Working With Fallen Arches
Overview
The term 'fallen arches' is rather a historical one, but is one many people seem to have heard of. What it essentially refers to is a ligament problem in the sole of his foot where these run along its length. In most people these ligaments provide support to the foot when walking and help keep the foot in a normal anatomical position. Some people however seem to have laxity in these ligaments so the foot becomes under undue strain and pain can occur as a result.
Causes
There are many reasons why flat feet develop. Here?s a look at some of the most common causes. Genetics, weak arches, injury, arthritis, diabetes, age, wear and tear on feet, tibialis posterior (ruptured tendon). Nervous system or muscle diseases such as cerebral palsy. Weakness and tightness of other muscles and tendons higher up in the lower extremity. The way our arches form depends on several factors. Our feet are complex structures that comprise twenty-six bones, thirty-three joints, and more than 100 muscles, tendons, and ligaments each. Each foot forms two arches. The arch that runs from the heel to the toe is known as the longitudinal arch, while the one that runs the width is known as the transverse arch. Ligaments (fibrous tissues) give our arches their shape and hold our bones together. The plantar fascia (the long, strong band of connective tissue that runs along the sole of your foot) and muscles add secondary support. There are also foot pads that absorb impact and assist with weight-bearing functions. How these things intertwine and work together determines the formation of our arches. A structural abnormality or injury to one of these components can result in flatfoot.
Symptoms
Knee/Hip/Back Pain - When the arch collapses in the foot, it triggers a series of compensations up the joint chain, leading to increased stress on the knee, pelvis and low back. Plantar fasciitis - This condition is characterized by heel pain, especially with the first few steps you take. The plantar fascia stretches as the arch falls, putting stress on the heel. Bunions - If you see a bony bump developing at the base of your big toe, you are likely developing a bunion. It may be swollen, red or painful when it rubs against your shoe. A flattened arch spreads the forefoot and causes the big toe to deviate toward the second toe. Shin splints - This term generally refers to pain anywhere along the shinbone. It is typically due to overuse and is aggravated after exercise and activity.
Diagnosis
Flat feet are easy to identify while standing or walking. When someone with flat feet stands, their inner foot or arch flattens and their foot may roll over to the inner side. This is known as overpronation. To see whether your foot overpronates, stand on tiptoes or push your big toe back as far as possible. If the arch of your foot doesn't appear, your foot is likely to overpronate when you walk or run. It can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.
Why do arches fall?
Non Surgical Treatment
Some of the aspects of the pain with a ?fallen arch? are related to the crushing of the joints of the outside of the foot and from the stretching of ligaments and tendons of the inside of the foot. Unfortunately, some parts of the damage from the fallen arch, the weakness in the tendons and the new shape of the foot, are not correctable without surgical reconstruction. The first goal is to stabilize the collapsed arch. This can be done through braces. If the deformity is mild, an over-the-counter arch support may be sufficient. In more severe deformities an hinged or solid ankle brace may be necessary. Rehabilitative exercises under the supervision of a physical therapist will help increase the strength of the remaining muscles. Stiffness of certain tendons including the Achilles and hamstring is also very helpful as tightness in these structures is very common in people with ?fallen arches?. Postural training is necessary. A short period of casting or walking in a cast boot will improve swelling of a recent partial tear of the tendons and ligaments on the inside of the ankle. Nonsteroidal anti-inflammatory medications such as ibuprofen, and naprosyn can help to relieve the pain, but do not heal the injuries associated with this or decrease the swelling significantly. Surgical reconstruction is available if the pain cannot be controlled reasonably with these measures.
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss. Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
After Care
Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.
The term 'fallen arches' is rather a historical one, but is one many people seem to have heard of. What it essentially refers to is a ligament problem in the sole of his foot where these run along its length. In most people these ligaments provide support to the foot when walking and help keep the foot in a normal anatomical position. Some people however seem to have laxity in these ligaments so the foot becomes under undue strain and pain can occur as a result.
Causes
There are many reasons why flat feet develop. Here?s a look at some of the most common causes. Genetics, weak arches, injury, arthritis, diabetes, age, wear and tear on feet, tibialis posterior (ruptured tendon). Nervous system or muscle diseases such as cerebral palsy. Weakness and tightness of other muscles and tendons higher up in the lower extremity. The way our arches form depends on several factors. Our feet are complex structures that comprise twenty-six bones, thirty-three joints, and more than 100 muscles, tendons, and ligaments each. Each foot forms two arches. The arch that runs from the heel to the toe is known as the longitudinal arch, while the one that runs the width is known as the transverse arch. Ligaments (fibrous tissues) give our arches their shape and hold our bones together. The plantar fascia (the long, strong band of connective tissue that runs along the sole of your foot) and muscles add secondary support. There are also foot pads that absorb impact and assist with weight-bearing functions. How these things intertwine and work together determines the formation of our arches. A structural abnormality or injury to one of these components can result in flatfoot.
Symptoms
Knee/Hip/Back Pain - When the arch collapses in the foot, it triggers a series of compensations up the joint chain, leading to increased stress on the knee, pelvis and low back. Plantar fasciitis - This condition is characterized by heel pain, especially with the first few steps you take. The plantar fascia stretches as the arch falls, putting stress on the heel. Bunions - If you see a bony bump developing at the base of your big toe, you are likely developing a bunion. It may be swollen, red or painful when it rubs against your shoe. A flattened arch spreads the forefoot and causes the big toe to deviate toward the second toe. Shin splints - This term generally refers to pain anywhere along the shinbone. It is typically due to overuse and is aggravated after exercise and activity.
Diagnosis
Flat feet are easy to identify while standing or walking. When someone with flat feet stands, their inner foot or arch flattens and their foot may roll over to the inner side. This is known as overpronation. To see whether your foot overpronates, stand on tiptoes or push your big toe back as far as possible. If the arch of your foot doesn't appear, your foot is likely to overpronate when you walk or run. It can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.
Why do arches fall?
Non Surgical Treatment
Some of the aspects of the pain with a ?fallen arch? are related to the crushing of the joints of the outside of the foot and from the stretching of ligaments and tendons of the inside of the foot. Unfortunately, some parts of the damage from the fallen arch, the weakness in the tendons and the new shape of the foot, are not correctable without surgical reconstruction. The first goal is to stabilize the collapsed arch. This can be done through braces. If the deformity is mild, an over-the-counter arch support may be sufficient. In more severe deformities an hinged or solid ankle brace may be necessary. Rehabilitative exercises under the supervision of a physical therapist will help increase the strength of the remaining muscles. Stiffness of certain tendons including the Achilles and hamstring is also very helpful as tightness in these structures is very common in people with ?fallen arches?. Postural training is necessary. A short period of casting or walking in a cast boot will improve swelling of a recent partial tear of the tendons and ligaments on the inside of the ankle. Nonsteroidal anti-inflammatory medications such as ibuprofen, and naprosyn can help to relieve the pain, but do not heal the injuries associated with this or decrease the swelling significantly. Surgical reconstruction is available if the pain cannot be controlled reasonably with these measures.
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss. Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
After Care
Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.
True Leg Length Discrepancy Testing
Overview
Shortening techniques can be used after skeletal maturity to achieve leg length equality. Shortening can be done in the proximal femur using a blade plate or hip screw, in the mid-diaphysis of the femur using a closed intramedullary (IM) technique, or in the tibia. Shortening is an accurate technique and involves a much shorter convalescence than lengthening techniques. Quadriceps weakness may occur with femoral shortenings, especially if a mid-diaphyseal shortening of greater than 10% is done. If the femoral shortening is done proximally, no significant weakness should result. Tibial shortening can be done, but there may be a residual bulkiness to the leg, and risks of nonunion and compartment syndrome are higher. If a tibial shortening is done, shortening over an IM nail and prophylactic compartment release are recommended. We limit the use of shortenings to 4 to 5 cm leg length inequality in patients who are skeletally mature.
Causes
LLDs are very common. Sometimes the cause isn?t known. But the known causes of LLD in children include, injury or infection that slows growth of one leg bone. Injury to the growth plate (a soft part of a long bone that allows the bone to grow). Growth plate injury can slow bone growth in that leg. Fracture to a leg bone that causes overgrowth of the bone as it heals. A congenital (present at birth) problem (one whole side of the child?s body may be larger than the other side). Conditions that affect muscles and nerves, such as polio.
Symptoms
As patients develop LLD, they will naturally and even unknowingly attempt to compensate for the difference between their two legs by either bending the longer leg excessively or standing on the toes of the short leg. When walking, they are forced to step down on one side and thrust upwards on the other side, which leads to a gait pattern with an abnormal up and down motion. For many patients, especially adolescents, the appearance of their gait may be more personally troublesome than any symptoms that arise or any true functional deficiency. Over time, standing on one's toes can create a contracture at the ankle, in which the calf muscle becomes abnormally contracted, a condition that can help an LLD patient with walking, but may later require surgical repair. If substantial enough, LLD left untreated can contribute to other serious orthopaedic problems, such as degenerative arthritis, scoliosis, or lower back pain. However, with proper treatment, children with leg length discrepancy generally do quite well, without lingering functional or cosmetic deficiencies.
Diagnosis
A systematic and well organized approach should be used in the diagnosis of LLD to ensure all relevant factors are considered and no clues are overlooked which could explain the difference. To determine the asymmetry a patient should be evaluated whilst standing and walking. During the process special care should be used to note the extent of pelvic shift from side to side and deviation along the plane of the front or leading leg as well as the traverse deviation of the back leg and abnormal curvature of the spine. Dynamic gait analysis should be conducted during waling where observation of movement on the sagittal, frontal and transverse planes should be noted. Also observe head, neck and shoulder movements for any tilting.
Non Surgical Treatment
In order to measure for correction, use a series of blocks or sheets of firm material (cork or neoprene) of varying thickness, e.g., 1/8", 1/4", and 1/2". Place them under the short limb, either under the heel or the entire foot, depending on the pathology, until the patient feels most balanced. Usually you will not be able to correct for the full amount of the imbalance at the outset. The longer a patient has had the LLD, the less likely he or she will be able to tolerate a full correction immediately. This is a process of incremental improvements. 2 inch External Platform Lift Bear in mind that the initial lift may need to be augmented as the patient's musculoskeletal system begins to adjust. It is often recommended that the initial buildup should be 50 percent of the total. After a suitable break-in period, one month say, another 25 percent can be added. If warranted, the final 25 percent can be added a month later. Once you determine how much lift the patient can handle, you then need to decide how to best apply it. There are certain advantages and disadvantages to using either internal or external heel lifts.
can gym help in increasing height?
Surgical Treatment
Limb deformity or leg length problems can be treated by applying an external frame to the leg. The frame consists of metal rings which go round the limb. The rings are held onto the body by wires and metal pins which pass through the skin and are anchored into the bone. During this operation, the bone is divided. Gradual adjustment of the frame results in creation of a new bone allowing a limb to be lengthened. The procedure involves the child having an anaesthetic. The child is normally in hospital for one week. The child and family are encouraged to clean pin sites around the limb. The adjustments of the frame (distractions) are performed by the child and/or family. The child is normally encouraged to walk on the operated limb and to actively exercise the joints above and below the frame. The child is normally reviewed on a weekly basis in clinic to monitor the correction of the deformity. The frame normally remains in place for 3 months up to one year depending on the condition which is being treated. The frame is normally removed under a general anaesthetic at the end of treatment.
Shortening techniques can be used after skeletal maturity to achieve leg length equality. Shortening can be done in the proximal femur using a blade plate or hip screw, in the mid-diaphysis of the femur using a closed intramedullary (IM) technique, or in the tibia. Shortening is an accurate technique and involves a much shorter convalescence than lengthening techniques. Quadriceps weakness may occur with femoral shortenings, especially if a mid-diaphyseal shortening of greater than 10% is done. If the femoral shortening is done proximally, no significant weakness should result. Tibial shortening can be done, but there may be a residual bulkiness to the leg, and risks of nonunion and compartment syndrome are higher. If a tibial shortening is done, shortening over an IM nail and prophylactic compartment release are recommended. We limit the use of shortenings to 4 to 5 cm leg length inequality in patients who are skeletally mature.
Causes
LLDs are very common. Sometimes the cause isn?t known. But the known causes of LLD in children include, injury or infection that slows growth of one leg bone. Injury to the growth plate (a soft part of a long bone that allows the bone to grow). Growth plate injury can slow bone growth in that leg. Fracture to a leg bone that causes overgrowth of the bone as it heals. A congenital (present at birth) problem (one whole side of the child?s body may be larger than the other side). Conditions that affect muscles and nerves, such as polio.
Symptoms
As patients develop LLD, they will naturally and even unknowingly attempt to compensate for the difference between their two legs by either bending the longer leg excessively or standing on the toes of the short leg. When walking, they are forced to step down on one side and thrust upwards on the other side, which leads to a gait pattern with an abnormal up and down motion. For many patients, especially adolescents, the appearance of their gait may be more personally troublesome than any symptoms that arise or any true functional deficiency. Over time, standing on one's toes can create a contracture at the ankle, in which the calf muscle becomes abnormally contracted, a condition that can help an LLD patient with walking, but may later require surgical repair. If substantial enough, LLD left untreated can contribute to other serious orthopaedic problems, such as degenerative arthritis, scoliosis, or lower back pain. However, with proper treatment, children with leg length discrepancy generally do quite well, without lingering functional or cosmetic deficiencies.
Diagnosis
A systematic and well organized approach should be used in the diagnosis of LLD to ensure all relevant factors are considered and no clues are overlooked which could explain the difference. To determine the asymmetry a patient should be evaluated whilst standing and walking. During the process special care should be used to note the extent of pelvic shift from side to side and deviation along the plane of the front or leading leg as well as the traverse deviation of the back leg and abnormal curvature of the spine. Dynamic gait analysis should be conducted during waling where observation of movement on the sagittal, frontal and transverse planes should be noted. Also observe head, neck and shoulder movements for any tilting.
Non Surgical Treatment
In order to measure for correction, use a series of blocks or sheets of firm material (cork or neoprene) of varying thickness, e.g., 1/8", 1/4", and 1/2". Place them under the short limb, either under the heel or the entire foot, depending on the pathology, until the patient feels most balanced. Usually you will not be able to correct for the full amount of the imbalance at the outset. The longer a patient has had the LLD, the less likely he or she will be able to tolerate a full correction immediately. This is a process of incremental improvements. 2 inch External Platform Lift Bear in mind that the initial lift may need to be augmented as the patient's musculoskeletal system begins to adjust. It is often recommended that the initial buildup should be 50 percent of the total. After a suitable break-in period, one month say, another 25 percent can be added. If warranted, the final 25 percent can be added a month later. Once you determine how much lift the patient can handle, you then need to decide how to best apply it. There are certain advantages and disadvantages to using either internal or external heel lifts.
can gym help in increasing height?
Surgical Treatment
Limb deformity or leg length problems can be treated by applying an external frame to the leg. The frame consists of metal rings which go round the limb. The rings are held onto the body by wires and metal pins which pass through the skin and are anchored into the bone. During this operation, the bone is divided. Gradual adjustment of the frame results in creation of a new bone allowing a limb to be lengthened. The procedure involves the child having an anaesthetic. The child is normally in hospital for one week. The child and family are encouraged to clean pin sites around the limb. The adjustments of the frame (distractions) are performed by the child and/or family. The child is normally encouraged to walk on the operated limb and to actively exercise the joints above and below the frame. The child is normally reviewed on a weekly basis in clinic to monitor the correction of the deformity. The frame normally remains in place for 3 months up to one year depending on the condition which is being treated. The frame is normally removed under a general anaesthetic at the end of treatment.
Do You Really Understand Heel Ache?
Overview
One of the most common foot problems seen by physicians is heel pain. Heel pain that occurs in adult patients is most commonly caused by a condition known as plantar fasciitis. This condition is sometimes also known as a heel spur. Heel pain can also be caused by other factors, such as stress fracture, tendinitis, arthritis, nerve entrapment, cyst in the heel bone.
Causes
some heel pain can be caused by rheumatological diseases, and these pains can do a real good impersonation of plantar fasciitis symptoms. Seronegative Arthropathies such as Psoriatic Arthritis, Reactive Arthritis and Ankylosing Spondylisis are the most common types to cause heel pain by producing an inflammatory reaction where the fascia attaches to the heel. This is called an enthesitis. If you have a history of Psoriasis or a family history of other arthritic conditions listed above we recommend you see a clinician about your heel pain to confirm the diagnosis. Another occasional cause of heel pain is loss of the cushioning fat pad of the heel, which can result in a bruised heel bone (calcaneus). If you can easily feel your heel bone through your skin on the bottom of your foot you may well have poor fatty tissue on your heel. Pressing on the centre of your heel should feel like pushing into firm rubber, and your skin should not move easily. If you can pinch the skin under your heel and feel a very hard lump when you press the bottom of your heel then it is likely you have a heel fat pad problem. One simple final test is to walk on a hard floor. If you feel the pain only when your heel hits the ground a fat pad problem is most likely. If the pain mainly occurs as you lift the heel off the ground it is more likely to be plantar fasciitis.
Symptoms
Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.
Diagnosis
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
Non Surgical Treatment
Initial treatment should consist of an ice pack. Some runners prefer to use a wet towel that has been in the fridge. We recommend you use commercially available ice packs for focused pain released. An anti-inflammatory such as Ibuprofen will help to reduce the swelling. Please note this should be taken with meals and never before running. As with all soft tissue injuries, you may have to re-examine your training regime. A reduction or even a total break form running may be necessary. . Examine your running shoes, making sure the shoes do not bend excessively near the middle of the foot and at the ball of the foot. Sports shoes with built in insoles can be beneficial, however we recommend you replace existing insoles with specific sports orthotics/ insoles. Silicone heel cups, leather heel pads and contrasting cold and hot therapy can all help to speed up the healing process. The plantar fascia stretch will help to prevent the injury from occurring again. Please note that this stretch should not be done while the heel is inflamed and should only be attempted once you?re a feeling minimal or no pain from your heel.
Surgical Treatment
Only a relatively few cases of heel pain require surgery. If required, surgery is usually for the removal of a spur, but also may involve release of the plantar fascia, removal of a bursa, or a removal of a neuroma or other soft-tissue growth.
Why do I have pain in my heel?
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.
One of the most common foot problems seen by physicians is heel pain. Heel pain that occurs in adult patients is most commonly caused by a condition known as plantar fasciitis. This condition is sometimes also known as a heel spur. Heel pain can also be caused by other factors, such as stress fracture, tendinitis, arthritis, nerve entrapment, cyst in the heel bone.
Causes
some heel pain can be caused by rheumatological diseases, and these pains can do a real good impersonation of plantar fasciitis symptoms. Seronegative Arthropathies such as Psoriatic Arthritis, Reactive Arthritis and Ankylosing Spondylisis are the most common types to cause heel pain by producing an inflammatory reaction where the fascia attaches to the heel. This is called an enthesitis. If you have a history of Psoriasis or a family history of other arthritic conditions listed above we recommend you see a clinician about your heel pain to confirm the diagnosis. Another occasional cause of heel pain is loss of the cushioning fat pad of the heel, which can result in a bruised heel bone (calcaneus). If you can easily feel your heel bone through your skin on the bottom of your foot you may well have poor fatty tissue on your heel. Pressing on the centre of your heel should feel like pushing into firm rubber, and your skin should not move easily. If you can pinch the skin under your heel and feel a very hard lump when you press the bottom of your heel then it is likely you have a heel fat pad problem. One simple final test is to walk on a hard floor. If you feel the pain only when your heel hits the ground a fat pad problem is most likely. If the pain mainly occurs as you lift the heel off the ground it is more likely to be plantar fasciitis.
Symptoms
Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.
Diagnosis
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
Non Surgical Treatment
Initial treatment should consist of an ice pack. Some runners prefer to use a wet towel that has been in the fridge. We recommend you use commercially available ice packs for focused pain released. An anti-inflammatory such as Ibuprofen will help to reduce the swelling. Please note this should be taken with meals and never before running. As with all soft tissue injuries, you may have to re-examine your training regime. A reduction or even a total break form running may be necessary. . Examine your running shoes, making sure the shoes do not bend excessively near the middle of the foot and at the ball of the foot. Sports shoes with built in insoles can be beneficial, however we recommend you replace existing insoles with specific sports orthotics/ insoles. Silicone heel cups, leather heel pads and contrasting cold and hot therapy can all help to speed up the healing process. The plantar fascia stretch will help to prevent the injury from occurring again. Please note that this stretch should not be done while the heel is inflamed and should only be attempted once you?re a feeling minimal or no pain from your heel.
Surgical Treatment
Only a relatively few cases of heel pain require surgery. If required, surgery is usually for the removal of a spur, but also may involve release of the plantar fascia, removal of a bursa, or a removal of a neuroma or other soft-tissue growth.
Why do I have pain in my heel?
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.
Mortons Neuroma Solutions
Overview
A morton's neuroma (or an "inter-digital" neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.
Causes
Morton's neuroma is an inflammation caused by a buildup of fibrous tissue on the outer coating of nerves. This fibrous buildup is a reaction to the irritation resulting from nearby bones and ligaments rubbing against the nerves. Irritation can be caused by wearing shoes that are too tight, wearing shoes that place the foot in an awkward position, such as high heels, a foot that is mechanically unstable, repetitive trauma to the foot such as from sports activities like tennis, basketball, and running. Trauma to the foot caused by an injury such as a sprain or fracture. It is unusual for more than one Morton's neuroma to occur on one foot at the same time. It is rare for Morton's neuroma to occur on both feet at the same time.
Symptoms
Feelings of numbness, tingling or tenderness in the ball of the foot (the area just behind the base of the toes) are some of the first signs of a condition known as Morton?s Neuroma. However, the condition is somewhat unpredictable, and symptoms may vary from patient to patient. Generally, however, the discomfort gets worse rather than better, and the patient may feel pain or a burning sensation that radiates out to the toes. Eventually, wearing shoes becomes uncomfortable (or even unbearable), and the patient may complain that the feeling is similar to that of having a stone bruise, or walking on a marble or pebble constantly, even though no there is no trauma to the skin, and no visible bump or lump on the sole of the foot.
Diagnosis
Podiatrists conduct a physical examination and may order imaging tests, such as x-ray or MRI scan to diagnose Morton's neuroma. Conservative treatment options include custom-fitted orthotics, medication, and/or alcohol injections designed to harden the nerve. However, most patients with Morton's neuroma need minor surgery.
Non Surgical Treatment
The first step in treating Morton's Neuroma is to select proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating and relieving the pain. The next step in treatment is to use an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure, and relieve the pain caused by the neuroma.
If problem persists, consult your foot doctor.
Surgical Treatment
If conservative treatments haven't helped, your doctor might suggest injections. Some people are helped by the injection of steroids into the painful area. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.
A morton's neuroma (or an "inter-digital" neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.Causes
Morton's neuroma is an inflammation caused by a buildup of fibrous tissue on the outer coating of nerves. This fibrous buildup is a reaction to the irritation resulting from nearby bones and ligaments rubbing against the nerves. Irritation can be caused by wearing shoes that are too tight, wearing shoes that place the foot in an awkward position, such as high heels, a foot that is mechanically unstable, repetitive trauma to the foot such as from sports activities like tennis, basketball, and running. Trauma to the foot caused by an injury such as a sprain or fracture. It is unusual for more than one Morton's neuroma to occur on one foot at the same time. It is rare for Morton's neuroma to occur on both feet at the same time.
Symptoms
Feelings of numbness, tingling or tenderness in the ball of the foot (the area just behind the base of the toes) are some of the first signs of a condition known as Morton?s Neuroma. However, the condition is somewhat unpredictable, and symptoms may vary from patient to patient. Generally, however, the discomfort gets worse rather than better, and the patient may feel pain or a burning sensation that radiates out to the toes. Eventually, wearing shoes becomes uncomfortable (or even unbearable), and the patient may complain that the feeling is similar to that of having a stone bruise, or walking on a marble or pebble constantly, even though no there is no trauma to the skin, and no visible bump or lump on the sole of the foot.
Diagnosis
Podiatrists conduct a physical examination and may order imaging tests, such as x-ray or MRI scan to diagnose Morton's neuroma. Conservative treatment options include custom-fitted orthotics, medication, and/or alcohol injections designed to harden the nerve. However, most patients with Morton's neuroma need minor surgery.
Non Surgical Treatment
The first step in treating Morton's Neuroma is to select proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating and relieving the pain. The next step in treatment is to use an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure, and relieve the pain caused by the neuroma.
If problem persists, consult your foot doctor.
Surgical Treatment
If conservative treatments haven't helped, your doctor might suggest injections. Some people are helped by the injection of steroids into the painful area. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.
For Leg Length Difference Chiropodists Prefer Shoe Lifts
There are actually not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital means that you are born with it. One leg is structurally shorter in comparison to the other. Through developmental phases of aging, the brain picks up on the walking pattern and recognizes some difference. Your body usually adapts by dipping one shoulder to the "short" side. A difference of less than a quarter inch is not really excessive, does not need Shoe Lifts to compensate and ordinarily does not have a profound effect over a lifetime.
Leg length inequality goes largely undiscovered on a daily basis, however this condition is simply corrected, and can eliminate many incidents of back discomfort.
Treatment for leg length inequality typically involves Shoe Lifts. Many are low cost, often costing less than twenty dollars, compared to a custom orthotic of $200 or maybe more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.
Low back pain is the most prevalent health problem impacting men and women today. Over 80 million people are afflicted by back pain at some point in their life. It's a problem which costs companies vast amounts of money annually due to time lost and production. Innovative and superior treatment methods are continually sought after in the hope of minimizing the economical influence this condition causes.
Men and women from all corners of the earth suffer from foot ache as a result of leg length discrepancy. In a lot of these cases Shoe Lifts can be of immense help. The lifts are capable of eliminating any discomfort and pain in the feet. Shoe Lifts are recommended by numerous certified orthopaedic doctors.
So that you can support the human body in a nicely balanced fashion, your feet have a very important function to play. Irrespective of that, it's often the most overlooked area of the human body. Some people have flat-feet meaning there is unequal force placed on the feet. This will cause other parts of the body such as knees, ankles and backs to be impacted too. Shoe Lifts guarantee that the right posture and balance are restored.
Leg length inequality goes largely undiscovered on a daily basis, however this condition is simply corrected, and can eliminate many incidents of back discomfort.
Treatment for leg length inequality typically involves Shoe Lifts. Many are low cost, often costing less than twenty dollars, compared to a custom orthotic of $200 or maybe more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.
Low back pain is the most prevalent health problem impacting men and women today. Over 80 million people are afflicted by back pain at some point in their life. It's a problem which costs companies vast amounts of money annually due to time lost and production. Innovative and superior treatment methods are continually sought after in the hope of minimizing the economical influence this condition causes.
Men and women from all corners of the earth suffer from foot ache as a result of leg length discrepancy. In a lot of these cases Shoe Lifts can be of immense help. The lifts are capable of eliminating any discomfort and pain in the feet. Shoe Lifts are recommended by numerous certified orthopaedic doctors.
So that you can support the human body in a nicely balanced fashion, your feet have a very important function to play. Irrespective of that, it's often the most overlooked area of the human body. Some people have flat-feet meaning there is unequal force placed on the feet. This will cause other parts of the body such as knees, ankles and backs to be impacted too. Shoe Lifts guarantee that the right posture and balance are restored.
Caring For Inferior Calcaneal Spur
Overview
Although a heel spur is often thought to be the source of heel pain, it rarely is. When a patient has plantar fasciitis, the plantar fascia pulls on the bottom of the heel bone. Over time this can cause a spur to form. Heels spurs are a very common x-ray finding, and because the heel spur is buried deep in soft tissue and not truly in a weight bearing area, there is often no history of pain. It is important to note that less than one percent of all heel pain is due to a spur. but frequently caused by the plantar fascia pulling on the heel. Once the plantar fasciitis is properly treated, the heel spur could be a distant memory.
Causes
A heel spur is caused by chronic plantar fasciitis. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis. When plantar fasciitis healing is delayed or injury persists, your body repairs the weak and injured soft tissue with bone. Usually your injured fascia will be healed via fibroblastic activity. They'll operate for at least six weeks. If your injury persists beyond this time, osteoblasts are recruited to the area. Osteoblasts form bone and the end result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs. This scenario is most common in the traction type injury. The additional bone growth is known as a heel spur or calcaneal spur.
Symptoms
Heel spurs are most noticeable in the morning when stepping out of bed. It can be described as sharp isolated pain directly below the heel. If left untreated heel spurs can grow and become problematic long-term.
Diagnosis
The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
The most important part of treatment is to rest. Do not undertake activities which hurt the foot or aggravate symptoms as will only cause painful symptoms to persist. Apply an ice pack regularly for 10 minutes at a time every hour initially to reduce pain and inflammation of the surrounding tissues. As symptoms subside frequency of application can reduce to 2 or 3 times per day. Exercises and stretches to keep the foot and ankle strong and mobile are important as long as pain allows. Stretching the plantar fascia is important, especially if symptoms are worse in the morning. A plantar fasciitis night splint is excellent for stretching and preventing the plantar fascia tightening up over night. Anti-Inflammatory medicine (e.g. ibuprofen) may be prescribed by a doctor but always check with a medical professional first as taking some medications such as ibuprofen should not be done if the patient has asthma. Shoe inserts can help to take the pressure off of the spur and reduce pain. If these treatments do not significantly ease the symptoms then surgery may be an option.
Surgical Treatment
Most studies indicate that 95% of those afflicted with heel spurs are able to relieve their heel pain with nonsurgical treatments. If you are one of the few people whose symptoms don?t improve with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament. Sometimes the bone spur is also removed, if there is a large spur (remember that the bone spur is rarely a cause of pain. Overall, the success rate of surgical release is 70 to 90 percent in patients with heel spurs. One should always be sure to understand all the risks associated with any surgery they are considering.
Prevention
To prevent this condition, wearing properly fitted shoes with good arch support is very important. If a person is overweight, weight loss can help diminish stress on the feet and help prevent foot problems. For those who exercise frequently and intensely, proper stretching is always necessary, especially when there is an increase in activities or a change in running technique. It is not recommended to attempt to work through the pain, as this can change a mild case of heel spurs and plantar fascitis into a long-lasting and painful episode of the condition.
Identifying Inferior Calcaneal Spur
Overview
Heel spur is a thorn-like, bony protrusion of the heel bone, which can become inflamed through irritation, thus causing pain. A heel spur forms at the tendon attachments on the muscles of the heel bone as a result of micro-injuries to the tissue caused by overstraining. As part of the healing process for these micro-injuries, the body stores bone material in the tendon attachments as a repair mechanism. Heel spurs can develop over a very long period without causing major complaints. However, irritation of the area surrounding the ossified tendon attachment can cause inflammations. Left untreated, the inflammations can in turn lead to increased ossification and thus to permanent degradation with a risk of chronic manifestation. The normal rolling procedure that we all use when walking is then frequently no longer possible.
Causes
An individual with the lower legs angulating inward, a condition called genu valgum or "knock knees," can have a tendency toward excessive pronation. As a result, this too can lead to a fallen arch resulting in plantar fascitis and heel spurs. Women tend to have more genu valgum than men do. Heel spurs can also result from an abnormally high arch. Other factors leading to heel spurs include a sudden increase in daily activities, an increase in weight, or a change of shoes. Dramatic increase in training intensity or duration may cause plantar fascitis. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia and possibly lead to heel spurs.
Symptoms
An individual with the lower legs turning inward, a condition called genu valgus or "knock knees," can have a tendency toward excessive pronation. This can lead to a fallen arch and problems with the plantar fascia and heel spurs. Women tend to suffer from this condition more than men. Heel spurs can also result from an abnormally high arch. Other factors leading to heel spurs include a sudden increase in daily activities, an increase in weight, or a thinner cushion on the bottom of the heel due to old age. A significant increase in training intensity or duration may cause inflammation of the plantar fascia. High-heeled shoes, improperly fitted shoes, and shoes that are too flexible in the middle of the arch or bend before the toe joints will cause problems with the plantar fascia and possibly lead to heel spurs.
Diagnosis
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
Some heel spurs do require surgery, however surgery is a last resort. In most cases the patients underlying foot problem needs to be addressed, such as Over Pronation and Over Supination and Heel Pain Treatment Options need to be implemented if Plantar Fasciitis and Achilles Tendonitis are still an ongoing concern. Your best treatment is always prevention.
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.
