-talar pain syndrome. PROGNOSIS Good-Fair with or without surgery.

10. TURF TOE

Severe Turf Toe Images
Fig. 14 This is a cartilage injury in MTP I as seen by arthroscopy. A typical cause of turf-toe syndrome

SYMPTOMS There is a gradually increasing stiffness and diffuse aching pain around MTP I. Commonly affects team sports players who wear studded shoes. AETIOLOGY Common theories include repetitive minor trauma to the capsule and cartilage of MTP I from ill-fitting shoes, direct impact and playing on hard turf with shoes that get stuck. The name refers to an injury that dramatically increased in frequency when new artifical turf on all-weather football pitches became common. CLINICAL FINDINGS There is tenderness on palpation, swelling, effusion and redness over MTP I. Decreased active and passive flexion and extension of MTP I.

INVESTIGATIONS X-ray is often normal in early stages but can later show bony intra-articular fragments. MRI may show effusion, oedema and swelling around MTP I.

TREATMENT Initially try orthotics and stretching of the structures around MTP I. NSAID or local cortisone injections can give short-term relief. REFERRALS Refer to podiatrist and physiotherapist for mild symptoms and to orthopaedic foot surgeon if symptoms become severe. Surgery can be carried out, arthroscopically, to remove loose intra-articular bodies and debride the joint.

EXERCISE PRESCRIPTION Rest will not help so allow all kinds of sporting activities, using well-fitting shoes and avoiding impact. If there is pain on impact suggest low-impact activities such as cycling and swimming. EVALUATION OF TREATMENT OUTCOMES Monitor the decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES Stress fracture of sesam bones below MTP I (X-ray or MRI can differentiate); Hallux rigidus (X-ray and clinical picture differentiate).

PROGNOSIS Excellent-Good but there can be long duration of symptoms.

o CO

FOOT INJURIES

T3 G

111 cc

o CD

2 rQ

T3 CD

G cj

CJ CJ CJ

CD O

Was this article helpful?

0 0
Arthritis Relief and Prevention

Arthritis Relief and Prevention

This report may be oh so welcome especially if theres no doctor in the house Take Charge of Your Arthritis Now in less than 5-Minutes the time it takes to make an appointment with your healthcare provider Could you use some help understanding arthritis Maybe a little gentle, bedside manner in your battle for joint pain relief would be great Well, even if you are not sure if arthritis is the issue with you or your friend or loved one.

Get My Free Ebook


Post a comment