It sounds like a catchy lyric from the Black Eye Peas or Beyonce, but “Pump Bump” is a common term used among podiatric physicians. Do you have pain behind your heel? Do shoes irritate areas behind your heel and cause pain? Do you feel an abnormal bump behind your heel? It may be a bump that is irritated by your pump and thus a pump bump!
Pump Bump may also be referred to as a Haglund’s deformity as well as a retrocalcaneal bursitis. Typically, women most commonly complain of the irritation due to their selected shoes designed for fashion rather than comfort. The pain is sharp and along the side of the Achilles tendon insertion into the heel. Many of my patients find significant relief when they wear athletic shoes or backless shoes, but additional treatment is often needed to be completely pain free.
Typically a pump bump is caused by some abnormality in the heel bone. It may be that the heel bone tilts slightly out or pronates. Or, the heel bone may be tilted upward in a high arch. The Achilles tendon is only attached to the middle one-third of the heel bone. The upper one-third of the heel normally allows a nice gliding motion of the tendon like a pulley. When the heel bone is mal-positioned, the gliding motion is less smooth. Eventually, the unusual rubbing of the Achilles tendon causes irritation and the body develops a bursa. The bursa then becomes inflamed and causes pain in the heel.
On examination, the back of the heel will appear red, slightly swollen and painful to the touch. X-rays or ultrasound will often reveal some degree of boney deformity or mechanical disruption.
When changing shoes does not resolve the painful symptoms, it is necessary to see a podiatric physician to begin a treatment regimen that will hopefully keep you out of surgery. A heel lift can be put in the shoe. This will elevate the heel and reduce the area of friction on the shoe. NSAIDs are also used to decrease the inflammation, but it should be noted that if the shoe is still rubbing hard up against the bump the drugs will not be of great effect. Some of my patients have seen great relief by stretching their Achilles tendon 2-3 times a day. In addition, cryosurgery, which is a minimally invasive procedure helps relieve the inflammation along the heel. In most cases, the pain at the back of the heel is due to the constant pulling of the Achilles tendon along a sack of tissue in this area. This is called bursitis. Cryosurgery requires a very small incision along the area and then a probe that sends liquid nitrous oxide at a temperature of (-) 72 degrees is placed into the inflamed area. This reduces the inflammation, thus relieving the pain permanently. One can walk right away after the procedure with their regular sneakers.
Depending on the cause of your bump, orthoses may be necessary to correct the mechanical problem of your heel. Sometimes, the bump is unable to be resolved by the treatments and surgical excision of the bone bump is necessary.
Wednesday, October 28, 2009
Children Get Heel Pain Too and They are Not Faking IT!
Many of us think that foot problems are one of the aches and pains of aging. But heel pain is not normal nor is it isolated to only adults. I have seen my share fair of children and teens that are having difficulty playing sports or participating in gym classes because of heel pain!
Sever’s disease is the most common cause of childhood heel pain and usually affects children 8-14 years of age. Traditionally, the disease was thought to affect males much more predominately, but now that we are seeing more young women athletes, the incidence is nearing the same between genders. Sever’s disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate in the back of your heal. During development, all bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton. This process is referred to as ossification. The calcaneus, or heel bone, has two separate areas of ossification that are connected by the cartilaginous growth plate.
Because of overuse or tight muscles, these two ossification centers are pulled away from each other causing strain on the growth plate. Overtime simple activities such as running, jumping or even standing can cause severe heel pain. I will often see children limping into my office when they have this condition.
Luckily, this is a self limiting condition meaning it will eventually go away. Unfortunately, children will have to tone down their activity schedule to reduce the pain. It is important to make the children as comfortable as possible and keep them active in their favorite’s sports, but we also have to be reasonable in the treatment options. Physical therapy will help the child stretch the muscles to decrease the pull on the developing calcaneus and Thera-band exercises can be used to strengthen the area. Ice massages will also help decrease the inflammation which is the culprit of pain. Heel lifts placed in the shoes, to decrease the pressure of the Achilles tendon on the calcaneus , and orthoses can also bring relief. Occasionally, there is need for a cast to immobilize the area to ensure proper healing. Though NSAIDS can bring relief to pain, large does are not always recommended for children. Thus, I prefer to have children to try topical pain relievers first.
Since Sever’s Disease can last up to 18 months, it is important to treat it aggressively soon as possible. Thus the child is not stuck on the bench, disappointed in their inability to perform. It may be necessary to take a short break from vigorous sports or exercise to allow proper healing time, but that is much better than sitting on the bench for an entire year!
Sever’s disease is the most common cause of childhood heel pain and usually affects children 8-14 years of age. Traditionally, the disease was thought to affect males much more predominately, but now that we are seeing more young women athletes, the incidence is nearing the same between genders. Sever’s disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate in the back of your heal. During development, all bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton. This process is referred to as ossification. The calcaneus, or heel bone, has two separate areas of ossification that are connected by the cartilaginous growth plate.
Because of overuse or tight muscles, these two ossification centers are pulled away from each other causing strain on the growth plate. Overtime simple activities such as running, jumping or even standing can cause severe heel pain. I will often see children limping into my office when they have this condition.
Luckily, this is a self limiting condition meaning it will eventually go away. Unfortunately, children will have to tone down their activity schedule to reduce the pain. It is important to make the children as comfortable as possible and keep them active in their favorite’s sports, but we also have to be reasonable in the treatment options. Physical therapy will help the child stretch the muscles to decrease the pull on the developing calcaneus and Thera-band exercises can be used to strengthen the area. Ice massages will also help decrease the inflammation which is the culprit of pain. Heel lifts placed in the shoes, to decrease the pressure of the Achilles tendon on the calcaneus , and orthoses can also bring relief. Occasionally, there is need for a cast to immobilize the area to ensure proper healing. Though NSAIDS can bring relief to pain, large does are not always recommended for children. Thus, I prefer to have children to try topical pain relievers first.
Since Sever’s Disease can last up to 18 months, it is important to treat it aggressively soon as possible. Thus the child is not stuck on the bench, disappointed in their inability to perform. It may be necessary to take a short break from vigorous sports or exercise to allow proper healing time, but that is much better than sitting on the bench for an entire year!
Monday, October 5, 2009
Eli Manning Out With Heel Pain?
NY Giants quarterback, Eli Manning, was just diagnosed with plantar fasciitis. Plantar fasciitis is an inflammation of a ligament under the foot. This ligament is very strong and thick and runs from the heel bone across the arch and into the ball of the foot.
The question right now is should Eli play on Sunday and possibly risk the season. In the late 1930s, Yankee centerfielder, Joe DiMaggio, sat out three months with plantar fasciitis. Times have changed and medical treatments have greatly improved since then.
The condition can come about in several ways. Usually in the non-athlete it occurs between the ages of 35-55 and can come about from faulty foot mechanics. The foot moves in a direction called pronation and the ligament then stretches. When the foot over-pronates (the heel turning outward), the ligament will stretch excessively. Over time, this will cause the ligament to become inflammed.
For an athlete like Eli Manning, all that is needed is for him to turn his foot in the wrong direction, or to plant it and rotate the foot excessively, to bring about the condition.
Plantar fasciitis can be very painful. Imagine having pain in the heel or arch with every step you take. Then try to plant that painful foot and throw a football down field with some force. Now lets add another factor. Planting your painful foot and then moving real fast when some 300 pound linebacker is coming at you. This can lead to favoring the foot and now setting yourself up for another injury, such as a knee.
Treatment can consist of taping, steroid injections, shoe modifications, orthotic inserts, rest, ice and physical therapy. The good news is that the injury rarely needs an invasive surgical procedure. There are minor procedures such as cryotherapy or extracorporeal shock wave therapy. These treatments are meant for the chronic type of plantar fasciitis.
In my opinion, if Eli can't plant is foot fully and move quickly, he should take the week off and get ready for New Orleans.
The Doctors of Family Foot & Ankle Specialists have written three books that they offer for FREE! Got Feet?, You Do Not Have To Suffer With Heel Pain, and The Truth About Diabetes and Your Feet. Click here to have your FREE copy mailed right to your door!
The question right now is should Eli play on Sunday and possibly risk the season. In the late 1930s, Yankee centerfielder, Joe DiMaggio, sat out three months with plantar fasciitis. Times have changed and medical treatments have greatly improved since then.
The condition can come about in several ways. Usually in the non-athlete it occurs between the ages of 35-55 and can come about from faulty foot mechanics. The foot moves in a direction called pronation and the ligament then stretches. When the foot over-pronates (the heel turning outward), the ligament will stretch excessively. Over time, this will cause the ligament to become inflammed.
For an athlete like Eli Manning, all that is needed is for him to turn his foot in the wrong direction, or to plant it and rotate the foot excessively, to bring about the condition.
Plantar fasciitis can be very painful. Imagine having pain in the heel or arch with every step you take. Then try to plant that painful foot and throw a football down field with some force. Now lets add another factor. Planting your painful foot and then moving real fast when some 300 pound linebacker is coming at you. This can lead to favoring the foot and now setting yourself up for another injury, such as a knee.
Treatment can consist of taping, steroid injections, shoe modifications, orthotic inserts, rest, ice and physical therapy. The good news is that the injury rarely needs an invasive surgical procedure. There are minor procedures such as cryotherapy or extracorporeal shock wave therapy. These treatments are meant for the chronic type of plantar fasciitis.
In my opinion, if Eli can't plant is foot fully and move quickly, he should take the week off and get ready for New Orleans.
The Doctors of Family Foot & Ankle Specialists have written three books that they offer for FREE! Got Feet?, You Do Not Have To Suffer With Heel Pain, and The Truth About Diabetes and Your Feet. Click here to have your FREE copy mailed right to your door!
Tuesday, April 21, 2009
You Are Not Alone if Suffering With Heel Pain
A survey done by the American Podiatric Medical Association revealed that 64 % of people suffering from heel pain have never sought treatment from a podiatric physician. The survey also revealed that nearly 40 percent of the American population suffers from heel pain! With the economy on a downturn and unemployment rates over 12% in some state, American’s cannot afford being off of their feet. What if your feet hurt? How long can you stand at work before your feet need a break! If you are avoiding the doctor for heel pain because you are scared of the cost or surgery, you are being foolish!
The most common cause of heel pain is plantar fasciitis. This is a soft tissue injury that is commonly healed with conservative treatment, meaning no surgery! Though there are many reasons for heel pain, plantar fasciitis is by far the most common and is one of the most debilitating. It is often characterized as pain with the first step of the day. When stepping out of bed in the morning or a long car ride, the sufferer experiences pain with the first few steps. Many patients describe the pain as an achy bruise on their heel times ten!
To understand the treatment of plantar fasciitis it is essential to understand why and how this chronic pain occurs. The plantar fascia is a thick band of tissue that attaches to you calcaneus, the heel bone, and bones in your forefoot. The fascia supports the arch of your foot. When standing or walking, feet tend to pronate. This means the foot is tilting inward and elongating. This biomechanical positioning causes stretching and tearing of the plantar fascia which leads to inflammation. It is the inflammation process that causes the pain in the heel of the foot where the fascia attaches. The human body is masterpiece; thus, not everyone experiences plantar fascia damage. Our body will often adjust to compensate for abnormal stresses, but sometimes it just cannot take the stress put it through. One may experience plantar fasciitis during pregnancy or after gaining weight. It is also associated with an increase in activity. So, if you are taking on more shifts at work or began a new work out plan, you may start to feel some foot discomfort.
Since the pain is due to inflammation, many treatment plans flight this problem first. Corticosteroid injections is an antinflammatory that will give many suffers great relief. There are side effects associated with steroid injections, thus the number of injections that one can receive is limited and not everyone is eligible for an injection. Another primary treatment is orthotics. Orthotics helps control the pronation that leads to the stretching and tearing of the fascia. The orthotics will also help the fascia support the arch. Another essential portion of the treatment plan is stretching, exercising, and rest. Since this is a dynamic process, many podiatric physicians will recommend physical therapy to optimize the healing process. This treatment will also play a critical role in prevention in the reoccurrence of facial injury.
No foot pain is normal and no one should have to suffer from foot pain. It can be debilitating to your everyday life and many American’s cannot afford to slow down or stop for foot pain. The good news is that heel pain is often treatable without surgery. With the pain so excruciating and the treatment options so obtainable, it unacceptable that 64% of heel pain suffers are living with pain because they fail to seek help.
The most common cause of heel pain is plantar fasciitis. This is a soft tissue injury that is commonly healed with conservative treatment, meaning no surgery! Though there are many reasons for heel pain, plantar fasciitis is by far the most common and is one of the most debilitating. It is often characterized as pain with the first step of the day. When stepping out of bed in the morning or a long car ride, the sufferer experiences pain with the first few steps. Many patients describe the pain as an achy bruise on their heel times ten!
To understand the treatment of plantar fasciitis it is essential to understand why and how this chronic pain occurs. The plantar fascia is a thick band of tissue that attaches to you calcaneus, the heel bone, and bones in your forefoot. The fascia supports the arch of your foot. When standing or walking, feet tend to pronate. This means the foot is tilting inward and elongating. This biomechanical positioning causes stretching and tearing of the plantar fascia which leads to inflammation. It is the inflammation process that causes the pain in the heel of the foot where the fascia attaches. The human body is masterpiece; thus, not everyone experiences plantar fascia damage. Our body will often adjust to compensate for abnormal stresses, but sometimes it just cannot take the stress put it through. One may experience plantar fasciitis during pregnancy or after gaining weight. It is also associated with an increase in activity. So, if you are taking on more shifts at work or began a new work out plan, you may start to feel some foot discomfort.
Since the pain is due to inflammation, many treatment plans flight this problem first. Corticosteroid injections is an antinflammatory that will give many suffers great relief. There are side effects associated with steroid injections, thus the number of injections that one can receive is limited and not everyone is eligible for an injection. Another primary treatment is orthotics. Orthotics helps control the pronation that leads to the stretching and tearing of the fascia. The orthotics will also help the fascia support the arch. Another essential portion of the treatment plan is stretching, exercising, and rest. Since this is a dynamic process, many podiatric physicians will recommend physical therapy to optimize the healing process. This treatment will also play a critical role in prevention in the reoccurrence of facial injury.
No foot pain is normal and no one should have to suffer from foot pain. It can be debilitating to your everyday life and many American’s cannot afford to slow down or stop for foot pain. The good news is that heel pain is often treatable without surgery. With the pain so excruciating and the treatment options so obtainable, it unacceptable that 64% of heel pain suffers are living with pain because they fail to seek help.
Tuesday, March 24, 2009
Stretching for Plantar Fasciitis
Why is it so important?
You may remember your podiatrist telling you how important it is to stretch and ice for plantar fasciitis. The doctor may have given you a sheet of paper that described the stretches with pictures and everything. Who knows where that is now? Are you doing your stretches? Do you remember how to do them or maybe no one ever showed you how to perform them properly.
First, let us review why stretching is important. Plantar fasciitis is inflammation of the fibrous band on the underside of your foot. Imagine your foot arch as a hunting bow. Your foot arch is the wood portion and the string is your plantar fascia. If you place the string portion on the ground and push down on the wooding handle, you stretch out the string. This is very similar to the stress on your plantar fascia when you stand, walk, and run. Overtime, these overuses cause inflammation and heal pain. A common reason why some people are more prone to developing plantar fasciitis is due to tight calf muscles and weak foot muscles. This is easily corrected! You can improve your symptoms and decrease the chance of recurrence just by
doing a few simple stretches.
Stretching is so critical to the treatment plan, that many podiatric physicians will refer you to a physical therapist. This will speed up the recovery process and will help prevent reoccurrence!
When stretching for plantar fasciitis, you must be persistent and diligent. While sleeping, your muscles are not being used and they become tight. When the alarm goes off and you jump out of bed, you will often have excruciating heal pain with your first step. This is because your tight muscles are causing increased pull on your plantar fascia. The first thing you should do in the morning is stretch! You may experience similar pain after sitting for a long time. Once again, the first thing you should do is stretch. Stretching should be done about three times a day along with icing. No excuses. Some stretches are so easy you can do them while sitting at your desk working!
Push the wall to China exercise
Place both hands on the wall at shoulder height. With your toes facing strait forward, extend one leg backwards. Imagine you are trying to push the wall to china. You should feel your calf being stretched.
Towel Stretch
While watching TV, sit on the floor with your legs stretched out in front of you. Wrap a towel around your feet so you are hold on to the ends, one in each hand. Slowly pull the towel toward you keeping your back strait at 90 degrees. You should feel your calf muscles stretching.
Bottle or Tennis Ball Roll
Use a frozen water bottle or a frozen tennis ball for best effect. This is too simple. Roll your foot over the bottle or tennis ball.
Now you have no excuses! Now you know three easy stretches for your plantar fasciitis. Remember to be persistent and diligent and to talk to your podiatric physician about other treatment options to help relieve your pain.
For a video presentation, go to youtube.com/pwishnie and click on the stretching video.