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.

Digital video gait analysis reveals what is causing your foot and lower extremity pain

Pedigait 4 camera system and treadmill

My colleague and good friend Brian Cragg from Markham Footcare has produced a very informative YouTube video (shown below) outlining the benefits of using the PediGait synchronous 4 camera gait analysis system.  We both introduced this technology into our offices in April 2012. 

Gait analysis is used on a daily basis by chiropodists/podiatrists  as a  component of the physical evaluation of the presenting patient.  Typically, gait analysis consists of watching a patient walk back and forth in a hallway.  The information observed in the gait analysis helps to reveal the the cause the patient's presenting symptoms.  

Hallway gait analysis provides valuable information to the practitioner but provides no visual feedback for you "the patient" relating to the way you walk or run. 

Gait analysis in hallway

Since the introduction of PediGait into our Whitby office,  we have elevated clinical gait analysis to the next level by providing more informed patient education as well as direct visual feedback to help you to understand why you have foot, ankle, shin, knee, hip and back pain.

The benefits of the Pedigait system include:

1. Films and records you walking or running on a treadmill simultaneously from the front view, back view, left side view and right side view.  

2. Archives a permanent visual record of your gait that can be played back immediately or at a future date.

3. 

   PediGait Screen
   

   Immediate playback to allow  observation of  your gait from four views at the same time or from one single view on a large high definition TV

4. The video can be slowed down, viewed frame by frame or paused to allow you to see your gait in complete detail from four different views or one single view.

5. Provides comparisons between multiple video captures such as walking or running barefoot, with shoes and with shoes plus orthotics. 

6. Can provide a video file either  for insurance purposes, or for another health professional such as your family doctor or simply to view on your home computer.

Comparison Screen

Finally, one of the benefits for the chiropodist/podiatrist is the ability to view your gait analysis video in more detail after you have left the office.  If your treatment plan requires a prescription foot orthotic,  the archived visual record  from 4 views is extremely useful  when writing a prescription for custom foot orthotics.

 

 

 

   

www.footcarewhitby.ca

www.painfreefeet.ca

Flip Flops: Why they are bad for flat feet

The summer is coming to a close and flip flop weather will come to a close as the weather gets cooler. Wearing flip flops can be difficult on your feet. The design of flip flops do not allow the foot to be properly secured to the foot. If you have flat feet (pronated foot) your heel will shift off of the flip flop (watch the video).  Furthermore, your toes will have to grip the flip flops to keep them from falling off while you walk. Over time( successive summers) this can result in clawed or hammered toes leading to pain in the ball of your foot. This can lead to metatarsalgia or pain in the ball of the foot.
The American Podiatric Medical Association has a seal of approval section which lists recommended  flip flops. These APMA approved flip flop sandals have a molded foot bed and more secure straps that help to minimize foot problems.

www.footcarewhitby.ca
www.painfreefeet.ca

The Olympic marathon run

This is the final day of the Olympics and one of the last events is the marathon run of 26 miles.  This event brings together the 100 best marathon runners from all over the world.  The trio of runners from Kenya: Wilson Kipsang Kiprotich, Abel Kirui and Emmanuel Mutai could sweep the marathon medals. The eventual marathon winner will be the runner most able to keep a constant speed throughout the race over the varied terrain.  The best marathon runners have a body type best suited for marathon running but more importantly, they can minimize their injury rate by proper training and recovery. Many recreational marathon runners develop many foot and lower leg injuries because of poor training methods, improper footwear and poor lower extremity biomechanics.  Structural problems occurring in the foot and lower leg can cause plantar fasciitis, shin splints, Achilles tendinitis, and ilio-tibial band syndrome.  If these problems occur should be addressed as soon as possible before the injury becomes chronic. Good luck to all the Olympic marathon runners.

The Mexican upset win over Brazil and congratulations to the Canadian women's soccer team.

This morning I have been watching the 2012 Olympic men’s soccer/football finals. It has been an excellent game between Mexico and Brazil. You can hear the Samba beat in the stands at Wembly Stadium. I have been impressed with the speed of the players. I know from treating soccer player in my practice that some of these players are participating with some type of foot injury. Plantar fasciitis, hallux limitus, bunions and ankle sprains are some of the most common foot injuries that occur while playing. Women soccer players’ tend to develop patellofemoral syndrome if their feet are flat or if the Q angle is large. I am sure the therapists and trainers involved in the Olympic soccer tournament have minimized these foot injuries. If you have any of these foot injuries as a result of playing recreational sports or due the repetitive nature of your job you should not delay getting treatment for these injuries. Congratulations to the Canadian Olympic Women’s soccer team for their bronze medal and to the Mexican Olympic Men’s soccer team for their gold medal.