�because nerds like us are allowed to be unironically enthusiastic about stuff� Nerds are allowed to love stuff, like jump-up-and-down-in-the-chair-can�t-control-yourself love it. Hank, when people call people nerds, mostly what they�re saying is �you like stuff.� Which is just not a good insult at all. Like, �you are too enthusiastic about the miracle of human consciousness�.

What Is A Heel Spur

Posterior Calcaneal Spur

Overview

A heel spur also known as a calcaneal spur, is a pointed bony outgrowth of the heel bone (calcaneus). Heel spurs do not always cause pain and often are discovered incidentally on X-rays taken for other problems. Heel spurs can occur at the back of the heel and also under the heel bone on the sole of the foot, where they may be associated with the painful foot condition plantar fasciitis.

Causes

The plantar fascia is a big strong ligament on the bottom of the foot, starting at the bottom of the heel bone and running into the ball of the foot. As the arch of the foot becomes weak, it sags slightly with each step and this causes the plantar fascia to tug and pull at the heel bone with each step. Over a period of time, a spur forms where this big strong ligament tugs and pulls at the heel bone. Soon, inflammation (swelling) starts around this spur and the pain becomes almost unbearable. (Sometimes heel spurs may be present without being painful if no inflammation is present).

Calcaneal Spur

Symptoms

Heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain. Your heel pain may be worse in the morning when you first wake up or during certain activities.

Diagnosis

Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.

Non Surgical Treatment

The first line of treatment for Heel Spur is to avoid the activities and positions that cause the pain. A physician can evaluate your foot with an X-ray to diagnose Heel Spur and determine a course of treatment. This condition can often be treated by non-surgical means; however in severe cases surgery may be necessary to relieve the pain. The most common surgical procedures treat the soft tissues around the Heel Spur, often a tarsal tunnel release or a plantar fascia release. Injections for heel spurs are sometimes controversial as steroids may cause heel pad atrophy or damage the plantar fascia.

Surgical Treatment

Heel spur surgery should only be considered after less invasive treatment methods have been explored and ruled insufficient. The traditional surgical approach to treating heel spurs requires a scalpel cut to the bottom of the food which allows the surgeon to access the bone spur. Endoscopic plantar fasciotomies (EPF) involve one or two small incisions in the foot which allow the surgeon to access and operate on the bone spur endoscopically. Taking a surgical approach to heel spur treatment is a topic to explore with a foot and ankle specialist.

What Are The Main Causes Of Inferior Calcaneal Spur

Posterior Calcaneal Spur

Overview

Heel spurs are a common reason for people to visit their podiatrist serving Scottsdale. These small calcium deposits can cause major pain, but treatments are available to relieve your symptoms. Heel spurs grow along the plantar fascia and create a sensation similar to that of a pebble being stuck in your shoe. Your podiatrist will use a physical exam plus X-rays to determine if a heel spur is the cause of your foot pain before beginning treatment. If you do have a heel spur, your podiatrist may recommend a cortisone injection to ease inflammation. Other techniques, such as stretching the calf muscles, treating the heel with ice, and wearing a custom orthotic may also provide relief from the discomfort of a heel spur.

Causes

Bone spurs can occur all over the body including the spine, shoulders, hands, hips and feet. The feet are a common place to find them. A heel spur happens when the body tries to mend itself. Building extra bone is one way your body tries to correct a weakness. Wearing shoes that are too tight in the heel can cause bone spurs. More women than men get heel spurs because of the kinds of shoes they wear. Athletes who stress their feet and legs routinely are also prone to heel spurs. Being overweight can also indirectly cause heel spurs by over-exerting the plantar fascia. Some heel spurs are caused by the aging process, in which the cartilage covering the ends of bones wears away. This process can lead to pain, swelling and spur formation. Stress-related problems with the plantar fascia frequently lead to heel spurs.

Posterior Calcaneal Spur

Symptoms

Heel spurs are most noticeable in the morning when stepping out of bed. It can be described as sharp isolated pain directly below the heel. If left untreated heel spurs can grow and become problematic long-term.

Diagnosis

The proper diagnosis of a heel spur often requires an X-ray. To make this process as convenient for his patients as possible, most clinics have an on-site digital X-ray and diagnostic ultrasound machines. This can make it unnecessary for patients to visit diagnostic imaging centers, allowing patients to receive more expedient treatment.

Non Surgical Treatment

FIRST, Reduce the acute pain. This is done by a combination of several things; injection of a synthetic relative of cortisone into the heel, a prescription of anti-inflammatory pills to reduce inflammation, physical therapy and a special heel pad. About 50% of the time, these treatments will permanently relieve the pain. In the other 50%, the pain becomes recurrent, and the treatment proceeds to Stage II. SECOND, Recurrent, painful heel spur is caused by the tug and pull of the plantar fascia ligament on the heel bone with each step. When the pain is recurrent, arch supports are made to prevent sagging of the arch. The arch supports are custom-made according to the size and shape of the feet. This prevents the arch from sagging and the ligament from tugging and pulling on the heel bone. The inflammation and pain eventually go away as the first phase of treatment is continued along with the arch supports, although the spur itself remains. THIRD, Surgery to remove the spur is possible and is usually done as Day Surgery.

Surgical Treatment

Surgery involves releasing a part of the plantar fascia from its insertion in the heel bone, as well as removing the spur. Many times during the procedure, pinched nerves (neuromas), adding to the pain, are found and removed. Often, an inflamed sac of fluid call an accessory or adventitious bursa is found under the heel spur, and it is removed as well. Postoperative recovery is usually a slipper cast and minimal weight bearing for a period of 3-4 weeks. On some occasions, a removable short-leg walking boot is used or a below knee cast applied.

Prevention

Heel Spur symptoms can be prevented from returning by wearing proper shoes and using customized orthotics and insoles to relieve pressure. It is important to perform your exercises to help keep your foot stretched and relaxed.

Treatment For Bursitis Of The Foot

Overview

Bursitis is defined as inflammation of a bursa. Humans have approximately 160 bursae. These are saclike structures between skin and bone or between tendons, ligaments, and bone. The bursae are lined by synovial tissue, which produces fluid that lubricates and reduces friction between these structures.

Causes

Normally, only one bursa is in the heel, between the Achilles tendon and the heel bone (calcaneus). This bursa may become inflamed, swollen, and painful, resulting in anterior Achilles tendon bursitis. Abnormal pressure and foot dysfunction can cause a protective bursa to form between the Achilles tendon and the skin. This bursa may also become inflamed, swollen, and painful, resulting in posterior Achilles tendon bursitis.

Symptoms

Unlike Achilles tendinitis, which tends to manifest itself slightly higher on the lower leg, Achilles tendon bursitis usually creates pain and irritation at the back of the heel. Possible signs of bursitis of the Achilles tendon include difficulty to rise on toes. Standing on your toes or wearing high heels may increase the heel pain. Inflammation and tenderness. The skin around your heel can become swollen and warm to the touch. Redness may be visible. Pain in the heel. Pain tends to become more prominent when walking, running, or touching the inflamed area. Stiffness. The back of your ankle may feel a little stiff due to the swelling of the bursa.

Diagnosis

In addition to a complete medical history and physical examination, diagnostic procedures for bursitis may include the following. X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. Ultrasound. A diagnostic technique that uses high-frequency sound waves to create an image of the internal organs. Aspiration. A procedure that involves removal of fluid from the swollen bursa to exclude infection or gout as causes of bursitis. Blood tests. Lab tests that are done to confirm or eliminate other conditions.

Non Surgical Treatment

In some cases, physicians may recommend drugs or medications like NSAIDs (non-steroidal anti-inflamatory drugs) to manage pain and inflammation. Alternative medications like cortisone injections are NOT advised for any type of Achilles Tendon injury or condition. This is because there is an increased risk of rupture of the tendon following a cortisone injection. Medical evidence shows that cortisone shots can damage the surrounding tissue, fray the Achilles tendon, and even trigger a rupture. Most side effects are temporary, but skin weakening (atrophy) and lightening of the skin (depigmentation) can be permanent.

Surgical Treatment

Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.

Hammer Toe Surgery Procedures

Hammer ToeOverview

A Hammer toes is a contracture-or bending-of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common to females than males.

Causes

Many people develop hammertoe because they wear shoes that are too tight. Shoes with narrow toe boxes squeeze the toes together, forcing hammertoes some to bend. This causes the toe muscles to contract. If the toes are forced into this cramped position too often, the muscles may permanently tighten, preventing the toes from extending. Chronic hammertoe can also cause the long bones that connect the toes to the foot, called metatarsals, to move out of position. The misaligned metatarsal bones may pinch a nerve running between them, which can cause a type of nerve irritation called a neuroma.

Hammer ToeSymptoms

The middle joint of the toe is bent. The end part of the toe bends down into a claw-like deformity. At first, you may be able to move and straighten the toe. Over time, you will no longer be able to move the toe. It will be painful. A corn often forms on the top of the toe. A callus is found on the sole of the foot. Walking or wearing shoes can be painful.

Diagnosis

A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.

Non Surgical Treatment

Hammer toes may be effectively corrected in different ways. Treatments can be non-invasive and involve physical therapy along with the advice that the person not wear any more shoes that restrict appropriate space for their toes. Appropriate shoes for people who want to avoid hammer toes, or for people who already have them, should be at least half an inch longer than the person’s longest toe. High-heeled shoes are something to definitely avoid.

Surgical Treatment

Toes can be surgically realigned and made straight again. They can even be made shorter. The good news is that toes can be corrected. Hammer toe surgery is often synonymous with ?toe shortening?, ?toe job? and/or ?toe augmentation?. Depending on the severity and length of the toe, there are several methods to surgically correct a hammer toe. In general, the surgery involves removing a portion of the bone at the contracted joint, to realign the toe.

HammertoePrevention

Few people realize that their feet grow over the years: actually, the heel stays the same, but the front of the foot becomes wider and longer. The result, most women wear shoes that fit at the heel but are much too narrow in the front. Buy shoes that fit the longer foot. For two out of three people, one foot is significantly bigger than the other. Have both feet measured whenever you buy shoes. Have your feet measured while you’re standing, and buy shoes that fit the larger foot. Shop at the end of the day, when foot swelling is greatest. No shoe should feel tight. Don’t go by numbers. You may think of yourself as a size 8B, but size varies from shoe to shoe. There is no standardization, so pick the shoes that fit best. Limit high-heel use. These shoes increase pressure on the front of the foot by at least 50 percent, so wear them only for special occasions. Flat shoes are more comfortable than high heels, but they, too, can be hard on your feet, especially if they are thin-soled. Change your shoes. If your shoes are too short or too narrow, get another pair. This is especially important for children going through periods of rapid growth. The toe area should be high enough so that it doesn’t rub against the top of your toes-especially if hammer toes have started to develop.

Hallux Valgus Deformity Foot

Overview
Bunions Callous
Hallux Abducto Valgus, commonly called bunion, is a bony deformity affecting the angle of the joint at the base of the big toe. Some medical professionals believe that the condition is solely due to ill-fitting footwear, while others believe it is a genetic structural defect that can be exacerbated by shoes. Despite the varying opinions, the reality is that it is probably a combination of both factors. A bunion forms when pressure is applied to the side of the big toe, causing it to become inflamed and painful. The joint then protrudes, effectively making the foot wider. The second toe might then become displaced, which can cause a multitude of other issues like corn and callus development. The bunion joint will have a reduced range of motion and often ends up arthritic. The condition usually develops later in life.

Causes
People born with abnormal bones (congenital) in their feet. Inherited foot type. Foot injuries. Inflammatory or degenerative arthritis causing the protective cartilage that covers your big toe joint to deteriorate. Wearing high heels forces your toes into the front of your shoes, often crowding your toes. Wearing shoes that are too tight, too narrow or too pointed are more susceptible to bunions. Pain from arthritis may change the way you walk, making you more susceptible to bunions. Occupation that puts extra stress on your feet or job that requires you to wear ill-fitting shoes. The tendency to develop bunions may be present because of an inherited structural foot defect.
SymptomsThe signs and symptoms of a bunion include a bulging bump on the outside of the base of your big toe, swelling, redness or soreness around your big toe joint, Thickening of the skin at the base of your big toe, Corns or calluses, these often develop where the first and second toes overlap, persistent or intermittent pain, restricted movement of your big toe. Although bunions often require no medical treatment, see your doctor or a doctor who specializes in treating foot disorders (podiatrist or orthopedic foot specialist) if you have persistent big toe or foot pain, a visible bump on your big toe joint, decreased movement of your big toe or foot, difficulty finding shoes that fit properly because of a bunion.

Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.

Non Surgical Treatment
This is probably the most important step. Wearing the right footwear can help reduce stress on a minor deformity and reduce the likelihood of it progressing. Recommendations are that the forefoot easily fits within the width of the shoe and there is adequate cushioning and arch support. Soft materials such as smooth leather, suede or fabric will also help to reduce irritation to the area. The podiatrist plays an invaluable role in managing patients with bunions. This is because they can offer a number of options to the patient that can help relieve pain and reduce the severity of the deformity. They can also reduce pressure on skin lesions that develop as a result of the biomechanical changes. Podiatrists can prescribe customised orthotic devices that help reduce the stress on a bunion and control biomechanical factors which cause them. These may be used in conjunction with bunion splints or cushions to further offload the area. Evidence has shown a significant reduction in pain with the use of customized orthotic devices.
Bunions Callous

Surgical Treatment
Bunion surgery is an option for those who have persisting pain and the condition is worsening. Surgery on a bunion can correct the bone deformity, increase function and relieve pain. Bunion surgery should not be considered lightly, the surgery is often successful but there is a rate of surgical failure. The big toe can move back into its previous place if the patient does not follow instructions, which will result in the pain returning. The surgical failure for bunions can be reduced greatly if activity restrictions are followed and proper footwear is worn after surgery.

Prevention
The best protection against developing bunions is to protect and care for your feet every day. Avoid tight and narrow-fitting shoes. Limit your use of high heels. Wear comfortable shoes with adequate space between your longest toe and the end of the shoe. Getting treatment for very flat or very high-arched feet (if you are experiencing symptoms) will give your feet the proper support and help maintain stability and balance.

Understand Heel Pains

Overview

Heel Discomfort

Plantar Fasciitis, also known as Heel Pain or a heel spur, is a musculoskeletal condition causing pain under the heel or into the inner arch of the foot. The condition is commonly mistaken for an impact trauma or heel bruise but in fact it is caused by mechanical overstretching of the fibrous tissue in the arch. Heel pain can develop suddenly or evolve gradually over time. It can affect people of all ages, but is more common beyond the 4th decade of life, those in standing occupations, overweight individuals and those involved in regular strenuous exercise.

Causes

Some of the many causes of heel pain can include abnormal walking style (such as rolling the feet inwards), obesity, ill-fitting shoes eg narrow toe, worn out shoes, standing, running or jumping on hard surfaces, recent changes in exercise program, heel trauma eg. stress fractures, bursitis (inflammation of a bursa), health disorders, including diabetes and arthritis.

Symptoms

Sever?s Disease. This is a condition that occurs in 10 – 15 year old children, predominantly boys and is associated with running and repetitive jumping. It is also associated with flimsy footwear that kids may wear. It occurs when the Achilles tendon continually pulls on the apophysis of the calcaneum and does not allow for it to fuse with the body of the calcaneum. Calcaneal enthesopathy. This occurs when there is repetitive trauma at the attachment of the Achilles tendon, resulting in a spur from the calcaneum up into the Achilles tendon. It is usually visualized on x-ray and may be tender if there is an associated bursitis or tendonitis. “Pump Bump”. Also known as Haglund?s Deformity, this is a bony enlargement that exists on the back of the heel – usually related to a congenital abnormality or with chronic bursitis, causing a thickening. There may have already been trauma or pressure from footwear. Treatment is usually protection of the bump and correct footwear. Associated with a symmetrical swelling at the base of the Achilles tendon. It is usually related to repetitive trauma or inappropriate footwear. It is often red and hot in the early stages. Treatment is usually to correct the footwear, provide padding and treat the local symptoms e.g. ice, rest, physiotherapy and cortisone injection. Fat Pad Syndrome. Direct contact with the base of the heel may result in trauma to the fat pad. Related to obesity, training on hard surfaces, uneven grounds, poor shoes especially overlarge shoes which can cause shearing forces on the heel. These conditions are renowned for taking a long time to recover – usually many months.

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

Non Surgical Treatment

If you develop heel pain, you can try several methods at home to ease your discomfort. For example rest as much as possible, apply ice to the heel for 10 to 15 minutes twice a day, use over-the-counter pain medications, wear shoes that fit properly, wear night splints, a special device that stretches the foot while you sleep, use heel cups or shoe inserts to reduce pain, If these home care strategies do not ease your pain, you will need to see your doctor. He or she will perform a physical exam and ask you about your symptoms and when they began. Your doctor may also take an X-ray to determine the cause of your heel pain. Once your doctor knows what is causing your pain, he or she will be able to provide you with the appropriate treatment. In many cases, your doctor may prescribe physical therapy. This can help to strengthen the muscles and tendons in your foot, which helps to prevent further injury. If your pain is severe, your doctor may provide you with anti-inflammatory medications. These medications can be injected into the foot or taken by mouth. Your doctor may also recommend that you support your foot as much as possible-either by taping the foot or by using special footwear devices. In very rare cases, your doctor may recommend surgery to correct the problem. However, heel surgery often requires a long recovery time and may not always relieve your foot pain.

Surgical Treatment

When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.

Prevention

Pain Under The Heel

You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.

All The Things You Want To Know About Achilles Tendinitis

Overview

Achilles TendonitisAchilles tendinitis is a common condition that causes pain along the back of the leg near the heel. The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration. Simply defined, tendinitis is inflammation of a tendon. Inflammation is the body’s natural response to injury or disease, and often causes swelling, pain, or irritation. There are two types of Achilles tendinitis, based upon which part of the tendon is inflamed. Noninsertional Achilles tendinitis, Noninsertional Achilles Tendinitis. In noninsertional In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active.

Causes

Tendinitis most often occurs when a tendon is over used. As the foot extends the Achilles tendon engages the calf muscles. The calf muscle generates force, which is transferred to the foot via this tendon. As this action repeats the tendon will endure large amounts of stress. An under-trained or inexperienced athlete is most likely to be affected by tendinitis since their body is not accustomed to the stress involved with athletics. Improper foot mechanics is another common cause of Achilles tendinitis. A properly functioning foot will distribute weight evenly across the foot. On the contrary, if the foot is experiencing improper mechanics, the weight of the body will not be evenly distributed. This can result in tendinitis, plantar fasciitis, calluses, bunions, neuromas and much more.

Symptoms

The symptoms associated with Achilles tendonitis and tendonosis include, Pain-aching, stiffness, soreness, or tenderness-within the tendon. This may occur anywhere along the tendon?s path, beginning with the tendon?s attachment directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity. Tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on the back of the tendon. When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.

Diagnosis

If you think you have Achilles tendinitis, make an appointment to see your doctor. The doctor will ask you questions about your recent activity and look for signs. The foot not flexing when the calf muscle is pressed ( if Achilles ruptures or tears in half). Swelling on the back of the foot. Pain in the back of the foot. Limited range of motion in ankle. An X-ray or MRI scan can check for tendinitis.

Nonsurgical Treatment

Treating Achilles tendinitis rarely requires much professional intervention. Ease the pain with OTC pain killers. Stretch and strengthen the Achilles tendon. Stop the condition from happening again. Doctors treating Achilles tendinitis will recommend the following options for accomplishing this. Pain Killers – Generally ibuprofen (Advil) or naproxen (Aleve) will ease the mild pain. Physical Therapy, Stretches and exercises devised to lengthen and strengthen the Achilles tendon will help reduce pain and prevent future recurrence. Orthopedic Supports, Heel-elevating insoles or other orthotic devices can reduce the strain on the Achilles tendon, helping ease the inflammation and pain.

Achilles Tendonitis

Surgical Treatment

The type of surgery you will have depends on the type of injury you are faced with. The longer you have waited to have surgery will also be a factor that determines what type of surgery is needed. With acute (recent) tearing the separation in your Achilles tendon is likely to be very minimal. If you have an acute tear you may qualify for less invasive surgery (such as a mini-open procedure). Surgeons will always choose a shorter, less invasive procedure if it is possible to do so. Most surgeons know that a less complicated procedure will have less trauma to the tendon and a much quicker rate of recovery after the surgery.

Prevention

The following measures can significantly reduce the risk of developing Achilles tendonitis. Adequately stretch and warm up prior to exercise. Warm down and stretch after exercise. Choose footwear carefully and use footwear appropriate to the sport being undertaken. Use orthotic devices in footwear to correctly support the foot. Exercise within fitness levels and follow a sensible exercise programme. Develop strong, flexible calf muscles.