Heel problems are common and can be painful. Often, they result from too much stress on your heel bone and the tissues that surround it. That stress can come from

• Injuries
• Bruises that you get walking, running or jumping
• Wearing shoes that don't fit or aren't made well
• Being overweight

These can lead to tendinitis, bursitis, and fasciitis, which are all types of inflammation of the tissues that surround your heel. Over time the stress can cause bone spurs and deformities. Certain diseases, such as rheumatoid arthritis and gout, can also lead to heel problems. Treatments for heel problems might include rest, medicines, exercises, taping, and special shoes. Surgery is rarely needed.

The posterior half of the foot is formed by seven tarsal bones. The most superior bone is the talus. This has a relatively square-shaped, upper surface that articulates with the tibia and fibula to form the ankle joint. Three areas of articulation form the ankle joint: The superomedial surface of the talus bone articulates with the medial malleolus of the tibia, the top of the talus articulates with the distal end of the tibia, and the lateral side of the talus articulates with the lateral malleolus of the fibula. Inferiorly, the talus articulates with the calcaneus (heel bone), the largest bone of the foot, which forms the heel. Body weight is transferred from the tibia to the talus to the calcaneus, which rests on the ground. The medial calcaneus has a prominent bony extension called the sustentaculum tali (“support for the talus”) that supports the medial side of the talus bone.

The cuboid bone articulates with the anterior end of the calcaneus bone. The cuboid has a deep groove running across its inferior surface, which provides passage for a muscle tendon. The talus bone articulates anteriorly with the navicular bone, which in turn articulates anteriorly with the three cuneiform (“wedge-shaped”) bones. These bones are the medial cuneiform, the intermediate cuneiform, and the lateral cuneiform. Each of these bones has a broad superior surface and a narrow inferior surface, which together produce the transverse (medial-lateral) curvature of the foot. The navicular and lateral cuneiform bones also articulate with the medial side of the cuboid bone.

You may love the sleek look of a high heel or pointy toe. But it’s a good idea to avoid those or at least save them for special occasions. Otherwise, your feet, ankles, knees, and back could face problems.

For example, wearing high heels a lot can cause unhealthy changes in the muscles of your legs and change the way you walk. They can also cause foot pain and problems with your posture. Plus, you can fall and hurt your ankles and feet much more easily when you wear high heels.

Want to keep your feet happy and healthy? Consider these tips:

• Look for shoes with heels that are not more than an inch high and that have a wide toe box (which means the front part doesn’t squish your toes).
• The height of a shoe’s heel makes a big difference. A 2-inch heel causes fewer problems than a 4-inch heel.
• Pointy, narrow-toed shoes put unhealthy pressure on the bones in your feet. If the shoes have high heels, the pressure is even worse.
• It’s not a good idea to buy shoes hoping that they’ll stretch. Shoes should fit well and already feel comfortable in the store.
• Slip off the flip-flops. Flip-flops don’t give your feet enough support, so definitely don’t wear them for walking long distances. Also, don’t wear them all the time because they can start to change how you walk in ways that can cause foot and back problems. And they don’t protect your feet from nasty things like stubbing your toe. Consider some flip-flop how-tos:
  • Buy new flip-flops when they look very worn.
  • Replace flip-flops if your foot hangs off the end.
  • Protect your feet with closed shoes when you’re playing sports or doing yard work.
  • When traveling, protect your feet with closed shoes to avoid painful run-ins with suitcases or fellow travelers.

What is plantar fasciitis?

Plantar fasciitis is an inflammation of the plantar fascia, a piece of strong, thick tissue that runs along the bottom of the foot. It connects the heel bone to the toes, creating the arch of the foot.

Plantar fasciitis is a common cause of heel pain and can develop as a result of overstretching, overuse or a medical condition.

Plantar fasciitis is often associated with a heel spur, a spike of bone poking out from the heel bone, although many people have heel spurs without any pain.

What are the symptoms of plantar fasciitis?

The main symptom of plantar fasciitis is pain under the heel, which can be dull or sharp. The foot sole may ache or burn and the heel may be slightly swollen.

The pain is often worse:

• in the morning, as you take your first steps
• after prolonged standing or sitting
• after intense activity

What causes plantar fasciitis?

Plantar fasciitis can be caused by:

• playing sports and doing activities that put stress on the heel bone, such as running, dance and aerobics
• being flat-footed or having high arches
• being middle-aged or older
• being overweight
• pregnancy
• spending a lot of time on your feet
• wearing shoes with poor arch support or stiff soles
• having tight calf muscles

How is plantar fasciitis diagnosed?

If your doctor suspects you might have plantar fasciitis, they will probably ask you some questions, including asking you about your symptoms, the type of work you do and your lifestyle.

They will probably do a physical exam to check the arches of your feet and to see whether there is any redness, swelling, tenderness, stiffness or tightness.

They may also refer you for an x-ray or ultrasound scan, which is sometimes needed to rule out other possible causes of heel pain.

How is plantar fasciitis treated?

Your doctor may initially recommend one or more of the following treatments:

• pain-relief medicine, such as ibuprofen or paracetamol
• physiotherapy with specific stretching exercises to stretch the Achilles tendon and plantar fascia
• resting your foot as much as possible
• wearing shoes with good support and cushioning
• wearing orthotics
• night splints to wear while sleeping
• heel pads and arch supports in your shoes (orthotics)
• an icepack applied to your foot for 10 to 20 minutes up to 4 times daily

If these measures don't work, your doctor may give you steroid injections in your heel. Very occasionally, people have surgery designed to treat plantar fasciitis.

Inflammation of the fascia. There are three major types: 1, Eosinophilic fasciitis, an inflammatory reaction with eosinophilia, producing hard thickened skin with an orange-peel configuration suggestive of scleroderma and considered by some a variant of scleroderma; 2, Necrotizing fasciitis, a serious fulminating infection (usually by a beta hemolytic streptococcus) causing extensive necrosis of superficial fascia; 3, Nodular/Pseudosarcomatous /Proliferative fasciitis, characterized by a rapid growth of fibroblasts with mononuclear inflammatory cells and proliferating capillaries in soft tissue, often the forearm; it is not malignant but is sometimes mistaken for fibrosarcoma.

Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests MUSCLES, nerves, and other organs.

Each of your feet has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. No wonder a lot of things can go wrong. Here are a few common problems:

• Bunions - hard, painful bumps on the big toe joint
• Corns and calluses - thickened skin from friction or pressure
• Plantar warts - warts on the soles of your feet
• Fallen arches - also called flat feet

Ill-fitting shoes often cause these problems. Aging and being overweight also increase your chances of having foot problems.

General or unspecified injuries involving the foot.

Fourteen of the 26 bones in your feet are in your toes. The toes, particularly your big toe, help you move and keep your balance. Playing sports, running, stubbing your toe, and dropping something on your foot can damage your toes. Wearing shoes that are too loose or too tight can also cause toe problems. Certain diseases, such as severe arthritis, can cause toe problems and pain. Gout often causes pain in the big toe.

Common toe problems include

• Corns and bunions
• Ingrown toenails
• Sprains and dislocations
• Fractures

Treatments for toe injuries and disorders vary. They might include shoe inserts or special shoes, padding, taping, medicines, rest, and in severe cases, surgery.

Your legs are made up of bones, blood vessels, muscles, and other connective tissue. They are important for motion and standing. Playing sports, running, falling, or having an accident can damage your legs. Common leg injuries include sprains and strains, joint dislocations, and fractures.

These injuries can affect the entire leg, or just the foot, ankle, knee, or hip. Certain diseases also lead to leg problems. For example, knee osteoarthritis, common in older people, can cause pain and limited motion. Problems in your veins in your legs can lead to varicose veins or deep vein thrombosis.

Your ankle bone and the ends of your two lower leg bones make up the ankle joint. Your ligaments, which connect bones to one another, stabilize and support it. Your muscles and tendons move it.

The most common ankle problems are sprains and fractures. A sprain is an injury to the ligaments. It may take a few weeks to many months to heal completely. A fracture is a break in a bone. You can also injure other parts of the ankle such as tendons, which join muscles to bone, and cartilage, which cushions your joints. Ankle sprains and fractures are common sports injuries.

Foot drop syndrome describes the inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot. As a result, individuals with foot drop scuff their toes along the ground or bend their knees to lift their foot higher than usual to avoid the scuffing, which causes what is called a “steppage gait."

Foot drop can be unilateral (affecting one foot) or bilateral (affecting both feet). Foot drop is a symptom of an underlying problem and is either temporary or permanent, depending on the cause.

Causes include:

• Neurodegenerative disorders of the brain that cause muscular problems, such as multiple sclerosis, stroke, and cerebral palsy
• Motor neuron disorders such as polio, some forms of spinal muscular atrophy and amyotrophic lateral sclerosis (commonly known as Lou Gehrig's disease)
• Injury to the nerve roots, such as in spinal stenosis
• Peripheral nerve disorders such as Charcot-Marie-Tooth disease or acquired peripheral neuropathy
• Local compression or damage to the peroneal nerve as it passes across the fibular bone below the knee
• Muscle disorders, such as muscular dystrophy or myositis

Treatment depends on the specific cause of foot drop. The most common treatment is to support the foot with lightweight leg braces and shoe inserts, called ankle-foot orthotics. Exercise therapy to strengthen the muscles and maintain joint motion also helps to improve gait. Devices that electrically stimulate the peroneal nerve during footfall are appropriate for a small number of individuals with foot drop. In cases with permanent loss of movement, surgery that fuses the foot and ankle joint or that transfers tendons from stronger leg muscles is occasionally performed.

Foot drop caused by trauma or nerve damage usually has partial or even complete recovery. For progressive neurological disorders, foot drop will be a symptom that is likely to continue as a lifelong disability. People with foot drop are more likely to fall.

Each step you take involves a complex network of bones, muscles, tendons, and ligaments. This, combined with all of the weight they carry, explains why feet can have problems. To keep your feet healthy

• Examine your feet regularly
• Wear comfortable shoes that fit
• Wash your feet daily with soap and lukewarm water
• Trim your toenails straight across and not too short

Your foot health can be a clue to your overall health. For example, joint stiffness could mean arthritis. Tingling or numbness could be a sign of diabetes. Swelling might indicate kidney disease, heart disease, or high blood pressure.

Good foot care and regular foot checks are an important part of your health care. If you have foot problems, be sure to talk to your doctor.

The distal extremity of the leg in vertebrates, consisting of the tarsus (ANKLE); METATARSUS; phalanges; and the soft tissues surrounding these bones.

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose can't get into your cells as quickly as usual. The glucose builds up in your blood and causes high blood sugar levels.

How does diabetes cause foot problems?

Foot problems are common in people with diabetes. They can happen over time when high blood sugar damages the nerves and blood vessels in the feet. The nerve damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of feeling in your feet.

If you can't feel pain, you may not know when you have a cut, blister, or ulcer (open sore) on your foot. A wound like that could get infected. The infection may not heal well because the damaged blood vessels can cause poor blood flow in your feet.

Having an infection and poor blood flow can lead to gangrene. That means the muscle, skin, and other tissues start to die. If you have gangrene or a foot ulcer that does not get better with treatment, you may need an amputation. This is a surgery to cut off your damaged toe, foot, or part of your leg. It may prevent a bad infection from spreading and could save your life.

But there's a lot you can do to prevent a foot wound from becoming a major health problem.

How can I protect my feet if I have diabetes?

The best way to protect your feet is by controlling your blood sugar levels every day. This will help keep nerve and blood vessel damage from getting worse. The next step is to keep the skin of your feet healthy.

Good foot care for people with diabetes includes:

• Checking your feet every day. Look for cuts, redness, and other changes in the skin and toenails, including warts or other spots that your shoes could rub. Make sure to check the bottoms of your feet too.
• Washing your feet every day. Use warm water and soap. Don't soak your feet because that can dry out your skin. After you dry your feet, you can use talcum powder or cornstarch between your toes. They soak up moisture that can cause infection. If you use lotion, don't apply it between your toes.
• Asking your doctor how to remove corns and calluses safely. Thick skin on your feet can rub and lead to sores. But removing it the wrong way could damage your skin. So you don't want to cut the skin or use medicated pads or liquid removers.
• Trimming your toenails straight across with a clipper. If it's hard for you to trim your own toenails, or if they're thick or curve into the skin, have a podiatrist (foot doctor) do it for you.
• Always wearing well-fitting shoes and socks or slippers to protect your feet when walking. You don't want to walk barefoot, even indoors. And be sure your shoes are smooth inside. A seam or pebble could rub your skin raw.
• Protecting your feet from heat and cold. Use sunscreen on exposed skin and don't walk barefoot at the beach. In cold weather, wear warm socks instead of warming your feet near a heater or fireplace.
• Keeping the blood flowing in your feet. Put your feet up when you're sitting. Wiggle your toes and circle your feet throughout the day. Don't wear tight socks. And get plenty of activity that's not too hard on the feet, such as walking.
• Getting your feet checked at your health care visits. Even if you haven't noticed a problem, it's good to have your health care provider look at your feet.

When should I see my health care provider about diabetic foot problems?

Serious foot problems can develop quickly. See your health care provider right away if you notice:

• A cut, blister, or bruise on your feet that doesn't start to heal in a few days
• Red, warm, or painful skin on your feet
• A callus with dried blood inside
• A foot infection that becomes black and smells bad that could be gangrene

Remember, controlling your blood sugar and caring for your feet every day are the best steps you can take to prevent serious diabetic foot problems.

How Are Sports Injuries Treated?

Although using the RICE technique described previously can be helpful for any sports injury, RICE is often just a starting point. Here are some other treatments your doctor or other health care provider may administer, recommend, or prescribe to help your injury heal.

All medicines can have side effects. Some medicines and side effects are mentioned in this publication. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

The moment you are injured, chemicals are released from damaged tissue cells. This triggers the first stage of healing: inflammation (see box "The Body's Healing Process"). Inflammation causes tissues to become swollen, tender, and painful. Although inflammation is needed for healing, it can actually slow the healing process if left unchecked.

To reduce inflammation and pain, doctors and other health care providers often recommend taking an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, or naproxen sodium. For more severe pain and inflammation, doctors may prescribe one of several dozen NSAIDs available in prescription strength.

Though not an NSAID, another commonly used OTC medication, acetaminophen, may relieve pain. It has no effect on inflammation, however.

Warning: Side effects of NSAIDs include stomach problems; skin rashes; high blood pressure; fluid retention; and liver, kidney, and heart problems. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs, because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you take NSAIDs. NSAIDs should only be used at the lowest dose possible for the shortest time needed.

Immobilization

Immobilization is a common treatment for musculoskeletal sports injuries that may be done immediately by a trainer or paramedic. Immobilization involves reducing movement in the area to prevent further damage. By enabling the blood supply to flow more directly to the injury (or the site of surgery to repair damage from an injury), immobilization reduces pain, swelling, and muscle spasm and helps the healing process begin. Following are some devices used for immobilization:

• Slings, to immobilize the upper body, including the arms and shoulders.
• Splints and casts, to support and protect injured bones and soft tissue. Casts can be made from plaster or fiberglass. Splints can be custom made or ready made. Standard splints come in a variety of shapes and sizes and have Velcro straps that make them easy to put on and take off or adjust. Splints generally offer less support and protection than a cast, and therefore may not always be a treatment option.
• Leg immobilizers, to keep the knee from bending after injury or surgery. Made from foam rubber covered with fabric, leg immobilizers enclose the entire leg, fastening with Velcro straps.

Surgery

In some cases, surgery is needed to repair torn connective tissues or to realign bones with compound fractures. The vast majority of musculoskeletal sports injuries, however, do not require surgery.

Rehabilitation (Exercise)

A key part of rehabilitation from sports injuries is a graduated exercise program designed to return the injured body part to a normal level of function.

With most injuries, early mobilization-getting the part moving as soon as possible-will speed healing. Generally, early mobilization starts with gentle range-of-motion exercises and then moves on to stretching and strengthening exercises when you can without increasing pain. For example, if you have a sprained ankle, you may be able to work on range of motion for the first day or two after the sprain by gently tracing letters with your big toe. Once your range of motion is fairly good, you can start doing gentle stretching and strengthening exercises. When you are ready, weights may be added to your exercise routine to further strengthen the injured area. The key is to avoid movement that causes pain.

As damaged tissue heals, scar tissue forms, which shrinks and brings torn or separated tissues back together. As a result, the injury site becomes tight or stiff, and damaged tissues are at risk of reinjury. That's why stretching and strengthening exercises are so important. You should continue to stretch the muscles daily and as the first part of your warm-up before exercising.

When planning your rehabilitation program with a health care professional, remember that progression is the key principle. Start with just a few exercises, do them often, and then gradually increase how much you do. A complete rehabilitation program should include exercises for flexibility, endurance, and strength; instruction in balance and proper body mechanics related to the sport; and a planned return to full participation.

Throughout the rehabilitation process, avoid painful activities and concentrate on those exercises that will improve function in the injured part. Don't resume your sport until you are sure you can stretch the injured tissues without any pain, swelling, or restricted movement, and monitor any other symptoms. When you do return to your sport, start slowly and gradually build up to full participation. For more advice on how to prevent injuries as you return to active exercise, see the box "Tips for Preventing Injury."

Rest

Although it is important to get moving as soon as possible, you must also take time to rest following an injury. All injuries need time to heal; proper rest will help the process. Your health care professional can guide you regarding the proper balance between rest and rehabilitation.

Other Therapies

Other therapies used in rehabilitating sports injuries include:

• Cold/cryotherapy: Ice packs reduce inflammation by constricting blood vessels and limiting blood flow to the injured tissues. Cryotherapy eases pain by numbing the injured area. It is generally used for only the first 48 hours after injury.
• Heat/thermotherapy: Heat, in the form of hot compresses, heat lamps, or heating pads, causes the blood vessels to dilate and increase blood flow to the injury site. Increased blood flow aids the healing process by removing cell debris from damaged tissues and carrying healing nutrients to the injury site. Heat also helps to reduce pain. It should not be applied within the first 48 hours after an injury.
• Ultrasound: High-frequency sound waves produce deep heat that is applied directly to an injured area. Ultrasound stimulates blood flow to promote healing.
• Massage: Manual pressing, rubbing, and manipulation soothe tense muscles and increase blood flow to the injury site.

Most of these therapies are administered or supervised by a licensed health care professional.

A bony outgrowth on the lower surface of the CALCANEUS. Though often presenting along with plantar fasciitis (FASCIITIS, PLANTAR), they are not considered causally related.