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Hammertoe is a foot deformity that occurs due to an imbalance in the tendons, muscles, or ligaments that are responsible for holding the toes in their normal position. This condition may be caused by poor footwear, foot structure, trauma, and disease. The most common solution for hammertoe is to relieve the pain by changing your footwear and wearing orthotics. In severe cases, surgery may be required.
The shoes that are most likely to cause hammertoe are high heeled shoes or shoes that are too tight in the toe box. Tight shoes will force your toes to crowd together in a curled position. This position will likely continue when you take your shoes off. Another cause is trauma. When you stub your toe, you are increasing the chance that you will develop hammertoe.
There are risk factors that may make you more likely to develop this condition. Women are more likely to have the condition compared to men, and it is also more likely to appear in those who are older in age.
Many different foot problems can be avoided by wearing shoes that have adjustability, adequate toe room, and low heels. Furthermore, if you want to buy new shoes, you should look to purchase them at the end of the day and make sure you know your correct size. The importance of buying shoes at the end of the day is that your feet swell as the day progresses. You should also ensure that you are wearing your correct size because your shoe size may change as you grow older.
To diagnose someone with hammertoe, your podiatrist will need to conduct a thorough examination of your foot. Your doctor may even order an x-ray to evaluate the bones and joints of your feet and toes.
If you have hammertoe, your podiatrist may recommend that you wear shoes that fit you better along with inserts to place inside them. Additionally, he or she may suggest special exercises for you to perform to stretch your toes. One helpful exercise it to pick up marbles with your feet or crumple a towel with your toes.
Prior to meeting with your podiatrist, it will be helpful to make a list of all the symptoms you are experiencing. You should also make a note of medications you are taking and important personal information about your medical history.
The plantar fascia is a connective tissue in the heel that stretches across the bottom length of your foot. Plantar fasciitis occurs when the connective tissue becomes inflamed, causing heel pain and discomfort during physical activity. Although the condition is completely treatable, traditional methods can take up to a year to start becoming effective.
Plantar fasciitis is caused by a number of everyday activities, so understanding the condition is important for managing and treating it. One of the most common causes of plantar fasciitis is excessive running, especially with improper fitting or non-supportive shoes. Too much exercise can lead to the plantar fascia being overworked and overstretched, which can cause tears in the tissue. Along with improper fitting shoes, pronation, the rolling of the feet inward, is a common cause of plantar fasciitis. If not treated properly, the plantar fascia becomes overstretched and starts to tear, causing inflammation.
Despite the common causes of plantar fasciitis, there are many different treatment options. For less severe cases, conservative home remedies include taking anti-inflammatory drugs to alleviate pain, applying ice packs to the bottom of your foot and heel, slowly stretching and exercising your feet to re-strengthen the tissue, and using orthotic devices are all ways to help manage your plantar fasciitis.
For more severe cases, shockwave therapy has become a common solution for plantar fasciitis. Shockwave therapy can effectively break up the tissue on the bottom of your foot which facilitates healing and regeneration. This fights the chronic pain caused by plantar fasciitis. Even if this doesn’t work, surgery is always a final option. Surgery on the tissue itself can be done to permanently correct the issue and stop the inflammation and pain in your heels.
No matter what the case may be, consulting your podiatrist is the first and best step to recovery. Even the slightest amount of heel pain could be the first stage of plantar fasciitis. Untreated symptoms can lead to the tearing and overstretching of tissue. Because the tearing of tissue can be compounded if it remains ignored, it can evolve into a severe case. The solution is early detection and early treatment. Talk to your podiatrist about the possibilities of plantar fasciitis if you’re experiencing heel pain.
Overtraining and overusing the feet are the main causes of common running injuries. A number of these common injuries are caused by overrunning. Runner’s knee is a condition that is characterized by the back of the kneecap beginning to wear away and cause pain in the knee. This frequently occurs due to either a decrease in strength in the quadriceps muscles or ill-fitting shoes that are lacking in proper support for the inside of the forefoot. Strengthening exercises focusing on the quad muscle and sports orthotics are the usual treatments for those suffering from runner’s knee. Prevention of the condition lies in a focus on hip strengthening and quad-strengthening to keep the kneecap aligned. To help learn the best exercise to heal runner’s knee, one can also undergo physical therapy.
One common injury, called iliotibial band syndrome, is often caused by overtraining. This condition occurs when the iliotibial band gets irritated, creating pain and discomfort in the outside knee area. Plantar fasciitis, another common running injury, also occurs as a result of inflammation and irritation. Plantar fasciitis is an inflammation and irritation of the bone in the foot. A large amount of pain is often experienced due to plantar fasciitis. The condition can be caused by a high arch, improper footwear, tight muscles, or flat feet. It can best be avoided by stretching and wearing appropriate footwear that supports the foot.
Another common injury for runners is stress fractures. These injuries occur due to running style, overtraining, or a lack of calcium. Stress fractures most often occur in several locations in runners, including the inner bone of the leg, the thighbone, the bone at the base of the spine and the bones of the toes. Stress fractures are best prevented by wearing proper footwear and by running on flat and hard surfaces; this will absorb some of the shock created during running.
Aside from overtraining, other causes of common running injuries include ill-fitting footwear, a lack of flexibility and strength, and irregular biomechanics. The best way to avoid running injuries is to prevent them from even occurring. Both iliotibial band syndrome and stress fractures are preventable. The first step that should be taken to prevent running injuries is to only wear footwear that fits properly and that is appropriate for whatever activity you are doing. Running shoes are the only protective gear available to runners that can safeguard them from sustaining injuries. Choosing the right pair of shoes is therefore extremely important. While running shoes are an important factor, it is also important to consider other facets of your running routine such as training schedules, flexibility, and strengthening. These elements should be considered and altered according to your running needs to best maximize your run and minimize the possibility of injury. Careful stretching before and after a run should also be considered to help prevent running injuries. Stretching muscles enables greater flexibility and a lesser chance of sustaining injury.
A congenital foot problem is a problem affecting the feet, toes, and/or ankle that a child is born with. Several issues with a child’s feet can occur congenitally. Such problems include clubfoot, vertical talus, tarsal coalition, polydactyly, macrodactyly, and cleft foot. Some of these problems have a genetic basis, with someone in their family history having a gene causing the condition, and some are simply an anomaly.
The following are specifics about a few of these conditions:
- Clubfoot, also called congenital talipes equinovarus or talipes equinovarus, is When the tendons of the foot shorten, the bones are of an unusual shape, and the Achilles tendon is tight, causing an inward and downward pointing of the foot. The soles of the feet might also face each other. In most cases of clubfoot, both feet are affected. If not treated, the affected child will walk on the sides of their feet or ankles.
- Polydactyly is a condition where the child has more than five fingers or toes on either or both feet. Presentation usually consists of a nubbin or small lump of tissue without a bone, a toe that is partially formed but has no joints, or an extra toe.
- Vertical talus is where the talus bone forms in the wrong position, other bones in the foot do not line up properly, the front of the foot points up, and the bottom of the foot is stiff, has no arch, and usually curves out. This can occur in one or both feet and if left untreated, can lead to serious disability or discomfort as the child grows.
- Tarsal coalition is when there is an abnormal connection of two or more bones in the foot leading to severe, rigid flatfoot. The tarsal bones, located toward the back of the foot and in the heel, are the ones affected. This condition is often present at birth, but signs of the disorder usually come on in early adolescence.
- Cleft foot is a rare condition where the foot has missing toes, a V-shaped cleft, and other anatomical differences. Surgery can often help improve the foot’s function since the heel remains normal and is what is most needed for walking. The main issues with this affliction are whether the affected foot can fit into a shoe and the shape and appearance of the foot.
- Macrodactyly is when the toes are abnormally large due to overgrowth of the underlying bone or soft tissue. Having this condition makes it harder for the child to use the affected foot for certain activities.
An ankle sprain occurs when one or more ankle ligament gets overly stretched. Ligaments are strong bands of tissue that bind and support the bones and other structures that make up the ankle. In more severe ankle sprains, the ligament(s) tear—either partially or completely—and there may be an audible popping noise at the moment of injury.
Ankle sprains are quite common and can occur when the ankle rolls outwardly (eversion) or inwardly (inversion), causing the ligament(s) to stretch beyond normal limits, or even tear. Falls, twists, or blows to the ankle during sports or other activities can cause this injury, as well as wearing improper footwear, running on uneven surfaces, or having weak ankles.
Depending on the injury’s severity, an ankle sprain will be classified as Grade I, Grade II, or Grade III. Grade I sprains involve ligament(s) being overly stretched but not torn, with symptoms of mild pain, swelling, and ankle instability. There may also be some difficulty bearing weight. A Grade II sprain usually involves a partial tear of the ligament which brings more intensity in these symptoms, along with possible bruising. With a Grade III sprain, the ligament is completely torn, the symptoms are severe, and it may not be possible to put weight on the affected foot at all.
To diagnose and grade an ankle sprain, a podiatrist will perform a physical examination, checking for tenderness and range of motion in the ankle. For more severe sprains, X-rays or other imaging studies may be necessary.
It is vitally important to have an ankle sprain treated properly as improper healing often leads to future ankle sprains and possibly even chronic ankle stability. Treatment for an ankle sprain will vary, depending on its severity, and may include the RICE method (Rest/Ice/Compression/Elevation), physical therapy, bracing, medications, and possibly even surgery to repair a torn ligament. Rehabilitation is very important for the sprain to heal properly and to restore functionality.
While not a serious issue, toenail fungus, or onychomycosis, can be an embarrassing and uncomfortable condition to experience. Toenail fungus is often caused from public areas that harbor fungi and improper cleaning/drying of the foot. Once infected, the fungus grows deeper into the nail and can be very hard to get rid of.
There are different types of fungus that cause toenail fungus. Dermatophytes, yeasts, and molds are the most frequent forms of fungus to infect the toenail. Dermatophytes are the most common among the three. Symptoms associated with fungal nails include the discoloration of the toenail, brittleness, and in some circumstances, a smell. Pain is rarely a symptom caused by toenail fungus.
Diagnosis of fungal nails is generally a rather quick process. However podiatrists will make sure that the cause is not another condition such as lichen planus, psoriasis, onychogryphosis, or nail damage. Podiatrists will make use of fungal cultures and microscopy to verify that it is fungus.
While over-the-counter ointments are readily available, most are ineffective. This is due to the fact that the nail is very protective and that the fungus slips in between the nail plate and bed. Podiatrists can offer oral medication which currently provides the best results.
Ultimately, prevention is the best line of defense against toenail fungus. Avoid unsanitary public showers. If you do use a public shower, use shower shoes to provide your foot with protection. Once you are finished showering, make sure to thoroughly dry your feet. Fungi thrive in warm, dark, and moist places like sweaty, warm feet that are left dark in shoes all day.
Running may seem like a simple to do. However, running is actually a complex movement that puts stress on the ligaments, bones, and joints of the body. Selecting the correct running shoe is important for increasing performance and avoiding risk of injury. Running shoes should be selected based on your foot type. Considerations such as trail versus road shoes are important. Your foot type dictates the degree of cushioning, stability and motion control you require. The most accurate way to learn your foot type is to visit a local shop that specializes in running shoes. Professionals can measure your arch type, stride and gait and help you with your shoe needs.
The design of running shoes is created around the idea of pronation. Pronation is the natural rolling movement of your ankle from the outside to inside when your foot strikes the ground. If you run properly you strike the ground on the outside of your heel and roll in the direction of your big toe before pushing off once more. Pronation is beneficial because it assists the lower half of your body in absorbing shock and storing energy. Those considered neutral runners pronate correctly and do not need running shoes that help correct their form. Neutral runners can choose from a wide variety of shoes, including barefoot or minimal types. However, those who have arch problems or who adopt an incorrect form while running may experience too much or too little pronation. They may require running shoes that offer additional support.
Those who overpronate experience an over-abundance of ankle rolling. Even while standing, those who severely overpronate display ankles that are angled inward. It is not uncommon for them to have flat feet or curved legs. The tendency to overpronate may cause many injuries. Areas that tend to become injured are the knees, ankles, and Achilles tendon. If you find that you have a tendency to overpronate, you should look at shoes that provide extra stability and motion-control. Motion-control shoes are straight and firm. Shoes of this type do not curve at the tip. The restricted flexibility along the middle of the shoe prohibits the foot from rolling too far inward as your foot strikes the ground.
A less common problem is underpronation. Underpronation, also called supination, is when the feet are unable to roll inward during landing. Those who underpronate have feet that lack flexibility and high arches. This prevents any kind of shock absorption, even though it does place less rotational stress on ankles and knees. This added force can cause fractures, ligament tears, and muscle strains because the legs are trying to compensate for the impact. Those who underpronate need shoes with more cushioning and flexibility. If you have a tendency to underpronate, selecting stability or motion-control shoes may cause you more problems by continuing to prevent pronation.
Neuropathy is the weakness, numbness, and pain in the hands and feet due to damage to the peripheral nerves. The peripheral nerves are responsible for sending information from the brain and spinal cord to the rest of your body. Causes of Neuropathy include: traumatic injuries, infections, metabolic problems, exposure to toxins, and diabetes.
Diabetes is the most common cause, with more than half of the diabetic population developing some type of neuropathy. There are several types of neuropathy and they vary based on the damage of the nerves. Mononeuropathy is classified as only one nerve being damaged. When multiple nerves are affected, it is referred as polyneuropathy. One of the types of polyneuropathy is distal symmetric polyneuropathy. It is the most common for people with diabetes and starts when the nerves furthest away from the central nervous begin to malfunction. The symptoms begin with pain and numbness in the feet and then they travel up to the legs. A rarer form of polyneuropathy is acute symmetrical peripheral neuropathy, which is a severe type that affects nerves throughout the body and is highly associated with Guillain-Barre syndrome, an autoimmune disorder that attacks the peripheral nervous system and can be fatal. Although there are many types of neuropathy, most of them share the same symptoms such as pain, extreme sensitivity to touch, lack of coordination, muscle weakness, dizziness, and digestive problems. Since neuropathy affects the nerves, those affected should be careful of burns, infection and falling, as depleted sensations disguise such ailments.
The best way to prevent neuropathy is to manage any medical conditions such as diabetes, alcoholism, or rheumatoid arthritis. Creating and managing a healthy lifestyle can also go a long way. Having a healthy diet full of fruits, vegetables, whole grains and lean protein can keep the nerves healthy. These types of food have the nutrients to prevent neuropathy. Regularly exercising can help as well, but it is best to consult with a doctor about the right amount. In addition to diet and exercise, avoiding risk factors will also prevent neuropathy. This includes repetitive motions, cramped positions, exposure to toxic chemicals, smoking and overindulging on alcohol.
Flatfoot is classified as having the entire sole of the foot in contact or near contact to the ground while standing. The disorder is also known as fallen arches, because those affected have no arch in their feet. Flexible flatfoot and rigid flatfoot are the two types of flatfoot.
A person has flexible flatfoot if when sitting or standing on their toes, they have an arch that disappears when they stand with the entire foot on the ground. Flexible flatfoot may also be called “pediatric flatfoot” because the condition first appears in childhood. It is common among infants because the arch does not develop until the age of 5 or 6 years. Rigid flatfoot is not as common in children as it is with adults. This type of flatfoot is developed due to the weakening of tibialis posterior muscle tendon, a major supporting structure of the foot arch. Development of this deformity is progressive and shows early signs of pain and swelling that begins at the inside arch of the foot and moves to the outside of the foot below the ankle. More severe cases can possibly lead to arthritis of the foot and ankle joints.
Although most cases of flatfoot involve people born with the condition, some less common causes are obesity, diabetes, pregnancy, and osteoporosis. In some cases, flatfoot may come with no symptoms at all and does not require any type of treatment. With other cases though, symptoms may include pain in the shin, knee, hips and lower back. If a person with flatfeet experiences such symptoms, a health care provider may suggest using orthotic devices or arch supports, which may reduce the pain. Wearing supportive shoes can also prove more comfortable with flatfeet and staying away from shoes with little support such as sandals. Other methods to relieve pain also include stretching the Achilles tendon properly and using proper form when doing any physical activity. In addition, losing weight can reduce the stress on your feet and reduce the pain.
Hyperhidrosis of the feet, also termed plantar hyperhidrosis, is characterized by excessive sweating of the feet that can be onset by any cause, such as exercise, fever, or anxiety. Most people suffering from hyperhidrosis of the feet also experience hyperhidrosis of the hands, or palmar hyperhidrosis. Approximately 1-2% of Americans suffer from this disorder.
Sweating is a healthy process utilized by the body in order to cool itself and maintain a proper internal temperature, which is controlled by the sympathetic nervous system. In individuals with hyperhidrosis, the sympathetic nervous system works in "overdrive", producing far more sweat than is actually needed.
Plantar hyperhidrosis is considered primary hyperhidrosis. Secondary hyperhidrosis refers to excessive sweating that occurs in an area other than the feet, hands, or armpits, and this indicates that is related to another medical condition, such as menopause, hyperthyroidism, or Parkinson's disease.
Symptoms of hyperhidrosis of the feet can include foot odor, athlete's foot, infections, and blisters. Because of the continual moisture, shoes and socks can rot which creates an additional foul odor and can ruin the material, requiring shoes and socks to be replaced frequently. In addition to the physical symptoms, emotional health is often affected as this disorder can be very embarrassing.
If left untreated, hyperhidrosis will usually persist throughout an individual's life. However, there are several treatment options available. A common first approach to treating hyperhidrosis of the feet is a topical ointment. Aluminum chloride, an ingredient found in antiperspirants, can be effective at treating hyperhidrosis if used in high concentration and applied to the foot daily. Some individuals can experience relief this way, while others encounter extreme irritation and are unable to use the product. Another procedure is the use of Botulinum Toxin A, commonly referred to as Botox. This is injected directly into the foot, and is effective at minimizing the sweat glands in the injected area. These injections must be repeated every 4 to 9 months.
If these treatments are ineffective, oral prescription medications may be taken in an effort to alleviate the symptoms. Again, some will experience relief while others do not. Going barefoot reportedly provides relief for most sufferers.
A final approach to combating hyperhidrosis of the feet is through surgery. Surgery has been less successful on patients with plantar hyperhidrosis than on those with palmar hyperhidrosis. It is only recommended when sweating is severe and other treatments have failed to work. This kind of surgery usually involves going into the central nervous system, and cutting nerves to stop the transmission of signals telling the foot to sweat.
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The forefoot is composed of five metatarsal bones and fourteen phalanges. Each toe has three phalanges except for the big toe which only has two. Our toes play an essential role to the walking process, which is why a broken toe could seriously disrupt one’s ability to move around. Toe fractures are common and can be very painful. Fortunately, these injuries rarely require surgery and usually heal with rest and a change in activity.
Broken toes typically result from a traumatic event such as falling, stubbing the toe, or dropping something on the toe. Traumatic toe fractures may be categorized as either minor or severe fractures. At times, one may hear a “pop” or “crack” sound when the bone breaks. Common symptoms of a traumatic toe fracture include pain, throbbing, bruising, swelling, and redness.
Another type of toe fractures is a stress fracture. These injuries usually appear in the form of small hairline breaks on the bone. Stress fractures develop after repetitive activity instead of a single injury. Stress fractures occur when the muscles in the bone become too weak to absorb impact. Consequently, the toe bone becomes vulnerable to any pressure and impact it endures. Symptoms for a stress fracture in the toe include swelling without bruising, tenderness to the touch, pain that goes away with rest, and pain after walking or running.
If you suspect that you have a broken toe, you should make an appointment with your podiatrist. He or she will likely diagnose you by performing a physical exam and an X-ray. Treatment for a broken toe may include the R.I.C.E. method, buddy taping, surgery, or antibiotics. The R.I.C.E. method (Rest, Ice, Compression, and Elevation) is a common treatment method for many injuries because it decreases pain. Buddy tapping involves wrapping the injured toe next to an adjacent toe to keep it supported and protected. These two methods have proven to be effective in the healing process for toe fractures. The estimated healing time for a broken toe is approximately four to six weeks. If the injury becomes infected or requires surgery, the estimated healing time may take eight weeks or more.
Heel pain can be difficult to deal with, especially if you do not know what the underlying cause is. If you ignore your heel pain, the pain can magnify and potentially develop into a chronic condition. Depending on the location of your heel pain, you have developed a specific condition.
One condition is plantar fasciitis. Plantar fasciitis is caused by the inflammation of the plantar fascia, or the band of tissue that connects the heel bone to the base of the toes. The pain from this condition is initially mild but can intensify as more steps are taken when you wake up in the morning. To treat this condition, medication will likely be necessary. Plantar fasciitis is often associated with heel spurs; both require rest and special stretching exercises.
There are various options your podiatrist may suggest for heel pain. Treatment options for heel pain typically include non-steroidal anti-inflammatory drugs (NSAIDS), which may reduce swelling and pain. Other options are physical therapy, athletic taping, and orthotics. In severe cases of heel pain, surgery may be required.
Preventing heel pain is possible. If you are looking to prevent heel pain from developing in the future, be sure to wear shoes that fit you properly and do not have worn down heels or soles. Be sure to warm up properly before participating in strenuous activities or sports that place a lot of a stress on the heels. If you are experiencing any form of heel pain, speak with your podiatrist to determine the underlying cause and receive the treatment you need.
Stress fractures are small breaks in the bone that are caused by repetitive stress. They typically occur due to overuse, forcing the bones of the foot or ankle to continually absorb the full impact of each step taken. Stress fractures can also be caused by abnormal foot structure, osteoporosis, bone deformities, or wearing improper footwear during exercise.
Stress fractures are common for individuals whose daily activities cause high levels of impact on their feet and ankles. Those who run, play tennis or basketball, or practice gymnastics tend to experience these fractures more frequently. Anyone is susceptible to this problem, though. Individuals who are normally sedentary and suddenly begin an intense, high impact workout may sustain stress fractures. This is because their muscles are not yet strong enough to handle and cushion the intensity of their activity. Osteoporosis may also cause someone to get stress fractures, because the disease weakens an afflicted person's bones and makes it easier for them to break down.
Pain from stress fractures typically occurs in the general area of the fracture. Pain can also manifest as “pinpoint pain” or pain that is felt when the site of the injury is touched, and can be accompanied by swelling. It may occur during or after activity, and it may disappear while resting and return when standing or moving. Engaging in any kind of activity, high impact or otherwise, will aggravate the pain. If the intensity of the activity increases before the stress fracture has properly healed, it can cause a full fracture.
Treatment can vary depending on the individual and the degree of injury. The primary way to treat a stress fracture is to rest the hurt foot. Some fractures will heal quickly with only a little bit of rest, while others may require a long rest period and the use of crutches, immobilization, or physical therapy. Under certain circumstances, surgery may be required to install support pins around the fracture to assist in healing.
If you are undergoing a new exercise regimen in running or some other kind of high impact activity, set incremental goals on a weekly basis so you can build up muscle strength. Make sure to wear supportive shoes to better protect you feet.
If you begin to experience any symptoms of stress fractures, you should stop exercising and rest. If the symptoms persist, consult with your podiatrist. Remembering these tips can help you prevent stress fractures to your foot and ankle, and allow you to continue living normally.
Ankle sprains occur when ligaments that support the ankle stretch beyond their limits and tear. These types of injuries are very common and can occur in people of all ages. Sprains may range from mild to severe, depending on how much damage is done to the ligaments. If a sprain goes untreated, a more severe sprain may occur which can further damage the ankle. Repeated ankle sprains can lead to chronic ankle pain.
There are some risk factors that can increase your risk of suffering a sprained ankle. Those who participate in sports, walk on uneven surfaces, have a prior ankle injury, are in poor physical condition, or wear improper shoes are more likely to get a sprained ankle.
There are a few symptoms to look out for if you suspect you are suffering from a sprained ankle. Some common symptoms are swelling, bruising, tenderness, and instability of the ankle. In cases where the tearing of the ligaments is severe, there may be a “popping” sound when the strain occurs.
The RICE method is proven to be effective in treating ankle sprains. RICE stands for Rest, Ice, Compression, and Elevation. Rest is important for treatment, especially within the first 24 to 48 hours. You should also ice your sprained ankle for the first 48 hours for 20 minutes at a time. A small piece of cloth should be placed between the ice and the affected area. For the compression step, you should wear a brace that is snug, but not too tight that it cuts off circulation. When choosing a brace, be sure to choose one that is suitable for the type of ankle sprain you have. Lastly, you should elevate your foot above the heart as often as possible.
After you treat a sprain, you should go through rehabilitation to prevent the injury from occurring again. There are three phases to the rehab process. The first phase involves resting, protecting, and reducing the swelling of the injury. The second phase consists of restoring the ankle’s flexibility, range of motion, and strength. The third phase consists of slowly returning to activity and maintenance exercises.
If you suspect you have an ankle sprain, you shouldn’t hesitate to consult with your podiatrist. Your podiatrist will be able to give you a proper diagnosis and a suitable treatment option for your condition.