What Are The Indications Of Inferior Calcaneal Spur

Heel Spur


Overview


A heel spur is a pointed bony outgrowth of the bone of the heel (the calcaneus bone). Heel spurs under the sole of the foot (plantar area) are associated with plantar fasciitis. Heel spurs and plantar fasciitis can occur alone or be related to underlying diseases. Heel spurs and plantar fasciitis are treated by measures that decrease the associated inflammation and avoid reinjury.


Causes


One of the most common causes for the development of heel spurs is the wearing of shoes that are too tight. That?s why more women suffer from heel spurs more than men. Athletes who tend to stress their feet a lot, people are overweight who have more pressure on their lower extremities and the elderly also tend to suffer more from heel spurs.


Heel Spur


Symptoms


With heel spurs, people often talk about a dull ache which is felt most of the time with episodes of a sharp pain in the center of the heel or on the inside margin of the heel. Often the pain is worse on first rising in the morning and after rest and is aggravated by prolonged weight bearing and thin-soled shoes.


Diagnosis


Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts. X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This 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 may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.


Non Surgical Treatment


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


Surgical Treatment


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


You can help prevent heel spur symptoms from returning by wearing the proper shoes. Customized orthotics and insoles can help relieve pressure. It is important to perform your exercises to help keep your foot stretched and relaxed.

Preventing Inferior Calcaneal Spur

Posterior Calcaneal Spur


Overview


Approximately 10 per cent of the population may have heel spurs without any heel pain. Whilst recent research has raised the question of whether or not heel spurs are the result of the body trying to increase its base of support, heel spurs are still considered to be the result from strain on the muscles of the foot (in particular the plantar fascia). This may result from a biomechanical imbalance, such as over pronation.


Causes


Heel spurs are bony outgrowths positioned where the plantar fascia tissue attaches to the heel bone (the calcaneus). Heel spurs seldom cause pain. It is the inflamed tissue surrounding the spur that causes the pain. The Latin meaning of Plantar Fasciitis is, ?Inflammation of Plantar Fascia.? The plantar fascia is a long, thick and very tough band of tissue beneath your foot that provides arch support. It also connects your toes to your heel bone. Each time you take a step, the arch slightly flattens to absorb impact. This band of tissue is normally quite strong and flexible but unfortunately, circumstances such as undue stress, being overweight, getting older or having irregularities in your foot dynamics can lead to unnatural stretching and micro-tearing of the plantar fascia. This causes pain and swelling at the location where the plantar fascia attaches to the heel bone. As the fascia continually pulls at the heel bone, the constant irritation eventually creates a bony growth on the heel. This is called a heel spur.


Calcaneal Spur


Symptoms


You'll typically first notice early heel spur pain under your heel in the morning or after resting. Your heel pain will be worse with the first steps and improves with activity as it warms up. When you palpate the tender area you may feel a tender bony lump. As your plantar fasciitis deteriorates and your heel spur grows, the pain will be present more often.


Diagnosis


The proper diagnosis of a heel spur often requires an X-ray. To make this process as convenient for his patients as possible, most clinics have an on-site digital X-ray and diagnostic ultrasound machines. This can make it unnecessary for patients to visit diagnostic imaging centers, allowing patients to receive more expedient treatment.


Non Surgical Treatment


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 orthotic with rearfoot 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 orthotic. 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.


Surgical Treatment


Surgery is used a very small percentage of the time. It is usually considered after trying non-surgical treatments for at least a year. Plantar fascia release surgery is use to relax the plantar fascia. This surgery is commonly paired with tarsal tunnel release surgery. Surgery is successful for the majority of people.

Bursitis In The Foot

Overview


Infracalcaneal bursitis can significantly affect your quality of life and your ability to perform your activities of daily living, due to pain and impaired gait. Inflammation of the bursal sac under your heel bone occurs because the bursa is abnormally stressed or strained in some way or bears excessive pressure for prolonged periods. Constant pressure and friction from footwear is a common cause of this health problem, and any treatment plan addressing infracalcaneal bursitis should include recommendations for footwear to avoid or use. Infracalcaneal bursitis may be diagnosed in several ways, including palpation, or light pressure applied to your affected area. If your heel pain has existed for an extended period, X-ray imaging studies may reveal localized calcification in your infracalcaneal bursa, though this is not always the case. MRI images are sometimes used as a diagnostic tool for this health problem, though MRI studies are considered unnecessary for diagnosis in many cases.


Causes


There are several factors which can lead to a person developing retrocalcaneal bursitis. In athletes, especially runners, overtraining, sudden excessive increase in running mileage may lead to retrocalcaneal bursitis. Tight or ill-fitting shoes can be another causative factor as they can produce excessive pressure at the back of the heel due to restrictive heel counter. A person with an excessively prominent posterosuperior aspect of the heel bone (Haglund deformity) may also have a higher predisposition to retrocalcaneal bursitis. In such individuals, pain would be reproduced when the ankle goes into dorsiflexion.


Symptoms


In retrocalcaneal bursitis, pain at the back of the heel is the main complaint from patients. Pain may worsen when tip-toeing, running uphill, jumping or hopping. Often, those who are accustomed to wearing high-heeled shoes on a long-term basis may also complain of pain at the back of the heel when switching to flat shoes. This is because when in high-heeled shoes, the calf muscle and the Achilles tendon are in a shortened position. Switching to flat shoes would cause an increased stretch to the calf muscle and Achilles tendon, irritating the Achilles tendon and the retrocalcaneal bursa. Other symptoms may include redness and swelling at the back of the heel.


Diagnosis


Careful examination by your physician or physiotherapist can determine if the inflammation is from the Achilles tendon or from the retrocalcaneal bursa. Tenderness due to insertional Achilles tendinitis is normally located slightly more distal where the tendon inserts into the back of the heel, whereas tenderness caused by the retrocalcaneal bursa is normally palpable at the sides of the distal Achilles tendon. Diagnosis can be confirmed with an ultrasound investigation, MRI or CT scan.


Non Surgical Treatment


There are a variety of treatments for bursitis of the heel. Bursitis on the bottom of your heel (which is called infracalcaneal bursitis) is common in heels with thinning fat pads. Gel heel cushions or custom made orthotics (that have a horse-shoe cut and extra foam in the heel) can be lifesavers in reducing the pain. For bursitis of the posterior heel (retrocalcaneal bursitis), try to avoid going barefoot and to reduce the stress on the Achilles tendon by not over flexing your heel, the tighter your Achilles becomes, the more you compress the bursa sacs of the posterior heel. Heel lifts can help this, or wearing shoes with elevated heels (note that this method is not sanctioning high heels, as high heels can provide little comfort or support and usually are tight in the areas where your bursitis is most inflamed). Products such as AirHeel made by Aircast can help massage the bottom and back of the heel, helping to decrease pain.


Surgical Treatment


Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.


Prevention


It isn't always possible to avoid the sudden blow, bump, or fall that may produce bursitis. But you can protect your body with measures similar to those that protect you from other kinds of overuse injuries, such as tendinitis. Keep yourself in good shape. Strengthening and flexibility exercises tone muscles that support joints and help increase joint mobility. Don?t push yourself too hard (or too long). If you?re engaged in physical labor, pace yourself and take frequent breaks. If you?re beginning a new exercise program or a new sport, work up gradually to higher levels of fitness. And anytime you?re in pain, stop. Work on technique. Make sure your technique is correct if you play tennis, golf, or any sport that may strain your shoulder. Watch out for ?elbow-itis.? If you habitually lean on your elbow at your work desk, this may be a sign that your chair is uncomfortable or the wrong height. Try to arrange your work space so that you don?t have to lean on your elbow to read, write, or view your computer screen. Take knee precautions. If you have a task that calls for lots of kneeling (for example, refinishing or waxing a floor), cushion your knees, change position frequently, and take breaks. Wear the right shoes. High-heeled or ill-fitting shoes cause bunions, and tight shoes can also cause bursitis in the heel. Problems in the feet can also affect the hips. In particular, the tendons and bursae in the hips can be put under excessive strain by worn-down heels. Buy shoes that fit and keep them in good repair. Never wear a shoe that?s too short or narrow. Women should save their high heels for special occasions only. Avoid staying in only one position for too long. Get up and walk around for a while or change positions frequently.

Hammer Toe Pain Treatments

HammertoeOverview


hammertoes deformities can be painful and unsightly. These toe deformities can be the result of a muscle/tendon imbalance or often the end stage result Hammer toe of some systemic disease such as diabetes or arthritis, especially Rheumatoid arthritis. Hammertoe deformities are progressive and can be prevented.


Causes


Hammertoes are usually structural in nature. Many times this is the foot structure you were born with and other factors have now made it so that symptoms appear. The muscles in your foot may become unbalanced over time, allowing for a deformity of the small bones in each toe. With longstanding deformity the toe may become rigid. Sometimes one toe is longer than another and this causes a buckling of the digit. A hammertoe may also be caused by other foot deformities such as a bunion. Trauma or other surgery of your foot may predispose you to having the condition if your foot structure is altered.


Hammer ToeSymptoms


A soft corn, or heloma molle, may exist in the web space between toes. This is more commonly caused by an exostosis, which is basically an extra growth of bone possibly due to your foot structure. As this outgrowth of excessive bone rubs against other toes, there is friction between the toes and a corn forms for your protection.


Diagnosis


The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.


Non Surgical Treatment


Hammertoes that are not painful (asymptomatic) and still flexible may not require treatment. In mild cases, open-toed, low-heeled, or wider shoes and foam or moleskin pads can provide symptomatic relief by reducing pressure. Taping (strapping) the affected toe can help to reduce deformity and pain. Physical therapy to instruct patients in exercises that passively stretch tight structures and strengthen weak foot intrinsic muscles is also helpful with mild cases. Periodic trimming (debridement) of corns (clavi, helomata) by a podiatrist can provide temporary relief. Corticosteroid injections are often very effective in reducing pain.


Surgical Treatment


Until recently, wires were used for surgical correction. In this technique, one or more wires are inserted into the bone through both the affected joint and a normally healthy toe joint, and the end of the toe. These wires stay in place for four to six weeks, protruding from the end of the toes. Due to the protruding wire, simple things such working, driving, bathing and even sleeping are difficult while these wires are in place. During this recovery period, patients often experience discomfort during sleep and are subject possible infection.


HammertoePrevention


Hammertoe can usually be prevented by wearing shoes that fit properly and give the toes plenty of room. Don?t wear shoes with pointed or narrow toes. Don?t wear shoes that are too tight or short. Don?t wear high-heeled shoes, which can force the toes forward. Choose shoes with wide or boxy toes. Choose shoes that are a half-inch longer than your longest toe. If shoes hurt, don?t wear them.

Overpronation Of The Feet Ache

Overview


The anatomy of a normal foot allows for both to occur at the same time. Approximately 30% of the population have a normal foot. The remainder of people either overpronate (95% of abnormal feet) or oversupinate (5% of abnormal feet). The important thing to know is that all feet pronate and supinate, but abnormal feet do one of these things too much or at the wrong time. When the foot overpronates or oversupinates, several foot ailments can develop.Overpronation


Causes


Unless there is a severe, acute injury, overpronation develops as a gradual biomechanical distortion. Several factors contribute to developing overpronation, including tibialis posterior weakness, ligament weakness, excess weight, pes planus (flat foot), genu valgum (knock knees), subtalar eversion, or other biomechanical distortions in the foot or ankle. Tibialis posterior weakness is one of the primary factors leading to overpronation. Pronation primarily is controlled by the architecture of the foot and eccentric activation of the tibialis posterior. If the tibialis posterior is weak, the muscle cannot adequately slow the natural pronation cycle.


Symptoms


Symptoms can manifest in many different ways. The associated conditions depend on the individual lifestyle of each patient. Here is a list of some of the conditions associated with over Pronation. Hallux Abducto Valgus (bunions). Hallux Rigidus (stiff 1st toe). Arch Pain. Heel Pain (plantar Facsitus). Metatarsalgia (ball of the foot pain). Ankle Sprains. Shin Splints. Achilles Tendonitis. Osteochondrosis. Knee Pain. Corns & Calluses. Flat Feet. Hammer Toes.


Diagnosis


When sitting, an over-pronating foot appears quite normal, i.e. showing a normal arch with room under the underside of the foot. The moment you get up and put weight on your feet the situation changes: the arches lower and the ankle slightly turns inwards. When you walk or run more weight is placed on the feet compared to standing and over-pronation will become more evident. When walking barefoot on tiles or timber floors over-pronation is more visible, compared to walking on carpet or grass.Over Pronation


Non Surgical Treatment


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 rearfoot 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.


Surgical Treatment


Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.


An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.
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Rivka Stage

Author:Rivka Stage
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