Tawanda Phuma

The Foot Ailments Database

The Diagnosis Of Posterior Calcaneal Spur

Posterior Calcaneal Spur

Overview

A heel spur is a bony growth at the underside of the heel bone. The underlying cause of heel spurs is a common condition called ?Plantar Fasciitis?. This is Latin for inflammation of the plantar fascia. This tendon forms the arch of the foot, starting at the heel and running to the ball of the foot. Plantar Fasciitis is a persistent and painful condition. Interestingly, in some people a heel spur has been present for a long time, but no pain is felt for years until one day the pain suddenly appears ?out of nothing?.

Causes

Heel Spurs develop when the plantar fascia is excessively and repetitively pulled away from the heel bone. In many cases, a heel spur can develop along with plantar fasciitis, but can also occur by itself. Heel spurs often develop in middle-aged patients, but can also occur in younger people as well. Athletes are especially prone to heel spur due to the regular stress on their heels.

Inferior Calcaneal Spur

Symptoms

Heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain. Your heel pain may be worse in the morning when you first wake up or during certain activities.

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

Acupuncture and acupressure can used to address the pain of heel spurs, in addition to using friction massage to help break up scar tissue and delay the onset of bony formations. Physical therapy may help relieve pain and improve movement. The Feldenkrais method could be especially helpful for retraining some of the compensation movements caused by the pain from the spur. Guided imagery or a light massage on the foot may help to relieve some of the pain. Other treatments include low-gear cycling, and pool running. Some chiropractors approve of moderate use of aspirin or ibuprofen, or other appropriate anti-inflammatory drugs. Chiropractic manipulation is not recommended, although chiropractors may offer custom-fitted shoe orthotics and other allopathic-type treatments.

Surgical Treatment

In some cases, heel spurs are removed by surgery after an X-ray. While the surgery is typically effective, it?s a timely and expensive procedure. Even after surgery, heel spurs can re-form if the patient continues the lifestyle that led to the problem. These reasons are why most people who develop painful heel spurs begin looking for natural remedies for joint and bone pain. Surgery isn?t required to cure a heel spur. In fact, more than 90 percent of people get better with nonsurgical treatments. If nonsurgical methods fail to treat symptoms of heel spurs after 12 months, surgery may be necessary to alleviate pain and restore mobility.

Bursitis Of The Foot Remedy

Overview

Achilles bursitis is one of those injuries that can really bring down the quality of your life. Anyone, young or old, can suffer from this injury, and if you're active this condition will keep you from doing the things you love to do. It will even start interrupting any of your normal daily tasks and make living life harder than it really needs to be. Fortunately for you, professional athletes have had access to state of the art treatment therapies for years that allow them to heal more quickly and completely than you or I. This is why athletes that have a serious heel bursitis injury can often get back in the game in a matter of weeks while you could suffer for months or even years (in chronic cases).

Causes

Inflammation of the bursa causes synovial cells to multiply and thereby increases collagen formation and fluid production. A more permeable capillary membrane allows entrance of high protein fluid. The bursal lining may be replaced by granulation tissue followed by fibrous tissue. The bursa becomes filled with fluid, which is often rich in fibrin, and the fluid can become hemorrhagic. One study suggests that this process may be mediated by cytokines, metalloproteases, and cyclooxygenases.

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

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

Most patients with achilles and retrocalcaneal bursitis heal well with appropriate physiotherapy and other usual bursitis conventional and natural cures being administered. Specific treatments for ankle / heel bursitis may include footwear correction. Get well-fitting, soft-backed (or even open-backed whenever possible) shoes for both day to day wear and exercise. High-heels should really be a no no or worn sparingly, ladies. Heel protectors. Heel pads and heel lifts are great simple solutions to cushion and protect the Achilles area from the irritation of the shoes. Orthotics. There are various orthotic devices out there (some only available over-the-counter). One example is a custom arch suppport. These can control abnormal motion in your feet by lining them up correctly in your shoes to help you move in the right matter so the bursitis heals faster and does not return back again. Exercise modification Stretch your heel, mainly Achilles tendon, frequently, particularly before and after excercise or prolonged sitting. If you are a jogger, try to run on softer surfaces (no hard concrete, please). Running uphill training is best to be avoided by Achilles and retrocalcaneal bursitis sufferers.

Surgical Treatment

Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.

Prevention

Protect that part of the body that may be most vulnerable, If you have to kneel a lot, get some knee pads. Elbow braces can protect tennis and golf players. If you are an athlete or avid walker, invest in some good walking or running shoes. When doing repetitive tasks have breaks. Apart from taking regular breaks, try varying your movements so that you are using different parts of your body. Warm up before exercise. Before any type of vigorous exercise you should warm up for at least 5 to 10 minutes. The warm up could include walking at a good speed, slow jogging, or a cycling machine. Strong muscles add extra protection to the area. If you strengthen the muscles in the area where you had bursitis (after you are better), especially the area around the joint, you will have extra protection from injury. Make sure you do this well after your bursitis has gone completely.

Natural Hammer Toe Treatment

Hammer ToeOverview

A hammertoe is a toe that's curled due to a bend in the middle joint of a toe. Mallet toe is similar, but affects the upper joint of a toe. Otherwise, any differences between hammertoes and mallet toe are subtle. Both hammertoe and mallet toe are commonly caused by shoes that are too Hammer toes short or heels that are too high. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a hammer-like or claw-like appearance. Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you may need surgery to experience relief.

Causes

Essentially, hammertoes are caused by an abnormal interworking of the bones, muscles, ligaments and tendons that comprise your feet. When muscles fail to work in a balanced manner, the toe joints can bend to form the hammertoe shape. If they remain in this position for an extended period, the muscles and tendons supporting them tighten and remain in that position. A common factor in development of hammertoe is wearing shoes that squeeze the toes or high heels that jam the toes into the front of the shoe. Most likely due to these factors, hammertoe occurs much more frequently in women than in men.

Hammer ToeSymptoms

Some people never have troubles with hammer toes. In fact, some people don't even know they have them. They can become uncomfortable, especially while wearing shoes. Many people who develop symptoms with hammer toes will develop corns, blisters and pain on the top of the toe, where it rubs against the shoe or between the toes, where it rubs against the adjacent toe. You can also develop calluses on the balls of the feet, as well as cramping, aching and an overall fatigue in the foot and leg.

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.

Non Surgical Treatment

Hammertoes that are not painful (asymptomatic) and still flexible may not require treatment. In mild cases, open-toed, low-heeled, or wider shoes and foam or moleskin pads can provide symptomatic relief by reducing pressure. Taping (strapping) the affected toe can help to reduce deformity and pain. Physical therapy to instruct patients in exercises that passively stretch tight structures and strengthen weak foot intrinsic muscles is also helpful with mild cases. Periodic trimming (debridement) of corns (clavi, helomata) by a podiatrist can provide temporary relief. Corticosteroid injections are often very effective in reducing pain.

Surgical Treatment

Surgical correction is needed to bring the toe into a corrected position and increase its function. Correction of the hammer toes is a simple outpatient surgery, with limited downtime. The best option is to fuse the deformed and contracted toe into a straight position. This limits the need for future surgery and deformity return. A new pin that absorbs in the bone or small screw is used by the Foot and Ankle Institute to avoid the need for a metal pin protruding from the toe during recovery. Although the absorbable pin is not for everyone, it is much more comfortable than the pin protruding from the end of the toe. In certain cases, a removal of a small area of bone in the deformity area will decrease pain and limit the need for a surgical waiting period that is found with fusions. Although the toe is not as stable as with a fusion, in certain cases, an arthroplasty is the best option.

Hammer ToePrevention

In some cases foot problems may present at birth, many foot problems such as hammer toes can be prevented. Hammer toe prevention can be a simple process, such as, checking your feet regularly and wearing the right shoes for your feet. Good circulation is also an essential part of foot health and hammer toe prevention. Taking a warm foot bath or giving yourself a foot massage are great ways of keeping your feet healthy.

How To Help Hammer Toe Pain

Hammer ToeOverview

Hammertoes are quite common and may range from mild to severe. A hammertoe is a contracture, or bending, of one or more toes, usually due to an imbalance between the muscles or tendons on the top and bottom of the toes. Over time, the affected toes lose flexibility, becoming rigid and fixed in a contracted position. The abnormal bend positions the knuckle of the toe upward, causing it to push against the top of the shoe leading to additional problems. The condition usually becomes progressively worse if not treated.

Causes

Flat feet can result in hammertoes, this is due to poor mechanics off the foot. High arched feet can also result in buckling toes. A major cause is in hereditary, all the toe conditions mentioned could be acquired due in hereditary factors. Bunions are a major cause of hammertoes. Claw toes are usually the result of a shoe that is too short. For many people, the second toe is actually longer than the great toe, and if shoes are sized to fit the great toe, the second (and maybe even the third toe) will have to bend to fit into the shoe. Shoes that hammertoes are pointed make matters even worse. Combine pointed shoes with high heels, the foot is under similar pressure as if it was constantly being pushed downhill into a wall. Rheumatoid arthritis can also lead to bunions, which in turn can lead to hammer toes.

HammertoeSymptoms

Common reasons patients seek treatment for toe problems are toe pain on the knuckle. Thick toe calluses. Interference with walking/activities. Difficulty fitting shoes. Worsening toe deformity. Pain at the ball of the foot. Unsightly appearance. Toe deformities (contractures) come in varying degrees of severity, from slight to severe. The can be present in conjunction with a bunion, and develop onto a severe disfiguring foot deformity. Advanced cases, the toe can dislocate on top of the foot. Depending on your overall health, symptoms and severity of the hammer toe, the condition may be treated conservatively and/or with surgery.

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.

Non Surgical Treatment

Wearing proper footwear may ease your foot pain. Low-heeled shoes with a deep toe box and flexible material covering the toes may help. Make sure there's a half-inch of space between your longest toe and the inside tip of your shoe. Allowing adequate space for your toes will help relieve pressure and pain. Avoid over-the-counter corn-removal products, many of which contain acid that can cause severe skin irritation. It's also risky to try shaving or cutting an unsightly corn off your toe. Foot wounds can easily get infected, and foot infections are often difficult to treat, especially if you have diabetes or poor circulation.

Surgical Treatment

Any surgery must be carefully considered and approached in a serious manner, as any procedure is serious for the patient. But in most cases the procedure is relatively straight forward. The surgery can be done using local anesthetic and does not require hospitalization. The patient goes home in a special post-operative shoe or a regular sandal, and in most cases can walk immediately. That's not to say that the patient is walking or functioning normally immediately after the procedure. The patient must take some time off work to rest the foot and allow it to heal.

Bunions Causes And Prevention

Overview
Bunion Pain The term hallux valgus actually describes what happens to the big toe. Hallux is the medical term for big toe, and valgus is an anatomic term that means the deformity goes in a direction away from the midline of the body. So in hallux valgus the big toe begins to point towards the outside of the foot. As this condition worsens, other changes occur in the foot that increase the problem. One of those changes is that the bone just above the big toe, the first metatarsal, usually develops too much of an angle in the other direction. This condition is called metatarsus primus varus. Metatarsus primus means first metatarsal, and varus is the medical term that means the deformity goes in a direction towards the midline of the body. This creates a situation where the first metatarsal and the big toe now form an angle with the point sticking out at the inside edge of the ball of the foot. The bunion that develops is actually a response to the pressure from the shoe on the point of this angle. At first the bump is made up of irritated, swollen tissue that is constantly caught between the shoe and the bone beneath the skin. As time goes on, the constant pressure may cause the bone to thicken as well, creating an even larger lump to rub against the shoe.

Causes
Bunions are a result of complex biomechanical changes that occur in your feet. The type of footwear that you wear does cause bunions. We know that foot bunions occur in about 30% of the population of most Western countries but only 3% in Eastern countries. They are seen most commonly in women and become more common as people get older. Tight-fitting shoes are thought to be the main cause of bunions.. Shoes such as high heels and shoes with tight toe boxes (eg womens fashion shoes and cowboy boots) are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box. The slope causes the front of the foot to bear your weight, which encourages your forefoot to widen. Also, the angle pushes your toes into the narrow toe box, causing the toes to become angled and squeezed together.

Symptoms
Patients with bunions will often display pain over the prominent bump on the inside of their forefoot (the medial eminence?). However, they may also have pain under the ball of the foot (under the area near the base of the second toe). Symptoms can vary in severity from none at all to severe discomfort aggravated by standing and walking. There is no direct correlation between the size of the bunion and the patient?s symptoms. Some patients with severe bunion deformities have minimal symptoms, while patients with mild bunion deformities may have significant symptoms. Symptoms are often exacerbated by restrictive shoe wear, particularly shoes with a narrow toe box or an uncomfortable, stiff, restraining upper.

Diagnosis
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.

Non Surgical Treatment
Wearing good footwear does not cure the deformity but may ease symptoms of pain and discomfort. Ideally, get footwear advice from a person qualified to diagnose and treat foot disorders (podiatrist - previously called a chiropodist). Advice may include wear shoes, trainers or slippers that fit well and are roomy. Don't wear high-heeled, pointed or tight shoes. You might find that shoes with laces or straps are best, as they can be adjusted to the width of your foot. Padding over the bunion may help, as may ice packs. Devices which help to straighten the toe (orthoses) are still occasionally recommended, although trials investigating their use have not found them much better than no treatment at all. Painkillers such as paracetamol or ibuprofen may ease any pain. If the bunion (hallux valgus) develops as part of an arthritis then other medication may be advised. A course of antibiotics may be needed if the skin and tissues over the deformity become infected. Bunion Pain

Surgical Treatment
The most simple procedure is reducing the bump, and while there will be a little pain and swelling afterwards and your mobility will be restricted, the recovery time is short (ie a few weeks), but it may not fix the underlying cause. More serious ops might involve lasers, robots, cutting bone in the foot and trying to reposition it, and/or inserting pins or wires. It can take months to recover fully and you might need a cast. Mike O?Neill recommends seeking an NHS consultant surgeon who specialises in bunion removal to ensure the best possible outcome. The type of anaesthetic, local or general, will depend on the procedure, but most are day cases and the surgery will take from less than 30 minutes to a couple of hours. Waiting times vary but from your first outpatient appointment to the op would be a minimum of a few months. Private treatment (preferably by an NHS consultant surgeon) is likely to cost thousands of pounds. A new less, invasive procedure called surgical correction of hallux valgus that makes a small incision in the bone has recently been approved for use in the NHS but there is still no conclusive evidence on how effective it is and it is not widely available.

Prevention
To minimize the chance of developing bunions, never force your feet into shoes that don?t fit. Choose a shoe that conforms to the shape of your foot. Opt for shoes with wider insteps, broad toes, and soft soles. Shoes that are short, tight, or sharply pointed should be avoided.

What Does Over-Pronation Of The Foot Mean

Overview

One of the most common causes of foot and leg discomfort is a condition known as overpronation. Normal pronation, or "turning inward" of the foot is necessary as the foot adapts to the ground. With over pronation, the arch flattens, collapses, and soft tissues stretch. This causes the joint surfaces to function at unnatural angles to each other. When this happens, joints that should be stable now become very loose and flexible. At first, over pronation may cause fatigue. As the problem gets worse, strain on the muscles, tendons, and ligaments of the foot and lower leg can cause permanent problems and deformities.Over Pronation

Causes

There has been some speculation as to whether arch height has an effect on pronation. After conducting a study at the Rose-Hulman Institute of Technology, Maggie Boozer suggests that people with higher arches tend to pronate to a greater degree. However, the generally accepted view by professionals is that the most pronation is present in those with lower arch heights. To complicate matters, one study done by Hylton Menz at the University of Western Sydney-Macarthur suggests that the methods for measuring arch height and determining whether someone is ?flat-footed? or ?high-arched? are unreliable. He says, ?For this reason, studies investigating the relationship between static arch height motion of the rearfoot have consistently found that such a classification system is a poor predictor of dynamic rearfoot function.

Symptoms

Symptoms can manifest in many different ways. The associated conditions depend on the individual lifestyle of each patient. Here is a list of some of the conditions associated with Over Pronation. Hallux Abducto Valgus (bunions). Hallux Rigidus (stiff 1st toe). Arch Pain. Heel Pain (plantar fascitis). Metatarsalgia (ball of the foot pain). Ankle sprains. Shin Splints. Achilles Tendonitis. Osteochondrosis. Knee Pain. Corns & Calluses. Flat Feet. Hammer Toes.

Diagnosis

If you cannot afford to get a proper gait analysis completed, having someone observe you on a treadmill from behind will give you an idea if you are an overpronator. It is possible to tell without observing directly whether you are likely to be an overpronator by looking at your foot arches. Check your foot arch height by standing in water and then on a wet floor or piece of paper which will show your footprint. If your footprints show little to no narrowing in the middle, then you have flat feet or fallen arches. This makes it highly likely that you will overpronate to some degree when running. If you have low or fallen arches, you should get your gait checked to see how much you overpronate, and whether you need to take steps to reduce the level to which you overpronate. Another good test is to have a look at the wear pattern on an old pair of trainers. Overpronators will wear out the outside of the heel and the inside of the toe more quickly than other parts of the shoe. If the wear is quite even, you are likely to have a neutral running gait. Wear primarily down the outside edge means that you are a supinator. When you replace your running shoes you may benefit from shoes for overpronation. Motion control or stability running shoes are usually the best bet to deal with overpronation.Over Pronation

Non Surgical Treatment

Mild cases of Overpronation may be controlled or corrected with a supportive shoe that offers medial support to the foot along with a strong heel counter to control excessive motion at the heel starting with heel strike. In mild cases with no abnormal mechanical pressures, an over the counter orthotic with heel cup and longitudinal or medial arch support to keep the foot from progressing past neutral may help to realign the foot. A Custom foot orthotic with heel cup and longitudinal arch support to help correct position of the foot as it moves through motion. Heel wedges may also assist in correcting motion.

Prevention

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

Diagnosing Severs Disease

Overview

Sever?s disease, also known as calcaneal apophysitis, is an inflammation of the heel?s growth plate. It is commonly seen in active children between the ages of 8 and 15 years. These children present with pain when walking, running and jumping. Observable inflammation may or may not be present and parents may often notice their child limping or favouring a limb during or after sports.

Causes

A child is most at risk for this condition when he or she is in the early part of the growth spurt in early puberty. Sever?s disease is most common in physically active girls eight to ten years old and in physically active boys ten to twelve years old. Soccer players and gymnasts often get Sever?s disease, but children who do any running or jumping activity may be affected. Sever?s disease rarely occurs in older teenagers, because the back of the heel has finished growing by the age of fifteen.

Symptoms

Symptoms of calcaneal apophysitis may include Pain in the back or bottom of the heel, Limping, Walking on toes, Difficulty running, jumping, or participating in usual activities or sports, Pain when the sides of the heel are squeezed.

Diagnosis

Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.

Non Surgical Treatment

Sever?s disease treatment should be based on eliminating pain and restoring normal foot and leg biomechanics. As with most soft tissue injuries the initial treatment is Rest, Ice, and Protect. In the early phase you?ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking activities. "No Pain. No Gain." does not apply in Sever's disease. If it hurts your child is doing too much exercise. Your child should reduce or cease any activity that causes heel pain. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Most children can tolerate paracetamol as a pain reducing medication. Check with your doctor. To support and protect your heels, you may need to be wear shock absorbing heel cups or a soft orthotic. Kinesio foot taping may help to provide pain relief.

Prevention

To prevent Sever's Disease, fit your child with kid's shoes with good cushioning in the footbed, shock absorption in the heel, and support in the outsole. Make sure children wear supportive shoes, especially when they're running and jumping, to reduce the impact on the heel and strain on the developing bone and muscle structure of a kids' feet. Children's arch supports and heel cups comfortably support the foot and encourage healthy alignment while your child runs or walks.