Mortons Neuroma Remedies

Overview

The nerves located on the bottom of the foot between the metatarsal heads (the bone of the toe closest to the foot) supply feeling, or sensation, to the toes. One of these nerves may become irritated by the ligament located above it, causing it to become thickened and painful. Generally this problem occurs most often between the third and fourth toes, but it can occur between the second and third toes as well. It is uncommon for a neuroma to be located between the first and second or fourth and fifth metatarsals. Rarely is there more than one neuroma in a foot.

Causes

The exact cause of Morton?s neuroma is not known, but the choice of footwear seems be a factor. Wearing high heels (shoes with heels over 2 inches) can put extra pressure on the balls of the feet. Wearing tight or pointed toed shoes may squeeze the toes together or otherwise constrict their movement. For that reason, women are about 8 to 10 times more likely to develop Morton?s neuroma compared with men. People who are born with flat feet, high arches, or an abnormal position of the toes are more prone to developing Morton?s neuroma. This may be due to instability around the toe joints. Certain conditions that develop over time, such as bunions or hammer toes, are also associated with Morton?s neuroma. Some sports that involve running, including tennis and other racquet sports, can also increase the chance of developing Morton?s neuroma due to trauma or injury to the foot.

Symptoms

There may be pain at the end of the push-off phase when walking or running, and this pain is generally worse when the client is wearing shoes as opposed to being barefoot. Clients may also report a relief of symptoms by massaging the foot, which may spread the metatarsal heads and mobilize the entrapped nerve.

Diagnosis

If you suspect Morton?s Neuroma, it is essential that you confirm your suspicions by consulting with a podiatric physician. Don?t wait for the symptoms to go away for good (even if they tend to come and go). Also, remember that many conditions have similar symptoms, and only a professional can tell the difference.

Non Surgical Treatment

If your Morton’s neuroma is painful, your doctor usually will begin treatment with conservative therapies, including a switch to shoes with low heels, wide toes and good arch support. Padding techniques, including metatarsal pads or toe crest pads. Shoe inserts (orthotics) to help correct any mechanical imbalance in the foot. Anti-inflammatory medication, such as ibuprofen (Advil, Motrin and other brand names) or naproxen (Aleve, Naprosyn and other brand names) A local injection of anesthetic and corticosteroid medication into the affected area. Inflamed or injured nerves can take months to improve, even after the underlying problem has been corrected.interdigital neuroma

Surgical Treatment

Interdigital neurectomy (removal of the diseased nerve) in right hands, should give satisfactory results almost all the time. Some of the reasons behind failure is when not enough nerve is dissected, mistakes in initial diagnosis, or bad handling of adjacent nerves, tendons and joint capsules during the operation. It is very common and acceptable to have some numbness in the area where the nerve used to be. This never causes any discomfort and often gets better in few years. It is crucial to address the biomechanical pathologies underlying the impingement of the nerve during and after the surgery.

What Is A Posterior Calcaneal Spur

Posterior Calcaneal Spur

Overview

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Causes

A heel spur usually develops as a result of wear and tear over time, which leads to the degeneration of connective tissue called fascia. Standing for prolonged periods and wearing shoes that do not provide the right type of arch support can also lead to connective tissue damage in the heel. The body attempts to repair the damaged tissue by delivering calcium to the affected region, but sometimes too much calcium begins to accumulate and this results in painful plantar fasciitis.

Inferior Calcaneal Spur

Symptoms

You’ll typically first notice early heel spur pain under your heel in the morning or after resting. Your heel pain will be worse with the first steps and improves with activity as it warms up. When you palpate the tender area you may feel a tender bony lump. As your plantar fasciitis deteriorates and your heel spur grows, the pain will be present more often.

Diagnosis

A Diagnosis of Heel Spur Syndrome is a very common reason for having heel pain. Heel pain may be due to other types of conditions such as tendonitis, Haglund’s Deformity, Stress Fracture, Tarsal Tunnel Syndrome, or low back problems. A more common condition in children is Sever’s Disease. The diagnosis is usually made with a combination of x-ray examination and symptoms.

Non Surgical Treatment

Heel pain may be associated with a heel spur, however the heel pain is usually due to plantar fasciitis, rather than a heel spur, so treatment is usually directed at the plantar fasciitis itself. Treatment usually involves application of ice to reduce pain and inflammation, special stretching exercises, and pain-relieving or anti-inflammatory medicines. Night splints or orthotics may be recommended. It may help to avoid the activities that aggravate pain, such as long walks and running. Surgery is very rarely recommended and only after other measures fail.

Surgical Treatment

More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it’s important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

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.

How You Can Treat Calcaneal Spur

Posterior Calcaneal Spur

Overview

A heel spur is a hook of bone that can form on the heel bone of the foot. Heel spurs are associated with plantar fasciitis. Heel spurs can cause extreme pain in the rearfoot. The pain is most intense while standing or walking. What Causes Heel Spurs? Heel spurs develop as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia stretches and pulls away from the heel. The plantar fascia is a ligament located at the bottom of your foot. This stretching of the plantar fascia is usually the result of flat feet or unusually high arches.

Causes

The main cause of heel spur is calcium deposit under the heel bone. Building of calcium deposits can take place over several months. Heel spurs happens because of stress on the foot ligaments and muscles and continuous tearing of the membrane covering the heel bone. It also happens due to continuous stretching the plantar fascia. Heel spurs are mostly seen in case of athletes who has to do lots of jumping and running. The risk factors that may lead to heel spurs include aormalities in walking which place too much stress on the heel bone, nerves in the heel and ligaments. Poorly fitted shoes without the right arch support. Jogging and running on hard surfaces. Excess weight. Older age. Diabetes. Standing for a longer duration.

Posterior 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

Sharp pain localized to the heel may be all a doctor needs to understand in order to diagnose the presence of heel spurs. However, you may also be sent to a radiologist for X-rays to confirm the presence of heel spurs.

Non Surgical Treatment

There are many temporary solutions to resolve the pain associated with irritation to the plantar ligaments. Common recommendations are ice and anti-inflammatory medications or even cortisone injections, however none of these solve the fundamental problem. To permanently resolve heel spurs you need to support and restrict the movement of the plantar ligaments. Flexible shoes will aggravate and often contribute to heel spurs. We recommend a RIGID orthotic that extends from the metatarsal heads to the heel to resolve heel spurs.

Surgical Treatment

More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it’s important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

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.

Bursitis Foot Symptoms

Overview

Bursitis is the inflammation of the small fluid-filled pads, or bursae, that act as cushions among your bones and the tendons and muscles near your joints. Bursitis occurs when the bursa become inflamed, and often occurs in joints that perform frequent and repetitive motion. The foot only contains one naturally occurring bursal sac between the Achilles tendon and the heel bone, which protects the Achilles from the pressure against the heel bone during ambulation. However, shoes may put pressure on this bursa. The bursa might also incur trauma from walking on hard ground. And, though they are not naturally occurring, bursa sacs can also form, and become inflamed, in other parts of the foot, including the bottom of the heel, and the metatarsal plate, the outside of the foot below the fifth toe, and so on.

Causes

Although rare, bursitis also may be caused by an infection, known as septic bursitis. This is a serious medical condition that requires antibiotics to treat the infection and prevent its spread to other points in the body or the bloodstream. Septic bursitis may cause the back of the ankle to become red or hot. The person may also get the chills or fever and may feel sick and tired. Typically this type of bursitis would be suspected if there has been any history of an open wound in the area, such as a blister.

Symptoms

Medical experts strongly recommend that you consult a doctor if you have any of the symptoms below. Disabling joint pain that prevents you from doing your daily activities. Pain that lasts for more than two weeks. Excessive swelling, redness, bruising or a rash around the painful joint. Sharp or shooting pain, especially when you exercise or do something more strenuous. A fever. Any of the above could be a sign of infection, a condition such as arthritis or a more serious injury such as a tendon tear that may require medical attention.

Diagnosis

A physical examination will be performed to determine if you have any signs of Achilles Bursitis or other ankle injury. He/she will look and feel the soft tissue and bones in your ankles to note any differences between the two of them. This will identify any abnormalities, such as swelling, bone deformities, atrophied muscles, redness and/or warmth on the skin. In many cases, the first sign that you have Achilles bursitis is swelling in the back of the foot and ankle pain.

Non Surgical Treatment

Rest, ice, and anti-inflammatory medication will help with pain and swelling. Physical therapy can help stretch the Achilles to relieve any impingement. Also, a switch to properly-fitting shoes will help to prevent the condition from worsening or recurring. You might also find relief with shoe inserts such as heel cups or padding. If you have tried these measures, yet symptoms remain severe and continue to progress, surgical intervention is a possibility. Calcaneal bursitis surgery consists of excision or removal of the inflamed tissues and resection of the boney prominence. Debridement of the affected area near the Achilles may also be performed, as well as repair of the Achilles if the condition has gone so far that the tendon ruptures.

Surgical Treatment

Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.

Treating Hammertoe Pain

HammertoeOverview

A hammertoe is a toe that is bent because of a weakened muscle. The weakened muscle makes the tendons (tissues that connect muscles to bone) shorter, causing the toes to curl under the feet. Hammertoes can run in families. They can also be caused by shoes that are too short. Hammertoes can cause problems with walking and can lead to other foot problems, such as blisters, calluses, and sores. Splinting and corrective footwear can help in treating hammertoes. In severe cases, surgery to straighten the toe may be necessary.

Causes

Hammer toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. This results in the joint curling downward. Arthritis can also lead to many different forefoot deformities, including hammer toes.

HammertoeSymptoms

The symptoms of a hammer toe include the following. Pain at the top of the bent toe upon pressure from footwear. Formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.

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

In the early stages, the deformities from mallet toe, claw toe and hammertoe can be corrected. But if treatment is delayed too long, permanent stiffness can ensue which can only be corrected by surgery. The most effective treatment options are good fitting footwear. Shoes with a wide toebox will be more comfortable and will reduce the tension on the muscles and friction on the toes. Avoid high heels as they push your feet forwards to the front of the shoes. This increases the pressure on the toes, forcing them to bend more than usual. Shoes should ideally be half an inch longer than your longest toe. Exercises to strengthen and stretch the muscles can be really helpful. Simple things like trying to pick marbles up with your feet or scrunching up a towel underneath your foot can work well.

Surgical Treatment

Bone-mending procedures realign the contracted toe by removing the entire deviated small joints of the toe (again, not at the ball of the foot). This allows for the buckled joint to be positioned flat and the bone ends to mend together. Often surgical hardware (fixation) is necessary to keep the bones hammertoe steady during healing. Hardware options can involve a buried implant inside the toe, or a temporary wire that is removed at a later date. Medical terminology for this procedure is called a proximal interphalangeal joint arthrodesis (fusion), or a distal interphalangeal joint arthrodesis (fusion), with the former being performed in a high majority of cases.

Hammertoe Repair Implant

HammertoeOverview

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with changes in shoe styles and foot care products. But if left untreated, hammertoes can become more rigid and painful. Corns are more likely to develop hammertoe as time goes on-and corns never really go away, even after trimming. In more severe cases of Hammer toes, corn lesions may evolve into severe ulcerations. These lesions frequently occur in patients who have vascular disease or are Diabetic with neuropathy. The ulcerations can extend to the bone and result in infection and possible loss of digit or amputation.

Causes

Shoes that narrow toward the toe may make your forefoot look smaller. But they also push the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles become unable to straighten the toe, even when there is no confining shoe.

Hammer ToeSymptoms

The symptoms of hammertoe are progressive, meaning that they get worse over time. Hammertoe causes the middle joint on the second, third, fourth, or fifth toes to bend. The affected toe may be painful or irritated, especially when you wear shoes. Areas of thickened skin (corns) may develop between, on top of, or at the end of your toes. Thickened skin (calluses) may also appear on the bottom of your toe or the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear.

Diagnosis

Hammer toes may be easily detected through observation. The malformation of the person’s toes begin as mild distortions, yet may worsen over time – especially if the factors causing the hammer toes are not eased or removed. If the condition is paid attention to early enough, the person’s toes may not be permanently damaged and may be treated without having to receive surgical intervention. If the person’s toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.

Non Surgical Treatment

Try to find shoes that are soft, roomy, and comfortable and avoid tight shoes or shoes with high heels. A shoe repair shop may be able to stretch a small pocket in regular shoes to make room for the hammertoe. Have a professional pedicure. Sometimes a skilled manicurist can file down a painful corn. Follow your healthcare provider’s instructions. Ask your provider what activities you should avoid and when you can return to your normal activities, how to take care of yourself at home, what symptoms or problems you should watch for and what to do if you have them. Make sure you know when you should come back for a checkup.

Surgical Treatment

If you are unable to flex your toe, surgery is the only option to restore movement. Surgery is used to reposition the toe, remove deformed or injured bone, and realign your tendons. Surgery is normally done on an outpatient basis, so you can return home on the day of your surgery.

HammertoePrevention

Preventative treatment of hammertoe is directed toward the cause of the deformity. A functional orthotic is a special insert that can be prescribed by your podiatrist to address the abnormal functioning of the foot that causes the hammertoe. Functional orthotics can be thought of as contact lenses for your feet. They correct a number of foot problems that are caused by an abnormally functioning foot. Our feet, much like our eyes, change with time. Functional orthotics slow down or halt this gradual change in the foot. Often when orthotics are used for flexible hammertoes, the toes will overtime straighten out and correct themselves. Calf stretching exercises are also helpful. Calf stretching can help to overcome part of the muscle imbalance that causes the hammertoe.

Everything You Need To Find Out Regarding Bunions

Overview
Bunions Callous
Bunions (hallux valgus) are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion’s “bump.” Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Bunions can be painful, but not always. Bunions are always progressive, so the deformity becomes more prounced over time, even if its not painful.

Causes
Inflammatory joint diseases. Those who suffer from rheumatoid and psoriatic arthritis are at risk for bunions, although many times, those who suffer from bunions will mistakenly attribute the soreness in their feet to arthritis. Genetic and neuromuscular factors. Individuals with Down?s Syndrome are believed to be more prone to developing bunions; therefore, the gait and feet of such patients should be examined carefully and regularly so that any problems can be caught and treated early. Similarly, individuals of any age who have been diagnosed with Ehlers-Danlos or Marfan?s Syndrome, have also been shown to have a higher than average occurrence of bunions. Limb inequality. Individuals who have legs of unequal length often suffer from bunions on the longer limb due to the irregular mechanics of their walking or running gait.
SymptomsThe most obvious symptoms of a bunion are. Pain in the area of the MTP joint, the joint where your big toe connects to your foot. Bending of the big toe in towards the other toes. An enlarged bump of bone or tissue at the MTP joint. Each symptom can range in degree from small to severe. Sometimes the pain can be sufficient to make it difficult to walk in normal shoes. Other symptoms may include. Swelling and inflammation of the skin around the MTP joint. Thickening of the skin in the area of the joint. Restricted motion in your big toe. Pressure from the inward bending of your big toe can affect your other toes, leading to corns on your smaller toes. Ingrown toenails on the smaller toes. Development of hammertoes in the other toes. Calluses on the bottom of your foot. If you have any of these symptoms, especially pain, displacement of your big toe or development of a bulge, you should consider consulting your physician. Even if you’re not significantly bothered by some of these symptoms, bunions tend to continue getting bigger and more serious over time and should be taken care of before they do so.

Diagnosis
Diagnosis begins with a careful history and physical examination by your doctor. This will usually include a discussion about shoe wear and the importance of shoes in the development and treatment of the condition. X-rays will probably be suggested. This allows your doctor to measure several important angles made by the bones of the feet to help determine the appropriate treatment.

Non Surgical Treatment
The initial treatment of a bunion should be non-operative. Symptoms can often be greatly improved with simple non-operative interventions. Non-operative treatment may include properly fitted shoes, Properly fitting comfort shoes with a wide non-constrictive toe box, especially one that is made out of a soft material such as leather, can be quite helpful in reducing the irritation over the prominent bunion. In some instances, it is helpful to have a shoemaker stretch the inside aspect of the shoe. Jamming a foot with a bunion into a constrictive shoe will likely lead to the development of uncomfortable symptoms. Bunion pads, Medial bunion pads may also be helpful in decreasing the symptoms associated with the bunion. These pads can be obtained at many drugstores. Essentially, they serve to lessen the irritation over the medial prominence and, thereby, decrease the associated inflammation This should be combined with comfortable non-constrictive shoes. A toe spacer placed between the great toe and the second toe can help to reduce the bunion deformity and, thereby, decrease the stretch on the medial tissue and the irritation associated with the bunion. Toe spacers can be obtained at most drug stores or online. Soft shoe inserts. Over-the-counter accommodative orthotics may also help bunion symptoms. This product is particularly helpful if bunion symptoms include pain that is under the ball of the foot. Orthotics with a slight medial longitudinal arch may be helpful for patients that have associated flatfoot deformity. These can be purchased at many sports stores, outdoors stores, or pharmacies. Bunion splints have often been used to treat the symptoms associated with hallux valgus. These splints are typically worn at night in an effort to reduce the bunion deformity. There is no evidence to suggest that these splints decrease the rate at which bunion deformities occur. There is also no evidence that clearly supports their effectiveness. However, some patients report good relief with the use of these splints.
Bunions Hard Skin

Surgical Treatment
Bunion surgery can be performed under local or general anaesthetic. The operation usually takes between half an hour to an hour. There are several types of bunionectomies. Some involve removal and realignment of the bones in your foot. Mild bunion problems can sometimes be resolved using soft tissue release or tightening. For some very severe cases bones of the big toe are fused or the bunion is cut out along with some of the bone at the base of the toe. Be sure and discuss which type of operation you will have with your surgeon. With any type of bunionectomy your surgeon will make one or more incisions (cuts) near your big toe. They will use instruments to trim the bones and remove the bunion. Wire, screws or plates may also be used to hold the new joint in place.

The Facts Related To Over-Pronation

Overview

Pronation is the natural motion of the foot as it roles inward after the foot makes contact with the ground. It gives the foot the opportunity to act as a shock absorber for the body and adapt to the contour of the ground. Too much pronation will cause the arch of the foot to flatten excessively placing stress and pressure on tissues and ligaments of the foot. Over pronation can lead to numerous foot problems including plantar fasciitis, ankle pain, shin pain, knee pain, bunions, mortons neuroma, chondromalcia patallae and lower back pain.Foot Pronation

Causes

Pronation can occur as an overuse syndrome in active runners, where a great deal of stress is placed on ligaments and tendons that support the medial column. Obesity is another predictor for pronation and deterioration of the medial ligaments and posterior tibial tendon due to excessive stress on these tissues. Acute Trauma can also lead to over-pronation when ligaments are torn or tendon is ruptured. Once again this can lead to a collapse of the medial column. Arthritic conditions involving the knee joint when the joint is in varus (inner collapse) posture, this places the center of gravity over the ankle joint rather than the foot causing undue pressure on the inner ankle.

Symptoms

Over-pronation is a condition where the arch flattens out which makes the feet roll inward while walking. This condition is also known as flat feet. It imposes extreme additional stresses on the plantar fascia, a fibrous band of tissue which connects the heel to the forefoot. Over-pronation makes walking a painful experience because of the additional strain on the calves, heel and/or back. Treatment for over-pronation involves the use of specially-made orthotics which offers arch support and medial rear foot posting as corrective measures.

Diagnosis

One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).Overpronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems.

Prevention

Strengthen the glutes to slow down the force of the foot moving too far inward. Most individuals who over-pronate have weak glute muscles and strengthening this area is a must. A simple exercise to strengthen glutes is lateral tube walking across a field/court/room. Place a lateral stretch band around your ankles and move your leg sideways while keeping your feet forward.

Treating Severs Disease

Overview

Pain in the heel of a child’s foot, typically brought on by some form of injury or trauma, is sometimes Sever’s Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon may contribute to Sever’s Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger children and is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats are also known to aggravate the condition. Treatment includes calf muscle stretching exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.

Causes

Sever?s disease is an osteochondrosis caused by overloading the insertion of the Achilles tendon onto the calcaneus and the apophyseal growth plate in this area. This C-shaped growth zone can become inflamed secondary to repetitive traction stress of the Achilles tendon. Calcaneal apophysitis is a common injury in young athletes and is believed to be caused by running and jumping. Active Children and adolescents (usual age of occurrence 7 to 15 years), particularly during the pubertal growth spurt or at the beginning of a sport season (e.g. gymnasts, basketball and football players), often suffer from this condition. This disease occurs most commonly during the early part of the growth spurt. A boy-to-girl ratio is 2-3:1. None of these causative factors has been tested prospectively and, where tested, none of the measurements has been carried out systematically, and reliability or validity of the measurements has not been considered.

Symptoms

Patients with Severs disease typically experience pain that develops gradually in the back of the heel or Achilles region. In less severe cases, patients may only experience an ache or stiffness in the heel that increases with rest (especially at night or first thing in the morning). This typically occurs following activities which require strong or repetitive contraction of the calf muscles, such as running (especially uphill) or during sports involving running, jumping or hopping. The pain associated with this condition may also warm up with activity in the initial stages of the condition. As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Pain may also increase when performing a calf stretch or heel raise (i.e. rising up onto tip toes). In severe cases, patients may walk with a limp, have difficulty putting their heel down, or be unable to weight bear on the affected leg. Pain may also increase on firmly touching the affected region and occasionally a bony lump may be palpable or visible at the back of the heel. This condition typically presents gradually overtime and can affect either one or both lower limbs.

Diagnosis

Sever?s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order x-rays or an MRI to determine if there are other injuries that may be causing the heel pain.

Non Surgical Treatment

First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 20 minutes 3 times a day. If your child has a high arch, flat feet or bowed legs, your doctor may recommend orthotics, arch supports or heel cups. Your child should never go barefoot. If your child has severe heel pain, medicines such as acetaminophen (one brand name: Tylenol) or ibuprofen (some brand names. Advil, Motrin, Nuprin) may help.

Exercise

Stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table leg. The other end is hitched around the child’s toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of “foot curling”) should be done about 3 times. The child should do this exercise routine a few times daily.

Understand Heel Serious Pain

Overview

Painful Heel

Heel pain is usually felt either under the heel or just behind it. Heel Pain has a prevalence of 3.6%. US studies estimate that 7% of older adults report tenderness under the heel. Plantar fasciitis is estimated to account for 8% of all running-related injuries. There are 26 bones in the human foot, of which the heel is the largest. Pain typically comes on gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe. In most cases the pain is under the foot, towards the front of the heel. The majority of patients recover with conservative treatments within months. Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain. To prevent heel pain, it’s recommended to reduce the stress on that part of the body.

Causes

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

See your doctor immediately if you have Severe pain and swelling near your heel. Inability to bend your foot downward, rise on your toes or walk normally. Heel pain with fever, numbness or tingling in your heel. Severe heel pain immediately after an injury. Schedule an office visit if you have. Heel pain that continues when you’re not walking or standing. Heel pain that lasts more than a few weeks, even after you’ve tried rest, ice and other home treatments.

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

The following steps may help relieve your heel pain. Use crutches to take weight off your feet. Rest as much as possible for at least a week. Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days. Take acetaminophen or ibuprofen for pain. Wear proper-fitting shoes. Use a heel cup, felt pads in the heel area, or shoe insert. Wear night splints. Your doctor may recommend other treatments, depending on the cause of your heel pain.

Surgical Treatment

When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.

Prevention

Heel Discomfort

It may not be possible to prevent all cases of heel pain. However, there are some easy steps that you can take to avoid injury to the heel and prevent pain. Whenever possible, you should wear shoes that fit properly and support the foot, wear the right shoes for physical activity, stretch your muscles before exercising, pace yourself during physical activity, maintain a healthy diet, rest when you feel tired or when your muscles ache, maintain a healthy weight.