All The Things You Ought To Understand About Heel Pain

Overview

Feet Pain

Heel pain accounts for one of the most common types of pain felt in the foot. Pain in the heel of the foot can be caused as a result of exercise, daily work routines or recreational activities. Some type of repetitive stress on the foot is often at the root of Heel Pain. The largest bone in the foot is the calcaneus, or heel bone. When we walk, the heel bone is usually the first part of the foot that hits the ground and is responsible for supporting much of the body’s weight. This makes the heel of the foot prone to injury.

Causes

Age plays a large role in the development of heel pain, particularly among those over 40. Being active is also a common factor of heel pain. Over time, the elasticity of the tissue in our feet decreases with age, causing us to become prone to damage and also slowing the body’s ability to heal damage. Adolescents are also not immune to heel pain. Those who are active in sports are particularly prone to excessively stretching or straining the plantar fascia or Achilles tendon, causing severe heel pain. In most cases, heel pain develops in only one heel. There are many risk factors that lead to heel pain. Abnormal gait and excessive, repetitive stress are common factors in the development of pain and damage. Among the other risk factors involved with the development of heel pain are repetitive exercise or activities, such as long distance running or jumping from activities such as basketball. Obesity. Walking barefoot on hard surfaces. Prolonged standing. Wearing poor fitting shoes, or shoes that do not provide enough support or cushioning. Not stretching properly or at all before and after exercise. Those who are on their feet for long periods of time.

Symptoms

Plantar fasciitis is a condition of irritation to the plantar fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness on the bottom of your heel and feels worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or runners will feel discomfort for the first few minutes of their run. This occurs because the plantar fascia is not well supplied by blood, which makes this condition slow in healing, and a certain amount of activity is needed to get the area to warm up. Plantar fasciitis can occur for various reasons: use of improper, non-supportive shoes; over-training in sports; lack of flexibility; weight gain; prolonged standing; and, interestingly, prolonged bed rest.

Diagnosis

A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.

Non Surgical Treatment

If the plantar fasciitis is acute, that is, a sprain of the plantar fascia then it is basically treated as a sprain, with anti-inflammatory drugs, ice, rest, possibly physical therapy. If chronic, the poor foot mechanics need be addressed. Foot mechanics are changed by use of specially moulded shoe inserts known as orthotics. Someone with plantar fasciitis needs an orthotic designed to relieve strain on the plantar fascia. Orthotics are often confused with arch supports. Arch supports, by holding up the arch can remove some of the tension from the plantar fascia. Orthotics, on the other hand, do most of their work on the heel and ball of the foot repositioning the foot for maximized function. What can you do before you see the foot doctor? First, try doing your own version of deep tissue massage by rolling a frozen cola bottle or can from the heel forward into the arch. Do it gently. Do stretching but the key to good stretching is not to stretch too hard so generally avoid weight bearing (standing) stretches but sit on a soft surface like your bed and pull the foot backward on the leg as far as it will go, holding for 20 seconds and relaxing for 5 seconds. Each 25 second ?set? can be repeated 5 times and you have invested about 2 minutes in giving yourself a lot of help. Watch out for the shoes you wear. It is tempting to obtain shoes that are colorful and soft. Here is the proof that soft shoes are bad. Wrap a pillow around your foot with duct tape and walk for a block or two. You will come back with your foot hurting more because your foot sank down deeper into the soft surface, allowing the ligament to stretch more. The shoes should be stiff in the shank and flexible at the ball. Such shoes, to running buffs, are known as motion control shoes or stability shoes so going to one of the small specialty running shoes stores is a good place to start. If you don?t have a desk job, or have an industrial job see if light duty is available. A note from your doc may be all that is required in most cases and most doctors are happy to oblige.

Surgical Treatment

With the advancements in technology and treatments, if you do need to have surgery for the heel, it is very minimal incision that?s done. And the nice thing is your recovery period is short and you should be able to bear weight right after the surgery. This means you can get back to your weekly routine in just a few weeks. Recovery is a lot different than it used to be and a lot of it is because of doing a minimal incision and decreasing trauma to soft tissues, as well as even the bone. So if you need surgery, then your recovery period is pretty quick.

Prevention

Foot Pain

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.

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What Could Cause Achilles Tendonitis ?

Overview

Achilles TendonitisAchilles tendonitis is one of the most common running injuries. The achilles tendon is the large tendon at the back of the ankle. It connects the calf muscles made up of the gastrocnemius and soleus to the heel bone or calcaneus. It provides the power in the push off phase of walking and running where huge forces are transmitted through the achilles tendon. Achilles tendonitis is often now referred to as achilles tendinopathy. This is because the term tendinopathy covers all types of overuse achilles tendon injury. Strictly speaking tendonitis suggests an inflammatory condition of the tendon but in reality few achilles tendon injuries are actually down to pure inflammation. Soleus muscleThe main finding, particularly in older athletes is usually degeneration of the tissue with a loss of normal fibre structure. Other very similar conditions may actually be due to inflammation or degeneration of the tendon sheath which surrounds the tendon rather than the achilles tendon itself. In addition to being either chronic or acute, achilles tendonitis can also be at the attachment point to the heel called insertional achilles tendonitis or in the mid-portion of the tendon typically around 4cm above the heel. Healing of the achilles tendon is often slow, due to its poor blood supply.

Causes

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including a bone spur that has developed where the tendon attaches to the heel bone, Sudden increase in the amount or intensity of exercise activity-for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance, Tight calf muscles, Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon, Bone spur-Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.

Symptoms

The symptoms associated with Achilles tendonitis and tendonosis include, Pain-aching, stiffness, soreness, or tenderness-within the tendon. This may occur anywhere along the tendon?s path, beginning with the tendon?s attachment directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity. Tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on the back of the tendon. When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.

Diagnosis

If you think you have Achilles tendinitis, make an appointment to see your doctor. The doctor will ask you questions about your recent activity and look for signs. The foot not flexing when the calf muscle is pressed ( if Achilles ruptures or tears in half). Swelling on the back of the foot. Pain in the back of the foot. Limited range of motion in ankle. An X-ray or MRI scan can check for tendinitis.

Nonsurgical Treatment

Treatment normally includes, A bandage, designed specifically to restrict motion of the tendon. Non-steroidal anti-inflammatory medication. Orthoses (devices to help to support the muscle and relieve stress on the tendon, such as a heel pad or shoe insert. Rest, and switching to an exercise, such as swimming, that does not stress the tendon. Stretching, massage, ultrasound and appropriate exercises to strengthen the weak muscle group in front of the leg and the upper foot flexors. In extreme cases, surgery is performed, to remove fibrous tissue and repair any tears.

Achilles Tendon

Surgical Treatment

Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from the transferred tendon.

Prevention

Do strengthening and stretching exercises to keep calf muscles strong and flexible. Keep your hamstring muscles flexible by stretching. Warm up and stretch adequately before participating in any sports. Always increase the intensity and duration of training gradually. Do not continue an exercise if you experience pain over the tendon. Wear properly fitted running and other sports shoes, including properly fitted arch supports if your feet roll inwards excessively (over-pronate).