Overview


The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are heel spurs and plantar fasciitis. A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur digs into the plantar fascia and causes small micro-tears in the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch.


Causes


This condition is a constellation of many causes; overweight, ill fitting shoes, bio-mechanical problems (mal-alignment of the heel), gout, pronation (a complex motion including outward rotation of the heel and inward rotation of the ankle) and rheumatoid arthritis are some of the causes of heel pain.





Symptoms


Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain, especially while walking, jogging, or running, if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning, a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.


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


The key is to identify what is causing excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support will help reduce the over-pronation and thus allow the condition to heal. Other common treatments for heel spurs include Stretching exercises. Losing weight. Wearing shoes that have a cushioned heel that absorbs shock. Elevating the heel with the use of a heel cradle, heel cup, or orthotics. For example, heel cradles and heel cups provide extra comfort and cushion to the heel, reducing the amount of shock and shear forces experienced from everyday activities.


Surgical Treatment


Sometimes bone spurs can be surgically removed or an operation to loosen the fascia, called a plantar fascia release can be performed. This surgery is about 80 percent effective in the small group of individuals who do not have relief with conservative treatment, but symptoms may return if preventative measures (wearing proper footwear, shoe inserts, stretching, etc) are not maintained.

Overview


Heel spurs are a relatively common cause of heel pain. A heel spur is a pointed bone fragment that extends forward from the bottom of the heel from the heel bone, also referred to as a calcaneous. Serious pain and discomfort often develops with this condition. In many cases, a heel spur develops along with plantar fasciitis which occurs when the plantar fascia ligament becomes inflamed.


Causes


When a patient has plantar fasciitis, the plantar fascia becomes inflamed and degenerative (worn out)--these abnormalities can make normal activities quite painful. Symptoms typically worsen early in the morning after sleep. At that time, the plantar fascia is tight so even simple movements stretch the contracted plantar fascia. As you begin to loosen the plantar fascia, the pain usually subsides, but often returns with prolonged standing or walking.





Symptoms


The vast majority of people who have heel spurs feel the asscociated pain during their first steps in the morning. The pain is quite intense and felt either the bottom or front of the heel bone. Typically, the sharp pain diminishes after being up for a while but continues as a dull ache. The pain characteristically returns when first standing up after sitting for long periods.


Diagnosis


Diagnosis is made using a few different technologies. X-rays are often used first to ensure there is no fracture or tumor in the region. Then ultrasound is used to check the fascia itself to make sure there is no tear and check the level of scar tissue and damage. Neurosensory testing, a non-painful nerve test, can be used to make sure there is not a local nerve problem if the pain is thought to be nerve related. It is important to remember that one can have a very large heel spur and no plantar fasciitis issues or pain at all, or one can have a great deal of pain and virtually no spur at all.


Non Surgical Treatment


Acupuncture and acupressure can used to address the pain of heel spurs, in addition to using friction massage to help break up scar tissue and delay the onset of bony formations. Physical therapy may help relieve pain and improve movement. The Feldenkrais method could be especially helpful for retraining some of the compensation movements caused by the pain from the spur. Guided imagery or a light massage on the foot may help to relieve some of the pain. Other treatments include low-gear cycling, and pool running. Some chiropractors approve of moderate use of aspirin or ibuprofen, or other appropriate anti-inflammatory drugs. Chiropractic manipulation is not recommended, although chiropractors may offer custom-fitted shoe orthotics and other allopathic-type treatments.


Surgical Treatment


In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.

Overview


Bursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot that cause an abnormal gait (way of walking). In other cases, wearing shoes with poorly cushioned heels can trigger bursitis.


Causes


The calcaneal bursa can become inflamed in patients with heel spurs or in patients with poor-fitting shoes (eg, high heels). Inflammation can occur secondarily from Achilles tendinitis, especially in young athletes. Patients exhibit tenderness to palpation of the bursa anterior to the Achilles tendon on both the medial and lateral aspects. They have pain with movement, which is worsened with dorsiflexion.


Symptoms


Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down.


Diagnosis


Your health care provider will take a history to find out if you have symptoms of retrocalcaneal bursitis. Examining your ankle can find the location of the pain. The physician will look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex). Or, the pain may be worse when you rise on your toes. You will not usually need imaging studies such as x-ray and MRI at first. If the first treatment does not improve the symptoms, your health care provider may recommend these tests. MRI may show inflammation.


Non Surgical Treatment


Your GP may prescribe a short course of anti-inflammatory painkillers to reduce and control the painful inflammation that occurs and antibiotics in cases of septic bursitis. Applying a covered ice pack to the area after the initial injury may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack regularly for 10-15 minutes with intervals of 30 minutes. Where possible it is advisable to avoid all aggravating movements and postures, however complete rest is not as this can lead to weakness and further shortening of the muscle. Massage and manipulative therapies can help loosen the surrounding muscles and tendons of the affected joint, reducing the pressure over the bursa and allowing it to heal faster. If the bursitis is chronic and not responding to treatment then your GP may refer you for a corticosteroid injection which will reduce the inflammation levels which will in turn reduce the pain levels experienced. Corticosteroid injections can have varied results. Surgery is a rare option when it comes to bursitis but occasionally it may be necessary for extremely chronic cases or to drain an infected bursa.


Surgical Treatment


Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to remove the inflamed bursa.

Overview


A hammertoe is a toe that's curled due to a bend in the middle joint of a toe. Mallet toe is similar, but affects the upper joint of a toe. Otherwise, any differences between hammertoes and mallet toe are subtle. Both hammertoe and mallet toe are commonly caused by shoes that are too short or heels that are too high. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a hammer-like or claw-like appearance. Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you may need surgery to experience relief.


Causes


Hammer toe may also be caused by other medical conditions such as rheumatoid arthritis, osteoarthritis, or stroke because these forms of illnesses involve affectation of the person's muscles and nerves. Diabetes is also a causative factor for hammer toes due to diabetic neuropathy, which often times accompanies advanced instances of diabetes. Injury to a person's toes may also cause hammer toes, particularly if the injury involves breaking of the toes. In some instances, hammer toes may be hereditary. Some people may be genetically predisposed to develop the condition because of the natural structure of their bodies.


Symptoms


For some people, a hammer toe is nothing more than an unsightly Hammer toes deformity that detracts from the appearance of the foot. However, discomfort may develop if a corn or callus develops on the end or top of the toe. If pressure and friction continue on the end or top of the toe, a painful ulcer may develop. Discomfort or pain can lead to difficulty walking.


Diagnosis


Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.


Non Surgical Treatment


If the toes are still mobile enough that they are able to stretch out and lay flat, the doctor will likely suggest a change of footwear. In addition, she may choose to treat the pain that may result from the condition. The doctor may prescribe pads to ease the pain of any corns and calluses, and medications ranging from ibuprofen to steroid injections for the inflammation and pain. Other options for non-surgical treatments include orthotic devices to help with the tendon and muscle imbalance or splinting to help realign the toe. Splinting devices come in a variety of shapes and sizes but the purpose of each is the same: to stretch the muscles and tendon and flatten the joint to remove the pain and pressure that comes from corns.


Surgical Treatment


If pinning the toe is not required during the procedure, then the surgery could be preformed in the doctor's office under a local anesthesia. Some patients prefer the comfort of sedation during the surgery and if this is the case or if a pin must be placed, then the surgery could be preformed in an outpatient surgery center.


Prevention


You can avoid many foot, heel and ankle problems with shoes that fit properly. See your doctor if you have foot pain that's persistent and that affects your ability to walk properly and carry out other motions with your foot. Also, see your doctor if one or more of your toes has developed a clenched or claw-like appearance.

Overview

Bunions (hallux valgus) are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion's "bump." Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Bunions can be painful, but not always. Bunions are always progressive, so the deformity becomes more prounced over time, even if its not painful.

Causes
Bunions are a result of complex biomechanical changes that occur in your feet. The type of footwear that you wear does cause bunions. We know that foot bunions occur in about 30% of the population of most Western countries but only 3% in Eastern countries. They are seen most commonly in women and become more common as people get older. Tight-fitting shoes are thought to be the main cause of bunions.. Shoes such as high heels and shoes with tight toe boxes (eg womens fashion shoes and cowboy boots) are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box. The slope causes the front of the foot to bear your weight, which encourages your forefoot to widen. Also, the angle pushes your toes into the narrow toe box, causing the toes to become angled and squeezed together.
SymptomsWith Bunions, a person will have inflammation, swelling, and soreness on the side surface of the big toe. Corns most commonly are tender cone-shaped patches of dry skin on the top or side of the toes. Calluses will appear on high-pressure points of the foot as thick hardened patches of skin.

Diagnosis
Bunions are readily apparent, you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the Podiatrist may arrange for x-rays to be taken to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. There is no clear-cut way to predict how fast a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.

Non Surgical Treatment
A bunion may only need to be treated if it's severe and causing significant pain and discomfort. The different treatments for bunions are described below. If possible, non-surgical treatment for bunions will be used, which your GP can discuss with you. Non-surgical treatments can ease the pain and discomfort caused by a bunion, but they can't change the shape of your foot or prevent a bunion from getting worse over time. Non-surgical treatments include painkillers, bunion pads, orthotics, wearing suitable footwear, These are discussed in more detail below. If your bunion is painful, over-the-counter painkillers such as paracetamol or ibuprofen may be recommended.Bunion pads may also ease the pain of a bunion. Reusable bunion pads, made of either gel or fleece, are available over the counter from pharmacies. Some are adhesive and stick over the bunion, while others are held against your foot by a small loop that fits over your big toe. Bunion pads stop your foot rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe. Orthotics are placed inside your shoes to help realign the bones of your foot. They may help relieve the pressure on your bunion, which can ease the pain. However, there's little evidence that orthotics are effective in the long term. It's important that the orthotic fits properly, so you may want to seek advice from your GP or podiatrist (a specialist in diagnosing and treating foot conditions), who can suggest the best ones for you.


Surgical Treatment
When deciding whether to have bunion surgery, there are several things to consider including your age, in children, bunion surgery is often delayed because of the risk of the bunion returning, your medical history and general health, problems with wound healing and infections are more likely in certain conditions such as diabetes, you?re also more likely to develop problems if your bunion is caused by a condition such as rheumatoid arthritis, your occupation and lifestyle, bunion surgery can make your toes less flexible, and you may be unable to return to the same level of physical activity, your expectations of surgery, bunion surgery has about an 85% success rate, but there's no guarantee that your foot will be perfectly straight or pain-free; the success of surgery depends on the type of procedure, the experience of the surgeon and your ability to rest after the operation, the severity of your symptoms, surgery will usually only be recommended if your bunions are causing considerable pain and non-surgical treatments haven't been unsuccessful (because of the associated risks and complications).