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05.05.2014

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With the advancements in technology and greater knowledge of how muscles and joints work, physical therapists can turn things around dramatically. A marvel of bioengineering, the human foot combines the mechanical complexity of a Swiss watch with the structural strength of a cantilever bridge. The forefoot is composed of the five toes, collectively called phalanges, and their connecting long bones, the metatarsals.
Pain on the inside heel and ankle that cause you to limp may be a sign of abductor hallucis muscle dysfunction. The abductor hallucis attaches to one of the bones of the big toe and runs down the inside of the bottom of the foot and connects to the heel.
Trigger points and muscle dysfunction in the abductor hallucis muscle can contribute to plantar fascitis and bone spurs. You use the abductor hallucis to move the big toe away from the other toes and to bend the big toe downward. Biofreeze Pain Relieving Gel is a cold therapy gel that provides pain relieve for new injuries and is great as a maintenance treatment for over use injuries.
Sombra Warm Therapy Pain Relieving Gel is a pain relieving gel that I use both personally and professionally in my massage therapy practice. It is important that immediately after an injury you apply cold treatment and compression to reduce pain and swelling. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief can help you treat foot pain by teaching you the techniques to find and eliminate trigger points Author Clair Davies explains the trigger point phenomenon and muscle pain in everyday language. Monarthritis of the ankle as manifestation of a calcaneal metastasis of bronchogenic carcinoma.
Osteomyelitis in feet of diabetics: clinical accuracy, surgical utility, and cost effectiveness of MR imaging.
When the tissues of the plantar fascia undergo a great deal of stress, it can lead to ligament separation from the heel bone, causing heel spurs. Cold therapy should be used on new and recent injuries instead of heat as it cools the area much like ice and does not promote swelling. For the most effective treatment, apply after using heat to prolong the treatment and pain relief. The location and onset of heel pain, its variation in character and severity throughout the day, and the relieving and aggravating factors all provide important diagnostic clues.
Patients present with diffuse heel pain and tenderness on medial and lateral compression of the calcaneus.Refractory heel pain that persists despite conservative treatment may require further diagnostic procedures to exclude bony pathology. The posterior tibial nerve courses through this tunnel and divides into its terminal branches, the medial and lateral plantar nerves (Figure 2). It is located directly beneath the calcaneus and acts as a hydraulic shock-absorbing layer. Serious foot infections are more likely to occur in patients who have diabetes mellitus or vascular insufficiency.
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The big toe, also called the hallux, has two phalanges and one joint (interphalangeal joint); it also features two tiny, round sesamoid bones that enable it to move up and down. A recent study showed that Biofreeze decreased pain 2 times more than ice and the pain relief lasts 9 – 10 longer.


It works well for post injury pain and stiffness as well as chronic arthritis pain as it can be applied several times a day. His diagrams and step by step instructions help you locate which muscles are contributing to your pain, how to find the trigger point and treat it. Narrowing the differential diagnosis begins with a history and physical examination of the lower extremity to pinpoint the anatomic origin of the heel pain. The most common cause of posterior heel bursitis is ill-fitting footwear with a stiff posterior edge that abrades the area of the Achilles tendon insertion. Radionuclide bone scans and magnetic resonance imaging (MRI) are more effective than plain-film radiographs in confirming a calcaneal stress fracture.
Heel pain accompanied by neuropathic features such as tingling, burning, or numbness may indicate tarsal tunnel syndrome, a compression neuropathy caused by entrapment of the posterior tibial nerve branches within the tunnel. Elderly and obese patients who present with plantar heel pain may have symptoms caused by heel pad damage or atrophy.
The largest and strongest tendon of the foot is the Achilles tendon, which extends from the calf muscle of the leg to the heel.
For abductor hallucis pain, rub Biofreeze on the bottom of the inside foot, from the arch including the heel and up into the ankle . Apply Sombra to the bottom of the foot including the heel up toward the inside ankle for abductor hallucis muscle pain. A visual survey of the foot may reveal swelling, bony deformities, bruising, or skin breaks.
Tenderness over the medial aspect of the calcaneal tuberosity usually is demonstrated, and the pain increases when the plantar fascia is stretched by passive dorsiflexion of the toes.Acute onset of severe plantar heel pain after trauma or vigorous athletics may indicate rupture of the plantar fascia.
Retrocalcaneal inflammation also may be associated with Achilles tendonitis and Haglund’s disease (a bony spur on the superior aspect of the posterior calcaneus)7 and, occasionally, may be caused by a systemic inflammatory arthritis such as rheumatoid arthritis. Both methods detect stress fractures several weeks earlier than plain-film radiographs, and MRI permits visualization of abnormal soft tissue structures that may indicate other causes of heel pain.9,10Calcaneal stress fractures are treated by cutting back on the quantity and intensity of walking and athletic activities. Inflammation of the heel pad also may be present in younger adults with sports-related injuries.Although the symptoms of heel pad disorders overlap considerably with those of plantar fasciitis, heel pad pain is typically more diffuse. All of these components work together in unison to provide the body with support, balance and mobility. The phalanges are connected to the metatarsals by five metatarsal phalangeal joints at the ball of the foot.
Its strength and joint function facilitate running, jumping, walking up stairs or raising the body onto the toes. The wrap without the inserts can be worn for both support and compression in the early injury phase. It takes time and practice to master finding trigger points, but once you learn you have a tool and method to help relieve muscle pain throughout the body.If you are suffering from pain in the bottom and arch of the foot including the heel that radiates up toward the ankle,  treating the trigger points in the abductor hallucis muscle of the foot can help reduce or eliminate you pain. Patients with plantar fasciitis report increased heel pain with their first steps in the morning or when they stand up after prolonged sitting. The physician should palpate bony prominences and tendinous insertions near the heel and midfoot, noting any tenderness or palpable defects. Findings suggestive of rupture include a palpable defect at the calcaneal tuberosity accompanied by localized swelling and ecchymosis.6If conservative treatment of plantar fasciitis fails to alleviate symptoms, radiographs are advisable to check for other causes of heel pain such as stress fractures, arthritis, or skeletal abnormalities. Simultaneous dorsiflexion and eversion of the foot may reproduce symptoms as the posterior tibial nerve is stretched and compressed (Figure 3).


Heel pad pain involves most of the weight-bearing portion of the calcaneus, whereas plantar fasciitis pain is centered for the most part near the calcaneal tuberosity. Collectively, the forefoot bears half the body's weight and balances pressure on the ball of the foot. This book is a must have for anyone interested in finding the cause and treating muscle pain.
Tenderness at the calcaneal tuberosity usually is apparent on examination and is increased with passive dorsiflexion of the toes. Passive range of motion of the foot and ankle joints should be assessed for indications of restricted movement.
Radiographs may reveal a calcification of the proximal plantar fascia, which is known as a heel spur. The midfoot, featuring five irregularly shaped tarsal bones, forms the foot's characteristic arch and serves as a shock absorber. Foot posture and arch formation should be visually examined while the patient is bearing weight; the physician is looking for abnormal pronation or other biomechanical irregularities. The bones of the midfoot are connected to the forefoot and the rearfoot by muscles and the plantar fascia or arch ligament.The rearfoot, composed of three joints, links the midfoot to the ankle or talus.
Observation of the foot while the patient is walking may allow the physician to identify gait abnormalities that provide further diagnostic clues.
The top of the talus is connected to the two long bones of the lower leg, the tibia and fibula, forming a hinge that allows the foot to move up and down.
Calcaneal stress fractures are more likely to occur in athletes who participate in sports that require running and jumping. It joins the talus to form the subtalar joint, which enables the foot to rotate at the ankle. Patients with plantar heel pain accompanied by tingling, burning, or numbness may have tarsal tunnel syndrome. Its bottom is cushioned with a layer of fat.Supporting this complex of bones and joints is a network of muscles, tendons, and ligaments.
Heel pad atrophy may present with diffuse plantar heel pain, especially in patients who are older and obese. Less common causes of heel pain, which should be considered when symptoms are prolonged or unexplained, include osteomyelitis, bony abnormalities (such as calcaneal stress fracture), or tumor. They give the foot its shape by holding the bones in position, and expand and contract to impart movement to the bones and joints.
Heel pain rarely is a presenting symptom in patients with systemic illnesses, but the latter may be a factor in persons with bilateral heel pain, pain in other joints, or known inflammatory arthritis conditions.
A thorough history and a physical examination of the lower extremity should be conducted to locate the pain, define its attributes, and narrow the differential diagnosis (Tables 11 and 2).



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