Heel Pain Strikes Even the Best Athletes

Plantar Fasciitis Disables Carlos Quentin

KANSAS CITY, Mo. — Outfielder Carlos Quentin, who led the Chicago White Sox in home runs last season, went on the 15-day disabled list Friday with painful plantar fasciitis in his left heel.

The condition causes soreness in the bottom of the heel when you walk or stand. The move was retroactive to Tuesday.

“You have to learn how to play with soreness,” manager Ozzie Guillen said. “But it’s hard to play when you’re in pain. That’s two different things — play when you’re sore and play when you’re in pain. And I think he was in pain for all this month and that’s why I think it was hard for him to perform.”

Source: ESPN

 

Dr. Nirenberg’s Comments:

Plantar fasciitis is number one reason for heel pain.

Surprisingly, heel pain due to plantar fasciitis often occurs after the person has been resting and first starts walk. Patients often tell me they hate to get out of bed. This isn’t because they want more sleep, but due to excruciating pain in their heel the moment their foot touches the floor.

 The pain may ease up or even go away completely as the person continues to walk. However, as soon as they rest and resume walking, it often returns with a vengeance. Plantar fasciitis is due to an inflammation of the main ligament in our heel. There are many conservative treatments for this problem and surgery is usually not necessary.

 

Dr. Michael Lacey, my associate, writes:

Many of our elderly or overweight patients believe heel pain is due to their age or weight. When heel pain is due to plantar fasciitis, age or weight may be part of the problem, but the main issue is usually an abnormality with the structure of the person’s foot. Clearly, Carlos Quentin of the Chicago White Sox is a 26 year old professional athlete in great physical shape!

Nonetheless, he is now on the disabled list—for at least two weeks. He has tried to play through the pain but recently, but it became so severe he had to be carried off the field. 

In our practice, plantar fascitis is the most common cause of heel pain and one of the most common ailments that we treat. If you have plantar fasciitis, see a podiatrist – don’t let it put you on the disabled list.

Are Your Running Shoes Dangerous?

Is it time to go bare?

Should You Toss Your Running Shoes and Just Go Barefoot? 

Remember when you were a kid? You raced around the playground or the yard for hours at a time, somehow managing not to hurt yourself despite your lack of $150 running shoes and custom-made $400 orthotic inserts. There’s a growing sense in many quarters that your childhood impulse may have been the correct one and that the very shoes we think are protecting us from harm may be causing it.

For decades, there’s been a grass-roots movement for extremely minimalist, i.e., barefoot, running. But only in the past few years have shoe companies begun to get in on the act, too. They now offer stripped-down models that don’t have the padding and structural elements that characterize conventional running shoes. There’s no little irony in Nike’s instructions to begin “barefoot-like” running with one $90-plus model of its Free lineup, then phase down through two more models before you’re running with a “nearly naked feeling.” (Presumably, they don’t want you to take the next step and swap Nikes for the actual naked feeling, though.) Other companies, including New Balance, Newton, Ecco, and Terra Plana, also have minimalist footwear for running and walking.

In his recent book, Born to Run, author Christopher McDougall explores the broader notion of what “natural” running would entail. Taking aim at shoe companies, he argues that modern running shoes promote a heel-first stride that makes us more vulnerable to injuries. (He’s a convert; since running in Vibram FiveFingers, a neoprene socklike foot covering, and changing his stride, he’s seen his problems disappear.) McDougall cites studies showing that more expensive running shoes don’t necessarily lead to fewer injuries. Other research suggests that heavily cushioned shoes actually prevent your foot from sensing the ground and can make you stomp down harder than if you didn’t have all that padding.

“They don’t let the foot, and ultimately the body, work like it’s supposed to,” says Galahad Clark, owner of Terra Plana, which produces a shoe technology—Vivo Barefoot—that puts just a 3-millimeter, flexible (but puncture-resistant) sole between your foot and the ground.

 

Vivo Barefoot Running Shoe

“Expensive running shoes let you run in a way and arguably for distances that you normally wouldn’t have been able to do,” he says. Walking and running barefoot, or close to it, allows what Clark calls your “amazing” foot to adjust to whatever surfaces—even modern, hard ones—and circumstances it experiences.

So what’s the evidence behind this notion? And should you try it? There isn’t strong evidence that barefoot running is any better or worse than running with more structured shoes, says Veni Kong, a kinesiologist at the University of Texas-El Paso, in part because there aren’t enough regular barefoot runners with whom to compare users of running shoes. But there’s a lack of a solid evidence base for running footwear in general, she notes. People are often prescribed shoes with elevated, padded heels that are designed to control pronation, but a March review in the British Journal of Sports Medicine found no evidence behind the idea that this will prevent injury or improve performance.

Keith Williams, an exercise biologist at the University of California-Davis, says humans are both incredibly varied and incredibly adaptable. The former means some of us pronate our feet as few as 2 degrees, and others as much as 25 degrees. Our bones articulate differently, our ligaments are structured differently. Some of us are heavy, some aren’t. And some people, he says, have truly been helped by modern shoes, inserts, and orthotics. Others probably don’t need the bells and whistles. So to prescribe one kind of shoe (or lack thereof) or running technique for everyone is not a good idea. “I’m against the one-size-fits-all approach for anything,” he says.

On the other hand, Williams says, our adaptability means that a lot of us could probably adjust over time to running with minimal or no cushioning, and for some, it might bring benefits. Just by wearing lighter footwear, you reduce the amount of energy involved in running. That kind of change, or varying the stresses on the lower legs, could theoretically reduce injury or improve performance for some people.

If you’d like to give it a whirl, don’t jump into it whole hog. Start off slowly, advises Kong, and stop if it doesn’t feel right, since you’re probably used to wearing regular shoes and need to adjust. “If we said to everyone in the world, just kick off your shoes and go running, a lot of people would hurt themselves,” says Clark. Obviously, be aware of the surface you’re running on; simply to protect against cuts and scrapes, going totally barefoot down the sidewalks of New York is probably not a great idea. If you’re using minimalist shoes, try to avoid landing on your heel, which you may be used to doing in padded shoes, and perhaps start out by running on grass, Clark says. In the end, he says, the ultimate experts on footwear are you and your body.

 

Source: U.S. News & World Report

 

Dr. Nirenberg’s Comments: 

Certainly, some running shoes can injure your feet, ankles or knees. But, that assumes you are wearing the right running shoes for your foot structure, biomechanics and deformities (if any).

Having to choose between a properly fitted, well-designed running shoe or going barefoot, is an easy decision. Wear the shoe.

Most people’s feet and ankles need good biomechanical control and support—especially runners.

However, there are exceptions. Some people do excel at barefoot running. I would suspect these athletes have a very good biomechanic structure to their feet and don’t need additional biomechanic control or support.

I would ponder to guess that the successful barefoot runners adapt to running barefoot and since they literally feel the ground and surface they consciously or eventually, unconsciously, place their foot on the ground in a way that protects them.

For those people who are considering barefoot running, I would only try it on a safe surface and if you have good health and great foot health—no biomechanical faults, foot weakness or other foot deformities.

Lastly, I will read McDougal’s book and give you an update on my thoughts. If anyone has read it or has experiences running barefoot, I would love to hear about them.

Feet Need Vitamins too

 

Many of my older patients wish they had taken better care of their feet when they were younger.

Thankfully, doctors and the health food industry are finally recognizing what many people have wanted for years: safe, natural ways to keep their feet strong and healthy.

The safest, simplest way to keep your feet healthy throughout life is already in your kitchen: water.

 

 

Water regulates temperature and metabolism, delivers electrolytes to muscles and lubricates our joints.

With each foot containing 33 joints and depending on 19 muscles, even slight dehydration can cause your feet to cramp and fatigue.

I recommend drinking eight glasses of water a day.

Guzzling Mountain Dew, Mocha Frappuccinos or six-packs of Bud Light isn’t the same.

Caffeinated and alcoholic beverages can actually cause dehydration.

Drinking water, not only for your feet, but also for your whole body, should be common sense, yet at any time, 75 percent of Americans are mildly dehydrated.

Moderate or severe lack of water can make feet cold and more vulnerable to infection.

Dehydration can also make toenails brittle and the skin of our feet dry.

Dry skin may not seem like a big problem, but on the feet, dry skin can crack and develop deep, painful fissures that are at risk for infection.

 

A patient with dry skin on their heel.

 

I’ve seen simple breaks in the skin, particularly in the feet of the elderly and people with diabetes, lead to catastrophic infections, at times resulting in the foot’s amputation.

However, dry skin on the feet may indicate more than just a lack of moisture.

Sometimes it’s psoriasis, a fungal infection or a sign of a more serious condition, such as diabetes, poor circulation or a thyroid disorder.

If your feet have severe or persisting dry skin, you should see a podiatrist.  

The best way to soothe dry skin is with moisturizers and applying vitamin A, D and E. You can put these on your feet separately, mix a concoction or buy a vitamin-enriched cream.

When choosing a cream, don’t go by price; more expensive doesn’t mean better.

Read the ingredients and avoid products containing alcohol or alcohol derivatives, which actually dry skin. Surprisingly, alcohol is common in many so-called moisturizers.

Dry, irritated skin also responds to foot powder, particularly when the powder is enriched with zinc or menthol.

A sprinkle a day will not only help keep the skin moisturized, but also lessen odor and perspiration.

Urea also helps keep feet healthy. A natural compound, urea attracts moisture, slowing its escape from the skin. Look for it by itself or in moisturizers.

For patients with severely cracked heels, I often prescribe medicated creams containing 40 percent urea.     

I also recommend urea for frail, brittle toenails.

To strengthen toenails, apply Biotin, a B vitamin, and take calcium and vitamin A. Vitamin C helps nails too—not that they have to fight off colds, but they can get painful hangnails, which this vitamin prevents.

Caring for your feet as you age also means keeping your bones strong.

Bones form the foot’s foundation, in turn supporting our entire body. With aging, bones lose strength and develop osteoporosis.

Combine osteoporosis in your feet—each foot a jigsaw puzzle of 28 small bones—with a one hundred and fifty or two hundred pound person landing on them repeatedly and you have a great chance for fractures.

Women past menopause are at the greatest risk for osteoporosis.

A simple test can check for osteoporosis and, if necessary, your doctor will prescribe medication.

To help prevent osteoporosis, eat foods rich in calcium and vitamin D and exercise regularly, doing activities that put weight on your feet such as walking, aerobics or weight lifting.

Lastly, vitamins and minerals—and in rare cases, even water—are not always safe for everyone. Before starting any supplements, always check with your doctor.

Common Foot Problems to Watch For

Painful Hammertoes & Fungal Toenails

Eighty percent of people, at some point in their lives, have a foot problem that requires medical care.

However, many people let their problems persist and worsen untreated.

Here is a list of the most common foot problems I see in my practice that you can watch for to ensure the health of your feet.

  

Heel Pain

Heels get a bad rap. The dictionary defines a heel as a dishonorable person, and the term “Achilles’ heel” refers to a fatal weakness.

The reality is your heels are quite strong, though no other part of your foot malfunctions more. Heel pain is the number one reason people come see me.

Heel pain can be very complicated and may have a variety of causes, including a stress fracture, pinched nerve, bone cyst, or tumor.

Most patients with heel pain believe they have a heel spur.

This may be part of the problem, but the most common cause of heel pain—whether or not a heel spur is also present—is inflammation of the largest ligament in our foot, the plantar fascia. In doctor-speak, this problem is called plantar fasciitis.

 Treatments for plantar fasciitis range from custom-made arch supports (called orthotics), to simple stretching exercises, to the revolutionary, high-tech shockwave treatment. 

 

Nerve Problems

 Burning, numbness, tingling, or shooting pain in your feet or ankles often means something is wrong with a nerve.

Nerve problems are common in feet, so if you have one, don’t get nervous. Most of the time, the treatment is relatively simple.

The main nerve problems I see are:

 

• Morton’s Neuroma

Not to be confused with Morton’s Steakhouse—which may cause a full stomach—Morton’s neuroma causes cramping, tingling (a feeling of pins and needles), burning, or shooting pain in the toes or ball of your foot.

A neuroma is a painful growth on a nerve that forms when the nerve becomes irritated.

Treatment for neuromas consists of using a special arch support, called an orthotic, and sometimes injections are needed. Surgery is rarely necessary.   

 

• Tarsal Tunnel Syndrome

Almost everyone has heard of carpal tunnel syndrome in the hands, but few people realize the same problem occurs in our feet.

Tarsal tunnel syndrome may cause burning, tingling, shooting pain, or a cramping sensation in your foot.

The good news is that there is a light at the end of this tunnel. Tarsal tunnel syndrome is often easily treated with orthotics, injections or a short, outpatient procedure.   

 

• Neuropathy

Neuropathy literally means a “disease of the nerves,” and it affects millions of people each year. Persons with neuropathy often experience loss of sensation, burning, tingling, or shooting pain.

The number one body part affected by neuropathy is the feet. Persons with diabetes are those most afflicted with neuropathy, but it also occurs in people with thyroid problems, vitamin deficiencies, alcoholism, and some types of arthritis.

Neuropathy has many treatment options and some people might opt for a new, somewhat controversial, procedure that involves surgically freeing up the nerves to restore normal sensation to their feet.

 

Arthritis of the Foot and Ankle

Degenerative joint disease, osteoarthritis, or just plain old “Arthur” is a deterioration of the joints between our bones.

When Arthur visits people’s feet or ankles, many believe they just have to live with it. This is far from the truth. The reality is podiatrists have many techniques to alleviate arthritis, including a high-tech, tiny arthroscopic camera that can remove arthritis from sore ankles.    

 

Nail Problems

I am not talking about rusty nails on your garage floor, but ingrown toenails and fungal toenails. Ingrown toenails occur when the edge of the nail grows deep into the flesh of the toe.

These are painful and can become infected. Fortunately, a brief, in-office technique can alleviate ingrown toenails, often permanently.

Fungal toenails are another story, and usually require a long course of medication.

 

Bunions

These are protrusions of bone or bumps that form on the inside of the foot at the joint at the base of the big toe.

If you wear ill-fitting shoes, don’t blame them for bunions—blame your parents. Bunions are inherited. However, poor footwear can contribute to the formation of a bunion.

Numerous conservative treatments, such as trying wider shoes or foot soaks, can alleviate painful bunions, though getting rid of them requires a short, outpatient surgical procedure.

 

Other Big Toe Problems

 

• Hallux Rigidus

With hallux rigidus, the big toe may look normal; however the inside of the joint at the base of the big toe is deteriorated and painful.

Sometimes the big toe won’t bend. Like bunions, simple treatments can lessen the pain, but in on some cases surgery is necessary.

 

• Gout

Known as the “rich man’s disease,” gout doesn’t just affect the rich. Gout is a type of arthritis that most often occurs in the joint at the base of the great toe, causing redness, swelling, and pain.

Some patients have said the pain was so severe that they couldn’t stand the bed sheet resting on their toe. Other patients describe less intense symptoms.

Gout occurs when too much uric acid is present in your body. Uric acid is a natural chemical that your body manufactures, and you ingest in certain foods, like pork, beer, or liver.

Treatment consists of altering your diet to limit the amount of uric acid you ingest, and if that isn’t enough, medication is prescribed.

 

Corns and Callouses

Corns have nothing to do with plants that grow ears. Painful corns (and callouses) are a build-up of hard, dead skin that often occurs due to an abnormal bony prominence or a bone out of position.

Corns occur on toes and callouses are found on the bottom of the foot.

Contracted toes (hammertoes) cause corns to form, and callouses form when a bone or bones are out of position. Treatment of a corn or callous depends on what is wrong with the bone underneath them.

 

Final Thoughts on Common Foot Problems

 

These are the top foot and ankle offenders, but the list of problems I see in my practice is endless. If you have foot or ankle pain or another problem, the best thing you can do is have it checked by a podiatrist.

Dr. Nirenberg Publishes Article: Is that blister really a blister?

IS THAT BLISTER REALLY A BLISTER?

Published in the Fixing Your Feet Ezine – http://vonhof.typepad.com/fixingyourfeet/
By Michael Nirenberg, DPM

Having treated thousands of feet, I often see patients complaining of a blister that is actually a type of cyst called a mucoid cyst. Recognizing you have a mucoid cyst and not a blister is important because mucoid cysts are treated differently. The key differences between blisters and mucoid cysts are:

•    Blisters can occur anywhere on the foot. Common places for blisters are the ball of the foot, the back of the heel, or on or between the toes. Mucoid cysts only occur on the top of the toes or fingers beside the nail or about a centimeter from the nail.
•    Blisters often develop from friction. We don’t know why mucoid cysts develop, however, scientists believe they are the result of minor trauma to the toe or finger. In runners, this could be due to the repetitive jamming of the toe against the shoe. 
•    Blisters contain a clear watery-like fluid sometimes tinged with blood, whereas mucoid cysts have a thick, jelly-like substance.
•    Blisters come in various shapes and sizes; mucoid cysts are dome shaped and round.

There are two types of mucoid cysts: those connected to a joint inside the finger or toe and those that are isolated or not connected to a joint. Most mucoid cysts are painless, though tight-fitting shoes can cause them to become painful. 
     Mucoid cysts tend to occur more often in females and usually during the fifth to seventh decades of life, but I have seen them occur in people of all ages, including teenagers.

The treatment for a blister is usually to drain it. Mucoid cysts will usually recur if simply drained; they require surgery. The doctor will need to excise the entire cyst, often dissecting down to the bone. However, if the mucoid cyst is not painful, you can ignore it or if it only causes minimal discomfort, your doctor may recommend padding it with moleskin or felt.
     Whenever any mass or lesion occurs on your foot, have it checked by a podiatrist; for lesions or masses elsewhere on your body, see a dermatologist. Even though you may believe it’s nothing serious, in some cases, an abnormal lesion or mass could be cancer.

Dr. Michael Nirenberg, “America’s PodiatristSM,” is a podiatric physician, surgeon and forensic podiatrist. 

Photos are used with permission: Dockery GL: Cutaneous Disorders of the Lower Extremity, WB Saunders, 1997.