I. Heel Pain Has Many Causes
Pain, such as may occur in our heels, alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.
a.) Heel Spurs
A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch.
Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone.
These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
b.) Plantar Fasciitis
Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.
The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that can accompany an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
c.) Excessive Pronation
Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward.
Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
d.) Disease and Heel Pain
Some general health conditions can also bring about heel pain.
i.) Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
ii.) An inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth can also call heel pain. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur.
iii.) Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called achilles tendinitis.
It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone.
This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
iv.) Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
v.) Stress fractures of the heel bone also can occur, although infrequently.
vi.) Children’s Heel Pain occurs most commonly between ages 8 and 13, as children become increasingly active in sports activity in and out of school.
This physical activity, particularly jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur.
When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief.
Make an appointment
With our seven locations across Middle Tennessee, Nashville Foot and Ankle Group has an office near you!
Call your nearest Nashville podiatrist today and a member of our courteous and smiling staff will be happy to assist you!
II. What Is a Bunion?
A bunion is an enlargement of the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place.
This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated.
The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion– from the Latin "bunio," meaning enlargement– can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor’s bunion."
a.) Bunion Symptoms
- A firm bump on the outside edge of the foot, at the base of the big toe.
- Redness, swelling, or pain at or near the MTP joint.
- Corns or other irritations caused by the overlap of the first and second toes.
- Restricted or painful motion of the big toe.
b.) Bunion Causes
Bunions form when the normal balance of forces exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability in the joint and cause the deformity.
They are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk, and our inherited foot type, our shoes, or other sources.
Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.
Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
c.) Bunion Remedies
- Apply a commercial, nonmedicated bunion pad around the bony prominence.
- Wear shoes with a wide and deep toe box.
- If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid high-heeled shoes over two inches tall.
See your podiatric physician if pain persists.
d.) Podiatric Treatment For Bunion Pain
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery.
Podiatric medical attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less of an option.
The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. A podiatric physician may recommend these treatments:
- Padding and taping the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.
- Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by joint deformities.
- Physical Therapy is also used to provide relief of the inflammation and from bunion pain.
- Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
- Orthotic shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
e.) Podiatric Surgical Options for Bunions
When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint.
Several surgical procedures are available to the podiatric physician. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.
A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint.
Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatric physician.
f.) Bunion Tips
- Wear comfortable shoes that conform to the shape of your foot.
- Wear shoes with a wide and deep toe box.
- Always fit the larger foot and have your feet sized each time you purchase shoes.
- Apply a commercial, nonmedicated bunion pad around the bony prominence.
- If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid high-heeled shoes over two inches tall.
- Seek professional podiatric evaluation and assistance with uncomfortable or noticeable bunions.
Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all foot conditions.
This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.
Make an appointment
With our seven locations across Middle Tennessee, Nashville Foot and Ankle Group has an office near you.
Call your nearest Nashville podiatrist today and a member of our courteous and smiling staff will be happy to assist you.
III. What is a Hammertoe?
A hammertoe is a contracture—or bending—of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side.
Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common to females than males.
There are two different types:
Flexible Hammertoes:
These are less serious because they can be diagnosed and treated while still in the developmental stage.
They are called flexible hammertoes because they are still moveable at the joint.
Rigid Hammertoes:
This variety is more developed and more serious than the flexible condition. Rigid hammertoes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment.
The tendons in a rigid hammertoe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.
a.) Hammertoe Symptoms
- Pain upon pressure at the top of the bent toe from footwear.
- The formation of corns on the top of the joint.
- Redness and swelling at the joint contracture.
- Restricted or painful motion of the toe joint.
- Pain in the ball of the foot at the base of the affected toe.
b.) Hammertoe Causes
A hammertoe is formed due an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture.
Heredity and trauma can also lead to the formation of a hammertoe.
Arthritis is another factor, because the balance around the toe in people with arthritis is so disrupted that a hammertoe may develop.
Wearing shoes that are too tight and cause the toes to squeeze can also be a cause for a hammertoe to form.
c.) Hammertoe Remedies
- Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
- Wear a shoe with a deep toe box.
- If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid heels more than two inches tall.
- A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician’s office will be necessary to repair the toe to allow for normal foot function.
- Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
See your podiatric physician if pain persists.
d.) Podiatric Hammertoe Treatment
The treatment options vary with the type and severity of each hammertoe, although identifying the deformity early in its development is important to avoid surgery.
Podiatric medical attention should be sought at the first indication of pain and discomfort because, if left untreated, hammertoes tend to become rigid, making a nonsurgical treatment less of an option.
Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.
i.) Padding and Taping:
Often this is the first step in a treatment plan. Padding the hammertoe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain.
ii.) Medication:
Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.
iii.) Orthotic Devices:
Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammertoe deformity.
iv.) Surgical Options:
Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain.
Severe hammertoes, which are not fully reducible, may require more complex surgical procedures.
Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.
Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all foot conditions.
This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.
Make an appointment
With our seven locations across Middle Tennessee, Nashville Foot and Ankle Group has an office near you.
Call your nearest Nashville podiatrist today and a member of our courteous and smiling staff will be happy to assist you.
IV. Your Feet Aren’t Supposed to Hurt
Remember that foot pain is not normal. Healthy, pain-free feet are a key to your independence. At the first sign of pain, or any noticeable changes in your feet, seek professional podiatric medical care.
Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented.
Remember that the advice provided on this website should not be used as a substitute for a consultation or evaluation by a podiatric physician.
