Our Cherry Hill, NJ & Ridley Park, PA Podiatrists are Foot & Ankle Pain Specialists
HEEL PAIN - PLANTAR FASCIITIS
Understanding Plantar Fasciitis
Plantar fasciitis is an inflammatory response that is caused by degenerative irritation at the insertion of the plantar fascia ligament—which is a thick band of tissue that attaches your heel bone to your toes. These ligaments act as shock absorbers that support the arch of your foot. However, too much pressure can cause the ligaments to become inflamed—when this occurs, the inflammation often causes heel pain and stiffness. This pain is most often felt when you take your first steps after getting out of bed or after extended periods of inactivity.
While most people associate plantar fasciitis with runners, it can be diagnosed in almost anyone regardless of their activity level. Increased pressure on the plantar fascia is thought to be the main cause of plantar fasciitis. Because of this, individuals who are overweight or obese have more risk of developing the condition.
How is Plantar Fasciitis Diagnosed?
Your podiatrist will perform a physical exam to check for pain and/or tenderness in your foot. He or she will locate the exact location of your pain in order to rule out other foot conditions. Next, your podiatrist may ask you to perform various stretches to test the strength and health of the plantar fascia ligaments.
If the physical exam is not enough to diagnose the cause of your heel pain, your doctor may order x-rays of your foot to verify there is no stress fracture or other issue causing the pain.
Plantar Fasciitis Treatment
Initial treatment for plantar fasciitis usually involves conservative approach such as rest, ice, and avoidance of certain exercises. Other conservative treatment methods include:
Shock Wave Therapy (ESWT)
Orthotics/padding: Custom orthotics or heel pads may be used to cushion the foot and prevent pain.
Stretches: Various stretches can be performed to elongate the plantar fascia ligament and relieve pain.
Night splint: Your doctor may recommend a night splint to hold your foot at a specific angle to prevent ligaments from contracting during sleep.
Injections: Anti-inflammatory steroid injections may be used to relieve inflammation and prevent pain.
More severe cases of plantar fasciitis might require surgery. The most common surgical procedure is known as a plantar fascia release, where the surgeon releases a portion of the plantar fascia ligament from the heel bone to relieve tension and pain. Surgery is often seen as a last result after conservative approaches have failed.
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What is a Heel Spur?
A heel spur is calcium deposit located underneath the heel that causes small pieces of bone to protrude. Pain associated with heel spurs is often confused with another condition called plantar fasciitis—which refers to inflammation in plantar fascia ligament. A heel spur, on the other hand, is a piece of bone that forms on the heel bone itself.
In most cases, heel spurs do not cause any symptoms. Although there are cases where heel spurs are associated with intermittent or chronic pain. However, the heel spur itself is not necessarily the root of the pain. Instead, the pain is attributed to the inflammation or irritation of the plantar fascia ligament. Pain is usually worst in the morning when you first wake up, but it recedes as ligaments loosen.
Heel Spur Causes
Heel spurs take months to develop and may go completely unnoticed. Heel spurs are most often a result of too much stress or pressure on the ligaments in the foot. They can also be the result of repeated tearing of the membrane that covers the heel bone. The same physical activities that cause plantar fasciitis can result in heel spurs.
Other significant factors that contribute to the development of heel spurs include:
Mechanical defects that cause gait abnormalities
Tight calf muscles that limit ankle flexibility
Being overweight or obese
Poorly shoe choice
Activities that demand extended time on your feet
Heel spurs cannot be diagnosed through a physical exam; they can only be seen using an x-ray. In fact, many heel spurs are diagnosed based off images your doctor takes while looking for something else. When heel pain persists for more than a month, you should contact your podiatrist. He or she may recommend the following non-invasive treatment methods:
Various stretching exercises
Most cases of heel pain can be treated with conservative methods, but anti-inflammatory medications or injections may also be recommended. These medications not only reduce pain, but inflammation too. Contact Dr. Lee S. Cohen & Associates today for a comprehensive evaluation.
What is Haglund’s Deformity?
Also known as the “pump bump”, Haglund’s deformity is a condition that causes the bone section of your heel—where the Achilles tendon is—to become enlarged or inflamed. Wearing shoes that put too much pressure on the back of the heel, which causes inflammation, most often causes Haglund’s deformity.
If left untreated, Haglund’s deformity can lead to bursitis—which is an inflammation of the fluid-filled sac that separates the tendon from the bone. When the heel becomes inflamed, it can actually calcify the heel bone and cause the bump to become more prominent. When this happens, pain becomes more noticeable and basic foot function could be affected.
Causes of Haglund’s Deformity
As its other name “pump bump” implies, the rigid backs of “pump-style” shoes usually cause Haglund’s deformity. These shoes create pressure that aggravates the growth during normal activities, like walking.
In addition to poor shoe choice, these factors can also contribute to the formation of Haglund’s deformity:
Having a high-arched foot
Having a tight Achilles tendon
Poor walking mechanics
Haglund’s Deformity Symptoms
Most cases of Haglund’s deformity are very painful—especially in the area where the growth is located o the heel. Other common symptoms of Haglund’s deformity include:
Noticeable bump on the back of the heel
Severe pain in the heel
Swelling in the heel
Redness or tenderness near the inflamed area
Diagnosis & Treatment Options
Because its symptoms are so similar to those of other common foot conditions—like arthritis—Haglund’s deformity can be difficult to diagnose. Your podiatrist may be able to diagnose this condition based off the appearance of your heel—although some cases require further diagnostic and imaging tests to confirm the diagnosis.
Treating Haglund’s deformity involves relieving pressure from the heel bone. This can be accomplished surgically or non-surgically—the treatment depends on the severity of your symptoms. For mild to moderate Haglund’s deformity, the following non-surgical treatments may be performed:
Heel pads or cushions
If non-surgical options are ineffective, your podiatrist may recommend a surgical procedure to relieve pressure from the heel bone. This can be done by removing excess bone from the heel or smoothing existing bone. These procedures are very effective in relieving pressure from the bone and surrounding soft-tissues. Contact Dr. Lee S. Cohen and Associates for a comprehensive evaluation.
What is Tendonitis?
Tendons are tough, but flexible bands of fibrous tissue that attach muscles to bone. Tendonitis is a very common cause of foot or ankle pain—it usually occurs due to inflammation around a tendon. This condition most often is the result of an overuse injury, but improper stretching prior to or incorrect form during physical activity can also contribute to the tendonitis.
Symptoms of Tendonitis
Tendon injuries can be acute, meaning they occur suddenly, or they can be chronic and develop over a period of time. Pain associated with tendonitis is typically dull and aching, but as the condition worsens, you may experience sharp, burning, or radiating pain around the foot or ankle. Other symptoms of tendonitis include:
Types of Tendonitis
The most common forms of tendonitis that affect the foot and ankle include:
Achilles tendonitis: The Achilles tendon is the largest tendon in the foot, and it attaches the calf muscles to the back of the heel. Achilles tendonitis occurs when this tendon becomes inflamed.
Posterior tibial tendonitis: This condition occurs when the posterior tibial tendon, which attaches the calf muscle to the bones on the inside of the foot, becomes inflamed or ruptured.
Peroneal tendonitis: The peroneal tendons run down the outside of the ankle just behind the fibula and can become strained and inflamed due to overuse.
Flexor tendonitis: The flexor tendon is responsible for stabilizing the toes. Pain may be felt in the arch of the foot or on the inside back of the ankle.
Diagnosis and Treatment of Tendonitis
Because tendon injuries typically worsen without proper treatment, immediate medical care is usually recommended. To diagnose your condition, your doctor will perform a physical examination and gather your medical history. During the physical examination, your doctor will look for instability, swelling, and weakness.
The goal of medical tendonitis treatment is to alleviate pain and inflammation.
Shock Wave Therapy (ESWT)
New shoe Recommendations
Anti-inflammatory or Cortisone Injections
When the condition does not respond to noninvasive treatments, minimally invasive surgical procedures may be required.
Contact Dr. Lee S. Cohen & Associates today for a complete evaluation
What is a Stress Fracture?
Stress fractures are tiny cracks that appear in your bones. These injuries are common in the bones in the lower body because these bones are responsible for distributing and bearing your body weight. Feet are particularly vulnerable to stress fractures because they are responsible for absorbing your body weight during normal activities—such as walking, running or jumping.
The most common area affected by stress fractures in the lower body is the tibia—or shin bone. Also called “shin splints”, this pain is usually felt during physical activity. In reality, shin splints are not stressed fractures—they are the result of muscle pulling away from the bone. When they first appear, patients are advised to stop training altogether because muscle shin splints can actually cause stress fractures.
Symptoms & Causes of Stress Fractures
Stress fractures are usually the result of an overuse injury and are most commonly experienced in runners and other athletes. Stress fractures occur over time due to repetitive forces that occur on weight-bearing bones and supporting muscles. This constant repetition eventually causes small cracks to form in the bone.
Because stress fractures so small, they typically don’t cause any pain at first. However, over time—with enough repetitive motion—pain can develop in the affected area. While repetition and overuse are the most common causes of stress fractures, there are other factors that contribute to their development. Some of these causes include:
Inflexible or weak muscles
Training on the wrong surfaces
Wearing improper or ill-fitting footwear
Family history of osteoporosis
Diagnosis & Treatment of Stress Fractures
To diagnose a stress fracture, your podiatrist will discuss your medical history and gather information about your symptoms. Then, he or she will perform a physical examination where they will check for areas of tenderness and pain. Once located, your podiatrist may recommend imaging tests—like x-rays or an ultrasound—to help confirm the diagnosis.
The treatment depends on the severity of your stress fracture. For mild stress fractures, your doctor will probably recommend non-surgical treatment. Some of these treatments include:
When a stress fracture does not respond to the above methods, surgery may be recommended. Surgery usually involves inserting some type of fastener—like pins, screws, and/or plates—to support the bones in the foot or shin. Schedule an appointment with Dr. Lee S. Cohen & Associates for a complete evaluation