Calcaneal Apophysitis (Sever’s Disease): Cause, Symptom & Treatment

Calcaneal apophysities is a bone disorder that causes inflammation of the growth plate in the heel. Although not a disease, it is also called Sever’s disease. During the development of the bone, cartilage cells change into bone cells, forming new bone at the growth plate. During the process, inflammation occurs in the growth plate, causing pain and swelling.

This condition occurs in children whose heel bones are still developing, around the ages 8 to 14. Most often an overuse condition, physically active kids are usually the ones at risk and more patients are reported to have both feet affected. From age 15 onwards, the bones are usually fully developed and unlikely to get this disorder.

Causes

When the heel bone grows faster than the leg muscles and tendons, they are overstretched. And with repeated stress on the growth plate due to physical activity, muscles are strained and tissue inflamed. Sports that require running and jumping such as basketball, soccer and track are common causes of calcaneal apophysities.

Ill-fitting shoes could also contribute to the condition. Without enough support or padding, the heel is constantly rubbing against the shoes or receiving the impact of the foot hitting against the ground, adding pressure to the heel.

Other reasons for this condition could be due to obesity, a tight Achilles tendon, flatfoot, high-arched foot or short leg syndrome.

Symptoms

The patient would feel pain in the back and/or bottom of the heel with redness, swelling and tenderness. When the sides of the heel are squeezed, a sharp pain is felt. During sports activities, the pain would worsen. Even while walking or standing, there would be discomfort and stiffness in the foot. To compensate, the child may limp or walk on toes.

Treatment

If there are no other serious conditions, conservative treatment is usually used to relieve the symptoms of calcaneal apophysities. The patient has to reduce or stop all physical activities. Shoe inserts, heel lifts or orthotic devices are used to support and cushion the heel. Medications such as Nonsteroidal anti-flammatory drugs (NSAIDs) are prescribed to reduce the pain and inflammation.

For further reduction of inflammation, the child has to go through physical therapy that helps to stretch and exercise the calf muscles and Achilles tendons. If the symptoms are very severe, the foot may have to be immobilized in a cast or brace to completely remove weight bearing and hold the heel in position to allow healing.

What Is Haglund’s Deformity?: Cause, Symptom & Treatment

If you notice that the boney section of your heel near the Achilles tendon is prominently enlarged, you probably have Haglund’s deformity. Because of the frequent pressure on the back of the heels due to inappropriate footwear or because of the natural shape of the foot, bursitis – an inflammation of the fluid-filled sac between the tendon and the bone – progressively develops.

Causes

Haglund’s deformity can happen to anyone. Also known as “pump bump”, the name derives from women that get this condition because of the rigid back of their pumps, though it can also occur in men who wear stiff dress shoes. Inherited foot structure is another cause. If you have a high arch, a tight Archilles tendon or tend to walk on the outer edge of your foot because of its shape, you would be more likely to develop this deformity. Seasoned ice skaters are also at risk because of the long hours practicing in rigid skates.

Symptoms and Diagnosis

Depending on the cause of the problem, Haglund’s deformity may occur in one or both feet. You would notice a bump on the back of the heel, along with severe pain and swelling. Because the soft tissue is inflamed, redness may be visible.

Diagnosis may be difficult because of the similar symptoms to arthritis. However, doing an X-ray to evaluate the structure of the heel could help determine the condition.

Treatment

Non-surgical and surgical treatment methods are used to relieve the pain and pressure from the heel bone depending on the severity of the deformity. Often, non-surgical treatment is initially tried out to see if the condition improves.

Non-Surgical Treatment

One or more of these methods may be used:

  • Icing for 20 minutes every 40 minutes a day to reduce swelling of the inflamed area.
  • Stretching exercises to reduce tension of the Achilles tendon.
  • Shoe modification using heel pads, heel lifts, arch supports or wearing open-heel shoes to minimize pressure on the heel.
  • Using custom orthotic devices to correct the position of the foot.
  • Physical therapy like ultrasound treatment and iontophoresis to reduce inflammation
  • Immobilization in a cast or brace.
  • Taking non-steroidal anti-inflammatory drugs (NSAIDS) to reduce pain and inflammation.

Surgical Treatment

If the pain persists even after the non-surgical treatment, surgery would be necessary. The excess bone of the heel is removed or filed down to relieve pressure on the bursa and soft tissue. After the surgery, the foot is immobilized in a cast for a week, followed by regular visits to the doctor’s to monitor the recovery.

Calcaneus Fractures: Symptoms & Treatment

Calcaneus fractures, or heel bones fractures, is the most common of fractures of the tarsal bone. Tarsal bone fractures account for 2% of all adult fractures and of those, 60% are calcaneus fractures.

Causes

Usually caused by a high-impact collision on the calcaneus, this type of fracture is most often incurred from jumping or falling from a great height or motor vehicle accidents. Patients with osteoporosis are also at greater risk for this fracture as their bones have lower mineral density and thus more brittle.

Patients with diabetes are more susceptible to fractures and have a high risk for infection and healing complications that might lead to limp amputation. It is important to let your doctor know about your full health condition beforehand.

Symptoms

Fracture patients would experience pain, bruising, swelling, heel deformity and may be unable to walk. Even if pain is tolerated, patient would walk with a limp as the muscle and tendon is not strong enough to fully support the weight. The intensity of the symptoms depends on the severity of the damage.

Types of treatment

There are a few considerations your doctor put into deciding your course of treatment. It depends on the severity of the fracture, the cause of injury and whether your health condition allows you to respond well to the treatment.

Usually surgery is needed to put the bones back together except for mild cases of cracked bones. Different treatments are used for the different types of fractures:

  • Stable fracture

The broken ends of the bones are still correctly aligned. No surgery is needed. The leg is immobilized in a cast to allow the bones to heal.

  • Display fracture

The bones are displaced and not aligned. The pieces are put back together with surgery. Your doctor may recommend waiting till the swelling has gone down before going through surgery to reduce the risk of infection. This is done by immobilizing the leg and elevating it for a few days.

  • Open fracture

The bones are broken through the skin and usually damage the muscles, tendons and ligaments. Immediate surgery is required as the wound is open and exposed to the environment.

  • Closed fracture

This is a closed wound and the skin is not broken. However, internal soft tissues may be badly damaged.

  • Comminuted fracture

The bones are shattered into several pieces and the damage is severe. Caused by a great impact like a head-on car collision.

 

Surgical Procedures:

  • Percutaneous Screw Fixation

Small incisions are made to place screws in to hold the bones together. This procedure only viable if the broken bones are still in large pieces and can be pulled back into alignment.

  • Open Reduction and Internal Fixation

The bone fragments are pieced back in place and held together with screws and metal plates.

 

Recovery Process

For nonsurgical treatment, the injury can recover in 6-8 weeks. Surgical treatments take longer to recover. It might require 3-4 months before normal activities can be resumed. Severe fractures might even take up to 1-2 years before full recovery is achieved.

If pressure is applied on the injury during the healing process, it might further aggravate it and the screws might break, causing the bones to collapse. This causes serious repercussions and it would be even harder to fully recover.

What Is Achilles Tendon Rupture?

The Achilles tendon is located at the back of our heel. Rupturing of it can occur due to several reasons but the most common is because of a sudden trauma acting on the ankle or foot. When the Achilles tendon is torn, the ability to tiptoe is diminished and the walking action will be that of a flat feet person. Due to the severity of this type of injury, it is important to be able to identify it immediately and perform the necessary remedial actions.

What is it?

The role of the Achilles tendon is extremely important. It is located at the back of the heel for a reason. This tendon connects the heel bone to the calf muscles to facilitate the downwards bending of the foot to the ankle. Medically, this action is termed as plantar flexion. A tear of the Achilles tendon be it a partial or complete one will result in the loss of connectivity between the bone and muscle.

What causes the rupture?

As mentioned above, there are various causes of a rupture but the most common is due to a sudden trauma. This extremely high force will cause the tendon to tear instantaneously. This is prevalent during high impact sports such as basketball or football. Constant repetitive movements may also lead to the weakening of the tendon, causing it to tear easily. Awkward landings from falls may also lead to the tearing of the tendon. This is due to the over flexing of the tendon which trying to cushion yourself from the fall.

Symptoms of a torn Achilles tendon

Rupture of the Achilles tendon can produce little to no symptoms in some people. For the others, there are a few common symptoms – there will be severe pain, tenderness and swelling present at the heel region. Some patients may also be unable to stand up on their own without the usage of crutches. During the time of injury, a pop sound may be heard and this is due to the tendon rupturing.

Types of treatment available

A suspected Achilles tendon tear should be diagnosed immediately in order to allow for proper treatment. The team at the emergency department will often refer you to an orthopaedic doctor who is equipped with the skills and knowledge of these musculoskeletal injuries. Treatment is classified into 2 groups – Surgical and non-surgical. Surgical treatment involves the repair and stitching back of the torn tendon together or the usage of a graft tendon from the hamstring. Non-surgical treatment on the other hand involves rehabilitation, physical therapy and a protective leg brace to allow the body to heal on its own.

4 Most Common Gymnastics Injuries

Gymnastics is a full body and physically demanding sport meant for all gender. Due to its stressful and challenging nature, risk of injuries are extremely high. Although most injuries are minor ones, some can be serious and life threatening! This risk is amplified when risky stunts are attempted. I will discuss some common Gymnastics injuries in this article.

Wrist sprains

The wrist is the most heavily used part of the body in Gymnastics. With the extreme twisting speed and jumps, the force acting on the wrist can be double of that of our body’s weight. Thus, the wrist is the most prone to injuries. Wrist sprains are common and the immediate response would be to terminate all activities and get plenty of rest. The intensity of training in future would need to be toned down as the wrist will be more prone to future sprains. To protect and offer better support, a wrist brace should be worn prior to any strenuous activities.

Anterior Cruciate Ligament tear

ACL injuries are common and can happen if the gymnast lands in an awkward position. The ACL supports the knee and provides stability. However, it can rupture if it is twisted suddenly under high forces and that exact force is provided by an improper landing position following a stunt. A “pop” sound will be heard and this is followed by knee swelling. To prevent ACL injuries, a supportive knee brace should be worn. In addition, gymnasts should strengthen their leg muscles to better hold and support the ligaments together.

Foot injuries

Foot injuries are another type of common gymnastics injury. The more frequently occurring one is ankle sprain. Minor foot injuries only suffer from slight swelling while more serious cases will lead to severe swelling and a limit in mobility.  Wearing a protective brace is often required after foot injuries but this can hinder the flexibility of the gymnast.

Back injuries

Injuries to the back can be either a muscle strain, ligament sprain or even spinal disc disorder. Back pain will intensify based on the activity engaged and extension motions will cause the pain to increase. Back injuries are often referred to physiotherapists but they can be more serious underlying. Serious back injuries that are not easy to detect is the spinal disc disorder. The spinal discs will cushion our spine from shocks and if it is injured, the protective capabilities will be compromised.

Gymnastics is a physically demanding and challenging sport activity that is filled with lots of injury risks. There are strict requirements for the gymnast and training often starts young. Unlike most sports, injuries in gymnastics are hard to prevent due to the lack of protective equipment that are flexible and concealable.

5 Applications of Shockwave Therapy

Extracorporeal shock wave therapy or more commonly known as Shockwave therapy is a non invasive medical treatment that sends acoustic waves to injured parts of the body with the intent to reduce pain and promote healing. The shockwaves used for Shockwave therapy is similar to those used to break down kidney stone, but it is only at one tenth of the intensity, rendering it rather safe for the body. There are many uses of shockwave therapy and it can be widely applied to treat different injuries. Let’s take a look at some of the common applications of Shockwave Therapy.

Decrease pain

Shockwave therapy promotes hyperaemia which is actually the increase in blood flow to a targeted part of the body. Hyperaemia is the basis of shockwave therapy and the increase in blood flow provides extra energy and loosens up the muscles and path interactions between the actin and myosin. This will reduce muscle tension and decrease pain.

Dispersion of substance P

Substance P is a neuropeptide in the body and it functions as a transmitter and modulator for nerve communication. The main purpose of substance P is to modulate inflammation. Shockwave therapy can efficiently disperse substance P and increase the secretion of histamine. Dispersion of substance P also helps to reduce pain in the affected area and reduce the risk of developing oedema or fluid retention.

Increases collagen production

Collagen is the main protein that is found in the connective tissues throughout the body. It works together with elastin to provide structure and flexibility to the skin. Collagen is also the pre-requisite for any repair mechanism in the body that is due to a damaged ligament structure. Shockwave therapy will help to stimulate collagen production in the deeper layers of the tissues and this is something that you can never achieve just by taking collagen supplements.

Increases metabolism

Shockwave therapy removes nociceptive metabolites and helps to increase oxygen levels in the body and increasing the energy source. It also helps to reduce histamine which is acidic and increases the metabolism rate in the body.

Plantar fasciitis

Shockwave therapy will over stimulate nerves that are responsible for the transmission of pain to the brain, reducing pain immediately. It will also trigger the healing mechanism of the body and increases the formation of blood vessels in the affected area, speeding up the recovery process.

Shockwave therapy is a non-invasive treatment method that can be used for treating soft tissue injuries. Since it is non-invasive, there is minimal downtime and a hospital stay is not required. However, shockwave therapy may be painful for some but it is otherwise tolerable.

5 Common Injuries Suffered by Dancers

Dancing is a physical activity that is accompanied with a certain level or risk. Dancing is something that needs to be gradually built up from scratch and one cannot simply jump into it expecting to do something they have never tried. Proper warm up and stretching as well as cooling down exercises will need to be performed religiously before and after every session. Injuries can be career threatening to any dancer and it is important to take precautions to prevent them from happening.

Meniscus Knee Tear

Dancing requires a lot of jumping and knee twisting actions accompanied by sudden direction changes. This will place a lot of stresses on the knee, particularly the ligaments and meniscus. A tear in the knee meniscus is one of the most frequent injuries experienced by dancers and it can put you out of action for up to 6 months depending on the severity. It is important to strengthen the leg muscles particularly the knee, thigh and calf to help reduce the burden on the knee.

Ankle sprains

A proper ankle connection is important in dancing. Ankle sprains occur when upon landing from a jump, the outside of the ankle rolls inwards due to a loss of balance. This will cause the ligaments in the ankle to tear. Ankle sprains are painful and will hinder you in many aspects of your daily life. You will be out of action for up to a month.

Achilles Tendonitis

Achilles tendonitis is tendonitis of the Achilles tendon and it occurs due to muscle overuse after repeatedly acting pressure on the calf muscle. It happens most frequently in dancers who place a lot of their weight on the lower body.

Neck strain

Neck strain is a common injury and it happens so frequently because dancers have to move their head throughout a dance and many of them control it incorrectly. Instead of using the spine when they arch their neck, they use the tendons, overusing them.

Muscle cramps

Dance practices and rehearsals can sometimes take a long time and start from early in the morning till late at night. As a result, they are easy victims to muscle cramps due to fatigue and a lack of required electrolytes to replace the ones they lost throughout the day. Sometimes it can happen due to improper warm up exercises.

Dancing is a very physical demanding activity and the risk of injuries is high. New dancers will need to start slow while experienced dancers cannot be complacent and skip the basic warm up and cooling down exercises. Dancers will also need to ensure that they replace their lost fluid to prevent muscle cramps.

5 Home Remedies for Plantar Fasciitis

Plantar Fasciitis is a medical condition which affects the feet. It will cause extreme pain and this pain is more pronounced during the morning when the ligaments and tendons in the feet are not yet warmed up. Many patients describe the pain they experience in the morning as being stabbed repeatedly in the feet. The onset of pain is largely due to long periods of immobility of the feet such as a long day of using the computer. As the activities around the leg increases, the pain will decrease. The most common treatment method is the use of anti-inflammatory medication as well as pain killers to provide pain relief. However, some home remedies can actually work wonders.

Ice

Ice is probably the cheapest and one of the most effective home remedies. If you have an ice pack, use it. If not, you can even use frozen peas. Massage the painful area for around 15 minutes, 5 times a day. Ice can help to bring down swelling and reduce inflammation.

Protective arch support insoles

You should purchase insoles that provide arch support and place them in your shoes. It can help to reduce pain and divert away some of the impact to bring relief of pain when you move around. If possible, you should even wear them at home when you move around.

Stretching

Whenever possible during the day, you should perform stretching exercises targeted at your legs. Exercises that stretch the Achilles tendon and Plantar Fascia will help to increase flexibility and warm the area up, reducing pain.

Massages using creams or oils

If able, you should massage the painful area with pain relief creams or even medicated oils multiple times during the day. Massages with medicated oils will help increase the blood circulation level at the legs and bring pain relief and promote healing.

Foot splints

When you turn in for the day, you should use foot splints to brace the foot, ankle and lower leg. The main purpose of the splint is to provide gradual stretches of the plantar fascia throughout the night, reducing stress levels and reducing pain and inflammation. Since the stretching continues through the night, you will experience lesser pain when you first wake up in the morning.

Plantar Fasciitis is a troublesome and painful leg condition that will cause a lot of discomfort throughout the day and night. It is not good to depend on pain relief medication always and whenever possible, you should substitute the pain relief medication with some home remedies.

Causes of Heel Pain

Heel pain is a very common problem experienced by many and is caused by different reasons. Patients will often suffer pain under the heel or behind the heel. Most of the time, heel pain will disappear on its own with time but in serious cases, they can become chronic problems. There are 26 bones in the human foot and the largest bone is the heel bone. The function of the heel is to provide support and balance the weight of the body. With such immense weight acting on it and various activities such as running and jumping, the heel is at a high risk of injury.

Plantar Fasciitis

Plantar fasciitis is a painful result of the inflammation of the plantar fascia. The plantar fascia links the heel bones to the toes and is responsible for the arch of the boot. Plantar fasciitis can cause immense pain which increases with every additional step you take but once you warm up the leg, the pain will start to go away, coming back again after periods of immobility.

Stress Fracture

As mentioned above, the heel bone is the largest bone in the human foot and stress fractures can occur due to overuse of the heel. Continuous activity on a hard surface can also contribute to stress fractures due to the higher force environment. When the heel bone fractures under stress, it will cause immense pain at the heel region and recovery time is often lengthy.

Heel bursitis

Heel bursitis results from inflammation of the bursa which is located at the back of the heel. It is most commonly occurred when the patient lands on the heels incorrectly, injuring the tendons and bursa. Improper footwear may also contribute to heel bursitis. The pain will normally get worse as the day passes.

Tarsal Tunnel Syndrome

The Tarsal tunnel is located between the bones in the foot and the fibrous tissues in spaces. There is a nerve located at the tarsal tunnel called the posterior tibial nerve and it is protected by bones and tendons. Sudden high impact can cause stress fractures which will result in the posterior tibial nerve being pinched onto, causing pain at the heel and numbness at the region.

Heel pad inflammation

Located under the heel bone is the corpus adiposum which acts as a shock absorber to protect the heel bone. After repeated hard landings on the foot or overuse, inflammation of the corpus adiposum can occur, causing pain and discomfort. In more serious cases, haemorrhaging of the heel pad can happen. At times, simple activities like walking can also be a difficult task.

There are many different causes of heel pain and most of it is caused by overuse and lack of sufficient rest periods. The heel bone is an important part of our body and heel bone pain can restrict us from carrying out daily activities smoothly.

Typical Treatments for Plantar Fasciitis

Have you ever experienced pain that does not go away with time at the bottom of your foot? The cause of this could possibly be Plantar Fasciitis, a condition that affects the bottom of the foot mainly due to inflammation of the fascia. Plantar Fasciitis is often caused by over usage of the Plantar Fascia. People who engage in long distance running without wearing shoes that provide good cushioning and support are much more prone to this.

Rest

The first and foremost is to stop whatever is causing the pain and this is usually running. You need to provide sufficient time for the inflammation in the fascia to go away and this can reduce the pain significantly. During this period, you should not engage in any form of sporting activities.

Ice pack

The next step would be to apply ice pack on the painful area. Ice pack will help to reduce the swelling, decrease the pain and help to control inflammation. Make sure that you are applying ice pack and not a warm pack as you should only apply a warm pack before any activities and not after.

Taping

Plantar fasciitis taping or simply taping can help to relieve stress and pressure on the plantar fascia ligament as it inhibits movement of the fascia. It can be easily done with athletic tape which is widely available in sporting stores.

Anti-inflammatory medication

Anti-inflammatory medication such as ibuprofen or aspirin can help to reduce inflammatory and reduce pain. If over the counter medication do not help, you may consider getting prescribed medication to relieve the pain.

Shock absorbing heel pads

Heel pads with shock absorbing features are excellent in treating plantar fasciitis. They help to cushion whatever shock that is experienced during walking and running. Heel pads can also help to reduce arch strain which is usually associated with plantar fasciitis.

Exercises

Stretching exercises can help to reduce the pain significantly in a short period of time. Stretching will also increase the flexibility of the ligaments and increase the muscular strength, allowing it to better support the arch of the foot.

Night splint

During night time, the plantar fascia muscle will contract and tighten, resulting in tremendous pain when you wake up in the morning. The pain will slowly decrease as the day passes as the muscles are stretched. Therefore, wearing a night splint during sleep will prevent the plantar fascia muscle from contracting and tightening, reducing the pain experienced when you wake up in the morning.

There is no one single treatment for plantar fasciitis. Rather, it is a combination of a number of methods all joined together for optimal results. It is important to keep the muscle warm and flexible to reduce the pain.