Why does my heel hurt?

It will happen to you.  If you ask, it has happened to your friends, neighbors, coworkers.  It’s pain in your heel.  First thing in the morning, you get up, and once your foot hits the floor, you want to fall down and cry.  It is very common, occurs to everyone, and won’t go away by itself.

It is heel pain, or plantar fasciitis.  That morning pain in the heel that makes you hop to the bathroom.  It makes you afraid to get out of the car when you get to work.  It makes you afraid to exercise.  And it hurts!

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10 reasons why you should choose We Treat Feet

The We Treat Feet Podiatry group takes great pride in putting our patients’ feet and needs first. We pride ourselves on our expert clinicians and top-notch customer service.

Here are 10 reasons why you should choose We Treat Feet Podiatry for all your podiatric needs.

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VIDEO: Dr. Daniels’ patient recalls limb-saving treatment provided by We Treat Feet

In Northwest Hospital’s Gala video, a patient of We Treat Feet’s Dr. Mike Daniels recalls the procedure that ended up saving him his foot. The patient had a very serious condition which combined with his diabetes would have required amputation for most patients without the aggressive treatment provided by Dr. Daniels and his colleagues at Northwest Hospital.

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Diabetes and podiatry; what’s the connection?

Foot complications in diabetes are common yet the link between the two is not very well-known. Here to tell us more about it ahead of World Diabetes Day on 14 November is specialist and author for Journal of Foot and Ankle Research Trevor Prior, with colleague Debbie Coleman.

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Report: FDA Strengthens NSAIDs Warnings

The US Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.

Based on the FDA’s review of new safety information, it is now requiring updates to the drug labels of all prescription NSAIDs.

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Report: Supreme Court Issues Ruling on Affordable Care Act Subsidies

The Supreme Court today voted to uphold the previous IRS ruling that the Affordable Care Act allows for tax subsidies in the 34 states that use federally funded health-care exchanges. The 6-3 decision preserves health-care coverage for millions of Americans who enrolled for health care on the federal exchange.

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We Treat Feet Supports Local High School After-Prom Program

We Treat Feet Podiatry recently pledged a donation to Franklin High School’s Project S.A.F.E. After-Prom Program. The program, according to organizers is an “all-night event [that] will provide a safe, substance-free environment for the students to share a memorable evening with their friends. The students will have a fantastic time celebrating safely!”

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Report: Gout Vastly Undertreated in USA & UK

Gout, the most common inflammatory arthritis worldwide, is treatable but vastly undertreated, according to epidemiologic studies that now encompass three continents. The undertreatment problems previously reported in the United Kingdom and the United States also characterize gout in Taiwan, according to a nationwide population study.

Chang-Fu Kuo, MD, from the Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, United Kingdom, and the Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, and colleagues report the study results in an article published online January 23 in Arthritis Research & Therapy. Dr Kuo was also the lead author on the UK study.

In the new article, Dr Kuo and colleagues report, although gout incidence in Taiwan decreased during the course of the study, prevalence remained high and stable and gout management remained poor, with only about one quarter of patients receiving potentially curative urate-lowering therapy.

Jasvinder A. Singh, MD, MPH, who led the US study and who was not involved in either the Taiwan or UK studies, told Medscape Medical News, “The rates of undertreatment of gout in the US are also quite high and have been widely published, and many of the observations published in this study have also been seen in many other countries. Undertreatment includes not only lower rate of use of urate-lowering drugs but also infrequent monitoring of the serum urate and a low proportion reaching the target serum urate of less than 6 mg/dL due to use of suboptimal dose of urate-lowering drugs.” Dr Singh is professor of medicine at the University of Alabama, Birmingham.

Dr Kuo and colleagues used data from the National Health Insurance Research Database for Taiwan, which covers the entire population of 23 million people, to identify gout patients, estimate prevalence and incidence for each year from 2005 to 2010, and examine patterns of gout treatment.

Gout prevalence was 1,458,569 (6.24%), and gout incidence was 56,595 (2.74/1000 person-years). Gout prevalence did not change significantly during the study, although gout incidence decreased 13.4% between 2005 and 2010 and 2.1% between 2007 and 2010. In comparison, estimates of annual incidence in US studies ranged from 0.45 to 1.73 per 1000 person-years.

Gout was most prevalent and had the highest incidence rates in eastern coast counties and offshore islets of Taiwan, which the authors note also have higher populations of indigenous Taiwanese. “However, genetic factors account for just one-third of phenotypic variation of gout in men and only one-fifth in women so environmental factors could also contribute to the variable geographical distribution of gout in Taiwan,” the authors write.

“To the best of our knowledge, our study is the first to report gout incidence in Asian populations. The incidence in Taiwan was much higher than other countries, suggesting significant racial and geographic variation in the aetiology of gout,” they add.

Dr Singh commented, “There are very few studies of gout risk in Asian patients in the US, so it’s not easy to say whether the problem is better, the same, or worse than Taiwan. There are no particular subgroups in the US that require particular attention, except that African-Americans have been shown to have poorer outcomes with gout compared to Caucasians, and lower rates of medication treatment.”

In the Taiwan study, in 2010, only about one third of patients with gout had contact with health services in relation to gout, and only one in five were prescribed urate-lowering therapy. Of those treated, 60.08% (95% confidence interval, 59.91% – 60.25%) received uricosuric agents alone, 28.54% (95% confidence interval, 28.39% – 28.69%) received a xanthine oxidase inhibitor, and 11.38% (95% confidence interval, 11.27% – 11.49%) received both. The authors add, “Unfortunately, this suboptimal care has not changed over the study period, despite the publication of national and international guidelines on gout management during this period.”

The authors have disclosed no relevant financial relationships. Dr Singh reported no financial conflicts related directly to this study but has received research and travel grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, Allergan, and Novartis.

Source: Janis C. Kelly, Medscape

Foot Injury Focus: Heel Pain

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

Causes
Heel pain has many causes. Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear (such as flimsy flip-flops); or being overweight.

Common causes of heel pain include:
Heel Spurs: A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.” Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

Excessive Pronation: Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

Achilles Tendinitis: Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.

Other possible causes of heel pain include:
rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint; an inflamed bursa (bursitis), a small, irritated sac of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur;
Haglund’s deformity (“pump bump”), a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe; a bone bruise or contusion, which is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

When to Visit a Podiatrist
If pain and other symptoms of inflammation—redness, swelling, heat—persist, limit normal daily activities and contact a doctor of podiatric medicine.

Diagnosis and Treatment
The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.

Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.

Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions:
-Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters
-Wear the proper shoes for each activity
-Do not wear shoes with excessive wear on heels or soles
-Prepare properly before exercising. Warm up and do stretching exercises before and after running.
-Pace yourself when you participate in athletic activities
-Don’t underestimate your body’s need for rest and good nutrition
-If obese, lose weight

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