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Friday, June 03, 2011

Lady Gaga and sore feet: Same old song ?

Lady Gaga pop star and diva has sore feet and needs to see her podiatrist. The poor girl (25 years young) has been complaining of shooting pains in her Achilles tendon (tendinitis) and has noticed she may have developing bunions. Not only that she appears to have cracked heels and painful corns according to a recent newspaper report. Her podiatrist has advised a change in footwear (typical) and to try wearing lower heels, at least through the day.
A bunion describes an adventitious bursitis (fluid filled sack) which forms over a vulnerable joint subjected to excessive shearing stress. This will often arise in conjunction with Hallux (abducto -dorsi) valgus, a bony deviation of the great toe which appears to drift laterally towards or over the lesser toes. The resulting prominent joint (big toe joint) is difficult to fit into regular shoes and friction between the foot and shoe results in shear and with repeated trauma, the formation of a bunion. A popular misconception is a bunion is hallux (abducto-dorsi) valgus. Whilst both may be painful, discomfort is more usually associated with the latter due to osteoarthritis (wear and tear) in the great toe joint. Not all cases of Hallux Valgus are painful. Shoes may excite secondary problems but are not the primary cause of Hallux Valgus, contrary to popular belief. The most likely cause of a prominent forefoot is partial dislocation (subluxation) of the metatrso-phalangeal joints due to rearfoot instability during weight bearing. In the normal course of events the heel rocks from side to side in a pendulum motion as ground reaction forces a turning effect on the heel. This in turn helps the forefoot lock and unlock as the foot goes through stance phase. The position of the heel is critical during certain phases and when not properly aligned leaves the forefoot unstable causing it to splay. The rolling action of the heel during walking causes a build up of tensile stress (tearing stress) across the skin surface. In certain cases this tears the skin leaving deep fissure (skin cracks).
The right design of shoe can help with foot mechanics and the heel counter provides useful restraint. Open back shoes may contribute to forefoot instability (hypermobility), ably assisted when the heel is elevated resting on heel lifts (high heel shoes or platforms). The clinical presence of hallux valgus confirms joint subluxation across the forefoot with subsequent lesser toe deformities i.e. buckled toes. Stiffness and changes to the small joints can leave prominent knuckles which may score against the shoes, particularly when shoe volume is limited. The usual consequence of this is corns develop.

Reliance on elevated shoes for some people may cause adaptive shortening of the tendon Achilles resulting in when the tendon is stretched it can cause painful tendinitis.

Whilst this may logically explain the cause of Lady Gaga’s reported ailments, it is important to bear in mind not all high heeled divas will suffer these ailments and in every case their needs to be a predilection

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