Calcaneal Spur, Heel Spur, Inferior Calcaneal Spur, Posterior Calcaneal Spur

The Right Way To Prevent Heel Spur

Inferior Calcaneal Spur

Overview

A heel spur also known as a calcaneal spur, is a pointed bony outgrowth of the heel bone (calcaneus). Heel spurs do not always cause pain and often are discovered incidentally on X-rays taken for other problems. Heel spurs can occur at the back of the heel and also under the heel bone on the sole of the foot, where they may be associated with the painful foot condition plantar fasciitis.

Causes

A heel spur is a bony overgrowth on the bottom of your heel bone. The heel spur is usually a result of an inflamed ligament (plantar fascia) on the bottom of the foot that attaches to the heel bone. Constant abnormal pulling of this ligament irritates the heel bone and the body lays down a bone spur as a protective mechanism. The patient usually complains of pain with the first step in the morning, some relief following activity, but returning after extended amounts of time standing or walking.

Calcaneal Spur

Symptoms

Heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain. Your heel pain may be worse in the morning when you first wake up or during certain activities.

Diagnosis

Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts. X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.

Non Surgical Treatment

Many treatment options exist, and good results are often observed. Generally, a calcaneal spur develops when proper care is not given to the foot and heels. It is often seen as a repetitive stress injury, and thus lifestyle modification is typically the basic course of management strategies. To alleviate heel spur pain, a person should begin doing foot and calf workouts. Strong muscles in the calves and lower legs will help take the stress off the bone and thus help cure or prevent heel spurs. Icing the area is an effective way to get immediate pain relief.

Surgical Treatment

More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it’s important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don’t underestimate your body’s need for rest and good nutrition. If obese, lose weight.

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Calcaneal Spur, Heel Spur, Inferior Calcaneal Spur, Posterior Calcaneal Spur

What Is The Most Effective Solution For Heel Spur

Inferior Calcaneal Spur

Overview

Heel spur (Calcaneal spur) is a bonny outgrowth of the heel bone which is pointy in shape. It?s a calcium deposit that happens under the heel bone. In some cases, the protrusion due to heel spur can extend up to half inch and can be seen in X rays. Generally it is painless but sometimes it may result in heel pain. Heel spur that occur under the sole of the foot or the planter area is associated with plantar fasciitis. That is frequently associated with plantar fasciitis as they have many similarities.

Causes

Heel spurs form in some patients who have plantar fasciitis (PLAN-tar fash-ee-I-tis), and tend to occur in patients who have had the problem for a prolonged period of time. While about 70 percent of patients with plantar fasciitis have a heel spur, X-rays also show about 50 percent of patients with no symptoms of plantar fasciitis also have a heel spur.

Posterior Calcaneal Spur

Symptoms

Heel spurs often do not show any symptoms. If you have intermittent or chronic pain when you walk, run or jog, it may be heel spur. There will be inflammation the point where spur formation happens. The pain is caused by soft tissue injury in the heel. Patients often describe the pain as a pin or knife sticking to the heel. The pain is more specially in the morning when the patient stands up for the first time.

Diagnosis

Your doctor will review your medical history and examine your foot. X-rays are used to identify the location and size of the heel spur.

Non Surgical Treatment

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

Surgical Treatment

Surgery is used a very small percentage of the time. It is usually considered after trying non-surgical treatments for at least a year. Plantar fascia release surgery is use to relax the plantar fascia. This surgery is commonly paired with tarsal tunnel release surgery. Surgery is successful for the majority of people.

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Bursitis, Foot Pain

Bursitis Of The Feet Bursal Cyst

Overview

Bursitis is the inflammation of the small fluid-filled pads, or bursae, that act as cushions among your bones and the tendons and muscles near your joints. Bursitis occurs when the bursa become inflamed, and often occurs in joints that perform frequent and repetitive motion. The foot only contains one naturally occurring bursal sac between the Achilles tendon and the heel bone, which protects the Achilles from the pressure against the heel bone during ambulation. However, shoes may put pressure on this bursa. The bursa might also incur trauma from walking on hard ground. And, though they are not naturally occurring, bursa sacs can also form, and become inflamed, in other parts of the foot, including the bottom of the heel, and the metatarsal plate, the outside of the foot below the fifth toe, and so on.

Causes

The swelling is the result of the blockage of blood, tissue fluids and circulation in the heel because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating, blood and fluids back up behind the injured heel, causing pain, inflammation, lumps and swelling.

Symptoms

Where the tendon joins the calcaneal bone, friction can cause the spaces between the tendon, bone and skin to swell and inflame with bursitis. This constitutes a calcaneal bursa. Apart from swelling over the back of the heel, you?ll feel acute tenderness and pain when you move it or even apply light pressure. Your swollen heel may look more red than the other one, and the swelling is often so hard it can feel like bone, partly because it sometimes is, as a bony overgrowth can occur in chronic cases.

Diagnosis

Magnetic resonance imaging (MRI) may demonstrate bursal inflammation, but this modality probably does not offer much more information than that found by careful physical examination. Theoretically, MRI could help the physician to determine whether the inflammation is within the subcutaneous bursa, the subtendinous bursa, or even within the tendon itself, however, such testing is generally not necessary. Ultrasonography may be a potentially useful tool for diagnosing pathologies of the Achilles tendon.

Non Surgical Treatment

In addition to R.I.C.E., there are a number of other treatments to reduce swelling and any associated pain or discomfort due to heel bursitis. Orthotics or change of footwear. Wearing an orthotic device such as a heel insert can encourage better mechanics in the foot and reduce irritation of the retrocalcaneal bursa. Some people do not need special orthotics but simply need to stop wearing shoes with rigid heel and ankle construction and instead wear more supportive, comfortable shoes. Shoes with an “Achilles notch,” a groove in the collar at the back of the shoe to protect the Achilles tendon, can be particularly helpful. (Almost all running shoes are designed with an Achilles notch.) Stretching and physical therapy. Stretching the Achilles tendon often helps alleviate pain. Once the pain is resolved it is important for the patient to continue a regular stretching program. Regular stretching reduces the chance of recurrence.

Surgical Treatment

Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.

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Hammer Toes

Can Hammer Toes Lead To Foot Tingling

HammertoeOverview

Hammertoes are another forefoot deformity that can take a walker out of their activity. A hammertoe generally represent a tendon imbalance in the toes caused by one of the toe tendons getting an advantage over another toe tendon. Most commonly, it is one or all of the long extensor tendons on the top of the foot that gets an advantage over one or all of the flexor tendons on the bottom of the foot, to cause the first joint in the toe to be elevated above the ground. Most shoe wearing people chronically alter the delicate balance that co-exists amongst the toe tendons whether they know it or not.

Causes

Many people develop hammertoe because they wear shoes that are too tight. Shoes with narrow toe boxes squeeze the toes together, forcing some to bend. This causes the toe muscles to contract. If the toes are forced into this cramped position too often, the muscles may permanently tighten, preventing the toes from extending. Chronic hammertoe can also cause the long bones that connect the toes to the foot, called metatarsals, to move out of position. The misaligned metatarsal bones may pinch a nerve running between them, which can cause a type of nerve irritation called a neuroma.

Hammer ToeSymptoms

Hammer, claw, and mallet toes can cause discomfort and pain and may make it hard to walk. Shoes may rub on your toes, causing pain, blisters, calluses or corns, or sores. Sores can become infected and lead to cellulitis or osteomyelitis, especially if you have diabetes or peripheral arterial disease. If you have one of these health problems and sores develop, contact your doctor.

Diagnosis

First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.

Non Surgical Treatment

A number of approaches can be undertaken to the manage a hammer toe. It is important that any footwear advice is followed. The correct amount of space in the toe box will allow room for the toes to function without excessive pressure. If a corn is present, this will need to be treated. If the toe is still flexible, it may be possible to use splints or tape to try and correct the toe. Without correct fitting footwear, this is often unsuccessful. Padding is often used to get pressure off the toe to help the symptoms. If conservative treatment is unsuccessful at helping the symptoms, surgery is often a good option.

Surgical Treatment

If pinning the toe is not required during the procedure, then the surgery could be preformed in the doctor’s office under a local anesthesia. Some patients prefer the comfort of sedation during the surgery and if this is the case or if a pin must be placed, then Hammer toes the surgery could be preformed in an outpatient surgery center.

HammertoePrevention

In some cases foot problems may present at birth, many foot problems such as hammer toes can be prevented. Hammer toe prevention can be a simple process, such as, checking your feet regularly and wearing the right shoes for your feet. Good circulation is also an essential part of foot health and hammer toe prevention. Taking a warm foot bath or giving yourself a foot massage are great ways of keeping your feet healthy.

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Arch Pain

Pain In The Foot’s Arch All You Want To Know

Overview
Arch pain is commonly experienced by middle aged women who’s feet have a tendency to overpronate or roll in. It is also commonly associated with bunions and hammer toe. The plantar plate is a thick ligament type structure with attachments which inserts into the base of our phalanges (toe bones) in the area of the ball of the foot. The plantar plate is designed to protect the head of the metatarsal from pressure and prevent over extension of our toes preventing our toes from spreading or splaying.
Arch Pain

Causes
Conditions that affect the nervous system (brain and spinal cord) can also cause the arches to fall. Over time, the muscles gradually become stiffer and weaker and lose their flexibility. Conditions where this can occur include cerebral palsy, spina bifida and muscular dystrophy. Adult-acquired flat feet often affect women over 40 years of age. It often goes undiagnosed and develops when the tendon that supports the foot arch gradually stretches over time. It’s not fully understood what causes the tendon to become stretched, but some experts believe that wearing high heels and standing or walking for long periods may play a part. Obesity, high blood pressure (hypertension) and diabetes are all risk factors.

Symptoms
Symptoms of plantar fasciitis may occur anywhere along the arch, but it is most common near its attachment to the heel bone. Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest–when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. This is known as “post-static dyskinesia.” The pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you’re on the foot. Fasciitis can be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, and by being overweight. Other factors which influence this condition are gender (females get this more than men), age (30s to 50s are most common), and those with flatter-than-normal feet. It doesn’t help that fascia doesn’t heal particularly quickly. This is because it has relatively poor circulation, which is why it’s white in colour.

Diagnosis
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.

Non Surgical Treatment
If it is flat feet, then you’d seek professional advice and maybe need orthotics, or arch supports to prevent the pressures and to stop the pain. One of the other reasons you can get pain in this area of the foot is plantar fasciitis. The plantar fascia is a membrane that is inside of the skin and attaches to the heel bone here. It divides into three bands that go out of the foot here: the outer band, the central band, and the medial band here. Often, from impact, you get an inflammation of that attachment to the heel bone and this can often spread up the medial band and this is another way of getting pain in that arch. Now, the way to treat that is also using arch supports but also heel cushions, better soled shoes to prevent the pressure. These things normally disappear after a year, 18 months. Plantar fasciitis is easier to treat because it’s not a long term problem. If you do need arch support, something like this would be very good for both problems.
Foot Arch Pain

Surgical Treatment
Surgical advances have dramatically improved the ability to alleviate the pain and decreased function that millions of Americans experience due to flat feet. Nevertheless, many patients and even some physicians remain unaware of the new procedures, which are best performed by a foot and ankle specialist who has the applicable training and experience.

Prevention
So how do you prevent plantar fasciitis? Factors which can be controlled include training progression, environmental factors, shoes, and strength and flexibility exercises. A useful guideline for a safe training progression is ?the 10% rule.? Limit increases in distance or intensity to 10% a week. For example, if a person is running 60 minutes at a session, 4 times a week, or 240 minutes, she or he can probably increase the running time to 264 minutes (240 + 10%), the following week if all else remains the same. Terrain is also an important factor in training. Running 30 minutes on hills is very different from running 30 minutes on flat surfaces in terms of the forces on the legs and feet. Work up gradually to increase your running time on hills. Also lean forward when running downhill. If you run on a banked or crowned surface, vary the direction you run in so you alternate which leg is higher and which leg is lower on the bank. If you know concrete or asphalt is causing you discomfort, try running on a cinder or composite track. If you are going on vacation and are not used to running on sand or grass, don?t spend your whole vacation doing it.

Stretching Exercises
Gastroc stretch. Stand on the edge of a step. Rise slowly on your toes. Lower yourself slowly as far as you can until you feel a stretch in your calf. Don?t roll your foot inward or outward. Hold for 1-2 seconds. Reps:10-20 (stop before you fatigue). Soleus stretch. Same as above, but start with your knee bent so that you feel a slight stretch in your calf or achilles. Maintain the angle of your knee throughout the stretch. Bicycle stretch. Lie on your side. Keeping your top leg straight, bring your knee toward your nose until you feel a slight stretch in the hamstring. Maintaining this angle at your hip, start pretending you are pedalling a bicycle with the top leg. Make sure you feel a slight stretch each time your knee is straight. Reps: 10-30 for each leg. If you feel any pops or clicks in your hip or back, try raising the top leg a little (making the thighs further apart) to eliminate the popping. Foot Intrinsic Exercises. Assisted metatarsal head raising. Sit in a chair. Find the bumps at the ball of your foot just before your big toe and just before the little toe. These are the first (big toe) and fifth (little toe) metatarsal heads. Place your second and third fingers from one hand under the first metatarsal head, and the second and third fingers from the other hand under the fifth metatarsal head. Now lay the thumbs from each hand in a diagonal across your toes so that they form a right angle meeting at the nail of the second toe. Your hands are now in position to assist your toes. Keep your toes straight, with the toe pads on the floor. Use your fingers to help raise all the metatarsal heads (the ball of your foot). Do not let your toes curl under keep them long. Now relax. Reps 7-10 for each foot. As this exercise gets easier, let your fingers do less of the work until your toes can do the exercise unassisted. This can take up to three weeks. When your strength has improved to this point, you can progress to the following three exercises, which are best done in stocking feet on a slippery floor. Active metatarsal head raising. Stand with your weight on both feet. Raise your metatarsal heads (the ball of your foot) while keeping your toes from curling under and maintaining your heel on the ground. Relax. Reps 6-7. Do one foot at a time. If you do more reps than you are ready for, you may well develop cramping in your foot. I once had a client who thought if seven reps were good, 10 were better. For good measure, she did the 10 reps 10 times in a day, and then she was unable to walk the next day from having used a set of muscles she had never exercised before. Don?t overdo it.

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Overpronation Of The Foot

Understand More About Overpronation

Overview

The majority of the population have a normal to low arch. Even though the arches appear to be normal most of us suffer from over-pronation during walking, running and standing, due to the hard, flat unnatural surfaces we walk on, combined with wearing unsupportive footwear. With every step we take the arches flatten and the ankles roll inwards. Pronation itself is not wrong because we need to pronate and supinate as part of our natural gait cycle. Pronation (rolling in) acts as a shock-absorbing mechanism and supination (rolling out) helps to propel our feet forward. Over-pronation occurs when the foot pronates too deep and for too long, not allowing the foot to ‘recover’ and supinate. Over-pronation hampers our natural walking pattern. It causes an imbalance and leads to wear and tear in several parts of the body with every step we take.Foot Pronation

Causes

There has been some speculation as to whether arch height has an effect on pronation. After conducting a study at the Rose-Hulman Institute of Technology, Maggie Boozer suggests that people with higher arches tend to pronate to a greater degree. However, the generally accepted view by professionals is that the most pronation is present in those with lower arch heights. To complicate matters, one study done by Hylton Menz at the University of Western Sydney-Macarthur suggests that the methods for measuring arch height and determining whether someone is ?flat-footed? or ?high-arched? are unreliable. He says, ?For this reason, studies investigating the relationship between static arch height motion of the rearfoot have consistently found that such a classification system is a poor predictor of dynamic rearfoot function.

Symptoms

Common conditions seen with overpronation include heel pain or plantar fasciitis. Achilles tendonopathy. Hallus Valgus and/or bunions. Patellofemoral pain syndrome. Iliotibial band pain syndrome. Low back pain. Shin splints. Stress fractures in the foot or lower leg.

Diagnosis

One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).Pronation

Non Surgical Treatment

An orthotic is a device inserted inside the shoe to assist in prevention and/or rehabilitation of injury. Orthotics support the arch, prevent or correct functional deformities, and improve biomechanics. Prescription foot orthoses are foot orthoses which are fabricated utilizing a three dimensional representation of the plantar foot and are specifically constructed for an individual using both weightbearing and nonweightbearing measurement parameters and using the observation of the foot and lower extremity functioning during weightbearing activities. Non-prescription foot orthoses are foot which are fabricated in average sizes and shapes in an attempt to match the most prevalent sizes and shapes of feet within the population without utilizing a three dimensional representation of the plantar foot of the individual receiving the orthosis.

Surgical Treatment

Calcaneal “Slide” (Sliding Calcaneal Osteotomy) A wedge is cut into the heel bone (calcaneus) and a fixation device (screws, plate) is used to hold the bone in its new position. This is an aggressive option with a prolonged period of non-weightbearing, long recovery times and many potential complications. However, it can and has provided for successful patient outcomes.

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Severs Disease

Severs Disease Physical Therapy

Overview

Sever’s disease is a disorder of the growth plate of the calcaneus. Symptoms most often occur at the posterior (back of the heel) aspect of the growth plate but sometimes are experienced at the plantar aspect below the heel. The Achilles tendon attaches to the posterior aspect of the growth plate and the plantar fascia takes part of its origin from the plantar aspect. Sever?s disease occurs more often in boys than girls. The age of onset is usually between 8 to 12 years. Sever?s disease is believed to be caused by overuse. On x-ray the growth center first appears in girls between the ages of 4 to 6 years and boys aged 7 to 8 years. The centers fuse to the primary ossification center of the calcaneus in girls at approximately ages 12 to 14 on boys at ages 15 to 17.

Causes

The pain of Severs usually occurs because of inflammation and micro-trauma to the growth plate of the heel bone. This can be caused by a sudden increase in activity, running on very hard surfaces, a growth spurt, tight muscles or feet that roll in.

Symptoms

The most prominent symptom of Sever?s disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever?s disease is primarily clinical.

Diagnosis

Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.

Non Surgical Treatment

If your child is diagnosed with Sever’s disease, treatment is fairly straightforward. He or she should avoid any activities that cause a flare-up of heel pain. Treat the pain with ice for 20 minutes, three times a day. If the pain is severe, over-the-counter pain relievers such as acetaminophen or ibuprofen can be used for a short period of time. (Don’t use aspirin in a child or teen because it can result in a rare but life-threatening condition called Reye’s syndrome.) In some instances, a child might have other foot problems, as well, such as high arches, flat feet, or bowed legs. In these instances, your doctor can recommend an orthotic device to help further prevent the pain related to Sever’s disease. One other simple tip that can prevent Sever’s disease or speed along recovery is for your child to wear supportive shoes and avoid going barefoot as much as possible.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

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Adult Aquired Flat Foot

What Can cause Adult Aquired FlatFeet ?

Overview

Just as an old bridge would become unsafe as the structure was compromised, your feet can experience the same. If you have PTTD and the tendon continues to weaken, it simply won’t be able hold up your arch. In this situation, the arch can fall or collapse, which is referred to as adult-acquired flat foot. You may experience pain and tenderness behind the inside of the ankle. Over time, in addition to the flattening of the foot, you may also notice a misalignment of the heel so that it no longer aligns underneath the rest of the leg. A tightening of the heel cord, arthritis, and possible deformity of the ankle joint may also occur. You may feel the discomfort move from the inside to the outside of the ankle as well. Flat foot can also contribute to problems with the plantar fascia, which is the tendon that runs along the length of your arch.Adult Acquired Flat Foot


Causes

Women are affected by Adult Acquired Flatfoot four times more frequently than men. Adult Flatfoot generally occurs in middle to older age people. Most people who acquire the condition already have flat feet. One arch begins to flatten more, then pain and swelling develop on the inside of the ankle. This condition generally affects only one foot. It is unclear why women are affected more often than men. But factors that may increase your risk of Adult Flatfoot include diabetes, hypertension, and obesity.


Symptoms

Symptoms are minor and may go unnoticed, Pain dominates, rather than deformity. Minor swelling may be visible along the course of the tendon. Pain and swelling along the course of the tendon. Visible decrease in arch height. Aduction of the forefoot on rearfoot. Subluxed tali and navicular joints. Deformation at this point is still flexible. Considerable deformity and weakness. Significant pain. Arthritic changes in the tarsal joints. Deformation at this point is rigid.


Diagnosis

Observe forefoot to hindfoot alignment. Do this with the patient sitting and the heel in neutral, and also with the patient standing. I like to put blocks under the forefoot with the heel in neutral to see how much forefoot correction is necessary to help hold the hindfoot position. One last note is to check all joints for stiffness. In cases of prolonged PTTD or coalition, rigid deformity is present and one must carefully check the joints of the midfoot and hindfoot for stiffness and arthritis in the surgical pre-planning.


Non surgical Treatment

This condition may be treated with conservative methods. These can include orthotic devices, special shoes, and bracing. Physical therapy, rest, ice, and anti-inflammatory medication may be prescribed to help relieve symptoms. If the condition is very severe, surgical treatment may be needed.

Acquired Flat Foot


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. Symptomatic flexible flatfoot conditions are common entities in both the adolescent and adult populations. Ligamentous laxity and equinus play a significant role in most adolescent deformities. Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult acquired flatfoot. One should consider surgical treatment for patients who have failed nonoperative therapy and have advancing symptoms and deformities that significantly interfere with the functional demands of daily life. Isolated Joint Fusion. This technique is used for well reducible flat foot by limiting motion at one or two joints that are usually arthritic. The Evans Anterior Calcaneal Osteotomy. This is indicated for late stage II adult acquired flatfoot and the flexible adolescent flatfoot. This procedure will address midtarsal instability, restore the medial longitudinal arch and reduce mild hind foot valgus. The Posterior Calcaneal Displacement Osteotomy (PCDO). This technique is indicated for late stage I and early stage II PTTD with reducible Calcaneal valgus. This is often combined with a tendon transfer. A PCDO is also indicated as an adjunctive procedure in the surgical reconstruction of the severe flexible adolescent flatfoot. Soft tissue procedure. On their own these are not very effective but in conjunction with an osseous procedure, soft tissue procedures can produce good outcome. Common ones are tendon and capsular repair, tendon lengthening and transfer procedures. Flat foot correction requires lengthy post operative period and a lot of patience. Your foot may need surgery but you might simply not have the time or endurance to go through the rehab phase of this type of surgery. We will discuss these and type of procedures necessary for your surgery in length before we go further with any type of intervention.

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Achilles Tendon

What Leads To Achilles Tendonitis Pain ?

Overview

Achilles TendonAchilles tendinitis is an irritation/inflammation in the achilles tendon, which attaches to the back of the heel. It is often a result of overuse and occurs frequently in runners who have altered their training suddenly, either with regard to duration or intensity. This injury is also prevalent in middle-aged people who are active.

Causes

The Achilles tendon is a strong band of connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel, producing movement. The Achilles tendon moves through a protective sheath and is made up of thousands of tiny fibres. It is thought that Achilles tendonitis develops when overuse of the tendon causes the tiny fibres that make up the tendon to tear. This causes inflammation, pain and swelling. As the tendon swells it can begin to rub against the sheath surrounding it, irritating the sheath and causing it too to become inflamed and swollen. It has a poor blood supply, which can make it susceptible to injury and can make recovery from injury slow. Factors that can lead to the development of Achilles tendonitis include, tight or weak calf muscles, rapidly increasing the amount or intensity of exercise. Hill climbing or stair climbing exercises. Changes in footwear, particularly changing from wearing high-heeled shoes to wearing flat shoes. Wearing inadequate or inappropriate shoes for the sporting activity being undertaken. Not adequately warming up and stretching prior to exercise. A sudden sharp movement that causes the calf muscles to contract and the stress on the Achilles tendon to be increased. This can cause the tendon fibres to tear.

Symptoms

The primary symptom of Achilles tendon inflammation is pain in the back of the heel, which initially increases when exercise is begun and often lessens as exercise continues. A complete tear of the Achilles tendon typically occurs with a sudden forceful change in direction when running or playing tennis and is often accompanied by a sensation of having been struck in the back of the ankle and calf with an object such as a baseball bat.

Diagnosis

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose an Achilles injury such as Achilles tendonitis. Occasionally, further investigations such as an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the condition.

Nonsurgical Treatment

Most cases are successfully treated non-surgically although this is time-consuming and frustrating for active patients. Treatment is less likely to be successful if symptoms have been present more than six months. Nonsurgical management includes nonsteroidal anti-inflammatory medications, rest, immobilization, limitation of activity, ice, contrast baths, stretching and heel lifts. If symptoms fail to resolve after two to three months, a formal physical therapy program may be of benefit. An arch support may help if there is an associated flatfoot. A cast or brace to completely rest this area may be necessary. Extracorporeal shockwave therapy and platelet-rich plasma injections? have variable reports of success. Nitroglycerin medication applied to the overlying skin may be of benefit.

Achilles Tendon

Surgical Treatment

Many people don’t realize that Achilles tendon surgery can be very traumatic to your body. The type of trauma you experience after surgery can be compared to what you go through when you first injured your Achilles tendon. During the first 24 to 72 hours after the surgery your ankle will be tender, swollen and very painful. Your leg will be weak and unstable making it impossible for you to put weight on your leg without some kind of help. This is why your doctor or surgeon will have you outfitted for a cast, ankle brace and/or crutches before the procedure. When you are relying on a cast/brace and crutches your Achilles tendon is less likely to be as active as it once was. This is usually why atrophy (loss) of your lower leg muscles (specifically your calf muscle) happens. In general, more than 80%* of people who undergo surgery for an injured Achilles Tendon are able to return to their active lifestyle. In order to avoid re-injury, it is important to commit to a regular conservative therapy routine.

Prevention

As with all injuries, prevention is your best defense especially with injuries that are as painful and inconvenient as Achilles tendonitis. Options for how to prevent Achilles tendonitis include, stretching- Stretching properly, starting slowly, and increasing gradually will be critical if you want to avoid Achilles tendonitis. To help maintain flexibility in the ankle joint, begin each day with a series of stretches and be certain to stretch prior to, and after, any exercise or excessive physical activity. Orthotics and Heel Support- Bio-mechanically engineered inserts and heel cups can be placed in your shoes to correct misalignments or bolster the support of your foot and are available without a prescription. The temporary heel padding that these provide reduces the length that the Achilles tendon stretches each time you step, making it more comfortable to go about your daily routine. Proper Footwear- Low-heeled shoes with good arch support and shock absorption are best for the health of your foot. Look into heel wedges and other shoe inserts to make sure that your everyday foot mechanics are operating under ideal conditions.

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Plantar Fasciitis

What Is Painful Heel

Pain Of The Heel

Overview

The plantar fascia is a strong, relatively inflexible, fibrous ligament band that runs through the bottom of the foot. That band helps to keep the complex arch system of the foot, absorb shock, plays a role in body balance and in the various phases of gait. The band transmits your weight across the bottom of the foot with each step you take. When the heel of the trailing leg starts to get off the ground, the band bears tension that is approximately twice the body weight. The tension on the band at this moment is even greater if the calf muscles are not flexible enough.


Causes

Plantar fasciitis tends to strike those who overtrain, neglect to stretch their calf muscles, or overdo hill work and speedwork. Plantar fasciitis can also be caused by biomechanical flaws, including flat, high-arched feet and a tight Achilles tendon; excessive pronation; sudden increases in training mileage; beginning speedwork; wearing worn running shoes; running on hard surfaces, like asphalt or concrete; or wearing high heels all day before switching into flat running shoes.


Symptoms

Symptoms of the plantar fasciitis include a gradual onset of pain under the heel which may radiate into the foot. Tenderness is usually felt under and on the inside of the heel which is initially worse first in the morning but eases as the foot warms up only to return later in the day or after exercise. Stretching the plantar fascia may be painful.


Diagnosis

After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited “up” motion of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.


Non Surgical Treatment

A steroid (cortisone) injection is sometimes tried if your pain remains bad despite the above ‘conservative’ measures. It may relieve the pain in some people for several weeks but does not always cure the problem. It is not always successful and may be sore to have done. Steroids work by reducing inflammation. Sometimes two or three injections are tried over a period of weeks if the first is not successful. Steroid injections do carry some risks, including (rarely) tearing (rupture) of the plantar fascia. Extracorporeal shock-wave therapy. In extracorporeal shock-wave therapy, a machine is used to deliver high-energy sound waves through your skin to the painful area on your foot. It is not known exactly how it works, but it is thought that it might stimulate healing of your plantar fascia. One or more sessions of treatment may be needed. This procedure appears to be safe but it is uncertain how well it works. This is mostly because of a lack of large, well-designed clinical trials. You should have a full discussion with your doctor about the potential benefits and risks. In studies, most people who have had extracorporeal shock-wave therapy have little in the way of problems. However, possible problems that can occur include pain during treatment, skin reddening, and swelling of your foot or bruising. Another theoretical problem could include the condition getting worse because of rupture of your plantar fascia or damage to the tissues in your foot. More research into extracorporeal shock-wave therapy for plantar fasciitis is needed. Other treatments. Various studies and trials have been carried out looking at other possible treatments for plantar fasciitis. Such treatments include injection with botulinum toxin and treatment of the plantar fascia with radiotherapy. These treatments may not be widely available. Some people benefit from wearing a special splint overnight to keep their Achilles tendon and plantar fascia slightly stretched. The aim is to prevent the plantar fascia from tightening up overnight. In very difficult cases, sometimes a plaster cast or a removable walking brace is put on the lower leg. This provides rest, protection, cushioning and slight stretching of the plantar fascia and Achilles tendon. However, the evidence for the use of splint treatment of plantar fasciitis is limited.

Heel Pain


Surgical Treatment

Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The most common complications of release surgery include incomplete relief of pain and nerve damage.


Prevention

Do not walk barefoot on hard ground, particularly while on holiday. Many cases of heel pain occur when a person protects their feet for 50 weeks of the year and then suddenly walks barefoot while on holiday. Their feet are not accustomed to the extra pressure, which causes heel pain. If you do a physical activity, such as running or another form of exercise that places additional strain on your feet, you should replace your sports shoes regularly. Most experts recommend that sports shoes should be replaced after you have done about 500 miles in them.

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