Diagnosing Inferior Calcaneal Spur

Heel Spur


Overview


Heel spurs are tiny protruding calcium deposits that can develop near the base of your heel bone. They can be caused by repetitive activities, such as dancing or running, or they can form in association with plantar fasciitis, which is an inflammation of the ligament (plantar fascia) on the bottom of your foot. When the plantar fascia is tight and pulls on your heel bone, the bone releases calcium to try to heal itself. The excess deposits of calcium can sometimes form heel spurs.


Causes


An individual with the lower legs angulating inward, a condition called genu valgum or "knock knees," can have a tendency toward excessive pronation. As a result, this too can lead to a fallen arch resulting in plantar fascitis and heel spurs. Women tend to have more genu valgum than men do. Heel spurs can also result from an abnormally high arch. Other factors leading to heel spurs include a sudden increase in daily activities, an increase in weight, or a change of shoes. Dramatic increase in training intensity or duration may cause plantar fascitis. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia and possibly lead to heel spurs.


Calcaneal Spur


Symptoms


The spur itself is not painful, however, if it is sharp and pointed it can poke into soft tissue surrounding the spur itself. As the bone spur irritates the tissue, inflammation and bruising can occur leading to heel pain. Heel spurs can affect your ability to do your usual work and/or activities, and can also trap and irritate the nerves in your heel area. They can change the way you walk, and can lead to knee, hip and low back injuries. If severe, they may require medical intervention.


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


Since heel spurs are not an indication of pain themselves unless fractured, treatment is usually aimed at the cause of the pain which in many cases is plantar fasciosis. Treatment of plantar fasciiosis includes; rest until the pain subsides, special stretching exercises and if required orthotics may be prescribed.


Surgical Treatment


Heel spur surgery should only be considered after less invasive treatment methods have been explored and ruled insufficient. The traditional surgical approach to treating heel spurs requires a scalpel cut to the bottom of the food which allows the surgeon to access the bone spur. Endoscopic plantar fasciotomies (EPF) involve one or two small incisions in the foot which allow the surgeon to access and operate on the bone spur endoscopically. Taking a surgical approach to heel spur treatment is a topic to explore with a foot and ankle specialist.

Bursitis Of The Heel Conditions

Overview


The most common bursa to be inflamed in the foot is the retrocalcaneal bursa (also referred to as the subtendinous calcaneal bursa). Located between the Achilles tendon and the heel bone (calcaneus), this is a "true" bursa that is present from birth. It acts as a cushion to protect the Achilles tendon from friction against the heel bone. Also commonly affected, the subcutaneous calcaneal bursa (also referred to as the Achilles bursa), located between the Achilles tendon and the skin, sits a little lower down the ankle towards the heel than the retrocalcaneal bursa. This bursa develops as you age, an "adventitious" bursa, to protect the tendon from friction at the back of the heel.


Causes


Overuse of the ankle joint may cause irritation of the bursa such as excessive walking, running or jumping. Poor biomechanics and foot function may ultimately lead to heel bursitis due to pulling on the back of the heel by the Achilles tendon.


A sudden increase in physical activity without adequate rest may result in heel bursitis. Excessive standing and walking bare foot on hard surfaces.


Symptoms


A person with bursitis can have one or more of the symptoms below. Pain, the pain increases with movement or pressure. Tenderness is felt even without movement. Swelling. Loss of movement. If the bursitis is caused by an infection it is called Septic Bursitis. The patient with septic bursitis may have the following additional symptoms. Fever. The affected area is red. The affected area feels hot when touched.


Diagnosis


Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis but may be requested to check for any underlying health conditions that may have triggered the bursitis.


Non Surgical Treatment


Despite appropriate physiotherapy management, some patients with retrocalcaneal bursitis do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may include further investigations such as an ultrasound, X-Ray, MRI or CT scan, pharmaceutical intervention, corticosteroid and anaesthetic injection into the retrocalcaneal bursa, draining of the bursa, or review by a specialist or podiatrist who can advise on any treatment that may be appropriate to improve the condition.


Surgical Treatment


Surgery is rarely done strictly for treatment of a bursitis. If any underlying cause is the reason, this may be addressed surgically. During surgery for other conditions, a bursa may be seen and removed surgically.


Prevention


It isn't always possible to avoid the sudden blow, bump, or fall that may produce bursitis. But you can protect your body with measures similar to those that protect you from other kinds of overuse injuries, such as tendinitis. Keep yourself in good shape. Strengthening and flexibility exercises tone muscles that support joints and help increase joint mobility. Don?t push yourself too hard (or too long). If you?re engaged in physical labor, pace yourself and take frequent breaks. If you?re beginning a new exercise program or a new sport, work up gradually to higher levels of fitness. And anytime you?re in pain, stop. Work on technique. Make sure your technique is correct if you play tennis, golf, or any sport that may strain your shoulder. Watch out for ?elbow-itis.? If you habitually lean on your elbow at your work desk, this may be a sign that your chair is uncomfortable or the wrong height. Try to arrange your work space so that you don?t have to lean on your elbow to read, write, or view your computer screen. Take knee precautions. If you have a task that calls for lots of kneeling (for example, refinishing or waxing a floor), cushion your knees, change position frequently, and take breaks. Wear the right shoes. High-heeled or ill-fitting shoes cause bunions, and tight shoes can also cause bursitis in the heel. Problems in the feet can also affect the hips. In particular, the tendons and bursae in the hips can be put under excessive strain by worn-down heels. Buy shoes that fit and keep them in good repair. Never wear a shoe that?s too short or narrow. Women should save their high heels for special occasions only. Avoid staying in only one position for too long. Get up and walk around for a while or change positions frequently.

How To Relieve Hammer Toe Pain

Hammer ToeOverview


Hammer, mallet, and claw toes have distinctive differences that can assist you in determining what kind of toe problem you are dealing with. All three conditions deal with toes that are curved into abnormal positions, which possibly look strange and may cause pain. Typically, the big toe is not affected by these problems. A hammertoes tends to bend downward at the center of a toe joint. It generally affects your second toe. The affliction causes the center of your toe to rise and is often accompanied with a bony lump.


Causes


Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problem (e.g., a bunion can force the big toe to turn inward and push the other toes). It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot-Marie-Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich's ataxia.


HammertoeSymptoms


For some people, a hammer toe is nothing more than an unsightly 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


Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.


Non Surgical Treatment


Changing the type of footwear worn is a very important step in the treatment of hammer toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the hammer toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes. Other conservative treatments include using forefoot products designed to relieve hammer toes, such as hammer toe crests and hammer toe splints. These devices will help hold down the hammer toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.


Surgical Treatment


For severe hammer toe, you will need an operation to straighten the joint. The surgery often involves cutting or moving tendons and ligaments. Sometimes the bones on each side of the hammertoe joint need to be connected (fused) together. Most of the time, you will go home on the same day as the surgery. The toe may still be stiff afterward, and it may be shorter. If the condition is treated early, you can often avoid surgery. Treatment will reduce pain and walking difficulty.


HammertoePrevention


Custom orthotics paired with a well made shoe can prevent the progression and development of hammertoes. Wearing proper-fitting shoes and custom orthotic devices can provide the support patients need to address muscle/tendon dysfunction. It can also support end stage diseases that result in hammertoe deformities by re-balancing the foot and ankle and controlling the deforming forces.

Hammer Toe Cause

HammertoeOverview


A hammertoe is a deformity of the middle joint of a toe, producing a clenched, clawlike appearance in the affected digit. The tendons in the toe become abnormally contracted, causing the toe to bend downward, which, in turn, forces the joint to protrude upward. A mallet toe is a deformity in which the end joint of a toe becomes bent downward, so that the toe curls underneath itself. In either case the affected joints are stiff, and often the toe cannot be straightened out. Constant rubbing against shoes may furthermore cause a painful corn (a round patch of rough, thickened, calloused skin) to develop over the joint or at the tip of the affected toe. Hammer and mallet toes may occur in any toe, although the second toe is the most common site. These deformities are often painful and limit the toe?s range of hammertoes motion-sometimes requiring surgery.


Causes


Your shoes, your genetic predisposition, an underlying medical condition or all of these can make you susceptible to developing one of these deformities of the toes. The genes your parents gave you. When it comes to genetics, the foot type you?re born with predisposes you to developing this type of joint deformity over a lifetime. For many, a flat flexible foot leads to hammertoes as the foot tries to stabilize against a flattening arch. Those with high arches can also form hammertoes as the extensor tendons overpower the flexors.


HammertoeSymptoms


The most obvious symptoms of this injury will be the the middle toe joint is permanently bent at an angle. In the beginning movement may still be possible but as time passes and the injury worsens the toe will be locked in place and possible require hammer toe correction surgery to fix. Another key indicator of hammer toe is that a lump or corn will form on top of the toe. The toe joint will be painful and walking can cause severe discomfort. Occasionally a callus may form on the sole of the injured foot. If you see any of these symptoms together or have been enduring pain for some time, seeing a podiatrist should be your next step.


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


Hammer toes usually get progressively worse over time, especially if you avoid seeking care. Not all cases are the same, so it is important to get your podiatrist or foot surgeon to evaluate your condition so that you can get the treatment you need as soon as possible. Your treatment options will vary depending on the severity of your hammer toe. You may not require surgery to treat your hammer toe. Your doctor may suggest one of these less invasive measures. Instead of wearing shoes that are too high or too short, wear comfortable shoes that have plenty of room and are flat or low-heeled. Your doctor can prescribe pads that will prevent your corns or calluses from getting irritated. Avoid over-the-counter medicated pads, as they contain acid that can worsen your condition. An orthotic device can be customized to fit your shoe and foot. It can help control your tendon and muscle imbalance, which in turn may ease your pain. NSAIDS (nonsteroidal anti-inflammatory drugs) such as ibuprofen can reduce inflammation. By relieving swelling in your toe joint, you can alleviate your pain. Splints or small straps can be placed on your toe by a foot surgeon to realign your bent toe. Applying ice packs wrapped in cloth on your hammer toe can reduce inflammation and swelling. Gently massaging your toes can assist in alleviating your pain caused by hammer toes. Try exercises that stretch your feet as these can help restore your muscle balance. A simple exercise that can help is to pick up a cloth or small object from the floor by curling your toes. This action will help your feet and toes by stretching them.


Surgical Treatment


Sometimes, if the deformity is severe enough or surgical modification is needed, the toe bones may be fused so that the toe does not bend. Buried wires are used to allow for the fusion to heal, and they remain in place after healing. Your skin is closed with fine sutures, which are typically removed seven to ten days after surgery. A dressing is used to help keep your toes in their new position. Dressings should not get wet or be removed. After surgery, your doctor may prescribe pain relievers, typically for the initial four to seven days. Most people heal completely within one month of surgery, with few complications, if any. Crutches or a cane may be needed to help you keep weight off your affected foot, depending on the procedure. Occasionally, patients receive a special post-op shoe or a walking boot that is to be worn during the healing process. Most people are able to shower normally after surgery, but must protect the dressing from getting wet. Many patients are allowed to resume driving within one week after the procedure, but care needs to be taken.

What Actually Causes Feet To Over Pronate

Overview


The foot and ankle complex needs to pronate to make the muscles of the hips and legs work correctly. Many muscles that originate from the pelvis attach to both the upper and lower leg. For example, the gluteus maximus and tensor fascia latae (TFL) attach to the outside of the lower leg via the iliotibial band, while the abductors attach to the outside of the femur. When the foot pronates, the whole leg rotates inward toward the center line of the body. This inward rotation pulls the attachment of the glutes, TFL and abductors away from the origin of these muscles up on the pelvis which creates tension. Similarly, the muscles of the lower leg such as the peroneals, tibialis anterior and tibialis posterior originate on the lower leg and attach to the underside of the foot. When the foot flattens out, as it does in pronation, this pulls the insertion of these muscles away from their origin on the tibia. This action also creates tension in the muscles.Foot Pronation


Causes


Pronation can occur as an overuse syndrome in active runners, where a great deal of stress is placed on ligaments and tendons that support the medial column. Obesity is another predictor for pronation and deterioration of the medial ligaments and posterior tibial tendon due to excessive stress on these tissues. Acute Trauma can also lead to over-pronation when ligaments are torn or tendon is ruptured. Once again this can lead to a collapse of the medial column. Arthritic conditions involving the knee joint when the joint is in varus (inner collapse) posture, this places the center of gravity over the ankle joint rather than the foot causing undue pressure on the inner ankle.


Symptoms


Due to the laxity of the soft tissue structures of the foot, and the fact that the joints are not held together properly, the bones of the feet shift. When this occurs, the muscles that attach to these bones must also shift, or twist, in order to attach to these bones. The strongest and most important muscles that attach to our foot bones come from our lower leg. So, as these muscles course down the leg and across the ankle, they must twist to maintain their proper attachments in the foot. This twisting of these muscles will cause shin splints, Achilles Tendonitis, generalized tendonitis, fatigue, muscle aches and pains, cramps, ankle sprains, and loss of muscular efficiency (reducing walking and running speed and endurance). The problems we see in the feet, which are due to over-pronation include bunions, heel spurs, plantar fasciitis, fallen and painful arches, hammertoes, metatarsalgia (ball of foot pain), and calluses.


Diagnosis


Pronounced wear on the instep side of shoe heels can indicate overpronation, however it's best to get an accurate assessment. Footbalance retailers offer a free foot analysis to check for overpronation and help you learn more about your feet.Over Pronation


Non Surgical Treatment


The following exercises help retrain the foot and ankle complex to correct overpronation. Step Up and Over. This exercise is designed to integrate skills learned in the Duck Stand, Big Toe Pushdowns and Side Step with Opposite Reach exercises to mimic walking and even running. Using the gluteal muscles and big toe in tandem will prevent overpronation while moving back and forth over the BT in a more effective, balanced motion. Movement Directions. Stand with left foot on top of the BT dome. (Note: For added balance, the right foot can tap on the ground, if needed). Extend right foot backwards to the ground and drop hips into a lunge position. Make sure that the right arm rotates across the left leg (this will activate the gluteal muscles on the left side). Now, step through and over the BT into a front lunge with the right leg forward. While lunging forward, the torso and left arm now rotate over the right leg. Throughout the exercise, push big toe down into the BT. Perform 8 to 10 repetitions on both sides.


Surgical Treatment


Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.


An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.
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