Calcaneal Apophysitis Rehab
Overview
Although the name might sound pretty frightening, Sever's disease is really a common heel injury that occurs in kids. It can be painful, but is only temporary and has no long-term effects. Sever's disease, also called calcaneal apophysitis, is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow. Sever's disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever's disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone. Sever's disease is similar to Osgood-Schlatter disease, a condition that affects the bones in the knees.
Causes
When a baby is born, most of the bones are still cartilage with only some starting to develop into bone. When the heel (calcaneus) starts to develop bone, there is generally one large area of development that starts in the center of the cartilage heel. This area of bone spreads to 'fill up' the cartilage. Another area of bone development (ossification) occurs at the back of the heel bone. These two areas of developing bone will have an area of cartilage between them, this is how the bone grows in size. At around age 16, when growth is nearly complete, these two bony areas fuse together. Sever's disease or calcaneal apophysitis is usually considered to be due to damage or a disturbance in this area of growth.
Symptoms
As a parent, you may notice your child limping while walking or running awkwardly. If you ask them to rise onto their tip toes, their heel pain usually increases. Heel pain can be felt in one or both heels in Sever's disease.
Diagnosis
Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.
Non Surgical Treatment
Fortunately Severs? disease can be treated and prevented through a number of different techniques that have all proven highly effective. The heel will repair itself even without active treatment provided that the suffering foot is given a chance to heal. Typically Severs? disease will take 2-8 weeks, although in many cases it can take longer as the continuous growing of the bone can exacerbate the condition. Podiatrists have an important role in preventing Severs? disease in young athletes, and in treating the condition when it develops so children can get back on their feet as quickly as possible. Generally treatment involves stretching muscles running down to the heel to relieve tension and pain, these include the hamstrings and calf muscles, and these stretching exercises will need to be performed at least 2 or 3 times a day. RICE is a classic method of speeding up the recovery of self-healing injuries like Severs? disease. This involves Rest, the application of Ice to the injury, Compression, and finally Elevation to encourage repaid. These measures can be advised by a trained podiatrist, but it is then up to a child to carry on with regular RICE.
Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
Although the name might sound pretty frightening, Sever's disease is really a common heel injury that occurs in kids. It can be painful, but is only temporary and has no long-term effects. Sever's disease, also called calcaneal apophysitis, is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow. Sever's disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever's disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone. Sever's disease is similar to Osgood-Schlatter disease, a condition that affects the bones in the knees.
Causes
When a baby is born, most of the bones are still cartilage with only some starting to develop into bone. When the heel (calcaneus) starts to develop bone, there is generally one large area of development that starts in the center of the cartilage heel. This area of bone spreads to 'fill up' the cartilage. Another area of bone development (ossification) occurs at the back of the heel bone. These two areas of developing bone will have an area of cartilage between them, this is how the bone grows in size. At around age 16, when growth is nearly complete, these two bony areas fuse together. Sever's disease or calcaneal apophysitis is usually considered to be due to damage or a disturbance in this area of growth.
Symptoms
As a parent, you may notice your child limping while walking or running awkwardly. If you ask them to rise onto their tip toes, their heel pain usually increases. Heel pain can be felt in one or both heels in Sever's disease.
Diagnosis
Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.
Non Surgical Treatment
Fortunately Severs? disease can be treated and prevented through a number of different techniques that have all proven highly effective. The heel will repair itself even without active treatment provided that the suffering foot is given a chance to heal. Typically Severs? disease will take 2-8 weeks, although in many cases it can take longer as the continuous growing of the bone can exacerbate the condition. Podiatrists have an important role in preventing Severs? disease in young athletes, and in treating the condition when it develops so children can get back on their feet as quickly as possible. Generally treatment involves stretching muscles running down to the heel to relieve tension and pain, these include the hamstrings and calf muscles, and these stretching exercises will need to be performed at least 2 or 3 times a day. RICE is a classic method of speeding up the recovery of self-healing injuries like Severs? disease. This involves Rest, the application of Ice to the injury, Compression, and finally Elevation to encourage repaid. These measures can be advised by a trained podiatrist, but it is then up to a child to carry on with regular RICE.
Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
Causes Of Acquired Flat Foot Deformity
Overview
There's an easy way to tell if you have flat feet. Simply wet your feet, then stand on a flat, dry surface that will leave an imprint of your foot. A normal footprint has a wide band connecting the ball of the foot to the heel, with an indentation on the inner side of the foot. A foot with a high arch has a large indentation and a very narrow connecting band. Flat feet leave a nearly complete imprint, with almost no inward curve where the arch should be. Most people have "flexible flatfoot" as children; an arch is visible when the child rises up on the toes, but not when the child is standing. As you age, the tendons that attach to the bones of the foot grow stronger and tighten, forming the arch. But if injury or illness damages the tendons, the arch can "fall," creating a flatfoot. In many adults, a low arch or a flatfoot is painless and causes no problems. However, a painful flatfoot can be a sign of a congenital abnormality or an injury to the muscles and tendons of the foot. Flat feet can even contribute to low back pain. 
Causes
There are a number of theories as to why the tendon becomes inflamed and stops working. It may be related to the poor blood supply within the tendon. Increasing age, inflammatory arthritis, diabetes and obesity have been found to be causes.
Symptoms
In many cases, adult flatfoot causes no pain or problems. In others, pain may be severe. Many people experience aching pain in the heel and arch and swelling along the inner side of the foot.
Diagnosis
The history and physical examination are probably the most important tools the physician uses to diagnose this problem. The wear pattern on your shoes can offer some helpful clues. Muscle testing helps identify any areas of weakness or muscle impairment. This should be done in both the weight bearing and nonweight bearing positions. A very effective test is the single heel raise. You will be asked to stand on one foot and rise up on your toes. You should be able to lift your heel off the ground easily while keeping the calcaneus (heel bone) in the middle with slight inversion (turned inward). X-rays are often used to study the position, shape, and alignment of the bones in the feet and ankles. Magnetic resonance (MR) imaging is the imaging modality of choice for evaluating the posterior tibial tendon and spring ligament complex.
Non surgical Treatment
Treating PTTD is almost always easier the earlier you catch it. So, the first step in treatment is to see your doctor as soon as you begin experiencing painful symptoms. However, once your condition has been diagnosed, your podiatrist will likely try to give the upset tendon a bit of a break so it?ll calm down and stop being so painful. This can often be accomplished by immobilizing the foot using tape and padding, braces, or casts, depending on what your podiatrist believes will work best for you, and depending on the severity of your condition. You may also be instructed to reduce inflammation by applying ice to the area (usually 40 minutes on and 20 minutes off, with a thin towel between you and the ice). Or, you might take anti-inflammatory medications like ibuprofen (steroidal anti-inflammatory meds are actually likely to make this problem worse, and are not usually recommended in treating PTTD), or use ultrasound therapy. Once the inflammation has gone down a bit, your podiatrist may recommend using orthotics (prescription shoe inserts) to support your damaged arch. Ankle braces can also be helpful. 
Surgical Treatment
In cases where cast immobilization, orthoses and shoe therapy have failed, surgery is the next alternative. The goal of surgery and non-surgical treatment is to eliminate pain, stop progression of the deformity and improve mobility of the patient. Opinions vary as to the best surgical treatment for adult acquired flatfoot. Procedures commonly used to correct the condition include tendon debridement, tendon transfers, osteotomies (cutting and repositioning of bone) and joint fusions. (See surgical correction of adult acquired flatfoot). Patients with adult acquired flatfoot are advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot - meaning you will be on crutches for two months. The bottom line is, Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.
All It Is Best To Understand About Heel Pain And Discomfort
Overview
Heel Pain is a very challenging problem as it can be local and/or referred. It has been more prevalent recently due to the hard grounds on which people have to run. Commonly people will present with heel pain, thrusting an x-ray at you, and being adamant that the problem is a heel spur. This is defined as a small bone that grows from the heel, directing forwards towards the toes. This may be as small as 1 mm to anything as large as 8 - 10 mm. Most of the time, this is an incidental finding, as there many heels that are pain free that have heel spurs evident on x-rays. The spur is thought to be a result of traction of the plantar fascia on the heel. In some cases, the spur may contribute to the symptoms, but is not the main cause. This should be explained very carefully to the patient, as the focus on the spur may limit the recovery, as the patient may believe that the only way to eliminate the pain is to remove the spur.
Causes
There are many reasons why people experience heel pain. Based on what we see in our office, heel pain affects, probably more than one in every four people. A lot of this is caused from conditions within the foot. These conditions could be related to hyper pronation, which is where you get a collapse of the foot or even a high arch of the foot called cavus foot. The underlying cause is something internal, within the bone structure. These problems are usually something you will have all your life. Hyper pronation is a hereditary issue where you can get an under development of a particular bone, usually in the ankle, and it causes a dislocation or a misalignment of the ankle on the heel. It throws off, not only the foot with the bones, joints and ligaments of the foot, but also the bones in the ankle. It affects the internal rotation of the knee, hip, back and causes issues within those areas as well. Hyper pronation is a pretty common, but very under diagnosed condition.
Symptoms
The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they?ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
Diagnosis
Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot. Surgery may be recommended in some cases.
Non Surgical Treatment
To properly treat heel pain, you must absorb shock, provide cushioning and elevate the heel to transfer pressure. This can be accomplished with a heel cup, visco heel cradle, or an orthotic designed with materials that will absorb shock and shear forces. When the condition is pronation related (usually plantar fasciitis), an orthotic with medial posting and good arch support will control the pronation and prevent the inflammation of the plantar fascia. Footwear selection is also an important criteria when treating heel pain. Shoes with a firm heel counter, good arch support, and appropriate heel height are the ideal choice. If the problem persists, consult your foot doctor.
Surgical Treatment
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.
Prevention
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.
Heel Pain is a very challenging problem as it can be local and/or referred. It has been more prevalent recently due to the hard grounds on which people have to run. Commonly people will present with heel pain, thrusting an x-ray at you, and being adamant that the problem is a heel spur. This is defined as a small bone that grows from the heel, directing forwards towards the toes. This may be as small as 1 mm to anything as large as 8 - 10 mm. Most of the time, this is an incidental finding, as there many heels that are pain free that have heel spurs evident on x-rays. The spur is thought to be a result of traction of the plantar fascia on the heel. In some cases, the spur may contribute to the symptoms, but is not the main cause. This should be explained very carefully to the patient, as the focus on the spur may limit the recovery, as the patient may believe that the only way to eliminate the pain is to remove the spur.
Causes
There are many reasons why people experience heel pain. Based on what we see in our office, heel pain affects, probably more than one in every four people. A lot of this is caused from conditions within the foot. These conditions could be related to hyper pronation, which is where you get a collapse of the foot or even a high arch of the foot called cavus foot. The underlying cause is something internal, within the bone structure. These problems are usually something you will have all your life. Hyper pronation is a hereditary issue where you can get an under development of a particular bone, usually in the ankle, and it causes a dislocation or a misalignment of the ankle on the heel. It throws off, not only the foot with the bones, joints and ligaments of the foot, but also the bones in the ankle. It affects the internal rotation of the knee, hip, back and causes issues within those areas as well. Hyper pronation is a pretty common, but very under diagnosed condition.
Symptoms
The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they?ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
Diagnosis
Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot. Surgery may be recommended in some cases.
Non Surgical Treatment
To properly treat heel pain, you must absorb shock, provide cushioning and elevate the heel to transfer pressure. This can be accomplished with a heel cup, visco heel cradle, or an orthotic designed with materials that will absorb shock and shear forces. When the condition is pronation related (usually plantar fasciitis), an orthotic with medial posting and good arch support will control the pronation and prevent the inflammation of the plantar fascia. Footwear selection is also an important criteria when treating heel pain. Shoes with a firm heel counter, good arch support, and appropriate heel height are the ideal choice. If the problem persists, consult your foot doctor.
Surgical Treatment
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.
Prevention
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.
The Primary Causes And Treatment Methods Of Achilles Tendinitis Aches
Overview
You can feel your Achilles tendon beneath the skin on the back of your ankle. It is a fibrous band of tissue that connects your calf muscles to your heel bone (calcaneus), which allows you to lift your heel off the ground. Most commonly an overuse injury, the term Achilles tendinitis commonly refers to, acute inflammation in the sheath surrounding your tendon, chronic damage to the tendon itself, called tendinosis, a combination of the two. Achilles tendinitis can range from mild inflammation to, in rare cases, a tendon rupture. One type of tendinitis, called insertional Achilles tendinitis, can affect the end of the tendon where it attaches to your heel bone. Achilles tendinitis also can be associated with other foot problems, such as painful flat feet.
Causes
Tendinitis typically develops after abrupt changes in activity or training level, use of poorly fit or worn footwear, or training on uneven or dense running surfaces. Overuse prior to sufficient training is generally the cause. This is due to forces 8-10 times the body weight acting on the tendon during physical activity. Achilles injuries range from inflammation to a breakdown in the tendon. Pain is generally felt low on the back of the heel due to the low vascularity and susceptibility for inflammation. Pain higher on the Achilles is generally more muscular pain and less tendonitis. If swollen spots or knots are found along the tendon, or if the tendon feels jagged, cease activity and seek professional medical care.
Symptoms
There are several types of Achilles tendinitis symptoms, but all of them are closely related. People who suffer from Achilles tendon pain typically have swelling in the Achilles tendon, and that pain can be chronic as the microscopic tears in the area become more prevalent over time. The most intense pain is typically located just a few centimeters above the area where the tendon meets the heel. This area is called the watershed zone, and the amount of blood moving through it is what gives it the highest potential for injury, especially for athletes. Most of the Achilles tendinitis symptoms in people with the condition will happen immediately after they have been inactive for a fairly significant amount of time. That means that the most pain will generally be felt after sitting or lying down for an extended period, or right after waking up in the morning and getting moving. If you aren?t positive that you are suffering specifically from Achilles tendinitis symptoms, consult a doctor to make sure.
Diagnosis
A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.
Nonsurgical Treatment
The aim, when treating Achilles tendinitis, is to relieve pain and reduce swelling. The kind of treatment used can vary, based on the severity of the condition and whether or not the patient is a professional athlete. After diagnosis, the doctor will decide which method of treatment is required for the patient to undergo, it is likely that they will suggest a combination. Stretching achilles tendon, a doctor might show the patient some stretching exercises that help the Achilles tendon heal, as well as preventing future injury. Methods used to treat Achilles tendinitis include, ice packs - applying these to the tendon, when in pain or after exercising, can alleviate the pain and inflammation. Resting, this gives the tissue time to heal. The type of rest needed depends on the severity of the symptoms. In mild cases of Achilles tendinitis, it may mean just reducing the intensity of a workout, in severe cases it might mean complete rest for days or weeks. Elevating the foot, swelling can be reduced if the foot is kept raised above the level of the heart. Exercise and stretching, a doctor might show the patient some stretching exercises that help the Achilles tendon heal, as well as preventing future injury. They may, instead, refer the patient to a physiotherapist or another specialist. The exercises learned will improve the flexibility of the area and likely increase calf strength. Pain relievers - non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen can reduce pain and swelling. If you suffer from asthma, kidney disease or liver disease do not take NSAIDs without first checking with your doctor. Steroid injections, these can reduce tendon swelling, but should be performed with caution, as this process has been associated with a greater risk of tendon rupture. A doctor would likely perform the injection while scanning the area with ultrasound to reduce this risk. Compression bandages and orthotic devices, such as ankle supports and shoe inserts can aid recovery as they take the stress off the Achilles tendon.
Surgical Treatment
Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from the transferred tendon.
Prevention
By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.
You can feel your Achilles tendon beneath the skin on the back of your ankle. It is a fibrous band of tissue that connects your calf muscles to your heel bone (calcaneus), which allows you to lift your heel off the ground. Most commonly an overuse injury, the term Achilles tendinitis commonly refers to, acute inflammation in the sheath surrounding your tendon, chronic damage to the tendon itself, called tendinosis, a combination of the two. Achilles tendinitis can range from mild inflammation to, in rare cases, a tendon rupture. One type of tendinitis, called insertional Achilles tendinitis, can affect the end of the tendon where it attaches to your heel bone. Achilles tendinitis also can be associated with other foot problems, such as painful flat feet.
Causes
Tendinitis typically develops after abrupt changes in activity or training level, use of poorly fit or worn footwear, or training on uneven or dense running surfaces. Overuse prior to sufficient training is generally the cause. This is due to forces 8-10 times the body weight acting on the tendon during physical activity. Achilles injuries range from inflammation to a breakdown in the tendon. Pain is generally felt low on the back of the heel due to the low vascularity and susceptibility for inflammation. Pain higher on the Achilles is generally more muscular pain and less tendonitis. If swollen spots or knots are found along the tendon, or if the tendon feels jagged, cease activity and seek professional medical care.
Symptoms
There are several types of Achilles tendinitis symptoms, but all of them are closely related. People who suffer from Achilles tendon pain typically have swelling in the Achilles tendon, and that pain can be chronic as the microscopic tears in the area become more prevalent over time. The most intense pain is typically located just a few centimeters above the area where the tendon meets the heel. This area is called the watershed zone, and the amount of blood moving through it is what gives it the highest potential for injury, especially for athletes. Most of the Achilles tendinitis symptoms in people with the condition will happen immediately after they have been inactive for a fairly significant amount of time. That means that the most pain will generally be felt after sitting or lying down for an extended period, or right after waking up in the morning and getting moving. If you aren?t positive that you are suffering specifically from Achilles tendinitis symptoms, consult a doctor to make sure.
Diagnosis
A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.
Nonsurgical Treatment
The aim, when treating Achilles tendinitis, is to relieve pain and reduce swelling. The kind of treatment used can vary, based on the severity of the condition and whether or not the patient is a professional athlete. After diagnosis, the doctor will decide which method of treatment is required for the patient to undergo, it is likely that they will suggest a combination. Stretching achilles tendon, a doctor might show the patient some stretching exercises that help the Achilles tendon heal, as well as preventing future injury. Methods used to treat Achilles tendinitis include, ice packs - applying these to the tendon, when in pain or after exercising, can alleviate the pain and inflammation. Resting, this gives the tissue time to heal. The type of rest needed depends on the severity of the symptoms. In mild cases of Achilles tendinitis, it may mean just reducing the intensity of a workout, in severe cases it might mean complete rest for days or weeks. Elevating the foot, swelling can be reduced if the foot is kept raised above the level of the heart. Exercise and stretching, a doctor might show the patient some stretching exercises that help the Achilles tendon heal, as well as preventing future injury. They may, instead, refer the patient to a physiotherapist or another specialist. The exercises learned will improve the flexibility of the area and likely increase calf strength. Pain relievers - non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen can reduce pain and swelling. If you suffer from asthma, kidney disease or liver disease do not take NSAIDs without first checking with your doctor. Steroid injections, these can reduce tendon swelling, but should be performed with caution, as this process has been associated with a greater risk of tendon rupture. A doctor would likely perform the injection while scanning the area with ultrasound to reduce this risk. Compression bandages and orthotic devices, such as ankle supports and shoe inserts can aid recovery as they take the stress off the Achilles tendon.
Surgical Treatment
Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from the transferred tendon.
Prevention
By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.
What Brings About Plantar Fasciitis And The Way To Cure It
Overview
Plantar fasciitis is an inflammation of the structures (of the plantar fascia) on the sole of the foot. The inflammation is caused by excess pressure on the structures on the sole of the foot. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. It tends to be most painful first thing in the morning, or when standing up after sitting for a while. The area becomes inflamed and swollen, and it is the increase in fluid to the area that accumulates when weight is taken off the area, that then causes the pain on standing. Plantar Fasciitis usually starts gradually with pain on standing after rest. Pain is usually located under the heel or to the inside of the heel. Pain is usually at its worst on standing first thing in the morning. The pain will begin to ease once you get moving. Pain in the early stages tends to occur after activity rather than during activity. As plantar fasciitis continues the pain can become more constant and can then start to affect the way you walk.
Causes
Training on improper, hard and/or irregular surfaces as well as excessive track work in spiked shoes, or steep hill running, can stress the plantar fascia past its limits of elasticity, leading to injury. Finally, failure in the early season to warm up gradually gives the athlete insufficient time for the structures of the foot to re-acclimate and return to a proper fitness level for intensive exercise. Such unprepared and repeated trauma causes microscopic tearing, which may only be detected once full-blown plantar fasciitis and accompanying pain and debilitation have resulted. If the level of damage to the plantar fascia is significant, an inflammatory reaction of the heel bone can produce spike-like projections of new bone, known as heel spurs. Indeed, plantar fasciitis has occasionally been refereed to as heel spur syndrome, though such spurs are not the cause of the initial pain but are instead a further symptom of the problem. While such spurs are sometimes painless, in other cases they cause pain or disability in the athlete, and surgical intervention to remove them may be required. A dull, intermittent pain in the heel is typical, sometimes progressing to a sharp, sustained discomfort. Commonly, pain is worse in the morning or after sitting, later decreasing as the patient begins walking, though standing or walking for long periods usually brings renewal of the pain.
Symptoms
When plantar fasciitis occurs, the pain is typically sharp and usually unilateral (70% of cases).Heel pain worsens by bearing weight on the heel after long periods of rest. Individuals with plantar fasciitis often report their symptoms are most intense during their first steps after getting out of bed or after prolonged periods of sitting. Improvement of symptoms is usually seen with continued walking. Numbness, tingling, swelling, or radiating pain are rare but reported symptoms. If the plantar fascia continues to be overused in the setting of plantar fasciitis, the plantar fascia can rupture. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot.
Diagnosis
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
In the early stages of plantar fasciitis resting the foot may ease the pain. Medication to reduce inflammation should help but should only be used short term. Strapping may temporarily reduce the pain. All of the above therapies are only temporary measures and the pain is likely to reoccur if the cause of the abnormal pressure which has triggered the plantar fasciitis has not been identified. In order to establish the cause of the plantar fasciitis a biomechanical assessment may be required.
Surgical Treatment
The most common surgical procedure for plantar fasciitis is plantar fascia release. It involves surgical removal of a part from the plantar fascia ligament which will relieve the inflammation and reduce the tension. Plantar fascia release is either an open surgery or endoscopic surgery (insertion of special surgical instruments through small incisions). While both methods are performed under local anesthesia the open procedure may take more time to recover. Other surgical procedures can be used as well but they are rarely an option. Complications of plantar fasciitis surgery are rare but they are not impossible. All types of plantar fasciitis surgery pose a risk of infection, nerve damage, and anesthesia related complications including systemic toxicity, and persistence or worsening of heel pain.
Stretching Exercises
Stretching exercises for the Achilles tendon and plantar fascia are recommend to relieve pain and aid in the healing process. Sometimes application of athletic tape is recommended. In moderate or severe cases of plantar fasciitis, your doctor may recommend you wearing a night splint, which will stretch the arch of your foot and calf while you sleep. This helps to lengthen the Achilles tendon and plantar fascia for symptom relief. Depending on the severity of your plantar fasciitis, your physician may prescribe a store-bought orthotic (arch support) or custom-fitted orthotic to help distribute your foot pressure more evenly.
What Is Heel Pain And The Right Way To Overcome It
Overview
Your plantar fascia ligament helps the bones of your foot absorb gait-related shock. It also holds your toes firmly on the ground as your body passes over your foot. Plantar fasciosis can manifest in people who possess either flat feet or feet with high arches, and it most commonly causes pain or discomfort at the point where your plantar fascia attaches to your calcaneus, or heel bone. Plantar fasciosis, sometimes known as calcaneal spur syndrome or calcaneal enthesopathy, can involve stretching, tearing, and degeneration of your plantar fascia at its attachment site. In some cases, heel pain at this attachment site may be caused by other health problems, including certain types of arthritis. Your physician may run several tests to help determine the true cause of your plantar fascia pain and the most effective treatment methods to resolve your complaint.
Causes
Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body's weight, and the foot flattens and this places a great deal of pressure and strain on the plantar fascia. There is very little elasticity to the plantar fascia, so as it stretches only slightly; it pulls on its attachment to the heel. If the foot is properly aligned this pull causes no problems. However, if the foot is "pronated" (the foot rolls outward at the ankle, causing a break down of the inner side of the shoe), the arch falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel. The same pathology occurs with "supination" (the rolling inward of the foot, causing a break down of the outer side of the shoe). Supinated feet are relatively in flexible; usually have a high arch, and a short or tight plantar fascia. Thus as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia hardly stretches at all, and pulls with great force on its attachment to the heel.
Symptoms
Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience ‘First step’ pain (stone bruise sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.
Diagnosis
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
Treatment of plantar fasciitis is sometimes a drawn out and frustrating process. A program of rehabilitation should be undertaken with the help of someone qualified and knowledgeable about the affliction. Typically, plantar fasciitis will require at least six weeks and up to six months of conservative care to be fully remedied. Should such efforts not provide relief to the athlete, more aggressive measures including surgery may be considered. The initial goals of physical therapy should be to increase the passive flexion of the foot and improve flexibility in the foot and ankle, eventually leading to a full return to normal function. Prolonged inactivity in vigorous sports is often the price to be paid for thorough recovery. Half measures can lead to a chronic condition, in some cases severely limiting athletic ability. As a large amount of time is spent in bed during sleeping hours, it is important to ensure that the sheets at the foot of the bed do not constrict the foot, leading to plantar flexion in which the foot is bent straight out with the toes pointing. This constricts and thereby shortens the gastroc complex, worsening the condition. A heating pad placed under the muscles of the calf for a few minutes prior to rising may help loosen tension, increase circulation in the lower leg and reduce pain. Also during sleep, a night splint may be used in order to hold the ankle joint in a neutral position. This will aid in the healing of the plantar fascia and ensure that the foot will not become flexed during the night.
Surgical Treatment
In unusual cases, surgical intervention is necessary for relief of pain. These should only be employed after non-surgical efforts have been used without relief. Generally, such surgical procedures may be completed on an outpatient basis in less than one hour, using local anesthesia or minimal sedation administrated by a trained anesthesiologist. In such cases, the surgeon may remove or release the injured and inflamed fascia, after a small incision is made in the heel. A surgical procedure may also be undertaken to remove bone spurs, sometimes as part of the same surgery addressing the damaged tissue. A cast may be used to immobilize the foot following surgery and crutches provided in order to allow greater mobility while keeping weight off the recovering foot during healing. After removal of the cast, several weeks of physical therapy can be used to speed recovery, reduce swelling and restore flexibility.
What Triggers Plantar Fasciitis To Flare Up
Overview
Plantar fasciitis is a common cause of heel pain in adults. The pain is usually caused by collagen degeneration (which is sometimes misnamed “chronic inflammation”) at the origin of the plantar fascia at the medial tubercle of the calcaneus. This degeneration is similar to the chronic necrosis of tendonosis, which features loss of collagen continuity, increases in ground substance (matrix of connective tissue) and vascularity, and the presence of fibro-blasts rather than the inflammatory cells usually seen with the acute inflammation of tendonitis. The cause of the degeneration is repetitive microtears of the plantar fascia that overcome the body's ability to repair itself.
Causes
There are several possible causes of plantar fasciitis, including wearing high heels, gaining weight, increased walking, standing, or stair-climbing. If you wear high-heeled shoes, including western-style boots, for long periods of time, the tough, tendonlike tissue of the bottom of your foot can become shorter. This layer of tissue is called fascia. Pain occurs when you stretch fascia that has shortened. This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning. If you gain weight, you might be more likely to have plantar fasciitis, especially if you walk a lot or stand in shoes with poor heel cushioning. Normally there is a pad of fatty tissue under your heel bone. Weight gain might break down this fat pad and cause heel pain. Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts. It can also occur with a change in exercise surface or terrain, or if your shoes are worn out and don't provide enough cushion for your heels. If the arches of your foot are abnormally high or low, you are more likely to develop plantar fasciitis than if your arches are normal.
Symptoms
The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it again after periods of rest. You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.
Diagnosis
To diagnose plantar fasciitis, your doctor will physically examine your foot by testing your reflexes, balance, coordination, muscle strength, and muscle tone. Your doctor may also advise a magnetic resonance imaging (MRI) or X-ray to rule out other others sources of your pain, such as a pinched nerve, stress fracture, or bone spur.
Non Surgical Treatment
No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better. Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces. To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). Do toe stretches camera.gif, calf stretches camera.gif and towel stretches camera.gif several times a day, especially when you first get up in the morning. (For towel stretches, you pull on both ends of a rolled towel that you place under the ball of your foot.) Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts. Use them in both shoes, even if only one foot hurts. If these treatments do not help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid) in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months. Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few weeks. But it may take time for the pain to go away completely. It may take a few months to a year. Stay with your treatment. If you don't, you may have constant pain when you stand or walk. The sooner you start treatment, the sooner your feet will stop hurting.
Surgical Treatment
If you consider surgery, your original diagnosis should be confirmed by the surgeon first. In addition, supporting diagnostic evidence (such as nerve-conduction studies) should be gathered to rule out nerve entrapment, particularly of the first branch of the lateral plantar nerve and the medial plantar nerve. Blood tests should consist of an erythrocyte sedimentation rate (ESR), rheumatoid factor, human leukocyte antigen B27 (HLA-B27), and uric acid. It’s important to understand that surgical treatment of bone spurs rarely improves plantar fasciitis pain. And surgery for plantar fasciitis can cause secondary complications-a troubling condition known as lateral column syndrome.
Prevention
Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.
