October Articles 2014

Plantar Fasciitis

Recently, a groundbreaking study concluded that their treatment combining ultrasound with steroid injections was 95% effective in the treatment of plantar fasciitis.

Plantar fasciitis is a foot problem affecting the plantar fascia, a connective tissue in the heel. This condition is treatable, but in many cases can take up to a year to be effective.

Conventional treatments have included exercises, rest, arch supports, and night splints. If this proves to be inaffective, many patients undergo shockwave therapy. In shockwave therapy, sound waves are directed to the area where pain is experienced. This therapy can be affective, but is somewhat painful, and calls for several sessions. Even still, shockwave therapy does not always alleviate the pain caused by plantar fasciitis.

Luca M. Sconfienza, M.D., from the University of Genoa in Italy, conducted the study. The new treatment involves an ultrasound-guided technique with a steroid injection to the plantar fascia. It is a one time out patient procedure involving a small amount of anesthesia. Then an anesthetic needle punctures the affected area. This technique, known as dry needling, causes small amounts of bleeding that aid in healing the fesci.

It was discovered that 42 of the 44 patients involved in the study had their symptoms disappear entirely within three weeks. “This therapy is quicker, easier, less painful, and less expensive than shockwave therapy” Sconfienza stated. “In cases of mild plantar fasciitis, patients should first try noninvasive solutions before any other treatments. But when pain becomes annoying and affects the activities of daily living, dry-needling with steroid injection is a viable option," she added.

Barefoot Running

A new trend in running and jogging has popped up recently, called barefoot running. Barefoot running is a popular and growing trend that is just what it sounds – running without shoes. Before deciding to do any running without shoes, it's best to understand how this kind of running affects the feet.

Running without shoes changes the motion of running. Most running is done by landing on the heel of the feet. Running barefoot requires a different way of running; in a barefoot stride landing is done on the front part of the feet. Because of this, the impact shifts from the heels to the front feet. Runners also shorten their strides to create a softer landing.

Running barefoot does have its advantages. When running and landing on the front feet, the impact on the feet and ankle is reduced, which may reduce the incidence of stress injuries. It strengthens muscles in the feet, and also strengthens muscles in the ankles and lower legs that aren't usually worked. Overall balance of the body is improved and there is greater sensory input from the feet to the rest of the body, making overall position and motion less stressful on the body. It has been found that in countries in which some of the population regularly wear shoes and some do not, numbers of foot and ankle injuries are much higher in those who wear shoes.

People hearing about barefoot running for the first time are skeptical about it, and there are good reasons for skepticism. Running barefoot certainly has its drawbacks, the obvious being no protection of the feet when running. This makes it likely that when runners land on sharp or rough objects,  scrapes, bruises, and cuts on feet will result. Blisters will form when beginning this kind of running especially, you may have plantar fascia problems. Landing on the front feet constantly also increases the risk of getting Achilles tendonitis.

So what can runners do to make barefoot running safe? It’s best to make a slow transition from running shoes to barefoot running. The body is used to wearing shoes so to slowly transition to bare feet, start by walking barefoot for a distance and then increase walking distance. Once the feet begin to adjust, try walking and then jogging and gradually increase the distance. If you have foot problems talk to the doctor first before attempting barefoot running. When starting out, it may also be helpful to begin by running on pavement or other consistent surfaces to avoid sharp or rough objects. Minimalist running shoes may also be an option, as they allow for many of the benefits of barefoot running while also protecting the feet from cuts and scrapes.

Effect of High-Heels on the Feet

Women have been wearing various kinds of high-heels for hundreds of years, mostly for aesthetic reasons. Shoes with heels make their wearer appear to be taller and to have longer and thinner legs, and change the wearer’s gait and posture. High-heels’ association with femininity have kept them popular over the years, but there are definite health problems caused by wearing high-heels too frequently.

High heels also limit the motion of the ankle joints as well when they are worn. The ankle is a very important joint in the body when it comes to walking. These joints have a great deal of weight put on them because of their location. This is why it is so important to keep them as healthy as possible. The main tendon in the ankle is the Achilles tendon. Studies have shown that wearing high heels often causes the calf muscle and Achilles tendon to shorten, and stiffens the Achilles tendon as well, which can cause problems when shoes without heels are worn.

By forcing the toes into a small toe box, and putting a great deal of pressure on the ball of the foot, high-heels can cause or worsen many foot problems, such as corns, hammertoe, bunions, Morton’s neuroma and plantar fasciitis. 

Wearing high-heels regularly, especially very high ones, can have long term negative effects on many other parts of the body, as well as the feet. One of the most important joints in the entire body, the knees, can be affected by wearing high heels. Wearing high heels causes the knees to stay bent at all times. It also causes them to bend slightly inward as well. Many doctors believe that constantly walking like this is the reason that women are so much more likely to suffer from osteoarthritis later in life. High-heels also cause increased stress on the knees by limiting the natural motion of the foot during walking.

The back may also be negatively affected by high heels because this shoe style causes the back to go out of alignment. This affects the spine’s ability to absorb shock, and can cause continued pain in the back if high heels are worn constantly. High-heels also compress the vertebrae of the lower back, and can cause overuse of the muscles in the lower back.

This is not to say that high heels should never be worn. They will not cause serious problems if they are worn only occasionally. However, they should not be worn every day in order to avoid long term physical health problems to the feet, knees, ankles and back.

Sever's Disease

Sever's disease, also known as calcaneal apophysitis, is a medical condition that causes heel pain in one or both feet of children during the period when their feet are growing. Sever's disease occurs most commonly in boys and girls between the ages of 8 and 14 years of age.

Sever's disease occurs when the part of the child's heel known as the growth plate, or the calcaneal epiphysis, an area attached to the Achilles tendon, suffers an injury or when the muscles and tendons of the growing foot do not keep pace with bone growth. The result is constant pain experienced at the back of the heel and the inability to put any weight on the heel, forcing the child to bear weight on their toes while walking. A toe gait develops in which the child must change the way they walk to avoid placing weight on the painful heel, a position that can lead to other developmental problems.

The most common symptom of Sever's disease is acute pain felt in the heel when a child engages in physical activity such as walking, jumping or running. Children who are very active athletes are among the group most susceptible to experiencing Sever's disease because of the extreme stress and tension they place on their growing feet. Improper pronation, the rolling movement of the foot during walking or running, and obesity are all additional conditions linked to causing Sever's disease.

The first step in treating Sever's disease is to rest the foot and leg and avoid sports activity which only worsens the problem. Over the counter pain medications targeted at relieving inflammation can be helpful for reducing the amount of heel pain. Combined with rest and pain medication, a child with Sever's disease should wear shoes that properly support the heel and the arch of the foot. Consider purchasing orthotic shoe inserts which can help support the heel and foot while it is healing. Most patients with Sever's disease symptoms report an eventual elimination of heel pain after wearing orthotic insoles that support the affected heel.

Sever's disease may affect just one heel of either foot as well as the heels of both feet. It is important to have a child experiencing heel pain get an examination by a foot doctor who can apply the squeeze test, which compresses both sides of the heel in order to determine if there is intense pain. Discourage any child diagnosed with Sever's disease from going barefoot as this can intensify the problem. Apply ice packs to the affected painful heel two or three times a day for pain relief.

Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.

Treatment methods should usually continue for at least 2 weeks and as long as 2 months before the heel pain goes completely away and the child can resume normal physical and athletic activities again. A child can continue doing daily stretching exercises for the legs and feet to prevent the heel pain of Sever's disease from returning.