Common Causes of Arch Pain

Article featured on News-Medical 

Arch pain, also known by the medical term plantar pain, refers to pain in the arch at the bottom of the foot. This pain can present as a result of various causes, usually following activities that involve significant stress to the arch of the foot.

The arches of the feet are a principle structure of the foot, which play an important role to absorb and return the force between the body and the ground, supporting bodily movement when people are on their feet. However, when the arches are put under excessive stress due to intense movements or extended periods of time standing on their feet, injury and pain to the area can present.

Plantar Fasciitis

The most common cause of arch pain is a condition known as plantar fasciitis, which involves inflammation of the plantar fascia connective tissue along the arch of the foot. This usually follows excessive stress to the area from activities such as extended periods of time spent on feet at work or after sporting activities.

Injury to the arch of the foot can occur due to direct force trauma can result in pain and inflammation. This may include:

  • Ligament sprains
  • Muscle strains
  • Biomechanical misalignment
  • Fractures due to mechanical stress
  • Muscle overuse
  • Inflammatory arthritis

Activities that are most likely to cause damage to the foot arch include those that involve a significant amount or extended period of stress to the feet. This includes intense sport activities, long distance running and simply standing on the feet all day in a workplace environment.

Foot Deformity

Some deformities of the foot, such as hammertoe or clubfoot, may also cause arch pain. Additionally, people with abnormal arches of the feet are more likely to be affected by arch pain, including both people with flat feet and those with high arches.

Sudden Weight Changes

Drastic changes in weight that occur over a short period of time can be responsible for causing stress to the arch of the foot and result in arch pain.

In particular, people who are obese, have Type 2 diabetes mellitus, or are pregnant are more likely to be affected by excess stress on their feet and report symptoms of arch pain.

Footwear

Inappropriate footwear that is ill-fitting or does not provide adequate support to the food and may lead to pain and inflammation in the arch of the foot. The sole of the shoe is of particular importance and those with poor arch support or soft soles are most likely to cause problems.

Diagnosis

The structure of the foot is very complex and, for this reason, an individual that is experiencing arch pain should be referred to a podiatrist who will make the relevant investigations as to the cause of the condition.

This usually begins with a physical examination of the foot and a consultation about the medical history and events recent that may have caused the pain. There is often evidence of a lump or bruise in the arch of the foot that is evidence of damage to the connective tissue.

Other tests that may be used to determine the cause of the arch pain include X-ray imaging, magnetic resonance imaging (MRI) or computed tomography (CT) scans.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Turf Toe: What is It?

Article featured on Mercy Health

What is turf toe?

Turf toe is a sprain in the ligaments around the big toe joint. Turf toe often happens suddenly when the toe becomes hyperextended.

Athletes, such as football players, are the most likely group of people to develop turf toe.

Causes of turf toe

Turf toe can be caused by the following:

  • The toe is hyperextended and forcibly bent backward, when the toe stays flat on the ground instead of lifting off in an athletic move the joint can be injured.
  • A toe stays flat instead of lifting off when a football player or other athlete is tackled.

Risk factors for turf toe

Athletes who play sports involving their feet including football, soccer, basketball, gymnastics, and dance are at a higher risk for developing turf toe.

Also, people who wear shoes that are not supportive in the toe box are also at higher risk for turf toe. These soft-soled shoes do not provide protection in the case of sudden force.

Symptoms of turf toe

Turf toe can be categorized in 3 grades:

  • Grade 1 — mild turf toe that is tender to the touch and slightly swollen.
  • Grade 2 — moderate turf toe where mobility is impacted, swelling is deeper and it is more painful to the touch.
  • Grade 3 — severe turf toe where ligaments have been torn and it is extremely painful, swollen and mobility is more severely impaired.

Diagnosis of turf toe

Turf toe is diagnosed under the care of your primary care doctor, podiatrist or sports medicine physician.

The physician will perform a full medical exam as well as work with you to understand your medical history. The physician may order an x-ray to determine if there has been a bone fracture or an MRI to confirm turf toe (MRIs provide images of structures that are not bones).

Treatments for turf toe

Early medical intervention for turf toe is important to avoid long term repercussions from the injury. Athletes especially need quick treatment in order to get back to play as quickly as possible.

For mild cases of turf toe (grade 1), the first line therapy is rest, ice, elevation, and compression in conjunction with anti-inflammatory medication and immobilization.

For moderate cases of turf toe (grade 2), patients should take a minimum of 3 days away from sporting activity in conjunction with all the treatments from grade 1.

For severe turf toe cases patients will need to develop a customized treatment plan with their physician that may include:

  • Splint or brace
  • Rehabilitation and physical therapy

Recovery from turf toe

Recovering from turf toe can be quick for grade 1 cases or can take many months for a grade 3 case.

It is imperative to follow your physician’s instructions in order to get back to normal activity as quickly as possible.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Could Your Foot Pain Be Caused by a Problem in Your Spine?

Article featured on Spine-Health

This blog provides a list of common causes of foot pain and helpful pointers to help you understand the origin of your foot pain.

Foot pain caused by a spinal problem

Nerve root irritation or compression in the lumbar or sacral spine (lower back) may cause sciatica pain to radiate down your leg and into the foot. Specifically, compression of the S1 nerve root, also called classic sciatica, can cause pain along the outer side of your foot.

Nerve roots may be compressed or irritated due to a number of causes. Common examples include:

  • Lumbar herniated disc: Leaking of the inner contents of an intervertebral disc
  • Lumbar degenerative disc disease: Age-related changes causing narrowing and shrinkage of the disc
  • Spondylolisthesis: Slipping of a vertebra over the one below it
  • Lumbar spinal stenosis: Narrowing of the bony openings for spinal nerves and/or the spinal cord

The inability to lift the front part of your foot or frequent tripping while walking may be due to a condition called foot drop. This condition is typically caused due to compression of the L5 nerve root. Rarely, compression of the L4 and/or S1 nerve roots may also cause foot drop.

Foot pain caused by compression of nerves in the hip, knee, or leg

Foot pain can also occur when nerves are compressed or damaged along their path in the hip, knee, or leg. For example:

  • Peroneal neuropathy, a condition where the peroneal nerve is compressed or injured near the knee may cause foot pain and foot drop when you try to move your foot.
  • Sciatic neuropathy or damage to the sciatic nerve in the pelvic region (hip) may cause foot pain along the top of your foot with some degree of weakness.
  • Tarsal tunnel syndrome or dysfunction of the tibial nerve within the tarsal tunnel of the inner ankle may cause a sharp, shooting pain in your ankle area and along the sole of your foot.
  • Sural nerve entrapment can occur in the leg or near the ankle and typically causes shooting pain along the outer side of your ankle and/or foot.

Additionally, a corn may develop on the skin around your toes. Corns grow over time as a result of excessive friction, and they can compress nearby nerves, causing pain and other symptoms. Another possible cause of nerve pain in your foot is Morton’s neuroma, which is a thickening of the tissue around a nerve in the foot.

How to identify the source of your foot pain

With all the possible causes of nerve pain in the foot, it may be difficult to pinpoint the exact underlying cause. Here are a few useful signs to help you identify the source of your foot pain:

  • Foot pain that follows recent trauma to the lower back, hip, knee, or ankle may help indicate the site of nerve damage
  • Foot pain due to nerve root compression or sciatica may also be associated with other symptoms, such as pain, numbness, and/or weakness in the buttock, thigh, and leg; and typically affects one leg at a time
  • Foot pain that develops after wearing tight boots or shoes may indicate peroneal or sural nerve compression near the knee or ankle
  • Foot pain that develops after a hip injection or hip surgery may indicate sciatic neuropathy.

Nerve pain in the foot may also occur due to nerve damage from systemic conditions, such as diabetes or multiple sclerosis.

Twisting, bending, or a direct hit on your ankle and/or foot may injure the foot bones, ankle joint, blood vessels, muscles, and/or tendons, causing foot pain.

Schedule a visit with your doctor

It is important to schedule an appointment with your doctor to accurately diagnose the cause of your foot pain. Treatments for foot pain can differ widely and must be directed at resolving the underlying cause; not just masking the symptoms. For example, a lumbar herniated disc may require heat therapy and exercise, while a corn on your toe can often be treated with special shoes and warm water.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What is Hammer Toe or Mallet Toe?

Article featured on Mercy Health

What is hammer toe or mallet toe?

Hammer toe is a foot abnormality that occurs because of imbalanced muscles, tendons, or ligaments around the toe. It typically impacts the second, third, or fourth toes. The toe appears like a hammer because it is bent in the middle joint of the toe.

Hammer toe can be healed with relatively simple treatments, but if left untreated may require surgery. Many people with hammer toe develop corns or calluses on the top of the middle joint of the toe or on the tip of the toe.

mallet toe is like hammer toe but impacts the joint closest to the tip of the toe.

Causes of hammer toe or mallet toe

There are many causes of hammer or mallet toe including:

  • Shoes that do not fit properly such as high-heeled shoes that do not have a proper toe box.
  • An impact such as jamming and breaking the toe can cause hammer toe or mallet toe.
  • Imbalanced toe muscles can cause toes to contract.

Risk factors for hammer toe or mallet toe

  • Age — hammer toe or mallet toe affect older people more than younger people but all ages can develop the conditions.
  • Gender — women are more likely to develop hammer or mallet toe.
  • Heredity — hammer toe or mallet toe can be passed down from parents.
  • Second toe length — a person who has a long second toe (longer than the big toe) is more likely to develop hammer or mallet toe.

Symptoms of hammer toe or mallet toe

Symptoms of hammer toe or mallet toe include:

  • Bend in the joint of the toe that is not typical
  • Pain when bending the toe
  • Corns or calluses that form from rubbing in shoes
  • Pain in the ball of the foot under the bent toe
  • Swelling and redness in the toe joint

Diagnosis of hammer toe or mallet toe

A primary care physician or an orthopedic specialist will diagnose hammer toe or mallet toe in a physical exam.

In order to get a better view of what is happening in the bones, joints, and muscles the physician may also order an x-ray.

Treatments for hammer toe or mallet toe

Treatments for hammer toe or mallet toe can be as simple as changing your shoes to surgery for the most severe cases. More advanced treatment options include:

  • Orthotics
  • Splint or brace
  • Rehabilitation or physical therapy

Recovery from hammer toe or mallet toe

Recovery after surgery to correct hammer toe can take as few as 2 weeks to as many as 3 months depending on the severity of the injury.

It is important to follow your physician’s instructions on resting your foot and choice of footwear during the healing process.

Patients who have surgery on the right foot will need to avoid driving for a few weeks to allow the injured toe to heal.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

3 Common Causes of Heel Pain & How it is Treated

Article featured on NY Orthopedics

Heel pain is one of the most common complaints of patients with foot and ankle disorders — but what causes heel pain, exactly? The pain often occurs at the back surface of the heel and can limit any standing, walking, or running activities. Explore our guide to the common causes of heel pain to learn how a foot and ankle specialist can get you back on your feet in no time.

Why Does My Heel Hurt?

Heel pain is not typically caused by a single injury, like a twist or fall, but from repetitive stress and pounding of the heel. Common heel pain causes include:

  • Plantar fasciitis. Too much running or jumping can inflame the fascia (tissue band) that connects the heel bone to the base of the toes. The pain, centered under your heel, may be mild at first but flares up when you take your first steps in the morning. Muscle cramps in the calf may also occur if the Achilles tendon tightens as well. If plantar fasciitis is left untreated, it may lead to heel spurs.
  • Stress fracture. This is often linked to repetitive stress to the bone over a short period of time, especially in young athletes who alter their training regimen suddenly. This may include more sprints, increased mileage while running, or increased training intensity. Stress fractures can also be caused by osteoporosis.
  • Achilles tendonitis. Achilles tendonitis occurs when the tendon that attaches to the calf muscles to the heel becomes inflamed or painful due to overuse. Any activity that requires pushing off — like basketball or running — can result in tendonitis.

How Can Heel Pain Be Treated?

Treatment for heel pain varies depending on the severity of the injury and your health goals. Your foot and ankle specialist may first suggest some home remedies — like rest, applying ice to the heel, and over-the-counter pain medications — to ease your symptoms. If your heel pain doesn’t get better within a few weeks, you should make an appointment with your doctor so that they can provide you with the appropriate treatment.

Your doctor may prescribe physical therapy in most cases. This can help strengthen the tendons and muscles in your foot, helping to prevent further injury. If your pain is severe, your foot and ankle specialist may provide you with anti-inflammatory medications that can be injected into the foot or taken orally. They may also recommend that you support your foot as much as possible — either by using orthotics or taping the foot.

In very rare cases, your foot and ankle specialist may recommend surgery to correct the problem.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Best Foot Exercises for Healthy Feet

Article featured on Medical News Today

What are the best foot exercises for healthy feet?

Many people experience foot or ankle pain at some point. Keeping the feet strong can help alleviate this soreness and improve overall health and flexibility.

Regularly exercising and stretching the feet and ankles can help ensure that the muscles are providing the best support. These exercises may also increase range of motion in the feet, helping keep a person active for as long as possible.

Most foot exercises are simple and require no complicated equipment to perform. People can do them at home or in the gym as part of a regular exercise routine. The following exercises can improve flexibility and mobility in the feet.

1. Toe raise, point, and curl

This exercise has three stages and will help strengthen all parts of the feet and toes.

To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Keeping the toes on the floor, raise the heels. Stop when only the balls of the feet remain on the ground.
  3. Hold this position for 5 seconds before lowering the heels.
  4. For the second stage, raise the heels and point the toes so that only the tips of the big and second toes are touching the floor.
  5. Hold for 5 seconds before lowering.
  6. For the third stage, raise the heels and curl the toes inward so that only the tips of the toes are touching the floor. Hold this position for 5 seconds.
  7. Build flexibility and mobility by repeating each stage 10 times.

2. Big toe stretch

Keeping a wide range of motion in the big toe is important. The following exercise also has three stages and is designed to stretch and relieve pain in the toes from wearing tight shoes.

To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Bring the left foot to rest on the right thigh.
  3. Using the fingers, gently stretch the big toe up, down, and to the side.
  4. Keep the big toe in each position for 5 seconds.
  5. Repeat this 10 times before switching to the other foot.

Exercises for strength

The following exercises can help enhance the strength of the feet.

3. Toe splay

Doing the toe splay exercise can improve control over the toe muscles. People can do it on both feet at once or on alternate feet, depending on which they find more comfortable.

To do this exercise:

  1. Sit in a straight backed chair, with the feet gently resting on the floor.
  2. Spread the toes apart as far as possible without straining. Hold this position for 5 seconds.
  3. Repeat this motion 10 times.
  4. Once a person has built up their strength, they can try looping a rubber band around the toes. This will provide resistance and make the exercise more challenging.

4. Toe curls

Doing toe curls builds up the flexor muscles of the toes and feet, improving overall strength.

To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Lay a small towel on the floor in front of the body, with the short side facing the feet.
  3. Place the toes of one foot on the short side of the towel. Try to grasp the towel between the toes and pull it toward oneself. Repeat this exercise five times before switching to the other foot.
  4. To make this exercise more challenging, try weighing down the opposite end of the towel with an object.

5. Marble pickup

Doing the marble pickup can increase strength in the muscles on the undersides of the feet and toes.

To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Place an empty bowl and a bowl of 20 marbles on the floor in front of the feet.
  3. Using only the toes of one foot, pick up each marble and place it in the empty bowl.
  4. Repeat this exercise using the other foot.

6. Sand walking

Walking barefoot on sand is a great way to stretch and strengthen the feet and calves. This is a good exercise in general because sand’s soft texture makes walking more physically demanding.

To do this exercise:

  1. Head to a beach, a desert, a volleyball court, or any other location with sand.
  2. Remove the shoes and socks.
  3. Walk for as long as possible. Try increasing the distance slowly over time to avoid overexerting the muscles in the feet and calves.
  4. The following exercises can be helpful for pain relief.

7. Toe extension

The toe extension is useful in preventing or treating plantar fasciitis, which is a condition that causes pain in the heel when walking and difficulty raising the toes.

To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Place the left foot on the right thigh.
  3. Pull the toes up toward the ankle. There should be a stretching feeling along the bottom of the foot and heel cord.
  4. Hold for 10 seconds. Massaging the arch of the foot while stretching will help ease tension and pain.
  5. Repeat this exercise 10 times on each foot.

8. Golf ball roll

Rolling a golf ball under the foot can help relieve discomfort in the arch and ease pain associated with plantar fasciitis.

To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Place a golf ball — or another small, hard ball — on the floor next to the feet.
  3. Lay one foot on the ball and move it around, pressing down as hard as is comfortable. The ball should be massaging the bottom of the foot.
  4. Continue for 2 minutes, then repeat using the other foot.
  5. A frozen bottle of water can be a soothing alternative if no suitable balls are available.

9. Achilles stretch

The Achilles tendon is a cord connecting the heel to the calf muscles. It can strain easily, but keeping it strong may help with foot, ankle, or leg pain.

To do this exercise:

  1. Face a wall and raise the arms so that the palms of the hands are resting flat against the wall.
  2. Move one foot back, keeping the knee straight. Then, bend the knee of the opposite leg.
  3. Keep both the heels flat on the floor.
  4. Push the hips forward until there is a stretching feeling in the Achilles tendon and calf muscles.
  5. Hold for 30 seconds before switching sides. Repeat three times on each side.
  6. For a slightly different stretch, bend the back knee and push the hips forward.

Foot health and safety tips

To help keep the feet strong and healthy:

  1. Complete a thorough warmup routine before exercising.
  2. Wear supportive footwear for day-to-day activities and sports.
  3. Replace worn-down shoes as often as possible.
  4. Build up strength and flexibility slowly to condition the feet and ankles.
  5. Avoid uneven surfaces, especially when running. Try not to run uphill too often.
  6. Listen to the body. Do not overdo activities.
  7. Prevent any recurrence of injury by resting and seeking appropriate treatment.

Summary

Keeping the feet and ankles healthy is a good idea. Performing the exercises above can help ease existing pain, prevent discomfort, and reduce the risk of injury.

People with a diagnosed foot condition such as plantar fasciitis or strain to the Achilles tendon may wish to try exercises to help.

Always check with a healthcare professional, if possible, before starting a new exercise and stretching routine.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Rheumatoid Arthritis within Foot and Ankle

Article featured on OrthoInfo

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

How It Happens

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities — such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

Statistics

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

Cause

The exact cause of RA is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.

Symptoms

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

Anatomy of the foot and ankle

Anatomy of the foot and ankle.

Ankle

Difficulty with inclines (ramps) and stairs are the early signs of ankle involvement. As the disease progresses, simple walking and standing can become painful.

Hindfoot (Heel Region of the Foot)

The main function of the hindfoot is to perform the side-to-side motion of the foot. Difficulty walking on uneven ground, grass, or gravel are the initial signs. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot.
As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort may be felt along the posterior tibial tendon (main tendon that supports the arch) on the inside of the ankle, or on the outside of the ankle beneath the fibula.

Midfoot (Top of the Foot)

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

Rheumatoid arthritis of the midfoot

This x-ray shows signs of RA of the midfoot. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot.

Forefoot (Toes and Ball of the Foot)

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.
The bunion is typically severe and the big toe commonly crosses over the second toe.

Illustration of bunion and claw toe

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Severe claw toes can become fixed and rigid. They do not move when in a shoe. The extra pressure from the top of the shoe can cause severe pain and can damage the skin.

Doctor Examination

Medical History and Physical Examination

After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.
Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.
Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.
Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.
Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.

Imaging Tests

Other tests that your doctor may order to help confirm your diagnosis include:
X-rays. This test creates images of dense structures, like bone. It will show your doctor the position of the bones. The x-rays can be used by your doctor to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine what surgery would best.
Computerized tomography (CT) scan. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. CT scans allow your doctor to more closely examine each joint for the presence of arthritis.
Magnetic resonance imaging (MRI) scan. An MRI scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Rheumatology Referral

Your doctor may refer you to a rheumatologist if he or she suspects RA. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered.

Nonsurgical Treatment

Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.
Rheumatoid arthritis is often treated by a team of healthcare professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Although orthopaedic treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.
Orthopaedic treatment of RA depends on the location of the pain and the extent of cartilage damage. Many patients will have some symptom relief with appropriate nonsurgical treatment.

Rest

Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot.

Ice

Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with your rheumatologist or medical doctor.

Orthotics

An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot/
For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

Braces

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

Ankle brace

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Steroid Injection

An injection of cortisone into the affected joint can help in the early stages of the disease. In many cases, a rheumatologist or medical doctor may also perform these injections. The steroid helps to reduce inflammation within the joint. The steroid injection is normally a temporary measure and will not stop the progression of the disease.

Surgical Treatment

Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to nonsurgical options.
Fusion. Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together to make one bone.
During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together with screws or a combination of screws and plates. This prevents the bones from moving.
Because the joint is no longer intact, this surgery does limit joint motion. Limited joint motion may not be felt by the patient, depending on the joints fused. The midfoot joints often do not have much motion to begin with, and fusing them does not create increased stiffness. The ankle joint normally does have a lot of motion, and fusing it will be noticeable to the patient. By limiting motion, fusion reduces the pain.
Fusion can be a successful technique. However, because patients with RA also show damaged cartilage and loose ligaments, the success rate of this type of surgery is lower in patients with RA than in patients without RA. The use of newer generation medication can slow the progression of the disease and impact the type of surgeries that can be performed successfully.
Other surgeries. The front of the foot is where there are more surgical options for some patients. Surgeons can now perform joint sparing operations to correct the bunion and hammertoes in some patients. Your surgeon will review the most appropriate options for your case.

Ankle

Ankle fusion and total ankle replacement are the two primary surgical options for treating RA of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors and is individualized for every patient.

Ankle fusion and ankle replacement

This patient had arthritis of the hindfoot. It was treated by fusing all three joints of the hindfoot (triple fusion). An ankle replacement was also done in order to improve mobility and avoid the severe stiffness that would result from another ankle fusion. The ankle replacement implants can be seen here from the front and the side.

Patients with severe involvement of other joints around the heel or patients who have previously undergone a fusion on the other leg, may be more suited for ankle replacement. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement.
Newer generation ankle replacement implants have shown promising early results. Ankle replacement implants have not yet been shown to be as long-lasting as those for the hip or knee, due to the fact that the newer generation of implants have not been available long enough to determine how long they will last.

Ankle fusion

These x-rays show an ankle fusion from the front and the side. The number and placement of screws and the use of a plate are dependent upon the surgeon’s technique.

Following ankle fusion, there is a loss of the up and down motion of the ankle. The up and down motion is transferred to the joints near the ankle. This creates a potential for pain in those joints, and possibly arthritis.
Patients are able to walk in shoes on flat, level ground without much difficulty after an ankle fusion, despite the loss of ankle motion. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally.

Arthritis in subtalar joint

Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. This patient had pain in the subtalar joint (arrow) and required an additional fusion of that joint to minimize the pain. Increased stress on other joints is the most concerning problem following ankle fusion.

Hindfoot (Heel Region of the Foot)

A fusion of the affected joints of the hindfoot is the most common surgery used to treat patients with flatfoot or arthritis of the hindfoot. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon’s discretion). This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.
If RA is only in one joint, then a fusion of just that affected joint may be all that is needed.

Ankle fusion

(Left) In this x-ray, two of the three joints in the hindfoot have been fused. (Right) Just the subtalar joint is fused in this x-ray.

Any fusion of the hindfoot will limit side-to-side motion of the foot. This will affect walking on uneven ground, grass, or gravel. There is no method to replace the joints of the hindfoot.

Midfoot (Middle of the Foot)

Fusion is the most reliable surgical method to treat RA of the midfoot joints. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.
There are joint replacement implants available for joints on the outside of the midfoot. This may preserve some midfoot motion. However, the use of these implants is at the surgeon’s discretion. These implants are not available for the joints on the inside of the midfoot.
Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes.

Reconstruction of collapsed arch

(Top) This x-ray shows RA of the midfoot that has collapsed the arch. (Bottom) The surgical reconstruction involved a fusion of the middle of the foot with plates and screws.

Forefoot (Toes and Ball of the Foot)

The choice of treatment for patients with a bunion or lesser toe deformities (hammer or claw toes) depends on a number of factors.
If the disease is very mild, joint-sparing procedures that preserve motion can be considered. The decision is dependent on the medication that the patient is taking and the amount of damaged cartilage that is present. A fusion of the great toe may be recommended despite that fact the bunion is very mild. If there is damage to the cartilage of the great toe joint, correcting the bunion will not minimize the arthritic pain.
If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. The operation involves fusion of the big toe and removing a portion of bone of each of the metatarsals. This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position.
Occasionally, the lesser toe metatarsals can be preserved by shortening them to allow the toes to resume their position within the joints. This is not always possible, however, and the joint may have to be removed.

RA of the forefoot before and after fusion

(Left) RA of the forefoot. The big toe is deviated and crosses over the second toe, a typical appearance of a bunion. The lesser toes (two through five) are dislocated, resulting in painful and severe claw toes. (Right) This x-ray taken immediately after fusion of the big toe shows that the prominent bones on the ball of the foot were removed and the claw toes were corrected. The pins hold the toes in place while the soft tissues heal. The pins are removed in the office after 4 to 6 weeks with minimal discomfort.

To fix the bend in the toes themselves, the surgeon may suggest cutting a tendon or removing a small portion of bone of the toes to allow them to straighten. Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place.
There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. These implants may not work if the bone is soft, or if significant destruction of the joints has occurred.
This operation puts a lot of stress on the blood vessels and skin of the foot. In severe cases, the toes may not survive the operation and may require amputation of a portion or the entire toe. This operation can provide the patient with a high level of function and the ability to enjoy a wider variety of shoewear.

Footwear

Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day. The patient shown here had both feet reconstructed. She is able to wear sandals and mild heels without difficulty. Although these types of shoes are not recommended all the time, they can be worn from time to time. Not all patients will achieve such an excellent result.

Preparing for Surgery

Many of the medications that help with RA also affect the ability of the body to heal wounds and fight infection. Your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Once the wounds are healed, the medication is typically resumed.
This period of time can be very difficult for patients with other areas of the body that are affected by RA. Many fusions require at least 6 weeks of time where no pressure can be placed on the foot. Making appropriate preparations to ensure you have help at home is crucial for success after surgery.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

8 Common Foot Injuries

Article featured on Healthgrades

What to Know About Foot (and Ankle) Injuries

Inside your foot lies machinery that would impress any engineer. A total of 26 bones, 33 joints, and more than 100 tendons, muscles and ligaments work in tandem to support your weight and propel you through your daily routine. Just as the highest-tech machine can malfunction, flaws in the inner workings of your feet—or overwhelming demands from the outside—can cause injuries. Here are eight problems that can strike your feet, along with solutions.

1. Neuromas

Too-tight or high-heeled shoes, among other causes, can compress the nerves between your toes. Most often, this occurs between your third and fourth toes, a condition called Morton’s neuroma. The pain, tingling, and numbness of a neuroma can often be relieved with padding, icing, orthotics, and wearing shoes with a wide toe box and low heels.

2. Stress Fracture

Among the more severe sports injuries, stress fractures often occur when you overdo a high-impact activity like running, dance or basketball. Fatigued muscles transfer stress to the bone. A small, hairline crack forms, causing potentially severe pain. Though stress fractures can occur in any part of your foot, they most often form in the second and third metatarsals, or long toe bones. Rest allows your bones to heal, usually in 6 to 8 weeks.

3. Plantar Fasciitis

Does the first step out of bed in the morning have you howling in pain? You likely have plantar fasciitis, an inflammation of the band of tissue—facscia—connecting your toes to your heel on the bottom of your foot. High-impact sports, extra weight, and jobs that require walking or standing on hard surfaces increase your risk. Stretch your foot and calf frequently, and consider wearing a night splint that lengthens your plantar fascia while you sleep.

4. Heel Spurs

Heel spurs occur when calcium deposits build up on the bottom of your heel bone. Often, they don’t cause pain themselves—but they can irritate the plantar fascia, triggering pain along the arch and heel. Calf and foot stretches work well to relieve it; rarely is surgery to remove the spur necessary.

5. Bunions

This bump of bone and tissue at the base of your big toe forms when the joint connecting it to your foot shifts out of place. Narrow-toed and high-heeled shoes cause most cases, though heredity plays a small role. Left untreated, bunions can cause pain so severe it limits your ability to walk. Fortunately, treatments like ice, over-the-counter foot pads, and wearing shoes with wider toe boxes often bring relief.

6. Sesamoiditis

Your sesamoids—two pea-shaped bones lodged in the tendon beneath the ball of your foot—help the big toe move normally. Activities that place strain on the ball of the foot, including running and golf, can injure the bones, tendons, or surrounding tissue. Padding, strapping, or taping the foot can relieve pressure on the sesamoids, while anti-inflammatory drugs reduce pain and swelling.

7. Achilles Tendinitis

The lengthy Achilles tendon can grow thick, inflamed, swollen or painful when asked to do too much, too soon (for example, after beginning an ambitious exercise program). Tight calf muscles may also play a role. Often, pain decreases after switching from a high-impact exercise to a cross-training program, such as biking, elliptical or swimming, paired with moves to stretch and strengthen the calves.

8. Ankle Sprains

About 25,000 people fall, step or twist their way into an ankle sprain each day. This common injury occurs when the ligaments on the outer side of your ankle stretch or tear, causing pain, swelling, and sometimes an inability to bear weight. Talk with a doctor if that’s the case, or if you have severe swelling or deformity. For mild sprains, rest, ice, compression and elevation—the RICE protocol—usually does the trick.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Common Heel Pain

This article is featured on Humpal Physical Therapy & Sports Medicine Centers
Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected.

ANATOMY

Where is the plantar fascia, and what does it do?

The plantar fascia (also known as the plantar aponeurosis) is a thick band of connective tissue. It runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer’s bow. It is the source of the painful condition plantar fasciitis.
The plantar fascia is made up of collagen fibers oriented in a lengthwise direction from toes to heel (or heel to toes). There are three separate parts: the medial component (closest to the big toe), the central component, and the lateral component (on the little toe side). The central portion is the largest and most prominent.
Both the plantar fascia and the Achilles’ tendon attach to the calcaneus. The connections are separate in the adult foot. Although they function separately, there is an indirect relationship. If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles’ tendon increases the strain on the plantar fascia. This is called the windlass mechanism. Later, we’ll discuss how this mechanism is used to treat plantar fasciitis with stretching and night splints.

CAUSES

How does plantar fasciitis develop?

Plantar fasciitis can come from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult.
As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body.
As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heel bone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.
As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis.

Fat Pad

Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. In many cases, the actual source of the painful heel may not be defined clearly.

SYMPTOMS

What does plantar fasciitis feel like?

The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor.
Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.

DIAGNOSIS

How do health care providers diagnose the condition?

When you first visit medical care, the doctor will typically examine your foot and speak with you about the history of your problem. Diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions.
Some patients may be referred to an additional doctor for further diagnosis. Once your diagnostic examination is complete, treatment options will be offered that will help speed your recovery, so that you can more quickly return to your active lifestyle.

TREATMENTS

Non-surgical Rehabilitation

Nonsurgical management of plantar fasciitis is successful in 90 per cent of all cases. When you begin physical therapy, Physical Therapists will design exercises to improve flexibility in the calf muscles, Achilles’ tendon, and the plantar fascia.
Treatments will be applied to the painful area to help control pain and swelling. Examples include ultrasound, ice packs, and soft-tissue massage. Physical Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine, prescribed by your doctor, into the sore area.
There may be customized arch support, or orthotic, designed to support the arch of your foot and to help cushion your heel. Supporting the arch with a well fitted orthotic may help reduce pressure on the plantar fascia. Alternatively, we may recommend placing a special type of insert into the shoe, called a heel cup. This device can also reduce the pressure on the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration.
Your Physical Therapist will also provide ideas for therapies that you can perform at home, such as doing your stretches for the calf muscles and the plantar fascia. We may also have you fit with a night splint to wear while you sleep. The night splint keeps your foot from bending downward and places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint and report having less heel pain when placing the sore foot on the ground in the morning.
We find that many times it takes a combination of different approaches to get the best results for patients with plantar fasciitis. There isn’t a one-size-fits-all plan. Some patients do best with a combination of heel padding, medications, and stretching. If this doesn’t provide relief from symptoms within four to six weeks, then we may advise additional Physical Therapy and orthotics.
Finding the right combination for you may take some time. Don’t be discouraged if it takes a few weeks to a few months to find the right fit for you. Most of the time, the condition is self-limiting. This means it doesn’t last forever but does get better with a little time and attention. But in some cases, it can take up to a full year or more for the problem to be resolved.

Post-surgical Rehabilitation

Although recovery rates vary among patients, it generally takes several weeks before the tissues are well healed after surgery. The incision is protected with a bandage or dressing for about one week after surgery. You will probably use crutches briefly, and your Physical Therapist can help you learn to properly use your crutches to avoid placing weight of your foot while it heals.
The stitches are generally removed in 10 to 14 days. However, if your surgeon used sutures that dissolve, you won’t need to have the stitches taken out. You should be released to full activity in about six weeks.
Surgical release of the plantar fascia decreases stiffness in the arch. However, it can also lead to collapse of the longitudinal (lengthwise) arch of the foot. Releasing the fascia alters the biomechanics of the foot and may decrease stability of the foot arch. The result may be increased stress on the other plantar ligaments and bones. Fractures and instability have been reported in up to 40 per cent of patients who have a plantar fasciotomy.
Throughout your post-surgical recovery, your Physical Therapist will note your progress and be watchful for the development of fractures and instability.

PHYSICIAN REVIEW

Your doctor may order an X-ray to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation.
Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.
cortisone injection into the area of the fascia may be used but has not been proven effective. Studies show better results when ultrasound is used to improve the accuracy of needle placement. Cortisone should be used sparingly since it may cause rupture of the plantar fascia and fat pad degeneration and atrophy, making the problem worse.
Botulinum toxin A, otherwise known as BOTOX, has been used to treat plantar fasciitis. The chemical is injected into the area and causes paralysis of the muscles. BOTOX has direct analgesic (pain relieving) and anti inflammatory effects. In studies so far, there haven’t been any side effects of this treatment.
Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.
Clinical trials are underway investigating the use of radio frequency to treat plantar fasciitis. It is a simple, noninvasive form of treatment. It allows for rapid recovery and pain relief within seven to 10 days. The radio waves promote angiogenesis (formation of new blood vessels) in the area. Once again, increasing blood flow to the damaged tissue encourages a healing response.

SURGERY

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas:

  • remove the bone spur (if one is present)
  • release the plantar fascia (plantar fasciotomy)
  • release pressure on the small nerves in the area

Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision.
Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present that is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What are the best foot exercises for healthy feet?

Article from MedicalNewsToday, medically reviewed by Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS — Written by Bethany Cadman

Many people experience foot or ankle pain at some point. Keeping the feet strong can help alleviate this soreness and improve overall health and flexibility.

Regularly exercising and stretching the feet and ankles can help ensure that the muscles are providing the best support. These exercises may also increase range of motion in the feet, helping keep a person active for as long as possible.
Most foot exercises are simple and require no complicated equipment to perform. People can do them at home or in the gym as part of a regular exercise routine.

Exercises for flexibility and mobility

The following exercises can improve flexibility and mobility in the feet.

1. Toe raise, point, and curl

a person curling their toes

This exercise has three stages and will help strengthen all parts of the feet and toes.
To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Keeping the toes on the floor, raise the heels. Stop when only the balls of the feet remain on the ground.
  3. Hold this position for 5 seconds before lowering the heels.
  4. For the second stage, raise the heels and point the toes so that only the tips of the big and second toes are touching the floor.
  5. Hold for 5 seconds before lowering.
  6. For the third stage, raise the heels and curl the toes inward so that only the tips of the toes are touching the floor. Hold this position for 5 seconds.
  7. Build flexibility and mobility by repeating each stage 10 times.

2. Big toe stretch

a person stretching their big toe

Keeping a wide range of motion in the big toe is important. The following exercise also has three stages and is designed to stretch and relieve pain in the toes from wearing tight shoes.
To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Bring the left foot to rest on the right thigh.
  3. Using the fingers, gently stretch the big toe up, down, and to the side.
  4. Keep the big toe in each position for 5 seconds.
  5. Repeat this 10 times before switching to the other foot.

Exercises for strength

The following exercises can help enhance the strength of the feet.

3. Toe splay

a person splaying their toes

Doing the toe splay exercise can improve control over the toe muscles. People can do it on both feet at once or on alternate feet, depending on which they find more comfortable.
To do this exercise:

  1. Sit in a straight backed chair, with the feet gently resting on the floor.
  2. Spread the toes apart as far as possible without straining. Hold this position for 5 seconds.
  3. Repeat this motion 10 times.
  4. Once a person has built up their strength, they can try looping a rubber band around the toes. This will provide resistance and make the exercise more challenging.

4. Toe curls

a person curling their toes using a towel

Doing toe curls builds up the flexor muscles of the toes and feet, improving overall strength.
To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Lay a small towel on the floor in front of the body, with the short side facing the feet.
  3. Place the toes of one foot on the short side of the towel. Try to grasp the towel between the toes and pull it toward oneself. Repeat this exercise five times before switching to the other foot.
  4. To make this exercise more challenging, try weighing down the opposite end of the towel with an object.

5. Marble pickup

A person picking up marbles with their toes

Doing the marble pickup can increase strength in the muscles on the undersides of the feet and toes.
To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Place an empty bowl and a bowl of 20 marbles on the floor in front of the feet.
  3. Using only the toes of one foot, pick up each marble and place it in the empty bowl.
  4. Repeat this exercise using the other foot.

6. Sand walking

A person walking on the beach with sand on the bottom of their foot

Walking barefoot on sand is a great way to stretch and strengthen the feet and calves. This is a good exercise in general because sand’s soft texture makes walking more physically demanding.
To do this exercise:

  1. Head to a beach, a desert, a volleyball court, or any other location with sand.
  2. Remove the shoes and socks.
  3. Walk for as long as possible. Try increasing the distance slowly over time to avoid overexerting the muscles in the feet and calves.
Exercises for pain

The following exercises can be helpful for pain relief.

7. Toe extension

a person extending their toes

The toe extension is useful in preventing or treating plantar fasciitis, which is a condition that causes pain in the heel when walking and difficulty raising the toes.
To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Place the left foot on the right thigh.
  3. Pull the toes up toward the ankle. There should be a stretching feeling along the bottom of the foot and heel cord.
  4. Hold for 10 seconds. Massaging the arch of the foot while stretching will help ease tension and pain.
  5. Repeat this exercise 10 times on each foot.

8. Golf ball roll

a person rolling their foot on a tennis ball

Rolling a golf ball under the foot can help relieve discomfort in the arch and ease pain associated with plantar fasciitis.
To do this exercise:

  1. Sit up straight in a chair, with the feet flat on the floor.
  2. Place a golf ball — or another small, hard ball — on the floor next to the feet.
  3. Lay one foot on the ball and move it around, pressing down as hard as is comfortable. The ball should be massaging the bottom of the foot.
  4. Continue for 2 minutes, then repeat using the other foot.
  5. A frozen bottle of water can be a soothing alternative if no suitable balls are available.

9. Achilles stretch

A person doing a standing calf stretch

The Achilles tendon is a cord connecting the heel to the calf muscles. It can strain easily, but keeping it strong may help with foot, ankle, or leg pain.
To do this exercise:

  1. Face a wall and raise the arms so that the palms of the hands are resting flat against the wall.
  2. Move one foot back, keeping the knee straight. Then, bend the knee of the opposite leg.
  3. Keep both the heels flat on the floor.
  4. Push the hips forward until there is a stretching feeling in the Achilles tendon and calf muscles.
  5. Hold for 30 seconds before switching sides. Repeat three times on each side.
  6. For a slightly different stretch, bend the back knee and push the hips forward.

Foot health and safety tips

To help keep the feet strong and healthy:

  • Complete a thorough warmup routine before exercising.
  • Wear supportive footwear for day-to-day activities and sports.
  • Replace worn-down shoes as often as possible.
  • Build up strength and flexibility slowly to condition the feet and ankles.
  • Avoid uneven surfaces, especially when running. Try not to run uphill too often.
  • Listen to the body. Do not overdo activities.
  • Prevent any recurrence of injury by resting and seeking appropriate treatment.

Summary

Keeping the feet and ankles healthy is a good idea. Performing the exercises above can help ease existing pain, prevent discomfort, and reduce the risk of injury.
People with a diagnosed foot condition such as plantar fasciitis or strain to the Achilles tendon may wish to try exercises to help.
Always check with a healthcare professional, if possible, before starting a new exercise and stretching routine.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.