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Heel pain and ankle pain usually appear separately. But sometimes, pain in the heel and ankle can occur together as a result of one injury or multiple, associated injuries.
Runners and other athletes are especially prone to overuse injuries in the heel and ankle. Some, especially those with long legs, are also prone to having a stiff Achilles tendon and stiff calf muscles. As the foot and ankle literally hinge on these mechanisms, inflexibility leaves the tendon, heel and ankle at risk of injury, especially when we play sports. Usually, the injury appears in the form of Achilles tendonitis, calcaneal (heel bone) bursitis, or plantar fasciitis.
If, at the first sign of pain you rest, elevate and ice the sore area until the pain subsides, healing may be achieved without medical intervention. If you ignore the pain and keep training, the injury may become very serious. If pain continues for 4 days or more, see a podiatrist.
A stress fracture in the ankle or foot generally occurs gradually from overuse. Depending on the location and severity of the fracture, pain can radiate through the entire foot, ankle and/or heel. The pain may be accompanied by numbness or tingling, redness, swelling and a feeling of instability.
It's essential that any fracture - whether a small stress fracture or a more serious break - be treated by a podiatrist to insure that it heals correctly. Don't blow it off - ask anybody who's middle aged or older and they'll tell you how much these "minor" stress fractures come back to haunt you later in life.
Tarsal Tunnel Syndrome and peripheral neuropathy can cause considerable pain and discomfort. Tarsal Tunnel is an entrapment of the posterior tibial nerve which passes through your ankle. When the nerve becomes compressed, pain can be felt from the sole of the foot and throughout the ankle. Pain may also radiate to the leg and hip. Peripheral neuropathy, usually a side effect of diabetes, can cause tingling and pain at any point in the foot and lower leg.
Both conditions require the intervention of a podiatrist to relieve symptoms.
In or near the ankle, the Achilles tendon is the most likely tendon to cause pain. But pain may also be felt from injury to the peroneal, posterior tibial or flexor hallucis longus tendons. The area of swelling and tenderness usually indicates which tendon has been damaged.
Treat with rest, ice and anti inflammatories, and see a podiatrist for an evaluation.
Ankle Impingement Syndrome
Anterior Ankle Impingement or Posterior Ankle Impingement Syndrome occurs when soft tissues around the ankle become pinched. When the ankle is bent fully up or down, pain occurs. Runners, footballers and dancers are notorious for developing these syndromes.
Treat as above with tendinitis.
An ankle sprain occurs when the ankle ligaments are subjected to an unnatural twisting, causing stretching or tearing of the ligaments. A sprain can easily cause pain in the entire area around the ankle, including the heel.
Treatment by a podiatrist is necessary to insure that the sprain heals correctly. Damaged ligaments which are not cared for properly become weak and are more likely to be reinjured and cause long-term problems.
Arthritis can occur in any joint in the body. It's especially debilitating when it takes up residence in the ankle. Due to the inflexibility of the arthritic ankle, arthritis patients are prone to plantar fasciitis.
This chronic autoimmune disease attacks joints at any point in the body. RA usually starts in the small joints of the hands and feet, and progresses to the larger joints. More than 90% of Rheumatoid Arthritis patients develop symptoms in their feet and ankles, usually occurring in both feet simultaneously. Difficulty climbing stairs is an early sign that the ankle is beset with RA. Difficulty on uneven ground suggests that the hindfoot - the heel area - is showing signs of the disease. A podiatrist can identify your symptoms and you will be referred to a rheumatologist for treatment.
Did you ever have one of those really active days - running, hiking, jumping, maybe just standing for a really long time on your feet - and the balls of your feet ached like crazy? Well my friend, you were probably suffering from the dreaded Metatarsalgia.
Metatarsalgia isn't as serious as it sounds. It simply refers to minor pain and inflammation of fatigued and overused metatarsal bones (the long bones in your feet). The pain appears in the area where the metatarsals join your toe bones, otherwise known as the ball of your foot - the area of your sole behind your toes (not just behind the big toe). The pain usually begins as a mild ache and worsens over a period of months.
Usually, metatarsalgia is caused by ill-fitting shoes combined with lots of activity. Most cases of metatarsalgia aren't serious, and rest, ice and over the counter pain medicine will resolve the pain.
But if left untreated, the classic cascade effect may kick in: The balls of your feet hurt, so you unconsciously shift weight to other parts of your feet, which eventually causes pain in those areas, which again causes you to shift your weight. Since your legs, ankles and feet are drifting farther out of alignment, the joints above your feet start feeling the impact and you suddenly have pain in your knees, back, or hips. And it all began with minor, treatable pain in your feet.
Prolonged metatarsalgia which doesn't resolve in 10 days should always be reported to your podiatrist, as it can be a symptom of other, more serious conditions.
Intense training. Most runners are accustomed to occasional bouts of metatarsalgia, as the front of the foot absorbs significant shock when running. But this can be true of anyone who plays a high impact sport, especially basketball, soccer, tennis, football, or track and field events. It's sometimes a sign that your athletic shoes are worn out and need to be replaced.
The shape of your foot. If you have a high arch, extra pressure is placed on the metatarsals, increasing the chance of pain from overuse. If your second toe is longer than your big toe, more weight than normal is shifted to the 2nd metatarsal head, and that may cause pain as well.
A muscle imbalance. Tight toe extensors or weak toe flexors don't properly support the metatarsal bones and may cause fatigue and pain from overuse. A too-tight tight achilles tendon may be a contributor as well.
Stiff ankles, perhaps the result of a previous injury or arthritis, don't support the foot correctly, placing too much pressure on the forefoot.
Excessive pronation - the side-to-side movement of your foot - may contribute.
Carrying too many pounds. Your forefoot carries most of your body weight when you walk of run. Extra pounds means extra pressure on the metatarsals. Additionally, as we age, the fat pad in the foot tends to thin out, reducing its cushioning effect. A weight management plan may reduce your symptoms.
Poorly fitting shoes and high heels. That's right, ladies. While high heels make you look great, they're murder on your feet (like I had to tell you that). High heel shoes are a very common cause of metatarsalgia in women, as they transfer your body weight to the front of the foot, working against how the foot is designed to carry your weight. Athletic shoes which don't support your feet correctly are also guilty of causing metatarsalgia.
Stress fractures in the metatarsals or in the toe bones change the way you walk, which may result in metatarsalgia.
Morton's Neuroma, a growth of fibrous tissue around the nerve between your 3rd and 4th metatarsal heads causes symptoms similar to metatarsalgia.
Your podiatrist may recommend one or more of these treatments for Metatarsalgia
Plantar Fasciitis is without a doubt the most common cause of heel pain - 10% of people are afflicted with it at some point in their lives. But if your heel pain continues for more than 2 months, it may not be plantar fasciitis at all.
Heel pain that lasts more than 8 weeks may be caused by a ligament tear in the heel, whose initial symptoms are almost identical to plantar fasciitis. However, the treatments for the two conditions are very different. In the case of a misdiagnosis, the treatment for plantar fasciitis can even make your heel pain worse.
Plantar fasciitis is a micro tear of the plantar fascia ligament, which occurs from overuse (too much demand on the ligament). A plantar fascia rupture (or tear) is less common and typically more painful. Pain from either injury will be felt in the bottom of the heel.
Even though the two injuries affect the same ligament, the treatment for plantar fasciitis vs. a plantar fascia tear are practically polar opposite. If you have a typical case of plantar fasciitis, the treatment protocol is usually stretching exercises via physical therapy, rest, ice, over the counter anti-inflammatories (ibuprofen or naproxen), and in some cases custom orthotics. If a patient follows the prescribed treatment, their plantar fasciitis will usually heal in 3-6 weeks.
But if your heel pain is caused by a tear to the plantar fascia ligament, those stretching exercises may make your condition worse. Healing a plantar fascia tear takes anywhere from 2-5 months, depending upon its severity. Treatment typically involves immobilization of the foot and lots of rest, to allow the tissue time to reconstruct without further stress. In some cases, surgery will be necessary to completely repair the ligament.
For this reason, a visit to a podiatrist is always recommended for heel pain. The subtle differences in these injuries can easily be missed by a general physician, and the wrong treatment can worsen your condition. Heel pain also puts more stress on the other joints in your body, as we shift weight off of our heel. It's common to develop pain in the ankle, knees and back as well when we have heel pain.
The best way to prevent heel pain is to be proactive. Wear supportive shoes to work and properly fitting and padded athletic shoes when you exercise. The key to protection is arch support and padding in the heel to absorb impact. It's also a good idea to do a proper warm-up before exercising, including gentle stretching exercises for your legs, ankles and feet.
Every parent knows that their children's feet grow at alarming speed. One day you buy them new shoes and the next day the shoes are too tight. It's enough to make you want to send them into the world barefoot.
The never-ending growth spurts in children's feet are due to the fact that the foot is one of the first parts of the body to grow to full size. This speedy growth is accompanied by uneven development in the lower leg and ankle, making muscles and tendons very tight and the heel less flexible. This inflexibility exposes the heel to injury and places a lot of stress on the growth plate, a soft area at the end of the heel which eventually fuses with the heel bone (calcaneus).
Sever's Disease (calcaneal apophysitis), the most common cause of heel pain in children, is a painful inflammation of the heel's growth plate. The heel bone is not fully developed until age 14 or 15, and is constantly adding new bone at the growth plate (physis). When the growth plate is subjected to a lot of repetitive stress, like that in athletics, inflammation can develop.
It should be noted that the symptoms of heel pain in adults are different from heel pain in children. In adults, heel pain is usually at its worst in the morning and decreases or subsides as the tissue warms up with activity. But in children, heel pain usually doesn’t diminish as the child moves around – in fact it may get much worse.
Fortunately, Sever’s Disease is a temporary condition and with rest and treatment, symptoms will usually subside within 8 weeks. If the condition persists, it's important that your child sees a podiatrist for a thorough evaluation and treatment plan. The risk of recurrence of Sever’s Disease diminishes with age and typically doesn't occur after 15, when foot growth is complete and the growth plate has fused to the rest of the heel bone.
If your child complains about heel pain, don’t take it lightly, as early intervention and treatment by a podiatrist is key to a continued healthy development.
Every golfer knows that their game depends on their swing and their swing depends on balance. If you have poor mechanics or tend to shift your weight, your balance will suffer and your swing will go off the rails. Strong ankles are key to maintaining your balance and hence your swing, so you'll spend less time in the sand trap. Or complaining of back pain.
The exercises below are meant to strengthen ankles and calf muscles, including ankle inverters and everters, responsible for the side-to-side movement of your feet. Strengthening these groups of muscles is extremely important for stability through your golf swing, especially on uneven surfaces.
1. Raise yourself on your toes. This is pretty self-explanatory. It's simple and very effective at strengthening the muscles in your calf, foot and toes.
While lightly holding on to the back of a chair to mainatin balance, slowly raise yourself on the toes of both feet. Repeat 10 times. For a challenge, try raising one foot off the ground, shift all of your weight to the opposite foot, and raise yourself on the toes of just one foot.
If you're in decent shape and would like a bigger challenge, hold on to light free weights while doing this. Don't go too heavy on the weights or you'll place undue stress on the muscles and do more harm than good. For balance training, alter your stance by pointing your toes in or out, or place one foot in front of the other.
2. Balance yourself on one leg. Not much explanation needed here. Pick one foot off the ground and hold for 20 seconds. Repeat with the other foot. If you're just starting, make sure you have a table or chair close by to hold onto until you maintain your balance. For "advanced users", stand on a pillow, which will simulate an uneven surface.
3. Stretch your heels and calf. Runners will be familiar with this one, as it's excellent at stretching out your heel cords. Stand facing a wall, keeping your back straight. Place your hands on the wall. One leg should be slightly forward and bent and the other leg extended behind you with the heel flat and the toes pointed in slightly. Keep both heels flat on the ground and press your hips toward the wall. Hold for 30 seconds and repeat. Then switch legs and repeat. To add an ankle stretch, perform the stretch from this position again, but bend both knees slightly. Keep your hips centered over both feet.
4. Sitting calf and ankle stretch: Sit on the floor with both legs extended straight. Loop a hand towel around the ball of your left foot and grasp the ends of the towel. Gently pull the towel towards you while keeping your leg straight. You'll feel the stretch in your calf and ankle. Hold for 30 seconds and repeat with the right foot.
5. Increase your ankle's range of motion. Sit in a chair of sufficient height so your feet do not touch the floor. Leading with your big toe, write each letter of the alphabet with your foot. Keep the movement small, using just your foot and ankle only, not your leg.
6. Strengthen your ankle's dorsiflexion and plantar flexion. You'll feel the muscles going to work in your calf, shin, the back of your heel, and the top of your foot. With your legs straight our in front of you and your heel on the floor, anchor an elastic band on a chair or table leg, and then wrap it around your midfoot. Pull your toes toward you and push your heel forward. Repeat 10 times. This strengthens dorsiflexion. To strengthen plantar flexion, loop the elastic band around the ball of your foot and hold the ends in your hand. Without pulling on the band, point your toes forward and then slowly return to the starting position. Repeat 10 times.
Keep your ankles in tip-top shape and you'll have a much better time on the greens.
If you're an adult, there's a very good chance that you've fractured or broken a bone in your foot at some point. After all, there are 26 bones in each foot, and they have to take the impact of everything from walking to skydiving. That means there's a high percentage that at least one of them is going to fracture under the stress, which can range from a small crack in the bone known as a stress fracture, to a complete break which penetrates through the skin.
The adult foot is divided into three sections: the forefoot, made up of the toes (phalanges) and the longer bones which connect to them (metatarsals); the midfoot, which contains a collection of bones that form your arches (navicular bone, cuboid bone, and cuneiform bones); and the hindfoot, which contains 2 bones that form part of your ankle and all of your heel (talas bone and calcaneus). Additionally, in most people there are very small bones called sesamoids at the base of the big toe. That's a lot of moving parts, and a fracture can occur in any of them.
It's essential to have a foot fracture treated as soon as possible by a podiatrist, so that the bone and tissue injury heals correctly. Without treatment, you run the risk of developing arthritis in the fractured area, blood clots, deformity, persistent pain, infection, weakness, reduced movement, loss of feeling in your foot or damage to blood vessels, tissues and nerves.
Types of fractures in the foot
There are a number of options your podiatrist may choose to treat your foot fracture. The treatment depends on what kind of fracture you have, where it's located in the foot, and how much discomfort it's causing you. Your podiatrist may choose one or more of the following treatments:
After initial treatment, your podiatrist will order you to rest and elevate the foot whenever possible, and ice the foot if it's swollen or painful. When the bone has healed, they may order physical therapy to help improve range of motion and strength in the bone and help to decrease any residual pain.
One of the most important aspects of a child's physical and emotional development is game play - the kind that doesn't involve sitting in front of a video screen. Organized sports, activities like climbing trees, biking, going for a swim, or just playing imaginary games with other kids in the neighborhood are all positive for their growth (think running, walking, jumping, moving - organized or otherwise). Good habits learned early follow a child into adulthood, and are key in combating the childhood and adult obesity epidemic.
But of course, foot, ankle, and heel pain complaints and other injuries run hand-in-hand with activity. Parents should note that the cause and symptoms of heel pain in children can be considerably different from heel pain in adults. If you've experienced heel pain, specifically plantar fasciitis, you know that its very bad in the morning, but diminishes as the tissue warms up with activity.
But in children, heel pain usually becomes much worse as the day wears on, and may be due to a condition called Sever's disease, an inflammation of the growth plate in their heel. This condition is especially common in children who are highly active or overweight. Heel pain in adolescents may also be due to plantar fasciitis, fractures in the heel bone, bursitis, achilles tendinitis, or other conditions. The good news is, a podiatrist can successfully resolve Sever's disease or other heel pain conditions in your child in almost every case.
Check out the Facebook page for NFL Play 60 to see how you can encourage your child to be more active.
Unfortunately, some children are slow to complain about heel pain and other injuries, which is where parents have to keep a watchful eye. When a child has pain in their heel, or pain elsewhere in their foot or ankle, it can cause any number of changes in the development of their bodies, as they shift weight and change their gait to compensate for the pain. This imbalance also makes them prone to further injuries. Parents should be mindful of changes in their children's body langauge and behavior, so that a heel pain injury can be addressed early.
Your child may be experiencing heel pain if you notice any of these changes:
If your child complains about heel pain (or any other kind of pain), take it seriously and don't encourage them to "walk it off" or "play through it" - that's old school advice and may cause more damage in a person of any age. Your child should immediately leave the game or curtail their activities. To treat the injury at home, they should rest, ice their foot, and use an age and weight appropriate dose of advil or aleve to manage the pain. They should not resume strenuous physical activity until the heel pain has completely subsided. When your child resumes activity, it should be gradually, accompanied by appropriate stretching exercises to warm up their ankles and feet. Children should also wear athletic shoes which support their feet properly (but it's okay to let them run barefoot when appropriate).
If your child's heel pain continues for more than one week, make an appointment to see a podiatrist for an exam and diagnosis. Early intervention and treatment is the key to successfully resolving their complaint so they can get back to kid stuff as soon as possible.
You know plantar fasciitis (PLAN-tur fas-e-I-tis) when you have it - a sharp, searing, knife-like pain on the bottom of your heel. In the morning, that first step out of bed can be excruciating, becoming less so as you walk and warm up the muscles and the plantar fascia ligament. Pain can also make itself known when you stand up after sitting for a while.
"itis" is a medical suffix used to indicate the inflammation of an organ - in this case the plantar fascia.
To understand plantar fasciitis, a little anatomy lesson is handy. The plantar fascia is a thick ligament made of dense, fibrous tissue which has very little stretch in it. It's main function is to act as a shock absorber. The plantar fascia starts at the bottom of your heel, runs across the arch and the ball of your foot, and then spreads out, attaching at the base of the toes.
When you take a step, and as your foot impacts the ground, your foot actually flattens, which lengthens the foot ever so slightly. This causes the plantar fascia to lengthen as well, as much as it can (remember, it doesn't have much stretch in it). Then when your heel lifts off the ground, the ligament returns to normal. When your foot impacts the ground hard, such as when playing sports, the foot flattens a little more than usual, and the plantar fascia stretches a little further than it would like to. As a result, small, usually minute tears develop where the ligament attaches to the heel bone (calcaneus). These small tears cause the ligament to bleed a little, and the tension of the plantar fascia pulling at the heel bone causes a spur to form on the bottom of the heel. However, the heel spur is not the cause of pain - it's caused by the plantar fascia trying to tear away from the heel bone. Many people have heel spurs and have no pain whatsoever.
Why does your foot flatten and tear the plantar fascia? The answer lies just below your ankle. When your foot contacts the earth, the subtalar joint, just below your ankle joint, flexes to absorb the impact. The flexing of the subtalar joint causes the arch of your foot to flatten (pronation) or heighten (supination). If the foot excessively flattens, it's said to overpronate, and the plantar fascia is constantly under strain. Over time this weakens the ligament where it attaches to the heel bone, and pain occurs. Then when you are at rest, the plantar fascia starts to mend itself. But even a full night's deep sleep isn't enough to heal the plantar fascia entirely, and when weight is applied with that first step in the morning, the fascia tears again, causing pain. It is this persistent irritation of the plantar fascia that is known as plantar fasciitis.
Another contributing factor to plantar fasciitis is a tight calf muscle. The calf muscle attaches to the foot by way of the achilles tendon behind your heel. If the calf muscle is tight it limits the movement of the ankle joint, contributing to over pronation. Calf muscles can become rigid due to exercise, but also inactivity. High heels, even boot heels can cause the calf to tighten, and in some people, it's just naturally so.
Read about how PA Foot and Ankle Associates treats the symptoms of plantar fasciitis
Very few adults are strangers to heel pain. At some point in our lives, we've run too hard, hiked too far, gained too much weight, played basketball in past-their-prime sneakers, or didn't rest when we should have. Sometimes it even appears for no reason we can pinpoint. But without a doubt, we never forget that pinching and excruciating pain in our heel.
Heel pain occurs in the underside or the back of your heel. When it appears on the underside, it's usually a result of damage or irritation to the plantar fascia, the tendon which runs from your heel to the base of your toes. This type of heel pain is called plantar fasciitis. If heel pain occurs at the back of your heel, the cause is usually damage to the Achilles tendon, such as achilles tendinitis. But heel pain can also be caused by arthritis, a bruise, heel spurs, gout, pinched nerve, bursitis ("pump bump"), peripheral neuropathy, a fracture, bone infection, or other conditions. For this reason, any heel pain should always be evaluated by a podiatrist to determine the best course of treatment to get you back on your feet as soon as possible.
Rest, Ice, and Elevation. Ice packs on the heel reduce inflammation, especially when paired with over the counter anti inflammatory medicine like advil or aleve. Rest and elevate the sore foot whenever possible.
Change your routine. If heel pain is the result of an athletic injury, change your routine. Training the same way, on the same surface, with the same shoes, will only make things worse.
Stretch before working out. Stretching your feet, raising yourself on your toes, even walking, will help warm up the plantar fascia and achilles tendon, reducing the risk of injury. When muscles, tendons, bones, and joints are gently warmed up before a workout, they're much better at handling the load you demand of them.
Are you wearing a quality pair of shoes? Whether athletic shoes or dress shoes, your footwear must fit your feet correctly and give ample support and padding. You may save money with cheap shoes, but the pain will be expensive.
Read more: Does your child have heel pain?
Hypoglycemia is a medical emergency and a dangerous condition for type 1 and type 2 diabetics. Sometimes referred to as insulin shock or an insulin reaction, hypoglycemia occurs when blood glucose levels have fallen well below the normal range. Hypoglycemia is rare in those without diabetes.
Patients who have been newly diagnosed with diabetes should learn to recognize the early symptoms of hypoglycemia, as this condition can accelerate very quickly and put the diabetic patient at risk of an accident. One may go from being light-headed and feeling a little "woozy" to involuntary muscle twitching, poor coordination, blurred vision, slurred speech, and possible seizure in a matter of minutes. In severe cases, hypoglycemia may cause coma or death.
Technically, hypoglycemia is present when blood sugal levels drop below 60 mg/dl. However, diabetics may start to experience some of these symptoms before their glucose levels fall to that point. The severity of symptoms depends on how long diabetes has been present, and the patient's individual blood glucose target as recommended by their health care provider. Drinking alcohol when diabetic may also cause low blood sugar, as well as certain prescription medicines when taken with your diabetes medication.
Each patient's reaction to hypoglycemia can be different - some exhibit mild symptoms and some quite severe symptoms in a matter of minutes. The early symptoms of the condition may also be confused with those of other illnesses like flu. If any symptoms of hypoglycemia are present, check blood glucose levels as soon as possible.
If you are diabetic and experience any of the above symptoms, check your blood glucose levels immediately. If your meter isn't close at hand, opt for caution and treat for low blood sugar by consuming 15-20 grams of glucose or simple carbohydrates by any of these methods:
After treatment, wait 15 minutes and check blood glucose levels. If hypoglycemia is still present, treat again. Once blood sugar returns to normal, eat a small meal or small snack as recommended by your diabetes health care provider. If hypoglycemia persists after a second treatment, call 911.
When your body digests food, it is broken down into various sugar molecules, including glucose, the primary source of energy for your body. This energy is needed not only for physical activity, but for cell function, brain function, and organ function as well. Glucose enters your bloodstream right after you eat, and with the assistance of insulin secreted by the pancreas, enters your cells. In the case of diabetics, insulin production or utilization is compromised, and glucose remains in the bloodstream, causing high blood sugar.
A normally functioning body deals with blood sugar very efficiently. When blood sugar rises after a meal, it signals beta cells in your pancreas to release insulin. Any glucose unused by your cells is stored in the liver and muscles as glycogen. When you skip a meal and your blood sugar level drops, a different hormone in your pancreas, glucagon, signals your liver to release the stored glycogen into your bloodstream as glucose. This two-fold process keeps glucose from becoming too high or too low at any time. As an added safeguard, your body also creates glucose in your liver and kidneys in a process called gluconeogenesis.
If you have type 1 diabetes, your pancreas does not produce enough insulin. If you have type 2 diabetes, your cells do not respond properly to insulin. To regulate insulin levels, you either take synthetic insulin or an oral medicine to help your cells utilize glucose. Hypoglycemia can be caused by taking too much insulin relative to your blood sugar levels. It can also be caused by taking your oral medicine and not eating a sufficient amount of food to maintain your blood levels. Hypoglycemia may also occur after exercising when not ingesting sufficient glucose to replace what is used by your muscles.
When Hypoglycemia occurs, your glucose blood levels have dropped below what is required for proper brain, cell, and organ function. The brain is particularly sensitive to low blood glucose levels, because sugar is its main energy source. This is why a diabetic suffering hypoglycemia becomes confused, may have blurred vision, or may display poor coordination.
The body first responds to a fall in the level of glucose in the blood by releasing epinephrine from the adrenal glands. Epinephrine stimulates the release of glucose from body stores but also causes symptoms similar to those of an anxiety attack: sweating, nervousness, shaking, faintness, palpitations, and hunger. More severe hypoglycemia reduces the glucose supply to the brain, causing dizziness, fatigue, weakness, headaches, inability to concentrate, confusion, inappropriate behavior that can be mistaken for drunkenness, slurred speech, blurred vision, seizures, and coma. Severe and prolonged hypoglycemia may permanently damage the brain. Symptoms can begin slowly or suddenly, progressing from mild discomfort to severe confusion or panic within minutes. Sometimes, people who have had diabetes for many years (especially if tightly controlled) are no longer able to sense the early symptoms of hypoglycemia, and faintness or even coma may develop without any other warning.
Skiing is a high speed sport involving quick turns at high speed down a sloped terrain, making huge demands of your feet and ankles. When you make those turns, your foot flattens, your ankle bones lower, and your leg rotates toward the opposing leg. That puts massive stress on everything below your waist. But even with all of that stress, you should never experience pain in your feet or ankles after a day on the slopes, assuming it was accident-free. If your ankles or feet are throbbing, sore, or icy cold when you end up in the lodge, your boots may need adjustment or refitting, or may need to be replaced. But your skiing technique may also contribute.
Do your ski boots fit correctly? Are they the right boots for your skill level?
In skiing, your boots are your most essential gear, because movement is initiated in the feet and ankles. They should offer plenty of support, but still be flexible enough to allow forward and lateral flexing ankle movements. Ski boots that are too soft or too stiff for your ankle strength and skill cause dysfunctional ankle movement, resulting in pain.
If your ski boots don't fit correctly, your foot may literally bounce around inside your boot, referred to as ankle and heel slop. Boots which are too large - even slightly - cause the ankle to sit too low in relation to the boot's intended ankle pocket area, and this impacts ski turning biomechanics. The result is again, dysfunctional movement patterns which may cause ankle pain.
Experienced skiers arrange for foot beds and boot alignment. Professional boot fitters correct your actual ski stance to a neutral position, called canting. The stance of some skiers may need to be moved forward, some more upright. A boot fitter will also mold the boot's inner lining to your foot's unique shape. If you're experiencing ankle pain, tell the boot fitter about it, and they'll make the appropriate adjustments. But canting and alignment are not magic bullets - you should also select boots appropriate for your skill level.
You may want to consider asking a podiatrist to mold custom orthotics for your ski boots to stabilize your foot.
Do your feet ache? Do they cramp after a day on the slopes?
If your feet ache or are cramping after skiing, it's usually due to the overexertion of the muscles on the bottom of your foot - they're working too hard to maintain control of your skis. This is also a problem with the fit of your boots.
Do your feet turn icy cold?
If your feet become icy cold after a day on the slopes, you either need to wear thicker socks, or you may be overtightening your boots in an effort to control your balance and foot movement. It's never recommended to overtighten your boots for balance, as it creates a false sense of confidence, which could get you in big trouble. Tightening your ski boots also cuts off circulation and causes cramping, which may in turn cause ankle pain.
Is your skiing technique hurting your feet?
Your turning technique may also be to blame for your foot or ankle pain. A smooth turn initiation helps skiers carve clean, controlled arcs. Abrupt turn initiations are jerky, which causes the skier to bang their ankles against the inside of the boot, causing pain. Begin a ski turn by gently and gradually tipping your skis on to their edges.
You have pain in your big toe, the joint below your big toe is sore and stiff and a bump protrudes from the side of your foot, frequently ruining your footwear. You may have just discovered a bunion.
[caption id="attachment_5040" align="alignleft" width="360"] The protrusion at the base of the big toe is a bunion.[/caption]
It's commonly thought that high heels and other non-flat footwear are the cause of bunions. While these shoes aren't the primary reason for developing a bunion, they definitely contribute to their severity.
The truth is, some women can wear high heels their entire lives and never develop a bunion. Others can make all the right choices in footwear and still develop them. That's because the foot structure which contributes to a bunion is an inherited trait, especially common in men and women of European descent (but especially women). Any podiatric surgeon will tell you that he/she has treated bunions in multiple generations of the same family - usually mothers and daughters.
Our feet are designed to carry our body weight evenly across all planes of the foot. When we inherit the faulty biomechanics which lead to a bunion, and then stuff our feet into high heels and other shoes which don't support our feet correctly, a bad situation gets even worse. Shoes with heels shift our body weight onto the front of the foot, placing stress on an already weakened joint. Other factors which may contribute to bunions are obesity, spending lots of time on hard surfaces (like factory floors), jobs that demand a lot of time on your feet, and hormonal changes.
What you see protruding from the side of your foot is a deformity of the joint at the base of the toe. The first metatarsal bone (the longest bone in the foot) has turned outward and the big toe has been pulled toward the other toes, causing the head of the metatarsal to protrude. As footwear rubs against this area, or body weight is shifted onto this joint via shoes with heels, the bursa which cushions and protects the joint becomes inflamed and sore, and the joint becomes stiff. The misalignment and compromised foot structure also causes pain on the side of your foot or in your arch, and pain and discomfort in the adjacent toes.
Unfortunately, a bunion is a progressive condition, which means it won't get better on its own. The longer you wait to treat the bunion, the worse it will become. There are stretching exercises and other therapies you can use to reduce the pain and progression of the bunion, but the only way to restore your foot to its pre-bunion condition is with bunion surgery.
The faulty biomechanics that cause a bunion also contribute to other foot conditions as well, such as hammer toes, overlapping toes, corns, and ingrown toenails.
[caption id="attachment_4812" align="alignleft" width="400"] UC Santa Barbara player Zalmico Harmon. Note how his right foot is flat on the court and his leg is bent outwards as he's pivoting. Your ankles and feet had better be in excellent condition to do that every day.[/caption]
Basketball demands a lot of your ankles and feet - they're subjected to sudden, explosive movements, quick turns, and a relentless pounding on a hard surface. If your lower extremities aren't in perfect condition, a lot can go wrong very quickly. The best way to avoid a missed game or worse, a lost season, is to keep your feet and ankles (and the rest of you) in peak condition. These exercises will work muscles, tendons, and ligaments in your toes, feet, and ankles which are often neglected, at the athlete's risk.
But before we get into that, we'd like to mention that a basketball player should use braces and tape as little as possible during training. They're very useful when recovering from an injury, but for training purposes, they'll work against you. If the muscles in your feet and ankles are immobilized and artificially supported by tape or other means, they don't get worked. And a muscle that doesn't get worked is a weak muscle.
Occasionally you should train in bare feet. We know this isn't a practical suggestion in a public space, but when you're working out solo at home, ditch the basketball shoes whenever possible. The foot is the base of the ankle - build it naturally, without restraint, for better balance, mobility, and strength.
While sitting, roll a tennis ball around with the bottom of your foot, applying light pressure. Work it under the arch, the toes, and your heel for 5 minutes on each foot.
When your feet flex upward toward your body, it's dorsiflexion, as when you land on the court after a jump. When the foot flexes down or away, it's plantar flexion, as when you make a jump, sprint, or cut. To condition your muscles to endure this full range of motion, perform a unilateral stretch:
Take the time to do the proper conditioning, and chances are you'll stay safe on the basketball court. If you experience any pain at all, take a break and get the advice of your trainer before continuing. Then follow up with a podiatrist who is expert in sports medicine for a full evaluation.
Many of our podiatry patients remark on how thick their toenails become as they enter (and pass) middle age. Their toenails become notably tougher to trim, which makes the possibility of cuts to the skin around the nails a real possibility. Thickened toenails also splinter easily.
[caption id="attachment_4884" align="alignleft" width="300"] Toenails thicken due to aging, but other factors may also be at play.[/caption]
Unfortunately, thickening toenails are a by-product of aging, in most cases. As we age, our toenails - and fingernails - slow their growth rate, and the nails thicken because the nail cells, called onychocytes, sort of pile up. Fingernails appear to thicken less, probably because we tend to them more often with filing and buffing, which thins them.
But in addition to this natural thickening of the nails, other factors may be at play also. Among them are trauma, fungal infections, and impaired circulation. Feet are under constant stress from falling objects, stubbing injuries, poor foowear, closed-in footwear, and athletic activities. All of these conditions can alter the cells from which the nails grow, and if one tends to stub or injure the same toe, the nail plate can easily become thickened or disfigured.
Peripheral arterial disease, or P.A.D., a vascular disease which restricts blood flow to the extremities, can also cause thickened, brittle toenails. Fungus also plays a key role, as it thrives in the moist, dark interior of a shoe. Besides causing the toenail to thicken, a fungal infection may also cause the nail to yellow, become brittle, separate from the nail bed, and possibly emit a foul odor. In this case, your podiatrist may recommend trimming and cleaning (debridement) the toenail, a prescription topical creme or prescription oral medicine.
**If you're diabetic, have peripheral arterial disease, or have diabetic peripheral neuropathy, a podiatrist should trim your toenails. Patients with these conditions frequently have a loss of sensation in the toes, and run the risk of wounding the skin or cutting too deeply when trimming the nails.
Besides debridement, there are few treatment options to alleviate the thickening of toenails due to the natural course of aging. If however, your toenails are thickening due to one of the other causes mentioned above, your podiatrist will discuss a course of treatment with you.
A bunion is a deformity which occurs when the head of the first metatarsal bone behind the big toe angles out from the foot, pushing the toe toward the adjacent toes (in most cases). The protruding metatarsal head irritates the soft tissue, causing soreness on the side, top and bottom of the foot. Additionally, muscles and tendons in the foot become cramped, tired, and fatigued.
In most cases, a bunion develops due to faulty biomechanics in the foot. You'll read a lot of info online that blames high heels and even ballerina shoes for bunions, and while they might contribute to the condition, the root cause is usually genetic. Any podiatric surgeon whose been at it for a decade or more will tell you that he or she has corrected bunion deformities in members of the same family - usually mothers and daughters, but a few sons thrown in for good measure. Faulty arches, flat feet, and loose ligaments, tendons, and muscles are inherited from our parents. We stuff our feet into too-tight shoes, high heels which shift our body weight to the front of the foot, and inexpensive shoes which offer no support to our arches. Combine all of these factors, and voila! A bunion!
Once a bunion starts forming there is absolutely nothing you can do to reverse it, as the metatarsal bone is already out of alignment. But you can slow the progression of the bunion and strengthen the toe and foot muscles to relieve pain and discomfort and increase flexibility. If one of your parents or older siblings have bunions and you don't, proper shoes and strengthening exercises may help delay the onset of your bunions.
Here are some exercises to relive bunion pain:
We recommend that you perform each of these exercise twice a day, morning and night, to releive your bunion pain. If your discomfort continues, make an appointment with PA Foot and Ankle Associates. One of our podiatrists will assess your condition and recommend a treatment plan for your bunions.
Shooting pain, dull pain, aching pain in your toes. There's nothing quite like it, is there? You can change footwear or buy over the counter insoles, but those measures only go so far. Ultimately, your toe pain will still be there, and may even get worse over time. Here then are the nine most common causes of toe pain and what your podiatrist may suggest as the best way to alleviate them.
[caption id="attachment_4690" align="alignleft" width="300"] No apparent problems with these toes - they're just the way they're supposed to look.[/caption]
1. Arthritis is an inflammatory disease which attacks the joints in your body. It's one of the most common causes of pain in the toes, as our appendages frequently show the early signs of this disease. Arthritis can also occur in previously fractured areas of bone and sprained joints injured years earlier.
Treatment: Rest when necessary, use over the counter pain medicine like advil or aleve to manage the pain and inflammation. Custom orthotics can be helpful in relieving the pressure on toes. If pain is intolerable, visit your podiatrist.
**A stiff big toe which is also painful at the joint may be a degenerative form of arthritis called Hallux rigidus. Read more about Hallux rigidus.
2. Gout, a form of arthritis (also called gouty arthritis), is caused by uric acid buildup in the joints. Gout causes severe pain and swelling in the joints, most commonly in the big toe.
Treatment for gout includes prescription or over the counter medications to manage the pain, and ice to reduce swelling. Gout is also treated with dietary changes to reduce uric acid output.
3. A bunion is a protuberance in the joint below the big toe. Anyone can develop a bunion, which is caused by defects in the biomechanical structure of the foot. While poor choices in footwear do not directly cause bunions, they certainly aggravate the condition. Hammer toes and overlapping toes frequently appear with bunions.
Treatment for bunions includes changes in footwear and/or custom orthotics to take pressure off of the bunion, over the counter pain medicine to manage the pain and inflammation, and surgery when necessary.
4. Hammer toes occur when the middle joint of the second, third or fourth toe becomes bent, giving the toe a hammer-like appearance. Hammer toes are caused by an imbalance in the muscles and tendons, which pull incorrectly in the foot, ultimately bending the toe.
Treatment of hammer toes includes changes in footwear to keep the hammer toe from rubbing on the inside of the shoe, and stretching exercises to strengthen the muscles and tendons. Your podiatrist may also recommend custom orthotics or surgery when necessary.
5. Overlapping toes, underlapping toes and crossover toes are deformities in which one toe crosses over or under the adjacent toe. Overlapping and crossover toes are each caused by abnormalities in the biomechanics of the foot, but for different reasons.
Treatment of overlapping toes, underlapping toes, and crossover toes includes over the counter pain relievers, stretching exercises, and splints to hold the affected toes in place. Only surgery can correct these conditions permanently, however.
6. Ingrown toenails occur when the skin on the side (or sides) of a toenail grow over the nail. Ingrown toenails can be incredibly painful and become infected if not treated.
Treatment for ingrown toenails includes soaking the foot in warm water four times each day, and treatment by a podiatrist to remove the skin and/or treat the infection.
7. Turf toe, most comonly occuring in athletes, is an overuse injury that occurs at the base of the big toe. It is usually the result of a hyperextension of the big toe, but may also be a form of sesamoiditis or sesamoid fracture (the sesamoids are two tiny bones in the ball of your foot).
Treatment of turf toe should always be handled by a podiatrist familiar with sports injuries.
8. Fractures can occur in any bone of the toe. A minor fracture needs only rest, ice, and if necessary, over the counter pain medicine to heal. But serious toe fractures must be immobilized and if extensive, may require surgery. Toe fractures should always be treated by a podiatrist.
9. A toe sprain occurs when the toe is jammed or stubbed, and the tendon or soft tissue is injured. Even though this injury can look quite nasty, the pain and swelling should subside in a few days, if there is nor fracture.
Any pain in your toes is not normal. Please make an appointment with the PA Foot and Ankle Associates office if you're experiencing any of these symptoms.
[caption id="attachment_4769" align="alignleft" width="600"] A good pair of insulated boots and thermal socks are your feet's best defense against winter weather.[/caption]
If you have type 1 or type 2 diabetes, you're at greater risk of foot injury during the winter months than you are at any other time of year. A side effect of diabetes called Diabetic Peripheral Neuropathy causes a loss of sensation in your feet, the result of persistently high blood sugar which damages blood vessels and nerves. DPN doesn't typically appear overnight - one experiences a slow loss of sensation over a period of years as the damage occurs. This makes a diabetic patient especially vulnerable to frostbite or frostnip, potentially damaging skin and other cells.
Diabetics - and everyone - should use common sense if they're going to be outdoors for a prolonged period. Keep moving to stimulate circulation, take breaks to warm up whenever possible, wear an excellent pair of waterproof boots, and wear 2 pair of thermal socks. Take an extra pair of socks with you in case your feet get wet. If your feet are icy cold to the touch, but you don't feel the appropriate sensation, you may have already developed DPN. Please make an appointment with your podiatrist immediately for an examination and treatment plan.
Just because you're moving, it doesn't mean you're invulnerable to freezing weather. In fact, splashing through wet streets, icy slopes, and getting your boots, socks, or sneakers wet, not only opens the door to a wicked wipeout, but also to frostbite or frostnip. Anyone who's spent significant time outdoors hiking, camping, sledding, or skiing is usually acutely aware of this from personal experience. But did you know that once you get frostbite or frostnip, you risk a more severe injury if it happens a second time?
[su_column][su_note note_color="#fff2f6" text_color="#ffffff" radius="3"]Learn to recognize the signs of frostbite (Mayo Clinic)[/su_note][/su_column]
Athletes should avoid training on wet surfaces, or at least splashing through puddles or snow. Hikers, campers, hunters, skiiers and snowboarders should have quality boots and appropriate socks to keep their feet warm and dry. If you notice a loss of sensation in your feet to any degree, get indoors immediately (or somewhere warm), take off your shoes and socks, dry your feet if wet, and allow your feet to slowly warm. If pain accompanies the warming, you may have frostnip. See a podiatrist for an evaluation.
Winter foot care for everyone
To counter any holiday weight gain, many runners will be fighting the cold to keep on exercising through the winter months. Exercising is also a great way to improve your mood and keep your energy throughout the day. Runners should keep in mind, however, the possibility of hypothermia while running. Prolonged exposure to cooler temperatures can decrease blood circulation to the hands, arms, legs, and particularly the feet. Keep in mind warning signs such as paleness, pain, or numbness of the affected area.
Poor circulation is a serious condition and needs immediate medical attention. If you have any concerns with poor circulation in your feet contact one of our podiatrists of Podiatry. Our podiatrists will treat your foot and ankle needs.
Poor Circulation in the Feet
Poor blood circulation in the feet and legs can be caused by peripheral artery disease (PAD), which is the result of a buildup of plaque in the arteries.
Plaque buildup, or atherosclerosis, results from excess calcium and cholesterol in the bloodstream. It usually restricts the amount of blood which can flow through the arteries. Poor blood circulation in the feet and legs are sometimes caused by inflammation in the blood vessels, known as vasculitis.
Lack of oxygen from poor blood circulation restricts muscle growth and development. It can also cause:
-muscle pain -numbness in legs
-cramps -skin discoloration
-weakness -slower nail & hair growth
-stiffness -erectile dysfunction
Those who are over 50-years-old, have diabetes and/or smoke are at greatest risk for poor circulation. If you have poor circulation in the feet and legs it may be caused by PAD, and it is important to make changes to your lifestyle in order to reduce the risk of getting a heart attack or stroke. Exercising and maintaining a healthy lifestyle will dramatically improve conditions.
Consult a podiatrist or doctor to help determine a regime that suits you.
If you have any questions please feel free to contact our offices located in New Jersey and Pennsylvania. We offer the newest diagnostic tools and technology to treat your foot and ankle needs.