A recent study published in the Scandanvian Journal of Medicine and Science in Sports found that the following simple strength-training exercise provides more relief than traditional stretching of the plantar fascia:
Stand barefoot with your sore foot on a step, a box or even a thick book, with a rolled-up towel placed under your toes and your heel hanging over the step’s back edge. Lift your other leg off the floor, bent slightly at the knee. Slowly raise your sore heel, count 3 seconds, pause for 2, then lower for 3 seconds. Do three sets of 8 to 12 repetitions every other day.
It has been a long winter in southern Ontario. Most people have limited their walking outside due to snow and ice on sidewalks and roads. The good news is most of the snow and ice has melted from the sidewalks making it safer to walk without slipping. The bad news is that first spring walk or run might lead to heel pain.
Plantar fasciitis is the most common cause of heel pain. The pain is caused by inflammation of the tissue along the bottom of your foot that connects your heel bone to your toes. Plantar fasciitis causes stabbing or burning pain that is usually worse in the morning because the fascia tightens overnight. The pain usually decreases as your foot limbers up, but it may return after standing for a long time or after getting up from a seated position. If plantar fasciitis is not dealt with quickly it can become chronic. The pain of plantar fasciitis can be dealt with by using conservative therapies however in a small number of cases surgical intervention may be indicated.
Plantar fasciitis usually comes on gradually, but can occur suddenly and be severe. It can affect both feet, but often occurs in only one foot at a time.
Sharp pain in the inside part of the bottom of your heels.
Heel pain that tends to be worse with the first few steps after awakening, climbing stairs or standing on your tiptoes.
Heel pain after standing long periods or after getting up from sitting.
Heel pain after, not during, exercise.
Mild swelling in your heel.
Normally, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot especially when you heel is lifting off the ground. The plantar fascia helps the foot from bending. If the foot structure is unstable, the plantar fascia can stretch or pull away from the heel bone. Small tears can be created in the fascia if tension on that bowstring becomes too great. Repeated stretching and tearing can cause the fascia to become irritated or inflamed and thickened.
Causes of the condition include:
Physical activity overload. It’s common in long-distance runners. Jogging, walking or stair climbing can also place too much stress on the heel bone and the soft tissue attached to it, especially when starting an aggressive exercise program. Even household exertion, such as moving furniture or large appliances, can trigger the pain.
Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal walking pattern, can adversely affect the way the weight is distributed when you’re on your feet, putting added stress on the plantar fascia.
Improper shoes. Thin-soled, loose shoes or ones which lack arch support or the ability to absorb shock don’t protect your feet. If you’re a wearer of high-heeled shoes, your Achilles tendon – which is attached to your heel – can contract and shorten, causing strain on the tissue around your heel.
Arthritis. Some types cause inflammation in the tendons in the bottom of your foot, leading to fasciitis.
Diabetes. We don’t know why, but plantar fasciitis occurs more often in diabetics.
Developing plantar fasciitis is more likely if you are:
Active in sports. This may put a lot of stress on your heel bone and attached tissue. Included are running, dancing and jumping.
High or low arched feet. Flat feet may have poor shock absorption, increasing the stretch and strain on the plantar fascia. High arched feet have tighter plantar fascia, which also leads to poor shock absorption.
Middle-aged or older. Heel pain tends to be more common with aging, because the arch of your foot tends to sag more, putting stress on the plantar fascia.
Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.
Pregnant. With this comes weight gain and swelling that can cause you body’s ligaments, including your foot ligaments, to relax. Mechanical problems and inflammatory conditions can result.
Occupation. Certain occupations demand this, such as teaching, working in a factory, or being a waitress. Damaging your plantar fascia is more common in these cases.
Wearing shoes with poor support or stiff soles. Using a lot of poorly designed pumps, loafers, and boots can lead to plantar problems.
Over time the plantar fascia can become thickened. This leads to a chronic pain situation which is more difficult to treat. Chronic pain in you heel will unfortunately change the way you walk and will put more stress on other joints in your body such as your ankles, knees and lower back. Chronic pain will limit your regular activities or your ability to work.
For most people, the condition improves within a year of starting conservative treatment. The longer you delay treatment the longer it will take to heal your plantar fasciitis.
Non-surgical treatments that may assist healing include:
Footwear. Footwear should have firm heel counters and a stiff midsole. The shoe should not be able to be twisted easily. The area across the ball of the foot should be flexible to allow for the toes to bend. If athletic footwear is required the type of athletic footwear should be sport specific. If a running shoe is required, the right class of running shoe should be determined. For example, do you require a cushioning running shoe, mild or moderate stability running shoe or a motion control running shoe?
Night splints. This is a splint fitted to your calf and foot while you sleep, holding the plantar fascia and Achilles tendon in a lengthened position overnight so they can be stretched more effectively.
Taping. Application of athletic taping to support the bottom of your foot. Foot orthotics are indicated if this arch taping is successful
Foot orthotics. These are over the counter or custom orthopedic devices that fit inside your shoes to help stabilize the foot bones. Foot orthotics can help distribute pressure more evenly underneath the plantar surfaces of both feet
Walking cast. A removable walking cast in chronic conditions
Exercise to stretch the calf muscles and to strengthen lower leg and foot muscles and increase range of motion of certain foot joints .
Ice massage to the area of the origin of the plantar fascia
Low level laser therapy to reduce pain and initiate healing
Mobilisations and manipulations of the foot joints.
When conservative treatments aren’t effective these treatments can be considered:
Corticosteroids injections. One or two injections of this kind of medication, such as Prednisone, into the region of the plantar fascia attachment at the heel, provides temporary relief. Multiple injections should be avoided because they can weaken your plantar fascia and even cause it to rupture, as well as shrink the fat pad covering the heel bone.
Extracorporeal shock wave therapy. Sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic cases unresponsive to conservative treatments. This is not used for children, pregnant women or people with a history of bleeding problems.
Plantar fasciotomy surgery. A small number of suffers need surgery to detach a plantar fascia from the heel bone (plantar fasciotomy). This is an option only when the pain is severe and all else fails. A side effect is weakening of the arch in your foot.
One of the analogies, I like using to explain plantar fasciitis is the flooded basement analogy. The water on the basement floor is like the symptoms of plantar fasciitis. You can get rid of the water but, the crack in the basement wall allowing water into the basement is the cause. If you don’t address the crack in the wall the water will come back into your basement during the next rainfall.
If you don’t address the cause of your plantar fasciitis your symptoms will come back.
In summary, your heel pain will reoccur if you don’t address your: faulty foot mechanics, weak or tight foot and lower leg muscles, physical activity levels, footwear, arthritis or diabetes.
Today is Groundhog Day in both Canada and the USA. The groundhog Wiarton Willie came out of his burrow and saw his shadow. Unfortunately, for us it means 6 more weeks of winter weather.
Winter weather can be difficult on our skin. The humidity inside our homes can be very dry especially if a humidifier is not installed on a furnace. You can see the effects low humidity on wood furniture. Skin needs to be hydrated or moisturized to maintain its ability to withstand stretching or tension.
Cracked dry skin especially on our feet can mean trouble. Some people suffer every winter with dry cracked heels or cracks on the bottom of their feet. As the skin gets drier it cannot withstand any type tension or pulling apart of the skin. This happens very easily on our heels. With every foot step we take, the skin at the edges of our heel will stretch. If our skin is adequately hydrated this skin stretching is not a problem. Dry skin is easier to stretch and tear causing deep cracks in the heels. As the body tries to repair the crack, thick callus will accumulate on either side of the crack. The deep crack in the skin can be painful because the nerve endings deep in the skin are aggravated.
Keeping your skin moisturized if you are diabetic is a must. If the skin becomes too dry on the foot it can change the balance of bacteria on the surface of the skin. There are many types of good bacteria that live on the skin. The good bacteria prevent the bad bacteria form causing skin infections. If the skin becomes too dry it will upset the balance of good bacteria and bad bacteria on the skin. Therefore dry skin can increase the risk for skin infections in the feet of diabetics.
You can prevent dry skin by regularly using an emollient or skin moisturizer. I recommend a urea-based skin moisturizers. Urea as a humectant. Humectants attract and retain moisture nearby by drawing the water vapor into and/or beneath the skin surface. I recommend using a urea based emollient at least once per day applied after a bath or shower. Urea based emollients can cause stinging when applied to the skin which is why applying after a shower or bath is recommended. Some examples of a urea based emollients are Dermal Therapy (25% urea), Uremol 20 (20% urea) and Urisec 22 (22% urea). If the cracked skin on your feet is not healed by using the recommended emollients you should seek treatment from your local chiropodist/podiatrist.
Be good to your feet moisturize your skin daily during the winter.
Over the past few weeks heel pain has sidelined or hobbled Albert Pujol’s of the Los Angeles Angels, Mike Napoli of the Boston Red Sox’s and Jarius Byrd of the Buffalo Bills. If you are student athlete going back to high school or university, heel pain is something you want to avoid. Heel pain will change the way you perform your sport.
If you are developing heel pain, you will start to notice pain when you take your first step in the morning. As time goes on, you will dread your first step out of bed because it is going to be painful. With practice you will perfect a method to keep as much weight off of your painful heel. You will realize the pain will get a little better as the day goes on but you also know that when you get home and sit down but have to get up again it’s going to be painful!
One of the main reasons heel pain occurs is because the plantar fascia pulls away from its attachment under the heel bone. This pulling away occurs with every step you take while walking or running. The plantar fascia has role to keep your foot stable as you lift your heel off the ground while walking or running. The plantar fascia helps to resist your foot from bending.
To give you an idea of what I am describing, I want you to take your hand and place it with your palm down on top of a table. Slowly lift the palm of your hand off the table. The more you lift your palm, the more you will pivot on the tips of your fingers. Now bend you hand, you will feel a tightening in the palm of your hand. You have just stretched your palmar fascia. When you bend your hand this is simulating what your foot is doing when you lift your heel off the ground and the weight is on your forefoot.
When we walk or run, there is a small period of time when all the weight of our body is only supported on one foot. During this time the heel lifts off the ground and the foot will want to bend. If the foot is stable not much bending will occur to stress the plantar fascia. If your foot is unstable, the foot will bend in the middle and the plantar fascia will try to prevent the foot from bending. This is when the damage to the plantar fascia occurs causing heel pain.
Your foot can be unstable for a number of reasons, the most common reason is flat feet. If your foot is unstable because you have flat feet you may not be able to withstand the bending forces applied to the middle of the foot especially if you play a sport that involves running, jumping, or twisting of the foot.
Whatever sport you play make sure you have the right type of footwear for the demands of your sport. You may require a custom made foot orthoses to help to stabilize your foot and prevent the bending forces on the foot. Most sports shoes will be orthotic friendly however some sports shoes such as soccer shoes may not be orthotic friendly.
The orthotic used for heel pain is pathology specific. It will have wide orthotic shell to support the mid-foot joints, a deep heel cup to stabilize the heel with and cushioning in the bottom of the heel cup.
If your heel pain has lasted for more than 2 weeks and the intensity of the pain is getting worse you should immediately seek professional help from a chiropodist/podiatrist or your family doctor. The longer your heel pain is left untreated, the greater the chance it can become chronic. The longer you have heel pain the more likely you will start to change the way you walk or run leading other problems. In the worst case scenario, you can develop heel pain in the other heel because you have compensated by putting more weigh on the non-painful heel.
I routinely see patients with heel pain who have waited longer than 4 to 6 months before they seek treatment or they have followed bad advice. If you have chronic heel pain it may require a longer duration of time and a more comprehensive approach to resolve your heel pain. If your heel pain is not chronic there is usually an easy solution for your heel pain. If you have heel pain do not let it become chronic and get treatment at the earliest possible date.
Thick, yellow nails are usually caused by the presence of a fungal nail infection. A fungal infection of the toe nails is a common foot problem. Nail fungus (onychomycosis) is an infection of the nail plate and nail bed. It is caused by various types of fungi, which are commonly found throughout the environment. Fungi are simple parasitic plant organisms that do not require sunlight for growth. A group of fungi called dermatophytes have evolved to attack human nails and skin.
The infection of the nail begins with some type of trauma to the nail. The dermatophyte gains entry into the nail and begins to feed on the nail protein called keratin. The big toe nail is the most commonly infected toe nail.
Our big toe nails can get damaged or traumatized from:
The way we walk or run. ( because of a unstable low arched foot or bunion)
The shoes we wear ( tight fitting shoes or high heels)
The type of job (the requirement to use steel-toed safety boots).
Furthermore, the environment inside of a shoe is dark and damp which provides a perfect growing climate for nails and skin fungus. Other contributory factors are a history of athlete's foot (fungal skin infection of the foot) and sweaty feet.
Several research studies have estimated onychomycosis affects 3% to 13% of the population. The vast majority of people who have fungal nails don't even recognize the existence of a problem and therefore don't seek treatment for many years because their thick nails are not yet causing them pain.
The rate of fungal infections rises sharply among older adults above 65 years as they start to experience more medical problems. For instance, those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. This can result in fungal nails being considered a minor problem in comparison to other concurrent medical problems.
Fungal infections of the nail can be graded as mild, moderate or severe. The severe fungal nail infection occurs when the infection extends into the nail matrix (the area of the nail at the base which has white half-moon). A severe fungal nail infection is very difficult to treat and has a poor prognosis.
Fungal nails can be treated by:
Thinning the nail plate
Removing diseased nail and fungal debris back to healthy appearing nail.
Applying topical nail softeners and topical anti-fungal medication exposed nail bed and remaining nail plate
Application of laser to nail plate
Oral anti-fungal medication
If you suspect you have a fungal nail infection you should visit a chiropodist/podiatrist to confirm if you have a fungal nail infection and discuss your treatment options.
Recently on the Ellen Show Mark Wahlberg discussed the removal of a portion of nail that was causing him pain in his nail groove. His co star Micky O'Keefe from the movie "The Fighter" advised Mark to see his daughter-in-law who is a podiatrist. A portion of Mark's big toenail that was digging into his skin was removed permanently so it would not grow back.
I use an internet service called Google Alerts. I subscribed to an alert for "Ingrown nails". Any query on "ingrown nails" is sent to my smart phone. One of the most common questions concerning ingrown nails is from the website "answers.yahoo.com" . Most questions are usually "what I can do to cure or get rid of my ingrown toenail". This type of question occurs daily. Many people suffer from the pain of ingrown nails.
Mark Wahlberg stated his nail was growing the wrong way. I am only guessing but Mark may have tried to cut his nail hoping to relieve the pressure in his nail groove. Unfortunately this action may have made the problem worse. He may have also aggravated the problem by wearing tight shoes. I'm glad he took the advice of visiting a podiatrist.
Ingrown nails usually pierce the skin causing inflammation and infection. If an ingrown nail is treated early all that may be required is the removal of a small piece of nail to alleviate the problem, most times without the need for freezing.
Unfortunately, some people delay treatment of their infected ingrown nail. Usually in these cases, the nail is highly curved which puts a great amount of pressure in the nail groove. The consequence of delayed treatment is procedure requiring a permanent partial or total removal of the nail performed using local anesthesia. This procedure uses a chemical called phenol to destroy the nail matrix. Destruction of the nail matrix prevents the removed nail from growing back.. The post operative care requires soaking of the nail bed using salt water followed by the use of an antibiotic cream. In some cases, if the infection is moderate to severe an oral antibiotic may be required. Generally the nail procedure will take about two to three weeks to heal.
Do not delay seeking treatment for an ingrown nail. It will probably only get worse.