What Exactly Is Severs Disease?
Overview
The true name of this complaint is calcaneal apophysitis which just means an inflamation of the growth centre of the bone in your heel as a result of pulling by the Achilles tendon - it is important to realise that it is not a disease but rather a condition that develops in the growing skeleton with activity. It is the most common cause of heel pain in young athletes, and is the second most common condition of its kind in the younger athelete after Osgood-Schlatter's disease. It is often seen at a time of rapid growth during which the muscles and soft tissues become tighter as the bones get longer. It occurs more in boys than girls and is seen most commonly between the ages of 8 and 14 years though it tends to be more prevalent in the younger of this group.
Causes
There is no specific known cause of Sever?s disease. However, there are several common factors associated with the condition including. Tight calf muscles. Pronated foot type (rolled in towards the ankle). Children who are heavier. Puberty/growth spurts. External factors, e.g. hard surfaces or poor footwear. Increase in physical activity levels.
Symptoms
The pain is at the heel or around the Achilles tendon. This is felt commonly during exercise, particularly activities involving running or jumping. The back of the heel may also be tender to touch and there may be localised swelling. There may be stiffness in the calf muscles first thing in the morning and you may notice limping or a tendency to tiptoe.
Diagnosis
This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.
Non Surgical Treatment
If your child lets you know that his heels are hurting, schedule a doctor's appointment. Your family doctor may or may not refer you to a podiatrist. Treatment for Sever's Disease typically consists of one or more of the following steps. Reducing physical activity. Because Sever's Disease appears to be most common in athletic children, reducing exercise periods will relieve pressure on the heel bones, thereby reducing pain. Your doctor may recommend that your child take a complete break from athletic activity for a set amount of time. Icing the heel bones can help to lower both inflammation and pain levels. Use a cold pack or wrap ice in a towel and apply it to the heels. A new exercise regimen that involves simple stretches designed to lengthen the calf muscles and tendons. Your doctor may prescribe the use of orthotic shoe inserts that will assist your child in maintaining a good level of physical activity. HTP Heel Seats may be an excellent option and have been purchased by many parents as an effective aide for children suffering from Sever's Disease. Read about HTP Heel Seats here and ask your doctor if they are right for your child's unique case. In extreme cases, a doctor may recommend a plaster cast or boot, but typically only if other less cumbersome solutions fail to reduce pain. Some doctors may prescribe anti-inflammatory medications. Never give these to a child yourself, without first seeking a doctor's advice. Some medications carry the risk of serious side effects for children. Only give medications if specifically prescribed your child's physician.
The true name of this complaint is calcaneal apophysitis which just means an inflamation of the growth centre of the bone in your heel as a result of pulling by the Achilles tendon - it is important to realise that it is not a disease but rather a condition that develops in the growing skeleton with activity. It is the most common cause of heel pain in young athletes, and is the second most common condition of its kind in the younger athelete after Osgood-Schlatter's disease. It is often seen at a time of rapid growth during which the muscles and soft tissues become tighter as the bones get longer. It occurs more in boys than girls and is seen most commonly between the ages of 8 and 14 years though it tends to be more prevalent in the younger of this group.
Causes
There is no specific known cause of Sever?s disease. However, there are several common factors associated with the condition including. Tight calf muscles. Pronated foot type (rolled in towards the ankle). Children who are heavier. Puberty/growth spurts. External factors, e.g. hard surfaces or poor footwear. Increase in physical activity levels.
Symptoms
The pain is at the heel or around the Achilles tendon. This is felt commonly during exercise, particularly activities involving running or jumping. The back of the heel may also be tender to touch and there may be localised swelling. There may be stiffness in the calf muscles first thing in the morning and you may notice limping or a tendency to tiptoe.
Diagnosis
This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.
Non Surgical Treatment
If your child lets you know that his heels are hurting, schedule a doctor's appointment. Your family doctor may or may not refer you to a podiatrist. Treatment for Sever's Disease typically consists of one or more of the following steps. Reducing physical activity. Because Sever's Disease appears to be most common in athletic children, reducing exercise periods will relieve pressure on the heel bones, thereby reducing pain. Your doctor may recommend that your child take a complete break from athletic activity for a set amount of time. Icing the heel bones can help to lower both inflammation and pain levels. Use a cold pack or wrap ice in a towel and apply it to the heels. A new exercise regimen that involves simple stretches designed to lengthen the calf muscles and tendons. Your doctor may prescribe the use of orthotic shoe inserts that will assist your child in maintaining a good level of physical activity. HTP Heel Seats may be an excellent option and have been purchased by many parents as an effective aide for children suffering from Sever's Disease. Read about HTP Heel Seats here and ask your doctor if they are right for your child's unique case. In extreme cases, a doctor may recommend a plaster cast or boot, but typically only if other less cumbersome solutions fail to reduce pain. Some doctors may prescribe anti-inflammatory medications. Never give these to a child yourself, without first seeking a doctor's advice. Some medications carry the risk of serious side effects for children. Only give medications if specifically prescribed your child's physician.
What Is Posterior Tibial Tendon Dysfunction ?
Overview
A painful flat foot, or adult acquired flatfoot deformity, is a progressive collapsing of the arch of the foot that occurs as the posterior tibial tendon becomes insufficient due to various factors. Early stages may present with only pain along the posterior tibial tendon whereas advanced deformity usually results in arthritis and rigidity of the rearfoot and ankle. 
Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
Symptoms
Posterior tibial tendon insufficiency is divided into stages by most foot and ankle specialists. In stage I, there is pain along the posterior tibial tendon without deformity or collapse of the arch. The patient has the somewhat flat or normal-appearing foot they have always had. In stage II, deformity from the condition has started to occur, resulting in some collapse of the arch, which may or may not be noticeable. The patient may feel it as a weakness in the arch. Many patients initially present in stage II, as the ligament failure can occur at the same time as the tendon failure and therefore deformity can already be occurring as the tendon is becoming symptomatic. In stage III, the deformity has progressed to the extent where the foot becomes fixed (rigid) in its deformed position. Finally, in stage IV, deformity occurs at the ankle in addition to the deformity in the foot.
Diagnosis
Observation by a skilled foot clinician and a hands-on evaluation of the foot and ankle is the most accurate diagnostic technique. Your Dallas foot doctor may have you do a walking examination (the most reliable way to check for the deformity). During walking, the affected foot appears more pronated and deformed. Your podiatrist may do muscle testing to look for strength deficiencies. During a single foot raise test, the foot doctor will ask you to rise up on the tip of your toes while keeping your unaffected foot off the ground. If your posterior tendon has been attenuated or ruptured, you will be unable to lift your heel off the floor. In less severe cases, it is possible to rise onto your toes, but your heel will not invert normally. X-rays are not always helpful as a diagnostic tool for Adult Flatfoot because both feet will generally demonstrate a deformity. MRI (magnetic resonance imaging) may show tendon injury and inflammation, but can?t always be relied on for a complete diagnosis. In most cases, a MRI is not necessary to diagnose a posterior tibial tendon injury. An ultrasound may also be used to confirm the deformity, but is usually not required for an initial diagnosis.
Non surgical Treatment
The adult acquired flatfoot is best treated early. Accurate assessment by your doctor will determine which treatment is suitable for you. Reduce your level of activity and follow the RICE regime. R - rest as often as you are able. Refrain from activity that will worsen your condition, such as sports and walking. I - ice, apply to the affected area, ensure you protect the area from frostbite by applying a towel over the foot before using the ice pack. C - compression, a Tubigrip or elasticated support bandage may be applied to relieve symptoms and ease pain and discomfort. E - elevate the affected foot to reduce painful swelling. You will be prescribed pain relief in the form of non-steroidal antiinflammatory medications (if you do not suffer with allergies or are asthmatic). Immobilisation of your affected foot - this will involve you having a below the knee cast for four to eight weeks. In certain circumstances it is possible for you to have a removable boot instead of a cast. A member of the foot and ankle team will advise as to whether this option is suitable for you. Footwear is important - it is advisable to wear flat sturdy lace-up shoes, for example, trainers or boots. This will not only support your foot, but will also accommodate orthoses (shoe inserts). 
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss.
What Is Adult Aquired FlatFoot ?
Overview
Collapsed arches occur in five percent of adults 40 years and older, especially those who are overweight or maintain sedentary lifestyles. At the onset of the condition, adult acquired flatfoot can be controlled with anti-inflammatory medications, physical therapy, taping, bracing, and orthotics. While most cases of adult-onset flatfoot require surgery, congenital flatfoot is an entirely different condition that is best treated with orthotics in children. Ninety percent of children born with flat feet will be fine with conservative treatment.
Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
Symptoms
Pain and swelling behind the inside of your ankle and along your instep. You may be tender behind the inner ankle where the posterior tibial tendon courses and occasionally get burning, shooting, tingling or stabbing pain as a result of inflammation of the nerve inside the tarsal tunnel. Difficulty walking, the inability to walk long distances and a generalised ache while walking even short distances. This may probably become more pronounced at the end of each day. Change in foot shape, sometimes your tendon stretches out, this is due to weakening of the tendon and ligaments. When this occurs, the arch in your foot flattens and a flatfoot deformity occurs, presenting a change in foot shape. Inability to tip-toe, a way of diagnosing Posterior Tibial Tendon Dysfunction is difficulty or inability to ?heel rise? (stand on your toes on one foot). Your tibialis posterior tendon enables you to perform this manoeuvre effectively. You may also experience pain upon attempting to perform a heel rise.
Diagnosis
It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal" treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.
Non surgical Treatment
In the early stages, simple pre-fabricated orthotics can help improve the heel position to reduce the mechanical load which is contributing to the symptoms. In advanced stages or long term orthotic use, a plaster of paris or foam box cast can be taken and specific bespoke orthotics manufactured. If the condition develops further a AFO (ankle foot orthotic) may be necessary for greater control. In more advanced stages of symptomatic Adult Acquired flat feet, where the conservative methods of treatment have failed there are various forms of surgery available depending upon the root cause of the issue and severity.
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss.
Collapsed arches occur in five percent of adults 40 years and older, especially those who are overweight or maintain sedentary lifestyles. At the onset of the condition, adult acquired flatfoot can be controlled with anti-inflammatory medications, physical therapy, taping, bracing, and orthotics. While most cases of adult-onset flatfoot require surgery, congenital flatfoot is an entirely different condition that is best treated with orthotics in children. Ninety percent of children born with flat feet will be fine with conservative treatment.
Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
Symptoms
Pain and swelling behind the inside of your ankle and along your instep. You may be tender behind the inner ankle where the posterior tibial tendon courses and occasionally get burning, shooting, tingling or stabbing pain as a result of inflammation of the nerve inside the tarsal tunnel. Difficulty walking, the inability to walk long distances and a generalised ache while walking even short distances. This may probably become more pronounced at the end of each day. Change in foot shape, sometimes your tendon stretches out, this is due to weakening of the tendon and ligaments. When this occurs, the arch in your foot flattens and a flatfoot deformity occurs, presenting a change in foot shape. Inability to tip-toe, a way of diagnosing Posterior Tibial Tendon Dysfunction is difficulty or inability to ?heel rise? (stand on your toes on one foot). Your tibialis posterior tendon enables you to perform this manoeuvre effectively. You may also experience pain upon attempting to perform a heel rise.
Diagnosis
It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal" treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.
Non surgical Treatment
In the early stages, simple pre-fabricated orthotics can help improve the heel position to reduce the mechanical load which is contributing to the symptoms. In advanced stages or long term orthotic use, a plaster of paris or foam box cast can be taken and specific bespoke orthotics manufactured. If the condition develops further a AFO (ankle foot orthotic) may be necessary for greater control. In more advanced stages of symptomatic Adult Acquired flat feet, where the conservative methods of treatment have failed there are various forms of surgery available depending upon the root cause of the issue and severity.
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss.
The Major Causes And Treatments Of Achilles Tendinitis
Overview
Achilles tendinitis can be a very crippling issue for runners - simply because the pain is enough to discourage loading of the foot. It can also be a tricky condition to treat because the tendon is not as heavily vascularized (i.e. more blood flow) as muscle, and therefore lacks healing potential. It is highly recommended that you see a physical therapist as soon as you experience acute symptoms, so chronic tendonosis (which is longer termed and harder to treat) does not set in.
Causes
Over-pronation, injury and overstresses of the tendon are some of the most common causes. Risk factors include tight heel cords, poor foot alignment, and recent changes in activities or shoes. During a normal gait cycle, the upper and lower leg rotate in unison (i.e. internally during pronation and externally during supination). However, when a person over-pronates, the lower leg is locked into the foot and therefore continues to rotate internally past the end of the contact phase while the femur begins to rotate externally at the beginning of midstance. The Gastrocnemius muscle is attached to the upper leg and rotates externally while the Soleus muscle is attached to the lower leg and rotates internally during pronation. The resulting counter rotation of the upper and lower leg causes a shearing force to occur in the Achilles tendon. This counter rotation twists the tendon at its weakest area, namely the Achilles tendon itself, and causes the inflammation. Since the tendon is avascular, once inflammation sets in, it tends to be chronic.
Symptoms
Symptoms of Achilles Tendinitis include the following. Pain and stiffness along the Achilles tendon in the morning. Pain along the tendon or back of the heel that worsens with activity. Severe pain the day after exercising. Thickening of the tendon. Bone spur (insertional tendinitis). Swelling that is present all the time and gets worse throughout the day with activity. If you have an Achilles tendon rupture, you might feel a pop or snap, accompanied by a sharp pain behind your ankle. You are likely to have difficulty walking properly. If you have ruptured your Achilles tendon then surgery is likely to be the best treatment option.
Diagnosis
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Nonsurgical Treatment
Proper footwear with a strong and secure counter (the heel circumference) may help to encourage heeling of the tendon. A tendinitis will occasionally resolve on it?s own, with rest, ice, and gentle stretching. If symptoms persist for more than 2 weeks, consult your physician. Your physician may suggest physiotherapy and custom orthotics. Physiotherapy can suggest appropriate exercises and modalities to aid in the healing process. Custom orthotics can be very successful in treating the problem, as the original cause may be due to an improper alignment of the foot and heel. Re-aligning the foot to a neutral position may provide an optimal, biomechanically sound environment for healing to occur.
Surgical Treatment
In most surgeries, damaged tissue is cleaned out before surgeons make the necessary repairs. However, a new minimally-invasive surgery to repair a torn Achilles tendon actually uses the damaged tissue to help repair the tear. The percutaneous Achilles repair system, or PARS technique, enables surgeons to better repair a torn Achilles tendon through a smaller incision. This procedure was recently performed at Houston Methodist Hospital to treat an NFL cornerback, getting him back on field for this season.
Prevention
Appropriately warm up and stretch before practice or competition. Allow time for adequate rest and recovery between practices and competition. Maintain appropriate conditioning, Ankle and leg flexibility, Muscle strength and endurance, Cardiovascular fitness. Use proper technique. To help prevent recurrence, taping, protective strapping, or an adhesive bandage may be recommended for several weeks after healing is complete.
Achilles tendinitis can be a very crippling issue for runners - simply because the pain is enough to discourage loading of the foot. It can also be a tricky condition to treat because the tendon is not as heavily vascularized (i.e. more blood flow) as muscle, and therefore lacks healing potential. It is highly recommended that you see a physical therapist as soon as you experience acute symptoms, so chronic tendonosis (which is longer termed and harder to treat) does not set in.
Causes
Over-pronation, injury and overstresses of the tendon are some of the most common causes. Risk factors include tight heel cords, poor foot alignment, and recent changes in activities or shoes. During a normal gait cycle, the upper and lower leg rotate in unison (i.e. internally during pronation and externally during supination). However, when a person over-pronates, the lower leg is locked into the foot and therefore continues to rotate internally past the end of the contact phase while the femur begins to rotate externally at the beginning of midstance. The Gastrocnemius muscle is attached to the upper leg and rotates externally while the Soleus muscle is attached to the lower leg and rotates internally during pronation. The resulting counter rotation of the upper and lower leg causes a shearing force to occur in the Achilles tendon. This counter rotation twists the tendon at its weakest area, namely the Achilles tendon itself, and causes the inflammation. Since the tendon is avascular, once inflammation sets in, it tends to be chronic.
Symptoms
Symptoms of Achilles Tendinitis include the following. Pain and stiffness along the Achilles tendon in the morning. Pain along the tendon or back of the heel that worsens with activity. Severe pain the day after exercising. Thickening of the tendon. Bone spur (insertional tendinitis). Swelling that is present all the time and gets worse throughout the day with activity. If you have an Achilles tendon rupture, you might feel a pop or snap, accompanied by a sharp pain behind your ankle. You are likely to have difficulty walking properly. If you have ruptured your Achilles tendon then surgery is likely to be the best treatment option.
Diagnosis
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Nonsurgical Treatment
Proper footwear with a strong and secure counter (the heel circumference) may help to encourage heeling of the tendon. A tendinitis will occasionally resolve on it?s own, with rest, ice, and gentle stretching. If symptoms persist for more than 2 weeks, consult your physician. Your physician may suggest physiotherapy and custom orthotics. Physiotherapy can suggest appropriate exercises and modalities to aid in the healing process. Custom orthotics can be very successful in treating the problem, as the original cause may be due to an improper alignment of the foot and heel. Re-aligning the foot to a neutral position may provide an optimal, biomechanically sound environment for healing to occur.
Surgical Treatment
In most surgeries, damaged tissue is cleaned out before surgeons make the necessary repairs. However, a new minimally-invasive surgery to repair a torn Achilles tendon actually uses the damaged tissue to help repair the tear. The percutaneous Achilles repair system, or PARS technique, enables surgeons to better repair a torn Achilles tendon through a smaller incision. This procedure was recently performed at Houston Methodist Hospital to treat an NFL cornerback, getting him back on field for this season.
Prevention
Appropriately warm up and stretch before practice or competition. Allow time for adequate rest and recovery between practices and competition. Maintain appropriate conditioning, Ankle and leg flexibility, Muscle strength and endurance, Cardiovascular fitness. Use proper technique. To help prevent recurrence, taping, protective strapping, or an adhesive bandage may be recommended for several weeks after healing is complete.
What Triggers Heel Discomfort
Overview
If you experience sharp, throbbing or aching heel pain with your first steps out of bed each morning, or when walking throughout the day, you may be suffering from Plantar Fasciitis. This guide will help you to understand the definition, symptoms and causes of this condition and will explore your treatment options for rapid relief from your pain.
Causes
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
Symptoms
When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)--these abnormalities cause plantar fasciitis and can make normal activities quite painful. Symptoms of plantar fasciitis are typically worsened early in the morning after sleep. At that time, the arch tissue is tight and simple movements stretch the contracted tissue. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking.
Diagnosis
Your doctor will ask you about the kind of pain you're having, when it occurs and how long you've had it. If you have pain in your heel when you stand up for the first time in the morning, you may have plantar fasciitis. Most people with plantar fasciitis say the pain is like a knife or a pin sticking into the bottom of the foot. After you've been standing for a while, the pain becomes more like a dull ache. If you sit down for any length of time, the sharp pain will come back when you stand up again.
Non Surgical Treatment
Plantar fasciitis can be a difficult problem to treat, with no panacea available. Fortunately, most patients with this condition eventually have satisfactory outcomes with nonsurgical treatment. Therefore, management of patient expectations minimizes frustration for both the patient and the provider.
Surgical Treatment
Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The most common complications of release surgery include incomplete relief of pain and nerve damage.
Stretching Exercises
You may begin exercising the muscles of your foot right away by gently stretching them as follows. Prone hip extension, Lie on your stomach with your legs straight out behind you. Tighten up your buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10. Towel stretch, Sit on a hard surface with one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds then relax. Repeat 3 times. When the towel stretch becomes too easy, you may begin doing the standing calf stretch. Standing calf stretch, Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day. Sitting plantar fascia stretch, Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat 3 times. When you can stand comfortably on your injured foot, you can begin standing to stretch the bottom of your foot using the plantar fascia stretch. Achilles stretch, Stand with the ball of one foot on a stair. Reach for the bottom step with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. After you have stretched the bottom muscles of your foot, you can begin strengthening the top muscles of your foot. Frozen can roll, Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This exercise is particularly helpful if done first thing in the morning. Towel pickup, With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel. Balance and reach exercises, Stand upright next to a chair. This will provide you with balance if needed. Stand on the foot farthest from the chair. Try to raise the arch of your foot while keeping your toes on the floor. Keep your foot in this position and reach forward in front of you with your hand farthest away from the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets. Stand in the same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 10. Heel raise, Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10. Side-lying leg lift, Lying on your side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.
What Is Plantar Fasciitis
Overview
Heel pain is the most common musculoskeletal complaint of patients presenting to podiatric practitioners throughout the country. It is well-recognized that subcalcaneal pain syndrome, commonly attributed to plantar fascitis, is a disease entity that is increasing in its incidence, owing partly to the fact that it has a predilection for people between the age of 40 and 60, the largest age segment in our population.
Causes
Training on improper, hard and/or irregular surfaces as well as excessive track work in spiked shoes, or steep hill running, can stress the plantar fascia past its limits of elasticity, leading to injury. Finally, failure in the early season to warm up gradually gives the athlete insufficient time for the structures of the foot to re-acclimate and return to a proper fitness level for intensive exercise. Such unprepared and repeated trauma causes microscopic tearing, which may only be detected once full-blown plantar fasciitis and accompanying pain and debilitation have resulted. If the level of damage to the plantar fascia is significant, an inflammatory reaction of the heel bone can produce spike-like projections of new bone, known as heel spurs. Indeed, plantar fasciitis has occasionally been refereed to as heel spur syndrome, though such spurs are not the cause of the initial pain but are instead a further symptom of the problem. While such spurs are sometimes painless, in other cases they cause pain or disability in the athlete, and surgical intervention to remove them may be required. A dull, intermittent pain in the heel is typical, sometimes progressing to a sharp, sustained discomfort. Commonly, pain is worse in the morning or after sitting, later decreasing as the patient begins walking, though standing or walking for long periods usually brings renewal of the pain.
Symptoms
Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time. If you have foot pain at night, you may have a different problem, such as arthritis , or a nerve problem such as tarsal tunnel syndrome.
Diagnosis
Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.
Non Surgical Treatment
Your health care provider will often recommend these steps first Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation. Heel and foot stretching exercises. Night splints to wear while sleeping to stretch the foot. Resting as much as possible for at least a week. Wearing shoes with good support and cushions. Other steps to relieve pain include aply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days. Try wearing a heel cup, felt pads in the heel area, or shoe inserts. Use night splints to stretch the injured fascia and allow it to heal. If these treatments do not work, your health care provider may recommend waring a boot cast, which looks like a ski boot, for 3 - 6 weeks. It can be removed for bathing. Custom-made shoe inserts (orthotics). Steroid shots or injections into the heel. Smetimes, foot surgery is needed.
Surgical Treatment
Surgery is rarely used in the treatment of plantar fasciitis. However it may be recommended when conservative treatment has been tried for several months but does not bring adequate relief of symptoms. Surgery usually involves the partial release of the plantar fascia from the heel bone. In approximately 75% of cases symptoms are fully resolved within six months. In a small percentage of cases, symptoms may take up to 12 months to fully resolve.
Stretching Exercises
You may begin exercising the muscles of your foot right away by gently stretching them as follows. Prone hip extension, Lie on your stomach with your legs straight out behind you. Tighten up your buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10. Towel stretch, Sit on a hard surface with one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds then relax. Repeat 3 times. When the towel stretch becomes too easy, you may begin doing the standing calf stretch. Standing calf stretch, Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day. Sitting plantar fascia stretch, Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat 3 times. When you can stand comfortably on your injured foot, you can begin standing to stretch the bottom of your foot using the plantar fascia stretch. Achilles stretch, Stand with the ball of one foot on a stair. Reach for the bottom step with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. After you have stretched the bottom muscles of your foot, you can begin strengthening the top muscles of your foot. Frozen can roll, Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This exercise is particularly helpful if done first thing in the morning. Towel pickup, With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel. Balance and reach exercises, Stand upright next to a chair. This will provide you with balance if needed. Stand on the foot farthest from the chair. Try to raise the arch of your foot while keeping your toes on the floor. Keep your foot in this position and reach forward in front of you with your hand farthest away from the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets. Stand in the same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 10. Heel raise, Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10. Side-lying leg lift, Lying on your side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.
What Triggers Plantar Fasciitis And Ways To Remedy It
Overview
Plantar fasciitis is thickening of the plantar fascia, a band of tissue running underneath the sole of the foot. The thickening can be due to recent damage or injury, or can be because of an accumulation of smaller injuries over the years. Plantar fasciitis can be painful.
Causes
You are at a greater risk for developing plantar fasciitis if you are overweight or obese. This is due to the increased pressure on your plantar fascia ligaments, especially if you have sudden weight gain. Women who are pregnant often experience bouts of plantar fasciitis, particularly during late pregnancy. If you are a long distance runner, you may be more likely to develop plantar fascia problems. You are also at risk if you have a very active job that involves being on your feet often, such as a factory worker or a restaurant server. Active men and women between the ages of 40 and 70 are at the highest risk for developing plantar fasciitis. It is also slightly more common in women than men. If you have foot problems, such as very high arches or very flat feet, you may develop plantar fasciitis. Tight Achilles tendons (the tendons attaching the calf muscles to the heels) may also result in plantar fascia pain. Simply wearing shoes with soft soles and poor arch support can also result in plantar fasciitis. Plantar fasciitis is not caused by heel spurs. A heel spur is a hook of bone that can form on the heel bone (calcaneus) of the foot. One out of every 10 people has a heel spur, but only one out of 20 people with heel spurs experience pain, according to OrthoInfo.
Symptoms
Heel pain is the most common symptom associated with plantar fasciosis. Your heel pain may be worse in the morning or after you have been sitting or standing for long periods. Pain is most common under your heel bone, but you also may experience pain in your foot arch or on the outside aspect of your foot. Other common signs and symptoms of plantar fasciosis include mild swelling and redness in your affected area, tenderness on the bottom of your heel, impaired ability to ambulate.
Diagnosis
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Non Surgical Treatment
Plantar fasciitis is usually controlled with conservative treatment. Following control of the pain and inflammation an orthotic (a custom made shoe insert) will be used to stabilize your foot and prevent a recurrence. Over 98% of the time heel spurs and plantar fasciitis can be controlled by this treatment and surgery can be avoided. The orthotic prevents excess pronation and prevents lengthening of the plantar fascia and continued tearing of the fascia. Usually a slight heel lift and a firm shank in the shoe will also help to reduce the severity of this problem. The office visit will be used for careful examination and review to distinguish plantar fasciitis and plantar heel pain syndrome from other problems, many of which are outlined below. It is important to distinguish between a stress reaction of the calcaneus and plantar fasciitis. A feature of many calcaneal stress fractures is pain on lateral and medial compression of the calcaneus.
Surgical Treatment
Surgery should be reserved for patients who have made every effort to fully participate in conservative treatments, but continue to have pain from plantar fasciitis. Patients should fit the following criteria. Symptoms for at least 9 months of treatment. Participation in daily treatments (exercises, stretches, etc.). If you fit these criteria, then surgery may be an option in the treatment of your plantar fasciitis. Unfortunately, surgery for treatment of plantar fasciitis is not as predictable as a surgeon might like. For example, surgeons can reliably predict that patients with severe knee arthritis will do well after knee replacement surgery about 95% of the time. Those are very good results. Unfortunately, the same is not true of patients with plantar fasciitis.
