Ankle & Foot

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HEEL PAIN

Heel pain is an extremely common complaint, and there are several common causes. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause.

 

Common Causes:

  • Plantar Fasciitis- Plantar fasciitis is the most common condition that causes heel pain. Plantar fasciitis is due to irritation and inflammation of the tight tissue that forms the arch of the foot. The most common symptom is pain under the heel after a period of rest, i.e. severe pain and inability to walk in the morning after getting up from sleep. The same might happen after sitting for a long time and then trying to walk. Interestingly the pain gets better after a few steps though it may not go away completely. Again, the pain may get worse with prolonged walking and standing. X-ray may show a bony spur which may develop in long-standing cases of heel pain due to plantar fasciitis, but it may not cause the symptoms.
  • Posterior Heel Pain – Posterior heel pain causes symptoms behind the foot, rather than underneath. Posterior heel pain causes include Achilles tendonitis and retrocalcaneal bursitis. These patients may also develop bony growth behind the heel bone and when they are large may lead to rupture of Achilles tendon. Patients may have difficulty to walk comfortably on the affected side and pain that occurs at night or while resting.

 

Treatment Options:

It is important to rule out other causes of heel pain. Treatment of heel pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms.

Some common treatments for heel pain are listed here. Not all of these treatments are appropriate for every condition, but they may be helpful in your situation.

  • Rest – Avoiding the precipitating activity; for example, take a few days off jogging or prolonged standing/walking. Rest can reduce the severity of pain and will allow the inflammation to begin to cool down.
  • Apply Ice Packs – Icing will help to diminish some of the symptoms and control the heel pain. The icing is especially helpful after an acute exacerbation of symptoms.
  • Exercises and Stretches – Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises performed in the morning and evening, often help patients feel better quickly.
  • Anti-Inflammatory Medications – Anti-inflammatory medications help to both control heel pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available.
  • Shoe Inserts – Shoe inserts are often the key to successful treatment of heel pain. The shoe inserts often permit patients to continue their routine activities without heel pain.
  • Injection therapy – In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
  • Removable walking cast – A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
  • Night splint – Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.

If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered.

 

Healthy Joint Club says:

Not being able to take the first step out of bed in the morning can be frightening. Moreover severe pain from the heel may force you to restrict several daytime activities. But please do not get disheartened. Except for a handful of cases and some uncommon conditions of heel pain, most cases improve with treatment and time. Even though the time taken for the recovery may vary from person to person there is a natural tendency for these conditions to get better spontaneously.

Flat Foot

Flat feet (pes planus or fallen arches) occurs when the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground. Heel tilts away from the midline of the body more than usual. In some individuals (an estimated 20–30% of the general population) the arch simply never develops in one foot (unilaterally) or both feet (bilaterally).

 

Causes:

Flat feet are a common condition. In infants and toddlers, the arch is not developed and flat feet are normal. The arch develops in childhood. By adulthood, most people have developed normal arches.

 

When flat feet persist, most are considered variations of normal. Most feet are flexible and an arch appears when the person stands on his or her toes. Stiff, inflexible, or painful flat feet may be associated with other conditions and require attention. Painful flat feet in children may be caused by a condition called a tarsal coalition. In tarsal coalition, two or more of the bones in the foot fuse together. This limits motion and often leads to a flat foot.

 

Most flat feet do not cause pain or other problems. Flat feet may be associated with pronation, in which the ankle bones lean inward toward the center line. When the shoes of children who pronate are placed side by side, they will lean toward each other (after they have been worn long enough for the foot position to remodel their sole). Foot pain, ankle pain, or lower leg pain (especially in children) may be a result of flat feet and should be evaluated. Adults can develop a flat foot when they are 60 – 70 years old. This type of flat foot is usually on one side.

 

Diagnosis:

An examination of the foot is enough for the health care provider to diagnose flat foot. However, the cause must be determined. If an arch develops when the patient stands on his or her toes, the flat foot is called flexible and no treatment or further work-up is necessary.

 

If there is pain associated with the foot or if the arch does not develop with toe-standing, x-rays are necessary. If a tarsal coalition is suspected, a CT scan is often ordered. If a posterior tibial tendon injury is suspected, your healthcare provider may recommend an MRI.

 

Treatment Options:

Flexible flat feet that are painless do not require treatment. If you have pain due to flexible flat feet, an orthotic (arch-supporting insert in the shoe) can bring relief. With the increased interest in running, many shoe stores carry shoes for normal feet and pronated feet. The shoes designed for pronated feet make long distance running easier and less tiring because they correct for the abnormality.

 

Rigid or painful flat feet require evaluation by a health care provider. The treatment depends on the cause of the flat feet. For tarsal coalition, treatment starts with rest and possibly a cast. If this fails to improve the pain, surgery may be necessary.

 

For problems with the posterior tibial tendon, treatment may start with rest, anti-inflammatory medications, and shoe inserts or ankle braces. In more advanced cases, surgery may be needed to clean or repair the tendon or fuse some of the joints of the foot into a corrected position. Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.

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