Protecting Against Calcaneal Spur

Inferior Calcaneal Spur


Overview


Heel spurs are small lumps of excess bone that grow and stick out on the calcaneus, aka heel bone. They usually develop in response to friction, tightness, inflammation or injury when the body lays down extra layers of bone to try and protect itself. There are two areas where heel bone spurs tend to develop. At the back of the heel: these are usually due to conditions such as Achilles tendonitis, tight calf muscles or wearing tight footwear. These are known as posterior calcaneal spurs. Underneath the heel: these are usually due to conditions such as plantar fasciitis, muscle imbalance or altered foot biomechanics. These are known as inferior calcaneal spurs.


Causes


A heel spur can develop when there is an abundance of calcium creating a deposit in the calcaneus, or heel bone. Over time, this deposit grows to create an outcropping under the heel that extends into the foot. The result is a protrusion that leads to foot pain when pressure is applied, and in some cases, even during rest.


Posterior Calcaneal Spur


Symptoms


Heel spurs result in a jabbing or aching sensation on or under the heel bone. The pain is often worst when you first arise in the morning and get to your feet. You may also experience pain when standing up after prolonged periods of sitting, such as work sessions at a desk or car rides. The discomfort may lessen after you spend several minutes walking, only to return later. Heel spurs can cause intermittent or chronic pain.


Diagnosis


Your doctor will review your medical history and examine your foot. X-rays are used to identify the location and size of the heel spur.


Non Surgical Treatment


Heel spurs are considered a self-limited condition, which means that by making small alterations in your lifestyle and regular routines you can often control the condition. The goal is to relieve pain, reduce friction and transfer pressure from your sensitive foot areas. By eliminating the cause of the heel spur and plantar fasciitis (i.e. better shoes, orthotics to fix your gait, losing weight) will help reduce the pressure put on your fascia and heel and can reduce the inflammation caused by your heel spur. Failure to see improvements after conservative treatments may make surgery your only option.


Surgical Treatment


In some cases, heel spurs are removed by surgery after an X-ray. While the surgery is typically effective, it?s a timely and expensive procedure. Even after surgery, heel spurs can re-form if the patient continues the lifestyle that led to the problem. These reasons are why most people who develop painful heel spurs begin looking for natural remedies for joint and bone pain. Surgery isn?t required to cure a heel spur. In fact, more than 90 percent of people get better with nonsurgical treatments. If nonsurgical methods fail to treat symptoms of heel spurs after 12 months, surgery may be necessary to alleviate pain and restore mobility.


Prevention


There are heel spur prevention methods available in order to prevent the formation of a heel spur. First, proper footwear is imperative. Old shoes or those that do not fit properly fail to absorb pressure and provide the necessary support. Shoes should provide ample cushioning through the heel and the ball of the foot, while also supporting the arch. Wearing an orthotic shoe insert is one of the best ways to stretch the plantar fascia and prevent conditions such as heel spurs. Stretching the foot and calf is also helpful in preventing damage. Athletes in particular should make sure to stretch prior to any physical activity. Stretching helps prevent heel spurs by making tissue stronger as well as more flexible. In addition, easing into a new or increasingly difficult routine should be done to help avoid strain on the heel and surrounding tissue.

Will A Inferior Calcaneal Spur Cause Pain?

Inferior Calcaneal Spur


Overview


The plantar fascia is connective tissue on the sole of your foot. When the arch of the foot is not properly supported, the plantar fascia can stretch and pull away from the heel area. When the plantar fascia pulls away from the heel, calcium deposits form in its absence. These calcium deposits are called heel spurs and can be very painful.


Causes


It is widely accepted now that the presence of this bony growth is not the cause of heel pain, but rather an effect of an underlying biomechanical foot problem where the soft tissue structures that are attached to the heel bone are pulling excessively on that area. At some point down the track, heel pain may develop, but the bony heel spur is not the cause of the heel pain.


Heel Spur


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


Sharp pain localized to the heel may be all a doctor needs to understand in order to diagnose the presence of heel spurs. However, you may also be sent to a radiologist for X-rays to confirm the presence of heel spurs.


Non Surgical Treatment


Heel spurs and plantar fascitis (inflammation of the plantar fascia) are usually controlled with conservative treatment. Early intervention includes stretching the calf muscles while avoiding reinjury to the plantar fascia. Decreasing or changing activities, losing excess weight, and improving the fit of shoes are all important measures to decrease foot pain. Modification of footwear includes well-padded shoes with a raised heel and better arch support. Shoe inserts recommended by a healthcare professional are often very helpful when used with exercises to increase the strength of the foot muscles and arch. The inserts prevent excessive pronation and continued tearing of the plantar fascia.


Surgical Treatment


More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.


Prevention


To prevent this condition, wearing shoes with proper arches and support is very important. Proper stretching is always a necessity, especially when there is an increase in activities or a change in running technique. It is not recommended to attempt working through the pain, as this can change a mild case of heel spurs and plantar fascitis into a long lasting and painful episode of this condition.

Bursitis Of The Foot And Ankle

Overview


Bursitis happens when the bursa is inflamed. The burse acts as a cushion between bones, tendons, joints and muscles, bursae are fluid-filled sacs (the plural of bursa is bursae). People with bursitis will feel pain at the site of inflammation. The medical word "bursa" comes from the Latin bursa, meaning a purse, which is what a bursa resembles.


Causes


A bursa is a fluid-filled sac that acts as a cushion and a lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel, where the large Achilles tendon connects the calf muscles to the heel bone (calcaneus). Repetitive or over use of the ankle, for instance by doing excessive walking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for achilles tendonitis. Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.


Symptoms


Symptoms include pain at the back of the heel, especially when running uphill or on soft surfaces. There will be tenderness and swelling at the back of the heel which may make it difficult to wear certain shoes. When pressing in with the fingers both sides are the back of the heel a spongy resistance may be felt.


Diagnosis


Before making a diagnosis of retrocalcaneal bursitis, a doctor must rule out other possible problems, such as arthritis, a fracture or tumor. A doctor also will try to determine if the Achilles tendon itself is a source of pain. To make a diagnosis, a doctor will use some or all of the diagnostic tools below Patient interview. A doctor will ask a patient about medical history, and to describe the onset of his or her symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask patients what types of shoes they wear and what they do for exercise. A patient's reported symptoms are important to diagnosis and treatment. The doctor will also ask what home treatments have helped the condition. Physical exam. A doctor will examine the patient's foot, noting swelling, tenderness and pain points, and range of motion. The doctor also may ask the patient to point and flex the feet and stand on his or her toes.


Non Surgical Treatment


Caregivers may give you special shoe inserts with a cutout around the tender area. You may also be told to wear shoes with a reinforced heel counter. This will give better heel control. You may need other shoe inserts (wedges) to raise your heel so it does not press against the back of the shoe. You may also wear shoes that are open in the back, such as sandals that have no strap across the heel. You may use ibuprofen (eye-bu-PROH-fen) and acetaminophen (a-seet-a-MIN-oh-fen) medicine for your pain. These may be bought over-the-counter at drug or grocery stores. Do not take ibuprofen if you are allergic to aspirin. You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This medicine helps decrease bursitis pain. Because these shots decrease swelling and pain, you may feel like your ankle is healed and that you can return to heavy exercise. It is important to not exercise until your caregiver says it is OK. You could make the bursitis worse if you exercise too soon. You may need surgery to remove the bursa or part of your ankle bone. Surgery is usually not necessary unless the bursitis is very bad and does not heal with other treatments. Your caregiver may want you to go to physical (FIZ-i-kal) therapy (THER-ah-pee). Physical therapists may use ultrasound to increase blood flow to the injured area. Caregivers may use massage to stretch the tissue and bring heat to the injury to increase blood flow. These and other treatments may help the bursitis heal faster. Exercises to stretch your Achilles tendon and make it stronger will be started after the bursitis has healed. You may gradually increase the amount of weight you put on your foot when caregivers say it is OK. You may be told to stop exercising if you feel any pain.


Prevention


Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition. Proper stretching of the Achilles tendon helps prevent injury.

Non Surgical Hammertoe Treatment

Hammer ToeOverview


The term, hammertoes, is commonly used as a general classification for any condition where the toe muscle weakens, causing digital contracture, and resulting in deformity, a digital contracture like this can actually be a hammertoe, claw toe or mallet toe, depending on which joints in the toe are contracted. Clawtoes are bent at the middle and end joints, while hammertoes are bent at the middle joint only. When it?s mallet toe, the joint at the end of the toe buckles. The skin near the toenail tip develops a painful corn that can eventually result in an ulcer. Doctors further categorize all forms of hammertoe based on whether the affected toe is flexible, semi-rigid or hammertoe rigid. The more rigid the toe, the more pain it will cause.


Causes


Hammertoe and mallet toe have been linked to certain shoes. High-heeled shoes or footwear that's too tight in the toe box can crowd your toes into a space that's not large enough for them to lie flat. This curled toe position may eventually persist even when you're barefoot. Trauma. An injury in which you stub, jam or break a toe may make it more likely for that digit to develop hammertoe or mallet toe. Nerve injuries or disorders. Hammertoe and mallet toe are more common in people who have nerve damage in their feet, which often occurs with such medical problems as a stroke or diabetes.


HammertoeSymptoms


A hammertoe causes you discomfort when you walk. It can also cause you pain when trying to stretch or move the affected toe or those around it. Hammertoe symptoms may be mild or severe. Mild Symptoms, a toe that is bent downward, corns or calluses. Severe Symptoms, difficulty walking, the inability to flex your foot or wiggle your toes, claw-like toes. See your doctor or podiatrist right away if you develop any of these symptoms.


Diagnosis


A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.


Non Surgical Treatment


Putting padding between your toes and strapping them in place can help to stop pain caused by the toes rubbing. Custom-made insoles for your shoes will help to take the pressure off any painful areas. Special shoes that are wider and deeper than normal can stop your toes rubbing. However if your pain persists your consultant may recommend an surgery.


Surgical Treatment


As previously mentioned it?s best to catch this problem early; hammer toe taping is relatively harmless and simple. Long term complications can cause foot deformities and even difficulty walking. It?s always best to stiff shoes and high heel, especially if you?re working on hammer toe recovery. Pick comfortable shoes with plenty of toe space. Prevention is the best cure here as this injury is nearly always self inflicted.


HammertoePrevention


The best first step you can take is to evaluate your shoe choices. Ditch any shoes that aren?t serving your feet well. Shoes that crowd the front of your foot, especially around your toes, aggravate the existing condition and can also cause the condition to develop. If you suspect the development of hammertoe, you may also try using protective pads to prevent irritation and the development of corns. Custom orthotics to correct muscle imbalances in your feet may also help prevent hammertoe.

Over-Pronation

Overview


Overpronation still continues to be misused and misunderstood. For example, there was a study that got a lot of recent mileage in the mainstream media and the blogosphere that claimed to show that foot pronation was not associated with injury risk. It was intriguing following comments on the study in mainstream media and in social media, especially the parroting of the press release without any critical appraisal. The study actually eliminated the ?overpronators? that were probably at high risk from the study then found that ?overpronation? was not a risk factor. What is more intriguing was that there was another study from around the same time that found the exact opposite. Clearly, the data on ?overpronation? and risk for injury in runners is mixed, so we need to rely on the more formal systematic reviews and meta-analyses of all the data. The most recent one of those concluded that ?overpronation? is just a small risk factor for running injury risk, but it is still statistically significant.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


Symptoms can manifest in many different ways. Here is a list of some of the common conditions associated with over-pronation in children. Achilles Pain. Ankle pain. Arch Pain. Low back pain. Heel Pain. Knee Pain (Runner's knee and Chondromalecia of the patella) Osgood Schlatter Disease (pain below the knee) Shin Splints (pain in the front of the lower leg) Over-pronation does not necessarily mean your child has "flat feet." Even though children's arches may be relatively high when they lie down or sit, over-pronation may not be seen until your child is standing. A certain amount of pronation is normal. During normal walking or running ("gait cycle"), the heel strikes the ground and the foot rolls inward to absorb shock and adapt to the surface. This gait cycle is even more important if the running surface is uneven.


Diagnosis


To easily get an idea of whether a person overpronates, look at the position and condition of certain structures in the feet and ankles when he/she stands still. When performing weight-bearing activities like walking or running, muscles and other soft tissue structures work to control gravity's effect and ground reaction forces to the joints. If the muscles of the leg, pelvis, and feet are working correctly, then the joints in these areas such as the knees, hips, and ankles will experience less stress. However, if the muscles and other soft tissues are not working efficiently, then structural changes and clues in the feet are visible and indicate habitual overpronation.Over-Pronation


Non Surgical Treatment


Overpronation of the feet can be corrected in some cases and in others it can be effectively managed. Overpronators can train themselves to change their running gait, wear arch supports, orthotic insoles or specialist shoes for overpronators. In order to determine exactly what is happening during the stride, it is necessary to have a gait analysis conducted by a professional. The extent of overpronation can then be determined, and the causes can be identified and corrected directly. The main corrective methods used for excessive pronation are orthotics. Orthotics are the most straightforward and simplest solution to overpronation. Orthotics are devices which can be slipped into shoes which will offer varying degrees of correction to the motion of the foot. Orthotics help to support the arches and distribute the body weight effectively, and are usually the best treatment choice for moderate to severe overpronation. Orthotics may require existing insoles to be removed from your shoes to accommodate them; although most running shoes will have a removable insole to accommodate an orthotic insole.


Prevention


Pronation forces us to bear most of our weight on the inner border of our feet. Custom-made orthotics gently redistributes the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist out at the ankle, but will strike the ground normally when the orthotics is used. This action of the custom-made orthotics will help to prevent shin splints, ankle sprains, knee and hip pain, lower back pain, nerve entrapments, tendonitis, muscle aches, bunions, generalized fatigue, hammer toes, and calluses.
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Brenna Biedrzycki

Author:Brenna Biedrzycki
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