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27 Sep 2015 

Avoiding Inferior Calcaneal Spur

Heel Spur


Overview


Heel spur is a hook of bone that protrudes from the bottom of the foot where plantar fascia connects to the heel bone. Pain associated with heel spurs is usually pain from plantar fasciitis, not the actual bone. Heel spurs are most often diagnosed when a patient has visited a pain specialist or podiatrist for on-going foot pain related to plantar fasciitis; spurs are diagnosed via X-ray of the foot. Heel spurs are most commonly diagnosed in middle-aged men and women. As noted, most patients with this condition have other podiatry-related pain. This condition is a result of plantar fasciitis (when the fascia, a thick connective tissue that connects the heel bone and ball of the foot) becomes inflamed. Some 70% of plantar fasciitis patients have a bone spur. Bone spurs are soft calcium deposits caused from tension in the plantar fascia. When found on an X-ray, they are used as evidence that a patient is suffering from plantar fasciitis. Plantar fasciitis is typically caused from repetitive stress disorder. Walking, running, and dancing can cause this with time.


Causes


One frequent cause of injury to the plantar fascia is pronation. Pronation is defined as the inward and downward action of the foot that occurs while walking, so that the foot's arch flattens toward the ground (fallen arch). A condition known as excessive pronation creates a mechanical problem in the foot, and the portion of the plantar fascia attached to the heel bone can stretch and pull away from the bone. This damage can occur especially while walking and during athletic activities.


Calcaneal Spur


Symptoms


An individual with the lower legs turning inward, a condition called genu valgus or "knock knees," can have a tendency toward excessive pronation. This can lead to a fallen arch and problems with the plantar fascia and heel spurs. Women tend to suffer from this condition more than men. Heel spurs can also result from an abnormally high arch. Other factors leading to heel spurs include a sudden increase in daily activities, an increase in weight, or a thinner cushion on the bottom of the heel due to old age. A significant increase in training intensity or duration may cause inflammation of the plantar fascia. High-heeled shoes, improperly fitted shoes, and shoes that are too flexible in the middle of the arch or bend before the toe joints will cause problems with the plantar fascia and possibly lead to heel spurs.


Diagnosis


Your doctor will discuss your medical history and will examine your foot and heel for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray or blood tests (to rule out diseases or infections) may be requested.


Non Surgical Treatment


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


Surgical Treatment


Though conservative treatments for heel spurs work most of the time, there are some cases where we need to take your treatment to the next level. Luckily, with today?s technologies, you can still often avoid surgery. Some of the advanced technologies to treat a Heel Spur are Platelet Rich Plasma Therapy. Platelet Rich Plasma Therapy (also known as PRP) is one of several regenerative medicine techniques that University Foot and Ankle Institute has helped bring to foot and ankle care. This amazing in-office procedure allows the growth factors in the blood to be used to actually begin the healing process again long after your body has given up on healing the area. Heel Pain Shockwave Therapy. Shockwave therapy is a non-invasive procedure done in the office that allows for new blood to get to the region of fascia damage and help with healing. Results have been excellent with more than 70 percent of patients getting relief with only one treatment. Topaz for Heal Spurs and pain. Another minimally invasive technology technique is called Coblation Surgery using a Topaz probe. This minimally invasive procedure involves controlled heating of multiple tiny needles that are inserted through the skin and into the plantar fascia. This process, like PRP and Shockwave therapy, irritates the fascia enough to turn a chronic problem back into an acute problem, greatly increasing the chances of healing. Heel Spur Surgery. Endoscopic Plantar Fasciotomy is one surgical procedure that we consider to release the tight fascia. University Foot and Ankle Institute has perfected an endoscopic (camera guided) approach for fascia release to allow rapid healing and limited downtime with minimal pain.
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25 Sep 2015 

What Is Inferior Calcaneal Spur

Calcaneal Spur


Overview


A heel spur is a painful condition that is caused by the accumulation of excessive calcium under the heel of the foot. The heel bone is made up of a large structure called the calcaneus, which is connected to the bottom of the foot by durable connective tissue called fascia. If the layers of connective tissue become damaged or begin to degenerate due to wear and tear, plantar fasciitis may develop. This causes calcification, which refers to the abnormal buildup of calcium on the heel bone. As the calcium continues to accumulate, a calcified protrusion called a spur may become visible on an X-ray.


Causes


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


Posterior Calcaneal Spur


Symptoms


The following symptoms are typical of heel spur. Stabbing pain when treading on the area affected. Dull, irregularly occurring pains in the heel area also without exerting pressure (e.g. in a reclining position) Pain when taking the first steps in the morning (after lying or sitting down for an extended period, especially in the morning) Occasional swelling in the ankle area. For the lower heel spur, extreme sensitivity at the tendon attachment (laterally in the lower heel area) For the upper heel spur, extreme pressure sensitivity of the Achilles tendon, primarily at approximately ankle height.


Diagnosis


Heel spurs and plantar fasciitis are diagnosed based on the history of pain and tenderness localized to these areas. They are specifically identified when there is point tenderness at the bottom of the heel, which makes it difficult to walk barefoot on tile or wood floors. X-ray examination of the foot is used to identify the bony prominence (spur) of the heel bone (calcaneus).


Non Surgical Treatment


The heel pain associated with heel spurs and plantar fasciitis may not respond well to rest. If you walk after a night's sleep, the pain may feel worse as the plantar fascia suddenly elongates, which stretches and pulls on the heel. The pain often decreases the more you walk. But you may feel a recurrence of pain after either prolonged rest or extensive walking. If you have heel pain that persists for more than one month, consult a health care provider. He or she may recommend conservative treatments such as stretching exercises, shoe recommendations, taping or strapping to rest stressed muscles and tendons, shoe inserts or orthotic devices, physical therapy. Heel pain may respond to treatment with over-the-counter medications such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). In many cases, a functional orthotic device can correct the causes of heel and arch pain such as biomechanical imbalances. In some cases, injection with a corticosteroid may be done to relieve inflammation in the area.


Surgical Treatment


When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide pain relief and restore mobility. The type of procedure used is based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. The procedure may also include removal of heel spurs.
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28 Aug 2015 

Bursitis Of The Feet Surgery

Overview


In your heel, there is a sac filled with fluid known as a bursa. It is located under your Achilles tendon at the back of your heel bone. Many of your large joints have a bursa around them. They provide cushioning and lubrication for the tendons, muscles and bone. Bursitis of the heel occurs when the bursa in your ankle becomes swollen.


Causes


A bursa is a fluid-filled sac that acts as a cushion and a lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel, where the large Achilles tendon connects the calf muscles to the heel bone (calcaneus). Repetitive or over use of the ankle, for instance by doing excessive walking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for achilles tendonitis. Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.


Symptoms


Pain or tenderness at the back of the heel around the Achilles region. Increased pain during activities with strong, repetitive calf contractions, walking (uphill), stair climbing, running, jumping. Pain may be worse with rest after activity (that night or the next morning) or at the beginning of the excercise. Pain when wearing shoes and the heel is getting rubbed. Bump forming on the back of the heel. Limping. Stiffness. Decreased range of motion. Redness and warmth (if the bursa gets infected).


Diagnosis


A good clinical practise includes evaluation of the tendon, bursa and calcaneum by, careful history, inspection of the region for bony prominence and local swelling as well as palpation of the area of maximal tenderness. Biomechanical abnormalities, joint stiffness and proximal soft tissue tightening can exacerbate an anatomical predisposition to retrocalcaneal bursitis, they warrant correction when present.


Non Surgical Treatment


Many times, Achilles tendon bursitis can be treated with home care. However, if self-care remedies do not work, your doctor may need to administer additional treatments. Home care. The most important thing you can do to help your healing is to refrain from activities that could further aggravate the bursitis. Typical home-care treatments for Achilles tendon bursitis include Anti-inflammatory medication. Take over-the-counter pain medication, like aspirin or ibuprofen, to reduce pain and swelling. Heel wedges. An over-the-counter or custom heel wedge can be placed in your shoe to minimize stress in the Achilles tendon. Ice. Apply ice or other cold therapy to your sore heel several times a day. Rest. Limit your activity on the injured leg, avoid putting pressure on it whenever possible. Also, elevate your leg during non-use to help reduce the swelling. The above remedies may be used on their own or in combination with others on the list. Physician-administered treatments. If the above self-care remedies are not effective, you should visit your doctor for additional treatment. Possible Achilles tendon bursitis treatments your doctor may administer include immobilization. If the bursitis is combined with Achilles tendonitis, your doctor may place a temporary cast on the ankle to prevent movement and allow it to heal. Physical therapy. Exercises may be used to improve the ankle's strength and flexibility. Steroids. Injection of steroids into the retrocalcaneal bursa (not the Achilles tendon) may be necessary. Surgery. In very rare circumstances, surgery may be needed to remove the retrocalcaneal bursa, however, this is typically a last resort.


Surgical Treatment


Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.
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17 Aug 2015 

Hammertoe Repair

HammertoeOverview


Patients and doctors often refer to all forms of toe abnormalities as a Hammer toes. There are in fact four main forms of toe abnormalities, hammer toes, claw toes, mallet toes and trigger toes. A hammertoe can be best described as an abnormal contraction or "buckling" of a toe. This occurs due to a partial or complete dislocation of one of the joints that form the toe. As the toe continues to be deformed, it will press up against the shoe and may cause corns.


Causes


Hammertoe and mallet toe have been linked to certain shoes. High-heeled shoes or footwear that's too tight in the toe box can crowd your toes into a space that's not large enough for them to lie flat. This curled toe position may eventually persist even when you're barefoot. Trauma. An injury in which you stub, jam or break a toe may make it more likely for that digit to develop hammertoe or mallet toe. Nerve injuries or disorders. Hammertoe and mallet toe are more common in people who have nerve damage in their feet, which often occurs with such medical problems as a stroke or diabetes.


Hammer ToeSymptoms


A toe stuck in an upside-down "V" is probably a hammertoe. Some symptoms are, pain at the top of the bent toe when putting on a shoe. Corns forming on the top of the toe joint. The toe joint swelling and taking on an angry red colour. Difficulty in moving the toe joint and pain when you try to so. Pain on the ball of the foot under the bent toe. Seek medical advice if your feet regularly hurt, you should see a doctor or podiatrist. If you have a hammertoe, you probably need medical attention. Ask your doctor for a referral to a podiatrist or foot surgeon. Act now, before the problem gets worse.


Diagnosis


The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.


Non Surgical Treatment


The treatment options vary with the type hammertoes and severity of each hammertoe, although identifying the deformity early in its development is important to avoid surgery. Podiatric medical attention should be sought at the first indication of pain and discomfort because, if left untreated, hammertoes tend to become rigid, making a nonsurgical treatment less of an option. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.


Surgical Treatment


Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammertoes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.
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01 Jul 2015 

Hammer Toe Symptoms Pain

Hammer ToeOverview


A Hammer toe is a contracture-or bending-of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can Hammer toe be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common to females than males.


Causes


Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problem (e.g., a bunion can force the big toe to turn inward and push the other toes). It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot-Marie-Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich's ataxia.


Hammer ToeSymptoms


The most obvious symptoms of this injury will be the the middle toe joint is permanently bent at an angle. In the beginning movement may still be possible but as time passes and the injury worsens the toe will be locked in place and possible require hammer toe correction surgery to fix. Another key indicator of hammer toe is that a lump or corn will form on top of the toe. The toe joint will be painful and walking can cause severe discomfort. Occasionally a callus may form on the sole of the injured foot. If you see any of these symptoms together or have been enduring pain for some time, seeing a podiatrist should be your next step.


Diagnosis


Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.


Non Surgical Treatment


Putting padding between your toes and strapping them in place can help to stop pain caused by the toes rubbing. Custom-made insoles for your shoes will help to take the pressure off any painful areas. Special shoes that are wider and deeper than normal can stop your toes rubbing. However if your pain persists your consultant may recommend an surgery.


Surgical Treatment


For severe hammer toe, you will need an operation to straighten the joint. The surgery often involves cutting or moving tendons and ligaments. Sometimes the bones on each side of the joint need to be connected (fused) together. Most of the time, you will go home on the same day as the surgery. The toe may still be stiff afterward, and it may be shorter. If the condition is treated early, you can often avoid surgery. Treatment will reduce pain and walking difficulty.


HammertoePrevention


The best first step you can take is to evaluate your shoe choices. Ditch any shoes that aren?t serving your feet well. Shoes that crowd the front of your foot, especially around your toes, aggravate the existing condition and can also cause the condition to develop. If you suspect the development of hammertoe, you may also try using protective pads to prevent irritation and the development of corns. Custom orthotics to correct muscle imbalances in your feet may also help prevent hammertoe.
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28 Jun 2015 

Hammertoe Repair Surgery

Hammer ToeOverview


If the joint on one of your toes, usually the toe next to the big toe or the smallest toe, points upward rather than lying flat, you might have a Hammer toe. The condition is actually a deformity that happens when one of the toe muscles becomes weak and puts pressure on the toe?s tendons and joints. This pressure forces the toe to become misshapen and stick up at the joint. Also, there?s frequently a corn or callus on top of the deformed toe. This outgrowth can cause pain when it rubs against the shoe.


Causes


Hammer toe is most often caused hammertoes by wearing compressive shoes. It might also be caused by the pressure from a bunion. A bunion is a corn on the top of a toe and a callus on the sole of the foot develop which makes walking painful. A high foot arch may also develop.


Hammer ToeSymptoms


The most obvious symptom of hammertoe is the bent, hammer-like or claw-like appearance of one or more of your toes. Typically, the proximal joint of a toe will be bending upward and the distal joint will be bending downward. In some cases, both joints may bend downward, causing the toes to curl under the foot. In the variation of mallet toe, only the distal joint bends downward. Other symptoms may include Pain and stiffness during movement of the toe, Painful corns on the tops of the toe or toes from rubbing against the top of the shoe's toe box, Painful calluses on the bottoms of the toe or toes, Pain on the bottom of the ball of the foot, Redness and swelling at the joints. If you have any of these symptoms, especially the hammer shape, pain or stiffness in a toe or toes, you should consider consulting your physician. Even if you're not significantly bothered by some of these symptoms, the severity of a hammertoe can become worse over time and should be treated as soon as possible. Up to a point hammertoes can be treated without surgery and should be taken care of before they pass that point. After that, surgery may be the only solution.


Diagnosis


Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.


Non Surgical Treatment


Conservative treatment is the first choice, often starting with a change of shoes to ones that have soft, larger toe spaces. Toe exercises may be prescribed to stretch and strengthen the toe muscles. Over-the-counter straps, cushions or non-medicated corn pads may be recommended to help relieve your symptoms.


Surgical Treatment


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


HammertoePrevention


In some cases foot problems may present at birth, many foot problems such as hammer toes can be prevented. Hammer toe prevention can be a simple process, such as, checking your feet regularly and wearing the right shoes for your feet. Good circulation is also an essential part of foot health and hammer toe prevention. Taking a warm foot bath or giving yourself a foot massage are great ways of keeping your feet healthy.
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31 May 2015 

Over-Pronation Of The Feet What Are The Treatments

Overview


Often misunderstood, pronation is considered by many to be a negative attribute; pronation is actually a good thing in the correct amount. Pronation is the body's response to the ground forces incurred during running and walking. When the foot impacts the ground, the arch elongates and flattens, which allows the foot to roll inward. This action helps the body to absorb shock. The degree to which the arch flattens is often associated with the degree the foot pronates. An ideal foot-strike is said to be neutral and is characterized by slight inward movement of the ankle-bone during stance (when the foot is in contact with the ground). Most runners for example exhibit over-pronation in varying degrees. 50-60% of runners exhibit mild to moderate over-pronation and are best suited for support orthotics. 20-30% of runners exhibit severe over-pronation and are best suited for motion control shoes.Foot Pronation


Causes


Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding additional stress to other parts of the foot. Therefore over-pronation can often lead to a case of Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions. There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. People with flat feet often do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.


Symptoms


Overpronation can lead to injuries and pain in the foot, ankle, knee, or hip. Overpronation puts extra stress on all the bones in the feet. The repeated stress on the knees, shins, thighs, and pelvis puts additional stress on the muscles, tendons, and ligaments of the lower leg. This can put the knee, hip, and back out of alignment, and it can become very painful.


Diagnosis


People who overpronate have flat feet or collapsed arches. You can tell whether you overpronate by wetting your feet and standing on a dry, flat surface. If your footprint looks complete, you probably overpronate. Another way to determine whether you have this condition is to simply look at your feet when you stand. If there is no arch on the innermost part of your sole, and it touches the floor, you likely overpronate. The only way to truly know for sure, however, is to be properly diagnosed by a foot and ankle specialist.Over Pronation


Non Surgical Treatment


Studies have shown that the most effective way to dexrease a high Q angle and lower the biomechanical stresses on the knee joint is to prevent excessive pronation with custom-maflexible orthotics. One study found that using soft corrective orthotics was more effective in reduknee pain than a traditional exercise program. A more recent study showed that Q angle asymmetries, secondary to excessive pronation affecting knee alignment, can be effectivecontrolled or corrected utilizing custom-made, flexible orthotics. Another project involving meof a running club determined that 75% of those using orthotics eliminated or greatly reduced pain in the feet, ankles, shins, knees and hips


Surgical Treatment


Hyperpronation can only be properly corrected by internally stabilizing the ankle bone on the hindfoot bones. Several options are available. Extra-Osseous TaloTarsal Stabilization (EOTTS) There are two types of EOTTS procedures. Both are minimally invasive with no cutting or screwing into bone, and therefore have relatively short recovery times. Both are fully reversible should complications arise, such as intolerance to the correction or prolonged pain. However, the risks/benefits and potential candidates vary. Subtalar Arthroereisis. An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer. HyProCure Implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.
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22 May 2015 

Calcaneal Apophysitis The Truth

Overview


Sever?s Disease is one of the most common overuse injuries affecting children during their secondary growth spurts and is described as a self-limiting condition resolving naturally with skeletal maturity 1. It is suggested to be caused by progressive microtrauma to the bone-cartilage interface in the calcaneal apophysis partly due to large traction forces in the Achilles tendon. The current standard treatment consists mainly of rest, and waiting for skeletal maturity.


Causes


At birth, most of our foot bones are still made of cartilage, which ossifies (becomes bony) over the first few years of life. At the back of the heel, there is a growth plate that is attached to the main body of the heel bone by a cartilaginous join. At about the age of 14-15 years, this area of cartilage between the growth plate and the heel bone ossifies, fusing the area to the heel. Sever?s disease occurs when there is too much motion or strain across the growth plate, resulting in this area becoming inflamed and painful.


Symptoms


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


Diagnosis


Radiography. Most of the time radiographs are not helpful because the calcaneal apophysis is frequently fragmented and dense in normal children. But they can be used to exclude other traumas. Ultrasonography. could show the fragmentation of secondary nucleus of ossification of the calcaneus in severs?s disease. This is a safe diagnostic tool since there is no radiation. This diagnostic tool can also be used to exclude Achilles tendinitis and/or retrocalcaneal bursitis.


Non Surgical Treatment


Treatment includes modifying activities and resting to reduce pain and inflammation and take pressure off the growth center. Ice can also be very helpful in relieving symptoms, as well as anti-inflammatory medication. A physical therapy program should be initiated to stretch tight calf muscles and strengthen the ankle muscles to relieve tension on the growth center. Shoes with padded heel surfaces and good arch support can decrease pain. Cleats may need to be avoided for some time to help reduce symptoms. The doctor may also recommend gel heel cups or supportive shoe inserts.


Exercise


For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3 times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or standing.
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28 Mar 2015 

All You Might Want To Understand About Heel Pain

Overview


Feet Pain


Heel Pain is one of the most common conditions treated by podiatrists. It is often a message that something is in need of medical attention. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we have suffered. Heel pain is a problem which affects people of all ages and vocations, whether they are active or not and it comes in many different forms. Heel pain can also occur in children usually between the ages of 8 and 13, as they become increasingly active in sporting activities and during the growing phase.


Causes


Common causes of heel pain include, Heel Spurs, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome." Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity. Plantar Fasciitis, both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and it can be quite painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle. Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking. Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern. As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation-excessive inward motion-can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back. Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon. Other possible causes of heel pain include rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, an inflamed bursa (bursitis), a small, irritated sac of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur. Haglund's deformity ("pump bump"), a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe, a bone bruise or contusion, which is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.


Symptoms


The heel can be painful in many different ways, depending on the cause. Plantar fasciitis commonly causes intense heel pain along the bottom of the foot during the first few steps after getting out of bed in the morning. This heel pain often goes away once you start to walk around, but it may return in the late afternoon or evening. Although X-ray evidence suggests that about 10% of the general population has heels spurs, many of these people do not have any symptoms. In others, heel spurs cause pain and tenderness on the undersurface of the heel that worsen over several months. In a child, this condition causes pain and tenderness at the lower back portion of the heel. The affected heel is often sore to the touch but not obviously swollen. Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down. Pump bump, this condition causes a painful enlargement at the back of the heel, especially when wearing shoes that press against the back of the heel. Heel bruises, like bruises elsewhere in the body, may cause pain, mild swelling, soreness and a black-and-blue discoloration of the skin. Achilles tendonitis, this condition causes pain at the back of the heel where the Achilles tendon attaches to the heel. The pain typically becomes worse if you exercise or play sports, and it often is followed by soreness, stiffness and mild swelling. A trapped nerve can cause pain, numbness or tingling almost anywhere at the back, inside or undersurface of the heel. In addition, there are often other symptoms, such as swelling or discoloration - if the trapped nerve was caused by a sprain, fracture or other injury.


Diagnosis


After you have described your foot symptoms, your doctor will want to know more details about your pain, your medical history and lifestyle, including. Whether your pain is worse at specific times of the day or after specific activities. Any recent injury to the area. Your medical and orthopedic history, especially any history of diabetes, arthritis or injury to your foot or leg. Your age and occupation. Your recreational activities, including sports and exercise programs. The type of shoes you usually wear, how well they fit, and how frequently you buy a new pair. Your doctor will examine you, including. An evaluation of your gait. While you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk. An examination of your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.


Non Surgical Treatment


Initial treatment consists of rest, use of heel cushions to elevate the heel (and take tension off the Achilles), stretching and applying ice to the area. You can ice and stretch the area simultaneously by filling a bucket with ice and cold water and placing the foot flexed with the toes upward so that the Achilles tendon region is bathed in the cold water for 10 to 15 minutes twice a day. The Achilles region can also become inflamed around the tendon, called paratendinosis. This condition can be treated with the ice bucket stretching, rest and physical therapy. Another area that is commonly subjected to problems is the attachment of the Achilles near or on the heel bone. The heel (calcaneus) itself can have an irregular shape to it, causing irritation to the Achilles as it twists over the region and inflames the bursa, a naturally occurring cushion. Shoes can often aggravate this condition. Sometimes over-stretching, such as the Achilles stretch with the knee bent, can irritate the tendon and cause a bursitis. Prescription foot orthoses can help reduce the torque of the Achilles tendon in these types of cases. Often, the Achilles tendon calcifies near its attachment due to constant torque and tension. Repetitive stress can cause this calcific spur to crack, creating a chronic inflammatory situation that can require surgery. All of these types of chronic Achilles tendinosis that require surgery are successfully treated in over 90 percent of the cases. As with most foot surgery, complete recovery can take up to a year. Though heel pain is common and can be chronic, it does not have to be your weakness (as was the case with the warrior Achilles from Greek mythology).


Surgical Treatment


Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).


Prevention


Pain At The Heel


Wear shoes that fit well, front, back and sides and have shock-absorbent soles, rigid uppers and supportive heel counters. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm-up before running or walking, and do some stretching exercises afterward. Pace yourself when you participate in athletic activities. If overweight, try non weight-bearing activities such as swimming or cycling. Your podiatrist may also use taping or strapping to provide extra support for your foot. Orthoses (shoe inserts) specifically made to suit your needs may be also be prescribed.
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