Month: March 2015

Do You Really Understand Heel Soreness?

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Overview

Painful Heel

Every mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain, the most common problem affecting the foot and ankle. A sore heel will usually get better on its own without surgery if you give it enough rest. However, many people ignore the early signs of Heel Pain and keep on doing the activities that caused it. When you continue to walk on a sore heel, it will only get worse and could become a chronic condition leading to more problems.

Causes

Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel may become tender or swollen from, shoes with poor support or shock absorption. Running on hard surfaces, like concrete. Running too often. Tightness in your calf muscle or the Achilles tendon. Sudden inward or outward turning of your heel. Landing hard or awkwardly on the heel. Conditions that may cause heel pain include. When the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. Swelling of the fluid-filled sac (bursa) at the back of the heel bone under the Achilles tendon (bursitis). Bone spurs in the heel. Swelling of the thick band of tissue on the bottom of your foot (plantar fasciitis). Fracture of the heel bone that is related to landing very hard on your heel from a fall (calcaneus fracture).

Symptoms

Plantar fasciitis is a condition of irritation to the plantar fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness on the bottom of your heel and feels worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or runners will feel discomfort for the first few minutes of their run. This occurs because the plantar fascia is not well supplied by blood, which makes this condition slow in healing, and a certain amount of activity is needed to get the area to warm up. Plantar fasciitis can occur for various reasons: use of improper, non-supportive shoes; over-training in sports; lack of flexibility; weight gain; prolonged standing; and, interestingly, prolonged bed rest.

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

As heel pain is basically a stress problem in the tissues of the heel, the main treatment is to reduce stress. Your doctor will advise you about weight loss and appropriate footwear. A soft heel pad is useful to wear in your shoe to act as a shock-absorber when you walk. If you have a stiff ankle or tight Achilles tendon a physiotherapist can advise on exercises for these. Stretching the Achilles tendon and plantar fascia is very effective general treatment for many patients. If you have a high-arched or flat foot, a podiatrist may advise an insole to reduce stress. Simple pain-killers such as paracetamol or anti-inflammatory medicines can help reduce the pain. Ask advice from your doctor or pharmacist before taking anti-inflammatory medicines as they can have troublesome side-effects in some people. The simple measures above will help the majority of people with heel pain. If the pain continues, a splint to wear on your ankle at night to prevent your Achilles tendon tightening up while you are asleep is often very effective in improving the severe pain that many people get first thing in the morning and breaking the cycle of pain. Your GP or an orthopaedic foot and ankle surgeon or rheumatologist may inject some steroid into the attachment of the plantar fascia to damp down the inflammation. These measures will reduce the pain in most people who are not helped by simple treatment. If you still have pain after one or two injections, your doctor may want to investigate your problem a bit further. If no other medical problem or cause of stress in your heel is found, a number of other treatments can be tried. Further physiotherapy, wearing a plaster cast to rest the inflamed tissues, pain control treatments such as transcutaneous nerve stimulation (TENS) or acupuncture. Only if all non-surgical treatments fail would an operation be considered.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

Prevention

Heel Discomfort

You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.

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Do You Really Understand Heel Soreness?

Posted on Updated on

Overview

Painful Heel

Every mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain, the most common problem affecting the foot and ankle. A sore heel will usually get better on its own without surgery if you give it enough rest. However, many people ignore the early signs of Heel Pain and keep on doing the activities that caused it. When you continue to walk on a sore heel, it will only get worse and could become a chronic condition leading to more problems.

Causes

Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel may become tender or swollen from, shoes with poor support or shock absorption. Running on hard surfaces, like concrete. Running too often. Tightness in your calf muscle or the Achilles tendon. Sudden inward or outward turning of your heel. Landing hard or awkwardly on the heel. Conditions that may cause heel pain include. When the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. Swelling of the fluid-filled sac (bursa) at the back of the heel bone under the Achilles tendon (bursitis). Bone spurs in the heel. Swelling of the thick band of tissue on the bottom of your foot (plantar fasciitis). Fracture of the heel bone that is related to landing very hard on your heel from a fall (calcaneus fracture).

Symptoms

Plantar fasciitis is a condition of irritation to the plantar fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness on the bottom of your heel and feels worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or runners will feel discomfort for the first few minutes of their run. This occurs because the plantar fascia is not well supplied by blood, which makes this condition slow in healing, and a certain amount of activity is needed to get the area to warm up. Plantar fasciitis can occur for various reasons: use of improper, non-supportive shoes; over-training in sports; lack of flexibility; weight gain; prolonged standing; and, interestingly, prolonged bed rest.

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

As heel pain is basically a stress problem in the tissues of the heel, the main treatment is to reduce stress. Your doctor will advise you about weight loss and appropriate footwear. A soft heel pad is useful to wear in your shoe to act as a shock-absorber when you walk. If you have a stiff ankle or tight Achilles tendon a physiotherapist can advise on exercises for these. Stretching the Achilles tendon and plantar fascia is very effective general treatment for many patients. If you have a high-arched or flat foot, a podiatrist may advise an insole to reduce stress. Simple pain-killers such as paracetamol or anti-inflammatory medicines can help reduce the pain. Ask advice from your doctor or pharmacist before taking anti-inflammatory medicines as they can have troublesome side-effects in some people. The simple measures above will help the majority of people with heel pain. If the pain continues, a splint to wear on your ankle at night to prevent your Achilles tendon tightening up while you are asleep is often very effective in improving the severe pain that many people get first thing in the morning and breaking the cycle of pain. Your GP or an orthopaedic foot and ankle surgeon or rheumatologist may inject some steroid into the attachment of the plantar fascia to damp down the inflammation. These measures will reduce the pain in most people who are not helped by simple treatment. If you still have pain after one or two injections, your doctor may want to investigate your problem a bit further. If no other medical problem or cause of stress in your heel is found, a number of other treatments can be tried. Further physiotherapy, wearing a plaster cast to rest the inflamed tissues, pain control treatments such as transcutaneous nerve stimulation (TENS) or acupuncture. Only if all non-surgical treatments fail would an operation be considered.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

Prevention

Heel Discomfort

You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.

The Leading Causes And Therapies For Achilles Tendonitis

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Overview

Achilles TendonAchilles tendinitis is an uncomfortable condition where a person?s large tendon in the back of their ankle becomes irritated and inflamed. It is a very common type of injury, most often seen in recreational athletes. This makes sense because recreational athletes still play hard at their sports, but don?t have the full knowledge or training that comes with being a professional to prevent injuries. Achilles tendon pain is not something to be taken lightly, so if you are aware of your own, you should definitely seek some medical advice.

Causes

Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis, also sometimes called Achilles tendinitis. Participating in activities that involve sudden stops and starts and repetitive jumping (e.g., basketball, tennis, dancing) increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear. Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time (overuse). Patients who develop arthritis in the heel have an increased risk for developing Achilles tendonitis. This occurs more often in people who middle aged and older. The condition also may develop in people who exercise infrequently and in those who are just beginning an exercise program, because inactive muscles and tendons have little flexibility because of inactivity. It is important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually. In some cases, a congenital (i.e., present at birth) condition causes Achilles tendonitis. Typically, this is due to abnormal rotation of the foot and leg (pronation), which causes the arch of the foot to flatten and the leg to twist more than normal.

Symptoms

Pain in the back of the heel that can be a shooting pain, burning pain or even an intense piercing pain. Swelling, tenderness and warmth over the Achilles tendon especially at the insertion of the tendon to the calcaneous, which may even extend into the muscle of the calf. Difficulty walking, sometimes the pain makes walking impossible. Pain that is aggravated by activities that repeatedly stress the tendon, causing inflammation or pain that occurs in the first few steps of the morning or after sitting down for extended periods of time which gets better with mild activity. It is important to note though that achilles tendinosis can develop gradually without a history of trauma.

Diagnosis

A doctor or professional therapist will confirm a diagnosis, identify and correct possible causes, apply treatment and prescribe eccentric rehabilitation exercises. An MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis. Gait analysis along with a physical assessment will identify any possible biomechanical factors such as over pronation which may have contributed to the achilles tendonitis and training methods will be considered. Biomechanical problems can be corrected with the use of orthotic inserts and selection of correct footwear.

Nonsurgical Treatment

Most cases are successfully treated non-surgically although this is time-consuming and frustrating for active patients. Treatment is less likely to be successful if symptoms have been present more than six months. Nonsurgical management includes nonsteroidal anti-inflammatory medications, rest, immobilization, limitation of activity, ice, contrast baths, stretching and heel lifts. If symptoms fail to resolve after two to three months, a formal physical therapy program may be of benefit. An arch support may help if there is an associated flatfoot. A cast or brace to completely rest this area may be necessary. Extracorporeal shockwave therapy and platelet-rich plasma injections? have variable reports of success. Nitroglycerin medication applied to the overlying skin may be of benefit.

Achilles Tendon

Surgical Treatment

In most surgeries, damaged tissue is cleaned out before surgeons make the necessary repairs. However, a new minimally-invasive surgery to repair a torn Achilles tendon actually uses the damaged tissue to help repair the tear. The percutaneous Achilles repair system, or PARS technique, enables surgeons to better repair a torn Achilles tendon through a smaller incision. This procedure was recently performed at Houston Methodist Hospital to treat an NFL cornerback, getting him back on field for this season.

Prevention

Regardless of whether the Achilles injury is insertional or non-insertional, a great method for lessening stress on the Achilles tendon is flexor digitorum longus exercises. This muscle, which originates along the back of the leg and attaches to the tips of the toes, lies deep to the Achilles. It works synergistically with the soleus muscle to decelerate the forward motion of the leg before the heel leaves the ground during propulsion. This significantly lessens strain on the Achilles tendon as it decelerates elongation of the tendon. Many foot surgeons are aware of the connection between flexor digitorum longus and the Achilles tendon-surgical lengthening of the Achilles (which is done to treat certain congenital problems) almost always results in developing hammer toes as flexor digitorum longus attempts to do the job of the recently lengthened tendon. Finally, avoid having cortisone injected into either the bursa or tendon-doing so weakens the tendon as it shifts production of collagen from type one to type three. In a recent study published in the Journal of Bone Joint Surgery(9), cortisone was shown to lower the stress necessary to rupture the Achilles tendon, and was particularly dangerous when done on both sides, as it produced a systemic effect that further weakened the tendon.