My Heel Is Killing Me… It Hurts So Much… What Is It?

Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better. It’s estimated that more than 1 million persons in the United States suffer from heel pain at any … Continue reading “My Heel Is Killing Me… It Hurts So Much… What Is It?”

Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better.

It’s estimated that more than 1 million persons in the United States suffer from heel pain at any given time.

When a patient complains of heel pain, it must be clarified by history whether the pain is in the bottom of the heel or the back of the heel because the diagnosis and treatment are very different.

Pain in the bottom of the heel is often due to plantar fasciitis (PF). The plantar fascia is a tough band of tissue that begins at the medial (inside) part of the bottom of the heel and extends forward to attach at the ball of the foot. The fascia is responsible for maintaining the normal arch. When an excessive load is placed on the fascia, pain can develop at the origin (the heel) as well as the mid-portion (arch) of the fascia.

PF can develop in anyone but is more common in certain groups such as athletes, people older than 30 years of age, and obese individuals.

PF must be distinguished from other causes of bottom of the heel pain such as nerve entrapment, atrophy of the normal heel fat pad, stress fracture of the calcaneus (heel bone), rupture of the plantar fascia, bone cyst, bone tumor, and bone infection.

The history typically describes a gradual onset of symptoms with no prior trauma. The most telling symptom is severe pain in the bottom of the heel when taking the first morning step. Patients may report difficulty walking to the bath room. The pain tends to lessen with more walking. This “first step” pain is also present during the day if the patient has been sitting for awhile, then getting up to walk.

On exam, pain is noted with pressure applied to the medial bottom of the heel. Tenderness is worsened by pointing the toes and ankle toward the head. This is because the plantar fascia is being stretched. Pain in the arch may also be present.

One in older patients should be ruled out and that is heel pad atrophy. Normally the heel has a thick feeling to it. In older patients the heel pad may lose this thickness and flatten out. The pain is located more centrally.

Another “fooler” is entrapment of the lateral plantar nerve. Pain is felt in the medial heel but may be present at rest as well. There may be weakness spreading the toes.

Fracture of the calcaneus (heelbone) causes pain at rest that is worsened with walking. Tenderness is present along the sides of the heel. Magnetic resonance imaging (MRI) can confirm the presence if fracture.

But what about “bone spurs”? The presence of a bone spur by itself means nothing. They are very common and by themselves are not a cause of pain. Some patients with inflammatory forms of arthritis such as psoriatic arthritis, ankylosing spondylitis, or Reiter’s disease have a specific type of spur that should prompt further evaluation looking for systemic forms of arthritis.

Diagnostic studies such as ultrasound and magnetic resonance imaging can be used to confirm the presence of plantar fasciitis. Electromyography (EMG) may be needed to rule out lateral plantar nerve entrapment.

So how is this condition treated?

The first thing is to institute a stretching regimen. Most people with PF also have a shortened Achilles tendon and the ability to dorsiflex (point the toes up) is limited. The plantar fascia is continuous with the Achilles fascia. Stretching the plantar fascia and the Achilles decreases the tension in the plantar fascia and helps relieve inflammation.

A temporary reduction in activity is important in athletes, particularly runners. Cross training with swimming and cycling can help maintain cardiovascular fitness while sparing the plantar fascia from pounding. Runners should avoid hills and make sure that any foot abnormality be corrected with custom orthotics.

Ice massage with ice cubes applied to the plantar fascia can also be helpful.

Shoes with soft heels and inner soles can relieve discomfort. Rigid heel cups and arch supports are generally not recommended. The patient may gradually resume normal activities over an eight week period of time. Rushing rehabilitation is not advised.

If there is no improvement, a night splint which holds the ankle in 10 degrees of dorsiflexion prevents the shortening of the plantar fascia.

If the night splint fails or the pain does not lessen, injection of glucocorticoid (cortisone) using ultrasound guidance is recommended. Injections should be limited to a maximum of two given over four weeks.

Patients who do not get better need to be reevaluated for systemic disease or other conditions causing heel pain.

Surgery is the last resort. Transverse release of the plantar fascia is the procedure of choice. This can be done using arthroscopic guidance.

Pain in the back of the heel is an entirely different condition.

The major structure here is the Achilles tendon which extends down from the gastrocnemius muscle to attach at the rear of the calcaneus.

Inflammation of the Achilles tendon can occur, usually in athletes or in people in engage in overxuberant physical activity involving running or jumping. Patient who are overweight are also at risk. The pain is usually described as a soreness. There is localized swelling and tenderness. Ultrasound can be used to differentiate an inflamed Achilles tendon from one that is partially or fully torn. The treatment involves anti-inflammatory medicines, physical therapy, and stretching exercises. Glucocorticoid injection is not recommended because of the danger of weakening the Achilles tendon leading to rupture. Using a foam rubber lift to elevate the heel in a shoe can help with symptoms.

Achilles rupture is handled surgically and requires a long recuperation.

Haglund’s syndrome, which is a condition where a spur develops at the back of the calcaneus and is often associated with localized Achilles tendonitis can also cause pain in the back of the heel. Ill-fitting shoes are the most common cause. Typically a bump develops at the back of the heel. Because of its association with ill-fitting shoes, this is sometimes referred to as a “pump bump.” Physical therapy, anti-inflammatory medicines, and stretching can often be of benefit. Glucocorticoid injection should be sparingly employed because of the danger of Achilles rupture. Wearing proper fitting shoes are an obvious adjunctive treatment.

Bursitis involving the retrocalcaneal bursa (the small sack that lies between the Achilles tendon and the calcaneus is a cause of pain behind the heel. Treatment involves the use of physical therapy modalities such as ultrasound. Sometimes glucocorticoid injection may be needed. It is important to limit the injection to one because of the danger of possible weakening of the Achilles tendon leading to rupture. Ultrasound needle guidance is advised to ensure proper localization of the injection.

The diagnosis is made by history and physical examination. Both MRI and ultrasound can be used for confirmation.

Keeping your Appendix Healthy with a Colon Cleanse

What if you found out that a recent surgery could have been avoided altogether with a seven day treatment regimen known as a colon cleanse? This is the case with some appendectomies which are the direct result of neglected colon health. The appendix itself is a small, easily forgotten organ that does not seem to fill any useful purpose. It is only thought about when a problem arises. While there are a number of causes that may impact an appendix to such an extent that it would die off and require removal, there is very real evidence that fecaloma are to be blamed in some instances.

Fecaloma refers to feces that have hardened to such an extent that they are sometimes called fecal tumors while at other times they are referred to as coproliths – stones fashioned from fecal waste. This hardened fecal matter is found in the colon where it will create blockages over time.

As more time passes, the appendix itself will become a storage vessel for mucus that will not be expelled but instead simply builds up, hardens, and builds up further. Eventually, it can no longer hold the built up mucus, blood flow will cease, and finally it becomes a mass of dying and then eventually dead cells.

As the body recognizes it as a bundle of foreign matter no longer living and part of the body itself, white blood cells will fight against the appendix and pus will begin to take up what little space there may be left in and around the appendix, eventually causing a rupture and voiding of pus into the abdominal cavity. Death is the end result if left untreated and a removal of the appendix is the only way to save the patient’s life.

What makes this particular course of action so unnecessary is the fact that with a little bit of effort appendicitis due to fecaloma could have been avoided. Since these obstructions are little more than hardened fecal matter, a lifestyle that includes a diet rich in raw fibrous veggies, fruits, and whole grains would consistently flush out the particles.

Since the American diet is anything but healthy, additional steps need to be taken that ensure removal of fecal matter before it hardens to the extent that it could adversely affect the health of the appendix. This may be accomplished with a colon cleanse, a process that may take anywhere from three, to five or seven days and simply focuses on the removal of built up fecal matter from the intestines.

A temporary change in diet accompanies the use of supplements which mix laxative properties with stool liquefying agents, thus permitting the hardened matter to be loosened from the walls of the intestines and thus get flushed out of the body.

Even though not each case of appendicitis is directly related to a buildup of fecal matter, in cases where it is at the root cause, the fact that this ailment could have been avoided should give you pause and reinforce your commitment to better colon health.

Understanding Skene's Duct Cysts In Women

Understanding an illness is the first step towards conquering it. A woman needs to know the symptoms, effects, and treatment of an illness she’s afflicted with. Cysts in the reproductive system of women are one of the rare illnesses of which they should be aware.

Gynecologic cysts are cysts that grow in any part of the woman’s reproductive system like the uterus, cervix, and vagina. Cysts are closed sacs containing a gelatin-like material that grow separately from the surrounding tissues.

Skene’s duct cysts are cysts located in the Skene’s glands also called periurethral glands. This type of cyst develops because of obstructions in the ducts to the Skene’s glands due to infection.

The Woman’s Skene’s Glands

Skene’s glands are also called lesser vestibular glands and periurethral glands. They are located around the opening of the urethra on the upper portion of the vaginal area. These glands are composed of soft tissues connected to the clitoris. They are involved in sexual stimulation. During sexual arousal, blood fills these glands.

The Symptoms of Skene’s Duct Cyst

Small cysts may be asymptomatic, but large Skene’s duct cysts have symptoms. Urine may be retained resulting in urinary tract infection. When the urinary tract is infected, a woman with this condition may find herself having a frequent and pressing need to urinate. She may also feel severe pain when urinating. Also, she may find it hard to start urination. During urination, urine may drip onto the vaginal area. All these happen because the cyst blocks the flow of urine towards the urethra. Skene’s duct cysts may result in abscesses that are soft, causing pain and inflammation. With this condition, a woman may have fever. A woman who has a Skene’s duct cyst may also experience pain during sexual intercourse, which is technically called dyspareunia.  

The Diagnosis of Skene’s Duct Cyst  

Skene’s duct cysts may be detected during pelvic examination. In pelvic examination, the doctor may feel the cyst especially if the cyst is large enough. When a woman complains of the symptoms such as pain during urination or during sexual intercourse, this may lead to the diagnosis of Skene’s duct cysts. The images of Skene’s duct cysts maybe seen by using the method of ultrasonography. Cytoscopy or the insertion of a viewing tube may also be used for diagnosis.  

The Skene’s Duct Cysts Treatment

If the size of the cyst is small and it has no symptoms, treatment may not be necessary. However, if cysts are big and cause symptoms like pain in urination, it may be necessary to perform surgery or doctors may make a tiny cut on the cyst in order to remove the semisolid contents of the sac. Sometimes Skene’s duct cysts are big enough to cause discomfort. In this case a surgery in an operating room setting is needed to remove the cysts. These cysts sometimes swell and cause the formation of abscess. In this case, the doctor may recommend the use of antibiotics for several days. When the swelling disappears, the cyst is surgically removed.

How to Get Rid of Gallstones without Surgery

How to get rid of gallstones without surgery.

When you consult your doctor about symptoms like persistent pain in the upper abdomen and pain in the stomach, if gallstones are confirmed after diagnosis, he will ask you to go in for surgery. Don’t panic, for one can get rid of gallstones without surgery and with home remedies.  Read on to know more about ‘how to get rid of gallstones without surgery’.

Gallstones are formed when bile gets trapped in the gallbladder and turn into pieces of stone-like material. Indigestion problems, nausea and vomiting, yellow skin and white of the eyes turning yellow and clay-like stools, accompanied by dark colored urine may also indicate formation of gallstones.

Being of female species, excess cholesterol, obesity, excess estrogen, being over 60 years and fasting are the causes of gallstones. Conventional or improvised home remedies can cure cholesterol, pigment and mixed stones which contain 80%, 20%and 20-80% of cholesterol respectively.

How to treat Gallstones without Surgery

Eat nuts and vegetables and avoid junk food and cut down on carbohydrates. One can have coffee and should drink 8-10 glasses of water every day. Retain healthy diet and do exercises regularly.

You will be able to pass stones on the third day if you drink apple juice for two days and take a mixture of fresh squeezed lemon and dark olive oil (3ounces each) on the second day night. Apples and citrus food contain Pection which helps fight this problem. Quebra Pedra, the herb can be taken in the form of tea to get relief.

Nature has all cures

Every one knows but rarely approaches nature for a cure .If you allow nature,she can dissolve stones in gallbladder .