Heel Pain

What is heel pain?

Heel pain is a common problem that troubles people of all ages. There are many different types and causes of heel pain, but if your heels hurt, you probably are very aware of it. Your heel pain may have started days, weeks, or even months ago. At first you may have felt a dull ache that didn’t last. For some people, heel pain worsens as the day goes on. For others, it’s a sharp jab that strikes every time the heel touches the ground. Heel pain may be the worst when you get out of bed in the morning, causing you to hobble for a few steps or a few minutes. In any case, heel pain can make standing or walking unbearable.

What causes heel pain?

Heel pain may be caused by the way your feet move or by the way your legs and feet are built. It also can result from an injury or a medical problem that affects your entire body. For many people, heel pain is part of aging. It shows up after your feet have supported you through years of daily wear and tear. To achieve the best long-term results, your podiatrist treats not only your heel pain but also the underlying cause of your problems.

Ligament And Tendon Problems
If your heel moves too much or too little, it can cause other parts of your foot to function incorrectly. Over time, stress from poor foot function can stretch or tear the ligaments or tendons in your heel. In some people, the constant demands of daily use are enough to weaken these tissues. Being overweight may aggravate such problems. Ligament and tendon injuries can also result from a direct blow or a sudden twist. Treatment goals for tissue problems include reducing abnormal pull on the ligaments and tendons.

Bone Problems
When incorrect heel movement strains tissue, it also increases stress on the bones in your heel and ankle. Over time, excess strain may change the structure of your foot, causing damage and heel pain. In addition, injury from a direct blow or the effects of arthritis can damage bones (and joints), causing pain. Treatment goals include reducing abnormal stress on bones.

Nerve Problems
Nerves are bundles of special fibers that act like electric wires, passing signals between your brain and your feet. When a nerve is pinched—by inflamed tissue or a swollen vein—some or all of the signals can’t travel their complete routes. As a result, you may feel pain, numbness, or tingling in your heel. Even a nerve pinched in your back may send abnormal signals (referred pain) to your heel. Treatment goals for these types of problems include reducing pressure on the affected nerve.

Treating heel pain

Depending on your problem, your podiatrist may recommend one or more types of treatment. Medication, physical therapy, and exercise promote proper healing and may be all the care you’ll need. However, for many people with movement problems or uneven leg lengths, custom-made shoe inserts (orthoses) provide the most lasting results. In some cases, surgery offers the best solution. Your podiatrist will discuss the treatment plan with your physician if an ongoing health problem is contributing to your heel pain.

Immediate Care
Your podiatric treatment plan begins with immediate care to reduce pain and swelling. Then, the underlying cause of your heel pain is treated. You can do some things at home to lessen swelling, such as applying RICE (Rest, Ice, Compression, and Elevation).

Your podiatrist may suggest taking aspirin or ibuprofen to control pain. To control extreme inflammation or pain, your podiatrist may inject cortisone, an anti-inflammatory medication.

Straps of tape can be applied to reduce the pull on tissues and help support bones and joints. If strapping is helpful, orthosis may be prescribed alone or with other treatment.

Physical Therapy
Your podiatrist may recommend ultrasound, deep heat, or water therapy. These forms of physical therapy all increase circulation and aid in healing one, joint, and tissue problems.  Your podiatrist also may recommend exercises to stretch and strengthen the tissues in your feet. Do the exercises in your bare feet to get the full benefit.

Foot Gear
Wearing foot gear that meets your needs can improve the way your feet feel. Shoes with laces, such as running shoes, provide some side-to-side support.

Custom-made from impressions of your feet, orthoses can improve foot movement or compensate for uneven leg length.

Your podiatrist may suggest surgery to release tight ligaments or pinched nerves. Surgery may also be performed to smooth sections of bone.

Hammer Toes

Problems with your little toes

Your little toes help balance and propel your body when you move. As your foot flattens, the little toes bend to grip the ground. Then they straighten, acting like levers to help push your foot so you can walk, run, or dance. But if the front of your foot is wide, you may develop a problem known as a hammer toe. Hammer toes are the little toes that buckle or curl under. Over time, these toes may hurt and make movement more difficult. But you don’t have to live with pain. With your doctor’s help, even severe hammer toes can usually be treated so you can move more easily.

What are hammer toes?

In general, the term “hammer toes” describes a buckling of any of the toe joints. Joints at the end or middle of the toe, as well as the joint near the ball of the toe, may be affected. Toe joints usually curl because of a muscle imbalance or tight tendons. Hammer toes vary in severity and in the number of joints and toes involved.

Types of hammer toes
Hammer toes may be flexible or rigid, depending on the joint’s ability to move. A flexible joint may become more rigid as you age.

A Flexible Joint
You can straighten a flexible hammer toe with your fingers. Although they look painful, flexible hammer toes may not hurt.

A Rigid Joint
A rigid hammer toe cannot be moved, even with the fingers. Rigid joints may cause pain and distort foot movement. This may put extra stress on the ball of the foot, causing a callus (a corn on the bottom of the foot).

Physical Exam

Your doctor will examine all your toes, testing whether or not buckled joints can be moved. Your feet will also be checked for any skin changes. Corns (a buildup of deadskin cells) often form between curled toes or on top of buckled joints where shoes rub. If irritated, corns may turn into open wounds and become infected.

X-rays may be taken of a curled toe to show the amount of deformity. An x-ray may also show whether or not the joint is affected by arthritis.
While examining your toes, your doctor also looks for skin changes commonly caused by buckled joints.

Treating hammer toes

If your symptoms are mild, changing shoes may be all the treatment you need. Using a splint or pad to hold your toes straight also may help. Or try cushioning corns and calluses with felt padding. If your symptoms are severe, surgery may be needed. The type of procedure often depends on whether your toe joints are flexible or rigid.

Flexible Joints
To release a buckled joint, the tight tendon (often the bottom one) is cut and repositioned.

Rigid Joints
A piece of bone may be removed to help straighten a rigid toe. Two surgical examples are described below. With either surgery, a pin may be used to hold the remaining bone in position during healing. With arthroplasty, part of the curled joint is cut away. The “gap” fills in with fibrous tissue. With fusion, the joint cartilage is removed. The toe bones heal as one longer bone.

After surgery

Almost all hammer-toe surgeries are outpatient procedures. In fact, you may even be able to bear weight on your foot by the time you get home. For best results, however, you may need to wear a surgical shoe for several weeks.

The First Few Weeks
Your foot will be bandaged after surgery, and you may need to wear a surgical shoe to support the foot during healing. Your doctor may recommend a special dressing to limit swelling. Elevation and ice can also help. For best results, raise your foot above heart level and apply ice for 15 to 20 minutes. Protect your skin by placing a towel between the ice pack and your skin.

Proper Shoes
Help make surgery a success by wearing shoes that fit your feet. Shoes should be long enough and wide enough to keep all your toes comfortable.


What is gout?

Have you been awakened at night by a hot, painful feeling in your big toe or ankle? Did the painful joint appear swollen and red (inflamed)? These can be symptoms of a gout attack. Gout is a disease that affects the joints. Left untreated, it can lead to painful foot deformity and even kidney problems. The good news is that by treating gout early, you can relieve pain and help prevent future problems. Gout can usually be treated with medication and proper diet. In severe cases, surgery may be needed.

What causes gout?

Gout is caused by an excess of uric acid (a waste product made by the body). The uric acid forms crystals that collect in the joints, bringing on a gout attack. If you have many gout attacks, crystals may form large deposits called tophi. Tophi can damage joints and cause deformity.
Gout often shows as an inflamed joint.

Who is at risk for gout?

Men are more likely to have gout than women. But women can also be affected, mostly after menopause. Some health problems, such as obesity and high cholesterol, make gout more likely. And some medications, such as diuretics (“water pills”), can trigger a gout attack. People who drink a lot of alcohol are at high risk for gout. Certain foods can also trigger a gout attack.

Foods That Trigger a Gout Attack

To help prevent a gout attack, avoid these foods:
- Alcohol (beer, red wine)
- Certain meats (red meat, processed meat, turkey)
- Organ meats (kidney, liver, sweetbread)
- Shellfish (lobster, crab, shrimp, scallop, mussel)
- Certain fish (anchovy, sardine, herring, mackerel)

Physical Exam

Your doctor will ask you questions about where and how often you feel pain. He or she will also ask about your diet, medications, and how much alcohol you drink. Your doctor will examine your feet for signs of gout. Signs include redness, heat, and swelling.

X-rays may be taken to check for tophi or changes in your bones. If needed, your doctor may use a syringe to take some fluid from your joint. This fluid will be analyzed for uric crystals. Your doctor may also take a blood sample to look for uric acid.

Treating gout attacks

Gout attacks are painful and often happen more than once. Taking medications may reduce pain and prevent attacks in the future. There are also some things you can do at home to relieve symptoms.

Your doctor may prescribe a daily long-term control medication to reduce levels of uric acid. This may help prevent gout attacks. Other medications can help relieve pain and swelling during an attack. Be sure to take your medication as directed.

What You Can Do
Below are some things you can do at home to relieve gout symptoms. Your doctor may have other tips.
- Rest the painful joint as much as you can.
- Raise the painful joint so it is at a level higher than your heart.

Preventing gout

With a little effort, you may be able to prevent gout attacks in the future. Here are some things you can do:
- Avoid alcohol and foods that trigger gout.
- Take any long-term control medications prescribed by your doctor.
- Lose weight if you need to.
- Control blood pressure and cholesterol.
- Drink plenty of water to help flush uric acid from your body.