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Sep272015

Working With Calcaneal Spur

Heel Spur


Overview


The heel spur (or calcaneal spur) is a nail-like growth of calcium around the ligaments and tendons of the foot where they attach to the heel bone. The spur grows from the bone and into the flesh of the foot. A heel spur results from an anatomical change of the calcaneus (heel bone). This involves the area of the heel and occasionally, another disability, such as arthritis. The heel bone forms one end of the two longitudinal arches of the foot. These arches are held together by ligaments and are activated by the muscles of the foot (some of which are attached beneath the arches and run from the front to the back of the foot). These muscles and ligaments, like the other supporting tissues of the body, are attached in two places. Many are attached at the heel bone. The body reacts to the stress at the heel bone by calcifying the soft tissue attachments and creating a spur.


Causes


Faulty foot structures such as abnormal growths, different leg lengths, and unhealed injuries and haveinf flat feet or high arches. Muscle imbalances tight, weak or shortened muscles in your foot, plantar fascia, ankle, calf and hamstring. Over pronation can cause imbalance in foot mechanics which puts excess pressure on the plantar fascia. Poor biomechanics affect the way your foot hits the ground. If you overpronate (feet roll inward) you tend to have flat feet (pes planus), which increases stress on the heel bone. Regular shoes or high heels that are too tight or don't support your heel or arch affect the distribution of your body weight on your foot. Health conditions such as obesity, inflammatory diseases (rheumatoid arthritis, ankylosing spondylitis), bursitis, neuroma (nerve growths), gout, diabetes, Haglund's deformity, and Achilles tendinitis can also instigate the problem. Running or jogging on hard surfaces, repetative striking of the heel bone.


Heel 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


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


To aid in the reduction of inflammation, applying ice for 10-15 minutes after activities and the use of anti-inflammatory medications, such as aspirin or ibuprofen, can be helpful. Corticosteroid injections may also be used to reduce pain and inflammation. Physical therapy can be beneficial with the use of heat modalities, such as ultrasound, that create a deep heat and reduce inflammation. If the pain caused by inflammation is constant, keeping the foot raised above the heart and/or compressed by wrapping with a bandage will help. Taping can help speed the healing process by protecting the fascia from reinjury, especially during stretching and walking.


Surgical Treatment


Have surgery if no other treatments work. Before performing surgery, doctors usually give home treatments and improved footwear about a year to work. When nothing else eases the pain, here's what you need to know about surgical options. Instep plantar fasciotomy. Doctors remove part of the plantar fascia to ease pressure on the nerves in your foot. Endoscopy. This surgery performs the same function as an instep plantar fasciotomy but uses smaller incisions so that you'll heal faster. However, endoscopy has a higher rate of nerve damage, so consider this before you opt for this option. Be prepared to wear a below-the-knee walking cast to ease the pain of surgery and to speed the healing process. These casts, or "boots," usually work better than crutches to speed up your recovery time.

Admin · 17 views · 0 comments
Sep222015

Dealing With Calcaneal Spur

Calcaneal Spur


Overview


A heel spur is a hooked bony growth protruding from the calcaneus or heel bone. It often occurs alongside plantar fasciitis, and as such the two conditions are often confused, however they are not the same.


Causes


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


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


Most patients who are suffering with heel spurs can see them with an X-ray scan. They are normally hooked and extend into the heel. Some people who have heel spur may not even have noticeable symptoms, although could still be able to see a spur in an X-ray scan.


Non Surgical Treatment


Conventional treatment for heel spurs typically includes rest, stretching exercises, icing and anti-inflammatory medications. Many people find it difficult to go through the day without some sort of routine activity or exercise, and this prolongs the heel spur and forces people to rely on anti-inflammatory medications for a longer period of time. This can be detrimental due to the many side effects of these medications, including gastrointestinal problems like leaky gut, bleeding and ulcer symptoms.


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.

Admin · 18 views · 0 comments
Aug292015

What Is Bursitis Of The Foot?

Overview


Do you experience pain at the back of your heel? Is the back of your heel red and swollen? And you were told that it might Achilles Tendonitis? But so far treatment for Achilles Tendonitis does not seem to be working? You might be suffering instead from Retrocalcaneal Bursitis.


Causes


If the posterior-superior portion of the heel has an abnormally large bony prominence protruding from it (called a Haglund's Deformity), in some instances it may rub against the Achilles Tendon. When this occurs, the bursa between the bone and the tendon will become inflamed, swollen, and painful. This condition is called Retrocalcaneal Bursitis. The presence of a Haglund's Deformity does not insure that these problems will occur. In order for these problems to occur, the heel and foot must be tilted in such a way as to actually force this bony prominence into the bursa and tendon.


Symptoms


Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down.


Diagnosis


Your health care provider will take a history to find out if you have symptoms of retrocalcaneal bursitis. Examining your ankle can find 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). Or, the pain may be worse when you rise on your toes. You will not usually need imaging studies such as x-ray and MRI at first. If the first treatment does not improve the symptoms, your health care provider may recommend these tests. MRI may show inflammation.


Non Surgical Treatment


Over-the-counter or custom heel wedges may help to decrease the stress placed on the attachment of the achilles tendon and the associated bursa. If these interventions are ineffective, then some health care providers may inject a small amount of steroids into the bursa. If the condition is associated with Achilles tendonitis, then casting the ankle to prevent motion for several weeks can be effective. Very rarely, surgery may be necessary to remove the inflamed bursa.


Surgical Treatment


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


Prevention


Prevention can be accomplished by controlling your foot structure with good supportive shoes or arch supports. Pay attention to early signs of friction like blister formation. This tells you where the areas that are more likely to cause a bursa to form and subsequently a bursitis.

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Aug192015

Coping With Bunion And Hammertoe Surgery

Hammer ToeOverview


There are two main types of Hammer toe. Hammertoes can be flexible, which means that you can still move the toe a bit - these are easier to treat with stretching, wider shoes and in some cases, toe splints. Rigid hammertoes occur when the foot condition has persisted for so long without treatment that the tendons become too rigid to be stretched back to normal. Rigid hammertoes are more common in people with arthritis. This foot condition usually needs to be treated with surgery.


Causes


While ill-fitting shoes may contribute to a hammertoe, shoes don't actually cause it, Hammertoes occur by the pull and stretch of the tendon. One tendon gets a more mechanical advantage over the other and allows the deformity to occur. Not surprisingly, wearing shoes that are too tight can make a hammertoe worse. If you're fond of narrow, pointy-toed shoes or high-heeled pumps, keep in mind you're squeezing those toes and tendons, which may aggravate hammertoes.


Hammer ToeSymptoms


Hammer, claw, and mallet toes can cause discomfort and pain and may make it hard to walk. Shoes may rub on your toes, causing pain, blisters, calluses or corns, or sores. Sores can become infected and lead to cellulitis or osteomyelitis, especially if you have diabetes or peripheral arterial disease. If you have one of these health problems and sores develop, contact your doctor.


Diagnosis


The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed Hammer toes in a weight-bearing position.


Non Surgical Treatment


Non-surgical methods for hammer toes (claw toes) are aimed at decreasing symptoms (i.e., pain and/or calluses) and/or limiting the progression into a larger problem. Simple treatments patients can do are wear supportive shoes. Use an arch support. Wear shoes with a wide toe box. Modify activities. Spot stretch shoes. Periodic callus care.


Surgical Treatment


Until recently, wires were used for surgical correction. In this technique, one or more wires are inserted into the bone through both the affected joint and a normally healthy toe joint, and the end of the toe. These wires stay in place for four to six weeks, protruding from the end of the toes. Due to the protruding wire, simple things such working, driving, bathing and even sleeping are difficult while these wires are in place. During this recovery period, patients often experience discomfort during sleep and are subject possible infection.

Admin · 50 views · 0 comments
Jun252015

Hammer Toe Treatment Pain

HammertoeOverview


hammertoes most commonly affects the second toe on the foot. It causes the middle joint to bend. Hammertoe is most frequently caused by structural problems in the toe or from wearing poor fitting shoes. It is important to diagnose and treat hammertoe early because the condition tends to become worse over time. If left untreated, hammertoe can require surgery.


Causes


Hammertoe is caused when muscles fail to work in a balanced manner and the toe joints bend to form the hammertoe shape. If they remain in this position, the muscles and tendons supporting them tighten and stay that way. Causes of hammertoe can include squeezing into a too-small or ill-fitting shoe or wearing high heels that jam your toes into a tight toe box. An injury such as badly stubbing your toe. Arthritis. Nerve and muscle damage from diseases such as hammertoes diabetes,


Hammer ToeSymptoms


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


Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.


Non Surgical Treatment


For hammertoes that are still flexible, a podiatrist might recommend padding or taping the toes to relieve pain and orthotic inserts for shoes to minimize pressure and keep the toe properly aligned. Anti-inflammatory drugs or corticosteroid injections can relieve pain and inflammation. For more advanced cases of hammertoe, a podiatrist might recommend a surgical procedure to cut the tendon, allowing the toe to straighten. For hammertoes that have become rigid, a more complicated surgery might be needed, during which the podiatrist removes part of the bone at the deformed joint to allow it to straighten.


Surgical Treatment


If conservative measures fail to provide relief, or if your hammertoe is in advanced stages with rigidity and a significant amount of pain, surgery may be required. Some patients also require surgery if they have open sores or wounds related to their hammertoe. For patients who also suffer from bunions, a combined procedure may be appropriate, addressing both conditions within the same surgery. Recovery time will vary from patient to patient, depending on the extent of the surgical repair and other conditions that may also be present.


HammertoePrevention


Avoid wearing shoes that are too short or narrow. Check children's shoe sizes often, especially during periods of fast growth. If you have hammer toe, call for an appointment with your health care provider. If you develop thick blisters or corns on your toes, if your pain gets worse, if you have difficulty walking call for an appointment with your health care provider.

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