What Might Cause Bunions?
Overview
A bunion is a bony deformity of the joint at the base of the big toe. The medical name is hallux valgus. The main sign of a bunion is the big toe pointing towards the other toes on the same foot, which may force the foot bone attached to it (the first metatarsal) to stick outwards. Other symptoms may include a swollen, bony bump on the outside edge of your foot, pain and swelling over your big toe joint that's made worse by pressure from wearing shoes hard, callused and red skin caused by your big toe and second toe overlapping, sore skin over the top of the bunion, changes to the shape of your foot, making it difficult to find shoes that fit. These symptoms can sometimes get worse if the bunion is left untreated, so it's best to see a GP. They'll ask you about your symptoms and examine your foot. In some cases, an X-ray may be recommended to assess the severity of your bunion. Anyone can develop a bunion, but they're more common in women than men. This may be because of the style of footwear that women wear.
Causes
The most important causative factor is poor fitting footwear. This accounts for an higher incidence among women than men. Family history of bunions. Abnormal foot function, excessive pronation. Poor foot mechanics, such as excessive pronation (rolling inwards of the foot), causes a medial force which exerts pressure and can lead to the formation of bunions. Rheumatoid or osteoarthritis. Genetic and neuromuscular diseases, which can result in a muscular imbalance such as Down's syndrome. If one leg is longer then the other, the longer leg is more inclined to develop a bunion. If the ligaments in the feet are very weak. In some cases, bunions can occur due to trauma or injury to the feet.
Symptoms
While bunions may be considered cosmetically undesirable, they are not necessarily painful. In cases where the individual has minor discomfort that can be eased by wearing wider shoes made of soft leather and/or with the aid of spacers-padding placed between the toes to correct alignment-further treatment may not be necessary. (Anti-inflammatory agents can be used to alleviate temporary discomfort at the site of the bursa.) For those who continue to experience pain on a daily basis and who cannot wear most types of shoe comfortably, surgical treatment may be the best choice.
Diagnosis
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.
Non Surgical Treatment
Except in severe cases, treatment for bunions is usually given to first relieve the pain and pressure, and then to stop the bunion from growing. Conservative treatment for bunions may include protective padding, typically with felt material, to prevent friction and reduce inflammation. Removing corns and calluses, which contribute to irritation. Precisely fitted footwear that?s designed to accommodate the existing bunion. Orthotic devices to stabilize the joint and correctly position the foot for walking and standing. Exercises to prevent stiffness and encourage joint mobility. Nighttime splints that help align the toes and joint properly. In some cases, conservative treatment might not be able to prevent further damage. This depends on the size of the bunion, the degree of misalignment, and the amount of pain experienced. Bunion surgery, called a bunionectomy, may be recommended in severe cases. This surgery removes the bunion and realigns the toe. 
Surgical Treatment
If conservative treatment doesn't provide relief, you may need surgery. A number of surgical procedures are performed for bunions, and no particular surgery is best for every problem. Knowing what caused your bunion is essential for choosing the best procedure to ensure correction without recurrence. Most surgical procedures include rmoving the swollen tissue from around your big toe joint Straightening your big toe by removing part of the bone Permanently joining the bones of your affected joint You may be able to walk on your foot immediately after some bunion procedures. With other procedures, it may be a few weeks or longer. To prevent a recurrence, you'll need to wear proper shoes after recovery.
What Will Cause Feet To Over Pronate
Overview
Over pronation of the foot is commonly referred to as "flat feet." Many middle-aged men and women suffer from over pronation over time and as a result of wearing poor-fitting shoes, continuing with repetitive exercising habits, or walking in high heels for long periods over several years. Regular speed-walkers often experience over pronation as well as a result of this activity.
Causes
There has been some speculation as to whether arch height has an effect on pronation. After conducting a study at the Rose-Hulman Institute of Technology, Maggie Boozer suggests that people with higher arches tend to pronate to a greater degree. However, the generally accepted view by professionals is that the most pronation is present in those with lower arch heights. To complicate matters, one study done by Hylton Menz at the University of Western Sydney-Macarthur suggests that the methods for measuring arch height and determining whether someone is ?flat-footed? or ?high-arched? are unreliable. He says, ?For this reason, studies investigating the relationship between static arch height motion of the rearfoot have consistently found that such a classification system is a poor predictor of dynamic rearfoot function.
Symptoms
Eventually, over-pronation can lead to a full list of maladies including flat feet, plantar fasciitis, plantar fibroma, neuromas, heel spurs, shin splints, ankle sprains, bunions, hammertoes, calluses, and pain in the arches, knee, hip and lower back. But it doesn?t have to go that far, because there are steps we can take to correct the over-pronation. In the vast majority of cases, we?ll prescribe custom foot orthotics, which will realign your ankles, redistribute the weight, support the arch and reduce the twisting. Many orthotics will fit snugly into your normal shoes. Although we?ll also take a look at the type of shoes you wear to see if they are contributing to the problem.
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.
Non Surgical Treatment
Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion, and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body. When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.
Surgical Treatment
The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.
Over pronation of the foot is commonly referred to as "flat feet." Many middle-aged men and women suffer from over pronation over time and as a result of wearing poor-fitting shoes, continuing with repetitive exercising habits, or walking in high heels for long periods over several years. Regular speed-walkers often experience over pronation as well as a result of this activity.
Causes
There has been some speculation as to whether arch height has an effect on pronation. After conducting a study at the Rose-Hulman Institute of Technology, Maggie Boozer suggests that people with higher arches tend to pronate to a greater degree. However, the generally accepted view by professionals is that the most pronation is present in those with lower arch heights. To complicate matters, one study done by Hylton Menz at the University of Western Sydney-Macarthur suggests that the methods for measuring arch height and determining whether someone is ?flat-footed? or ?high-arched? are unreliable. He says, ?For this reason, studies investigating the relationship between static arch height motion of the rearfoot have consistently found that such a classification system is a poor predictor of dynamic rearfoot function.
Symptoms
Eventually, over-pronation can lead to a full list of maladies including flat feet, plantar fasciitis, plantar fibroma, neuromas, heel spurs, shin splints, ankle sprains, bunions, hammertoes, calluses, and pain in the arches, knee, hip and lower back. But it doesn?t have to go that far, because there are steps we can take to correct the over-pronation. In the vast majority of cases, we?ll prescribe custom foot orthotics, which will realign your ankles, redistribute the weight, support the arch and reduce the twisting. Many orthotics will fit snugly into your normal shoes. Although we?ll also take a look at the type of shoes you wear to see if they are contributing to the problem.
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.
Non Surgical Treatment
Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion, and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body. When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.
Surgical Treatment
The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.
Does Calcaneal Apophysitis Often Need Surgical Treatment?
Overview
Sever?s disease is particularly prevalent among active children between ages 8 and 15. Young boys and girls who play soccer and other sports in which footwear is inappropriate-i.e. too narrow in the toe box, too rigid, etc. are most commonly affected. Sever?s disease usually appears during the adolescent growth spurt-the 2-year period in early puberty where children grow the quickest. The adolescent growth spurt occurs between the ages of 8 and 13 in girls and 10 and 15 in boys. Teenagers over 15 years old rarely experience this heel problem, as heel bone growth is usually complete by this age. Sever?s disease usually self-resolves within 6 months of onset, though it can last longer.
Causes
The heel bone grows faster than the ligaments in the leg. As a result, muscles and tendons can become very tight and overstretched in children who are going through growth spurts. The heel is especially susceptible to injury since the foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. Sever?s disease occurs as a result of repetitive stress on the Achilles tendon. Over time, this constant pressure on the already tight heel cord can damage the growth plate, causing pain and inflammation. Such stress and pressure can result from, Sports that involve running and jumping on hard surfaces (track, basketball and gymnastics). Standing too long, which puts constant pressure on the heel. Poor-fitting shoes that don?t provide enough support or padding for the feet. Overuse or exercising too much can also cause Sever?s disease.
Symptoms
The pain associated with Sever's disease is usually felt along the back of the heel and becomes worse when running or walking. In some children, the pain is so severe they may limp when walking. One of the diagnostic tests for Sever's disease is the "squeeze test". Squeezing both sides of the heel together will produce immediate discomfort. Many children feel pain immediately upon waking and may have calf muscle stiffness in the morning.
Diagnosis
The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.
Non Surgical Treatment
Orthotics, The orthotics prescribed are made to align the foot in its correct foot posture. This will reduce stress and force at the site of the growth plate of the heel bone. Rest and Ice the heel 20 minutes before and after sporting activity. Calf muscle stretching exercises.
Exercise
Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.
Sever?s disease is particularly prevalent among active children between ages 8 and 15. Young boys and girls who play soccer and other sports in which footwear is inappropriate-i.e. too narrow in the toe box, too rigid, etc. are most commonly affected. Sever?s disease usually appears during the adolescent growth spurt-the 2-year period in early puberty where children grow the quickest. The adolescent growth spurt occurs between the ages of 8 and 13 in girls and 10 and 15 in boys. Teenagers over 15 years old rarely experience this heel problem, as heel bone growth is usually complete by this age. Sever?s disease usually self-resolves within 6 months of onset, though it can last longer.
Causes
The heel bone grows faster than the ligaments in the leg. As a result, muscles and tendons can become very tight and overstretched in children who are going through growth spurts. The heel is especially susceptible to injury since the foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. Sever?s disease occurs as a result of repetitive stress on the Achilles tendon. Over time, this constant pressure on the already tight heel cord can damage the growth plate, causing pain and inflammation. Such stress and pressure can result from, Sports that involve running and jumping on hard surfaces (track, basketball and gymnastics). Standing too long, which puts constant pressure on the heel. Poor-fitting shoes that don?t provide enough support or padding for the feet. Overuse or exercising too much can also cause Sever?s disease.
Symptoms
The pain associated with Sever's disease is usually felt along the back of the heel and becomes worse when running or walking. In some children, the pain is so severe they may limp when walking. One of the diagnostic tests for Sever's disease is the "squeeze test". Squeezing both sides of the heel together will produce immediate discomfort. Many children feel pain immediately upon waking and may have calf muscle stiffness in the morning.
Diagnosis
The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.
Non Surgical Treatment
Orthotics, The orthotics prescribed are made to align the foot in its correct foot posture. This will reduce stress and force at the site of the growth plate of the heel bone. Rest and Ice the heel 20 minutes before and after sporting activity. Calf muscle stretching exercises.
Exercise
Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.
Posterior Tibial Tendon Dysfunction Surgery
Overview
The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot. PTTD is often called ?adult acquired flatfoot? because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn?t treated early. 
Causes
As the name suggests, adult-acquired flatfoot occurs once musculoskeletal maturity is reached, and it can present for a number of reasons, though one stands out among the others. While fractures, dislocations, tendon lacerations, and other such traumatic events do contribute to adult-acquired flatfoot as a significant lower extremity disorder, as mentioned above, damage to the posterior tibial tendon is most often at the heart of adult-acquired flatfoot. One study further elaborates on the matter by concluding that ?60% of patients [presenting with posterior tibial tendon damage and adult-acquired flatfoot] were obese or had diabetes mellitus, hypertension, previous surgery or trauma to the medial foot, or treatment with steroids?.
Symptoms
Some symptoms of adult acquired flat foot are pain along the inside of the foot and ankle, pain that increases with activity, and difficulty walking for long periods of time. You may experience difficulty standing, pain on the outside of the ankle, and bony bumps on the top of the foot and inside the foot. You may also have numbness and tingling of the feet and toes (may result from large bone spurs putting pressure on nerves), swelling, a large bump on the sole of the foot and/or an ulcer (in diabetic patients). Diabetic patients should wear a properly fitting diabetic shoe wear to prevent these complications from happening.
Diagnosis
Although you can do the "wet test" at home, a thorough examination by a doctor will be needed to identify why the flatfoot developed. Possible causes include a congenital abnormality, a bone fracture or dislocation, a torn or stretched tendon, arthritis or neurologic weakness. For example, an inability to rise up on your toes while standing on the affected foot may indicate damage to the posterior tibial tendon (PTT), which supports the heel and forms the arch. If "too many toes" show on the outside of your foot when the doctor views you from the rear, your shinbone (tibia) may be sliding off the anklebone (talus), another indicator of damage to the PTT. Be sure to wear your regular shoes to the examination. An irregular wear pattern on the bottom of the shoe is another indicator of acquired adult flatfoot. Your physician may request X-rays to see how the bones of your feet are aligned. Muscle and tendon strength are tested by asking you to move the foot while the doctor holds it.
Non surgical Treatment
Flatfoot deformity can be treated conservatively or with surgical intervention depending on the severity of the condition. When people notice their arches flattening, they should immediately avoid non-supportive shoes such as flip-flops, sandals or thin-soled tennis shoes. Theses shoes will only worsen the flatfoot deformity and exacerbate arch pain. Next, custom orthotics are essential for people with collapsed arches. Over-the-counter insoles only provide cushion and padding to the arch, whereas custom orthotics are fabricated to specifically fit the patient?s foot and provide support in the arch where the posterior tibial tendon is unable to anymore. Use of custom orthotics in the early phases of flatfoot or PTTD can prevent worsening of symptoms and prevent further attenuation or injury to the posterior tibial tendon. In more severe cases of flatfoot deformity an ankle foot orthosis (AFO) such as a Ritchie brace is needed. This brace provides more support to the arch and hindfoot rather than an orthotic but can be bulky in normal shoegear. Additional treatment along with use of custom orthotics is use of non-steroidal anti-inflammatories (NSAIDS) such as Advil, Motrin, or Ibuprofen which can decrease inflammation to the posterior tibial tendon. If pain is severe, the patient may need to be placed in a below the knee air walker boot for several weeks which will allow the tendon to rest and heal, especially if a posterior tibial tendon tear is noted on MRI. 
Surgical Treatment
Good to excellent results for more than 80% of patients have been reported at five years' follow up for the surgical interventions recommended below. However, the postoperative recovery is a lengthy process, and most surgical procedures require patients to wear a plaster cast for two to three months. Although many patients report that their function is well improved by six months, in our experience a year is required to recover truly and gain full functional improvement after the surgery. Clearly, some patients are not candidates for such major reconstructive surgery.
Heel Pain All It Is Best To Know Heel Soreness
Overview
Heel pain is usually felt either under the heel or just behind it. Heel Pain has a prevalence of 3.6%. US studies estimate that 7% of older adults report tenderness under the heel. Plantar fasciitis is estimated to account for 8% of all running-related injuries. There are 26 bones in the human foot, of which the heel is the largest. Pain typically comes on gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe. In most cases the pain is under the foot, towards the front of the heel. The majority of patients recover with conservative treatments within months. Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain. To prevent heel pain, it's recommended to reduce the stress on that part of the body.
Causes
The most common cause of heel pain in adults is plantar fasciitis, which is an inflammation of the band of tissue in the sole that connects the heel to the toes and forms the natural foot arch. Plantar fasciitis may or may not be complicated by a calcaneal spur, a small bone growth that protrudes out of the heel. Plantar fasciitis may also be referred to as plantar fasciosis. In contrast to fasciitis, which essentially means inflammation, fasciosis refers to degeneration of the tissue. In fact, if left untreated, acute plantar fasciitis may develop into a chronic painful condition, which results in slow and irreversible degeneration of the fascia, hence plantar fasciosis. The location of the pain is usually exactly under the heel but may also occur in the arch of the foot. Pain typical to plantar fasciitis is that which feels worse when arising on to your feet such as in mornings or after sitting down for a while, and usually progresses in severity when left untreated.
Symptoms
Symptoms may also include swelling that is quite tender to the touch. Standing, walking and constrictive shoe wear typically aggravate symptoms. Many patients with this problem are middle-aged and may be slightly overweight. Another group of patients who suffer from this condition are young, active runners.
Diagnosis
A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.
Non Surgical Treatment
Treatment of heel pain generally occurs in stages. At the earliest sign of heel pain, aggressive calf muscle stretching should be started. Additionally, taking an oral anti-inflammatory medication and over-the- counter arch supports or heel cushions may be beneficial. The next phase of treatment might consist of continued calf muscle stretching exercises, cortisone injections and orthopedic taping of the foot to support the arch. If this treatment fails, or if there is reoccurrence of the heel pain, then functional foot orthotics might be considered. A functional orthotic is a device that is prescribed and fitted by your foot doctor, which fits in normal shoes like an arch support. Unlike an arch support, however the orthotic corrects abnormal pronation of the subtalar joint. Thus orthotics address the cause of the heel pain - abnormal pronation of the foot. Pump bump, treatment is similar to the treatment of bursitis and heel spurs. In rare cases, the bony growth at the heel may need to be removed surgically. Heel bruises can be treated by applying an ice pack for the first few minutes after injury. Achilles tendonitis, this condition is treated conservatively with rest, NSAIDs and physical therapy. If a sprain, fracture or other injury has caused the trapped nerve, this underlying problem must be treated first. In rare cases, surgery may be done to release the trapped nerve.
Surgical Treatment
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
Prevention
Make sure you wear appropriate supportive shoes. Don't over-train in sports. Make sure you warm up, cool down and undertake an exercise regime that helps maintain flexibility. Manage your weight, obesity is a factor in causing plantar fasciitis. Avoid walking and running on hard surfaces if you are prone to pain. You should follow the recognized management protocol "RICED" rest, ice, compression, elevation and diagnosis. Rest, keep off the injured ankle as much as possible. Ice, applied for 20 minutes at a time every hour as long as swelling persists. Compression, support the ankle and foot with a firmly (not tightly) wrapped elastic bandage. Elevation, keep foot above heart level to minimize bruising and swelling. Diagnosis. Consult a medical professional (such as a Podiatrist or doctor) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment. An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.
Heel pain is usually felt either under the heel or just behind it. Heel Pain has a prevalence of 3.6%. US studies estimate that 7% of older adults report tenderness under the heel. Plantar fasciitis is estimated to account for 8% of all running-related injuries. There are 26 bones in the human foot, of which the heel is the largest. Pain typically comes on gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe. In most cases the pain is under the foot, towards the front of the heel. The majority of patients recover with conservative treatments within months. Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain. To prevent heel pain, it's recommended to reduce the stress on that part of the body.
Causes
The most common cause of heel pain in adults is plantar fasciitis, which is an inflammation of the band of tissue in the sole that connects the heel to the toes and forms the natural foot arch. Plantar fasciitis may or may not be complicated by a calcaneal spur, a small bone growth that protrudes out of the heel. Plantar fasciitis may also be referred to as plantar fasciosis. In contrast to fasciitis, which essentially means inflammation, fasciosis refers to degeneration of the tissue. In fact, if left untreated, acute plantar fasciitis may develop into a chronic painful condition, which results in slow and irreversible degeneration of the fascia, hence plantar fasciosis. The location of the pain is usually exactly under the heel but may also occur in the arch of the foot. Pain typical to plantar fasciitis is that which feels worse when arising on to your feet such as in mornings or after sitting down for a while, and usually progresses in severity when left untreated.
Symptoms
Symptoms may also include swelling that is quite tender to the touch. Standing, walking and constrictive shoe wear typically aggravate symptoms. Many patients with this problem are middle-aged and may be slightly overweight. Another group of patients who suffer from this condition are young, active runners.
Diagnosis
A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.
Non Surgical Treatment
Treatment of heel pain generally occurs in stages. At the earliest sign of heel pain, aggressive calf muscle stretching should be started. Additionally, taking an oral anti-inflammatory medication and over-the- counter arch supports or heel cushions may be beneficial. The next phase of treatment might consist of continued calf muscle stretching exercises, cortisone injections and orthopedic taping of the foot to support the arch. If this treatment fails, or if there is reoccurrence of the heel pain, then functional foot orthotics might be considered. A functional orthotic is a device that is prescribed and fitted by your foot doctor, which fits in normal shoes like an arch support. Unlike an arch support, however the orthotic corrects abnormal pronation of the subtalar joint. Thus orthotics address the cause of the heel pain - abnormal pronation of the foot. Pump bump, treatment is similar to the treatment of bursitis and heel spurs. In rare cases, the bony growth at the heel may need to be removed surgically. Heel bruises can be treated by applying an ice pack for the first few minutes after injury. Achilles tendonitis, this condition is treated conservatively with rest, NSAIDs and physical therapy. If a sprain, fracture or other injury has caused the trapped nerve, this underlying problem must be treated first. In rare cases, surgery may be done to release the trapped nerve.
Surgical Treatment
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
Prevention
Make sure you wear appropriate supportive shoes. Don't over-train in sports. Make sure you warm up, cool down and undertake an exercise regime that helps maintain flexibility. Manage your weight, obesity is a factor in causing plantar fasciitis. Avoid walking and running on hard surfaces if you are prone to pain. You should follow the recognized management protocol "RICED" rest, ice, compression, elevation and diagnosis. Rest, keep off the injured ankle as much as possible. Ice, applied for 20 minutes at a time every hour as long as swelling persists. Compression, support the ankle and foot with a firmly (not tightly) wrapped elastic bandage. Elevation, keep foot above heart level to minimize bruising and swelling. Diagnosis. Consult a medical professional (such as a Podiatrist or doctor) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment. An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.
What Are The Key Treatment And Cause Of Achilles Tendon Pain ?
Overview
If you have pain along the back of your leg near your heel, you may have Achilles tendonitis. Achilles tendonitis is an overuse injury that commonly occurs in runners and ?weekend warriors?. The Achilles tendon is the largest tendon in the body. Named after a tragic hero from Greek mythology, it connects your calf muscle to your heel bone to allow you to jump, run and walk. Achilles tendonitis is most common in middle-aged men, but it can happen to anyone who has a sudden increase in physical activity. The risk is increased if you also have tight calf muscles and/or a flat arch in your foot. Other risk factors include running in worn out shoes, cold weather, frequently running uphill or if you suffer from medical conditions such as diabetes or high blood pressure. There are two main types of Achilles tendinitis: insertional and noninsertional. Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches to the heel bone. Noninsertional Achilles tendinitis is when the fibers in the middle portion of the tendon have started to break down with tiny tears, swell, and/or thicken. This type is more often seen in younger, active people. Both types can also cause bone spurs. Achilles tendonitis should be diagnosed by your doctor. However, if you experienced a sudden ?pop? in the back of your calf or heel, this might be something more serious like a ruptured or torn Achilles tendon. If this happens, see your doctor immediately.
Causes
Some of the causes of Achilles tendonitis include, overuse injury - this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis - Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions, both tendons can be affected. Foot problems - some people with flat feet or hyperpronated feet (feet that turn inward while walking) are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear - wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels. Overweight and obesity - being overweight places more strain on many parts of the body, including the Achilles tendon. Quinolone antibiotics - can in some instances be associated with inflammatory tenosynovitis and, if present, will often be bilateral (both Achilles), coming on soon after exposure to the drug.
Symptoms
Achilles tendonitis and tendinopathy present as pain in the Achilles tendon, usually several centimeters above where it inserts on the heel. In some patients, pain and tendon damage are primarily at the insertion to the heel bone. There may be swelling and/or thickening of the tendon. Bending at the ankle, walking, jumping, and running are often painful with this condition.
Diagnosis
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs, calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not be visible on MRI. It depends upon the severity of the condition.
Nonsurgical Treatment
Initial treatment of mild Achilles tendinitis involves rest, stretching exercises, and non-prescriptive medications to relieve pain and reduce inflammation. These medications include nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen or naproxen. Relief of pain and swelling may be achieved with the application of ice for15 minutes at a time. Sleeping with the affected foot propped up on a pillow may also relieve swelling. Adequate time must be given to rest and recovery, meaning months or weeks, to prevent re-injury of the Achilles tendon. Most people make a full recovery and are able to return to their regular sports and exercise programs.
Surgical Treatment
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
Prevention
By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.
If you have pain along the back of your leg near your heel, you may have Achilles tendonitis. Achilles tendonitis is an overuse injury that commonly occurs in runners and ?weekend warriors?. The Achilles tendon is the largest tendon in the body. Named after a tragic hero from Greek mythology, it connects your calf muscle to your heel bone to allow you to jump, run and walk. Achilles tendonitis is most common in middle-aged men, but it can happen to anyone who has a sudden increase in physical activity. The risk is increased if you also have tight calf muscles and/or a flat arch in your foot. Other risk factors include running in worn out shoes, cold weather, frequently running uphill or if you suffer from medical conditions such as diabetes or high blood pressure. There are two main types of Achilles tendinitis: insertional and noninsertional. Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches to the heel bone. Noninsertional Achilles tendinitis is when the fibers in the middle portion of the tendon have started to break down with tiny tears, swell, and/or thicken. This type is more often seen in younger, active people. Both types can also cause bone spurs. Achilles tendonitis should be diagnosed by your doctor. However, if you experienced a sudden ?pop? in the back of your calf or heel, this might be something more serious like a ruptured or torn Achilles tendon. If this happens, see your doctor immediately.
Causes
Some of the causes of Achilles tendonitis include, overuse injury - this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis - Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions, both tendons can be affected. Foot problems - some people with flat feet or hyperpronated feet (feet that turn inward while walking) are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear - wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels. Overweight and obesity - being overweight places more strain on many parts of the body, including the Achilles tendon. Quinolone antibiotics - can in some instances be associated with inflammatory tenosynovitis and, if present, will often be bilateral (both Achilles), coming on soon after exposure to the drug.
Symptoms
Achilles tendonitis and tendinopathy present as pain in the Achilles tendon, usually several centimeters above where it inserts on the heel. In some patients, pain and tendon damage are primarily at the insertion to the heel bone. There may be swelling and/or thickening of the tendon. Bending at the ankle, walking, jumping, and running are often painful with this condition.
Diagnosis
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs, calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not be visible on MRI. It depends upon the severity of the condition.
Nonsurgical Treatment
Initial treatment of mild Achilles tendinitis involves rest, stretching exercises, and non-prescriptive medications to relieve pain and reduce inflammation. These medications include nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen or naproxen. Relief of pain and swelling may be achieved with the application of ice for15 minutes at a time. Sleeping with the affected foot propped up on a pillow may also relieve swelling. Adequate time must be given to rest and recovery, meaning months or weeks, to prevent re-injury of the Achilles tendon. Most people make a full recovery and are able to return to their regular sports and exercise programs.
Surgical Treatment
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
Prevention
By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.
What Triggers Plantar Fasciitis And How To Eliminate It
Overview
A common condition that affects people of all ages. Symptoms include heel pain that is worse upon arising in the morning or standing after prolonged sitting. The pain is caused by inflammation of the plantar fascia, the ligament that connects the heel bone to the toes.
Causes
As a person gets older, the plantar fascia becomes less like a rubber band and more like a rope that doesn't stretch very well. The fat pad on the heel becomes thinner and can't absorb as much of the shock caused by walking. The extra shock damages the plantar fascia and may cause it to swell, tear or bruise. You may notice a bruise or swelling on your heel. Other risk factors for plantar fasciitis include being overweight and obesity. Diabetes. Spending most of the day on your feet. Becoming very active in a short period of time. Being flat-footed or having a high arch.
Symptoms
Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain will often subside as you begin to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more long-lasting form of heel pain will cause you to shorten your stride while running or walking. You also may shift your weight toward the front of the foot, away from the heel.
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
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home. Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery. Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia. Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel,do not apply ice directly to the skin. Limit activities. Cut down on extended physical activities to give your heel a rest. Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches. Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia. Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain. Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal. Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients. Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
Surgical Treatment
Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The most common complications of release surgery include incomplete relief of pain and nerve damage.
Stretching Exercises
While it's typical to experience pain in just one foot, massage and stretch both feet. Do it first thing in the morning, and three times during the day. Achilles Tendon Stretch. Stand with your affected foot behind your healthy one. Point the toes of the back foot toward the heel of the front foot, and lean into a wall. Bend the front knee and keep the back knee straight, heel firmly planted on the floor. Hold for a count of 10. Plantar Fascia Stretch. Sit down, and place the affected foot across your knee. Using the hand on your affected side, pull your toes back toward your shin until you feel a stretch in your arch. Run your thumb along your foot--you should feel tension. Hold for a count of 10.
