Some of the most frequent foot injuries I see involve the heel and arch.  A number of different injures can cause pain in this part of the foot, including muscle and tendon strains.  However, one structure by far sees the most number of injuries in this region:  the plantar fascia.  The plantar fascia is a stout ligament that runs along the bottom of the foot  Typically it is injured over time, often as a result of strain and inflammation  to the fibers from abnormal foot structure, poorly supportive shoes, or repetitive activities like climbing up and down ladders.  This type of pain has a more gradual onset, and is known as plantar fasciitis.  However, when the pain is sudden, and accompanied by a mis-step as well as a tearing or snapping sensation, the injury is often more severe, and involves a partial tearing of the fascia.  As fasciitis and a tear are treated quite differently, prompt diagnosis and proper treatment can make the difference between a relatively short recovery period and a prolonged done.

The plantar fascia tear, or rupture as it is commonly known, can occur when a foot is planted on the ground firmly at the base of the toes, causing a sudden stretching of the plantar fascia beyond its limit to stretch.  This can also occur when the foot is suddenly flexed upward by force, or when stepping on an object like a root or the broad edge of a rock while barefoot or in poorly supportive shoes or sandals, in which a specific part of the fascia is forced upward suddenly.  The symptoms can include a sudden sharp or burning sensation, accompanied by a sensation of tearing or snapping.  For most, it is extremely difficult to bear weight.  The fascia tissue usually only tears partially, with most of its substance remaining intact.  However, this smaller part that is torn can create a significant amount of pain.  Often felt in a specific location in the arch or heel, the pain can eventually expand to include a broader area.

Treatment of plantar fascia tears requires immediate immobilization of the foot to reduce forces that load onto the plantar fascia when walking, and permit the tissue to heal.  The mainstay of my treatment includes the use of a pneumatic walking boot to displace the forces of walking, as the shape of the bottom of the boot is that of a rigid rocker bottom design, which helps the foot roll over the ground without bending.  Severe cases of plantar fascia tears do require further immobilization in a below knee cast and non- weight bearing, although most people do just fine in the walking boot.  It is typical for the fascia to take four weeks to heal, although some people can have prolonged discomfort for another month or two.  If this injury is not treated and left to heal on its own, the time for healing could extend into months and years, as the development of inflammatory plantar fasciitis becomes inevitable at that point.

If you suddenly feel pain in the heel or arch after stepping oddly (especially with a tearing or snapping sensation), and the pain does not go away within a day or two, it is a good idea to see your local foot specialist for immediate care (or see me if you are in the central Indiana region).  This could make the difference between a quick recovery and a protracted one.

I am often asked by my patients: “how much should I spend on a good pair of shoes to keep my feet from pain?”   The answer to this question is not as simple as one would expect.

The short answer to this question is that cost may not necessarily matter.   Shoe prices, while often reflective of the overall quality and construction of the shoe, are just as loosely dependent on the whims of the fashion world as any other article of clothing.  Certain trendy items and products from high end fashionable manufacturers will always have higher prices that do not necessarily reflect either the quality or the medical grade ‘worth’ of the actual shoe.  In fact, some highly expensive shoes are downright awful for the human foot.

Recent poor trends include rocker bottom shoes a few years ago, and more recently lightweight minimalist type of cushioned shoe.  Of course, the fashion industry historically always contributes its own horrific shoe designs that have little correlation with the actual shape of the foot.

Given these considerations, the most expensive shoe is not necessarily the best.  So how can one gauge how much should be spent on a shoe?   Well, the way to ultimately reach this decision is to forget about price.  First and foremost, a shoe should be proper for one’s foot structure.  In particular, flatter feet need stiffer shoes, high arch feet need cushioned shoes, and regular feet need something in between.  Your podiatrist can help determine what type of shoe your foot structure requires.  From this basic criteria, one must then figure out what type of activity the shoes are going to be worn in, as this influences the general need for construction quality and durability. Finally, one should be properly fitted into the shoes by a trained clerk who knows their products well.  Often, this does require going to a store that costs a little more in exchange for better service.

From the above criteria, the price of the shoe should become self apparent based what shoe supports one’s foot the best, is appropriate for its intended activity (daily use versus labor versus specific athletic activities etc.), and fits appropriately.  The price of the shoe that fits these criteria is the price you should pay.

Oh, if you are paying over $180 on a pair of retail shoes, you really are paying too much, no matter what you are buying.

Fist off- yes, I am still here!  Unfortunately due to some pressing work projects, I had to take a break from posting to my website and social media.  I’m back now, and I promise to post more frequently.

As the title says, the foot can experience the exact same type of condition the hand experiences during carpal tunnel syndrome.  In the wrist, a ligament (firm connective tissue) binds together nerve, blood vessel, and tendon tissue that crosses underneath this tunnel-like region on the way to the hand.  Caused by a number of issues, including chronic wrist strain and repetitive motions such as chipping away on a keyboard, the resulting symptoms can include pain, numbness, burning, or tingling in the wrist and hand, amongst other possible symptoms.  Carpal tunnel syndrome is well known as it is very common, and very annoying.  The EXACT SAME condition can occur in the foot.

In the foot, the condition is called tarsal tunnel syndrome (carpal refers to hand, tarsal to foot).  The same symptoms can be felt in the bottom of the foot and heel, and the cause is generally the same.  A ligament is present on the inner side of the ankle, and binds down a group of blood vessels and tendons under the inner side of the ankle bone.  The tibial nerve is present in this area also running through a space that can be considered like a tunnel, and can be irritated.  The nerve irritation can come from tightness in the overlying ligament, fibrous adhesions within the tarsal tunnel, varicose vein braces in the vein that runs next to the nerve, or masses/cysts in the space near the nerve.  This irritation will eventually damage the nerve, and abnormal sensations will develop in the part of the foot the nerve gives sensation to, namely the majority of the bottom of the foot and heel.

Most of the time, the cause is repetitive strain to the inner ankle, either from a foot structure that rolls outward (flat or flattening feet) and tightens the ligament, tight shoes with abnormal pressure to the inner ankle, or trauma to this region that raises the pressure in the tarsal tunnel.  Varicose vein braces, masses and cysts, as well as multiple less common causes can lead to tarsal tunnel syndrome as well.

If not treated in a timely manner, the symptoms can worsen, and be more difficult to treat and reverse.  Initial treatment usually revolves around stabilizing the inner ankle to reduce mechanical strain the tissue, as well as measures to actively reduce inflammation within the tarsal tunnel.  Diagnostic studies during treatment may include x-rays to look for bone abnormality, a nerve conduction velocity test that looks for delayed nerve transmission time across the tarsal tunnel, or an MRI to look for masses.
Surgical release of the tarsal tunnel, just like surgery for carpal tunnel syndrome, is very successful and nearly always leads to instant symptom resolution when conservative measure have failed.

Tarsal tunnel syndrome can be misdiagnosed by those not well trained in foot and ankle conditions, as sometimes the symptoms mimic other common conditions like plantar fasciitis or a neuroma in the ball of the foot.  It is important that this be treated by a foot specialist experienced in treating the tarsal tunnel.

 

With fall approaching and the start of school already here for many Hoosiers, many parents have already been hunting for the perfect bargain for school supplies and clothes. While we start early, many parts of the country are not starting until after the upcoming Labor Day holiday weekend.  Among the bustle of supply searches and new outfits to impress comes shoe shopping. Shoe shopping can be challenging, as parents have to weigh between fashion and function.  The most common question I get is what are the best shoes for children and how often do shoes need to be changed?

To answer that question, one must consider the anatomy of a child’s foot in combination with recess and after school activity.  The bones of children are different from those of adults.  Growth plates in children’s bones do not close until age 15-17 in boys and age13-15 in girls.  Repetitive overuse can cause inflammation of the growth plates causing heel pain. This is most commonly seen in children who participate in multiple sports or have long or frequent practice schedules after school, but can also be seen in children whose only activity is recess or after school play.  Additionally, growing feet are at risk for skin irritation from poorly fitting shoes.  This includes skin pressure damage and pain in the case of tight shoes, and skin blistering from shoes that have been ‘over-sized’ to permit growth throughout the school year.  A larger, floppier shoe can also lead to sprains and other injuries from the unstable shoe.

When looking for shoes, the shoe itself should have several characteristics that provide support to the growing foot.  Unfortunately, many children’s shoes available in retain stores are cheaply made and offer little support.   A quality shoe should have a firm heel counter (material in the back of the shoe) that does not easily compress or break with pressure, and the shoe should not slip at the heel.  A shoe that can twist like a wringing towel is also not very supportive, and should be avoided.  The shoe should have adequate cushioning of the insole to help absorb the shock of activity, and some children with flat feet may need additional arch support in the form of a quality insert or custom orthotic.  The initial shoe purchase should be based on the child’s current shoe size, and ideally only a half size increase should be considered to give ‘room to grow’ if these can be found.  Children’s feet should be measured monthly as they can grow quickly.  From a simple space perspective, there should be about one-half inch (1 cm) of space between the tip of the toes and the end of the shoe.   As this decreases while there is foot growth, the shoes will begin to become uncomfortable.

Parents should avoid the use of ‘hand-me-down’ shoes from older siblings, as the internal structural wear and tear will likely be substantial, even if externally the shoe looks fine.  Conversely, a new shoe should be comfortable from the start.  The concept of breaking-in a shoe is outdated and not healthy for the feet.

Overall, a parent should certainly look for a shoe that their child likes and will want to wear, but the shoe needs to provide support and stable structure. Not only is this necessary for comfort, but it may help prevent or sow the progression of adult acquired foot deformities in the future.

I hope your kids have a great school year, and that you find a shoe your child likes and feels comfortable in!

Finishing on my prior posts, I am discussing  prevention of foot problems that we commonly see an increase of during the summer months.

The final topic I want to discuss is foot pain, specifically heel and arch pain as well as tendon damage.

Heel and arch pain, often caused by inflammation to a ligament called the plantar fascia, can develop throughout the summer.  The use of less supportive shoes, like sandals, slides, and flip flops, as well as barefoot walking around the pool can directly lead to gradual strain on the plantar fascia.  As this strain builds over the summer, the plantar fascia can become inflamed and thickened.  Eventually, pain in the heel and arch will develop.  This pain can come and go, but will eventually remain constant each day.

Prevention of this painful condition is not difficult if one keeps in mind the structure of their feet and their choice of shoes for the summer.  Simply put, flip flops and flat sandals are bad for the feet, and should be used only for short periods of time.  A better choice is a more supportive sandal, such as Orthaheel, Birkenstocks, Naot, or Fit Flop.  For longer periods of activity, such as during a walking tour or shopping trip, more appropriate shoes, such as walking or athletic shoes, should be worn.  With these shoes, the arch has a better chance of staying supported, and there is less likelihood the plantar fascia will become strained.

The foot also has a number of important tendons that function in a specific way and in balance with each other to keep the foot stable during standing and walking.  There are times in which these tendons can become damaged due to poor support or an unstable walking surface.

The human foot has the capability to adapt to instability over time, but in our concrete surface world full of dangerous things to step on, we rely on shoes for most of our lives.  The adaptability of these tendons is reduced, and anytime we convert to less supportive shoes we run the risk of harming the tendons.  This is especially true in the summer, when we increase our activity and at the same time wear less supportive sandals or walk barefoot.  When this is combined with one’s naturally occurring flat feet, high arches, or activity on unstable and uneven surfaces, the potential for tendon strain is much higher.

The primary tendons that can be injured include the Achilles tendon on the back of the heel, the posterior tibial tendon on the inner side of the foot, and the peroneal tendons on the outer side of the foot.  Simple tendon stretching and straining can turn into inflammation, tendonitis, and tendon weakening.  These problems can become chronic, and last well beyond the summer.

Prevention of tendon damage is fairly easy, similar to reducing heel pain potential.  The use of proper footwear during increased activity or activity on unstable or uneven surfaces is very important.  Wearing a flip-flop sandal during a long walk or trip to an amusement park, for example, is not a good idea.  The same can be said about wearing an improper shoe during a short hike on a hilly or rocky surface.  The right shoe for the activity can make a difference, and can protect important tendons that attach in the foot from harm.  If pain in the foot does develop, a timely assessment by one’s podiatrist can start the treatment and recovery process early, and stop the involved tendon from becoming chronically damaged.

This concludes my discussion of common foot problems seen in the summer, almost as the summer here in central Indiana concludes for most schoolchildren.  I plan on discussing back-to-school foot and shoe considerations in a future post, so stay tuned!

Once again adding to my prior posts regarding this topic, I am discussing  prevention of foot problems that we commonly see an increase of during the summer months.  Once again, there are several common foot conditions that we see year round that become somewhat more prevalent during the summer months, for various reasons.

Today, I will discuss athlete’s foot infection.  This infection is due to invasion of the foot skin by fungus, a microorganism similar to bacteria that is found everywhere.  Fungus and related yeasts and molds are well known by their larger family members, including mushrooms.  The kinds of fungus that infect humans are microscopic.  There are a few species that take a liking to warm, dark, moist parts of the body.  These include skin folds, the groin area, as well as the bottom of the feet and in between the toes.  The resulting infection by these fungal species causes red, scaling, irritated skin that can itch and can also be blistery.  It can easily pass from person to person, especially through contact with moisture and moist skin, such as seen in showers and locker rooms.

While athlete’s foot fungus is fairly easy to treat, it is a nuisance infection, and if present long term can spread to the toenails where it causes a much harder to treat infection.  Preventing the infection is possible if one avoids direct contact with moist surfaces in shared bathing and changing areas.  Shower shoes can help prevent spreading this condition, both for those wanting to prevent it and those with the condition.  If one does develop the common symptoms associated with athlete’s foot, prompt treatment can help keep this condition from becoming chronic, and place family members at less risk for developing the infection.  Fungus cannot be outright avoided, as it is found in multiple sources and some people may simply be more genetically likely to get the infection, but simple avoidance measures and early treatment of developing infections can help.

 

I will continue this discussion next post.