Foot Pain Services
Heel Spurs and Plantar Fasciitis
Plantar fasciitis is a very common cause of heel pain and most common between ages 40 to 60. It involves inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes.
Normally, your plantar fascia supports the arch of your foot and helps with shock absorption. If tension and stress placed on it becomes too great, microscopic tears can occur in the fascia. Repetitive stretching and tearing can cause the fascia to become inflamed and painful.
Plantar fasciitis very commonly causes a pain that is stabbing in nature, and usually comes on with your first steps in the morning. As you get up and walk about more, the pain usually decreases, but it might return after long periods of standing or after getting up from sitting. The pain is usually worse after exercise, not during it.
Plantar fasciitis is very common in runners. Additionally, people who are overweight and those who wear shoes with improper insoles that don’t provide adequate support are at an increased risk of plantar fasciitis.
Steroid injections and surgery should not be first choices in treating this condition. Physical therapy and proper footwear are very effective in treating most cases.
Main risk factors for plantar fasciits are:
- Certain types of activities: Physical activity that places a lot of stress on your heel and attached tissue such as long-distance running, ballistic jumping activities and ballet dancing can contribute to an earlier onset of plantar fasciitis.
- Poor foot mechanics: Being flat-footed, having a high arch or even having an abnormal walking pattern can affect the way your weight is distributed when you're standing and put added stress on the plantar fascia. Poor neck posture and lack of thoracic mobility are also contributing factors.
- Obesity: Excess pounds put additional mechanical stress on your plantar fascia. There is also a theory that fat deposition within the fascia contributes to pain.
- Occupations where you are on your feet a lot: Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can injure their plantar fascia.
Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities and also affect the manner in which you walk. This may cause you to develop foot, knee, hip or back problems as you try to compensate. When plantar fasciitis is chronic, calcium is deposited into the inflamed tissue and causes heel spurs that are visible on X-ray. However, in most cases the heel spur is not the direct cause of heel pain.
While steroid injections are a common quick fix, the relief may be temporary and it does nothing to solve the root problem. We usually advise physiotherapy in most cases of plantar fasciitis. However, if you choose to receive a steroid injection into the heel for quick relief, be sure to engage in physical therapy after, because the pain can be worse if the plantar fasciitis returns. Also, discuss with you doctor the possible side effects of continuous steroid medication before choosing to receive it.
Achilles tendinitis is an overuse injury of the achilles tendon. The achilles tendon (calcaneal tendon) is the tendon that connects calf muscles at the back of the lower leg to your heel bone. This is the tendon that is involved when you walk, run, jump or push up on your toes.
Runners who have suddenly increased the intensity or duration of their runs are at a high risk of developing this condition. It's also common in middle-aged people who play sports, such as tennis or basketball, but only on the weekends.
In most cases, achilles tendinitis can be treated with a basic home regimen under your doctor's supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair. In the case of a complete rupture, you won’t be able to extend the foot, that is point the toes towards the floor.
The pain associated with achilles tendinitis typically begins as a mild ache at the back of the leg or above the heel after running or other sporting activities. Instances of more-severe pain may occur after prolonged running, sprinting or stair climbing.
In the morning, you may also experience tenderness or stiffness, but this usually improves with mild activity.
If you are experiencing persistent pain around the achilles tendon, it might be a good time to see a doctor or therapist. Seek immediate medical attention if the pain or disability is severe, because you may have a torn (ruptured) achilles tendon.
The structure of the achilles tendon weakens as we age, and this can make it more susceptible to injury especially in people who participate in sports only on the weekends or who have suddenly increased the intensity and distance of their running programs.
- Your sex. Achilles tendinitis is more common in men.
- Age. Achilles tendinitis is more prevalent in older populations
- Mechanical problems. A naturally flat arch in your foot can lead to more strain on the achilles tendon. Also, obesity and tight calf muscles can increase the mechanical forces on the tendon.
- Footwear. Running in worn-out shoes can increase your risk of achilles tendinitis. Improper insoles without the proper arch support are also a factor.
- Training environment. Tendon pain occurs more frequently in cold weather than in warm weather, and running on hilly terrain as opposed to a flat surface can predispose you to achilles injury.
- Medical conditions. People who suffer from high blood pressure or psoriasis are at a higher risk of developing achilles tendinitis.
- Medications. Certain types classes of antibiotics, such as fluoroquinolones, have been associated with higher incidences of achilles tendinitis.
Chronic achilles tendinitis can weaken the tendon, making it more vulnerable to a tear (rupture). This is a painful injury and may actually require a surgical repair.
While it may not be possible to totally prevent achilles tendinitis, there are measure you can take to reduce your risk:
- Gradually increase your intensity level as opposed to doing it abruptly. If you are now starting an exercise regimen start at an appropriate level and gradually increase the duration and intensity of the program.
- Exercise at your level of strength and fitness. Also, cycle your intensity levels. Alternate between light and heavy days. Warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest.
- Utilize proper footwear. Your shoes should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the achilles tendon. Replace worn-out shoes. If your shoes are in good condition but don't support your feet, try insoles with proper arch supports.
- Do daily stretches. Take the time to stretch your calf muscles and massage around the achilles tendon in the morning, before and after exercise to maintain flexibility. This is especially important to avoid a recurrence of achilles tendinitis.
- Strengthen your calf muscles with exercises such a weighted heel raises. Proper strength training enable the calf and achilles tendon to better handle the stresses they encounter during activity.
- Cross-train. Alternate your high-impact activities, such as running, sprinting and jumping, with low-impact activities, such as cycling, swimming and the elliptical machine.
Diabetic Foot Pain
Uncontrolled diabetes is a very common cause of feet pain. With diabetes, four general types of foot problems may come about:
- Nerve problems
- Circulation compromise
- Muscle and joint issues
The most common cause of diabetic foot pain is a nerve condition called “Peripheral Neuropathy”. This is where the insulation of the nerve fibres (myelin) becomes damaged due to prolonged exposure to high blood sugar levels. There are essentially three types of peripheral neuropathy:
A large proportion of diabetic patients report pain that is due to sensory neuropathy. This can present as "sensitive pain," where the amount of pain experienced is not proportional to the degree of the insult that is causing it. For example, simply dragging a bedsheet over your feet can be very painful. Numbness can also be present in the feet along with the “sensitive pain”. The symptoms of sensory neuropathy can include:
- Stabbing pain
Relief is the first thing on a patient’s mind when painful neuropathy is being experienced. The first thing to do is to start logging your blood sugar 3-4 times a day for 5 to 7 days to determine if the general picture is one of uncontrolled diabetes.
The Hb A1c test is a great and affordable way to determine what your average sugar control has been like over the last 3 months. Persistent high blood sugar can contribute to the pain of sensory neuropathy.
Massaging your feet with a diabetic foot cream, or using a foot roller, can lead to a temporary reduction in the pain, but unlikely to fully alleviate it. Vitamin B supplements are often recommended to assist with nerve repair and subsequent pain reduction.
Supportive shoes that are well cushioned and have proper insoles are highly recommended. They can protect the feet from the mechanical forces that add to neuropathic pain.
In motor neuropathy, the nerves that supply the muscles become affected by the disease and this leads to muscular weakness and pain. Some of the first muscles to become affected are those in the upper leg. Other muscles that are affected include the shin muscle (anterior tibialis) and the small muscles of the feet. As a result, walking imbalances can result. These can lead to increased friction between the foot and the shoe, bruising of the skin, increased callous formation, and pain.
To assist with some of the effects of motor neuropathy you need to correct walking imbalances with supportive shoes and foot support inserts (orthotics). You should also incorporate foot exercises, massage and foot rolling devices to help keep your muscles and joints from becoming stiff.
Autonomic neuropathy affects the nerves that regulate functions that are not under our conscious control such as sweating and skin oil production. The sweating mechanism becomes altered so the person who suffers with this condition may have thickened, dry cuticles and nails, as well as dry, stiff, cracked skin. This type of skin is subject to formation of thicker calluses with more pain. There is also a greater risk of bacterial and fungal infections which can be an additional source of discomfort.
Available on the market are toenail oils and conditioning foot cream made specifically for diabetics. You should consider using them daily.
Poor blood circulation to the feet may cause intense pain, even though the feet may feel numb to the touch.
Arteries supply oxygenated blood from the heart to the rest of the body. Then de-oxygenated blood returns to the heart via the veins. The arteries most commonly affected by poorly controlled diabetes are those behind the knee and the calf. These arteries are subject to the same fatty deposits that most people have, however, the process can be accelerated in diabetes. These fatty deposits thicken the walls of the arteries, and causes narrowing of the channel that the blood flows through. Blood flow to the feet can then become partially or totally blocked. Because the tissues are oxygen deprived, they tbecome painful. Patients often state as though their feet are in a vise, or are being strangled.
Also, the capillaries are known to get thickened and stiff from diabetes and hence, they are not as efficient in delivering oxygen and nutrients to tissues.
With the clearance of your medical doctor, exercise, massage, physical therapy, medications and various surgical procedures can be used to improve the circulation.
Muscle & Joint Problems
Muscle cramping is relatively common in diabetes. It can be due to electrolyte imbalances, low blood sugar, reduced blood supply and nerve injury. The cramps tend to be more common in the legs and feet and occur more commonly at night.
A particular type of joint problem is “Charcot neuropathic osteoarthropathy”, also known as the “Charcot foot”. This condition affects the bones, joints, and soft tissues of the foot and ankle. It is characterized by inflammation in the earliest phase. The foot becomes red, swollen and painful. Later, foot joints become displaced and fractures may develop creating the possibility of ulcer formation. It is highly advised you see an orthopedic surgeon for adequate management.
The interaction of several factors: sensory-motor neuropathy, autonomic neuropathy, trauma, and metabolic abnormalities of bone result in an acute localized inflammatory condition that may lead to various degrees of bone destruction, partial dislocation, complete dislocation, and deformity. The characteristic deformity associated with this condition is midfoot collapse, also known as “rocker-bottom” foot, although the condition can appear in other joints and with other types of deformations.
Diabetic persons are more susceptible to bacterial, fungal and yeast infections due to medical and nutritional changes that takes place in the body.
Bacterial infections can occur in regions of the foot that become irritated, ulcerated or injured. The signs of a bacterial infection include redness, swelling, warmth, pain and tenderness as well as the presence of pus. This kind type infection, when it occurs on the skin is called a “cellulitis”, and if it spreads to the bone, it is termed an “osteomyelitis”.
Even though diabetics may have numbness in their foot, they can sometimes feel pain when they develop a bacterial infection. When a diabetic suddenly develops pain while their feet are numb, it could be a sign that an infection is present and medical attention should be sought immediately.
Fungal or yeast infections in the foot commonly present as athlete's feet or fungal toenails. Athlete's feet can cause the skin to become blistered, scaly, red, inflamed and painful. A bacterial infection can subsequently occur in the same region because the irritated skin serves as a good place for bacteria to flourish. Fungal toenails can become very thick, powdery and ingrown. The fungus under the toenails can cause severe irritation to the skin surrounding the nails. This can lead to infection, and medical attention is needed if this happens.
In order to maximize a person's ability to fight off infections, they need to strengthen the immune system. This comes from proper blood sugar control, moderate exercise, good nutrition and supplements, if recommended by your health care professional.
Self-inspection of the feet and daily maintenance of the skin and nails is essential to prevention. Be vigilant. Once your toenails or skin become infected with fungus, it is important to treat it quickly to prevent ulceration and bacterial infection. Medications prescribed by your foot healthcare professional are recommended, but various over-the-counter and home remedies have found success. The use of tea tree oil, sesame oil, garlic, grapefruit seed extract, and galberry root soaks are among them.
When to see a doctor or therapist: