HEEL SPURS

HEEL SPUR SYNDROME

A very common reason for patients to seek a podiatrist’s help is due to the pain of plantar fasciitis / heel spur.  Those afflicted are generally active, overweight, and posses an unstable foot type, either high arched, or flat.   Athletes have a higher incidence of heel spurs than the overall population.

The intensity of pain may not vary with the shape and location of the spur, size is not a crucial factor. Most heel spurs are painless at first and may only be discovered while the foot is being x-rayed due to another problem. The spur may later go on to become symptomatic and cause pain and disability.

A heel spur is a bony overgrowth just in front of the heel bone extending along its entire width. Initially the patient has discomfort upon taking the first steps of the day in the morning or standing on their feet after sitting for a prolonged time. Once walking for a few minutes, the arch starts to stretch out and the heel pain decreases to some degree but tends to get worse again at the end of the day. Pain also returns after beginning to walk after periods of non ambulating. Upon examination, there is a localized area of pain under the inner aspect of the heel.

The major cause of heel spurs is abnormal pronation due to an unstable foot type. There is a strong ligament called the plantar fascia, which attached to the front of the heel and stretches along the sole of the foot to the front of the metatarsals. With pronation this ligament is stressed and over a long period of time, reactive changes cause the bone spur.

Treatment can usually be successful without the need for surgical intervention. In the initial treatment, taping of the foot to provide biomechanical control to reduce abnormal pronation, local injection therapy, and anti inflammatory medications are employed. Usually, four or five weekly treatments eliminate the painful complaints while normal routine is uninterrupted. Orthotics are then custom fabricated to control pronation and reduce fascial strain. Over ninety percent of all heel spurs are controlled in this manner. In the remainder of the cases the painful spur must be surgically removed and the tension on the plantar fascia must be released. The patient wears a special shoe for a few weeks, then gradually goes back to regular shoes.

The heel spur syndrome is a common foot ailment which usually responds to conservative medical and biomechanical care and does not have to be a source of discomfort and disability to the patient.

Diabetic foot care

FOOT CARE HINTS

FOR PATIENTS WITH DIABETES OR POOR CIRCULATION 

Many patients with diabetes don’t realize just how much this disease impacts and affects the circulation and nerves to their feet,  leaving them at risk for delayed healing,  infections, ulcerations, neuropathy, gangrene and amputations among other complications.  It is much easier and preferable to prevent a complication to begin with than to deal with an existing complication.  With that in mind I would like to post these do and don’t rules for optimum foot care with diabetes.   These rules would also apply to those with PVD (peripheral vascular disease) or people with generally poor circulation.

FIRST THE DO’S

Do inspect your feet daily for blisters, cuts, scratches, ulcers.

Do wash your feet daily with warm (not hot) water and soap.  Test bath water with hand.

Do dry feet thoroughly, especially between toes with a blotting action.

Do apply a skin cream after drying feet , avoid between toes.

Do keep feet warm and dry.

Do wear comfortable well fitting shoes.

Do inspect inside of shoes for foreign objects and torn linings.

Do change your shoes everyday.

Do buy all shoe gear at days end when feet are their largest.

Do wear loose fitting socks to bed if feet are cold.

Do avoid wet feet, wet shoes or wet socks, especially during the winter months.

Do avoid extremes of temperature, hot or cold.

Do keep all appointments that your physician or podiatrist schedule for you.

NOW THE DON’TS

 Don’t walk barefoot indoor or outdoors.

Don’t cut corns, calluses, or nails yourself.

Don’t pull or tear any dead skin from toes, corns, feet.

Don’t use caustic chemical agents for the removal of corns and calluses.

Don’t smoke.  Smoking reduces circulation.

Don’t wear any garters that encircle the leg.

Don’t wear shoes without stockings.

Don’t wear the same shoes or socks more than 1 day in a row.

Don’t soak feet unless directed.

PLANTAR FASCIITIS

PLANTAR  FASCIITIS

 

      A very common reason to see a podiatrist is plantar fasciitis.   This foot problem leads to arch and heel pain where the sufferer usually finds the first steps of the day the most painful.  Pain can be all day long but many times patients find that anytime they start walking after being off their feet for a period of time the most painful where the pain lessens or disappears after a period of ambulation.  This problem is caused by inflammation of the ligament that makes up the arch support of the foot called the plantar fascia.

The major cause of this is abnormal pronation due to an unstable foot type.   This ligament which attaches to the front of the heel bone and runs along the sole of the foot to the balls of your feet is stretched and strained beyond its normal ability to stretch and results in inflammation as the bony portion of the arch collapses and the foot rolls in as you walk.

Initial treatment goals are to reduce the inflammation and pain through biomechanical control with foot strappings, anti-inflammatory medications and possibly cortisone injections.   Orthotics are then custom fabricated to control pronation and reduce facial strain.  These orthotics are then worn in the patients shoes.  By eliminating the unstable forces causing the inflammation and pain of the plantar fascia, orthotics stabilize the function of the feet and prevent recurrence of the symptoms.