Archives for the month of: January, 2015

Heel Pain

Overview

Plantar Fasciitis is actually, in most cases, plantar fasciosis but it’s a bit like pen/biro or hoover/vacuum. The term ‘-itis‘ means ‘inflammation’. This is a term we use for this problem in the early stages of damage because it usually is quite literally an inflammation of part of the plantar fascia. So, what is commonly known as ‘plantar fasciitis’ is really ‘plantar fasciosis’ – a degradation or degeneration of the collagen fibres because of prolonged (most of your adult life) unsustainable stress being applied to the fascia. So, we call it plantar fasciitis but it usually hasn’t been an ‘-itis‘ for years and that is why in many cases anti-inflammatory drugs do not help ease the pain of walking. This is also why most sufferers experience pain first thing in the morning. If inflammation was the source of discomfort then why would it hurt after a nights rest and the good old drugs pumping through your system.


Causes

Plantar Fasciitis is caused by abnormal pronation of the foot. Contributing factors are obesity, weight gain, jobs that require a lot of walking or standing on hard surfaces, badly worn shoes with little support, and also inactivity. As a result of over-pronation, with every step the Plantar Fascia (band of tissue under the foot) is being stretched, resulting in inflammation, irritation and pain at the attachment of the fascia into the heel bone. In some cases the pain is felt under the foot, in the arch. Continuous pulling of the fascia at the heel bone, eventually may lead to the development of bony growth on the heel. This is called a heel spur. When you’re at rest, such as while sleeping, the Plantar Fascia tightens and shortens. When body weight is rapidly applied to the foot, the Fascia must stretch and quickly lengthen, causing micro-tears in the Fascia. As a result, the foot pain is more severe with your first steps in the morning, or after sitting for a long period. Plantar Fasciitis is more likely to happen if you suffer from over-pronation (flattening of the arch), you stand or walk on hard surfaces, for long periods, you are overweight or pregnant, you have tight calf muscles.


Symptoms

The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel. This develops gradually over time. It usually affects just one foot, but can affect both feet. Some people describe the pain as dull, while others experience a sharp pain, and some feel a burning or ache on the bottom of the foot extending outward from the heel. The pain is usually worse in the morning when you take your first steps out of bed, or if you’ve been sitting or lying down for a while. Climbing stairs can be very difficult due to the heel stiffness. After prolonged activity, the pain can flare-up due to increased inflammation. Pain is not usually felt during the activity, but rather just after stopping.


Diagnosis

A physical exam performed in the office along with the diagnostic studies as an x-ray. An MRI may also be required to rule out a stress fracture, or a tear of the plantar fascia. These are conditions that do not normally respond to common plantar fasciitis treatment.


Non Surgical Treatment

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

Pain In The Heel


Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.


Prevention

Stretching the plantar fascia and the calf muscle area can help to prevent inflammation. Slowly increasing the amount or intensity of athletic activities by graded progression can also help to prevent injury. Recommended Stretches: Taking a lunge position with the injured foot behind and keeping your heels flat on the floor, lean into a wall and bend the knees. A stretch should be felt in the sole and in the Achilles tendon area. Hold the stretch for 20-30 seconds. Also try this stretch with the back leg straight.

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Foot Pain

Overview

If your first step in the morning often feels like it involves a rusty nail being inserted into your heel, you’re not alone. Heel pain resulting from plantar fasciitis is the most prevalent condition treated in podiatric clinics, and an additional 1 million Americans annually are seen by medical doctors for the condition, according to the Centers for Disease Control and Prevention. The plantar fascia is the ligament that runs from the heel bone across the entire bottom of the foot and connects at the base of the toes. Ligaments connect bone to bone, and don’t really constrict or contract, but can become thickened because of inflammation. Inflammation of the plantar fascia can cause strain when you walk, specifically heel pain that is especially bad for the first few steps after prolonged inactivity. It then typically loosens up once you’re up and about.


Causes

Plantar fasciitis is caused by drastic or sudden increases in mileage, poor foot structure, and inappropriate running shoes, which can overload the plantar fascia, the connective tissue that runs from the heel to the base of the toes. The plantar fascia may look like a series of fat rubber bands, but it’s made of collagen, a rigid protein that’s not very stretchy. The stress of overuse, overpronation, or overused shoes can rip tiny tears in it, causing pain and inflammation, a.k.a. plantar fasciitis.


Symptoms

Most patients with plantar fasciitis describe a sharp or stabbing pain on the bottom of the heel that is most severe when they first get up in the morning or after a period of resting. Some may feel like the heel is bruised while others may describe tightness or even a pulling sensation on the heel or arch.


Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.


Non Surgical Treatment

Anti-inflammatory agents used in the treatment of plantar fasciitis include ice, NSAIDs, iontophoresis and cortisone injections. Ice is applied in the treatment of plantar fasciitis by ice massage, ice bath or in an ice pack. For ice massage, the patient freezes water in a small paper or foam cup, then rubs the ice over the painful heel using a circular motion and moderate pressure for five to 10 minutes. To use an ice bath, a shallow pan is filled with water and ice, and the heel is allowed to soak for 10 to 15 minutes. Patients should use neoprene toe covers or keep the toes out of the ice water to prevent injuries associated with exposure to the cold. Crushed ice in a plastic bag wrapped in a towel makes the best ice pack, because it can be molded to the foot and increase the contact area. A good alternative is the use of a bag of prepackaged frozen corn wrapped in a towel. Ice packs are usually used for 15 to 20 minutes. Icing is usually done after completing exercise, stretching, strengthening and after a day’s work.

Heel Discomfort


Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.

Painful Heel

Overview

Plantar fasciitis is one of the most common explanations of heel pain. It is caused by inflammation to the thick band that connects the toes to the heel bone, called the plantar fascia, which runs across the bottom of your foot. The condition is most commonly seen in runners, pregnant women, overweight people, and individuals who wear inadequately supporting shoes. Plantar fasciitis typically affects people between the ages of 40 and 70.


Causes

Plantar Fasciitis is frequently cited as the number one cause of heel pain. The condition affects both children and adults. Children typically outgrow the problem, but affected adults may experience recurring symptoms over the course of many months or years. The syndrome afflicts both highly active and sedentary individuals. Typically, Plantar Fasciitis results from a combination of causes, including, pronation, a condition in which the plantar fascia doesn’t transfer weight evenly from the heel to the ball of the foot when you walk. Overuse of the feet without adequate periods of rest. High arches, flat feet or tightness in the Achilles’ tendon at the back of the heel. Obesity. Working conditions that involve long hours spent standing or lifting heavy objects. Worn or ill-fitting footwear. The normal aging process, which can result in a loss of soft tissue elasticity. Physical trauma to the foot, as in the case of taking a fall or being involved in a car accident.


Symptoms

If you are concerned that you may have developed this syndrome, review this list of symptoms to see if they match with your experience. Aching, sharp or burning pain in the sole of your foot, often centering in the heel area. Foot pain that occurs as soon as you step out of bed or get to your feet after prolonged periods of sitting. Pain that may decrease eventually after you’ve been on your feet for awhile, only to return later in the day. Sudden heel pain or pain that builds gradually. Foot pain that has lasted for more than a few days, or which you experience periodically over the course of months or years. Pain in just one foot, though it is possible to have Plantar Fasciitis affect both feet. Swelling, redness, or feelings of heat in the heel area. Limping.


Diagnosis

Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.


Non Surgical Treatment

There are a number of treatments that can help relieve heel pain and speed up your recovery. These include resting your heel, try to avoid walking long distances and standing for long periods, regular stretching, stretching your calf muscles and plantar fascia, pain relief, using an icepack on the affected heel and taking painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDs) wearing good-fitting shoes that support and cushion your foot, running shoes are particularly useful, using supportive devices such as orthoses (rigid supports that are put inside the shoe) or strapping. Around four out of five cases of heel pain resolve within a year. However, having heel pain for this length of time can often be frustrating and painful. In around one in 20 cases, the above treatments are not enough, and surgery may be recommended to release the plantar fascia.

Heel Discomfort


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.


Stretching Exercises

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 – 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head until you feel a stretch in the back of your calf, Achilles tendon, plantar fascia or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Resistance Band Calf Strengthening. Begin this exercise with a resistance band around your foot as demonstrated and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 – 20 times provided the exercise is pain free.

The causes of lip swelling could range from trauma and contact dermatitis to allergic reactions to certain medical conditions. I am a 44 year old Pe teacher who has been experiencing Pes Planus since October. Vinegar has been used as a condiment for several centuries.

TOE CONDITIONS: Ingrown toenails, blood accumulation under the nail plate (subungual hematoma), corns and calluses are all often seen as a result of playing baseball. It is important that good foot hygiene be practiced with washing between the toes and drying the feet well after bathing. Topical antifungals work well to treat athletes foot. ORTHOPEDIC INJURIES: Most orthopedic baseball foot and ankle injuries are acute or sudden. If an individuals foot or ankle is injured, seek immediate evaluation with one of our doctors. If your athlete has a baseball related injury, call our specialists at Advanced Foot and Ankle Center in McKinney and Prosper Texas at 972-542-2155. However, toe numbness and pain occurring together is one such problem that you cannot afford to ignore. Common symptoms are flat feet knee problems , burning sensation, numbness.

Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

The spur occurs where the plantar fascia attaches, and the pain in that area is really due to the plantar fascia attachment being irritated. However, there are many people with heel spurs who have no symptoms at all. Haglund’s deformity is a bony growth on the back of the heel bone, which then irritates the bursa and the skin lying behind the heel bone. Achilles tendinopathy is degeneration of the tendon that connects your calf muscles to your heel bone. Stress fractures are common in military training.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

Junctional Epidermolysis Bullosa: A condition that causes blistering of the skin because of a mutation of a gene which in normal conditions helps in the formation of thread-like fibers that are anchoring filaments, which fix the epidermis to the basement membrane. Kanner Syndrome: Also referred to as Autism, this is one of the neuropsychiatric conditions typified by deficiencies in communication and social interaction, and abnormally repetitive behavior. Kaposi’s Sarcoma: A kind of malignancy of the skin that usually afflicts the elderly, or those who have problems in their immune system, like AIDS. For example, a year of perfect health is regarded as equivalent to 1.0 QALY.

The causes of lip swelling could range from trauma and contact dermatitis to allergic reactions to certain medical conditions. I am a 44 year old Pe teacher who has been experiencing Pes Planus since October. Vinegar has been used as a condiment for several centuries.

TOE CONDITIONS: Ingrown toenails, blood accumulation under the nail plate (subungual hematoma), corns and calluses are all often seen as a result of playing baseball. It is important that good foot hygiene be practiced with washing between the toes and drying the feet well after bathing. Topical antifungals work well to treat athletes foot. ORTHOPEDIC INJURIES: Most orthopedic baseball foot and ankle injuries are acute or sudden. If an individuals foot or ankle is injured, seek immediate evaluation with one of our doctors. If your athlete has a baseball related injury, call our specialists at Advanced Foot and Ankle Center in McKinney and Prosper Texas at 972-542-2155. However, toe numbness and pain occurring together is one such problem that you cannot afford to ignore. Common symptoms are flat feet knee problems , burning sensation, numbness.

Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

The spur occurs where the plantar fascia attaches, and the pain in that area is really due to the plantar fascia attachment being irritated. However, there are many people with heel spurs who have no symptoms at all. Haglund’s deformity is a bony growth on the back of the heel bone, which then irritates the bursa and the skin lying behind the heel bone. Achilles tendinopathy is degeneration of the tendon that connects your calf muscles to your heel bone. Stress fractures are common in military training.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

Junctional Epidermolysis Bullosa: A condition that causes blistering of the skin because of a mutation of a gene which in normal conditions helps in the formation of thread-like fibers that are anchoring filaments, which fix the epidermis to the basement membrane. Kanner Syndrome: Also referred to as Autism, this is one of the neuropsychiatric conditions typified by deficiencies in communication and social interaction, and abnormally repetitive behavior. Kaposi’s Sarcoma: A kind of malignancy of the skin that usually afflicts the elderly, or those who have problems in their immune system, like AIDS. For example, a year of perfect health is regarded as equivalent to 1.0 QALY.