Heel Aches The Causes, Signals And Therapy Choices
Overview
Heel pain is a problem for many people. It makes standing and even walking around for long periods of time very uncomfortable. Several different conditions can lead to uncomfortable heels, but the most common culprit is plantar fasciitis. This is the inflammation and swelling of the plantar fascia, a tendon that runs along the sole of your foot and attaches to the bottom of the calcaneus, or heel bone. Repeated hard impacts or strain from overuse causes micro-tears to develop in the tendon, irritating it. The minor damage compounds over time and causes the tissue to swell and tighten, painfully pulling on the heel bone.
Causes
If you have pain behind your heel, you may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). People often get this by running too much or wearing shoes that rub or cut into the back of the heel. Pain behind the heel may build slowly over time, causing the skin to thicken, become red and swell. You might develop a bump on the back of your heel that feels tender and warm to the touch. The pain might flare up when you first start an activity after resting. It often hurts too much to wear normal shoes. You may need an X-ray to see if you also have a bone spur.
Symptoms
The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they?ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
Diagnosis
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
Non Surgical Treatment
Treatment options for plantar fasciitis include custom prescription foot orthoses (orthotics), weight loss when indicated, steroid injections and physical therapy to decrease the inflammation, night-splints and/or cast boots to splint and limit the stress on the plantar fascia. Orthotripsy (high frequency ultra-sonic shock waves) is also a new treatment option that has been shown to decrease the pain significantly in 50 to 85 percent of patients in published studies. Surgery, which can be done endoscopically, is usually not needed for over 90 percent of the cases of plantar fasciitis. (However, when surgery is needed, it is about 85 percent successful.) Patients who are overweight do not seem to benefit as much from surgery. Generally, plantar fasciitis is a condition people learn to control. There are a few conditions similar to plantar fascia in which patients should be aware. The most common is a rupture of the plantar fascia: the patient continues to exercise despite the symptoms and experiences a sudden sharp pain on the bottom of the heel and cannot stand on his or her toes, resulting in bruising in the arch. Ruptures are treated very successfully by immobilization in a cast boot for two to six weeks, a period of active rest and physical therapy. Another problem with prolonged and neglected plantar fasciitis is development of a stress fracture from the constant traction of this ligament on the heel bone. This appears more common in osteoporotic women, and is also treated with cast boot immobilization. The nerves that run along the heel occasionally become inflamed by the subsequent thickening and inflammation of the adjacent plantar fascia. These symptoms often feel like numbness and burning and usually resolve with physical therapy and injections. Patients should also be aware that heel numbness can be the first sign of a back problem.
Surgical Treatment
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
pain in back of heel
Prevention
Before you get out of bed in the morning, and then periodically throughout the day, do the following exercises to increase flexibility and ease pain. Slowly flex your foot and toes to stretch the tissue on the bottom of your sore foot. Hold the stretch for 10 counts. Relax and repeat. Do gentle ankle rolls to keep the tissues around the ankle and on the back of the heel flexible. Sit on the edge of your bed and roll your foot back and forth over a tennis ball.
Heel pain is a problem for many people. It makes standing and even walking around for long periods of time very uncomfortable. Several different conditions can lead to uncomfortable heels, but the most common culprit is plantar fasciitis. This is the inflammation and swelling of the plantar fascia, a tendon that runs along the sole of your foot and attaches to the bottom of the calcaneus, or heel bone. Repeated hard impacts or strain from overuse causes micro-tears to develop in the tendon, irritating it. The minor damage compounds over time and causes the tissue to swell and tighten, painfully pulling on the heel bone.
Causes
If you have pain behind your heel, you may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). People often get this by running too much or wearing shoes that rub or cut into the back of the heel. Pain behind the heel may build slowly over time, causing the skin to thicken, become red and swell. You might develop a bump on the back of your heel that feels tender and warm to the touch. The pain might flare up when you first start an activity after resting. It often hurts too much to wear normal shoes. You may need an X-ray to see if you also have a bone spur.
Symptoms
The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they?ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
Diagnosis
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
Non Surgical Treatment
Treatment options for plantar fasciitis include custom prescription foot orthoses (orthotics), weight loss when indicated, steroid injections and physical therapy to decrease the inflammation, night-splints and/or cast boots to splint and limit the stress on the plantar fascia. Orthotripsy (high frequency ultra-sonic shock waves) is also a new treatment option that has been shown to decrease the pain significantly in 50 to 85 percent of patients in published studies. Surgery, which can be done endoscopically, is usually not needed for over 90 percent of the cases of plantar fasciitis. (However, when surgery is needed, it is about 85 percent successful.) Patients who are overweight do not seem to benefit as much from surgery. Generally, plantar fasciitis is a condition people learn to control. There are a few conditions similar to plantar fascia in which patients should be aware. The most common is a rupture of the plantar fascia: the patient continues to exercise despite the symptoms and experiences a sudden sharp pain on the bottom of the heel and cannot stand on his or her toes, resulting in bruising in the arch. Ruptures are treated very successfully by immobilization in a cast boot for two to six weeks, a period of active rest and physical therapy. Another problem with prolonged and neglected plantar fasciitis is development of a stress fracture from the constant traction of this ligament on the heel bone. This appears more common in osteoporotic women, and is also treated with cast boot immobilization. The nerves that run along the heel occasionally become inflamed by the subsequent thickening and inflammation of the adjacent plantar fascia. These symptoms often feel like numbness and burning and usually resolve with physical therapy and injections. Patients should also be aware that heel numbness can be the first sign of a back problem.
Surgical Treatment
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
pain in back of heel
Prevention
Before you get out of bed in the morning, and then periodically throughout the day, do the following exercises to increase flexibility and ease pain. Slowly flex your foot and toes to stretch the tissue on the bottom of your sore foot. Hold the stretch for 10 counts. Relax and repeat. Do gentle ankle rolls to keep the tissues around the ankle and on the back of the heel flexible. Sit on the edge of your bed and roll your foot back and forth over a tennis ball.
Do I Have Fallen Arches??
Overview
Fallen arches, or flatfoot, is a condition in which the arch on the inside of the foot is flat and the entire sole of the foot rests on the ground. It affects about 40% of the general population. Although flat feet in themselves are not usually problematic, they can create problems in the feet, hips, ankles and knees. Pain may be experienced in the lower back if there are alignment problems and if the individual is engaged in a lot of heavy, high impact activities that put stress on the bones and muscles in the lower legs. The arches of most individuals are fully developed by the age of 12 to 13. While some people are born with flat arches, for others the arches fall over time. The tibial tendon, which runs along the inside of the ankle from above the ankle to the arch, can weaken with age and with heavy activity. The posterior tendon, main support structure for the arch, can become inflamed (tendonitis) or even tear if overloaded. For women, wearing high heels can affect the Achilles tendon and alter the structure and function of the ankle. The posterior tibial tendon may compensate for this stress and break down, causing the arches to fall. Obesity is another contributing factor, as well as a serious injury to the ankle or foot, arthritis and bad circulation such as occurs with diabetes.
Causes
Fallen arches may be caused by a number of causes, including increased elastin during pregnancy, arthritis, injury, excessive stress on the foot, fused bones in the foot, or an extra bone. They may cause not only foot pain, but also pain in the legs, knees, and back and a loss of mobility. The condition is most often treated with orthotics, structures placed in the shoes to support the feet, but this may not be enough for severe cases. Exercises to strengthen and rebuild the arches can also be helpful. Surgery is sometimes the best method of treatment, as it can completely rebuild the arches and has lasting results, but it is quite expensive and considered a last resort.
Symptoms
People will have a very heavily dropped arch and it won?t affect them at all and people will have it slightly dropped and it could cause fierce problems. It could cause things like plantar fasciitis, it could cause heel spurs, desperate ball-of-the-foot pressure, or pressure on the big toe known as the hallux which causes discomfort in the foot. It will create problems upwards to the knees, hips and the back once you?re out of line.
Diagnosis
Most children and adults with flatfeet do not need to see a physician for diagnosis or treatment. However, it is a good idea to see a doctor if the feet tire easily or are painful after standing, it is difficult to move the foot around or stand on the toes, the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot, the pain interferes with activity or the person has been diagnosed with rheumatoid arthritis. Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the doctor can see how much the arch flattens during walking. The doctor may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases. Imaging tests may be used to help in the diagnosis. If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI scan) may be performed.
Why do arches fall?
Non Surgical Treatment
If fallen arches are not causing any pain or discomfort, then they will not need any treatment. If they were causing a persistent pain in the feet, or in the hips, legs or knees, then it would be best to consult your family doctor. Walking is the natural activity of feet and if it is not too painful, sufferers should walk as much as possible to strengthen their arches. When it is possible, go barefoot, or wear soft flexible shoes. In cases of severe fallen arches, your doctor may recommend special shoe inserts.
Surgical Treatment
A better approach is to strengthen the weakened ligaments with Prolotherapy, supplemented by an arch support if the condition has existed for several years. Chronic pain is most commonly due to tendon and ligament weakness, or cartilage deterioration. The safest and most effective natural medicine treatment for repairing tendon, ligament and cartilage damage is Prolotherapy. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing. Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What?s more, the tissue strengthening and pain relief stimulated by Prolotherapy is permanent.
Prevention
Orthotic inserts, either prescribed or bought over the counter, can help keep the arches fixed into position, but always wear them as although they support, they don?t strengthen, which is why some experts reccomend avoiding them. Gait analysis at a run specialist can help to diagnose overpronation and flat feet. Most brands produce shoes that will give support and help to limit the negative effects of a poor gait on the rest of the body. Barefoot exercises, such as standing on a towel and making fists with the toes, can help to strengthen the arches. Start easy and build up the reps to avoid cramping. Short barefoot running sessions can help take pressure off the arches by using the natural elasticity of the foot?s tendons to take impact and build strength to help prevent flat feet. These should be done on grass for only a few minutes at a time.
After Care
Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.
Fallen arches, or flatfoot, is a condition in which the arch on the inside of the foot is flat and the entire sole of the foot rests on the ground. It affects about 40% of the general population. Although flat feet in themselves are not usually problematic, they can create problems in the feet, hips, ankles and knees. Pain may be experienced in the lower back if there are alignment problems and if the individual is engaged in a lot of heavy, high impact activities that put stress on the bones and muscles in the lower legs. The arches of most individuals are fully developed by the age of 12 to 13. While some people are born with flat arches, for others the arches fall over time. The tibial tendon, which runs along the inside of the ankle from above the ankle to the arch, can weaken with age and with heavy activity. The posterior tendon, main support structure for the arch, can become inflamed (tendonitis) or even tear if overloaded. For women, wearing high heels can affect the Achilles tendon and alter the structure and function of the ankle. The posterior tibial tendon may compensate for this stress and break down, causing the arches to fall. Obesity is another contributing factor, as well as a serious injury to the ankle or foot, arthritis and bad circulation such as occurs with diabetes.
Causes
Fallen arches may be caused by a number of causes, including increased elastin during pregnancy, arthritis, injury, excessive stress on the foot, fused bones in the foot, or an extra bone. They may cause not only foot pain, but also pain in the legs, knees, and back and a loss of mobility. The condition is most often treated with orthotics, structures placed in the shoes to support the feet, but this may not be enough for severe cases. Exercises to strengthen and rebuild the arches can also be helpful. Surgery is sometimes the best method of treatment, as it can completely rebuild the arches and has lasting results, but it is quite expensive and considered a last resort.
Symptoms
People will have a very heavily dropped arch and it won?t affect them at all and people will have it slightly dropped and it could cause fierce problems. It could cause things like plantar fasciitis, it could cause heel spurs, desperate ball-of-the-foot pressure, or pressure on the big toe known as the hallux which causes discomfort in the foot. It will create problems upwards to the knees, hips and the back once you?re out of line.
Diagnosis
Most children and adults with flatfeet do not need to see a physician for diagnosis or treatment. However, it is a good idea to see a doctor if the feet tire easily or are painful after standing, it is difficult to move the foot around or stand on the toes, the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot, the pain interferes with activity or the person has been diagnosed with rheumatoid arthritis. Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the doctor can see how much the arch flattens during walking. The doctor may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases. Imaging tests may be used to help in the diagnosis. If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI scan) may be performed.
Why do arches fall?
Non Surgical Treatment
If fallen arches are not causing any pain or discomfort, then they will not need any treatment. If they were causing a persistent pain in the feet, or in the hips, legs or knees, then it would be best to consult your family doctor. Walking is the natural activity of feet and if it is not too painful, sufferers should walk as much as possible to strengthen their arches. When it is possible, go barefoot, or wear soft flexible shoes. In cases of severe fallen arches, your doctor may recommend special shoe inserts.
Surgical Treatment
A better approach is to strengthen the weakened ligaments with Prolotherapy, supplemented by an arch support if the condition has existed for several years. Chronic pain is most commonly due to tendon and ligament weakness, or cartilage deterioration. The safest and most effective natural medicine treatment for repairing tendon, ligament and cartilage damage is Prolotherapy. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing. Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What?s more, the tissue strengthening and pain relief stimulated by Prolotherapy is permanent.
Prevention
Orthotic inserts, either prescribed or bought over the counter, can help keep the arches fixed into position, but always wear them as although they support, they don?t strengthen, which is why some experts reccomend avoiding them. Gait analysis at a run specialist can help to diagnose overpronation and flat feet. Most brands produce shoes that will give support and help to limit the negative effects of a poor gait on the rest of the body. Barefoot exercises, such as standing on a towel and making fists with the toes, can help to strengthen the arches. Start easy and build up the reps to avoid cramping. Short barefoot running sessions can help take pressure off the arches by using the natural elasticity of the foot?s tendons to take impact and build strength to help prevent flat feet. These should be done on grass for only a few minutes at a time.
After Care
Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.
Functional Leg Length Discrepancy Definition
Overview
Leg length discrepancy (LLD) or Lower limb discrepancy is a condition of unequal lengths of the lower limbs. The discrepancy may be in the femur, or tibia, or both. In some conditions, the whole side is affected, including the upper limbs. However, it is the discrepancy of the lower limbs that causes problems with ambulation, and the focus of this discussion will be about lower limb discrepancy.
Causes
Limb-length conditions can result from congenital disorders of the bones, muscles or joints, disuse or overuse of the bones, muscles or joints caused by illness or disease, diseases, such as bone cancer, Issues of the spine, shoulder or hip, traumatic injuries, such as severe fractures that damage growth plates.
Symptoms
LLD do not have any pain or discomfort directly associated with the difference of one leg over the other leg. However, LLD will place stress on joints throughout the skeletal structure of the body and create discomfort as a byproduct of the LLD. Just as it is normal for your feet to vary slightly in size, a mild difference in leg length is normal, too. A more pronounced LLD, however, can create abnormalities when walking or running and adversely affect healthy balance and posture. Symptoms include a slight limp. Walking can even become stressful, requiring more effort and energy. Sometimes knee pain, hip pain and lower back pain develop. Foot mechanics are also affected causing a variety of complications in the foot, not the least, over pronating, metatarsalgia, bunions, hammer toes, instep pain, posterior tibial tendonitis, and many more.
Diagnosis
Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.
Non Surgical Treatment
After the leg length discrepancy has been identified it can be categorized in as structural or functional and appropriate remedial action can be instigated. This may involve heel lifters or orthotics being used to level up the difference. The treatment of LLD depends on the symptoms being experienced. Where the body is naturally compensating for the LLD (and the patient is in no discomfort), further rectifying action may cause adverse effects to the biomechanical mechanism of the body causing further injury. In cases of functional asymmetry regular orthotics can be used to correct the geometry of the foot and ground contact. In structural asymmetry cases heel lifts may be used to compensate for the anatomic discrepancy.
leg length discrepancy hip pain
Surgical Treatment
Lengthening is usually done by corticotomy and gradual distraction. This technique can result in lengthenings of 25% or more, but typically lengthening of 15%, or about 6 cm, is recommended. The limits of lengthening depend on patient tolerance, bony consolidation, maintenance of range of motion, and stability of the joints above and below the lengthened limb. Numerous fixation devices are available, such as the ring fixator with fine wires, monolateral fixator with half pins, or a hybrid frame. The choice of fixation device depends on the desired goal. A monolateral device is easier to apply and better tolerated by the patient. The disadvantages of monolateral fixation devices include the limitation of the degree of angular correction that can concurrently be obtained; the cantilever effect on the pins, which may result in angular deformity, especially when lengthening the femur in large patients; and the difficulty in making adjustments without placing new pins. Monolateral fixators appear to have a similar success rate as circular fixators, especially with more modest lengthenings (20%).
Leg length discrepancy (LLD) or Lower limb discrepancy is a condition of unequal lengths of the lower limbs. The discrepancy may be in the femur, or tibia, or both. In some conditions, the whole side is affected, including the upper limbs. However, it is the discrepancy of the lower limbs that causes problems with ambulation, and the focus of this discussion will be about lower limb discrepancy.
Causes
Limb-length conditions can result from congenital disorders of the bones, muscles or joints, disuse or overuse of the bones, muscles or joints caused by illness or disease, diseases, such as bone cancer, Issues of the spine, shoulder or hip, traumatic injuries, such as severe fractures that damage growth plates.
Symptoms
LLD do not have any pain or discomfort directly associated with the difference of one leg over the other leg. However, LLD will place stress on joints throughout the skeletal structure of the body and create discomfort as a byproduct of the LLD. Just as it is normal for your feet to vary slightly in size, a mild difference in leg length is normal, too. A more pronounced LLD, however, can create abnormalities when walking or running and adversely affect healthy balance and posture. Symptoms include a slight limp. Walking can even become stressful, requiring more effort and energy. Sometimes knee pain, hip pain and lower back pain develop. Foot mechanics are also affected causing a variety of complications in the foot, not the least, over pronating, metatarsalgia, bunions, hammer toes, instep pain, posterior tibial tendonitis, and many more.
Diagnosis
Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.
Non Surgical Treatment
After the leg length discrepancy has been identified it can be categorized in as structural or functional and appropriate remedial action can be instigated. This may involve heel lifters or orthotics being used to level up the difference. The treatment of LLD depends on the symptoms being experienced. Where the body is naturally compensating for the LLD (and the patient is in no discomfort), further rectifying action may cause adverse effects to the biomechanical mechanism of the body causing further injury. In cases of functional asymmetry regular orthotics can be used to correct the geometry of the foot and ground contact. In structural asymmetry cases heel lifts may be used to compensate for the anatomic discrepancy.
leg length discrepancy hip pain
Surgical Treatment
Lengthening is usually done by corticotomy and gradual distraction. This technique can result in lengthenings of 25% or more, but typically lengthening of 15%, or about 6 cm, is recommended. The limits of lengthening depend on patient tolerance, bony consolidation, maintenance of range of motion, and stability of the joints above and below the lengthened limb. Numerous fixation devices are available, such as the ring fixator with fine wires, monolateral fixator with half pins, or a hybrid frame. The choice of fixation device depends on the desired goal. A monolateral device is easier to apply and better tolerated by the patient. The disadvantages of monolateral fixation devices include the limitation of the degree of angular correction that can concurrently be obtained; the cantilever effect on the pins, which may result in angular deformity, especially when lengthening the femur in large patients; and the difficulty in making adjustments without placing new pins. Monolateral fixators appear to have a similar success rate as circular fixators, especially with more modest lengthenings (20%).
Mortons Neuroma Overview
Overview
Morton?s Neuroma is a pathological condition of the common digital nerve in the foot, most frequently between the third and fourth metatarsals (third inter-metatarsal space). The nerve sheath becomes abnormally thickened with fibrous (scar) tissue and the nerve fibres eventually deteriorate.This condition is named for the American surgeon, Thomas George Morton (1835-1903), who first recognised the condition in 1876. Incidentally his father was the dentist who discovered the anaesthetics; initially Nitrous oxide, the very gas used today in cryosurgery for the condition his son lent his name to? Morton?s neuroma.
Causes
Morton's neuroma is an inflammation caused by a buildup of fibrous tissue on the outer coating of nerves. This fibrous buildup is a reaction to the irritation resulting from nearby bones and ligaments rubbing against the nerves. Irritation can be caused by Wearing shoes that are too tight. Wearing shoes that place the foot in an awkward position, such as high heels. A foot that is mechanically unstable. Repetitive trauma to the foot such as from sports activities like tennis, basketball, and running. Trauma to the foot caused by an injury such as a sprain or fracture. It is unusual for more than one Morton's neuroma to occur on one foot at the same time. It is rare for Morton's neuroma to occur on both feet at the same time.
Symptoms
People with Morton's neuroma usually complain of pain that can start in the ball of the foot and shoot into the affected toes. However, some people just have toe pain. There may also be burning and tingling of the toes. The symptoms are usually felt up the sides of the space between two toes. For example, if the nerve between the third and fourth long bones (metatarsals) of the right foot is affected, the symptoms will usually be felt up the right-hand side of the fourth toe and up the left-hand side of the third toe. Some people describe the pain that they feel as being like walking on a stone or a marble. Symptoms can be made worse if you wear high-heeled shoes. The pain is relieved by taking your shoe off, resting your foot and massaging the area. You may also experience some numbness between the affected toes. Your affected toes may also appear to be spread apart, which doctors refer to as the 'V sign'. The symptoms can vary and may come and go over a number of years. For example, some people may experience two attacks of pain in a week and then nothing for a year. Others may have regular and persistent (chronic) pain.
Diagnosis
To diagnose Morton's neuroma the podiatrist commonly palpates the area to elicit pain, squeezing the toes from the side. Next he or she may try to feel the neuroma by pressing a thumb into the third interspace. The podiatrist then tries to elicit Mulder's sign, by palpating the affected interspace with one hand and squeezing the entire foot at the same time with the other hand. In many cases of Morton's neuroma, this causes an audible click, known as Mulder's sign. An x-ray should be taken to ensure that there is not a fracture. X-rays also can be used to examine the joints and bone density, ruling out arthritis (particularly rheumatoid arthritis and osteoarthritis).
Non Surgical Treatment
Most non-operative treatment is usually successful, although it can take a while to figure out what combination of non-operative treatment works best for each individual patient. Non-operative treatment may include the use of comfort shoe wear. The use of a metatarsal pad to decrease the load through the involved area of the plantar forefoot. A period of activity modification to decrease or eliminate activities, which maybe exacerbating the patient?s symptoms. For example, avoiding long periods of standing or other activities that result in significant repetitive loading to the forefoot can be very helpful. Wearing high heels should be avoided. Local corticosteroid injections can help decrease inflammation associated with the nerve. However, this does not necessarily address the underlying loading forces that maybe causing the injury to the nerve in the first place. It has been proposed that an alcohol injection in and around the nerve will cause a controlled death to the nerve and subsequently eliminate symptoms from the nerve. In theory, this may be helpful. In practice, adequate prospective studies have not demonstrated the benefit of this procedure above and beyond the other standard non-operative treatments available. In addition there is the concern that the alcohol will cause excessive scarring and death of other important structures in the area.
Surgical Treatment
Operative treatment of Morton?s neuroma should be entertained only after failure of non-operative management. Standard operative treatment involves identifying the nerve and cutting (resecting) it proximal to the point where it is irritated/injured. This is usually done through an incision on the top (dorsal) aspect of the foot, although an incision on the sole (plantar) aspect of the foot can be used. Some physicians will attempt to treat Morton?s neuroma by releasing the intermetatarsal ligament, and freeing the nerve of local scar tissue. This may also be beneficial.
Morton?s Neuroma is a pathological condition of the common digital nerve in the foot, most frequently between the third and fourth metatarsals (third inter-metatarsal space). The nerve sheath becomes abnormally thickened with fibrous (scar) tissue and the nerve fibres eventually deteriorate.This condition is named for the American surgeon, Thomas George Morton (1835-1903), who first recognised the condition in 1876. Incidentally his father was the dentist who discovered the anaesthetics; initially Nitrous oxide, the very gas used today in cryosurgery for the condition his son lent his name to? Morton?s neuroma.Causes
Morton's neuroma is an inflammation caused by a buildup of fibrous tissue on the outer coating of nerves. This fibrous buildup is a reaction to the irritation resulting from nearby bones and ligaments rubbing against the nerves. Irritation can be caused by Wearing shoes that are too tight. Wearing shoes that place the foot in an awkward position, such as high heels. A foot that is mechanically unstable. Repetitive trauma to the foot such as from sports activities like tennis, basketball, and running. Trauma to the foot caused by an injury such as a sprain or fracture. It is unusual for more than one Morton's neuroma to occur on one foot at the same time. It is rare for Morton's neuroma to occur on both feet at the same time.
Symptoms
People with Morton's neuroma usually complain of pain that can start in the ball of the foot and shoot into the affected toes. However, some people just have toe pain. There may also be burning and tingling of the toes. The symptoms are usually felt up the sides of the space between two toes. For example, if the nerve between the third and fourth long bones (metatarsals) of the right foot is affected, the symptoms will usually be felt up the right-hand side of the fourth toe and up the left-hand side of the third toe. Some people describe the pain that they feel as being like walking on a stone or a marble. Symptoms can be made worse if you wear high-heeled shoes. The pain is relieved by taking your shoe off, resting your foot and massaging the area. You may also experience some numbness between the affected toes. Your affected toes may also appear to be spread apart, which doctors refer to as the 'V sign'. The symptoms can vary and may come and go over a number of years. For example, some people may experience two attacks of pain in a week and then nothing for a year. Others may have regular and persistent (chronic) pain.
Diagnosis
To diagnose Morton's neuroma the podiatrist commonly palpates the area to elicit pain, squeezing the toes from the side. Next he or she may try to feel the neuroma by pressing a thumb into the third interspace. The podiatrist then tries to elicit Mulder's sign, by palpating the affected interspace with one hand and squeezing the entire foot at the same time with the other hand. In many cases of Morton's neuroma, this causes an audible click, known as Mulder's sign. An x-ray should be taken to ensure that there is not a fracture. X-rays also can be used to examine the joints and bone density, ruling out arthritis (particularly rheumatoid arthritis and osteoarthritis).
Non Surgical Treatment
Most non-operative treatment is usually successful, although it can take a while to figure out what combination of non-operative treatment works best for each individual patient. Non-operative treatment may include the use of comfort shoe wear. The use of a metatarsal pad to decrease the load through the involved area of the plantar forefoot. A period of activity modification to decrease or eliminate activities, which maybe exacerbating the patient?s symptoms. For example, avoiding long periods of standing or other activities that result in significant repetitive loading to the forefoot can be very helpful. Wearing high heels should be avoided. Local corticosteroid injections can help decrease inflammation associated with the nerve. However, this does not necessarily address the underlying loading forces that maybe causing the injury to the nerve in the first place. It has been proposed that an alcohol injection in and around the nerve will cause a controlled death to the nerve and subsequently eliminate symptoms from the nerve. In theory, this may be helpful. In practice, adequate prospective studies have not demonstrated the benefit of this procedure above and beyond the other standard non-operative treatments available. In addition there is the concern that the alcohol will cause excessive scarring and death of other important structures in the area.
Surgical Treatment
Operative treatment of Morton?s neuroma should be entertained only after failure of non-operative management. Standard operative treatment involves identifying the nerve and cutting (resecting) it proximal to the point where it is irritated/injured. This is usually done through an incision on the top (dorsal) aspect of the foot, although an incision on the sole (plantar) aspect of the foot can be used. Some physicians will attempt to treat Morton?s neuroma by releasing the intermetatarsal ligament, and freeing the nerve of local scar tissue. This may also be beneficial.
Why Shoe Lifts Are The Answer To Leg Length Discrepancy
There are actually not one but two different kinds of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is structurally shorter in comparison to the other. Through developmental phases of aging, the brain senses the stride pattern and recognizes some variation. The human body typically adapts by tilting one shoulder over to the "short" side. A difference of less than a quarter inch isn't grossly irregular, require Shoe Lifts to compensate and generally does not have a profound effect over a lifetime.
Leg length inequality goes mainly undiagnosed on a daily basis, however this condition is very easily remedied, and can eradicate many instances of upper back pain.
Therapy for leg length inequality usually involves Shoe Lifts. Most are low-priced, generally being less than twenty dollars, in comparison to a custom orthotic of $200 or even more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.
Back ache is easily the most prevalent ailment affecting men and women today. Around 80 million people are afflicted by back pain at some stage in their life. It's a problem which costs businesses vast amounts of money each year on account of time lost and productivity. Fresh and superior treatment methods are always sought after in the hope of decreasing the economical influence this issue causes.
Men and women from all corners of the earth suffer the pain of foot ache due to leg length discrepancy. In these situations Shoe Lifts are usually of very helpful. The lifts are capable of decreasing any discomfort in the feet. Shoe Lifts are recommended by numerous certified orthopaedic physicians.
To be able to support the human body in a well-balanced manner, your feet have got a vital task to play. Despite that, it's often the most overlooked region of the human body. Many people have flat-feet which means there is unequal force placed on the feet. This causes other areas of the body including knees, ankles and backs to be impacted too. Shoe Lifts ensure that the right posture and balance are restored.
Leg length inequality goes mainly undiagnosed on a daily basis, however this condition is very easily remedied, and can eradicate many instances of upper back pain.
Therapy for leg length inequality usually involves Shoe Lifts. Most are low-priced, generally being less than twenty dollars, in comparison to a custom orthotic of $200 or even more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.
Back ache is easily the most prevalent ailment affecting men and women today. Around 80 million people are afflicted by back pain at some stage in their life. It's a problem which costs businesses vast amounts of money each year on account of time lost and productivity. Fresh and superior treatment methods are always sought after in the hope of decreasing the economical influence this issue causes.
Men and women from all corners of the earth suffer the pain of foot ache due to leg length discrepancy. In these situations Shoe Lifts are usually of very helpful. The lifts are capable of decreasing any discomfort in the feet. Shoe Lifts are recommended by numerous certified orthopaedic physicians.
To be able to support the human body in a well-balanced manner, your feet have got a vital task to play. Despite that, it's often the most overlooked region of the human body. Many people have flat-feet which means there is unequal force placed on the feet. This causes other areas of the body including knees, ankles and backs to be impacted too. Shoe Lifts ensure that the right posture and balance are restored.
Protecting Against Posterior Calcaneal Spur
Overview
Heel spurs are a bone growth that extends from the heel bone, particularly on the bottom front of the heel bone and sometimes slightly to the side. Usually, a heel spur forms where the plantar fascia ligament attaches to the bottom of the heel bone. Those who overuse, or put heavy stress on the plantar fascia, are at risk of developing heel spurs.
Causes
Fctors that increase the risk of developing heel spurs include a high body mass index (BMI), regular vigorous activity, and intensive training routines or sports. Factors such as these are believed to increase the incidence of repetitive stress injuries that are associated with the formation of heel spurs. When a heel spur forms, extremely sharp pain along with the feeling that a part of the heel is trying to burst through the skin usually occurs. If left untreated, an individual may eventually begin to struggle to perform simple activities such as walking.
Symptoms
Heel spurs result in a jabbing or aching sensation on or under the heel bone. The pain is often worst when you first arise in the morning and get to your feet. You may also experience pain when standing up after prolonged periods of sitting, such as work sessions at a desk or car rides. The discomfort may lessen after you spend several minutes walking, only to return later. Heel spurs can cause intermittent or chronic pain.
Diagnosis
Diagnosis is made using a few different technologies. X-rays are often used first to ensure there is no fracture or tumor in the region. Then ultrasound is used to check the fascia itself to make sure there is no tear and check the level of scar tissue and damage. Neurosensory testing, a non-painful nerve test, can be used to make sure there is not a local nerve problem if the pain is thought to be nerve related. It is important to remember that one can have a very large heel spur and no plantar fasciitis issues or pain at all, or one can have a great deal of pain and virtually no spur at all.
Non Surgical Treatment
Treatment of Heel Spurs is the same as treatment of plantar fasciitis. To arrive at an accurate diagnosis, our foot and ankle Chartered Physiotherapists will obtain your medical history and examine your foot. Throughout this process the physio will rule out all the possible causes for your heel pain other than plantar fasciitis. The following treatment may be used. Orthotics/Insoles. Inflammation reduction. Mobilisation. Taping and Strapping. Rest.
Surgical Treatment
Heel spur surgery should only be considered after less invasive treatment methods have been explored and ruled insufficient. The traditional surgical approach to treating heel spurs requires a scalpel cut to the bottom of the food which allows the surgeon to access the bone spur. Endoscopic plantar fasciotomies (EPF) involve one or two small incisions in the foot which allow the surgeon to access and operate on the bone spur endoscopically. Taking a surgical approach to heel spur treatment is a topic to explore with a foot and ankle specialist.
Prevention
Use orthotic inserts. You can purchase orthotics over the counter, or you can have orthotics specially fitted by your podiatrist. Try 1 of these options. Heel cups. These inserts will help to align the bones in your foot and to cushion your heel. Check your skin for blisters when you first start using heel cups. Also, your feet may sweat more with a heel cup, so change your socks and shoes often. Insoles. While you can pick up generic insoles at a drugstore, you may have more luck if you go to a store that sells athletic shoes. Push on the arch to make sure that it doesn't collapse. If your insoles help but could use a little work, you can take them to a podiatrist to get them customized. Custom orthotics. A podiatrist can make a cast of your foot and provide you with custom-made orthotics. These may be more expensive, but they are made of materials specifically designed for your needs, and they can last up to 5 years if your podiatrist refurbishes them every 1 or 2 years. To find a podiatrist near you, look at the Web page for the American Academy of Podiatric Sports Medicine. Dynamic Insoles. Lack of elasticity in plantar fascia in the foot is for most people the real problem. If there is poor elasticity in the lengthwise tendons in the foot (plantar fascia) in relation to a person's general condition, only a small additional strain is required for the pull on the tendons to cause damage to the tissues connecting the tendons to the heel bone. This will generate an inflamed condition called Plantar Fasciitis.
Working With Calcaneal Spur
Overview
The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are heel spurs and plantar fasciitis. A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur digs into the plantar fascia and causes small micro-tears in the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch.
Causes
Causes of Heel Spur Syndrome are mostly due to your foot structure. Foot structure is due to hereditary for the most part, meaning it was the way you were when born. Other factors such as increase in weight, injury, improper shoes, or different activities may change the way your foot functions as well. If one leg is longer or shorter than the other, this may make your foot function improperly and be the cause of the heel spur syndrome. Improper shoes may be ones that are new or ones that are worn out and do not give good support. The higher priced shoes do not mean it's a better shoe. Pronation is a term used to describe a foot which allows the arch to fall more than normal and allows for the fascia along the bottom of the foot to put a tighter pull or a different angle of pull on the heel bone. Over time, this constant pull of the tight fascia can force the bone to enlarge and form a spur. It is not the heel spur that causes the pain directly. The spur may cause pressure against a nearby nerve causing a neuritis, or a bursa causing a bursitis.
Symptoms
The following symptoms are typical of heel spur. Stabbing pain when treading on the area affected. Dull, irregularly occurring pains in the heel area also without exerting pressure (e.g. in a reclining position) Pain when taking the first steps in the morning (after lying or sitting down for an extended period, especially in the morning) Occasional swelling in the ankle area. For the lower heel spur, extreme sensitivity at the tendon attachment (laterally in the lower heel area) For the upper heel spur, extreme pressure sensitivity of the Achilles tendon, primarily at approximately ankle height.
Diagnosis
Your doctor will discuss your medical history and will examine your foot and heel for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray or blood tests (to rule out diseases or infections) may be requested.
Non Surgical Treatment
The heel pain associated with heel spurs and plantar fasciitis may not respond well to rest. If you walk after a night's sleep, the pain may feel worse as the plantar fascia suddenly elongates, which stretches and pulls on the heel. The pain often decreases the more you walk. But you may feel a recurrence of pain after either prolonged rest or extensive walking. If you have heel pain that persists for more than one month, consult a health care provider. He or she may recommend conservative treatments such as stretching exercises, shoe recommendations, taping or strapping to rest stressed muscles and tendons, shoe inserts or orthotic devices, physical therapy. Heel pain may respond to treatment with over-the-counter medications such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). In many cases, a functional orthotic device can correct the causes of heel and arch pain such as biomechanical imbalances. In some cases, injection with a corticosteroid may be done to relieve inflammation in the area.
Surgical Treatment
Approximately 2% of people with painful heel spurs need surgery, meaning that 98 out of 100 people do well with the non-surgical treatments previously described. However, these treatments can sometimes be rather long and drawn out, and may become considerably expensive. Surgery should be considered when conservative treatment is unable to control and prevent the pain. If the pain goes away for a while, and continues to come back off and on, despite conservative treatments, surgery should be considered. If the pain really never goes away, but reaches a plateau, beyond which it does not improve despite conservative treatments, surgery should be considered. If the pain requires three or more injections of "cortisone" into the heel within a twelve month period, surgery should be considered.
