What Exactly Leads To Plantar Fasciitis

Plantar Fasciitis

Overview

The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to insert into the deep, short transverse ligaments of the metatarsal heads, dividing into 5 digital bands at the metatarsophalangeal joints and continuing forward to form the fibrous flexor sheathes on the plantar aspect of the toes. Small plantar nerves are invested in and around the plantar fascia, acting to register and mediate pain.




Causes

Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel bone. You are more likely to injure your plantar fascia in certain situations. For example, if you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when you are not used to it. (Plantar fasciitis may be confused with 'Policeman's heel', but they are different. Policeman's heel is plantar calcaneal bursitis - inflammation of the sack of fluid (bursa) under the heel bone. This is not as common as plantar fasciitis.) Also, people with a sedentary lifestyle are more prone to plantar fasciitis. If you have recently started exercising on a different surface, for example, running on the road instead of a track. If you have been wearing shoes with poor cushioning or poor arch support. If you are overweight this will put extra strain on your heel. If there is overuse or sudden stretching of your sole. For example, athletes who increase running intensity or distance; poor technique starting 'off the blocks', etc. If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Often there is no apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth or 'spur' coming from the heel bone (calcaneum). Many people have a bony spur of the heel bone but not everyone with this gets plantar fasciitis.




Symptoms

Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain will often subside as you begin to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more long-lasting form of heel pain will cause you to shorten your stride while running or walking. You also may shift your weight toward the front of the foot, away from the heel.




Diagnosis

After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.




Non Surgical Treatment

You may experience concern in reading about treatment options for this condition that involve taking medications, having injections or undergoing surgery. While these remedies may be necessary in some cases, there are natural, non-invasive, affordable methods for treating and healing Plantar Fasciitis. A simple, three-step approach may be all you need to experience immediate or rapid symptom relief. Step 1) Give Your Feet A Rest. When a ligament is stressed and inflamed, it is absolutely essential to take pressure off it and let it rest. Adjust your daily habits to spend some time each day off your feet. Step 2) Ice Brings Cooling Relief. Apply an ice bag or cold pack to your heel for twenty minutes, twice a day. This will numb soreness and help control inflammation. Step 3) Gain Support From Orthotics. Orthotics are devices designed to modify body motions or lessen pressure on areas of the body. In the case of foot orthotics, these products may include splints, wraps and shoe inserts.

Plantar Fascitis




Surgical Treatment

Most practitioners agree that treatment for plantar fasciitis is a slow process. Most cases resolve within a year. If these more conservative measures don't provide relief after this time, your doctor may suggest other treatment. In such cases, or if your heel pain is truly debilitating and interfering with normal activity, your doctor may discuss surgical options with you. The most common surgery for plantar fasciitis is called a plantar fascia release and involves releasing a portion of the plantar fascia from the heel bone. A plantar fascia release can be performed through a regular incision or as endoscopic surgery, where a tiny incision allows a miniature scope to be inserted and surgery to be performed. About one in 20 patients with plantar fasciitis will need surgery. As with any surgery, there is still some chance that you will continue to have pain afterwards.




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.

What Can Cause Plantar Fasciitis To Surface

Heel Pain

Overview

Plantar fasciitis causes pain in the bottom of the heel. The plantar fascia is a thin ligament that connects your heel to the front of your foot. It supports the arch in your foot and is important in helping you walk. Plantar fasciitis is one of the most common orthopedic complaints. Your plantar fascia ligaments experience a lot of wear and tear in your daily life. Normally, these ligaments act as shock absorbers, supporting the arch of the foot. Too much pressure on your feet can damage or tear the ligaments. The plantar fascia becomes inflamed, and the inflammation causes heel pain and stiffness.




Causes

Inappropriate footwear is the No. 1 cause of plantar fasciosis. Footwear that possesses toe spring and a tapered toe box holds your big toe in an adducted and extended position. In this position, your abductor hallucis muscle-the muscle responsible for moving your big toe away from your foot’s midline-pulls on a foot structure called the flexor retinaculum and may restrict blood flow through your posterior tibial artery, the vessel that carries blood to the bottom of your foot. Tissues in the sole of your feet begin to degenerate as blood supply to this area is decreased. Other recognized causes of or contributors to this health problem include the following, calf muscle shortening, plantar fascia contracture, Obesity, rheumatoid arthritis, reactive arthritis, Psoriatic arthritis, Corticosteroid injections.




Symptoms

Among the symptoms for Plantar Fasciitis is pain usually felt on the underside of the heel, often most intense with the first steps after getting out of bed in the morning. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Plantar Fasciitis also called “policeman’s heel” is presented by a sharp stabbing pain at the bottom or front of the heel bone. In most cases, heel pain is more severe following periods of inactivity when getting up and then subsides, turning into a dull ache.




Diagnosis

Plantar fasciitis is usually diagnosed by a health care provider after consideration of a person’s presenting history, risk factors, and clinical examination. Tenderness to palpation along the inner aspect of the heel bone on the sole of the foot may be elicited during the physical examination. The foot may have limited dorsiflexion due to tightness of the calf muscles or the Achilles tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis. However, in certain cases a physician may decide imaging studies (such as X-rays, diagnostic ultrasound or MRI) are warranted to rule out other serious causes of foot pain. Bilateral heel pain or heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Lateral view x-rays of the ankle are the recommended first-line imaging modality to assess for other causes of heel pain such as stress fractures or bone spur development. Plantar fascia aponeurosis thickening at the heel greater than 5 millimeters as demonstrated by ultrasound is consistent with a diagnosis of plantar fasciitis. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.




Non Surgical Treatment

The good news is that plantar fasciitis is reversible and very successfully treated. About 90 percent of people with plantar fasciitis improve significantly within two months of initial treatment. If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). Cortisone injections have been shown to have short-term benefits but they actually retard your progress in the medium to long-term, which usually means that you will suffer recurrent bouts for longer. Due to poor foot biomechanics being the primary cause of your plantar fasciitis it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development of a heel spur. Your physiotherapist is an expert in foot assessment and its dynamic biomechanical correction. They may recommend that you seek the advice of a podiatrist, who is an expert in the prescription on passive foot devices such as orthotics.

Feet Pain




Surgical Treatment

Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The most common complications of release surgery include incomplete relief of pain and nerve damage.




Stretching Exercises

You may begin exercising the muscles of your foot right away by gently stretching them as follows. Prone hip extension, Lie on your stomach with your legs straight out behind you. Tighten up your buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10. Towel stretch, Sit on a hard surface with one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds then relax. Repeat 3 times. When the towel stretch becomes too easy, you may begin doing the standing calf stretch. Standing calf stretch, Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day. Sitting plantar fascia stretch, Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat 3 times. When you can stand comfortably on your injured foot, you can begin standing to stretch the bottom of your foot using the plantar fascia stretch. Achilles stretch, Stand with the ball of one foot on a stair. Reach for the bottom step with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. After you have stretched the bottom muscles of your foot, you can begin strengthening the top muscles of your foot. Frozen can roll, Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This exercise is particularly helpful if done first thing in the morning. Towel pickup, With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel. Balance and reach exercises, Stand upright next to a chair. This will provide you with balance if needed. Stand on the foot farthest from the chair. Try to raise the arch of your foot while keeping your toes on the floor. Keep your foot in this position and reach forward in front of you with your hand farthest away from the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets. Stand in the same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 10. Heel raise, Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10. Side-lying leg lift, Lying on your side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.

What Is Heel Discomfort

Heel Pain

Overview

Plantar fasciitis is that pain in the bottom of your foot usually in the heel. That pain hurts especially with the first few steps in the morning as you get out of bed. This strange name comes from: "Plantar" means something that belongs to the foot, "fascia" means a band or ligament or a connective tissue, and "itis" means inflammation. You can see in the picture the plantar fascia band as it runs along the foot. This band connects your heel bone to the toes.




Causes

Plantar fasciitis can develop when your feet roll in too far as you take each step. This rolling in, known as over-pronation, can happen for many reasons. It can be due to excessive weight gain, pregnancy, quickly increasing physical activity, tight calf muscles, poor biomechanics or merely wearing unsupportive, flat footwear. When your feet over-pronate, your arches can collapse, putting strain on the tissues in the bottom of your foot.




Symptoms

Plantar fasciitis and heel spur pain usually begins in the bottom of the heel, and frequently radiates into the arch. At times, however, the pain may be felt only in the arch. The pain is most intense when first standing, after any period of rest. Most people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain usually becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated due to the swollen plantar fascia, this pain may radiate into the ankle. In the early stages of Plantar Fasciitis and Heel Spurs, the pain will usually subside quickly with getting off of the foot and resting. As the disease progresses, it may take longer periods of time for the pain to subside.




Diagnosis

A physical exam performed in the office along with the diagnostic studies as an x-ray. An MRI may also be required to rule out a stress fracture, or a tear of the plantar fascia. These are conditions that do not normally respond to common plantar fasciitis treatment.




Non Surgical Treatment

Treatment for plantar fasciitis should begin with rest, icing, and over the counter medications. As mentioned above, an orthotic is a device that can be slipped into any pair of shoes and can often relieve pain and help to reverse the damage and occurrence of plantar fasciitis. They do this by adding support to the heel and helping to distribute weight during movement. In addition to orthotics, many people consider night splints for treating this condition. These devices are worn during the night while you sleep, helping to keep the plantar fascia stretched to promote healing. Physical therapy has also become a common option. With this conservative treatment alternative, a physical therapist designs a set of exercises that are intended to address your specific needs in order to promote healing.

Heel Pain




Surgical Treatment

The most dramatic therapy, used only in cases where pain is very severe, is surgery. The plantar fascia can be partially detached from the heel bone, but the arch of the foot is weakened and full function may be lost. Another surgery involves lengthening the calf muscle, a process called gastrocnemius recession. If you ignore the condition, you can develop chronic heel pain. This can change the way you walk and cause injury to your legs, knees, hips and back. Steroid injections and some other treatments can weaken the plantar fascia ligament and cause potential rupture of the ligament. Surgery carries the risks of bleeding, infection, and reactions to anesthesia. Plantar fascia detachment can also cause changes in your foot and nerve damage. Gastrocnemius resection can also cause nerve damage.




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 Causes Heel Discomfort To Surface

Heel Pain

Overview

Plantar Fasciitis is a painful foot condition that affects the Plantar Fascia tendon that runs along the bottom of the foot (as seen in the picture). This tendon runs along the arches of the foot. Sometimes this tendon can become sore from normal use or strenuous activity, but this is not to be confused with the pain associated with Plantar Fasciitis. Small tears in the plantar fascia tendon can cause foot discomfort and pain, if left untreated, can become unbearable (seen in picture below). These tears are made worse by over-use, strenuous activity, weight gain, improper foot wear and a variety of other factors. Although there is no one absolute cause for the condition, it remains clear that this condition, while painful, can be corrected with products such as footwear, night splints, insoles and a variety of other plantar fasaciitis products.




Causes

Plantar fasciitis can develop when your feet roll in too far as you take each step. This rolling in, known as over-pronation, can happen for many reasons. It can be due to excessive weight gain, pregnancy, quickly increasing physical activity, tight calf muscles, poor biomechanics or merely wearing unsupportive, flat footwear. When your feet over-pronate, your arches can collapse, putting strain on the tissues in the bottom of your foot.




Symptoms

Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.




Diagnosis

X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more rare problems, stress fractures, bone tumors-are contributing to your heel pain.




Non Surgical Treatment

In many instances, plantar fasciitis can be treated with home care. Changing your physical activities, resting the foot, and applying ice to the area are common remedies. Taking over the counter medications such as ibuprofen or acetaminophen can help reduce pain and inflammation that may have developed. An orthotic device placed in your shoes can also significantly help to reduce pain. In addition, orthotics can also help promote healing to reverse plantar fasciitis. If pain from plantar fasciitis continues despite conservative treatments, you may need to visit a doctor or podiatrist. It's important to seek medical advice before heel pain and damage becomes worse. If the condition is allowed to worsen, more serious or invasive forms of treatment may be required to stop pain. A visit to a doctor may reveal other conditions affecting the foot as well, such as Achilles tendonitis, heel spurs, or other heel pain conditions. An x-ray may also be taken, which can reveal the presence of a heel spur. In rare cases surgery may be required to release tension on the plantar fascia, or to remove a portion of a heel spur. But again, most heel pain conditions can be resolved using conservative treatment.

Pain On The Heel




Surgical Treatment

More invasive procedures to treat plantar fasciitis are usually sought only after other treatment has failed to produce favorable results. Corticosteroid injections deliver medicine into the injured fascia to reduce pain. However, this treatment may weaken the plantar fascia and result in further damage. In addition, extracorporeal shock wave therapy (ESWT) is a treatment where sound waves are sent through the damaged tissue in order to stimulate the damaged tissue and encourage healing. This method is relatively new in treating plantar fasciitis and your doctor will be able to tell you if it is the right method for you. Lastly, surgery is the last option for those suffering from chronic or severe plantar fasciitis.




Stretching Exercises

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head until you feel a stretch in the back of your calf, Achilles tendon, plantar fascia or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Resistance Band Calf Strengthening. Begin this exercise with a resistance band around your foot as demonstrated and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free.

Exercise Sessions For Intermetatarsal Neuroma

Metatarsal pain, often referred to as metatarsalgia, can be caused by several foot conditions, including Freiberg's disease, Morton's neuroma and sesamoiditis. According to a 2003 article in the British Journal of Sports Bunions Callous Medicine,” a flat or high arch is one of many risk factors for lower extremity injuries including foot injuries. Poor circulation occurs when there is not enough blood supplied to an area to meet the needs of the cells.

If changing your shoes isn't helping to solve your foot pain, it is time for us to step in. Contact Dr. Jeff Bowman at Houston Foot Specialists for treatment that will keep your feet feeling great. Inserting arch support insoles in the shoes is also a good option.

When the tissue of the arch of the foot becomes irritated and inflamed, even simple movements can be quite painful. Plantar fasciitis is the name that describes inflammation of the fibrous band of tissue that connects the heel to the toes. Symptoms of plantar fasciitis include pain early in the morning and pain with long walks or prolonged standing. Arch pain early in the morning is due to the plantar fascia becoming contracted and tight as you sleep through the night. Bunions develop from a weakness in the bone structure of your foot.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

On the other hand, the surgical hip pain treatment includes total hip bone replacement surgery. Although it is always advisable to consult the doctor if you experience pain in the hip that lasts for more than a couple of hours, you can try some home remedies to temporarily get rid of the sharp hip pain. One should note that these home remedies are not to be substituted for proper medical treatment. Ice packs and cool compresses are helpful to ease pain and inflammation on various parts of the body. Rest and ice the sole of your feet.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

Bunions are bony lumps that develop on the side of your foot and at the base of your big toe. They're the result of a condition called hallux valgus, which causes your big toe joint to bend towards your other toes and become may also develop a bursa here too, especially if your shoes press against the bunion. Sometimes swellings or bursae on the joints in your feet are also called bunions, but these aren't the same as bunions caused by hallux valgus. Hallux valgus is different to hallux rigidus, which is osteoarthritis of the big toe joint. Hallux rigidus causes your big toe to become stiff and its range of movement is reduced. Symptoms of a bunion can be controlled by choosing shoes with a soft, wide upper to reduce pressure and rubbing on your joint. Toes form hammer or claw shape.

A Bunion Is A Bit more Complicated Than A Lump Of Extra Bone

Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

Review surgical procedures for hallux valgus, with step-by-step instruction of approaches, soft tissue handling, bony procedures and fixation options, and closure. The first ray is an inherently unstable axial array that relies on a fine balance between its static (capsule, ligaments, and plantar fascia) and dynamic stabilizers (peroneus longus and small muscles of the foot) to maintain its alignment.

A deviation of the disal portion of the great toe, at the metatarsophalangeal joint, toward the outer or lateral side of the foot. A deviation of the tip of the great toe, or main axis of the toe, toward the outer or lateral side of the foot. There are over 100 named surgical techniques for the correction of hallux abductovalgus, most of which are modifications of a number of principles of approach. The big toe tilts outwards, crowding the smaller toes, and a bony lump (called a bunion) appears on the inside of the foot. These are used to remove the bunion and to divide one or more of the bones of the front of the foot. Compared with standard (open) surgery, this procedure uses smaller cuts to the foot and X-rays or endoscopy to see inside the foot. Scar symptoms are a recognized complication of forefoot surgery. The tourniquet was released, and the skin was sutured.

I must caution you that the use of the TightRope for bunion correction is a relatively new concept but is very promising. The most common complication from this type of procedure has been fracturing of the second metatarsal bone which in all cases required further surgery to correct the fracture. The study mentions other possible causes for failure such as the fact that the drill holes through the second metatarsal bone will naturally weaken the bone. The next video demonstrates implant surgery for correction of a bunion. This procedure is sometimes performed in conjunction with an osteotomy procedure to realign the metatarsal and toe bones. Many patients ask me if you can have laser surgery on bunions. More importantly, lasers cannot remove bone, all they do is burn bone, so a laser could not be used to remove the large bump of a bunion deformity.

Associated deformities may include second digit hammertoes and flexible or rigid flat foot. Instability of the second digit may allow a more rapid progression of hallux valgus, as it is unable to act as an adequate lateral buttress. If surgery it to be contemplated it is imperative that peripheral blood flow be adequate for healing. Understand that bunions are progressive and that non-surgical treatments alleviate symptoms but do not limit progression. The most important indication for surgery is pain, not deformity, although there will often be concern about the appearance of the deformed joint. It is usually a combination of bone and soft tissue surgery.

Contributing factors, if present, include gastrocnemius or gastrocsoleus equinus, flexible or rigid pes plano valgus, rigid or flexible forefoot varus, dorsiflexed first ray, hypermobility, or short first metatarsal. During normal propulsion, Heel Pain approximately 65° of dorsiflexion is necessary at the first metatarsophalangeal joint, yet only 20-30° is available from hallux dorsiflexion. Note the greater deformity of the right foot (image left) versus the left foot (image right).Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain

Achilles Tendonitis

Overview

Achilles TendinitisThe Achilles tendon is the largest and strongest tendon in the human body. It is the ?cord? in the back of the leg that inserts into the back of the heel. The Achilles tendon got its name, according to Greek legend, when the Greek warrior, Achilles, was dipped into the River Styx by Thetis, his mother. This rendered him invincible with the exception of his unsubmerged heel. Unfortunately, he went on to get mortally wounded during the siege of Troy when he was struck in that heel by an arrow. Achilles tendinitis is inflammation and partial tearing of the Achilles tendon. It can occur with overuse of the tendon such as when starting or increasing the intensity of an exercise program or performing impact loading activities that include a lot of running and/or jumping.




Causes

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time. Health professionals may use different terms to describe a tendon injury. You may hear, Tendonitis (or Tendinitis): This actually means "inflammation of the tendon," but inflammation is rarely the cause of your tendon pain.




Symptoms

The Achilles tendon is a strong muscle and is not usually damaged by one specific injury. Tendinitis develops from repetitive stress, sudden increase or intensity of exercise activity, tight calf muscles, or a bone spur that rubs against the tendon. Common signs and symptoms of Achilles Tendinitis include, gradual onset of pain at the back of the ankle which may develop in several days up to several months to become bothersome. Heel pain during physical activities which may diminish after warming up in early stages, or become a constant problem if the problem becomes chronic. Stiffness at the back of the ankle in the morning. During inactivity, pain eases. Swelling or thickening of the Achilles tendon. Painful sensation if the Achilles tendon is palpated. If a pop is heard suddenly, then there is an increased chance that the Achilles tendon has been torn and immediate medical attention is needed.




Diagnosis

In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient?s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays or other imaging modalities.




Nonsurgical Treatment

Tendinitis usually responds well to self-care measures. But if your signs and symptoms are severe or persistent, your doctor might suggest other treatment options. If over-the-counter pain medications - such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) - aren't enough, your doctor might prescribe stronger medications to reduce inflammation and relieve pain. A physical therapist might suggest some of the following treatment options. Exercises. Therapists often prescribe specific stretching and strengthening exercises to promote healing and strengthening of the Achilles tendon and its supporting structures. Orthotic devices. A shoe insert or wedge that slightly elevates your heel can relieve strain on the tendon and provide a cushion that lessens the amount of force exerted on your Achilles tendon.

Achilles Tendon




Surgical Treatment

Most people will improve with simple measures or physiotherapy. A small number continue to have major problems which interfere with their lifestyle. In this situation an operation may be considered. If an operation is being considered, the surgeon will interview you and examine you again and may want you to have further treatment before making a decision about an operation. Before undergoing Achilles tendonitis surgery, London based patients, and those who can travel, will be advised to undergo a scan, which will reveal whether there is a problem in the tendon which can be corrected by surgery. Patients will also have the opportunity to ask any questions and raise any concerns that they may have, so that they can proceed with the treatment with peace of mind.




Prevention

So what are some of the things you can do to help prevent Achilles Tendinitis? Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Balancing Exercises, Any activity that challenges your ability to balance, and keep your balance, will help what's called proprioception, your body's ability to know where its limbs are at any given time. Plyometric Training, Plyometric drills include jumping, skipping, bounding, and hopping type activities. These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint. Footwear, Be aware of the importance of good footwear. A good pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion. Cool Down properly, Just as important as warming up, a proper cool down will not only help speed recovery, but gives your body time to make the transition from exercise to rest. Rest, as most cases of Achilles tendinitis are caused by overuse, rest is probably the single biggest factor in preventing Achilles injury. Avoid over training, get plenty of rest; and prevent Achilles tendinitis.