Nice little segment from Dr. Oz that will help you this summer.
Foot Care, Healing and Cosmetic Surgery
Nice little segment from Dr. Oz that will help you this summer.
Pain in the heel of your foot is frustrating, isn’t it? You are trying to do the right thing by hiking, walking, running, or getting back to the gym more regularly. The problem is, your feet have been nice and cozy in those boots all winter. Even in Arizona, shoes have been worn and your feet are kind of lazy, for lack of a better term. The sudden increase in activity is a harsh awakening to your feet and the muscles let you know it by causing pain.
Think of it this way: when you exercise your muscles are working extra hard and reach the point of fatigue. The next day or two your muscles let you know they have been worked hard by causing stiffness and a little pain. Well, walking is exercise to the muscles in your feet. The arch pain is nothing more than your muscles having been worked to fatigue. If you try these next few steps you most likely will successfully get rid of this heel pain.
There are three key steps to relieving heel pain:
Don’t let your heel pain get you down. You are doing the right thing for your body. Don’t hesitate, come see us at Desert Foot Surgeons and get back on your feet!
These chilly winter mornings certainly don’t lend themselves to flip-flops and thoughts of sand between your toes. What they do mean is wearing closed-in shoes that might make you notice that lump behind your big toe or the slight bend in your toe that never bothers you in sandals. Of course when your toes are stuck in those shoes all day the pedicures seem less important so maybe you let your toes go for a while. As the polish chips and fades you notice white or yellow discoloration on the corners of your toenails even some lifting of the nail from the skin. You could cover it with polish come summer, but maybe it can be cured.
Now is the time to start getting your feet in shape for summer. We are 4 months away from schools’ summer vacation. If you are thinking about fixing your hammertoes or bunions, now is the time so that your surgery will be fully healed and ready for serious beach activities or lounging by the pool.
Bunion surgery involves fixing that lump or bump behind your big toe. Unfortunately the bump is not a growth of bone, but a bone that has shifted position. Moving the bone back into position often times requires breaking that bone in surgery. This takes time to heal ranging from 4-8 weeks depending upon the nature of the procedure performed. The work needed to straighten your big toe and remove the bump is determined by x-rays. I always examine patients seated, standing, and walking to determine the best approach for long-term correction of your deformity. Acting early will have your feet ready to show off this summer.
Hammertoe surgery is performed to straighten a bent or buckled toe. Having your toe straightened takes on average 4 weeks to heal the bone and gradually increasing your activities from that point forward. Getting back into shoes depends on swelling so the better behaved you are the first few weeks will determine how fast you can wear a shoe. The worse your toe is bent, the longer the recovery. In order to choose the appropriate surgery to straighten your toes, I need to see you walk. The cause of the toe buckling is due to the way your foot hits the ground as you walk. Cutting edge technology is available to correct your hammertoes. You do not need to have pins sticking out of your foot when you have hammertoe surgery. Now is the perfect time to fix those buckled toes for summer sandals.
If you have discoloration, thickening, or lifting of the nail from the skin this could be a fungal infection. Everyone has heard of athlete’s foot. This is a fungal infection of your skin. The same fungus can infect your toenails causing discoloration on the edges, thickening, and lifting of the nail from the skin beneath. There are many other causes of thick and discolored toenails. Testing of the nail must be done to assure that the cause is fungus before planning your treatment. If the nail problem is due to a fungal infection you should not delay treatment because nails grow slow. If you want clear toenails by summer, now is the time to act.
Those closed shoes are good at keeping your feet warm, but when you have lumps, bumps, and crooked toes they can be a constant source of aggravation. If your feet want to be free for the summer months splashing in the waves, soaking up sun at poolside, or playing in the sand now is the time to take action.
Did you know that in 1949 Joe DiMaggio missed the first 65 games of the season because of heel pain? Officially it was called “an inflamed right heel”, but now we know it was plantar fasciitis. Unfortunately for Joltin’ Joe, there was not a lot known about plantar fasciitis or heel pain. Arch supports did not exist at that time.
If you suffer from pain in the heel of your foot, you can relate to what “the greatest player in major league baseball” was going through back in 1949. That searing pain when you stand up after resting, improving as you get going on your feet, only to return later in the day. Just when you think you’ve beaten the pain, it comes back.
In this series I have already described the treatment of plantar fasciitis as a pyramid with the base supporting all higher levels. Basic treatment includes ice, stretching, and arch supports. The ice is used to help alleviate inflammation, because as I always say, you can’t heal until the inflammation is gone. Gentle stretching helps the over-worked muscles in your foot work more efficiently and stop hurting. Flexible strength is what stretching achieves.
Arch supports come in numerous forms. There are those that you see at flea markets or even in the grocery store. You can stand on a plate in a store and the “magic” computer will tell you the best insole for your foot, as if the computer can tell what the problem you are having with your foot.
The types of arch supports I use at Desert Foot Surgeons come in 2 forms. I like to relate these two types to eye glasses. There are reading glasses and there are prescription lenses made for your eyes and only your eyes. We have the same thing for your feet. You can get off-the-shelf arch supports or custom made foot orthoses.
Off-the-shelf arch supports:
These shoe inserts are not made to anyone in particular’s foot. There is modest arch support to fit a wide range of arch heights comfortably and the materials allow some shock absorption so they do not push too firmly into your arch. These off-the-shelf arch supports are less expensive than custom molded and are often used as an initial step in the treatment of heel pain.
Custom molded foot orthoses:
Custom foot orthoses are made to your feet specifically. The mold has to be taken with your foot held in a very specific position, known as neutral subtalar joint with the midtarsal joint locked. This can be done with a digital scanning device or plaster casting, but it cannot be achieved if there is any weight or pressure on your foot. The prescription has to be written based upon a detailed exam that involves the effect of your hip, knee, and ankle on your foot, how your foot is aligned and moves, and then how your foot hits the ground standing and walking. The materials used to make a custom orthotic depends upon the shoes you want to wear them in. This involves a discussion between you and me. This is the Desert Foot Surgeons difference. I talk to you, exam you sitting, standing, and walking. Video gait analysis is done to see what the naked eye cannot in order to get you the best custom foot orthotic possible.
That’s the basic treatment of heel pain. Most of these you can try before going to see a doctor so that a solid foundation will have been established upon which more advanced treatment can be added. Your time spent with the podiatrist will be more efficient because basic treatment will have been done and you will get better sooner. Remember: ice, stretching, and arch support. It all starts there!
Are you afraid of that sharp, searing pain in your heel when you get out of bed? How about if you’ve been sitting for a while then try to get up? That pain in the heel of your foot is no fun. The official diagnosis is plantar fasciitis, which affects millions of people everyday. Remember the problem involves inflammation of the muscles in your foot and those muscles all begin at the heel. Why do these muscles become inflamed? Some people’s feet work too hard. The muscles are always tight and eventually get irritated or inflamed.
The treatment of plantar fasciitis is like building a pyramid. The base has to be strong to support all higher levels. In part one I talked about ice. This is the beginning of relieving inflammation. The next step is gently stretching these inflamed muscles.
Flexible strength is a big word in fitness. What it means is that muscles that remain stretched are stronger than muscles that are always tight. This is a huge part of avoiding injury, so stretching is key to keeping yourself healthy. Since plantar fasciitis involves tight and over-worked muscles it makes sense that you need to stretch them in order to make the pain go away. The actual muscles in your foot are difficult to stretch on their own, but if you stretch your calf muscles, you will actually help these foot muscles more than if you try to stretch your toes.
The stretch is known as a “runner’s stretch”. The goal is to stretch your calf muscle more specifically known as the gastrocnemius muscle. Stand about 2 feet away from a wall you are facing with your feet shoulders width apart. Put your hands straight out in front of you at shoulder height and touch the wall. If you can’t touch the wall you are too far away. This is a one foot at a time stretch. For argument sake, move your right foot back a little and your left foot forward a bit. Now you are going to be stretching the right leg. It is very important to make certain that the toes of your right foot are pointing straight at the wall. If your foot turns away from your body (out), you can injure your foot. Keep your right heel on the ground, right knee straight, and bend your left knee slightly as you slightly bend your elbows and lean into the wall. You will feel stretch in your calf. If you feel stretch any place other than your calf, STOP, reposition yourself as described above. Hold the stretch for a count of 30 seconds then change feet. Repeat the stretch 3 times per day. That’s it, just 3 minutes per day.
To make that horrible morning pain go away you can use a frozen water bottle or small foam roller. Place the bottle on the floor while you are seated. Rest your arch on the bottle (wear a sock if using the frozen water bottle) and roll for 30 minutes. Don’t push hard, just allow the weight of your leg to do the work. Do this as close to going to bed as possible.
“A journey of a thousand miles begins with a single step.” Lao-tzu from “The Way of Lao-tzu”
Pain in the heel of your foot can be frustrating. As long as you keep moving the pain stays away, but when you stop for while and try to get up again it feels like something just stuck you in the foot. I can assure you that you are not alone. This is the most common complaint I see at Desert Foot Surgeons. The official diagnosis is called plantar fasciitis. What this means is that the muscles in your foot become inflamed where they attach to your heel bone. Why these muscles become inflamed involves tightness in your Achilles tendon, how your foot reacts when it hits the ground, a change in shoes, activities, or an injury. Some people can have a heel spur, but the problem is still plantar fasciitis.
The treatment of plantar fasciitis is like building a pyramid. You must first form a solid foundation at the base and then progress upward. It’s the base of treatment I want to tell you about today. The basic treatment of all plantar fasciitis includes three steps: ice, stretching, and arch support.
Remember what I always say to my patients at Desert Foot Surgeons, “You can’t heal until the inflammation is gone.” I’ve discussed ice in many other posts on this site. The general rule is apply the ice for 20 minutes and leave the ice off for 40 minutes. As long as you stay with this basic rule you may repeat as many times as you want. Some people need to have a sock on their foot in order to tolerate the ice, others do not. That’s an individual decision and I would say that if in doubt wear a sock. Ice can be applied in three forms: the store bought gel pack, ice massage using a small paper cup filled with water and frozen, or a frozen water bottle. In the case of heel pain the ice bag is placed on the ground and you put your heel on the bag for 20 minutes. The ice massage gets the cold deeper. You peel the top edge off the paper cup, turn the exposed ice toward your foot and use the paper cup in your hand to push the ice along the arch and heel of your foot for 20 minutes. The frozen water bottle is best done before bed. The bottle is placed on the floor, your put your foot on the bottle and roll through your arch for 20 minutes.
|Frozen Water Bottle||Ice Massage||Ice pack|
“You can’t heal until the inflammation is gone!”
If you have heard me say this before than you also know that at Desert Foot Surgeons, I recommend using ice, stretching, and Biofreeze as methods to relieve inflammation. There are pills I prescribe and shots I can give to relieve inflammation as well, but these can be scary to some people. Let’s face it, there is a movement away from drugs because we are seeing that continued abuse of some of these medications affects your entire body. Natural methods to relieve inflammation have been around since man first walked on two feet and anything that has stood the test of time that long has to have some merit.
One thing that makes Desert Foot Surgeons different is that I have always been athletic, working out nearly everyday of the week. Because of this level of activity I get injured just like you. I understand how hard it is to make inflammation go away with a busy work schedule, kids, and the various other demands on your life. Still when you are in pain it means there is inflammation and you can’t heal until the inflammation is gone. There are a ton of methods to relieve inflammation, and I have tried all of them. Therapeutic massage, yoga, acupuncture, various relaxation methods (if you know me, you know I’m no good at these), you name it I have probably tried it. I am always looking for massage therapists and yoga studios to recommend for my patients.
What makes me most excited about the new office location on 44th street and Camelback in Phoenix is the friendships I have made in such a short time with other business owners in the area. I’m happy to tell you about a business I think will be a huge asset to patients at Desert Foot Surgeons. I have found you a business that contains all of the things I recommend quite often. Massage, yoga, spa services.
Spa Lamar is located at 5155 N. Scottsdale Road (480.945.7066). Services at Spa Lamar include the usual spa services such as hair styling, manicures, and pedicures, plus services that I’ve never been able to find under one roof. Heidi Lamar has been developing her spa for years and with recent expansions has been able to include a yoga studio and massage therapists in her spa among the pool and hot tub, steam room, and dry sauna. The first Wednesday night of the month, if you bring a friend, you can enjoy live music and snacks to help with that relaxation that I find so difficult. What’s best is with the pricey resort spas in the same area, Spa Lamar is truly priced for the locals. You will not get this level of service at a comparable price anywhere in the area.
When you’re in pain don’t forget: You Can’t Heal Until The Inflammation is Gone!
I’m sitting on a plane as I write this flipping through the airline magazines. I notice a few things that drive me nuts. There are suggested exercises to do while seated. Ankle rotation, foot flex, and heel lift. You’re not serious are you? Have you done these? Who is this supposed to help? So I flip past it and come across a section of foot products where there are 2 flimsy night splints, orthotic sandals, inserts to make you taller, and a stretchy thing. OK I’m in a bad mood because I just paid to bring my luggage on the trip, but come on! We’re talking plantar fasciitis. This is severe pain in the heel of your foot. Why do people buy this stuff? Then I remember the single question I ask of all my residents when discussing heel pain, “why?”.
Why does your heel hurt, but mine does not? Why are your first steps out of bed so painful? Why did my aunt say that wearing cowboy boots is one of the best heel pain treatments? Why is your right foot heel pain seem so much worse than your left foot?
Enough already, the flight attendant just spilled water on me. Let’s get technical.
Why do we call it plantar fasciitis?
The plantar fascia is a broad ligament that runs from your heel to the ball of your foot. If you pull your toes back (up) you can feel your plantar fascia in the arch of your foot. Because there is this severe pain in the heel of your foot and into the arch it seemed reasonable to the first doctors who described this condition to call it inflammation of the plantar fascia. They never asked “why?” or “what else could it be?”. Here’s the technical part. Inflammation at its’ most basic level is increased blood flow to an area that has been injured. That’s why you can sometimes feel throbbing like your heart beat in your foot. The plantar fascia is a ligament. That means it is a thick, tough band that doesn’t have any space for wimpy, soft, little arteries. How can you have increased blood flow to something that has no arteries? Ha, ha you can’t.
We now know that the problem in your heel is the muscles not the plantar fascia. The small muscles in your foot also run from your heel to your toes. Bend you toes back and feel the fascia again. The muscles are right under that, so how can you tell which one hurts by pushing on the heel or arch? You can’t! MRI has shown that plantar fasciitis type heel pain is really inflammation in the muscles where they attach to your heel. Have you heard of a heel spur? Well the spur actually develops from the muscles pulling away from the heel bone. The plantar fascia attaches to the heel bone in a different area not at the spot where a heel spur is seen. A classic heel pain treatment is injecting steroids. The shot goes in the area where the muscles attach to the bone, not the plantar fascia.
Why are my first steps out of bed so painful?
That feeling of a hot poker sticking into your heel when you get out of bed is a classic complaint if you’re suffering from plantar fasciitis. In order to explain this severe pain in the heel of your foot, I need you to keep in mind that the problem lies in the muscles. Ligaments resist stretch up to a point then they break, like spraining your ankle. Muscles can stretch. It takes a very special set of circumstances all occurring at the same time to break a muscle. When muscles work they are happy. Lots of fresh blood circulates through bringing oxygen and washing out the used stuff. If you stretch a happy muscle too far or too fast what happens? That muscle is not so happy anymore and lets you know it my fighting back, in other words, cramping. So you’re walking along, doing your own thing. The muscles in your legs and feet are working so they’re happy. Eventually you go to sleep and the muscles get what seems like a well deserved rest. Of course from the muscles point of view it is not working anymore so tightens up a little to try to keep active. You wake up and step on your foot, stretch the muscles all of a sudden, and they fight back. Zing, zang, zoom you’re seeing stars and thinking you have a harpoon stuck in your heel. Gradually the muscles relax with a few more steps and you feel better. If I place your foot in a night splint that holds your foot muscles stretched slightly while you sleep the muscles stay happy because they are taught so working a little and when you get out of bed there is no harpoon because there is no sudden stretch. This is no flimsy piece of fabric night splint like in the airline magazines. I have a night splint in my office that goes along the top of your foot and ankle so it’s more comfortable than other rigid splints and not slippery if you have to get up to go to the bathroom in the middle of the night.
Why do people tell me to wear cowboy boots for my heel pain?
This was a big topic not too long ago when Eli Manning, the quarterback for the New York Giants, was following the advice of his old coach by wearing his cowboy boots for heel pain. Why the cowboy boots? Because wearing a slight heel and I’m not talking high heels here, but wearing a 1 1/2 to 2 inch heel relaxes your ankle. This will decrease the pull of your Achilles tendon just enough to decrease the stretch on the muscles in your arch.
Feel the arch of your foot with one hand. With your other hand pull your foot back until you feel pulling in the back of your calf. The muscles in your foot just became firm.
Relax your foot and feel the arch again. Now using your other hand pull your toes back (up) but not your ankle. The muscles in your foot are not as tight. That’s what a cowboy boot or low heel does to the muscles in your foot.
Wearing heels or cowboy boots all the time causes other problems so this is not a long term treatment or prevention. Remember what I always say, “ you can’t begin to heal until the inflammation is gone”. Sometimes a patient who has a decent pair of cowboy boots or low heels will ask and I will tell them that wearing these shoes or boots is a good idea for a week or two, but stretching is the real treatment.
Ok, the plane is about to land so let’s wrap this up. This has been a little more technical than other pieces on this website. It’s ok to read it over a time or two. When you think you have it then I want you to ask yourself one more question:
Why can one heel hurt and not the other?
I’ll answer that and other questions in another technical article about the nuts & bolts of how the foot works.
The back of your heel is a small area, but there are a few different problems that can cause pain here. This isn’t plantar fasciitis we’re talking about. The area where your Achilles tendon attaches to your heel is what I want to discuss. You can imagine that since this involves your Achilles tendon the more you walk or run the worse it gets. Shoes that push on the back of the heel can cause horrible pain. Achilles heel pain is all in this one small area on the back of your heel so it can be easy to confuse what is causing your pain. If I play tic-tac-toe on the back of your heel I can tell exactly is causing your Achilles pain.
Just this week a resident surgeon diagnosed one of my patients with a “pump” bump. This is a lump of bone on the back outside “shoulder” of the heel that was thought to be caused by high heeled women’s shoes. Unfortunately in this case the patient was a man. How was I going to diagnose the cause of his heel pain without embarrassing my resident or the patient? We played tic-tac-toe. I drew a grid around his Achilles tendon attachment to the heel. Next, I pushed on each square and marked an “X” if he felt pain. When finished I stepped back and looked at the pattern of X’s. All of a sudden the true cause of this patient’s heel pain was staring me in the face.
The center square is where the Achilles tendon attaches to your heel bone. If my X-pattern involves the center row or even sometimes the bottom your problem is with the Achilles tendon insertion. An X-pattern in the upper squares are a sign of Haglund’s deformity. This is a lump of bone extending across the top portion of the heel. The Achilles tendon sits right over this area and is separated from the bone by a fluid filled sack called a bursa. The tendon, bursa, or both can be involved in this pain pattern. If my X’s are more along the outside of the heel (right side of the picture) this would be the “pump” bump my resident had suggested.
You can see from the picture that my patient has a problem in the central square. This is pain at the Achilles tendon attachment to bone. Fortunately anti-inflammatory medicine, ice, stretching, a lift under his heel, night splints, and physical therapy will usually make this better. Some times a heel spur can form in this tendon attachment and needs to be removed, other times an arthritic condition such as Rheumatoid arthritis or systemic lupus can inflame the tendon attachments to bone. This is called enthesopathy and requires medical care with arthritis medications besides the ice, night splints, and physical therapy we just talked about.
The other areas of heel pain in this part of the foot are lumps and bumps. If the pain is across the top squares, a Haglund’s deformity, or along the outside squares, a pump bump, I will recommend starting with the relief of inflammation like I always do and add a change in shoes that won’t push on this painful area of the heel. If your pain does not go away with stretching, night splints, ice, anti-inflammatory medicine, changing shoes, and physical therapy that pretty leaves us with only one option, surgery.
Even though there are 3 causes of heel pain in this area surgery always involves the Achilles tendon because either the tendon is the cause or it lies just over the problem area. For this reason no matter which diagnosis you have the recovery from Achilles heel surgery is the same. Your game plan for recovery will include 2 months completely off that foot using crutches or a knee walker. I will begin your physical therapy at 2 weeks. Your first steps will be in a cast boot with the help of a physical therapist around the 8 week mark. From there I’ll teach you how to gradually return to shoes. Your total time out of shoes will be about 3 months.
I don’t think my resident will ever forget how to diagnose Achilles heel pain after this. Using a simple child’s game to make a complex diagnosis is just one of the things I love about my job.
Heel pain is the most common complaint a podiatrist hears. In fact, I don’t have to be at work to hear it. My friends joke because at any given time a stranger can walk up to me waving their foot around asking me about the pain in their heel. This article is a guide to the most common causes of heel pain. I like to base the descriptions on location of the pain because not all heel pain is plantar fasciitis.
The most common diagnosis given to heel pain. The problem is inflammation of the small muscles in the foot where they attach to the heel. This is caused by an unstable foot and is most often described as deep sharp pain when you get out of bed in the morning or after sitting for a prolonged period of time. It can extend into the arch and will get worse if left untreated.
A growth of bone on the bottom of the heel along the attachment of the small muscles in the foot. This is the same problem as plantar fasciitis. The best way to think of this is your muscles are pulling away from the bone because your foot is unstable. The spur forms when the bone tries to hold onto the muscles to keep them from pulling away. The spur does not cause the pain, it is the plantar fasciitis that is causing your pain.
Yes, that’s right your heel spur might not be related to plantar fasciitis at all. Systemic arthritis such as Systemic Lupus, Reiter’s Syndrome, or Psoriatic arthritis cause inflammation along the attachment points of tendons. This is called enthesopathy. The heel is a common spot for this to occur, but the spur is different. With enthesopathy the spur is not crisp at the margins. We call this “whispering”. If you have pain in other joints or your low back, your heel pain might not be plantar fasciitis.
Heel pain that is described as electrical or shooting is more likely to be from nerves. There are nerves in the heel that can become entrapped or pinched as they cross muscles and fascia. This pain can mimic plantar fasciitis, but when I press along the side of your heel and run my finger over the nerve you will have the pain. The low back is a common area to have pinched nerves that send pain to the heel. If you tell me you also have pain in your low back I will test your spine to see if the heel pain occurs with stress.
The Achilles tendon runs from the muscles in your calf to the back of the heel. This is one of the strongest tendons in the body. Inflammation of the tendon occurs either around the tendon or within the tendon. With inflammation around the tendon there is sharp and stabbing pains with activity, but this might be improved in heels. Inflammation within the tendon is worse, but hurts less. You will notice swelling of the tendon. If left untreated the tendon will weaken. Everyone has heard of a friend of family member who was playing sport and suddenly without warning ruptured (broke) their Achilles tendon.
Pump Bump or Haglund’s deformity:
The heel bone can form a lump on the back side usually the outside edge of the Achilles tendon area. This area is a pressure point in shoes, especially women’s shoes, therefore was given the name of pump bump. Avoiding shoes that apply pressure to that area is the easiest treatment of all, but many people need to wear dress shoes for work. Prominent bone can only be removed by surgery.
The Achilles tendon attaches to the back of your heel bone, but not at the top edge. As the tendon passes the top edge working its way to the attachment in the center of the bone there is a fluid filled sack called a bursa. This allows the tendon to slide over the top edge of the bone as you walk. This fluid filled sack can become irritated causing pain and swelling. Relieving the inflammation and stretching your Achilles tendon usually make this problem go away completely.
Heel pain is very common and as you can see there are many reasons your heel can hurt. Think about where the pain is and when it hurts. You might not be suffering from plantar fasciitis.