What Is Posterior Calcaneal Spur

Posterior Calcaneal Spur

Overview

In the setting of plantar fasciitis, heel spurs are most often seen in middle-aged men and women, but can be found in all age groups. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an x-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.

Causes

A heel spur can develop when there is an abundance of calcium creating a deposit in the calcaneus, or heel bone. Over time, this deposit grows to create an outcropping under the heel that extends into the foot. The result is a protrusion that leads to foot pain when pressure is applied, and in some cases, even during rest.

Posterior Calcaneal Spur

Symptoms

Some symptoms at the beginning of this condition include pain and swelling, and discomfort when pushing off with the toes during walking. This movement of the foot stretches the fascia that is already irritated and inflamed. If this condition is not treated, pain will be noticed in the heel when a heel spur develops in response to the stress. This is a common condition among athletes and others who run and jump a significant amount.

Diagnosis

Most patients who are suffering with heel spurs can see them with an X-ray scan. They are normally hooked and extend into the heel. Some people who have heel spur may not even have noticeable symptoms, although could still be able to see a spur in an X-ray scan.

Non Surgical Treatment

Heel spurs are considered a self-limited condition, which means that by making small alterations in your lifestyle and regular routines you can often control the condition. The goal is to relieve pain, reduce friction and transfer pressure from your sensitive foot areas. By eliminating the cause of the heel spur and plantar fasciitis (i.e. better shoes, orthotics to fix your gait, losing weight) will help reduce the pressure put on your fascia and heel and can reduce the inflammation caused by your heel spur. Failure to see improvements after conservative treatments may make surgery your only option.

Surgical Treatment

Surgery involves releasing a part of the plantar fascia from its insertion in the heel bone, as well as removing the spur. Many times during the procedure, pinched nerves (neuromas), adding to the pain, are found and removed. Often, an inflamed sac of fluid call an accessory or adventitious bursa is found under the heel spur, and it is removed as well. Postoperative recovery is usually a slipper cast and minimal weight bearing for a period of 3-4 weeks. On some occasions, a removable short-leg walking boot is used or a below knee cast applied.

The Diagnosis Of Posterior Calcaneal Spur

Posterior Calcaneal Spur

Overview

The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are heel spurs and plantar fasciitis. A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur digs into the plantar fascia and causes small micro-tears in the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch.

Causes

The plantar fascia is a thick, ligamentous connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. That’s why tremendous stress is placed on the plantar fascia.

Posterior Calcaneal Spur

Symptoms

Pain and discomfort associated with heel spurs does not occur from the spur itself. The bone growth itself has no feeling. However, as you move, this growth digs into sensitive nerves and tissue along the heel of the foot, resulting in severe pain. Pain can also be generated when pushing off with the toes while walking. Swelling along the heel is also common.

Diagnosis

The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.

Non Surgical Treatment

The key is to identify what is causing excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support will help reduce the over-pronation and thus allow the condition to heal. Other common treatments for heel spurs include Stretching exercises. Losing weight. Wearing shoes that have a cushioned heel that absorbs shock. Elevating the heel with the use of a heel cradle, heel cup, or orthotics. For example, heel cradles and heel cups provide extra comfort and cushion to the heel, reducing the amount of shock and shear forces experienced from everyday activities.

Surgical Treatment

Almost 90% of the people suffering from heel spur get better with nonsurgical treatments. However, if the conservative treatments do not help you and you still have pain even after 9 to 12 months, your doctor may advise surgery for treating heel spur. The surgery helps in reducing the pain and improving your mobility. Some of the surgical techniques used by doctors are release of the plantar fascia. Removal of a spur. Before the surgery, the doctor will go for some pre-surgical tests and exams. After the operation, you will need to follow some specific recommendations which may include elevation of the foot, waiting time only after which you can put weight on the foot etc.

Bursitis Of The Foot Surgical Procedure

Overview

Bursae are situated in various locations throughout the body where friction between tissues commonly occurs. These sacs are designed to help reduce friction and prevent pain. Repetitive movements or prolonged and excessive pressure are the most common causes of bursal inflammation, though traumatic injury may also cause this painful problem. In fact, the body sometimes creates bursal sacs in response to trauma or tissue damage.

Causes

Overtraining in an athlete. Tight or poorly fitting shoes that produce excessive pressure at the posterior heel. Haglund deformity. Altered joint axis. Inflammation of the calcaneal bursae is most commonly caused by repetitive (cumulative) trauma or overuse, and the condition is aggravated by pressure, such as when athletes wear tight-fitting shoes. Retrocalcaneal bursitis may also be associated with conditions such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies. In some cases, retrocalcaneal bursitis may be caused by bursal impingement between the Achilles tendon and an excessively prominent posterosuperior aspect of the calcaneus (Haglund deformity). In Haglund disease, impingement occurs during ankle dorsiflexion.

Symptoms

Pain at the back of the heel, especially with jumping, hopping, tip-toeing, walking or running uphill or on soft surfaces. If tendonitis is also present, the pain can radiate away from the bursa. Direct pressure on the bursa will exacerbate the pain and should be avoided if possible. Tenderness and swelling which might make it difficult to wear certain shoes on the feet. As the bursa becomes more inflamed you will experience swelling and warmth. In severe cases, the bursa will appear as a bump, called a “pump bump”, and is usually red, and extremely tender. Swelling can cause difficulties moving as the range of motion in the ankle can be affected. Limping due to the pain may occur. If you press on both sides of the inflamed heel, there may be a firm spongy feeling. Weakness in the tendons and muscles surrounding the bursa can develop as the pain worsens and the inflammation in the area spreads. Possibly a fever if you are suffering from septic bursitis (You will need to see a doctor for medication to get rid of the infection). Pain at the back of the heel makes it difficult to continue wearing shoes, especially high heels with straps or shoes that don’t fit properly.

Diagnosis

A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose a retrocalcaneal bursitis. Diagnosis may be confirmed with an ultrasound investigation, MRI or CT scan.

Non Surgical Treatment

Relieving the symptoms of bursitis initially focuses on taking the pressure off the bursa. This can be done with proper cushioning, inserts, or footwear but may require surgery if it is a bone formation problem (i.e. Huglund’s Deformity). If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and prescribe antibiotics to treat the infection.

Prevention

Contact your physician if bursitis pain is disabling (when movement of the joint is largely or entirely restricted), if the pain doesn?t subside after a week of self-care, or if the joint is red and swollen. Also call your doctor if you develop a fever, which could signal infectious bursitis-a condition that especially can afflict the elbow. Except for the fever, symptoms resemble other forms of bursitis, but infectious bursitis requires immediate medical attention.

Hammer Toes Pain

HammertoeOverview

Hammer toes are usually not a serious condition, but can become painful as the bent joint rubs against the inside of the shoe, causing irritation, corns, or calluses on the top of the middle joint or the tip of the toe. A hammertoes may also cause occasional shooting pains throughout the toes or elsewhere in the foot. A hammertoe has a kink or contracture in its second joint–called the proximal interphalangeal joint–that causes the toe to bend upward in the middle, giving it a hammer-like appearance. The raised part of the toe often rubs on shoes, leading to the formation of corns or calluses. Usually hammertoe affects the smaller toes, causing pain and interfering with the ability to walk normally.

Causes

While ill-fitting shoes may contribute to a hammertoe, shoes don’t actually cause it, Hammertoes occur by the pull and stretch of the tendon. One tendon gets a more mechanical advantage over the other and allows the deformity to occur. Not surprisingly, wearing shoes that are too tight can make a hammertoe worse. If you’re fond of narrow, pointy-toed shoes or high-heeled pumps, keep in mind you’re squeezing those toes and tendons, which may aggravate hammertoes.

Hammer ToeSymptoms

Signs and symptoms of hammertoe and mallet toe may include a hammer-like or claw-like appearance of a toe. In mallet toe, a deformity at the end of the toe, giving the toe a mallet-like appearance. Pain and difficulty moving the toe. Corns and calluses resulting from the toe rubbing against the inside of your hammertoe footwear. Both hammertoe and mallet toe can cause pain with walking and other foot movements.

Diagnosis

Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.

Non Surgical Treatment

To keep your hammertoes more comfortable, start by replacing your tight, narrow, pointy shoes with those that have plenty of room in the toes. Skip the high heels in favor of low-heeled shoes to take the pressure off your toes. You should have at least one-half inch between your longest toe and the tip of your shoe. If you don’t want to go out and buy new shoes, see if your local shoe repair shop can stretch your shoes to make the toe area more accommodating to your hammertoe.

Surgical Treatment

Toe Relocation procedures are ancillary procedures that are performed in conjunction with one of the two methods listed about (joint resection or joint mending). When the toe is deformed (buckled) at the ball of the foot, then this joint often needs to be re-positioned along with ligament releases/repair to get the toe straight. A temporary surgical rod is needed to hold the toe aligned while the ligaments mend.

HammertoePrevention

In some cases foot problems may present at birth, many foot problems such as hammer toes can be prevented. Hammer toe prevention can be a simple process, such as, checking your feet regularly and wearing the right shoes for your feet. Good circulation is also an essential part of foot health and hammer toe prevention. Taking a warm foot bath or giving yourself a foot massage are great ways of keeping your feet healthy.

What Does Overpronation Of The Feet Mean

Overview

While a slight amount of pronation is the proper means to absorb shock naturally, too much pronation (over-pronation) can potentially contribute to many maladies, which can sideline a runner. A foot that pronates excessively is one that continues to roll inward past a neutral position after the shock of impact has been absorbed. Uncorrected and repeated, this motion may lead to repetitive stress related injuries of the feet and legs. More times than not, the runner who over-pronates needs a shoe that reduces excess pronation and guides the foot along a neutral path.Overpronation

Causes

For those not familiar with the term pronation, you might be familiar with terms related to shoes and pronation such as ?motion control?, ?stability,? and ?neutral cushioned.? The terms motion control and stability are typically associated with the word ?over-pronation? or a foot that is supposedly pronating too much and needs correction. According to the running shoe industry, ?over-pronation? is a biomechanical affliction evident when the foot and or ankle rolls inward past the vertical line created by your leg when standing.

Symptoms

Overpronation can negatively affect overall body alignment. The lowering of the longitudinal arch pulls the heel bone in, causing the leg, thigh bone and hip to rotate inwards, and an anterior tilt of the pelvis. Unnecessary strain to the ankles, knees, hips and back can result. Plantar fasciitis and inflammation, metatarsal pain, problems with the Achilles tendon, pain on the inside of the knee, and bursitis in the hip are just some of the conditions commonly associated with pronation.

Diagnosis

You can test for pronation by looking at the leg and foot from the back. Normally you can see the Achilles Tendon run straight down the leg into the heel. If the foot is pronated, the tendon will run straight down the leg, but when it lies on the heel it will twist outward. This makes the inner ankle bone much more prominent than the outer ankle bone.Over-Pronation

Non Surgical Treatment

Over-pronation and the problems that go with it are treated with shoe inserts called arch supports or orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom made. Make sure the arch supports are firm. If you can easily bend them in half, they may be too flexible.

Prevention

Many of the prevention methods for overpronation orthotics, for example, can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.

Learn How To Diagnose Severs Disease?

Overview

Sever’s disease, is a musculoskeletal condition occurring in adolescence that symptomatically manifests as posterior heel pain during ambulation. Often participation in physical activity is severely limited resulting in frustration for children and parents alike. Conservative treatment options have included rest, abstinence from athletic activity, heel lifts, foot orthotic devices, ice, and calf-stretching exercise. The authors are proposing arch taping as an additional viable treatment option for controlling heel pain during athletic and other weight-bearing activities in patients with Sever’s disease.

Causes

Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease, External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.

Symptoms

Adolescents suffering from Sever?s disease usually complain of pain at the back of their heel which is often worse after exercising. It is most common between the ages of 10-12 in boys and 8-10 in girls due to the rapid growth spurts that occur during this time. It can however happen anytime up until the age of 15. Whilst most people present with pain worse in one foot, it is very common to have symptoms in both feet.

Diagnosis

Children or adolescents who are experiencing pain and discomfort in their feet should be evaluated by a physician. In some cases, no imaging tests are needed to diagnose Sever?s disease. A podiatrist or other healthcare professional may choose to order an x-ray or imaging study, however, to ensure that there is no other cause for the pain, such as a fracture. Sever?s disease will not show any findings on an x-ray because it affects cartilage.

Non Surgical Treatment

Occasionally, an orthotic may need to be prescribed for temporary or long-term correction of their foot biomechanics (eg flat feet or high arches). During the acute phase of Sever’s disease a small heel rise or shock-absorbing heel cup placed under the heel pad of your child’s foot may help to ease the symptoms. Your podiatrist or physiotherapist can assess your child’s arch and guide you in the best management of your child’s condition. We recommend that your child should never go barefooted during the painful stages of Sever’s disease.

Recovery

The condition is normally self-limiting, and a return to normal activities is usually possible after a period of 2-3 months. In one study, all the patients treated with a physiotherapy programme (above) improved and could return to their sport of choice after two months of treatment. The condition may recur, although recurrence was uncommon, according to one study.

What exactly is Adult Aquired Flat Feet ?

Overview

Adult acquired flatfoot is a progressive disorder that involves a compromise of soft tissue supports of the medial arch. The condition most commonly affects middle aged women and is characterized by lowering of the arch, turning out of the forefoot, and a sideways angulation of the heel. There are five stages of the disorder that becomes progressively disabling. The end stage can potentially compromise the ankle joint along with the joints in the hindfoot.Acquired Flat Foot


Causes

Damage to the posterior tendon from overuse is the most common cause for adult acquired flatfoot. Running, walking, hiking, and climbing stairs are activities that add stress to this tendon, and this overuse can lead to damage. Obesity, previous ankle surgery or trauma, diabetes (Charcot foot), and rheumatoid arthritis are other common risk factors.


Symptoms

The symptoms of PTTD may include pain, swelling, a flattening of the arch, and inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle. Symptoms, which may occur in some persons with flexible flatfoot, include. Pain in the heel, arch, ankle, or along the outside of the foot. ?Turned-in? ankle. Pain associated with a shin splint. General weakness / fatigue in the foot or leg.


Diagnosis

Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course. Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is available. Check the anterior tibial tendon for size and strength.


Non surgical Treatment

Get treated early. There is no recommended home treatment. While in stage one of the deformity, rest, a cast, and anti-inflammatory therapy can help you find relief. This treatment is followed by creating custom-molded foot orthoses and orthopedic footwear. These customized items are critical in maintaining the stability of the foot and ankle. Once the tendon has stretched and deformity is visible, the chances of success for non-surgical treatment are significantly lower. In a small percentage of patients, total immobilization may arrest the progression of the deformity. A long-term brace known as an ankle foot orthosis is required to keep the deformity from progressing. The Richie Brace, a type of ankle foot orthosis, shows significant success as a treatment for stage two posterior tibial dysfunction. It is a sport-style brace connected to a custom corrected foot orthodic that fits into most lace-up footwear (including athletic shoes). It is also light weight and more cosmetically appealing than traditionally prescribed ankle foot orthosis. The Arizona Brace, California Brace or Gauntlet Brace may also be recommended depending on your needs.

Flat Foot


Surgical Treatment

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.