Student athletes - Avoiding heel pain

Over the past few weeks heel pain has sidelined or hobbled  Albert Pujol’s of the Los Angeles Angels, Mike Napoli of the Boston Red Sox’s and Jarius Byrd of the Buffalo Bills.  If you are student athlete going back to high school or university, heel pain is something you want to avoid.  Heel pain will change the way you perform your sport.  

If you are developing heel pain, you will start to notice pain when you take your first step in the morning.  As time goes on, you will dread your first step out of bed because it is going to be painful. With practice you will perfect a method to keep as much weight off of your painful heel.  You will realize the pain will get a little better as the day goes on but you also know that when you get home and sit down but have to get up again it’s going to be painful! 

One of the main reasons heel pain occurs is because the plantar fascia pulls away from its attachment under the heel bone.  This pulling away occurs with every step you take while walking or running.  The plantar fascia has role to keep your foot stable as you lift your heel off the ground while walking or running. The plantar fascia helps to resist your foot from bending.

To give you an idea of what I am describing, I want you to take your hand and place it with your palm down on top of a table.  Slowly lift the palm of your hand off the table.  The more you lift your palm, the more you will pivot on the tips of your fingers.  Now bend you hand, you will feel a tightening in the palm of your hand.  You have just stretched your palmar fascia.  When you bend your hand this is simulating what your foot is doing when you lift your heel off the ground and the weight is on your forefoot. 

When we walk or run, there is a small period of time when all the weight of our body is only supported on one foot.  During this time the heel lifts off the ground and the foot will want to bend. If the foot is stable not much bending will occur to stress the plantar fascia.  If your foot is unstable, the foot will bend in the middle and the plantar fascia will try to prevent the foot from bending.  This is when the damage to the plantar fascia occurs causing heel pain.

Your foot can be unstable for a number of reasons, the most common reason is flat feet. If your foot is unstable because you have flat feet  you may not be able to withstand the bending forces applied to the middle of the foot especially if you play a sport that involves running, jumping, or twisting  of the foot.

Whatever sport you play make sure you have the right type of footwear for the demands of your sport.  You may require a custom made foot orthoses to help to stabilize your foot and prevent the bending forces on the foot.  Most sports shoes will be orthotic friendly however some sports shoes such as soccer shoes may not be orthotic friendly.

 The orthotic used for heel pain is pathology specific.  It will have wide orthotic shell to support the mid-foot joints, a deep heel cup to stabilize the heel with and cushioning in the bottom of the heel  cup.

If your heel pain has lasted for more than 2 weeks and the intensity of the pain is getting worse you should immediately seek professional help from a chiropodist/podiatrist or your family doctor.  The longer your heel pain is left untreated, the greater the chance it can become chronic.  The longer you have heel pain the more likely you will start to change the way you walk or run leading other problems.  In the worst case scenario, you can develop heel pain in the other heel because you have compensated by putting more weigh on the non-painful heel.

I routinely see patients with heel pain who have waited longer than 4 to 6 months before they seek treatment or they have followed bad advice.  If you have chronic heel pain it may require a longer duration of time and a more comprehensive approach to resolve your heel pain.   If your heel pain is not chronic there is usually an easy solution for your heel pain.  If you have heel pain do not let it become chronic and get treatment at the earliest possible date.

Act quickly so you can stay in the game.

Are you embarrassed by your thick, yellow nails?

Thick, yellow nails are usually caused by the presence of a fungal nail infection.   A fungal infection of the toe nails is a common foot problem.  Nail fungus (onychomycosis) is an infection of the nail plate and nail bed.  It is caused by various types of fungi, which are commonly found throughout the environment. Fungi are simple parasitic plant organisms that do not require sunlight for growth.  A group of fungi called dermatophytes have evolved to attack human nails and skin.

The infection of the nail begins with some type of trauma to the nail. The dermatophyte gains entry into the nail and begins to feed on the nail protein called keratin. The big toe nail is the most commonly infected toe nail.  

Our big toe nails can get damaged or traumatized from:

1.  The way we walk or run. ( because of a unstable low arched foot or bunion)
2. The  shoes we wear ( tight fitting shoes or high heels)
3.  The type of job (the requirement to use steel-toed safety boots). 

Furthermore, the environment inside of a shoe is dark and damp which provides a perfect growing climate for nails and skin fungus. Other contributory factors are a history of athlete's foot (fungal skin infection of the foot) and sweaty feet.

Several research studies have estimated onychomycosis affects 3% to 13% of the population.  The vast majority of people who have fungal nails don't even recognize the existence of a problem and therefore don't seek treatment for many years because their thick nails are not yet causing them pain.  

The rate of fungal infections rises sharply among older adults above 65 years as they start to experience more medical problems.  For instance, those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. This can result in fungal nails being considered a minor problem in comparison to other concurrent medical problems.

Fungal infections of the nail can be graded as mild, moderate or severe.  The severe fungal nail infection occurs when the infection extends into the nail matrix (the area of the nail at the base which has white half-moon).  A severe fungal nail infection is very difficult to treat and has a poor prognosis. 

Fungal nails can be treated by: 

1.  Thinning the nail plate
2.  Removing diseased nail and fungal debris back to healthy appearing nail.
3.  Applying topical nail softeners  and  topical anti-fungal medication exposed nail bed and remaining nail plate
4.   Application of laser to nail plate
5.  Oral anti-fungal medication

If you suspect you have a fungal nail infection you should visit a chiropodist/podiatrist to confirm if you have a fungal nail infection and discuss your treatment options.

www.painfreefeet.ca

Mark Wahlberg talks about his ingrown nail on the Ellen Show

Recently on the Ellen Show Mark Wahlberg discussed the removal of a portion of nail that was causing him pain in his nail groove.  His co star Micky O'Keefe from the movie "The Fighter" advised Mark to see his daughter-in-law who is a podiatrist.  A portion of Mark's big toenail that was digging into his skin was removed permanently so it would not grow back. 

I use an internet service called Google Alerts.  I subscribed to an alert for "Ingrown nails".  Any query on "ingrown nails" is sent to my smart phone.  One of the most common questions concerning ingrown nails is from the website "answers.yahoo.com" . Most questions are usually  "what I can do to cure or get rid of my ingrown toenail".   This type of question occurs daily.  Many people suffer from the pain of ingrown nails. 

Mark Wahlberg stated his nail was growing the wrong way.  I am only guessing but Mark may have tried to cut his nail hoping to relieve the pressure in his nail groove. Unfortunately this action may have made the problem worse.  He may have also aggravated the problem by wearing tight shoes.  I'm glad he took the advice of visiting a podiatrist.

Ingrown nails usually pierce the skin causing inflammation and infection.   If  an ingrown nail is treated early all that may be  required is the removal of a small piece of nail to alleviate the problem, most times without the need for freezing. 

Unfortunately, some people delay  treatment of their infected ingrown nail. Usually in these cases, the nail is highly curved which puts a great amount of pressure in the nail groove.   The consequence of delayed treatment is procedure requiring a permanent partial or total removal of the nail performed using local anesthesia.   This procedure uses a chemical called phenol to destroy the nail matrix.  Destruction of the nail matrix prevents the removed nail from growing back.. The post operative care requires soaking of the nail bed using salt water followed by the use of an antibiotic cream.   In some cases,  if the infection is moderate to severe an oral antibiotic may be required.  Generally the nail procedure will take about two to three weeks to heal. 

Do not delay seeking treatment for an ingrown nail.  It will probably only get worse.