Do Hammer Toes Hurt
Overview
A #LINK is a common and painful deformity in the three middle toes where they appear to always be bent. Causes of hammer toes include shoes that don?t fit properly, foot injuries, bunions and rheumatoid arthritis. Having toe joints sticking out can cause them to rub and a person may walk differently, risking other foot conditions, such as metatarsalgia. Hammer toes can be a serious problem in people with diabetes or poor circulation.
Causes
Footwear is actually the leading cause of this type of toe deformity so much so that people sometimes require hammer toe surgery to undo some of the damage. The most common problem is wearing shoes that are too short, too narrow or too tight. These shoes constricts the feet and force the toes into a bend position. Women are more at risk especially due to high heels. Footwear isn?t the only problem, poor foot posture can lead to muscle and even bone imbalances. This asymmetry can cause excessive strain on the toes either by forcing the toe into unnatural positions. Arthritis can also play a factor in the development of hammer toe, especially if the toe joint is stiff and incapable of a full range of motion.
Symptoms
Patients with hammer toe(s) may develop pain on the top of the toe(s), tip of the toe, and/or on the ball of the foot. Excessive pressure from shoes may result in the formation of a hardened portion of skin (corn or callus) on the knuckle and/or ball of the foot. Some people may not recognize that they have a hammer toe, rather they identity the excess skin build-up of a corn.The toe(s) may become irritated, red, warm, and/or swollen. The pain may be dull and mild or severe and sharp. Pain is often made worse by shoes, especially shoes that crowd the toes. While some hammer toes may result in significant pain, others may not be painful at all. Painful toes can prevent you from wearing stylish shoes.
Diagnosis
Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.
Non Surgical Treatment
Hammer toes usually get progressively worse over time, especially if you avoid seeking care. Not all cases are the same, so it is important to get your podiatrist or foot surgeon to evaluate your condition so that you can get the treatment you need as soon as possible. Your treatment options will vary depending on the severity of your hammer toe. You may not require surgery to treat your hammer toe. Your doctor may suggest one of these less invasive measures. Instead of wearing shoes that are too high or too short, wear comfortable shoes that have plenty of room and are flat or low-heeled. Your doctor can prescribe pads that will prevent your corns or calluses from getting irritated. Avoid over-the-counter medicated pads, as they contain acid that can worsen your condition. An orthotic device can be customized to fit your shoe and foot. It can help control your tendon and muscle imbalance, which in turn may ease your pain. NSAIDS (nonsteroidal anti-inflammatory drugs) such as ibuprofen can reduce inflammation. By relieving swelling in your toe joint, you can alleviate your pain. Splints or small straps can be placed on your toe by a foot surgeon to realign your bent toe. Applying ice packs wrapped in cloth on your hammer toe can reduce inflammation and swelling. Gently massaging your toes can assist in alleviating your pain caused by hammer toes. Try exercises that stretch your feet as these can help restore your muscle balance. A simple exercise that can help is to pick up a cloth or small object from the floor by curling your toes. This action will help your feet and toes by stretching them.
Surgical Treatment
Surgery may be the treatment of choice if conservative approaches prove unsuccessful. Usually performed as hammertoe an outpatient procedure, the specific surgery will depend on the type and extent of injury to the toe. Recovery my take several days or weeks and you may experience some redness, stiffness and swelling of the affected toe. Your physician will recommend taking it easy and to keep your foot elevated while you recover.
Bunions Surgery
Overview
A bunion is a firm, painful bump that forms over a bony bulge at the base of the big toe. In most cases, the big toe joint also is enlarged and has degenerative arthritis. The toe also may be pushed toward the second toe (hallux valgus). Bunions tend to be inherited, but they also are common in the following groups. Women who wear high heels. People who wear shoes that are too narrow or too pointed. People with flatfeet. All of these situations force the big toe to drift toward the little toes, and this can cause bunions to form.
Causes
Bunions tend to run in families, although it is the faulty foot mechanics that lead to bunions that are inherited, not the bunions themselves. Some authorities, in fact, suggest that the most significant factor in bunion formation is the poor foot mechanics passed down through families. However, the American Orthopaedic Foot and Ankle Society estimates that women have bunions nine times more often than men, that 88 percent of women in the United States wear shoes that are too small, and that 55 percent of women have bunions. Again, this reflects the wearing of shoes with tight, pointed toes, or with high heels that shift all of your body's weight onto your toes and also jam your toes into your shoes' toe boxes. It should be noted that it generally takes years of continued stress on the toes for bunions to develop.
Symptoms
Most patients complain of pain directly on the bunion area, within the big toe joint, and/or on the bottom of the foot. The bunion may become irritated, red, warm, swollen and/or callused. The pain may be dull and mild or severe and sharp. The size of the bunion doesn?t necessarily result in more pain. Pain is often made worse by shoes, especially shoes that crowd the toes. While some bunions may result in significant pain, other bunions may not be painful at all.
Diagnosis
X-rays are the best way to determine the amount of deformity of the MTP joint. Blood work may be required to rule out other diseases that may be associated with bunions such as rheumatoid arthritis. Other tests such as bone scans or MRI's are not usually required.
Non Surgical Treatment
There are many treatment options for bunions and they will vary with the type and severity of each bunion and will also depend on what is causing the symptoms. Bunions are almost always progressive and tend to get larger and more painful with time, how fast this happens may be a function of the fit of the footwear. The initial goal of treatment options is to relieve pressure on the bunion and any symptoms that may be present and to halt or slow the progression of the joint deformity. There is no effective may be "get rid off" a bunion without surgery. There are a number of things that individuals and Podiatrists can do to help the symptoms and slow (if not halt) progression.
What Causes Over-Pronation Of The Foot
Overview
During a normal gait cycle, the forward movement is a result of the body's mass being displaced, putting the body in a forward-falling position. At this time, the lead foot hits the ground preventing the fall, followed by the rear leg as it swings forward, and the cycle repeats with each step.
Causes
Over-pronation occurs when the foot collapses too far inward stressing the plantar fascia (the area underneath the arch of the foot.) Normally, one pronates every time he or she walks, but excessive pronation is called over-pronation. When this occurs it can cause pain in the feet, knees, hips, low back and even the shoulder. Decreasing over-pronation, which is very prominent in runners, will help add endurance, speed and efficiency to your run and ultimately place less stress on your body.
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 sitting, an over-pronating foot appears quite normal, i.e. showing a normal arch with room under the underside of the foot. The moment you get up and put weight on your feet the situation changes: the arches lower and the ankle slightly turns inwards. When you walk or run more weight is placed on the feet compared to standing and over-pronation will become more evident. When walking barefoot on tiles or timber floors over-pronation is more visible, compared to walking on carpet or grass.
Non Surgical Treatment
Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion, and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body. When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.
Surgical Treatment
Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.
During a normal gait cycle, the forward movement is a result of the body's mass being displaced, putting the body in a forward-falling position. At this time, the lead foot hits the ground preventing the fall, followed by the rear leg as it swings forward, and the cycle repeats with each step.
Causes
Over-pronation occurs when the foot collapses too far inward stressing the plantar fascia (the area underneath the arch of the foot.) Normally, one pronates every time he or she walks, but excessive pronation is called over-pronation. When this occurs it can cause pain in the feet, knees, hips, low back and even the shoulder. Decreasing over-pronation, which is very prominent in runners, will help add endurance, speed and efficiency to your run and ultimately place less stress on your body.
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 sitting, an over-pronating foot appears quite normal, i.e. showing a normal arch with room under the underside of the foot. The moment you get up and put weight on your feet the situation changes: the arches lower and the ankle slightly turns inwards. When you walk or run more weight is placed on the feet compared to standing and over-pronation will become more evident. When walking barefoot on tiles or timber floors over-pronation is more visible, compared to walking on carpet or grass.
Non Surgical Treatment
Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion, and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body. When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.
Surgical Treatment
Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.
Rehab For Calcaneal Apophysitis
Overview
Sever?s Disease (calcaneal aphophysitis) is not really a disease, but more a repetitious strain injury. This is the most common cause of kids heel pain seen at Podiatry Care. Active children in football, soccer, basketball, netball and tennis with this type of foot pain complain of pain in the region of the heel bone particularly after exercise. In severe cases, children will complain of pain during exercise as well. It is a frequent cause of heel pain in children, particularly in the very active child. It is most often seen in children between the ages of 8 to 15 years as the growth plate is not fully developed or calcified at this time.
Causes
Sever?s disease is common, and typically occurs during a child?s growth spurt, which can occur between the ages of 10 and 15 in boys and between the ages of 8 and 13 in girls. Feet tend to grow more quickly than other parts of the body, and in most kids the heel has finished growing by the age of 15. Being active in sports or participating in an activity that requires standing for long periods can increase the risk of developing Sever?s disease. In some cases, Sever?s disease first becomes apparent after a child begins a new sport, or when a new sports season starts. Sports that are commonly associated with Sever?s disease include track, basketball, soccer, and gymnastics. Children who are overweight or obese are also at a greater risk of developing this condition. Certain foot problems can also increase the risk, including. Over pronating. Kids who over pronate (roll the foot inward) when walking may develop Sever?s disease. Flat foot or high arch. An arch that is too high or too low can put more stress on the foot and the heel, and increase the risk of Sever?s disease. Short leg. Children who have one leg that is shorter than the other may experience Sever?s disease in the foot of the shorter leg because that foot is under more stress when walking.
Symptoms
The symptoms include pain, tenderness, swelling or redness in the heel, and they might have difficulty walking or putting pressure on the heel. If you notice that your child suddenly starts walking around on their toes because their heels hurt, that?s a dead giveaway. Kids who play sports might also complain of foot pain after a game or practice. As they grow, the muscles and tendons will catch up and eventually the pressure will subside along with the pain. But in the meantime, it can become very uncomfortable.
Diagnosis
A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.
Non Surgical Treatment
Fortunately Severs? disease can be treated and prevented through a number of different techniques that have all proven highly effective. The heel will repair itself even without active treatment provided that the suffering foot is given a chance to heal. Typically Severs? disease will take 2-8 weeks, although in many cases it can take longer as the continuous growing of the bone can exacerbate the condition. Podiatrists have an important role in preventing Severs? disease in young athletes, and in treating the condition when it develops so children can get back on their feet as quickly as possible. Generally treatment involves stretching muscles running down to the heel to relieve tension and pain, these include the hamstrings and calf muscles, and these stretching exercises will need to be performed at least 2 or 3 times a day. RICE is a classic method of speeding up the recovery of self-healing injuries like Severs? disease. This involves Rest, the application of Ice to the injury, Compression, and finally Elevation to encourage repaid. These measures can be advised by a trained podiatrist, but it is then up to a child to carry on with regular RICE.
Sever?s Disease (calcaneal aphophysitis) is not really a disease, but more a repetitious strain injury. This is the most common cause of kids heel pain seen at Podiatry Care. Active children in football, soccer, basketball, netball and tennis with this type of foot pain complain of pain in the region of the heel bone particularly after exercise. In severe cases, children will complain of pain during exercise as well. It is a frequent cause of heel pain in children, particularly in the very active child. It is most often seen in children between the ages of 8 to 15 years as the growth plate is not fully developed or calcified at this time.
Causes
Sever?s disease is common, and typically occurs during a child?s growth spurt, which can occur between the ages of 10 and 15 in boys and between the ages of 8 and 13 in girls. Feet tend to grow more quickly than other parts of the body, and in most kids the heel has finished growing by the age of 15. Being active in sports or participating in an activity that requires standing for long periods can increase the risk of developing Sever?s disease. In some cases, Sever?s disease first becomes apparent after a child begins a new sport, or when a new sports season starts. Sports that are commonly associated with Sever?s disease include track, basketball, soccer, and gymnastics. Children who are overweight or obese are also at a greater risk of developing this condition. Certain foot problems can also increase the risk, including. Over pronating. Kids who over pronate (roll the foot inward) when walking may develop Sever?s disease. Flat foot or high arch. An arch that is too high or too low can put more stress on the foot and the heel, and increase the risk of Sever?s disease. Short leg. Children who have one leg that is shorter than the other may experience Sever?s disease in the foot of the shorter leg because that foot is under more stress when walking.
Symptoms
The symptoms include pain, tenderness, swelling or redness in the heel, and they might have difficulty walking or putting pressure on the heel. If you notice that your child suddenly starts walking around on their toes because their heels hurt, that?s a dead giveaway. Kids who play sports might also complain of foot pain after a game or practice. As they grow, the muscles and tendons will catch up and eventually the pressure will subside along with the pain. But in the meantime, it can become very uncomfortable.
Diagnosis
A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.
Non Surgical Treatment
Fortunately Severs? disease can be treated and prevented through a number of different techniques that have all proven highly effective. The heel will repair itself even without active treatment provided that the suffering foot is given a chance to heal. Typically Severs? disease will take 2-8 weeks, although in many cases it can take longer as the continuous growing of the bone can exacerbate the condition. Podiatrists have an important role in preventing Severs? disease in young athletes, and in treating the condition when it develops so children can get back on their feet as quickly as possible. Generally treatment involves stretching muscles running down to the heel to relieve tension and pain, these include the hamstrings and calf muscles, and these stretching exercises will need to be performed at least 2 or 3 times a day. RICE is a classic method of speeding up the recovery of self-healing injuries like Severs? disease. This involves Rest, the application of Ice to the injury, Compression, and finally Elevation to encourage repaid. These measures can be advised by a trained podiatrist, but it is then up to a child to carry on with regular RICE.
How To Correct Flat Feet In Adults
Overview
Over 60 Million Americans suffer from Adult Acquired Flatfoot (AAF), otherwise known as Posterior Tibial Tendon Dysfunction or PTTD. This condition generally occurs in adults from 40-65 years of age, and it usually only occurs in one foot, not both. The Posterior Tibial (PT) Tendon courses along the inside part of the ankle and underneath the arch of the foot. It is the major supporting structure for the arch. Over time, the tendon becomes diseased, from overuse, and starts to lose it's strength. As a result, the arch begins to collapse, placing further strain on the PT Tendon, leading to further decrease in tendon strength, which causes further collapse of the arch. This is described as a progressive deformity because it will generally get worse over time. 
Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
Symptoms
Posterior tibial tendon insufficiency is divided into stages by most foot and ankle specialists. In stage I, there is pain along the posterior tibial tendon without deformity or collapse of the arch. The patient has the somewhat flat or normal-appearing foot they have always had. In stage II, deformity from the condition has started to occur, resulting in some collapse of the arch, which may or may not be noticeable. The patient may feel it as a weakness in the arch. Many patients initially present in stage II, as the ligament failure can occur at the same time as the tendon failure and therefore deformity can already be occurring as the tendon is becoming symptomatic. In stage III, the deformity has progressed to the extent where the foot becomes fixed (rigid) in its deformed position. Finally, in stage IV, deformity occurs at the ankle in addition to the deformity in the foot.
Diagnosis
Clinicians need to recognize the early stage of this syndrome which includes pain, swelling, tendonitis and disability. The musculoskeletal portion of the clinical exam can help determine the stage of the disease. It is important to palpate the posterior tibial tendon and test its muscle strength. This is tested by asking patient to plantarflex and invert the foot. Joint range of motion is should be assessed as well. Stiffness of the joints may indicate longstanding disease causing a rigid deformity. A weightbearing examination should be performed as well. A complete absence of the medial longitudinal arch is often seen. In later stages the head of the talus bone projects outward to the point of a large "lump" in the arch. Observing the patient's feet from behind shows a significant valgus rotation of the heel. From behind, the "too many toes" sign may be seen as well. This is when there is abducution of the forefoot in the transverse plane allowing the toes to be seen from behind. Dysfunction of the posterior tibial tendon can be assessed by asking the patient to stand on his/her toes on the affected foot. If they are unable to, this indicates the disease is in a more advanced stage with the tendon possibly completely ruptured.
Non surgical Treatment
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support. 
Surgical Treatment
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.
All You Will Need To Understand About Heel Pain
Overview
The most common form of Heel Pain, is pain on the bottom of the heel. It tends to occur for no apparent reason and is often worse when first placing weight on the foot. Patients often complain of pain the first thing in the morning or after getting up to stand after sitting. The pain can be a sharp, searing pain or present as a tearing feeling in the bottom of the heel. As the condition progresses there may be a throbbing pain after getting off your feet or there may be soreness that radiates up the back of the leg. Pain may also radiate into the arch of the foot.
Causes
Heel pain can have many causes. If your heel hurts, see your primary care doctor or orthopaedic foot and ankle specialist right away to determine why and get treatment. Tell him or her exactly where you have pain and how long you've had it. Your doctor will examine your heel, looking and feeling for signs of tenderness and swelling. You may be asked to walk, stand on one foot or do other physical tests that help your doctor pinpoint the cause of your sore heel. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.
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 heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
If the plantar fasciitis is acute, that is, a sprain of the plantar fascia then it is basically treated as a sprain, with anti-inflammatory drugs, ice, rest, possibly physical therapy. If chronic, the poor foot mechanics need be addressed. Foot mechanics are changed by use of specially moulded shoe inserts known as orthotics. Someone with plantar fasciitis needs an orthotic designed to relieve strain on the plantar fascia. Orthotics are often confused with arch supports. Arch supports, by holding up the arch can remove some of the tension from the plantar fascia. Orthotics, on the other hand, do most of their work on the heel and ball of the foot repositioning the foot for maximized function. What can you do before you see the foot doctor? First, try doing your own version of deep tissue massage by rolling a frozen cola bottle or can from the heel forward into the arch. Do it gently. Do stretching but the key to good stretching is not to stretch too hard so generally avoid weight bearing (standing) stretches but sit on a soft surface like your bed and pull the foot backward on the leg as far as it will go, holding for 20 seconds and relaxing for 5 seconds. Each 25 second ?set? can be repeated 5 times and you have invested about 2 minutes in giving yourself a lot of help. Watch out for the shoes you wear. It is tempting to obtain shoes that are colorful and soft. Here is the proof that soft shoes are bad. Wrap a pillow around your foot with duct tape and walk for a block or two. You will come back with your foot hurting more because your foot sank down deeper into the soft surface, allowing the ligament to stretch more. The shoes should be stiff in the shank and flexible at the ball. Such shoes, to running buffs, are known as motion control shoes or stability shoes so going to one of the small specialty running shoes stores is a good place to start. If you don?t have a desk job, or have an industrial job see if light duty is available. A note from your doc may be all that is required in most cases and most doctors are happy to oblige.
Surgical Treatment
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
Prevention
You can reduce the risk of heel pain in many ways, including. Wear shoes that fit you properly with a firm fastening, such as laces. Choose shoes with shock-absorbent soles and supportive heels. Repair or throw out any shoes that have worn heels. Always warm up and cool down when exercising or playing sport, include plenty of slow, sustained stretches. If necessary, your podiatrist will show you how to tape or strap your feet to help support the muscles and ligaments. Shoe inserts (orthoses) professionally fitted by your podiatrist can help support your feet in the long term.
The most common form of Heel Pain, is pain on the bottom of the heel. It tends to occur for no apparent reason and is often worse when first placing weight on the foot. Patients often complain of pain the first thing in the morning or after getting up to stand after sitting. The pain can be a sharp, searing pain or present as a tearing feeling in the bottom of the heel. As the condition progresses there may be a throbbing pain after getting off your feet or there may be soreness that radiates up the back of the leg. Pain may also radiate into the arch of the foot.
Causes
Heel pain can have many causes. If your heel hurts, see your primary care doctor or orthopaedic foot and ankle specialist right away to determine why and get treatment. Tell him or her exactly where you have pain and how long you've had it. Your doctor will examine your heel, looking and feeling for signs of tenderness and swelling. You may be asked to walk, stand on one foot or do other physical tests that help your doctor pinpoint the cause of your sore heel. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.
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 heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
If the plantar fasciitis is acute, that is, a sprain of the plantar fascia then it is basically treated as a sprain, with anti-inflammatory drugs, ice, rest, possibly physical therapy. If chronic, the poor foot mechanics need be addressed. Foot mechanics are changed by use of specially moulded shoe inserts known as orthotics. Someone with plantar fasciitis needs an orthotic designed to relieve strain on the plantar fascia. Orthotics are often confused with arch supports. Arch supports, by holding up the arch can remove some of the tension from the plantar fascia. Orthotics, on the other hand, do most of their work on the heel and ball of the foot repositioning the foot for maximized function. What can you do before you see the foot doctor? First, try doing your own version of deep tissue massage by rolling a frozen cola bottle or can from the heel forward into the arch. Do it gently. Do stretching but the key to good stretching is not to stretch too hard so generally avoid weight bearing (standing) stretches but sit on a soft surface like your bed and pull the foot backward on the leg as far as it will go, holding for 20 seconds and relaxing for 5 seconds. Each 25 second ?set? can be repeated 5 times and you have invested about 2 minutes in giving yourself a lot of help. Watch out for the shoes you wear. It is tempting to obtain shoes that are colorful and soft. Here is the proof that soft shoes are bad. Wrap a pillow around your foot with duct tape and walk for a block or two. You will come back with your foot hurting more because your foot sank down deeper into the soft surface, allowing the ligament to stretch more. The shoes should be stiff in the shank and flexible at the ball. Such shoes, to running buffs, are known as motion control shoes or stability shoes so going to one of the small specialty running shoes stores is a good place to start. If you don?t have a desk job, or have an industrial job see if light duty is available. A note from your doc may be all that is required in most cases and most doctors are happy to oblige.
Surgical Treatment
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
Prevention
You can reduce the risk of heel pain in many ways, including. Wear shoes that fit you properly with a firm fastening, such as laces. Choose shoes with shock-absorbent soles and supportive heels. Repair or throw out any shoes that have worn heels. Always warm up and cool down when exercising or playing sport, include plenty of slow, sustained stretches. If necessary, your podiatrist will show you how to tape or strap your feet to help support the muscles and ligaments. Shoe inserts (orthoses) professionally fitted by your podiatrist can help support your feet in the long term.
What Causes Achilles Tendinitis Aches ?
Overview
Achilles Tendinitis is a painful condition. Running and walking are made possible by the Achilles tendon, which attaches the calf muscle to the heel bone. Strenuous exercise, jumping, and climbing are all movements that can strain the tendon and calf muscles, causing an inflammation known as tendinitis. The injury to the Achilles can be mild, requiring only rest and over-the-counter anti-inflammatory drugs, or severe, necessitating surgical repair of the damaged tendon. Chronic Achilles tendinitis can lead to micro tears in the tissue (tendinosis), which weaken the tendon and put it at risk for severe damage such as a tear or rupture.
Causes
Achilles tendinitis may be caused by intensive hill running, sprinting, or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing intensity of exercise, especially after a period of inactivity. Sudden and hard contraction of the calf muscles when exerting extra effort, like that in a final sprint or high jump.
Symptoms
Paratenonitis presents in younger people. Symptoms start gradually and spontaneously. Aching and burning pain is noted especially with morning activity. It may improve slightly with initial activity, but becomes worse with further activity. It is aggravated by exercise. Over time less exercise is required to cause the pain. The Achilles tendon is often enlarged, warm and tender approximately 1 to 4 inches above its heel insertion. Sometimes friction is noted with gentle palpation of the tendon during ankle motion. Tendinosis presents similarly but typically in middle-aged people. If severe pain and limited walking ability are present, it may indicate a partial tear of the tendon.
Diagnosis
There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.
Nonsurgical Treatment
The latest studies on Achilles tendonitis recommend a treatment plan that incorporates the following three components. Treatment of the inflammation. Strengthening of the muscles that make up the Achilles tendon using eccentric exercise. These are a very specific type of exercise that has been shown in multiple studies to be a critical component of recovering from Achilles tendonitis. Biomechanical control (the use of orthotics and proper shoes). Shockwave therapy.
Surgical Treatment
Occasionally, conservative management of Achilles tendon conditions fails. This failure is more common in older male patients and those with longstanding symptoms, those who persist in full training despite symptoms or those who have uncorrected predisposing factors. In these cases, surgery may be indicated. It should be remembered, however, that the rehabilitation program, particularly for severe Achilles tendon injuries, is a slow, lengthy program. Surgery is only indicated when there is failure to progress in the rehabilitation program. Surgery should not be considered unless at least six months of appropriate conservative management has failed to lead to improvement.
Prevention
Regardless of whether the Achilles injury is insertional or non-insertional, a great method for lessening stress on the Achilles tendon is flexor digitorum longus exercises. This muscle, which originates along the back of the leg and attaches to the tips of the toes, lies deep to the Achilles. It works synergistically with the soleus muscle to decelerate the forward motion of the leg before the heel leaves the ground during propulsion. This significantly lessens strain on the Achilles tendon as it decelerates elongation of the tendon. Many foot surgeons are aware of the connection between flexor digitorum longus and the Achilles tendon-surgical lengthening of the Achilles (which is done to treat certain congenital problems) almost always results in developing hammer toes as flexor digitorum longus attempts to do the job of the recently lengthened tendon. Finally, avoid having cortisone injected into either the bursa or tendon-doing so weakens the tendon as it shifts production of collagen from type one to type three. In a recent study published in the Journal of Bone Joint Surgery(9), cortisone was shown to lower the stress necessary to rupture the Achilles tendon, and was particularly dangerous when done on both sides, as it produced a systemic effect that further weakened the tendon.
Achilles Tendinitis is a painful condition. Running and walking are made possible by the Achilles tendon, which attaches the calf muscle to the heel bone. Strenuous exercise, jumping, and climbing are all movements that can strain the tendon and calf muscles, causing an inflammation known as tendinitis. The injury to the Achilles can be mild, requiring only rest and over-the-counter anti-inflammatory drugs, or severe, necessitating surgical repair of the damaged tendon. Chronic Achilles tendinitis can lead to micro tears in the tissue (tendinosis), which weaken the tendon and put it at risk for severe damage such as a tear or rupture.
Causes
Achilles tendinitis may be caused by intensive hill running, sprinting, or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing intensity of exercise, especially after a period of inactivity. Sudden and hard contraction of the calf muscles when exerting extra effort, like that in a final sprint or high jump.
Symptoms
Paratenonitis presents in younger people. Symptoms start gradually and spontaneously. Aching and burning pain is noted especially with morning activity. It may improve slightly with initial activity, but becomes worse with further activity. It is aggravated by exercise. Over time less exercise is required to cause the pain. The Achilles tendon is often enlarged, warm and tender approximately 1 to 4 inches above its heel insertion. Sometimes friction is noted with gentle palpation of the tendon during ankle motion. Tendinosis presents similarly but typically in middle-aged people. If severe pain and limited walking ability are present, it may indicate a partial tear of the tendon.
Diagnosis
There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.
Nonsurgical Treatment
The latest studies on Achilles tendonitis recommend a treatment plan that incorporates the following three components. Treatment of the inflammation. Strengthening of the muscles that make up the Achilles tendon using eccentric exercise. These are a very specific type of exercise that has been shown in multiple studies to be a critical component of recovering from Achilles tendonitis. Biomechanical control (the use of orthotics and proper shoes). Shockwave therapy.
Surgical Treatment
Occasionally, conservative management of Achilles tendon conditions fails. This failure is more common in older male patients and those with longstanding symptoms, those who persist in full training despite symptoms or those who have uncorrected predisposing factors. In these cases, surgery may be indicated. It should be remembered, however, that the rehabilitation program, particularly for severe Achilles tendon injuries, is a slow, lengthy program. Surgery is only indicated when there is failure to progress in the rehabilitation program. Surgery should not be considered unless at least six months of appropriate conservative management has failed to lead to improvement.
Prevention
Regardless of whether the Achilles injury is insertional or non-insertional, a great method for lessening stress on the Achilles tendon is flexor digitorum longus exercises. This muscle, which originates along the back of the leg and attaches to the tips of the toes, lies deep to the Achilles. It works synergistically with the soleus muscle to decelerate the forward motion of the leg before the heel leaves the ground during propulsion. This significantly lessens strain on the Achilles tendon as it decelerates elongation of the tendon. Many foot surgeons are aware of the connection between flexor digitorum longus and the Achilles tendon-surgical lengthening of the Achilles (which is done to treat certain congenital problems) almost always results in developing hammer toes as flexor digitorum longus attempts to do the job of the recently lengthened tendon. Finally, avoid having cortisone injected into either the bursa or tendon-doing so weakens the tendon as it shifts production of collagen from type one to type three. In a recent study published in the Journal of Bone Joint Surgery(9), cortisone was shown to lower the stress necessary to rupture the Achilles tendon, and was particularly dangerous when done on both sides, as it produced a systemic effect that further weakened the tendon.
