03Jun / 2017

Working with Mortons Neuroma

Overview

intermetatarsal neuromaThis is a painful condition affecting a small nerve in the foot. It occurs when the five long bones that run the length of the foot get pushed together, pinching the nerve in between. This friction on the nerve causes it to thicken and inflame causing pain. The condition gets its name from an American surgeon, George Morton.

Causes

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common causes comes from wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box and overload pressure onto the forefoot. An injury or trauma to the forefoot may also lead to a neuroma. People at a higher risk of developing a Neuroma include people with certain foot deformities, such as bunions or hammertoes. Certain foot types, such as flat feet (Pronation) More flexible feet, and woman after pregnancy.

Symptoms

Morton’s neuroma can cause a very painful burning or sharp pain in your foot that feels worse when you walk. It may feel like a small lump inside the ball of your foot. It is usually between the third and fourth toes, but it can also be between other toes.

Diagnosis

During the exam, your doctor will press on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot. Some imaging tests are more useful than others in the diagnosis of Morton’s neuroma. Your doctor is likely to order X-rays of your foot, to rule out other causes of your pain such as a stress fracture. Ultrasound. This technology uses sound waves to create real-time images of internal structures. Ultrasound is particularly good at revealing soft tissue abnormalities, such as neuromas. Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, an MRI also is good at visualizing soft tissues. But it’s an expensive test and often indicates neuromas in people who have no symptoms.

Non Surgical Treatment

Common treatments involve wearing different shoes or using arch supports. Resting the foot, massaging the toes and using an ice pack may work for some people. A GP or a podiatrist (foot specialist) may also recommend anti-inflammatory painkillers or a course of steroid injections. Numbing injections, in which alcohol and a local anaesthetic are injected into the affected area of the foot, may also be effective. In extreme cases, when the condition does not respond to treatment, day case surgery may be needed.

Surgical Treatment

The ultimate success of a Morton?s neuroma treated surgically can be variable. In cases where the underlying problem is only an irritated nerve (a true Morton?s neuroma), then surgery will probably be curative (although it may take a few months for the foot to fully heal). But in many cases, forefoot pain is more complex. There may be an irritated nerve or two causing pain, but the real problem is often excessive loading of the lesser metatarsals. The generic term for this condition is metatarsalgia. When considering surgery, identifying and addressing these problems may lead to a better end result.

Posted in Uncategorized

Permalink

20Feb / 2016

For Leg Length Imbalances Chiropodists Prefer Shoe Lifts

There are two different types of leg length discrepancies, congenital and acquired. Congenital means that you are born with it. One leg is anatomically shorter than the other. As a result of developmental phases of aging, the human brain picks up on the gait pattern and identifies some variance. The entire body typically adapts by dipping one shoulder over to the “short” side. A difference of under a quarter inch isn’t blatantly uncommon, doesn’t need Shoe Lifts to compensate and typically won’t have a serious effect over a lifetime.

Shoe Lift

Leg length inequality goes typically undiagnosed on a daily basis, yet this issue is easily fixed, and can eradicate quite a few incidents of upper back pain.

Treatment for leg length inequality usually consists of Shoe Lifts. Many are cost-effective, in most cases being under twenty dollars, compared to a custom orthotic of $200 plus. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Back pain is easily the most prevalent ailment impacting men and women today. Around 80 million people are affected by back pain at some point in their life. It is a problem that costs employers millions of dollars yearly on account of time lost and production. Fresh and better treatment solutions are continually sought after in the hope of reducing the economical impact this issue causes.

Shoe Lifts

People from all corners of the earth suffer from foot ache as a result of leg length discrepancy. In these situations Shoe Lifts can be of immense help. The lifts are capable of easing any discomfort in the feet. Shoe Lifts are recommended by many experienced orthopaedic physicians.

To be able to support the human body in a healthy and balanced manner, your feet have got a significant part to play. Irrespective of that, it is often the most neglected zone in the body. Some people have flat-feet which means there may be unequal force exerted on the feet. This causes other body parts such as knees, ankles and backs to be impacted too. Shoe Lifts ensure that the right posture and balance are restored.

Posted in Shoe Lifts

Tags:

Permalink Leave a comment

28Sep / 2015

What Is A Calcaneal Spur

Posterior Calcaneal Spur

Overview

Bone spurs are bony projections that develop along the edges of bones. Bone spurs (osteophytes) often form where bones meet each other – in your joints. They can also form on the bones of your spine. The main cause of bone spurs is the joint damage associated with osteoarthritis. Most bone spurs cause no symptoms and may go undetected for years. They may not require treatment. Decisions about treatment depend on where spurs are situated and how they affect your health.

Causes

Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body’s weight, and the foot flattens and this places a great deal of pressure and strain on the plantar fascia. There is very little ?give? to the plantar fascia, so as it stretches only slightly, it pulls on its attachment to the heel. If the foot is properly aligned this pull causes no problems. However, if the foot is ?pronated?(the foot rolls outward at the ankle, causing a break down of the inner side of the shoe), the arch falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel. The same pathology occurs with ?supination? (the rolling inward of the foot, causing a break down of the outer side of the shoe). Supinated feet are relatively inflexible; usually have a high arch, and a short or tight plantar fascia. Thus as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia hardly stretches at all, and pulls with great force on its attachment to the heel. In both cases, the abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and possibly swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill in this torn area with calcium; eventually it becomes bone, and a heel spur results.

Heel Spur

Symptoms

The vast majority of people who have heel spurs feel the asscociated pain during their first steps in the morning. The pain is quite intense and felt either the bottom or front of the heel bone. Typically, the sharp pain diminishes after being up for a while but continues as a dull ache. The pain characteristically returns when first standing up after sitting for long periods.

Diagnosis

A thorough medical history and physical exam by a physician is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.

Non Surgical Treatment

To aid in the reduction of inflammation, applying ice for 10-15 minutes after activities and the use of anti-inflammatory medications, such as aspirin or ibuprofen, can be helpful. Corticosteroid injections may also be used to reduce pain and inflammation. Physical therapy can be beneficial with the use of heat modalities, such as ultrasound, that create a deep heat and reduce inflammation. If the pain caused by inflammation is constant, keeping the foot raised above the heart and/or compressed by wrapping with a bandage will help. Taping can help speed the healing process by protecting the fascia from reinjury, especially during stretching and walking.

Surgical Treatment

Almost 90% of the people suffering from heel spur get better with nonsurgical treatments. However, if the conservative treatments do not help you and you still have pain even after 9 to 12 months, your doctor may advise surgery for treating heel spur. The surgery helps in reducing the pain and improving your mobility. Some of the surgical techniques used by doctors are release of the plantar fascia. Removal of a spur. Before the surgery, the doctor will go for some pre-surgical tests and exams. After the operation, you will need to follow some specific recommendations which may include elevation of the foot, waiting time only after which you can put weight on the foot etc.

Prevention

The best way to prevent heel spurs is by wearing properly fitted footwear. Shoes should have a shock absorbing tread and soles and should be effective in supporting the heel and arch. Proper warm up and stretching before embarking on any physical activity that will put pressure or impact on the area is highly recommended. Also, just as it?s important for your general health, if you can lose some extra pounds, you will be more likely to avoid heel spurs. If you are starting to feel the onset of pain, it may not be heel spurs, but could be a tendonitis condition that could lead to heel spurs.

Posted in Calcaneal Spur, Heel Spur, Inferior Calcaneal Spur, Posterior Calcaneal Spur

Tags: , , ,

Permalink

24Sep / 2015

What Are The Signs And Symptoms Of Posterior Calcaneal Spur

Heel Spur

Overview

A heel spur is a hook of bone that can form on the heel bone of the foot. Heel spurs are associated with plantar fasciitis. Heel spurs can cause extreme pain in the rearfoot. The pain is most intense while standing or walking. What Causes Heel Spurs? Heel spurs develop as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia stretches and pulls away from the heel. The plantar fascia is a ligament located at the bottom of your foot. This stretching of the plantar fascia is usually the result of flat feet or unusually high arches.

Causes

The cause of heel spurs is excessive strain placed on the plantar fascia over a long period of time, as a result of different factors. These factors include incorrect gait, being overweight, ageing or being in a job that requires a lot of standing on hard floors. It is usually a combination of any of these factors that will bring on the development of heel spurs.

Inferior 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

A heel spur is often seen on X-ray as a bony protrusion, which can vary in size. However, because a Heel Spur only indicates increased load on the plantar fascia, and not pain, an ultra sound may be required to assess other actual cause of the heel pain such and may include checking to see if the plantar fascia is inflamed or degenerated.

Non Surgical Treatment

Treatment of Heel Spurs is the same as treatment of plantar fasciitis. To arrive at an accurate diagnosis, our foot and ankle Chartered Physiotherapists will obtain your medical history and examine your foot. Throughout this process the physio will rule out all the possible causes for your heel pain other than plantar fasciitis. The following treatment may be used. Orthotics/Insoles. Inflammation reduction. Mobilisation. Taping and Strapping. Rest.

Surgical Treatment

Though conservative treatments for heel spurs work most of the time, there are some cases where we need to take your treatment to the next level. Luckily, with today?s technologies, you can still often avoid surgery. Some of the advanced technologies to treat a Heel Spur are Platelet Rich Plasma Therapy. Platelet Rich Plasma Therapy (also known as PRP) is one of several regenerative medicine techniques that University Foot and Ankle Institute has helped bring to foot and ankle care. This amazing in-office procedure allows the growth factors in the blood to be used to actually begin the healing process again long after your body has given up on healing the area. Heel Pain Shockwave Therapy. Shockwave therapy is a non-invasive procedure done in the office that allows for new blood to get to the region of fascia damage and help with healing. Results have been excellent with more than 70 percent of patients getting relief with only one treatment. Topaz for Heal Spurs and pain. Another minimally invasive technology technique is called Coblation Surgery using a Topaz probe. This minimally invasive procedure involves controlled heating of multiple tiny needles that are inserted through the skin and into the plantar fascia. This process, like PRP and Shockwave therapy, irritates the fascia enough to turn a chronic problem back into an acute problem, greatly increasing the chances of healing. Heel Spur Surgery. Endoscopic Plantar Fasciotomy is one surgical procedure that we consider to release the tight fascia. University Foot and Ankle Institute has perfected an endoscopic (camera guided) approach for fascia release to allow rapid healing and limited downtime with minimal pain.

Prevention

Walk around before you buy shoes. Before you purchase your shoes, do the following. Re-lace the shoes if you’re trying on athletic shoes. Start at the farthest eyelets and apply even pressure to the laces as you come closer to the tongue of the shoe. Make sure that you can wiggle your toes freely inside of the shoe. Also, make sure that you have at enough space between your tallest toe and the end of the shoe. You should have room equal to about the width of your thumb in the tip of your shoe. Walk around to make sure that the shoe has a firm grip on your heel without sliding up and down. Walk or run a few steps to make sure your shoes are comfortable. Shoes that fit properly require no break-in period.

Posted in Calcaneal Spur, Heel Spur, Inferior Calcaneal Spur, Posterior Calcaneal Spur

Tags: , , ,

Permalink

12Jun / 2015

Bunion Exercises Prevention

Overview
Bunions Hard Skin
The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents additional bone formation, often in combination with a misalignment of the big toe. The misalignment causes the big toe to move outward (medically termed hallux valgus deformity). The normal position of the big toe (straight forward) becomes outward directed toward the smaller toes. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor’s bunion.

Causes
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won?t actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.
SymptomsSymptoms include pain in and around the ball of the big toe, usually from the bone rubbing too much against the shoe. You may be unable to wear certain types of shoes due to the shape of the forefoot. The big toe appears to be bent inwards towards and in come cases over the inside toe.

Diagnosis
Your doctor is very likely to be able to diagnose your bunion simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate the types of shoes you wear. You’ll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to determine the extent of your deformity.

Non Surgical Treatment
Some bunions can be treated without surgery. If you have a bunion, wear shoes that are roomy enough so that they won?t put pressure on it. You can choose to have your shoes stretched out professionally or try cushioning the painful area with protective pads. Orthotics have been shown to help prevent progression of bunions. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Applying an ice pack several times a day can also help reduce inflammation and pain. If your bunion progresses to a point where you have difficulty walking or experience pain even with accommodative shoes, surgery may be necessary.
Bunions

Surgical Treatment
If all nonsurgical measures fail to control the symptoms, then surgery may be suggested to treat the hallux valgus condition. Well over 100 surgical procedures exist to treat hallux valgus. The basic considerations in performing any surgical procedure for hallux valgus are to remove the bunion, to realign the bones that make up the big toe, to balance the muscles around the joint so the deformity does not return.

Prevention
Here are some tips to help you prevent bunions. Wear shoes that fit well. Use custom orthotic devices. Avoid shoes with small toe boxes and high heels. Exercise daily to keep the muscles of your feet and legs strong and healthy. Follow your doctor?s treatment and recovery instructions thoroughly. Unfortunately, if you suffer from bunions due to genetics, there may be nothing you can do to prevent them from occurring. Talk with your doctor about additional prevention steps you can take, especially if you are prone to them.

Posted in Uncategorized

Tags:

Permalink

02Jun / 2015

The Treatment Of Over-Pronation Of The Feet

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.Overpronation

Causes

There is a relationship between biomechanics and injury that is specific to each body part. Overall though, poor mechanics will either increase the landing forces acting on the body or increase the work to be done by the muscles. Both increase the stress, which, depending on the individual and the amount of running can become excessive and cause injury.

Symptoms

Symptoms can manifest in many different ways. The associated conditions depend on the individual lifestyle of each patient. Here is a list of some of the conditions associated with over Pronation. Hallux Abducto Valgus (bunions). Hallux Rigidus (stiff 1st toe). Arch Pain. Heel Pain (plantar Facsitus). Metatarsalgia (ball of the foot pain). Ankle Sprains. Shin Splints. Achilles Tendonitis. Osteochondrosis. Knee Pain. Corns & Calluses. Flat Feet. Hammer Toes.

Diagnosis

Firstly, look at your feet in standing, have you got a clear arch on the inside of the foot? If there is not an arch and the innermost part of the sole touches the floor, then your feet are over-pronated. Secondly, look at your running shoes. If they are worn on the inside of the sole in particular, then pronation may be a problem for you. Thirdly, try the wet foot test. Wet your feet and walk along a section of paving and look at the footprints you leave. A normal foot will leave a print of the heel, connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you?re feet are pronated there may be little distinction between the rear and forefoot, shown opposite. The best way to determine if you over pronate is to visit a podiatrist or similar who can do a full gait analysis on a treadmill or using forceplates measuring exactly the forces and angles of the foot whilst running. It is not only the amount of over pronation which is important but the timing of it during the gait cycle as well that needs to be assessed.Foot Pronation

Non Surgical Treatment

Treatment with orthotics will provide the required arch support to effectively reduce excessive pronation and restore the foot and its posture to the right biomechanical position. It should be ensured that footwear has sufficient support, for example, shoes should have a firm heel counter to provide adequate control.

Prevention

Exercises to strengthen and stretch supporting muscles will help to keep the bones in proper alignment. Duck stance: Stand with your heels together and feet turned out. Tighten the buttock muscles, slightly tilt your pelvis forwards and try to rotate your legs outwards. You should feel your arches rising while you do this exercise. Calf stretch: Stand facing a wall and place hands on it for support. Lean forwards until stretch is felt in the calves. Hold for 30 seconds. Bend at knees and hold for a further 30 seconds. Repeat 5 times. Golf ball: While drawing your toes upwards towards your shins, roll a golf ball under the foot between 30 and 60 seconds. If you find a painful point, keep rolling the ball on that spot for 10 seconds. Big toe push:

Stand with your ankles in a neutral position (without rolling the foot inwards). Push down with your big toe but do not let the ankle roll inwards or the arch collapse. Hold for 5 seconds. Repeat 10 times. Build up to longer times and fewer repetitions. Ankle strengthener: Place a ball between your foot and a wall. Sitting down and keeping your toes pointed upwards, press the outside of the foot against the ball, as though pushing it into the wall. Hold for 5 seconds and repeat 10 times. Arch strengthener: Stand on one foot on the floor. The movements needed to remain balanced will strengthen the arch. When you are able to balance for 30 seconds, start doing this exercise using a wobble board.

Posted in Overpronation Of The Feet

Tags:

Permalink

24Mar / 2015

Flat Feet In Adults (Adult Aquired Flat Foot)

Overview

Adults with an acquired flatfoot deformity may present not with foot deformity but almost uniformly with medial foot pain and decreased function of the affected foot (for a list of causes of an acquired flatfoot deformity in adults. Patients whose acquired flatfoot is associated with a more generalised medical problem tend to receive their diagnosis and are referred appropriately. However, in patients whose adult acquired flatfoot deformity is a result of damage to the structures supporting the medial longitudinal arch, the diagnosis is often not made early. These patients are often otherwise healthier and tend to be relatively more affected by the loss of function resulting from an acquired flatfoot deformity. The most common cause of an acquired flatfoot deformity in an otherwise healthy adult is dysfunction of the tibialis posterior tendon, and this review provides an outline to its diagnosis and treatment.Acquired Flat Foot


Causes

There are a number of theories as to why the tendon becomes inflamed and stops working. It may be related to the poor blood supply within the tendon. Increasing age, inflammatory arthritis, diabetes and obesity have been found to be causes.


Symptoms

In many cases, adult flatfoot causes no pain or problems. In others, pain may be severe. Many people experience aching pain in the heel and arch and swelling along the inner side of the foot.


Diagnosis

Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course. Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is available. Check the anterior tibial tendon for size and strength.


Non surgical Treatment

Treatment will vary depending on the degree of your symptoms. Generally, we would use a combination of rest, immobilization, orthotics, braces, and physical therapy to start. The goal is to keep swelling and inflammation under control and limit the stress on the tendon while it heals. Avoidance of activities that stress the tendon will be necessary. Once the tendon heals and you resume activity, physical therapy will further strengthen the injured tendon and help restore flexibility. Surgery may be necessary if the tendon is torn or does not respond to these conservative treatment methods. Your posterior tibial tendon is vital for normal walking. When it is injured in any way, you risk losing independence and mobility. Keep your foot health a top priority and address any pain or problems quickly. Even minor symptoms could progress into chronic problems, so don?t ignore your foot pain.

Flat Foot


Surgical Treatment

The indications for surgery are persistent pain and/or significant deformity. Sometimes the foot just feels weak and the assessment of deformity is best done by a foot and ankle specialist. If surgery is appropriate, a combination of soft tissue and bony procedures may be considered to correct alignment and support the medial arch, taking strain off failing ligaments. Depending upon the tissues involved and extent of deformity, the foot and ankle specialist will determine the necessary combination of procedures. Surgical procedures may include a medial slide calcaneal osteotomy to correct position of the heel, a lateral column lengthening to correct position in the midfoot and a medial cuneiform osteotomy or first metatarsal-tarsal fusion to correct elevation of the medial forefoot. The posterior tibial tendon may be reconstructed with a tendon transfer. In severe cases (stage III), the reconstruction may include fusion of the hind foot,, resulting in stiffness of the hind foot but the desired pain relief. In the most severe stage (stage IV), the deltoid ligament on the inside of the ankle fails, resulting in the deformity in the ankle. This deformity over time can result in arthritis in the ankle.

Posted in Flat Feet

Tags: ,

Permalink

07Mar / 2015

All About Achilles Tendonitis

Overview

Achilles TendonitisAchilles tendonitis, also sometimes called Achilles tendinitis, is a painful and often debilitating inflammation of the Achilles tendon (heel cord). The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone (calcaneus), and connects the leg muscles to the foot. The Achilles tendon gives us the ability to rise up on our toes, facilitating the act of walking, and Achilles tendonitis can make walking almost impossible. There are three stages of tendon inflammation, Peritenonitis, Tendinosis, Peritenonitis with tendinosis. Peritenonitis is characterized by localized pain during or following activity. As this condition progresses, pain often develops earlier on during activity, with decreased activity, or while at rest. Tendinosis is a degenerative condition that usually does not produce symptoms (i.e., is asymptomatic). It may cause swelling or a hard knot of tissue (nodule) on the back of the leg. Peritenonitis with tendinosis results in pain and swelling with activity. As this condition progresses, partial or complete tendon rupture may occur. The overall incidence of Achilles tendonitis is unknown. The condition occurs in approximately 6-18% of runners, and also is more common in athletes, especially in sports that involve jumping (e.g., basketball), and in people who do a lot of walking. Achilles tendonitis that occurs as a result of arthritis in the heel is more common in people who are middle aged and older.

Causes

Short of a trauma, the primary cause of Achilles tendonitis is when the calf muscle is so tight that the heel is unable to come down to the ground placing extreme stress on the Achilles tendon at the insertion. Keep in mind that the calf muscle is designed to contract up, lifting the heel bone off the ground, propelling you forwards to the front of the foot for push off. When the calf is so tight that the heel is prevented from coming down on the ground there will be stress on the tendon and the foot will over pronate causing the Achilles tendon to twist, adding to the stress on the insertion. Improper treatment may lead to a more severe injury, such as a rupture or chronic weakening, which may require surgery.

Symptoms

People with achilles tendinitis experience mild aching on the back of the leg close to the heel after increased activity. Stiffness in the back of the ankle when you first wake up in the morning, which subsides after mild activity. In some cases, the area may have swelling, thickening or be warm to the touch. Tenderness to touch along the tendon in the back of the ankle. Pain when the tendon is stretched (i.e. when you lift your foot/toes up).

Diagnosis

To diagnose the condition correctly, your doctor will ask you a few questions about the pain and swelling in your heel. You may be asked to stand on the balls of your feet while your doctor observes your range of motion and flexibility. The doctor may also touch the area directly. This allows him to pinpoint where the pain and swelling is most severe.

Nonsurgical Treatment

If caught early enough, simple physical therapy that you can do by yourself should be fine. Over the counter solutions as easy as pain medication, cold compresses, a different pair of shoes, or a new set of stretching exercises can make most of the symptoms of Achilles tendinitis disappear. Further trouble or extreme pain should be regarded as a sign that something more serious is wrong, and you should immediately consult a doctor or physician. They will look to see whether non-surgical or surgical methods are your best options, and from there you can determine what your budget is for dealing with the condition.

Achilles Tendon

Surgical Treatment

Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated. Several procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some patients, these procedures can help restore function of a chronically damaged Achilles.

Prevention

Suggestions to reduce your risk of Achilles tendonitis include, icorporate stretching into your warm-up and cool-down routines. Maintaining an adequate level of fitness for your sport. Avoid dramatic increases in sports training. If you experience pain in your Achilles tendon, rest the area. Trying to ?work through? the pain will only make your injury worse. Wear good quality supportive shoes appropriate to your sport. If there is foot deformity or flattening, obtain orthoses. Avoid wearing high heels on a regular basis. Maintaining your foot in a ?tiptoe? position shortens your calf muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury. Maintain a normal healthy weight.

Posted in Achilles Tendon

Tags:

Permalink

16Jan / 2015

What Is Heel Pain

Plantar Fascia

Overview

The plantar fascia (a connective tissue structure) stretches from the toes and ball of the foot, through the arch, and connects to the heel bone in three places: outside, center and inside. Normally it helps the foot spring as it rolls forward. It also provides support for the arch of the foot. The plantar fascia helps keep the foot on track, cutting down on oscillation. When the foot over-pronates (rolls to the inside) the plantar fascia tries to stabilize it and prevent excessive roll. In time, the inside and sometimes center connections are overstressed and pull away from their attachments. The first sign is usually heel pain as you rise in the morning. When you walk around, the pain may subside, only to return the next morning. Inflammation and increased soreness are the results of long-term neglect and continued abuse. A heel bone spur may develop after a long period of injury when there is no support for the heel. The plantar fascia attaches to the heel bone with small fibers. When these become irritated they become inflamed with blood containing white blood cells. Within the white blood cells are osteoblasts which calcify to form bone spurs and calcium deposits. The body is trying to reduce stress on that area by building a bone in the direction of stress. Unfortunately, these foreign substances cause pain and further irritation in the surrounding soft tissue.


Causes

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.


Symptoms

Among the symptoms for Plantar Fasciitis is pain usually felt on the underside of the heel, often most intense with the first steps after getting out of bed in the morning. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Plantar Fasciitis also called “policeman’s heel” is presented by a sharp stabbing pain at the bottom or front of the heel bone. In most cases, heel pain is more severe following periods of inactivity when getting up and then subsides, turning into a dull ache.


Diagnosis

Plantar fasciitis is usually diagnosed by a health care provider after consideration of a person’s presenting history, risk factors, and clinical examination. Tenderness to palpation along the inner aspect of the heel bone on the sole of the foot may be elicited during the physical examination. The foot may have limited dorsiflexion due to tightness of the calf muscles or the Achilles tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis. However, in certain cases a physician may decide imaging studies (such as X-rays, diagnostic ultrasound or MRI) are warranted to rule out other serious causes of foot pain. Bilateral heel pain or heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Lateral view x-rays of the ankle are the recommended first-line imaging modality to assess for other causes of heel pain such as stress fractures or bone spur development. Plantar fascia aponeurosis thickening at the heel greater than 5 millimeters as demonstrated by ultrasound is consistent with a diagnosis of plantar fasciitis. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.


Non Surgical Treatment

Most doctors recommend an initial six- to eight-week program of conservative treatment, including Rest, balanced with stretching exercises to lengthen the heel cord and plantar fascia. Ice massage to the bottom of the foot after activities that trigger heel pain. Avoidance of walking barefoot or wearing slippers or sandals that provide little arch support. A temporary switch to swimming and/or bicycling instead of sports that involve running and jumping. Shoes with soft heels and insoles. Taping the bottom of the injured foot. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin and other brand names), or acetaminophen (Tylenol) for pain. Physical therapy using ultrasound, electrical stimulation with corticosteroids or massage techniques. If this conservative treatment does not help, your doctor may recommend that you wear a night splint for six to eight weeks. While you sleep, the night splint will keep your foot in a neutral or slightly flexed (bent) position to help maintain the normal stretch of the plantar fascia and heel cord. If the night splint doesn’t work, your doctor may inject corticosteroid medication into the painful area or place your foot in a short leg cast for one to three months. Shock wave therapy, in which focused sound energy is applied to the sore heel, may be recommended for plantar fasciitis. The shock waves are intended to irritate or injure the plantar fascia to promote healing. The overall benefit of this approach is uncertain. Other therapies that have been tried include radiation therapy and botulinum toxin injections. But their effectiveness is unclear. If all else fails, your doctor may suggest surgery. But this is rare, and surgery is not always successful.

Foot Pain


Surgical Treatment

The most dramatic therapy, used only in cases where pain is very severe, is surgery. The plantar fascia can be partially detached from the heel bone, but the arch of the foot is weakened and full function may be lost. Another surgery involves lengthening the calf muscle, a process called gastrocnemius recession. If you ignore the condition, you can develop chronic heel pain. This can change the way you walk and cause injury to your legs, knees, hips and back. Steroid injections and some other treatments can weaken the plantar fascia ligament and cause potential rupture of the ligament. Surgery carries the risks of bleeding, infection, and reactions to anesthesia. Plantar fascia detachment can also cause changes in your foot and nerve damage. Gastrocnemius resection can also cause nerve damage.


Prevention

An important part of prevention is to perform a gait analysis to determine any biomechanical problems with the foot which may be causing the injury. This can be corrected with orthotic inserts into the shoes. If symptoms do not resolve then surgery is an option, however this is more common for patients with a rigid high arch where the plantar fascia has shortened.

Posted in Plantar Fasciitis

Tags: , ,

Permalink

09Jan / 2015

What Exactly Leads To Heel Pain

Pain Of The Heel

Overview

Plantar fasciitis was previously believed to be inflammation of the fascia near its insertion on the heel bone. The suffix (-itis) means inflammation. Studies, however, reveal that changes in the tissue associated with the injury are degenerative and not related to inflammation, at least not in the way most people typically think of inflammation. Sudden onset of heel pain may indeed be related to acute inflammation. For persistent heel pain the condition more closely resembles long-standing degeneration of the plantar fascia near its attachment than inflammation. This could explain why anti-inflammatory medications and injections have been unsuccessful at treating it. But there is more to heel pain than just the plantar fascia.


Causes

As a person gets older, the plantar fascia becomes less like a rubber band and more like a rope that doesn’t stretch very well. The fat pad on the heel becomes thinner and can’t absorb as much of the shock caused by walking. The extra shock damages the plantar fascia and may cause it to swell, tear or bruise. You may notice a bruise or swelling on your heel. Other risk factors for plantar fasciitis include being overweight and obesity. Diabetes. Spending most of the day on your feet. Becoming very active in a short period of time. Being flat-footed or having a high arch.


Symptoms

Heel pain is the most common symptom associated with plantar fasciosis. Your heel pain may be worse in the morning or after you have been sitting or standing for long periods. Pain is most common under your heel bone, but you also may experience pain in your foot arch or on the outside aspect of your foot. Other common signs and symptoms of plantar fasciosis include mild swelling and redness in your affected area, tenderness on the bottom of your heel, impaired ability to ambulate.


Diagnosis

Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.


Non Surgical Treatment

Night splints usually are designed to keep a person’s ankle in a neutral position overnight. Most individuals naturally sleep with the feet plantar-flexed, a position that causes the plantar fascia to be in a foreshortened position. A night dorsiflexion splint allows passive stretching of the calf and the plantar fascia during sleep. Theoretically, it also allows any healing to take place while the plantar fascia is in an elongated position, thus creating less tension with the first step in the morning. A night splint can be molded from plaster or fiberglass casting material or may be a prefabricated, commercially produced plastic brace. Several studies have shown that use of night splints has resulted in improvement in approximately 80 percent of patients using night splints. Other studies found that night splints were especially useful in individuals who had symptoms of plantar fasciitis that had been present for more than 12 months. Night splints were cited as the best treatment by approximately one third of the patients with plantar fasciitis who tried them. Disadvantages of night splints include mild discomfort, which may interfere with the patient’s or a bed partner’s ability to sleep.

Plantar Fascitis


Surgical Treatment

When more-conservative measures aren’t working, your doctor might recommend steroid shots. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic plantar fasciitis that hasn’t responded to more-conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective. Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It’s generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.


Prevention

Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed. Doing activities in moderation can also help.

Posted in Plantar Fasciitis

Tags: , ,

Permalink