What Is Mortons Neuroma

Overview

plantar neuromaMorton neuromas are focal areas of symptomatic perineural fibrosis around a plantar digital nerve of the foot. The abnormality is non-neoplastic and does not represent a true neuroma. It may more correctly be known as Morton?s metatarsalgia. The condition is thought to be due to chronic entrapment of the nerve by the intermetatarsal ligament. It most often occurs in middle-aged individuals and is many times more common in women than men. Approximately 30% of asymptomatic middle-aged persons have the radiological pathologic findings of a Morton?s neuroma.

Causes

The pain of Morton’s neuroma occurs when the nerve connecting the toe bones (metatarsal bones) becomes irritated or compressed. The exact cause of the irritation is unknown, but it may be the metatarsal bones pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken. Some experts believe that a number of other foot problems, including flat feet, high foot arches, bunions and hammer toes, may also play a role in Morton’s neuroma.

Symptoms

The most common presenting complaints include pain and dysesthesias in the forefoot and corresponding toes adjacent to the neuroma. Pain is described as sharp and burning, and it may be associated with cramping. Numbness often is observed in the toes adjacent to the neuroma and seems to occur along with episodes of pain. Pain typically is intermittent, as episodes often occur for minutes to hours at a time and have long intervals (ie, weeks to months) between a single or small group of multiple attacks. Some patients describe the sensation as “walking on a marble.” Massage of the affected area offers significant relief. Narrow tight high-heeled shoes aggravate the symptoms. Night pain is reported but is rare.

Diagnosis

X-rays of your affected foot will not show a neuroma, as neuromas are made up of soft tissue. X-rays may be helpful, however, in helping rule in osteoarthritis or a stress fracture as the cause of your symptoms. Ultrasonography and MRI are sometimes used to help diagnose neuromas, although they are often ineffective. The clinical diagnosis by a foot care expert with experience treating this health problem is usually the most effective way to diagnose neuromas. Your podiatrist will attempt to duplicate your neuroma symptoms by pressing on the involved nerve at various points, and he or she may try to cause a clicking of your nerve that indicates nerve enlargement.

Non Surgical Treatment

Treatment for Morton’s neuroma may depend on several factors, including the severity of symptoms and how long they have been present. The earlier on the condition is diagnosed, the less likely surgery is required. Doctors will usually recommend self-help measures first. These may include resting the foot, massaging the foot and affected toes. Using an ice pack on the affected area (skin should not be directly exposed to ice, the ice should be in a container or wrapped in something) Changing footwear, wearing wide-toed shoes, or flat (non high-heeled) shoes. Trying arch supports (orthotic devices). A type of padding that supports the arch of the foot, removing pressure from the nerve. The doctor may recommend a custom-made, individually designed shoe-insert, molded to fit the contours of the patient’s foot. There are several OTC (over the counter, non-prescription) metatarsal pads or bars available which can be placed over the neuroma. Taking over-the-counter, non-prescription painkilling medications. Modifying activities, avoiding activities which put repetitive pressure on the neuroma until the condition improves. Bodyweight management,if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with foot problems, such as flat feet, who successfully lose weight experience considerable improvement of symptoms.

Surgical Treatment

If pain persists with conservative care, surgery may be an appropriate option. The common digitial nerve is cut and the Mortons neuroma removed. This will result is numbness along the inside of the toes affected, and there is a small chance the end of the nerve will form a Stump Neuroma. Approximately 75% of people receive symptom resolution for Mortons Neuroma with conservative care.

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What Is The Perfect Remedy For Inferior Calcaneal Spur

Inferior Calcaneal Spur

Overview

The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are heel spurs and plantar fasciitis. A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur digs into the plantar fascia and causes small micro-tears in the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch.

Causes

Bone spurs can occur all over the body including the spine, shoulders, hands, hips and feet. The feet are a common place to find them. A heel spur happens when the body tries to mend itself. Building extra bone is one way your body tries to correct a weakness. Wearing shoes that are too tight in the heel can cause bone spurs. More women than men get heel spurs because of the kinds of shoes they wear. Athletes who stress their feet and legs routinely are also prone to heel spurs. Being overweight can also indirectly cause heel spurs by over-exerting the plantar fascia. Some heel spurs are caused by the aging process, in which the cartilage covering the ends of bones wears away. This process can lead to pain, swelling and spur formation. Stress-related problems with the plantar fascia frequently lead to heel spurs.

Calcaneal Spur

Symptoms

Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain, especially while walking, jogging, or running, if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning, a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.

Diagnosis

Your doctor will discuss your medical history and will examine your foot and heel for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray or blood tests (to rule out diseases or infections) may be requested.

Non Surgical Treatment

The key for the proper treatment of heel spurs is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rear foot posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal. Other common treatments include stretching exercises, losing weight, wearing shoes that have a cushioned heel that absorbs shock, and elevating the heel with the use of a heel cradle, heel cup, or orthotic. Heel cradles and heel cups provide extra comfort and cushion to the heel, and reduce the amount of shock and shear forces experienced from everyday activities.

Surgical Treatment

Heel spur surgery should only be considered after less invasive treatment methods have been explored and ruled insufficient. The traditional surgical approach to treating heel spurs requires a scalpel cut to the bottom of the food which allows the surgeon to access the bone spur. Endoscopic plantar fasciotomies (EPF) involve one or two small incisions in the foot which allow the surgeon to access and operate on the bone spur endoscopically. Taking a surgical approach to heel spur treatment is a topic to explore with a foot and ankle specialist.

What Can Induce Heel Spur

Heel Spur

Overview

A heel spur is a buildup of calcium or a bone hook on the heel bone. This is typically the source of most heel pain. It usually takes an X-ray to see the heel spur protruding from the heel. Without proper heel spur treatment, a heel spur cause inflammation and lead to other ailments like plantar fasciitis and Achilles tendonitis. It is important to be examined by an orthopedic specialist.

Causes

It is widely accepted now that the presence of this bony growth is not the cause of heel pain, but rather an effect of an underlying biomechanical foot problem where the soft tissue structures that are attached to the heel bone are pulling excessively on that area. At some point down the track, heel pain may develop, but the bony heel spur is not the cause of the heel pain.

Inferior Calcaneal Spur

Symptoms

Symptoms may be similar to those of plantar fasciitis and include pain and tenderness at the base of the heel, pain on weight bearing and in severe cases difficulty walking. The main diagnosis of a heel spur is made by X-ray where a bony growth on the heel can be seen. A heel spur can occur without any symptoms at all and the athlete would never know they have the bony growth on the heel. Likewise, Plantar fasciitis can occur without the bone growth present.

Diagnosis

The proper diagnosis of a heel spur often requires an X-ray. To make this process as convenient for his patients as possible, most clinics have an on-site digital X-ray and diagnostic ultrasound machines. This can make it unnecessary for patients to visit diagnostic imaging centers, allowing patients to receive more expedient treatment.

Non Surgical Treatment

If pain and other symptoms of inflammation-redness, swelling, heat-persist, you should limit normal daily activities and contact a doctor of podiatric medicine. The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments. A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery. Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Surgical Treatment

Most studies indicate that 95% of those afflicted with heel spurs are able to relieve their heel pain with nonsurgical treatments. If you are one of the few people whose symptoms don?t improve with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament. Sometimes the bone spur is also removed, if there is a large spur (remember that the bone spur is rarely a cause of pain. Overall, the success rate of surgical release is 70 to 90 percent in patients with heel spurs. One should always be sure to understand all the risks associated with any surgery they are considering.

Prevention

There are heel spur prevention methods available in order to prevent the formation of a heel spur. First, proper footwear is imperative. Old shoes or those that do not fit properly fail to absorb pressure and provide the necessary support. Shoes should provide ample cushioning through the heel and the ball of the foot, while also supporting the arch. Wearing an orthotic shoe insert is one of the best ways to stretch the plantar fascia and prevent conditions such as heel spurs. Stretching the foot and calf is also helpful in preventing damage. Athletes in particular should make sure to stretch prior to any physical activity. Stretching helps prevent heel spurs by making tissue stronger as well as more flexible. In addition, easing into a new or increasingly difficult routine should be done to help avoid strain on the heel and surrounding tissue.

Bursitis Of The Feet Bursa Reduction

Overview

Bursa is a fluid filled sac of tissue that is often found around the bony prominences over which tendons and soft tissues rub. This therefore helps the tendons to glide with least amount of friction. Retrocalcaneal bursa is found behind the heel under the Achilles tendon. Retrotendoneal bursa is found on the back of the attachment of the tendon where the shoe rubs on the skin. This can cause swelling, pain and difficulty in footwear. Sometimes there is a bony prominence on the heel bone that predisposes to this condition (Haglund?s deformity). Treatment of this can be modification of footwear. However surgery is often required which involves excision of the bursa and also the bony prominence on the heel bone.

Causes

The following are some of the more common causes for heel bursitis. Overuse (common in runners and athletes). Running with the wrong footwear. A sudden impact to the foot. Repetitive stress. Underlying inflammatory condition (such as osteoarthritis).

Symptoms

Pain when activating the Achilles tendon (running and jumping) and when applying pressure at the point of attachment of the tendon on the heel bone. Contrary to the tenderness occurring with inflammation of the Achilles tendon, the tenderness is localised to the point of attachment to the heel bone.

Diagnosis

The doctor will discuss your symptoms and visually assess the bones and soft tissue in your foot. If a soft tissue injury is suspected, an MRI will likely be done to view where and how much the damage is in your ankle. An x-ray may be recommended to rule out a bone spur or other foreign body as the cause of your ankle pain. As the subcutaneous bursa is close to the surface of the skin, it is more susceptible to septic, or infectious, bursitis caused by a cut or scrape at the back of the heel. Septic bursitis required antibiotics to get rid of the infection. Your doctor will be able to determine whether there is an infection or not by drawing a small sample of the bursa fluid with a needle.

Non Surgical Treatment

For non-infectious bursitis, the preliminary treatment starts with non-operative options such as cold compression therapy and Blood Flow Stimulation Therapy. Surgery to remove the inflamed bursa is normally not required for bursitis, however if you fail to see improvement with the conservative treatments, your physician may recommend surgery to remove the bursa completely. Although this removes the problem of an inflamed bursa, you are left with less cushioning in your joint which can lead to a host of other conditions.

Surgical Treatment

Surgery is rarely done strictly for treatment of a bursitis. If any underlying cause is the reason, this may be addressed surgically. During surgery for other conditions, a bursa may be seen and removed surgically.

Prevention

Once your pain and inflammation is gone, you can prevent retrocalcaneal bursitis deformity by wearing the best shoes for your foot type. You should high-heels and pumps if possible. Wear orthotics (custom arch supports) or over-the-counter orthotic devices. Perform frequent Achilles tendon stretching exercises to prevent it from becoming tight agian. Avoiding running uphill when training. Try to run on softer surfaces and avoid concrete.

Hammer Toe Causes

Hammer ToeOverview

Hammer, claw, and mallet toes are toes that do not have the right Hammer toes shape. They may look odd or may hurt, or both. Tight shoes are the most common cause of these toe problems. A Hammer toes is a toe that bends down toward the floor at the middle toe joint. It usually happens in the second toe. This causes the middle toe joint to rise up. Hammer toes often occur with bunions. Claw toe often happens in the four smaller toes at the same time. The toes bend up at the joints where the toes and the foot meet. They bend down at both the middle joints and at the joints nearest the tip of the toes. This causes the toes to curl down toward the floor. A mallet toe often happens to the second toe, but it may happen in the other toes as well. The toe bends down at the joint closest to the tip of the toe.

Causes

People who have a high-arched feet have an increased chance of hammer toes occurring. Also, patients with bunion deformities notice the second toe elevating and becoming hammered to make room for the big toe that is moving toward it. Some patients damage the ligament that holds the toe in place at the bottom of the joint that connects the toe and foot. When this ligament (plantar plate) is disrupted or torn, the toe floats upward at this joint. Hammer toes also occur in women wearing ill-fitting shoes or high heels, and children wearing shoes they have outgrown.

Hammer ToeSymptoms

If you have any of these symptoms, do not assume it is due to hammer toe. Talk to your doctor about symptoms such as a toe that curls down, corns on the top of a toe, calluses on the sole of the foot or bottom of the toe, pain in the middle joint of a toe, discomfort on the top of a toe, difficulty finding any shoes that fit comfortably, cramping in a toe, and sometimes also the foot and leg, difficult or painful motion of a toe joint, pain in the ball of the foot or at the base of a toe.

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.

Non Surgical Treatment

To keep your hammertoes more comfortable, start by replacing your tight, narrow, pointy shoes with those that have plenty of room in the toes. Skip the high heels in favor of low-heeled shoes to take the pressure off your toes. You should have at least one-half inch between your longest toe and the tip of your shoe. If you don’t want to go out and buy new shoes, see if your local shoe repair shop can stretch your shoes to make the toe area more accommodating to your hammertoe.

Surgical Treatment

If these non-invasive treatments don?t work, or if the joint is rigid, a doctor?s only recourse may be to perform surgery. During the surgery, the doctor makes an incision and cuts the tendon to release it or moves the tendon away from or around the joint. Sometimes part of the joint needs to be removed or the joint needs to be fused. Each surgery is different in terms of what is needed to treat the hammertoe. Normally after any foot surgery, patients use a surgical shoe for four to six weeks, but often the recovery from hammertoe surgery is more rapid than that. An unfortunate reality is that hammertoe can actually return even after surgery if a patient continues to make choices that will aggravate the situation. Though doctors usually explain pretty clearly what needs to be done to avoid this.

Hammer ToePrevention

Preventing foot problems, including hammertoes, is often a matter of wearing the right shoes and taking care of your feet. Check your feet regularly for problems. This is especially true if you have diabetes or any other medical condition that causes poor circulation or numbness in your toes. If you do, check feet daily so that problems can be caught early on.

Contracted Toe Treatment

HammertoeOverview

A hammertoe is a deformity in the foot, causing the second, third, or fourth toe to be permanently bent in the middle joint, causing the toe to resemble a hammer (hence, its name!) or a claw. They are most commonly found in women who wear narrow shoes, such as high heels, that cause the toes to bend unnaturally for extended periods of time. A hammertoes may be difficult or painful to move, and the skin may become callused from rubbing against the inside of the shoe. In fact, there are two types of hammertoe: flexible and rigid. Flexible hammertoes can still move at the joint and are indicative of an earlier, milder form of the problem. Rigid hammertoes occur when the tendon no longer moves, and at this stage, surgery is usually necessary to fix the problem.

Causes

Essentially, hammertoes are caused by an abnormal interworking of the bones, muscles, ligaments and tendons that comprise your feet. When muscles fail to work in a balanced manner, the toe joints can bend to form the hammertoe shape. If they remain in this position for an extended period, the muscles and tendons supporting them tighten and remain in that position. A common factor in development of hammertoe is wearing shoes that squeeze the toes or high heels that jam the toes into the front of the shoe. Most likely due to these factors, hammertoe occurs much more frequently in women than in men.

Hammer ToeSymptoms

Common reasons patients seek treatment for toe problems are toe pain on the knuckle. Thick toe calluses. Interference with walking/activities. Difficulty fitting shoes. Worsening toe deformity. Pain at the ball of the foot. Unsightly appearance. Toe deformities (contractures) come in varying degrees of severity, from slight to severe. The can be present in conjunction with a bunion, and develop onto a severe disfiguring foot deformity. Advanced cases, the toe can dislocate on top of the foot. Depending on your overall health, symptoms and severity of the hammer toe, the condition may be treated conservatively and/or with surgery.

Diagnosis

The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be Hammer toes observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.

Non Surgical Treatment

Often padding and taping are the first steps in a treatment plan. Padding the hammer toe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain. Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity. Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammer toe deformity.

Surgical Treatment

The deformity is corrected in a variety of ways. There are actually a large number of procedures. The simplest procedure would involve a Tenotomy, the cutting of the tendon causing the deformity or a Tendon Lengthening procedure. These procedures are infrequently done, though, as the structural deformity (the arthritis and joint adaptation) is not addressed with these surgeries. Other soft-tissue procedures involve rebalancing the tendons around the joint. There are several techniques to do this, but the most common is probably the Girdlestone-Taylor procedure, which involves rerouting the tendons on the bottom of the toe up and over the toe where it sticks up, so that the tendon helps pull the toe downwards into proper alignment.

Do I Suffer From Overpronation Of The Foot

Overview

The rolling of the foot is a natural process and the degree to which pronation occurs will depend on an individual?s gait. It has been suggested that up to 70 percent of runners may overpronate to some degree, although it is not always bad for the body even though pronation may not be at optimum levels. Slight overpronation may be perfectly acceptable and may not place an individual at an increased risk of injury; however determining whether this is the case can only come from a doctor, podiatrist or sports therapist. While specialist running shoe stores may be able to spot whether you are an overpronator after observing you on a treadmill and suggest the best running shoes to suit your gait, it is still wise if you are an overpronator to get your gait checked professionally.Over Pronation

Causes

Over-pronation has different causes. Obesity, pregnancy, age or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Over-pronation is also very common with athletes, especially runners and most of them nowadays use orthotics inside their shoes. Over-pronation affects millions of people and contributes to a range of common complaints including sore, aching feet, ball of foot pain, heel Pain, achilles tendonitis, bunions, shin pain, tired, aching legs, knee pain and lower back pain. The most effective treatment solution for over-pronation is wearing an orthotic shoe insert. Orthotics correct over-pronation, thereby providing natural, lasting pain relief from many common biomechanical complaints.

Symptoms

Overpronation can be a contributing factor in other lower extremity disorders, such as foot pain, plantar fasciitis, ankle injuries, medial tibial stress syndrome (shin splints), periostitis, stress fractures and myofascial trigger points. Overpronation increases the degree of internal tibial rotation, thereby contributing to various knee disorders such as meniscal injury or ligament sprains. The effects of the postural deviation are exaggerated in athletes due to the increase in foot strikes while running and the greater impact load experienced. When running, three to four times the body weight is experienced with each foot strike.2 If overpronation exists, the shock force is not adequately absorbed by the foot and is transmitted further up the kinetic chain.

Diagnosis

When you overpronate your foot rolls inwards causing the lower leg to rotate inwards too. It’s thought that this increases stress on the soft tissues of the lower leg causing pain and inflammation, or more commonly known as shin splints.Over-Pronation

Non Surgical Treatment

Flat feet and fallen arches can be treated effectively by wearing an orthotic insert in your shoes. Orthotics can be custom-made and prescribed by your foot specialist (podiatrist), or you can use a so called pre-made foot orthotic. Most people do not require expensive custom-made orthotics to combat excess pronation, unless they have a specific medical foot condition. Footlogics orthotic insoles were developed to correct excess pronation, thereby providing sustainable, long-lasting pain relief to many aches and pains in a natural way. Footlogics Comfort, Casual and Sports are products which promote excellent biomechanical control of the foot.

Prevention

Many of the prevention methods for overpronation-orthotics, for example-can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.

Severs Disease Physical Rehabilitation

Overview

Sever’s disease is the most common cause of heel pain in the growing child. It is due to overuse and repetitive stress of the Achilles tendon where it attaches to the heel bone.

Causes

Sever?s is often present at a time of rapid growth in adolescent athletic children. At this time the muscles and tendons become tighter as the bones become larger. Between 8 – 15 years of age is the usual onset of this condition.

Symptoms

Chief complaint is heel pain which increases pain during running and jumping activities. Pain is localized to the very posterior aspect of the heel. Pain is elicited only with weightbearing. Mild involvement is present if pain is brought on only with running during sports. The symptoms can be severe, with pain (and possibly limp) with activities of daily living (ie walking).

Diagnosis

This condition is self limiting, it will go away when the two parts of bony growth join together, this is natural. Unfortunately, Sever’s disease can be very painful and limit sport activity of the child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever’s disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join, usually around the age of 16 years. There are no known long term complications associated with Sever’s disease.

Non Surgical Treatment

Please realize that the disorder may last only a couple of weeks to as long as 1-2 years. The treatment plan as prescribed by your doctor MUST be adhered to closely, and the activity level of the child must be controlled during the early stages of treatment. All jumping and running sports, such as basketball, trampoline, volleyball, tennis, soccer, etc., must be eliminated as part of the initial treatment. Once the child has improved and the pain has subsided, a rigid stretching program must then be implemented.

Exercise

Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever’s disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever’s disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.

All You Should Know About Heel Aches

Overview

Foot Pain

Your foot is made up of 26 bones, 33 joints, and more than 100 tendons. The heel is the largest bone in your foot. If you overuse or injure your heel, you may experience Heel Pain. This can range from mild to disabling. In many cases, if you have heel pain, you will need a doctor to diagnose the cause.

Causes

In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we’ve suffered. When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury. Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

Symptoms

Usually when a patient comes in they?ll explain that they have severe pain in the heel. It?s usually worse during the first step in the morning when they get out of bed. Many people say if they walk for a period of time, it gets a little bit better. But if they sit down and get back up, the pain will come back and it?s one of those intermittent come and go types of pain. Heel pain patients will say it feels like a toothache in the heel area or even into the arch area. A lot of times it will get better with rest and then it will just come right back. So it?s one of those nuisance type things that just never goes away. The following are common signs of heel pain and plantar fasciitis. Pain that is worse first thing in the morning. Pain that develops after heavy activity or exercise. Pain that occurs when standing up after sitting for a long period of time. Severe, toothache type of pain in the bottom of the heel.

Diagnosis

The diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. Pain can be referred to the heel and foot from other areas of the body such as the low back, hip, knee, and/or ankle. Special tests to challenge these areas are performed to help confirm the problem is truly coming from the plantar fascia. An X-ray may be ordered to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation. Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.

Non Surgical Treatment

Most patients get better with the help of nonsurgical treatments. Stretches for the calf muscles on the back of the lower leg take tension off the plantar fascia. A night splint can be worn while you sleep. The night splint keeps your foot from bending downward. It places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint. They report having less heel pain when placing the sore foot on the ground in the morning. There have been a few studies that reported no significant benefit from adding night splinting to a program of antiinflammatory meds and stretching. Other studies report the benefits of short-term casting to unload the heel, immobilize the plantar fascia, and reduce repetitive microtrauma. Supporting the arch with a well fitted arch support, or orthotic, may also help reduce pressure on the plantar fascia. Placing a special type of insert into the shoe, called a heel cup, can reduce the pressure on the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration. Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.

Surgical Treatment

If treatment hasn’t worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery – where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.

Prevention

Painful Heel

Wear properly fitting shoes. Place insoles or inserts in your shoes to help control abnormal foot motion. Maintain a healthy weight. Exercise and do foot stretches as they have been shown to decrease the incidence of heel pain.

The Main Causes And Treatments For Achilles Tendonitis Problems

Overview

Achilles TendonA tendon is a band of connective tissue that anchors muscle to bone. The Achilles tendon is the largest tendon in the body. It attaches the calf muscles to the heel bone (calcaneus) and is very important because it lets you lift your heel when you start to walk. It also helps you to walk, run or stand on tiptoe. Achilles tendonitis is inflammation of the Achilles tendon. In most cases, it is a type of overuse injury and is more common in younger people. Professional and weekend athletes can suffer from Achilles tendonitis, but it is also a common overuse injury in people not involved in sport. Treatment includes rest, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy and avoiding activities that aggravate the condition.

Causes

Achilles tendonitis is a common sports injury caused by repeated or intense strain on the tendon. But non-athletes also can get it if they put a lot of stress on their feet. Other things that contribute to Achilles tendonitis include. An increase in activity. Starting a training program after a period of inactivity or adding miles or hills to a jogging regimen are two examples of things that put people at risk for Achilles tendonitis. Sports that require sudden starts and stops; for example, tennis and basketball. A change in footwear, or wearing old or badly fitting shoes. New shoes, worn-out shoes, or the wrong size shoes can cause a person’s feet to overcompensate and put stress on the Achilles tendon. Additionally, wearing high heels all the time can cause the tendon and calf muscles to get shorter, and the switch to flat shoes and exercise can put extra strain on the heel. Running up hills. Going uphill forces the Achilles tendon to stretch beyond its normal range. Weak calf muscles, flat arches, “overpronation” (feet that roll in when running), or “oversupination” (feet that roll out when running). Overpronation and oversupination make the lower leg rotate and put a twisting stress on the tendon. Exercising without warming up. Tight calf muscles or muscles that lack flexibility decrease a person’s range of motion and put an extra strain on the tendon. Running or exercising on a hard or uneven surface or doing lunges or plyometrics without adequate training. A traumatic injury to the Achilles tendon.

Symptoms

There are several types of Achilles tendinitis symptoms, but all of them are closely related. People who suffer from Achilles tendon pain typically have swelling in the Achilles tendon, and that pain can be chronic as the microscopic tears in the area become more prevalent over time. The most intense pain is typically located just a few centimeters above the area where the tendon meets the heel. This area is called the watershed zone, and the amount of blood moving through it is what gives it the highest potential for injury, especially for athletes. Most of the Achilles tendinitis symptoms in people with the condition will happen immediately after they have been inactive for a fairly significant amount of time. That means that the most pain will generally be felt after sitting or lying down for an extended period, or right after waking up in the morning and getting moving. If you aren?t positive that you are suffering specifically from Achilles tendinitis symptoms, consult a doctor to make sure.

Diagnosis

If you think you might have Achilles tendonitis, check in with your doctor before it gets any worse. Your doc will ask about the activities you’ve been doing and will examine your leg, foot, ankle, and knee for range of motion. If your pain is more severe, the doctor may also make sure you haven’t ruptured (torn) your Achilles tendon. To check this, the doc might have you lie face down and bend your knee while he or she presses on your calf muscles to see if your foot flexes. Any flexing of the foot means the tendon is at least partly intact. It’s possible that the doctor might also order an X-ray or MRI scan of your foot and leg to check for fractures, partial tears of the tendon, or signs of a condition that might get worse. Foot and ankle pain also might be a sign of other overuse injuries that can cause foot and heel pain, like plantar fasciitis and Sever’s disease. If you also have any problems like these, they also need to be treated.

Nonsurgical Treatment

Treatment for achilles tendonitis is based around initially reducing pain and inflammation, stretching the muscles out and a gradual return to activity. No one single approach may cure achilles tendonitis, particularly a chronic condition but a combination of treatment approaches and patience will work best. It is essential the correct treatment is started as soon as possible in the acute stage to avoid the injury becoming chronic. Acute achilles tendonitis requires rest. Continuing to train on a painful achilles tendon could lead to the injury becoming chronic and more difficult to treat. Applying ice or cold therapy as soon as possible to a painful achilles tendon will reduce pain and inflammation. After the first 24 to 48 hours alternating hot and cold or just heat may be more beneficial. Tendons work better when they are warm but if they are painful then rest and ice. Wear a heel pad to raise the heel and shorten the calf muscles which in turn reduces some of the strain on the achilles tendon. This should only be a temporary measure while the achilles tendon is healing. An achilles tendon taping technique can aid rest by supporting the tendon with elastic bandages. This is an excellent way of taking the load off the tendon if you have to walk around on your feet as well as protecting the tendon when returning to full fitness. Achilles tendon exercisesMake sure you have the right running shoes for your foot type and the sport. If you are a runner that over-pronates then a motion control or support running shoe may be needed. Visit a specialist running shop for advice. In the later stages apply heat, especially before exercise. The tendon will perform better when warm. Finish with cold after training to reduce any inflammation.

Achilles Tendon

Surgical Treatment

Histological and biological studies on tendon healing have made it possible to envisage surgical repair using a percutaneous approach, with the following objectives, a minimal, and not very aggressive, operation, which is quick and easy and within the capabilities of all surgeons, the shortest hospitalisation period possible, above all, early and effective re-education, providing a satisfactory result both in terms of solidity and the comfort of the patient. The percutaneous tenosynthesis TENOLIG combines stability, reliability, patient comfort and lower overall social and professional costs for this type of lesion.

Prevention

Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 – 3 times per day. Remember to stretch well before running strengthening of foot and calf muscles (eg, heel raises) correct shoes, specifically motion-control shoes and orthotics to correct overpronation. Gradual progression of training programme. Avoid excessive hill training. Incorporate rest into training programme.