Find Out How To Treat Bursitis Of The Foot?

Overview

You might be suffering from Achilles bursitis if you have sharp pain at the back of your heel. You have lump on the back of your heel. You have loss of range of motion walking and the pressure for shoes causes you to limp and you have weakness in your leg. You have warmth, redness and swelling on the heel. If any of those statements are true for you or you’re suffering from on-going pain in your heel then you might have an injury called “retrocalcaneal bursitis”. Many people don’t know that Achilles bursitis is a very real injury affecting the bursa sac in your ankle. It can happen to anyone who regularly puts stress with repetitive movements as part of your job, sports related activities, acute trama to the ankle/foot and/or aging weakness the tissue around the ankle and the bursa.

Causes

As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions. Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.

Symptoms

Where the tendon joins the calcaneal bone, friction can cause the spaces between the tendon, bone and skin to swell and inflame with bursitis. This constitutes a calcaneal bursa. Apart from swelling over the back of the heel, you?ll feel acute tenderness and pain when you move it or even apply light pressure. Your swollen heel may look more red than the other one, and the swelling is often so hard it can feel like bone, partly because it sometimes is, as a bony overgrowth can occur in chronic cases.

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

Gradually progressive stretching of the Achilles tendon may help to relieve impingement on the subtendinous calcaneal bursa. Stretching of the Achilles tendon can be performed by having the patient place the affected foot flat on the floor and lean forward toward the wall until a gentle stretch is felt in the ipsilateral Achilles tendon. The stretch is maintained for 20-60 seconds and then is relaxed. Achilles stretch 1. The patient stands with the affected foot flat on the floor and leans forward toward the wall until a gentle stretch is felt in the ipsilateral Achilles tendon. The stretch is maintained for 20-60 seconds and then is relaxed. Achilles stretch 2. This stretch, which is somewhat more advanced than that shown in Images 1-2, isolates the Achilles tendon. It is held for at least 20-30 seconds and then is relaxed. To maximize the benefit of the stretching program, the patient should repeat the exercise for multiple stretches per set, multiple times per day. Ballistic (ie, abrupt, jerking) stretches should be avoided in order to prevent clinical exacerbation. The patient should be instructed to ice the posterior heel and ankle in order to reduce inflammation and pain. Icing can be performed for 15-20 minutes at a time, several times a day, during the acute period, which may last for several days. Some clinicians also advocate the use of contrast baths, ultrasound or phonophoresis, iontophoresis, or electrical stimulation for treatment of calcaneal bursitis. If the patient’s activity level needs to be decreased as a result of this condition, alternative means of maintaining strength and cardiovascular fitness (eg, swimming, water aerobics) should be suggested.

Prevention

Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.


Hammer Toe Treatment

HammertoeOverview

The hammertoe condition is usually irreversible, but often its progression can be slowed or halted. You should visit a Podiatrist if the toe becomes painful and you have difficulty walking. A Podiatrist will be able to provide advice and treatment including padding the bony top-part of your hammertoe to relieve pain or to tape your toes as a way to change their position. Podiatrists have an important role to play in preventing and managing foot problems. Prompt action is important. Problems which are left without assessment or treatment may result in major health risks.

Causes

But what causes the imbalance of the tendons and muscles in the first place so that they begin to pull and bend the joint? A bad fitting shoe could be the cause but it usually isn?t the primary cause. Many people are genetically predisposed to hammertoe, and the condition begins to progress more quickly when they wear shoes that fit poorly, for example pointy toes, high heels, or shoes that are too short. Hammertoe may also be caused by damage to the joint as a result of trauma.

HammertoeSymptoms

Common symptoms of hammertoes include pain or irritation of the affected toe when wearing shoes. corns and calluses (a buildup of skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location. Inflammation, redness, or a burning sensation. Contracture of the toe. In more severe cases of hammertoe, open sores may form.

Diagnosis

The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.

Non Surgical Treatment

Conservative treatment is limited to accommodation, not correction, of the deformity, though some patients find the relief they can get from these options to be more than enough to put off or even avoid surgery. These include better Footwear. Shoe gear with a wider toe box and higher volume causes less friction to the toes. Toe Braces and Strapping. Some toe braces and strapping techniques take some pressure off the toes during gait. Custom molded orthotics can redistribute the forces through the tendons that control the toe, lessening the pain and extent of the deformity.The calluses on the toe and the ball of the foot can be shaved occasionally to reduce some pain and pressure, although they will return due to the constant deformity.

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 hammertoe can often avoid surgery. Treatment will reduce pain and walking difficulty.


Do Hammer Toes Hurt

HammertoeOverview

There are two different types. Flexible hammertoe. These are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammertoes because they are still moveable at the joint. Rigid Hammertoes. This variety is more developed and more serious than the flexible condition. Rigid hammertoes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammertoe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.

Causes

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

Hammer ToeSymptoms

The symptoms of 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 hammertoe 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

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

If the toes are still mobile enough that they are able to stretch out and lay flat, the doctor will likely suggest a change of footwear. In addition, she may choose to treat the pain that may result from the condition. The doctor may prescribe pads to ease the pain of any corns and calluses, and medications ranging from ibuprofen to steroid injections for the inflammation and pain. Other options for non-surgical treatments include orthotic devices to help with the tendon and muscle imbalance or splinting to help realign the toe. Splinting devices come in a variety of shapes and sizes but the purpose of each is the same: to stretch the muscles and tendon and flatten the joint to remove the pain and pressure that comes from corns.

Surgical Treatment

Surgery to straighten the toe may be needed if an ulcer has formed on either the end or the top surface of the toe. Surgery sometimes involves cutting the tendons that support movement in the toe so that the toe can be straightened. Cutting the tendons, however, takes away the ability to bend the very end of the toe. Another type of surgery combines temporary insertion of a pin or rod into the toe and alteration or repair of the tendons, so that the toe is straightened. After surgery, the deformity rarely recurs.


Bunions Triggers Signs And Symptoms And Treatment Plans

Overview
Bunion Pain
A bunion is an enlargement of ?the metatarsophalangeal (MTP) joint?, this is the big toe?s base joint that forms when the bone or tissue moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. The MTP joint, which carries lots of weight, is stiff and sore, making even the wearing of shoes difficult or impossible. It also causes swelling of the feet to occur. Hammer toes are also associated with the formation of bunions.

Causes
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.
SymptomsThe pain from a bunion is felt around the MTP joint of the big toe. People with bunions often complain of pain when they when they stand or walk for long periods of time. High heeled shoes or shoes with a small toe area can make bunions feel and look worse. As a result of the deformity the big toe can lose some of its range of motion or become stiff. Sometimes both feet are affected.

Diagnosis
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.

Non Surgical Treatment
Wearing the right shoes, using shoe inserts (orthoses) and padding, and taking painkillers can all help to ease your symptoms of a bunion. However, these treatments can?t cure a bunion or stop it getting worse. If you have severe pain or discomfort from a bunion, you may be advised to have an operation to correct it. One of the most important things you can do is to wear the right footwear. You should try to wear flat, wide-fitting shoes with laces or an adjustable strap that fits you properly. You may also want to place a bunion pad over your bunion to give it some protection from the pressure of your shoes. You can usually buy these pads from a pharmacy, or get them from your podiatrist or chiropodist. He or she may also recommend a shoe insert, which can be moulded specifically to your foot. Shoe inserts aim to reduce the pain of your bunion by improving how you walk. You can take over-the-counter painkillers, such as paracetamol or ibuprofen, to help relieve the pain and inflammation of your bunion. Always follow the instructions in the patient information leaflet that comes with your medicine. Medicines give temporary relief but they won?t be able to cure your bunion or prevent it from getting worse. If you have a bunion as a result of underlying arthritis, your doctor may prescribe specific medicines to treat this.
Bunions Callous

Surgical Treatment
In severe hallux valgus bunion cases, the first long bone (metatarsal) in the foot dramatically shifts away from the second metatarsal, resulting in looseness and a large deformity. In severe bunion corrections, a surgery known as the Lapidus procedure realigns the first metatarsal into its natural position. Using screws, the surgery holds the bone stable so it does not shift again and reduces the change of the bunion returning to basically none. Surgery may also involve removing the enlarged portion of the bunion region, cutting and realigning the bone, and correcting the position of the tendons and ligaments. By using a special plate with Lapidus procedures, University Foot and Ankle Institute patients are able to put weight on their foot after only 2-3 weeks, rather than the typical 6-8 weeks of no weight.


What Causes Over-Pronation Of The Feet

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.Over-Pronation

Causes

During our development, the muscles, ligaments, and other soft tissue structures that hold our bones together at the joints become looser than normal. When the bones are not held tightly in place, the joints are not aligned properly, and the foot gradually turns outward at the ankle, causing the inner ankle bone to appear more prominent. The foot moves in this direction because it is the path of least resistance. It is more difficult for the foot to move in the opposite direction (this is called supination). As we develop, the muscles and ligaments accommodate to this abnormal alignment. By the time growth is complete, the pronated foot is: abnormally flexible, flat, and its outer border appears raised so that as you step down you do not come down equally across the entire foot; instead, you come down mostly on the inner border of the foot. Normal aging will produce further laxity of our muscles that causes the pronation to become gradually worse.

Symptoms

Common conditions that develop with prolonged overpronation typically include plantar fasciitis, achilles tendonitis, shin splints, posterior tibial stress syndrome and even IT band syndrome. With long term neglect you may see the development of bunyons, foot deformities and early onset of hip and knee arthritis.

Diagnosis

When sitting, an over-pronating foot appears quite normal, i.e. showing a normal arch with room under the underside of the foot. The moment you get up and put weight on your feet the situation changes: the arches lower and the ankle slightly turns inwards. When you walk or run more weight is placed on the feet compared to standing and over-pronation will become more evident. When walking barefoot on tiles or timber floors over-pronation is more visible, compared to walking on carpet or grass.Pronation

Non Surgical Treatment

Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.

Surgical Treatment

HyProCure implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.


Calcaneal Apophysitis Physical Therapy

Overview

Sever’s Disease is not a disease in the sense of an infection or other chronic pathology but is an injury/irritation of a growth plate. The Calcaneal growth plate or growth plate in the heel bone has attachments from the achilles tendon and the plantar fascia. Pull from either or both of these structures can cause enough motion within the apophysis or growth plate space to create irritation and inflammation which can be quite painful and limiting. This can start when the growth plate is still wide open but is more often seen as the growth plate starts to close further limiting its ability to move with the traction of soft tissue attachments. It was believed by Sever that fractures within the growth plate were the source of the discomfort. When looking at a growth plate that has started to close it can appear to be fragmented into 2 or 3 pieces. It has since been proven that this is the normal appearance of a closing growth plate.

Causes

The actual pathology of the condition is one of more of an overuse syndrome in which the growth plate of the heel may become slightly displaced, causing pain. Biopsies of similar conditions have shown changes consistent with separation of the cartilage. The cause of Sever’s disease is not entirely clear. It is most likely due to overuse or repeated minor trauma that happens in a lot of sporting activities – the cartilage join between the two parts of the bone can not take all the shear stress of the activities. Some children seem to be just more prone to it for an unknown reason, combine this with sport, especially if its on a hard surface and the risk of getting it increases. A pronated foot and tight calf muscles are common contributing factors. The condition is very similar to Osgood-Schlatters Disease which occurs at the knee.

Symptoms

Pain in the lower calf and heel area which may be worse when applying pressure either side. Pain worse on activity especially those involving running or jumping. In severe cases this may cause the child to limp when walking. One or both heels affected.

Diagnosis

The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.

Non Surgical Treatment

First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 25 minutes three times a day. Your child should not go barefoot. If your child has severe heel pain, ibuprofen (Advil) will 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 five times each, two or three times a day. Each stretch should be held for 20 seconds. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, have your child stand facing a wall to stretch the calves and the heel cord. Place one foot a shoulder?s width in front of the other, both feet facing the wall. The front knee is bent and the back knee is straight during the calf stretch. Then have your child push against the wall and feel the stretch in his or her back leg. To stretch out the heel cord, have him or her stay in the same position and bend the back knee. Repeat three times. Practice this stretch twice daily.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.


What Are The Causes Of Heel Pain

Overview

Heel Pain

Heel pain is common and can be due to a number of conditions. The calcaneus (heel bone) is the largest bone in the foot and is the first to hit the ground when walking. The heel bone is designed to be the first contact the foot has with the ground. The achilles tendon inserts into the back of the heel bone (calcaneus) and a very strong ligament along the bottom of the foot attaches to the bottom of the heel bone (the plantar fascia). Several small muscles also attach to the heel bone above the insertion of the plantar fascia. Given the forces of walking that the heel bone is subjected to and the pull of all these ligaments and muscles, then it is not surprising that Heel Pain is so common.

Causes

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.

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

Depending on the condition, the cause of heel pain is diagnosed using a number of tests, including medical history, physical examination, including examination of joints and muscles of the foot and leg, X-rays.

Non Surgical Treatment

Most heel pain is caused by a combination of poor biomechanics, or muscle weakness or tightness. The good news is that heel pain can be effectively managed once the cause is identified. Most heel pain can be successfully treated via pain and pressure relief techniques, biomechanical correction eg orthotics, taping, foot posture exercises, muscle stretches and massage, lower limb muscle strengthening, proprioceptive and balance exercises to stimulate your foot intrinsic muscles. If you feel that your footwear or sports training schedule are potentially causing your heel pain, then we recommend that you seek the advice of a sports physiotherapist, podiatrist or trained footwear specialist (not just a shop assistant) to see if your shoe is a match for your foot; or discuss your training regime to see if you are doing too much. Heel pain and injury are extremely common. With accurate assessment and early treatment most heel pain injuries respond extremely quickly to physiotherapy allowing you to quickly resume pain-free and normal activities of daily living. Please ask you physiotherapist for their professional treatment advice.

Surgical Treatment

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.

Prevention

Foot Pain

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.


The Primary Causes And Treatment Plans Of Achilles Tendinitis

Overview

Achilles TendonitisAchilles tendon injuries are one of the most common overuse injuries in recreational sports. A very small percentage of these injuries are diagnosed and treated by doctors of chiropractic. What is especially interesting is that a high percentage of these injuries are caused by a posterior calcaneus subluxation.

Causes

Achilles tendinitis can be caused by overly tight calf muscles, excessive running up hill or down hill, a sudden increase in the amount of exercise, e.g. running for a longer distance, wearing ill-fitting running shoes, such as those with soles that are too stiff, or wearing high heels regularly, or changing between high heels all day and flat shoes or low running shoes in the evening. Overuse is common in walkers, runners, dancers and other athletes who do a lot of jumping and sudden starts/stops, which exert a lot of stress on the Achilles tendon. Continuing to stress an inflamed Achilles tendon can cause rupture of the tendon – it snaps, often with a distinctive popping sound. A ruptured Achilles tendon makes it virtually impossible to walk. An Achilles tendon rupture is usually treated by surgical repair or wearing a cast.

Symptoms

There are several types of Achilles tendinitis symptoms, but all of them are closely related. People who suffer from Achilles tendon pain typically have swelling in the Achilles tendon, and that pain can be chronic as the microscopic tears in the area become more prevalent over time. The most intense pain is typically located just a few centimeters above the area where the tendon meets the heel. This area is called the watershed zone, and the amount of blood moving through it is what gives it the highest potential for injury, especially for athletes. Most of the Achilles tendinitis symptoms in people with the condition will happen immediately after they have been inactive for a fairly significant amount of time. That means that the most pain will generally be felt after sitting or lying down for an extended period, or right after waking up in the morning and getting moving. If you aren?t positive that you are suffering specifically from Achilles tendinitis symptoms, consult a doctor to make sure.

Diagnosis

There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.

Nonsurgical Treatment

The aim of the treatment is to reduce strain on the tendon and reduce inflammation. Strain may be reduced by, avoiding or severely limiting activities that may aggravate the condition, such as running, using shoe inserts (orthoses) to take pressure off the tendon as it heals. In cases of flat or hyperpronated feet, your doctor or podiatrist may recommend long-term use of orthoses. I8nflammation may be reduced by, applying icepacks for 20 minutes per hour during the acute stage, taking non-steroidal anti-inflammatory drugs, placing the foot in a cast or restrictive ankle-boot to minimise movement and give the tendon time to heal. This may be recommended in severe cases and used for about eight weeks. Occasionally depot (slowly absorbed) steroid injections may be tried, particularly for peri-tendinitis, but great care needs to be taken to avoid injecting into the tendon. This should only be done by a specialist doctor. You may also be given specific exercises to gently stretch the calf muscles once the acute stage of inflammation has settled down. Your doctor or physiotherapist will recommend these exercises when you are on the road to recovery. Recovery is often slow and will depend on the severity of the condition and how carefully you follow the treatment and care instructions you are given.

Achilles Tendonitis

Surgical Treatment

Surgery can be done to remove hardened fibrous tissue and repair any small tendon tears as a result of repetitive use injuries. This approach can also be used to help prevent an Achilles tendon rupture. If your Achilles tendon has already ruptured or torn, Achilles tendon surgery can be used to reattach the ends of the torn tendon. This approach is more thorough and definitive compared to non surgical treatment options discussed above. Surgical reattachment of the tendon also minimizes the change of re-rupturing the Achilles tendon.

Prevention

While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you’re just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don’t support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.


What May Cause Heel Pain And Ways To Treat It

Painful Heel

Overview

Plantar fasciitis is the most common cause of heel pain. The plantar fascia camera.gif is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk. Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.


Causes

Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arches of the feet, the presence of a leg length inequality, and flat feet. The tendency of flat feet to excessively roll inward during walking or running makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals who present with plantar fasciitis and is an independent risk factor. Studies have suggested a strong association exists between an increased body mass index and the development of plantar fasciitis. Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors.


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

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose plantar fasciitis. Occasionally, further investigations such as an X-ray, ultrasound or MRI may be required to assist with diagnosis and assess the severity of the condition.


Non Surgical Treatment

Treatment of heel pain caused by plantar fasciitis begins with simple steps. There are a number of options for treatment of plantar fasciitis, and almost always some focused effort with nonsurgical treatments can provide excellent relief. In rare circumstances, simple steps are not adequate at providing relief, and more invasive treatments may be recommended. Typically, patients progress from simple steps, and gradually more invasive treatments, and only rarely is surgery required.

Foot Pain


Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.


Stretching Exercises

Stretching exercises for your foot are important. Do the stretches shown here at least twice a day. Don’t bounce when you stretch. Plantar fascia stretch. To do the plantar fascia stretch, stand straight with your hands against a wall and your injured leg slightly behind your other leg. Keeping your heels flat on the floor, slowly bend both knees. You should feel the stretch in the lower part of your leg. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Calf stretch. Stand with your hands against a wall and your injured leg behind your other leg. With your injured leg straight, your heel flat on the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should feel the stretch in the middle of your calf. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Other exercises. You can also strengthen your leg muscles by standing on the ball of your foot at the edge of a step and raising up as high as possible on your toes. Relax between toe raises and let your heel fall a little lower than the edge of the step. It’s also helpful to strengthen the foot by grabbing a towel with your toes as if you are going to pick up the towel with your foot. Repeat this exercise several times a day.


What Leads To Pain At The Heel To Flare Up

Heel Pain

Overview

Plantar fasciitis is one of the most common sources of heel pain. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflammed it is known as plantar fasciitis.


Causes

Plantar fasciitis is caused by drastic or sudden increases in mileage, poor foot structure, and inappropriate running shoes, which can overload the plantar fascia, the connective tissue that runs from the heel to the base of the toes. The plantar fascia may look like a series of fat rubber bands, but it’s made of collagen, a rigid protein that’s not very stretchy. The stress of overuse, overpronation, or overused shoes can rip tiny tears in it, causing pain and inflammation, a.k.a. plantar fasciitis.


Symptoms

Plantar fasciitis which usually occurs on one foot at a time typically develops slowly. Some cases can be sudden and severe. If you suspect that you have plantar fasciitis, you should feel a sharp, stabbing heel pain, usually in the inside bottom part of the heel. The pain will likely be worse when you take the first steps after long periods of rest (especially after sleep). The pain may also worsen as you stand, climb stairs, or tiptoe. You typically will not feel a lot of pain during exercise, but will feel the ache after. In some cases, the affected heel may even swell.


Diagnosis

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose plantar fasciitis. Occasionally, further investigations such as an X-ray, ultrasound or MRI may be required to assist with diagnosis and assess the severity of the condition.


Non Surgical Treatment

Treatment for heel pain usually involves using a combination of techniques, such as stretches and painkillers, to relieve pain and speed up recovery. Most cases of heel pain get better within 12 months. Surgery may be recommended as a last resort if your symptoms don’t improve after this time. Only 1 in 20 people with heel pain will need surgery. Whenever possible, rest the affected foot by not walking long distances and standing for long periods. However, you should regularly stretch your feet and calves using exercises such as those described below. Pain relief. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to help relieve pain. Some people also find applying an ice pack to the affected heel for 5-10 minutes can help relieve pain and inflammation. However, do not apply an ice pack directly to your skin. Instead, wrap it in a towel. If you do not have an ice pack, you can use a packet of frozen vegetables.


Surgical Treatment

If you consider surgery, your original diagnosis should be confirmed by the surgeon first. In addition, supporting diagnostic evidence (such as nerve-conduction studies) should be gathered to rule out nerve entrapment, particularly of the first branch of the lateral plantar nerve and the medial plantar nerve. Blood tests should consist of an erythrocyte sedimentation rate (ESR), rheumatoid factor, human leukocyte antigen B27 (HLA-B27), and uric acid. It’s important to understand that surgical treatment of bone spurs rarely improves plantar fasciitis pain. And surgery for plantar fasciitis can cause secondary complications-a troubling condition known as lateral column syndrome.


Stretching Exercises

Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch. Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.