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March 27 2015

allfootpain

Do You Understand Heel Pain?

Overview

Foot Pain

Heel pain is one of the most common conditions to affect the foot. It is usually felt as an intense pain when the affected heel is used. The pain is usually worse when you get out of bed in the morning or after a long period of activity. In most cases, only one heel is affected. After walking, the pain usually improves. However, it is common for it to be painful when you first take a step after a period of rest. The pain often worsens by the end of the day. Most cases of Heel Pain are caused by damage and thickening of the plantar fascia. Sometimes, the surrounding tissue and the heel bone also become inflamed (swollen).

Causes

The most common local causes of heel pain include. Plantar fasciitis, plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the sole of the foot that helps to support the arch. Plantar fasciitis occurs when the plantar fascia is overloaded or overstretched. This causes small tears in the fibers of the fascia, especially where the fascia meets the heel bone. Plantar fasciitis may develop in just about anyone but it is particularly common in the following groups of people: people with diabetes, obese people, pregnant women, runners, volleyball players, tennis players and people who participate in step aerobics or stair climbing. You also can trigger plantar fasciitis by pushing a large appliance or piece of furniture or by wearing worn out or poorly constructed shoes. In athletes, plantar fasciitis may follow a period of intense training, especially in runners who push themselves to run longer distances. People with flat feet have a higher risk of developing plantar fasciitis. Heel spur, a heel spur is an abnormal growth of bone at the area where the plantar fascia attaches to the heel bone. It is caused by long-term strain on the plantar fascia and muscles of the foot, especially in obese people, runners or joggers. As in plantar fasciitis, shoes that are worn out, poorly fitting or poorly constructed can aggravate the problem. Heel spurs may not be the cause of heel pain even when seen on an X-ray. In fact, they may develop as a reaction to plantar fasciitis. Calcaneal apophysitis, in this condition, the center of the heel bone becomes irritated as a result of a new shoe or increased athletic activity. This pain occurs in the back of the heel, not the bottom. Calcaneal apophysitis is a fairly common cause of heel pain in active, growing children between the ages of 8 and 14. Although almost any boy or girl can be affected, children who participate in sports that require a lot of jumping have the highest risk of developing this condition. Bursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot that cause an abnormal gait (way of walking). In other cases, wearing shoes with poorly cushioned heels can trigger bursitis. Pump bump, this condition, medically known as posterior calcaneal exostosis, is an abnormal bony growth at the back of the heel. It is especially common in young women, in whom it is often related to long-term bursitis caused by pressure from pump shoes. Like other parts of the foot, the heel can be bumped and bruised accidentally. Typically, this happens as a "stone bruise," an impact injury caused by stepping on a sharp object while walking barefoot. In most cases, Achilles tendonitis (inflammation of the Achilles tendon) is triggered by overuse, especially by excessive jumping during sports. However, it also can be related to poorly fitting shoes if the upper back portion of a shoe digs into the Achilles tendon at the back of the heel. Less often, it is caused by an inflammatory illness, such as ankylosing spondylitis (also called axial spondylarthritis), reactive arthritis, gout or rheumatoid arthritis. Compression of a small nerve (a branch of the lateral plantar nerve) can cause pain, numbness or tingling in the heel area. In many cases, this nerve compression is related to a sprain, fracture or varicose (swollen) vein near the heel.

Symptoms

Depending on the specific form of heel pain, symptoms may vary. Pain stemming from plantar fasciitis or heel spurs is particularly acute following periods of rest, whether it is after getting out of bed in the morning, or getting up after a long period of sitting. In many cases, pain subsides during activity as injured tissue adjusts to damage, but can return again with prolonged activity or when excessive pressure is applied to the affected area. Extended periods of activity and/or strain of the foot can increase pain and inflammation in the foot. In addition to pain, heel conditions can also generate swelling, bruising, and redness. The foot may also be hot to the touch, experience tingling, or numbness depending on the condition.

Diagnosis

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

Non Surgical Treatment

If you develop heel pain, you can try several methods at home to ease your discomfort. For example rest as much as possible, apply ice to the heel for 10 to 15 minutes twice a day, use over-the-counter pain medications, wear shoes that fit properly, wear night splints, a special device that stretches the foot while you sleep, use heel cups or shoe inserts to reduce pain, If these home care strategies do not ease your pain, you will need to see your doctor. He or she will perform a physical exam and ask you about your symptoms and when they began. Your doctor may also take an X-ray to determine the cause of your heel pain. Once your doctor knows what is causing your pain, he or she will be able to provide you with the appropriate treatment. In many cases, your doctor may prescribe physical therapy. This can help to strengthen the muscles and tendons in your foot, which helps to prevent further injury. If your pain is severe, your doctor may provide you with anti-inflammatory medications. These medications can be injected into the foot or taken by mouth. Your doctor may also recommend that you support your foot as much as possible-either by taping the foot or by using special footwear devices. In very rare cases, your doctor may recommend surgery to correct the problem. However, heel surgery often requires a long recovery time and may not always relieve your foot pain.

Surgical Treatment

If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.

Prevention

Heel Discomfort

Flexibility is key when it comes to staving off the pain associated with these heel conditions. The body is designed to work in harmony, so stretching shouldn?t be concentrated solely on the foot itself. The sympathetic tendons and muscles that move the foot should also be stretched and gently exercised to ensure the best results for your heel stretches. Take the time to stretch thighs, calves and ankles to encourage healthy blood flow and relaxed muscle tension that will keep pain to a minimum. If ice is recommended by a doctor, try freezing a half bottle of water and slowly rolling your bare foot back and forth over it for as long as is comfortable. The use of elastic or canvas straps to facilitate stretching of an extended leg can also be helpful when stretching without an assistant handy. Once cleared by a doctor, a daily regimen of over-the-counter anti-inflammatory medication like Naproxen Sodium will keep pain at bay and increase flexibility in those afflicted by heel pain. While this medication is not intended to act as a substitute for medical assessments, orthopedics or stretching, it can nonetheless be helpful in keeping discomfort muted enough to enjoy daily life. When taking any medication for your heel pain, be sure to follow directions regarding food and drink, and ask your pharmacist about possible interactions with existing medications or frequent activities.
Tags: Heel Pain

March 06 2015

allfootpain

What Can I Do About Achilles Tendon Pain ?

Overview

Achilles TendinitisAchilles tendonitis is a relatively common condition characterized by tissue damage and pain in the Achilles tendon. The muscle group at the back of the lower leg is commonly called the calf. The calf comprises of 2 major muscles, one of which originates from above the knee joint (gastrocnemius), the other of which originates from below the knee joint (soleus). Both of these muscles insert into the heel bone via the Achilles tendon. During contraction of the calf, tension is placed through the Achilles tendon. When this tension is excessive due to too much repetition or high force, damage to the tendon occurs. Achilles tendonitis is a condition whereby there is damage to the tendon with subsequent degeneration and inflammation. This may occur traumatically due to a high force going through the tendon beyond what it can withstand or, more commonly, due to gradual wear and tear associated with overuse.

Causes

Tight or tired calf muscles, which transfer too much of the force associated with running onto the Achilles tendon. Not stretching the calves properly or a rapid increase in intensity and frequency of sport training can make calf muscles fatigued. Activities which place a lot of stress on the achilles tendon, such as hill running and sprint training, can also cause Achilles Tendinitis. Runners who overpronate (roll too far inward on their feet during impact) are most susceptible to Achilles Tendinitis. Runners with flat feet are susceptible to Achilles Tendinitis because flat feet cause a 'wringing out' effect on the achilles tendon during running. High arched feet usually absorb less shock from the impact of running so that shock is transferred to the Achilles tendon. Use of inappropriate footwear when playing sport or running e.g., sandals, can also put an extra load on the Achilles tendon. Shoes are now available that have been designed for individual sports and provide cushioning to absorb the shock of impact and support for the foot during forceful movements. Training on hard surfaces e.g., concrete, also increases the risk of Achilles Tendinitis. Landing heavily or continuously on a hard surface can send a shock through the body which is partly absorbed by the Achilles tendon. A soft surface like grass turf helps to lessen the shock of the impact by absorbing some of the force of the feet landing heavily on the ground after a jump or during a running motion.

Symptoms

Most cases of Achilles tendonitis start out slowly, with very little pain, and then grow worse over time. Some of the more common symptoms include mild pain or an ache above the heel and in the lower leg, especially after running or doing other physical activities, pain that gets worse when walking uphill, climbing stairs, or taking part in intense or prolonged exercise, stiffness and tenderness in the heel, especially in the morning, that gradually goes away, swelling or hard knots of tissue in the Achilles tendon, a creaking or crackling sound when moving the ankle or pressing on the Achilles tendon, weakness in the affected leg.

Diagnosis

Examination of the achilles tendon is inspection for muscle atrophy, swelling, asymmetry, joint effusions and erythema. Atrophy is an important clue to the duration of the tendinopathy and it is often present with chronic conditions. Swelling, asymmetry and erythema in pathologic tendons are often observed in the examination. Joint effusions are uncommon with tendinopathy and suggest the possibility of intra-articular pathology. Range of motion testing, strength and flexibility are often limited on the side of the tendinopathy. Palpation tends to elicit well-localized tenderness that is similar in quality and location to the pain experienced during activity. Physical examinations of the Achilles tendon often reveals palpable nodules and thickening. Anatomic deformities, such as forefoot and heel varus and excessive pes planus or foot pronation, should receive special attention. These anatomic deformities are often associated with this problem. In case extra research is wanted, an echography is the first choice of examination when there is a suspicion of tendinosis. Imaging studies are not necessary to diagnose achilles tendonitis, but may be useful with differential diagnosis. Ultrasound is the imaging modality of first choice as it provides a clear indication of tendon width, changes of water content within the tendon and collagen integrity, as well as bursal swelling. MRI may be indicated if diagnosis is unclear or symptoms are atypical. MRI may show increased signal within the Achilles.

Nonsurgical Treatment

Use the R.I.C.E method of treatment when you first notice the pain. Although rest is a key part of treating tendonitis, prolonged inactivity can cause stiffness in your joints. Move the injured ankle through its full range of motion and perform gentle calf and ankle stretches to maintain flexibility. If self-care doesn't work, it's important to get the injury treated because if the tendon continues to sustain small tears through movement, it can rupture under excessive stress. Your doctor may suggest a temporary foot insert that elevates your heel and may relieve strain on the tendon. Other possible treatments include special heel pads or cups to wear in your shoes to cushion and support your heel, or a splint to wear at night. Physical therapy may also help allow the tendon to heal and repair itself over a period of weeks.

Achilles Tendon

Surgical Treatment

Surgery should be considered to relieve Achilles tendinitis only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendinitis and the amount of damage to the tendon. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the Achilles tendon, this procedure is useful for patients who still have difficulty flexing their feet, despite consistent stretching. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope-an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Gastrocnemius recession can be performed with or without d?bridement, which is removal of damaged tissue. D?bridement and repair (tendon has less than 50% damage). The goal of this operation is to remove the damaged part of the Achilles tendon. Once the unhealthy portion of the tendon has been removed, the remaining tendon is repaired with sutures, or stitches to complete the repair. In insertional tendinitis, the bone spur is also removed. Repair of the tendon in these instances may require the use of metal or plastic anchors to help hold the Achilles tendon to the heel bone, where it attaches. After d?bridement and repair, most patients are allowed to walk in a removable boot or cast within 2 weeks, although this period depends upon the amount of damage to the tendon. D?bridement with tendon transfer (tendon has greater than 50% damage). In cases where more than 50% of the Achilles tendon is not healthy and requires removal, the remaining portion of the tendon is not strong enough to function alone. To prevent the remaining tendon from rupturing with activity, an Achilles tendon transfer is performed. The tendon that helps the big toe point down is moved to the heel bone to add strength to the damaged tendon. Although this sounds severe, the big toe will still be able to move, and most patients will not notice a change in the way they walk or run. Depending on the extent of damage to the tendon, some patients may not be able to return to competitive sports or running. Recovery. Most patients have good results from surgery. The main factor in surgical recovery is the amount of damage to the tendon. The greater the amount of tendon involved, the longer the recovery period, and the less likely a patient will be able to return to sports activity. Physical therapy is an important part of recovery. Many patients require 12 months of rehabilitation before they are pain-free.

Prevention

While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you're just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don't support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.

January 17 2015

allfootpain

What Is Heel Pain And Ideas On How To End It

Heel Pain

Overview

Plantar fasciitis is thickening of the plantar fascia, a band of tissue running underneath the sole of the foot. The thickening can be due to recent damage or injury, or can be because of an accumulation of smaller injuries over the years. Plantar fasciitis can be painful.



Causes

The most frequent cause is an abnormal motion of the foot called excessive pronation. Normally, while walking or during long distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch. Your arch should only dip slightly during this motion. If it lowers too much, you have what is known as excessive pronation. For more details on pronation, please see the section on biomechanics and gait. Clinically not only those with low arches, but those with high arches can sometimes have plantar fasciitis. The mechanical structure of your feet and the manner in which the different segments of your feet are linked together and joined with your legs has a major impact on their function and on the development of mechanically caused problems. Merely having "flat feet" won't take the spring out of your step, but having badly functioning feet with poor bone alignment will adversely affect the muscles, ligaments, and tendons and can create a variety of aches and pains. Excess pronation can cause the arch of your foot to stretch excessively with each step. It can also cause too much motion in segments of the foot that should be stable as you are walking or running. This "hypermobility" may cause other bones to shift and cause other mechanically induced problems.



Symptoms

Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time. If you have foot pain at night, you may have a different problem, such as arthritis , or a nerve problem such as tarsal tunnel syndrome.



Diagnosis

Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which 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 (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.



Non Surgical Treatment

About 90% of plantar fasciitis cases are self-limited and will improve within six months with conservative treatment and within a year regardless of treatment. Many treatments have been proposed for the treatment of plantar fasciitis. First-line conservative approaches include rest, heat, ice, calf-strengthening exercises, techniques to stretch the calf muscles, achilles tendon, and plantar fascia, weight reduction in the overweight or obese, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. NSAIDs are commonly used to treat plantar fasciitis, but fail to resolve the pain in 20% of people. Extracorporeal shockwave therapy (ESWT) is an effective treatment modality for plantar fasciitis pain unresponsive to conservative nonsurgical measures for at least three months. Corticosteroid injections are sometimes used for cases of plantar fasciitis refractory to more conservative measures. The injections may be an effective modality for short-term pain relief up to one month, but studies failed to show effective pain relief after three months. Notable risks of corticosteroid injections for plantar fasciitis include plantar fascia rupture, skin infection, nerve or muscle injury, or atrophy of the plantar fat pad. Custom orthotic devices have been demonstrated as an effective method to reduce plantar fasciitis pain for up to 12 weeks. Night splints for 1-3 months are used to relieve plantar fasciitis pain that has persisted for six months. The night splints are designed to position and maintain the ankle in a neutral position thereby passively stretching the calf and plantar fascia overnight during sleep. Other treatment approaches may include supportive footwear, arch taping, and physical therapy.

Painful Heel



Surgical Treatment

The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment. There are a number of reasons why surgery is not immediately entertained including. Non-operative treatment when performed appropriately has a high rate of success. Recovery from any foot surgery often takes longer than patients expect. Complications following this type of surgery can and DO occur! The surgery often does not fully address the underlying reason why the condition occurred therefore the surgery may not be completely effective. Prior to surgical intervention, it is important that the treating physician ensure that the correct diagnosis has been made. This seems self-evident, but there are other potential causes of heel pain. Surgical intervention may include extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.



Stretching Exercises

Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch. Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.

January 14 2015

allfootpain

What Causes Pain On The Heel To Appear

Pain Of The Heel

Overview

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



Causes

Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if your feet roll inward too much when you walk ( excessive pronation ). You have high arches or flat feet. You walk, stand, or run for long periods of time, especially on hard surfaces. You are overweight. You wear shoes that don't fit well or are worn out. You have tight Achilles tendons or calf muscles.



Symptoms

The symptoms of plantar fasciitis include pain in the bottom of your foot, especially at the front or centre of the heel bone, pain that is worse when first rising in the morning (called "first-step pain"), when first standing up after any long period of sitting, or after increased levels of activity especially in non-supportive shoes. Seek medical advice about plantar fasciitis if you have heel pain or pain in the bottom of your foot, especially when you get up in the morning, that does not respond to treatment or if there is redness or bruising in the heel.



Diagnosis

Your doctor will ask you about the kind of pain you're having, when it occurs and how long you've had it. If you have pain in your heel when you stand up for the first time in the morning, you may have plantar fasciitis. Most people with plantar fasciitis say the pain is like a knife or a pin sticking into the bottom of the foot. After you've been standing for a while, the pain becomes more like a dull ache. If you sit down for any length of time, the sharp pain will come back when you stand up again.



Non Surgical Treatment

The following self-help treatments have been found to be most effective. Rest your foot. Reduce the amount of weight-bearing activities you participate in. Get off of your feet and elevate them. This will allow healing to begin. Apply ice to your foot. Applications of ice packs that provide a comfortable cooling to the heel and arch (not a freezing cold) will help reduce pain, swelling, and inflammation. Apply the ice to the heel and arch (not the toes). Make sure it is comfortable, and leave on your foot for about 20 minutes, 3 times a day. If you have any medical problems such as diabetes, poor circulation, etc., discuss the use of ice with your doctor before applying the ice. ActiveWrap allows you to apply comfortable cold therapy to your foot without messy ice cubes. Use while on the "go." Do not walk with bare feet. Always protect your heels, arches, and plantar fascia with good supportive shoes. Orthaheel Orthotic Flip Flops For Men and Women are designed for walking comfort with built in orthotic footbeds that help reduce foot pain from plantar fasciitis. Use in the house or on the beach. Stretch the Plantar Fascia while sleeping. Plantar Fasciitis and Heel Spur pain is usually worse with the first steps in the morning. This is due to the Plantar Fascia tightening up, or contracting while we sleep. To prevent these pain producing contractures of the plantar fascia, the foot must be held in its normal or neutral position while we sleep. This optimal position of the foot is maintained with our comfortable and supportive Night Splint. When foot contractures are prevented during sleep, the "first step pains" Plantar Fasciitis and Heel Spurs will gradually subside. Stretch the Plantar Fascia during the day. Even though the Plantar Fascia is a thick tissue band with very little "give" to it, with the proper care (a Night Splint and the following exercises) it can be stretched a small amount. By stretching the Plantar Fascia even a bit, its abnormal pull on the heel is reduced. This will help to reduce pain and inflammation in the heel and arch. Two of the most effective exercises recommended are. Before stepping down, especially after sleeping or resting, stretch the arch of the foot by stretching your legs out in front of you (do not bend the knee). Place a towel around the ball of the foot. Slowly pull on the ends of the towel, pulling the toes and ball of the foot back as far as is comfortable. Hold the foot in this position for ten seconds. Repeat at least ten times. You should feel a pull on the bottom of the foot, especially in the arch. This stretches the plantar fascia, and reduces its pull on the heel. Stand about 2 to 3 feet from a wall. Lean forward with your hands against the wall. With the painful foot behind, place the other foot forward. Press against the wall, shifting weight over the front foot, while straightening the back leg. Keep the heel of the back foot on the floor and feel the stretch in the heel, Achilles tendon, and calf. Hold this position for ten seconds. Repeat at least ten times, and try to do this three times a day. When these things are achieved, the inflammation and pain of Plantar Fasciitis and Heel Spurs will gradually subside. If you are unsure of the nature of your foot problem, if your pain is intense and does not subside, if you are a diabetic or have other medical problems, if your pain is due to an injury, if an open sore is present, if a mass can be felt, or if you think that you may have an infection, we suggest that before beginning any of the above treatments you consult with your doctor.

Feet Pain



Surgical Treatment

Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.



Prevention

Plantar fasciitis can be a nagging problem, which gets worse and more difficult to treat the longer it's present. To prevent plantar fasciitis, run on soft surfaces, keep mileage increases to less than 10 percent per week, and visit a specialty running shop to make sure you're wearing the proper shoes for your foot type and gait. It's also important to stretch the plantar fascia and Achilles tendon.

January 10 2015

allfootpain

What Is Plantar Fasciitis

Heel Discomfort

Overview

Plantar fasciitis is a poorly understood condition. There is little consensus among medical professionals about what causes the problem, and no treatments have been reliably proven to treat it. A number of theories exists for why plantar fasciitis develops, but the ineffectiveness of conventional treatments suggests something is missing. The plantar fascia is a band of connective tissue that runs along the underside of the foot from the heel to the toes. The fascia helps maintain the integrity of the arch, provides shock absorption, and plays an important role in the normal mechanical function of the foot.



Causes

There are several possible causes of plantar fasciitis, including wearing high heels, gaining weight, increased walking, standing, or stair-climbing. If you wear high-heeled shoes, including western-style boots, for long periods of time, the tough, tendonlike tissue of the bottom of your foot can become shorter. This layer of tissue is called fascia. Pain occurs when you stretch fascia that has shortened. This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning. If you gain weight, you might be more likely to have plantar fasciitis, especially if you walk a lot or stand in shoes with poor heel cushioning. Normally there is a pad of fatty tissue under your heel bone. Weight gain might break down this fat pad and cause heel pain. Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts. It can also occur with a change in exercise surface or terrain, or if your shoes are worn out and don't provide enough cushion for your heels. If the arches of your foot are abnormally high or low, you are more likely to develop plantar fasciitis than if your arches are normal.



Symptoms

Plantar fasciitis is the inflammation of the plantar fascia - a band of tough fibrous tissue running along the sole of the foot. It occurs when small tears develop in the plantar fascia, leading to inflammation and heel pain. The plantar fascia tissue branches out from the heel like a fan, connecting the heel bone to the base of the toes. When the foot moves, the plantar fascia stretches and contracts. The plantar fascia helps to maintain the arch of the foot in much the same way that the string of a bow maintains the bow's arch. The most notable symptom of plantar fasciitis is heel pain. This is typically most severe in the middle of the heel though it may radiate along the sole of the foot. The pain is most often felt when walking first thing in the morning or after a period of rest. As walking continues the pain may decrease; however some degree of pain remains present on movement. The pain may disappear when resting, as the plantar fascia is relaxed. Redness, swelling and warmth over the affected area may also be noticed. The onset of plantar fasciitis is gradual and only mild pain may be experienced initially. However, as the condition progresses the pain experienced tends to become more severe. Chronic plantar fasciitis may cause a person to change their walking or running action, leading to symptoms of discomfort in the knee, hip and back.



Diagnosis

To diagnose plantar fasciitis, your doctor will physically examine your foot by testing your reflexes, balance, coordination, muscle strength, and muscle tone. Your doctor may also advise a magnetic resonance imaging (MRI) or X-ray to rule out other others sources of your pain, such as a pinched nerve, stress fracture, or bone spur.



Non Surgical Treatment

Sometimes physical therapy modalities are helpful. The most frequently used modalities include ultrasound (high frequency sound vibrations that create a deep heat and reduce inflammation) and galvanic electrical stimulation ( a carefully applied intermittent muscular stimulation to the heel and calf that helps reduce pain and relax muscle spasm, which is a contributing factor to the pain). This treatment has been found most effective when given twice a week. Repeated taping and padding is sometimes used. The felt pads that will be strapped to your feet will compress after a few days and must be reapplied. While wearing them they should be kept dry, but may be removed the night before your next appointment. Resistant cases of heel pain caused by plantar fasciitis, heel spurs or cases of stress fracture of the calcaneus often need to be placed in a removable below knee cast boot. It is important to be aware of how your foot feels over this time period. If your foot is still uncomfortable without the strapping, but was more comfortable while wearing it, that is an indication that the treatment should help. Remember, what took many months or years to develop can not be eliminated in just a few days.

Heel Pain



Surgical Treatment

More invasive procedures to treat plantar fasciitis are usually sought only after other treatment has failed to produce favorable results. Corticosteroid injections deliver medicine into the injured fascia to reduce pain. However, this treatment may weaken the plantar fascia and result in further damage. In addition, extracorporeal shock wave therapy (ESWT) is a treatment where sound waves are sent through the damaged tissue in order to stimulate the damaged tissue and encourage healing. This method is relatively new in treating plantar fasciitis and your doctor will be able to tell you if it is the right method for you. Lastly, surgery is the last option for those suffering from chronic or severe plantar fasciitis.

January 07 2015

allfootpain

What Exactly Triggers Heel Pain

Plantar Fascitis

Overview

Plantar fasciitis is a common painful disorder affecting the heel and underside of the foot. It is a disorder of the insertion site of plantar fascia on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot’s plantar fascia. It is often caused by overuse injury of the plantar fascia, increases in exercise, weight or age. Although plantar fasciitis was originally thought to be an inflammatory process, newer studies have demonstrated structural changes more consistent with a degenerative process. As a result of this new observation, many in the academic community have stated the condition should be renamed plantar fasciosis.



Causes

Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Approximately 10% of people have plantar fasciitis at some point during their lifetime. It is commonly associated with long periods of standing and is much more prevalent in individuals with excessive inward rolling of the foot, which is seen with flat feet. Among non-athletic populations, plantar fasciitis is associated with obesity and lack of physical exercise.



Symptoms

Patients experience intense sharp pain with the first few steps in the morning or following long periods of having no weight on the foot. The pain can also be aggravated by prolonged standing or sitting. The pain is usually experienced on the plantar surface of the foot at the anterior aspect of the heel where the plantar fascia ligament inserts into the calcaneus. It may radiate proximally in severe cases. Some patients may limp or prefer to walk on their toes. Alternative causes of heel pain include fat pad atrophy, plantar warts and foreign body.



Diagnosis

Your doctor may look at your feet and watch the way you stand, walk and exercise. He can also ask you questions about your health history, including illnesses and injuries that you had in your past. The symptoms you have such as the pain location or when does your foot hurts most. Your activity routine such as your job, exercise habits and physical activities preformed. Your doctor may decide to use an X-ray of your foot to detect bones problems. MRI or ultrasound can also be used as further investigation of the foot condition.



Non Surgical Treatment

Treatment for plantar fasciitis should begin with rest, icing, and over the counter medications. As mentioned above, an orthotic is a device that can be slipped into any pair of shoes and can often relieve pain and help to reverse the damage and occurrence of plantar fasciitis. They do this by adding support to the heel and helping to distribute weight during movement. In addition to orthotics, many people consider night splints for treating this condition. These devices are worn during the night while you sleep, helping to keep the plantar fascia stretched to promote healing. Physical therapy has also become a common option. With this conservative treatment alternative, a physical therapist designs a set of exercises that are intended to address your specific needs in order to promote healing.

Feet Pain



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

To reduce your risk of getting plantar fasciitis take these steps. Wear appropriate and well-fitted footwear during sports and exercise. Do stretching exercises for the Achilles tendon and plantar fascia. Increase the intensity and duration of exercise gradually. Maintain an appropriate weight.

January 04 2015

allfootpain

Symptoms Of Accessory Navicular Syndrome

Did you know that redheads require 20% more general anesthesia than non-gingers before going under the knife? Often taken for granted, our feet and ankles are subjected to a rigorous workout everyday. Pain, such as may occur in our heels, alerts Bunions Callous us to seek medical attention. The fungal problems seen most often are athlete's foot and fungus nails. Big toe joint pain can be a warning sign of arthritis. Enter the shape, color, or imprint of your prescription or OTC drug. Help!!!!!

These conditions include different types of arthritis , osteonecrosis , neuromas , tumors, or infections. Lastly, traumatic injuries, including fractures and ligament tears, can cause this type of foot pain. Treatment of foot pain often consists of anti-inflammatory medications , footwear modifications, and inserts for your shoes. When buying footwear, look for shoes with a wide toebox, good support, and avoid high heels. These pads help to take pressure off the ball of the foot. If some simple steps do not alleviate your symptoms, you should see your doctor to ensure you are receiving adequate treatment. In some rare situations, patients don't find relief with shoe modifications, and may require a surgical procedure. Remember that our shoes protect us from injury.

Pain often occurs suddenly and mainly around the undersurface of the heel, although it often spreads to your arch. The condition can be temporary, but may become chronic if you ignore it. Resting usually provides relief, but the pain may return. Heel spurs are bony growths that protrude from the bottom of the heel bone, and they are parallel to the ground. There is a nerve that runs very close to this area and may contribute to the pain which occurs.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

Another solution is to wear custom foot orthotics, like ezWalker ® Performance Custom Orthotics, in your shoes to help correct your body posture, stabilize your balance, relieve pain during follow-through and evenly redistribute your weight on your feet. EzWalker® Custom Orthotics are specifically made for each of your feet to properly support your arches while reducing pressure on the balls of your feet. With ezWalker® Custom Orthotics, you'll walk from lateral heel to medial forefoot for better biomechanics of your entire body. This condition manifests as a skin lesion that assumes a ring-like pattern. It can affect any region of the body, right from the scalp to the foot. One such common home remedy is the use of bleach. Many people claim that this is a very effective ringworm treatment.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

During the average lifetime our feet cover over 70,000 miles, the equivalent of walking four times around the world., so it's not surprising that problems can occur. Indeed around three-quarters of all adults will experience some sort of problem with their feet at some time. And without treatment most foot complaints will become gradually worse with time. This means people often endure painful conditions for far too long, and the problem can get worse. People often assume nothing can be done to help their condition, but in fact these conditions are extremely treatable. Swollen lump on big toe joint; lump may become numb but also make walking painful.

November 16 2014

allfootpain

Caring For Your Feet As You Age

A bunionette is similar to a bunion, but it develops on the outside of the foot. Kate Middleton is barely seen out in public engagements without her trusty nude LK Bennett high heels on. When she made a pre-Olympic visit to a judo center however, she gamely kicked off her heels to step on the mat. Pain is a symptom common to many foot conditions, and pain medications are a good solution for most types of foot pain.

Elderly people wearing shoes with thick inflexible soles may be unable to sense the position of their feet relative to the ground, significantly increasing the risk for falling. If shoes need breaking in, place moleskin pads next to areas on the skin where friction is likely to occur.

Skin conditions that involve open sores, lesions, or contagions may also be treated with medical ointments and bandages or wraps. Skin disorders that are temporary and merely cosmetic in nature can often be treated with medicated make-up, over-the-counter skin care products, hygiene techniques, and small lifestyle changes. In addition, some skin conditions can be treated or improved with changes in diet. Some skin disorders cannot be prevented; genetic conditions and disorders that are brought on by other illnesses cannot be avoided. However, it is possible to prevent some skin disorders. Learning about proper skin care and skin disorder treatment can be very important for skin health. Some conditions require the attention of a doctor, while others can be safely addressed at home.

Go for those, which provide support, cushioning, and enough room for the toes to move. People with flexible flat feet have arches that disappear when they put weight on their feet, but which reappear when the feet are not weight-bearing, or when they go up on their toes. In fact, this reappearance of the arch while the foot is non-weight bearing is really what separates this type of flatfoot from other types. It's as though the arches take toe-standing as a general call of olly-olly-oxen-free: time to come out and tease the seeker about how great your hiding place was. Visit Cure Athlete's Foot In 7 Days.

I also have arthritis in my knees and spine, and some problems with my left foot. The biggest problems for me are side effects from drugs, I am on morphine, and exhaustion. Her pain is treated by injections into both knees when they become painful. Between treatments my wife's knees are able to function normally - a recent holiday in Madeira climbing dozens of steps twice daily with no pain or difficulty!! I also suffered extreme back pain which prevented 5 years of good sleep.

Even when you are experiencing ankle, knee, leg or back pain podiatry Windsor can often help. Podiatry Windsor is really no different than a dentist; we should all get regular checkups, even when nothing seems wrong, to ensure we take care of the health of our feet. However some of the important reasons to get a consultation with a Podiatrist are; persistent foot or ankle pain that won't go away with rest, ice or anti-inflammatories, a wound or sore that does not heal, foot discolorations (if one foot is a much different color than the other), any pain or swelling, and numbness, burning or tingling in the feet. An important thing to point out is that podiatry Windsor is a very good preventative practice. Below is Dr Foot's 20 foot care tips.

To stop foot pain it is advisable to wear shoes that are well cushioned and have a flexible area at the ball of the foot. For severe conditions doctors and podiatrists may recommend orthotics or orthoses. These are insoles which are specifically modelled from plaster cast of the patient's foot. Orthopaedic footwear is also good in treating foot pain. For correct treatment of widespread orthopedic issues within the foot it is required to make use of orthopedic sneakers regularly. The feminine part of the sufferers are more likely to immediately hurry to buy only essentially the most beautiful models of orthopedic sneakers for women Nonetheless, do consult your orthopaedist prior to purchase, as he will recommend probably the most suitable footwear needed to your specific feet situation. Bunions can also be a result of arthritis, which often affects the big toe joint. There are numerous ways to treat flat feet.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

March 25 2014

allfootpain






March 23 2014

allfootpain

March 21 2014

allfootpain

Athletes Agree: Platelet-Rich Plasma Therapy Successfully Treats Chronic Achilles Tendonitis and Other Ankle Injuries




Athletes Agree: Platelet-Rich Plasma Therapy Successfully Treats Chronic Achilles Tendonitis and Other Ankle Injuries
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Beverly Hills. CA (PRWEB) August 06, 2012

Like professional athletes, many Olympic contenders have found that Platelet-Rich Plasma (PRP) therapy relieves pain and speeds healing. Their stories have brought attention to the use of PRP to treat heel and ankle pain caused by chronic disorders like Achilles tendonitis and retrocalcaneal bursitis. Dr. Bill J. Releford, doctor of podiatric medicine, finds PRP therapy beneficial in his practice treating these and other injuries.

Dr. Releford, medical director and founder of The Releford Foot and Ankle Institute, describes how he used PRP injections to treat an Olympic track and field hopeful. "After suffering an ankle injury, the patient was treated with a series of two injections of platelet-rich plasma over a four-week period. The most significant initial subjective findings showed reduced pain and moderate to significant increases in range of motion," continues Dr. Releford. "The patient reported that she ran her best season after receiving PRP injections."

About Achilles Tendonitis

Achilles tendonitis occurs when the Achilles tendon"the large band of tissues connecting the muscles in the back of the lower leg to the heel"becomes inflamed or irritated. Symptoms often develop gradually, and include pain and stiffness especially when first getting out of bed. Some people report a crackling or creaking sound at the site. Pain may lessen, or even disappear, upon activity. Once activity stops, however, pain returns and may increase. Athletes and others may develop Achilles tendonitis when they over-train.

About Retrocalcaneal Bursitis

Bursas are fluid-filled sacs located around most of the body"s large joints. A bursa acts as a cushion and lubricant between tendons and muscles sliding over bone. Retrocalcaneal bursitis is an inflammation of the bursa at the back of the heel bone under the Achilles tendon, where the calf muscles connect. Possible causes of retrocalcaneal bursitis include too much walking, running, or jumping. This condition is usually linked to Achilles tendonitis, and is sometimes mistaken for it. Athletes may develop retrocalcaneal bursitis after starting an aggressive workout schedule, or suddenly increasing activity without proper conditioning.

About Platelet-Rich Plasma Therapy

PRP therapy is an innovative, non-surgical approach that uses healing components derived from a small, concentrated amount of a patient"s own blood. Injected into damaged tissue, PRP therapy has the potential to "supercharge" the healing process. PRP has been successfully used in orthopedics and sports medicine to treat joint and tendon pain, ankle sprains, heel pain, non-healing wounds, plantar fasciitis, poor circulation, diabetic neuropathy, and many other conditions, as cited in the Journal of Orthopaedic Research (Jan. 2006). Recently, PRP therapy has made headlines due to its successful use by professional athletes like Tiger Woods, Kobe Bryant, Alex Rodriguez, and Rafael Nadal.

About Dr. Bill J. Releford, D.P.M.

Dr. Bill J. Releford, D.P.M., a graduate of the Temple School of Podiatric Medicine in Philadelphia, began his practice in 1990 and established the Diabetic Foot Institute, a facility dedicated exclusively to the reduction of diabetes-related amputations in high-risk populations. Dr. Releford is recognized both domestically and internationally as a leader in the field of diabetic limb preservation and wound care. Dr. Releford uses Platelet-Rich Plasma Therapy to treat foot injuries as well as chronic non-healing wounds.

Dr. Releford is an assistant professor at Charles R. Drew University and lectures worldwide about the latest techniques in limb salvage and community-based outreach. He authored the book "Five Colors A Day to Better Health," and has been featured on "NBC Nightly News" with Brian Williams, ABC"s "The View," and in The Washington Post, Newsweek, and The Los Angeles Times.

About The Releford Foot and Ankle Institute

The Releford Foot & Ankle Institute"s mission is to effectively decrease the diabetes-related amputation rate in Los Angeles and surrounding communities by providing comprehensive wound care and limb salvage services.

Dr. Releford"s community outreach and health-care advocacy efforts are facilitated through the Diabetic Amputation Prevention Foundation (DAP), a non-profit organization he founded in 2001. Its mission is to educate at-risk populations to better understand diabetes and its complications through community-based programs.
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Dr. Releford and the DAP Foundation have been recognized for the success of the Black Barbershop Health Outreach Program. Since its inception in December 2007, the program has screened over 25,000 men for diabetes and hypertension in more than 450 black-owned barbershops in over 26 cities
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March 19 2014

allfootpain

Claw Toe-OrthoInfo - AAOS




Claw Toe-OrthoInfo - AAOS
Copyright 2012 American Academy of Orthopaedic SurgeonsClaw ToePeople often blame the common foot deformity claw toe on wearing shoes that squeeze your toes, such as shoes that are too short or high heels. However, claw toe also is often the result of nerve damage caused by diseases like diabetes or alcoholism, which can weaken the muscles in your foot. Having claw toe means your toes "claw," digging down into the soles of your shoes and creating painful calluses. Claw toe gets worse without treatment and may become a permanent deformity over time. SymptomsYour toes are bent upward (extension) from the joints at the ball of the foot.Your toes are bent downward (flexion) at the middle joints toward the sole of your shoe.Sometimes your toes also bend downward at the top joints, curling under the foot.Corns may develop over the top of the toe or under the ball of the foot.Top of pageEvaluation
If you have symptoms of a claw toe, see your doctor for evaluation. You may need certain tests to rule out neurological disorders that can weaken your foot muscles, creating imbalances that bend your toes. Trauma and inflammation can also cause claw toe deformity.
Top of pageTreatment
Claw toe deformities are usually flexible at first, but they harden into place over time. If you have claw toe in early stages, your doctor may recommend a splint or tape to hold your toes in correct position. Additional advice:
Wear shoes with soft, roomy toe boxes and avoid tight shoes and high-heels.Use your hands to stretch your toes and toe joints toward their normal positions.Exercise your toes by using them to pick up marbles or crumple a towel laid flat on the floor.
If you have claw toe in later stages and your toes are fixed in position:
A special pad can redistribute your weight and relieve pressure on the ball of your foot.Try special "in depth" shoes that have an extra 3/8" depth in the toe box.Ask a shoe repair shop to stretch a small pocket in the toe box to accommodate the deformity.
If these treatments do not help, you may need surgery to correct the problem.
Top of pageLast reviewed: September 2012
Co-Developed by the American Orthopaedic Foot and Ankle Society
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.Copyright 2012 American Academy of Orthopaedic SurgeonsFoot and Ankle Exercise Conditioning Program
Download this PDFDownload this PDF(/PDFs/Rehab_Foot_and_Ankle_4.pdf)OrthoInfo
The American Academy of Orthopaedic Surgeons
6300 N. River Road
Rosemont, IL 60018
Phone: 847.823.7186
Email: orthoinfo@aaos.org


March 17 2014

allfootpain

Dr. Pribut on Achilles Tendonitis, Tendinopathy and Tendinosis




Dr. Pribut on Achilles Tendonitis, Tendinopathy and Tendinosis



Achilles Tendonitis, Tendinopathy and Tendinosis
The Scoop On Achilles Tendon Injuries
by Stephen M. Pribut, D.P.M.
Achilles Tendon Pain: Symptoms and Causes
Achilles tendonitis is the bane of many runners. You shouldnot allow this to turn into a chronic and troubling malady leadingto moans about how it will never end, contributing to roadsidesstrewn with air cushioned clad runners, all with ice packs attachedto their heels. First, we will review some basic informationabout the achilles tendon.

The Achilles tendon is the connection between the heel and themost powerful muscle group in the body. This has long been knownas a site which is prone to disabling injury. Forces up to 12 times bodyweight (9kN) may arise during sprinting. This tendon is namedafter Achilles, who according to myth, was protected from woundsby being dipped in a magical pond by his mother. She held himby the heel, which was not immersed, and later died by an arrowwound in his heel. Although injuries to this areamust have been known for more than 2,000 years, it was firstreported in the medical literature by Ambroise Par?(C) only 400years ago.

"...the biggest contributor to chronic achilles tendonitis is ignoring pain."

The Achilles tendon joins three muscles: the two heads of thegastrocnemius and the soleus. The gastrocnemius heads arise fromthe posterior portions of the femoral condyles. The soleus arisesfrom the posterior aspect of the tibia and fibula.

The gastrocnemius is a muscle that crosses three joints: theknee, the ankle, and the subtalar joint. The functioning of thesejoints and influence of other muscles on these joints has a significanteffect on the tension that occurs within the achilles tendon.As an example tight hamstrings impact the functioning of theankle joint, the subtalar joint, and increase tension in theachilles tendon. The soleus does not cross the knee and is abiarticualar muscle.

The plantaris is a nearby muscle that has its separate tendon.It arises from the lateral condyle of the femur. It has a thintendon that passes between the gastrocnemius and soleus and insertsinto the calcaneus. When this musclculotendinous structure isinjured it is frequently felt as a "pellet shot" inthe back of the leg. The tear is usually about eight inches belowthe knee joint.

The bulk of the achilles tendon inserts into the posterior superiorthird of the calcaneus. Some fibers course distally and continueto where portions of the plantar fascia insert into the plantaraspect of the calcaneus.

The achilles tendon does not have a rich blood supply. The bloodsupply has been found to be weakest at a point between 2 and6 cm above its insertion into the calcaneus. (Although Astromfound with Doppler flow measurements the least vascularity atthe insertion.) It is not invested within a true tendon sheath.A paratenon composed of other soft tissue surround it. The outerlayer is a portion of the deep fascia, the middle layer is calledthe mesotenon and the inner layer is contiguous with a thin layersurrounding the tendon itself (epitenon). The blood supply tothe proximal portion of the tendon comes from the branches ofthe muscles themselves. The distal portion is supplied by branchesfrom the tendon-bone interface. The mesotenon supplies the majorblood supply to the Achilles tendon.

Contributing Factors
There are several factors that can contribute to achillestendonitis. First, you should know that the biggest contributorto chronic achilles tendonitis is ignoring pain in your achillestendon and running through the pain of early achilles tendonitis.If your achilles tendon is getting sore it is time to pay attentionto it, immediately.

Sudden increases in training can contribute to achillestendonitis. Excessive hill running or a sudden additionof hills and speed work can also contribute to this problem.Two sole construction flaws can also aggravate achilles tendonitis.The first is a sole that is too stiff, especially at theball of the foot. (In case you are having difficulty locatingthe "ball" of your foot, I mean the part where thetoes join the foot and at which the foot bends) If this areais stiff than the "lever arm" of the foot is longerand the achilles tendon will be under increased tension and thecalf muscles must work harder to lift the heel off the ground.

The second contributing shoe design factor which may lead tocontinuing achilles tendon problem is excessive heel cushioning.Air filled heels, while supposedly are now more resistant todeformation and leaks are not good for a sore achilles tendon.The reason for this is quite simple. If you are wearing a shoethat is designed to give great heel shock absorption what frequentlyhappens is that after heel contact, the heel continues to sinklower while the shoe is absorbing the shock. This further stretchesthe achilles tendon, at a time when the leg and body are movingforward over the foot. Change your shoes to one without this "feature".

Of course another major factor is excessive tightness of theposterior leg muscles, the calf muscles and the hamstrings maycontribute to prolonged achilles tendonitis. Gentle calf stretchingshould be performed preventatively. During a bout of acute achillestendonitis, however, overly exuberant stretching should not beperformed.

Treatment
The first thing to do is to cut back your training. If you areworking out twice a day, change to once a day and take one ortwo days off per week. If you are working out every day cut backto every other day and decrease your mileage.Training modificationis essential to treatment of this potentially long lasting problem.You should also cut back on hill work andspeed work. Post running ice may also help. Be sure to avoidexcessive stretching. The first phase of healing should be accompaniedby relative rest, which doesn't necessarily mean stopping running,but as I am emphasizing, a cut back in training. If this doesnot help quickly, consider the use of a 1/4 inch heel lift canalso help. Do not start worrying if you will become dependenton this, concentrate on getting rid of the pain. Don't walk barefootaround your house, avoid excessively flat shoes, such as "sneakers",tennis shoes, cross trainers, etc.

"...Training modification is essential."

In office treatment would initially consist of the use of thephysical therapy modalities of electrical stimulation, (HVGS,high voltage galvanic stimulation), and ultrasound. Your sportsmedicine physician should also carefully check your shoes. Aheel lift can also be used and control of excessive pronationby taping can also be incorporated into a program of achillestendonitis rehabilitation therapy. Orthotics with a small heellift are often helpful.

Exercises to Avoid
Excessive stretching is not good for your achilles tendon. Thestretch that I most often recommend is the "wall stretch".I do not recommend the "stair stretch", the "inclinestretch", or the "put a towel around your feet andpull up until it hurts stretch". If any of these are workingfor you, that's great, you don't need any advice. In most cases,for the patients I see, these stretches put too much tensionon the already tender achilles tendon. Contracting the musclewhen it is in a stretched position, as initial therapy of aninjured achilles tendon is not a good thing.

Treatment Outline:Relative rest (see above)Cut back mileageLower intensityAvoid hills, speedwork, plyometricsAvoid over-stretchingGentle stretch after warm-upStart with Straight leg calf stretch, build up muchlater to bent leg, consider eccentric stretch later.Ice Massage10 to 20 minutes after exerciseNSAIDsAlleve, Motrin, etc. 10 - 14 days.Check Running ShoesReplace if heel is wornReplace if excessive heel shock absorption (soft airsole cushion, excessive gel shock absorption)Replace if shoe is excessively stiff at the "breakpoint" (ball of foot).Physical Therapy ModalitiesHVGS (electrical stimulation)UltrasoundExercise instruction: Strength and flexibility
Current Concepts
While Achilles tendon problems are widespread, the terminologyused to describe them is often inaccurate and is undergoing asignificant transition. First to be precise we must considerwhere along the course of the tendon does the problem exist.This may be in one of three main areas:
InsertionMusculo-tendinous JunctureNon-insertional (main body of tendon)
While the term that most people use and that most individualswill search for on the web is "tendonitis", most Achillestendon problems could better be called a tendinopathy and morespecifically a tendinosis and are a non-inflammatory problemof the tendon. Inflammatory cells are not found on microscopicexamination.

Clinically there may be two differing entities in acute achillestendinopathy:
PeritendonitisInflammation in the tissue surrounding the tendonOften 2 - 6 cm above insertionPossible crepitus with long standing injury (paratenonwith fibrin exudate)In chronic tendinopathy approximately 20% of the injuredperitendinous area are scar forming myofibroblast cells.TendinosisImpairment of circulation with resulting damage totendon structureFocal areas of tendon degeneration
Future Research and Solutions
Much future research and better understanding of these injuriesis needed. In spite of the vagaries of scientific understandingof these entities a successful approach using training modification,stretching, strengthening and appropriate return to exercisemay be undertaken. At this time there are few significant clinicalstudies with valid results for treatment. There is often disagreementon approach and much is likely to be changed in the future. Atthis point treatment and treatment recommendations for this problemremain an art practiced with varying degrees of success. Whenevaluating new research, it is hard to recommend major paradigmchanges in thought and recommendations based on studies of fewerthen 20 cases or even 50 cases.

Stretching Demonstration
As anyone knows who has spent time on my web site, I am not a fan of excessive stretching for this problem. In individuals who are experiencing pain, I advise against the stair stretch, particularly if you've been trying it already for 6 weeks or more and found only more pain, and no improvement. In early cases of pain, I like to restrict stretching, thangraduate to the wall stretch, and then the wall stretch with a bent knee.

Roxanne Darling of Beachwalks with Rox does an excellent job of demonstrating a variety of stretches from the hard to the easy. For those without pain, you may carefully follow Rox's example of the stair stretch if you'd like. If you have pain, skip the stair stretch fornow. Start with the straight leg, wall stretch and about 3 weeks - 4 weeks later add the bent knee variation. Read this article in its entirety. In the meantime, if you need a little downtime and some chilling, visit Beachwalks With Rox for words of wisdom, thought and relaxation.

Visit: Rox's Stretching demonstration

Beachwalks With Rox

Achilles Tendon Ruptures
The achilles tendon is the connection between the heel and themost powerful muscle group in the body. This has long been knownas a site prone to disabling injury. It is named after Achilles,who according to myth was protected from wounds by being dippedin a magical pond by his mother. She held him by the heel, whichwas not immersed, and later died by an arrow wound in his heel.Although obviously, injuries to this area must have been knownfor more than 2,000 years, it was first reported in the medicalliterature by Ambroise Par?(C) only 400 years ago.

The achilles tendon joins three muscles: the two heads of thegastrocnemius and the soleus. The gastrocnemius heads arise fromthe posterior portions of the femoral condyles. The soleus arisesfrom the posterior aspect of the tibia and fibula.

The gastrocnemius is a muscle that crosses three joints: theknee, the ankle, and the subtalar joint. The functioning of thesejoints and influence of other muscles on these joints has a significanteffect on the tension that occurs within the achilles tendon.As an example tight hamstrings impact the functioning of theankle joint, the subtalar joint, and increase tension in theachilles tendon. The soleus does not cross the knee and is abiarticualar muscle.

The plantaris is a nearby muscle that has its separate tendon.It arises from the lateral condyle of the femur. It has a thintendon that passes between the gastrocnemius and soleus and insertsinto the calcaneus. When this musclculotendinous structure isinjured it is frequently felt as a "pellet shot" inthe back of the leg. The tear is usually about eight inches belowthe knee joint.

The bulk of the achilles tendon inserts into the posterior superiorthird of the calcaneus. Some fibers course distally and continueto where portions of the plantar fascia insert into the plantaraspect of the calcaneus.

The achilles tendon does not have a rich blood supply. It isnot invested within a true tendon sheath. A paratenon composedof other soft tissue surround it. The outer layer is a portionof the deep fascia, the middle layer is called the mesotenonand the inner layer is a thin layer. The blood supply to theproximal portion of the tendon comes from the branches of themuscles themselves. The distal portion is supplied by branchesfrom the tendon-bone interface. The mesotenon supplies the majorblood supply to the Achilles tendon.

The actual cause of rupture of the Achilles tendon is not known.The mechanism of injury is a force that increases the tensileforce in the tendon beyond its tensile strength. This may bevisualized as a dorsiflexion force at the foot or concomitantlya forward motion of the tibia over the foot while the calf musclesare contracting. As stated the force must exceed the tensilestrength of the tendon. A forceful stretch of the tendon or acontraction of the muscles may create this force. Most oftenit is a combination of the two forces. Many researchers feelthat some degeneration is present in the tendon prior to rupture.The usual site of rupture is approximately 2 to 6 centimetersproximal to the insertion in the calcaneus. This is also theportion of the tendon that has the poorest blood supply. Occasionallyruptures occur at the tendon-bone interface or musculo-tendinousjunction. Since vascularity decreases with age, this frequentlyoccurs in the ageing athlete. A weakening of the Achilles tendonhas been observed following intra- tendinous steroid injection.Therefore, injections of steroids are not recommended at thislocation. Diseases associated with a possibly increased incidenceof tendon rupture include gout, systemic lupus erythematosis,rheumatoid arthritis and tuberculosis.

Diagnosis
Physical examination of the site of a recent rupture may reveala palpable gap at the site of the rupture. Swelling will be seen.The most frequently described clinical test is called the Thompsontest. With the patient lying prone (on his stomach) the calfis squeezed. The foot will plantarflex in a patient who doesnot have a completely torn Achilles tendon. The foot will notplantar flex when the Achilles tendon is completely torn. AnMRI will accurately reveal the extent of the tear. Diagnosticultrasound is also used to assist in the diagnosis of a tornAchilles tendon.

AnMRI image of a partially torn Achilles Tendon is availableon line at the site of The Graduate Hospital Imaging Center.

Treatment
Complete tears of the Achilles tendon, in the athlete, are usuallytreated with surgical repair followed with up to 12 weeks ina series of casts. Partial tears are sometimes treated with castingfor up to 12 weeks alone, and sometimes are treated as are thecomplete tears, with surgery and casting. A heel lift is usuallyused for 6 months to one year following removal of the cast.Rehabilitation to regain flexibility and then to regain musclestrength are also instituted following removal of the cast.

Additional Resources:
The Science of Tendinopathy. Stephen M. Pribut, DPM. Web. Accessed May 22, 2011.

Mechanotransduction and Overuse Injuries. Stephen M. Pribut, DPM. Web. Accessed May 22, 2011

Overuse Injuries: All The Small Things? - (PDF)Stephen M. Pribut.Podiatry Management Magazine, October 2010.

Blog: PRP Disappoints in Study Stephen M. Pribut. Blog. January 14, 2010.

Runner's Achilles Heel - Running Times Magazine. Mackenzie Lobby. Accessed April 15, 2011

Selected References:Current Concepts Review: Achilles Tendinopathy. Paavolaet. al. JBJS 84-A: 2062-2076. November 2002.In vivo measurements of Achilles Tendon Forces In Man. Komiet. al. Med Sci Sports Exer 1984; 16:165-6.Biomechanical Loading Of Achilles tendon during normal locomotion.Clin Sports Med. 1992;11:521-531.Ruptured Achilles Tendons are more degenerated then TendinopathicTendons. Tallon et. al. Med Sci Sports Exer 2001; 33:1983-1990.Blood Flow in the Human Achilles Tendon. Astrom M. et. WestlinN.. J. Orthop Res. 1994;12:246-252.Classification of Achilles Tendon Disease. Puddu G. et. al..Am J Sports Med. 1976; 4:145-150.Paavola M: Long-term prognosis of patients with Achillestendinopathy. Am J Sports Med 2000, 28:634-641Treatment of Acute Achilles Tendon Ruptures A SystematicOverview and Metaanalysis. Bhandari, M; Guyatt, G, et.al. ClinicalOrthopedics and Related Research (400) July 2002 pp 190-200


About Dr. Pribut:Dr. Pribut is a member of the Advisory Board of Runner's World magazine. He is a past presidentof the American Academyof Podiatric Sports Medicine (AAPSM). He served as chair of the AAPSM Athletic Shoe Committee for 5 years and has served on the Education Committee, the Research Committee, the Public Relations Committee and the Annual Meeting Committee. He is a co-Editor of the current AAPSM Student's Manual. Dr. Pribut is a past president of the District of Columbia Podiatric Medical Association, serving in that post for 4 years. Dr. Pribut currently is a member of the American Podiatric Medical Association's Clinical Practice Advisory Committee. Dr. Pribut is a Clinical Assistant Professor of Surgery at the George Washington University Medical Center.

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March 16 2014

allfootpain

Bunion Surgery | Johns Hopkins Medicine Health Library




Bunion Surgery | Johns Hopkins Medicine Health Library

Bunion Surgery
(Hallux Valgus Repair, Bunionectomy)

Procedure overview
What is a bunion?
A bunion (hallux valgus) is an enlargement of the bone or tissue around a joint at the base of the big toe or at the base of the little toe (in which case it is called a "bunionette" or "tailor's bunion"). Bunions often occur when the joint is stressed over a prolonged period. Ninety percent of bunions occur in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis, which often affects the big toe joint.


Illustration of a normal great toe and a great toe with a bunionClick Image to Enlarge
Initial treatment of bunions may include wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas) or the use of splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe. For bunions caused by arthritis, medications may help reduce pain and swelling.

If nonsurgical treatment fails, your doctor may suggest surgery, which resolves the problem in nearly all persons. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot.

Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot. Please see these procedures for additional information.

Different types of bunion surgery
The type of surgical procedure performed depends upon the severity of the bunion, the individual's age, general health, activity level, and the condition of the bones and connective tissue. Other factors may influence the choice of a procedure used:

Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone and realign the muscles, tendons, and ligaments surrounding the joint.

Moderate bunion. For a moderate bunion, the surgeon may cut the bone and shift it to its proper position. Whether or not the bone is cut depends on the severity and location of the deformity. In addition, the surrounding tendons and ligaments may need to be repositioned.

Severe bunion. For a severe bunion, surgery may involve removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments.

Arthritic bunion or big toe joint. If the joint is damaged beyond repair, as is commonly seen in arthritis, it may need to be reconstructed or replaced with an artificial joint. Joint replacement implants may be used in the reconstruction of the big toe joint.

Reasons for the procedure
Reasons to undergo bunion surgery may include severe foot pain that occurs even when walking or wearing flat, comfortable shoes. Surgery may also be indicated when chronic big toe inflammation and swelling does not subside with rest or medications.

Other reasons for surgery include toe deformity, a drifting in of the big toe toward the small toe, and an inability to bend and straighten the big toe.

There may be other reasons for your doctor to recommend bunion surgery.

Risks of the procedure
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to:

Stiffness

Numbness

Swelling

Delayed healing

Infection

Other complications may include recurrence of the bunion, nerve damage, and continued pain. The surgery may also result in overcorrection of the problem, in which the big toe extends away from the other toes.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure
Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

If you are pregnant or suspect that you are pregnant, you should notify your doctor.

You may be asked to fast for 8 hours before the procedure, generally after midnight.

You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.

Based on your medical condition, your doctor may request other specific preparation.

During the procedure
Bunion surgery may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

Most bunion surgery is performed under ankle block anesthesia, in which your foot is numb, but you are awake. Occasionally, general or spinal anesthesia is used.

Generally, bunion surgery follows this process:

You will be asked to remove clothing and will be given a gown to wear.

An intravenous (IV) line may be started in your arm or hand.

The skin over the bunion will be cleansed with an antiseptic solution.

If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. If general anesthesia is used, you will be put to sleep using intravenous medication.

The doctor will cut, realign, and possibly remove portions of bone, ligaments, and tendons of the affected foot based on the severity of the bunion.

The doctor will close the opening with stitches and apply a sterile bandage or dressing.

After the procedure
After your surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. The circulation and sensation of the foot will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

Your doctor will give you specific instructions for caring for your foot at home during the first few weeks after surgery. You may be discharged from the hospital wearing a special surgical shoe or cast to protect your foot.

Once you are at home, you will need to rest and keep the foot elevated on 1 or 2 pillows to help reduce pain and swelling. Your doctor may also recommend that you apply ice and limit walking. You may be advised to use a cane or walker following surgery.

It is important to keep the dressing clean and dry. You should cover the dressing with a plastic bag or plastic wrap and tape it with plastic tape when showering. An alternative is to take a sponge bath. The stitches will be removed during a follow-up visit, generally scheduled about 2 weeks after surgery.

Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. Your doctor may also prescribe antibiotics to help prevent infection following your surgery.

Notify your doctor to report any of the following:

Fever

Redness, swelling, bleeding, or other drainage from the incision site

Increased pain around the incision site

Swelling in lower leg of the affected foot

You doctor will advise you as to your postoperative activities. Your foot may require continuous support from dressings or a brace for 6 to 8 weeks after surgery. You may need to refrain from driving for about a week after surgery.

Exercises or physical therapy may be recommended to help the foot recover its strength and range of motion after surgery. High heels should be avoided for at least 6 months after surgery.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American Academy of Orthopaedic Surgeons

American College of Foot and Ankle Surgeons

American Orthopaedic Foot and Ankle Society

American Podiatric Medical Association

Arthritis Foundation

National Institute of Child Health and Human Development

National Institutes of Health (NIH)

National Library of Medicine

March 14 2014

allfootpain

Bones of the Foot - Seif & Associates, Inc. | Seif & Associates, Inc.




Bones of the Foot - Seif & Associates, Inc. | Seif & Associates, Inc.
The bones of the foot follow basically the same pattern of the hand bones. There is a double layer of sesamoid-like bones forming the ankle, which articulate with the long bones making up the central foot (metatarsals), which are in turn attached to the phalanges, or toes.The tendons and the many ligaments of the foot attach to the tough, thin tissue covering the bones, the periosteum. The ligaments attach the bones to each other, and the tendons connect the muscles to the bones.As in the hand, there are intrinsic muscles in the feet.The bones of the foot form a longitudinal arch and a transverse arch. Most of the body's weight is borne on the metatarsal heads, particularly the first and fifth.
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March 12 2014

allfootpain

Exercise For Plantar Fasciitis Pain


Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle.5 Recurrence rates may be lower if injection is performed under ultrasound guidance.6 Repeated steroid injections may result in rupture of the plantar fascia. This may actually improve pain initially, but has deleterious long-term consequences. Stretching before exercising or walking Stretching your calf muscles and Achilles tendon will help relieve the pain. This can be done with the traditional calf stretch leaning against a wall and extending one leg back, pressing your heel to the ground for about 10 seconds.

Plantar fasciitis is common in athletes, those who stand for long periods of time at their job such as waitresses and factory workers, and people with high arches or those who are flat footed. It is more common in women than men and is more likely to occur after age forty. Obesity and shoes with poor support or high heels can contribute to the development of plantar fasciitis. The plantar fascia is a tough, fibrous band of connective tissue that runs from the heel bone to the ball of the foot. It plays an vital part in the way the foot is intended to operate whilst walking and running.

Plantar fasciitis is a combination of two separate problems. If your Achilles tendon is too tight, that leads to abnormal tension on the plantar fascia when you run or walk. Second, there is inflammation from all of the tissue damage as the plantar fascia is tearing away at its attachment to the heel bone. You must address both. The plantar fascia is a broad ligament-like structure that extends from the heel bone to the base of the toes, acting like a thick rubber-band on the bottom arch of the foot. It plays an important part in the way the foot is intended to operate during walking and running.

If pressing hard in the middle of the heel results in acute pain, then it must be plantar fasciitis The problem must not be ignored or left untreated. Acute pain may sometimes lead to involuntary change in the gait, causing other problems such as backache, knee pain or hip pain. Plantar Fasciitis causes many people to feel severe heel pain in the morning, when they get out of bed and take their first steps. This pain is a result of tightening of the plantar fascia that happens as you are sleeping. Massaging and stretching the plantar fascia before getting up will help diminish heel pain.plantar fasciitis taping

The doctor may advise you to wear night splint fitted to your calf and foot before retiring for the day. It is better to maintain proper weight to minimize the stress on plantar fascia. Avoid heels and choose shoes that provides good arch support and shock absorbance. A runner should replace his worn out athletic shoes as they cannot provide the cushioning and support required for the feet. Exercises for plantar fasciitis also provides relief to the pain. A bit of precaution will help you overcome plantar fascia. Plantar fasciitis night splint is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

Cold therapy, like applying ice, to help reduce pain and inflammation. Cold therapy can be applied regularly until symptoms have resolved. Some patients prefer to roll their foot over an iced cold drink can or bottle taken out of the freezer. Exercise the feet muscles to make them stronger. One good exercise is grabbing and lifting up a towel or marbles using your toes. You can do the same exercise without a towel as though you are grasping something with the toes of each foot. Another good exercise is walking as tall as you can on your toes and ball of your feet.

Stretching the plantar fascia and the calf muscles several times a day is an important part of treatment and prevention. There are many stretching exercises for the plantar fascia and the calf muscles that you can find. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The plantar fascia tightens up making the origin at the heel more susceptible to stress. Anti-inflammatory or Pain medication that a clinician may recommend. Non-steroidal anti-inflammatory drug such as ibuprofen can reduce swelling and relieve pain. However, these medications have many possible side effects and it is important to weigh the potential risks and benefits.

Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain. Possible Complications Pain may continue despite treatment. Some people may need surgery. Surgery has its own risks. Talk to your doctor about the risks of surgery. When to Contact a Medical Professional Don't be upset , you can treat plantar fasciitis at home by using natural remedies available at home. Familiarity with the symptoms, causes and diagnosis of plantar fasciitis will be helpful in selecting the appropriate treatment.plantar fasciitis shoes

or along the arch. A different sign is the morning hobble. Fatness, excessive walking for lengthy stretches of time, foot injuries and take a seat too long are all causes of the confusion. The good news is that relaxed footwear with arch support can help ease the pain. Plantar fasciitis is a condition that occurs when the connective tissue on the bottom of the foot becomes inflamed. The plantar fascia supports the arch and structure of the foot. It extends from the heel to the toes. After seeing your doctor for a good advice, you will be able to eliminate the problem. Try to be patient and strong for now.

March 10 2014

allfootpain

Plantar Fasciitis


Putting up with the pain from plantar fasciitis in the hope that it will abate naturally is unwise. Whilst plantar fasciitis can be a fairly minor foot condition, soldiering on without treatment can lead to the condition becoming more severe. In addition to this, leaving the condition untreated may also lead to other problems such as knee, hip and back strain, as when suffering from pain in the feet, the walking gait changes, which puts the rest of the body out of kilter. The posture is altered, which can lead to all manner of joint and muscle problems.

Sometimes physical therapy modalities are helpful. The most frequently used modalities include ultrasound (high frequency sound vibrations that create a deep heat and reduce inflammation) and galvanic electrical stimulation ( a carefully applied intermittent muscular stimulation to the heel and calf that helps reduce pain and relax muscle spasm, which is a contributing factor to the pain). This treatment has been found most effective when given twice a week. Repeated taping and padding is sometimes used. The felt pads that will be strapped to your feet will compress after a few days and must be reapplied.

Arch plantar fasciitis taping does not stretch out the plantar ligament, but supports it as it runs underneath the foot arch. This treatment for plantar fasciitis can be a little tricky to do for yourself because you tape from the outside of the foot towards the inside flexing the big toe joint to create a high arch as you do so. Full foot plantar fasciitis taping is done by separately covering the ball of the foot and the heel with tape and then connecting the heel to the toes using a criss-cross taping pattern until the whole sole of the foot is covered.

Splints are particularly effective at preventing morning foot pain, and are strapped to the foot at bedtime and keep the tissue in its stretched state. Without the contraction the foot is prepared for the first few steps, and the devices can eradicate morning foot pain. Heel seats on the other hand are devices which are placed under the heel and fit easily into most shoes. By elevating the heel the plantar fascia is not required to stretch and flex as much when walking which eases the pain and prevents further damage. They are also particularly effective at easing the pain from heel spurs by cushioning the heel.

Stretch your hamstrings-the muscles on the backs of your thighs-before and after impact activities. According to Sports Injury Bulletin, tight hamstrings lead to overflexion at the knee and cause the foot to flex more in response, increasing impact on the ball of the foot. Stretch your Achilles tendon by standing with your toes on a raised surface and dropping your heel below your toes. Do this with your feet facing forward, inward and outward to stretch in all planes. Stretch your plantar fascia by putting your weight on one leg. Shift your weight to the outside, center and inside of the foot on that leg. Strengthening Exercises.plantar fasciitis brace

Among the footwear brands that offer specific features in their sneakers to address plantar fasciitis are Asics, New Balance, and Saucony. Visit these companies online to search for the right fit for you and your plantar fasciitis. Then shop around either on the Internet, where you may find a great sale price, or at a specialty running store for their expertise and to try on a pair or two. Getting the best shoes for plantar fasciitis may be time-intensive process , but it is a necessary one if you want to experience the relief you need from this awful condition.

I have found that the perfect combination for me that got rid of my plantar fasciitis problem was two things; wearing good quality shoes, and if I started to feel the pain trying to come back I just pop my foam toe separators on. Not only do I feel like I am getting a mini spa treatment , but my feet feel great and are pain free. So if you are searching for a cheap and easy plantar fasciitis home remedy you could try the pedicure foam toe separators. Your feet may thank you in the morning.

To carry out this stretch, stand with your weight on your left foot and place your right heel on a table or bench at or near waist height. Face straight forward with your upper body and keep both legs nearly straight. As you stand with your right heel on the table and your left foot on the ground, rotate your left foot outward (to the left) approximately 45 degrees, keeping your body weight on the full surface of your left foot (both heel and toes are in contact with the ground). You are now ready to begin the stretch.

Plantar Fasciitis is a rather common condition of the foot causing significant heel pain and proximal foot arch pain. The most common presentation of plantar fasciitis is when a patient experiences pain with their first step in the morning. This initial step incurs the most pain that the patient will feel throughout the day, but there will be continual pain in those who suffer from plantar fasciitis Typically people describe the pain as relating to the sensation of walking on glass. These initial steps incur tremendous pain near the proximal aspect of their foot where the plantar fascia inserts into the heel bone.

While a well designed athletic shoe can prevent foot damage that leads to plantar fasciitis, treatment of the problem requires special help. Once the problem has been diagnosed by a podiatrist, special inserts or orthopedic shoes will probably be prescribed until healing is completed. Regardless of this form of treatment, it is still always a good idea to look for the best shoes for plantar fasciitis in order to get the maximum benefit of your therapeutic regimen, as getting the right pair of shoes is essential if you to foster a healing environment around your foot.plantar fasciitis stretches

February 16 2014

allfootpain

What Causes Feet Ache?

Treatment for Tarsal Tunnel Syndrome. Specially designed shoe inserts called orthotics can relieve pain from tarsal tunnel syndrome because they help redistribute weight and take pressure off the nerve. Corticosteroid injections may also help. Surgery is sometimes performed, particularly if symptoms persist for more than a year, although its benefits are a matter of debate. Tarsal tunnel syndrome caused by known conditions, such as tumors or cysts, may respond better to surgery than tarsal tunnel syndrome of unknown cause. It can take months after this surgery for a person to recover and resume normal activities. Only experienced surgeons should perform tarsal tunnel syndrome surgery. Foot Injury

The pain can start from toes, forefoot or hind foot. The reason why pain can begin at the toes is mostly because of shoes that do not fit you properly. Shoes that do not fit properly are a regular cause of pain. High heeled shoes especially concentrate pressure on the toes and can cause or aggravate toe problems. In some cases people who experience this kind of pain could be as a result of medical conditions that cause disturbance in the way a person walks. Such conditions include diabetes, leg or foot deformities, spinal problems, cerebral palsy among others.

RICE The acronym RICE (rest, ice, compression, elevation) is used to remind people of the four basic elements of immediate treatment for an injured foot. People should get off injured feet as soon as possible (Rest). Ice is particularly important to reduce swelling and promote recovery during the first forty-eight hours. A bag or towel containing ice should be wrapped around the injured area on a repetitive cycle of 20 minutes on, 40 minutes off (Ice). An ace bandage should be lightly wrapped around the area (Compression). The foot should be elevated on several pillows (Elevation).foot pain icd 9

When the reason for foot pain is not known, it is important to let your doctor check for any underlying conditions you may have. Osteoarthritis and rheumatoid arthritis can both cause foot pain. Diabetes can also cause you to experience foot pain. When this occurs, it is referred to Heel Spurs as diabetic neuropathy. This is a nerve pain that is intense and can cause your toes to cramp. For a diabetic, good blood glucose control can help prevent the pain. Once your doctor determines the cause of your foot pain, treating the pain will be easier. Prevention and Treatment

You can also develop foot problems in you heels. While this heel pain is very common , it can begin without any injury being caused to the foot. You will usually feel the pain under the heel of the foot. It is generally present when you are standing or walking. The time that the pain is the worst is when you are getting out of bed. The cause of these foot problems is that the tissues on the sole of the foot have become inflamed. The place where the inflammation is the worst is the heel area.

In today's high-fashion world, lack of willingness to give up these types of shoes is regrettable. However, with the use of orthotics for high heels, metatarsalgia can be relieved with consistent wear. It is advisable to choose shoes that have a heel with a less than 2" heel and with a wider-profile heel such as a wedge to avoid future ball of foot pain. If pain occurs at the end of the day, consider switching to flat dress shoes for several days per week to allow the feet some time for increased blood flow which will help feet heal in between wearing higher heels.

One of the best home remedies for foot pain is to opt for a massage. A good foot rub, whether you do it yourself or go to a professional reflexologist will help in easing the pain. Massaging the feet with gentle pressure, helps to ease the pain and relaxes sore muscles. One of the best herbal remedies for foot pain is to use a foot rub that contains essential oils. You can also make your own foot rub by mixing two drops of rosemary essential oil and two drops of chamomile oil with two tablespoons of olive oil.

June 30 2013

allfootpain

All Feet Pain

On the whole, the feet are very small when compared to the rest of the body. During the day, most people spend about 12 to 14 hours on their feet. Because the feet are used so much during normal daily activity, the excessive loads that are placed on the feet mean approximately 75% of people worldwide will suffer foot pain at some stage in their lives. Foot pain can also reduce your mobility and independence, as is often seen in the elderly. When your feet hurt, it not only disturbs your body but it can prove to be distracting to your work and concentration.

Causes of foot pain

Prolonged standing, over pronation and the pressures that this places on the joints, muscles and ligaments of the foot are major causes of foot pain. There are many occupations that require long periods of static standing such as the health, retail, fashion and construction industries. Standing for long periods of time causes the muscles of the lower limb to become fatigued and overworked. Blood pooling due to decreased venous return also increases discomfort in the lower limb. The overall result of this being tired aching legs. Ill fitted shoes and wearing high heels can also contribute to foot pain. High heels make women to look smart and taller, however they can become very uncomfortable if they wear these for long periods or during inappropriate activities. High heels increase the pressure on the ball of the foot and toe region above what the foot is designed to withstand. This overloads the structures of the forefoot leading to ball of foot pain and discomfort.

Aging, being overweight and many other systemic diseases such as diabetes, gout, arthritis all increase the likelihood of foot problems. Generally these systemic (whole body) diseases affect the function and structure (depending on the disease) of the foot. This changes the function of the foot and often leads to foot pain. Certain age groups also suffer foot pain at different times of their lives. Children suffer from aches and pains during their growth and development. This was traditionally called growing pains, however today we know that there is treatment for these aches and pains. The two most common children's pains are, Severs disease (pain at the heel) and Osgoodschlatters Syndrome (pain at the knee). These are both growing related problems that are aggravated by over use and poor mechanics. The elderly are another group that often suffer foot pain. This is largely due to over use from a life time of wear and tear. Although wear and tear are not reversible, there are still treatment options available for this group of patients, to make walking pain free.

What people do when they face the problem of foot pain?

In most of the cases when people suffer foot pain the first thing they do is to reduce their activity. This usually works quote well as it will rest the foot. They apply pain removing gel to the painful area or take anti-inflammatory medications. This approach masks the symptoms of their foot pain. The real underlying problem of most kinds of foot pain is a functional abnormality that will need to be corrected. Over weight and unfit people who are trying to lose weight often walk for exercise. The extra weight and activity further strains the feet, making walking less enjoyable, making exercise and weight loss even less likely. Some people have no option other than to continue activity. This patient group wither either has to work due to financial commitments or has to continue activity as they are part of a sporting team. This group usually tends to push through the pain barrier until it is impossible to go on any longer. Some people chose to ignore their foot pain and continue to wear their fashion shoes (Fore example ladies wearing high heeled fashion shoes). Over time the strain on the foot compounds and eventually results in an overuse injury. When the foot injury gets to this stage it is often impossible to ignore.

The solution for foot pain

Overall the best solution to the above mentioned problems is to support the foot and help to limit excess wear and tear on the foot. This is best done with orthotic innersoles and appropriate footwear. Orthotic innerosles help to support the foot, prevent over pronation and limit wear and tear on the joints, ligaments and muscles of the foot. Orthotic innersoles align the foot in its most efficient functional position and help to reduce the wear and tear on your feet and ankles. The use of these orthotics results in a reduction in the pain in the feet. It is important when selecting orthotic innersoles to select an orthotic that matches your activity level and also your shoe type. For example different orthotic innersoles are used for running as opposed to ladies fashion shoes.
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Don't be the product, buy the product!

Schweinderl