What Is Mortons Neuroma

Overview

Morton’s Neuroma is a common foot problem associated with pain, swelling and/or an inflammation of a nerve, usually at the ball-of-the-foot between the 3rd and 4th toes. Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton’s Neuroma may also cause numbness, tingling, or cramping in the forefoot.

Causes

Some say that this condition should not be called Morton’s neuroma as, in fact, it is not actually a neuroma. A neuroma is a non-cancerous (benign) tumour that grows from the fibrous coverings of a nerve. There is no tumour formation in Morton’s neuroma. The anatomy of the bones of the foot is also thought to contribute to the development of Morton’s neuroma. For example, the space between the long bones (metatarsals) in the foot is narrower between the second and third, and between the third and fourth metatarsals. This means that the nerves that run between these metatarsals are more likely to be compressed and irritated. Wearing narrow shoes can make this compression worse.

Symptoms

Neuroma pain is classically described as a burning pain in the forefoot. It can also be felt as an aching or shooting pain in the forefoot. Patients with this problem frequently say they feel like they want to take off their shoes and rub their foot. This pain may occur in the middle of a run or at the end of a long run. If your shoes are quite tight or the neuroma is very large, the pain may be present even when walking. Occasionally a sensation of numbness is felt in addition to the pain or even before the pain appears.

Diagnosis

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a Morton’s neuroma. Investigations such as an X-ray, ultrasound, MRI, CT scan or bone scan may sometimes be used to assist with diagnosis, assess the severity of the injury and rule out other conditions.

Non Surgical Treatment

Conservative treatment involves a reduction in the inflammation and removing the impingement factor. Reduction in inflammation is achieved via rest, elevation, ice, and massage with anti-inflammatory gels. Removing foot wear and and/r wearing broad type footwear would also help. Injection therapy is useful in reducing symptoms but not very successful in providing long term relief. The only time when it is most appropriate is when the cause of the space occupying object is not a neuroma but an inflamed bursa. Injection would help to relieve symptoms, and often cortisone is not even necessary.

Surgical Treatment

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

Have I Got Calcaneal 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

This condition is a constellation of many causes; overweight, ill fitting shoes, bio-mechanical problems (mal-alignment of the heel), gout, pronation (a complex motion including outward rotation of the heel and inward rotation of the ankle) and rheumatoid arthritis are some of the causes of heel pain.

Symptoms

With heel spurs, people often talk about a dull ache which is felt most of the time with episodes of a sharp pain in the center of the heel or on the inside margin of the heel. Often the pain is worse on first rising in the morning and after rest and is aggravated by prolonged weight bearing and thin-soled shoes.

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

Heel spurs and plantar fascitis are usually controlled with conservative treatment. Early intervention includes stretching the calf muscles while avoiding re-injuring the plantar fascia. Decreasing or changing activities, losing excess weight, and improving the proper fitting of shoes are all important measures to decrease this common source of foot pain. Modification of footwear includes shoes with a raised heel and better arch support. Shoe orthotics recommended by a healthcare professional are often very helpful in conjunction with exercises to increase strength of the foot muscles and arch. The orthotic prevents excess pronation and lengthening of the plantar fascia and continued tearing of this structure. To aid in this reduction of inflammation, applying ice for 10-15 minutes after activities and use of anti-inflammatory medication can be helpful. Physical therapy can be beneficial with the use of heat modalities, such as ultrasound that creates a deep heat and reduces inflammation. If the pain caused by inflammation is constant, keeping the foot raised above the heart and/or compressed by wrapping with an ace bandage will help. Corticosteroid injections are also frequently used to reduce pain and inflammation. Taping can help speed the healing process by protecting the fascia from reinjury, especially during stretching and walking.

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.

Prevention

o help prevent heel and bone spurs, wear properly designed and fitted shoes or boots that provide sufficient room in the toe box so as not to compress the toes. They should also provide cushioning in appropriate areas to minimize the possibility of the irritation and inflammation that can lead to bone spurs in the feet. If needed, use inserts that provide arch support and a slight heel lift to help ensure that not too much stress is placed on the plantar fascia. This helps to reduce the possibility of inflammation and overstress. Wearing padded socks can also help by reducing trauma. Peer-reviewed, published studies have shown that wearing clinically-tested padded socks can help protect against injuries to the skin/soft tissue of the foot due to the effects of impact, pressure and shear forces. Also consider getting your gait analyzed by a foot health professional for appropriate orthotics. If you have heel pain, toe pain or top-of-the-foot pain, see your doctor or foot specialist to ensure that a spur has not developed.

Controlling Heel Spur

Overview

A heel spur occurs when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping. Heel spurs often cause no symptoms but can be associated with intermittent pain, especially while walking, jogging, or running. Sharp pain in the heel can also be experienced when standing after sitting for a long period of time. Heel spurs can be a result of plantar fasciitis.

Causes

When a bone is subjected to pressure, rubbing, or other stress over long periods, it tries to repair itself by building extra bone. This extra bone is what is referred to as a ?spur?. Many form as part of the aging process when cartilage breaks down in the joints.

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

Diagnosis of a heel spur can be done with an x-ray, which will be able to reveal the bony spur. Normally, it occurs where the plantar fascia connects to the heel bone. When the plantar fascia ligament is pulled excessively it begins to pull away from the heel bone. When this excessive pulling occurs, it causes the body to respond by depositing calcium in the injured area, resulting in the formation of the bone spur. The Plantar fascia ligament is a fibrous band of connective tissue running between the heel bone and the ball of the foot. This structure maintains the arch of the foot and distributes weight along the foot as we walk. However, due to the stress that this ligament must endure, it can easily become damaged which commonly occurs along with heel spurs.

Non Surgical Treatment

There are both conservative and surgical heel spur treatment options. Because the heel pain caused by heel spurs is symptomatic of inflammation, the first step is to ice the area in hopes to reduce the inflammation. The next step is to see our orthopedic specialist to prescribe an appropriate treatment plan. Some conservative treatment options might include Anti-inflammatory medications. Shoe orthotics. Shoe inserts. If conservative treatments are not working, surgery may be required to remove the heel spur. As in all cases of heel pain, it is important to see an orthopedic doctor who specializes in foot and ankle pain.

Surgical Treatment

Surgery to correct for heel spur syndrome is a common procedure which releases plantar fascia partially from its attachment to the calcaneous (heel bone). This part of the surgery is called a plantar fasciotomy due to the fact the fascia is cut. This is most often done through an open procedure as any heel spur or bursa can be removed at the same time. If the spur is not removed during the surgery, it will probably be just as successful, as the large spur is not the true problem. Some physicians use an endoscopic approach (EPF) where a small camera aids the physician during surgery with typically smaller incisions on each side of your foot.

Exercises For Bursitis Of The Foot

Overview

In your calf at the back of the lower leg sit two major muscles (gastrocnemius and soleus), both held by the Achilles tendon (Equinus). Between the Achilles tendon and the heel bone is a bursa sac called a retrocalcaneal bursa (‘calcaneus’ = ‘heel bone’ and ‘retro’ = ‘behind’). During contraction of the calf muscles, the Achilles tendon rubs against the retrocalcaneal bursa, which can become irritated as a result.

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

Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down.

Diagnosis

Carrying out a diagnosis for bursitis is fairly straightforward. The doctor will examine the affected area and ask the patient some questions about his/her recent activities. If the patient has a high temperature the physician may take a small sample of fluid from a bursa near the affected body part. The sample will be tested for bacteria, and perhaps also crystals. If the patient does not get better after treatment the doctor may carry out further tests so that he/she can eliminate the possibility that the symptoms might not be due to something else. These may include an x-ray, to make sure no bones are broken or fractured. Blood tests, to check for rheumatoid arthritis. A CT scan or MRI scan to see if there is a torn tendon.

Non Surgical Treatment

Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence in all patients with retrocalcaneal bursitis. Treatment may comprise soft tissue massage (particularly to the calf muscles), joint mobilization (of the ankle, subtalar joint and foot), dry needling, electrotherapy (e.g. ultrasound), stretches, the use of heel wedges, the use of crutches, ice or heat treatment, arch support taping, the use of a compression bandage, exercises to improve strength, flexibility, balance and core stability, education, anti-inflammatory advice, activity modification advice, biomechanical correction (e.g. the use of orthotics), footwear advice, a gradual return to activity program.

Surgical Treatment

Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to remove the inflamed bursa.

Hammer Toe Pain Treatment

Overview

When there?s an imbalance in the muscle and ligament surrounding a toe joint, the effect is a bend in the middle joint of the toe, which causes the whole toe to bend upward. Because the toe is bent in an unnatural way, it?s common for the toe to become irritated and even develop corns. A toe that curls under rather than bends upward is also considered a Hammer toes.

Causes

Poorly fitting shoes and muscle imbalances are the most common causes of hammertoe. When shoes are too narrow or do not accommodate the shape and size of your feet, they often contort the position of your toes. Choosing a shoe that fits is very important when it comes to avoiding foot problems like bunions or hammertoe. Having your toes bent for an extended period of time in a shoe that is too narrow or small forces your toes to adapt to the cramped space. With time, the muscles in your feet hammertoes become accustomed to holding the flexed position of your toes, making it harder, or even impossible to straighten them.

Symptoms

The symptoms of hammertoe are progressive, meaning that they get worse over time. Hammertoe causes the middle joint on the second, third, fourth, or fifth toes to bend. The affected toe may be painful or irritated, especially when you wear shoes. Areas of thickened skin (corns) may develop between, on top of, or at the end of your toes. Thickened skin (calluses) may also appear on the bottom of your toe or the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear.

Diagnosis

Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.

Non Surgical Treatment

Try to find shoes that are soft, roomy, and comfortable and avoid tight shoes or shoes with high heels. A shoe repair shop may be able to stretch a small pocket in regular shoes to make room for the hammertoe. Have a professional pedicure. Sometimes a skilled manicurist can file down a painful corn. Follow your healthcare provider’s instructions. Ask your provider what activities you should avoid and when you can return to your normal activities, how to take care of yourself at home, what symptoms or problems you should watch for and what to do if you have them. Make sure you know when you should come back for a checkup.

Surgical Treatment

If these non-invasive treatments don?t work, or if the joint is rigid, a doctor?s only recourse may be to perform surgery. During the surgery, the doctor makes an incision and cuts the tendon to release it or moves the tendon away from or around the joint. Sometimes part of the joint needs to be removed or the joint needs to be fused. Each surgery is different in terms of what is needed to treat the hammertoe. Normally after any foot surgery, patients use a surgical shoe for four to six weeks, but often the recovery from hammertoe surgery is more rapid than that. An unfortunate reality is that hammertoe can actually return even after surgery if a patient continues to make choices that will aggravate the situation. Though doctors usually explain pretty clearly what needs to be done to avoid this.

Prevention

These tips may help you buy the right shoes. Buy shoes at the end of the day. Your feet are smaller in the morning and swell throughout the day. Don’t assume your shoe size hasn’t changed. As you age, your shoe size may change, especially the width. Measure both feet and buy for the larger foot. Ask for just the right fit. A shoe repair store can stretch shoes in tight spots.

Hammer Toe Repair Recovery

Overview

A hammertoes is a term used to describe a crooked, deviated, or contracted toe. Although the condition usually stems from muscle imbalance, it is often aggravated by poor-fitting shoes or socks that cramp the toes. Over a period of years, the tendons that move the toe up and down begin to pull the toe with unequal tension, and the toe then begins to buckle or become contracted, causing an abnormal “v”-shaped bending of the little toes. Patients with this condition often experience pain, swelling, redness and stiffness in the affected toes.

Causes

Wearing ill-fitting shoes is probably the main cause of hammer toe. As the toe bends, tendons add to the problem by contracting in such a way that the bending is reinforced to the point of becoming permanent. In some cases, tendons that are abnormal to begin with may start the bending process.

Symptoms

Symptoms may include pain in the affected toe or toes when you wear shoes, making it hard or painful to walk. A corn or callus on the top of the joint caused by rubbing against the shoe. Swelling and redness of the skin over the joint. Trouble finding comfortable shoes.

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

Treating hammertoe involves straightening the toe, making tendons in the toes flexible again, and preventing the problem from returning. Some simple treatments include splinting the toe to keep it straight and to stretch the tendons of the foot. Using over-the-counter pads, cushions or straps to decrease discomfort Exercising the toes to relax the foot tendons (a session with a physical therapist may help you get started with foot exercises) Wearing shoes that fit properly and allow toes plenty of room to stretch out.

Surgical Treatment

Until recently, wires were used for surgical correction. In this technique, one or more wires hammertoes are inserted into the bone through both the affected joint and a normally healthy toe joint, and the end of the toe. These wires stay in place for four to six weeks, protruding from the end of the toes. Due to the protruding wire, simple things such working, driving, bathing and even sleeping are difficult while these wires are in place. During this recovery period, patients often experience discomfort during sleep and are subject possible infection.

Prevention

Preventing foot problems, including hammertoes, is often a matter of wearing the right shoes and taking care of your feet. Check your feet regularly for problems. This is especially true if you have diabetes or any other medical condition that causes poor circulation or numbness in your toes. If you do, check feet daily so that problems can be caught early on.

What Is A Tailor’S Bunion?

Overview

A bunion is a bony bump on the joint at the base of your big toe. The bony growth on the joint sometimes causes your big toe to Bunion Surgery at Nuffield Health Hospitalsturn in towards your second toe. Symptoms include pain, swelling of your big toe and, as the bunion sticks out, it can often rub on the inside of your shoe. The cause is not always known, there may be a deformity of the joint, called hallux valgus (hallux means big toe, valgus means bent outwards). Or it can be as simple as ill fitting footwear not allowing enough width to fit the toes in their natural position. Sometimes bunions are associated with arthritis in the joint at the base of your big toe. Left untreated bunions can continue to grow and become more painful.

Causes
Bunions most commonly affect women. Some studies report that bunion symptoms occur nearly 10 times more frequently in women. It has been suggested that tight-fitting shoes, especially high-heel and narrow-toed shoes, might increase the risk for bunion formation. Tight footwear certainly is a factor in precipitating the pain and swelling of bunions. Complaints of bunions are reported to be more prevalent in people who wear shoes than in barefoot people. Other risk factors for the development of bunions include abnormal formation of the bones of the foot at birth (congenital) and arthritic diseases such as rheumatoid arthritis. In some cases, repetitive stresses to the foot can lead to bunion formation. Bunions are common in ballet dancers.
Symptomssymptoms and problems caused by bunions include pain. You may then have difficulty walking due to pain. Inflammation and swelling at the base of the toe. This sometimes becomes infected. The foot may become so wide that it can be difficult to find wide enough shoes. You may get arthritis in the big toe. The second toe can become deformed. In severe cases, the big toe can push your second toe up out of place.

Diagnosis
Diagnosis begins with a careful history and physical examination by your doctor. This will usually include a discussion about shoe wear and the importance of shoes in the development and treatment of the condition. X-rays will probably be suggested. This allows your doctor to measure several important angles made by the bones of the feet to help determine the appropriate treatment.

Non Surgical Treatment
Apply special pads and dressings to protect the bunion from shoe pressure. Inject steroid and local anesthetic around the bunion to reduce inflammation. This is especially useful if there is an associated bursitis. Recommend commercially available or custom made shoes. Prescribe functional orthotics to correct faulty foot function, and help prevent worsening of the deformity. Recommend bunion surgery to correct the deformity.

Surgical Treatment
If conservative treatment doesn’t provide relief, you may need surgery. A number of surgical procedures are performed for bunions, and no particular surgery is best for every problem. Knowing what caused your bunion is essential for choosing the best procedure to ensure correction without recurrence. Most surgical procedures include rmoving the swollen tissue from around your big toe joint Straightening your big toe by removing part of the bone Permanently joining the bones of your affected joint You may be able to walk on your foot immediately after some bunion procedures. With other procedures, it may be a few weeks or longer. To prevent a recurrence, you’ll need to wear proper shoes after recovery.

What Will Cause Feet To Over Pronate

Overview

Pronation describes a slight inward rolling motion the foot makes during a normal walking or running stride. The foot (and ankle) roles slightly inward to accommodate movement. Some people, however, over-pronate and roll more than normal. With over-pronation, the arch of the foot flattens and causes excessive stress and pressure on the soft tissues of the foot. Over-pronation is more common in those with flat feet, and can lead to foot aches and pain, such as plantar fasciitis, Shin Splints and Knee Pain.

Causes

Generally fallen arches are a condition inherited from one or both parents. In addition, age, obesity, and pregnancy cause our arches to collapse. Being in a job that requires long hours of standing and/or walking (e.g. teaching, retail, hospitality, building etc) contributes to this condition, especially when standing on hard surfaces like concrete floors. Last, but not least unsupportive footwear makes our feet roll in more than they should.

Symptoms

Overpronation causes alterations in proper muscle recruitment patterns leading to tightness in the outside of the ankle (lateral gastrocnemius, soleus, and peroneals). This tightness can lead to weakness in the opposing muscles such as the medial gastrocnemius, anterior tibialis, and posterior tibialis. If these muscles are weak, they will not be able to keep the knee in proper alignment, causing the valgus position. All this tightness and weakness can cause pain within the ankle, calf, and knee region. And it can send imbalance and pain all the way up to the upper back, if deep core strength is lacking and can’t hold the pelvis in neutral.

Diagnosis

At some point you may find the pain to much or become frustrated. So what are you options? Chances are your overpronation has led to some type of injury if there’s pain. Your best bet is to consult with someone who knows feet. Start with your pediatrist, chiropodist or chiropractor. They’ll be able to diagnose and treat the injury and give you more specific direction to better support your feet. One common intervention is a custom foot orthotic. Giving greater structural support than a typical shoe these shoe inserts can dramatically reduce overpronation.

Non Surgical Treatment

Fortunately, there are simple things you can do to cure and correct your overpronation issues. Certain exercises help. Pull your toes back using a rolled up towel. Roll your feet over a golf or tennis ball for a minute. And do calf raises by standing up and lifting up on your toes. These all help reposition the foot and strengthen the muscles and tendons necessary for proper support. Beyond that, simple adjustments to footwear will help immensely.

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.

Severs Disease The Truth

Overview

Sever?s Disease (calcaneal aphophysitis) is not really a disease, but more a repetitious strain injury. This is the most common cause of kids heel pain seen at Podiatry Care. Active children in football, soccer, basketball, netball and tennis with this type of foot pain complain of pain in the region of the heel bone particularly after exercise. In severe cases, children will complain of pain during exercise as well. It is a frequent cause of heel pain in children, particularly in the very active child. It is most often seen in children between the ages of 8 to 15 years as the growth plate is not fully developed or calcified at this time.

Causes

One of the most common causes of heel pain in adolescents, Sever’s disease is an overuse injury to the growth plate of the calcaneus (heel). It is commonly seen in growing, active children 8-12 years of age. Soccer players, gymnasts, and children who do any sort of running or jumping activity have an increased risk of developing Sever’s disease. Occurring in one or both feet, Sever?s disease occurs at the back of the heel (also known as the apophysis or the insertion of the Achilles tendon).

Symptoms

Symptoms of Sever?s disease, mostly pain at the back of heel, usually occur during and after sporting activity, and usually disappear with rest. In some cases, children may find it difficult to place pressure on their heels, and begin walking on their toes to gain relief. For some children, the heel pain will persist until the next morning, causing some stiffness or hobbling on first arising. Some children may experience mild swelling at the back of the heel.

Diagnosis

A doctor or other health professional such as a physiotherapist can diagnose Sever?s disease by asking the young person to describe their symptoms and by conducting a physical examination. In some instances, an x-ray may be necessary to rule out other causes of heel pain, such as heel fractures. Sever?s disease does not show on an x-ray because the damage is in the cartilage.

Non Surgical Treatment

If the problem is bad enough, it is important to totally rest the symptomatic foot. Take a break from sport activity until the pain has significant improvement. Severe cases will need to be treated with a cast boot. Anti-inflammatory treatments include Icing, Over-the-counter anti-inflammatory medicine as recommended by your pediatrician or podiatrist. Shock absorption and support. Don’t go barefoot at home, wear some type of good sandal or shoe. A significant and/or chronic case should be treated with prescription orthotics. This addresses mechanical problems that cause this problem, Using an over-the-counter heel cushion inside of the shoe, Athletic foot taping, Stretching. Runners stretch to stretch out the calf muscle. A night splint will also help. Severe or chronic cases respond best to prescription orthotics with specific modifications for this problem. May require a night splint. Daytime braces that may also help.

Exercise

Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever’s disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever’s disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.

What Causes Heel Ache

Overview

The heel is the first bone to contact the ground when walking and takes the full force of impact and the resulting shock of bearing weight during motion. The primary symptom is pain in the heel area that varies in severity and location. The pain is commonly intense when getting out of bed or a chair. The pain often lessens when walking. The most common cause of Heel Pain is plantar fasciitis. Plantar fasciitis is a stretching of the plantar fascia, a ligament that runs from the ball of foot through the arch and is attached to the heel. It is that attachment which becomes aggravated and typically causes pain after being on your feet for lengths of time. Abnormal motion of the foot (pronation) is one cause of plantar fasciitis. Heel spurs, which are abnormal bone growths coming off the heel, can also cause heel pain. Other causes include repetitive stress or shock to the heel, standing for prolonged periods or osteoarthritis. To prevent heel pain, always wear properly fitting shoes, place insoles or inserts in your shoes to help control abnormal foot motion, maintain a healthy weight, exercise and do foot stretches as they have been shown to decrease the incidence of heel pain.

Causes

The most common cause of heel pain is a pull on the heel bone exerted by the muscles and ligaments (plantar fascia shown in illustration above) that support the arch of the foot. This is an overuse condition similar to bursitis of the shoulder or tennis elbow. Plantar fasciitis is typically very painful in the morning during the first few steps, after sitting and again at the end of the day.

Symptoms

The primary symptom is pain in the heel area that varies in severity and location. The pain is commonly intense when getting out of bed or a chair. The pain often lessens when walking.

Diagnosis

The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.

Non Surgical Treatment

The proper treatment for your heel pain depends entirely on the specific cause(s) of your symptoms. Therefore, it is critical to understand the cause(s) of your symptoms before beginning any treatment program and if you are unsure, then seeking medical advice is essential to develop the proper treatment program for your condition. Some common treatments are listed and can be performed at home. Keep in mind that not all of these treatments are appropriate for every condition, but they usually a good place to start. Rest, reducing activities for a few days can help to reduce the most severe pain. Ice, applying ice to the heel for 10 minutes several times a day will help to reduce inflammation. Stretching exercises, to lengthen the muscles in the back of the leg, including the hamstrings, will help to ease pain, reduce focal pressures to your feet and assist in recovery. For plantar fasciitis, this may be the best treatment of all. Avoid going barefoot, when without shoes excessive stress and strain is placed on the plantar fascia. Proper shoe gear, supportive shoes that fit and are not too worn along with good arch support help to reduce the stress and strain on the plantar fascia over time. Medications, non-steroidal anti-inflammatory medication, such as Motrin (ibuprofen), may help to reduce inflammation. If the pain persists or worsens after a couple of days, an appointment may be necessary where Dr. Talarico may add one or more of these additional modalities to your treatment program. Orthotic b, whether pre-fabricated or custom orthotic is used, these devices can help reduce the underlying structural abnormalities of the foot which have lead to the development of plantar fasciitis. These are often used to limit the recurrence of plantar fasciitis pain. Strapping, a special taping technique to help reduce the strain on the fascia. Injection therapy, in some instances injections are used to reduce the inflammation and reduce pain. Night Splint, this allows you to maintain an extended stretch on the plantar fascia while sleeping. Over time, this has shown to reduce the morning pain which some people experience. Removable Walking Cast, in some case of severe heel pain this may be used to keep your foot immobile for a few weeks allowing it to rest and heal. Physical Therapy may be recommended to aid in pain relief. At The Foot & Ankle Center, PC, Dr Talarico will often utilize two additional in-office modalities, EPAT and MLS Laser Therapy, which are very effective in treating most inflammatory conditions of the foot and ankle, including plantar fasciitis.

Surgical Treatment

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.

Prevention

Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.