9/17/2019

Magnesium And Gout: Posterior Tibial Tendon Dysfunction (PTTD)

Magnesium And Gout: Posterior Tibial Tendon Dysfunction (PTTD)

Posterior tibial tendon dysfunction (PTTD), also known as posterior tibial tendonitis, is one of the leading causes of acquired flatfoot in adults. The onset of PTTD may be slow and progressive or sudden. An abrupt onset is typically linked to some form of trauma, whether it be simple (stepping down off a curb or ladder) or severe (falling from a height or vehicle accident). PTTD is rarely seen in children and increases in frequency with age.

  • Stage II Tendon status Attenuated with possible partial or complete rupture Clinical findings Pain in arch.
  • Unable to raise on feet.
  • Too many toes sign present X-ray/MRI MRI notes tear in muscle.
  • X-ray noting abduction of forefoot, collapse of talo-navicular joint
  • Stage III symptoms are severe with an inability to complete most normal daily activities such as washing or going to the store.
  • Collapse of the medial arch will be obvious.
  • Abduction of the forefoot will show 'too many toes sign'.
  • Mix oil of wintergreen, chloroform and rubbing alcohol in the ratio of 1:3:12.
  • Once the mixture is prepared, rub it on the affected area.

Treatment of Posterior Tibial Tendon Dysfunction and Posterior Tibial Tendonitis

Treatment for PTTD is dependant on the clinical stage and the health status of the patient. It is important to recognize that PTTD is a mechanical problem that requires a mechanical solution. This means that treating PTTD with medication on your own is fraught with failure. Timely introduction of some form of mechanised support is imperative.

The characteristic finding of PTTD include; Loss of medial arch height Edema (swelling) of the medial ankle Loss of the ability to resist force to abduct or push the foot out from the midline of the body.

  • Having sex prevents men from getting gout.
  • It seems that increased sexual activity reduces uric acid amounts in fertile men.

The Dr. Ellenburg Show - Cherries and Gout, Colds, Magnesium and Diabetes, Childhood Lead Exposure

http://drellenburg.com/ October 22nd, 2012 On today's show, Dr. Michael James Ellenburg, ND, MPH, L.Ac, discusses cherries and gout, vitamin D and the ...

Gout is undoubtedly one of the most common and painful ailments that affects mankind. It is a result of accumulation of uric acid in the form of crystals in joints and tissues. It starts from the major portions of the body like the big toe and then start spreading all over. The enhancement of the uric acid level is mainly a result of eating food items an excellent source of protein or fat content. To take care of gout efficiently there are a a number of food products that are to be avoided. This article aims at throwing a little light on individuals products.

The posterior tibial tendon is the extension of the posterior tibial muscle that lies deep to the calf. The origin of the rear tibial muscle is the posterior aspect of both the tibia and fibula and the interosseus membrane. The insertion of the posterior tibial muscle is the medial navicular where the tendon divides into nine different insertion web site on the bottom of the foot.

Two Tbsp of Water, Add One Tbsp Fresh Limejuice

Have this twice a day -in the morning and at night. In a pint of warm water, mix juice of three lemons and three tablespoons Epsom salts. Take one tsp of the mixture in the morning and one in the evening.

Surgical procedures which focus on primary repair of the posterior tibial tendon have been very unsuccessful. This is due to the fact that tendons heals slowly following injury and cannot be relied upon as a sole solution for PTTD cases. Surgical success is usually attained through stabilization of the rearfoot subtalar joint) which significantly reduces the work carried out by the posterior tibial muscle.

  • Include foods rich in calcium, magnesium and vitamin C in the diet.
  • This would help in treating rheumatism.
  • Extract a cup of bitter gourd juice.
  • Mix it with a tsp of honey.
  • Daily dose of this, for three months, would be helpful in treating rheumatism.
  • Stage II symptoms are seen with more regularity.
  • Pain is present at the onset of weight bearing.
  • Some restriction of the ability to raise up on the toes will be present.

Lateral Subtalar Joint (Outside of the Ankle) Pain

A common test to evaluate PTTD is the 'too many toes sign'. The a lot of toes sign' is a test used to measure abduction deviation away from the midline of the body) of the forefoot. With damage to the rear tibial tendon, the forefoot will abduct or relocate in relationship to the rest of the foot. In cases of PTTD, once the foot is viewed from behind, the toes show up as 'too many' on the outside of the foot due to abduction of the forefoot.

Differential Diagnosis:

Conditions that may resemble PTTD include tarsal tunnel syndrome, tibial stress fractures, posterior tibial tendon rupture, flexor hallucis longus tendonitis, gout, joint disease of the subtalar joint or a fracture of the posterior process of the talus.

Poisoning of blood with acid wastes Physically stressful work Damp weather conditioner Acid-alkaline imbalance (Acidosis) Home Remedy for Rheumatism

  • Eating generous amounts of other fruits and vegetables helps keep uric acid crystals in solution.
  • Eat foods high in potassium, as mentioned above.

Equinus is Also a Contributing Factor to PTTD

Equinus is the term used to describe the ability or lack of ability to dorsiflex the foot at the ankle (move the toes toward you). Equinus is usually because of tightness in the calf muscle, also known as the gastroc-soleal complex (a combination of the gastrocnemius and soleus muscles). Equinus may also be due to a bony block in the front of the ankle. The presence of equinus makes the posterior tibial tendon to accept additional fill during gait.

Consuming Half a Dozen Walnuts Everyday is Beneficial in Treating Rheumatism

However, make sure you chew them properly. In a bucket of warm water, add some rosemary oil. Dip the affected area in this water. This would provide relief from the pain and treat the inflammation too.

  • Stage I Tendon status Attenuated (lengthened) with tendonitis but no rupture Clinical findings Palpable pain in the medial arch.
  • Foot is supple, versatile with too many toes indicator X-ray/MRI Mild to moderate tenosynovitis on MRI, no X-ray changes
  • Avoid foods with high levels of purines.
  • As we mentioned before, foods with high purine levels consist of shellfish, alcohol, organ meat, creamy sauces, dried peas, etc.

There have been many proposed explanations for PTTD over the years since this condition was first described by Kulkowski in The most modern explanation refers to an area of hypovascularity (limited blood flow) in the tendon just below the ankle. Tendon derives most of its' nutritional support from synovial fluid produced by the particular outer lining of the tendon. Very small blood vessels also permeate the tendon sheath to achieve tendon. This makes all tendon notoriously slow to be able to heal. In the case of the posterior tibial tendon, this problem is exacerbated by a distinct area of bad blood flow hypovascularity). This area is located in the posterior tibial tendon just below or distal to the inside ankle bone (medial malleolus).

Dairy Products

Dairy products have high level of fat and thus must not be taken in extreme amounts. Milk, ice cream, cheese and butter are responsible for gout symptoms, given that they have an excessive amount of of fat.

  • Symptoms: The symptoms of stage I PTTD include a dull ache of the medial arch.
  • The pain become worse with activity, better on days with limited time on the feet.
  • Extensive activity may result in a partial rupture of the tendon, shifting to stage II.

Alcohol. Consuming opposite foods. Lack of sleep. Obesity. Sedentary work Causes of Gout: - Gout is caused by high blood levels of uric acid that crystallize and form painful deposits in the joints. Traditional thinking informs us that gout is the result of excessive amounts of alcohol, protein, heavy foods, coffee and soft drinks in your diet. These foods cause uric acid levels to rise. Other foods that increase uric acid are anchovies, asparagus, legumes, mushrooms, meat, organ meat, and also shellfish. Reduction in consumption of these foods is very often successful in reducing or eliminating gout.

  • The green stalk of rhubarb is effective in curing rheumatism.
  • Crush this with equal amounts of sugar.
  • Have a tsp of this blend three or four times everyday.

Certain Vegetables

Vegetables are often known for their medicinal values. But veggies like mushroom, lentils, spinach, peas, beans, cauliflowers, and asparagus cause gout. The addition of butter to these vegetables just instigates their uncomfortable side effects.

  • An effective way to treat rheumatism would be to have one or two tsp of raw potato juice before meals.
  • Mix 1 tbs of cod liver oil in a glass of orange juice.
  • Whip and drink this juice before going to bed.

Stage I May Respond to Rest, Like a Walking Cast

Pain and inflammation may be controlled with anti-inflammatory medications. It is important to make certain that Stage I patients realize that the use of shoes with additional arch support as well as heel elevation, for the rest of their lives, is essential. Arch support, whether built into the shoe or added as an orthotic, helps support the posterior tibial muscle and decrease its' work. Elevation of the heel, reduces equinus, one of the most significant contributing factors to PTTD. If Stage I patients return to low heels without having arch support, PTTD can recur.

Maintaining a proper weight and getting regular exercise reduces the risk and severity of gout episodes.

  • Immediately treating gout will not allow it to worsen.
  • We will now go over treatment, and natural remedies for gout in more detail.
  • Celery is beneficial in curing rheumatism.
  • You can either use it as a condiment or a fluid extract. 5 to 10 drops of this fluid should be mixed with a glass of hot water.
  • Possess this decoction before meals.
  • Most patients might complain, that is all the delicious food items are labeled forbidden for them, how would they be able to enjoy life?
  • It is also true that the food items mentioned are some of the most common ones.
  • However, if one wishes to be able to eliminate gout from its roots, these are a few safeguards that he has to follow.
  • For veggies that do not cause gout one would have to check out the gourmet section of the stores.
  • And, as said earlier fresh and natural food are far more advantageous and hygienic than processed food.
  • Why should one take a risk having junk food, when there is no guarantee that no harmful element has been used in it.

Stage II patients, or Stage I patients that do not respond to rest and support, require surgical correction to strengthen the subtalar joint prior to further damage to the posterior tibial tendon. Subtalar arthroeresis is a procedure used to stabilize the subtalar joint. Arthroeresis is a term that means the motion of the joint is blocked without fusion. Subtalar arthroeresis can only be used in cases of Stage I or II where mild to be able to moderate deformation of the arch has occurred and MRI findings show the tendons to be only partially ruptured. Subtalar arthroeresis is typically performed in conjunction with an Achilles tendon lengthening procedure to correct equinus. These treatments require casting for a period of weeks following the procedure.

  • A quarter of cranberry juice, dissolve 4 tsp blackstrap molasses.
  • Drink one glass of this juice daily, for curing rheumatism.
  • A glass of warm water, dissolve 2 tsp each of apple cider vinegar and honey.
  • Have this concoction once or twice a day.
  • Mix carrot juice and lemon juice in equal proportions.
  • Have a big spoonful of this concoction, everyday, to cure rheumatism.

Stage III Tendon status Severe degeneration with likely rupture Clinical findings Rigid flatfoot with inability to raise up on toes X-ray/MRI MRI shows tear in tendon. X-ray noting abduction of forefoot, collapse of talo-navicular joint.

Foods known to decrease the occurrence of gout include: dairy, foods high in potassium, black cherry juice, blueberries and lemon juice.

Advanced cases of PTTD, in addition to the pain of the tendon itself, pain will also be noted at the sinus tarsi. The sinus tarsi refers to a small tunnel or divot on the outside of the ankle that can actually be felt. This tunnel is the entry to the subtalar joint. The subtalar joint is the joint that controls the side to side motion of the foot, motion that would occur with uneven surfaces or sloped hills. As PTTD progresses and the ability of the rear tibial tendon to support the arch becomes diminished, the arch will collapse overloading the subtalar joint. As a result, there is increased pressure put on the joint areas of the lateral aspect of the subtalar joint, resulting in pain.

Tendon is also most susceptible to fatigue and failure at a place where the tendon changes direction. As the posterior tibial tendon descends the leg and comes to the inside of the ankle, the tendon follows a well defined groove in the back of the tibia (bone of the lining of the ankle). The tendon then takes a dramatic turn towards the arch of the foot. If the tendons is put into a situation where significant load is applied to the foot, the tendon responds by pulling up as the load of the body (in addition in order to gravity) pushes down. At the location where the tendon changes course, the tibia acts as a wedge and may even apply enough force to actually damage or rupture the tendon.

Natural Remedies for Gout:

Alternative therapies are popular among people with gout. However, if they are used, they ought to complement and not replace conventional care. There is very little evidence right now that shows alternative therapies are effective for gout. Below are a few natural remedies that are commonly used.

  • Diet Fruits Eat fresh fruits, especially citrus fruits.
  • Drink one or more of the following three times each day: orange juice, fresh lemonade and grapefruit juice.
  • You may also eat the fruits if you want.
  • Drink the juice or eat the fruits first thing to get the vitamins working in your system.

Author's Bio Mary Watson, the well known author writes on gout problem and Buy Colcrys. He regularly writes for http://www.colchicine.ca/.

Myerson, M.S. Adult acquired flatfoot deformity. J. Bone and Joint Surgery. 78-A;780, 1996 Johnson, K.A., Tibialis posterior tendon rupture. Clin. Orthop. 177:140-147, 1983

PTTD is a condition that increases in frequency with age and the prevalence of poor health indicators such as diabetes and obesity. As a result, many patients with PTTD are poor surgical candidates for correction of PTTD. Prosthetics such as an ankle foot orthotic (AFO), Arizona Brace or other bracing may be very helpful to control the symptoms of PTTD. Anatomy:

Rheumatoid Arthritis

Osteo-arthritis Gout Ankylosing spondylitis Tennis elbow Frozen shoulder Cervical spondylitis Fibrositis Read more on Rheumatism and Home Remedies for Rheumatism. Also go to on Singapore Travel InformationCauses of Rheumatism.

Yeast and Yeast Products

Yeast or yeast by products is also to be struck off from the diet list. They also behave in catalyzing gout effects. Any kind of alcohol, even if it is just beer are to avoided as well. the reason behind this being that yeast is a main ingredient in them.

  • Symptoms of Gout: - Indigestion Excessive consumption of salty, sour, hot, spicy, oily foods.
  • Consumption of Fish.
  • Consuming horse gram, urad dal.

Magnesium and Gout

  • Read more on Rheumatism and Home remedies for Rheumatism.
  • Also visit on Singapore Travel InformationCauses of Rheumatism
  • Peel some potatoes.
  • Wash 30 grams of this peeling in half a liter of water.
  • Strain the decoction and have it three or four times daily.
  • This is an effective way to treat rheumatism.

Foods to Avoid

Avoid eating meat and fish, caffeinated beverages, sugar, white bread and pasta, alcoholic beverages and pickled or very salty foods. All of these foods are acidic and, while they don't cause your rheumatism in order to get worse, may inhibit the work of the healthy foods in the rheumatism diet. The fewer acidic foods you consume, the more likely the alkaline foods will eliminate away the toxins causing rheumatoid pain rather than the acids in the foods you've just eaten.

  • Additional contributing factor to the onset of PTTD may include hypertension, diabetes, peripheral neuropathy, smoking or arthritis.
  • The progression of PTTD may result in tendonitis, partial tears of the tendon or even complete tendon rupture.
  • Many categories have been developed to describe PTTD.
  • The classification as described by Johnson and Strom is most commonly used today.
  • Drinking a lot of water, six or more glasses a day, will help the body to excrete more uric acid.
  • Water also decreases the chances of getting kidney stones.

About the Author:Jeffrey a

Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Doctor. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.

  • Additional references include;
  • Cantanzariti, A.R., Lee, M.S., Mendicino, R.W.
  • Posterior Calcaneal Displacement Osteotomy for Adult Acquired Flatfoot.
  • J. of Foot and Ankle Surgery. 39-1: 2-14, 2000

Pain on the medial ankle with weight bearing Inability to raise up on the toes without pain Too many toes sign

Rheumatism is Not a Single Disease

It pertains to a whole range of conditions, all of which cause pain. These conditions affect the joints, the muscles and the structures. Rheumatism is more common among the middle aged and elderly people. The exact cause of most forms of rheumatism is not known. Exposure to wet and cold may aggravate the pain. There are many forms of rheumatism, as well as some of the most common ones are:

Stage III patients require stabilization of the rearfoot with procedures that fuse the primary joints of the arch and foot. These procedures are salvage procedures as well as require prolonged casting and disability following surgery. A common procedure for Stage III is called triple arthrodesis which is a technique used to fuse the subtalar joint, the talo-navicular joint as well as the calcaneal cuboid joint.

No matter how hard it seems to avoid junk and prepared foods, one must actually avoid them. Most manufacturers utilized yeast in processed food. Some also use certain chemicals which are normally not tested regarding gout. The consumption of these ingredients is certainly going to have adverse effects on gout sufferers. However, it is always advisable for any individual to have real food; it is more useful for one who has gout. It is upon themselves to check any further enhancement in the level of uric acid in their body. One will need to have small quantities of food and must make sure that the overall consumption is kept low.

  • Myerson, M.S., Corrigan, J.
  • Treatment of posterior tibial tendon dysfunction with flexor digitorum longus tendons transfer and calcaneal osteotomy.
  • Orthopedics 19:383-388, 1996

Food High in Purine Content

Any kind of food that is high in purine level, are to be purely avoided. Seafood, fish, pork, poultry or beef are a few of such foods. Meat from certain organs of animals can also be held responsible for gout. Liver, brains, kidneys, have high purine content. Therefore the consumption of meat needs to be reduced as much as possible. Broths or fish roe, can cause gout as well, since they have meat as their main ingredient.

Biomechanics: The function of the posterior tibial tendon is to plantarflex the foot in the toe off phase of the gait cycle and to stabilize the medial arch.

For people with gout the uric acid level in the blood is so high that uric acid crystals form and put in joints along with other tissues. This causes the joint cellular lining to become inflamed, resultant in sudden and severe attacks of pain, softness, redness and warmth. Either way, gout remedies may include medication to lower the uric acid level or a special gout diet in order to decrease the amount of purine ingested.

  • Take the falconoid quercetin - see below under Folk Remedies.
  • This should be part of your permanent gout-prevention diet.

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