Tag Archives: Achilles tendon

Heel pain

Alternative Names: Pain – heel

Defination:
Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone.

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Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).

There are 26 bones in the human foot, of which the heel (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running. Consequently, the heel is vulnerable to damage, and ultimately pain.

Heel pain is usually felt either under the heel or just behind it.
There are 26 bones in the human foot, of which the heel is the largest.
Pain typically comes on gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe.
In most cases the pain is under the foot, towards the front of the heel.
The majority of patients recover with conservative treatments within months.
Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain.
To prevent heel pain, it’s recommended to reduce the stress on that part of the body

Symptoms:
Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed).

In most cases, the pain is under the foot, toward the front of the heel.

Post-static dyskinesia (pain after rest) – symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day.

After a bit of activity symptoms often improve a bit. However, they may worsen again toward the end of the day.

Causes:
In the majority of cases, heel pain has a mechanical cause. Heel pain tends to occur if a person has flat feet or high arches, is overweight, diabetic, wears poorly fitting or worn out shoes, runs or jogs on hard surfaces or has an abnormal gait.  Quite often the pain is due to a “spur” or extra bone growth.It may also be caused by arthritis, infection, an autoimmune problem trauma, a neurological problem, or some other systemic condition (condition that affects the whole body).

Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel.

The most common causes of heel pain are:

*Plantar fasciitis (plantar fasciosis) – inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot. When the plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too

*Heel bursitis  inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse

*Heel bumps (pump bumps) – common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature

*Tarsal tunnel syndrome a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot..

*Chronic inflammation of the heel pad—caused either by the heel pad becoming too thin, or heavy footsteps
Stress fracture – this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused by osteoporosis

*Severs disease (calcaneal apophysitis) – the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected

*Achilles tendonosis (degenerative tendinopathy) – also referred to as tendonitis, tendinosis and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself correctly – the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful.

Treatment:
Treatment for heel pain usually involves using a combination of techniques, such as stretches and painkillers, to relieve pain and speed up recovery.
Most cases of heel pain get better within 12 months. Surgery may be recommended as a last resort if your symptoms don’t improve after this time. Only 1 in 20 people with heel pain will need surgery.

Rest:
Whenever possible, rest the affected foot by not walking long distances and standing for long periods. However, you should regularly stretch your feet and calves using exercises such as those described  in the pictures...>…..click & see

To learn more click to see :

Prevention:
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising.

Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.medicalnewstoday.com/articles/181453.php
http://www.nlm.nih.gov/medlineplus/ency/article/003181.htm

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Calcaneal spur

Definition:
A calcaneal spur is a small bony projection from the back or underside of the heel bone. The calcaneus, also known as the back or underside of the heel bone, develops bony spurs when the Achilles tendon becomes inflamed and overloaded. The localized tendons are forced to take on the weight that was previously held by the Achilles tendon, causing tenderness in the back of the heel. The tendons are constantly being agitated as the patient rests, then gets up again.

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A calcaneal spur (or heel spur) is a radiological (X-ray) finding, and when it is located on the inferior aspect of the calcaneus, is often associated with plantar fasciitis and ankylosing spondylitis. A posterior calcaneal spur may also develop on the back of the heel at the insertion of the Achilles tendon.

An inferior calcaneal spur consists of a calcification of bone, which lies superior to the plantar fascia at the insertion of the plantar fascia . Posterior heel spurs are often large and palpable through the skin and may need to be removed as part of the treatment of insertional Achilles tendonitis

There is stress at the plantar(bottom of the foot) aspect of the calcaneus(heel bone) at the attachment of the plantar aponeurosis. This stress is caused by excessive running, standing, or walking, especially when the individual is unaccustomed to the activity.

Symptoms:
A sharp, stabbing pain under or on the inside of the heel. The pain is typically relieved during rest, but is worse after getting up again.As a rule of thumb, it is most painful first thing in the morning.The pain is made worse by walking on a hard surface or carrying something heavy, such as a suitcase. The pain can become so severe that it becomes difficult to continue your daily work

Special risk groups
*Most sufferers are people who are overweight and middle-aged. This is due to the shock-absorbing fat pillow under the foot shrinking over the years and becoming less effective.

*Weekend athletes.

*People who have feet that are pronated and not corrected. Pronated means that the foot tends to roll inwards when a person walks or runs.

Causes:
A bone spur forms as the body tries to repair itself by building extra bone. It generally forms in response to pressure, rubbing, or stress that continues over a long period of time.

Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the ends of the bones within joints breaks down and eventually wears away (osteoarthritis). Also, the discs that provide cushioning between the bones of the spine may break down with age. Over time, this leads to pain and swelling and, in some cases, bone spurs forming along the edges of the joint. Bone spurs due to aging are especially common in the joints of the spine and feet.

Bone spurs also form in the feet in response to tight ligaments, to activities such as dancing and running that put stress on the feet, and to pressure from being overweight or from poorly fitting shoes. For example, the long ligament on the bottom of the foot (plantar fascia) can become stressed or tight and pull on the heel, causing the ligament to become inflamed (plantar fasciitis). As the bone tries to mend itself, a bone spur can form on the bottom of the heel (known as a “heel spur”). Pressure at the back of the heel from frequently wearing shoes that are too tight can cause a bone spur on the back of the heel. This is sometimes called a “pump bump,” because it is often seen in women who wear high heels.

Another common site for bone spurs is the shoulder. Your shoulder joint is able to move in a number of directions due to its complex structure. Over time, the bones, muscles, tendons, and ligaments that make up your shoulder can wear against one another. The muscles that allow you to lift and rotate your arm (called the rotator cuff) start at your shoulder blade and are attached to your upper arm with tendons. As these tendons move through the narrow space between the top of your shoulder and your upper arm, they can rub on the bones. Bone spurs can form in this narrow area that, in turn, pinch the rotator cuff tendons, resulting in irritation, inflammation, stiffness, weakness, pain, and sometimes tearing of the tendon. This condition, rotator cuff disorder commonly occurs with age and/or repetitive use of the shoulder. It is also common in athletes, especially baseball players, and in people such as painters who frequently work with their arms above their heads.

Diagnosis:
A bone spur is usually visible on an X-ray. But since most bone spurs do not cause problems, it would be unusual to take an X-ray just to see whether you have a bone spur. If you had an X-ray to evaluate one of the problems associated with bone spurs, such as arthritis, bone spurs would be visible on that X-ray.

Treatment:
Bone spurs do not require treatment unless they are causing pain or damaging other tissues. When needed, treatment may be directed at the causes, the symptoms, or the bone spurs themselves.

Treatment directed at the cause of bone spurs may include weight loss to take some pressure off the joints (especially when osteoarthritis or plantar fasciitis is the cause) and stretching the affected area, such as the heel cord and bottom of the foot. Seeing a physical therapist for ultrasound or deep tissue massage may be helpful for plantar fasciitis or shoulder pain.

Treatment directed at symptoms could include rest, ice, stretching, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Education in how to protect your joints is helpful if you have osteoarthritis. If a bone spur is in your foot, changing footwear or adding padding or a shoe insert such as a heel cup or orthotic may help. If the bone spur is causing corns or calluses, padding the area or wearing different shoes can help. A podiatrist (foot doctor) may be consulted if corns and calluses become a bigger problem. If the bone spur continues to cause symptoms, your doctor may suggest a corticosteroid injection at the painful area to decrease pain and inflammation of the soft tissues next to the bone spur.

Sometimes the bone spurs themselves are treated. Bone spurs can be surgically removed or treated as part of a surgery to repair or replace a joint when osteoarthritis has caused considerable damage and deformity. Examples might include repair of a bunion or heel spur in the foot or removal of small spurs underneath the point of the shoulder.

Foot care advice:
*Take time to warm up and stretch before taking part in sport or exercise and cool down afterwards.
If you run or jog, it is better to run a short distance several times a week than one long run once a week.
Do not overestimate your abilities. If necessary, seek advice about creating a suitable running schedule that will give your body time to adapt.

*If you experience pain in the heel, you may be overloading your tendons.

*To help the healing process, follow the RICE principle, which stands for Rest, Ice, Compression and Elevation.

*Rest the foot and do not run until it is completely healed. Apply an ice pack, such as a packet of frozen peas that has first been wrapped in a towel or cloth. An elasticated support bandage will compress and support the foot. It should be firm, but not so tight that it affects the circulation of blood. Elevate the foot by resting it on a chair or a pillow.

*Invest in suitable shoes.

*The heel can be supported with a small cushioned insole inside the shoe.

*Arch supports that fit inside shoes will prevent feet from pronating.

*If you are overweight, losing weight can help prevent foot problems.

Click to see :Heel Spur: Calcaneal Spur Treatment

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.webmd.com/a-to-z-guides/bone-spur-topic-overview?page=2
http://en.wikipedia.org/wiki/Calcaneal_spur
http://www.netdoctor.co.uk/diseases/facts/heelpain.htm
http://www.painreliever.com/calcaneal-spurs.html

Achilles Tendon Inflammation

Definition :
The Achilles is the tendonous extension of two muscles in the lower leg: gastrocnemius and soleus . In humans, the tendon passes behind the ankle. It is the thickest and strongest tendon in the body. It is about 15 centimetres (6 in) long, and begins near the middle of the calf, but receives fleshy fibers on its anterior surface, almost to its lower end. Gradually becoming contracted below, it is inserted into the middle part of the posterior surface of the calcaneus, a bursa being interposed between the tendon and the upper part of this surface. The tendon spreads out somewhat at its lower end, so that its narrowest part is about 4 centimetres (1.6 in) above its insertion. It is covered by the fascia and the integument, and stands out prominently behind the bone; the gap is filled up with areolar and adipose tissue. Along its lateral side, but superficial to it, is the small saphenous vein. The Achilles’ muscle reflex tests the integrity of the S1 spinal root. The tendon can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running.
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Although it’s the largest tendon in the body and can withstand immense force, the Achilles is surprisingly vulnerable. And the most common Achilles tendon injuries are Achilles tendinosis and Achilles tendon rupture. Achilles tendinosis is the soreness or stiffness of the tendon, generally due to overuse. Achilles tendinitis (inflammation of the tendon) was thought to be the cause of most tendon pain, until the late 90s when scientists discovered no evidence of inflammation. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden eccentric stretching, such as sprinting. Maffulli et al. suggested that the clinical label of tendinopathy should be given to the combination of tendon pain, swelling and impaired performance. Achilles tendon rupture is a partial or complete break in the tendon; it requires immobilization or surgery. Xanthoma can develop in the Achilles tendon in patients with familial hypercholesterolemia.
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Achilles tendon, which feels like a very painful sudden kick in the back of the ankle and needs urgent repair. Inflammation of the tendon, or Achilles tendonitis, is more common.

Symptoms:
•Mild pain after exercise or running that gradually gets worse
•Localised pain along the tendon during or a few hours after running, which may be quite severe
•Localised tenderness of the tendon about 3cm above the point where it joins the heel bone, especially first thing in the morning
•Stiffness of the lower leg, again particularly first thing in the morning
•Swelling or thickening around the tendon
There are several conditions that can cause similar symptoms, such as inflammation of a heel bursa (or fluid sac) or a partial tear of the tendon. You should see your doctor to confirm what’s causing your symptoms

Causes and risk factors:
To help prevent another attack, it’s important to know what triggers Achilles tendonitis in the first place.

Triggers may include:
•Overuse of the tendon – the result of a natural lack of flexibility in the calf muscles. Ask your coach about exercises specifically to improve calf muscle flexibility, and ensure your running shoes cushion the heel fully
•Starting up too quickly, especially after a long period of rest from sport – always warm up thoroughly
•Rapidly increasing running speeds or mileage – build your activity slowly, by no more than ten per cent a week
•Adding stair climbing or hill running to a training programme too quickly

•Sudden extra exertion, such as a final sprint

•Calf pain

Diagnosis & Tests:
The doctor will perform a physical exam and look for tenderness along the tendon and for pain in the area of the tendon when you stand on your toes.

Imaging studies can also be helpful. X-rays can help diagnose arthritis, and an MRI will show inflammation in the tendon.

Treatment :

Treatment of Achilles tendonitis depends on the severity of the injury and whether you’re a professional sportsperson. Treatment includes:

•Rest, to allow the inflammation to settle. Any sport that aggravates the tendon should be sped for at least a week, although exercise that doesn’t stress the tendon, such as swimming, may be possible
•Regular pain relief with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
•Steroid injections
•Bandaging and orthotic devices, such as shoe inserts and heel lifts, to take the stress off the tendon
•Physiotherapy to strengthen the weak muscle group in the front of the leg and the upward foot flexors
•Surgery (rarely needed) to remove fibrous tissue and repair tears

According to reports by Hakan Alfredson, M.D., and associates of clinical trials in Sweden, the pain in Achilles tendinopathy arises from the nerves associated with neovascularization and can be effectively treated with 1–4 small injections of a sclerosant. In a cross-over trial, 19 of 20 of his patients were successfully treated with this sclerotherapy.


Prognosis :

Conservative therapy usually helps improve symptoms. However, symptoms may return if activities that cause the pain are not limited, or if the strength and flexibility of the tendon is not maintained.
Depending on the severity of the injury, recovery from an Achilles injury can take up to 12–16 months.

Prevention:
Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/achilles.shtml
http://en.wikipedia.org/wiki/Achilles_tendon
http://www.umm.edu/ency/article/001072all.htm

High Heels are Heath-Wreckers

Like the tall Lara Dutta or the shorter Rani Mukerji, you might want to flaunt stilettos to look glamorous and sleek. But experts feel this style statement can cause serious harm to the body if proper care is not taken.
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“Increased pressure puts the forefoot at risk of injuries such as stress fractures, bunions and hammer toes. Knee pain is also common when high heels are involved,” says Ashish Jain, M.S. (orthopaedics), consultant joint replacement specialist at Max Hospital.

“The heel height causes increased strain on the knee joint and associated tendons. The quadriceps muscle group in the front of the thigh works harder, increasing pressure on the kneecap by up to 26 percent.”

“This can ultimately increase the incidence of osteoarthritis of the knee and quadriceps tendonitis,” Jain added.

Jain also spoke of other hazards
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He revealed that when the heel is constantly elevated, the calf muscle and Achilles tendon can contract and shorten. Wearing high heels habitually can result in a woman not being able to tolerate a flat shoe. On occasions, this can even require surgery to lengthen the Achilles tendon.

Sometimes the tight fit of many heels will force the toes to conform to its shape. The pressure of the shoe itself can cause corns to form. Furthermore, the compression of the metatarsal bones can cause pressure on the nerves that run between them.

“The toenails are also at risk as the incidence of in-growing toenails and nail infections is higher in heel wearers. In-growing toenails can be very painful, unsightly and require surgery to correct,” Jain added.

Women feel high heels like gladiator sandals, tip toes and others add a touch of elegance and glamour to one’s overall style and the legs appear longer and slimmer. Thus, to look special in that chic footwear and not experience painful after effects, many are going in for dermal fillers.

“It has been observed that women are undergoing filler injections to plump up the underside of their feet, thus filling them out and providing padding inside the foot to relieve the pain that comes from wearing high heels,” said Satish Bhatia, dermatologist and skin surgeon, Lady Ratan Tata Medical and Research Centre.

“This trend is rising despite the fact that the effect does not usually last for more than six-seven months,” Bhatia added.

Given that certain industries like hospitality, aviation and fashion place a premium on height and appearance, wearing heels becomes a norm, thus making women opt for the expensive solution to ease pain arising out of use of high heels.

“The dermal filler injection is injected in the ball of the foot to ease the pain caused by wearing high heels. The injection costs between Rs.12,000 and Rs.15,000,” he added.

Rajesh Malhotra, professor of orthopaedics, AIIMS, threw light on a few other ways of curing the pain arising out of extended use of stilettos.

“The best way to avoid pain is that one stops wearing high heels at all because they are the cause of the problem. But if that is not possible then there are a few treatments,” he said.

“The entire body pressure is on the ball of the foot; so among many treatments one is that we put the metatarsal bar on the sole of the footwear so that the entire body weight is not on the ball of the foot, which results in less pain,” Malhotra told.

If it is very essential to wear heels, the maximum height advised by doctors is not more than an inch.

“The height of the heel also changes the amount of weight on the forefoot. A one-inch heel will increase the pressure by 22 percent, a two-inch heel by 57 percent and a three-inch heel by 76 percent. So anything not more than an inch is fine,” said Jain.

Source:
The Times Of India. June 12. 2010

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Roller Enhances a Leg Stretch

For a more intense stretch in the backs of your thighs and calves, try elevating your foot on a roller. But it’s important to put only your lower ankle and heel on top of the roller; this avoids any pressure on your Achilles tendon.
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STEP-1. Sit upright on the floor with your left leg straight in front of you and your left heel on top of the roller. Bend your right knee and position your right foot against the inside of your left knee (if your left knee tends to hyperextend, place your right foot directly under your left knee for support). Inhale, sit up tall and reach your arms overhead.

STEP-2. On an exhale, maintain a long spine as you tilt forward, hinging at the hips. Keep your left leg straight and rest your fingertips on the roller. Hold this stretch for 10 to 20 seconds while breathing fully. Focus on feeling the stretch in the back of your left thigh and calf. You might feel a stretch in your back and hips too. Switch legs and repeat.

Source: Los Angeles Times

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