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Pain in the lower calf along the Achilles tendon, the cord connecting the heel to the calf muscle. The injury is actually the swelling of the sheath within which the cord slides. When it becomes swollen, it creates too tight a fit for the tendon. Friction -- and pain -- are the results. To confirm that you have Achilles Tendonitis, pinch the tendon starting close to the heel and working your way up toward the calf. If you feel some serious pain and maybe some swelling, you've got Achilles Tendonitis.
Your tendon is being pulled, and because tendons don't much like to stretch, you feel a lot of pain. There are two reasons it might be getting stretched. First, your calf muscle might be too short. Second, your heel might be too far from the calf muscle.
Reduce the pain and swelling by icing the area immediately after running. You can use either a store-bought cold pack or a frozen wet towel. Ice for 10 or 15 minutes. To reduce inflammation, take an aspirin or ibuprofen at mealtime. At other times (before bed, for example), soak the sore tendon in hot water.
Lifting your heel up toward your calf will relieve the pull on your tendon. Try a heel insert in your regular shoes as well as your running shoes. You can purchase heel lifts in the foot section of many drugstores, or try using a makeup sponge as a substitute. You'll probably notice an immediate difference.
Most important, though, you'll have to stop running for a few days. Give your tendon as much time as it needs for the pain to go away. If you continue to run through the injury, you risk tearing the tendon, and then you're looking at real pain. The time you should take off will range anywhere from a few days to two weeks. And don't stretch during this period, either. Your tendon has already been yanked around too much, and stretching, at least at first, will hurt more than help.
When you begin running again, pay special attention to stretching your calves with Wall Push-Ups and your hamstrings with the Hamstring Stretch (these stretches, incidentally, are the key modes of preventive maintenance for avoiding Achilles Tendonitis in the future). Avoid running on soft surfaces which might let your heel sink in too much (e.g., sand). Ice your tendon after every run and put a heating pad (at a low setting) on the area in the evening and at bedtime.
Incidentally, hill work is particularly aggravating to your injury. Cut way back on hills until the injury has healed, and then return to hill work only gradually.
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An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue—like rubber bands—that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.
Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.
Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface.
Sometimes ankle sprains occur because of weak ankles, a condition that some people are born with. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.
Signs and Symptoms:
The signs and symptoms of ankle sprains may include:
- Pain or soreness
- Difficulty walking
- Stiffness in the joint
These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains—instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if you don’t have pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain—whether it's your first or your fifth—requires prompt medical attention.
If you think you've sprained your ankle, contact your foot and ankle surgeon for an appointment as soon as possible. In the meantime, immediately begin using the "R.I.C.E." method — Rest, Ice, Compression, and Elevation — to help reduce swelling, pain, and further injury.
Why Prompt Medical Attention is Needed
There are four key reasons why an ankle sprain should be promptly evaluated and treated by a foot and ankle surgeon:
- An untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a "giving way" of the ankle. You may also develop weakness in the leg.
- You may have suffered a more severe ankle injury along with the sprain. This might include a serious bone fracture that could lead to troubling complications if it goes untreated.
- An ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.
- Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.
In evaluating your injury, the foot and ankle surgeon will take your history to learn more about the injury. He or she will examine the injured area, and may order x-rays, an MRI study, or a CT scan to help determine the severity of the injury.
Non-Surgical Treatment and Rehabilitation
When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:
- Immobilization. Depending on the severity of your injury, you may receive a short-leg cast, a walking boot, or a brace to keep your ankle from moving. You may also need crutches.
- Early Physical Therapy. Your doctor will start you on a rehabilitation program as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.
- Icing. You may be advised to ice your injury several times a day until the pain and swelling resolves. Wrap ice cubes, or a bag of frozen peas or corn, in a thin towel. Do not put ice directly on your skin.
- Compression Wraps. To prevent further swelling, you may need to keep your ankle wrapped in an elastic bandage or stocking.
Pain in the front and outer edge of your legs. If the strain continues, it is possible that micro-fractures may form in your tibia; these are stress fractures. There won't be a sudden break, just a gradual increase in pain until it becomes quite severe. If you have extreme shin pain, see a doctor for an x-ray. If you have only mild pain, it's probably shin splints (but if the pain does not respond to remedies after a few days, go see a doctor; it may be a stress fracture after all).
While the root cause of shin splints are tight calf muscles and weak shin muscles, the injury may have been further aggravated by a variety of factors. Running on hard surfaces can put an added strain on your front leg muscles. You may have a foot that tilts in (pronates) or out (supinates) when you run, causing your front leg muscles to work harder to achieve foot stability. Or you may have developed flat feet, which you should treat separately. Most likely, however, is that you're simply running too much.
Shin splints are very common among beginning runners, whose enthusiasm for their new sport has over-stepped the limits of their legs. Take a look at your running program; you may be doing too much too soon.
If you have a stress fracture, you should stop running immediately and see a doctor. Your injury will likely keep you off the roads for about six weeks, and depending on the severity of the stress fracture you may need a cast. Don't screw around with this, it's a serious injury.
For shin splints, there are a number of steps you can take to speed recovery. First, to reduce the pain, ice your lower legs after you run. Use a commercial freeze-pack that you can wrap around your leg (or just put a wet towel in the freezer before you go out for a run). Keep the ice wrap on for ten to fifteen minutes, keeping your foot elevated. To help reduce the inflammation further, take aspirin or ibuprofen with food. Never take it on an empty stomach or before running. In the evening or at bedtime wrap a heating pad around your leg and put it on a low setting.
Cut back on your running. If you can stand it, you might consider taking a few days off altogether. The important thing is not to run through the pain. You'll only make it worse.
With all that extra downtime, you'll have plenty of opportunity to stretch your calves and strengthen your anterior leg muscles. Do wall pushups, and be particularly careful not to overstretch; ease into your stretches gradually. Do these several times a day, and especially before and after you run.
You might have the wrong shoes. Check your feet to see if you might need more stability and/or cushioning. Also, try inserting heel lifts so that your calves don't have to stretch as far. You can buy these at your local drugstore, or use makeup sponges as a substitute.
Finally, check to make sure that you have good running form. In particular, be sure that you aren't leaning forward too much. If you slouch forward when you run, you may be pulling too hard on your calf muscles.
If you try these suggestions, and your pain persists, see an orthopedist about the possibility of a stress fracture. If that's the problem, you may need orthotics to correct a foot imbalance. In general, though, keep in mind that shin splints, like most running injuries, are basically an overuse injury. Listen to your body and back off when you begin to feel pain.
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Bunions 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. Usually the symptoms of bunions appear at later stages, although some people never have symptoms.
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.
Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity get progressively worse. That means you may experience symptoms sooner.
Symptoms occur most often when wearing shoes that crowd the toes—shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.
Symptoms, which occur at the site of the bunion, may include:
- Pain or soreness
- Inflammation and redness
- A burning sensation
- Perhaps some numbness
Other conditions which may appear with bunions include calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe.
Common Diagnosis (see your own doctor for your specific 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 foot and ankle surgeon may take x-rays 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. Once your foot and ankle surgeon has evaluated your particular case, a treatment plan can be developed that is suited to your needs.
Sometimes observation of the bunion is all that's needed. A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed.
Early treatments are aimed at easing the pain of bunions, but they won't reverse the deformity itself.
These options include:
- Changes in shoe wear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
- Padding. Pads placed over the area of the bunion can help minimize pain. You can get bunion pads from your foot and ankle surgeon or purchase them at a drug store.
- Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.
- Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
- Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.
- Orthotics devices. In some cases, custom Orthotics devices may be provided by the foot and ankle surgeon.
When is Surgery Needed?
When the pain of a bunion interferes with daily activities, it's time to discuss surgical options with your foot and ankle surgeon. Together you can decide if surgery is best for you.
Recent advances in surgical techniques have led to a very high success rate in treating bunions.
A variety of surgical procedures are performed to treat bunions. The procedures are designed to remove the "bump" of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred. The goal of these corrections is the elimination of pain.
In selecting the procedure or combination of procedures for your particular case, the surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
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Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person's arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, potentially causing severe discomfort and leading to other foot problems.
Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding stress to other parts of the foot. As a result, over-pronation, often leads to Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions.
There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Often people with flat feet do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.
Treatment and Prevention
Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics.
These orthotics should be designed with appropriate arch support and medial rear foot posting to prevent the over-pronation.
Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems.
If the problem persists, consult your foot doctor.
Gout is a disorder that results from the build-up of uric acid in the tissues or a joint—most often the joint of the big toe. An attack of gout can be miserable, marked by the following symptoms:
- Intense pain that comes on suddenly — often in the middle of the night or upon arising.
- Redness, swelling, and warmth over the joint — all of which are signs of inflammation.
Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid. Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is furthest from the heart, it’s also the coolest part of the body—and, thus, the most likely target of gout. However, gout can affect any joint in the body.
The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body’s ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications (“water pills”), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men and also occurs in women.
Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding the following foods and beverages: shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.
Diagnosis and Treatment
In diagnosing gout, the foot and ankle surgeon will take your personal and family history and examine the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.
Initial treatment of an attack of gout typically includes the following:
- Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation.
- Dietary restrictions. Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid.
- Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
- Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce the swelling.
The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.
This information is for educational purposes ONLY. Only a qualified Doctor can make a medical recommendation for treatment or diagnosis. We do not claim that our products cure any medical condition. The foot has very complex anatomy so there can be many different reasons to explain what is causing your feet to hurt, and some problems can cause more to arise. For this reason, you should always consult a doctor for a correct diagnosis or recommendation for insoles, especially if your pain is severe, worsens, or persists, even with the aid of insoles.
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Patients often refer to all forms of toe abnormalities as a hammer toe. There are in fact four main forms of toe abnormalities, hammer toes, claw toes, mallet toes and trigger toes. A hammer toe can be best described as an abnormal contraction or "buckling" of a toe. This occurs due to a partial or complete dislocation of one of the joints that form the toe. As the toe continues to be deformed, it will press up against the shoe and may cause corns.
Apperance of Hammer Toes
- There are two joints in the lesser toes and one joint in the large toe. If the deformity occurs in the lesser toes and in the joint nearest the nail, it is called a mallet toe.
- If the deformity occurs in the lesser toes and in the joint nearest the foot, it is called a hammer toe.
- If the deformity in the lesser toes involves both of the joints, then the toe is referred to as a claw toe.
- If the deformity occurs in the large toe, it is known as a trigger toe.
- A hammer toe may be painful, especially when irritated by a shoe.
- All four toe conditions may cause cramps in the toes, foot and leg due to the abnormal function of the tendons in the foot.
- If a mallet toe has occurred, you are likely to suffer from a corn at the end of the toe.
- A hammer toe may cause a corn on the top of the toe.
- Infections and ulcers can also occur.
- In severe cases a mallet toe, trigger toe, claw toe or a hammer toe may create a downward pressure on the foot, which can result in hard skin and corns on the soles of the feet.
- Inappropriate shoes.
- Flat feet can result in hammer toes.
- High arched feet can also result in buckling toes.
- A major cause is in hereditary (family), all the toe conditions mentioned could be acquired due in hereditary factors.
- Bunions are a major cause of hammer toes.
- Claw toes are usually the result of poor fitting footwear. For many people, the second toe is actually longer than the great toe. Shoes are sized to fit the great toe, the second (and maybe even the third toe) will have to bend to fit into the shoe. Shoes that are pointed make matters even worse. Combine pointed shoes with high heels; the foot is under similar pressure as if it was constantly being pushed downhill into a wall.
- Rheumatoid arthritis can also lead to bunions, which in turn can lead to hammer toes.
- Purchase wide fitted, low heeled shoes, running shoes are ideal.
- Make sure that stockings, tights and socks are not too constrictive.
- Non-medicated pads may relieve pressure away from corns and hard skin.
- Applying an appropriate moisturizing cream will help to keep the skin soft.
- Purchase high quality silicone products such as the silicone toe prop to help cure this condition.
- A silicone toe prop will prevent the toe from contracting any further.
The heel bone is the largest bone in the foot and absorbs the most amount of shock and pressure. A heel spur develops as an abnormal growth of the heel bone. Calcium deposits form when the plantar fascia pulls away from the heel area, causing a bony protrusion, or heel spur to develop. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Heel spurs can cause extreme pain in the rear foot, especially while standing or walking.
Heel spurs develop as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia pulls away from the heel. This stretching of the plantar fascia is usually the result of over-pronation (flat feet), but people with unusually high arches (pes cavus) can also develop heel spurs. Women have a significantly higher incidence of heel spurs due to the types of footwear often worn on a regular basis.
Treatment and Prevention:
The key for the proper treatment of heel spurs is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an Orthotics with rear foot posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal.
Other common treatments include stretching exercises, losing weight, wearing shoes that have a cushioned heel that absorbs shock, and elevating the heel with the use of a heel cradle, heel cup, or Orthotics. Heel cradles and heel cups provide extra comfort and cushion to the heel, and reduce the amount of shock and shear forces experienced from everyday activities.
In growing toe nails are one of the most common foot complaints treated by a chiropodist. This condition can be very painful and patients may often be very reluctant to have the condition treated. However, we can assure you that this condition will not resolve itself and requires specialist care. An In growing toe nail is caused by a splinter of nail or the whole nail causing pressure into the skin. Some In growing toe nails are acute which means that they have occurred due to a injury to the toe. Others are chronic, which means the patient has had the problem for a long period of time. The large toe is usually affected, however, it can also affect the lesser toes.
- In an acute condition the toe will be very red, swollen, painful to touch and there may be a discharge of pus or a watery discharge with a hint of blood.
- In a chronic condition the toe will appear slightly inflamed at the corner of the nail.
- The condition may be aggravated by wearing tight shoes or shoes with a inadequate depth.
- In an acute condition the toe will be very painful to touch and there may be presence of a infection.
- In a chronic condition the toe will only be painful when the patient is walking with shoes on.
- Trauma to the nail
- Improper cutting of toe nails
- Tight shoes or hosiery
- Abnormal shape of nail plate
- Abnormal thickness of nail
Treatment and Prevention:
- Cut toe nails straight across and leave them slightly longer to prevent a In growing toe nail.
- Avoid tight shoes.
- If discomfort occurs try soaking the feet in luke warm salt water for 10 minutes each day.
Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot). This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia (ball-of-foot-pain) is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe).
With this common foot condition, one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with metatarsalgia. Ball-of-foot pain is often caused from improper fitting footwear, most frequently by women's dress shoes and other restrictive footwear. Footwear with a narrow toe box (toe area) forces the ball-of-foot area to be forced into a minimal amount of space. This can inhibit the walking process and lead to extreme discomfort in the forefoot.
Other factors can cause excessive pressure in the ball-of-foot area that can result in metatarsalgia. These include shoes with heels that are too high or participating in high impact activities without proper footwear and/or orthotics. Also as we get older, the fat pad in our foot tends to thin out, making us much more susceptible to pain in the ball-of-the-foot.
Treatment and Prevention:
The first step in treating metatarsalgia is to determine the cause of the pain. If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole is ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot.
Unloading pressure to the ball-of-the-foot can be accomplished with a variety of foot care products. Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad. The orthotic is constructed with the pad placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Other products often recommended include gel metatarsal cushions and metatarsal bandages. When these products are used with proper footwear, you should experience significant relief.
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The term neuroma refers to a swelling of a nerve. The nerve commonly affected is a small nerve that connects the 3rd and 4th toes, counting from the big toe. The patient will complain of pain in the sole of the foot.
- Begins with numbness or tenderness in the foot, just behind the 3rd and 4th toes.
- At a later stage, pain, numbness, burning and tingling sensations can radiate around the foot.
- The symptoms may appear and disappear spontaneously.
- Severe pain may be present at weight bearing.
- The patient may experience spontaneous shooting pains, which is often referred to as an "electric shock". This can affect patients when are sleeping at night.
- The pulling of the ligaments under the foot irritates the nerve.
- High heels can damage the nerve.
- A tight toe box will squeeze the toes in the foot and therefore put pressure on the nerve.
- Mechanical problems with the feet such as "over pronation". Over pronation can be simply described as a condition, which causes your arches to flatten out when you stand up. This causes your ankles to roll in towards each other and disturbs your normal walking pattern. If a foot over pronates the structures of the foot are put under stress, which increases the likelihood of a neuroma occurring.
- Firstly, the chiropodist will diagnose the condition. History of the condition, clinical presentation and your description of the problem may be sufficient.
- The chiropodist may squeeze the area between the bases of the toes. The area may be sensitive and an audible click may be present. This click is the neuroma pushing between the bones and is often referred to as a mulders click.
- X-rays may be necessary of the foot. This may rule out a stress fracture of the foot.
- You may be referred for a MRI scan, this will enable the chiropodist to see the neuroma.
- Various types of pads can be used to redistribute pressure away from the lesion.
- Orthotics (insoles) may be prescribed to redistribute pressure away from the neuroma.
- The chiropodist may advise your General Practitioner to inject inflammatory medicine into the neuroma.
- Appropriate shoes may be recommended.
- A decrease in symptoms may occur instantaneously, with a complete recovery in a few months. However, the patient may need to use insoles to prevent a further reoccurrence.
- In severe cases, surgery may be necessary. Removal of part of the nerve may be performed.
A strain occurs when a muscle or the tendon that attaches it to the bone is overstretched or torn. Muscle strains are also called pulled muscles. Anyone can strain a muscle. However, people involved in sports or other forms of strenuous exercise are more likely to strain a muscle.
Muscles are bunches of fibers that can contract. Muscle strains usually occur during activities that require the muscle to tighten forcefully. The muscle is strained either because it is not properly stretched, or warmed up, before the activity; it is too weak; or because the muscle is already injured and not allowed time to recover. So, many muscle strains occur during exercise or sports activities. They can also occur when lifting heavy objects.
When a muscle is strained, it hurts and is difficult to move. You may also feel a burning sensation in the area of the injured muscle, or feel as though something has "popped." Sometimes the area of the strained muscle looks bruised or swells. A strained muscle might spasm, which means it contracts suddenly and involuntarily, causing severe pain.
Diagnosis and Treatment:
To diagnose a muscle strain, your doctor will examine the painful area, and ask how and when the injury happened. He or she may order other diagnostic tests, such as x-rays, to rule out any injury to the bone.
Muscle strains are treated with Rest, Ice, Compression, and Elevation, or RICE. You will be told to rest the injured area to reduce pain and swelling. If the strain is in the leg or foot area, you may need to use crutches. Ice packs are recommended at regular intervals (as recommended by your doctor) over the first few days after the injury. Ice causes the blood vessels to constrict, which reduces inflammation and pain. Anti-inflammatory medications might also be used to relieve pain. Compression and elevation help to reduce swelling. Your doctor may also recommend physical therapy to speed your recovery. You should avoid the type of activity that caused the injury until the muscle is completely healed.
You can prevent muscle strains by warming up for at least 10 minutes before participating in any strenuous exercise or heavy lifting. When you warm up, you increase the blood circulation to the muscle and prepare it for exercise. When starting any new exercise program or sport, it's important to begin gradually so your muscles are conditioned for the activity.
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Plantar fasciitis is the inflammation of the plantar fascia, which is the ligament that connects the heel to the toes; it runs along the bottom of the foot, forming the arch of the foot. When inflamed, the plantar fascia contracts, causing excruciating pain, usually in the morning when it has not yet been stretched out.
This happens most with overuse from obesity or weight gain, frequent walking on hard surfaces, or lack of arch support. It is also called ‘joggers’ heel, tennis heel, Policeman’s heel’ or “heel spur syndrome,” the latter of which is most the common nickname. It is actually a misnomer, though, since heel spurs, or inferior calcaneal exostoses, do not actually cause the pain associated with plantar fasciitis.
Plantar Fasciitis is a serious, painful, and progressing illness that occurs when the long, flat ligament along the bottom of the foot develops tears and inflammation. Serious cases of plantar fasciitis can possibly lead to ruptures in the ligament. This ligament is called the plantar fascia and it extends your five toes and runs along the bottom of your foot, attaching to your heel. When you walk or run, you land on your heel and raise yourself on your toes as you shift your weight to your other foot, causing all your weight to be held up by your plantar fascia. Such repetitive force can pull the fascia from its attachment on your heel and cause damage and plantar fasciitis.
The most apparent symptom of plantar fasciitis is extremely painful heel pain in the morning, but it may also occur after standing or exercising. As the plantar fascia is flexed, however, it tends to loosen up and the pain eases. The pain occurs only on the bottom and/or heel of the foot. Plantar fasciitis usually only happens in one foot at a time, but has been known to occur in both at the same time. Signs of mild swelling or redness may also be observed.
While the exact cause is unknown, plantar fasciitis is understood to be the result of repeated small tears in the plantar fascia. These tears can be an effect of several factors: biomechanical, lifestyle, and biological. Sometimes, this condition can result from the way one walks: abnormal pronation, or twisting inward of the foot, high arches, flat feet, tight calf muscles, or tight Achilles tendons. It also results from activities that put great stress on the foot, including walking, running, standing/walking on hard surfaces, sports, walking barefoot too frequently, or wearing shoes that do not provide enough cushion or arch support. Furthermore, biological factors including age, weight, diabetes and arthritis (ankylosing spondylitis or Reiter’s syndrome) can increase likelihood of development. Also, in some rare cases, plantar fasciitis has been known to occur following a single injury to the foot. Lastly, the condition may strike again in patients who have a history of the condition.
Many factors can cause plantar fasciitis to develop. When walking with a normal step, the plantar fascia ligament stretches as the foot strikes the ground. When walking with an abnormal step, or when putting repetitive pressure on the heel, the plantar fascia ligament can stretch irregularly, become stressed, and develop small tears. These small tears can cause the fascia ligament to become inflamed (plantar fasciitis) and also lead to serious pain.
The pain from plantar fasciitis is described as being dull aching or sharp and can usually be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia. Plantar fasciitis tends to worsen after standing or exercising for prolonged periods or after getting out of bed in the morning. Morning heel pain from plantar fasciitis is one of the most common symptoms and occurs because the fascia becomes tense after a protracted rest. As the person walks, the fascia warms up and lengthens slightly, reducing the tension on the ligament and lessening pain.
- Biomechanical factors, such as abnormal inward twisting of the foot (pronation), high arches, flat feet, or tight tendons along the back of the heel (Achilles tendons).
- Excessive pronation has been found in about 85% of those who suffer from plantar fasciitis. Prontion can be responsible for added tension in the plantar fascia as the arch lowers during standing or walking.
- Repetitive pressure on the feet, such as from jobs or activities that require prolonged walking or standing on hard or irregular surfaces. Running and exercise can also lead to wear and tear on the plantar fascia.
- Aggravating factors, such as being overweight or having poorly cushioned shoes.
- Natural process of aging which may cause tissue in the heels to weaken over time and/or promote wear and tear.
- In rare cases, a single, traumatic injury to the foot such as from a motor vehicle accident can cause the onset of plantar fasciitis.
Doctors will diagnose plantar fasciitis based on patient history, and by physical examination, paying close attention to signs of pronation or high/low arches. Sometimes, a doctor will perform an x-ray or MRI in order to rule out other possible injuries or causes for pain.
Additional Information on Plantar Fasciitis:
Plantar fasciitis is such as common condition, affecting millions of people each year, because the foot must endure significant weight on an almost constant basis. With every step, all of our weight is absorbed by tissue throughout the foot. The heel in particular must absorb the brunt of our body?s weight, not to mention any additional pressure from lifting heavy objects or from other activities. Normally, the foot is should be able to accommodate this weight and allow us to remain on our feet free of pain. But when the foot is loaded to a degree greater than what it can physically tolerate, damage can develop and problems such as plantar fasciitis begin to occur.
As we stand and apply our weight to the foot, the arch drops and the plantar fascia becomes tightened. Plantar fasciitis occurs when the weight that is applied to the foot is so great that the tension in the plantar fascia increase, causing damage as it begins to pull away from the heel bone. This is a very important concept to understand and is probably why plantar fasciitis is such a misunderstood medical condition. The painful symptoms of plantar fasciitis do not result from standing on the heel, but rather result from overwhelming tension or repetitive stress that is exerted on the plantar fascia as we stand or exercise. In such instances, the plantar fascia can become so tight that it is literally being torn from the bottom of the heel bone.
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Pain on the inner side of your leg, right where the calf muscle meets the big shin bone. If the pain is severe, you may have strained this area enough to cause a stress fracture in the tibia. If this is the case you should see a doctor immediately.
You've strained a muscle that gives some support to the arch of your foot (the muscle runs from the shin bone around the ankle and attaches behind the ball of the foot). You probably have Flat Feet.
To ease the pain and reduce inflammation, ice your shins immediately after running. Use either a store-bought cold pack or simply freeze a wet towel before going out on a run. Whatever you use, wrap the ice pack around your leg and keep it on for 10 or 15 minutes, keeping your foot elevated all the while. Take aspirin or ibuprofen at mealtime to help reduce inflammation further.
Definitely cut back on your mileage and perhaps take a few days off from running. Whatever you do, do not try to run through the pain. You will only make your injury worse and could wind up with a stress fracture.
Work on stretching your calf muscles. Do wall pushups several times a day, particularly before and after running, but be careful not to overdo it. Wall pushups are done by standing about a foot from a wall and leaning into it with your hands on the wall like a pushup on the floor. The difference is that you are not pushing with your arms, you are pushing up with your toes. Your hands are just helping you position yourself. Overstretching the calf can only do more damage. Ease into the stretch slowly and go only to the point where you begin to feel the muscle resist the stretch. There should never be discomfort.
Also, follow the remedy for flat feet to give your arch a little extra support and ease the burden of your strained shin muscle. In particular, try wearing an arch strapping and a commercial arch support.
If your pain persists, go to see an osteopath to find out if you might have a stress fracture.
Sesamoiditis is painful inflammation of the sesamoid apparatus, which is located in the forefoot. It is a common condition that typically affects physically active young people. Sesamoiditis causes pain in the ball of the foot, especially on the inner (medial) side. The pain may be constant, or it may occur with or be aggravated by, movement of the big toe joint. It may be accompanied by swelling (edema) throughout the bottom (plantar aspect) of the forefoot.
The forefoot consists of the five toes and their connecting long bones, the metatarsals. Each toe (phalanx) is made up of several small bones called phalanges. The phalanges of all five toes are connected to the metatarsals by metatarsophalangeal joints at the ball of the foot. The forefoot bears half the body's weight and balances pressure on the ball of the foot.
The big toe, or hallux, has two phalanges and two joints (interphalangeal joints); it also has two tiny, round, sesamoid bones that enable it to move up and down. On an x-ray of the foot, they appear as a pair of distinctive oval dots near the first metatarsal head (front end of the first long bone of the forefoot). The other four toes each have three phalanges, two joints, and no sesamoid bones.
The sesamoid bones closest to the inner side of the foot are called medial sesamoid bones; the ones closest to the outside of the foot are called lateral sesamoid bones. The sesamoids are embedded in the flexor hallucis brevis tendon, one of several tendons that exert pressure from the big toe against the ground and help initiate the act of walking. The sesamoid bones have two principal functions.
- They absorb impact forces in the forefoot during walking through a series of attachments to other structures in the forefoot. Although they are separated by a bony ridge called the crista at the bottom (plantar aspect) of the first metatarsal head, they are connected to one another by an intersesamoid ligament. They also are attached to other tendons and ligaments in the forefoot (e.g., tendons of the abductor and abductor hallucis muscles, sesamophalangeal ligament, metatarsosesamoid ligament). This array of attachments enables the sesamoids to disperse some of the impact of the foot striking the ground during walking.
- The connecting ligaments, the first metatarsophalangeal joint capsule, and the sesamoid bones (known collectively as the sesamoid apparatus) act as a fulcrum, providing the flexor tendons a mechanical advantage as they pull the big toe down against the ground during walking.
Sesamoiditis is usually caused by repetitive, excessive pressure on the forefoot. It typically develops when the structures of the first metatarsophalangeal joint are subjected to chronic pressure and tension. The surrounding tissues respond by becoming irritated and inflamed. This is a common problem among ballet dancers and people who play the position of catcher in baseball. Any activity that places constant force on the ball of the foot—even walking—can cause sesamoiditis.
Damage to the sesamoid bone may also result in sesamoiditis. Stress fractures (microscopic tears in the bone structure due to repetitive abuse) can produce this condition.
Signs and Symptoms:
Sesamoiditis typically can be distinguished from other conditions that cause pain in the forefoot by its gradual onset. The pain usually begins as a mild ache and increases gradually if the aggravating activity is continued. It may build to an intense throbbing. In most cases, there is little or no bruising or redness. Pain and swelling can limit the ability of the first metatarsophalangeal joint to flex upward (dorsiflexion) or downward (plantarflexion), causing a loss of range of motion in the big toe and difficulty walking.
Treatment for sesamoiditis is usually noninvasive. Minor cases require a strict period of rest and the use of a modified shoe or a shoe pad with a cutout to reduce pressure on the affected area. A metatarsal pad can be placed away from the joint to redistribute the pressure of weight bearing to other parts of the forefoot. In addition, the big toe may be bound with tape or athletic strapping to immobilize the joint as much as possible and allow healing to occur. Oral anti-inflammatory drugs can be used to reduce swelling.
Severe cases may require a below-the-knee walking cast for 2 to 4 weeks and the injection of steroids into the inflamed first metatarsophalangeal joint.
A fracture of one or both sesamoid bones produces many of the same symptoms as sesamoiditis: pain in the ball of the foot and first metatarsophalangeal joint, swelling, and limited plantarflexion/dorsiflexion. In sesamoiditis, chronic abuse causes a gradual onset of pain and in a sesamoid fracture, the onset of pain usually results from traumatic injury to the ball of the foot. This commonly involves a fall from height, in which the patient lands heavily on the feet, fracturing one or both sesamoid bones.
A fractured sesamoid produces substantial swelling throughout the forefoot and a deep, tender bruise in the area of the big toe's metatarsophalangeal joint. X-rays are often necessary to confirm a sesamoid fracture. Occasionally, however, x-rays are inconclusive because a small percentage of people have bipartite sesamoid bones. Instead of one medial and one lateral sesamoid bone under each first metatarsal head, they have sesamoid bones that are divided into two pieces. Because these bones are so small, the radiologist may be unable to distinguish a fractured sesamoid from a bipartite sesamoid, or a fractured bipartite sesamoid from a whole one. In rare cases, a bone scan may be necessary to confirm a fracture.
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Exercise or just walking up stairs can cause tiny micro tears in the muscles cause them to go into spasm. When they are in spasm or contracted then blood cannot easily get into them. The muscles have squeezed the blood out like a sponge. If the muscles do not get enough blood then they will not get enough nutrients and so will tighten up to protect themselves and weaken and so on.
Treatment and Care:
- Have the flexibility of the muscles tested.
- See a sports massage therapist who can give a deep massage. Depending on how bad it is they might need three or more treatments. It is important the gap between them is not too long as they will regress back to their original condition.
- Start a stretching program.
- Continue to stretch for at least 6 weeks at this rate.
I stretch and stretch but seem to get nowhere, why?
- You might not be stretching enough even though you think you are.
- You might be stretching too hard. If you force the muscle the 'stretch reflex' is triggered which contracts it. By going against this you are damaging the muscle. Stretch gently, do not bounce, ease into it and feel the muscle stretching.
- If it is just one leg that is tight you could have pressure on the sciatic nerve which causes the tightness. You should get this sorted out first.
Haglunds is a bony enlargement on the back of the heel. It often leads to bursitis, which is the inflammation or irritation of the bursa (a fluid-filled sac which forms and situates between tissues such as the bone and tendons). There are a few known causes for Haglunds, including heredity (for example, having high arches), a tight Achilles tendon, or a tendency to walk on the outside of the heel. This tendency causes the heel to rotate inward, which results in a grinding of the heel bone against the tendon. To give itself some relief, the tendon forms a bursa, which can eventually become inflamed and tender. Bursitis is most often caused by repetitive, minor impacts to the bursa.
Signs and Symptoms:
The signs and symptoms of haglunds and bursitis may include:
- A pronounced bump on the back of the heel
- Pain at the back of the foot, where the Achilles tendon attaches to the heel
There are many ways to deal with the pain of haglunds and bursitis, including:
- Physical therapy and exercises for stretching and range of motion
- Resting the injured area
- Icing the area
- Anti-inflammatory medications
- Heel lifts or heel pads
- Orthotic arch supports
Tendinitis is the inflammation of the tendon – thick cords of tissue that connect the muscles to the bone. Achilles tendinitis is one of the most common causes of foot or ankle pain. Please see our section on Achilles Tendonitis for more information.
Stress fractures are tiny cracks in the bone, caused by repetitive impact or overuse. Stress fractures can also come about from normal use of a bone that suffers from a weakening condition such as osteoporosis. They are most common in the weight-bearing bones of the leg and foot.
Signs and Symptoms:
- Gradual pain, which increases with activity and decreases with rest
- Pain that occurs during normal, daily activities and becomes more severe
- Swelling on the top of the foot or around the ankle
- Tenderness to touch
Diagnosis and Treatment:
Only a doctor can diagnose stress fractures. They will do so by asking you about your activities and medical history, then by examining the foot and ankle. Imaging tests such as X-Ray or an MRI may be used to help your doctor confirm the diagnosis.
If you suspect that you have a stress fracture in your foot or ankle, immediately stop the activity causing you pain and rest. Ignoring stress fracture pain can worsen the injury and have serious consequences. Apply an ice pack and elevate the affected foot above your heart if possible. Over the counter anti-inflammatory medicines such as ibuprofen may help to relieve pain and swelling. See your doctor immediately.
Treatment of the foot or ankle will vary, depending on the location of the stress fracture and its severity. Typically, treatment involves rest. It is important to take a break from the activity that caused the stress fracture. You can switch to activities that place less stress on the area such as swimming or cycling. Treatment for stress fractures may also involve protective footwear or casts, to reduce the stress on your foot/leg. Protective footwear may be something like a stiff-soled shoe, but sometimes your doctor will want to apply a cast to your foot to keep the bones in a fixed position and remove stress as you heal. Some stress fractures may require surgery to heal properly. This usually involves applying pins, screws and/or plates to hold the small bones of the foot and ankle in place during the healing process.
Tailor’s Bunion is caused as a result of the inflammation of the fifth metatarsal bone at the base of the little toe. It is similar to a bunion (which affects the big toe) and also known as Metatarsalgia or intractable plantar keratosis.
Signs and Symptoms:
- Pain at the site of the enlargement around the toe
Surgery is considered only after the pain continues for a long period of time with no improvement, after utilizing non-surgical therapies. Non-surgical therapies include:
- Wearing shoes that have a wide toe box, avoiding pointed toes or high heels
- Anti-inflammatory drugs to help relieve pain and inflammation
- Injections of steroid to treat the inflammation
- Bunionette pads can be placed over the area to help reduce pain and impact
- Icing may also reduce pain and swelling.