Dr. Marla: Causes and treatments of plantar fasciitis and bunions
One of the most common causes of heel pain:
- Involves pain and inflammation of a thick band of tissue, called the plantar fascia
- Runs across the bottom of foot
- Connects heel bone to toes.
- Causes stabbing pain that usually occurs with very first steps in the morning.
- Once foot limbers up, the pain of plantar fasciitis normally decreases (but it may return after long periods of standing or after getting up from a seated position).
- Particularly common in runners.
- People who are overweight (those who wear shoes with inadequate support are at risk of plantar fasciitis).
- Plantar fascia acts like a shock-absorbing bowstring (supporting the arch in foot).
- Tension on that bowstring becomes too great; it can create small tears in the fascia.
- Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.
Factors that may increase your risk of developing plantar fasciitis include:
- Age. Plantar fasciitis is most common between the ages of 40 and 60.
- Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue - such as long-distance running, ballet dancing and dance aerobics - can contribute to an earlier onset of plantar fasciitis.
- Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're standing and put added stress on the plantar fascia.
- Obesity. Excess pounds put extra stress on your plantar fascia.
- Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.
- Chronic heel pain that hinders your regular activities.
- Change the way you walk to minimize plantar fasciitis pain, you might also develop foot, knee, hip pain
- An X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a stress fracture or a pinched nerve.
- X-ray shows a spur of bone projecting forward from the heel bone.
- In the past, these bone spurs were often blamed for heel pain and removed surgically. Many people who have bone spurs on their heels have no heel pain.
- Most people who have plantar fasciitis recover with conservative treatments in just a few months.
- Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) may ease the pain and inflammation associated with plantar fasciitis.
Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include: Physical therapy-series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel:
- Apply athletic taping to support the bottom of your foot.
- Night splints stretch your calf and the arch of your foot while you sleep.
- Holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
- Orthotics Surgical or other procedures
- Steroid shots
- Multiple injections aren't recommended because they can weaken plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone.
- Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing *used for chronic plantar fasciitis that hasn't responded to more-conservative treatments.
- This procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective.
- Surgery-Few people need surgery to detach the plantar fascia from the heel bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.
Bunion is an unnatural, bony hump that forms at the base of the big toe where it attaches to the foot.
- Big toe deviates toward the other toes
- The base of the big toe pushes outward on the first metatarsal bone -- which is the bone directly behind the big toe -- forming a bunion.
- If this happens on the little toe and fifth metatarsal, it's called a bunionette.
- Bunion occurs at a joint, where the toe bends in normal walking
- Entire body weight rests on the bunion at each step.
- Can be extremely painful. Vulnerable to excess pressure and friction from shoes and can lead to the development of calluses.
- Foot problems typically develop in early adulthood
- Get worse as the foot spreads with aging.
- Runs in the family
- One of several problems due to weak or poor foot structure.
- Sometimes develop with arthritis.
- Leg length discrepancies, bunions usually form in the longer leg
- Women are especially prone to developing bunions
- Wearing tight, poorly fitting shoes -- especially high-heeled, pointed shoes -- can bring on bunions.
- Such shoes gradually push the foot bones into an unnatural shape.
- Bunion is a bony bump that forms on the joint at the base of your big toe
- Forms when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out.
- Skin over the bunion might be red and sore.
- Wearing tight, narrow shoes might cause bunions or might make them worse.
- Also develop as a result of an inherited structural defect, stress on your foot or a medical condition, such as arthritis.
- Smaller bunions (bunionettes) also can develop on the joint of your little toes.
The 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
- 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
- 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
- Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons in your feet.
- Imbalance in pressure makes big toe joint unstable, eventually molding the parts of the joint into a hard knob that juts out beyond the normal shape of foot.
- Experts disagree on whether tight, high-heeled or too-narrow shoes cause bunions or whether footwear simply contributes to bunion development.
Other causes include:
- Inherited foot type
- Foot injuries
- Deformities present at birth (congenital)
- Arthritis, particularly inflammatory types, such as rheumatoid arthritis.
- Occupation that puts extra stress on your feet or one that requires you to wear pointed shoes also can be a cause.
These factors may increase your risk of bunions:
- High heels. Wearing high heels forces your toes into the front of your shoes, often crowding your toes.
- Ill-fitting shoes. People who wear shoes that are too tight, too narrow or too pointed are more susceptible to bunions.
- Arthritis. Pain from arthritis may change the way you walk, making you more susceptible to bunions.
- Heredity. The tendency to develop bunions may be present because of an inherited structural foot defect.
Although they don't always cause problems, bunions are permanent unless surgically corrected. Possible complications include:
- Bursitis. This painful condition occurs when the small fluid-filled pads (bursae) that cushion bones, tendons and muscles near your joints become inflamed.
- Hammertoe. An abnormal bend that occurs in the middle joint of a toe, usually the toe next to your big toe, can cause pain and pressure.
- Metatarsalgia. This condition causes pain and inflammation in the ball of your foot.
- Nonsurgical treatments that may relieve the pain and pressure of a bunion include:
- Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
- Padding and taping or splinting- reduce stress on the bunion and alleviate your pain.
- Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) Cortisone injections
- Shoe inserts
- Prescription orthotic devices.
- Applying ice
Goal of bunion surgery is to relieve discomfort by returning your toe to the correct position. A number of surgical procedures for bunions, and no one technique is best for every problem.
Surgical procedures for bunions might involve:
- Removing the swollen tissue from around your big toe joint.
- Straightening your big toe by removing part of the bone.
- Realigning the long bone between the back part of your foot and your big toe, to straighten out the abnormal angle in your big toe joint Joining the bones of your affected joint permanently.
To prevent a recurrence, you'll need to wear proper shoes after recovery. It's unlikely that you'll be able to wear narrower shoes after surgery.
**Surgery isn't recommended unless a bunion causes frequent pain or interferes with daily activities
Lifestyle and home remedies
These tips may provide relief from a bunion:
- Non-medicated bunion pad to the bony bump.
- Apply an ice pack two to three times daily to help reduce swelling if a bunion becomes inflamed or painful.
- Wear shoes with a wide, deep toe box.
- Avoid shoes with heels higher than 2 1/4 inches (5.7 centimeters).
See your doctor if pain persists.