The Foot Clinic

Heel spur and calcaneal spurs

Heel Spur syndrome, the medical term for this condition is Calcaneal spur is quite common and a common cause of foot pain. Other definitions include Calcaneussporn and also Fascilitis plantaris (tendinitis in the foot sole). A heel spur can be very painful and occurs at the heel bone. It is shown on an X-Ray as a spinelike, fossilised extraction of the heel bone (calcalneus). Often these long heel spurs just a symptom, and not the actual cause of heel pain. Patients with splayed feet, fallen arches or even high arches are more prone to heel pain than other people. In Germany it is estimate some 4 million people suffer from heel spur syndrome every daily. Risk groups include the over fifties and athletes. Also young adolescents may suffer from heel pain, which is referred to as Severe's Disease and is often a side effect of growing pains.

What exactly causes a heel spur?

Previously it was thought that increased pressure on the inside of the heel bone leads to inflammation. Today we know that heel spur is a result of overloading or improper loading of the plantar fascia ligaments under the foot. This leads to microtrauma and therefore causes inflammation at the base of the tendon. The plantar fascia is a coarse and broad tissue, which starts from from the toes and runs under the arch of the foot to the heel bone and then tapers into a small attachment. The primary function of these tendons is supporting the longitudinal foot arch for stabilisation of the foot, especially in propulsive phase of walking gait. If tension is placed on the tendons over a longer period, chronic inflammatory develops and a deposition of calcium occurs where the tendon inserts into the calcaneus. This is an automatic repair action of the body, in order to reduce the excess tension on the ligament structures. This in turn leads to further irritation and inflammation, causing a stabbing pain with normal walking no longer possible. The emergence of a heel spur or Fersensporn can also be traced to the deformity of the foot arch (flat foot and over-pronation) which increases the strain on that tendon. Not the presence of a heel spur is causing the discomfort, but the inflamed tendons around the spur. Various factor play a role in the formation of heel spurs and plantar fasciitis, including overload and overuse because of sports and work activities. Being overweight or sudden weight gain will place pressure on the heels and plantar fascia. Pre-existing rheumatoid arthritis can contribute to spurs formation. A low arch, flat arch or over-pronating foot causes a problem too. (more...)

Plantar Fasciitis (heel pain) Causes and Treatment

Plantar Fasciitis is an inflammation of the connective tissue band that runs under the foot. This link connects the heel bone to the ball of the foot. The band helps stabilise the foot and helps the toes to bend. If this band is inflamed, it will cause pain and discomfort in the heel area.. Plantar Fasciitis is sometimes simply called heel pain or heel spur syndrome. The pain is at the bottom of the heel, especially in morning when getting up, taking your first steps out of bed. As the day progresses, the pain will lessen. At the end of the day there is sometimes a dull pain on the inside of the heel and with rest the pain will further decline. Plantar fasciitis is caused by activities that put extra stress on the feet including: physical exertion, especially in sports that require running and jumping such as: athletics, volleyball, tennis, football etc. A risk factor is something that increases your chance of getting a disease, condition, trauma or injury. The main risk factors for plantar fasciitis are: sudden changes in activity or physical forces endured by the feet, weight gain, pre-existing foot problems, including an abnormally tight Achilles tendon (heel cord), tight calf muscles, flat feet, overpronation, or very high arches, badly worn unsupportive footwear. If you are running again, the pain will gradually return. Also,redness and swelling in the heel may be present. Plantar Fasciitis pain is most common in men between 45 and 65 years, mostly because of work demanding long hours of standing. Plantar Fasciitis is a clear result of overuse of the foot. The connective tissue band may be corrupted in many ways. This common foot condition can be determined by physical examination. An X-ray of the foot may provide additional information. Sometimes a bone spur is visible, this is an extra bone growth of the heel bone. A bone spur may not be the cause of heel pain. Symptoms of plantar fasciitis may come on gradually or suddenly and include the following: burning pain on the sole of the foot, heel pain when taking the first steps in the morning, tenderness when touching the sole or heel, pain when standing on your tiptoes. The treatment of fasciitis is designed to reduce the pain. Therefore, the affected foot should be rested. Some stretching exercises for the heel may also help. You doctor or physiotherapist can provide more information about these exercises. In case of severe pain your foot specialist may prescribe painkillers or give an injection of steroids into the heel bone. It is advisable to use orthotic insoles. If the pain persists, surgery may help. In this case the band is loosened, reducing the strain on the connective tissue.

The following medications can relieve pain and inflammation: Ibuprofen (for example Motrin, Advil and Nurofen), Naproxen (Naprosyn), Acetaminophen (Tylenol) or just plain aspirin can help as well. Corticosteroid injections may be an option in some cases given by your GP. In certain cases, a new special type of sound wave called extracorporeal shock wave may be appropriate. To reduce the risk of getting plantar fasciitis we advice you to do the following: maintain an appropriate, healthy weight, wear well-fitted and supportive shoes during sports, walking, running and exercise. Do some simple stretching exercises for the Achilles tendons, plantar fascia and calves. Miminise walking and apply ice on the heel in the evenings. The low-cost prefabricated and customized foot orthotics had similar effectiveness in the treatment of plantar fasciitis after 10 weeks of use. The trial results were similar to other trials although those trials did not use orthoses made from EVA. Thus, EVA prefabricated orthotic shoe inserts may be the best choice for the treatment of plantar fasciitis without complication.

Exercises for Plantar Fasciitis Relief

Foot and heel pain are very common. About half of the population will suffer some type of foot pain at some time in their lives. The foot is a complex structure of twenty-six bones and many joints, layered with an intertwining web of more than over a hundred muscles, ligaments, and nerves. If one considers that with each step we take, a force of tow or three times our body weight is placed on the feet and during a typical day we take seven thousand steps, it comes as no surprise that at some time in our lives we will suffer from foot pain. The purpose of this website is to provide you with information in regards to the most common types of foot pain. And how it occurs and what you can be done to alleviate foot pain. Plantar Fasciitis is a common cause of pain at the bottom of the heel and usually defined by pain during the first steps of the morning. Pain also occurs at the start of activity and generally diminishes after a while. It seems to return after a long rest with restarting activity and weight-bearing. Plantar Fasciitis is considered a chronic injury rather than an acute injury. It is common in runners performing repetitive plantar flexion and dorsiflexion of the toes. It is also common with sudden weight gain. The plantar fascia provides support for the longitudinal arch of the foot. The plantar fascia is stretched and the arch flattens slightly to absorb the impact each time the heel impacts the ground. The fascia is not very flexible and such repetitive stretching from impact can result in micro-tearing in the fascia ligaments. Heel pain during the first steps of the morning is a classic sign of plantar fasciitis. This pain is the result of the foot resting in plantar flexion overnight. This allows the fascia to shorten. When the shortened fascia is stretched pain occurs. Aching heels are also common at the start of exercise and when resuming activity after rest.

Treatment of Plantar Fasciitis with exercises

Research has shown that certain exercises can assist greatly in the relief of Plantar Fasciitis. Below are the exercises prescribed most by podiatrists and physiotherapists. Please note that these exercises should create a pulling feeling and never should cause any pain. It is recommended to do these exercises first thing in the monring and again throughout the day for best results. If these exercises, combined with wearing orthotic insoles do not provide any relief from your heel problems, you should consult a podiatrist (foot specialist) or a chiropodist. (more...)

Ball of foot pain treatment and relief

Pain in the balls of the feet is what doctors refer to as Metatarsalgia. It is a general term used to denote a painful foot condition in the metatarsal region of the foot or the area under the foot, just before the toes, commonly referred to as the ball of the foot. Metatarsalgia is especially common in women wearing tight fashion shoes with medium to high heels. Metatarsalgia causes a burning sensation in the ball of the foot and it is often combined with excess callous forming under the foot. Sometimes a tingling sensation is felt between 3rd and 4th toe. This is a condition called Morton's Neuroma. Ball of Foot Pain occurs when the metatarsal bones collapse (the transverse arch) and the surrounding ligaments and tissue weakens. The forefoot structure collapses leading to excess pressure and friction under the ball of the foot. In some patients inflammation at the metatarsal heads is present. An estimated 70 percent of women who wear heels will suffer from Metatarsalgia, podiatrists tell us. With this common foot condition one or more of the metatarsal heads become painful and inflamed because of continuous excessive pressure over long periods of time. The patient will experience acute or chronic pain in the balls of the feet. Metatarsalgia is often caused by wearing thigh-fitting high-heeled fashion shoes. In addition to the heel height, especially shoe with a narrow toe box forces the forefoot into a minimal amount of space, squeezing the bones and ligaments. Plus, wearing heels means most of your bodyweight is concentrated in the forefoot area leading to excessive pressure in the ball-of-foot area. Pain present in the ball of the foot can have various other causes including poor circulation, (osteao-) arthritis, injury or trauma, pinched nerves or disease. Metatarso-phalangeal joint mis-alignment is a type of ball of foot pain caused by rheumatoid arthritis or osteoarthritis, and the result of this condition is commonly referred to as hammer toes. This may occur when fat tissue that normally cushions the joints during weight-bearing is pushed forward. The loss of cushioning may lead to nerve damage in the ball of the foot. Metatarso-phalangeal joint pain usually begins in the area of the big toe and often people suffering from this condition display an abnormal gait pattern. This condition can be very debilitating and very painful. Treatment for this type of joint misalignment includes foot orthotics designed to redistribute body weight away from the affected joint. Sometimes surgery is necessary when the use of orthotics has no or little effect.

Freiberg’s disease

Another common cause of ball of foot pain is a medical foot condition referred to asFreiberg’s Disease. It is actually necrosis or tissue death in some of the joints that make up the forefoot. Usually the second metatarsal head is affected by this disease. Freiberg’s Disease may be caused by injury to the bone in this area. Pain is often worsened when the patient puts their weight on the area, for example when wearing certain types of footwear, like high heels. The joints in the ball of the foot often become very stiff and swollen. Treatment for this type of ball of foot pain consists of cortisone-steroid injections and the use of a cast or splint. Your foot specialist or GP probably recommends to wear only shoes with low heels in combination with orthotic insoles to shift the weight and pressure away from the toe joint. Orthotic treatment can be very successful for Metatarsalgia, as well as Morton's Neuroma. In some cases the podiatrist will place a metatarsal raise on top of the orthotic device to lift the forefoot bone structure up even further, thus releasing any pressure on these foot bones.

Different types of Foot pain and heel pain

There are many different types of foot complaints. This article briefly explains the most common foot conditions such as Arthritis of the foot, heel pain and flat feet. Arthritis in the feet is a painful, but rather common condition that affects mostly elderly patients and sometimes younger people as well. It is important to understand that there are different types of arthritis. Namely Osteo-arthritis and Rheumatoid arthritis. Osteoarthritis is present because of natural wear and tear of the joints with ageing in particular to the soft cartilage in our joints, acting as a shock absorbing mechanism. On the other hand Rheumatoid arthritis is mostly due to genetic factors or because it has been initiated by other problems in the body. The foot and ankle has many joints so it comes as no surprise that the lower limb and knees are very susceptible to the development of arthritis. Osteo-arthritis if the foot develops with age and is characterised by joint stiffness, as well as pain and swelling in the affected areas. As the cartilage degenerates our natural lubrication disappears and the bones now rub together leading to pain and inflammation. People with flat feet or high arches have a far greater chance of developing oste-oarthritis. The same applies to people have suffered some trauma or injury to the foot or ankle. Fractures or sprains will also contribute to the degeneration of the soft cartilage of the foot joints. Drugs including pain relief and anti-inflammatory medications may be useful. For example, paracetamol contains pain relieving and anti-inflammatory benefits. Orthotic shoe insoles may provide a reduction of pressure and pain during walking.

Heel Pain (Plantar Fasciitis)

This pain is basically any type of discomfort or pain in the heel region of the foot. This can be under the heel or at the back of the heel. Symptoms can range from very sharp, acute pain to a dull ache (like a stone bruise). Some people experience Plantar Fasciitis on and off, others have it have it permanently for many months or even years! There are many possible causes for heel pain. Generally pain in the heels may stem from simply being on your feet all day, especially in shoes that don't provide any good support or ankle stability. The most common cause of heel spurs, however is a condition referred to as plantar fasciitis. This condition occurs when the plantar fascia under the arch of the foot becomes inflamed and irritated. This usually happens from the fascia being overstretched as a result of incorrect foot mechanics. This ligament inserts into the heel bone and can becomes strained from continuous stretching. Foot abnormalities such as fallen arches and flat feet make this problem even worse. If you are experiencing heel pain following a long day on your feet, it is recommended to take a look at your footwear. If your doctor or foot specialist has diagnosed you with plantar fasciitis they will recommend ice treatments, heat packs, anti-inflammatory drugs they will also probably suggest the use of orthotics, designed to reduce the pressure on the heel and the tension on the plantar fascia. (more...)