Dr. Berg's Foot Facts

Posts for category: Heel pain

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 can actually grow in response to the tight ligament or tendon as the micro-tears in these structures repair themselves. Heel spurs my 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.

Doctor holding cell phoneDespite current concerns about Covid-19, most of us are getting outside. We’re soaking up the sun while gardening or by walking and running in our neighborhoods. Some of us are also frequenting parks and golf courses, now that those are open as of May 1st.

With more physical activity comes foot pain. You may be wondering if you need to come into the office to get your particular foot condition evaluated and treated. The answer is, not necessarily. Through the wonders of telemedicine I can listen to you describe the pain you’re having, you can show me your feet, and I can watch you walk. Oftentimes these will be sufficient for me to prescribe you a home treatment program and/or write you a prescription you can pick up at your pharmacy.  Sometimes we will have the item you need at the office. You can pay for these over the phone and then pick them at the door.

So what are some of the most common conditions I’m seeing through telemedicine?

  • Heel pain
  • Ingrown toenails
  • Cracked skin
  • Broken toes

Heel Pain

Heel pain is usually either plantar fasciitis (bottom of the heel pain) or Achilles tendonitis (back of the heel pain). These conditions are most often brought on by a combination of the following factors: an increase in exercise (walking and running), going barefoot in the house or outside, overpronation (a tendency to pronate or roll your foot inward during movement) and having tight calf muscles.

I’ve helped many patients resolve their heel pain during a telemedicine call by learning more about their particular issues and by watching them walk.

To resolve your heel pain at home, take the following steps:

  • Wear supportive tennis shoes
  • Don't go barefoot at home, but instead wear support sandals
  • Reduce your inflammation
  • Add over-the-counter inserts
  • Reduce your calf tightness
  • Use a heel lift

To learn more about how to resolve your heel pain at home, review the blog I wrote and the companion video, “6 Self-Care Tips to Resolve Heel Pain During the Covid-19 Pandemic”.  The blog contains links to all the products I recommend.

Ingrown Toenail

If you’ve ever experienced an ingrown toenail you know how painful it can be. Although in most cases I’ll need to see you in the office to do minor surgery, we may be able to resolve your issue through a telemedicine call.

First I’ll ask you about the state of your toe. Is it painful, red, swollen, or is there any pus or drainage? Your responses to these questions will help me understand whether your ingrown toenail is infected. I’ll also view your toe during our telemedicine call. After my assessment I’ll determine whether you can start home treatment or whether you need to come into the office for surgery.

To care for your ingrown nail at home take the following steps:

  • Epsom salt soak - soak your toe in a bucket or other container with warm water and ½ cup of Epsom salt for about 15 minutes twice a day.
  • Apply a wet to dry dressing – wrap your toe with gauze and secure with tape (make sure you don’t tape the gauze to your toe. Saturate the gauze with the Epsom salt soak and let it dry while you wear an open toed shoe. Apply twice daily.
  • Wear sandals - wear sandals or another open toed shoe to avoid pressure on the nail.
  • Prescription medication – if your toenail is infected, I’ll prescribe medication. Use as directed.

Note: If redness, pain, or drainage increase you’ll need to make an in office appointment.

Cracked Heels

Walking around barefoot indoors and outside will often lead to dry and cracked heels due to increased pressure on that part of the foot. If your cracks are minor you won’t need a telemedicine appointment. However, more severe cracks particularly those that are deep and bleeding will require a telemedicine call.

To care for your cracked heels at home, take the following steps:

Mild to Moderately Cracked Heels

More Severe Cracked Heels

  • Put moisturizer on before you go to bed and wrap your feet in Saran wrap.
  • Purchase gel socks and use for two hours during the day only. Adessa Gel Socks can be purchased over the phone from our office and then picked up at the door.

Note: Patients who have cracked heels and diabetes, wounds, or ulcers will need to be seen at the office due to increased risk of infection.

Broken Toes

Broken toes often occur when we walk around barefoot during the night and slam our foot into a piece of furniture.  Most often broken toes won’t require an X-ray so you can easily treat this at home.

To care for your broken toe at home, take the following steps:

  • Use ice, 15 minutes on 15 minutes off.
  • Buddy splint your toes using one inch wide Coflex bandages starting on your baby toe (5th toe), then tape your 4th, and then tape your 3rd.

One Final Note: Covid Toes

Recently we’ve been reading about a new phenomenon some people are calling Covid toes. Mostly younger patients with Covid-19 in their 20s and 30s are experiencing a pinkish-red rash that can also turn purple over time. The toes can appear to be frostbitten with skin sores or bumps. This condition can also cause burning in some people. Most people who get this rash are asymptomatic with it disappearing in two to three weeks.

Because patients are asymptomatic the most important thing about this condition is that people who experience it should get tested and isolate themselves from others who could have a much worse case of Covid-19.

If you think you or your child has this condition, I can diagnose it through a telemedicine appointment.

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.

 

Woman in pink tennis shoesAs we shelter in place, most of us are stuck at home and unable to participate in many of our usual activities. Without gyms or swimming pools to go to for recreation and exercise many more of us are turning to walking. A great thing with all the lovely weather we’ve been having. Unfortunately, a lot people are calling my office because they’ve suddenly developed heel pain.

During our telemedicine appointments I’m finding that there are three main culprits to this Covid-related problem. People are walking much more than usual. When folks are at home they’re going barefoot more often. And finally, many people are wearing flip flops because the weather has been so nice.

Fortunately, there are a lot of things you can do at home to help with a case of heel pain.

Wear Supportive Tennis Shoes

It’s important to wear supportive tennis shoes or a supportive sandal when walking if you’re experiencing heel pain. To get a better understanding of why people are suddenly developing heel pain, let’s look at how the foot works. To work well, the feet need to bend at the ankle and at the ball of the foot, not in half. Shoes need to support the feet in the same way. They should allow you to bend at the ankle and at the ball of the foot, not in the middle. When the shoe is twisted from side to side it should be fairly firm. The heel counter in the back of the shoe should also be firm.

Instead people have been coming in wearing shoes with mesh and squishy soles. Shoes like that bend in half right with little pressure and can easily twist when wrung out like a rag. This type of shoe provides little support. Instead of the shoe propelling you forward you’re going to spend more time on the heel.

To make sure you’re getting the right support from your shoes, test your shoes to be sure they’re supportive enough.

Instead of Going Barefoot At Home Wear These Sandals Instead

People who are experiencing heel pain or are prone to developing it shouldn’t go barefoot at home. And even flip flops won’t provide you with the support you need. Instead try a shoe or sandal that has some degree of stability. I recommend Crocs, Merrills, Tevas, or Keens.

Reduce Your Inflammation

The pain in heel pain comes from inflammation. Along with all the other tips I provide here, you must do something to bring it down. In the office, I could give you a cortisone shot or provide you with MLS laser therapy. But at home there are some things you can do to treat the inflammation yourself.

First, use Biofreeze. It can provide temporary relief of heel pain.

Ice can also be very beneficial in bringing down the inflammation. Take a water bottle and put it in the freezer. Use is to massage the bottom of your heel while you’re watching television. Use it for 10 minutes and then remove it for 10 minutes and then begin again.

Add Over-the-Counter Shoe Inserts

Finally, adding an over-the-counter insert to the shoe can help prevent your feet from rolling inward or pronating, a problem that can increase your chance of developing heel pain. You might wonder why you’d need to do that with a brand, new pair of expensive tennis shoes. That’s because the insert that’s provided by most shoe companies does not provide sufficient support even if the shoes pass the support test in the video link above.

To demonstrate what I mean, start by taking the insert out of your tennis shoe. When you look inside you’ll notice that it’s totally flat on the bottom of the shoe. Now take the arch support and roll it up from the bottom to the top. If you can easily roll it you’ll understand why it can’t possibly provide the support you need if you have heel pain or you’re prone to it.

The over-the-counter inserts I recommend are Powersteps. These inserts bend at the ball of the foot, not in the middle, and they have a cushioned heel that’s slightly elevated. The combination of these factors can stop you from overpronating relieving stress on your arch. Superfeet are also effective, although Powersteps are little more shock absorbing. Sole Supports are also helpful.

Of course, many people who’ve had heel pain in the past have tried over-the-counter inserts and haven’t gotten much, if any pain relief. If this is true for you, you’ll need to come into the office so I can make you a pair of custom orthotics.

Reduce Your Calf Tightness

The other factor that plays a major role in developing heel pain is tightness of the calf. During two telemedicine appointments, I observed patients walking who also had hard heel strikes and very tight calf muscles. A tight calf doesn’t allow your ankle to bend properly. When that happens the force goes into the foot and adds to the heel pain. It’s imperative to do proper calf stretching to alleviate this problem. Check out our website for more information about how to stretch your calves.

Use A Heel Lift

Finally, a small heel lift can raise your heel just enough to relax the calf muscle temporarily while you’re working to get the inflammation down. I recommend a firm heel lift such as Adjust A Lift. It’s peels apart to provide you with just the right amount of lift. I usually recommend a quarter of an inch. This along with the over-the-counter supports will likely diminish your heel pain.

If these self-care treatments don’t work, please call our office at 206-368-7000 to set up an appointment by telemedicine or in person.

For more information about how to treat 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! Sign up today!

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
March 24, 2020
Category: Heel pain
Tags: Untagged

woman walkingAh, spring is in the air. With the great weather and no gym to go to, many people are starting to walk. Walking is great for many reasons. But now it’s particularly important in helping reduce the stress we all feel as a result of the coronavirus outbreak. In addition, people who walk at a moderate pace regularly have a lower risk of high blood pressure, high cholesterol and type 2 diabetes.

Perhaps you walk all the time and it’s no big deal to dive into your kicks and walk a 3-5 miles. But for people who’ve taken it easy all winter or participated in other forms of exercise, increased walking can cause problems with the feet, ankles, and back.

Conditions like plantar fasciitis and Achilles tendonitis can flare up and low back pain can occur due to imbalances in the feet. Bunions and neuromas which have been silent all winter can become aggravated.

So how can you counter these problems?

Increase Distance Gradually

Your best friend might want to walk a 5K, but if you’ve been swimming or riding a bike as your main form of exercise, walking that far could be problematic. You’re best off increasing your distance gradually – experts suggest no more than 10% a week. Not sure where to start? Think about the farthest you walked last summer and then back off by 25% before increasing by 10%. Always ask your doctor before starting any new exercise program.

Check Your Shoes for Wear and Buy New If Necessary

Your shoes are your best protection when it comes to cushioning your feet and preventing foot and ankle problems.

First, take your tennis shoes and flip them over. Is any part of your sole more worn down more than the others? If so, you need a new pair of shoes.

When you look for new shoes comfort and support are the two most important factors. How will you know? You can only tell by trying and testing. Since the pandemic is going full force you’ll likely only be able to order online. Zappos is an excellent choice because returns are so easy. Once you get your shoes, test them for support. Here’s my video for how to do that.

Add a Pair of Over-the-Counter Inserts

Many of us need more support than any built-in shoe insert will provide. That’s because a large percentage of us are either pronators (roll our feet inwards) or supinators (roll our feet outwards). An over-the-counter insert can help provide a little bit of support in this area. So go ahead and buy some. They’re relatively inexpensive and will last about 6 months with regular wear. I recommend Powersteps.

Get Your Orthotics Checked

You may already have a pair of orthotics if you have flat feet, pronate, or you’ve had plantar fasciitis. But when was the last time you had them checked? Although they should last 5-7 years that doesn’t mean they still work for you. It’s a good idea to have them checked annually, but particularly if your weight has changed, they feel a bit uncomfortable, or you notice uneven wear on your shoes.

Do Dynamic Warm-ups

A special kind of warm-up called "dynamic warm-ups" are great for getting your body ready to walk and prevent foot and ankle problems.  Make these warm-ups part of your daily walking ritual.

Try Yoga to Improve Foot and Ankle Strength and Flexibility

Want to help your feet and ankles even more? Check out these yoga exercises for your lower extremities. Yoga can also build awareness of how you’re walking. Currently our local Lake City yoga studio, Two Dog Yoga is offering classes on Zoom.

Having pain in your feet? If you're reading this during the coronavirus outbreak, leave a message at 206-368-7000 and we'll return your call and set up a telemedicine appoinment. 

Otherwise Call us today at 206-368-7000 for an in person 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 FacebookTwitterand Pinterest.