Dr. Berg's Foot Facts

Posts for category: Heel pain

By Dr. Rion Berg
September 23, 2020
Category: Heel pain
Tags: Untagged

woman runningWith gyms barely open, many of my women patients have taken up running outdoors. And that's great news since the health benefits of running are well known. However, many of those patients are ending up with painful foot conditions as a result. Women tend to have more painful foot problems when they run than men do. 

Check out the reasons for the most common painful foot conditions in women and how we treat them.

Neuromas
Women runners with flat feet are more at risk for developing a neuroma. High heel wearers are even more apt to develop this painful condition which worsens over time. A neuroma most commonly develops between the third and fourth toes. Symptoms can include tingling, pain, burning, and numbness. As your Seattle podiatrist I use variety of treatments for this condition including orthotics, alcohol injections, MLS laser, and education about proper footwear.

Plantar Fasciitis
Women runners get a double whammy when it comes to developing heel pain or plantar fasciitis. Anyone involved in high impact sports is more at risk and women are more prone to develop it than men. If you’re a woman runner who happens to love high heels you have the trifecta of risk for heel pain. Women who wear high heels often develop a shortened achilles or calf muscle. Shortend calf muscles are often a big factor in causing heel pain. Treatment includes avoiding high heels, low-dye taping, PRP, stretching exercises before running, OTC supportsorthotics.

Stress Fracture
While stress fractures are common in both men and women runners, certain conditions put women at greater risk for developing one. Estogren plays a significant role in bone strength. Once women begin menopause their estogen decreases and they lose bone. Sometimes that bone loss can progress to osteoporosis. Bones can be more fragile in women who are very thin, don’t get proper nutrition to keep bones healthy, or develop amenorrhea from an eating disorder. Immediate treatment requires rest and immobilization with a walking boot. Patients with osteoporosis will require treatment to improve their bone health and patients with an eating disorder will require mental health counseling.

If you’re a woman who uses running as a way to stay fit or just for the sheer joy of it, I recommend taking the extra time to ensure that your feet and physical health are in tip top shape so you can keep doing what you love.

If you run into any foot problems along your daily path, call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

For chronic heel pain, download our eBook, "Stop Living With Stubborn Heel Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on FacebookTwitterand Pinterest.

 

By Dr. Rion Berg
September 21, 2020
Category: Heel pain
Tags: plantar fasciitis  

Louise was a 45 year old woman who came to see me in April 2019 for heel pain. She'd been suffering from it for many years and had gone to several doctors to help resolve her problem. One of her podiatrists made her a pair of custom orthotics and that seemed to help for a while. But then the pain came back worse than ever. Louise is also a runner who runs at least one marathon a year. Having heel pain not only interfered with her daily life, but it also interfered with her ability to continue engaging in her passion, running.

Assessment

Louise brought in her running shoes and they seemed fine; very supportive and stabile. They also had light, even wear on the bottom. Her orthotics were two years old, were still in good shape and fit her well. Then I asked her what other shoes she wore when she wasn't running. She told me she wore high heels of over two inches at work and would often run around Green Lake as soon as she left her job. She's a shoe salesperson at Nordstrom so she's constantly on her feet. In addition to having flat feet Louise also has very tight calf muscles. When I asked her about her stretching regimen she told me she spends about 5 minutes stretching before her run.

Conclusion

I told her the high heels were the primary cause of her heel pain reoccurence. Regular high heel wear can cause the calf muscle to shorten. Shortened calf muscles are often a big factor in causing plantar fasciitis. In Louise's case, her 5 minute stretching routine was not sufficient to relax her calf muscles before her run. The shortened calf muscle combined with the high impact from running led to the micro-tears, inflammation, and plantar fasciitis.

Recommendations

I recommended Louise cut back her high heel time. While it's fine to wear high heels for special occasions, daily wear was the biggest problem. I suggested she begin wearing a lower heeled (one inch or less) supportive shoe. I told her the lower heeled shoes would reduce her calf tightness. In addition, I recommended she begin a daily stretching routine using an Achilles splint, 1-2 times a day for 30 mins while reading or watching television. Here's a video explaining how to use the splint properly.

Resolution

After a couple of months Louise returned to our office for a follow-up visit. Her heel pain had subsided. Her calf tightness was also much reduced. She had stopped wearing high heels to work and instead she was wearing a Dansko shoe. Dansko shoes can be very effective for helping people with flat arches get the support they need. She was also stretching at least once a day for 30 minutes.

Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

For chronic heel pain, download our eBook, "Stop Living With Stubborn Heel Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.

 

Women running

As a runner you know the importance of keeping your feet in top condition. You may be well aware of the most common cause of runner's foot pain, namely heel pain or plantar fasciitis. But another condition nearly as prevalent as heel pain in runners is Achilles tendon pain.

And this shouldn't be surprising. After all the term "Achilles heel" comes from the Greek tragedy, the Illiad. In this saga, Achilles leads the Greeks against the Trojans. A powerful warrior his only weakness is his Achilles. For today's runner this is also true. An Achilles rupture or tear can be a season ending event.

While an Achilles rupture can change the outcome of a game or race, it's by no means the most common form of Achilles tendon pain. Achilles tendonitis and it's cousin Achilles tendonosis are much more common.

What is the Achilles tendon?

The Achilles is the largest and strongest tendon in the body. It can withstand forces of up to 1000 pounds or more. It's located where the calf muscle joins the heel bone. The Achilles makes it possible for us to push off while we run, jump, or walk. Without it we would be incapable of movement. That's why when our Achilles tendon becomes inflamed or sustains an injury treatment is imperative.

Achilles Tendonitis

Achilles tendonitis is an inflammation of the Achilles tendon. It results from micro-tears that develop as a result of too heavy or sudden pressure on the tendon. These can occur as a result of running hills, rapidly increasing training time and distance, and sprinting.

Other risk factors

Other risk factors for Achilles tendonitis are:

  • Sex (men are more prone to it)
  • Increased age
  • Over pronation resulting from flat or low arches
  • Tight calf muscles
  • Wearing unsupportive or worn out running shoes
  • Medical conditions such as psoriasis and high blood pressure
  • Taking antibiotics called fluoroquinolones.

Two types of Achilles tendonitis

There are two types of Achilles tendonitis based on where the inflammation is located, insertional and non-insertional.

Insertional

Insertional Achilles tendonitis occurs in the lower portion of the heel where the tendon inserts into the heel bone. This type of tendonitis tends to develop with years of overuse and is most commonly seen in marathoners and sprinters.

Non-insertional

Non-insertional Achilles tendonitis occurs in the middle portion of the tendon and is more common in younger athletes.

Sign and Symptoms

  • Mild pain after running that gradually worsens.
  • Pain occurs most often after periods of rest and with first steps out of bed in the morning.
  • A dull or sharp pain along back of tendon.
  • Tenderness or sometimes intense pain can be experienced when the sides of the tendon are squeezed.

Treatment

If you're experiencing any of the signs and symptoms of Achilles tendon pain it's important to stop running. Running through your pain will make the condition worse. Rest and sometimes immobilization in a walking boot are necessary to recover from Achilles tendonitis.

In addition, treatment at home or at your podiatry office often includes the following:

Reduce the inflammation

To assist in your recovery it's important to reduce the inflammation.

  • Use ice 20 minutes out of every hour.
  • Take nonsteroidal anti-inflammatory medication. Note: Consult your physician before taking any medication.
     
  • Receive MLS laser therapy for pain relief and reduction of inflammation

Improve your foot biomechanics.

  • Orthotics can help support the muscle and relieve stress on the tendon. Over-the-counter shoe inserts or custom orthotics will both work depending on your foot type and the length and severity of the problem.

Stretch your calf muscles

Adequately stretching tight calf muscles is needed in the treatment and prevention of Achilles tendonitis. One of the best ways to do this is by using an Achilles splint 1-2 times/day for 20-30 minutes while watching TV or reading a book. Please watch this video on How to Use An Achilles Splint for Stretching Calf Muscles. Sports medicine physicians and others also recommend using a foam roller as an adjunct to stretching.

Physical therapy

We recommend physical therapy for:

  • exercises to lengthen the Achilles tendon
  • strengthen the Achilles tendon
  • gait training

Surgery

Surgery may be needed if the tendon does not recover using more conservative approaches.

Prevention

It's far better to prevent Achilles tendonitis than to heal from it.

Achilles Tendonosis

Achilles tendonosis in runners is a degeneration of the collagen protein that forms the tendon. It's a response to chronic overuse without adequate time to heal and rest. When the tendon is damaged in this way, healing is haphazard and abnormal, resulting in pain when put under tension, stressed, or touched. This new tendon can be weaker, prone to re-injury and rupture if not adequately rehabilitated. The tendon will show up thicker on MRI.

Tendonitis can progress to tendonosis when treatment of the former condition has been insufficient. When the disorder progresses to degeneration, it can become enlarged and nodules can develop in the area where the tissue is damaged.

Signs and Symptoms

Runners with Achilles tendonosis will experience pain, tenderness, and stiffness without inflammation (swelling and redness) seen in Achilles tendonitis.

  • Tightness and loss of flexibility in the ankle.
  • Pain particularly after rest and upon wakening in the morning.
  • A nodule on the back of the heel
  • A jellylike consistency internally making the tendon soft and weak

Treatment and Prevention

Treatment and prevention are similar to those employed for Achilles tendonitis with special emphasis on curtailing all activities that put stress on the tendon. Immobilization will be required to ensure the tendon gets adequate healing time. Ice may be of limited value since there is typically no inflammation in this condition. MLS laser therapy has been shown to work well in healing old injuries by bringing more blood floor to the site. It could be of important value in healing Achilles tendonosis.

Achilles Tendon Rupture

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Sudden accelerations during running or a trip or fall can overstretch the tendon and cause a tear.

Achilles tendon ruptures are most often seen in "weekend warriors" – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

Signs and Symptoms

While sometimes there are no signs and symptoms of Achilles tendon rupture the most common ones are:

  • Feeling of being kicked or stabbed in the calf or ankle
  • Popping or snapping sensation
  • Swelling in the back of the leg between the heel and calf
  • Difficulty walking and rising up on the toes

Risk Factors

Men are at greater risk for Achilles tendon rupture due to their lack of flexibility compared to women. Runners with a previous history of Achilles tendonosis are also at greater risk.

Treatment

Most often Achilles tendon ruptures require surgery since the chance of re-rupture is great for those still planning to continue with their running career. For those who plan a more sedentary lifestyle or concerns about nerve damage or infection should choose a more conservative treatment route similar to those used to treat the other two Achilles tendon conditions.

Prevention

In addition to following all the previous recommendations stated earlier, runners who've a history of Achilles tendonosis should take great care to moderate their level of activity and watch out for irregularities in their running surface.

Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

For chronic heel pain, download our eBook, "Stop Living With Stubborn Heel Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.

 

By Dr. Rion Berg
July 06, 2020
Category: Heel pain
Tags: back of heel pain  

back of heel painTo relieve the stress of living in lockdown many of us have dramatically increased our level of exercise. Exercise is a fantastic outlet for reducing anxiety and improving our overall health. It can help reduce blood pressure, kick our metabolism into high gear, and help us sleep better.

Unfortunately a rapid increase in our mileage when walking or running can also lead to foot and ankle problems such as back of heel pain. If you've increased your exercise distance by more than 10-20% a week you're doing too much. Reducing your level of exercise may be all you need to relieve your pain.

However, an increase in exercise is only one factor in causing back of heel pain.

Low or Flat Arches

Your foot type can play a major role in developing foot pain. People who have flat feet or low arches are at greater risk for developing Achilles tendonitis one of several conditions that results in back of heel pain. The Achilles tendon is the largest tendon in the body. While it's able to withstand forces of 1,000 pounds or more, it can become inflamed.

Why?

People who have flat or low arches tend to roll their feet inwards or over pronate, increasing the pull on this tendon. People with this foot type also tend to develop a related condition--plantar fasciitis. Instead of feeling pain in the back of the heel, patients with this condition experience pain in the bottom of the heel.

Improper Footwear

Old, worn out, or poorly fitting athletic shoes can also increase the likelihood of developing Achilles tendonitis and plantar fasciitis. This is particularly true for patients who have flat feet or low arches. A person with this foot type often needs more supportive shoes to keep their feet stable and pain free.

Tight calf muscles

Another factor in development of back of heel pain are tight calf muscles or equinus. Tight calf muscles limit range of motion and make it much more likely for a person to roll inward or pronate causing strain and inflammation on the heel cord.

Other Types of Back of Heel Conditions

Other types of back of heel conditions can result from too much exercise or other factors.

Heel spurs
Heel spurs are osteophytes on the bottom or back of the calcaneus, or heel bone. These result from conditions such as plantar fasciitis or Achilles tendonitis, in which additional stress is placed on the plantar fascia ligament or Achilles tendon.  The bone grows in response to the tight ligament or tendon as the micro-tears in these structures repair themselves. Heel spurs may not cause pain by themselves but may be associated with back of heel pain.

Bursitis

Bursitis occurs when the bursa located at the back of the heel becomes irritated and inflamed from excessive walking or running. Initially the fluid-filled sac develops as a protection from micro trauma that occurs from the repetitive movements, but eventually the sac also becomes inflamed leaving the person with bursitis.

A special type of bursitis can be caused by Haglund's deformity or "pump bump". The back of the heel bone or calcaneus enlarges as a result of wearing shoes that are too tight or stiff in the heel. This condition can also develop as a result of a tight Achilles tendon or having a high arched foot.

Insertional Pain of the Achilles Tendon

Insertional pain of the Achilles Tendon occurs at the site where the Achilles tendon inserts on the back of the heel bone. The tendon and its covering become inflamed, and a spur may form at the back of the heel. This condition is commonly caused by chronic overuse of the Achilles, a flatfoot deformity, or an acute injury.

Stress Fracture         

Athletes and others can also develop an overuse injury called a stress fracture on the back of the heel from a rapid increase in exercise. Stress fractures can also develop by changing the exercise surface (going from running on a soft track to concrete), poor running technique (i.e. compensating for a blister or bunion), and/or poor bone health (women who have low bone density due to menopause or low weight due to dieting or eating disorders).

Sever's Disease

Sever's disease is a condition that affects children between the ages of 8-14. Pain can be felt at the back or the bottom of the heel as a result of inflammation of the growth plate. Sever's disease or calcaneal apophysitis is most commonly experienced in youth athletes, particularly those involved in soccer, track, or basketball. Unlike adult heel pain it doesn't subside immediately once the activity stops.

Treatment for Back of Heel Pain

To treat and prevent back of heel pain it's important to properly diagnose the condition and the factors that contribute to it. The following modalities and suggestions are part of a comprehensive plan to resolve back of heel pain

Build Up Your Exercise Slowly
As mentioned earlier back of heel pain can result from rapid increases in exercise. Therefore it's best to increase your time and distance by no more than 10-20% per week. You’re much more likely to get a repetitive injury if you’re body and feet aren’t ready.

Curtailing Exercise

While limiting or reducing exercise may be enough to prevent or stop some back of heel pain, curtailing exercise altogether is necessary with a someone with a stress fractures or Sever's disease in order to heal.

Shopping for Shoes

The type of exercise you engage in should dictate the type of shoes you purchase. Supportive shoes designed for your sport can make a big difference in preventing back of heel pain and other painful foot conditions. Be sure to follow these tips when shopping for shoes:

  • Go to a reputable store - go to a store that specializes in the sport you engage in.
  • Replace the insert that comes with your athletic shoes with an over-the-counter insert like Powerstep.
  • Go shopping later in the day when feet are more likely to swell.
  • Get your feet measured and buy shoes to fit your larger foot.
  • Test your shoes for stability - shoes should bend at the toe not in the center, be difficult to twist when you try to wring them out like a rag, and have a stiff heel counter that you can’t move easily.
  • Replace worn out shoes every 500 miles.

Stretching for Tight Calf Muscles

While everyone should stretch before engaging in exercise, this is essential for people with tight calf muscles. For many people standing stretches may be sufficient, but for those with very tight calf muscles I recommend using an Achilles splint for 30 mins during the day while watching television or reading a book. This needs to be done daily for a least three weeks.

Custom Orthotics

To resolve and prevent flare ups of most back of heel pain, custom orthotics are often necessary. This is particular true for those with a diagnosis of Achilles tendonitis and if your back of heel pain is worse because you have flat feet or low arches. Custom orthotics will correct faulty foot mechanics and relieve pressure from the Achilles tendon.

Light Laser Treatments       

MLS laser and other light lasers can greatly help reduce back of heel inflammation and pain. The MLS laser uses dual wavelengths of infrared light to penetrate deep into the tissue and stimulate regeneration at the cellular level. Patients often experience relief with as few as 2-3 treatments.

Restarting Exercise

As with any inflammatory condition, a return to exercise must be gradual.

If you're experiencing back of heel pain, call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about foot and ankle problems, download our eBook, "No More Foot Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.

 

 

By Dr. Rion Berg
May 21, 2020
Category: Heel pain
Tags: barefoot  

You're stuck at home. If you're like many people, you've been walking more. Perhaps you've also started working out at home. As a result, you may be wondering if it's OK to work out barefoot or in stocking feet.

The answer is, it depends. If you've been Zooming into a yoga or Pilates class your fine. These forms of exercise are low impact.

But recently patients have been coming in with foot pain as a result of doing higher impact workouts at home while barefoot. Heel pain, Achilles tendonitis, and other foot problems can result when additional pressure is added to the plantar fascia--the thick band of tissue which originates at the heel, travels across the arches, and inserts into the base of the toes.

When you go barefoot your feet don't have the support they need to withstand the higher pressure placed on them.

When doing higher impact activities it's important to wear athletic shoes designed for that exercise. Be sure you're shoes aren't showing signs of wear. Also, shoes should only bend at the toes, not in the middle, be hard to wring out like a rag, and have a firm heel counter. To learn more about buying supportive shoes, view this video on how to test your shoes.

If you're experiencing foot pain call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

For chronic heel pain, download our eBook, "Stop Living With Stubborn Heel Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.