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29 Sep 2015 
Inferior Calcaneal Spur


Overview


While the term heel spur may create the impression of a sharp bony projection on the bottom of the heel that pokes the bottom of our foot causing our pain. Painful heel spurs are actually a result of damage to the soft tissue at the bottom of the foot. While this may be confusing, we'll try to explain. Heel spurs is the more common name for a condition that is medically referred to as plantar fascitiis or heel spur syndrome. Plantar fasciitis is a location oriented term that refers to the bottom of the foot(i.e. plantar warts). Fascia is a tough, inelastic band. 'itis'is a term used to describe something that is inflamed (i.e. tendonitis, bursitis).


Causes


Causes for heel spurs (and related plantar fasciitis) include increase or change in activity, lack of arch support or poor shoe choice, injury, inflexibility in Achilles tendon and calf muscles, and spending hours daily on the feet. Also, arthritis from aging is often a common cause of bone loss and natural cushioning under the heel. Tarsal tunnel syndrome can also be to blame. Ultimately, in the United States, the most likely cause of this pain is being overweight. With more than 60% of the nation obese or morbidly obese, foot pain related to excessive weight is most likely. Dietary changes are most likely to cause long-term relief for bone spurs and plantar fasciitis.


Posterior Calcaneal Spur


Symptoms


Most of the time heel spurs present as pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.


Diagnosis


Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.


Non Surgical Treatment


In many cases treatment is non-surgical and can relieve pain, but may take from three months to a year to fully recover. Performing stretching exercises to help relax the tissues in the heel as well as rest, icing, and over-the-counter anti-inflammatory or prescription medications can help ease symptoms. Customized orthotics or shoe inserts to position and cushion your heel can help.


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.


Prevention


Choose new shoes that are the right size. Have your foot measured when you go to the shoe store instead of taking a guess about the size. Also, try on shoes at the end of the day or after a workout, when your feet are at their largest. To ensure a good fit, wear the same type of socks or nylons that you would normally wear with the type of shoe that you are trying on.
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23 Sep 2015 
Calcaneal Spur


Overview


A bone spur (osteophyte) is a bony growth that forms along the edge of normal bone in response to wear and tear, most frequently in the joints. A heel spur is a bone spur of the heel bone, which causes heel pain by rubbing on the achilles tendon or other soft tissues.


Causes


You are more likely to develop plantar fasciitis and heel spurs if you are Active. Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. running, ballet dancing and aerobics. Overweight. Carrying around extra weight increases the strain and stress on your plantar fascia. Pregnant. The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation. On your feet. Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses. Flat Feet or High Foot Arches. Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force. Middle-Aged or Older. With ageing the arch of your foot may begin to sag - putting extra stress on the plantar fascia. Wearing shoes with poor support. Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury. Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis. Diabetes. Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.


Posterior Calcaneal Spur


Symptoms


Although it may take years to become a problem, once it appears, it may cause considerable suffering. Because of proximity to the tendons, the spur is a source of continuous painful aching. The sensation has been described as "a toothache in the foot." When you place your weight on the heel, the pain can be sufficient to immobilize you.


Diagnosis


Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products such as Advil or Ibuprofin are helpful in eradicating the pain. Pain creams, such as Neuro-eze, BioFreeze & Boswella Cream can help to relieve pain and help increase circulation.


Non Surgical Treatment


In extreme cases, a doctor may recommend surgery for the removal of heel spurs. Fortunately, this is the exception rather than the rule. Most cases can be resolved with a combination of icing, rest, foot stretches and supporting the foot with an orthodic shoe insert specifically designed for this condition. We recommend that you continue on to our article on Heel Spur Treatment to discover the best, speediest and most affordable methods of resolving this ailment without invasive medical procedures.


Surgical Treatment


Usually, heel spurs are curable with conservative treatment. If not, heel spurs are curable with surgery, although there is the possibility of them growing back. About 10% of those who continue to see a physician for plantar fascitis have it for more than a year. If there is limited success after approximately one year of conservative treatment, patients are often advised to have surgery.


Prevention


To prevent this condition, wearing shoes with proper arches and support is very important. Proper stretching is always a necessity, especially when there is an increase in activities or a change in running technique. It is not recommended to attempt working through the pain, as this can change a mild case of heel spurs and plantar fascitis into a long lasting and painful episode of this condition.
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23 Agos 2015 
Overview


The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The Achilles is attached to the heel bone (calcaneus). At the heel bone there is a bursa in front of the Achilles anchor point (bursae tendinis Achilles), as well as behind (bursae subcutanea calcanei). The bursa reduce the pressure against the heel bone.


Causes


Systemic diseases such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, pancreatitis, Whipple disease, oxalosis, uremia, hypertrophic pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome have also been associated with bursitis.


Symptoms


Bursitis usually causes a dull pain, tenderness, and stiffness near the affected bursa. The bursa may swell and make the skin around it red and warm to the touch. Bursitis is most common in the shoulder camera.gif, elbow camera.gif, hip camera.gif, and knee camera.gif. Bursitis may also occur near the Achilles tendon or in the foot. Symptoms of bursitis may be like those of tendinopathy. Both occur in the tissues in and around the joints. Check with your doctor if your pain is severe, if the sore area becomes very hot or red, or if you have a fever.


Diagnosis


Obtaining a detailed history from the patient is important in diagnosing calcaneal bursitis. The following complaints (which the physician should ask about during the subjective examination) are commonly reported by patients.


Other inquiries that the physician should make include the following. The clinician should ask about the patient's customary footwear (whether, for example, it includes high-heeled shoes or tight-fitting athletic shoes). The patient should be asked specifically about any recent change in footwear, such as whether he/she is wearing new athletic shoes or whether the patient has made a transition from flat shoes to high heels or vice versa. Individuals who have been accustomed to wearing high-heeled shoes on a long-term basis may find that switching to flat shoes causes increased stretch and irritation of the Achilles tendon and the associated bursae. The specifics of a patient's activity level should be ascertained, including how far the patient runs and, in particular, whether the individual is running with greater intensity than before or has increased the distance being run. The history of any known or suspected underlying rheumatologic conditions, such as gout, rheumatoid arthritis, or seronegative spondyloarthropathies, should be obtained.


Non Surgical Treatment


Treatment is primarily comprised of relief from the painful activity (running). It is important that shoes do not pinch the heel. If satisfactory progress is not made during the rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the bursa. Injections should be performed under ultrasound guidance to ensure optimal effect and reduce the risk of injecting into the Achilles itself. If progress is not made neither through rehabilitation nor medicinal treatment, surgical treatment can be attempted.


Surgical Treatment


Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.


Prevention


Because many soft tissue conditions are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause problems. Underlying conditions such as leg length differences, improper position or poor technique in sports or work must be corrected. Be aware of potential overuse or injury in your daily activities and change your lifestyle to prevent problems. Otherwise, problems may persist or occur repeatedly. Following are some ways you can avoid future problems. Wear walking or jogging shoes that provide good support. High-top shoes provide support for people with ankle problems. Wear comfortable shoes that fit properly. Wear heel cups or other shoe inserts as recommended by your doctor. Exercise on level, graded surfaces.
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16 Agos 2015 
Hammer ToeOverview


There are two types of hammertoes. Flexible hammer toes. If the toe can still be moved at the joint, it's a flexible hammer toe. That's good, because this is an earlier, less-severe form of the problem. There may be several treatment options. Rigid hammer toes. If the tendons in the toe become rigid, they press the joint out of alignment. At this stage, the toe can't be moved. This usually means surgery is required to correct the problem.


Causes


The cause of hammertoes varies, but causes include genetics, arthritis and injury to the toe. Treatment for hammertoes depends on the severity and can include anti-inflammatory medication, metatarsal pads, foot exercises and better-fitting shoes. If the pain caused by a hammertoe is so severe that wearing a shoe is uncomfortable, surgery may be necessary. Typically this surgery is an outpatient procedure that doesn?t require general anesthesia, though it is an option. Recovery from surgery usually takes a few weeks, and patients are given special shoes to wear.


HammertoeSymptoms


Hammer toes can cause problems with walking and lead to other foot problems, such as blisters, calluses, and sores. Pain is caused by constant friction over the top of the toe?s main joint. It may be difficult to fit into some shoe gear due to the extra space required for the deformed toe. In many cases there will hammertoe be pain on the ball of the foot over the metatarsals along with callus formation. This is due to the toes not functioning properly, failing to properly touch the ground during the gait cycle. The ball of the foot then takes the brunt of the ground forces, which causes chronic pain.


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


There are several treatment options. These are based on how severe the problem has become. The sooner a person seeks treatment, the more options that person may have. Wear properly fitting shoes; this does not necessarily mean expensive shoes. Padding any prominent areas around the bony point of the toe may help to relieve pain. Medication that reduces inflammation can ease the pain and swelling. Sometimes a doctor will use cortisone injections to relieve acute pain. A podiatrist may also custom-make an insert to wear inside your shoe. This can reduce pain and keep the hammer toe from getting worse. Your doctor may recommend foot exercises to help restore muscle balance. Splinting the toe may help in the very early stages.


Surgical Treatment


For the surgical correction of a rigid hammertoe, the surgical procedure consists of removing the damaged skin where the corn is located. Then a small section of bone is removed at the level of the rigid joint. The sutures remain in place for approximately ten days. During this period of time it is important to keep the area dry. Most surgeons prefer to leave the bandage in place until the patient's follow-up visit, so there is no need for the patient to change the bandages at home. The patient is returned to a stiff-soled walking shoe in about two weeks. It is important to try and stay off the foot as much as possible during this time. Excessive swelling of the toe is the most common patient complaint. In severe cases of hammertoe deformity a pin may be required to hold the toe in place and the surgeon may elect to fuse the bones in the toe. This requires several weeks of recovery.
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24 Jun 2015 
Hammer ToeOverview


The term, hammertoe, is commonly used as a general classification for any condition where the toe muscle weakens, causing digital contracture, and resulting in deformity, a digital contracture like this can actually be a hammertoe, claw toe or mallet toe, depending on which joints in the toe are contracted. Clawtoes are bent at the middle and end joints, while hammertoes are bent at the middle joint only. When it?s mallet toe, the joint at the end of the toe buckles. The skin near the toenail tip develops a painful corn that can eventually result in an ulcer. Doctors further categorize all forms of hammertoe based on whether the affected toe is flexible, semi-rigid or rigid. The more rigid the toe, the more pain it will cause.


Causes


Wearing shoes that squeeze the toes or high heels that jam the toes into the front of the shoe. Other causes or factors in the development of hammertoes can include an injury such as badly stubbing your toe, arthritis and nerve and muscle damage from diseases such as diabetes. And, hammertoes tend to run in families, although it is more likely the faulty foot mechanics that lead to hammertoes that are inherited, not the hammertoes themselves. Hammertoe generally affect the smaller toes of the foot, especially the second toe, which for many people is the longest toe. It's uncommon for the big toe to be bent this way.


Hammer ToeSymptoms


The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes. There may be a bursa under the corn or instead of a corn, depending on the pressure. Most of the symptoms are due to pressure from footwear on the toe. There may be a callus under the metatarsal head at the base of the toe. Initially a hammer toe is usually flexible, but when longstanding it becomes more rigid.


Diagnosis


Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.


Non Surgical Treatment


Mild hammer toe in children can be treated by manipulating and splinting the affected toe. The following changes in footwear may help relieve symptoms. Wear the right size shoes or shoes with wide toe boxes for comfort, and to avoid making hammer toe worse. Avoid high heels as much as possible. Wear soft insoles to relieve pressure on the toe. Protect the joint that is sticking out with corn pads or felt pads. A foot doctor can make foot devices called hammer toe regulators or straighteners for you, or you can buy them at the store. Exercises may be helpful. You can try gentle stretching exercises if the toe is not already in a fixed position. PIcking up a towel with your toes can help stretch and straighten the small muscles in the foot.


Surgical Treatment


Any surgery must be carefully considered and approached in a serious manner, as any procedure is serious for the patient. But in most cases the procedure is relatively straight forward. The surgery can be done using local anesthetic and does not require hospitalization. The hammertoes patient goes home in a special post-operative shoe or a regular sandal, and in most cases can walk immediately. That's not to say that the patient is walking or functioning normally immediately after the procedure. The patient must take some time off work to rest the foot and allow it to heal.


Hammer ToePrevention


elect and wear the right shoe for specific activities (such as running shoes for running). Alternate shoes. Don't wear the same pair of shoes every day. Avoid walking barefoot, which increases the risk for injury and infection. At the beach or when wearing sandals, always use sunblock on your feet, as you would on the rest of your body. Be cautious when using home remedies for foot ailments. Self-treatment can often turn a minor problem into a major one. It is critical that people with diabetes see a podiatric physician at least once a year for a checkup. People with diabetes, poor circulation, or heart problems should not treat their own feet, including toenails, because they are more prone to infection.
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