Micha Broadie

Insanity is doing the same thing, over and over again, but expecting different results.

Calcaneal Spur


Overview


The term heel spur generally refers more specifically to a heel spur, also known as a calcaneal spur. These calcium growths form around the tendons and ligaments of the foot and eventually become attached to the heel bone. The spurs then continue to grow, piercing the skin of the foot and causing pain and discomfort. When left untreated the spur can continue to grow causing agonizing pain and even immobilizing the patient.


Causes


Heel spurs form in some patients who have plantar fasciitis (PLAN-tar fash-ee-I-tis), and tend to occur in patients who have had the problem for a prolonged period of time. While about 70 percent of patients with plantar fasciitis have a heel spur, X-rays also show about 50 percent of patients with no symptoms of plantar fasciitis also have a heel spur.


Inferior Calcaneal Spur


Symptoms


Most heel spurs cause no symptoms and may go undetected for years. If they cause no pain or discomfort, they require no treatment. Occasionally, a bone spur will break off from the larger bone, becoming a ?loose body?, floating in a joint or embedding itself in the lining of the joint. This can cause pain and intermittent locking of the joint. In the case of heel spurs, sharp pain and discomfort is felt on the bottom of the foot or heel.


Diagnosis


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


Non Surgical Treatment


Only in rare cases do the symptoms of heel spurs fail to be resolved through conservative treatment. Conservative treatment, although not 100% effective, is successful in most cases and should be given ample time to work. In many cases, conservative methods should be utilized as long as a year depending on the rate at which your body responds to the treatment. When treatment is unsuccessful, surgery may be considered. A common surgical procedure for this condition is plantar fascia release surgery. In this procedure, the tension of the plantar fascia ligament is released, lessening tension in the heel and helping to prevent damage.


Surgical Treatment


Surgery to correct for heel spur syndrome is a common procedure which releases plantar fascia partially from its attachment to the calcaneous (heel bone). This part of the surgery is called a plantar fasciotomy due to the fact the fascia is cut. This is most often done through an open procedure as any heel spur or bursa can be removed at the same time. If the spur is not removed during the surgery, it will probably be just as successful, as the large spur is not the true problem. Some physicians use an endoscopic approach (EPF) where a small camera aids the physician during surgery with typically smaller incisions on each side of your foot.


Prevention


A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don't underestimate your body's need for rest and good nutrition. If obese, lose weight.
Heel Spur


Overview


A bone spur (osteophyte) is a bony growth that forms along the edge of normal bone in response to wear and tear, most frequently in the joints. A heel spur is a bone spur of the heel bone, which causes heel pain by rubbing on the achilles tendon or other soft tissues.


Causes


The plantar fascia is a big strong ligament on the bottom of the foot, starting at the bottom of the heel bone and running into the ball of the foot. As the arch of the foot becomes weak, it sags slightly with each step and this causes the plantar fascia to tug and pull at the heel bone with each step. Over a period of time, a spur forms where this big strong ligament tugs and pulls at the heel bone. Soon, inflammation (swelling) starts around this spur and the pain becomes almost unbearable. (Sometimes heel spurs may be present without being painful if no inflammation is present).


Inferior Calcaneal Spur


Symptoms


Most heel spurs cause no symptoms and may go undetected for years. If they cause no pain or discomfort, they require no treatment. Occasionally, a bone spur will break off from the larger bone, becoming a ?loose body?, floating in a joint or embedding itself in the lining of the joint. This can cause pain and intermittent locking of the joint. In the case of heel spurs, sharp pain and discomfort is felt on the bottom of the foot or heel.


Diagnosis


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


Non Surgical Treatment


By reducing excessive motion and controlling and supporting the foot during physical activities an orthotic can help to limit how far the plantar fascia is pulled or torn away from the heel. A Heel Spur pad can be offered- which is a pad designed to take pressure off the spur. If the problem persists, consult your foot doctor.


Surgical Treatment


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


Prevention


Use orthotic inserts. You can purchase orthotics over the counter, or you can have orthotics specially fitted by your podiatrist. Try 1 of these options. Heel cups. These inserts will help to align the bones in your foot and to cushion your heel. Check your skin for blisters when you first start using heel cups. Also, your feet may sweat more with a heel cup, so change your socks and shoes often. Insoles. While you can pick up generic insoles at a drugstore, you may have more luck if you go to a store that sells athletic shoes. Push on the arch to make sure that it doesn't collapse. If your insoles help but could use a little work, you can take them to a podiatrist to get them customized. Custom orthotics. A podiatrist can make a cast of your foot and provide you with custom-made orthotics. These may be more expensive, but they are made of materials specifically designed for your needs, and they can last up to 5 years if your podiatrist refurbishes them every 1 or 2 years. To find a podiatrist near you, look at the Web page for the American Academy of Podiatric Sports Medicine. Dynamic Insoles. Lack of elasticity in plantar fascia in the foot is for most people the real problem. If there is poor elasticity in the lengthwise tendons in the foot (plantar fascia) in relation to a person's general condition, only a small additional strain is required for the pull on the tendons to cause damage to the tissues connecting the tendons to the heel bone. This will generate an inflamed condition called Plantar Fasciitis.
Overview


Retrocalcaneal bursitis is the painful inflammation and swelling of the retrocalcaneal bursa that is situated between the calcaneus (heel bone) and the Achilles tendon. A bursa is a small fluid filled sac that forms around joints in areas where there is a lot of friction between muscles, tendons and outcrops of bone. The bursae position themselves in between the tendon or muscle and the bone, buffering any friction from movement. To picture a bursa imagine it as a very small water filled balloon that sits in places where things rub against each other, such as in between a tendon and a bone, to provide a soft smooth cushion for the tendon to pass over painlessly. The covering of the bursa also acts as a lubricant and aids the tendon?s movement. It is estimated that there is over 150 bursae in your body which protect the joint and tendons from wear. They are all very small and unnoticeable until they become swollen and painful with bursitis.


Causes


Systemic diseases such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, pancreatitis, Whipple disease, oxalosis, uremia, hypertrophic pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome have also been associated with bursitis.


Symptoms


Limping. Decreased movement. Your ankles may feel stiff or unable to move as well as they usually do. Pain or tenderness in the back of the ankle. It may be worse at the beginning of exercise, or when running uphill. You may also have pain when wearing shoes. Redness and warmth. If the bursa is infected, the skin over the heel may be red and warm. You may also have a fever. Swelling on the back of the heel.


Diagnosis


Diagnosis is first by clinical suspicion of symptoms. This can be mistaken for gout or infection especially in the big toe region. A diagnosis of bursitis is usually used in combination of the underlying cause, for instance a bunion deformity, Haglund's deformity, or Heel Spur Syndrome. Many times the cause needs to be addressed to rid the problem of bursitis.


Non Surgical Treatment


The underlying cause of the bursitis must be identified to prevent further reoccurrences. Failure to eliminate the cause will lead to future flare ups and a poor and slow recovery. Future occurrences can be prevented with the use of stretches and strengthening exercises which will help prevent the muscles from tightening up over the bursa, Pilates and yoga are very good for this providing the aggravating movements are avoided. Wearing joint supports such as knee pads or elbow supports may also reduce the likelihood of redeveloping bursitis.


Surgical Treatment


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


Prevention


Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.
HammertoeOverview


Generally a hammertoe or mallet toe is caused by wearing high heels or shoes that are too small around the toe area, so it?s no surprise that it is mostly women who suffer from them. A hammertoe has a bend in the middle joint of the toe whereas a mallet toe has a bend in the upper joint of the affected toe. The way someone walks (gait) can also lead to the formation of hammertoes and mallet toes as can overuse and injury. Sometimes a deep blister will form over the bent joint and often after some time calluses and corns will develop on the affected toe joint. People with arthritis, diabetes or neuromuscular conditions are also more likely to develop a hammer toe or mallet toe.


Causes


The muscles of each toe work in pairs. When the toe muscles get out of balance, a hammertoe can form. Muscle imbalance puts a lot of pressure on the toe's tendons and joints. This pressure forces the toe into a hammerhead shape. How do the toe hammertoe muscles get out of balance? There are three main reasons. Genes. you may have inherited a tendency to develop hammertoes because your feet are somewhat unstable, they may be flat or have a high arch. Arthritis. Injury to the toe, ill-fitting shoes are the main culprits. If shoes are too tight, too short, or too pointy, they push the toes out of balance. Pointy, high-heeled shoes put particularly severe pressure on the toes.


Hammer ToeSymptoms


A toe (usually the second digit, next to the big toe) bent at the middle joint and clenched into a painful, clawlike position. As the toe points downward, the middle joint may protrude upward. A toe with an end joint that curls under itself. Painful calluses or corns. Redness or a painful corn on top of the bent joint or at the tip of the affected toe, because of persistent rubbing against shoes Pain in the toes that interferes with walking, jogging, dancing, and other normal activities, possibly leading to gait changes.


Diagnosis


Hammer toes may be easily detected through observation. The malformation of the person's toes begin as mild distortions, yet may worsen over time - especially if the factors causing the hammer toes are not eased or removed. If the condition is paid attention to early enough, the person's toes may not be permanently damaged and may be treated without having to receive surgical intervention. If the person's toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.


Non Surgical Treatment


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


Surgical Treatment


If you are unable to flex your toe, surgery is the only option to restore movement. Surgery is used to reposition the toe, remove deformed or injured bone, and realign your tendons. Surgery is normally done on an outpatient basis, so you can return home on the day of your surgery.


HammertoePrevention


Preventative treatment of hammertoe is directed toward the cause of the deformity. A functional orthotic is a special insert that can be prescribed by your podiatrist to address the abnormal functioning of the foot that causes the hammertoe. Functional orthotics can be thought of as contact lenses for your feet. They correct a number of foot problems that are caused by an abnormally functioning foot. Our feet, much like our eyes, change with time. Functional orthotics slow down or halt this gradual change in the foot. Often when orthotics are used for flexible hammertoes, the toes will overtime straighten out and correct themselves. Calf stretching exercises are also helpful. Calf stretching can help to overcome part of the muscle imbalance that causes the hammertoe.

Overview
Bunions Hard Skin
A bunion is a firm, fluid-filled pad overlying the inside of the joint at the base of the big toe (metatarsophalangeal joint). The pad (bursa), which may get larger and stick out, can become inflamed and painful. Bunions may run in families, but many result from wearing tight shoes. Nine out of 10 bunions are developed by women. Nine out of 10 women wear shoes that are too small. Tight shoes also can cause other disabling foot problems like corns, calluses and hammertoes.

Causes
What causes bunions? This question is often answered by blaming shoes. But in fact, shoes only play a small role in developing bunions. Yes, shoes, especially high heels cause abnormal squeezing of your forefoot. This in turn to help promote a bunion. But if everyone who wore high heels shoes had a bunion, there would be a lot more then the 15% prevalence we see in the general population. As you can see from the flow chart, genetics plays the major role in development of bunion deformities. Genetics determines the way your foot functions. Are you flatfooted? Are your joints flexible or stiff? Do you have a high arch? Do you have tight muscles? These traits are determined by your genetic code. These characteristics then govern how your bones and joints move when you walk. As an example, if your joints are very flexible, this can cause an abnormal amount of instability in your forefoot when you walk. Over time, this abnormal motion will cause the a bunion to develop by allowing your first metatarsal to "drift" towards the mid-line of your body.
SymptomsSymptoms of a bunion include irritated skin, sensitivity to touch, and pain when walking or running. Since the bunion may grow so prominent as to affect the shape of the foot, shoes may no longer fit properly, and blisters may form at the site of friction and pressure. Bunions may grow so large that an individual must wear shoes that are a larger size than they would otherwise wear. If the bunion becomes a severe case, walking may become difficult.

Diagnosis
Bunions are readily apparent - the prominence is visible at the base of the big toe or side of the foot. However, to fully evaluate the 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 surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs.

Non Surgical Treatment
The treatment method your doctor chooses for you will be based on the severity of the bunion. Treatment can be simple and non-surgical or it can be complex, surgical, and costly. A bunion is permanent unless surgery is performed to remove it, but self-care can help to improve your symptoms. If you suspect that a bunion is developing, you should seek medical attention immediately. Here are the most common conservative treatment options. Changing your shoes. Adding custom orthotics to your shoes. Medication such as Tylenol for pain relief. Padding and taping to put your foot in its normal position. Applying ice or cold compresses to reduce swelling and pain. Keeping pressure off your affected toe, especially if there is swelling, redness, and pain. Before bed, separate the affected toe from the others with a foam-rubber pad and leave it there while you sleep.
Bunion Pain

Surgical Treatment
A bunion is considered moderate when it pushes against the second toe. In fact, over time, the big toe can force itself under the second toe, causing it to buckle and form a "hammer toe." If non-invasive treatment is not effective, and the joint is still causing discomfort, the doctor may suggest a bunionectomy to realign the big toe. With this procedure, the bunion head is moved over realigning the angled great toe joint back to a normal position. The tendons and ligaments are also balanced for a more normal pull on the toe. In moderate bunion cases, you will experience a relatively rapid recovery. The procedure allows for immediate weight on the foot in a boot and return to tennis shoes in about a month. The choice of procedure best for each patient depends on the deformity size, the stiffness of the 1st metatarsal and the ease of realignment of the 1st metatarsal during the clinical exam.