Bursitis Of The Feet Symptoms

Overview

Heel bursitis is specifically the inflammation of the retrocalcaneal bursa, located at the back of the heel, under the Achilles tendon. There are a handful of factors that put you at risk for developing heel bursitis. Long distance runners are prone to heel bursitis, due to repeated stress and pounding upon the heel joint. Engaging in activities such as running, bicycling, walking, jumping, and stair climbing for extended periods of time can overwork the heel joints and start to irritate the bursae. Suddenly changing to a high-intensity workout regime puts a lot of stress on the heel, making it vulnerable to injury. Hard blows/bumps to the heel can immediately damage the bursae, leading to swelling and inflammation. Training at high intensities without stretching and warming up can also contribute to the development of heel bursitis. Even improper footwear can be a big factor. Some other conditions can put you at risk as well, such as: tarsal tunnel syndrome, rheumatoid arthritis, plantar fasciitis, muscle weakness, joint stiffness, and heel spurs. It is very important to get a professional diagnosis if you are having heel pain because heel bursitis is often confused for Achilles tendonitis, and the proper treatments are very different. The pain could also be plantar fasciitis or general heel pain syndrome.

Causes

There are several factors which can lead to a person developing retrocalcaneal bursitis. In athletes, especially runners, overtraining, sudden excessive increase in running mileage may lead to retrocalcaneal bursitis. Tight or ill-fitting shoes can be another causative factor as they can produce excessive pressure at the back of the heel due to restrictive heel counter. A person with an excessively prominent posterosuperior aspect of the heel bone (Haglund deformity) may also have a higher predisposition to retrocalcaneal bursitis. In such individuals, pain would be reproduced when the ankle goes into dorsiflexion.

Symptoms

The signs and symptoms of heel bursitis can include heel pain wearing particular footwear, Pain or discomfort in the heel when walking, jogging or running, Swelling or inflammation in the heel.

Diagnosis

Magnetic resonance imaging (MRI) may demonstrate bursal inflammation, but this modality probably does not offer much more information than that found by careful physical examination. Theoretically, MRI could help the physician to determine whether the inflammation is within the subcutaneous bursa, the subtendinous bursa, or even within the tendon itself, however, such testing is generally not necessary. Ultrasonography may be a potentially useful tool for diagnosing pathologies of the Achilles tendon.

Non Surgical Treatment

Home treatment is often enough to reduce pain and let the bursa heal. Your doctor may suggest physical therapy to strengthen the muscles around your joints. Rest the affected area. Avoid any activity or direct pressure that may cause pain. Apply ice or cold packs as soon as you notice pain in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 3 days (72 hours). You can try heat, or alternating heat and ice, after the first 72 hours. Use pain relievers. Use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to reduce pain and inflammation. NSAIDs come in pills and also in a cream that you rub over the sore area. Acetaminophen (such as Tylenol) can also help with pain. Don't rely on medicine to relieve pain so that you can keep overusing the joint. Do range-of-motion exercises each day. If your bursitis is in or near a joint, gently move the joint through its full range of motion, even during the time that you are resting the joint area. This will prevent stiffness. As the pain goes away, add other exercises to strengthen the muscles around your joint. Avoid tobacco smoke.Smoking delays wound and tissue healing. If you have severe bursitis, your doctor may use a needle to remove extra fluid from the bursa. You might wear a pressure bandage on the area. Your doctor may also give you a shot of medicine to reduce swelling. Some people need surgery to drain or remove the bursa. Sometimes the fluid in the bursa can get infected. If this happens, you may need antibiotics. Bursitis is likely to improve in a few days or weeks if you rest and treat the affected area. But it may return if you don't stretch and strengthen the muscles around the joint and change the way you do some activities.

Surgical Treatment

Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.

Prevention

To prevent bursitis of the heel in the first place, always keep proper form during exercise. In addition, don?t jump into exercises that are too intense without building up to them. Strengthen and flex your ankle.

Do Hammer Toe Splints Work

HammertoeOverview

Hammer toes most commonly affects the second toe on the foot. It causes the middle joint to bend. Hammertoe is most frequently caused by structural problems in the toe or from wearing poor fitting shoes. It is important to diagnose and treat hammertoe early because the condition tends to become worse over time. If left untreated, hammertoe can require surgery.

Causes

The cause of hammertoes varies, but causes include genetics, arthritis and injury to the toe. Treatment for hammertoes depends on the severity and can include anti-inflammatory medication, metatarsal pads, foot exercises and better-fitting shoes. If the pain caused by a hammertoe is so severe that wearing a shoe is uncomfortable, surgery may be necessary. Typically this surgery is an outpatient procedure that doesn?t require general anesthesia, though it is an option. Recovery from surgery usually takes a few weeks, and patients are given special shoes to wear.

Hammer ToeSymptoms

The symptoms of a hammer toe include the following. Pain at the top of the bent toe upon pressure from footwear. Formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.

Diagnosis

Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are Hammer toes not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).

Non Surgical Treatment

Mild hammer toe in children can be treated by manipulating and splinting the affected toe. The following changes in footwear may help relieve symptoms. Wear the right size shoes or shoes with wide toe boxes for comfort, and to avoid making hammer toe worse. Avoid high heels as much as possible. Wear soft insoles to relieve pressure on the toe. Protect the joint that is sticking out with corn pads or felt pads. A foot doctor can make foot devices called hammer toe regulators or straighteners for you, or you can buy them at the store. Exercises may be helpful. You can try gentle stretching exercises if the toe is not already in a fixed position. PIcking up a towel with your toes can help stretch and straighten the small muscles in the foot.

Surgical Treatment

Surgical correction is needed to bring the toe into a corrected position and increase its function. Correction of the hammer toes is a simple outpatient surgery, with limited downtime. The best option is to fuse the deformed and contracted toe into a straight position. This limits the need for future surgery and deformity return. A new pin that absorbs in the bone or small screw is used by the Foot and Ankle Institute to avoid the need for a metal pin protruding from the toe during recovery. Although the absorbable pin is not for everyone, it is much more comfortable than the pin protruding from the end of the toe. In certain cases, a removal of a small area of bone in the deformity area will decrease pain and limit the need for a surgical waiting period that is found with fusions. Although the toe is not as stable as with a fusion, in certain cases, an arthroplasty is the best option.

How To Resolve Hammer Toes

Hammer ToeOverview

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 Hammer toes 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

More often than not, wearing shoes that do not fit a person well for too long may actually cause hammer toes. Wearing shoes that are too narrow or too tight for the person for extended periods of time may eventually take a toll on the person's feet. The same is true for women who like wearing high-heeled shoes with narrow toe boxes.

Hammer ToeSymptoms

The symptoms of hammertoe include a curling toe, pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward. Thickening of the skin above or below the affected toe with the formation of corns or calluses. Difficulty finding shoes that fit well. In its early stages, hammertoe is not obvious. Frequently, hammertoe does not cause any symptoms except for the claw-like toe shape.

Diagnosis

The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.

Non Surgical Treatment

A number of approaches can be undertaken to the manage a hammer toe. It is important that any footwear advice is followed. The correct amount of space in the toe box will allow room for the toes to function without excessive pressure. If a corn is present, this will need to be treated. If the toe is still flexible, it may be possible to use splints or tape to try and correct the toe. Without correct fitting footwear, this is often unsuccessful. Padding is often used to get pressure off the toe to help the symptoms. If conservative treatment is unsuccessful at helping the symptoms, surgery is Hammer toes often a good option.

Surgical Treatment

Until recently, wires were used for surgical correction. In this technique, one or more wires are inserted into the bone through both the affected joint and a normally healthy toe joint, and the end of the toe. These wires stay in place for four to six weeks, protruding from the end of the toes. Due to the protruding wire, simple things such working, driving, bathing and even sleeping are difficult while these wires are in place. During this recovery period, patients often experience discomfort during sleep and are subject possible infection.

Bunions All You Need To Know

Overview
Bunion Pain A foot bunion is a common cause of foot pain caused by deformity of one of the toe bones. They most commonly affect the big toe, known as hallux abducto valgus, but can also affect the little toe, known as a bunionette. The classic presentation is a large bump on the outer side of the big toe that is red, swollen and painful caused by the toe deviating across towards the second toe. Left untreated, the condition usually gets gradually worse, so it is important to get treatment early on else you may end up needing bunion surgery.

Causes
What causes bunions? This question is often answered by blaming shoes. But in fact, shoes only play a small role in developing bunions. Yes, shoes, especially high heels cause abnormal squeezing of your forefoot. This in turn to help promote a bunion. But if everyone who wore high heels shoes had a bunion, there would be a lot more then the 15% prevalence we see in the general population. As you can see from the flow chart, genetics plays the major role in development of bunion deformities. Genetics determines the way your foot functions. Are you flatfooted? Are your joints flexible or stiff? Do you have a high arch? Do you have tight muscles? These traits are determined by your genetic code. These characteristics then govern how your bones and joints move when you walk. As an example, if your joints are very flexible, this can cause an abnormal amount of instability in your forefoot when you walk. Over time, this abnormal motion will cause the a bunion to develop by allowing your first metatarsal to "drift" towards the mid-line of your body.

Symptoms
A bulging bump on the outside of the base of your big toe. Swelling, redness or soreness around your big toe joint aggravated by footwear. Red, calloused skin along the inside edge of the big toe. Corns or calluses under the ball of the foot or where the first and second toes overlap. Persistent or intermittent pain. Restricted movement of your big toe.

Diagnosis
A simple visual exam is all it will take for your doctor to determine whether you have a bunion. He or she may also ask you to move your big toe in order to ascertain your range of motion. Your doctor may also look for any inflammation, redness, or pain. X-rays can help your doctor determine the severity and cause of the bunion. Your doctor may also ask you questions about your footwear, the symptoms you are experiencing, and if other family members also suffer from the condition. All these factors will help him or her diagnose you properly.

Non Surgical Treatment
Making sure that shoes don't press against the bunion worsening the pain is the first line of treatment. Protecting the bunion with felt or foam pads or devices to separate the first and second toes at night may be recommended as may cutting a hole in a pair of old, comfortable shoes to take the pressure off the bony protrusion. Nonsteroidal anti-inflammatory drugs may be recommended to help relieve toe pain. In rare cases, physicians may administer injections of corticosteroids to treat the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions. Custom orthotic devices are another option that may be beneficial in some cases. Bunions Hard Skin

Surgical Treatment
The aim of surgery is to correct the cause of the bunion and prevent it growing back. Which type of surgery your podiatric surgeon recommends will depend on the severity of your bunion. Because there are risks and complications with any type of surgery, it?s not usually advised unless your bunions are causing pain, or if it is starting to deform your other toes.

Over-Pronation

Overview

Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person?s arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, possibly causing severe discomfort and leading to other foot problems.Foot Pronation

Causes

You do not have to be a runner or athlete to suffer from overpronation. Flat feet can be inherited, and many people suffer from pain on a day-to-day basis. Flat feet can also be traumatic in nature and result from tendon damage over time. Wearing shoes that do not offer enough arch support can also contribute to overpronation.

Symptoms

Symptoms can manifest in many different ways. Here is a list of some of the common conditions associated with over-pronation in children. Achilles Pain. Ankle pain. Arch Pain. Low back pain. Heel Pain. Knee Pain (Runner's knee and Chondromalecia of the patella) Osgood Schlatter Disease (pain below the knee) Shin Splints (pain in the front of the lower leg) Over-pronation does not necessarily mean your child has "flat feet." Even though children's arches may be relatively high when they lie down or sit, over-pronation may not be seen until your child is standing. A certain amount of pronation is normal. During normal walking or running ("gait cycle"), the heel strikes the ground and the foot rolls inward to absorb shock and adapt to the surface. This gait cycle is even more important if the running surface is uneven.

Diagnosis

At some point you may find the pain to much or become frustrated. So what are you options? Chances are your overpronation has led to some type of injury if there's pain. Your best bet is to consult with someone who knows feet. Start with your pediatrist, chiropodist or chiropractor. They'll be able to diagnose and treat the injury and give you more specific direction to better support your feet. One common intervention is a custom foot orthotic. Giving greater structural support than a typical shoe these shoe inserts can dramatically reduce overpronation.Over Pronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improper fitting footwear can lead to additional problems of the foot. If the problem persists, call your doctor to schedule an appointment.

Surgical Treatment

Hyperpronation can only be properly corrected by internally stabilizing the ankle bone on the hindfoot bones. Several options are available. Extra-Osseous TaloTarsal Stabilization (EOTTS) There are two types of EOTTS procedures. Both are minimally invasive with no cutting or screwing into bone, and therefore have relatively short recovery times. Both are fully reversible should complications arise, such as intolerance to the correction or prolonged pain. However, the risks/benefits and potential candidates vary. Subtalar Arthroereisis. An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer. HyProCure Implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.

What Are The Chief Causes Of Severs Disease?

Overview

Sever's disease, or calcaneal apophysitis, is a common cause of heel pain among active children between 10 to 13 years old. This spontaneous heel pain results from injury to the heel bone?s growth plate which is caused by overuse rather than specific injury or trauma. The condition is common among athletic children, particularly those active in soccer, football, and baseball. Treatment is available to reduce pain and discomfort associated with Sever's disease, but the condition usually resolves on its own once feet stop growing.

Causes

Sever?s disease is most likely to occur during the growth spurt that occurs in adolescence. For girls, growth spurts usually occurs between 8 and 13 years of age. For boys, it?s typically between 10 and 15 years of age. The back of the heel hardens and becomes stronger when it finishes growing, which is why Sever?s rarely occurs in older adolescents and teenagers.

Symptoms

Sever's disease causes pain and tenderness in the back and bottom of the heel when walking or standing, and the heel is painful when touched. It can occur in one or both feet.

Diagnosis

Radiography. Most of the time radiographs are not helpful because the calcaneal apophysis is frequently fragmented and dense in normal children. But they can be used to exclude other traumas. Ultrasonography. could show the fragmentation of secondary nucleus of ossification of the calcaneus in severs?s disease. This is a safe diagnostic tool since there is no radiation. This diagnostic tool can also be used to exclude Achilles tendinitis and/or retrocalcaneal bursitis.

Non Surgical Treatment

Rest is best to allow healing .Only do as much exercise as able without causing pain. Many children can continue to play sports but if pain is severe then stopping the activity may be the only way to allow the pain to settle. The child might be able to do things that do not put pressure on the heel, such as swimming and cycling. Ice and cold therapy may be useful to reduce pain and swelling, particularly following activity or sport. The area should be iced until it feels cold not ?frozen?. Never apply ice directly onto the skin, as this may cause tissue damage. Medication. The following will help treat your child?s pain. Paracetamol (see bottle for instructions) Ibuprofen (see bottle for instructions). Exercises, perform foot and leg exercises to stretch and strengthen the leg muscles & tendons. Increase calf flexibility by doing calf stretches several times per day. Protect the heel, your shoes might need a heel lift or arch support. Select a shoe with good arch support and heel lift if possible. Take it one step at a time: gradually resume running and impact activities as symptoms allow.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

Acquired Flat Foot Surgery

Overview
Another common term for this condition is Posterior Tibial Tendon Dysfunction (PTTD). There is a cause-effect relationship between pronation, flatfoot deformity and subsequent tenosynovitis of the posterior tibial tendon. Mechanical irritation of the tendon may lead to synovitis, partial tearing and eventually full rupture of the tendon. Other structures, including ligaments and the plantar fascia, have also been shown to contribute to the arch collapsing. As the deformity progresses, these structures have been shown to attenuate and rupture as well. In later stages, subluxation of various joints lead to a valgus rearfoot and transverse plane deformity of the forefoot. These deformities can become fixed and irreducible as significant osteoarthritis sets in. Flat Feet

Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Symptoms
Often, this condition is only present in one foot, but it can affect both. Adult acquired flatfoot symptoms vary, but can swelling of the foot's inner side and aching heel and arch pain. Some patients experience no pain, but others may experience severe pain. Symptoms may increase during long periods of standing, resulting in fatigue. Symptoms may change over time as the condition worsens. The pain may move to the foot's outer side, and some patients may develop arthritis in the ankle and foot.

Diagnosis
Your podiatrist is very familiar with tendons that have just about had enough, and will likely be able to diagnose this condition by performing a physical exam of your foot. He or she will probably examine the area visually and by feel, will inquire about your medical history (including past pain or injuries), and may also observe your feet as you walk. You may also be asked to attempt standing on your toes. This may be done by having you lift your ?good? foot (the one without the complaining tendon) off the ground, standing only on your problem foot. (You may be instructed to place your hands against the wall to help with balance.) Then, your podiatrist will ask you to try to go up on your toes on the bad foot. If you have difficulty doing so, it may indicate a problem with your posterior tibial tendon. Some imaging technology may be used to diagnose this condition, although it?s more likely the doctor will rely primarily on a physical exam. However, he or she may order scans such as an MRI or CT scan to look at your foot?s interior, and X-rays might also be helpful in a diagnosis.

Non surgical Treatment
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support. Acquired Flat Feet

Surgical Treatment
Many operations are available for the treatment of dysfunction of the posterior tibial tendon after a thorough program of non-operative treatment has failed. The type of operation that is selected is determined by the age, weight, and level of activity of the patient as well as the extent of the deformity. The clinical stages outlined previously are a useful guide to operative care (Table I). In general, the clinician should perform the least invasive procedure that will decrease pain and improve function. One should consider the effects of each procedure, particularly those of arthrodesis, on the function of the rest of the foot and ankle.