Morton's Foot
Morton’s Foot

Morton’s foot and pyridoxal 5′-phosphate deficiency: genetically linked traits.

I came across an extremely interesting article lately regarding Morton’s foot and vitamin B6 deficiency. A lot of what I say in the article comes from scientifically published research referenced at the end of the article. Apologies if some of it is a bit technical. I have tried to simplify it while keeping the content intact.

What is Morton’s foot?

A Morton’s foot  also  called Morton’s toe, is a condition characterized by a longer second toe.

Pathophysiology

Morton’s Toe will cause an individual to have abnormal or over pronation.  It is this pronation that is the ultimate cause or contributing factor to most of the problems not only of the foot but also of the whole body.

Normal Pronation is a series of motions the foot must have, so that it can absorb the shock of meeting the ground. It must be able to do this, in order to adapt and adjust to the new walking surfaces it has just met. This adjustment should only last a fraction of a second to allow the foot to slow down; absorb the shock of your body weight in order to adjust and adapt to the walking surface. If this adjustments last longer, the foot will then begin to abnormally pronate and to correct itself. This is the start of a “chain reaction” that puts the foot under a lot of abnormal stress and strain, causing  Bunions, Heel Spurs, plantar fasciitis, Corns, Callouses, ingrown toenails and numerous other foot problems.

 

Vitamin B6 deficiency

Vitamin B6 is an essential vitamin needed for many chemical reactions in the human body. It exists as several active forms but pyridoxal 5′-phosphate (PLP) is the phosphorylated form needed for transamination, deamination, and decarboxylation. PLP is important in the production of neurotransmitters, acts as a Schiff base and is essential in the metabolism of homocysteine, a toxic amino acid involved in cardiovascular disease, stroke, thrombotic and Alzheimer’s disease. Nichols and Gaiteri(2014) showed the connection between a deficit of pyridoxal 5′-phosphate and the physical foot deformity known as the Morton’s foot. Morton’s foot has been associated with fibromyalgia/myofascial pain syndrome. PLP deficiency also plays a role in impaired glucose tolerance and may play a much bigger role in the obesity, diabetes, fatty liver and metabolic syndrome. Without the Schiff-base of PLP acting as an electron sink, storing electrons and dispensing them in the mitochondria, free radical damage occurs.

 

Summary

To put this all very simply : Vitamin B6 is an essential vitamin needed for many chemical reactions that take place within the human body. This vitamin is obtained from your diet. The genetically linked condition of ”Morton’s toe” has been linked to the inability to convert Vitamin B6 into the active form pyridoxal 5′-phosphate needed for cetain chemical processes in the human body. This in turn can lead to conditions seen with vitamin B6 deficiency. Some of these conditions include:

  • Anemia
  • Skin/Hair/Nail problems
  • Depression/Anxiety
  • Nerve damage
  • Pain syndrome development
  • Systemic Inflammation
  • Circulation problems, including oxygen transport
  • Hormone Issues
  • Seizures

Do not take a B6 supplement, or “b-vitamin complex” and expect it to help. It won’t.
You need the activated form of B6 called P5P. This is the only form that your body can use.

 

Reference:

Supplementation with PLP, L5-MTHF, B12 and trimethylglycine should be used in those patients with hyperhomocysteinemia and/or MTHFR gene mutation.(Trent W. Nichols, Christopher Gaiteri ,Published in Medical hypotheses 2014, DOI:10.1016/j.mehy.2014.09.003).

 

Physiotherapists in Tralee.  Open early until late. Phone 086-7700191

bicipital-tendonitisBicipital tendonitis is a common cause of shoulder pain, often developing in people who perform repetitive, overhead movements. Biceps tendinitis develops over time, the pain being located at the front of the shoulder. The biceps muscle has two parts referred to as the long head and the short head. The tendon of the long head of the biceps is most commonly implicated with tendonitis. When this tendon is subjected to repetitive stresses, it can become irritated, swollen, and painful.This occurs where the tendon sits within the bicipital groove at the top of the humerus under the transverse ligament before it becomes part of the shoulder joint capsule.

Pain at this exact spot when pressed with a finger as the arm is rotated in and out while standing, is usually a fairly reliable test to confirm this condition. Imaging techniques such as MRI are typically not needed to diagnose biceps tendonitis.

Symptoms – Bicipital Tendonitis

Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity.

Pain that moves down along the upper arm

An occasional snapping sound or sensation in the shoulder

Treatment – Bicipital Tendonitis

The initial goals of treatment for bicipital tendonitis are to reduce inflammation and swelling. Patients should restrict above shoulder height movements, reaching out with the affected arm and lifting. They should apply ice to the affected area for 10-15 minutes, 2-3 times daily for several days. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help recovery. Probably the biggest aid to recovery is rest from the aggravating activity for several weeks. I often come across this condition in weight trainers who front press or incline bench press, the bar being too far out from their neck during pressing. It is also common in swimmers with poor technique or who ramp up their training distance/pace too quickly.

 

Physiotherapist Tralee : Phone 086-7700191 for an appointment, second opinion or to discuss your injury.

Sub-acromial bursitis. Overview by Physio in Tralee.

 

sub-acromial bursitis Sub-acromial bursitis is a common cause of shoulder pain that is usually related to impingement of the bursa between the supraspinatus muscle tendon and the acromion bone(see diagram). Bursae(single = bursa) are fluid-filled sacs that help reduce friction wherever tendons move under or over bone. The Supraspinatus muscle runs along the top of the shoulder blade and inserts via the tendon onto the top of the arm(humerus bone). This muscle is used to lift the arm up sideways . Above the supraspinatus tendon and under the acromion there is a bursa. When this bursa gets inflamed and swollen it can become trapped under the acromium bone of the shoulder causing pain and inflammation.

 

Symptoms

Symptoms of sub-acromial bursitis can be similar to those of supraspinatus  muscle/tendon injury within the shoulder. There will be pain and weakness in the arm, particularly when it is lifted sideways from the hip to overhead.  Pain at different levels 0f this 180 degree arc can indicate different injuries. If it is the tendon that is injured rather than the bursa somebody may be able to lift your arm over your head for you, with much less pain than you would have lifting your arm by itself. If you have a sub-acromial bursitis, especially if it is severe, neither you or another person will be able to lift that arm fully over your head. As the arm is lifted, there is increased compression on the bursa due to reduction within the sub-acromial space. This limits the upward movement of the arm  due to severe pain and restriction caused to the swollen/inflamed bursa. If a supraspinatus muscle/tendon tear is the cause of the pain, another person will be able to lift your arm fully over your head for you, with significantly less pain than you doing it on your own. This is  because they take over the function of the torn or injured muscle/tendon. These are important differences, as they often allow a practitioner to differentiate between both injuries .

What Causes It?

Sometimes, an injury damages the bursa in your shoulder. Overuse of your shoulder muscle can also cause damage. People who do a lot of overhead lifting and/or forceful pulling are at risk.  Sports  involving a lot of throwing or pitching can also irritate the sub-acromial bursa. Other factors that can help cause this type of bursitis include:

Your age. Bursitis in the shoulder becomes more likely as you age.

Poor posture with the shoulders arched forwards increases the risk of this injury. It causes impingement of the supraspinatus tendon and bursa by making the sub-acromial space smaller.

Poor shoulder flexibility/mobility.

Infection, arthritis, gout, diabetes, or thyroid disease can also cause issues.

Treatment

With very mild bursitis rest from aggravating activities and the use of non-steroid anti-inflammatories can be beneficial. A physio can loosen out the shoulder structure and give you exercises to improve shoulder posture, mobility and strength. In bad cases of bursitis, a cortisone injection into the area, done correctly, can bring full relief within days, especially if the condition is recent. Posture must be corrected, and aggravating activities reduced, thereafter, for long-term relief. For more troublesome recurring bursitis, a surgeon may need to remove the bursa altogether. Bursae do grow back, but now you have a new one to start afresh.

Physical Therapist in Tralee phone 086-7700191