Common Heel Pain

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This article is featured on Humpal Physical Therapy & Sports Medicine Centers

Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected.

ANATOMY

Where is the plantar fascia, and what does it do?

The plantar fascia (also known as the plantar aponeurosis) is a thick band of connective tissue. It runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer’s bow. It is the source of the painful condition plantar fasciitis.

The plantar fascia is made up of collagen fibers oriented in a lengthwise direction from toes to heel (or heel to toes). There are three separate parts: the medial component (closest to the big toe), the central component, and the lateral component (on the little toe side). The central portion is the largest and most prominent.

Both the plantar fascia and the Achilles’ tendon attach to the calcaneus. The connections are separate in the adult foot. Although they function separately, there is an indirect relationship. If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles’ tendon increases the strain on the plantar fascia. This is called the windlass mechanism. Later, we’ll discuss how this mechanism is used to treat plantar fasciitis with stretching and night splints.

CAUSES

How does plantar fasciitis develop?

Plantar fasciitis can come from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult.

As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body.

As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heel bone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.

As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis.

Fat Pad

Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. In many cases, the actual source of the painful heel may not be defined clearly.

SYMPTOMS

What does plantar fasciitis feel like?

The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor.

Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.

DIAGNOSIS

How do health care providers diagnose the condition?

When you first visit medical care, the doctor will typically examine your foot and speak with you about the history of your problem. Diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions.

Some patients may be referred to an additional doctor for further diagnosis. Once your diagnostic examination is complete, treatment options will be offered that will help speed your recovery, so that you can more quickly return to your active lifestyle.

TREATMENTS

Non-surgical Rehabilitation

Nonsurgical management of plantar fasciitis is successful in 90 per cent of all cases. When you begin physical therapy, Physical Therapists will design exercises to improve flexibility in the calf muscles, Achilles’ tendon, and the plantar fascia.

Treatments will be applied to the painful area to help control pain and swelling. Examples include ultrasound, ice packs, and soft-tissue massage. Physical Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine, prescribed by your doctor, into the sore area.

There may be customized arch support, or orthotic, designed to support the arch of your foot and to help cushion your heel. Supporting the arch with a well fitted orthotic may help reduce pressure on the plantar fascia. Alternatively, we may recommend placing a special type of insert into the shoe, called a heel cup. This device can also reduce the pressure on the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration.

Your Physical Therapist will also provide ideas for therapies that you can perform at home, such as doing your stretches for the calf muscles and the plantar fascia. We may also have you fit with a night splint to wear while you sleep. The night splint keeps your foot from bending downward and places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint and report having less heel pain when placing the sore foot on the ground in the morning.

We find that many times it takes a combination of different approaches to get the best results for patients with plantar fasciitis. There isn’t a one-size-fits-all plan. Some patients do best with a combination of heel padding, medications, and stretching. If this doesn’t provide relief from symptoms within four to six weeks, then we may advise additional Physical Therapy and orthotics.

Finding the right combination for you may take some time. Don’t be discouraged if it takes a few weeks to a few months to find the right fit for you. Most of the time, the condition is self-limiting. This means it doesn’t last forever but does get better with a little time and attention. But in some cases, it can take up to a full year or more for the problem to be resolved.

Post-surgical Rehabilitation

Although recovery rates vary among patients, it generally takes several weeks before the tissues are well healed after surgery. The incision is protected with a bandage or dressing for about one week after surgery. You will probably use crutches briefly, and your Physical Therapist can help you learn to properly use your crutches to avoid placing weight of your foot while it heals.

The stitches are generally removed in 10 to 14 days. However, if your surgeon used sutures that dissolve, you won’t need to have the stitches taken out. You should be released to full activity in about six weeks.

Surgical release of the plantar fascia decreases stiffness in the arch. However, it can also lead to collapse of the longitudinal (lengthwise) arch of the foot. Releasing the fascia alters the biomechanics of the foot and may decrease stability of the foot arch. The result may be increased stress on the other plantar ligaments and bones. Fractures and instability have been reported in up to 40 per cent of patients who have a plantar fasciotomy.

Throughout your post-surgical recovery, your Physical Therapist will note your progress and be watchful for the development of fractures and instability.

PHYSICIAN REVIEW

Your doctor may order an X-ray to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation.

Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.

A cortisone injection into the area of the fascia may be used but has not been proven effective. Studies show better results when ultrasound is used to improve the accuracy of needle placement. Cortisone should be used sparingly since it may cause rupture of the plantar fascia and fat pad degeneration and atrophy, making the problem worse.

Botulinum toxin A, otherwise known as BOTOX, has been used to treat plantar fasciitis. The chemical is injected into the area and causes paralysis of the muscles. BOTOX has direct analgesic (pain relieving) and anti inflammatory effects. In studies so far, there haven’t been any side effects of this treatment.

Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.

Clinical trials are underway investigating the use of radio frequency to treat plantar fasciitis. It is a simple, noninvasive form of treatment. It allows for rapid recovery and pain relief within seven to 10 days. The radio waves promote angiogenesis (formation of new blood vessels) in the area. Once again, increasing blood flow to the damaged tissue encourages a healing response.

SURGERY

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 that 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.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Treating Ankle Injuries

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Article featured on UCSF Health

Ankle sprains are the most common ankle injury among regular athletes and weekend warriors. The top orthopedic complaint, sprains occur in an estimated 27,000 Americans a day.

Many athletes, however, who suffer from ankle sprains tend to play right through their injury, which can lead to lifelong problems with recurring sprains, unstable joints, arthritis-like pain or other complications like tendon or cartilage damage. And the earlier in life a sprain occurs, the higher the chance of recurrence. Therefore, it’s important to properly treat initial sprains, especially in young athletes.

If you sprain your ankle and it hurts to run, you should sit out the rest of the game. Once a sprain has occurred, follow these three steps to help you recover:

Step 1: RICE

Follow the instructions represented by the acronym RICE as often as possible for three days. RICE stands for rest, ice, compression (with an elastic ankle wrap) and elevation (toes above the nose). For significantly swollen ankles or if limping persists for more than three days, you should see a doctor.

Step 2: Rehabilitation

To prevent permanent damage to the ankle, take steps to achieve better range of motion (flexibility), balance and strength. Many of these exercises can be done at home.

Range of motion exercise

Place one foot on a stairway step. Allow the back heel to stretch downward over the edge of the step. Hold each foot in this position for 30 seconds.

Balance restoration exercise

Stand on one leg with your eyes closed. Gradually build up to standing 30 seconds on each leg. Repeat three times.

Strength exercise

Lie on your side on the sofa, with the upper leg hanging over the edge. Place the top of your foot through the handles of a plastic shopping bag filled with one to two pounds of weight (one or two cans of soup). Slowly lift your toes toward the ceiling and hold for three seconds. Repeat 10 times.

Step 3: Supportive devices

When back to playing sports, previously injured athletes should probably wear an ankle brace, no matter how much they have rehabilitated their ankle or how good their sneakers. An injured ankle will never have the same support again, so a brace should be considered.

Step 4: If pain continues

For ankle pain and significant instability that persists despite adequate rehabilitation or physical therapy, you should see a doctor for further evaluation. You may have injured the cartilage or tendons in your ankle, which may require special testing.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Why are My Legs and Feet Numb?

Why are My Legs and Feet Numb?

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From Medical News Today; Medically reviewed by Seunggu Han, M.D. — Written by Jennifer Huizenon January 22, 2020

A person may feel numbness in their legs and feet due to sitting in a position that puts too much pressure on the nerves or reduces blood flow. However, long-lasting or unexplained numbness may be a sign of an underlying medical condition.

Long-term numbness or a tingling feeling in the legs and feet may be due to conditions such as multiple sclerosis(MS), diabetes, peripheral artery disease, or fibromyalgia. The sensation may be felt in the whole leg, below the knee, or in different areas of the foot.

In this article, we look at some of the reasons why a person might experience numbness in the legs and feet, along with symptoms and treatments.

Causes of numbness in legs and feet

Crossing the legs for a long time may cause numbness and tingling in the legs and feet.

Often, a person’s legs go numb temporarily because of their posture. However, chronic or long-lasting numbness in the feet and legs is almost always a sign of an underlying medical condition.

Conditions associated with feet and leg numbness include:

Posture

Postural habits that put pressure on nerves or reduce blood flow in the lower limbs are the most common cause of temporary numbness in the legs and feet. Many people say their leg has “fallen asleep,” and the medical term is transient (temporary) paresthesia.

Habits that can cause the feet and legs to fall asleep include:

  • crossing the legs for too long
  • sitting or kneeling for long periods
  • sitting on the feet
  • wearing pants, socks, or shoes that are too tight

Injury

Injuries to the torso, spine, hips, legs, ankles, and feet can put pressure on nerves and cause the feet and legs to go numb.

Diabetes

Some people with diabetes develop a type of nerve damage called diabetic neuropathy. Diabetic neuropathy can cause numbness, tingling, and pain in the feet, and if severe, the legs as well.

Lower back issues and sciatica

Problems in the lower back, such as a breakdown or herniation of spinal discs, can cause compression of the nerves going to the legs, leading to numbness or sensory disturbances.

Sciatica is the name for irritation of the sciatic nerve, which runs from the lower back to the legs. If this nerve becomes irritated or compressed, a person may experience numbness or tingling in their legs or feet.

Tarsal tunnel syndrome

Tarsal tunnel syndrome occurs when a nerve that runs down the back of the leg and along the inside of the ankle and into the foot is compressed, squeezed, or damaged.

The tarsal tunnel is a narrow space on the inside of the ankle. People with tarsal tunnel syndrome tend to feel numbness, burning, tingling, and shooting pain in their ankles, heels, and feet.

Peripheral artery disease

Peripheral artery disease (PAD) causes the peripheral blood arteries in the legs, arms, and stomach to narrow, reducing the amount of blood they can pump and reducing blood flow. The legs are one of the most common parts of the body impacted by PAD.

Most people with PAD experience pain and cramping in their legs and hips when they are walking or going upstairs. Some people with PAD also experience leg numbness and weakness.

Symptoms of PAD typically go away after a few minutes of rest.

Tumors or other abnormal growths

Tumors, cysts, abscesses, and benign (non-cancerous) growths can put pressure on the brain, spinal cord, or any part of the legs and feet. This pressure can restrict blood flow to the legs and feet, causing numbness.

Alcohol use

The toxins in alcohol can cause nerve damage that is associated with numbness, especially in the feet.

Chronic or excessive alcohol consumption can also lead to nerve damage that causes numbness. This type of nerve damage is linked to reduced levels of B vitamins, such as B-1 (thiamine), B-9 (folate), and B-12, which is caused by excessive alcohol intake.

Fibromyalgia

Fibromyalgia is a chronic or long-lasting condition that causes widespread body pain, aching, and tenderness. Some people with fibromyalgia also experience numbness and tingling in the hands and feet.

Most people with fibromyalgia experience a variety of symptoms including:

  • stiffness and soreness for no apparent reason, especially in the morning or after sleeping
  • chronic exhaustion
  • memory problems and difficulty thinking clearly, sometimes called fibro-fog
  • restless leg syndrome

Almost everyone with fibromyalgia experiences symptoms in more than one part of their body for at least 3 months at a time. If numbness in the legs and feet is not accompanied by any other symptoms or is not long-term, it is unlikely to be caused by fibromyalgia.

Multiple sclerosis

People with multiple sclerosis (MS) experience sensory nerve damage that can cause numbness in a small region of their body or whole limbs. Although numbness associated with MS often only lasts for a short period, it can last long enough to become disabling.

Stokes and mini-strokes

Strokes or mini-strokes can cause brain damage that may affect how the mind interprets and processes nerve signals. A stroke or mini-stroke can sometimes cause temporary or long-term numbness in parts of the body.

Symptoms

Numbness is just one of the many symptoms associated with temporary and chronic numbness.

Many people with numbness in their legs and feet experience additional symptoms at the same time or intermittingly, such as:

  • tingling
  • burning
  • tickling
  • itching
  • a crawling feeling under the skin
Treatment

The proper treatment for numb legs and feet depends entirely on the cause.

Medication

Medical options for long-term numbness in the legs and feet include:

  • Antidepressants. Some antidepressants, such as duloxetine and milnacipran, have been approved for the treatment of fibromyalgia.
  • Corticosteroids. Some corticosteroids can help reduce chronic inflammation and numbness associated with conditions such as MS.
  • Gabapentin and pregabalin. Medications that block or change nerve signaling may help reduce numbness associated with conditions such as fibromyalgia, MS, and diabetic neuropathy.

Home remedies

Home remedies that may help to relieve uncomfortable numbness in the legs and feet include:

  • Rest. Many of the conditions that cause leg and foot numbness, such as nerve pressure, improve with rest.
  • Ice. Ice can help reduce swelling that can put pressure on nerves. Apply cold compresses or wrapped icepacks to numb legs and feet for 15 minutes at a time several times daily.
  • Heat. Heat can sometimes help loosen stiff, sore, or tense muscles that can put pressure on nerves and cause numbness. However, avoid overheating numb legs and feet, as this may or worsen inflammation and cause pain and numbness.
  • Massage. Massaging numb legs and feet helps improve blood flow and may reduce symptoms.
  • Exercise. A lack of proper exercise can weaken the heart and blood vessels, reducing their ability to pump blood to the lower limbs. Activities such as yoga, Pilates, and tai chi can promote blood flow and reduce chronic inflammation or pain.
  • Supportive devices. Braces and specially designed footwear can help reduce nerve pressure caused by conditions such as injury, tarsal tunnel syndrome, or flat feet.
  • Epsom salt baths. Epsom salts contain magnesium, a compound known to increase blood flow and circulation. Epsom salts are available for purchase online.
  • Mental techniques and stress reduction. People with conditions that cause chronic numbness, such as MS and fibromyalgia, should try to focus on the fact that the periods of numbness are often short-lived and go away on their own. Stress also tends to make the symptoms of central nervous system disorders worse.
  • Sleep. Many of the chronic conditions associated with leg and feet numbness are known to worsen with a lack of proper sleep.
  • A healthful, balanced diet. Malnutrition, especially vitamin B deficiencies, can cause nerve damage leading to numbness. Getting enough vitamins and other nutrients can also reduce chronic inflammation and pain, which can cause numbness.
  • Alcohol reduction or avoidance. Alcohol contains toxins that can cause nerve damage and numbness. Alcohol also usually makes the symptoms of chronic pain and inflammatory conditions worse and can even cause flare-ups of symptoms.

When to see a doctor

Talk with a doctor about numbness in the legs and feet that:

  • is not related to postural habits or lifestyle factors, such as tight clothing and footwear
  • lasts for long periods
  • is accompanied by any other chronic symptoms
  • is accompanied by permanent or long-term changes in the color, shape, or temperature of the legs and feet

Numbness in the legs and feet is a common disorder, though when it becomes chronic, it may be a sign of an underlying medical condition.

Anyone who experiences numbness that is unexplained, persistent, frequent, painful, disabling, or accompanied by other chronic symptoms should see a doctor for a diagnosis and to discuss treatment options.

 

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

All About Foot Pain

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From WebMD
Feet. They carry you from here to there every day. But you may not think much about them until they hurt. And when they do, you want relief. To get the right treatment, you need to know the problem. The first thing to consider is where your pain is located.
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