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In mybook®: Health
Foot Pain is Not Normal
ArthritisUnlike osteoarthritis which follows a predictable pattern in certain joints, rheumatoid arthritis is a system-wide disease. It is an inflammatory disease where the patient’s own immune system attacks and destroys cartilage.
Plantar FasciitisPlantar fasciitis is a painful inflammatory process of the plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes and is termed, plantar fasciosis. The plantar fascia is a thick fibrous band of tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the five toes. The term fasciitis is a misnomer as studies of the tissue do not demonstrate inflammation. Plantar fasciosis is a more accurate diagnosis. It has been reported plantar fasciitis occurs in two million Americans a year and 10% of the population over a lifetime. It is commonly associated with long periods of work-related weight bearing. Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is increased probability of knee pains, especially among runners.
CryotherapyThere are many different treatments and procedures associated with wart removal. One review of 52 clinical trials of various cutaneous wart treatments concluded that topical treatments containing salicylic acid were the best supported, with an average cure rate of 75%, compared with 48% for the placebo in six placebo-controlled trials including a total of 376 participants. The reviewers also concluded that there was little evidence of a significant benefit of cryotherapy over salicylic acid or duct tape.
Weight ManagementOne should question all runners about their training habits. This includes terrain, speed, surface type and body weight. Would the athletes be able to run with less pain if they switched from hills to flatter terrain? How would soft surfaces like grass compare to asphalt or concrete? Another factor would include running on the side of a hill versus on a flat surface. Weight loss will help reduce the stress on the body during gait. Considering that running places three to five times the body’s weight on the lower extremities, the heavier a runner, the more likely he or she will develop lower extremity overuse syndromes. Plantar fascia night braces keep the muscles from shortening in the foot and calf areas. This is especially helpful in relieving post-static dyskinesia upon arising in the morning.
Computed TomographyAnother cause of heel pain may be radiculopathy from the low back. Most of the heel is innervated by the S2 disc with surrounding areas innervated by the L4, L5 and S1 discs. Bulging discs, arthritis, spondylolisthesis and other impingement or narrowing problems can cause radiating pain to the heel. X-rays of the back may or may not show pathology. In these cases, a MRI or computed tomography (CT) scan is necessary. Give the patient a referral to physical medicine and rehabilitation and/or neurosurgery for evaluation and management. Usually, this consists of physical therapy and/or epidural injections. Since surgery may be quite debilitating to the runner, do it only after exhausting conservative treatment.
IontophoresisNon-surgical treatment consists of removing the irritating force from the calcaneus and/or controlling excessive pronation. Shoe modification involves softening of a rigid heel counter or switching to shoes that have a softer heel counter. One can place padding in the shoes as well as heel cups to reduce shearing forces. There are elastic ankle braces with silicone or gel padding along the posterior heel area that reduce pain. If there is excessive pronation, one needs to control this with a foot orthotic. Stretching and strengthening exercises along with iontophoresis can reduce the pain as well.
UltrasoundClinicians can use X-rays to rule out other causes of heel pain. Musculoskeletal ultrasound has been an excellent diagnostic tool as it allows one to measure the thickness of the plantar fascia against the norm. Runners usually complain of pain being the worst when they first get up in the morning or after other periods of rest. With activities, the pain subsides although prolonged standing/ambulation on hard surfaces may cause increased pain. The pain is usually the worst at the medial band of the plantar fascia at the attachment into the medial plantar calcaneal tubercle.
MRIWhen runners describe their pain as getting worse the more they are on their feet, one has to be concerned about the possibility of a calcaneal stress fracture. One can elicit pain with side-to-side compression of the calcaneus, palpation of the medial and lateral plantar heel, and palpation of the medial and lateral walls of the calcaneus away from the medial calcaneal and sural nerve branches. X-rays may or may not show any changes. In some cases, a white sclerotic line will be visible on the calcaneus. Further imaging studies such as a bone scan or a magnetic resonance image (MRI) may be needed.
CataractsA Noveon-type laser, already in use by physicians for some types of cataract surgery on the eye, is used by some podiatrists, although the only scientific study on its efficacy as of 2010, while showing positive results, included far too few test subjects for the laser to be proven generally effective.
Ankle SurgeryFoot and ankle surgery can be painful. Pain relievers in the hospital and for a time period after being released from the hospital may help.
Bunion SurgeryDepending on the severity of the bunion there are non surgical and surgical treatments available. Non surgical treatments would be, to change your footwear to relieve pressure on the bunion. Shoes with a wide toe and good arch support will help. Also applying ice to the bunion and taking anti inflammatory medications. If these practice do not remove the bunions surgery may be needed. Bunion surgery is designed to realign the toes and so the bunion will not reoccur.
Joint ReplacementAlthough not as common as as total hip or knee joint replacement, advances in implant design have made ankle replacement a feasible option for many people.
BunionsA bunion is a bony bulge at the base of the big toe or commonly referred to as a bony bump on your foot. Bunions are more common in woman, due to the wearing of high heels and tight fitting shoes. Bunions often become painful over time and cause the toes to angle towards each other.
Ingrown ToenailsOne study compared patients with ingrown toenails to healthy controls and found no difference in the shape of toenails between patients and controls and suggested that treatment should not be based on the correction of a non-existent nail deformity. Ingrown toenails are caused by weight-bearing (activities such as walking, etc.) in patients that have too much soft tissue (skin) on the sides of the nail. Weight bearing causes this excessive amount of skin to bulge up along the sides of the nail. The pressure on the skin around the nail results in the tissue being damaged, resulting in swelling, redness and infection.
Geriatric Foot Care
Achilles TendonitisAn inferior calcaneal spur consists of a spike of calcification, which lies superior to the plantar fascia at the insertion of the intrinsic foot musculature onto the calcaneus. Until recently, an inferior calcaneal bone spur was erroneuously thought to develop at the insertion of the plantar fascia. While heel spurs are commonly associated with plantar fascitis, they are not caused by plantar fasciitis and many people who suffer from plantar fasciitis do not have heel spurs. Often times, inferior heels spurs do not have to be removed as part of the treatment for plantar fascitis. However, posterior heel spurs are often large and palpable through the skin and may need to be removed as part of the treatment of insertional Achilles tendonitis.
Ankle InstabilityOur podiatrists specialized in the science and art of medical-surgical management of foot and ankles, and guarantee the foot and ankle health of your family. We concentrate on the prevention and treatment of foot and ankle complications like Achilles’ tendon problems, ankle instability, ankle sprains, arthritic foot and ankle, athlete’s foot and bunions. Our podiatrists will treat your calluses, corns, crush injuries, diabetic foot, toenail fungus, heel spurs, ingrown toenails, and injuries. Our team of experts corrects flat feet, hammertoes, and plantar fasciitis. Other conditions like neuromas, warts and wounds are also given appropriate medical attention. Plus, older adults will benefit from our state of the art geriatric foot care services.
Ankle SprainTreatment of a sprained ankle are to apply ice and elevate the foot. Also, to apply an ankle brace for stability. In some severe cases surgery could be require, if the sprain has damaged the ligaments.
Arthritic Foot Care
Bunions ProblemsThe great toe (first metatarsophalangeal joint). This is where the first metatarsal connects to the great toe bone (phalange).This is also the area where bunions usually develop.
Diabetic Foot Care
General PodiatryIn 1983, a group of prominent Indiana podiatrists formed the Achilles Podiatry Group. The need to develop and build an infrastructure for the future of podiatry in Indiana was based on several significant factors that were changing health care management throughout the United States.
HammertoesSome effects of wearing high heels are morton’s neuroma, bunions and hammertoes. A morton’s neuroma is caused, because of heel height and the narrow toe box, a thickening tissue around the nerve can develop at the 3rd and 4th toes. This causes a pain or numbness in the toes. Bunions are a bony growth at the joint at the base of the big toe. The bunion makes the toes to turn at an angle causing an unnaturally pointing of the other toes and pain. Hammertoes are caused by the narrow toe box the pushes the smaller toes into a bent position at the middle joint. The toes can become unable to be straighten, even when not wearing a shoe.
Heel SpursEven today, some physicians tell patients they have heel spurs. In actuality, the presence or absence of a plantar calcaneal spur often has little to do with the cause of the pain except in rare cases. Historically, we also thought that inflammation of the plantar fascia is what caused the pain. We now know the pain is more due to chronic thickening of the plantar fascia.
Foot InfectionsIf an athlete’s foot infection is more serious, it can take longer than a couple of weeks to get better. In these cases, it’s a good idea to see a podiatrist, who may prescribe a stronger anti fungal cream, spray, or pill.
Ingrown ToenailsA more physiologically sound hypothesis is that an “Ingrown Toenail” is actually a problem where there is too much skin around the nail (“ Overgrown Toeskin “) – the nail is not the problem. Vandenbos and Bowers theorized that pressure necrosis of the soft tissues surrounding the nail due to weight bearing is the primary cause of ingrowing toenails. They wrote “the term ‘ingrown toenail’ is unfortunate in that it
Plantar FasciitisThe symptoms: Plantar fasciitis, an inflammation in the bottom of the foot, is perhaps the peskiest problem that plagues the running wounded. The common characteristic of this condition is a sharp, tight, painful sensation at the base of the heel that can be anywhere from annoying to excruciating.
Podiatric SurgeryOne of the biggest advancements in foot surgery has been the advent of endoscopic procedures. Endoscopic plantar fasciotomy has reduced the recovery period for many patients. The patient can bear weight immediately since the incisions are small and located medially and laterally on the heel. Similar to performing the in-step procedure, surgeons should take care to release the medial band only. A non-weightbearing lateral X-ray is necessary for preoperative planning. There is also a learning curve for the procedure.
CornsFoam wedges – these may be used for corns on the toes to reduce pressure. Sometimes special silicone wedges may be used.
FrostbiteProtect Your Feet From Hot and Cold. Always wear shoes at the beach or on hot pavement. Put sunscreen on the tops of your feet for protection from the sun. Keep your feet away from radiators or open fires. DO NOT use hot water bottle or heating pads on your feet. If your feet are cold, wear seamless socks at night. Lined boots are good to keep your feet warm in the winter. Choose socks carefully. DO NOT wear socks with seams or bumpy areas. Choose padded socks to protect your feet and make walking more comfortable. In cold weather, check your feet often to keep your feet warm avoid frostbite.
CallusesA callus is similar to a corn in that they are a protective layer of dead skin that comes from the same material, but instead builds up around the balls or heels of your feet. Some of the causes of calluses are poorly fitting shoes, flat feet and walking on hard surfaces.
FungusWhite superficial onychomycosis (WSO) is caused by fungal invasion of the superficial layers of the nail plate to form “white islands” on the plate. It accounts for only 10 percent of onychomycosis cases. In some cases, WSO is a misdiagnosis of “keratin granulations” which are not a fungus, but a reaction to nail polish that can cause the nails to have a chalky white appearance. A laboratory test should be performed to confirm.
LesionsDermatophytids are fungus-free skin lesions that sometimes form as a result of a fungus infection in another part of the body. This could take the form of a rash or itch in an area of the body that is not infected with the fungus. Dermatophytids can be thought of as an allergic reaction to the fungus.
PsoriasisOther risk factors include perspiring heavily, being in a humid or moist environment, psoriasis, wearing socks and shoes that hinder ventilation and do not absorb perspiration, going barefoot in damp public places such as swimming pools, gyms and shower rooms, having athlete’s foot (tinea pedis), minor skin or nail injury, damaged nail, or other infection, and having diabetes, circulation problems, which may also lead to lower peripheral temperatures on hands and feet, or a weakened immune system.
Orthotics and Prosthetic Therapy
Ankle SprainAn ankle sprains is an over or unnatural twisting of the ankle. This can be caused by a quick side movement or from walking on uneven ground.
Physical TherapyThe pain has a local and a systemic manifestation so one should treat both. Local treatment includes orthotics (soft or semi-rigid), a change in shoes, control of faulty mechanics and a change in training. For systemic treatments, I refer the patient to a rheumatologist for medical management and a physical therapist for physical therapy.
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