FAQ Category: Foot

Heel pain is a fairly common symptom with a variety of possible causes. Plantar fasciitis is the most likely diagnosis. But you’ll need a medical evaluation to find out for sure.

There are neurologic reasons for heel pain. Pressure on nerves anywhere from the low back down to the foot can cause heel pain. Soft tissue injuries can also cause heel pain. This can include tendinitis, rupture of the plantar fascia, or atrophy of the protective fat pad next to the calcaneus (heel bone).

Fractures, arthritis, and tumors (benign or malignant) can result in heel pain. Peripheral vascular disease (loss of blood supply to the feet) can cause heel pain. This is usually present in both feet but can affect one side first leading to a misdiagnosis of plantar fasciitis.

Your physician will do a work-up to rule out any of these more serious problems. A history, physical exam, and some imaging studies help with the diagnosis.

Plantar fasciitis can be difficult to treat successfully. Often, it requires time and many trials of different treatment combinations. Some patients get lucky and within six to eight weeks, they are better. For others, it can take six to 12 months to find the right mix.

Even if you have tried a variety of methods, you may still get pain relief by trying them together in different ways. The American Orthopaedic Foot and Ankle Society (AOFAS) recommends heel padding, medications, and stretching first.

If you fail to get pain relief, or if your pain is reduced but not eliminated, then custom orthotics and physical therapy can be added next.

Two new methods are under investigation. Early reports are favorable. The first is shock wave therapy. Sound waves directed at the insertion point of the plantar fascia may help the healing process.

Scientists aren’t sure yet exactly how this works. They think the force of the energy waves sets up a microdisruption of the plantar fascia tissue. The body responds with the release of growth factors and stem cells. The result is a healing response.

Another new treatment is radiofrequency waves. Exposing the area to radiofrequency stimulation aids in the formation of new blood vessels. Increased blood flow to the area generates tissue healing.

Clinical trials are underway using BOTOX injections for plantar fasciitis. The toxin causes paralysis of the injected muscles. In short-term studies done so far, there have been no side effects. More studies are needed before shock waves, radiofrequency, or BOTOX become standard methods of treatment.

Without knowing exactly what your mother’s problems are, it would be impossible to give a realistic suggestion that your mother can use. A lot depends on what type of arthritis your mother has, where exactly in the foot it is,and if anything has been tried before.

In some situations, people with arthritis in the foot do well with special shoes or inserts in their shoes. Others do well with surgery. It’s important to discuss her options with her doctor and, if needed, a surgeon, to see what can be done.

Unfortunately, it’s not always possible to tell who will develop arthritis in their feet and who will have difficulties with pain and movement.

That being said, there is on-going research to try and identify people at risk early enough to be able to make a difference with treatment and intervention. Some research is focusing on the gait and evaluating if a person’s gait starts to change before the symptoms of arthritis become obvious.

The tendon in the back of your foot is called the Achilles tendon. It is the strongest of the tendons in your body because it has to bear your weight and the force of your walking, running, jumping, and so on.

Because the tendon is under so much stress, it can be damaged through over use or with trauma. While no recommendations can be made without an examination of your foot to tell what the problem is, there are some issues you may look at to see if they prevent pain.

First, are you a regular athlete or do you just exercise occasionally? If you exercise only once in a while, this could be why your tendon is hurting. On the other hand, if you participate in regular exercise, your tendon may be suffering from overuse.

Do your shoes fit properly and are they the right shoe for your activity? It is amazing how many people aren’t wearing the correct shoes for their particular activity. Be sure they’re the right shoes and that they fit well. As well, make sure they’re not too old.

If your tendon pain continues, you should be examined in case you could be making things worse.

Ruptured tendons can be treated with surgery or without. Generally, it is accepted that the tendon repairs better with surgery and lasts longer, but sometimes surgery is not an option.

All surgeries have risks, such as infection. As well, if someone has a particular illness that could make surgery riskier, his or her doctor may wish to try to fix the tendon non-operatively first.

It is possible to break a bone in your midfoot or dislocate a joint there so it is possible that you injured it. If you do injure your midfoot, it is important to get it checked because the damage may be more involved than it may appear.

The bones and joints in your midfoot help stabilize your foot and your gait (walking), so they play an important role. So, a doctor may brace or cast an injury like that or may even suggest surgery, if it seems necessary. If your foot is still sore, you should get it checked to see if there is something that can be done

Casts on a foot can be a burden, they’re heavy, they’re hot, they make your foot itch, they limit your ability to do things, and you can’t get them wet (the plaster ones, anyway). However, casts play an important role in healing.

A cast that is properly applied keeps your foot in the prescribed position so the bones can heal in the right shape. A cast also protects your foot from further harm as you can’t dislodge the bone as it is healing and it prevents you from putting undue weight on your foot.

While it’s possible that your foot may have healed without a cast, if your doctor was concerned about the break being displaced, the cast was likely the best bet. You may be very good at using your crutches, but it would only take one loss of balance for you to be forced to put unexpected weight on your foot and cause more damage.

Flatfootedness is also called pes plano valgus or pronation. The calcaneus (heel bone) angles inward and the arch drops. Without support, the lack of an arch can cause foot pain and fatigue. Injury is a possible result.

When running, the heel of a normal foot hits the ground first. Some of the force is transferred or translated to the medial foot (arch of the foot). The arch flattens as it absorbs some of this shock. But if the foot is already flat, the extra load and force can cause problems over time.

There are several shoe designs that can help with this. The first is a balancing bar around the base of the heel. This bar supports the calcaneus in a neutral position and holds the foot steady. This keeps it from pronating too much.

A second design feature is an arch support. Simply placing the foot in a position that mimics a normal arch can be helpful. Some shoes have a motion control design to help absorb the shock.

Different materials are used in the midsole of the shoes. A soft flare on the outside of the shoe slows the pronation movement of the rear foot. At the same time, a firmer material in the midsole along the medial (inside) of the shoe helps prevent excessive pronation.

If possible, shop at a store where athletic equipment and clothing are sold. Ask for help finding the right kind of shoe for your interests and activities. Unless you have a severe foot deformity, this may be all you need.

Sometimes the type of shoes worn does make a difference. Even more important is making sure your shoes aren’t too run down and ready for the garbage. Many people wait too long to replace their running shoes.

Without proper support, injuries are more likely. This is especially true for folks with flat feet or other foot problems.

Studies show that running patterns change as you increase your mileage. The foot tends to pronate or flatten more during the landing phase of running. The load and impact on the foot increases as well. Stress along the medial (arch) side of the foot to the bottom of the big toe increases. So does the risk of injury.

Shoes with a special motion control design can help with this problem. This technology is fairly common. You should have no trouble finding this type of shoe. The most popular type has two different types of materials in the midsole of the shoe. Force, load, and position of the heel can be changed depending on where softer or firmer materials are placed.

He could have a second bout of compartment syndrome. Having it once does increase the chances of getting it again. But it doesn’t guarantee the problem will come back. Some of it depends on the original cause of the problem and the presence of any risk factors.

Trauma to the soft tissues or bone is the usual way compartment syndrome gets started. Only a handful of cases have been reported without a specific traumatic event. Running a marathon could be considered a traumatic event in itself. But it’s possible that your grandfather suffered a fall, twisted ankle, or other injury to his foot.

In the cases that have been reported, the patients recovered well from exertional compartment syndrome. One 40-year old man was able to resume running and training for marathons within six months’ time.

Compartment syndrome is an acute medical problem. Swelling and loss of blood supply to an area of confined muscle define the condition. It develops following injury, surgery or in many cases, repetitive motion.

Increased pressure caused by inflammation within the confined space of a fascial compartment cuts off blood supply to the area. Without prompt treatment, nerve damage and muscle necrosis (death) can occur.

This condition is most commonly seen in the anterior compartment (front of the leg or shin) and posterior compartment (back) of the leg. It can occur anywhere there are groups of muscles contained within the tight boundaries of connective tissue.

The connective tissue doesn’t stretch so any bleeding or inflammation in the area can cause the pressure inside the compartment to rise rapidly. Once the pressure starts to rise in one compartment, it can rise in others as well. Fasciotomy to cut the fascia around the compartment and relieve the pressure may be required. This is a decompressive procedure.

Fractures, hemorrhage, too-tight casts, crush injuries, burns, and injection drug use are some of the ways traumatic compartment syndromes develop. In your case, it could be a case of exertional compartment syndrome.

Compartment syndrome can occur in a runner as a result of repetitive heavy use of the muscles. It’s not usually an emergency. But the loss of circulation can cause temporary or permanent damage to nearby nerves and muscle. In severe cases, long-term deformities of the foot can develop from nerve damage and muscle contractures.

Stretching the calf muscle and/or the plantar fascia itself can be very effective. Improving ankle motion and flexibility can bring pain relief for many people who have this condition.

The first stretch (the calf stretch) can be done in several different ways. The most commonly used stretch is the standing wall stretch. Stand in front of a blank wall with your feet two to three feet away from the wall. You should be about an arm’s length away from the wall. Lean toward the wall and brace yourself against it with your hands.

Place one leg forward with the knee bent. Hold the other leg back with the knee straight and the heel down. Most of your weight is on this back leg. Keeping your back straight, move your hips toward the wall until you feel a stretch in the lower leg and calf. Hold for 20 to 30 seconds. Relax and rest one minute. Repeat the stretch. You may prefer to hold it one time for 60, 90, or more seconds. Switch legs and do the stretch on the other leg.

The second stretch is for the plantar fascia. While in the sitting position, place your feet flat on the floor. Keep the heel down and lift the toes and foot up off the floor. Hold the same amount of time as mentioned for the ankle calf stretch. Repeat on the other side.

You can also use a tennis ball or rolling pin to roll very gently along the bottom of your feet. This is another way to stretch the plantar fascia ligament. One other popular stretch is called the windlass mechanism. While still in the sitting position, place your leg/foot that has the plantar fasciitis across the other knee. Very gently, pull your toes up with your hand. You can massage the bottom of the foot while doing this. Hold for as long as you can and release. Repeat.

All stretches should be done two or three times each day. The stretch can be held for anywhere from 20 seconds to three full minutes. Studies have not been able to determine the perfect length of time to hold a stretch for this condition. You’ll have to try different holding patterns to see what works best for you.

The stretch should be felt as a stretch but not as a painful (can’t-bear-it-another-second) sensation. Stretching alone may not be enough to reduce the painful symptoms. If the foot is pronated (flat foot position), repetitive microtrauma can occur with every step you take causing ongoing symptoms. You may need an orthotic inside your shoe to help hold and support your foot and ankle in good alignment.

Plantar fasciitis is a common cause of heel pain in the United States. The connective tissue along the bottom of the foot is usually involved. This band of tissue is referred to as the plantar aponeurosis or fascia. It runs from the base of the calcaneus (heel bone) to the base of the metatarsal (long toe) bones.

The exact cause of this problem remains a mystery. We know that anything that reduces ankle motion (specifically dorsiflexion — pulling the toes up toward the face) can result in plantar fasciitis. Obesity seems to be a major factor as well. Standing for long hours on the feet is a third risk factor.

The first step is to find out for sure if your symptoms are really caused by plantar fasciitis. There are many other possible causes of heel pain, including tumors and fractures. You should see your physician for an examination.

If you do indeed have plantar fasciitis, then there are a number of treatment options that might help. Stretching, taping, and a night splint are three of the most common approaches. Calf stretching is advised by many experts. This may help improve ankle motion as well as stretch the surrounding soft tissues.

Adhesive taping seems to offer pain relief — at least in the short run. Taping may be more effective when it’s combined with a heat treatment called iontophoresis. With iontophoresis, a physical therapist uses ultrasound to drive anti-inflammatory chemicals through the skin directly to the inflamed area.

Night splints have a similar use. Besides stretching the soft tissues, this device also holds the foot in proper alignment. This takes the stress and pressure off the plantar fascia. Reducing strain and load on the fascia and maintaining the proper foot arch may provide pain relief and improved function of the foot and ankle complex.

All of these treatment approaches can be obtained through the services and skills of a physical therapist. If anything is going to help, the treatment methods described here will be effective in one to three months. Your physician will help determine the best approach for you and follow your progress throughout this time.

If you suspect you have a broken toe, you should get it checked by a physician. This is important in case it is more than just a simple break. However, there are some things you can do to relieve your pain before you see your doctor.

The standard treatment for any type of fracture is rest, elevation and ice. By applying ice to your toe, you can reduce the swelling and the pain. Be sure not to put the ice directly on your skin and to remove it after 20 minutes or so for a break.

Elevate your foot while you sit and try not to walk as much as is possible.

Therapeutic footwear is an important tool in the treatment of the diabetic foot. Loss of protective sensation and foot deformities are the two most common uses for shoe modifications and/or foot orthoses in patients with diabetes.

A foot orthotic or orthosis (orthoses, plural) fits inside the shoe. It can be taken off-the-shelf and used as is or (more often) a custom-made insert is needed. Foot orthoses are designed to take the load or pressure off certain areas of the skin, especially over areas where the bones stick out. This idea is called off-loading.

Orthoses can be used to decrease shear forces, cushion tender spots, and support and control the foot. It’s hard to believe but something as small and as simple as a shoe insert can improve your balance and the way you walk. It can protect your foot from injuries or pressure ulcers that can lead to loss of limb.

You may not need any kind of supportive footwear. But if you do, then a podiatrist, orthotist, or pedorthist can help you. The pedorthist is trained and certified in the selection and management of footwear for all kinds of patients.

Not all shoes are wide enough for an orthotic. This has to be taken into consideration when making or selecting the right device for you. Take your two most favorite shoes with you to your appointment. You may need a modified shoe as well as an orthotic. The pedorthist will help find what’s best for you.

A pedorthist specializes in footwear. This can include the shoes themselves but is usually much broader than that. Anything used on the foot to solve a foot problem comes under the jurisdiction of a pedorthist. This can include boots, slippers, sandals, socks, hosiery, night splints, bandages, and braces.

Another commonly prepared shoe insert used by C.Peds is the foot orthosis. These arch supports or shoe inserts can make a big difference in alignment, comfort, and support of the foot and ankle. Even biomechanics of the leg can be affected by the right foot and ankle support.

When choosing a pedorthist, you’ll want to see a certified pedorthist or C.Ped. The C.Ped will select, make and/or modify footwear and orthoses to help you maintain or regain as much mobility as possible. Support, stability, cushion, and protection of the foot are needed by many patients in order to maintain or improve walking.

When ability to walk is affected, footwear can be a crucial part of the treatment. Sometimes currently available shoes can be modified. In other cases, a mold or model must be taken of the foot and a custom insert is designed. Computer scanning has now made it possible to use 3-D models to create a custom designed supportive device.

The C.Ped has training and expertise in all of these areas. He or she will work with you for as long as it takes to get the right fit and best support possible.

Your recovery time depends on several factors. Your age, general health, and diet and nutrition are very important in the recovery process. Older adults (60 years and older) tend to have more problems with bone healing. Those who have diabetes, heart disease, or peripheral vascular disease can have a delayed rehab process.

The presence of osteopenia (low bone mass) or osteoporosis (brittle bones) can really slow things down. This may mean being nonweight-bearing for a period of time after the operation.

For some patients, the surgeon can apply a weight-bearing cast. This will immobilize your foot but you’ll still be able to get around the dance floor. You probably won’t be able to dance until the cast is removed and you have enough strength and joint proprioception (sense of joint position) back.

The surgeon can use X-rays to help monitor the progress of the bone healing. This may help move you along in the rehab and recovery process. You can expect a recovery time of at least six to eight weeks and maybe longer depending on your own risk factors.

There’s always a risk of recurrence with reconstruction of the foot for hallux valgus (bunions). Some procedures are riskier than others. It may depend on the extent of the operation and the condition of the bone.

Patients with osteopenia (low bone mass) or osteoporosis (brittle bones) may have a delayed healing. This can compromise the operation, especially if pins or screws (fixation) are used to hold the bone in place.

Movement between bones can occur even with fixation. This can delay and even prevent healing from taking place. Older adults (over 60 years of age) tend to have more problems than younger patients. Other complications can include infection, joint stiffness, and joint arthritis.

Because of some of the problems that occur with corrective hallux valgus surgery, current procedures are being changed or modified. Fewer surgeons are doing the operation from underneath the foot. They are using an incision from the side of the foot instead. Malunion is less likely to occur with this approach.

Some patients just aren’t good candidates for this surgery. Severe arthritis of the first toe joints and severe foot instability may be two reasons conservative care is used instead of operative care.

It’s possible there is a simple solution to your failed surgery. A revision (second) operation may be able to correct the problem. Ask your surgeon what (if any) are your options at this point.

Tendons are made up of strong, fibrous tissue and their job is to connect muscle to bone. The Achilles tendon, located in the back of your leg, just above the heel, has a very big job. This tendon bears the body weight plus the weight and force of acceleration – often without any warm up.

The Achilles tendon can be hurt by suddenly starting up without adequate warming up to stretch the tendon, adding one too many stairs or climbs to your regular routine, running too fast too suddenly, or overuse. It can also be hurt by a trauma, such as being hit with an object.

The best way to prevent such an injury is by proper warming up and cooling down, and to be smart about exercising within your body’s limits.