Iola Wetz
Time is a drug. Too much of it kills you.


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Iola Wetz

Author:Iola Wetz
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Preventing Inferior Calcaneal Spur
Posterior Calcaneal Spur


Overview


A heel spur is a buildup of calcium or a bone hook on the heel bone. This is typically the source of most heel pain. It usually takes an X-ray to see the heel spur protruding from the heel. Without proper heel spur treatment, a heel spur cause inflammation and lead to other ailments like plantar fasciitis and Achilles tendonitis. It is important to be examined by an orthopedic specialist.


Causes


The pain caused by heel spurs can be a sharp, stabbing pain when using the foot after a long period of rest. Sometimes it then reduces to a dull throb that can worsen when engaging in activities like jogging or jumping. People sometimes describe the pain of heel spurs and plantar fasciitis as a pin sticking into the bottom of the foot when they first stand up in the morning, this pain later turns into a bearable ache. The cause of the pain is generally not the heel spur itself, but the soft-tissue buildup associated with it. People often complain that the sharp pain returns after they stand up following sitting for a prolonged period of time.


Posterior 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


Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.


Non Surgical Treatment


Heel spurs are considered a self-limited condition, which means that by making small alterations in your lifestyle and regular routines you can often control the condition. The goal is to relieve pain, reduce friction and transfer pressure from your sensitive foot areas. By eliminating the cause of the heel spur and plantar fasciitis (i.e. better shoes, orthotics to fix your gait, losing weight) will help reduce the pressure put on your fascia and heel and can reduce the inflammation caused by your heel spur. Failure to see improvements after conservative treatments may make surgery your only option.


Surgical Treatment


Almost 90% of the people suffering from heel spur get better with nonsurgical treatments. However, if the conservative treatments do not help you and you still have pain even after 9 to 12 months, your doctor may advise surgery for treating heel spur. The surgery helps in reducing the pain and improving your mobility. Some of the surgical techniques used by doctors are release of the plantar fascia. Removal of a spur. Before the surgery, the doctor will go for some pre-surgical tests and exams. After the operation, you will need to follow some specific recommendations which may include elevation of the foot, waiting time only after which you can put weight on the foot etc.

What Can Lead To Heel Spur
Calcaneal Spur


Overview


Heel spurs are a small calcification, which extends into the attachment of the connective tissues from the calcaneus (heel bone). This is easily observed on X-Ray and is very commonly misdiagnosed as the cause of your pain. Why? Because the wrong type of scan is used and only one foot is examined. Do you know if you have a spur on the other heel, the heel without the pain? Probably? and the heel spur would have been there long before you had the pain, and will still be there long after the pain is gone. Heel spurs are not the actual cause of heel pain, and are virtually always a secondary observation or symptom caused by long term pulling on the heel bone.


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


Symptoms of heel spur syndrome often include pain early in the morning or after rest, as you take the first few steps. It may also include severe pain after standing or walking long hours, especially on hard cement floors. Usually more pain exist while wearing a very flat soled shoe. A higher heel may actually relieve the pain as an arch is created. The pain is usually sharp, but can also be a dull ache. The pain may only be at the bottom of the heel, or may also travel along the arch of the foot.


Diagnosis


Your doctor will review your medical history and examine your foot. X-rays are used to identify the location and size of the heel spur.


Non Surgical Treatment


Exercise. If you think your pain is exercise-related, change your exercise routine, environment, or foot-ware, and emphasize movements and/or body parts that do not cause pain. Mind/Body. Occasionally foot pain can be related to stress. The body may respond with generalized tension that contributes to pain in many areas, including the feet. Hypnosis and guided imagery are worth exploring if an anatomical problem is not apparent. Supplements. Natural anti-inflammatories can be just as effective as ibuprofen or other over-the-counter pain relievers with fewer side effects. Try one of the following. Ginger (Zingiber officinale) standardized to 5-6% gingerols and 6% shogoals, take one to two 500 mg tablets three to four times daily. Turmeric (Curcuma longa) standardized to 95% curcuminoids, take 400-600 mg three times daily. Also, be sure that you're wearing well-fitting shoes, the proper shoes for each activity, and that you buy new foot-ware as soon as you notice signs of wear. You can also take the pressure off your heel with a donut-shaped heel cushion or a heel-raising pad placed in your shoe. Acupuncture can also relieve the pain, as can for some sufferers, magnetic shoe inserts, although the evidence behind their effectiveness is not conclusive. Osteopathic or chiropractic manipulation can help with soft tissue pain in and around the feet.


Surgical Treatment


More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

Bursitis Foot Pad
Overview


Heel bursitis is a common foot pain in athletes, and is often mistaken for Achilles tendinitis, although it can also occur together with Achilles tendinitis. Heel bursitis occurs when small cushions in the heel called bursas become inflamed and swell with fluid irritating surrounding tissue and pressing on nerves. Other names given to heel bursitis are Achilles bursitis and Retrocalcaneal bursitis.


Causes


Systemic diseases such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, pancreatitis, Whipple disease, oxalosis, uremia, hypertrophic pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome have also been associated with bursitis.


Symptoms


Pain or tenderness at the back of the heel around the Achilles region. Increased pain during activities with strong, repetitive calf contractions, walking (uphill), stair climbing, running, jumping. Pain may be worse with rest after activity (that night or the next morning) or at the beginning of the excercise. Pain when wearing shoes and the heel is getting rubbed. Bump forming on the back of the heel. Limping. Stiffness. Decreased range of motion. Redness and warmth (if the bursa gets infected).


Diagnosis


Obtaining a detailed history from the patient is important in diagnosing calcaneal bursitis. The following complaints (which the physician should ask about during the subjective examination) are commonly reported by patients.


Other inquiries that the physician should make include the following. The clinician should ask about the patient's customary footwear (whether, for example, it includes high-heeled shoes or tight-fitting athletic shoes). The patient should be asked specifically about any recent change in footwear, such as whether he/she is wearing new athletic shoes or whether the patient has made a transition from flat shoes to high heels or vice versa. Individuals who have been accustomed to wearing high-heeled shoes on a long-term basis may find that switching to flat shoes causes increased stretch and irritation of the Achilles tendon and the associated bursae. The specifics of a patient's activity level should be ascertained, including how far the patient runs and, in particular, whether the individual is running with greater intensity than before or has increased the distance being run. The history of any known or suspected underlying rheumatologic conditions, such as gout, rheumatoid arthritis, or seronegative spondyloarthropathies, should be obtained.


Non Surgical Treatment


You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping. Ice. Place a plastic bag with ice on the foot for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications. Compression. Lightly wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold. Elevate. Make sure to elevate the ankle above heart level. To improve symptoms of plantar calcaneal bursitis after the acute phasetry the baked bean tin stretch, using a baked bean tin roll the foot backwards and forwards. 2 minutes in the morning before putting the foot to the floor. 5-10 minutes every evening. Contrast foot baths. 10 minutes warm water. 10 minutes cool water morning and evening (morning may be missed if time is restricted). Stretches. Start with 10 stretches per day, holding the stretch for 30 seconds, then relax and then repeat. Continue this stretch daily until you can no longer feel it pulling on the heel, then progress to stretch. Do 10 per day holding for 30 seconds per stretch. When you can no longer feel it pulling on the heel proceed to stretches. Do 10 per day holding for 30 seconds on every stretch.


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.


Prevention


People can lower the risk of bursitis by gradually strengthening and stretching the muscles around the joints and taking regular breaks from repetitive motion that might irritate bursae. Prolonged time resting on the elbows or kneeling should be avoided, if it cannot be avoided, wearing cushioned elbow and knee pads can help protect the bursae. Comfortable, supportive, low-heeled shoes can help prevent bursitis in the foot.

Pain After Hammertoe Surgery
Hammer ToeOverview


Generally a hammertoe or mallet toe is caused by wearing high heels or shoes that are too small around the toe area, so it?s no surprise that it is mostly women who suffer from them. A hammertoes has a bend in the middle joint of the toe whereas a mallet toe has a bend in the upper joint of the affected toe. The way someone walks (gait) can also lead to the formation of hammertoes and mallet toes as can overuse and injury. Sometimes a deep blister will form over the bent joint and often after some time calluses and corns will develop on the affected toe joint. People with arthritis, diabetes or neuromuscular conditions are also more likely to develop a hammer toe or mallet toe.


Causes


Hereditary and shoe gear are probably the most likely reasons to develop a hammer toe. Tight pointy shoes may cause a hammer toes. High heels also can cause hammer toes. A deformed toe often develops over time, and certain types of feet may be predisposed. Some patients may develop a hammer toe or cross over toe (of the 2nd toe) due to a bunion of the big toe.


Hammer ToeSymptoms


At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses.


Diagnosis


Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.


Non Surgical Treatment


Changing the type of footwear worn is a very important step in the treatment of hammer toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the hammer toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes. Other conservative treatments include using forefoot products designed to relieve hammer toes, such as hammer toe crests and hammer toe splints. These devices will help hold down the hammer toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.


Surgical Treatment


Surgery is the approach that is often necessary to correct hammertoe that fails to respond to nonsurgical management. Surgery is appropriate when the muscles and tendons involved in a hammertoe problem have become so tight that the hammertoes joints are rigid, misaligned and unmovable. There are a number of surgical techniques for dealing with the complex range of joint, bone, muscle, tendon and ligament abnormalities that define each hammertoe's make-up. To correct a hammertoe deformity, the surgeon's goal is to restore the normal alignment of the toe joint, relieving the pressure that led to the hammertoe's development (this should also relieve the pain, as well). To do this, he or she may remove part of the boney structure that creates a prominence at the top of the joint. Tighten or loosen the muscles, tendons and ligaments around the toe joints. Realign the toe bones by cutting one or more and shifting their position, realigning muscles, tendons and ligaments accordingly. Use screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.


Hammer ToePrevention


How can I prevent hammer toe? Avoid wearing shoes that are narrow or don?t fit well. Also, don?t wear heels higher than 2 inches. Instead, choose shoes with a wide toe box that give you ? inch between the end of your longest toe and the inside tip of the shoe. Check often to make sure your child?s shoes fit, especially when he or she is having a growth spurt.

HammerToes
HammertoeOverview


hammertoes is a deformity of the toe in which the toe bends downward at the middle joint, causing it to resemble a hammer. Hammertoes usually begin as mild problems, but over time they can develop into severe cases. Hammertoes are often flexible during the initial stages, and if treatment is administered promptly, symptoms can be managed with non-surgical methods. But if time passes and you do not seek treatment, your hammertoe will become more rigid, and surgical treatment may be required.


Causes


Most hammertoes are caused by wearing ill-fitting, tight or high-heeled shoes over a long period of time. Shoes that don?t fit well can crowd the toes, putting pressure on the middle toes and causing them to curl downward. Other causes include genes. Some people are born with hammertoe, bunions. These knobby bumps sometimes develop at the side of the big toe. This can make the big toe bend toward the other toes. The big toe can then overlap and crowd the smaller toes. Arthritis in a toe joint can lead to hammertoe.


HammertoeSymptoms


Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most common at hammertoe the level of the affected joint due to continuous friction of the deformity against your shoes.


Diagnosis


Your doctor is very likely to be able to diagnose your hammertoe simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate your gait as you walk and the types of shoes you wear. You'll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to better define your deformity.


Non Surgical Treatment


Treatment for a hammertoe usually depends on the stage of the hammertoe and the cause of the condition. If your toe is still bendable, your doctor may suggest conservative care-relieving pressure with padding and strapping, or proper shoes that have a deep toe box and are of adequate length and width. Early intervention can often prevent the need for surgery.


Surgical Treatment


Surgery is used when other types of treatment fail to relieve symptoms or for advanced cases of hammertoe. There are several types of surgeries to treat hammertoe. A small piece of bone may be removed from the joint (arthroplasty). The toe joint may be fused to straighten it (arthrodesis). Surgical hardware, such as a pin, may be used to hold the bones in place while they heal. Other types of surgery involve removing skin (wedging) or correcting muscles and tendons to balance the joint.


Hammer ToePrevention


These tips may help you buy the right shoes. Buy shoes at the end of the day. Your feet are smaller in the morning and swell throughout the day. Don't assume your shoe size hasn't changed. As you age, your shoe size may change, especially the width. Measure both feet and buy for the larger foot. Ask for just the right fit. A shoe repair store can stretch shoes in tight spots.