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Pes Planus What To Expect

July 3, 2017
Overview

Flat Feet

Some people have always had flat feet from a young age. Unfortunately as people reach their fifties they will suddenly have one foot with a flatter arch than the other foot. This situation is termed adult acquired flatfoot. Adult acquired flatfoot is a painful condition occurring in one foot. The common patient profile is a female over the age of 50 with pre-existing flatfeet, high blood pressure, high cholesterol, diabetes and obesity. All of these underlying problems will lead to a weakening of the support structures of the arch. If you have adult acquired flat foot you will not be able to lift your heel off the ground while standing on one leg. Adult acquired flatfoot may develop due to trauma or degeneration of major tendons ankle & foot. Weakness or paralysis of leg muscles can also create a flatfoot deformity. Adult acquired flat foot can be treated with physical therapies, motion control running shoes or hiking boots, custom foot orthoses, and ankle foot orthoses.

Causes

Factors that increase your chance of flat feet include family history, diseases that cause muscle or nerve damage, such as peripheral neuropathy, diabetes, cerebral palsy, spina bifida, or muscular dystrophy. Foot injuries. Conditions of the feet that can injure foot tissue such as osteoarthritis. Conditions present at birth, such as excess laxity of joint capsules and ligaments, such as Ehlers-Danlos syndrome. Obesity.

Symptoms

It?s possible to have fallen arches and experience no symptoms whatsoever. But many people do notice some problems with this condition. Their feet, back and legs ache. Standing on their toes is difficult, if not impossible, and they note swelling around the arch and heel.

Diagnosis

Runners are often advised to get a gait analysis to determine what type of foot they have and so what kind of running shoe they require. This shouldn?t stop at runners. Anyone that plays sports could benefit from this assessment. Sports shoes such as football boots, astro trainers and squash trainers often have very poor arch support and so for the 60-80% of us who do overpronate or have flat feet they are left unsupported. A change of footwear or the insertion of arch support insoles or orthotics can make a massive difference to your risk of injury, to general aches and pains and even to your performance.

fallen arches surgery

Non Surgical Treatment

The treatment your podiatrist recommends will depend upon the trouble and pain you?re experiencing. Custom shoe inserts (orthotics) are most often recommended and are quite effective. Stretching exercises to loosen and strengthen the supporting tendons may also be recommended. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may recommend an ankle brace or a custom orthotic device that fits into your shoe to support the arch. A short-leg cast or boot may be worn to immobilize the foot and allow the tendon to heal. Ultrasound therapy and stretching exercises may help rehabilitate the tendon and muscle following immobilization. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Your foot and ankle surgeon may recommend changes in your footwear.

Surgical Treatment

Adult Acquired Flat Foot

Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.

Prevention

Strap the arches into the anatomically correct positions with athletic tape and leave them like this for some time. If the fallen arches are an issue with the muscular structure, this may give the muscles an opportunity to strengthen. This is definitely not a fallen arches cure all the time but it can help prevent it more times than not. Ask a doctor or physical therapists to show you how to do this taping. Find shoes that fit. This may require that you get your foot measured and molded to ensure that the shoe will fit. Shoes that are too big, too tight or too short, may not directly cause the fallen arches, but they can assist with the damage to the area. These shoes should have thick cushioning inside and have plenty of room for your toes. Walk without shoes as much as possible. Shoes directly assist with weakening and distorting the arches of the feet so going without shoes can actually help strengthen your arches and prevent fallen arches. Walking on hard and bumpy surfaces barefooted makes the muscles in your feet strengthen in order to prevent injury. It is a coping mechanism by your body. Insert heel cups or insoles into the shoes that you wear the most. Many people wear uncomfortable shoes to work and these are the same shoes that cause their arches the most problems. Inserting the heel cups and insoles into these shoes can prevent fallen arches from occurring. Many people place these inserts into all their shoes to ensure support. Ask a medical professional, either your doctor or a physical therapist, about daily foot exercises that may keep the arches stronger than normal. Many times, you can find exercises and stretches on the Internet on various websites. Curling your toes tightly and rotating your feet will help strengthen your longitudinal arches. Relax your feet and shake them for a minute or so before you do any arch exercises. This will loosen the muscles in your feet that stay tight due to normal daily activities. Wear rigid soled sandals whenever possible to provide a strong support for your arches. Wooden soled sandals are the best ones if available. Walk or jog on concrete as much as you can. This will create a sturdy support for your arches. Running or walking in sandy areas or even on a treadmill, does not give rigid support. Instead, these surfaces absorb the step, offering no support for arches.

Everything You Need To Understand About Heel Serious Pain

July 3, 2017
Overview

Heel Pain

The most common cause of heel pain is plantar fasciitis. Many patients with plantar fasciitis have a heel spur on the front and bottom of their heel, but heel spurs do not cause pain. The common name is "heel spur" because it's easier to pronounce than "plantar fasciitis" and doctors are able to point to the spur on an x-ray. Causes of heel pain include inadequate flexibility in the calf muscles, lack of arch support, being overweight, suddenly increasing activity, and spending too much time on the feet. Arch support was rated the best treatment in our first survey of 1,800 visitors to heelspurs.com. The Plantar Fasciitis Orthotic is getting the best customer reviews and it is the most popular product. It is new for 2011. Returning customers may be seeking the Pinnacle Orthotic. The primary difference is that the PF Orthotic should be used only for current cases of plantar fasciitis or heel spurs and the Pinnacle is best for general use once the condition has subsided. Survery respondents also benefited from: rest, ice, tape, and night splints.

Causes

Age plays a large role in the development of heel pain, particularly among those over 40. Being active is also a common factor of heel pain. Over time, the elasticity of the tissue in our feet decreases with age, causing us to become prone to damage and also slowing the body's ability to heal damage. Adolescents are also not immune to heel pain. Those who are active in sports are particularly prone to excessively stretching or straining the plantar fascia or Achilles tendon, causing severe heel pain. In most cases, heel pain develops in only one heel. There are many risk factors that lead to heel pain. Abnormal gait and excessive, repetitive stress are common factors in the development of pain and damage. Among the other risk factors involved with the development of heel pain are repetitive exercise or activities, such as long distance running or jumping from activities such as basketball. Obesity. Walking barefoot on hard surfaces. Prolonged standing. Wearing poor fitting shoes, or shoes that do not provide enough support or cushioning. Not stretching properly or at all before and after exercise. Those who are on their feet for long periods of time.

Symptoms

Sever?s Disease. This is a condition that occurs in 10 - 15 year old children, predominantly boys and is associated with running and repetitive jumping. It is also associated with flimsy footwear that kids may wear. It occurs when the Achilles tendon continually pulls on the apophysis of the calcaneum and does not allow for it to fuse with the body of the calcaneum. Calcaneal enthesopathy. This occurs when there is repetitive trauma at the attachment of the Achilles tendon, resulting in a spur from the calcaneum up into the Achilles tendon. It is usually visualized on x-ray and may be tender if there is an associated bursitis or tendonitis. "Pump Bump". Also known as Haglund?s Deformity, this is a bony enlargement that exists on the back of the heel - usually related to a congenital abnormality or with chronic bursitis, causing a thickening. There may have already been trauma or pressure from footwear. Treatment is usually protection of the bump and correct footwear. Associated with a symmetrical swelling at the base of the Achilles tendon. It is usually related to repetitive trauma or inappropriate footwear. It is often red and hot in the early stages. Treatment is usually to correct the footwear, provide padding and treat the local symptoms e.g. ice, rest, physiotherapy and cortisone injection. Fat Pad Syndrome. Direct contact with the base of the heel may result in trauma to the fat pad. Related to obesity, training on hard surfaces, uneven grounds, poor shoes especially overlarge shoes which can cause shearing forces on the heel. These conditions are renowned for taking a long time to recover - usually many months.

Diagnosis

Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.

Non Surgical Treatment

Treating plantar fasciitis in the early stages usually allows for a quicker recovery. Left untreated, this condition can progress to the point where there is pain with each and every step. This typically means a return to a pain free day will take much longer. Initial treatments are aimed at reducing stress on the fascia so it can begin to heal. Also, treatment to reduce the associated inflammation is started. These treatments often include: ice therapy, anti-inflammatory medications, stretching exercises, wearing shoes with appropriate support, taping of the foot and the use of a night splint. If these interventions do not lead to a full resolution, custom shoe inserts, cortisone injections and additional treatment by a physical therapist are often utilized. For patients that fail to respond to all of these efforts, surgical release of the plantar fascia can be a very effective course of action. The good news is this: 95% of the time plantar fasciitis can be fully resolved without the need for surgery. High energy shock wave therapy, sometimes referred to as orthotripsy, is a relatively new treatment that has been shown to be effective 70% of the time in patients that continue to have pain despite extensive non-surgical treatment.

Surgical Treatment

At most 95% of heel pain can be treated without surgery. A very low percentage of people really need to have surgery on the heel. It is a biomechanical problem and it?s very imperative that you not only get evaluated, but receive care immediately. Having heel pain is like having a problem with your eyes; as you would get glasses to correct your eyes, you should look into orthotics to correct your foot. Orthotics are sort of like glasses for the feet. They correct and realign the foot to put them into neutral or normal position to really prevent heel pain, and many other foot issues. Whether it be bunions, hammertoes, neuromas, or even ankle instability, a custom orthotic is something worth considering.

Where is a heel spur located?

Prevention

Painful Heel

Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.

Leg Length Discrepancy Symptoms Running

July 2, 2017
Overview

Surgical lengthening of the shorter extremity (upper or lower) is another treatment option. The bone is lengthened by surgically applying an external fixator to the extremity in the operating room. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins or both. A small crack is made in the bone and tension is created by the frame when it is "distracted" by the patient or family member who turns an affixed dial several times daily. The lengthening process begins approximately five to ten days after surgery. The bone may lengthen one millimeter per day, or approximately one inch per month. Lengthening may be slower in adults overall and in a bone that has been previously injured or undergone prior surgery. Bones in patients with potential blood vessel abnormalities (i.e., cigarette smokers) may also lengthen more slowly. The external fixator is worn until the bone is strong enough to support the patient safely, approximately three months per inch of lengthening. This may vary, however, due to factors such as age, health, smoking, participation in rehabilitation, etc. Risks of this procedure include infection at the site of wires and pins, stiffness of the adjacent joints and slight over or under correction of the bone?s length. Lengthening requires regular follow up visits to the physician?s office, meticulous hygiene of the pins and wires, diligent adjustment of the frame several times daily and rehabilitation as prescribed by your physician.Leg Length Discrepancy

Causes

Leg discrepancy can develop from a medical issue in any portion of the femur or tibia. One leg may lengthen, but leg shortening is much more common. Factors that can cause leg length discrepancy include inherited growth deficiencies. Infections. A bone infection can cause delayed growth in the affected limb. Injury. If your child breaks a leg, it may be shorter once it heals. This is most likely to happen if the fracture or break was complicated, an open fracture, or an injury that affected the growth plate near the end of the bone. Alternatively, a break can cause bones to grow faster after healing, making a leg longer. Tumors. Legg-Calve-Perthes disease. This is a condition that affects the ball (femoral head) of the hip joint. The femoral head may be friable and damage easily, sometimes leading to shortening of the thigh bone. Hemihypertrophy. In children with this condition, one side of the body grows more quickly than the other. Vascular malformations. These are abnormal clusters of veins and arteries that can form close to the bone and stimulate growth. Juvenile arthritis. Inflammation from arthritis can stimulate growth in the affected leg and cause discrepancy.

Symptoms

As patients develop LLD, they will naturally and even unknowingly attempt to compensate for the difference between their two legs by either bending the longer leg excessively or standing on the toes of the short leg. When walking, they are forced to step down on one side and thrust upwards on the other side, which leads to a gait pattern with an abnormal up and down motion. For many patients, especially adolescents, the appearance of their gait may be more personally troublesome than any symptoms that arise or any true functional deficiency. Over time, standing on one's toes can create a contracture at the ankle, in which the calf muscle becomes abnormally contracted, a condition that can help an LLD patient with walking, but may later require surgical repair. If substantial enough, LLD left untreated can contribute to other serious orthopaedic problems, such as degenerative arthritis, scoliosis, or lower back pain. However, with proper treatment, children with leg length discrepancy generally do quite well, without lingering functional or cosmetic deficiencies.

Diagnosis

On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD. The LLD should be measured using bony fixed points. X-Ray should be taken in a standing position. The osteopath, physiotherapist or chiropractor will look at femoral head & acetabulum, knee joints, ankle joints.

Non Surgical Treatment

A properly made foot orthotic can go a long way in substituting additional millimeters or centimeter on the deficient side. Additional full length inserts are added to the shorter side bringing the runner closer to symmetrical. Heel lifts do not work in runners because when you run you may land on your heel but the rest of the time you are on your forefoot then your toes pushing off. The right custom-made, biomechanical orthotic can address the underlying cause of your pain. Abnormal joint position, overpronation or foot rigidity can be addressed and the biomechanics normalized. San Diego Running Institute orthotics are custom molded to your foot and are designed with your specific body weight, leg length discrepancy, and activity in mind. The restoration of correct mechanical function takes the abnormal stress from the uneven side and allows the body to heal naturally.

LLD Insoles

how do you get taller?

Surgical Treatment

In growing children, legs can be made equal or nearly equal in length with a relatively simple surgical procedure. This procedure slows down the growth of the longer leg at one or two growth sites. Your physician can tell you how much equalization can be gained by this procedure. The procedure is performed under X-ray control through very small incisions in the knee area. This procedure will not cause an immediate correction in length. Instead, the limb length discrepancy will gradually decrease as the opposite extremity continues to grow and "catch up." Timing of the procedure is critical. The goal is to reach equal leg length by the time growth normally ends. This is usually in the mid-to-late teenage years. Disadvantages of this option include the possibility of slight over-correction or under-correction of the limb length discrepancy. In addition, the patient's adult height will be less than if the shorter leg had been lengthened. Correction of significant limb length discrepancy by this method may make a patient's body look slightly disproportionate because of the shorter leg. In some cases the longer leg can be shortened, but a major shortening may weaken the muscles of the leg. In the thighbone (femur), a maximum of 3 inches can be shortened. In the shinbone, a maximum of 2 inches can be shortened.

Mortons Neuroma Remedies

May 31, 2017
Overview

MortonMorton's neuroma is a swollen or thickened nerve in the ball of your foot. When your toes are squeezed together too often and for too long, the nerve that runs between your toes can swell and get thicker. This swelling can make it painful when you walk on that foot. High-heeled, tight, or narrow shoes can make pain worse. Sometimes, changing to shoes that give your toes more room can help.

Causes

Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the nerve running between the metatarsal heads. This chronic pinching can make the nerve sheath enlarge. As it enlarges it than becomes more squeezed and increasingly troublesome. Tight shoes, shoes with little room for the forefoot, pointy toeboxes can all make this problem more painful. Walking barefoot may also be painful, since the foot may be functioning in an over-pronated position.

Symptoms

The primary symptoms include sharp, shooting pain, numbness or paresthesia in the forefoot and extending distally into the toes, typically in the region of the third and fourth toes. Symptoms are aggravated with narrow toe box shoes or those with high heels. There is usually a reduction of symptoms when walking barefoot or wearing shoes with an appropriately wide toe box. Symptoms are also aggravated with shoes that are tied too tight.

Diagnosis

Podiatrists conduct a physical examination and may order imaging tests, such as x-ray or MRI scan to diagnose Morton's neuroma. Conservative treatment options include custom-fitted orthotics, medication, and/or alcohol injections designed to harden the nerve. However, most patients with Morton's neuroma need minor surgery.

Non Surgical Treatment

Depending on your overall health, symptoms and severity of the neuroma, the condition may be treated conservatively and/or with surgery. Non-surgical methods for neuroma are aimed at decreasing and/or eliminating symptoms (pain). Wear proper supportive shoes. Use an arch support. Wear shoes with a wide toe box. Modify your activities. Lose weight. Wear shoes with cushion. Prescribe an oral anti-inflammatory medication. Anti-inflammatory medication is useful to significantly reduce pain and inflammation. A physical therapist may perform ultrasound and other techniques to reduce inflammation. You will also be instructed how to stretch your foot and leg properly. Padding and/or cushioning of the ball of the foot is an effective method of preventing physical irritation with shoes. A custom foot orthotic is a doctor prescribed arch support that is made directly from a casting (mold) of your feet, and theoretically should provide superior support compared to shoe insert that you would purchase from a pharmacy. A cortisone injection is a powerful anti-inflammatory medication that is used to rapidly reduce the pain associated with an inflamed nerve. The pain relief that you may experience from the injection(s) is often temporary. Typically injection(s) are administered once every 2 months for a total of 3 injections or until the pain is resolved. A sclerosing alcohol injection is placed around the involved nerve to weaken its capacity to report pain. In other words, the alcohol injection will ?deaden? the affected nerve. The pain relief that you may experience from the injection(s) can be permanent. Typically injection(s) are administered once every week for a few weeks until the pain is resolved.Morton

Surgical Treatment

Surgical treatment has provided relief in some cases while poor results and surgical complications have resulted in other cases. It is believed that ligament weakness, as opposed to the pinching of nerves in the foot, may be to blame for recurrent pain in these situations. For reasons which are not fully understood, the incidence of Morton?s Neuroma is 8 to 10 times greater in women than in men.

Does A Calcaneal Spur Cause Pain?

September 27, 2015
Heel Spur

Overview

A heel spur is a painful condition that is caused by the accumulation of excessive calcium under the heel of the foot. The heel bone is made up of a large structure called the calcaneus, which is connected to the bottom of the foot by durable connective tissue called fascia. If the layers of connective tissue become damaged or begin to degenerate due to wear and tear, plantar fasciitis may develop. This causes calcification, which refers to the abnormal buildup of calcium on the heel bone. As the calcium continues to accumulate, a calcified protrusion called a spur may become visible on an X-ray.

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.

Posterior Calcaneal Spur

Symptoms

The pain caused by a calcaneal spur is not the result of the pressure of weight on the point of the spur, but results from inflammation around the tendons where they attach to the heel bone. You might expect the pain to increase as you walk on the spur, but actually it decreases. The pain is most severe when you start to walk after a rest. The nerves and capillaries adapt themselves to the situation as you walk. When you rest, the nerves and capillaries rest, also. Then, as you begin to move about again, extreme demands are made on the blood vessels and nerves, which will cause pain until they again adjust to the spur. If excessive strain has been placed on the foot the day before, the pain may also be greater. A sudden strain, as might be produced by leaping or jumping, can also increase the pain. The pain might be localized at first, but continued walking and standing will soon cause the entire heel to become tender and painful.

Diagnosis

A Diagnosis of Heel Spur Syndrome is a very common reason for having heel pain. Heel pain may be due to other types of conditions such as tendonitis, Haglund's Deformity, Stress Fracture, Tarsal Tunnel Syndrome, or low back problems. A more common condition in children is Sever's Disease. The diagnosis is usually made with a combination of x-ray examination and symptoms.

Non Surgical Treatment

Rest won?t help you in case of pain from the heel spur. When you get up after sleeping for some time, the pain may get worse. The pain worsens after a period of rest. You will feel pain because the plantar fascia elongates during working which stresses the heel. It is important to see a doctor if you are having consistent pain in you heel. The doctors may advise few or all of the conservative treatments, stretching exercises, shoe recommendations, shoe inserts or orthotic devices, physical therapy, taping or strapping to rest stressed muscles and tendons. There are some over-the-counter medicines available for treatment of heel pain. Acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve) are some such medicines which can help you to get relief from the pain. In case of biomechanical imbalances causing the pain, a functional orthotic device can help you to get relief. Your doctor may also advise a corticosteroid injection for eliminating the inflammation.

Surgical Treatment

Surgery, which is a more radical treatment, can be a permanent correction to remove the spur itself. If your doctor believes that surgery is indicated, he will recommend an operation - but only after establishing that less drastic methods of treatment are not successful.

Does A Inferior Calcaneal Spur Hurt?

September 27, 2015
Calcaneal Spur

Overview

A bone spur (osteophyte) is a bony growth that forms along the edge of normal bone in response to wear and tear, most frequently in the joints. A heel spur is a bone spur of the heel bone, which causes heel pain by rubbing on the achilles tendon or other soft tissues.

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.

Posterior Calcaneal Spur

Symptoms

Most people think that a bone "spur" is sharp and produces pain by pressing on tissue, when in fact, these bony growths are usually smooth and flat. Although they rarely cause pain on their own, bone spurs in the feet can lead to callus formation as tissue builds up to provide added cushion over the area of stress. Over time, wear and tear on joints may cause these spurs to compress neighboring ligaments, tendons or nerves, thus injuring tissue and causing swelling, pain and tearing.

Diagnosis

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

Non Surgical Treatment

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

Surgical Treatment

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

Avoiding Calcaneal Spur

September 27, 2015
Calcaneal Spur

Overview

Heel Spurs are deposits of calcium in the heel area of the foot that are the typically the result of tension, abrasion and/or inflammation in the plantar fascia attachment to the heel. The heel spur itself is said not to be painful. The pain likely arises from the inflammation of the plantar fascia. The plantar fascia encapsulates muscles in the sole of the foot. It supports the arch of the foot by acting as a bowstring to connect the ball of the foot to the heel. Common causes of heel spurs include excessive load on the foot from obesity or a sudden increase in weight, a sudden increase in walking or sports activities.

Causes

One frequent cause of heel spurs is an abnormal motion and mal-alignment of the foot called pronation. For the foot to function properly, a certain degree of pronation is required. This motion is defined as an inward action of the foot, with dropping of the inside arch as one plants the heel and advances the weight distribution to the toes during walking. When foot pronation becomes extreme from the foot turning in and dropping beyond the normal limit, a condition known as excessive pronation creates a mechanical problem in the foot. In some cases the sole or bottom of the foot flattens and becomes unstable because of this excess pronation, especially during critical times of walking and athletic activities. The portion of the plantar fascia attached into the heel bone or calcaneous begins to stretch and pull away from the heel bone.

Inferior Calcaneal Spur

Symptoms

Some symptoms at the beginning of this condition include pain and swelling, and discomfort when pushing off with the toes during walking. This movement of the foot stretches the fascia that is already irritated and inflamed. If this condition is not treated, pain will be noticed in the heel when a heel spur develops in response to the stress. This is a common condition among athletes and others who run and jump a significant amount.

Diagnosis

Heel spurs and plantar fasciitis are diagnosed based on the history of pain and tenderness localized to these areas. They are specifically identified when there is point tenderness at the bottom of the heel, which makes it difficult to walk barefoot on tile or wood floors. X-ray examination of the foot is used to identify the bony prominence (spur) of the heel bone (calcaneus).

Non Surgical Treatment

The key is to identify what is causing excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support will help reduce the over-pronation and thus allow the condition to heal. Other common treatments for heel spurs include Stretching exercises. Losing weight. Wearing shoes that have a cushioned heel that absorbs shock. Elevating the heel with the use of a heel cradle, heel cup, or orthotics. For example, heel cradles and heel cups provide extra comfort and cushion to the heel, reducing the amount of shock and shear forces experienced from everyday activities.

Surgical Treatment

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

Best Solution For Bursitis Of The Foot

August 28, 2015
Overview

There are about 160 bursae in the human body. These little, fluid-filled sacs cushion pressure and lubricate points between our bones, tendons, and muscles near our joints. The bursae are lined with synovial cells. Synovial cells produce a lubricant that reduces friction. This cushioning and lubrication allows our joints to move easily. When a person has bursitis, inflammation of the bursa, movement or pressure is painful. Overuse, injury and sometimes an infection from gout or rheumatoid arthritis may cause bursitis.

Causes

Feet are extremely resilient and are designed to stand up to the pressures of day-to-day living. In some cases, though, foot structures may break down when subjected to chronic stress associated with long periods of weight-bearing activity on concrete, asphalt, or other hard surfaces (especially when footwear does not allow for proper weight distribution). Foot problems, including infracalcaneal bursitis, are often made worse by poorly designed footwear, and pressure, impact, and shear forces can damage the feet over time. Bursal sacs are intended to minimize this damage, but sometimes the bursa itself becomes inflamed. A rapid increase in physical activity levels or thinning of the heel?s protective fat pad are factors that may contribute to infracalcaneal bursitis. Other possible causes of infracalcaneal bursitis include blunt force trauma. Arthritic conditions. Acute or chronic infection. The following factors may increase a person?s risk of bursitis, including infracalcaneal bursitis. Poor conditioning. Exposure to cold weather. Participating in contact sports. Having a previous history of bursitis in any joint. Heel striking when running, especially in conventional running shoes with heel elevation.

Symptoms

You might have Retrocalcaneal Bursitis if you notice any of the following symptoms. You have pain or tenderness at the back of the heel where the Achille's tendon attaches. Have swelling near the attachment of the tendon to the heel bone. You have noticed a slowly growing bump on the back of the heel. The back of the heel turns red after getting rubbed in shoes. The back of the heel hurts worse when you run, walk up hill or wear high heels.

Diagnosis

Medical examination is not necessarily required in light cases where the tenderness is minimal. In all cases where smooth improvement is not experienced, medical attention should be sought as soon as possible to exclude a (partial) rupture of the Achilles tendon or rupture of the soleus muscle. This situation is best determined by use of ultrasound scanning, as a number of injuries requiring treatment can easily be overlooked during a clinical examination (Ultrasonic image). Ultrasound scanning enables an evaluation of the extent of the change in the tendon, inflammation of the tendon (tendinitis), development of cicatricial tissue (tendinosis), calcification, inflammation of the tissue surrounding the tendon (peritendinitis), inflammation of the bursa (bursitis), as well as (partial) rupture.

Non Surgical Treatment

All types of bursitis often can be successfully managed non-surgically, and possible treatments include use of ice packs or compressive dressings, activity modification that may reduce stress or irritation, administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics, corticosteroid injections (knee and elbow), stretching exercises, and/or change of footwear (heel). Surgery may be required in patients whose symptoms remain following these treatments and in certain situations when infection is involved.

Surgical Treatment

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

Prevention

Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.

Bursa Foot Signs Or Symptoms

August 26, 2015
Overview

Achilles tendon bursitis, or retrocalcaneal bursitis, can affect anyone, but is typically a foot condition in athletes, especially runners. Because of similar symptoms, this condition is often confused with Achilles tendinitis. At times, bursitis of the Achilles tendon can occur in conjunction with Achilles tendinitis. When both conditions are present, it is referred to as Haglund's syndrome. If you are a runner and are experiencing pain in your lower leg and heel area, you may be suffering from Achilles tendon bursitis. Proper treatment of the condition can help relieve the pain and allow your leg to heal.

Causes

Bursitis has many causes, including autoimmune disorders, crystal deposition (gout and pseudogout), infectious diseases, traumatic events, and hemorrhagic disorders, as well as being secondary to overuse. Repetitive injury within the bursa results in local vasodilatation and increased vascular permeability, which stimulate the inflammatory cascade.

Symptoms

Below is a list of common signs and symptoms of retrocalcaneal bursitis. Recognizing and treating symptoms early can prevent retrocalcaneal bursitis from becoming chronic. Swelling. The retrocalcaneal bursa is located behind the Achilles tendon, just above where the tendon attaches to the heel bone. When the bursa is inflamed it will cause visible soft tissue swelling near the top of the heel bone. It is worth noting that bursitis of the retroachilles bursa, which is located between the Achilles tendon and skin, can manifest slightly differently: swelling may be more distinct, appearing as a hard lump behind the heel. Retroachilles bursitis is also more likely than retrocalcaneal bursitis to cause the skin at the back of the heel to turn red.

Diagnosis

Your doctor will examine you, including an evaluation of your gait, while you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk. An examination of your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.

Non Surgical Treatment

Specific treatment for bursitis will be determined by your doctor based on your age, overall health, and medical history. Extent of the condition. Your tolerance for specific medications, procedures, or therapies. Expectations for the course of the condition. Your opinion or preference. The treatment of any bursitis depends on whether or not it involves infection. Aseptic bursitis. A noninfectious condition caused by inflammation resulting from local soft-tissue trauma or strain injury. Treatment may include R.I.C.E. Rest, Ice, Compression, and Elevation. Anti-inflammatory and pain medications, such as ibuprofen or aspirin. Aspiration of the bursa fluid for evaluation in the laboratory. Injection of cortisone into the affected area. Rest. Splints.

Prevention

Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.

Hammertoe Surgery

July 2, 2015
HammertoeOverview

A hammertoe is a contracture, or bending, of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammer toes are more common Hammer toe in females than males.

Causes

Hammer toes are most frequently caused by a muscle - tendon imbalance in the foot, and are seen both in adults and children. Foot muscles work in pairs to straighten and bend the toes. If your foot has a biomechanical defect, the muscles tighten and the tendons shorten. Eventually, the toe muscles can?t straighten the toe, even when barefoot. Contributing factors are poor choices in footwear, arthritis, or trauma.

Hammer ToeSymptoms

A hammertoe may be present but not always painful unless irritated by shoes. One may have enlarged toe joints with some thickened skin and no redness or swelling. However, if shoes create pressure on the joint, the pain will usually range from pinching and squeezing to sharp and burning. In long standing conditions, the dislocated joints can cause the pain of arthritis.

Diagnosis

Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

Non Surgical Treatment

You can usually use over-the-counter cushions, pads, or medications to treat bunions and corns. However, if they are painful or if they have caused your toes to become deformed, your doctor may opt to surgically remove them. If you have blisters on your toes, do not pop them. Popping blisters can cause pain and infection. Use over-the-counter creams and cushions to relieve pain and keep blisters from rubbing against the inside of your shoes. Gently stretching your toes can also help relieve pain and reposition the affected toe.

Surgical Treatment

Surgery to correct for a hammertoe may be performed as a day procedure. There are several different types of procedures that can be used depending on the foot structure and if the deformity is flexible or rigid.

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