Managing Mortons Neuroma

Overview

This is a painful condition affecting a small nerve in the foot. It occurs when the five long bones that run the length of the foot get pushed together, pinching the nerve in between. This friction on the nerve causes it to thicken and inflame causing pain. The condition gets its name from an American surgeon, George Morton.

Causes

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot deformities – bunions, hammertoes, flatfeet, or more flexible feet – are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury or other type of trauma to the area may also lead to a neuroma.

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

During the examination, your physician will feel for a palpable mass or a “click” between the bones. He or she will put pressure on the spaces between the toe bones to try to replicate the pain and look for calluses or evidence of stress fractures in the bones that might be the cause of the pain. Range of motion tests will rule out arthritis or joint inflammations. X-rays may be required to rule out a stress fracture or arthritis of the joints that join the toes to the foot.

Non Surgical Treatment

Common treatments involve wearing different shoes or using arch supports. Resting the foot, massaging the toes and using an ice pack may work for some people. A GP or a podiatrist (foot specialist) may also recommend anti-inflammatory painkillers or a course of steroid injections. Numbing injections, in which alcohol and a local anaesthetic are injected into the affected area of the foot, may also be effective. In extreme cases, when the condition does not respond to treatment, day case surgery may be needed.interdigital neuroma

Surgical Treatment

Surgical treatment has provided relief in some cases while poor results and surgical complications have resulted in other cases. It is believed that ligament weakness, as opposed to the pinching of nerves in the foot, may be to blame for recurrent pain in these situations. For reasons which are not fully understood, the incidence of Morton?s Neuroma is 8 to 10 times greater in women than in men.

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Does A Posterior Calcaneal Spur Hurt?

Posterior Calcaneal Spur

Overview

The calcaneus is the largest bone in the foot. Pain in the heel region can sometimes be related to Plantar Fasciitis, inflammation of the plantar fascia ligament in the heel area. A heel spur is a hook of bone that forms on the calcaneus where the plantar fascia attaches. Heel spurs can be identified with an X-ray. A heel spur can occur with or without Plantar Fasciitis.

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.

Heel Spur

Symptoms

The Heel Spur itself is not thought to be painful. Patients who experience pain with Plantar Fasciitis are suffering from inflammation and irritation of the plantar fascia. This the primary cause of pain and not the Heel Spur. Heel Spurs form in some patients who have plantar fasciitis, and tend to occur in patients who have had the problem for a prolonged period of time. While about 70 % of patients with plantar fasciitis have a heel spur, X-rays also show about 50 % of patients with no symptoms of plantar fasciitis also have a heel spur.

Diagnosis

Most patients who are suffering with heel spurs can see them with an X-ray scan. They are normally hooked and extend into the heel. Some people who have heel spur may not even have noticeable symptoms, although could still be able to see a spur in an X-ray scan.

Non Surgical Treatment

The majority of heel spurs are treated with non-surgical interventions. These can relieve pain, but may take from about 3 months to up to a year for symptoms to resolve. Rest, icing, and over-the-counter anti-inflammatory or prescription medications can help ease symptoms. Cortisone injections may also be used. Physical therapists may instruct you to perform stretching exercises to help relax the tissues in the heel. Your doctor may recommend custom orthotics or shoe inserts to position and cushion your heel. Night splints can help position the heel and arch of the foot while you sleep. Some doctors may recommend extracorporeal shock wave therapy (ESWT). This treatment uses energy pulses to start the repair process in the heel tissues. ESWT is recommend when other non-surgical treatments have failed.

Surgical Treatment

Usually, heel spurs are curable with conservative treatment. If not, heel spurs are curable with surgery, although there is the possibility of them growing back. About 10% of those who continue to see a physician for plantar fascitis have it for more than a year. If there is limited success after approximately one year of conservative treatment, patients are often advised to have surgery.

Prevention

If you have not yet developed this condition, you can take steps to protect yourself from it. Most importantly, make it a rule to wear properly fitted footwear. Avoid shoes that have become worn down in the heel, and don’t choose shoes that cause you to walk in an abnormal fashion. Maintaining a healthy weight will ensure that undue pressure isn’t being put on the ligaments, tendons and bones of your feet. If your job requires a great deal of time on your feet, or if you exercise regularly, be sure to balance periods of activity with periods of rest for your feet.

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Does A Posterior Calcaneal Spur Cause Pain?

Calcaneal Spur

Overview

A heel spur is a calcium deposit on the underside of the heel bone. Heel spurs are related to plantar fasciitis in that both are caused by irritation and lack of support of the plantar ligaments. Your plantar ligaments are a band of connective tissue that extend along the bottom of the foot and connect your heel bone to the ball of your foot.

Causes

At the onset of this condition, pain and swelling become present, with discomfort particularly noted as pushing off with the toes occurs during walking. This movement of the foot stretches the fascia that is already irritated and inflamed. If this condition is allowed to continue, pain is noticed around the heel region because of the newly formed bone, in response to the stress. This results in the development of the heel spur. It is common among athletes and others who run and jump a significant amount.

Heel Spur

Symptoms

Heel spurs result in a jabbing or aching sensation on or under the heel bone. The pain is often worst when you first arise in the morning and get to your feet. You may also experience pain when standing up after prolonged periods of sitting, such as work sessions at a desk or car rides. The discomfort may lessen after you spend several minutes walking, only to return later. Heel spurs can cause intermittent or chronic pain.

Diagnosis

The proper diagnosis of a heel spur often requires an X-ray. To make this process as convenient for his patients as possible, most clinics have an on-site digital X-ray and diagnostic ultrasound machines. This can make it unnecessary for patients to visit diagnostic imaging centers, allowing patients to receive more expedient treatment.

Non Surgical Treatment

Get some rest. You need to stay off of your aching foot as much as possible for at least a week. Think about possible causes of the problem while you’re resting and figure out how you can make some changes. Some actions that can contribute to heel spurs include running too often or running on hard surfaces such as concrete, tight calf muscles, shoes with poor shock absorption. Ease back into your activities. In many cases, you’ll be in too much pain to go ahead with a strenuous exercise routine that puts pressure or impact on your heel. Listen to your body and switch to different activities such as swimming or riding a bike until your heel spurs improve.

Surgical Treatment

Though conservative treatments for heel spurs work most of the time, there are some cases where we need to take your treatment to the next level. Luckily, with today?s technologies, you can still often avoid surgery. Some of the advanced technologies to treat a Heel Spur are Platelet Rich Plasma Therapy. Platelet Rich Plasma Therapy (also known as PRP) is one of several regenerative medicine techniques that University Foot and Ankle Institute has helped bring to foot and ankle care. This amazing in-office procedure allows the growth factors in the blood to be used to actually begin the healing process again long after your body has given up on healing the area. Heel Pain Shockwave Therapy. Shockwave therapy is a non-invasive procedure done in the office that allows for new blood to get to the region of fascia damage and help with healing. Results have been excellent with more than 70 percent of patients getting relief with only one treatment. Topaz for Heal Spurs and pain. Another minimally invasive technology technique is called Coblation Surgery using a Topaz probe. This minimally invasive procedure involves controlled heating of multiple tiny needles that are inserted through the skin and into the plantar fascia. This process, like PRP and Shockwave therapy, irritates the fascia enough to turn a chronic problem back into an acute problem, greatly increasing the chances of healing. Heel Spur Surgery. Endoscopic Plantar Fasciotomy is one surgical procedure that we consider to release the tight fascia. University Foot and Ankle Institute has perfected an endoscopic (camera guided) approach for fascia release to allow rapid healing and limited downtime with minimal pain.

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Bursitis Of The Foot Treatments

Overview

Bursitis is inflammation or irritation of a bursa, a small sac located between a bone and muscle, skin, or tendon. The bursa allows smooth gliding between these structures. Below are some of the specific types of bursitis. Subacromial bursitis The subacromial bursa lies just above the rotator cuff. Bursitis often develops due to injury, impingement (pinching), overuse of the shoulder, or calcium deposits. Symptoms include pain in the upper shoulder or upper third of the arm, and severe pain upon moving the shoulder.

Causes

Causes of bursitis can be from any form of friction between bone and the soft tissues. The most common cause is due to abnormal pronation.

Symptoms

Retrocalcaneal bursitis is very similar to Achilles bursitis as the bursae are very close in proximity and symptoms are almost identical however retrocalcaneal bursitis is a lot more common. The symptoms of bursitis vary depending on whether the bursitis is the result of injury or an underlying health condition or from infection. From normal overuse and injury the pain is normally a constant dull ache or burning pain at the back of the heel that is aggravated by any touch, pressure like tight shoes or movement of the joint. There will normally be notable swelling around the back of the heel. In other cases where the bursa lies deep under the skin in the hip or shoulder, swelling might not be visible. Movement of the ankle and foot will be stiff, especially in the mornings and after any activity involving the elbow. All of these symptoms are experienced with septic bursitis with the addition of a high temperature of 38?C or over and feverish chills. The skin around the affected joint will also appear to be red and will feel incredibly warm to the touch. In cases of septic bursitis it is important that you seek medical attention. With injury induced bursitis if symptoms are still persisting after 2 weeks then report to your GP.

Diagnosis

Gram stain. A lab test called a Gram stain is used to determine if certain troublesome bacteria are present. Not all bacteria can be identified with a Gram stain, however, so even if the test comes back negative, septic bursitis cannot be completely ruled out. White blood cell count. An elevated number of white blood cells in the bursa’s synovial fluid indicates an infection. Glucose levels test. Glucose levels that are significantly lower than normal may indicate infection.

Non Surgical Treatment

With anterior and posterior Achilles tendon bursitis, applying warm or cool compresses to the area and using nonsteroidal anti-inflammatory drugs (NSAIDs) can temporarily relieve the pain and inflammation, as can injections of a corticosteroid/anesthetic mixture into the inflamed bursa. The doctor is careful not to inject the mixture into the tendon. After this treatment, the person should rest. When these treatments are not effective, part of the heel bone may need to be surgically removed.

Surgical Treatment

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

Prevention

Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.

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Hammer Toe Pain Treatment

HammertoeOverview

If you sneak a peek at your feet and notice that your toes are crossed, bent, or just pointing at an odd angle, you probably suffer from a hammertoe. Toes that are scrunched up inside tight shoes or pressed against the toe box of the shoe can bend at the joints and stay that way – resulting in a hammertoe. A hammertoe is a contracture of the toe at one of the two joints in the toe. Due to the pull of the tendons, the joints become more rigid over time. The toe is bent up at the joint and does not straighten out.

Causes

The APMA says that hammertoe can result from a muscle imbalance in the foot that puts undue pressure on the joints, ultimately causing deformity. Inherited factors can contribute to the likelihood of developing hammertoe. Arthritis, stroke or nerve damage from diabetes or toe injuries such as jamming or breaking a toe can affect muscle balance in the foot, leading to hammertoe. The Mayo Clinic says that hammertoe wearing improper shoes often causes hammertoe. Shoes that squeeze the toes, such as those with a tight toe box or with heels higher than two inches, can put too much pressure on the toe joints.

HammertoeSymptoms

The most common symptoms of hammertoes include. The toe is bent upward at the middle toe joint, so that the top of this joint rubs against the top of the shoe. The remainder of the toe is bent downward. Pain upon pressure at the top of the bent toe from footwear. The formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe. This occurs because the contracted digit puts pressure on the metatarsal head creating callouse and pressure on the ball of the foot.

Diagnosis

The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Non Surgical Treatment

There are many non-surgical treatments to help relieve symptoms of hammertoe. The first step for many people is wearing the right size and type of shoe. Low-heeled shoes with a boxy or roomy toe area are helpful. Cushioned insoles, customized orthopedic inserts, and pads can provided relief as well. Splints or straps may be used to help correct toe position. Your doctor may show you toe stretches and exercises to perform. Your doctor can safely remove corns and calluses. You should not try to remove them at home.

Surgical Treatment

Treatment of a severe hammertoe that has become rigid includes surgery. What is done during the surgery depends on how misshapen and inflexible the toe is. The surgeon may make a cut over your toe and release the tendon by cutting the tendon away from the bone. The surgeon may remove a small piece of bone from the toe. The surgeon may realign the tendons to reposition your toe or fasten the bones with pins. Sometimes the surgeon may have to join the bones in the toe. In this case, you will no longer be able to bend the toe, but the toe will be flat.

HammertoePrevention

The best first step you can take is to evaluate your shoe choices. Ditch any shoes that aren?t serving your feet well. Shoes that crowd the front of your foot, especially around your toes, aggravate the existing condition and can also cause the condition to develop. If you suspect the development of hammertoe, you may also try using protective pads to prevent irritation and the development of corns. Custom orthotics to correct muscle imbalances in your feet may also help prevent hammertoe.

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Over-Pronation Of The Foot Cause And Treatment

Overview

Excessive pronation hampers our natural walking pattern, causing an imbalance and leading to wear and tear in other parts of the body, with every step we take! Whether you have a true flat foot or suffer from over-pronation in both cases your poor walking pattern may contribute to a range of different complaints. Especially with age, poor alignment of the feet will cause very common conditions such as heel pain or knee Pain.Pronation

Causes

Acquired “Flat Feet” this develops over a period of time rather than at birth (unlike Congenital “Flat Feet”). In children, many different factors may contribute to the development of this condition such as the type of shoes that a child wears, a child’s sitting or sleeping positions or it may occur as some type of compensation for other abnormalities located further up the leg. Compensation may occur due to the rupture (tearing) of ligaments or tendons in the foot. One common reason for this condition is that the foot is compensating for a tight Achilles Tendon. If this tendon is tight it may cause the foot to point downward away from the body. This gives the body the perception that the affected leg is longer in length and the body attempts to compensate for the perceived additional length by flattening out the foot arch in an attempt to provide balance and stability.

Symptoms

If you overpronate, your symptoms may include discomfort in the arch and sole of foot. Your foot may appear to turn outward at the ankle. Your shoes wear down faster on the medial (inner) side of your shoes. Pain in ankle, shins, knees, or hips, especially when walking or running.Unfortunately, overpronation can lead to additional problems with your feet, ankles, and knees. Runners in particular find that overpronation can lead to shin splints, tarsal tunnel syndrome, plantar fasciitis, compartment syndrome, achilles tendonitis, bunions (hallux valgus) patello femoral pain syndrome, heel spurs, metatarsalgia. You do not have to be a runner or athlete to suffer from overpronation. Flat feet can be inherited, and many people suffer from pain on a day-to-day basis. Flat feet can also be traumatic in nature and result from tendon damage over time. Wearing shoes that do not offer enough arch support can also contribute to overpronation.

Diagnosis

So, how can you tell if you have overpronation, or abnormal motion in your feet, and what plantar fasciitis treatment will work to correct it? Look at your feet. While standing, do you clearly see the arch on the inside of your foot? If not, and if the innermost part of your sole touches the floor, then your feet are overpronated. Look at your (running/walking) shoes. If your shoes are more worn on the inside of the sole in particular, then pronation may be a problem for you. Use the wet foot test. Wet your feet and walk along a section of pavement, then look at the footprints you leave behind. A normal foot will leave a print of the heel connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you?re feet are pronated there may be little distinction between the rear and forefoot.Foot Pronation

Non Surgical Treatment

If you overpronate, you should talk with a foot and ankle specialist, especially if symptoms have not developed yet. Questions you may want to ask your doctor include what are the best running shoes on the market? Where can I find those shoes? If over-the-counter orthotics don?t work, how long should I wait before contacting you for custom-made orthotics? On my next visit, what type of diagnostic testing should I expect? If I limit the amount of time I spend running, will my overpronation symptoms disappear? What additional treatment options can we try?

Surgical Treatment

The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.

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Severs Disease Physical Therapy

Overview

Sever’s disease is a condition characterized by pain in one or both heels with walking. The pain is caused by shortening of the heel-cord. It usually affects children between the ages of 10 and 13 years old. During this phase of life, growth of the bone is taking place at a faster rate than the tendons. Sever’s disease is also called calcaneal apophysitis.

Causes

The exact cause of Severs disease is not completely understood. It is thought to be associated with an overuse type injury, in which repetitive stress from the Achilles tendon causes a portion of the growth plate to pull away from the heel. In medical terms, this is described as cyclic, micro-avulsion type fractures to the calcaneal apophyses.

Symptoms

Sever?s disease is a clinical diagnosis based on the youth?s presenting symptoms, rather than on diagnostic tests. While x-rays may be ordered in the process of diagnosing the disease, they are used primarily to rule out bone fractures or other bone abnormalities, rather than to confirm the disease. Common Characteristics of Sever?s Disease include Posterior inferior heel pain. Pain is usually absent when waking in the morning. Increased pain with weight bearing, running, or jumping (or activity-related pain). Area often feels stiff or inflexible. Youth may limp at the end of physical activity. Tenderness at the insertion of the tendons. Limited ankle dorsiflexion range that is secondary to tightness of the Achilles tendon. Activity or sport practices on hard surfaces can also contribute to pain, as well as poor quality shoes, worn out shoes, or the wrong shoes for the sport. Typically, the pain from this disease gradually resolves with rest.

Diagnosis

In Sever’s disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child’s heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child’s heel tendons have become tight.

Non Surgical Treatment

To help relieve pain, give your child nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen, as directed by your child?s provider. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen and naproxen, may cause stomach bleeding and other problems. Read the label and take as directed. Unless recommended by your healthcare provider, your child should not take the medicine for more than 10 days. Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye’s syndrome. Ask your child?s healthcare provider, How and when you will hear your child?s test results. How long it will take for your child to recover. What activities your child should avoid and when your child can return to normal activities. How to take care of your child at home. What symptoms or problems you should watch for and what to do if your child has them. Make sure you know when your child should come back for a checkup.

Recovery

Sever?s disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2-8 weeks. Some orthopedic surgeons will put the affected foot in a cast to immobilize it. However, while the disease does subside quickly, it can recur, for example at the s It is more common in boys, although occurs in girls as well. The average age of symptom onset is 9-11.

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