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.
Showing posts with label running causing pain. Show all posts
Showing posts with label running causing pain. Show all posts
Tuesday, February 22, 2011
Wednesday, August 25, 2010
Barefoot Running
Have you seen the alien shoes spotted on celebrities recently? Matthew McConaughey and girlfriend Camila Alves wear them to work out, actor Channing Tatum runs in them, and Heisman Trophy winner Eddie George sports them for beach football.
Just what are these funky, rubber glove toe socks? They’re Vibram FiveFingers—shoes that are meant to mimic the experience of running without shoes, yet protect your feet from dirt and debris. Why would people want to run without their cushy trainers? Running without shoes can strengthen your feet, ankles, and lower legs and improve balance. Some say modern running shoes are to blame for injuries. And one man wrote an immensely popular book that concluded as much.
The 10 laws of injury prevention
Vibram started making the five-toed shoes in 2006, but the trend really picked up steam last year, following the publication of Christopher McDougall's book “Born to Run.” The book describes how Mexico’s Tarahumara Indians have become some of the greatest long-distance runners in the world despite running barefoot or in sandals fashioned from tire rubber. McDougall chronicles an ultramarathon race in Mexico’s Copper Canyons attended by a group of Americans including “Barefoot Ted” McDonald, who either ran sans shoes or in FiveFingers, in case of sharp rocks. The author argues that we’d be better off without the souped-up shoes marketed to us by giants like Nike and Adidas, which he says have done nothing to prevent injuries. The book made “The New York Times” bestseller list, and now TMZ is photographing celebrities in their very own lizard shoes.
According to CNN, the FiveFingers have become so popular that the company is having a hard time keeping them in stock—and stopping counterfeiters from selling knock-offs online.
Your ultimate guide to fall running shoes
Some barefoot devotees simply like the sensation of feeling the surface they’re running on while others swear up and down that ditching traditional running shoes has helped them prevent injuries. While there’s no scientific evidence to support the latter claim, we do know that running barefoot or in barefoot-style shoes like the FiveFingers or Nike Free changes one’s running mechanics. When runners aren’t wearing shoes with built-up soles, they tend to land in the middle or toward the front of their feet rather than on their heel and researchers believe that such midfoot or forefoot striking results in less impact on the body. But as Susan Paul, M.S., exercise physiologist and program director for the Orlando Track Shack Foundation says, “To date, there are no studies indicating that running shoes contribute to injury or, conversely, that barefoot running reduces injury or makes you run faster.”
The mechanics of barefoot running
If you’re thinking about shedding your shoes, consider these guidelines:
1. Barefoot training is not for people who are just starting to run or returning from a long layoff—it’s something to slowly incorporate into an existing running regimen.
2. If you have persistent or serious foot problems, consult your podiatrist first.
3. Ease in slowly. Paul advises starting with a few minutes on a flat, relatively forgiving surface once a week. Grassy fields, smooth roads, and soft trails qualify. Running on sand might be tempting, but barefooting newbies should stick to wet sand at first as the unstable soft stuff puts a lot of torque on your joints and is much harder to run on.
4. Listen to your body. “Barefoot Ken Bob” Saxton, founder of runningbarefoot.org and finisher of more than 70 barefoot marathons, says, “Luckily, your feet are sensitive, which is a good thing. Listen to them and they'll keep you from doing something stupid.”
Has anyone run barefoot or in minimalist shoes like Vibrams? What did you think? If not, would you ever try it? Why or why not?
A head-to-heel guide to running
Susan Rinkunas is an associate editor at Runner’s World, a magazine (and website) that informs, advises, and motivates runners of all ages and abilities—and we mean it. Her blog on Yahoo! Shine offers tips on running technique, nutrition and weight loss, shoes and apparel, and balancing fitness and life.
Just what are these funky, rubber glove toe socks? They’re Vibram FiveFingers—shoes that are meant to mimic the experience of running without shoes, yet protect your feet from dirt and debris. Why would people want to run without their cushy trainers? Running without shoes can strengthen your feet, ankles, and lower legs and improve balance. Some say modern running shoes are to blame for injuries. And one man wrote an immensely popular book that concluded as much.
The 10 laws of injury prevention
Vibram started making the five-toed shoes in 2006, but the trend really picked up steam last year, following the publication of Christopher McDougall's book “Born to Run.” The book describes how Mexico’s Tarahumara Indians have become some of the greatest long-distance runners in the world despite running barefoot or in sandals fashioned from tire rubber. McDougall chronicles an ultramarathon race in Mexico’s Copper Canyons attended by a group of Americans including “Barefoot Ted” McDonald, who either ran sans shoes or in FiveFingers, in case of sharp rocks. The author argues that we’d be better off without the souped-up shoes marketed to us by giants like Nike and Adidas, which he says have done nothing to prevent injuries. The book made “The New York Times” bestseller list, and now TMZ is photographing celebrities in their very own lizard shoes.
According to CNN, the FiveFingers have become so popular that the company is having a hard time keeping them in stock—and stopping counterfeiters from selling knock-offs online.
Your ultimate guide to fall running shoes
Some barefoot devotees simply like the sensation of feeling the surface they’re running on while others swear up and down that ditching traditional running shoes has helped them prevent injuries. While there’s no scientific evidence to support the latter claim, we do know that running barefoot or in barefoot-style shoes like the FiveFingers or Nike Free changes one’s running mechanics. When runners aren’t wearing shoes with built-up soles, they tend to land in the middle or toward the front of their feet rather than on their heel and researchers believe that such midfoot or forefoot striking results in less impact on the body. But as Susan Paul, M.S., exercise physiologist and program director for the Orlando Track Shack Foundation says, “To date, there are no studies indicating that running shoes contribute to injury or, conversely, that barefoot running reduces injury or makes you run faster.”
The mechanics of barefoot running
If you’re thinking about shedding your shoes, consider these guidelines:
1. Barefoot training is not for people who are just starting to run or returning from a long layoff—it’s something to slowly incorporate into an existing running regimen.
2. If you have persistent or serious foot problems, consult your podiatrist first.
3. Ease in slowly. Paul advises starting with a few minutes on a flat, relatively forgiving surface once a week. Grassy fields, smooth roads, and soft trails qualify. Running on sand might be tempting, but barefooting newbies should stick to wet sand at first as the unstable soft stuff puts a lot of torque on your joints and is much harder to run on.
4. Listen to your body. “Barefoot Ken Bob” Saxton, founder of runningbarefoot.org and finisher of more than 70 barefoot marathons, says, “Luckily, your feet are sensitive, which is a good thing. Listen to them and they'll keep you from doing something stupid.”
Has anyone run barefoot or in minimalist shoes like Vibrams? What did you think? If not, would you ever try it? Why or why not?
A head-to-heel guide to running
Susan Rinkunas is an associate editor at Runner’s World, a magazine (and website) that informs, advises, and motivates runners of all ages and abilities—and we mean it. Her blog on Yahoo! Shine offers tips on running technique, nutrition and weight loss, shoes and apparel, and balancing fitness and life.
Monday, August 16, 2010
Runners: Fit Feet Finish Faster
Both long-distance runners and casual joggers can improve their performance by keeping their feet in top condition and taking steps to control foot problems common in runners.
The human foot is a biological masterpiece that amazingly endures the stresses of daily activity. For runners, the feet are more vulnerable to injury than any other part of the body, and these athletes should be on the alert for signs of foot problems that can slow them down if not treated promptly.
The most common complaint from runners is heel pain caused by inflammation of the ligament that holds up the arch, a condition known as plantar fasciitis. In athletes, heel pain can result from faulty mechanics and overpronation in which pressure is unequally applied to the inside of the foot. It also can be caused by wearing running shoes that are worn out or too soft.
At the first sign of heel pain, runners are advised to do stretching exercises, wear sturdier shoes and use arch supports. In some cases, icing and anti-inflammatory drugs, such as ibuprofen, are helpful. Should heel pain continue, custom orthotics, injections and physical therapy might be required? Surgery normally isn’t considered unless heel pain persists for more than a year and conservative treatment has failed to bring relief.
Neuromas and tendonitis are other common foot problems that affect runners. A neuroma is a pinched nerve between the toes that can cause pain, numbness and a burning sensation in the ball of the foot. Overly flexible shoes often are the cause and padding, orthotics or injections usually are effective. Sometimes surgery is the answer if pain between the toes continues for more than six months.
Serious runners can be sidelined with tendonitis if they ignore the warning signs of this overuse-related condition. There are several forms of tendonitis that affect the Achilles and other areas, and all are treated with rest, icing, stretching and anti-inflammatory medications, and sometimes with orthotics and physical therapy. Over-zealous training usually causes tendonitis, especially among beginners who try to do too much too soon.
A common myth among athletes is that it’s not possible to walk or run if a bone in the foot is fractured. Surprised patients often say “It can’t be broken, I can walk on it." That’s dead wrong, especially with stress fractures when pain and swelling might not occur for a few days. If a fracture or sprain is suspected, runners should remember the word RICE as an abbreviation for Rest-Ice-Compression-Elevation. Should pain and swelling continue after following this procedure for three or four days, you should see a foot and ankle specialist for an x-ray and proper diagnosis.
Other common foot ailments runners should watch for are:
Athlete’s Foot: This fungal skin disorder causes dry, cracking skin between the toes, itching, inflammation and blisters. It can be prevented and controlled by washing the feet regularly and carefully drying between the toes; switching running shoes every other day to allow them to dry; wearing socks made with synthetic material instead of cotton; and applying over-the-counter ointments.
Toenail Problems: Ingrown nails can cause inflammation and possible infection and usually are treated by cutting the corner of the nail with sterile clippers. Black toenails happen when a blood blister forms under the nail from trauma, and it’s best to let the nail fall off by itself. Fungal toenails are yellow, brown or black and sometimes are irregularly shaped and thick. They are best treated with oral anti-fungal medications.
Foot Odor: There are more than 250,000 sweat glands in the foot and daily hygiene plus regular changing of shoes and socks are best for controlling sweat and odor. Runners should avoid wearing cotton socks and running without socks. Foot powders, aerosols antiperspirants and vinegar soaks also are helpful.
Blisters, corns and calluses: Never pop blisters unless they are larger than a quarter or are painful or swollen. Use a sterile instrument to lance the corner, leave the top as a biological dressing, wash, apply antibiotic ointment, and cover with a Band-aid. Corns and calluses are caused by repeated friction, and should be treated by aseptically trimming the dead skin and eliminating the underlying cause.
The human foot is a biological masterpiece that amazingly endures the stresses of daily activity. For runners, the feet are more vulnerable to injury than any other part of the body, and these athletes should be on the alert for signs of foot problems that can slow them down if not treated promptly.
The most common complaint from runners is heel pain caused by inflammation of the ligament that holds up the arch, a condition known as plantar fasciitis. In athletes, heel pain can result from faulty mechanics and overpronation in which pressure is unequally applied to the inside of the foot. It also can be caused by wearing running shoes that are worn out or too soft.
At the first sign of heel pain, runners are advised to do stretching exercises, wear sturdier shoes and use arch supports. In some cases, icing and anti-inflammatory drugs, such as ibuprofen, are helpful. Should heel pain continue, custom orthotics, injections and physical therapy might be required? Surgery normally isn’t considered unless heel pain persists for more than a year and conservative treatment has failed to bring relief.
Neuromas and tendonitis are other common foot problems that affect runners. A neuroma is a pinched nerve between the toes that can cause pain, numbness and a burning sensation in the ball of the foot. Overly flexible shoes often are the cause and padding, orthotics or injections usually are effective. Sometimes surgery is the answer if pain between the toes continues for more than six months.
Serious runners can be sidelined with tendonitis if they ignore the warning signs of this overuse-related condition. There are several forms of tendonitis that affect the Achilles and other areas, and all are treated with rest, icing, stretching and anti-inflammatory medications, and sometimes with orthotics and physical therapy. Over-zealous training usually causes tendonitis, especially among beginners who try to do too much too soon.
A common myth among athletes is that it’s not possible to walk or run if a bone in the foot is fractured. Surprised patients often say “It can’t be broken, I can walk on it." That’s dead wrong, especially with stress fractures when pain and swelling might not occur for a few days. If a fracture or sprain is suspected, runners should remember the word RICE as an abbreviation for Rest-Ice-Compression-Elevation. Should pain and swelling continue after following this procedure for three or four days, you should see a foot and ankle specialist for an x-ray and proper diagnosis.
Other common foot ailments runners should watch for are:
Athlete’s Foot: This fungal skin disorder causes dry, cracking skin between the toes, itching, inflammation and blisters. It can be prevented and controlled by washing the feet regularly and carefully drying between the toes; switching running shoes every other day to allow them to dry; wearing socks made with synthetic material instead of cotton; and applying over-the-counter ointments.
Toenail Problems: Ingrown nails can cause inflammation and possible infection and usually are treated by cutting the corner of the nail with sterile clippers. Black toenails happen when a blood blister forms under the nail from trauma, and it’s best to let the nail fall off by itself. Fungal toenails are yellow, brown or black and sometimes are irregularly shaped and thick. They are best treated with oral anti-fungal medications.
Foot Odor: There are more than 250,000 sweat glands in the foot and daily hygiene plus regular changing of shoes and socks are best for controlling sweat and odor. Runners should avoid wearing cotton socks and running without socks. Foot powders, aerosols antiperspirants and vinegar soaks also are helpful.
Blisters, corns and calluses: Never pop blisters unless they are larger than a quarter or are painful or swollen. Use a sterile instrument to lance the corner, leave the top as a biological dressing, wash, apply antibiotic ointment, and cover with a Band-aid. Corns and calluses are caused by repeated friction, and should be treated by aseptically trimming the dead skin and eliminating the underlying cause.
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