May Articles 2014

Nerve Disorders of the Foot and Ankle

Similar to well-known nerve disorders in the hands, such as carpal tunnel syndrome, nerve disorders that affect the foot and ankle occur in patients for reasons ranging from stress to genetics. Nerve disorders of the foot should be addressed right away because they may be immobilizing in serious cases. Two of the most common nerve disorders of the foot and ankle are Interdigital Neuroma and Tarsal Tunnel Syndrome.

Interdigital Neuroma is caused by localized inflammation of one of the nerves that controls toe sensitivity in the frontal area of the foot. This inflammation is generally only found in the second or third interspace, and any other symptoms similar to Neuroma on other digits should be checked against other disorders. Symptoms include chronic burning or tingling sensations between the affected toes which can, at times, migrate to the toes themselves. This pain is often increased by walking, running, or by wearing shoes that compress the toes, such as high heels. A doctor should be consulted if this pain is chronic and if the symptoms get worse.

Typical examinations to determine the presence of Neuroma include radiographs, MRIs, and even bone scans of the affected area. Bone scans are only required if degeneration of bone is suspected, however. Surgery is often not required to alleviate the symptoms of Neuroma, and in many cases functional orthotics can be used to alleviate the stress of constant weight on the affected toes. Surgery is recommended for those patients that suffer from symptoms for 6 months or more, so reporting symptoms early can increase the rate of non-surgical recovery.

Tarsal Tunnel Syndrome, a condition that is less common than Interdigital Neuroma, is similar to Carpal Tunnel Syndrome in that it is caused by a compression of the nerve caused by any number of factors (mostly associated with excess pronation). Typically seen in those that have either flatfeet or valgus heel positions, Tarsal Tunnel Syndrome has patients complaining of moderate to severe ankle pain that starts along the bottom of the foot and often proceeds to the calf. Some more extreme cases occur with partial numbness and even atrophy of the foot and surrounding muscles.

If there is a good chance that someone has Tarsal Tunnel Syndrome, an EMG test is often used to diagnose the condition.  If the diagnosis is positive, an MRI can be used to identify the compression of the nerve. Treatment with NSAIDS, functional orthotics, and rest off of the feet is often prescribed, but again, long standing symptoms require surgery, as do exacerbated symptoms caused by lesions present between nerves.

Stretching Your Feet

Debilitating foot pain is a problem for many people. But just as stretching the torso can help alleviate back pain, stretching the feet can also mend existing problems and prevent future ones.

The feet carry the entire weight of the human body all day and can get easily strained from overexertion. Persistent sharp pain and cramping in the feet are common problems. Foot pain and problems can be due to any number of causes, and in many cases pain may be eased without medication or doctor visits; however, it is always a good idea to rule out any serious medical issues first with a physician.

Stretching may help relax the feet and alleviate pain at any time, but it is especially important before    heavy aerobic exercise to avoid painful cramps or straining muscles in the feet. Stretches should be performed slowly and deliberately without forceful pulling. The stretch should be held for several seconds, and then relaxed.

A great way to stretch out and loosen up the foot muscles while sitting is to cross one leg over the other and pull the toes carefully back without overextending. Start by resting the left ankle on the right knee. With the left hand, gently flex the left foot by pulling back on the toes. Do not pull too hard, just hard enough to feel the stretch in the arch of the foot. Then point the toes of the left foot as far as you can. Rotate the motion of pointing with pulling back on the toes. This should relax and stretch the muscles on the bottom and the top of the foot. Doing this stretch ten to twenty times should bring relief. Repeat the whole process for the other foot by resting the right ankle on the left knee.

A stretch that focuses on the often injured Achilles tendon involves standing, facing a wall, with your arms out and hands flat against the wall. Step back with one foot, keeping it flat against the floor. Move the other leg forward and lean toward the wall. You should feel a stretch through the back of your leg and your Achilles tendon, but do not push yourself too much. Stop when you feel the stretching sensation and hold for 30 seconds. Ten repetitions may be done for each foot.

Stretching the feet is important for athletes or those performing aerobic exercise, but it can also help anyone with foot pain caused by poor footwear, plantar fasciitis, or long hours standing and walking. Individuals who tend to their feet by regular stretching every day should be able to minimize foot pain and prevent new problems from arising.

How to Prevent Running Injuries

Many common running injuries are caused by overuse and overtraining. Several common injuries can occur due to running. When the back of the kneecap starts wearing away and starts causing pain in the knee, this is commonly referred to as runner’s knee. Runner’s knee can occur because of decreased strength in the quadricep muscles or shoes that do not offer proper support to the inside of the forefoot. Runner’s knee usually is treated with strengthening exercises focusing on the quad muscle and sports orthotic. To prevent runner’s knee, efforts should be focused on hip strengthening. Physical therapy is also beneficial in helping to learn the best exercises to heal runner’s knee. To prevent runner’s knee, strengthen the quad muscles to keep the kneecap aligned.

Overtraining is one cause of a common running injury called iliotibial band syndrome, which occurs when the iliotibial band gets irritated, causing pain and discomfort to the outside knee area. Another common running injury is known as plantar fasciitis, which occurs when the bone in the foot becomes inflamed and irritated. This injury primarily causes pain in the foot. Causes can include a high arch, incorrect footwear, tight muscles and flat feet. The best way to avoid plantar fasciitis is stretching and proper footwear.

Stress fractures are a common injury for runners. These fractures can occur because of overtraining, lack of calcium or running style. In runners, it is common for stress fractures to occur in several locations including the inner bone of the leg, the thighbone, the bone at the base of the spine and the toe bones in the foot. The best approach to preventing stress fractures are proper footwear maintenance and running on a surface with enough “give” to absorb some of the shock produced during running.

Besides overtraining, other causes of these common running injuries are poorly fitting footwear, irregular biomechanics, and lack of flexibility and strength. The best way to avoid running injuries is to prevent them. Fortunately, each of these common running injuries can be prevented. To avoid running injuries it is highly recommended to wear only footwear that fits properly and that suits your needs. Running shoes are the only protective gear that runners have to safeguard them from injury; therefore, choosing the correct footwear for running is important. It is important, too, to think about other aspects of your running routine like training schedules, flexibility and strengthening, and tailor them to your needs in order to minimize the possibility of injury. Regular stretching before and after running should be considered also when trying to avoid running injuries. Stretching keeps muscles limber resulting in greater flexibility.

Playing Sports With Foot Injuries

There are many types of foot injuries common among athletes such as plantar fasciitis, overpronation, strains, turf toe, heel spurs, and stress fractures of the foot. Plantar fasciitis is when the thick ligament in the base of the foot becomes swollen, and causes pain. Overpronation is excessive movement of the foot during gait. Pronation would be normal movement of the gait, but when movements become excessive, it leads to a variety of areas becoming painful due to the overpronation. The most common complaint is a burning sensation or inflammation under the arch of the foot, often called strain or arch pain. Heel spurs are growths of the bone in the heel where soft tissues and tendons connect. Turf toe comes from upward bending of the big toe outside of the normal range of motion. It most commonly occurs in athletes that play on artificial surfaces because a shoe grips the surface and forces and athletes weight forward causing the upward bending of the large toe. This causes damage by stretching the ligaments under the toe. Stress fractures could be caused by overuse due to muscle fatigue in the foot, preventing the muscles and ligaments from absorbing the shock and trauma.

Many athletes continue to play with mild foot injuries. You should remember to properly stretch  before any activities, focusing on their calves to prevent injuries and reduce reoccurring pain. It is also common to wear braces to protect the areas that commonly become overstretched and use shoe inserts such as heel pads. It is important to remember to wear proper footwear and replace shoes when needed.

There are many kinds of treatments required to keep the injury from becoming serious. Most commonly an athlete should immediately ice the injury to take down swelling and inflammation. Applying a compression bandage and resting will also reduce pain and stress on the foot. Rest could include using crutches to keep weight off of the injury to allow proper healing for instance. For plantar fasciitis, make sure calves are properly stretched and refrain from hills or speed work. One should try wearing an arch strap to add support. Those with heel spurs should also try arch straps to reduce strain and ice often. The best remedy would be heel pads. Aside from that, one would need a podiatrist or orthopedic specialist. It may require surgery. Those who are suffering from overpronation or turf toe should invest in a quality shoe to reduce motion. There are special insert and braces for the big toe, as well as shoes with firm soles to prevent bending. Stress fractures usually require rest, so an athlete may participate in lower impact activities to allow rest and healing. Most importantly, one should seek medical advice if pain does not go away or recurs frequently.

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