Tuesday, October 4, 2011

My Heel Is Killing Me... It Hurts So Much... What Is It?

Author: Nathan Wei

Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better.
It's estimated that more than 1 million persons in the United States suffer from heel pain at any given time.
When a patient complains of heel pain, it must be clarified by history whether the pain is in the bottom of the heel or the back of the heel because the diagnosis and treatment are very different.

Pain in the bottom of the heel is often due to plantar fasciitis (PF). The plantar fascia is a tough band of tissue that begins at the medial (inside) part of the bottom of the heel and extends forward to attach at the ball of the foot. The fascia is responsible for maintaining the normal arch. When an excessive load is placed on the fascia, pain can develop at the origin (the heel) as well as the mid-portion (arch) of the fascia.

PF can develop in anyone but is more common in certain groups such as athletes, people older than 30 years of age, and obese individuals.
PF must be distinguished from other causes of bottom of the heel pain such as nerve entrapment, atrophy of the normal heel fat pad, stress fracture of the calcaneus (heel bone), rupture of the plantar fascia, bone cyst, bone tumor, and bone infection.

The history typically describes a gradual onset of symptoms with no prior trauma. The most telling symptom is severe pain in the bottom of the heel when taking the first morning step. Patients may report difficulty walking to the bath room. The pain tends to lessen with more walking. This "first step" pain is also present during the day if the patient has been sitting for awhile, then getting up to walk.

On exam, pain is noted with pressure applied to the medial bottom of the heel. Tenderness is worsened by pointing the toes and ankle toward the head. This is because the plantar fascia is being stretched. Pain in the arch may also be present.
One in older patients should be ruled out and that is heel pad atrophy. Normally the heel has a thick feeling to it. In older patients the heel pad may lose this thickness and flatten out. The pain is located more centrally.

Another "fooler" is entrapment of the lateral plantar nerve. Pain is felt in the medial heel but may be present at rest as well. There may be weakness spreading the toes.
Fracture of the calcaneus (heelbone) causes pain at rest that is worsened with walking. Tenderness is present along the sides of the heel. Magnetic resonance imaging (MRI) can confirm the presence if fracture.

But what about "bone spurs"? The presence of a bone spur by itself means nothing. They are very common and by themselves are not a cause of pain. Some patients with inflammatory forms of arthritis such as psoriatic arthritis, ankylosing spondylitis, or Reiter's disease have a specific type of spur that should prompt further evaluation looking for systemic forms of arthritis.

Diagnostic studies such as ultrasound and magnetic resonance imaging can be used to confirm the presence of plantar fasciitis. Electromyography (EMG) may be needed to rule out lateral plantar nerve entrapment.



So how is this condition treated?



The first thing is to institute a stretching regimen. Most people with PF also have a shortened Achilles tendon and the ability to dorsiflex (point the toes up) is limited. The plantar fascia is continuous with the Achilles fascia. Stretching the plantar fascia and the Achilles decreases the tension in the plantar fascia and helps relieve inflammation.

A temporary reduction in activity is important in athletes, particularly runners. Cross training with swimming and cycling can help maintain cardiovascular fitness while sparing the plantar fascia from pounding. Runners should avoid hills and make sure that any foot abnormality be corrected with custom orthotics.
Ice massage with ice cubes applied to the plantar fascia can also be helpful.

Shoes with soft heels and inner soles can relieve discomfort. Rigid heel cups and arch supports are generally not recommended. The patient may gradually resume normal activities over an eight week period of time. Rushing rehabilitation is not advised.

If there is no improvement, a night splint which holds the ankle in 10 degrees of dorsiflexion prevents the shortening of the plantar fascia.
If the night splint fails or the pain does not lessen, injection of glucocorticoid (cortisone) using ultrasound guidance is recommended. Injections should be limited to a maximum of two given over four weeks.

Patients who do not get better need to be reevaluated for systemic disease or other conditions causing heel pain.Surgery is the last resort. Transverse release of the plantar fascia is the procedure of choice. This can be done using arthroscopic guidance.
Pain in the back of the heel is an entirely different condition.The major structure here is the Achilles tendon which extends down from the gastrocnemius muscle to attach at the rear of the calcaneus.



Inflammation of the Achilles tendon can occur, usually in athletes or in people in engage in overxuberant physical activity involving running or jumping. Patient who are overweight are also at risk. The pain is usually described as a soreness. There is localized swelling and tenderness. Ultrasound can be used to differentiate an inflamed Achilles tendon from one that is partially or fully torn. The treatment involves anti-inflammatory medicines, physical therapy, and stretching exercises. Glucocorticoid injection is not recommended because of the danger of weakening the Achilles tendon leading to rupture. Using a foam rubber lift to elevate the heel in a shoe can help with symptoms. Achilles rupture is handled surgically and requires a long recuperation.



Haglund's syndrome, which is a condition where a spur develops at the back of the calcaneus and is often associated with localized Achilles tendonitis can also cause pain in the back of the heel. Ill-fitting shoes are the most common cause. Typically a bump develops at the back of the heel. Because of its association with ill-fitting shoes, this is sometimes referred to as a "pump bump." Physical therapy, anti-inflammatory medicines, and stretching can often be of benefit. Glucocorticoid injection should be sparingly employed because of the danger of Achilles rupture. Wearing proper fitting shoes are an obvious adjunctive treatment.



Bursitis involving the retrocalcaneal bursa (the small sack that lies between the Achilles tendon and the calcaneus is a cause of pain behind the heel. Treatment involves the use of physical therapy modalities such as ultrasound. Sometimes glucocorticoid injection may be needed. It is important to limit the injection to one because of the danger of possible weakening of the Achilles tendon leading to rupture. Ultrasound needle guidance is advised to ensure proper localization of the injection.



The diagnosis is made by history and physical examination. Both MRI and ultrasound can be used for confirmation.
Article Source: http://nathanwei.articlesbase.com/medicine-articles/my-heel-is-killing-me-it-hurts-so-much-what-is-it-188558.html

About the Author :

Nathan Wei MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. For more info : Types of Arthritis

A Burning Headache And Some Of Its Causes


Author: Ann Marier

Many people suffer from this common nuisance called burning headache every day, in some cases which can even last for days. Burning headache is not a medically recognized term if you were to look around in medical journals and clinical documents, but it's pretty much commonly used. There are many different causes of burning headache, and different people have different parts of the head which aches. Besides, there are also many different causes of this headache, some of which we will be looking at today.



Different Parts of the Head



In many instances, burning headache is related to sinusitis. In that case, the pain is usually on the frontal part of the head, on the forehead, upper cheeks, and sometimes can even travel around the whole face. In other cases, this burning headache can be caused by fever. In this, the pain is usually on both sides of the forehead, which are the weakest points of sensitivity in our head.



Causes



As we have already known, the common reasons for burning headache would be fever, flu, and sinusitis. In these cases, the pain is constant, and can be stinging and tingling, and not to mention burning. It can originate from any side of the head, but usually after a while it will travel to other areas as well.
Some people tend to get thrusts of extreme pains. Although medically there is no proof as to what causes this sudden uprising in the burning headache symptoms, it is believed to be caused by pulsating nerves due to tension.



Burning headache can also be caused by certain other reasons besides the above listed. These are more serious cases such as tumors or growth in the head. In such cases, the pain is not constant like the ones listed above, but comes on and off. The pain is usually violent, far stronger than the ones you get for fever, and not to forget; it pulsates often.



It is also believed that toxins and chemicals can also cause acute or burning headache. This is pretty common to many people, especially those who are not so favorable of newly painted houses, chemical labs, and so on. On top of these, even certain edible toxins and foods can cause burning headache, such as alcohol, caffeine, and so on.



Alcohol and caffeine especially, are believed to be causes of many serious headaches that can cause the whole head to ache severely, with the nerves being extremely tensed.
Article Source: http://annmarier.articlesbase.com/medicine-articles/a-burning-headache-and-some-of-its-causes-138084.html
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