Archive for Heel
Pain Upon Rising
Posted by: | CommentsA very common description of foot pain from my patients at Sowell Podiatry is the complaint that “my feet hurt when I get out of bed in the morning”. Now this can be caused by many things, but I would like to explain the phenomenon of post-static dyskinesia that my patients often experience. The spaces for swelling in the deeper tissues of the foot are very tight. Very small amounts of swelling can often lead to discomfort in some areas. When the foot is in motion, particularly when weight bearing, the muscles and motion of the foot squeeze any swelling in these places away and the swelling will move up into the lower leg. This “natural pump” is very efficient as long as it keeps running.
When we get off of our feet for an extended time, such as driving home from work, sitting to rest or sleeping at night the “pump” is turned off and the swelling collects. When we engage this “pump” by getting up on our feet and walking there is a build up swelling that must be moved quickly and it is painful until a few steps are taken and we begin to get the swelling moving. So often, patients think it is the first few steps that are the problem but actually it is the activity before resting that led to the swelling build up.
Most likely, the foot is not being properly supported while walking or working and this leads to continual swelling throughout the day. If you are suffering with pain upon rising, you might try icing your feet at the end of your day. Rolling a frozen water bottle on the floor underneath your foot from your heel to the ball of your foot can be very helpful. As a podiatrist I can assess the foot for lack of support and swelling and often can relieve this pain upon rising with simple shoe, insole or lifestyle modifications
Heel Spurs
Posted by: | CommentsA few quick misconceptions about heel spurs:
- That they have to be cut out for the pain to go away.
- That they are digging into your flesh.
- That they are due to a “stone bruise”.
In fact, if we took one hundred people off the street and took x-rays ten would have heels spurs with no pain. This should tell us that heel spurs are fairly common and are not always painful. At Sowell, Podiatry we are very good at ending your heel pain without surgery.
The band that runs along the bottom of the foot from your heel to the ball of the foot is called the plantar fascia. To find your plantar fascia, simply lift your big toe and the plantar fascia will typically “pooch” out along the arch on the bottom of your foot. The swelling of this band is our focus in this article and is called plantar fasciitis. Patients with plantar fasciitis often have pain upon rising from a chair, getting out of the car or during the first few steps of the day.
Plantar fasciitis is often caused by poor foot mechanics. If your foot flattens out too much the fascia may overstretch and swell and if your foot is very high arched the fascia may be too tight and ache. Additionally, many activities can injure your plantar fascia leading to irritation along it. Chronic pulling of the plantar fascia with concurrent swelling can lead to the condition commonly known as a heel spur.
Physical examination of the foot can reveal if plantar fasciitis and a good understanding of foot mechanics will often lead to a determination as to why it is present. X-rays are required to diagnose a heel spur. The presence of a heel spur is a good indicator that the plantar fascia has been under increased tension for an extended period.
Reducing the symptoms of plantar fasciitis and heel spurs can include many things:
- Ice. We recommend rolling a frozen water bottle under the bottom of the foot.
- Anti-inflammatory medications.
- Controlling foot motion with insoles and shoes.
- Starting a stretching program to reduce tension on the area.
Occasionally plantar fasciitis and heel spurs require surgery but typically they can be addressed with conservative measures. We are very successful in treating this condition and we can often return patients back to a pain free active lifestyle in just a few visits.
Plantar Fasciitis – Heel Pain
Posted by: | CommentsThe band that runs along the bottom of the foot from your heel to the ball of the foot is called the plantar fascia. To find your plantar fascia, simply lift your big toe and the plantar fascia will typically “pooch” out along the arch on the bottom of your foot. The swelling of this band is our focus in this article and is called plantar fasciitis.
Plantar fasciitis is often caused by poor foot mechanics. If your foot flattens out too much the fascia may overstretch and swell and if your foot is very high arched the fascia may be too tight and ache. Additionally, many activities can injure your plantar fascia leading to irritation along it. Chronic pulling of the plantar fascia with concurrent swelling can lead to the condition commonly known as a heel spur.
Physical examination of the foot can reveal if plantar fasciitis and a good understanding of foot mechanics will often lead to a determination as to why it is present. X-rays are required to diagnose a heel spur.
Reducing the symptoms of plantar fasciitis can include many things:
- Ice. We recommend rolling a frozen water bottle under the bottom of the foot.
- Anti-inflammatory medications.
- Controlling foot motion with insoles and shoes.
- Starting a stretching program to reduce tension on the area.
Occasionally plantar fasciitis and heel spurs require surgery but typically it can be addressed with conservative measures. We are very successful in treating this condition and we can often return patients back to a pain free active lifestyle in just a few visits. However, sometimes long term support of the foot is needed and Dr. Sowell recommends custom orthotics in these situations.
Achilles Tendonitis
Posted by: | CommentsThe calf muscles are attached to the heel by the Achilles tendon. This is primarily the thickened cord or fibrous band that runs down the back of one’s leg and attaches to the heel bone. The main function of this complex is to force the foot downward in gait and thus propel one forward. Achilles tendonitis is a common diagnosis for all podiatrists and Dr. Sowell is no different. Athletes, housewives, factory workers and professionals are just a few of the types of patients who suffer from Achilles tendonitis. The cause may be varied. Sometimes it is to injury from a direct impact, from over-use or excessive training, or can just start hurting as a result of shoe pressure. The patient with an Achilles tendonitis will most often have pain and swelling in the lower portion of the tendon just above the heel, will have discomfort when moving the foot upwards thus stretching the tendon, and will probably note that the condition has worsened over time.
It is hard to predict who will suffer from Achilles tendonitis but there are certain factors, which seem to be likely. Trauma or injury to the Achilles tendon itself is an obvious cause of subsequent tendonitis. An altered gait, high heels over a long period of time or limb length discrepancy can also create excessive strain upon the Achilles tendon resulting in localized swelling and pain. Over use, excessive training and improper stretching can also result in Achilles tendon injuries. The bottom line though, in most cases of Achilles tendonitis, is the same…pain, reduced range of motion, localized swelling, and a potential long-term problem that is usually slow to respond to therapy.
In discussing the treatment approaches to an Achilles tendonitis, we must first mention the necessity of a thorough examination by a specialist. Fractures of the heel bone, partial ruptures of the tendon itself, and localized soft tissue problems must all be carefully considered and ruled out. The specific treatment of an Achilles tendonitis might include physical therapy, shoe padding (lifts to raise the heel), possible orthotics, oral anti-inflammatory medication, some form of immobilization, and reduced physical activity until the condition improves. Surgery, although mentioned for completeness is rarely used. It should be mentioned that this painful and often disabling condition, while frequently slow to respond, will usually improve and resolve with therapy over time.
Patients often find themselves in a “catch 22” where the tendon needs to be lengthened through a progressive stretching program but said program only aggravates the condition. With careful diagnosis and addressing of symptoms, Dr. Sowell can determine the best way to proceed and hopefully return the patient to activity sooner than expected.
Orthotics at Sowell Podiatry in Nacogdoches
Posted by: | CommentsOrthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotic are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual’s unique foot structure.
Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.
Rigid Orthotics
Rigid orthotic devices are designed to control function and are used primarily for walking or dress shoes. They are often composed of a firm material, such as plastic or carbon fiber. Rigid orthotics are made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot. Rigid orthotics control motion in the two major foot joints that lie directly below the ankle joint and may improve or eliminate strains, aches, and pains in the legs, thighs, and lower back.
Soft Orthotics
Soft orthotics are generally used to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. They are usually effective for diabetic, arthritic, and deformed feet. Soft orthotics are typically made up of soft, cushioned materials so that they can be worn against the sole of the foot, extending from the heel past the ball of the foot, including the toes. Like rigid orthotics, soft orthotics are also made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot.
Semi-Rigid Orthotics
Semi-rigid orthotics provide foot balance for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials. Semi-rigid orthotics are often prescribed for children to treat flatfoot and in-toeing or out-toeing disorders. These orthotics are also used to help athletes mitigate pain while they train and compete.
Heel Pain in the Young Athlete – Sowell Podiatry – Nacogdoches
Posted by: | CommentsEvery year I see a dozen, or so, young athletes that are having problems when playing. Typically they are running on their toes to avoid heel pressure and play explosive sports with increased heel pressures. Of course these children need to be assessed and properly diagnosed to rule out more severe conditions, but I want to discuss calcaneal apophysitis today as spring begins!
We can often learn a good deal about a particular medical condition if we understand the terminology used in its description. The term, calcaneal, refers to the heel bone while apophysitis describes an inflammation of the heel’s growth center in a child. A calcaneal apophysitis is a condition usually seen in young athletic or physically active children of the age group 8-15. The heel is painful with running or jumping, is usually not swollen visually or discolored, and seems to get progressively worse without treatment. A parent will often bring in a child because of limping during game play along with complaints by the child of discomfort in and around the heel.
Most authorities seem to agree that this condition results from acute or chronic (repetitive) trauma to the heel at a time of vulnerability due to natural growth periods. It should be noted that the heel area of the foot is under normal circumstances, not highly vascularized or well supplied by blood circulation. This means that the area of the foot will heal slower and might be subject to increased risk of injury. Acute trauma refers to a sudden impact or blow to the involved site while repetitive trauma involves cumulative stress over an extended period of time. The bottom line is similar however, with trauma to the growth plate area of the heel being the culprit.
The management of a calcaneal apophysitis condition involves protection and support of the heel in order to allow for normal developmental growth. This can be accomplished by padding the heel of the shoe, wearing protective cups, and in some cases to even further reduce weight-bearing by casting and or crutches. Often I’ll recommend alternating NSAIDs and applying ice before and after activity. The continuance of athletic competition during treatment is an issue that is largely dependent upon how the child responds to therapy initially. In most cases, where the symptoms reduce early on with treatment, the child might continue with physical activity. On the other hand, if the symptoms persist well into the therapy period, then reducing or eliminating continued physical activity might be necessary. This condition in most cases, can be readily managed once identified and properly treated and almost always resolves over time.
