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Footcare For the Homeless: Part 1


Foot Care
When we are in love we may be “swept off our feet.” When we don’t want to do something, we are said to have “cold feet.” A sensible person “has both feet on the ground.” Sometimes we even “vote with our feet.”
Years of wear and tear can be hard on our feet. So can disease, poor circulation, improperly trimmed toenails, and wearing shoes that don’t fit properly. Problems with our feet can be the first sign of more serious medical conditions such as arthritis, diabetes, and nerve and circulatory disorders.

Preventing Foot Trouble
Practice good foot care. Check your feet regularly, or have a member of your family check them. Podiatrists and primary care doctors (internists and family practitioners) are qualified to treat most foot problems. Sometimes the special skills of an orthopedic surgeon or dermatologist are needed.
It also helps to keep blood circulating to your feet as much as possible. Do this by putting your feet up when you are sitting or lying down, stretching if you’ve had to sit for a long while, walking, having a gentle foot massage, or taking a warm footbath. Try to avoid pressure from shoes that don’t fit right. Try not to expose your feet to cold temperatures. Don’t sit for long periods of time (especially with your legs crossed). Don’t smoke.
Wearing comfortable shoes that fit well can prevent many foot ailments. Here are some tips for getting a proper shoe fit:
The size of your feet changes, as you grow older so always have your feet measured before buying shoes. The best time to measure your feet is at the end of the day when your feet are largest. Most of us have one foot that is larger than the other, so fit your shoe to your larger foot. Don’t select shoes by the size marked inside the shoe but by how the shoe fits your foot. Select a shoe that is shaped like your foot. During the fitting process, make sure there is enough space (3/8″ to 1/2″) for your longest toe at the end of each shoe when you are standing up. Make sure the ball of your foot fits comfortably into the widest part of the shoe. Don’t buy shoes that feel too tight and expect them to stretch to fit. Your heel should fit comfortably in the shoe with a minimum amount of slipping – the shoes should not ride up and down on your heel when you walk. Walk in the shoes to make sure they fit and feel right. Then take them home and spend some time walking on carpet to make sure the fit is a good one.
The upper part of the shoes should be made of a soft, flexible material to match the shape of your foot. Shoes made of leather can reduce the possibility of skin irritations. Soles should provide solid footing and not be slippery. Thick soles cushion your feet when walking on hard surfaces. Low-heeled shoes are more comfortable, safer, and less damaging than high-heeled shoes.
Common Foot Problems
Fungal and Bacterial Conditions, including athlete’s foot, occur because our feet spend a lot of time in shoes – a warm, dark, humid place that is perfect for fungus to grow. Fungal and bacterial conditions can cause dry skin, redness, blisters, itching, and peeling. If not treated right away, an infection may be hard to cure. If not treated properly, the infection may reoccur. To prevent infections, keep your feet – especially the area between your toes – clean and dry. Change your shoes and socks or stockings often to help keep your feet dry. Try dusting your feet daily with foot powder. If your foot condition does not get better within 2 weeks, talk to your doctor.
Dry skin can cause itching and burning feet. Use mild soap in small amounts and a moisturizing cream or lotion on your legs and feet every day. Be careful about adding oils to bath water since they can make your feet and bathtub very slippery.
Corns and calluses are caused by friction and pressure when the bony parts of your feet rub against your shoes. If you have corns or calluses, see your doctor. Sometimes wearing shoes that fit better or using special pads solves the problem. Treating corns and calluses yourself may be harmful, especially if you have diabetes or poor circulation. Over-the-counter medicines contain acids that destroy the tissue but do not treat the cause. Sometimes these medicines reduce the need for surgery, but check with your doctor before using them.
Warts are skin growths caused by viruses. They are sometimes painful and, if untreated, may spread. Since over-the-counter preparations rarely cure warts, see your doctor. A doctor can apply medicines, burn or freeze the wart off, or take the wart off with surgery.
Bunions develop when the joints in your big toe no longer fit together as they should and become swollen and tender. Bunions tend to run in families. If a bunion is not severe, wearing shoes cut wide at the instep and toes, taping the foot, or wearing pads that cushion the bunion may help the pain. Other treatments include physical therapy and wearing orthotic devices or shoe inserts. A doctor can also prescribe anti-inflammatory drugs and cortisone injections for pain. Sometimes surgery is needed to relieve the pressure and repair the toe joint.
Ingrown toenails occur when a piece of the nail breaks the skin – which can happen if you don’t cut your nails properly. Ingrown toenails are very common in the large toes. A doctor can remove the part of the nail that is cutting into the skin. This allows the area to heal. Ingrown toenails can often be avoided by cutting the toenail straight across and level with the top of the toe.
A shortening of the tendons that control toe movements causes hammertoe. The toe knuckle is usually enlarged, drawing the toe back. Over time, the joint enlarges and stiffens as it rubs against shoes. Your balance may be affected. Wearing shoes and stockings with plenty of toe room is a treatment for hammertoe. In very serious cases, surgery may be needed.
Spurs are calcium growths that develop on bones of your feet. They are caused by muscle strain in the feet. Standing for long periods of time, wearing badly fitting shoes, or being overweight can make spurs worse. Sometimes spurs are completely painless – at other times they can be very painful. Treatments for spurs include using foot supports, heel pads, and heel cups. Sometimes surgery is needed.
Finding the Right Shoe For You
The wrong shoes can cause or aggravate foot ailments. The right shoes can often prevent – but cannot correct – problems. So wearing the right shoes is vital to foot health. Follow this checklist when you buy shoes. Be sure they measure up.
· Leather is best because is breathes like skin and molds to your foot. But cheaper canvas is fine for fast-growing children.
· Soles should be strong and flexible with a good gripping surface.
· Insoles should be cushioned to absorb the jolts of walking on hard surfaces.
· Arch supports distribute weight over a wider area. Rigid shanks also give added support.
· High heels are fun and look good, but they should not be worn too long at a stretch or for much walking. Besides cramping the toes, they change body posture, making backaches more likely.

· Only you can tell if shoes fit. If they aren’t comfortable, don’t buy them!
· Don’t plan on shoes stretching with wear. If you already own shoes that are too tight, ask your shoe repair shop if they can be stretched.
· Because feet spread with age, have your feet measured every time you buy shoes. Both feet should be measured as they are often different sizes. Always buy shoes for the BIGGEST foot.
· Go shoe shopping late in the afternoon. Feet swell to their largest then.
· Size depends on shoe make and style, too. Don’t insist you always wear one size if the next feels better.
· The toe box should be roomy enough so you can wiggle all your toes.
· Your forefoot should NOT be wider than your shoe.
· The heel should fit snugly and the instep should not gape open.
· If you can’t find shoes that fit, ask your doctor for advice.


Good shoes are especially important to avoid problems in developing feet.

· Because shoes serve only to protect children’s feet from injury, none are needed before a child walks.
· High-topped infant shoes do not support ankles – oxfords and tennis shoes are equally good.
· Check OFTEN to be sure shoes aren’t too small. Children’s feet are so flexible they can be crammmed into shoes two sizes too small – and the child may not complain.
· Don’t have children wear hand-me-down shoes. They are permanently molded to the original owner’s foot.
Unfortunately, most shoes today are narrower in the front than the foot is. You can check this by standing on paper and tracing around your bare foot. Compare the outline of your foot with the sole of your shoe. If your shoe appears too narrow, you may be inviting foot problems. Choose only shoes that feel comfortable – you are the best judge of that.
Our marvelous feet evolved for flexibility and strength – not to be stuffed into shoes. When people roamed the earth barefoot 4,000 years ago, foot problems were not the rule. Today, we need shoes to protect our feet from cold, injury, disease, and pounding on hard pavement. But too often we choose shoes for style rather than comfort and function. Remember: good shoes are part of the good care your feet deserve.
How You Walk
Your heel swings from side to side as your foot moves. When the heel swings correctly, your foot can flatten and regain its arch as you walk. But if your heel swings too much, your foot may flatten more than it should. Over time, such excess movement may cause foot problems.
When the heel hits the ground, its outer edge touches first. Soft tissues (muscles, tendons and ligaments) relax. Your foot is able to flatten, adapt to uneven surfaces, and absorb the shock of touchdown.
During midstance, your heel is below the anklebone, and the front and back of your foot are aligned. Your foot easily bears your weight.
As the heel lifts, it swings slightly to the inside. Muscles, tendons, and ligaments tighten. Your foot regains its arch, allowing your toes to push your weight off the ground.
Too Much Movement Causes Strain!
When your foot flattens too much (overpronation), some bones are forced to support too much weight. The muscles pull harder on these areas, making it more difficult for tendons and ligaments to hold bones and joints in place. Over time, you may develop swelling or pain on the bottom of your foot or near the heel. Or a bony bump (bunion) may form at your toe joint.
When your foot flattens too much, the ankle and heel do not align during midstance. The foot strains under your body’s weight.
Foot Facts
How Foot Smart Are You?
DID YOU KNOW… More than 70% of all people will have painful foot problems at some time during their lifetime. Foot pain is not normal.
Take these quizzes to see how Foot Smart you are!
(Answers can be found at the bottom of the page.)

Quiz I

Some famous people down through the ages have made memorable statements about feet or have otherwise influenced the way we think about feet and shoes. Can you identify the person connected with the following?

1. Which Greek philosopher said, “When our feet hurt, we hurt all over”?
a. Plato
b. Socrates
c. Aristotle
2. Which Renaissance artist called the foot “a masterpiece of engineering and a work of art”?
a. Leonardo da Vinci
b. Raphael
c. Michelangelo
3. What hero of ancient Greece gave his name to the largest and strongest tendon in the foot?
a. Ulysses
b. Jason
c. Achilles

DID YOU KNOW… The average person, engaging in non-strenuous activity, walks approximately 4 miles every day or about 115,000 miles in a lifetime.
Quiz II

Use these numbers to answer the following questions about parts of the foot – 5, 20, 26, 33, 100
1. How many of the body’s 206 bones are located in each foot?
2. How many joints hold these bones together?
3. How many muscles are used to move the bones of each foot?
4. How many ligaments join these bones?
5. (This one’s easy…) How many nails protect the toes of each foot?

DID YOU KNOW… During a typical day, the feet endure a cumulative force of several hundred tons.

Answers to Quiz I:
1)B 2)A 3)C
Answers to Quiz II:
1) 26, 2) 33, 3) 20, 4) 100, 5) 5

YES, IT’S TRUE… The human foot is a highly specialized structure containing 26 relatively small bones, more than 150 ligaments and an intricate network of muscles, nerves and blood vessels.

Spurs are calcium growths that develop on bones of your feet. They are caused by muscle strain in the feet. Standing for long periods of time, wearing badly fitting shoes, or being overweight can make spurs worse. Sometimes spurs are completely painless – at other times they can be very painful. Treatments for spurs include using foot supports, heel pads, and heel cups. Sometimes surgery is needed.

Gout (hyperuricemia or elevated uric acid) is a systematic disorder that affects the big toe joint. Gout is the end result of a build-up of uric acid in the blood. The uric acid crystallizes and settles in the joints in the body, most often in the big-toe joint. When it does so, it produces an excruciating pain. The onset of an attack of gout can be sudden and vicious. It is not uncommon for the victim to be awakened by this excruciating pain in the middle of the night. (Gout is often confused with Osteoarthritis, a condition that is characterized by a much slower onset of pain, and seems worse after a person has been walking or running.)

Gout is generally thought to be a hereditary disease, but there are many causes: increased purine intake ..sudden weight loss due to dieting, and/or diuretics can cause elevated uric acid and mimic the symptoms of gout. In rare cases, leukemia’s and/or blood dyscrasias can cause elevated uric acid. Gout can be a serious disease and needs medical intervention, generally by an Internist.

If gout is not treated properly, it will eventually cause permanent changes in the big-toe joint. It is important to seek medical attention if you suspect the existence of gout. It is encouraging to note that drugs can be prescribed that will control the uric-acid level in the blood. You need not suffer from gout in this day and age.
Common foods that cause gout, such as alcohol, red meat, lobster, shell fish, etc., should be eliminated from the diet. Cranberry juice has been used as a substance which helps to eliminate uric acid through the urine.
Warts (Verruca Plantaris) are caused by a virus and are contagious. They may grow singularly or in groups.
They are painful and appear particularly on the bottom of the feet. Conservative treatments include topical medicines and patches. If these treatments fail, your podiatrist may use a series of freezing methods .If the warts still persist after several treatments, the warts may be removed surgically. The wart is then scooped out with a curette, a special surgical instrument. The base is then laser cauterized to discourage regrowth. Since warts are caused by a virus, they can recur.
The Evolution of Foot Problems
The first human being stood upright about 1 million years ago. Then when our feet took on a double load, they freed our hands for other things and civilization was born. With it came shoes – first, simple skin sandals that protected feet from cold and injury. But since those early times, shoes have more often been worn for status and style than comfort and function.
Early Greek and Oriental actors used platform shoes to make the main character on state stand above the supporting players. In sixteenth-century England, male dandies wore shoes with extremely pointed toes. And although it nearly crippled them, years ago upper-class Chinese women bound their feet so they could wear tiny shoes – a sign of being well bred!
Today’s high heels are almost as rough on modern women’s feet, so it’s no surprise that 80% of all foot problems occur in women.
But men’s feet haven’t fared too well either. The stresses and inactivity of contemporary life often lead to obesity. And if those extra pounds weren’t enough to make a pair of feet ache, the out-of-shape, weekend athlete doesn’t always wear the right shoes for the right activity. The result, often as not, is a foot problem or two. And wearing improper footwear on the job not only causes painful problems for the worker, but contributes to thousands of hours of downtime – which translates into the loss of millions of dollars – in industry each year.
Fortunately, most foot problems can be prevented. Just follow the Golden Rule: Be good to your feet . . . and they’ll be good to you.
Tarsal tunnel syndrome — tarsal: meaning the lower ankle area of the foot — is a condition that usually affects the medial (inside) aspect of the ankle. There are many structures that run through this area, including tendons, veins, arteries and nerves. Tarsal Tunnel Syndrome occurs when the posterior tibial nerve, as it courses under the ligament at the ankle, becomes inflamed for a variety of reasons, namely: excessive pronation, arthritic problems such as rheumatoid arthritis, trauma, and even obesity.
The symptoms that are characteristic of this disease are persistent burning pain, pain that radiates down to the toes and/or up to the lower leg, and pain that is usually unremitting, in that is does not subside after weight has been removed from the foot.
Simple techniques to relieve some of the symptoms are ice, anti-inflammatories, immobilization (such as with a cast walking boot) and cortisone injections. In some cases where the pain is unresolved after conservative measures have been employed, then surgery is utilized. Sweaty Feet / Foot Odor
Sweaty feet (hyperhydrosis) and smelly feet (bromohydrosis) are two very common, annoying conditions of the feet. While some cases of excessive smelling or sweating of the feet are systemic (throughout the whole body) in nature, such as anemia (low blood count) or hyperthyroidism (overactive thyroid), these conditions are usually of a local cause.
The wearing of shoes that have synthetic materials, which most shoes have, especially tennis shoes, and socks that are of man made fabric are contributing factors of the production of excessive perspiration and the bacteria growth that causes this condition. These two conditions set up a condition called athletes foot (tinea pedis).
Stress Fractures
Stress fractures are usually the result of altered biomechanics, in that the structures of the foot are either mechanically not stable and/or the bones of the foot are subjected to repetitive micro trauma.
A runner with a mildly pronated foot could very easily sustain a stress fracture by repetitive usage on an altered biomechanical foot.
Stress fractures usually take time to develop and the symptoms are pain, redness and swelling. X-rays are usually only positive after about three weeks of symptoms. In some cases, a bone scan is necessary to make the diagnosis. Again, treatment for this condition, like most conditions of the foot, requires immobilization, ice and compression. Orthotics are the best treatment for long-term control of stress fractures. Immediate control would consist of a cast boot.
Shin Splints
A shin splint is technically the tearing away of the anterior tibial muscle from the bone. Shin splints, or tenosynovitis of the anterior tibial muscle (the muscle that runs from the mid portion of the foot up the front of the leg, just below the knee, on the inside front of the calf) is usually caused by over-use. Beginning runners or other people who engage in sport activities who have not sufficiently allowed their muscle tone to build up over a proper conditioning program, or whose conditioning program is too rigorous in the beginning, develop shin splints.
However, people with biomechanical, excessive pronation or supination of the foot also develop shin splints. Ice wraps, the Cho-Pat Shin Splint Sleeve, anti-inflammatories, and a shorter stride are also good modalities for this problem.
Definition:Sesamoiditis is a common ailment that affects the forefoot, typically in young people who engage in physical activity like running or dancing. Its most common symptom is pain in the ball-of-the-foot, especially on the medial or inner side. The term is a general description for any irritation of the sesamoid bones, which are tiny bones within the tendons that run to the big toe. Like the kneecap, the sesamoids function as a pulley, increasing the leverage of the tendons controlling the toe. Every time you push off against the toe the sesamoids are involved, and eventually they can become irritated, even fractured. Because the bones are actually within the tendons, sesamoiditis is really a kind of tendinitis – the tendons around the bones become inflamed as well.
Sesamoiditis typically can be distinguished from other forefoot conditions by its gradual onset. The pain usually begins as a mild ache and increases gradually as the aggravating activity is continued. It may build to an intense throbbing. In most cases there is little or no bruising or redness. One of the major causes of sesamoiditis is increased activity. You’ve probably stepped up your activity level lately, which has forced you to put more pressure on the balls of your feet. Speedwork, hillwork, or even increased mileage can cause this. If you have a bony foot, you simply may not have enough fat on your foot to protect your tender sesamoids. Also, if you have a high arched foot, you will naturally run on the balls-of-your-feet, adding even more pressure.
Treatment for sesamoiditis is almost always noninvasive. Minor cases call for a strict period of rest, along with the use of a modified shoe or a shoe pad to reduce pressure on the affected area. This may be accomplished by placing a metatarsal pad away from the joint so that it redistributes the pressure of weight bearing to other parts of the forefoot. In addition, the big toe may be bound with tape or athletic strapping to immobilize the joint as much as possible and allow for healing to occur. It is recommended to decrease or stop activity for awhile. This will give your sesamoids time to heal. You should apply ice to the area for 10 to 15 minutes after exercise, or after any activity that aggravates the area. As with icing, anti-inflammatories will help the swelling go down so healing can begin. While the injury is healing, women should wear flat shoes on a daily basis. If home remedies do not work, see your doctor for a correct diagnosis.
Pregnancy & Your Feet
Definition:Pregnancy triggers many different changes in a woman’s body. Many women have common complaints throughout their pregnancy. One of these complaints, often overlooked, is foot pain. Due to the natural weight gain during pregnancy, a woman’s center of gravity is completely altered. This causes a new weight-bearing stance and added pressure to the knees and feet.Two of the most common foot problems experienced by pregnant woman are over- pronation and edema. These problems can lead to pain at the heel, arch, or the ball-of-foot. Many women may also experience leg cramping and varicose veins due to weight gain. Because of this, it is important for all pregnant women to learn more about foot health during their pregnancy to help make this nine month period more comfortable for them.
Two of the most common foot problems experienced by pregnant woman are over- pronation and edema. These problems can lead to pain at the heel, arch, or the ball-of-foot. Many women may also experience leg cramping and varicose veins due to weight gain. Because of this, it is important for all pregnant women to learn more about foot health during their pregnancy to help make this nine month period more comfortable for them.
Cause:Over-pronation and edema a very common foot problem experienced during pregnancy.
Over-Pronation, also referred to as flat feet, is caused when a person’s arch flattens out upon weight bearing and their feet roll inward when walking. This can create extreme stress or inflammation on the plantar fascia, the fibrous band of tissue that runs from the heel to the forefoot.
Over-pronation can make walking very painful and can increase strain on the feet, calves and/or back. The reason many pregnant women suffer from over-pronation is the added pressure on the body as a result of weight gain. Over-pronation is also very prominent in people who have flexible, flat feet or in people who are obese.
Edema, also referred to as swelling in the feet, normally occurs in the latter part of pregnancy. Edema results from the extra blood accumulated during pregnancy. The enlarging uterus puts pressure on the blood vessels in the pelvis and legs causing circulation to slow down and blood to pool in the lower extremities. The total water fluid in the body remains the same as before pregnancy, however it becomes displaced. When feet are swollen, they can become purplish in color. Sometimes extra water is retained during pregnancy, adding to the swelling. If there is swelling in the face or hands, a doctor should be contacted immediately.
Treatment and Prevention
There are effective ways to treat both over-pronation and edema during pregnancy.
Over-Pronation can be treated conservatively with “ready-made” orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to correct the over-pronation. Proper fitting footwear is also very important in treating over-pronation. Choose comfortable footwear that provides extra support and shock absorption.
It is important to treat over-pronation for pain relief but also to prevent other foot conditions from developing such as Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-Tib Tendonitis and/or Bunions.
Edema in the feet can be minimized by the following methods:
· Elevate your feet as often as possible. If you have to sit for long periods of time, place a small stool by your feet to elevate them.
· Wear proper fitting footwear. Footwear that is too narrow or short will constrict circulation.
· Have your feet measured several times throughout your pregnancy. They will probably change sizes.
· Wear seamless socks that do not constrict circulation.
· If you are driving for a long period of time, take regular breaks to stretch your legs to promote circulation.
· Exercise regularly to promote overall health; walking is the best exercise.
· Drink plenty of water to keep the body hydrated. This helps the body retain less fluid.
· Eat a well-balanced diet and avoid foods high in salt that can cause water retention.
Swelling is normally similar in both feet. If swelling is not symmetrical in both feet, this may be a sign of a vascular problem and a doctor should be contacted immediately.
If any problems persist, consult your doctor.
Definition:Of the 16 million Americans with diabetes, 25% develop foot problems related to the disease. This is primarily due to a condition called neuropathy. Diabetic Neuropathy is a complication of diabetes that affects the nerves. The most common type of diabetic neuropathy is called peripheral neuropathy and affects the peripheral nerves. Peripheral nerves are the nerves that go out from the brain and spinal cord to the muscles, skin, internal organs, and glands. Peripheral neuropathy impairs proper functioning of these sensory and motor nerves. The most common symptoms of neuropathy include numbness and loss of feeling, usually in the feet and hands.
Cause:Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.
It is very important for diabetics to take the necessary precautions to prevent all foot-related injuries. Due to the consequences of neuropathy, daily observation of the feet is critical. When a diabetic patient takes the necessary preventative footcare measures, he or she reduces the risk of developing serious foot conditions.
Treatment and Prevention:The most successful way to prevent diabetic neuropathy from occurring is to control the diabetes. It is important to maintain blood sugars at normal levels and maintain normal blood pressure. In addition to this, it is important to:
· Stop Smoking
· Limit the amount of alcohol you drink
· Have regular physical exams
· Have regular blood and urine tests
· Exercise regularly, according to your doctor’s recommendation.
It is important for diabetics to treat their feet properly to avoid any future problems. Footwear and foot orthotics play an important role in diabetic footcare. Footwear that fits poorly can cause irritation and injury.
· Diabetic footwear should also provide the following benefits:
· High, wide toe box (high and wide space in the toe area)
· Removable insoles for fitting flexibility and the option to insert orthotics if necessary
· Rocker soles, designed to reduce pressure in the areas of the foot most susceptible to pain, most notably the heel and the ball-of-the-foot.
· Firm Heel Counters for extra and support and stability.
It is important for diabetics with neuropathy to take the necessary precautions to prevent injury and keep their feet healthy. If you have diabetes and are experiencing a foot problem, immediately consult with your foot doctor.
Neuroma: pinched nerve, nerve tumor, or swollen nerve are some common terms for a rather painful condition. A neuroma is usually situated between the third and fourth toes. They are characterized by a sharp, lancinating type pain, usually when the patient is wearing shoes. The patient feels that they may need to remove their shoe and rub their foot for relief. The reason for this patient activity is that the nerve between the toes is pinched by constricting shoe gear. When the pain becomes more frequent and lasts over a longer period of time, the nerve becomes enlarged.
Early treatment for the patient consists of a thick soled shoe, a wide toe box, and certainly avoidance of high heels.
A professional, such as a podiatrist, or an orthopedist trained in foot care, can offer many treatments for this condition. Usually an x-ray is indicated, and a complete exam and history is taken. The first line of treatment is usually injections of cortisone into the neuroma mixed with a local anesthetic. This is usually carried out to a maximum of three injections. Anti-inflammatory medications such as Motrin or Naprosyn are also used in the treatment of this condition. A third line of defense is biomechanical. Prescription orthotics, made from a cast of the foot are also beneficial in relieving pain of the neuroma.
But if all these conservative measures fail then surgical excision is indicated. Usually this surgery can be done under a local block (xylocaine) anesthetic, and is done on an out-patient basis. The recovery time for this procedure is usually less than three weeks and return to normal shoe gear is very rapid.
Achilles Tendonitis
Achilles tendonitis, enthesis, tenosynovitis, and bursitis are all terms that can be used interchangeably for the pain associated with the posterior or the back of the heel of the human foot.
The achilles tendon is the co-joined tendon of the Gastrocnemius and the soleus muscle which form the thickened tendon at the back of the leg as it inserts into the calcaneous (heel bone). This structure becomes inflamed and damaged from a variety of mechanical forces: pronation (inward tilting of the heel) or supination (outward tilting of the heel); excessive weight; over-use, such as running or tennis or other sport activities; and sometimes metabolic problems, such as diabetes, arthritis or even gout can play a major role in inflammation of the achilles tendon. However, most achilles tendon problems are mechanical in nature.
The following devices are usually effective in controlling this altered biomechanical problem:
· The Achilles Tendon Strap is very good in over-use injuries that runners would experience.
· Shortened achilles tendons (equinus deformities) are usually acquired by people who have worn high heeled shoes (any heel that is over an inch high) and who experience pain when they try to go down to a lower heeled shoe. The achilles shortening is best relieved with stretching exercises. The Night Splint is an excellent item for self-help in stretching out the achilles tendon. Some cases may need surgical lengthening.
· People that have excessive pronation or supination are best controlled with an orthotic device.
· Medical treatment would consist of anti-inflammatories, ice packs, and rest.