A Two-Pronged Approach to Treatment
To develop an effective treatment plan, one should consider using what I refer to as a “two pronged” treatment approach for the patient. This approach considers treating the symptoms and treating the cause. Treating the symptoms of pain and inflammation would include any combination of: nonsteroidal anti-inflammatory drugs (NSAIDs); cortisone injection; physical therapy; or cryotherapy. Treating the cause would include any combination of: taping; orthotics; shoe recommendations or modifications; night splints; cross training; and/or modification or restriction of activity.
Too often, a treatment plan will address only one of these areas. For example, the patient receives an injection, which does nothing to address the cause of the heel pain.
I have found taping to be a valuable tool in treating heel pain but it appears to be a lost art. Taping can be therapeutic as well as diagnostic in determining if a patient could benefit from functional orthotics. I like to say, “Orthotics are only as good as the shoes that you put them in.” If shoes are worn out or not recommended for your patient, orthotics will not be as effective in controlling the foot.
The biomechanical exam and gait evaluation are critical to addressing the underlying cause. You need to determine what diagnostic studies are needed to confirm your diagnosis, especially if it does not appear to be your classic plantar fasciitis injury.
Is Stretching Beneficial For Patients With Heel Pain?
To stretch or not to stretch — that is the question. All too often we will recommend stretching to patients for treating heel pain in the acute phase of the injury. Unfortunately, stretching often starts before the area has healed sufficiently. Stretching should not begin until the rehabilitation phase of the injury, after the healing phase has occurred. If stretching starts too early, it creates a vicious cycle and can prolong the healing of the injury.
There is also quite a bit of controversy over the value of stretching so the jury is still out. However, I tend to be a believer in the benefit of stretching both in recovering from an injury as well as helping to prevent injuries. When addressing stretching, one should specifically focus on stretching the calf muscles as well as the plantar fascia for both sides. It should be a gradual approach with slow, long, static stretching that builds up gradually over time as the patient can tolerate. One should avoid rapid, violent stretching (ballistic). I will usually recommend a pre-activity stretch after a brief warm-up and a post-activity stretch after cooling down.
How Cross Training Can Keep Heel Pain Patients Active
Cross training is a very important aspect of the treatment plan. It is important that patients are able to keep up their level of fitness while recovering from heel pain. Ideally, you can have them use pool therapy, bike or elliptical training to stay in shape and avoid stressing their foot.
Limiting or restricting activity is often difficult, especially for the athlete. One should address the intensity and frequency of activity, especially when it comes to those participating in youth sports. Fortunately, children are often involved in varied activities anyway so cross training is helpful in the treatment plan for youth injuries. Cross training is an essential part of the treatment plan for dealing with high school, college and professional athletes.
It is important to realize that exercise prescription is a major part of dealing with the treatment of heel pain. Prescribing exercise and tailoring it to a specific patient is a talent you should develop. Proper exercise prescription can greatly assist in motivating patients to be actively involved in the treatment and help ensure that their fitness level does not drop off significantly. Improper exercise can prolong the recovery time and increase the rehabilitation period. Return to activity guidelines should be clear to the patient with reasonable goals and expectations.
Showing posts with label achellis tendon. Show all posts
Showing posts with label achellis tendon. Show all posts
Wednesday, February 23, 2011
Tuesday, February 22, 2011
Current Insights on Conservative Care for Heel Pain
Heel pain in children is commonly caused by calcaneal apophysitis or Sever’s disease. This is a traction apophysitis at the calcaneus due to the pull of the Achilles tendon insertion and the origin of the plantar fascia. Typically, the child is involved in a youth sport or activity, such as soccer, baseball, track or basketball, which involves a lot of running and jumping.
Usually, the condition will resolve on its own over time but it is helpful to treat symptoms in the active child using many of the aforementioned treatments such as taping, proper shoe recommendations, ice, stretching (not during acute episodes), etc. I like to apply a low Dye strapping with a closed basket weave on the heel. This has worked very well in allowing children to participate in their activity relatively pain free.
Institute a stretching exercise program for the Achilles tendon and plantar fascia when the child is not in a pain cycle. Addressing footgear is also critical in allowing the child to return to activity and reduce symptoms.
During the exam, the child with calcaneal apophysitis will have a positive squeeze test with medial and lateral compression over the heel with localized tenderness. The activity level is based on response to treatment and minimizing pain with activity.
Keys to Ensuring a Good Fit with Athletic Shoes
• Measure both feet standing on a Brannock device.
• Have patients try on shoes in the afternoon or evening due to swelling.
• Have patients wear similar weight socks or orthotics for activity.
• Have patients try on shoes a half size larger to compare fit.
• Do the basic three shoe tests to evaluate quality.
• Tell patients there should be at least one finger width from the end of the longest toe to the end of the shoe.
• Have patients wear new shoes indoors first to make sure they are comfortable.
• The shoe should not require a break-in period.
• Educate patients on knowing when to replace shoes and the differences among shoe brands.
Treating heel pain can be a real challenge. It is very important to get a detailed history from the patient as to the etiology of the heel pain. The vast majority of heel pain results from overuse. When acute injuries become chronic, one should identify and address biomechanical causes. Evaluating the patient’s training, shoe gear and any previous treatment is essential to a successful treatment plan.
Commonly, the diagnosis points to plantar fasciitis. However, remember there are many causes of heel pain and your differential diagnosis could include a calcaneal stress fracture, nerve entrapment/neuritis, calcaneal apophysitis, calcaneal bone cyst, Reiter’s syndrome or a possible tumor. A good history and exam will help pinpoint a diagnosis and direct a subsequent treatment plan.
Heel pain in the athlete is commonly caused by an increase in the intensity and frequency of activity. Often the athlete is adding running to the workout routine and for cross-training workouts. A good history will include the following key points: sudden or gradual onset of pain, localized or diffuse pain, pain intensity (scale of 1-10), duration of pain and what relieves the pain. The patient history also includes any prior history of problems, any previous treatment, any changes in training intensity and frequency, and any changes in athletic footwear.
The problem with using the pain scale is getting the patient to understand the relative number as most patients will say it is a 10. It is sometimes difficult to determine if the pain is mechanical or neurological in nature. Commonly, the pain is insidious in nature and there is no incidence of trauma.
Usually, the condition will resolve on its own over time but it is helpful to treat symptoms in the active child using many of the aforementioned treatments such as taping, proper shoe recommendations, ice, stretching (not during acute episodes), etc. I like to apply a low Dye strapping with a closed basket weave on the heel. This has worked very well in allowing children to participate in their activity relatively pain free.
Institute a stretching exercise program for the Achilles tendon and plantar fascia when the child is not in a pain cycle. Addressing footgear is also critical in allowing the child to return to activity and reduce symptoms.
During the exam, the child with calcaneal apophysitis will have a positive squeeze test with medial and lateral compression over the heel with localized tenderness. The activity level is based on response to treatment and minimizing pain with activity.
Keys to Ensuring a Good Fit with Athletic Shoes
• Measure both feet standing on a Brannock device.
• Have patients try on shoes in the afternoon or evening due to swelling.
• Have patients wear similar weight socks or orthotics for activity.
• Have patients try on shoes a half size larger to compare fit.
• Do the basic three shoe tests to evaluate quality.
• Tell patients there should be at least one finger width from the end of the longest toe to the end of the shoe.
• Have patients wear new shoes indoors first to make sure they are comfortable.
• The shoe should not require a break-in period.
• Educate patients on knowing when to replace shoes and the differences among shoe brands.
Treating heel pain can be a real challenge. It is very important to get a detailed history from the patient as to the etiology of the heel pain. The vast majority of heel pain results from overuse. When acute injuries become chronic, one should identify and address biomechanical causes. Evaluating the patient’s training, shoe gear and any previous treatment is essential to a successful treatment plan.
Commonly, the diagnosis points to plantar fasciitis. However, remember there are many causes of heel pain and your differential diagnosis could include a calcaneal stress fracture, nerve entrapment/neuritis, calcaneal apophysitis, calcaneal bone cyst, Reiter’s syndrome or a possible tumor. A good history and exam will help pinpoint a diagnosis and direct a subsequent treatment plan.
Heel pain in the athlete is commonly caused by an increase in the intensity and frequency of activity. Often the athlete is adding running to the workout routine and for cross-training workouts. A good history will include the following key points: sudden or gradual onset of pain, localized or diffuse pain, pain intensity (scale of 1-10), duration of pain and what relieves the pain. The patient history also includes any prior history of problems, any previous treatment, any changes in training intensity and frequency, and any changes in athletic footwear.
The problem with using the pain scale is getting the patient to understand the relative number as most patients will say it is a 10. It is sometimes difficult to determine if the pain is mechanical or neurological in nature. Commonly, the pain is insidious in nature and there is no incidence of trauma.
Monday, February 21, 2011
Current Insights On Conservative Care For Heel Pain
Pertinent Tips For Performing Corticosteroid Injections
Corticosteroid injections can be helpful as part of the treatment plan you offer to the patient. I tell the patient the injection can help with the pain and inflammation. This can also be a good alternative for a patient who cannot take NSAIDs.
I inject at the medial aspect at the transition area of the dorsal to plantar skin. This approach can avoid the fat pad inferiorly and the calcaneus superiorly.
I always offer ethyl chloride to help minimize the pain. I penetrate the skin quickly and then slowly inject the heel. It is important to explain to patients that they will feel the cold spray, then a stick and a little burning or discomfort. I will usually inject dexamethasone phosphate or Kenalog (Bristol-Myers Squibb) with bupivacaine. I will do up to three injections depending on how the patient responds to the initial injection but usually one or two injections is sufficient to calm down the heel pain.
I stress that a corticosteroid injection is not a cure, just part of the treatment plan. If the patient does not respond to the injection series, I would consider an oral corticosteroid, such as a Medrol dosing pack. It is pointless to repeat steroid injections when there is little or no response in reducing symptoms. I typically do not offer cortisone injections in the acute phase. Also, I warn the patient of a possible steroid flare-up following the injection, which usually resolves in a short period of time. Be sure to caution the patient to reduce activity following a corticosteroid injection as it can mask the pain during activity and make the condition worse.
Can Physical Therapy Have An Impact?
Physical therapy can be beneficial in the treatment process and the earlier it begins, the better. There are many modalities that one can prescribe such as icing, massage, ultrasound, iontophoresis, stretching and strengthening exercises.
Remember that physical therapy is a prescription so you need to order the frequency and duration of therapy, and establish specific goals. Physical therapy needs to be at least two to three times per week to be effective. I will usually reassess the patient at three- to four-week intervals. If physical therapy is not helping patients after several weeks, reassess the plan. If patients are progressing well, I will often continue their therapy.
The major goals of physical therapy are to decrease pain and increase function. Patients need to understand treatment expectations. I also like to make sure patients receive home exercises to do so they take an active role in their treatment. It is important to work closely with a physical therapist and athletic trainer in the treatment of heel pain.
What You Should Know About Taping
Taping should be the key ingredient in treating heel pain that is mechanical in nature. As I said earlier, taping is becoming a lost art but it is therapeutic as well as diagnostic. When one properly applies a low Dye strapping, it can provide dramatic relief of symptoms. Physicians can apply this strapping with accommodative padding, such as a cobra pad or medial longitudinal arch pad. I will typically offer taping to all of my heel pain patients who have a biomechanical cause of the pain, which one typically sees with plantar fasciitis. I always check to make sure the patient has not had any trouble with taping in the past.
I use a pre-tape spray. Using 1-inch anchors and 2-inch strips, I apply the strips in an overlapping fashion from lateral to medial, causing an anti-pronation force. I will apply another anchor and then repeat another series of overlapping straps. Then I apply a retention strap on the dorsum of the foot to secure the tape job.
Ideally, the tape job can last several days. Sometimes I will do a criss-cross strapping under the arch if the patient has a cavus foot type and that will tend to provide better support. Although the tape will stretch some in a short time, the proprioceptive feedback benefit will last much longer.
I allow the patient to take a brief shower and then use a hair dryer to help dry out the tape job. Since I use porous cloth athletic tape, it holds up pretty well for several days to a week if needed. If you are taping the patient multiple times for several weeks, an under-wrap or pre-wrap will help protect the skin.
Taping restricts excessive motion but allows for functional movement. Taping is not a substitute for rehabilitation but rather an adjunct therapy. If patients respond well to taping, it is a good indication that functional orthotics will be a benefit for them. Usually, if the patient does not respond to a low Dye strapping, the problem is most likely not plantar fasciitis.
What About Functional Orthoses And Night Splints?
Functional orthotics can greatly benefit patients who have had heel pain and chronic plantar fasciitis. Typically, I will put them in a flexible orthotic with a deep heel cup, wide plate and rearfoot post. A medial heel skive of 2 to 4 mm is also helpful in patients with extreme pronation. A plantar fascial groove may be needed for patients who have a tight plantar fascia to prevent irritation of the medial arch. The easiest way to check is to maximally pronate the foot and dorsiflex the hallux as a tight medial band will be prominent. Sometimes one can use a cobra pad to help increase the medial arch height and decrease pronatory forces. A prefabricated sports orthotic can also be helpful in the interim but usually the patient will require a prescription custom orthotic because of the benefits of a heel cup and rearfoot posting providing more support. I typically do not use orthotics in acute or sub-acute cases, or with patients who have not postively responded to taping.
Try to avoid the trap of fitting the orthotic to the shoe. I will usually have patients wait to get any new footwear until they have their orthotics to help ensure a good fit. Then I will have patients bring in their new footwear and check for fit and control with the orthotic. I always advise the patient with heel pain to avoid flip-flops or sandals due to lack of support and cushioning. It is surprising how often a patient will be in flip-flops when he is she is being treated for a foot problem.
Night splints are also a good alternative for treatment to help retain the plantar fascia tension by providing constant force. However, patients may not tolerate the night splints for a prolonged period of time. One can set the night splints for positioning with dorsiflexion commonly from 5 to 15 degrees. This reduces the effect of post-static dyskinesia by reducing the effect of shortening of the plantar fascia and intrinsic muscles of the foot.
Emphasizing The Value Of Proper Footwear And Fit To Combat Heel Pain
Proper footwear is essential for the patient with heel pain. Often, part of the cause of heel pain is an improper shoe for that patient. Usually, the proper athletic shoe will be a great benefit. There are many brands and models of shoes out there so it is best to give your patients some qualitative guidelines. Most patients find they have gravitated to a particular brand that tends to fit their foot. However, it is often not the best model or size for them.
Depending upon the foot type and biomechanics, patients will typically need guidance toward one of the following shoes: motion control, stability or cushion shoes. I typically do a shoe exam that checks for heel counter rigidity, midfoot torsion stability and forefoot flexion of the shoe. Ideally, a removable sock liner or inner sole will allow for easy placement of an orthotic and allow the heel area of the orthotic to sit flat in the shoe.
Typically, a pes cavus foot type will do best in a cushion or neutral type of shoe. A pes planus/hyperpronated foot type will need a moderate to maximum motion control shoe. A normal foot type will usually do well with a stability or mild motion control shoe. One needs to address the shoes before even getting to the orthotic stage. At this point, there is no evidence that toning shoes or rocker bottom shoes provide any benefit for dealing with heel pain. The American Academy of Podiatric Sports Medicine has a helpful section on its website (www.aapsm.org) on athletic footwear recommendations, which can help the practitioner keep current on models and styles.
Have patients try on shoes in the afternoon or evening when their feet will be the largest. Measure patients with a Brannock device while they are standing. Use the measurements as a guide or reference only as different brands can run relatively different sizes. One can also use the shoe fit test to trace the foot and then the shoe, and compare for overlap. Patients should be wearing a similar style of sock. If they have an orthotic device, they should have it in the shoe. There should be a finger width between the end of their longest toe and the shoe. I always have them try on a half size bigger shoe to compare the fit.
I do not recommend breaking in shoes as this tends to break in the feet. Have patients wear the new shoes indoors for a day or two to make sure they feel comfortable. I will then repeat the three-point shoe exam with them to help make sure it is the proper shoe for them. Most patients do best in a running shoe as they offer the best support and cushioning (see “Keys To Ensuring A Good Fit With Athletic Shoes” above).
In Conclusion
A two-pronged approach is helpful in treating heel pain. Most heel pain will respond well to conservative care using this approach. Make sure to address biomechanical issues, footwear considerations and return to activity principles. I rely on taping and athletic footwear prescription as the gold standards of my approach to heel pain. Cross training and exercise prescription are also critical to successful rehabilitation. Stretching programs can be helpful, especially in children with calcaneal apophysitis or plantar fasciitis.
When the patient is not responding to conservative treatment measures, consider additional diagnostic tests to identify the cause and rule out some of the other differential diagnoses of heel pain. Extracorporeal shockwave treatments or surgical repair may be necessary. Consider post-treatment orthotics and proper footwear to prevent further problems.
Corticosteroid injections can be helpful as part of the treatment plan you offer to the patient. I tell the patient the injection can help with the pain and inflammation. This can also be a good alternative for a patient who cannot take NSAIDs.
I inject at the medial aspect at the transition area of the dorsal to plantar skin. This approach can avoid the fat pad inferiorly and the calcaneus superiorly.
I always offer ethyl chloride to help minimize the pain. I penetrate the skin quickly and then slowly inject the heel. It is important to explain to patients that they will feel the cold spray, then a stick and a little burning or discomfort. I will usually inject dexamethasone phosphate or Kenalog (Bristol-Myers Squibb) with bupivacaine. I will do up to three injections depending on how the patient responds to the initial injection but usually one or two injections is sufficient to calm down the heel pain.
I stress that a corticosteroid injection is not a cure, just part of the treatment plan. If the patient does not respond to the injection series, I would consider an oral corticosteroid, such as a Medrol dosing pack. It is pointless to repeat steroid injections when there is little or no response in reducing symptoms. I typically do not offer cortisone injections in the acute phase. Also, I warn the patient of a possible steroid flare-up following the injection, which usually resolves in a short period of time. Be sure to caution the patient to reduce activity following a corticosteroid injection as it can mask the pain during activity and make the condition worse.
Can Physical Therapy Have An Impact?
Physical therapy can be beneficial in the treatment process and the earlier it begins, the better. There are many modalities that one can prescribe such as icing, massage, ultrasound, iontophoresis, stretching and strengthening exercises.
Remember that physical therapy is a prescription so you need to order the frequency and duration of therapy, and establish specific goals. Physical therapy needs to be at least two to three times per week to be effective. I will usually reassess the patient at three- to four-week intervals. If physical therapy is not helping patients after several weeks, reassess the plan. If patients are progressing well, I will often continue their therapy.
The major goals of physical therapy are to decrease pain and increase function. Patients need to understand treatment expectations. I also like to make sure patients receive home exercises to do so they take an active role in their treatment. It is important to work closely with a physical therapist and athletic trainer in the treatment of heel pain.
What You Should Know About Taping
Taping should be the key ingredient in treating heel pain that is mechanical in nature. As I said earlier, taping is becoming a lost art but it is therapeutic as well as diagnostic. When one properly applies a low Dye strapping, it can provide dramatic relief of symptoms. Physicians can apply this strapping with accommodative padding, such as a cobra pad or medial longitudinal arch pad. I will typically offer taping to all of my heel pain patients who have a biomechanical cause of the pain, which one typically sees with plantar fasciitis. I always check to make sure the patient has not had any trouble with taping in the past.
I use a pre-tape spray. Using 1-inch anchors and 2-inch strips, I apply the strips in an overlapping fashion from lateral to medial, causing an anti-pronation force. I will apply another anchor and then repeat another series of overlapping straps. Then I apply a retention strap on the dorsum of the foot to secure the tape job.
Ideally, the tape job can last several days. Sometimes I will do a criss-cross strapping under the arch if the patient has a cavus foot type and that will tend to provide better support. Although the tape will stretch some in a short time, the proprioceptive feedback benefit will last much longer.
I allow the patient to take a brief shower and then use a hair dryer to help dry out the tape job. Since I use porous cloth athletic tape, it holds up pretty well for several days to a week if needed. If you are taping the patient multiple times for several weeks, an under-wrap or pre-wrap will help protect the skin.
Taping restricts excessive motion but allows for functional movement. Taping is not a substitute for rehabilitation but rather an adjunct therapy. If patients respond well to taping, it is a good indication that functional orthotics will be a benefit for them. Usually, if the patient does not respond to a low Dye strapping, the problem is most likely not plantar fasciitis.
What About Functional Orthoses And Night Splints?
Functional orthotics can greatly benefit patients who have had heel pain and chronic plantar fasciitis. Typically, I will put them in a flexible orthotic with a deep heel cup, wide plate and rearfoot post. A medial heel skive of 2 to 4 mm is also helpful in patients with extreme pronation. A plantar fascial groove may be needed for patients who have a tight plantar fascia to prevent irritation of the medial arch. The easiest way to check is to maximally pronate the foot and dorsiflex the hallux as a tight medial band will be prominent. Sometimes one can use a cobra pad to help increase the medial arch height and decrease pronatory forces. A prefabricated sports orthotic can also be helpful in the interim but usually the patient will require a prescription custom orthotic because of the benefits of a heel cup and rearfoot posting providing more support. I typically do not use orthotics in acute or sub-acute cases, or with patients who have not postively responded to taping.
Try to avoid the trap of fitting the orthotic to the shoe. I will usually have patients wait to get any new footwear until they have their orthotics to help ensure a good fit. Then I will have patients bring in their new footwear and check for fit and control with the orthotic. I always advise the patient with heel pain to avoid flip-flops or sandals due to lack of support and cushioning. It is surprising how often a patient will be in flip-flops when he is she is being treated for a foot problem.
Night splints are also a good alternative for treatment to help retain the plantar fascia tension by providing constant force. However, patients may not tolerate the night splints for a prolonged period of time. One can set the night splints for positioning with dorsiflexion commonly from 5 to 15 degrees. This reduces the effect of post-static dyskinesia by reducing the effect of shortening of the plantar fascia and intrinsic muscles of the foot.
Emphasizing The Value Of Proper Footwear And Fit To Combat Heel Pain
Proper footwear is essential for the patient with heel pain. Often, part of the cause of heel pain is an improper shoe for that patient. Usually, the proper athletic shoe will be a great benefit. There are many brands and models of shoes out there so it is best to give your patients some qualitative guidelines. Most patients find they have gravitated to a particular brand that tends to fit their foot. However, it is often not the best model or size for them.
Depending upon the foot type and biomechanics, patients will typically need guidance toward one of the following shoes: motion control, stability or cushion shoes. I typically do a shoe exam that checks for heel counter rigidity, midfoot torsion stability and forefoot flexion of the shoe. Ideally, a removable sock liner or inner sole will allow for easy placement of an orthotic and allow the heel area of the orthotic to sit flat in the shoe.
Typically, a pes cavus foot type will do best in a cushion or neutral type of shoe. A pes planus/hyperpronated foot type will need a moderate to maximum motion control shoe. A normal foot type will usually do well with a stability or mild motion control shoe. One needs to address the shoes before even getting to the orthotic stage. At this point, there is no evidence that toning shoes or rocker bottom shoes provide any benefit for dealing with heel pain. The American Academy of Podiatric Sports Medicine has a helpful section on its website (www.aapsm.org) on athletic footwear recommendations, which can help the practitioner keep current on models and styles.
Have patients try on shoes in the afternoon or evening when their feet will be the largest. Measure patients with a Brannock device while they are standing. Use the measurements as a guide or reference only as different brands can run relatively different sizes. One can also use the shoe fit test to trace the foot and then the shoe, and compare for overlap. Patients should be wearing a similar style of sock. If they have an orthotic device, they should have it in the shoe. There should be a finger width between the end of their longest toe and the shoe. I always have them try on a half size bigger shoe to compare the fit.
I do not recommend breaking in shoes as this tends to break in the feet. Have patients wear the new shoes indoors for a day or two to make sure they feel comfortable. I will then repeat the three-point shoe exam with them to help make sure it is the proper shoe for them. Most patients do best in a running shoe as they offer the best support and cushioning (see “Keys To Ensuring A Good Fit With Athletic Shoes” above).
In Conclusion
A two-pronged approach is helpful in treating heel pain. Most heel pain will respond well to conservative care using this approach. Make sure to address biomechanical issues, footwear considerations and return to activity principles. I rely on taping and athletic footwear prescription as the gold standards of my approach to heel pain. Cross training and exercise prescription are also critical to successful rehabilitation. Stretching programs can be helpful, especially in children with calcaneal apophysitis or plantar fasciitis.
When the patient is not responding to conservative treatment measures, consider additional diagnostic tests to identify the cause and rule out some of the other differential diagnoses of heel pain. Extracorporeal shockwave treatments or surgical repair may be necessary. Consider post-treatment orthotics and proper footwear to prevent further problems.
Tuesday, January 18, 2011
Ugg Boots Achilles Heel? They May Cause Foot Pain
Podiatrists say popular slipper-like boot can be shear agony on the feet.
The wildly popular Australian boots are everywhere these days--even worthy of "how to wear them" videos on Youtube.
Forest Park Medical Center podiatrist Rachel Verville said that's probably a good idea because if not worn properly the super-comfy boots can be a real pain in the feet.
"The main thing is moderation," Dr. Verville said. "If you only wear them for a few hours every day you should be fine but if you wear them for an extended period of time or multiple days on end you can develop pain."
Dr. Verville sees a growing number of young women experiencing foot pain--she asks them all the same question: What shoes are you wearing?
"Often times its UGG's," Dr. Verville added that UGG's and knockoff-boots like them are comfortable but with their slipper-like feel they offer no support. "Basically there is a large tendon that runs down the inside of your foot called the posterior tibial tendon and if you wear non-supportive shoes for a long period of time you can develop posterior tibial tendonitis which is tendonitis of that tendon."
Which is painful enough for people to seek medical help.
Katie Taylor wears high heels at work and then slips out of them and into her UGG's on her way home. She wears them with caution and hasn't had any problems.
"They're warm, my feet get cold a lot so I really wanted to have a warm shoe," Katie said. "But also whenever I'm at work I wear really uncomfortable shoes and I change into my UGG's when I can't take the pain from my other shoes."
Dr. Verville also owns a pair of UGG's and says many women wear theirs without socks which can turn the sheepskin lined boots into bacteria traps.
"I suggest one should wear socks," Dr. Verville said. "Just a thin layer of sock inside the boots because if you sweat, moisture develops and athlete's foot and that kind of thing can develop."
So with UGG's and other sensible shoes like them--use a little common sense.
The wildly popular Australian boots are everywhere these days--even worthy of "how to wear them" videos on Youtube.
Forest Park Medical Center podiatrist Rachel Verville said that's probably a good idea because if not worn properly the super-comfy boots can be a real pain in the feet.
"The main thing is moderation," Dr. Verville said. "If you only wear them for a few hours every day you should be fine but if you wear them for an extended period of time or multiple days on end you can develop pain."
Dr. Verville sees a growing number of young women experiencing foot pain--she asks them all the same question: What shoes are you wearing?
"Often times its UGG's," Dr. Verville added that UGG's and knockoff-boots like them are comfortable but with their slipper-like feel they offer no support. "Basically there is a large tendon that runs down the inside of your foot called the posterior tibial tendon and if you wear non-supportive shoes for a long period of time you can develop posterior tibial tendonitis which is tendonitis of that tendon."
Which is painful enough for people to seek medical help.
Katie Taylor wears high heels at work and then slips out of them and into her UGG's on her way home. She wears them with caution and hasn't had any problems.
"They're warm, my feet get cold a lot so I really wanted to have a warm shoe," Katie said. "But also whenever I'm at work I wear really uncomfortable shoes and I change into my UGG's when I can't take the pain from my other shoes."
Dr. Verville also owns a pair of UGG's and says many women wear theirs without socks which can turn the sheepskin lined boots into bacteria traps.
"I suggest one should wear socks," Dr. Verville said. "Just a thin layer of sock inside the boots because if you sweat, moisture develops and athlete's foot and that kind of thing can develop."
So with UGG's and other sensible shoes like them--use a little common sense.
Sunday, January 2, 2011
Wearing High Heels Can Lead to Osteoarthritis of the Foot
If you wear low heels or sturdy one- to two-inch heels or limit your wearing of high heels to evenings or special occasions, you're probably okay. However, if you wear very high heels day in and day out, you may increase your risk for developing osteoarthritis of the foot. “It’s harder to stand straight when wearing high heels, and this causes a lot of stress on the balls of your feet and your toes” says Dr. Weaver. Feet are one of the chief areas to be hit by osteoarthritis. In addition, high heels that are tight across the toes can aggravate bunions, or arthritis of the toes. You're better off wearing low heels and leaving the stilettos to the models
Thursday, December 9, 2010
NBA bans its first pair of shoes due to 'unfair advantage'
Though no NBA player actually professed an interest in buying these special Athletic Propulsion Labs vertical-influencing basketball shoes, you have to wonder if there are a series of floor-bound big men, the league over, that just had their Tuesday ruined by David Stern.
This is a press release, and not an actual report from the frontlines, but it's an interesting turn nevertheless.
The NBA has actually banned some shoes (which can be yours for only $300!) due to an apparent "unfair competitive advantage," which will no doubt send the sales of these Athletic Propulsion Labs' duds through the roof. I hope Messrs. Stern and Adam Silver bought some stock in this company before they made it infamous.
[Related: Basketball team faces 'desperate' shoe shortage]
To the release!
For the first time in its 64-year history, the National Basketball Association (NBA) has banned a new line of shoes based on the league's rule against an "unfair competitive advantage" that increases a player's vertical leap. The league's ban on Athletic Propulsion Labs' Concept 1 confirms the company's claims that the shoe, with its Load ‘N LaunchTM Technology, performs as advertised. No professional player will be allowed to wear the product in games for the upcoming 2010-2011 NBA season.
This action comes on the 25th anniversary of the NBA's ban on Nike's Air Jordan shoes, albeit for reasons of their colorful appearance rather than any performance advantage.
Athletic Propulsion Labs (APL) was notified by a senior NBA official who stated, "League rules regulate the footwear that players may wear during an NBA game. Under league rules, players may not wear any shoe during a game ‘that creates an undue competitive advantage (e.g., to increase a player's vertical leap).' In light of that rule...players will not be permitted to wear the APL shoes during NBA games."
[Rewind: Trainer banishes Nike shoe]
Shoe companies, for decades, have promoted a sort of "unfair competitive advantage" through their shoes, from PF Flyers to the most recent set of Derrick Rose(notes)-brand adidas that we'll showcase here at BDL later this afternoon. But this is the first time that the NBA has borderline endorsed one brand of shoe being better than another, even if they won't allow its players to run in it.
This is a press release, and not an actual report from the frontlines, but it's an interesting turn nevertheless.
The NBA has actually banned some shoes (which can be yours for only $300!) due to an apparent "unfair competitive advantage," which will no doubt send the sales of these Athletic Propulsion Labs' duds through the roof. I hope Messrs. Stern and Adam Silver bought some stock in this company before they made it infamous.
[Related: Basketball team faces 'desperate' shoe shortage]
To the release!
For the first time in its 64-year history, the National Basketball Association (NBA) has banned a new line of shoes based on the league's rule against an "unfair competitive advantage" that increases a player's vertical leap. The league's ban on Athletic Propulsion Labs' Concept 1 confirms the company's claims that the shoe, with its Load ‘N LaunchTM Technology, performs as advertised. No professional player will be allowed to wear the product in games for the upcoming 2010-2011 NBA season.
This action comes on the 25th anniversary of the NBA's ban on Nike's Air Jordan shoes, albeit for reasons of their colorful appearance rather than any performance advantage.
Athletic Propulsion Labs (APL) was notified by a senior NBA official who stated, "League rules regulate the footwear that players may wear during an NBA game. Under league rules, players may not wear any shoe during a game ‘that creates an undue competitive advantage (e.g., to increase a player's vertical leap).' In light of that rule...players will not be permitted to wear the APL shoes during NBA games."
[Rewind: Trainer banishes Nike shoe]
Shoe companies, for decades, have promoted a sort of "unfair competitive advantage" through their shoes, from PF Flyers to the most recent set of Derrick Rose(notes)-brand adidas that we'll showcase here at BDL later this afternoon. But this is the first time that the NBA has borderline endorsed one brand of shoe being better than another, even if they won't allow its players to run in it.
Sunday, October 10, 2010
Advice for Hikers and Hunters: Long, Vigorous Hikes Take Toll on Feet, Ankles
As brightly colored leaves dazzle the fall landscape, hikers and hunters nationwide will migrate to mountains, woods and fields, but many, unfortunately, are ill prepared for the beating their feet will take.
Hikers, hunters and others who love the outdoors often don’t realize how strenuous it can be to withstand constant, vigorous walking on uneven terrain. Lax physical conditioning and inappropriate footwear bring scores of outdoor enthusiasts to foot specialists each fall for treatment of foot and ankle problems such as chronic heel pain, ankle sprains, Achilles tendonitis, fungal infections and severe blisters.
Walking up and down steep hillsides and tramping through wet, slippery fields and wooded areas puts stress on the muscles and tendons in the feet and ankles, especially if you haven’t conditioned properly before hitting the trail. Also, many don’t realize that cross-training athletic shoes aren’t the best choice for extended hiking and hunting. Many injuries can be avoided by wearing sturdy, well constructed hiking boots.
Hikers and hunters should investment in top-quality hiking boots. Strong, well insulated and moisture-proof boots with steel or graphite shanks offer excellent ankle and foot support that helps lessen stress and muscle fatigue to reduce injury risk. Supportive shanks decrease strain on the arch by allowing the boot to distribute impact as the foot moves forward. If a boot bends in the middle, it may not be well suited for hunting or hiking.
In wet and cold weather, wearing the right socks can help prevent blisters, fungal infections and frostbite. Synthetic socks are excellent as the first layer to keep the feet dry and reduce blister-causing friction. For the second layer, wool socks add warmth, absorb moisture away from the skin, and help make the hiking boot more comfortable. Wool lets moisture evaporate more readily than cotton, so fewer blisters develop.
What happens if your feet or ankles hurt during a hike or hunt? Pain usually occurs from overuse, even from just walking. If you’re not accustomed to walking on sloped or uneven ground, your legs and feet will get tired and cause muscles and tendons to ache. To avoid a serious injury, such as a severe ankle sprain or an Achilles tendon rupture, rest for awhile if you start hurting.
Pain is a warning sign that something is wrong. Serious injury risk escalates significantly if you continue hiking in pain. Hiking, like skiing, is an activity in which beginners should take on less difficult trails until they become better conditioned and more confident.
Evaluation by a foot and ankle specialist is recommended if there is persistent pain following a hiking or hunting outing. Ankle instability and strained Achilles tendons are most concerning. Inattention to these problems at their early stages may lead to a serious injury that will keep you off the trails for a long time.
Hikers, hunters and others who love the outdoors often don’t realize how strenuous it can be to withstand constant, vigorous walking on uneven terrain. Lax physical conditioning and inappropriate footwear bring scores of outdoor enthusiasts to foot specialists each fall for treatment of foot and ankle problems such as chronic heel pain, ankle sprains, Achilles tendonitis, fungal infections and severe blisters.
Walking up and down steep hillsides and tramping through wet, slippery fields and wooded areas puts stress on the muscles and tendons in the feet and ankles, especially if you haven’t conditioned properly before hitting the trail. Also, many don’t realize that cross-training athletic shoes aren’t the best choice for extended hiking and hunting. Many injuries can be avoided by wearing sturdy, well constructed hiking boots.
Hikers and hunters should investment in top-quality hiking boots. Strong, well insulated and moisture-proof boots with steel or graphite shanks offer excellent ankle and foot support that helps lessen stress and muscle fatigue to reduce injury risk. Supportive shanks decrease strain on the arch by allowing the boot to distribute impact as the foot moves forward. If a boot bends in the middle, it may not be well suited for hunting or hiking.
In wet and cold weather, wearing the right socks can help prevent blisters, fungal infections and frostbite. Synthetic socks are excellent as the first layer to keep the feet dry and reduce blister-causing friction. For the second layer, wool socks add warmth, absorb moisture away from the skin, and help make the hiking boot more comfortable. Wool lets moisture evaporate more readily than cotton, so fewer blisters develop.
What happens if your feet or ankles hurt during a hike or hunt? Pain usually occurs from overuse, even from just walking. If you’re not accustomed to walking on sloped or uneven ground, your legs and feet will get tired and cause muscles and tendons to ache. To avoid a serious injury, such as a severe ankle sprain or an Achilles tendon rupture, rest for awhile if you start hurting.
Pain is a warning sign that something is wrong. Serious injury risk escalates significantly if you continue hiking in pain. Hiking, like skiing, is an activity in which beginners should take on less difficult trails until they become better conditioned and more confident.
Evaluation by a foot and ankle specialist is recommended if there is persistent pain following a hiking or hunting outing. Ankle instability and strained Achilles tendons are most concerning. Inattention to these problems at their early stages may lead to a serious injury that will keep you off the trails for a long time.
Saturday, September 25, 2010
Why Does My Achilles Tendon Hurt?
You don’t have to be an accomplished athlete to suffer Achilles tendon injuries. They can occur from performing minor household tasks, such as climbing a ladder. Achilles tendon weakness is common in adults and prompt treatment when symptoms occur can prevent more serious injury.
The Achilles tendon is the longest and strongest tendon in the body, but is subjected to considerable wear and tear. When the tendon becomes inflamed from overuse or too much sudden stress, tendonitis can weaken it over time and cause microscopic tears. Going without treatment only increases risk for further deterioration and possible rupture.
Pain, stiffness and tenderness in the area are the main symptoms of Achilles tendonitis. Pain occurs in the morning, improves with motion, but gets worse with increasing stress and activity.
In addition to athletes, Achilles tendonitis is common for anyone whose work routine puts constant stress on the feet and ankles. Achilles tendon injuries happen most often to less conditioned, “weekend warrior” athletes who overdo it.
When pain and other symptoms indicate possible Achilles tendonitis, a thorough diagnosis is necessary to determine the extent of the trauma and evaluate the flexibility and range of motion in the tendon. Treatment options depend on the extent of the injury.
They include:
• Casting to immobilize the Achilles tendon and promote healing
• Ice to reduce swelling
• Non-steroidal anti-inflammatory medication to reduce pain and inflammation
• Physical therapy to strengthen the tendon
• Surgery, if other approaches fail to restore the tendon to its normal condition
Recreational activities involving jumping and running are the major cause of Achilles tendon injuries. In sports like basketball and tennis, muscles and tendons in the back of the leg are prone to injury from an imbalance that occurs from a lot of forward motion. As a result, the frontal imbalance can weaken the tendon unless stretching exercises are performed regularly.
The best way to prevent Achilles tendon injuries is to warm up gradually by walking and stretching. Further, it’s best to avoid strenuous sprinting or hill running if you are not in shape for it.
The Achilles tendon is the longest and strongest tendon in the body, but is subjected to considerable wear and tear. When the tendon becomes inflamed from overuse or too much sudden stress, tendonitis can weaken it over time and cause microscopic tears. Going without treatment only increases risk for further deterioration and possible rupture.
Pain, stiffness and tenderness in the area are the main symptoms of Achilles tendonitis. Pain occurs in the morning, improves with motion, but gets worse with increasing stress and activity.
In addition to athletes, Achilles tendonitis is common for anyone whose work routine puts constant stress on the feet and ankles. Achilles tendon injuries happen most often to less conditioned, “weekend warrior” athletes who overdo it.
When pain and other symptoms indicate possible Achilles tendonitis, a thorough diagnosis is necessary to determine the extent of the trauma and evaluate the flexibility and range of motion in the tendon. Treatment options depend on the extent of the injury.
They include:
• Casting to immobilize the Achilles tendon and promote healing
• Ice to reduce swelling
• Non-steroidal anti-inflammatory medication to reduce pain and inflammation
• Physical therapy to strengthen the tendon
• Surgery, if other approaches fail to restore the tendon to its normal condition
Recreational activities involving jumping and running are the major cause of Achilles tendon injuries. In sports like basketball and tennis, muscles and tendons in the back of the leg are prone to injury from an imbalance that occurs from a lot of forward motion. As a result, the frontal imbalance can weaken the tendon unless stretching exercises are performed regularly.
The best way to prevent Achilles tendon injuries is to warm up gradually by walking and stretching. Further, it’s best to avoid strenuous sprinting or hill running if you are not in shape for it.
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