orthotics

Each of your feet has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. No wonder a lot of things can go wrong. Here are a few common problems:

• Bunions - hard, painful bumps on the big toe joint
• Corns and calluses - thickened skin from friction or pressure
• Plantar warts - warts on the soles of your feet
• Fallen arches - also called flat feet

Ill-fitting shoes often cause these problems. Aging and being overweight also increase your chances of having foot problems.

Heel problems are common and can be painful. Often, they result from too much stress on your heel bone and the tissues that surround it. That stress can come from:

• Injuries
• Bruises that you get walking, running or jumping
• Wearing shoes that don't fit or aren't made well
• Being overweight

These can lead to tendinitis, bursitis, and fasciitis, which are all types of inflammation of the tissues that surround your heel. Over time the stress can cause bone spurs and deformities. Certain diseases, such as rheumatoid arthritis and gout, can also lead to heel problems. Treatments for heel problems might include rest, medicines, exercises, taping, and special shoes. Surgery is rarely needed.

Osteoarthritis, sometimes called OA, is a type of arthritis that only affects the joints, usually in the hands, knees, hips, neck, and lower back. It's the most common type of arthritis.

In a healthy joint, the ends of the bones are covered with a smooth, slippery tissue called cartilage. The cartilage pads the bones and helps them glide easily when you move the joint. With osteoarthritis, the cartilage breaks down and becomes rough. Sometimes, all the cartilage wears away and the bones rub together. Bumps of extra bone called bone spurs may grow in the joint area.

There is no cure for osteoarthritis. It usually gets worse slowly. But there's a lot you can do to manage the symptoms.

Osteoarthritis affects people in different ways, and not everyone has pain. The most common symptoms are:

• Pain when you move, which often gets better with rest
• Stiffness, especially for the first 30 minutes after you get up from resting
• Swollen joints, especially after using the joint a lot
• Less movement in the joint than normal
• A joint that feels loose or unstable

Researchers aren't sure what causes osteoarthritis. They think that it could be caused by a combination of factors in the body and the environment. Your chance of developing osteoarthritis increases with age. They also know that some people are more likely to develop it than others.

Things that make you more likely to develop osteoarthritis include:

• Aging. Osteoarthritis can happen at any age, but the chance of getting it increases in middle-aged adults and older. After age 50, it is more common in women than in men.
• Being overweight. Extra weight puts more stress on your joints.
• Having a past injury or surgery on a joint. This is often the cause of osteoarthritis in younger adults.
• Doing a lot of activities that overuse the joint. This includes sports with a lot of jumping, twisting, running, or throwing.
• Having a joint that doesn't line up correctly.
• A family history of osteoarthritis. Some people inherit genetic changes that increase their chance of developing osteoarthritis.

There is no specific test for osteoarthritis. To find out if you have osteoarthritis, your provider:

• Will ask about your symptoms and medical history
• Will do a physical exam
• May use x-rays or other imaging tests to look at your joints
• May order lab tests to make sure that a different problem isn't causing your symptoms

The goal of treating osteoarthritis is to ease your pain, help you move better, and stop it from getting worse.

Treatment usually begins with:

• Exercises to improve strength, flexibility and balance
• Weight loss, if needed, to improve pain, especially in your hips or knees
• Braces or shoe inserts (orthotics) that a health care provider fits for you

You can buy some pain relievers and arthritis creams without a prescription. They can be helpful, but it's best to talk to your provider about using them. If they don't help enough, your provider may prescribe injections (shots) into the joint or prescription pain relievers.

Complementary therapies may help some people. Massage can increase blood flow and bring warmth to the area. Some research shows that acupuncture may help relieve osteoarthritis pain. Simple things like heat and ice can help, too.

If none of these treatments help enough, surgery may be an option. You and your provider can decide if it's right for you.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Spinal muscular atrophy (SMA) is a group of genetic diseases that damages and kills motor neurons. Motor neurons are a type of nerve cell in the spinal cord and lower part of the brain. They control movement in your arms, legs, face, chest, throat, and tongue.

As the motor neurons die off, your muscles start to weaken and atrophy (waste away). The muscle damage gets worse over time and can affect speaking, walking, swallowing, and breathing.

There are different types of SMA. They are based on how serious the disease is and when the symptoms start:

• Type l is also called Werdnig-Hoffman disease or infantile-onset SMA. It is the most severe type. It is also the most common. Babies with this type usually show signs of the disease before 6 months of age. In more severe cases, the signs show up even before or just after birth (Types 0 or 1A). The babies may have trouble swallowing and breathing and may not move around a lot. They have chronic shortening of muscles or tendons (called contractures). They usually cannot sit up without help. Without treatment, many children with this type will die before 2 years of age.
• Type ll is a moderate to severe type of SMA. It usually first noticed between 6 and 18 months of age. Most children with this type can sit without support but cannot stand or walk without help. They may also have trouble breathing. They can usually live into adolescence or young adulthood.
• Type lll is also called Kugelberg-Welander disease. It is the mildest type that affects children. The signs of the disease usually show up after age 18 months. Children with this type can walk by themselves but may have trouble running, getting up from a chair, or climbing stairs. They may also have scoliosis (curvature of the spine), contractures, and respiratory infections. With treatment, most children with this type will have a normal lifespan.
• Type IV is rare and often mild. It usually causes symptoms after 21 years of age. The symptoms include mild to moderate leg muscle weakness, tremors, and mild breathing problems. The symptoms slowly get worse over time. People with this type of SMA have a normal lifespan.

Most types of SMA are caused by a change in the SMN1 gene. This gene is responsible for making a protein that the motor neurons need to be healthy and to function. But when part of the SMN1 gene is missing or abnormal, there isn't enough protein for the motor neurons. This causes the motor neurons to die off.

Most people have two copies of the SM1 gene - one from each parent. SMA normally only happens when both copies have the gene change. If only one copy has the change, there usually aren't any symptoms. But that gene could be passed down from parent to child.

Some of the less common types of SMA may be caused by changes in other genes.

Your health care provider may use many tools to diagnose SMA:

• A physical exam
• A medical history, including asking about family history
• Genetic testing to check for the gene changes that cause SMA
• Electromyography and nerve conduction studies and a muscle biopsy may be done, especially if no gene changes were found

Parents who have a family history of SMA may want to do a prenatal test to check to see whether their baby has an SMN1 gene change. An amniocentesis or in some cases a chorionic villi sampling (CVS) is used to get the sample for testing.

In some states, genetic testing for SMA is part of newborn screening tests.

There is no cure for SMA. Treatments can help manage symptoms and prevent complications. They may include:

• Medicines to help the body make more of the proteins that the motor neurons need
• Gene therapy for children under 2 years of age
• Physical, occupational, and rehabilitation therapy to help to improve posture and the mobility of the joints. These therapies may also improve blood flow and slow muscle weakness and atrophy. Some people may also need therapy for trouble speaking, chewing, and swallowing.
• Assistive devices such as supports or braces, orthotics, speech synthesizers, and wheelchairs to help people stay more independent
• Good nutrition and a balanced diet to help maintain weight and strength. Some people might need a feeding tube in order to get the nutrition they need.
• Breathing support for people who have muscle weakness in the neck, throat, and chest. The support may include devices to help with breathing during the day and to prevent sleep apnea at night. Some people might need to be on a ventilator.

NIH: National Institute of Neurological Disorders and Stroke

If you are like most people, you walk thousands of steps each day. You walk to do your daily activities, get around, and exercise. It's something that you usually don't think about. But for those people who have a problem with walking, daily life can be more difficult.

Walking problems may cause you to:

• Walk with your head and neck bent over
• Drag, drop, or shuffle your feet
• Have irregular, jerky movements when walking
• Take smaller steps
• Waddle
• Walk more slowly or stiffly

The pattern of how you walk is called your gait. Many different diseases and conditions can affect your gait and lead to problems with walking. They include:

• Abnormal development of the muscles or bones of your legs or feet
• Arthritis of the hips, knees, ankles, or feet
• Cerebellar disorders, which are disorders of the area of the brain that controls coordination and balance
• Foot problems, including corns and calluses, sores, and warts
• Infections
• Injuries, such as fractures (broken bones), sprains, and tendinitis
• Movement disorders, such as Parkinson's disease
• Neurologic diseases, including multiple sclerosis and peripheral nerve disorders
• Vision problems

To make a diagnosis, your health care provider will ask about your medical history and do a physical exam. This will include checking your bones and muscles and doing a neurological exam. In some cases, you may have other tests, such as lab or imaging tests.

Treatment of walking problems depends on the cause. If the cause is a medical condition, treating that condition often improves your walking. Some common types of treatments for walking problems may include:

• Medicines
• Mobility aids such as walkers and canes
• Physical therapy
• Special shoes, insoles, splints, or braces
• Surgery