PLANTAR FASCIITIS

WHAT IS PLANTAR FASCIITIS?

Plantar fasciitis (PLAN-tur fas-e-I-tis) involves pain and inflammation of a thick, ligament-like band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. This band pulls on the heel bone, raising the arch of your foot as it pushes off the ground. If your foot moves incorrectly, the plantar fascia could become strained. The fascia may swell and its tiny fibers may begin to fray causing Plantar fasciitis.

CAUSES

Plantar fasciitis is usually caused by improper foot mechanics. If your foot flattens out too much, the fascia may overextend and swell. If your foot flattens too little, the fascia may hurt from being pulled to tight.

SYMPTOMS

Stabbing foot pain that usually occurs with your first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally lessens, but may return after prolonged movement or after rest. The pain usually happens on the inside of the foot, close to the spot where your heel and arch meet.

MEDICAL HISTORY AND PHYSICAL EXAM

Your podiatrist may ask you about your symptoms first. Where does it hurt? When and how often? Next, he or she may examine your foot and feel for damaged ligaments, displaced bones or joints and inflamed tendons. Your podiatrist may also watch you walk to see if your symptoms are caused by improper bio-mechanics. X-rays may be taken to see if there is a stress fracture of the heel bone or a heel spur.

TREATMENTS

To relieve mild symptoms try aspirin, ibuprofen, or other medications as directed. Rubbing ice on the affected area may also help.

If your pain is due to poor foot mechanics, custom molded orthotics, shoe inserts, may help.

To reduce severe pain and swelling, your podiatrist may prescribe injections or pills. Physical therapy, such as stretching or ultrasound may also be advised.

To reduce symptoms caused by irregular foot bio-mechanics, your podiatrist may tape them or use strappings that will support the arch and temporarily controls movement. Night splints may also be used.

It may also help to avoid running on hard or uneven ground, wear house slippers that support your arch and lose excess weight.

SURGERY MAY BE NEEDED

Your podiatrist may want to do a procedure if all other treatments don't control the pain. In surgery, the plantar fascia is partially cut to release tension. As you get better, fibrous tissues fill in the space between the heel bone and the plantar fascia.

WARTS

What are Plantar Warts?
A wart is an infection caused by a virus, which can enter your skin through small breaks or cuts. Warts
are one of several soft tissue conditions of the foot that can be quite painful. Over time, the wart
develops into a hard, rough growth on the surface of the skin.


Technically only those on the bottom of the foot are properly called plantar warts.

Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune.

Identification Problems
Warts are generally harmless, even though they may be painful. Many times they are mistaken for corns or calluses—which are layers of dead skin that build up to protect an area which is being continuously rubbed. The wart, however, is a viral infection. If left untreated, warts can spread to other parts of the body, like the hands.

It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is smart to consult a podiatric physician when any suspicious growth or eruption is noticed on the skin of the foot in order to ensure a correct treatment and diagnosis.

Plantar warts tend to be hard and flat, may appear spongy, with tiny red, brown or black spots, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. They can grow up to an inch or more across, occurring alone or with smaller warts clustered nearby. It is important to note that warts can persist for years and recur in the same area.

Source of the Virus
The plantar wart is often acquired by walking barefoot on dirty surfaces. Avoid going barefoot in public places like showers, gyms, and locker rooms. Wear sandals on your feet. The causative virus thrives in warm, moist environments.
Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
When plantar warts develop on the weight-bearing areas of the foot—the ball of the foot, or the heel, for example—they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Tips for Prevention
• Avoid walking barefoot, except on beaches.
• Change shoes and socks daily.
• Keep feet clean and dry.
• Check children's feet periodically.
• Avoid direct contact with warts.
• Do not ignore growths or changes in your skin.
• Visit your podiatric physician.

Self Treatment
Self treatment is generally not a good idea. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes a podiatric foot and ankle surgeon to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.




Professional Treatment
It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated. Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia where the wart is vaporized using focused light energy in your podiatrist’s office surgical setting. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.

Tips for Individuals with Warts
• Avoid over-the-counter preparations.
• Seek professional podiatric evaluation.
• Diabetics should be especially careful.
• Warts may spread and are catching.

FRACTURES, STRAINS AND SPRAINS

STRESS FRACTURE OF THE FOOT AND ANKLE

A stress fracture is a small break or crack in the bone. Stress fractures may develop from overuse, such as from high-impact sports like football, distance running or basketball.

Most stress fractures occur in the weight-bearing bones of the foot and lower leg. Research shows that athletes participating in tennis, track and field, gymnastics, dance, and basketball are at an increased risk for stress fractures. In all of these sports, the continued stress of the foot striking the ground can cause problems.

Rest is the best remedy to recover from a stress fracture.

A stress fracture is an overuse injury. When muscles are overworked, they are no longer able to lessen the shock of repeated impacts. When this happens, the muscles transfer the stress to the bones. This can create small cracks or fractures.

The most common sites of stress fractures are the second and third metatarsals of the foot. Stress fractures are also common in the heel, the outer bone of the lower leg, and the navicular, a bone on the top of the midfoot.

Stress fractures usually occur when you increase your high-impact activity by:

• Frequency (how often you exercise)
• Duration (how long you exercise)
• Intensity (your level of exertion)

People who do not exercise can also have stress fractures. If osteoporosis or other disease has weakened bones, normal daily activities may result in a stress fracture. This is called bone insufficiency. It is one of many factors that can increase your risk for stress fracture.

Doing too much too soon is a common cause of stress fractures. For example, runners who are confined indoors for the winter may want to pick up where they left off at the end of the previous season. Instead of starting slowly, they try to match their previous mileage. Because of the lower level of conditioning, muscles become fatigued faster. The result could be a stress fracture in the foot or ankle.

Those who are new to exercise and try to do too much too soon are also at risk.

Wear the proper shoes and change your environment

Improper sports equipment, such as shoes that are too worn or stiff, can contribute to stress fractures. A change of surface, such as going from a grass tennis court to one of clay, or a change from an indoor to an outdoor running track, can also increase the risk.

Your risks increase if you have these symptoms:

• Pain that starts at a low threshold and increases with physical activity, and lessens with rest
• Pain that becomes more serious and happens with regular, daily activities.
• Inflammation on the top part of the foot or the outside of the ankle.
• Touching the site is painful.
• Bruising.

FIRST VISIT

On your initial visit, your podiatrist will ask you about your work, your physical activities, and any prescription medications you take. It is important that your podiatrist understands what your medical history is.

After going over your conditions and medical history, your podiatrist will physically examine your feet and ankles.

Tests

Stress fractures are almost impossible to locate on X-rays until they have actually started to heal. Your podiatrist may order a bone scan or a magnetic resonance imaging (MRI) scan, which are more sensitive than an X-ray and can show stress fractures early.

How to Treat

If you think you have a stress fracture in your foot or ankle, stop what you are doing and rest. Do not ignore the pain as you may have a serious break.

Place an ice pack on the area and elevate your foot above the level of your heart. Try not to put weight on your foot until after you see a podiatrist.

Proper Footwear


To alleviate pressure on your lower extremities, your podiatrist will probably recommend wearing protective shoes. This may be a rigid-soled shoe or a removable short-leg fracture boot.

APOPHYSITIS

APOPHYSITIS

Unlike the heel spurs that occur in adults, heel pain is very unusual in children. For the children who do get heel pain, the most common cause is an irregularity to the growing area at the back of the heel bone where the large achilles tendon attaches to it. This is called Calcaneal Apophysitis (an inflammation of the growth plate). It occurs most often to children between the ages of 10 to 14.

 

The Development of Heel Pain:

Most of the bones are still cartilage when a baby is born. Only some are developing into bone. When the heel starts to develop bone, there is usually a large area of growth that begins in the middle of the cartilage heel. This area of bone spreads and expands into cartilage. Ossification, another area of bone development happens at the back of the heel bone. The two areas of developing bone will have cartilage between them - this is how the bone grows in size. At about 16 years of age, the growth is nearly complete, these two bony areas merge together.

Symptoms of Heel Pain in the Child:

In severe cases, the child will be limping. The back and side of the heel bone will have discomfort. Also, there may be pain at the bottom of the heel. The pain usually stops when the child is not active and becomes painful with physical activity. Pinching the sides of the heel bone is often painful. Running, jumping make the symptoms worse. One or both heels may be affected.

The Cause:

It is most likely due to repeated trauma that happens in a lot of sporting activities - the cartilage join between the two parts of the bone can not take all the shear stress of the activities. Some children seem to be just more prone to it for an unknown reason - combine this with sport, especially if its on a hard surface and the risk of getting it increases. It can be almost epidemic at the start of some sports seasons, especially winter. At the start of winter, the grounds are often harder, but soften later.

Treatments:

* Minimize physical activities - don't stop, just reduce the amount until symptoms improve.

* Do not go barefoot

* Use a soft cushioned heel raise.

* Stretch the calf muscles provided the stretch does not cause pain.

* Ice the area for 20 minutes after the activity, can be done 2 to 3 times a day.

What your Podiatrist may do:

Strapping or taping can be used during activity to restrict the ankle joint range of motion.

If the symptoms are bad enough and not responding to these treatments, medication to help with anti-inflammatory may be used. In some cases the lower limb may need to be put in a cast for 2-6 weeks to give it a good chance to heal.

Get a good supportive shock absorbing shoe at our Sole Savers Shoe Store and heel raises are important to prevent it from happening again.

TAKE CARE OF YOUR FEET EVERY DAY

TAKE CARE OF YOUR FEET

Check your feet every day for sores, red marks, hot spots, blisters, or any unusual condition that was not there the day before. If you cannot pull your feet up to look at them, use a mirror or have someone else hold it up for you. If you are diabetic, you may not feel a blister or sore until it is too late.

Ulcers are the most harmful problems to your feet. They are the cause of approximately 80,000 amputations of the diabetic feet every year. It is very important to catch an ulcer before it becomes a wound.

If you have an infrared thermometer you can measure the temperature of your feet, by measuring the heat on your feet, you can catch the 4 degree temperature difference before you get an ulcer and know to stay off your feet for a couple of days. No medication or surgery needed.

If you notice any changes on your feet you should call Cortese Foot and Ankle Clinic right away and make an appointment. We are board certified foot and ankle surgeons and specialists. This means we have the qualifications and the experience that you are looking for. We just see foot and ankle injuries. It doesn't matter what age you are, we can treat everyone.

Call if you have any questions or concerns at: (309) 452-3000.

Neuropathy

Neuropathy is a condition in which the nerves in our body are damaged or not working correctly. There are several different types of neuropathies and many different ways to categorize. The type of nerve damage may distinguish different neuropathies, as well as, the cause of the nerve damage, or the pattern of nerve damage.

Approximately 21 million Americans are affected by peripheral neuropathy. Altho

ugh only 30% of neuropathy is caused by diabetes, diabetes still remains the leading cause of peripheral neuropathy. Please note that some form of neuropathies can be fatal.

Peripheral is a term used for the most distal (the nerves in your body, aside from your spinal cord and brain, further down) nerves in our body including those in our feet or hands.

A polyneuropathy is a neuropathy pattern, whereby the nerve damage initially starts in both feet and may progress to involve the feet, calves, and fingers/hands. Another word for this pattern is a Stocking and Glove Neuropathy. Many patients with polyneuropathy may not even have any symptoms; in this case the diagnosis is made by a physical examination or a laboratory test (electromyography (EMG) and nerve conduction velocity test (NCV)). Some patients with polyneuropathy have only numbness, “tingling,” and/or “pins and needles.” More often, unlucky patients with polyneuropathy experience some type of pain.

Signs & Symptoms

While every person’s experience with peripheral neuropathy can be as unique as the individual himself or herself, there are some common neuropathy signs and symptoms shared by most individuals. The symptoms of diabetic or peripheral neuropathy start in the toes and feet (right and left). In some patients the symptoms gradually rise up the calves and into the knees. This is called a stocking pattern. Then, in some the symptoms may also begin in the fingers and hands — causing a stocking and glove pattern. It cannot be predicted how any one’s symptoms will spread. In some patients, the pain does not spread beyond the toes or feet and there is no progression; in others, the progression to calves and hands occurs in months, rapidly; and yet in others the spread is very gradual, over many years. There are three categories of nerves and up to five specific peripheral nerves that may be affected, and symptoms depend on these nerves and their location:

Patients who develop pain with peripheral neuropathy describe the pain using a variety of words, including “burning,” “throbbing,” “deep ache”, “raw skin,” “skin sensitivity,” “tingling”, “sharp,” “electric-like,” “pins and needles,” “freezing cold,” “like walking on ground glass,” “itchy,” and others. Some patients say they don’t have pain but have unpleasant and irritating sensations (Allodynia), which may include “itching”, “buzzing,” “like bugs crawling,” “like leather or sand paper”, “hard ball on bottom of feet”, and “aching. Some people feel like they have socks on, even though they are barefoot. Over time, this feeling can spread to the legs and hands.

Patients may find it harder and harder to walk. Their legs feel heavy and they may have to drag them selves up the stairs. Some patients have constant pains, day and night, whereas others only have noticeable pain at bedtime. Often, patients may complain that the pain interferes with their sleep and they may develop Restless Leg Syndrome and or Insomnia (difficulty sleeping). As with all chronic pain, patients with painful peripheral neuropathy may also develop depression. Patients with advanced neuropathy may also have trouble with their sense of positioning; and therefore, have difficulty with their gait or balance.

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