What Causes Mortons Neuroma

Overview

Morton neuromaA 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

The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon. Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour.

Symptoms

Episodes of pain are intermittent. Patients may experience 2 attacks in a week and then none for a year. Recurrences are variable and tend to become more frequent. Between attacks, no symptoms or physical signs occur. Two neuromas coexist on the same foot about 2-3% of the time. Other diagnoses should be considered when 2 or more areas of tenderness are present.

Diagnosis

In some cases your doctor will be able to feel the Morton’s as a swelling in the middle of your foot. However they may also suggest an X-ray or a blood test – this is normally to rule our other causes of the pain such as arthritis. The most accurate way to diagnose Morton?s itself is with magnetic resonance imaging (MRI) or ultrasound.

Non Surgical Treatment

Most patients’ symptoms subside when they change footwear to a wide soft shoe with a metatarsal support inside to relieve the pressure on the involved area. If this treatment fails, a cortisone injection into the nerve is occasionally helpful.interdigital neuroma

Surgical Treatment

Surgery to remove the neuroma may be recommended if more conservative treatment does not solve the problem. While surgery usually relieves or completely removes the symptoms, it often leaves a permanent numb feeling at the site of the neuroma.

Shoe Lifts The Answer To Leg Length Imbalances

There are actually two unique variations of leg length discrepancies, congenital and acquired. Congenital implies that you are born with it. One leg is anatomically shorter in comparison to the other. As a result of developmental stages of aging, the brain senses the walking pattern and recognizes some variation. The human body typically adapts by dipping one shoulder to the “short” side. A difference of less than a quarter inch is not grossly excessive, doesn’t need Shoe Lifts to compensate and usually won’t have a serious effect over a lifetime.

Leg Length Discrepancy Shoe Lift

Leg length inequality goes largely undiscovered on a daily basis, however this condition is very easily solved, and can eliminate many instances of upper back pain.

Therapy for leg length inequality usually consists of Shoe Lifts. These are generally low cost, usually being under twenty dollars, compared to a custom orthotic of $200 or maybe more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Lumbar pain is easily the most prevalent ailment affecting men and women today. Around 80 million men and women are afflicted by back pain at some stage in their life. It’s a problem that costs employers huge amounts of money year after year because of time lost and production. New and superior treatment solutions are constantly sought after in the hope of decreasing the economic impact this condition causes.

Shoe Lift

Men and women from all corners of the world suffer the pain of foot ache due to leg length discrepancy. In a lot of these situations Shoe Lifts might be of immense help. The lifts are capable of reducing any pain in the feet. Shoe Lifts are recommended by countless expert orthopaedic orthopedists.

So as to support the human body in a nicely balanced manner, the feet have a critical function to play. Inspite of that, it is often the most neglected zone of the body. Many people have flat-feet which means there may be unequal force exerted on the feet. This will cause other parts of the body including knees, ankles and backs to be impacted too. Shoe Lifts make sure that correct posture and balance are restored.

What Is A Inferior Calcaneal Spur

Posterior Calcaneal Spur

Overview

The plantar fascia is connective tissue on the sole of your foot. When the arch of the foot is not properly supported, the plantar fascia can stretch and pull away from the heel area. When the plantar fascia pulls away from the heel, calcium deposits form in its absence. These calcium deposits are called heel spurs and can be very painful.

Causes

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

Heel Spur

Symptoms

Heel spur is characterised by a sharp pain under the heel when getting out of bed in the morning or getting up after sitting for a period of time. Walking around for a while often helps reduce the pain, turning it into a dull ache. However, sports, running or walking long distance makes the condition worse. In some cases swelling around the heel maybe present.

Diagnosis

The proper diagnosis of a heel spur often requires an X-ray. To make this process as convenient for his patients as possible, most clinics have an on-site digital X-ray and diagnostic ultrasound machines. This can make it unnecessary for patients to visit diagnostic imaging centers, allowing patients to receive more expedient treatment.

Non Surgical Treatment

Treatments for bone spurs and plantar fasciitis include Stretching the calf muscles several times daily is critical in providing tension relief for the plantar fascia. Some physicians may recommend using a step to stretch, while others may encourage yoga or pushing against a wall to stretch. Icing after activity. A frozen tennis ball can provide specific relief. Rolling the tennis ball under the arch of the foot after exercise can lessen pain in the area. Taping is also recommended at times. Several manufacturers of sports tape have plantar fascia specific lines. Orthotics are a good idea for those on their feet during the day. Orthotics can provide cushioning and relief. Cortisone shots in the fascia can provide temporary anti-inflammatory relief. Losing weight is perhaps the most effective method of improving heel and foot pain. Those who are overweight are far more likely to report these syndromes.

Surgical Treatment

Approximately 2% of people with painful heel spurs need surgery, meaning that 98 out of 100 people do well with the non-surgical treatments previously described. However, these treatments can sometimes be rather long and drawn out, and may become considerably expensive. Surgery should be considered when conservative treatment is unable to control and prevent the pain. If the pain goes away for a while, and continues to come back off and on, despite conservative treatments, surgery should be considered. If the pain really never goes away, but reaches a plateau, beyond which it does not improve despite conservative treatments, surgery should be considered. If the pain requires three or more injections of “cortisone” into the heel within a twelve month period, surgery should be considered.

Prevention

In order to prevent heel spurs, it?s important that you pay attention to the physical activities you engage in. Running or jogging on hard surfaces, such as cement or blacktop, is typical for competitive runners, but doing this for too long without breaks can lead to heel spurs and foot pain. Likewise, the shoes you wear can make a big difference in whether or not you develop heel spurs. Have your shoes and feet checked regularly by our Dallas podiatrist to ensure that you are wearing the proper equipment for the activities. Regular checkups with a foot and ankle specialist can help avoid the development of heel spurs.

What Causes Bursitis Of The Feet?

Overview

Pain at the posterior heel or posterior ankle is most commonly caused by pathology at the posterior calcaneus, the Achilles (calcaneal) tendon, or the associated bursae. The following bursae are located just superior to the insertion of the Achilles tendon. Subtendinous calcaneal bursa. This bursa (also called the retrocalcaneal bursa), situated anterior (deep) to the Achilles tendon, is located between the Achilles tendon and the calcaneus. Subcutaneous calcaneal bursa. Also called the Achilles bursa, it is found posterior (superficial) to the Achilles tendon, lying between the skin and the posterior aspect of the distal Achilles tendon. Inflammation of one or both of these bursae can cause pain in the posterior heel and ankle regions.

Causes

There are several factors which can lead to a person developing retrocalcaneal bursitis. In athletes, especially runners, overtraining, sudden excessive increase in running mileage may lead to retrocalcaneal bursitis. Tight or ill-fitting shoes can be another causative factor as they can produce excessive pressure at the back of the heel due to restrictive heel counter. A person with an excessively prominent posterosuperior aspect of the heel bone (Haglund deformity) may also have a higher predisposition to retrocalcaneal bursitis. In such individuals, pain would be reproduced when the ankle goes into dorsiflexion.

Symptoms

Pain at the back of the heel at the attachment site of the Achilles tendon when running. Pain on palpation of the back of the heel or bottom of heel. Pain when standing on tiptoes. Swelling and redness at the back and bottom of the heel.

Diagnosis

Your doctor will take a history to find out if you have the symptoms of retrocalcaneal bursitis. By examining your ankle, he or she can generally tell the location of the pain. The physician will look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex), as this may tighten the achilles tendon over the inflamed bursa. Alternatively, the pain may be worse with toe rise, as this puts stress on the attachment of the achilles tendon to the heel bone. Imaging studies such as X-ray and MRI are not usually necessary at first. If initial treatment fails to improve the symptoms, these studies may be obtained. MRI may show inflammation.

Non Surgical Treatment

Treatments should involve decreasing swelling, relieving pain and stress on the Achilles, correcting any biomechanical dysfunction (over-pronation or flat feet), treating scar tissue, and then restoring strength and movement. If you are performing an activity that could cause further trauma to the bursa, it is recommended that you protect the area with padding and/or proper footwear to prevent further irritation or damage.

Surgical Treatment

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

Could Hammer Toes Cause Neuropathy

HammertoeOverview

The term hammertoes describes three unique contracture deformities of the toes. The deformities differ by the location of contracture in each joint of the toe. The three deformities include hammer toe, claw toe and mallet toe. Hammer toes may be flexible or rigid. Hammer toes are most common on the lesser toes (2-5) and may affect one or more toes simultaneously. Hallux malleus is the term used to described a hammer toe of the great toe. Hallux malleus is often found as an isolated foot problem. Hammer toes are found equally in men and women. The onset of hammer toes is between the ages of 30 and 80 years of age.

Causes

People who have a high-arched feet have an increased chance of hammer toes occurring. Also, patients with bunion deformities notice the second toe elevating and becoming hammered to make room for the big toe that is moving toward it. Some patients damage the ligament that holds the toe in place at the bottom of the joint that connects the toe and foot. When this ligament (plantar plate) is disrupted or torn, the toe floats upward at this joint. Hammer toes also occur in women wearing ill-fitting shoes or high heels, and children wearing shoes they have outgrown.

Hammer ToeSymptoms

Well-developed hammertoes are distinctive due to the abnormal bent shape of the toe. However, there are many other common symptoms. Some symptoms may be present before the toe becomes overly bent or fixed in the contracted position. Often, before the toe becomes permanently contracted, there will be pain or irritation over the top of the toe, particularly over the joint. The symptoms are pronounced while wearing shoes due to the top of the toe rubbing against the upper portion of the shoe. Often, there is a significant amount of friction between the toe and the shoe or between the toe and the toes Hammer toes on either side of it. The corns may be soft or hard, depending on their location and age. The affected toe may also appear red with irritated skin. In more severe cases, blisters or open sores may form. Those with diabetes should take extra care if they develop any of these symptoms, as they could lead to further complications.

Diagnosis

Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

Non Surgical Treatment

Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than your longest toe. (Note: For many people, the second toe is longer than the big toe.) Avoid wearing tight, narrow, high-heeled shoes. You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. Or, a shoe specialist (Pedorthist) may be able to stretch the toe box so that it bulges out around the toe. Sandals may help, as long as they do not pinch or rub other areas of the foot.

Surgical Treatment

Curative treatment of hammertoes varies depending upon the severity of the deformity. When the hammertoe is flexible, a simple tendon release in the toe works well. The recovery is rapid often requiring nothing more that a single stitch and a Band-Aid. Of course if several toes are done at the same time, the recovery make take a bit longer.

Hammer ToePrevention

The key to prevention is to wear shoes that fit you properly and provide plenty of room for your toes. Here?s how to get the right fit. Have your feet properly measured. The best way to do this is to get someone to draw the outline of your foot while you stand barefoot with your full weight on it, then measure the outline at the widest point. Measure the soles of your shoes. Ideally, they should be as wide as your feet, but certainly no more than half an inch narrower. Length matters, too, of course: your shoes should be half an inch longer than your longest toe.

Hammertoe Correction

Hammer ToeOverview

A hammertoe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery. People with hammer toe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes

Ill-fitting shoes or a muscle imbalance are Hammer toe the most common causes of Hammer Toe. If there is an issue with a muscle in the second, third or fourth toes preventing them from straightening, Hammer Toe can result. If one of these toes is bent long enough in one position, the muscles tighten and cannot stretch out. Left untreated, surgery may be required. Women are especially prone to developing Hammer Toe because of their shoes. Hammer Toe results from shoes that don?t fit properly. Shoes that narrow toward the toe, pushing smaller toes into a bend position for extended periods of time. High heels that force the foot down into a narrow space, forcing the toes against the shoe, increasing the bend in the toe.

HammertoeSymptoms

Pain on the bottom of your foot, especially under the ball of your foot, is one of the most common symptoms associated with hammertoes. Other common signs and symptoms of hammertoes include pain at the top of your bent toe from footwear pressure. Corns on the top of your bent toe. Redness and swelling in your affected area. Decreased joint range of motion in your affected toe joints.

Diagnosis

Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).

Non Surgical Treatment

Your doctor will decide what type of hammertoe you have and rule out other medical conditions. Treatment may range from more appropriate footgear to periodic trimming and padding of the corn. Cortisone injections may be indicated if a bursitis is present. Antibiotics may be utilized in the presence of infection. Removable accommodative pads may be made for you.

Surgical Treatment

For severe hammer toe, you will need an operation to straighten the joint. The surgery often involves cutting or moving tendons and ligaments. Sometimes the bones on each side of the joint need to be connected (fused) together. Most of the time, you will go home on the same day as the surgery. The toe may still be stiff afterward, and it may be shorter. If the condition is treated early, you can often avoid surgery. Treatment will reduce pain and walking difficulty.

Dealing With Severs Disease

Overview

Sever’s disease is a condition characterized by pain in one or both heels with walking. The pain is caused by shortening of the heel-cord. It usually affects children between the ages of 10 and 13 years old. During this phase of life, growth of the bone is taking place at a faster rate than the tendons. Sever’s disease is also called calcaneal apophysitis.

Causes

Sever?s disease is often associated with a growth spurt, when the bones grow but the muscles do not. Therefore the muscles effectively become tighter which results in increased stress at the heel. It may also be related to unusual biomechanics, for instance poor foot posture, muscle tightness or muscle weakness. Overtraining or incorrect training can also play a part. Usually, the cause is a combination of factors.

Symptoms

The most prominent symptom of Sever?s disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever?s disease is primarily clinical.

Diagnosis

This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.

Non Surgical Treatment

The aims are to reduce trauma to the heel, allow rest/recovery and prevent recurrence. Most cases are successfully treated using physiotherapy and exercises, eg to stretch the gastrocnemius-soleus complex, to mobilise the ankle mortise, subtalar joint and medial forefoot. Soft orthotics or heel cups. Advice on suitable athletic footwear. Other modes of treatment are in severe cases, temporarily limiting activity such as running and jumping. Ice and non-steroidal anti-inflammatory drugs (NSAIDs), which can reduce pain. In very severe cases, a short period of immobilisation (eg 2-3 weeks in a case in mild equinus position) has been suggested.

Exercise

For children with Sever’s disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3 times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for patient suffering from Sever’s disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or standing.

Heel Discomfort

Overview

Heel Pain

Plantar Fasciitis, also known as Heel Pain or a heel spur, is a musculoskeletal condition causing pain under the heel or into the inner arch of the foot. The condition is commonly mistaken for an impact trauma or heel bruise but in fact it is caused by mechanical overstretching of the fibrous tissue in the arch. Heel pain can develop suddenly or evolve gradually over time. It can affect people of all ages, but is more common beyond the 4th decade of life, those in standing occupations, overweight individuals and those involved in regular strenuous exercise.

Causes

Many things can cause heel pain. Most commonly seen at our Troy, MI office are heel spurs, which are small growths on the heel bone. Heel pain can be caused from heavy activities and increased weight that put extra pressure on feet. Dr. Weinert often treats heel pain in athletes, runners and women who are pregnant. There are other cases where Dr. Weinert has related a patient?s heel pain to arthritis, stress fractures, fractures, bone tumors, cysts, achilles tendonitis and Haglund’s deformity. The main cause of heel pain is usually a biomechanical problem in the foot and it?s, in a nutshell, having a foot out of alignment. There are numerous conditions. One of the most prevalent is called talotarsal dislocation syndrome. What that is in lay terms is you?ve just got a misalignment of your ankle on your heel and as you bear weight you?re getting a collapse of the ankle on the heel causing the foot to be out of alignment. So the plantar fascia, bones, joints, and ligaments receive constant stress. This stress occurs at the point where the plantar fascia (the major tissue that connects your toes to your heel) meets the heel. Many patients explain the pain as being in the middle of the inside of the heel. As a patient bears weight, they get the collapse of the foot and that ligament pulls. And if you think of a rubber band constantly getting pulled on that area of the insertion on the heel, you eventually start getting some micro tears in that ligament and causing inflammation and pain specifically right there in middle area of the heel. Plantar fasciitis is also a common source of heel pain. The plantar fascia, a band of tissue that runs from your heel to your toes, can become strained and inflamed due to overuse and wear and tear. This band of tissue can only withstand so much pressure and when it gives way, the pain can be severe and requires immediate and effective treatment.

Symptoms

Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis. The inflammation maybe aggravated by shoes that lack appropriate support and by the chronic irritation that sometimes accompanies an athletic lifestyle. Achilles Tendinopathy, Pain and inflammation of the tendon at the back of the heel that connects the calf muscle to the foot. Sever?s, Often found in children between the ages of 8 – 13 years and is an inflammation of the calcaneal epiphyseal plate (growth plate) in the back of the heel. Bursitis, An inflamed bursa is a small irritated sack of fluid at the back of the heel. Other types of heel pain include soft tissue growths, Haglunds deformity (bone enlargement at the back of the heel), bruises or stress fractures and possible nerve entrapment.

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non Surgical Treatment

Once diagnosed, treatment for plantar fasciitis may include one or more of the following: advice on footwear, in particular use of arch-supportive footwear; avoid walking barefoot; stretching exercises, shoe modifications such as heel pads, taping and strapping, anti-inflammatories and orthotic devices to correct abnormal foot mechanics. Injection therapy with corticosteroids is only advisable if all the conservative treatment methods mentioned above have been exhausted due to undesired effects implicated with steroid infusion in the heels.

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

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don?t underestimate your body’s need for rest and good nutrition. If obese, lose weight.

What Is The Leading Cause Of Achilles Tendonitis ?

Overview

Achilles TendinitisAchilles tendonitis (tendinitis), is a painful and often debilitating inflammation of the Achilles tendon than can progress into degeneration which we call Achilles Tendinosis. The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone (calcaneus), and connects the calf muscles to the heel bone. In most cases, Achilles tendonopathy’s are overuse injuries are more common among athletes and people who train heavily, however it can also occur in people who are less active. Achilles Tendonitis can vary in severity from a mild pain in the tendon during a particular activity to more severe cases when any form of activity that puts strain on this ligament, even standing or walking, can cause pain.

Causes

Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes. The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury – particularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs.

Symptoms

Symptoms of Achilles tendinitis and tendinosis include recurring localized heel pain, sometimes severe, along the achilles tendon during or after exercise. Pain often begins after exercise and gradually worsens. Morning tenderness or stiffness about an inch and a half above the point where the Achilles tendon is attached to the heel bone. Sluggishness in your leg. Mild to severe swelling. Stiffness that generally diminishes as the tendon warms up with use.

Diagnosis

The diagnosis is made via discussion with your doctor and physical examination. Typically, imaging studies are not needed to make the diagnosis. However, in some cases, an ultrasound is useful in looking for evidence of degenerative changes in the tendon and to rule out tendon rupture. An MRI can be used for similar purposes, as well. Your physician will determine whether or not further studies are necessary.

Nonsurgical Treatment

Treatment for achilles tendonitis is based around initially reducing pain and inflammation, stretching the muscles out and a gradual return to activity. No one single approach may cure achilles tendonitis, particularly a chronic condition but a combination of treatment approaches and patience will work best. It is essential the correct treatment is started as soon as possible in the acute stage to avoid the injury becoming chronic. Acute achilles tendonitis requires rest. Continuing to train on a painful achilles tendon could lead to the injury becoming chronic and more difficult to treat. Applying ice or cold therapy as soon as possible to a painful achilles tendon will reduce pain and inflammation. After the first 24 to 48 hours alternating hot and cold or just heat may be more beneficial. Tendons work better when they are warm but if they are painful then rest and ice. Wear a heel pad to raise the heel and shorten the calf muscles which in turn reduces some of the strain on the achilles tendon. This should only be a temporary measure while the achilles tendon is healing. An achilles tendon taping technique can aid rest by supporting the tendon with elastic bandages. This is an excellent way of taking the load off the tendon if you have to walk around on your feet as well as protecting the tendon when returning to full fitness. Achilles tendon exercisesMake sure you have the right running shoes for your foot type and the sport. If you are a runner that over-pronates then a motion control or support running shoe may be needed. Visit a specialist running shop for advice. In the later stages apply heat, especially before exercise. The tendon will perform better when warm. Finish with cold after training to reduce any inflammation.

Achilles Tendinitis

Surgical Treatment

There are two types of Achilles repair surgery for tendonitis (inflammation of the Achilles Tendon), if nonsurgical treatments aren’t effective. Gastrocnemius recession – The orthopaedic surgeon lengthens the calf muscles to reduce stress on your Achilles tendon. D?bridement and repair – During this procedure, the surgeon removes the damaged part of the Achilles tendon and repairs the remaining tendon with sutures or stitches. Debridement is done when the tendon has less than 50% damage.

Prevention

By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.

What Triggers Heel Pain

Painful Heel

Overview

The plantar fascia acts like a bowstring and supports the arch and several muscles inside the foot. When there is increased stress on the arch, microscopic tears can occur within the plantar fascia, usually at its attachment on the heel. This results in inflammation and pain with standing and walking and sometimes at rest.


Causes

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.


Symptoms

The heel pain characteristic of plantar fasciitis is usually felt on the bottom of the heel and is most intense with the first steps of the day. Individuals with plantar fasciitis often have difficulty with dorsiflexion of the foot, an action in which the foot is brought toward the shin. This difficulty is usually due to tightness of the calf muscle or Achilles tendon, the latter of which is connected to the back of the plantar fascia. Most cases of plantar fasciitis resolve on their own with time and respond well to conservative methods of treatment.


Diagnosis

Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.


Non Surgical Treatment

Treatment of plantar fasciitis is sometimes a drawn out and frustrating process. A program of rehabilitation should be undertaken with the help of someone qualified and knowledgeable about the affliction. Typically, plantar fasciitis will require at least six weeks and up to six months of conservative care to be fully remedied. Should such efforts not provide relief to the athlete, more aggressive measures including surgery may be considered. The initial goals of physical therapy should be to increase the passive flexion of the foot and improve flexibility in the foot and ankle, eventually leading to a full return to normal function. Prolonged inactivity in vigorous sports is often the price to be paid for thorough recovery. Half measures can lead to a chronic condition, in some cases severely limiting athletic ability. As a large amount of time is spent in bed during sleeping hours, it is important to ensure that the sheets at the foot of the bed do not constrict the foot, leading to plantar flexion in which the foot is bent straight out with the toes pointing. This constricts and thereby shortens the gastroc complex, worsening the condition. A heating pad placed under the muscles of the calf for a few minutes prior to rising may help loosen tension, increase circulation in the lower leg and reduce pain. Also during sleep, a night splint may be used in order to hold the ankle joint in a neutral position. This will aid in the healing of the plantar fascia and ensure that the foot will not become flexed during the night.

Plantar Fascia


Surgical Treatment

Surgery for plantar fasciitis can be very successful in the right patients. While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery. This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery. New surgical techniques allow surgery to release the plantar fascia to be performed through small incisions using a tiny camera to locate and cut the plantar fascia. This procedure is called an endoscopic plantar fascia release. Some surgeons are concerned that the endoscopic plantar fascia release procedure increases the risk of damage to the small nerves of the foot. While there is no definitive answer that this endoscopic plantar fascia release is better or worse than a traditional plantar fascia release, most surgeons still prefer the traditional approach.