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Have I Got Fallen Arches?

July 5, 2017
Overview

Flat Foot

A ?fallen arch? is a change in the shape of the foot. The normal gap between the floor and the arch on the inside of the foot narrows. It is usually painful, sometimes cripplingly painful and crippling. The heel leans to the inside, giving the inner ankle a bowed appearance. The joints of the outside of the crush together causing pain and swelling. The ligaments on the inside of the ankle stretch causing additional pain. Over time, the joints of the midfoot and forefoot adapt to the tilting of the ankle so that the front of the foot remains on the floor, complicating the deformity.

Causes

Just as there are many different causes of flat feet, there are also many different treatment options. The most important aspect of treatment is determining the exact type or underlying cause of flat feet that you have. Foot and ankle specialists can determine this through thorough clinical examination and special imaging studies (e.g., x-rays, computed tomography, and/or magnetic resonance imaging). Conservative treatment is effective in the vast majority of flat foot cases, and consists of things such as insoles, splints, manipulation, or casting. Surgery is required much less frequently, and is reserved only for some of the severe types of flat foot that do not respond to conservative therapy. You may have noticed that one common element in the conservative treatment of all types of flat feet is orthoses. Many companies now manufacture semi-custom orthotic devices that not only improve comfort, but also seek to control abnormal motion of the foot. These over-the-counter inserts, in the $25 to $50 range, are an economical treatment that may help a majority of people. Unfortunately, these semi-custom devices will not fit everyone perfectly, and those of us who differ too much from the average may respond better to custom orthotic devices. Custom inserts are prescribed by your foot and ankle specialist and are made individually from either a physical or computerized impression of your feet. The only drawback of custom orthoses is their cost, ranging anywhere from $300 to $500. Many physicians recommend trying over-the-counter inserts first (and even keep them in stock) as they may save their patients large sums of money.

Symptoms

Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.

Diagnosis

Determining whether you have fallen arches may be as easy as looking at the shape of the middle bottom of your foot. Is there any kind of arch there? If you cannot find any kind of arch, you may have a flat foot. There are, however, other ways to decide in case you're still not sure. Another way to figure out if you have flat feet is to look at a few pairs of your shoes. Where do you see the most wear on the heels? If you notice significant wear in the heel and the ball of the foot extending to the big toe, this means you are overpronating. Overpronators roll their feet too far inward and commonly have fallen arches. To figure out if you have flat feet, you can also do an easy test. Get the bottoms of your feet wet and then step on to a piece of paper carefully. Step off the paper and take a look at the print your foot made. If your print looks like the entire bottom of a foot, your feet are flat. People with an arch will be missing part of the foot on their print since the arch is elevated off of the paper. Regular visits to your podiatrist are highly recommended.

How do you get an arch in your foot?

Non Surgical Treatment

The simplest form of treatment is the use of custom fitted orthotics. For this, it is best to see a podiatrist, who is a trained medical professional that assesses feet and gives you a prescription for the orthotic. If the orthotics do not work - or if the deformity is very severe - then surgical management may be needed. There is a very wide range of procedures available, with varying downtimes and complexity. The simplest procedure of all is a simple calf release. This can be done at the back of the knee or the calf, and has a very quick recovery. It is a day-surgery procedure, and the patient can walk immediately after the surgery without the need for a cast. Recovery back to jogging can be as early as three weeks. The calf release stops the deforming force but obviously does not correct the arch itself. It is usually done in combination with some of the other procedures mentioned below. Done by itself, the patient will probably still require orthotics but by releasing the calf, it allows the orthotics to be much more effective. The other end of the spectrum is a complete reconstruction of the arch with bone work and screws to fuse joints.

Surgical Treatment

Acquired Flat Feet

Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.

After Care

Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.

Heel Pain And Discomfort The Leading Causes, Indications And Cure Methods

July 3, 2017
Overview

Pain Under The Heel

Millions of people each year suffer from heel pain. Many of those don?t understand heel pain causes and will often not seek proper heel pain treatment. Heel pain is often directly related to plantar fasciitis. Plantar fasciitis is an inflammation of the plantar fascia that, when addressed early, can be easily treated.

Causes

Plantar fasciitis can come from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult. As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body. As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes forms as the body's response to try to firmly attach the fascia to the heelbone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem. As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis. Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. In many cases, the actual source of the painful heel may not be defined clearly. Other factors that may contribute to the development of plantar fasciitis include obesity, trauma, weak plantar flexor muscles, excessive foot pronation (flat foot) or other alignment problems in the foot and or ankle, and poor footwear.

Symptoms

Plantar fasciitis is a condition of irritation to the plantar fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness on the bottom of your heel and feels worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or runners will feel discomfort for the first few minutes of their run. This occurs because the plantar fascia is not well supplied by blood, which makes this condition slow in healing, and a certain amount of activity is needed to get the area to warm up. Plantar fasciitis can occur for various reasons: use of improper, non-supportive shoes; over-training in sports; lack of flexibility; weight gain; prolonged standing; and, interestingly, prolonged bed rest.

Diagnosis

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

Non Surgical Treatment

Essentially rest from aggravating activity, physiotherapy treatment to alleviate the inflammatory component, stretching the tight calf, strengthening up of the intrinsic muscles of the foot e.g. tissue scrunch, picking up pens etc. and correction of biomechanical problems in the foot e.g. orthotics. Sometimes, a heel cup or pad to relieve pressure - a donut type pad may be helpful. Strapping has been shown to be helpful, especially in circumstances where the patient can?t wear orthotics - the foot is strapped to help support the arch. There has been limited success with cortisone injections or surgery and the latter is very rarely required.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

pain in back of heel

Prevention

Heel Pain

Before you get out of bed in the morning, and then periodically throughout the day, do the following exercises to increase flexibility and ease pain. Slowly flex your foot and toes to stretch the tissue on the bottom of your sore foot. Hold the stretch for 10 counts. Relax and repeat. Do gentle ankle rolls to keep the tissues around the ankle and on the back of the heel flexible. Sit on the edge of your bed and roll your foot back and forth over a tennis ball.

Leg Length Discrepancy Shoe Inserts

July 1, 2017
Overview

Approximately 75% of us present with one leg longer than the other. It?s staggering, literally, that so many people walk about with an imbalance. Yet to have one leg longer than the other doesn?t seem to create pain for everyone but for those that it does it brings pain in a myriad of dysfunction from TMJ, headaches, low back pain, IBS, bladder problems, sexual dysfunction, sacroiliac joint pain, pubis dysfunction, groin strain, gluteal dysfunction as well as the formation of trigger points.Leg Length Discrepancy

Causes

An anatomical short leg is due to several orthopedic or medical condition mechanisms. Often, one leg simply stops growing before the other one does and is called ?congenital?. We often see mother-daughters or father-sons who exhibit virtually the same degree of shortness on the same side. Often it is not known why this occurs, but it seems to account for approximately 25% of the population demonstrating a true LLD. Other causes of a true LLD include trauma or broken bones, surgical repair, joint replacement, radiation exposure, tumors or Legg-Calves-Perthes disease.

Symptoms

In addition to the distinctive walk of a person with leg length discrepancy, over time, other deformities may be noted, which help compensate for the condition. Toe walking on the short side to decrease the swaying during gait. The foot will supinate (high arch) on the shorter side. The foot will pronate (flattening of the arch) on the longer side. Excessive pronation leads to hypermobility and instability, resulting in metatarsus primus varus and associated unilateral juvenile hallux valgus (bunion) deformity.

Diagnosis

The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.

Non Surgical Treatment

To begin a path torwards a balanced foundation and reduce pain from leg length discrepancy, ask your doctor about these Functional Orthotics and procedures. Functional Orthotics have been shown to specifically reduce pain from leg length inequality, support all three arches of the foot to create a balanced foundation, maximize shock absorption, add extra propulsion, and supply more stability, enable posture correction and long-term preventive protection. Will improve prolonged effectiveness of chiropractic adjustments. Shoe or heel Lifts, Correct the deficiencies that causes imbalances in the body.

Leg Length Discrepancy

how do you get taller?

Surgical Treatment

Surgeries for LLD are designed to do one of three general things ? shorten the long leg, stop or slow the growth of the longer or more rapidly growing leg, or lengthen the short leg. Stopping the growth of the longer leg is the most commonly utilized of the three approaches and involves an operation known as an epiphysiodesis , in which the growth plate of either the lower femur or upper tibia is visualized in the operating room using fluoroscopy (a type of real-time radiographic imaging) and ablated , which involves drilling into the region several times, such that the tissue is no longer capable of bone growth. Because the epiphyseal growth capabilities cannot be restored following the surgery, proper timing is crucial. Usually the operation is planned for the last 2 to 3 years of growth and has excellent results, with children leaving the hospital within a few days with good mobility. However, it is only appropriate for LLD of under 5cm.

Mortons Neuroma Cure

May 30, 2017
Overview

Morton neuromaMorton?s Neuroma is a common foot condition characterized by pain and swelling in the ball of the foot, between the third and fourth toes. It?s caused by bones in your feet squeezing a nerve. Symptoms include a sharp, burning pain and possibly separation between the affected toes.

Causes

Wearing shoes that are too tight can make the pain of Morton's neuroma worse. This is because the toe bones are more likely to press on the affected nerve if your shoes are too tight. High-heeled shoes, particularly those over 5cm (2 inches), or shoes with a pointed or tight toe area, can also compress your toes and make the pain worse. This is why women tend to be affected by Morton's neuroma more than men.

Foot conditions.

Symptoms

It usually occurs in between the 3rd and 4th toes (about 65% of cases) as is pictured to the right. It is less commonly found in the 2nd webspace, and rarely at all in the 1st or 4th webspaces. You can also experience pins and needles and/or numbness as a result of the nerve being affected. The condition tends to occur predominantly in middle aged females.

Diagnosis

Your doctor will suspect that you have a Morton's neuroma based on the nature and location of your foot pain. He or she may ask questions about your shoes - what type of shoes you usually wear and whether these shoes have narrow toes or high heels. To rule out other causes of foot pain, your doctor may ask questions about your medical history, especially any history of arthritis, nerve and muscle problems or previous injury to your foot or leg.

Non Surgical Treatment

Anti-inflammatory drugs may be recommended to dull the pain and lessen swelling. Neuropathic pain medications such as the antionvulsants and / or antidepressants may be tried as well. Many are able to recover from this issue at home by icing the area, resting the feet, and by avoiding wearing narrow or tight shoes. If these remedies do not work to alleviate symptoms, the doctor may give special devices to separate the toes and avoid the squeezing of the nerve. Steroid injections may reduce pain and swelling. Surgery may be required if these do not help.Morton

Surgical Treatment

When conservative measures are unsuccessful, surgery can be a good choice in the treatment of Morton's neuroma. The operation for Morton's neuroma does not require an overnight hospital stay. The anesthetic used is an ankle block, which completely numbs the foot during the surgery. The physician removes the neuroma from an incision made on the top of the foot between the involved metatarsal heads. The nerve to the interspace is exposed and cut next to the metatarsal heads.

Shoe Lifts The Answer To Leg Length Discrepancy

February 20, 2016
There are actually not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital means you are born with it. One leg is structurally shorter in comparison to the other. As a result of developmental stages of aging, the human brain picks up on the stride pattern and identifies some variation. The entire body usually adapts by tilting one shoulder over to the "short" side. A difference of under a quarter inch is not blatantly excessive, does not need Shoe Lifts to compensate and commonly does not have a serious effect over a lifetime.

Shoe Lifts

Leg length inequality goes mainly undiagnosed on a daily basis, yet this problem is simply remedied, and can eliminate quite a few incidents of lower back pain.

Treatment for leg length inequality usually consists of Shoe Lifts. These are generally economical, commonly costing less than twenty dollars, in comparison to a custom orthotic of $200 and up. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Lumbar pain is the most common health problem afflicting people today. Over 80 million people have problems with back pain at some stage in their life. It's a problem which costs employers millions year after year because of lost time and output. New and improved treatment methods are constantly sought after in the hope of lowering economic influence this condition causes.

Shoe Lifts

People from all corners of the earth suffer the pain of foot ache as a result of leg length discrepancy. In a lot of these situations Shoe Lifts might be of immense help. The lifts are capable of reducing any discomfort in the feet. Shoe Lifts are recommended by countless expert orthopaedic orthopedists.

So that they can support the body in a healthy and balanced fashion, your feet have a crucial job to play. Inspite of that, it is often the most overlooked area in the body. Many people have flat-feet meaning there is unequal force placed on the feet. This causes other parts of the body such as knees, ankles and backs to be affected too. Shoe Lifts guarantee that ideal posture and balance are restored.

Shoe Lifts The Specialists Choice For Leg Length Imbalances

February 20, 2016
There are actually two unique variations of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is anatomically shorter than the other. As a result of developmental stages of aging, the human brain senses the gait pattern and identifies some variance. The human body typically adapts by dipping one shoulder to the "short" side. A difference of under a quarter inch isn't grossly excessive, demand Shoe Lifts to compensate and typically won't have a serious effect over a lifetime.

Shoe Lift

Leg length inequality goes typically undiscovered on a daily basis, however this condition is very easily solved, and can reduce numerous cases of upper back pain.

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

Mid back pain is the most widespread condition afflicting people today. Over 80 million people experience back pain at some point in their life. It's a problem which costs businesses millions annually due to lost time and production. Innovative and improved treatment methods are always sought after in the hope of lowering economic influence this issue causes.

Leg Length Discrepancy Shoe Lifts

Men and women from all corners of the world suffer from foot ache due to leg length discrepancy. In a lot of these cases Shoe Lifts might be of immense help. The lifts are capable of eliminating any discomfort and pain in the feet. Shoe Lifts are recommended by countless certified orthopaedic doctors.

So that you can support the human body in a nicely balanced fashion, your feet have got a significant job to play. In spite of that, it can be the most overlooked region in the human body. Some people have flat-feet meaning there is unequal force exerted on the feet. This causes other parts of the body such as knees, ankles and backs to be affected too. Shoe Lifts ensure that proper posture and balance are restored.

What Is A Posterior Calcaneal Spur

September 27, 2015
Inferior Calcaneal Spur

Overview

The calcaneus is the largest bone in the foot. Pain in the heel region can sometimes be related to Plantar Fasciitis, inflammation of the plantar fascia ligament in the heel area. A heel spur is a hook of bone that forms on the calcaneus where the plantar fascia attaches. Heel spurs can be identified with an X-ray. A heel spur can occur with or without Plantar Fasciitis.

Causes

A heel spur can develop when there is an abundance of calcium creating a deposit in the calcaneus, or heel bone. Over time, this deposit grows to create an outcropping under the heel that extends into the foot. The result is a protrusion that leads to foot pain when pressure is applied, and in some cases, even during rest.

Posterior Calcaneal Spur

Symptoms

Heel spurs can be quite painful, but can just as likely occur with no symptoms at all. Plantar fasciitis is a contributing condition to heel spurs. The cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. The feeling has been described as a knife or pin sticking into the bottom of your feet when you first stand up after sitting or laying down for a long period of time - a pain that later turns into a dull ache.

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

Heel spurs are considered a self-limited condition, which means that by making small alterations in your lifestyle and regular routines you can often control the condition. The goal is to relieve pain, reduce friction and transfer pressure from your sensitive foot areas. By eliminating the cause of the heel spur and plantar fasciitis (i.e. better shoes, orthotics to fix your gait, losing weight) will help reduce the pressure put on your fascia and heel and can reduce the inflammation caused by your heel spur. Failure to see improvements after conservative treatments may make surgery your only option.

Surgical Treatment

Have surgery if no other treatments work. Before performing surgery, doctors usually give home treatments and improved footwear about a year to work. When nothing else eases the pain, here's what you need to know about surgical options. Instep plantar fasciotomy. Doctors remove part of the plantar fascia to ease pressure on the nerves in your foot. Endoscopy. This surgery performs the same function as an instep plantar fasciotomy but uses smaller incisions so that you'll heal faster. However, endoscopy has a higher rate of nerve damage, so consider this before you opt for this option. Be prepared to wear a below-the-knee walking cast to ease the pain of surgery and to speed the healing process. These casts, or "boots," usually work better than crutches to speed up your recovery time.

Prevention

Use orthotic inserts. You can purchase orthotics over the counter, or you can have orthotics specially fitted by your podiatrist. Try 1 of these options. Heel cups. These inserts will help to align the bones in your foot and to cushion your heel. Check your skin for blisters when you first start using heel cups. Also, your feet may sweat more with a heel cup, so change your socks and shoes often. Insoles. While you can pick up generic insoles at a drugstore, you may have more luck if you go to a store that sells athletic shoes. Push on the arch to make sure that it doesn't collapse. If your insoles help but could use a little work, you can take them to a podiatrist to get them customized. Custom orthotics. A podiatrist can make a cast of your foot and provide you with custom-made orthotics. These may be more expensive, but they are made of materials specifically designed for your needs, and they can last up to 5 years if your podiatrist refurbishes them every 1 or 2 years. To find a podiatrist near you, look at the Web page for the American Academy of Podiatric Sports Medicine. Dynamic Insoles. Lack of elasticity in plantar fascia in the foot is for most people the real problem. If there is poor elasticity in the lengthwise tendons in the foot (plantar fascia) in relation to a person's general condition, only a small additional strain is required for the pull on the tendons to cause damage to the tissues connecting the tendons to the heel bone. This will generate an inflamed condition called Plantar Fasciitis.

What Is Calcaneal Spur

September 27, 2015
Heel Spur

Overview

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

Causes

An individual with the lower legs angulating inward, a condition called genu valgum or "knock knees," can have a tendency toward excessive pronation. As a result, this too can lead to a fallen arch resulting in plantar fascitis and heel spurs. Women tend to have more genu valgum than men do. Heel spurs can also result from an abnormally high arch. Other factors leading to heel spurs include a sudden increase in daily activities, an increase in weight, or a change of shoes. Dramatic increase in training intensity or duration may cause plantar fascitis. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia and possibly lead to heel spurs.

Inferior Calcaneal Spur

Symptoms

Major symptoms consist of pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may report heel pain to be more severe when waking up in the morning. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.

Diagnosis

Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.

Non Surgical Treatment

There are many ways to treat heel spurs. Some remedies you can even do at home once a podiatrist shows you how. Heel spur treatment is very similar to treatment of plantar fasciitis. Here are a few of the most common treatments. First, your doctor will assess which activities are causing your symptoms and suggest rest and time off from these activities. Ice packs are used to control pain and reduce symptoms. Certain exercises and stretches help you to feel relief quickly. Medications that reduce inflammation and decrease pain are also used. Sometimes cortisone injections are given. Often special shoe orthotics can help to take the pressure off of the plantar fascia and reduce symptoms. Night splints that keep your heel stretched are sometimes recommended. Rarely, surgery is an option. A new treatment called extracorporeal shock wave therapy is being studied.

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

If you have not yet developed this condition, you can take steps to protect yourself from it. Most importantly, make it a rule to wear properly fitted footwear. Avoid shoes that have become worn down in the heel, and don't choose shoes that cause you to walk in an abnormal fashion. Maintaining a healthy weight will ensure that undue pressure isn't being put on the ligaments, tendons and bones of your feet. If your job requires a great deal of time on your feet, or if you exercise regularly, be sure to balance periods of activity with periods of rest for your feet.

Heel Spur Symtoms

September 25, 2015
Heel Spur

Overview

Heel spurs usually form under the base of the foot or the back of the heel bone. Spurs that develop underneath the foot may visibly protrude through the skin. In addition, plantar fasciitis as well as heel spurs may eventually lead to chronic pain that persists for three or more months, especially if the sides and base of the heel bone have been affected. A large heel spur can affect movement and prevent an individual from walking or even standing properly. If a heel spur begins to protrude excessively, then surgery usually becomes necessary.

Causes

A heel spur is caused by chronic plantar fasciitis. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis. When plantar fasciitis healing is delayed or injury persists, your body repairs the weak and injured soft tissue with bone. Usually your injured fascia will be healed via fibroblastic activity. They'll operate for at least six weeks. If your injury persists beyond this time, osteoblasts are recruited to the area. Osteoblasts form bone and the end result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs. This scenario is most common in the traction type injury. The additional bone growth is known as a heel spur or calcaneal spur.

Posterior Calcaneal Spur

Symptoms

Major symptoms consist of pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may report heel pain to be more severe when waking up in the morning. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.

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

Ice compresses, stretching exercises, night splint for traction of the leg muscles to stretch the muscle in the back of the leg, and massage of the back of the leg, along with padding and heel cushions are also things that you can do at home. The number one recommendation for relief of heel pain is wearing good shoe gear. Good shoe gear usually consists of a sturdy, solid shoe. Heel pain is not relieved by a soft, ill supported shoe. Shoes such as Nike, K-Swiss, and Avia are the best shoes for this condition. Custom orthotics are highly recommended. Physical therapy is another way physicians treat this condition. Ice packs, muscle stimulation, ultra sound, paraffin baths, and the new Plantar Fascitis Night Splint are also helpful. If all these conservative measures fail to relieve the pain, then surgery is indicated. The newer minimal incision surgeries such as the Endoscopic plantar fasciotomy surgery is extremely beneficial for this condition, and for earlier ambulation, the use of the newer Cast Walking Boot is recommended.

Surgical Treatment

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

What Is A Calcaneal Spur

September 21, 2015
Heel Spur

Overview

The heel bone is the largest bone in the foot and absorbs the most amount of shock and pressure. A heel spur develops as an abnormal growth of the heel bone. Calcium deposits form when the plantar fascia pulls away from the heel area, causing a bony protrusion, or heel spur to develop. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Heel spurs can cause extreme pain in the rearfoot, especially while standing or walking.

Causes

There exists a membrane that covers most of the bone along the heel. When this membrane gets torn repeatedly due to straining of the muscles in the foot, the calcium deposits that lead to heel spurs are more likely to occur.

Inferior Calcaneal Spur

Symptoms

Heel spur is characterised by a sharp pain under the heel when getting out of bed in the morning or getting up after sitting for a period of time. Walking around for a while often helps reduce the pain, turning it into a dull ache. However, sports, running or walking long distance makes the condition worse. In some cases swelling around the heel maybe present.

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

In case of heel spurs rest is most important. Active sports, running, long walks etc should be avoided to start with. If you?re in a job that requires a lot of standing, take a few days off work. Rest (or reduced activity) is essential to allow the inflammation from becoming aggrevated. Furthermore, you can use ice packs (placed on the heel for 5-10 minutes) to ?cool down? the inflamed area. You may take anti-inflammatory medication or apply a topical inflammatory (i.e. a cream) to help reduce inflammation. In addition, there are some simple exercises that should be done daily to help relieve heel spur pain.

Surgical Treatment

Approximately 2% of people with painful heel spurs need surgery, meaning that 98 out of 100 people do well with the non-surgical treatments previously described. However, these treatments can sometimes be rather long and drawn out, and may become considerably expensive. Surgery should be considered when conservative treatment is unable to control and prevent the pain. If the pain goes away for a while, and continues to come back off and on, despite conservative treatments, surgery should be considered. If the pain really never goes away, but reaches a plateau, beyond which it does not improve despite conservative treatments, surgery should be considered. If the pain requires three or more injections of "cortisone" into the heel within a twelve month period, surgery should be considered.

Prevention

Choose new shoes that are the right size. Have your foot measured when you go to the shoe store instead of taking a guess about the size. Also, try on shoes at the end of the day or after a workout, when your feet are at their largest. To ensure a good fit, wear the same type of socks or nylons that you would normally wear with the type of shoe that you are trying on.

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