Definition: synovial fluid   

A clear fluid secreted by membranes in joint cavities, tendon sheaths, and bursae, and functioning as a lubricant. When a joint disorder is present, the synovial fluid that is removed and examined can contain indicators of disease, such as white blood cells or crystals.      http://dictionary.reference.com/browse/synovial-fluid


The human body contains @ 160 bursa sacs in an adult. We are born with some and others develop around joints and muscles to reduce friction. Muscles and tendons move over our bones, bursa sacs form in between these surfaces and help the muscles and tendons glide across the bony surface. They also form in pressure points, like the knee cap. A normal bursa sac is thin and filled with a few drops of Synovial fluid.  This fluid acts as a lubricant within the sac. The bursa sac would feel like a quarter sized Zip Lock bag, containing only oil, no air. The bursa sac acts like a lubricating bag and shock absorber. Usually bursitis develops from an overuse injury like tennis elbow but it can develop in the knee or heel of the foot from constant pressure. In both cases the sac fills with additional synovial fluid trying to protect the body from further injury. This usually is noticed by pain.

Symptoms include Pain when the affected joint is touched or pressure is applied. The area is may feel warm to the touch also.  This is often first noticed after a period of rest. Like washing the floor on your knees one day and waking up with sore knees that are swollen the next. Typically rotation or movement is hindered and is often described as a dull aching pain that increases with added pressure.


Bursitis can develop from a traumatic injury but most cases develop from an overuse injury due to constant repetitive movement or prolonged pressure!

Common Areas Include But Not Limited To:

The Foot – the heel, the forefoot pad.

The Shoulders





Since Bursitis is caused by overuse. First thing to do is stop the activity that is causing the injury. The body will heal itself (unless it is infected for some reason) if given adequate time to heal. Otherwise you could end up like Sandy Koufax- Famous Baseball Pitcher- who used to get Cortisone shots in his elbow almost every time he pitched. This is not good, eventually the cortisone attacks the joints.

Use Knee braces, ankle braces, shoulder braces, etc. to limit movement.

Cushion the area if applicable. If you have heel pain buy a pair of heel cushions or knee pads for knees.

If Swelling Won’t Go Down:

The doctor may choose to drain the excess fluid from the sac with a needle

The doctor may inject Cortisone.

Surgery in extreme cases.

Sesamoid Pain

The main joint of the big toe (great toe) forms the inside edge of the ball of the foot There is one sesamoid bone on each side of the base of the big toe, the tibial and fibular sesamoids. They look like small navy beans. They are embedded in the tendon of the Flexor Hallucis Brevis muscle just under the base of the big toe. These sesamoid bones are similar to a knee cap in that, they float around and are connected only to tendons or are embedded in muscle (there is no joint). There are 2 grooves on the bottom of your first metatarsal bone in which the sesamoid bones are seated but they are not attached. These little bones serve 2 main purposes. The toe flexor  muscles bend and pass underneath the main joint of the big toe (view pictures), crossing over the hump that is formed by the sesamoid bones. This hump acts as a fulcrum point for the toe flexors, giving these muscles extra leverage and power. They also act as a fulcrum for the short flexor tendon. The sesamoids in the forefoot ease friction, assist with weight bearing and elevate the bones of the big toe.

Causes of Sesamoiditis

These bones are accustomed to massive pressure because of the leverage that is placed upon them. Any type of exertion that propels the body forward and upward involves the Sesamoid bones and tendons. Occasionally they can become irritated. Any activity where pressure is placed on the ball of the foot and the large toe is flexed continuously aggravate the bones and tendons. Catchers in baseball and ballerina’s are famous for getting Sesamoiditis. This is basically an overuse injury so even walking and running can cause it.

Other Factors:

  • Over Pronation (walking on the inside of the foot) adds excessive pressure to the big toes.
  • High Arches: can concentrate more pressure to the big toe. You are more prone if you notice that the big toe has become stiff.
  • Loss of Padding. As a person becomes older they lose some of the padding in the bottom of their feet and become more prone to a sesamoid injury.
  • Arthritis: If it develops between the sesamoid bones and the big toe, there will be friction and pain

Other Causes:

  • Stress Fractures: The sesamoid bones can become fractured from over exertion or any activity with sudden directional changes, like basketball, tennis, or dancing.
  • Traumatic Fractures: Involve a sudden impact. Like jumping off a wall.


  • Sesamoiditis typically starts with a dull pain under the big toe joint. The sesamoids will feel tender to the touch. Any added weight or pressure to the sesamoids will cause increased pain, usually felt when the heel leaves the ground.
  • Other Symptoms:
  • A catching or popping that is followed by increased pain, which usually subsides after the foot is rested.
  • Swelling and bruising
  • Impaired ability to bend or straighten your big toe
  • When numbness is felt in the web of the first two toes.

Conservative Treatment:

  • Stopping the activity that causes the pain
  • Icing the sole of your foot.
  • Purchase a cushioning pad to relieve the weight.
  • Use cushioning foot orthotics to relieve stress. A custom therapeutic orthotic is highly recommended as it will change your gait if needed, put more stress on the arch of the foot and relieve stress from the big toe.
  • Aspirin or ibuprofen to relieve the pain.
  • Tape the big toe in a downward direction.
  • Consider a steroid shot
  • Pneumatic walker with rocker sole when walking.  2 to 6 weeks may be required.

Fracture of the Sesamoid:

  • Wear a short leg fracture brace, for up to 12 weeks. If pain persists use crutches even with the brace.
  • After 8-12 weeks. If the stress fracture won’t heal and is separated (nonunion fracture). Surgery is most likely the outcome. To avoid surgery doctors will want a cast and limited weight applied to the foot.

When Is Surgery Needed?

When the injury fails to respond to conservative treatment, surgery may be required as a last resort. Your surgeon may recommend removing part or all of the sesamoid bone. If only one sesamoid bone is removed the other sesamoid bone can still provide a fulcrum point for the toe flexors.  Surgeons will avoid taking both bones out if possible because the toe flexors lose necessary leverage and can’t function. Therefore Claw Toe can develop.

If you have had sesamoiditis and/or surgery please share with us your experiences.

Hammer Toe

What Does Hammertoe Look Like?

The PIP Joint/s (proximal interphalangeal joints) of the toes will be pointed upward, when you look down at them they will be waiving at you. Usually with a corn or callus on the top. The end of the toe is the hammer that hits the ground.

The Claw, Mallet and Curly Toe are all typically caused by the same things just affecting different joints in the toes. View the Image above to see the visual differences. Symptoms and Cures are almost identical.

What you might feel with Hammer, Claw, Mallet and Curly Toe?

  • During movement of the toe, Pain and stiffness may be felt
  • Since the top of the toe/s rub on shoes, there are often painful corns and calluses
  • The bottom of the toe that hits the ground, there are often painful corns and calluses
  • Pain may develop on the bottom or the ball of the foot
  • Inflammation, Redness and swelling in the toe joints often occurs
  • In a diabetic the hammertoes may be susceptible to ulcers and infections.

What Caused My Hammertoe?

Hammertoe can be hereditary or caused by a severely stubbed toe but just like bunions women are much more prone to acquire hammertoe than men. It is said that as high as 4 to 5 times as likely. This is because of the shoes women wear. Squishing a foot into a shoe that is tight and narrow shoe, cramps the toes upward. Eventually the toe can become stuck like this. High heels further exasperate the condition, the toes are under more pressure and crammed forward even further.

Other Factors:

  • Highly arched feet.
  • Rheumatoid arthritis.
  • Tendon imbalance. When the foot cannot function normally, the tendons may stretch or tighten to compensate and lead to toe deformities.


What Can I Do About Having Hammertoe?

Remember when I said, “That toes could become stuck in that position”. If the toes cannot be straightened forward there is no self-help solutions but you can treat the symptoms and hopefully become pain free. First step is to get a pair of therapeutic shoes, ones that are called ultra-depth. Explain to our Certified Pedorthist what condition you have and they will tailor an Orthotic Insert to your specific needs.  PodiatryNetwork.com says, “Functional orthotics can be thought of as contact lenses for your feet. They correct a number of foot problems that are caused by an abnormally functioning foot. Our feet, much like our eyes, change with time. Functional orthotics slow down or halt this gradual change in the foot. Often when orthotics are used for flexible hammertoes, the toes will overtime straighten out and correct themselves. Calf stretching exercises are also helpful. Calf stretching can help to overcome part of the muscle imbalance that causes the hammertoe”.

Therapeutic Shoes will allow the toes to move forward and or stop rubbing on the shoe. This will also help the corns and calluses to go away. Sandals in the summer, again look at therapeutic sandals they have much mort support. Padding and Taping is available to protect the boney top-part of the hammertoe as a means of relieving pain, and to change their current position. This will help to relieve the pressure that led to the hammertoe’s development. Medication. Anti-inflammatory drugs such as aspirin and Ibuprofen/Aleve can help deal with inflammation, swelling and pain caused by your hammertoe. Cortisone may be injected into the joints, this will relieve the pain temporarily.

Don’t be vain, therapeutic shoes are more stylish than ever and pricing is comparable to store bought shoes. These aren’t Granny Shoes anymore.

I Can’t Stop The Pain?

The good news is that toe surgery has a high success rate and is usually done on an outpatient basis. The bad news is that it can take a while to heal. Any surgery on the foot is prone to extended swelling because the blood is drawn into the feet. In severe cases swelling can last a year. Full recovery time is typically 1-3 months.

Flexible Hammertoe (one that can be straightened forward): A procedure of transferring the tendons from the bottom of the toe to the top of the toe where it is sticking up. This helps pull the bent joint into a straight position.

Fixed Hammertoe: (when the hammertoe has become fixed (stiff).

Joint resection: The end of the toe bone is cut and removed, this allow the toe to straighten. Tendons and ligaments may be cut to help straighten the toe. Then temporary pins (removed 3-4 weeks post surgery) are used to hold the toe straight.

Fusion:  In this procedure, the ends of the toe bone are cut and the toe is straightened. Pins, screws or other implants can be used to keep the toe straight (fusion process) while the bone ends heal together. The ligaments and tendons are also cut to help straighten the toe.

If you have a toe ailment like hammertoe, claw toe, mallet toe, curly toe, or have had surgery please share with us, your experiences.

Bunions of the Feet

Bunions are a common problem where the Great Toe (Big Toe) metatarsal bone shifts outward and away from the second. This is recognizable by the Great Toe pointing inwards. Bunions develop in approximately 30% of the population, which 9 out of 10 are women.  Bunions start slowly and progress as we get older. At first the Great tow will lean against the second toe. Over many years the bone on at the end of the 1st metatarsal will jut outward and on severe cases the second toe will overlap the Great Toe. This is the classic Bunion.

A tailor’s bunion is similar to a bunion in that it is caused by the same circumstances. They are recognizes as smaller bunions that form on the joint(s) at the base of the little toes


What Cases A Bunion?

  • Heredity – most people have parents or grandparents who have had bunions.
  • Pronation – during the walking gate the pressure is carried mostly by the Great Toe. If the inside of your shoes show greater wear, this is a noticeable sign.
  • Rheumatoid Arthritis can contribute
  • NUMBER 1 REASON – (Improper fitting of footwear) although experts disagree, I think the evidence states its case. 9 out 10 cases are women and what do they wear. Tight fitting shoes and high heels with little or no cushioning. Yes they can say that there mother had them too, but what did the mother wear? Probably shoes that were narrow or pointed and high heels. Why else would men be one out of ten?

What Are The Symptoms?

  • The Great Toe facing inward toward the other toes
  • A bulging bump on the outside of the base of your big toe that is often red from swelling and is painful to the touch
  • A callus forms at the base of the Great Toe
  • Limited motion of the Great Toe
  • Swelling in the joint
  • Joint pain increases when wearing shoes
  • Continuous Pain

How to Treat a Bunion Before and After It Becomes Painful?

  • Podiatrists are experts on Bunions and they don’t recommend surgery unless there is pain. Many say don’t consider surgery unless the Bunion is painful for at least one year. Almost all agree, don’t have surgery for cosmetic reasons.
  • First line of attack is to get proper fitting shoes that are wide enough not to squish your toes together. Do not wear shoes with stitching that runs along the bump. Remember you cannot correct the bunion but you can keep it from getting worse and in most cases remove the painful aspect.
  • Bunions shields, padding and splints help with pain.
  • Avoid activity that causes pain to the bunion.
  • Use an ice pack to reduce inflammation.
  • Keep your body at the proper weight.
  • Most Effective – Orthotic shoe inserts. The best ones are called Custom Orthotics or Custom Therapeutic inserts. These are made from a mold of your feet and when you tell the Pedorthist that you have bunions. They will correct any pronation qualities in your gait. Most importantly they will supply strong arch support, this will help relieve pressure felt by the Great Toe. Usually with a custom Orthotic Therapeutic shoes are recommended, they are called Ultra Depth Shoes. Meaning they are deeper allowing room for the Orthotic. Therapeutic Shoes are more stylish than ever and are priced relative to a normal shoe.

The Shoes and Orthotics Help But I Still Have Pain Sometimes.  You May Consider!

  • Oral nonsteroidal anti-inflammatory drugs such as Ibuprofen or Aleve, may reduce pain and inflammation.
  • Prescription strength pain relievers
  • Cortisone injections

I Can’t Take It Anymore, I Need Surgery.

  • Dr. Botek from the Cleveland Clinic says, “There are more than 150 types of bunion surgeries, but surgeons typically choose one from about a half-dozen commonly used procedures”.
  • Almost all patients are happy with the results the conflict that they can’t agree upon is the recovery. Many patients say the pain is intense or excruciating from 4 to 8 weeks. Others say that it’s only a couple weeks. Most say that they are in a Cam Walker Boot (A Walking Brace) for 6 to 8 weeks. Podiatrists and Surgeons both agree that the foot draws blood down to it, so swelling frequently postpones the wearing of normal shoes.

WebMD Recommends:  What to Expect After Surgery

  • The usual recovery period after bunion surgery is 6 weeks to 6 months, depending on the amount of soft tissue and bone affected. Complete healing may take as long as 1 year.
  • When you are showering or bathing, the foot must be kept covered to keep the stitches dry.
  • Stitches are removed after 7 to 21 days.
  • Pins that stick out of the foot are usually removed in 3 to 4 weeks. But in some cases they are left in place for up to 6 weeks.
  • Walking casts, splints, special shoes, or wooden shoes are sometimes used. Regular shoes can sometimes be worn in about 4 to 5 weeks, but some procedures require wearing special shoes for about 8 weeks after surgery. In some cases, it can be 3 to 4 months before you can wear regular shoes. Many activities can be resumed in about 6 to 8 weeks.
  • After some procedures, no weight can be put on the foot for 6 to 8 weeks. Then there are a few more weeks of partial weight-bearing with the foot in a special shoe or boot to keep the bones and soft tissues steady as they heal.

Please Share Your Story. If you have bunions please share with us, when they first started showing, when they became painful and what things helped with the pain. If you have had surgery for Bunions Please share with us, what the experience was like!

Safe and Effective Ways to Remove Calluses and Corns

A callus is a local thickening of skin, characterized by accelerated keratinization, a process by which skin cells lose their moisture and are replaced by horny tissue. Calluses tend to be yellowish in color, picture yellow tented sheets of wax paper. The thicker they are stacked the more yellow the color. The thickening of the skin is caused by constant friction. It’s the body’s way of protecting the sensitive skin underneath. Unfortunately after time calluses can dry, crack and become painful. Most calluses are on the bottom of the foot and are called a plantar callus. Young people develop calluses from activity. Elderly people lose the padding in there metatarsal area and are prone to calluses. Ill-fitting shoes that are tight will increase friction between the toes and cause calluses. Most calluses are not painful and can be treated with a sanding pad.

A corn is an area of skin which has become thickened due more to pressure than friction. Corns are small and round in shape. Corns press into the deeper layers of skin and can be painful. Corns can be confused with calluses because they are often inside or underneath a callus. Three Types of corns:

  1. The first is a hard corn, recognized by its dry, horny appearance. Hard corns frequently occur on the top of the smaller toes or on the outer side of the little toe. Tight shoes tend to apply the most pressure in these areas. Hard corns are the most common and usually appear within a callus. Having a hard corn feels like having a small pebble held under the skin, held there by a callus and then walking on it.
  2. A soft corn is described as such because of its softer and rubbery texture, this is because of moisture from sweat. They most commonly develop between the fourth and fifth (baby) toes.  Usually the least painful of the three unless they become infected.
  3. The third type is a Seed corn, the most often occur on the ball of the foot underneath a callus but can also occur near or on the edge of a nail. Like seeds spread upon the ground they usually appear in clusters. They are small and are recognized by a white plug in the skin. They also can also be painful.

How Can I Treat my Corns and Calluses?

We are going to recommend a few treatments, I want to state clearly that anyone who has an infection or is Diabetic should only see a physician and or podiatrist and none of these treatments involve a person cutting, scrapping or digging with a sharp object.

File down the calluses and corns by using a file or pumice stone (emphasis on gently). This should be done after soaking your feet.

After bathing use a moisturizing cream (Goal is to soften those calluses and corns). Podiatrist recommend one that contains urea.

There are sleeves for toes that relieve pressure. Splints can be used to create separation between the toes, this will allow corns to heal. For calluses, use cushioning pads and shoe insoles to relieve the pain and help the healing process

Do Not Use Salicylic Acid: People have success with it but podiatrists claim that if the foot is kept wet from the moisture of sweat the acid keeps working. There are cases when the podiatrist sees the patient when the acid has eaten its way down to the bone or tendons.

8 Homeopathic remedies recommended by Readers Digest:

  1. Castor Oil and Apple Cider Vinegar: Fill a basin with hot, soapy water, then add a cup of apple cider vinegar before soaking your feet in the water for at least 15 minutes. Calluses should be softened enough to be filed with a pumice stone. For corns, dab some castor oil on after soaking your feet. Corns should peel away after about 10 days of the treatment.
  2. Vitamin E or A : Before bed, use a needle to prick a vitamin E or A capsule, then rub the oil into your corn. After letting the oil sit for a few minutes, put on a white cotton sock and head to bed. Repeat nightly until the corn is gone.
  3. Lemon: Before going to sleep, cut a slice of lemon peel about an inch long and the width of your toe. Place the pith over the corn, securing with a bandage and covering with a white cotton sock overnight. Continue each night until the corn disappears.
  4. Onion: In a glass container, pour white vinegar over a slice of white onion. Leave the container in a warm place during the day, then cover the corn with the onion before you go to bed. Use a bandage or bandage tape to hold it in place while you sleep. If the corn is not soft enough to be removed in the morning, repeat the treatment nightly until it softens more.
  5. Bread: Soak a half a slice of stale bread in apple cider vinegar and secure it to the affected part of your foot with adhesive tape. Wrap with plastic wrap and slip on a cotton sock. Your corn or callus should disappear by morning.
  6. Castor Oil: For corns on toes, place a non-medicated, O-shaped corn pad around the corn. Use a cotton swab to dab a few drops of castor oil onto the corn, then cover with adhesive tape to keep it from moving. Wear old socks in case the castor oil leaks through.
  7. Aspirin: Crush five or six uncoated aspirin tablets and mix with equal parts apple cider vinegar and water. Once you’ve added enough to form a paste, rub it onto a corn or callus, using a bandage to hold it in place. After at least 10 minutes, the bump should be loose enough to gently rub off with a pumice stone.
  8. Epsom Salts: For calluses, toss a handful of Epsom salts into a basin of warm water, then soak feet for about 10 minutes. Once the dead skin has softened, use a callus file or pumice stone to rub off the top layers. Continue to grind the callus down a bit each day after a bath or shower. It might take a few weeks, but trying to remove the whole thing at once will make the callus worse if you grind too deep.

See a podiatrist: There are many videos on U-tube showing Podiatrists removing corns and calluses. They most often us a scalpel and grinder. The scalpel blade looks like a ¾ inch pen knife.

Now That I Have Gotten Rid Of Them, How Do I Keep Them from Coming Back?

  • First and foremost get proper fitting shoes. Therapeutic shoes with inserts are recommended. They are Ultra Depth, this will allow the fitting of a shoe insert and should illuminate the top of the toes from rubbing on the shoe. Therapeutic shoes are now more stylish and reasonably priced than ever.
  • Buy Therapeutic shoe inserts: These can be bought off the shelf or made from a mold of your feet. These inserts will cushion the friction and pressure of your walking gait. You won’t believe the difference between a custom insert and an insert that comes with a standard shoe. When I first compared, I thought, “I have been walking on tissue paper”.
  • Avoid wearing high heels.
  • Keep your feet moisturized.

Morton’s Toe


If your second toe is longer than your big toe (The big toe is also called the Great Toe) or your first metatarsal joint is shorter than your second metatarsal joint you have Morton’s toe (View Images). This is hereditary, 10-20% of the population have it. Many people have it with no complications. In the Greek Classic Period almost all statues were modeled after people with the “Greek Toe”. Not only was it considered attractive, a person lucky enough to poses this trait was considered to be intelligent and with qualities of creativity and leadership. One Lady that we all recognize (The Statute of Liberty) has a Greek or Morton Toe.

Why Does a Morton Toe Cause problems:

The Great Toe is supposed to carry @ 65% of the pressure with each adjacent toe bearing less and less. The Little Toe is said to carry 5% leaving 30% of the pressure to be carried by the middle three toes. Other factors contribute. If you pronate (walk on the inside of your foot) the big toe will carry a greater percentage of the pressure. Pain from Morton’s Toe can develop because the longer second toe bears an excessive amount of pressure. The 1st Metatarsal bone is much bigger in diameter than the 2nd Metatarsal because it is meant to carry the majority of pressure. When the second toe is longer it can create a side to side movement in the foot often called hypermobility. This adds to the complications of Morton’s Foot. Anything that adds additional pressure to the mentioned metatarsals increases the odds of Morton foot. Because of high heels, women are 8 times more likely to develop Morton’s Toe than men.

I Now Have Pain from Morton’s Toe, How do I Treat it?

  • Custom Orthotics with Metatarsal pads are highly recommended. They can offer relief from pain by distributing pressure on the foot evenly and help stop over pronation which is common with Morton’s Toe.
  • Comfort Shoe Wear.
  • Taping the first two toes together
  • Icing the bottom of the foot
  • Cortisone shots
  • Anti-inflammatory drugs: Ibuprofen, Aleve or aspirin, may be taken orally to reduce pain and inflammation.

If pain remains chronic, contact a podiatrist, there is surgery to shorten the bone in the second toe. Recovery time can be as little as two weeks.

Metatarsal Pain

Metatarsalgia (Met-uh-tahr-SAL-juh)

Metatarsalgia is pain in the ball of the foot. It is called stone bruise for good reason, it feels like you stepped on a sharp stone and then a 300 LB person stepped on that foot. The degree of pain varies and it can be tender to the touch. Pain is caused by inflammation at the end of the metatarsal bones which is above the ball of the feet. There are five long metatarsal bones that extend above the arch of the foot to the toe joints. The first and second metatarsal bones absorb the majority of this force. Most Metatarsal pain is between the third and fourth metatarsal heads (view pictures). Pain is felt when weight is applied to the ball of the foot and worsens when the walking gait transfers the weight to the toes. People with high arches and long second toes are prone to metatarsal pain. The longer second toe absorbs more weight during the gait and aggravates the metatarsal joint. If the pain is in the big toe it is often from osteoarthritis. Metatarsal pain is mostly an overuse pain. It is most common in athletes, runners, women who wear high heels and overweight or obese people.


  • 80% of the time symptoms develop slowly as it is an overuse condition. 20% of the time it is from an extreme overuse condition. Take a father who plays basketball with his son for example. The next day he might wake up and feel extreme pain in the balls of his foot/feet.
  • Pain in the ball of the foot and or in the second, third, or fourth toes
  • Increasing pain when walking on hard surfaces
  • Pain that increases when flexing the feet
  • A tingling or numbness that can be felt in the toes
  • When standing or moving there is pain but when sitting pain decreases

Healing Time of the injury include:

  • Lifestyle of the patient
  • Medical history of the patient.
  • How long the injury has been inflicted.
  • Severity and frequency of the pain
  • The person’s medical history and is there pain elsewhere?
  • The person’s gait, does the patient put excessive weight on the injured area from pronation?
  • Is surgery required?

Treatments may include:

  • Anti-inflammatory drugs, such as Ibuprofen or Aleve, are useful in pain relief.
  • Appling ice to the area up to several times a day. Do not apply ice directly to the skin.
  • Doctors may subscribe Steroid injections to reduce pain and swelling. Remember to ease into recovery often steroids mask the pain and patients are eager to over evert the injury.
  • Foot orthotics with metatarsal pads work well especially for people with high arches and arthritis pain and will be likely be prescribed to all, with or without surgery.
  • Shoes with Cushioned heels that absorb shock.

Note: if pain is persistent see a doctor it could be a stress fracture in the toe. Be aware that forefoot pain is the most misdiagnosed in podiatry. Other mitigating circumstances: Hammer Toe, a pinched nerve, etc.

Cause and Effect of Plantar Fasciitis

There are over two million cases of plantar fasciitis treated in America every year. It is one of the most commonly treated symptoms addressed by a podiatrist and is slightly more prevalent in women than men. Most cases are reported from people between the age of 40 and 70. The planta fascia runs from the heel bone to the toes. This is a long ligament and is very strong as it supports the arch and springs the energy created by walking/running from the heel to the toes. Just like a carbon fishing rod it is very strong and will flex from up and down but stretch it length wise and the fibers will tear. When this happens pain and inflammation are felt, usually around the heel and arch area at the bottom of the foot.

Symptoms of Plantar Fasciitis:

  • Pain in the morning on the bottom of the foot, near the heel, that will subside after a brief period of walking.
  • Typically the pain develops gradually, but after several weeks, the pain escalates and doesn’t diminish. Most often described as a sharp pain in the heel or arch although some people describe it as a dull pain.
  • Tenderness is felt when pressure is applied to the heel pad or the arch. Most often there is no swelling or bruising.
  • The pain is greater after exercising than during the exercise.

According to podiatrytoday.com –  Over the past two years, our team of doctors has treated more than 2,000 patients with plantar fasciitis. This has allowed us to try multiple conservative and surgical options. We have concluded that certain conservative options seem to make significant improvements.

If I have one conservative option to offer patients on a consistent basis that has the most impact in their recovery from heel pain, it would be Achilles and gastrocnemius stretching. We usually will ask patients to perform both calf and Achilles stretches for five minutes three times per day. We teach the patients these stretches on the initial visit.

Second in line for conservative options is a close tie between physical therapy and orthotic use. We have found that the combination of stretching, physical therapy and orthotic use has helped over 80 percent of our patients recover without further need for care. The average time to recovery has been less than two months and no further treatment has been necessary in over 90 percent of this initial group.          http://www.podiatrytoday.com/issue/2108

Pain Relief: Bandaging the arch helps but does not last long. Products that support the arch are your best bet. A custom made orthotic made from the mold of your foot will supply cushioning to the heel area and support the arch. Highly recommended is a night splint this will prop the foot up in a 90 degree position, situating the plantar tendon in a shortened position, making it possible for the tears in the plantar fascia to heal. These braces are relatively inexpensive.

Pain Relief: Using Advil or Aleve will help ease the pain but if these don’t work the doctor will most likely, administer an injection of a corticosteroid directly into the fascia tendon. Typically two shots are given anywhere from two weeks to a month apart. The steroid will most likely relieve the pain but do not overexert the fascia because the steroid shot is not healing the tendon, only addressing the pain. The good news is that only around 3% of cases require surgery.

Diabetes and the Foot

Definition of  “metabolic disease”  a syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to an increased risk of cardiovascular disease and type 2 diabetes often called also insulin resistance syndrome. From Merriam-Webster Dictionary      http://www.merriam-webster.com

“Metabolic syndrome” – is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes. From the staff at the Mayo Clinic    http://www.mayoclinic.org

“Neuropathy” – means nerve disease or damage and affects the nerves in your toes, feet, legs, hands, and arms.

“Peripheral neuropathy” A common, often misdiagnosed disorder that results from damage to the peripheral nervous system. Symptoms include numbness, weakness, tingling and/or burning in the toes or fingers. https://www.foundationforpn.org

Why does nerve damage from diabetes usually start in the feet? These nerves travel the farthest from the brain and spinal cord.

There are too many types of peripheral neuropathy to list. We are going to concentrate on “Sensory Neuropathy” because this is most likely the first one that a person with diabetes will develop. Sensory neuropathy affects the nerves that control what a person feels, like pain or an itching sensation. Again we will pertain to the feet since it will most often occur there. Some symptoms that a person might feel are: Numbness and tingling of the feet, Loss of sensation, like poking the bottom of the foot with a pin and not feeling pain. Loss of balance, especially in the dark.

Why do diabetics tend to get foot problems?

In the diabetic foot, glucose reacts with the collagen in the connective tissue. The short version is it causes both inelasticity and toughness in the foot’s connective tissue. This creates stiffness and weakens the muscles in the foot. Pressures on the foot that used to dissipate throughout the foot while walking are now accumulated to specific areas, causing blisters sores and ulcers.

Serious problems can begin when the diabetic foot or areas of the foot becomes numb. The diabetic skin cracks easier and if goes unnoticed can easily become infected. There are many people who started out with sores, blisters and have ended up with an amputation.

“I’m Pre-Diabetic” or “I have Type II Diabetes”.  Unfortunately it doesn’t matter, there is equal prevalence in types I and II. Only 5 percent of the diabetics in this country are type I. However time does matter – people are most likely to develop diabetic foot problems with over 20 years of being diabetic. Approximately 15% of the people with diabetes have consequential foot problems but that’s still millions of people, there’s @ 29 million people with diabetes in the USA.

Let’s not talk about preventing diabetes. You could fill a library with the books that have been written and I’m sure you have read that about 9 cases in 10 could be avoided by taking several simple steps: keeping weight under control, exercising more, eating a healthy diet, and not smoking (I’m talking about type II diabetes). Please don’t Google “Diabetic Foot Photo” unless you have a strong stomach, although the pictures will probably do much more for change in lifestyle than all the books written?

Care for diabetic neuropathy in the foot:

Clean Daily – Soaking of the feet should be avoided, use lotion to moisturize the feet, avoid letting lotion seep between the toes.

Cut Toenails: We don’t want a sharp edge to cut another toe. Cut and file appropriately and gently file calluses

Wear Shoes/Slippers to Protect the Feet: Wearing thick, soft, seamless socks can help prevent skin irritation.

Shoes: Wear ones that fit well and allow the toes to move (Ultra Depth/Therapeutic Shoes Preferred). Break new shoes in gradually.

Use Diabetic Shoe Inserts: they are smooth and less likely to rip the skin. They are soft which will help prevent skin from cracking. There are generally two types to consider. A flat diabetic insert (Generic) or a custom made diabetic insert (Molded). A diabetic insert is made of a special material that allows the foot to settle downward, into the insert. This allows the pressure points in the foot to settle so that surrounding areas that did not bear weight before, will now, creating a more even weight distribution. This is extremely important to a diabetic because neuropathy can prevent the feeling of pain. Diabetic Inserts have been proven to greatly reduce the development of Diabetic foot complications such as ulcers and lesion’s. When more severe Diabetic Foot Symptoms exist: loss of foot padding, thin skin, sores, Hammer toe, Claw’s Toe, Morton’s Toe, Bunions, Calluses, Red Spots, Blisters, Extreme Foot Neuropath, Diabetic with a Charcot foot, Metatarsal Pain (pain in the ball of the foot), etc., then Custom Molded Inserts should be used. These have been scientifically proven to reduce Metatarsal Pressure by increasing weight distribution and pressure onto the Plantar (Arch) area of the foot. Since they are custom molded to each foot, they supply ample arch support.  There are mixed reviews about relieving pressure stress in the heel area, although they are much thicker and softer than a flat prefabricated diabetic insert and will allow all pressure points to settle further.  That being said, pain is diabetic foot complications generally start in the mid to forefoot area.

If pain, sores, ulcers, etc. develop: See a Podiatrist!


 Merriam-Webster Medical Definition:   “Supination”: a corresponding movement of the foot and leg in which the foot rolls outward with an elevated arch so that in walking the foot tends to come down on its outer edge.

Pronation”: rotation of the medial bones in the midtarsal region of the foot inward and downward so that in walking the foot tends to come down on its inner margin.

By looking at your shoes can tell you a lot, if the outside of the shoe is worn from the back to the front you are supinating. If the heel is worn on the inside to the big toe you are pronating. Imagine balancing yourself on two broomsticks down the center of your feet, now rotate your weight to the outside of your foot-supination, now to the inside of your foot – pronation.  This is exaggerated but the picture is clear. Many problems can occur because of the way we walk and by added weight that is carried by our feet. If a person’s gait is pronated (over 90% of the people with foot problems over pronate) it is common for them to have claw toes, toes that are curled up, this is because only the big toe carries the weight. If the other toes carried weight they would be forced spread out. People that walk on the inside of their foot are prone to ankle, knee and back pain. The least common issue is supination, where the weight of the body is carried on the outside the foot. People that supinate, are prone to aching arches, knee and back pain, because shock absorption from the feet is reduced. “So, what is the big deal, I was born this way”?  30% of the people have normal feet and gait, out of the 70% left, probably only 30-40% are abnormal enough to cause pain. I personally played baseball, football, basketball and played outdoors from sunup to sundown when I was young- no pain. Looking back, when I reached my mid 40’s I started noticing ankle, knee and back pain. (Read the article – “Build Your Foundation”) https://www.mondaymedical.com/blog   Being out of line didn’t matter before I was 40ish. I can remember my big toe aching sometimes after basketball practice, now I know it was carrying most of the weight. As I approach 60, I notice my ankles and knees kill me if I forget my orthotics on a day of walking or working in the yard. Advil and Aleve help but my orthotics have done wonders. They have actually changed my walking gait. As soon as I walk with my orthotics I can feel my outer toes bearing weight. It is so apparent I notice before I walk 20 ft.

Breaking them in: When I first received my orthotics years ago I was told to wear them a few hours a day and progress more hours every day. This was good advice. The Orthotics supported my high arches for the first time, so I could feel pressure in my arch then to my toes. The toes were fine but it took a couple weeks before my arches were pain free. Now it feels abnormal if I am not walking on them. At first you will notice the distribution of weight in your feet, then you will notice the knees feeling different, like the body weight is wearing on a different part of the knee, finally you’ll notice less back pain.