Our Podiatrists In Miami & Hialeah Can Help With Your Foot and Ankle Pain
HEEL PAIN - PLANTAR FASCIITIS
Plantar fasciitis is one of the most common orthopedic conditions relating to the foot. It is when the thick tissue on the bottom of the foot (the plantar fascia) becomes inflamed and irritated, making it difficult to walk. This is most often the result of repeated episodes of minor but recurring injury, such as with frequent running or long periods of standing. The pain can be located in the heel area of the foot or in the arch. It is often worse in the morning due to stiffness of the tissue, and also becomes worse after long periods of walking. The pain often decreases with rest.
Your podiatrist will exam your foot searching for:
- Tenderness on the bottom of your foot
- Flat feet or high arches
- Mild foot swelling or redness
- Stiffness or tightness of the arch in the bottom of your foot.
- X-rays may be taken to rule out other problems.
Treatment options for plantar fasciitis include rest, stretching, night splints, physical therapy, cold therapy, heat therapy, orthotics, anti-inflammatory medications, injection of corticosteroids and surgery in refractory cases. Also, in some cases, massaging of the inflamed location serves as a temporary relief.
Treatment can span several months to two years before symptoms improve. Most patients will see an improvement within one year. Further treatment may include steroid injections into the sole of the foot, or in certain situations a surgical procedure that releases the plantar
Foot pain can continue, and progress into a severe condition that affects the ability to walk. Eventually, permanent damage to the plantar fascia.
A heel spur is a calcium deposit on the underside of the heel bone. On an X-ray, a heel spur protrusion can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as "heel spur syndrome."
Although heel spurs are often painless, they can cause heel pain. They are frequently associated with plantar fasciitis, a painful inflammation of the fibrous band of connective tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot.
Treatments for heel spurs and associated conditions include exercise, custom-made orthotics, anti-inflammatory medications, and cortisone injections. If conservative treatments fail, surgery may be necessary.
A heel spur can be seen on an X-ray as an extension of bone in front of the heel. Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain - especially while walking, jogging, or running - if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it.
Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning: a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.
Non-Surgical Treatments for Heel Spurs
The heel pain associated with heel spurs and plantar fasciitis may not respond well to rest. If you walk after a night's sleep, the pain may feel worse as the plantar fascia suddenly elongates, which stretches and pulls on the heel. The pain often decreases the more you walk. But you may feel a recurrence of pain after either prolonged rest or extensive walking.
If you have heel pain that persists for more than one month, consult a health care provider. He or she may recommend conservative treatments such as:
- Stretching exercises
- Shoe recommendations
- Taping or strapping to rest stressed muscles and tendons
- Shoe inserts or orthotic devices
- Physical therapy
Heel pain may respond to treatment with over-the-counter medications such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). In many cases, a functional orthotic device can correct the causes of heel and arch pain such as biomechanical imbalances. In some cases, injection with a corticosteroid may be done to relieve inflammation in the area.
Surgery for Heel Spurs
If conservative treatment fails to treat symptoms of heel spurs, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include:
- Release of the plantar fascia
- Removal of a spur
In most cases, plantar fascia release -- with or without heel spur removal -- has proven effective. But pre-surgical tests or exams are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.
The pain due to the plantar fasciitis that causes the heel spur can become progressively more severe, in some cases damaging the tissue.
FOOT AND ANKLE FRACTURES
No one plans to break their foot. It just happens. You can twist the wrong way playing a sport, step into a hole in the parking lot, or trip and fall. Foot or ankle fractures are unique in that you have to bear weight on your foot after it heals. For that reason, it is crucial to have your foot evaluated and treated. In our PerfectFeetCare Podiatry Centers specialist are uniquely suited to handle this all in the office...no waiting in the ER!
A fracture is a break in the bone, which is caused by trauma. The foot or ankle will appear bruised and swollen and will likely be very painful. A fracture is often not displaced and may be simply treated by immobilizing the foot, ankle, and leg to allow the bone to heal. There are times where the fracture is more severe and will need to be corrected surgically.
A stress fracture is not caused by a particular trauma but rather a continuous repetitive stress. This type of fracture is often seen in athletes and â€œweekend warriors.â€ A stress fracture, however, can happen to anyone. It does not present with bruising, but rather with a moderate amount of swelling. The pain is not severe, but can often be described as a bad ache.
It is important to have a stress fracture immobilized to allow the bone to heal, recover, and return to full strength. Once healed, we use orthotics to manage the pressure and stress on the bone which will prevent a reoccurrence of the fracture.
Symptoms and Diagnosis
Pain, swelling, and sometimes bruising are the most common signs of a fracture in the foot. If you have a broken toe, you may be able to walk, but this usually aggravates the pain. If the pain, swelling, and discoloration continue for more than two or three days, or if pain interferes with walking, something could be seriously wrong; see a doctor as soon as possible. If you delay getting treatment, you could develop persistent foot pain and arthritis. You could also change the way you walk (your gait), which could lead to the formation of painful calluses on the bottom of your foot or other injuries.
Our doctor will examine your foot to pinpoint the central area of tenderness and compare the injured foot to the normal foot. You should tell the doctor when the pain started, what you were doing at the time, and if there was any injury to the foot. X-rays will show most fractures, although a bone scan may occasionally be needed to identify stress fractures. Usually, the doctor will be able to realign the bone without surgery, although in severe fractures, pins or screws may be required to hold the bones in place while they heal.
Come to our offices as soon as possible if you think that you have a broken bone in your foot or toe. Until your appointment, keep weight off the leg and apply ice to reduce swelling. Use an ice pack or wrap the ice in a towel so it does not come into direct contact with the skin. Apply the ice for no more than 20 minutes at a time. Take an analgesic such as aspirin or ibuprofen to help relieve the pain. Wear a wider shoe with a stiff sole.
Rest is the primary treatment for stress fractures in the foot. Stay away from the activity that triggered the injury, or any activity that causes pain at the fracture site, for three to four weeks. Substitute another activity that puts less pressure on the foot, such as swimming. Gradually, you will be able to return to activity. Your doctor or coach may be able to help you pinpoint the training errors that caused the initial problem so you can avoid a recurrence.
The bone ends of a displaced fracture must be realigned and the bone kept immobile until healing takes place. If you have a broken toe, the doctor will "buddy-tape" the broken toe to an adjacent toe, with a gauze pad between the toes to absorb moisture. You should replace the gauze and tape as often as needed. Remove or replace the tape if swelling increases and the toes feel numb or look pale. If you are diabetic or have peripheral neuropathy (numbness of the toes), do not tape the toes together. You may need to wear a rigid flat-bottom orthopaedic shoe for two to three weeks.
If you have a broken bone in your forefoot, you may have to wear a short-leg walking cast, a brace, or a rigid, flat-bottom shoe. It could take six to eight weeks for the bone to heal, depending on the location and extent of the injury. After a week or so, the doctor may request another set of X-rays to ensure that the bones remain properly aligned. As symptoms subside, you can put some weight on the leg. Stop if the pain returns. Surgery is rarely required to treat fractures in the toes or forefoot. However, when it is necessary, it has a high degree of success.
Shin splints refers to pain along the shins, or the front of the leg between the knee and ankle. The pain is typically worse along the lower one-third of the leg. The muscle in this area controls upward movement of the foot, and the pain is caused by overuse and strain of this muscle. The most common cause of shin splints is athletic activity that involves running.
Shin splints are diagnosed on the basis of the typical area involved and the type of movement that increases the pain.
Although shin splints may be caused by different problems, most general treatment is usually the same: Rest your body so the underlying issue heals.
Medications can also be used to help control pain and inflammation. Activities may need to be modified to prevent shin splints from recurring. Here are some other things to try:
- Icing the shin to reduce pain and swelling. Do it for 20-30 minutes every three to four hours for two to three days, or until the pain is gone.
- Anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling. However, these drugs can have side effects, like an increased risk of bleeding and ulcers. They should be used only occasionally unless your doctor specifically says otherwise.
- Arch supports for your shoes. These orthotics -- which can be custom-made or bought off the shelf -- may help with flat feet.
- Range of motion exercises, if your doctor recommends them.
- Neoprene sleeve to support and warm the leg.
- Physical therapy to strengthen the muscles in your shins.
In rare cases, surgery is needed for severe stress fractures and other problems that can cause shin splints.
Shin splints may become more severe and cause pain with normal walking. Progressive damage to involved muscle can occur, especially if there is swelling. Damage to the bone to which the muscle is attached, a stress fracture, can also occur.
The sesamoid is a small bone under the ball of the foot. It can become strained in repetitive activities that place pressure on the ball of the foot or involve repeated upward flexion of the big toe. Sesamoiditis is inflammation and pain as a result of this.
We will ask many questions about your medical history. You will be asked about your current symptoms and whether you've had other foot and joint problems in the past. We will then examine your painful toe by feeling it and moving it. This may hurt, but it is important that we locate the source of the pain and determines how well the toe is moving. You may also be asked to walk back and forth.
We will probably order an X-ray. The axial view gives us a good idea whether there are problems in the sesamoids. To get an axial view, the X-ray is angled to show the space between the sesamoids and the bottom part of the big toe joint.
The X-ray image may show a sesamoid bone that looks like it is divided into two or more separate bones, as though it were fractured. This is normal in about 10 percent of people. If the small space between the bone pieces is smooth, it's probably okay. If the space is jagged, there could be a fracture. Further tests may be needed to make the diagnosis.
We may order a bone scan when the X-ray appears normal, or if there is a question about whether the division inside the bone is a fracture. A bone scan involves giving intravenous agents that travel through the blood and then show up in a scan. The agents accumulate in areas where there is a great deal of stress to the bone tissue. More intravenous agents will likely appear on the painful sesamoid bone than on the sesamoids of the other foot.
We may want to do other imaging tests, such as magnetic resonance imaging (MRI). An MRI scan may help determine whether the bone is infected. More testing may help to make the final diagnosis.
Treatment involves primarily rest. Special footwear with a rigid sole that minimizes movement of the joint at the base of the big toe may also be prescribed. In some cases a steroid injection along the sesamoid is given.
Pain may increase. In some cases the sesamoid can become fractured. In severe problems that involve the seasamoid the bone itself can be surgically removed.