Archive for category Heal Pain/Plantar

Foot Problems

Feb 25

Posted by efootpain in Foot Blister, Foot Pain, Foot Treatment, Heal Pain/Plantar, Ingrown Toenail, Ingrown Toenails | No Comments

Foot problems are one of the most common sources of pain that we as humans experience. Most of us are on our feet the majority of time during the day, and as the old saying goes, “when our feet hurt, we hurt all over”.

Foot problems can range from a simple blister on our toe to painful, disabling deformities such as bunions. Pain levels can range from the inability to wear shoes for a day or so to total disability. Fortunately, modern Podiatric care can offer treatment plans, either conservative or surgical, that will render those suffering from foot problems relief.

The most commonly treated foot problems are ingrown toenails, heel pain, warts, corns, calluses, flat feet, and bunions. Ankle sprains and strains are also frequently seen in the Podiatrists’ office. It is not uncommon that immediate relief can be offered a patient in one or two treatments by their Podiatrist. However, long term relief of these problems may require longer treatment plans or surgical correction. Surgery is usually performed either as an out-patient at a hospital or surgical center, or, for minor procedures, in the Podiatrists’ office. Depending on what procedure is performed, recovery times can range from one day to a few weeks.

One of the most common, painful complaints is ingrown toenails. These are caused when the nail breaks off under the skin due to trauma, improper trimming, or a nail deformity. This usually results in infection. Treatment requires removal of the offending nail portion. If the deformity or injury is severe enough, removal of the corresponding portion of nail root is also required. Reoccurrence is likely if this procedure is not performed. Warts, another common foot problem, are caused by a virus, and if the virus is not eliminated from the tissue, the problem continues. Heel pain, caused by spurs or plantar fasciitis usually respond favorably to conservative care with exercise, anti-inflammatory drugs, and custom shoe inserts called orthotics. Flat foot problems also respond well to orthotic therapy. Corns, calluses, and bunions, if not responsive to conservative care, respond well to surgical intervention.

Foot problems, although being one of the most common reasons for chronic pain and disability, can sometimes respond to conservative methods with some success. Many times, foot problems respond temporarily to “drug-store remedies”. These treatments are not for everyone, however. Patients suffering from circulatory disease, diabetes, lack of nerve sensation, poor vision and infections should not attempt to treat common foot problems by themselves. In these cases, the advice of a Podiatrist is recommended. When conservative therapy fails, surgery is usually the treatment of choice.

FOOT CARE

Jan 8

Posted by efootpain in Bone Spur, Bunion, Callus, Corns, Foot Care, Foot Problems, General, Heal Pain/Plantar, Ingrown Toenails, Plantar Fasciitis, Toe Pain | No Comments

Discussions regarding proper foot care can be widely diversified. The feet are our “organs for propulsion”, and just like our brain functions to keep our body organized and functioning and the heart keeps our blood circulating, our feet keep us moving. If they are neglected, just as any organ of our body, they can fail. Unfortunately, our feet are the most widely neglected part of our body.

Proper care of our feet is important for us to be able to stand, walk, run, work and enjoy our leisure time. Make sure to wear sensible shoes that fit well and fit the activity you are participating in. Wearing flip-flops to the beach is fine; not for all day shopping at the local mall.

Every-day care:

Our feet are always in contact with a surface and require protection from contaminants located on these surfaces such as bacteria, viruses, fungi, and chemicals (to name a few). We protect our feet and body with shoes and good hygiene. Proper bathing of you feet with soap and water on a daily basis, with careful drying, especially between the toes, is necessary. Pathogens love to grow in dark, moist areas, and what is better that damp feet inside of a dark shoe? Application of a cornstarch- based bath powder after bathing would be beneficial. Inspect your feet – top, bottom, and in-between the toes on a daily basis. Take action if redness, itching, blisters, cuts, rashes or bruises are noticed. Wear shoes or sandals routinely.

SHOES and Hosiery

It is common sense to wear shoes that fit, or else they will be uncomfortable and could cause irritation and pain. But it is also important to wear proper fitting hose. Socks that are too tight can cause constriction resulting in swelling. Hose made with some synthetic products in hot climates can cause excess perspiration, resulting in dampness. “Support” hose should be recommended by a medical professional and fit professionally, or could cause circulation problems.

When in doubt, have your shoes fit by a professional. Be sure your shoes are wide enough around the “ball” of your foot (where your toes connect to the rest of your foot) so as to not be constrictive and that when standing you have ½ inch of toe space from your longest toe to the end of the shoe. Make sure the tops of your toes are not rubbing on the shoe, and when trying shoes on be sure you are wearing the type of socks you will be wearing with the shoe you are going to purchase. Walk around the store to make sure they are comfortable. Finally, make sure that the soles of your shoes will match the activity you are wearing them for; shoes with a hard sole with no traction control would not be good if you were working on damp, slippery surfaces.

Common foot problems

Corns, calluses, blisters, rashes (athlete’s foot), warts, ingrown toenails, heel pain, bunions and hammertoes are some of the common foot problems. Injuries can result in strains, sprains, or fractures. Many can be treated effectively with conservative methods, and others need professional (sometimes surgical) care.

CORNS AND CALLUSES

Corns and calluses, if never present before, often follow blistering of an area of the skin of the foot or toes, secondary to irritation from shoes, hose, or abnormal activity. Corns are associated with the toes, whereas calluses are associated with the side or bottom of the foot. Over a period of time the blistered area can harden into a thickening of the skin over an area that was irritated, and becomes painful If the irritation is removed, the corn or callus, and pain, should gradually disappear. If the corn or callus is a chronic condition, it is usually associated by a contraction or deformity of the toe (hammertoe, or a problem with a prominent metatarsal bone. Professional examination and treatment is recommended in these chronic conditions.

RASHES, ATHLETE’S FOOT, WARTS

Rashes and athlete’s foot can be caused by an irritant such as a fungus, chemical, or an allergen (poison ivy or insect bite). Warts are caused by a virus. There are many non-prescription remedies available for these skin conditions, but if no results are seen with a 7-10 days professional assistance is recommended

INGROWN TOENAILS

Ingrown toenails are conditions whereby the edge of the toenail pinches the skin alongside, causing pain and many times infection. Sometimes these are caused by improper nail trimming or a tight shoe, but oftentimes there is an actual nail curvature that causes the nail to grow improperly. Chronic infected, ingrown toenails can easily be treated by your medical professional.

HEEL PAIN

Heel pain is usually associated by plantar fasciitis (an inflammation of the plantar fascia or arch ligament) where it attaches to the bottom of the heel bone. Heel pain can also be associated with a heel spur, or an enlargement of the attachment point of the heel bone to the plantar fascia. Sometimes pads help the problem, but oftentimes professional help is needed, and if a chronic problem, orthotics with physical therapy, stretching and icing is necessary. Some situations may need surgical intervention.

BUNIONS

Bunions are dislocation or deviation of the great toe (hallux) at the big toe joint (first metatarsal joint). The medical term for a bunion is “hallux valgus”. This is not a temporary condition; it is a progressive problem that gets worse with time. Bunions can be irritated by improper footgear and result in temporary pain, but usually it is a chronic problem resulting in constant pain (with or without shoes) requiring appropriate medical evaluation and treatment.

SPRAINS AND STRAINS

Injuries to the foot and ankle are common, and fortunately our body is able to heal minor injuries quickly. However, if there is considerable swelling, eccymosis (black and blue), and pain either at rest or when bearing weight, should NOT be dismissed as a simple strain or sprain. Professional examination and treatment with X-rays and possible a MRI is necessary to rule out a significant injury. Without proper treatment, an injury passed off as a simple strain or sprain may result in a lifelong problem.

The “common-sense” approach to foot care should result in the prevention of many common foot ailments. Unfortunately, injuries and our environment can cause problems that even the best preventative methods cannot avoid. Contact your local Podiatrist or medical professional whenever there is a foot related issue that persists for any length of time.

Tags: bath powder, blisters, bruises, circulation problems, cornstarch, daily basis, dampness, excess perspiration, moist areas, proper foot care, rashes, sensible shoes, soap and water, support hose, synthetic products, top bottom

BONE SPURS

Jan 2

Posted by efootpain in Bone Spur, Causes & Symptoms, Foot Pain, Glossary, Heal Pain/Plantar, Medicine | No Comments

Is there such a thing as bone spurs? Should this term be used to explain pain? This has been a point of contention amongst medical professionals for years. Like many colloquial expressions used in the English language, the term “bone spur” is used “generically” to explain an abnormal bump or growth on a bony surface.

Perhaps the term “bone spur” is easy to understand and less frightening to a patient than advising the patient that they have an abnormal enlargement of bone. Just like the term “cartilage deposit” is used to describe a bony bump, the term bone spur is used so as to not alarm the patient.

In all actuality, the term “bone spur” is used to describe an enlargement or overgrowth of bone, usually associated with a joint or the heel, where the bone has enlarged due to a genetic or biomechanical abnormality. The “bone spur” takes years to develop, and is not noticed by the patient until pain is present. Often the term “bone spur” is used to describe a enlargement of the bottom of the heel, and looks like a “spur” when visualized with an X-ray. This type of spur is actually an elongation of the bottom portion of the heel secondary to stress exerted on the heel due to tightness of the plantar fascia, or arch ligament. It is associated with chronic heel pain, usually noticed after periods of rest or first thing in the morning.

Abnormal enlargement of bone (bone spurs) are usually associated with joint surfaces. As the bone enlarges, restriction of joint motion occurs, and pain will ensue. The enlargement of bone can very often take on the appearance of a spur when visualized with an X-Ray. In these situations, the pain caused is due to the restriction of motion of the joint, not the actual spur. Unfortunately, we use the term to describe the appearance of the problem, not why the problem exists.

“Bone spurs” cannot be dissolved by physical therapy or cortisone injections. The pain associated with spurs is reduced with these treatments. The only way “spurs” can removed is by surgical excision.

Tags: Bone Spur, bone spurs, cartilage, chronic heel pain, cortisone, cortisone injections, physical therapy, x ray

PLANTAR FACIITIS – BEYOND THE PAIN

Nov 6

Posted by efootpain in Foot Pain, Heal Pain/Plantar | No Comments

Plantar fasciitis is the most common cause of heel pain. Usually, symptoms occur with activity after resting – getting out of bed in the morning, getting out of a car after driving, getting up after sitting for a while. All of these situations tend to cause immediate pain. In general, shorter periods of standing and walking may actually provide some relief after the fascia loosens up. However, if you are on your feet all day, the pain usually returns.

The causes of plantar fasciitis are due to a variety of factors. Weight, age, physical stress and foot alignment are among the culprits.

Patients who are overweight may be more likely to develop plantar fasciitis; though, the condition can occur in all weight classes. However, overweight patients may not find relief as easily. The stress of additional weight on the feet, especially the heel, can cause the condition and continue to aggravate it.

Age can affect plantar fasciitis, as well. As a patient gets older, the plantar fascia does not stretch as well as it used to. The fat pad on the bottom of the foot tends to thin out with age. This may cause more stress on the heel, since it affects the combined shock-absorbing ability of the fascia and the fat pad.

Other situations that can lead to the development of plantar fasciitis include:

* A walking or jogging program or during prolonged standing, such as a job with little sit-down time, that adds pressure to the foot.
* The use of ill-fitted shoes and shoes that do not provide appropriate support or shock absorption.
* A switch from a higher-heeled to a lower-heeled shoe that causes tightness in the calf muscle.
* Feet that are malaligned or pronated, which is an excessively flattened foot structure, as well as a high-arched foot may cause abnormality in a patient’s gait.

DO IT YOURSELF TREATMENTS

If a patient begins at-home treatment soon after symptoms start, the painful symptoms due to plantar fasciitis may be improved. Appropriate treatments include:

* Resting the foot/feet;
* Cutting back on athletic activities, or cross-training with such activities as swimming or cycling that put less stress on the foot;
* Applying ice to the area either directly after the activity for 15-20 minutes or icing the heel on a daily basis twice a day to try to reduce some of the inflammation;
* Stretching exercises for the gastrocnemius-soleus calf muscle and the plantar fascia;
* Wearing appropriate shoe gear, especially with heel support. An anti-pronatory style running shoe might be beneficial. Over-the-counter arch supports seem to work better than just a heel pad in relieving discomfort.
* Taking over-the-counter anti-inflammatory medication, such as Advil, Aleve, Tylenol;
* Starting a diet if over-weight. Any weight loss will help to reduce pressure on the feet and strain of the plantar fascia.

DIAGNOSTIC TESTING

The main standards used to try to identify a diagnosis of plantar fasciitis include x-rays, diagnostic ultrasound and magnetic resonance imaging (MRI). In addition, computed axial tomography (CT) scans and bone scans can be utilized to help rule out other associated bone conditions or fractures involving the heel. And importantly, nerve conduction testing with an Electromyography (EMG), Nerve Conduction Velocity (NCV) and neuro-sensory testing may need to be done to rule out a neurological cause of the heel pain.

MEDICAL TREATMENTS

Once the appropriate diagnosis has been made, physical therapy is often prescribed and can be quite beneficial. Options within therapy include icing, ultrasound, iontophoresis, deep massage and an aggressive stretching and strengthening program. If the pain has been long-standing and resistant to these modalities, the Graston technique can be employed. This method utilizes stainless steel tools to detect and resolve adhesions in muscles, tendons and fascia.

Another treatment option is the night splint. This removable “boot” can be worn while the patient is sleeping. It helps to maintain tension on the plantar fascia and stretch it out through the night. This frequently helps to resolve the morning pain one gets when getting out of bed.

Orthotics are yet another option. These custom-made devices can realign and compensate for foot deformity and help to redistribute pressure throughout the foot more evenly.

Trigger point injections of corticosteroids can often relieve the inflammation associated with plantar fasciitis. The injection needs to be given in an appropriate fashion within the plantar fascia. It should not be administered into the heel pad, as this would shrink the heel pad and reduce some of the soft shock absorption that is provided. Usually up to three injections can be given over the course of time to try to relief the discomfort.

TREATING PLANTAR FASCIITIS WITH SHOCK WAVE

If more conservative treatments have been tried without success, a patient and his podiatrist may consider extra-corporeal shockwave therapy (ESWT). This treatment option should be considered prior to surgical options for release of the plantar fascia. There are two types of ESWT. Low-energy shockwave uses a series of several treatments, usually not too painful and with no need for anesthesia. The high-energy shockwave tends to be more effective, but can be painful when administered. Therefore, a regional nerve block or general anesthesia is needed to lessen the patient’s discomfort. Shockwave therapy is thought to work by causing micro-trauma to the area of the plantar fascia that is affected by the fasciitis. The body then sees this micro-trauma as an area that needs to be healed. The healing response causes blood vessels and other nutrients to be brought to the affected area, thereby healing the micro-trauma, as well as healing the long-standing plantar fasciitis.

SURGERY

Surgery should be a treatment of last resort. Still, surgical intervention is needed in 1% to 2% of the population to improve nonresponsive plantar fasciitis. Studies show a success rate in the 60% to 70% range. The surgical option can take the form of a release of the plantar fascia done through an endoscope, which can be more of a closed, minimally-invasive procedure. The more traditional open procedure frequently releases the fascia, as well as removing the bone spur. Patients still may experience pain or weakening of the arch as a side effect of the surgical procedure.

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