Mortons Neuroma Diagnosis

Uncategorized

Overview

intermetatarsal neuromaMorton’s neuroma, also called Morton’s metatarsalgia, Morton’s disease, Morton’s neuralgia, Morton metatarsalgia, Morton nerve entrapment, plantar neuroma, or intermetatarsal neuroma is a benign (non-cancerous) growth of nerve tissue (neuroma) that develops in the foot, usually between the third and fourth toes (an intermetatarsal plantar nerve, most commonly of the third and fourth intermetatarsal spaces). It is a common, painful condition.

Causes

Some say that this condition should not be called Morton’s neuroma as, in fact, it is not actually a neuroma. A neuroma is a non-cancerous (benign) tumour that grows from the fibrous coverings of a nerve. There is no tumour formation in Morton’s neuroma. The anatomy of the bones of the foot is also thought to contribute to the development of Morton’s neuroma. For example, the space between the long bones (metatarsals) in the foot is narrower between the second and third, and between the third and fourth metatarsals. This means that the nerves that run between these metatarsals are more likely to be compressed and irritated. Wearing narrow shoes can make this compression worse.

Symptoms

Neuroma pain is classically described as a burning pain in the forefoot. It can also be felt as an aching or shooting pain in the forefoot. Patients with this problem frequently say they feel like they want to take off their shoes and rub their foot. This pain may occur in the middle of a run or at the end of a long run. If your shoes are quite tight or the neuroma is very large, the pain may be present even when walking. Occasionally a sensation of numbness is felt in addition to the pain or even before the pain appears.

Diagnosis

The exact cause of Mortons neuroma can often vary between patients. An accurate diagnosis must be carefully made by the podiatrist through thorough history taking and direct questioning to ensure all possible causes are addressed. The podiatrist will also gather further information about the cause through a hands on assessment where they will try to reproduce your symptoms. A biomechanical and gait analysis will also be performed to assess whether poor foot alignment and function has contributed to your neuroma.

Non Surgical Treatment

In most cases, initial treatment for this condition consists of padding and taping to disperse weight away from the neuroma. If the patient has flatfeet, an arch support is incorporated into footwear. The patient is instructed to wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered. The patient is advised to return in a week or 2 to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient’s foot and the type of shoes the patient wears. It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position. Another type of therapy that may be used is alcohol sclerosing injections. In this treatment, the doctor injects a small amount of alcohol in the area of the neuroma area to help harden (sclerose) the nerve and relieve the pain. Injections are given every 7-10 days and, in many cases, 4-7 injections are needed for maximum relief. Please ask your physician for more information regarding this type of treatment.Morton neuroma

Surgical Treatment

If conservative treatment does not relieve your symptoms, your orthopaedic surgeon may discuss surgical treatment options with you. Surgery can resect a small portion of the nerve or release the tissue around the nerve, and generally involves a short recovery period.

Prevention

How can Morton?s neuroma be prevented? Do not wear tight shoes or high-heeled shoes for prolonged periods. Do wear shoes with a wide toe box so that your toes are not squeezed or cramped. Do wear athletic footwear with enough padding to cushion the balls of the feet when exercising or participating in sports.

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Podiatrists Choose Shoe Lifts For Leg Length Discrepancy

Shoe Lifts

There are two different types of leg length discrepancies, congenital and acquired. Congenital means that you are born with it. One leg is structurally shorter than the other. Through developmental periods of aging, the brain senses the walking pattern and identifies some variance. The body usually adapts by tilting one shoulder to the “short” side. A difference of less than a quarter inch isn’t really uncommon, require Shoe Lifts to compensate and ordinarily does not have a profound effect over a lifetime.

Shoe Lifts

Leg length inequality goes largely undiscovered on a daily basis, yet this problem is easily corrected, and can eradicate many incidents of back pain.

Therapy for leg length inequality commonly involves Shoe Lifts. These are generally cost-effective, typically priced at under twenty dollars, in comparison to a custom orthotic of $200 or maybe more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Back ache is the most prevalent health problem afflicting men and women today. Around 80 million people are afflicted by back pain at some point in their life. It’s a problem which costs businesses vast amounts of money annually due to time lost and productivity. Fresh and superior treatment methods are always sought after in the hope of lowering economic influence this issue causes.

Leg Length Discrepancy Shoe Lift

People from all corners of the world experience foot ache due to leg length discrepancy. In these types of cases Shoe Lifts might be of very useful. The lifts are capable of eliminating any pain and discomfort in the feet. Shoe Lifts are recommended by many certified orthopaedic orthopedists.

In order to support the body in a healthy and balanced manner, your feet have a very important function to play. Inspite of that, it can be the most overlooked area in the body. Many people have flat-feet meaning there is unequal force exerted on the feet. This causes other areas of the body such as knees, ankles and backs to be impacted too. Shoe Lifts guarantee that proper posture and balance are restored.

The Best Ways To Spot Heel Spur

Calcaneal Spur, Heel Spur, Inferior Calcaneal Spur, Posterior Calcaneal Spur

Heel Spur

Overview

Bone spurs usually form around joints that have arthritis, in the vertebrae of the spine, and on the heel. When they form on the heel, they may form on the back of the heel but usually form on the bottom of the heel. Of course, this is where all of the body weight comes down with each step. Spurs on the bottom of the heel are usually most painful the first few steps out of bed each morning. The pain may lessen somewhat after walking for a few minutes, but may be intense again after sitting for a half hour or so, such as after lunch. The pain usually gets worse throughout the day as you are up on your feet more. Often the pain feels like a nail being driven through the heel into the ankle and leg.

Causes

The plantar fascia is a thick, ligamentous connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. That’s why tremendous stress is placed on the plantar fascia.

Inferior Calcaneal Spur

Symptoms

The vast majority of people who have heel spurs feel the asscociated pain during their first steps in the morning. The pain is quite intense and felt either the bottom or front of the heel bone. Typically, the sharp pain diminishes after being up for a while but continues as a dull ache. The pain characteristically returns when first standing up after sitting for long periods.

Diagnosis

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

Non Surgical Treatment

Only in rare cases do the symptoms of heel spurs fail to be resolved through conservative treatment. Conservative treatment, although not 100% effective, is successful in most cases and should be given ample time to work. In many cases, conservative methods should be utilized as long as a year depending on the rate at which your body responds to the treatment. When treatment is unsuccessful, surgery may be considered. A common surgical procedure for this condition is plantar fascia release surgery. In this procedure, the tension of the plantar fascia ligament is released, lessening tension in the heel and helping to prevent damage.

Surgical Treatment

In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.

Prevention

The best way to prevent heel spurs is by wearing properly fitted footwear. Shoes should have a shock absorbing tread and soles and should be effective in supporting the heel and arch. Proper warm up and stretching before embarking on any physical activity that will put pressure or impact on the area is highly recommended. Also, just as it?s important for your general health, if you can lose some extra pounds, you will be more likely to avoid heel spurs. If you are starting to feel the onset of pain, it may not be heel spurs, but could be a tendonitis condition that could lead to heel spurs.

How You Can Protect Against Posterior Calcaneal Spur

Calcaneal Spur, Heel Spur, Posterior Calcaneal Spur

Inferior Calcaneal Spur

Overview

A heel spur is a painful condition that is caused by the accumulation of excessive calcium under the heel of the foot. The heel bone is made up of a large structure called the calcaneus, which is connected to the bottom of the foot by durable connective tissue called fascia. If the layers of connective tissue become damaged or begin to degenerate due to wear and tear, plantar fasciitis may develop. This causes calcification, which refers to the abnormal buildup of calcium on the heel bone. As the calcium continues to accumulate, a calcified protrusion called a spur may become visible on an X-ray.

Causes

Bone spurs can occur all over the body including the spine, shoulders, hands, hips and feet. The feet are a common place to find them. A heel spur happens when the body tries to mend itself. Building extra bone is one way your body tries to correct a weakness. Wearing shoes that are too tight in the heel can cause bone spurs. More women than men get heel spurs because of the kinds of shoes they wear. Athletes who stress their feet and legs routinely are also prone to heel spurs. Being overweight can also indirectly cause heel spurs by over-exerting the plantar fascia. Some heel spurs are caused by the aging process, in which the cartilage covering the ends of bones wears away. This process can lead to pain, swelling and spur formation. Stress-related problems with the plantar fascia frequently lead to heel spurs.

Calcaneal Spur

Symptoms

If your body has created calcium build-ups in an effort to support your plantar fascia ligament, each time you step down with your foot, the heel spur is being driven into the soft, fatty tissue which lines the bottom of your heel. Heel spur sufferers experience stabbing sensations because the hard protrusion is literally being jabbed into the heel pad. If left untreated, Plantar Fasciitis and heel spurs can erode the fatty pad of the heel and cause permanent damage to the foot. Fortunately, most cases can be resolved without medications or surgeries.

Diagnosis

Heel spurs and plantar fasciitis are diagnosed based on the history of pain and tenderness localized to these areas. They are specifically identified when there is point tenderness at the bottom of the heel, which makes it difficult to walk barefoot on tile or wood floors. X-ray examination of the foot is used to identify the bony prominence (spur) of the heel bone (calcaneus).

Non Surgical Treatment

The most important part of treatment is to rest. Do not undertake activities which hurt the foot or aggravate symptoms as will only cause painful symptoms to persist. Apply an ice pack regularly for 10 minutes at a time every hour initially to reduce pain and inflammation of the surrounding tissues. As symptoms subside frequency of application can reduce to 2 or 3 times per day. Exercises and stretches to keep the foot and ankle strong and mobile are important as long as pain allows. Stretching the plantar fascia is important, especially if symptoms are worse in the morning. A plantar fasciitis night splint is excellent for stretching and preventing the plantar fascia tightening up over night. Anti-Inflammatory medicine (e.g. ibuprofen) may be prescribed by a doctor but always check with a medical professional first as taking some medications such as ibuprofen should not be done if the patient has asthma. Shoe inserts can help to take the pressure off of the spur and reduce pain. If these treatments do not significantly ease the symptoms then surgery may be an option.

Surgical Treatment

When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide pain relief and restore mobility. The type of procedure used is based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. The procedure may also include removal of heel spurs.

Prevention

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.

Find Out How To Treat Bursitis Of The Foot?

Bursitis, Foot Pain

Overview

Retrocalcaneal Bursitis. This bursa is located at the back of the heel. Bursitis in this area is often associated with conditions such as ankylosing spondylitis or rheumatoid arthritis. It can occur in healthy individuals who wear improperly fitted shoes. Symptoms include painful swelling that develops at the back of the heel. Calcaneal Bursitis. This bursa is located at the sole or bottom of the heel. Inflammation usually produces pain in the heel when standing. Causes include heel spurs, excess weight, injury, and wearing improperly fitted shoes.

Causes

The most common causes of bursitis are injury or overuse, although infection may also be a cause. Bursitis is also associated with other causes, such as arthritis, gout, tendinitis, diabetes, and thyroid disease.

Symptoms

Patients with this condition typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone. Pain is typically experienced during activities requiring strong or repetitive calf contractions (often involving end of range ankle movements) such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially whilst wearing excessively tight shoes). Often pain may be worse with rest after these activities (especially that night or the following morning). The pain associated with this condition may ‘warm up’ with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles region.

Diagnosis

During the physical examination of a patient with calcaneal bursitis, the physician should keep the following considerations in mind. Swelling and redness of the posterior heel (the pump bump) may be clearly apparent. The inflamed area, which may be slightly warm to the touch, is generally tender to palpation. Careful examination can help the clinician to distinguish whether the inflammation is posterior to the Achilles tendon (within the subcutaneous calcaneal bursa) or anterior to the tendon (within the subtendinous calcaneal bursa). Differentiating Achilles tendinitis/tendinosis from bursitis may be impossible. At times, the 2 conditions co-exist. Isolated subtendinous calcaneal bursitis is characterized by tenderness that is best isolated by palpating just anterior to the medial and lateral edges of the distal Achilles tendon. Conversely, insertional Achilles tendinitis is notable for tenderness that is located slightly more distally, where the Achilles tendon inserts on the posterior calcaneus. A patient with plantar fasciitis has tenderness along the posterior aspect of the sole, but he/she should not have tenderness with palpation of the posterior heel or ankle. A patient with a complete avulsion or rupture of the Achilles tendon demonstrates a palpable defect in the tendon, weakness in plantarflexion, and a positive Thompson test on physical examination. During the Thompson test, the examiner squeezes the calf. The test is negative if this maneuver results in passive plantarflexion of the ankle, which would indicate that the Achilles tendon is at least partially intact.

Non Surgical Treatment

Rest and apply cold therapy or ice. Ice should not be applied directly to the skin as it may cause ice burns but wrap in a wet tea towel. Commercially available hot and cold packs are often more convenience than using ice. Taping the bursa with a donut shaped pad to take some of the pressure from footwear may help. A doctor may prescribe anti-inflammatory medication e.g. ibuprofen to reduce the pain and inflammation. Applying electrotherapy such as ultrasound may reduce inflammation and swelling. A steroid injection followed by 48 hours rest may be given for persistent cases. If the bursitis is particularly bad and does not respond to conservative treatment then surgery is also an option.

Surgical Treatment

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

Can Hammertoes Lead To Leg Ache

Hammertoe

Hammer ToeOverview

Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning as it should. A hammertoes occurs when the joint at the end of the toe cannot straighten. Excessive rubbing of the hammer toe against the top of the shoe can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe causing pressure and discomfort.

Causes

Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning as it should. A mallet toe occurs when the joint at the end of the toe cannot straighten. Excessive rubbing of the mallet toe against the top of the shoe can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe causing pressure and discomfort. Arthritis can also lead to many forefoot deformities including mallet toes. Mallet toes can cause extreme discomfort, and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.

Hammer ToeSymptoms

The most obvious sign of hammertoes are bent toes, other symptoms may include pain and stiffness during movement of the toe. Painful corns on the tops of the toe or toes from rubbing against the top of the shoe’s toe box. Painful calluses on the bottoms of the toe or toes. Pain on the bottom of the ball of the foot. Redness and swelling at the joints.

Diagnosis

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

Non Surgical Treatment

Orthotics are shoe inserts that can help correct mechanical foot-motion problems to correct pressure on your toe or toes and reduce pain. Changing shoes. You should seek out shoes that conform to the shape of your feet as much as possible and provide plenty of room in the toe box, ensuring that your toes are not pinched or squeezed. You should make sure that, while standing, there is a half inch of space for your longest toe at the end of each shoe. Make sure the ball of your foot fits comfortably in the widest part of the shoe. Feet normally swell during the course of the day, so shop for shoes at the end of the day, when your feet are at their largest. Don’t be vain about your shoe size, sizes vary by brand, so concentrate on making certain your shoes are comfortable. Remember that your two feet are very likely to be different sizes and fit your shoe size to the larger foot. Low-heel shoes. High heels shift all your body weight onto your toes, tremendously increasing the pressure on them and the joints associated with them. Instead, wear shoes with low (less than two inches) or flat heels that fit your foot comfortably.

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 Hammer toe time will vary from patient to patient, depending on the extent of the surgical repair and other conditions that may also be present.

Bunions Cause And Effect

Uncategorized

Overview
Bunions
A bunion is a painful deformity of the joint where the bones of the foot and the big toe meet. The enlargement of the bone and tissue around this joint is known as a bunion or hallux valgus. Symptoms of a bunion include a swollen bursal sac, a bony deformity on the side of the great toe joint, tender and swollen tissues surrounding the deformity, and displacement of the big toe, which may turn inward.

Causes
A bunion is more common in women than men due to women wearing tighter fitting shoes. This condition can cause a variety of different soft tissue and bony complaints which may result in severe pain.
SymptomsIt is unusual to have much bunion or hallux valgus pain when out of shoe wear or at rest. There are exceptions to this and in particular if symptoms have been ignored during the day and the bunion has become very painful during the day then some symptoms may be present at night. The pain from the region of the great toe at rest or at night is however more often a symptom of an arthritic big toe (hallux rigidus) rather than a straightforward bunion. To confuse matters these two conditions can sometimes coexist. Bunion or hallux valgus pain is most often present when walking in enclosed shoes. There may be little bunion pain in sandals or barefoot. It is unusual to have much bunion pain when not putting weight on the foot or at night. If there is bunion pain at rest or at night then there may also be arthritic change within the toe.

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

Non Surgical Treatment
Treatment options vary depending on the severity of your bunion and the amount of pain it causes you. Early treatment is best to decrease your risk of developing joint deformities. Conservative treatment Nonsurgical treatments that may relieve the pain and pressure of a bunion include changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes. Padding and taping. Your Podiatrist can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.(Obviously pending on footwear selection). Medications. Acetaminophen (Tylenol, others) can control the pain of a bunion. Your doctor may suggest nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), for relieving pain and reducing inflammation. Cortisone injections also can be helpful. But keep in mind that medications do not alleviate the actual cause of the pain. Physical therapy. The heating effect of ultrasound therapy or whirlpool baths can provide relief from the pain and inflammation of a bunion. Orthotics can help control abnormal movement of your foot, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people, though others may require prescription orthotics.
Bunion Pain

Surgical Treatment
This involves surgically correcting the deformity and can involve a variety of different methods. However, outcomes can be variable. This is very dependant of the amount of damage to the joint and the procedure used to correct it. Removal of the bunion is performed using different methods that are out of the scope of this article. Unfortunately, bunions can recur following surgery, and even if it surgery is successful, around 30% of patients still report existing difficulties.

Over-Pronation

Over-Pronation

Overview

The anatomy of a normal foot allows for both to occur at the same time. Approximately 30% of the population have a normal foot. The remainder of people either overpronate (95% of abnormal feet) or oversupinate (5% of abnormal feet). The important thing to know is that all feet pronate and supinate, but abnormal feet do one of these things too much or at the wrong time. When the foot overpronates or oversupinates, several foot ailments can develop.Over-Pronation

Causes

Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding additional stress to other parts of the foot. Therefore over-pronation can often lead to a case of Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions. There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. People with flat feet often do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.

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

Do the wet foot test. Get your feet wet and walk along a paved surface or sand and look at the footprints you leave. If you have neutral feet you will see a print of the heel with a thin strip connecting to your forefoot, but if you’re overpronating your foot print will look a bit like a giant blob with toes.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.

Prevention

Custom-made orthotics supports not only the arch as a whole, but also each individual bone and joint that forms the arch. It is not enough to use an over-the-counter arch support, as these generic devices will not provide the proper support to each specific structure of the arch and foot. Each pronated foot?s arch collapses differently and to different degrees. The only way to provide the support that you may need is with a custom-made device. This action of the custom-made orthotic will help to prevent heel spurs, plantar fasciitis, calluses, arch pain, and weakness of the entire foot.

Calcaneal Apophysitis The Facts

Severs Disease

Overview

Sever?s disease is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates in the heel. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 14 years of age. Sever?s disease will go away on its own when it is used less or when the bone is through growing, but it can recur (for example, at the start of a new sports season). Traditionally, the only known cure was for children to outgrow the condition, with recurrences happening an average of 18 months before this occurs.

Causes

Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel?s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable. Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

Symptoms

Pain is usually felt at the back and side of the heel bone. Sometimes there may be pain at the bottom of the heel. The pain is usually relieved when the child is not active and becomes painful with sport. Squeezing the sides of the heel bone is often painful. Running and jumping make the symptoms worse. One or both heels can be affected. In more severe cases, the child may be limping.

Diagnosis

Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a “squeeze test” and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include a decrease in ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.

Non Surgical Treatment

* Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.

* Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.

* Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).

* Anti-inflammatory creams: Also an effective management tool.

* Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.

* Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.

* Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.

* Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Recovery

This condition is self limiting – it will go away when the two parts of bony growth join together – this is natural. Unfortunately, Sever’s disease can be very painful and limit sport activity of the child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever’s disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join – usually around the age of 16 years. There are no known long term complications associated with Sever’s disease.

Heel Serious Pain All You Need To Understand Heel Soreness

Heel Pain

Overview

Foot Pain

Heel pain is a common symptom that has many possible causes. Although Heel Pain sometimes is caused by a systemic (body-wide) illness, such as rheumatoid arthritis or gout, it usually is a local condition that affects only the foot. The most common local causes of heel pain includePlantar fasciitis, Heel spur, Calcaneal apophysitis, Bursitis, Pump bump, Local bruises, Achilles tendonitis,Trapped nerve.

Causes

A sharp stabbing pain, like a nail going into the bottom of the heel when first stepping on the foot after getting out of bed or after sitting for period of time, is the most common description for plantar fasciitis or heel spur syndrome. Typically the pain eases off as the day goes on but it may not go away completely. A thick ligament that attaches to the bottom of the heel and runs the length of the foot to the toes can become inflamed and swollen at the attachment site. This tends to be an overuse type of injury where poor foot structure is involved; also, wearing of shoe gear that lacks adequate support (ie: worn out shoes, boots and flip-flops) and prolonged standing or walking are often implicated. A throbbing pain that gets worse as the day goes on and can be worse at night when laying in bed is most often associated with an irritated or entrapped nerve on the inside of the ankle or heel. This is similar to carpel tunnel syndrome in the wrist and hand. Approximately 7 / 10 patients with heel pain have a component of nerve entrapment as the cause of their heel pain. This is also one of the most common causes of chronic heel pain because it is often missed as a diagnosis. When nerve entrapment is considered to be a cause, painless neurosensory testing is performed with the Pressure Specified Sensory Device? (PSSD) at The Foot & Ankle Center, PC to determine the extent of compression. A less common cause of heel pain but a stress fracture is often considered in athletes, such as long distance runners, who have heel pain. Posterior Heel Pain (Retrocalcaneal) This is pain in the back of the heel that flares up when first starting an activity. It is often associated with a large bump that can be irritated by shoes. The Achilles tendon attaches to the back of the heel and, like on the bottom, this attachment site can often become inflamed; a spur may or may not be present. Another painful area is a sac of fluid (bursa) that sits between the tendon and bone to act as a cushion for the tendon. This bursa can become inflamed often leading to significant pain called retrocalcaneal bursitis.

Symptoms

Usually when a patient comes in they?ll explain that they have severe pain in the heel. It?s usually worse during the first step in the morning when they get out of bed. Many people say if they walk for a period of time, it gets a little bit better. But if they sit down and get back up, the pain will come back and it?s one of those intermittent come and go types of pain. Heel pain patients will say it feels like a toothache in the heel area or even into the arch area. A lot of times it will get better with rest and then it will just come right back. So it?s one of those nuisance type things that just never goes away. The following are common signs of heel pain and plantar fasciitis. Pain that is worse first thing in the morning. Pain that develops after heavy activity or exercise. Pain that occurs when standing up after sitting for a long period of time. Severe, toothache type of pain in the bottom of the heel.

Diagnosis

The diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. Pain can be referred to the heel and foot from other areas of the body such as the low back, hip, knee, and/or ankle. Special tests to challenge these areas are performed to help confirm the problem is truly coming from the plantar fascia. An X-ray may be ordered to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation. Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.

Non Surgical Treatment

Treatment for plantar fasciitis should be directed at resting the plantar fascia, providing support for the arch area and limiting pronation. This is often accomplished with the use of supportive strapping with athletic tape, arch supports and orthotics. Heel lifts may also be helpful. Anti-inflammatories, pills as well as cortisone injections, may be effective as an adjunctive treatment by speeding up the reduction of inflammation. However, if used alone, anti-inflammatories rarely lead to resolution of the condition. Stretching exercises, physical therapy and night splints may also be helpful. The majority of cases respond to non-surgical treatment although it may take several weeks to reach a comfortable level. In those cases that do not respond adequately to conservative measures, surgical release of the plantar fascia may be considered. However, a new non-surgical treatment called Extracorporeal Shockwave Therapy (ESWT) is now available as an option for recalcitrant plantar fasciitis. ESWT was approved by the FDA recently for the treatment of chronic heel pain. It has been in use for several years on thousands of patients in Europe and has been successfully used to restore patients with chronic plantar fasciitis to a normal, active lifestyle. ESWT is a non-invasive procedure that uses high intensity sound waves similar to what is routinely used to treat kidney stones. The treatment is usually performed in the office or in an outpatient surgical center. The procedure is performed under local anesthesia and takes about 25 minutes. The shockwaves are directed at the plantar fascia and stimulate an inflammatory healing response.

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

Pain On The Heel

Make sure you wear appropriate supportive shoes. Don’t over-train in sports. Make sure you warm up, cool down and undertake an exercise regime that helps maintain flexibility. Manage your weight, obesity is a factor in causing plantar fasciitis. Avoid walking and running on hard surfaces if you are prone to pain. You should follow the recognized management protocol “RICED” rest, ice, compression, elevation and diagnosis. Rest, keep off the injured ankle as much as possible. Ice, applied for 20 minutes at a time every hour as long as swelling persists. Compression, support the ankle and foot with a firmly (not tightly) wrapped elastic bandage. Elevation, keep foot above heart level to minimize bruising and swelling. Diagnosis. Consult a medical professional (such as a Podiatrist or doctor) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment. An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.