Podiatric Foot and Ankle Surgeon

Feet are complex structures of bones, muscles, tendons, nerves, and more. You rely on your feet to carry you through the day, but if they hurt, this can impact your ability to function and enjoy life.

If you experience stabbing foot pain, you don’t have to live with it. David B. Glover, DPM, FACFAS, and our team at Mountain View Foot & Ankle Institute are equipped to diagnose and treat all types of foot issues. In this blog, Dr. Glover explains some of the common causes of stabbing foot pain.

Common causes of stabbing foot pain

Feet are complex, and any number of issues can trigger stabbing pain in one or both feet. A few of the most common causes of stabbing pain are plantar fasciitis, nerve damage, and acute injuries.

Plantar fasciitis

One of the top causes of stabbing foot pain is plantar fasciitis, which is inflammation of the plantar fascia. The plantar fascia is the fibrous tendon that connects your toes to the underside of your heel.

Plantar fasciitis pain is often described as stabbing pain in the bottom of the foot or heel. It’s generally worse when you take your first steps in the morning, or when you start walking after sitting for a long period of time. 

Nerve damage

Peripheral neuropathy is nerve damage in the feet, legs, arms, and/or hands. Nerve damage in the feet is particularly common in people who have diabetes, because high blood sugar levels can damage nerves and circulation over time. 

Nerve pain in the feet can feel like sharp, stabbing pain. Some people describe nerve pain as a burning or tingling sensation. Nerve pain can severely impact your mobility if the pain makes it unbearable to stand or walk.

Acute injury

A sudden injury that damages the bones, muscles, tendons, or other tissues in the foot can trigger stabbing foot pain, both at the time of the injury and afterward. Dr. Glover sees patients of all ages who have suffered sports injuries or other musculoskeletal injuries affecting the feet and ankles.

Treating stabbing foot pain

Don’t ignore stabbing foot pain. The only way to confirm what’s causing your foot pain is by visiting a podiatrist. At Mountain View Foot & Ankle Institute, we offer comprehensive evaluations to assess foot health.

If you’re experiencing stabbing foot pain, come to your appointment prepared to discuss your symptoms and your medical history. Do your best to describe how the pain feels and how long the bouts of pain last.

Tell Dr. Glover if you have other symptoms, such as:

• Bruising
• Swelling
• Stiffness
• Numbness or tingling
• Bleeding
• Decreased mobility in the foot or ankle

Dr. Glover will perform a physical exam of your foot, and he may order X-rays to confirm his diagnosis. Treatment for stabbing foot pain will focus on minimizing symptoms and healing the damaged muscles, tendons, or bones. 

For example, treatment for plantar fasciitis generally includes a combination of nonsteroidal anti-inflammatory drugs, rest, and specialized stretches. Dr. Glover and our team will work with you to help you return to your daily life safely, and we may recommend custom orthotics, night splints, or other assistive devices to support and protect your feet. 

If you have foot pain, we can help you get back on your feet. To learn more, book an appointment online or over the phone with Mountain View Foot & Ankle Institute today.

Chronic Heel Pain? 4 Home Remedies for Plantar Fasciitis – Cleveland Clinic

If you’re dealing with chronic heel pain, one likely culprit is plantar fasciitis. It’s a common foot injury that can cause a stabbing pain in the bottom of your foot near the heel. It sometimes resolves on its own, but there are a few simple home treatments that also can help.

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The plantar fascia is a band of deep tissue that runs from your heel bone to your toes. Plantar fasciitis is deformation or a tear of that tissue. It causes irritation, inflammation, and, eventually, pain.

Sports chiropractor Thomas Torzok, DC, says the problem typically develops over time. It also can take some time to heal — anywhere from months to a year, he says.

“The plantar fascia is not a tissue with great blood supply or high metabolic activity,” he notes. “It probably takes years for plantar fasciitis to form to the point where you start to notice it. And, as a result, it takes some time for it to heal. Once it’s irritated, it’s pretty stubborn.”

Despite this, he says there are some simple things you can do at home to combat the problem. But first, you need to understand why it’s happening.

Why do my heels hurt?

Plantar fasciitis is often an overuse injury, typically from sports-related activities that involve running or jumping. “It also may trace back to abnormal foot mechanics or poor footwear choices,” Dr. Torzok explains.

“Usually, you’ll feel pain upon initial weight-bearing in the bottom of your foot,” he says. “Sometimes that will occur first thing in the morning when you wake up.”

Other factors that can increase your risk of developing plantar fasciitis include:

• Age. It’s more common between the ages of 30 and 60.
• Obesity. Additional weight can put undue stress on the plantar fascia.
• Prolonged standing. Standing on hard surfaces for several hours or longer can damage the tissue.

Home remedies for plantar fasciitis

Simple home treatments can often resolve plantar fasciitis, especially if you catch it early. But it may take longer to heal if it has worsened over time.

“Plantar fasciitis may go away after you stretch your foot out and walk around for a while,” Dr. Torzok says. “But for some people, prolonged standing or sitting may aggravate it again. It’s bearing the entire amount of your body weight, and that can lead to delayed recovery. ”

Try these tips for relief:

1. Rest and stretch. If overuse is the likely cause of your pain, rest is one key to recovery. And, it’s a good idea to couple that with daily stretching exercises. Foot exercises allow you to keep the plantar fascia from pulling and tightening up, so it’s better able to bear your weight when you get moving again.
2. Wear proper footwear. Make sure you get a good fit and avoid flat shoes that lack support. “Find proper shoes to match your actual foot and biomechanics,” Dr. Torzok says. “Arch supports might help some people.” He also advises people not to walk barefoot around the house. “This can stress the tissue in the bottom of the foot even more. Instead, wear running shoes or sneakers — something with natural arch support — so they don’t deform that tissue and chronically stretch and irritate it,” he says.
3. Ice your feet. Roll your foot over a frozen water bottle for 5 minutes, or hold an ice pack over the bottom of your foot for 15 minutes, three times a day. Also use the ice treatment after any strenuous activity or extended periods of standing or sitting, Dr. Torzok says.
4. Wear a splint. For more severe cases, a night splint can brace your foot and ankle in the proper position as you sleep. “Night splints will help stretch the plantar fascia and alleviate the pain,” he says.

What not to do with plantar fasciitis

The pain and uncomfortability that comes with plantar fasciitis can be so frustrating that you’d probably try anything to get rid of it, but Dr. Torzok wants you to know that certain remedies will only exacerbate the problem.

If you have heel pain, do not:

• Exercise your feet. You may think that running or jumping will stretch out the problem, but high impact in the feet will only make it worse. In fact, try to avoid all running, hiking and high-intensity cardio.
• Stand for long periods of time. Make modifications if you have a job that requires you to stand for hours at a time, as this only adds more pressure to plantar fasciitis.
• Wait for treatment. You may think that with a few days’ rest, you’ll be back on your feet. But the truth is, your heel pain may only subside with help from a doctor. Don’t tough it out. Get to the bottom of what’s causing your plantar fasciitis so that you can treat it properly.

If the pain continues, talk to
your doctor

If home treatment isn’t working, get help, Dr. Torzok says. Your doctor can make sure the pain you’re feeling is from plantar fasciitis — and further advise you if it isn’t.

“That’s the tricky thing, because other factors can cause pain in the bottom of your feet,” he says. “So if you’re still in pain after working on relieving it for a few days, call your doctor.”

Plantar Fasciitis: Causes, Symptoms & Treatment

Overview

The plantar fascia is the rubber band-like ligament that stretches from your heel to your toes.

What is plantar fasciitis?

An inflamed plantar fascia — the rubber band-like ligament that stretches from your heel to your toes — is very painful. Imagine walking around with a strong ache in your heel, a tender bruise on the bottom of your foot, or a stabbing pain that hits you the moment your feet hit the ground in the morning. Now, if you already have it, imagine your pain beginning to go away or disappearing altogether — this too can happen.

The normal foot has 28 bones, 33 joints and more than 100 muscles, tendons and ligaments. It does so much! The plantar fascia itself supports the arch of your foot. It absorbs pressure — think of the shock absorbers of your car. It bears your weight. Pain is inevitable when the tissues are inflamed, or partially or completely torn.

The word “fasciitis” means “inflammation of the fascia of a muscle or organ” while “plantar” relates to the sole of the foot. Two million patients get treatment for plantar fasciitis, annually. That makes it the most common cause of heel pain. It’s common especially for athletes — specifically, runners. The repetitive motion of pushing off with your feet can injure the tissues.

How common is plantar fasciitis? Who gets it?

About one in 10 people will develop plantar fasciitis sometime in their lives. Young male athletes and middle-aged obese females get it most often.

Symptoms and Causes

What causes plantar fasciitis?

Too much pressure and stretching damages, inflames or tears your plantar fascia.

Unfortunately, there’s no discernable cause for some cases. However, you’re more likely to get plantar fasciitis if:

• You have high-arched feet or flat feet.
• You wear shoes that don’t support your feet (especially for a long time on a hard surface).
• You’re obese. (70% of patients with plantar fasciitis are also obese.)
• You’re an athlete.
• You’re a runner or jumper.
• You work or exercise on a hard surface.
• You stand for prolonged periods of time.
• You exercise without stretching your calves.

What are the symptoms of plantar fasciitis?

Both a dull pain and a stabbing pain have been reported by patients with plantar fasciitis. The symptoms of plantar fasciitis include:

• Pain on the bottom of the heel, or nearby.
• Increased pain after exercise (not during).
• Pain in the arch of the foot.
• Pain that is worse in the morning or when you stand after sitting for a long time.
• A swollen heel.
• Pain that continues for months.
• A tight Achilles tendon. (80% of people report this symptom.) Your Achilles tendon connects your calf muscles to your heel.

Can plantar fasciitis cause pain in the toes?

Occasionally. This is not a usual symptom.

Can plantar fasciitis cause pain in the calf?

Pain in the calf usually comes from muscles that are too tight. If those muscles are tight, that contributes to additional stress on the plantar fasciitis. Plantar fasciitis itself does not cause calf muscle pain.

Can plantar fasciitis cause ankle pain?

Plantar fasciitis pain is in the foot but sometimes, if it irritated a nerve, the pain can radiate up to your ankle.

Can plantar fasciitis cause back pain?

People with plantar fasciitis can experience back pain. It’s unclear what causes what. Perhaps your back pain actually results from a change in your posture and walk as you try to avoid pain by not putting full pressure on your foot. Any shift in how your body weight is distributed shifts how your muscles around your hip and leg are used and could cause muscle strain and ache in your back.

Can plantar fasciitis cause arthritis?

You can get arthritis in the bones of your foot, but it is not caused by plantar fasciitis.

Diagnosis and Tests

How is plantar fasciitis diagnosed?

Your healthcare provider will, after noting your medical history, perform a physical examination of your foot. If putting pressure on the plantar fascia causes pain, then plantar fasciitis is the likely culprit. If it’s difficult to raise your toes, or if you have tingling or loss of feeling in your foot, those are big red flags.

They will ask questions like “is the pain worse in the morning?” and “does the pain typically decrease throughout the day and with use?” These and other affirmative answers to questions help your healthcare provider determine if it’s plantar fasciitis.

Part of diagnosing plantar fasciitis is a process of elimination. Many conditions are considered when you report foot pain: a fracture, stress fracture, tendinitis, arthritis, nerve entrapment or a cyst in the heel. To determine other possible causes, your healthcare provider may order imaging tests including:

Are plantar fasciitis and heels spurs the same thing?

No. Heel spurs and plantar fasciitis are not the same thing, and heel spurs do not cause plantar fasciitis. A heel spur is an extra piece of bone that sticks out from the heel while plantar fasciitis is pain from an inflamed or microscopically torn plantar fascia. Removing a heel spur will not cure plantar fasciitis.

Management and Treatment

Stretches for Plantar Fasciitis

How is plantar fasciitis treated?

Over 90% of those who have plantar fasciitis will improve within 10 months with the following at-home remedies. They include:

• Stretching your calf muscles.
• Wearing supportive, sturdy, well-cushioned shoes. Don’t wear sandals or flip flops that do not have a built in arch support. Don’t walk with bare feet.
• Using appropriate shoe inserts, arch supports or custom-made foot orthotics.
• Using a night splint to reduce tightness in the calf muscle.
• Massaging the area.
• Putting ice on the area three to four times per day for 10 to 15 minutes.
• Limiting physical activity including prolonged standing.
• Taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®, Motrin®) or naproxen (Aleve®).
• Losing weight.
• Using crutches.

Outpatient treatments include:

• Cortisone (steroid) injections.
• Physical therapy for stretching and exercises.
• Extracorporeal shockwave therapy (ESWT). Shockwaves stimulate the healing process. This procedure is not commonly used.
• Seeing a podiatrist (foot specialist) for recommendations regarding insoles and shoes.

Occasionally, if none of the above solutions are effective after 12 months, surgery may be considered. There are two types of surgeries:

• Gastronemius recession. This surgery lengthens the calf muscles. Tight calf muscles put additional stress on the plantar fascia.
• Plantar fascia release. The plantar fascia is cut, partially, to relieve some of the tension.

Prevention

How can I reduce my risk of future plantar fasciitis?

• Tape your arches.
• Stretch your feet, calves and Achilles tendon.
• Ice your foot.
• Get plenty of rest.
• Do a low-impact exercise, like swimming, that doesn’t put pressure on your feet.
• Change your shoes regularly if you’re a walker or a runner.

Outlook / Prognosis

Massaging the area can improve plantar fasciitis pain. About one in 10 people will develop it.

What can I expect if I have plantar fasciitis?

Expect the worst pain when you first get out of bed in the morning and after you’ve been sitting for a long time. Expect that severe pain will be worsened by high-impact exercise, but remember that in most cases it’s not permanent as long as you follow your treatment plan. Expect to have to change some of your behaviors to decrease symptoms.

How long will I have plantar fasciitis?

More than 90% of plantar fasciitis patients improve within 10 months just by using at-home remedies.

If the underlying reason for your plantar fasciitis is something you can’t help, like the fact that your foot is flat, permanent recovery is difficult. Continue to fight the symptoms with at-home remedies and recommendations from your healthcare provider.

Living With

How do I take care of myself?

Avoid activities that put you at risk (see “Causes” above). Wear supportive shoes, avoid hard floors and experiment with other at-home remedies to figure out which ones work best for you. Don’t hesitate to contact your healthcare provider.

When should I see my healthcare provider about plantar fasciitis?

See your healthcare provider if the plantar fasciitis pain doesn’t improve in two weeks. See him/her again if your symptoms don’t improve after 6-8 weeks.

Can plantar fasciitis go away on its own?

Plantar fasciitis is unlikely to go away without some sort of behavioral change or treatment. Follow the at-home remedies and listen to your healthcare provider’s advice.

Will losing weight improve my plantar fasciitis?

Yes! Less weight means less pressure on your inflamed or microscopically torn plantar fascia.

What questions should I ask my healthcare provider about plantar fasciitis?

• What do you think caused my plantar fasciitis?
• Do I need to take any tests?
• Do you predict that this will go away right away or will it be chronic?
• How should I restrict my activities?
• Is there a specific brand(s) of shoes that you recommend?
• What brand(s) of shoes should I avoid?
• What type of night splint should I purchase?
• What low-impact exercises do you recommend?
• What should I do if the pain becomes unbearable?
• How often can I receive steroid shots?
• Do you think I’ll need surgery for my plantar fasciitis?
• Should I ask for reasonable accommodations at my job because of my plantar fasciitis?

A note from Cleveland Clinic

See your healthcare provider if you have heel pain. It might be plantar fasciitis, or it might be something else like a stress fracture or arthritis. You need to verify the proper diagnosis so that you use the most helpful at-home remedies. Remember that you don’t have to live with this pain! Educate yourself and access the right resources to improve your quality of life!

Heel pain – NHS

There are lots of causes of heel pain. You can usually ease the pain yourself. But see a GP if the pain does not improve.

How to ease heel pain yourself

If you see a GP, they’ll usually suggest you try these things:

Do

• rest and raise your heel when you can

• put an ice pack (or bag of frozen peas) in a towel on your heel for up to 20 minutes every 2 to 3 hours

• wear wide comfortable shoes with a low heel and soft sole

• use soft insoles or heel pads in your shoes

• wrap a bandage around your heel and ankle to support it

• try regular gentle stretching exercises

• take paracetamol

Don’t

• do not take ibuprofen for the first 48 hours after an injury

• do not walk or stand for long periods

• do not wear high heels or tight pointy shoes

Video: exercises to reduce heel pain

This video demonstrates exercises that can help reduce heel pain.

Media last reviewed: 1 April 2021
Media review due: 1 April 2024

See exercise video safety information

This exercise video is suitable for most people, but is not tailored to any specific condition, characteristic or person.

Get advice from a GP or health professional before trying it, especially if:

• you have any concerns about your health
• you are not sure if the exercises are suitable
• you have any pre-existing health problems or injuries, or any current symptoms

Stop the exercise immediately and get medical help if you feel any pain or feel unwell.

You can ask a pharmacist about:

• the best painkiller to take
• insoles and pads for your shoes
• treatments for common skin problems
• if you need to see a GP

Non-urgent advice: See a GP if:

• the pain is severe or stopping you doing normal activities
• the pain is getting worse or keeps coming back
• the pain has not improved after treating it at home for 2 weeks
• you have any tingling or loss of sensation in your foot
• you have diabetes – foot problems can be more serious if you have diabetes

What we mean by severe pain

Severe pain:

• always there and so bad it’s hard to think or talk
• you cannot sleep
• it’s very hard to move, get out of bed, go to the bathroom, wash or dress

Moderate pain:

• always there
• makes it hard to concentrate or sleep
• you can manage to get up, wash or dress

Mild pain:

• comes and goes
• is annoying but does not stop you doing things like going to work

Information:

Coronavirus (COVID-19) update: how to contact a GP

It’s still important to get help from a GP if you need it. To contact your GP surgery:

• visit their website
• use the NHS App
• call them

Find out about using the NHS during COVID-19

Common causes of heel pain

Heel pain is often caused by exercising too much or wearing shoes that are too tight.

Your symptoms might also give you an idea of what’s causing your heel pain.

Information:

Do not worry if you’re not sure what the problem is.

Follow the advice on this page and see a GP if the pain does not get better in 2 weeks.

You can also read about pain in other areas of your foot.

Heel Pain In The Morning: Help Plantar Fasciitis

Do the first few steps out of bed each morning cause you to wince in pain? Plantar fasciitis might be the cause.

Plantar fasciitis is one of the most common causes of heel pain, impacting more than 2 million people each year. This condition in the heel of your foot is caused by inflammation and swelling of the plantar fascia, a ligament that extends from the heel to the toes on the bottom of the foot. The inflammation and swelling can lead to a feeling of sharp pain in the foot, toward the heel, or a feeling of tenderness throughout the underside of the foot, especially at the ball of the foot.

“The plantar fascia is a thick band of tissue that forms part of your soft arch in your foot,” explained Adam Lyon, MD, a foot and ankle surgeon with Franciscan Physician Network Orthopedic Specialists Indianapolis. “Chronic overuse or repetitive tension on the plantar fascia causes pain at the its origin on the plantar calcaneus (heel bone).”

Why Does Plantar Fasciitis Hurt In The Morning?

“Plantar fasciitis most commonly occurs with the first few steps in the morning or after sitting for a long time and toward the end of the day from prolonged standing,” Dr. Lyon said. “Morning pain is from the sudden tension of the plantar fascia as it gets stretched after shortening overnight.”

What Is The Main Cause Of Plantar Fasciitis?

“The primary cause of plantar fasciitis is calf or Achilles tightness,” Dr. Lyon said. “Other risk factors include repetitive impact activities and obesity.”

This ligament in the heel of the foot can become inflamed after wearing non-supportive footwear on hard, flat surfaces for a prolonged period. Also, being overweight or having a very high arched foot or a flat foot can irritate the ligament.

Plantar fasciitis is the most common heel injury in athletes, especially runners, because jumping and repeated pushing off can hurt the plantar fascia.

Are Plantar Fasciitis And Heel Spurs The Same?

A bone spur is a small, abnormal bone growth that can cause pain if they rub on a nerve or other tissue. A heel spur may be located on the underside of the heel bone where it attaches to the plantar fascia.

“Heel spurs are frequently seen on X-rays in those with long-standing plantar fasciitis,” Dr. Lyon said. “Heel spurs do not cause the pain, rather they are sign of long-standing tension on the plantar fascia.”

Treatment options for heel spurs are similar to treatment as for plantar fasciitis. These include home care including rest, ice, anti-inflammatory medicine, stretching and correct footwear or shoe inserts.

More serious heel spurs may require corticosteroid shots (injections) under a physician’s guidance or surgery.

Can I Treat Plantar Fasciitis At Home?

Home treatment of plantar fasciitis includes stretching exercises to stretch out the calf and plantar fascia, massage therapy, losing weight as well as avoiding walking barefoot. Pain relievers such as ibuprofen and naproxen also can ease heel pain and inflammation.

Icing the heel is important, as well as rest and elevating the foot.

“The most effective treatment for plantar fasciitis includes calf and Achilles stretching, plantar fascia stretching, and a night splint or a night sock,” Dr. Lyon said. Heel pain is usually treated conservatively without surgery.

What Are Good Exercises With Plantar Fasciitis?

While plantar fasciitis may make it harder to do your regular activities, it is important to not change the natural way you walk, as this can lead to other joint, foot or back problems.

Most people with plantar fasciitis recover without much treatment in a few months.

“Non-impact exercises such as swimming, walking, or biking are well tolerated in those with plantar fasciitis,” Dr. Lyon said.

When Do I Need To See A Doctor For Heel Pain?

If home treatments for heel pain and plantar fasciitis fail, a visit to your doctor may be in order. Your doctor may suggest a steroid injection, physical therapy, wearing a custom orthotic splint, or ASTYM therapy or surgery to separate the plantar fascia from the heel bone.

“Should conservative treatment fail and the symptoms are severe enough, surgery may be needed,” Dr. Lyon said. “My preferred surgical treatment is a gastrocnemius recession, which is to release and effectively lengthening one of the calf muscles to decrease the calf tightness and relieve the tension of the plantar fascia.”

What Happens If Plantar Fasciitis Is Left Untreated?

Not treating plantar fasciitis may result in chronic heel pain that makes it harder to do your regular activities. It is important to not change the natural way you walk, trying to prevent pain, since this may cause foot, knee, hip or back problems.

What Is Plantar Fasciitis? – Symptoms and Treatment

Plantar fasciitis treatment

In most cases, your doctor will start with basic treatments that can be done at home. These may vary depending on the cause of your pain.

• If you walk or run a lot, you may need to cut back. Ask your doctor how much exercise you should do.
• If you have high arches, talk to your doctor about using shoe inserts called orthotics. These help to support your arches. You will need to be fitted for them.
• If you are overweight or obese, losing weight can help reduce pressure on your heels.
• If your job involves standing for long periods of time, place some type of padding on the floor where you stand. You also may try orthotics to provide extra cushion to your heels.

Stretching exercises for your feet and legs are important. Do the stretches shown here at least twice a day. Do not bounce when you stretch.

• Plantar fascia stretch: Stand straight with your hands forward against a wall. Place your injured leg slightly behind your other leg. With your heels flat on the floor and your feet pointed straight ahead, slowly bend both knees. You should feel the stretch in the lower part of your leg. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times.
• Calf stretch: Stand straight with your hands forward against a wall. Place your injured leg behind your other leg. With your injured leg straight, your heel flat on the floor, and your feet pointed straight ahead, lean forward slowly and bend the front leg. You should feel the stretch in the middle of your calf. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times.

Strengthening exercises are important as well. You can strengthen your leg muscles by standing on the ball of your foot at the edge of a step and rising up onto your toes as high as possible. Relax between toe raises and let your heel fall a little lower than the edge of the step. You can strengthen your foot muscles by grabbing a towel with your toes as if you are going to pick it up with your foot. Repeat these exercises several times a day.

Medicines, such as naproxen and ibuprofen, can help reduce swelling and pain. Talk to your family doctor before you start a new medicine.

Ask a Foot and Ankle Surgeon: Why Does My Heel Hurt?

7/20/2017

Why Does My Heel Hurt?

Michael T. Ambroziak, DPM, FACFAS
Foot & Ankle Surgeon from Michigan
Fellow Member of the American College of Foot and Ankle Surgeons

Chicago, IL (July 20, 2017)-One of the most common questions I am asked by my patients is, “Why does my heel hurt?”  

While there can be many reasons for heel pain, we as foot and ankle surgeons categorize heel pain into four major causes: plantar fasciitis, Achilles tendonitis, bursitis and nerve pain. Diagnosing the specific issue depends on the exact location of the pain and how the pain affects the mechanical movement of the leg.

The most common cause of the heel pain is plantar fasciitis, which is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. When patients suffer from this ailment, the fascia becomes irritated and then inflamed, resulting in heel pain or pain in the arch of the foot. Plantar fascia pain is a tell-tale sign there are mechanical issues going on in how the foot works. We typically treat plantar fasciitis first with nonsurgical strategies, such as stretching exercises; rest; shoe pads and footwear modifications; orthotic devices; night splints and injection therapy. While most patients respond well to conservative treatments, some require surgery to correct the problem.

Achilles tendonitis, or the inflammation of the Achilles tendon, can also be a cause of heel pain. We often see this “overuse” condition in our athletic patients who play high-impact sports, such as basketball or tennis. They often have a sudden increase of repetitive activity involving the Achilles tendon, which puts too much stress on the tendon too quickly, leading to microinjuries of the tendon. To treat Achilles tendonitis, we often immobilize the foot with a walking boot or cast; and also use physical therapy, orthotics and ice to help repair the tendon. If the tendon is severely damaged or if nonsurgical treatments don’t work, surgery may be necessary.  

Another cause of heel pain commonly seen is bursitis, where the “fat pad” of the heel exhibits redness and swelling from inflammation of the small fluid-filled sac inside the heel, called the bursa. The bursa, which protects the heel from friction, can become inflamed from repetitive motion or irritation from shoes. In the case of bursitis, the heel and the toes are most often affected. Treatment may include resting the foot, ice and anti-inflammatory drug therapy, padding and corticosteroid injections to reduce the inflammation and relieve pain. Surgery may be necessary if conservative methods do not provide relief.

Finally, a somewhat less common cause of heel pain is nerve pain. When the nerves are involved, it feels more like a burning or electrical pain shooting or radiating down the foot from the heel, typically toward the toes. A patient will often tell me their heel “burns.” There are medications that may help with nerve pain, but in this instance, the patient tends to need nerve decompression surgery, a procedure to help “untrap” the nerve causing the pain. These patients tend to have several misdiagnoses before they visit with a foot and ankle surgeon to correctly remedy their pain.

Whatever your heel pain, I always encourage people to see a foot and ankle surgeon for a proper diagnosis. We specialize in only the foot and ankle and our training helps us effectively get to the bottom of what is ailing our patients

To find a foot and ankle surgeon near you, visit FootHealthFacts.org, the American College of Foot and Ankle Surgeon’s patient education website or by talking with your family physician, diabetes educator or nurse practitioner for a referral to a local foot and ankle surgeon.

Michael T. Ambroziak, DPM, FACFAS, a foot and ankle surgeon with offices in Bay City and West Branch, Michigan, has been in private practice since 1996. He is board certified in foot surgery by the American Board of Foot and Ankle Surgery. Dr. Ambroziak is a Fellow Member of the American College of Foot and Ankle Surgeon and a Diplomat, American Board of Foot and Ankle Surgery. He is also a lecturer at foot and ankle surgical conferences nationwide.
 
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Diseases of the foot

Surgery

Yulia Kalenichina:

The program “Point of application” is on the air, and we are with you, its hosts Oksana Mikhailova and Yulia Kalenichina. Today we are talking about foot diseases. The guest of our program is Viktor Gennadievich Protsko, Doctor of Medical Sciences, Associate Professor of the Department of Traumatology and Orthopedics of the RUDN University, Head of the Center for Foot Surgery at the Yudin City Clinical Hospital, Vice President of the Russian Society of Foot and Ankle Surgeons.

First question, Viktor Gennadievich: what is a heel spur, what kind of passion?

Viktor Protsko:

The foot is the organ through which we move and walk. It carries the main support during movement, therefore diseases in the foot immediately cause discomfort, limit, worsen the quality of life, and worsen physical activity. There are many diseases of the foot, only there are more than 400 types of deformities. Patients are worried about different pathologies: deformation of the forefoot, hind foot, flat feet, deformities associated with varus clubfoot.

It would seem that against the background of an ordinary normal foot without any pathologies, a sharp pain syndrome suddenly appears in the heel. It would seem that life is normal, nothing bothers, good shoes, good legs, there is no deformation, unlike a neighbor whose toe hurts. And then again: “I can not walk.” The patient is unable to walk, aching, aching or shooting pain in the heel. This is not just a spur, some kind of hook that sticks out and cuts the foot. This is really a pathology that occurs over time with a certain deformation, flattening of the foot.Stretching of tendons and ligaments occurs with flat feet, with a vaulted foot, when the main load falls on the toe and heel, and the plane of support is not evenly distributed, but only to the extreme points. There is an overstrain of the ligamentous structures that hold the foot, roughly speaking, like ropes that are pulled over the structures of the foot. They stretch, break, and in the place of their attachment there is hemorrhage, edema, inflammation, which is accompanied by a certain pain syndrome, pain. The pain can last a month, and 2, and 3, and 2 years be, and 2.5 years.As a rule, then the pain goes away. When we see a pronounced hook on the radiograph, the heel spur, as a rule, the pain is already gone, and the state when the rupture and damage, stretching of the structures just happened, hurts. There is a so-called pain syndrome, which is not noticeable on an x-ray.

Yulia Kalenichina:

And at this time something else can be done so that later the hook does not grow?

Viktor Protsko:

When the hook grows, even good.It does not affect anything, the pain will pass and everything will be fine. For a certain period, maybe you need to wait it out, be patient. For some, pain disappears in six months, some really suffer for 2 – 3 years, 3 years rarely, but it still causes discomfort and limits the patient’s quality of life. How can the mechanism of the development of pathology be explained? As with the spine: one vertebra, the second vertebra, the intervertebral disc collapses, irritation of the ligamentous structures occurs, a focus of hyperexcitation occurs in a certain zone.The foot is the same where we have ligaments. An additional mechanism, injuries, overload, cold factor, overload, for example, changed shoes, walked a lot, stood – a pathological focus of hyperexcitation arises, and a person feels pain, begins to constantly feel aching pain that does not let him go, because a certain dominant has already formed – inflammation, which provokes, irritates the receptors of the foot, is accompanied by pain.

Oksana Mikhailova:

Please tell me who is more susceptible, women or men?

Yulia Kalenichina:

Yes, I’ve heard that women complain more often, or do men just not complain?

Oksana Mikhailova:

Women, because they wear certain shoes, or do men just endure?

Viktor Protsko:

They tolerate, men, yes, they do.As for the deformity of the anterior region – yes, there are more women, there are 5% of men. Calcaneal time – not peritonitis, they do not die from it. The only thing is that there is pain syndrome, which can really worsen the quality of life.

Yulia Kalenichina:

Where to run, how to be examined?

Viktor Protsko:

It often happens that you changed your shoes, went on a hike, switched to flat shoes, sneakers, ballet flats. With a flat sole, the ligaments begin to stretch, causing the plantar aponeurosis, and when stretching, pain occurs. Therefore, change shoes, after flat shoes, switch to a small heel, which transfers the load to the forefoot. Or put an insole-instep support with a soft heel, which, firstly, distributes the plane of support over the entire foot, and, secondly, displaces the heel impact. This is the first thing to do. Heel spur and heel pain cannot be relieved by a single pill, or insoles, or leeches. A set of measures helps one or another patient. We start with insoles, with shoe recommendations. Doesn’t help – we prescribe anti-inflammatory drugs; together with drugs that reduce, destroy the focus of pathological pulsation, we prescribe muscle relaxants, like sirdalud and midocalm, they reduce muscle spasm.In combination with anti-inflammatory drugs, they reduce pain and reduce the feeling of pain in the foot.

Oksana Mikhailova:

For example, my foot hurt. What should I do, which specialist should I contact?

Viktor Protsko:

Of course, to an orthopedist. But, the heel spur is a really big problem, both insoles and anti-inflammatory drugs are used. If insoles, anti-inflammatory drugs, shoes do not help, then the next stage is injections of hormonal drugs, such as diprospan.

Oksana Mikhailova:

Very painful injections with heel spurs, they say, very painful.

Viktor Protsko:

Painful, but 50-60% effective, which relieve pain. It is necessary to use 1-2 injections, even up to 3, it is no longer recommended, and the interval between injections should be at least several weeks. As a rule, then the pain goes away. In 2-3% of patients, neither insoles, nor shoes, nor anti-inflammatory drugs, together with drugs that relieve muscle spasms and block NMDA receptors, block the focus of hyperexcitation in the spine, nor injections of diprospan help.There is X-ray therapy, certain doses.

Yulia Kalenichina:

Will the laser help here?

Viktor Protsko:

With regard to shock wave therapy, it is difficult to explain from the point of view of evidence-based medicine. What’s the point? The spur does not break, in no case does the massive osteophyte break. Here is the anti-inflammatory effect. How it works in shock wave therapy is difficult to say, therefore 50/50. There are patients who are helped, some are not helped.The price of the procedure varies, there are several of them, and you need to immediately inform the patient that there will not always be a good result, that you can get to 50% and the procedure will not help you.

If the entire list of recommendations did not help, then you can do it promptly. Operatively, the aponeurosis is partially dissected, the tension of the ligament is excised, the tension decreases and the pain passes.

Yulia Kalenichina:

Is there a guarantee that it will not return?

Viktor Protsko:

Pain can most often be in the center, then migrate to the inner surface, the outer surface of the foot, it can have a floating character.Pain in the heel may be accompanied by bursitis, which is the most difficult to treat; there is a bursa in the center of the heel, a bursa of skin, which can also become inflamed and give a bad sensation in the foot. Here it is already more difficult to fight, it has to be excised. A rather rare pathology.

Oksana Mikhailova:

If such “happiness” is to be obtained once in a lifetime, then it is almost impossible to get rid of it, anyway, somewhere, either there or there, will it shoot all the time?

Viktor Protsko:

Another pathology must always be ruled out.

Yulia Kalenichina:

Can she come back?

Viktor Protsko:

For a certain period, as a rule, it progresses, then dies down. The pain decreases slightly and may persist for a period.

Oksana Mikhailova:

Okay, the pain is going down. Is it possible at the same time to lead an active lifestyle, or will there always be restrictions?

Viktor Protsko:

You can, of course, be tolerated.It all depends on the pain. Again, you always need to exclude other pathologies: take an X-ray, exclude a volumetric formation. Maybe Ledderhosen disease, aponeurosis, like Dupuytren’s, that is, plantar aponeurosis, a fibroma is formed, shrinks, contracture, seals appear. If they progress, grow, they need to be removed. They are often prone to relapse. An uncomplicated operation, but after it, a relapse of the pathology is possible. Eliminate other sores.

Oksana Mikhailova:

My leg hurts, my foot hurts, I go to the clinic to see an orthopedist.Will the orthopedist at the polyclinic level treat and prescribe examinations, or will he send you to a specialized hospital? To be honest, I have not heard that heel spurs are dealt with in our district polyclinics. Or is it just that I haven’t come across them?

Viktor Protsko:

Not everything is as easy as it seems. There must be a specialist who will take a person and will lead him.

Oksana Mikhailova:

Where to find a specialist? Should a podiatrist refer?

Viktor Protsko:

Orthopedist. You make an agreement with the orthopedist to whom you got.

Yulia Kalenichina:

It turns out that the orthopedist makes the necessary diagnostic minimum in the clinic, and then he has to send?

Viktor Protsko:

The orthopedist can do it himself, and it is treated at the polyclinic level. The treatment is not surgical. Surgical treatment of pathology – when all stages were unsuccessful. Everything needs to be addressed at the polyclinic level. Again, a treatment plan for the pathology must be developed, because there is no standard plan.Someone starts with insoles and shoes and shock wave therapy, someone immediately injects an injection there. This tactic is also possible if the doctor monitors the patient further. You must always be prepared for the fact that the pain will not go away, and the patient will still come to you, he has a pain, it still hurts until a certain time. You will apply one method of treatment here, the second, the third. In some cases, you have to do small operations.

Oksana Mikhailova:

Still, it seems to me that a spur is a rather rare direction for district polyclinics.Again, maybe I didn’t come across it. If I do not find understanding, if it is not possible to resolve the issue in the polyclinic, then where can I contact? Probably there are federal centers. It is clear that there are paid ones. And on the compulsory medical insurance, where is it possible to apply, to take a referral to the center, to the research institute? Where can you ask for a referral or come yourself, or for a fee, in the end, in order to receive quality assistance?

Yulia Kalenichina:

Can I go to your foot surgery center, Yudin Hospital?

Viktor Protsko:

More complex pathologies are treated in our center, no need to take the time of specialists.In principle, every orthopedist should be able to carry out simple manipulations.

Oksana Mikhailova:

That is, it is decided at the polyclinic level?

Viktor Protsko:

Definitely, it is necessary to decide at the polyclinic level. Maybe even organize a conference on this pathology, where you can share your experience. The topic has not been fully resolved yet. At the last congress in Bangkok, we saw devices that make the foot roll, devices from foreign companies that help develop a roll in the heel area, do extensions, that is, extension of the foot to the rear, extension.There is a Strasbourg sock if you look at the treatment. At night, they put on a sock, tied to the lower leg so that the foot does not bend forward, but is in a bent position, at an angle. Also a definite treatment: extension stretches the aponeurosis and should at least improve the condition. All sorts of devices, there is plenty to choose from.

Yulia Kalenichina:

It turns out an individual approach.

Viktor Protsko:

Yes, here you need to be approached individually.Different patients have different threshold of sensitivity of perception, in one it is lowered, in the other it is increased. One patient with an induced disease who says: “I am suffering, I have hellish pain, I am not.” – “What do you have?” – “Heel spur”. Another: “Well, yes, it hurts,” and suffers. Their pain may be at the same level, someone perceives it more. Therefore, perhaps, in some cases, not only an orthopedist, but also a psychotherapist is needed. 70–80% of pain in the foot, 40–50% of patients definitely need to be treated with the assistance of a psychotherapist, because of stress.In our rhythm, a person does not get hung up on a small definite fragment – well, the foot hurts, it hurts and that’s it.

Yulia Kalenichina:

Another one at the computer works and sits, and the other is a courier and on legs all day long, and it is very important for him.

Let’s move on to the second question: the deformity of the big toe. Again, women complain more. Is this our observation or is it really so?

Viktor Protsko:

Here, indeed, about 5-10% are men, and the rest are women.Most of all, it provokes the weakness of the ligamentous structures. A woman’s hormonal background, certain hormonal cycles, are constantly changing. Again, pregnancy, when not only the pelvic ring is stretched, but with a certain amount of estrogen, all ligamentous structures are stretched, and the foot too. With a certain shape of the foot, it spreads more, both longitudinal flat feet and transverse ones occur, with spreading of the metatarsal bones and, accordingly, in relation to them toes. Therefore, in women, the deformity of the thumb is more related to hormones.

Yulia Kalenichina:

Does heredity play a role?

Viktor Protsko:

Heredity also plays a role. Among orthopedists who deal with this pathology, there is an observation that most often manifests itself after a generation. If the grandmother suffers, most often after a generation: the daughter may be more or less normal, and the granddaughter will already have a deformity of the foot.

Oksana Mikhailova:

A bump on the toe, on the leg, depends on the female cycle! I’m just shocked!

Viktor Protsko:

There are many theories.Patients come to me with the question: “Why?” You can talk all day about why, and what ligament, and what shape of the foot, and what shape of the metatarsal bones, and how much the muscles pull back and forth. It all depends on the condition of the ligaments.

Yulia Kalenichina:

Do shoes matter?

Viktor Protsko:

Still important. Everyone comes and asks: “I have flat feet, spare me from flat feet.” A surgeon and an orthopedist can count 15 types of flat feet, even more, each deformity. Flat feet are more of the shape of the foot. The patient comes, he has a normal foot: “Do I have flat feet?” Flat feet – like walrus flippers, so flat. And the shape of the foot has its own definite shape. Yes, it changes a little, there are certain changes in the foot, but they cannot be said to be flat feet. There is a valgus foot, a varus foot. The foot has 28 bones and 33 joints. A change in 50-60% of these joints leads to deformity, but it cannot be said that these are flat feet. Flat feet is a broad term, it cannot be applied to one or another foot, so you should not be afraid of it.Yes, of course, if you have a hallux valgus, if the feet fall inward, then this leads to a change in the load on the forefoot and this must be fought. Or, if there is a pronounced complex of pathological links following each other, they need to be restored and stabilized so that the process does not spread further. For example, changing the position of the heel, plus stretching the plantar aponeurosis. When the stop is more or less normal, then you can stop.

Yulia Kalenichina:

Viktor Gennadievich, let’s talk about the treatment of deformity of the big toe.

Viktor Protsko:

Yes, the problem is, first of all, aesthetically disturbing, unpleasant to look at, and a complex arises. It is difficult to choose shoes, there are scuffs and the formation of calluses in the area of ​​the lump, the so-called. What do you need to know? This is not a lump, not a build-up. There is a change in the position of a certain bone and the first finger deviates from the displaced bone, as we say, a hinge appears. It is impossible to correct this pathology with various inserts, interdigital inserts or correctors at night, this is all marketing.If it is easy for you, if it seems to you that you are feeling changes, please. But, you know that the bump will not diminish from this. On the contrary, if there is a deformation of the second fingers, then the insert inserted between the first and second fingers deforms the second and third fingers faster, because the insert will twist even more, it will not correct the position of the first finger. With small deformations, so, for comfort, you can use these devices.

With regard to treatment, then, unequivocally, at the initial stages – insoles-instep supports, which stabilize the position of the heel, stabilize the arch of the foot, distributing the load correctly.Pronation of the heel, that is, tilting the heel inward, increases the pressure on the first metatarsal bone by 20 to 30 Newtons, a few kilograms. Here it is important to restore the structure of the foot, the hindfoot. With severe deformity, it can be up to surgical interventions. But, again, you should not immediately run to the surgeon, because there must be a pronounced deformation. Or, if there really is a deviation of the finger, then only in an operative way. It is necessary not only to straighten the finger, but to put the metatarsal bone in the correct position.The first metatarsal bone deviates from the second and the distance between them increases, we need to bring them closer. There are over 400 types of operations. The surgeon can use different operations, but the main point is that it is important to bring the first metatarsal bone closer to the second, but not with ties, but manipulation on the bones. There are both minimally invasive techniques and open techniques.

Oksana Mikhailova:

Long-term operation, plastering, something else?

Viktor Protsko:

The operation is not long, it lasts from 15 – 20 minutes to an hour with different surgeons, 15 minutes is done by an experienced surgeon.After the operation, modern methods imply rehabilitation without plaster, that is, the patient can immediately walk in special shoes with unloading of the forefoot. If a minimally invasive technique was used, then bandaging is performed for a certain period of time. If the techniques are open, with fixation, then the patient can also be quickly activated.

Oksana Mikhailova:

Where can you get help of this level?

Viktor Protsko:

In specialized hospitals, in our country, they are already performed by many surgeons. The last congress of the Russian Association of Foot and Ankle Surgeons was attended by surgeons from more than 40 regions of our country: Khabarovsk, Vladivostok, Kazan, Simferopol, Rostov, and Krasnodar. There are also a lot of doctors in Moscow.

Oksana Mikhailova:

That is, you need to look at orthopedic hospitals?

Viktor Protsko:

Even 20 years ago, when we started, we used the old methods, because there was no special equipment.Now there are special plunge screws and oscillating saws. They are now in many clinics, so doctors specialize and in some clinics do with varying degrees of success.

Oksana Mikhailova:

That is, my route is first to an orthopedist, and he already gives a referral to a specialized hospital, where do they do it?

Viktor Protsko:

Yes, look at the statistics of operations and do it. If the surgeon performs a lot of operations. ..

Yulia Kalenichina:

The operation gives a guarantee that there will be …

Viktor Protsko:

In general, it is difficult for a surgeon to give a 100% guarantee. According to statistics, about 97%.

Yulia Kalenichina:

And the foot will be correct?

Viktor Protsko:

Of course, 3-5% there is a certain nuance in the foot. Again, we can only align the first finger, and the problem with the second and third is much more relevant than with the first, because we need to make sure that the fingers are down.The step can be divided into 6 phases. An important point is to roll with the fingers fixed so that the fingers work. It is quite difficult here, because we can expose the first finger, the axis, it will not deform, but as for the pain, deformation of the second or third fingers, so that it does not progress in the future, it is difficult to give a guarantee here. Maybe small reoperations will be needed. It is necessary to immediately discuss everything with the patient.

Yulia Kalenichina:

More often deformity occurs on one leg, or are 2 affected?

Viktor Protsko:

And two legs, and one is amazed.Even more, it is not the bone that worries, but the pain in the anterior section, corns. You need to know that calluses in the foot, or hyperkeratosis, is not just a callus, but a change in the position of the bones. The load is transferred to the adjacent bones, to the second and third metatarsal bones, the heads of the metatarsal bones exert excessive pressure on the foot and cause the formation of painful calluses. There may even be a shooting pain in the third or fourth toe, the so-called Morton’s neuroma. This is perineural fibrosis of the fourth interdigital nerve, which thickens, and there is a burning sensation in the third and fourth fingers.Therefore, treatment is proposed: either the removal of the neuroma, or the unloading of the foot with insoles-instep supports.

Oksana Mikhailova:

That is, in 95% of cases, elegant shoes will wait for their owner?

Viktor Protsko:

Of course. We are doing the operation, and after the operation, the woman is sure to make sure that the bone does not grow further, so that in the future she will wear the desired shoes. Shoes with heels are possible, you just need to know that you can fully step on the entire foot in 5-6 weeks, but the swelling can persist up to 5 months.Therefore, it would seem that the foot is straight, but it is difficult to fit into model shoes. Time should pass, several months after the operation, when the swelling completely disappears. Maybe even a year goes by.

Yulia Kalenichina:

Let’s go back to flat feet. Tell me, please, is flat feet always due to an innate predisposition or can it form in the process of life?

Viktor Protsko:

As for the flat, valgus foot, that is, when the hind part of the foot changes . ..

Yulia Kalenichina:

Like a walrus flipper, you said.

Viktor Protsko:

Walrus fins are, of course, congenital, due to the weakness of the ligamentous apparatus. Definite positioning of the foot at birth, which is then aggravated. Everything begins, the root of all evil is the back of the foot, the heel, the talus, where a certain rotation takes place. Further, the load is transferred to the midfoot, the plantar aponeurosis is stretched, which causes the heel spur, the tendons of the posterior tibial muscle, which holds the scaphoid, are stretched.The foot spreads out even more, it is difficult for a person to stand on one leg, on the toe. It collapses because a muscle, for example, the back tibia is stretched, does not support the foot. This is a certain test that shows the weakness of the ligamentous apparatus, such a test can be carried out at home. Stand on the toe of one foot, holding on to the wall; if you feel unstable, if the heel leaves, then this is evidence that the ligamentous structures are already sufficiently stretched and the anatomy between the joints is disrupted, the foot spreads out.

Yulia Kalenichina:

What should such people do with such a disaster?

Viktor Protsko:

First of all, shoes, insole, better made to fit the foot.

Yulia Kalenichina:

Individual?

Viktor Protsko:

Yes, when a certain arch for the foot is formed by heating, individually for the leg, with the arch of the foot. Heel braids are used, which reduce the inclination of the heel, the so-called pronation of the heel.If the deformation is really pronounced, then you need to operate. Already from 10 – 11 years old, you can see what kind of stop. If it is flat, valgus and a pronounced blockage of the foot inward, then there are a number of operational aids that allow you to correct it. There are minimally invasive ones, when we insert a small endoorthesis, a small orthosis in the foot, and reduce the initial stage of rotation in the subtalar joint – a simple operation of subtalar arthroereisis, it is often used. You need to know that it should be used in soft feet, elastic, and up to a certain age period.When the foot is already stiff, when there are arthritic changes, the operation will have no effect, but may cause additional pain in the back of the foot. Often this operation needs to be combined with plasty of the tendon-muscle complex, as stabilization of the posterior tibial muscle – what I have noted, which stabilizes the talonavicular joint and stabilizes the foot, for example, when standing on toes. The complex of these manipulations, small operations, helps to relieve, stabilize the foot, or, at least during the period of active growth, set the direction, as we tie a crooked tree to a post, and it grows evenly.Flat feet can be corrected at any stage of life, but more traumatic operations will be required. Then you will need an osteotomy – sawing the calcaneus, somewhere later the closure of the joints. But, in any case, there is a benefit.

Yulia Kalenichina:

In general, to use insoles at first?

Viktor Protsko:

Insoles. And, if the deformation is pronounced, causes discomfort, the foot is already collapsing, then there are operations that stabilize the foot and correct it.

Yulia Kalenichina:

Now in specialized pharmacies are sold rugs with spikes, with pebbles. Are they useful or not?

Viktor Protsko:

In any case, it’s like reflexology. You can put a rug in the morning, if it gives you pleasure, stomp on it.

Yulia Kalenichina:

But, is it good for the foot?

Viktor Protsko:

At least not harmful.

Yulia Kalenichina:

Is walking barefoot useful in general?

Viktor Protsko:

Helpful. Again, as for the pathology, when the parents noticed that the feet of the children are collapsing. Everything, they immediately run, buy shoes, and the child crawls at home in these boots. When they come to me with a question whether to wear or not, I suggest: “You, too, put on your boots and walk together. Of course, you will be uncomfortable. So it is for a child. ” Shoes should be used in the garden, you should walk in shoes with a stiff heel, with a certain heel, which allows you to properly stabilize or distribute the load.There is also a heel, special designs that rotate the heel, supinate it and eliminate deformation. And at home, let the child crawl, jump on tiptoes, muscles, the leg should rest. Any footwear will not correct the pathology, but only, I think, will cause discomfort. Therefore, I am against wearing shoes at home. With minor deformities, you can walk barefoot.

Yulia Kalenichina:

Viktor Gennadievich, very often they ask questions about the usual subluxations in the ankle joint.

Viktor Protsko:

Yes, there is a problem.Again, there must be a certain arch of the foot. If now we were talking about a flat foot that falls inward, then here is a vaulted foot, high. In such patients, when they step on a wet floor or with a wet foot on the floor, only the forefoot and hindfoot will be imprinted when the foot is turned outward, that is, the heel is already supinated. You can remember: carry soup and spill soup.

Orthopedists have the concepts of supination and pronation. Pronation is flat feet, supination is on the contrary, varus foot.There is mechanical and functional instability. Mechanical – when there is a rupture of the ligaments, damage to the peroneal talus ligament, when the foot is constantly twisted, it swells. Here you need to operate, you need to perform an operation to stabilize the ligamentous structures. Or a vaulted foot that can be stabilized with an insole. But the insole should not be with a high arch, but, on the contrary, with a pronator, which goes along the outer surface of the insole, in order to fill the heel from the supination state, on the contrary, into pronation, to stabilize.If a patient constantly complains: “I am turning my foot”, you need to take functional images and radiographs, see if it is mechanical or functional instability, and choose one or another type of treatment.

Yulia Kalenichina:

Is it possible to do this in a polyclinic too?

Viktor Protsko:

Here, it is already more difficult for the orthopedist of the outpatient link to identify. Most likely, it is necessary to be sent to specialized hospitals, in which we will take certain pictures, make a diagnosis and choose one or another operation – either to stabilize the ligament, or to stabilize the external tendon complex, tibial muscles, or to do an osteotomy of the heel, saw it off, put in a more correct position.It all depends on how often the foot is twisted, how much the shape of the foot is changed from behind. For example, if the varus foot is like a clubfoot, then the pathology cannot be corrected only with the ligaments on the tendon-muscle complex, here it is already necessary to intervene on the bones.

Oksana Mikhailova:

I will read a question from our listeners: “How do high heels affect the foot? How long during the day can you wear tight shoes, high-heeled pumps without consequences for the foot? ”

Viktor Protsko:

You need to look at which stop.Again, with regard to narrow shoes – this is our further topic, the diabetic foot. If there is neuropathy, diabetes, then in no case are narrow shoes needed. For diabetic feet, certain shoes are made for a certain last. An important topic to touch upon. As for an ordinary foot, thin, narrow – please, as much as you like, let them walk in such shoes. If it’s convenient, let them walk. I have had a lot of patients who never wore heels and had creepy feet.

Again, the cause of the deformity is not simply ligamentous weakness, as we said.There is a weakness of the connective tissue, due to which the foot gradually spreads out, static changes of the foot occur, and there are diseases – rheumatoid arthritis, diabetes mellitus – those that cause inflammation. Inflammation leads to the fact that there is a stretching of the ligaments, dystrophy of the ligamentous structures. Then one or another deformation occurs, a pronounced deformation of the foot. Therefore, if a patient with one pathology or another – rheumatoid arthritis, ankylosing spondylitis, diabetes mellitus, then it is advisable to wear certain shoes.Again, it depends on how much sensitivity of the foot is maintained. If a person retains the sensitivity of the foot, there is no neuropathy, then I think that you can use shoes that are comfortable for you. If you have neuropathy, you must adhere to certain rules for the selection of shoes.

Yulia Kalenichina:

Another question: an ingrown toenail. A common problem since adolescence. How to be here?

Viktor Protsko:

Yes, this is also a problem, like a heel spur.What to do? A purulent surgeon deals with such a pathology. This is a pathology of the nail bed. You can turn to podiatrists who have different devices that are glued to the nail, which gradually align the nail plate. Perhaps, such manipulation will help some patients. But the patient will be, like a dentist, constantly attached to his podiatrist, who will change the nail stickers and level the nail bed. There are more complex deformations, when an operation is required, it is precisely the shape of the nail bed that needs to be corrected, not just cut at the root, but it is precisely the germinal part that needs to be removed together, the marginal part, so that the nail goes more evenly.This should be done by a purulent surgeon or a surgeon in the clinic, who can do the manipulation under local anesthesia.

Yulia Kalenichina:

And what is more correct? Different experts give different advice. Some say let the nail grow indefinitely until it grows beyond the finger, while others say cut it off.

Viktor Protsko:

If there is inflammation, pus, if the finger swells up, flows, then, of course, it is necessary to remove the inflammation and then operate.If there are slight abrasions, redness, you can wait and watch. Here you need to look clinically. If the toe is really swollen, the nail grows in, it oozes, a person cannot wear normal shoes …

Oksana Mikhailova:

That is, there are no general recommendations, individually? Someone to grow, someone to cut, who is more convenient?

Viktor Protsko:

To cut off someone, depending on the clinic, how much deformation the patient has in general.

Yulia Kalenichina:

Dry calluses. You said a little about the corns. Dry calluses are on the little fingers or on the toes.

Viktor Protsko:

Dry calluses, calluses under the heads of the metatarsal bones, next to the sole. This is a consequence of most, 80%, of the transverse spread of the forefoot. When the metatarsal bones fan out, the load is transferred one segment more, the second and third metatarsal bones more.It is due to the fact that the bone has subsided. It needs to be corrected, either raised promptly, or a special liner should be made on the insole, which will hang the head in the correct position and reduce the pressure so that it does not trample. Depending on how pronounced they are, either use insoles in shoes, or come to an orthopedist for surgical treatment.

It often happens that on such a callus, on hyperkeratosis, there is also a core callus, which penetrates deeply, as it pierces with a needle.The most common cause is human papillomavirus. This is the cambial layer of cells of viral etiology, which divide internally, and the corn grows inward, it needs to be cut out. It is cut out or burned out with a laser. Why does it often relapse or resume – because part of the cambial layer of cells remains, it continues to multiply, divide, and the corn progresses again. It is necessary to cut everything out with subcutaneous tissue.

Yulia Kalenichina:

And ointments do not exist, as for warts?

Viktor Protsko:

Ideferon is injected, and you can exfoliate with salicylic, cauterize with iodine.But it takes a long enough period to cauterize the callus. It also happens quite often between the little finger and the 4th finger; an osteophyte, exostosis, and a spine grow near the interphalangeal joint. Friction between 4 and 5 fingers. Often it does not cause any discomfort, but if a papillomavirus core is formed, then it causes discomfort. You can use a small silicone pad to delimit your fingers, but it won’t help. Cut, burn.

Oksana Mikhailova:

Viktor Gennadievich, can I ask you in conclusion to give advice on the correct selection of shoes, insoles, so that the legs are always healthy and feel comfortable?

Viktor Protsko:

You need to know that shoes can roll.What roll? For example, if we shift to the center of the foot, then the roll takes 50% off the load on the forefoot, on the toes. Shoes should be comfortable and should not chafe. It is best to make insoles individual, in specialized institutions. A regular insole inserted into a shoe takes up additional volume, leads to discomfort, rubs, which is wrong. Should be more or less comfortable. It is advisable to make insoles in specialized institutions. Shoes should be comfortable.If you do not have a sensitivity disorder, neuropathy, then experiment if you have more or less normal feet.

Yulia Kalenichina:

Thank you very much! We have dealt with a lot of questions.

Oksana Mikhailova:

As always, a lot of interesting and new things. Thank you very much!

Yulia Kalenichina:

We will do a separate diabetic foot transmission, and today we are finishing.

Viktor Protsko:

Thank you.

90,000 Heel pain – causes, diagnosis and treatment

Causes of heel pain

Physiological causes

The most common physiological causes of heel pain are:

• overvoltage due to wearing uncomfortable shoes, changing shoes with high heels to unusual shoes without heels;
• physical overload during prolonged standing, long walking or running;
• Increased load on the heels due to pregnancy, rapid weight gain.

Pain usually aching or burning, associated with staying on the legs, may be accompanied by heaviness, swelling of the feet and legs, disappear after rest.

Traumatic injury

Heel contusion is more common in children after jumping from low heights. On landing, there is moderate, gradually subsiding pain. The pains are superficial, localized along the plantar surface, acquire an aching character, subside when the limb is elevated, disturbed when resting on the heel, because of which the victim steps “on the toe” when walking.Edema is mild to moderate, and bruising is rare. All symptoms disappear within 1 or 2 weeks.

Achilles tendon rupture is a consequence of a sharp muscle contraction, occurs when overload, starting a workout without prior warm-up. Less commonly, it is determined after a direct blow to the tendon. It manifests itself as a sudden sharp pain along the back of the heel, sometimes in combination with the characteristic crackle of tearing fibers. At the site of the rupture, a “failure” is formed, and swelling rapidly increases.With complete damage, lifting the heel is impossible, with a partial rupture, movements are preserved, moderately limited due to pain.

Fracture of the calcaneus is diagnosed after a fall from a height of 2 or more floors, more often found in young men. It manifests itself in a sharp, explosive, unbearable pain. Then the intensity of the pain decreases slightly, but after a while it may increase again due to the increasing edema. The pain is diffuse, sharp, sometimes throbbing. The heel is enlarged, cyanotic, covered with bruises.Support is impossible, feeling is sharply painful, in some patients a bone crunch is heard on palpation.

A pathological fracture of the heel is found in older women with osteoporosis and people with diseases associated with a decrease in bone strength. It develops with minor trauma and is characterized by moderate or non-intense pain. In the future, there is a long-lasting aching pain, aggravated by walking, difficulty in supporting on the heel. When palpating, the edema is insignificant or absent, palpation is moderately painful, sometimes the crunch of fragments is heard.

Ankle ligament injury is identified when the leg is tucked inward or outward. It is manifested by a sharp pain in the area of ​​the outer or inner surface of the heel (in the projection of the location of the corresponding ligaments). Subsequently, the pain becomes aching, bursting, rapidly growing edema is detected, and bruising is often found. The support is limited, palpation of the ligament is sharply painful, pain sensations increase when an attempt is made to deflect the foot to the side opposite to the damaged ligament.

Heel pain

Inflammation of tendons and ligaments

Tendinitis of the Achilles tendon occurs due to constant overload of the Achilles, is diagnosed in athletes, usually accompanied by the development of Achilles bursitis (inflammation of the superficial bursa). Initially, it is characterized by short-term, non-intense superficial aching pains in the back of the heel and just above it in the first minutes of training.

Over the course of several months, the pains intensify, their duration increases.Subsequently, the pain syndrome does not disappear, but increases after a warm-up, and remains at rest for a long time. Patients often complain of pain when going up and down stairs. There is edema, hyperemia, local hyperthermia, palpation of Achilles is painful.

Haglund’s deformity is more often defined in women 20-30 years old. Pain syndrome is caused by the development of tendinitis and bursitis of the deep bursa of the Achilles tendon, which is compressed between the bony outgrowth and the hard back of the shoe. Patients complain of pressing, pulling pain in the back of the heel while walking.With increasing load, the pain intensifies, becomes sharp, cutting, burning. In the affected area, a small dense “bump” (exostosis) is palpable, over which calluses are often formed.

Calcaneal bursitis is provoked by the occurrence of a heel spur and is diagnosed in patients over 40 years of age, more often in women. It is manifested by pain, most pronounced at the beginning of the movement. In some people, painful sensations are not intense, pressing, aching, disappear after a few steps. In others, the pain is burning, shooting, baking, persisting throughout the entire period of walking, disturbing the gait.In especially severe cases, heel support becomes impossible, patients are forced to use crutches.

Sever’s disease (calcaneal apophysitis), develops in children 10-15 years old, more often in boys. It is accompanied by a gradually increasing, first pulling, aching, and then burning, bursting pain below the Achilles, aggravated by running and rising on tiptoes. The pain decreases at rest, especially when bending the knee, turning the foot to the outer edge. External changes are absent or insignificant.On palpation, the maximum pain is determined by the posterior inner and posterior outer surfaces of the heel.

Diseases of the joints

Pain in the heel can be caused by arthritis of the subtalar or talocalcaneonavicular joint. Inflammation of these joints sometimes occurs with rheumatoid, infectious arthritis. Rheumatoid arthritis is characterized by a chronic course, combined with lesions of the toes. Infectious arthritis develops after acute infections.Common symptoms are morning stiffness, pain that worsens when standing and walking, and subside after rest.

Arthrosis of the listed joints is detected after trauma or is idiopathic in nature. It is accompanied by “starting pain”, crunching, minor or moderate pain, aggravated by movement. Then the intensity of pain gradually increases, pain begins to bother before the weather changes, at night. The course of the pathology is undulating, during periods of exacerbation, swelling of the foot is possible.Over time, there are deformations, movement restrictions.

Bone infections

Hematogenous osteomyelitis of the calcaneus is rare, is found in children and adolescents, occurs as a result of the introduction of infection from a distant focus. It is characterized by a stormy onset, an increase in temperature to 39-40 ° C, a pronounced intoxication syndrome, localized bursting, boring, tearing intense pain in the heel.

To reduce pain, the child lies absolutely still, with the slightest movements screaming in pain.Within 2 days, local manifestations increase: edema, hyperthermia, hyperemia. By the end of 1-2 weeks, the severity of pain decreases, the condition improves somewhat, fluctuation can be determined in the affected area.

Exogenous osteomyelitis can be post-traumatic (with open fractures, deep wounds) or contact (usually with trophic ulcers in patients with diabetes mellitus). It is accompanied by an increase in the existing symptoms: a deterioration in the general condition, an increase in temperature, an increase in edema.Pain in the post-traumatic form is intense, tearing, boring, in contact – moderate, pulling, bursting. In the first case, a large amount of pus is released from the wound, in the second, fistulas are formed.

Osteochondropathy

Schinz’s disease is diagnosed in adolescents, mainly girls. It manifests itself as acute or gradually increasing pain in the heel. Pain occurs during exertion (running, jumping), then with any attempt to lean on the heel area. The intensity of the pain syndrome at the height of the disease varies, in some patients the pain remains moderate, in others it reaches the degree of unbearable, excludes the possibility of full support on the foot.At rest and at night, painful sensations are absent. Swelling is detected without signs of inflammation.

Dermatological and vascular problems

The back of the heel often develops calluses associated with chafing from tight or uncomfortable shoes. At the initial stage, the soreness is insignificant, accompanied by local swelling, redness. After the appearance of the bladder, the pains sharply intensify, become burning. When the bladder is opened, a painful wound remains on the skin.

When corn is infected, a callus abscess develops, characterized by pulsating, twitching pains, an increase in edema and hyperemia, clouding of the bladder contents, and an increase in body temperature to subfebrile numbers.The process of formation of an abscess takes place against the background of night pains that deprive you of sleep. After opening the abscess, the condition improves, with the breakthrough of pus into the surrounding tissues, the pain intensifies, becomes diffuse, the general condition worsens.

A plantar wart is a slightly protruding zone of compaction up to 1–2 cm in diameter located on the plantar surface of the heel. Initially, the wart is painless, but due to pressure and friction, it is constantly injured, which causes discomfort, pressing, stitching, burning pain in the foot, especially after a long walk.

With hyperkeratosis of the feet, hemorrhages, calluses and cracks form on the heels. All of these conditions are accompanied by pain. With calluses, burning, twitching prevails, with cracks – stitching, cutting pain sensations, which intensify when walking, using uncomfortable shoes. The general condition does not suffer, however, the chronic course of the pathology negatively affects the quality of life.

Trophic ulcer is determined in patients with diabetes mellitus with diabetic foot syndrome, is formed in severe varicose veins, post-thrombophlebitic disease.The patient complains of twitching, pressing, pulling pain in the heel against the background of rapid fatigue, intermittent claudication, and edema of the feet. The pain syndrome is usually moderate or not intense, sometimes the appearance of necrotic ulcerative defects is accompanied by only vague insignificant pain sensations or vague discomfort.

Other reasons

Burning pains, combined with hypersensitivity, numbness or paresthesia, are characteristic of calcanodinia, a neuropathy of the calcaneal branches of the tibial nerve.Pain syndrome appears after prolonged walking barefoot, using shoes with too thin soles, jumping from a height. In some cases, the pain is so intense that the patient walks on his toe without resting on the heel.

Sometimes patients with mental disorders – neuroses, depression, hypochondria, schizophrenia – complain of pain in the heels. In disorders of the neurotic level, pains have a “rich” set of shades, are emotionally described as shooting, twisting, burning, aching, etc.In severe psychopathology, the pain syndrome becomes pretentious, unusual, sometimes clearly delusional interpretations.

Diagnostics

Trauma doctors are involved in determining the causes of heel pain. If indicated, patients are referred to dermatologists, surgeons, neurologists, and other specialists. The diagnosis is made on the basis of survey data, examination, additional studies. The following diagnostic procedures can be prescribed:

• Radiography. Take pictures of the calcaneus or foot bones. On radiographs, fracture lines, bone growths, signs of degeneration, inflammation, and aseptic necrosis are revealed.
• Ultrasound examination. Ultrasound of the foot confirms the presence of signs of inflammation of the ligaments, tendons, plantar aponeurosis. To diagnose plantar warts, ultrasound of the skin formation is performed, to clarify the cause of the appearance of trophic ulcers – ultrasound scan of the veins of the lower extremities.
• CT and MRI. Conducted at the final stage of the survey with ambiguous results from other studies. They make it possible to clarify the location of fragments, localization and prevalence of pathological changes in hard structures and soft tissues.
• Laboratory research . With osteomyelitis, infectious arthritis, the severity of inflammatory changes in the blood is assessed, with rheumatoid arthritis, specific markers are detected, with plantar warts, PCR is performed to determine the papilloma virus, and with hyperkeratosis, a histological examination is performed.

Physiotherapy exercises for heel pain

Treatment

Prehospital care

In case of heel injuries, immobilization with a splint is performed, cold is applied, and anesthetic is given. With inflammation of the tendon-ligamentous apparatus, arthrosis of the tarsal joints, they limit the load, apply local anesthetic and anti-inflammatory drugs. Sharp pains, deterioration of the general condition, hyperthermia, local signs of inflammation and suppuration are indications for immediate referral to a specialist.

Conservative therapy

Conservative treatment for heel pain is usually a combination of medication and non-medication. The following test methods can be applied:

• Safety mode . The level of load on the foot, the duration of restrictions is determined individually, ranging from 1-2 weeks for minor injuries to 1 year or more for chronic diseases. It is possible to apply a plaster cast, use orthopedic shoes, heel pads and other devices, walk with crutches or a cane.
• Drug therapy . In inflammatory processes, NSAIDs are prescribed, in infectious diseases, antibiotics are recommended. The presence of trophic ulcers is an indication for treatment with antiplatelet agents and phlebotonics, in the case of diabetes mellitus – for the correction of antidiabetic therapy.
• Other methods . In case of skin damage, dressings are carried out, in case of hyperkeratosis, a special treatment of the feet is carried out, in case of traumatic injuries and inflammatory diseases, patients are sent for physiotherapy, physiotherapy exercises.

Surgical treatment

The tactics of surgical interventions are selected taking into account the nature of the pathology. The following open manipulations are possible:

Sometimes operations are performed for Haglund deformity, Schinz’s disease, arthrosis of the tarsal joints, and other diseases of the heel region. In the postoperative period, rehabilitation is carried out, including exercise therapy and physiotherapy.

90,000 Pain in the legs – vascular clinic on Patriarch’s

08.11.2013

Leg pain

What is pain

Pain is a sensation that most often makes a person pay attention to their state of health, take a pill, inject, use a heating pad, etc. etc. And if these elementary “home” techniques do not help, the patient seeks medical help.

Leg pain is not an easy problem

In this situation, it is very important to understand which specialist can help you , since the pain syndrome of the same localization can be associated with damage to various structures and organs, the treatment of pathologies of which is dealt with by various “narrow” specialists.

In the overwhelming majority of cases, differential diagnostics is carried out according to the results of instrumental examinations, the most universal of which is ultrasound scanning.

In a number of situations, only the results of an ultrasound examination are sufficient to formulate a correct clinical diagnosis, in a number, other diagnostic procedures are required: electroneuromyography, computed X-ray and magnetic resonance imaging, laboratory testing.

The causes of pain in the legs can be diseases of the joints of various origins, pathology of veins, arteries, nerve trunks, skin, muscles and soft tissues, bones, and so on.

There are often several reasons. And this is not an exclusive situation.

Who to go to

In accordance with the established practice, “each sandpiper praises exclusively its own swamp”, therefore calls to visit this or that specialist sound from all sides, although in fact they are irrational from any position.

A qualified examination is required to obtain an optimal result, and it is absolutely preferred that the examination is conducted by a well-educated clinician.

The latter presupposes not only knowledge of angiology (vascular pathology), but also arthrology, osteology and, oddly enough, therapy or internal diseases and neurology. All this does not mean at all that the surgeon is not able to help you specifically, but in many cases the surgical approach refuses to be insufficient to solve the problem.

Main causes of leg pain: details

Let’s get acquainted in more detail with the indicated causes of pain in the legs

Joint pathology

The most common causes of pain in the joint area are inflammation and degenerative changes in the joint capsules and articular surfaces.

Inflammatory changes in the structures of the joint can be accompanied by inflammatory changes in the synovial fluid (located inside the articular bag).

In the presence of inflammation, there is usually strong pain in the area of ​​the affected joint, both at rest and during movement, with possible irradiation along the limb, mobility in the joint is limited due to pain, the skin may be hyperemic (reddened), local an increase in skin temperature, and sometimes a general increase in body temperature.

There may be swelling of the skin of the affected limb. The inflammatory reaction develops, as a rule, acutely, after hypothermia, trauma, injection manipulations, etc.d.

Most often, an acute inflammatory reaction occurs against the background of a chronic process: osteoarthritis, gout, arthrosis of a specific origin (with systemic diseases of connective tissue).

Diagnostic ultrasound examination in this situation makes it possible to assess the presence and degree of inflammatory changes, to diagnose complications of a vascular nature, first of all, venous thrombosis, to carry out differential diagnostics with other lesions accompanied by the development of edema and pain in the limb.

To obtain additional (and accurate!) Diagnostic information, the patient may require X-ray and computed (magnetic resonance) tomography.

The chronic inflammatory process is accompanied by a less pronounced local reaction, the absence of general signs of inflammation, minimal pain at rest, the appearance of pain and limited mobility during exercise. Joint structures are often deformed. An ultrasound diagnostic study makes it possible to assess the degree of degenerative changes in the articular surfaces, changes in the geometry of the joint, the presence of secondary negative effects on the adjacent structures and vessels.

Arterial pathology

Pain associated with damage to the arterial trunks – ischemic, i.e. due to insufficient blood supply to various parts of the leg (foot, lower leg, thigh) due to stenosis (narrowing of the lumens) or occlusions (complete obstruction) of the affected vessel (vascular basin).

The main causes of arterial obstruction are atherosclerosis, thrombosis, thromboembolism (more often from the cavities of the heart, aorta with atrial fibrillation and other types of arrhythmias, endocarditis, aortic aneurysms, and so on), metabolic (diabetic) angiopathy, complicated by dissection of the vascular wall with (or without) the formation of intramural hematoma, vasculitis (inflammatory lesions of the arterial walls).

The clinical picture of ischemic pain is very characteristic. At first, they appear only during walking and other physical activity with the involvement of the leg muscles, have a “pulling”, “squeezing” character.

For high stenoses and occlusions of the large trunk trunks, pains that make them stop when walking are more characteristic – intermittent claudication.

As the lesion progresses, the pain becomes constant. They are localized in that part of the limb where blood flow disturbances are most pronounced, of the same intensity at any time of the day.

An exception is embolic occlusion of the lumen of the arteries, in which pain, and sometimes weakness in the affected leg occurs acutely in a matter of minutes (seconds).

The skin of the legs in chronic ischemia of the extremities is usually pale, the hair is weak or absent, the muscles are hypotrophied (the legs become “thin”). The skin temperature is lowered.

In arterial pathology, vascular ultrasound studies provide an almost exhaustive amount of information required for further treatment of the patient.

The results of duplex scanning of peripheral arteries make it possible to differentiate various pathological processes among themselves, to assess the degree and localization of the lesion, the presence of complications, and the degree of individual compensation for hemodynamic changes. Radiopaque and multispiral computed tomographic angiography in these situations is advisable only when planning surgical treatment in case of ineffectiveness of conservative therapeutic measures.

In any case, you SHOULD KNOW AND REMEMBER that stenoses and occlusions may not be directly related to pain (which is often found in combination with radicular syndromes, polyneuropathies, etc.).

Vein pathology

Venous (lympho-venous) pains are usually combined with a feeling of heaviness in the legs, swelling of the legs, have an internal diffuse character, are more pronounced in the evening and at night, after prolonged static load.

They decrease under dynamic loads, with an elevated position of the legs.With prolonged static load or at night in the calf muscles, less often in the muscles of the feet and thighs, convulsions may occur (acute, sudden, intense local painful sensations, accompanied by tonic muscle contraction). Expanded deformed subcutaneous venous trunks, hyperpigmentation (the appearance of light and later dark brown spots) of the skin, trophic ulcers can be visually recorded. A similar clinical picture is characteristic of varicose veins of the superficial veins of the lower extremities or post-thrombotic disease (post-thrombophlebitic syndrome) of deep veins.

In acute thrombosis of both deep and superficial veins, pain is localized in the area of ​​the thrombus.

A thrombus in a superficial vein is defined as a dense cord, palpation (touch) of which is painful.

There is swelling of the affected limb, hyperemia (redness) of the skin, an increase in body temperature of a local or general nature is possible.

With the development of complications in the form of pulmonary embolism, a cough appears, bloody sputum may be released, and shortness of breath may develop.

For any signs of venous pathology, it is necessary to perform ultrasound duplex scanning of the peripheral veins, and sometimes the inferior vena cava, in order to determine the nature and extent of the lesion, to predict the development of local and general complications.

The ultrasound method allows you to directly visualize a thrombus, assess its mobility, the state of the compensation system, which is absolutely necessary for planning the patient’s treatment tactics.

There are certain situations in the presence of which emergency hospitalization is required due to the threat of thromboembolic complications.First of all, these are floating (pseudoflotting) thrombi in the lumen of deep veins, as well as thrombosis of the saphenous veins above the knee line. IT IS IMPORTANT TO KNOW that URGENT CONSULTATION OF VASCULAR SURGEONS (PHLEBOLOGISTS) IS NOT REQUIRED IN THESE CASES. If the described changes are found, it is necessary to call an ambulance – and it does not matter who calls it – a phlebologist (ie a surgeon or cardiovascular surgeon), a therapist or an administrator of a medical center. The IMPORTANT thing is that this is done immediately.

Nerve pathology

Pain in the legs of a neurogenic origin is mainly associated with two reasons: secondary radicular syndromes arising from pathology of the lumbosacral spine (osteochondrosis, disc herniation, trauma, tumor) and spinal cord (inflammation, volumetric lesion) or damage to the nerve trunks themselves – neuropathy or neuritis (due to exposure to toxic, metabolic, vascular, traumatic factors).

Pain associated with radicular disorders is localized in the area of ​​innervation of the corresponding root, neuropathic pain is usually diffuse internal in nature. By its nature, the pains are more often shooting, burning with varying degrees of intensity.

Neuropathic pain caused by metabolic disorders is characterized by the predominance of pain at night, the appearance of a burning sensation in the feet (less often in the legs). Palpation along the nerve trunk and in the adjacent areas may be local pain.In parallel with the pain syndrome, there may be numbness of the skin, a tingling sensation, “creeping creeps.” The skin temperature is usually unchanged. There may be a decrease in muscle strength in various parts of the limb, impaired sensitivity, muscle wasting gradually develop.

For vertebral causes of pain, as a rule, palpation pain along the spinal column in the lumbosacral region and a number of neurological signs are noted.

Ultrasound studies in this category of patients are necessary for the differential diagnosis of vascular and neurogenic sources of pain syndrome, given the relative similarity of the clinical manifestations of the disease, as well as the identification of secondary vascular phenomena associated with neurogenic disorders.

Pain associated with damage to soft tissues, muscles and skin.

The main pathological processes in soft tissues and skin are inflammatory (erysipelas), intermuscular abscesses, hematomas, tumors (for example, soft tissue sarcoma, metastases). Similar lesions appear after trauma, hypothermia, against the background of a general infectious disease. Pain in these lesions develops more often acutely, is localized in the zone of pathological changes, can have a different character and intensity, and is more often nonspecific.For the diagnosis of these lesions and the detection of secondary vascular complications, diagnostic ultrasound examination is optimal.

Bone affections

Diagnosis of these lesions requires an x-ray or computed tomography examination.

So, from our small excursion, it is clear that pain in the legs is caused by different causes, which are verified in different ways, diagnosed) and treated in different ways. At the same time, the success of treatment (consisting in isolated pain syndrome in its complete relief) is determined, on the one hand, by the quality and literacy of the diagnostic search carried out, on the other hand, by the qualifications and experience of clinicians (neurologists, cardiovascular surgeons, traumatologists, etc.).etc.).

In each case, the approach should be individual and we offer you such an approach.

We and our partners have all the necessary diagnostic methods, including high-resolution ultrasound duplex scanning, high-field magnetic resonance imaging, multislice X-ray computed tomography, etc.

Our clinic is consulted by specialists with extensive experience in this field, including candidates of medical sciences and professors.

We will do our best to relieve you of the pain!

We are waiting for you in our clinic.

90,000 From fasciitis to melanoma: five things your legs can tell you about your health

Feet is an excellent diagnostic tool that doctors often use to make a more accurate diagnosis. But you don’t have to be a doctor to understand that your legs are trying to tell you about possible health problems. Here are five examples of what legs can whisper to their wearer.

1. Dry, flaky skin

If the skin around the heel is dry, cracked, or flaky, this could be a sign of a thyroid problem. It “produces” hormones that control metabolism, blood pressure, cell growth, and the functioning of the nervous system. Dry skin is one of the symptoms that something is wrong with this important organ.

Of course, dry skin is a sign of much less serious problems, including even just a change in the weather. However, if the flaky skin in the heel area is accompanied by weight gain, numbness in the hands or vision problems, it’s time to make an appointment with a doctor.

2. Balding fingers

Foto: Shutterstock

Men have more hair on their toes and they are better visible, but women also have hairs. If they have suddenly disappeared or are in the process of disappearing, this could be a sign of poor circulation. One of the reasons for this is peripheral arterial disease. If left untreated, it can cause a heart attack and even amputation. This disease often “accompanies” diabetes and hypertension.Needless to say, it is simply dangerous to leave this without a doctor’s attention?

3. Numbness of the legs

Numbness of the legs is also one of the symptoms of peripheral arterial disease. It can also be one of the neurological symptoms of type 2 diabetes, and the consequence of this can be the fact that the wounds on the legs do not heal for a long time, which leads to infections.

Of course, most often it occurs if you have sat in one place for too long or fell asleep in an uncomfortable position – as they say, “sat your leg.”Blood flow usually recovers quickly and everything is fine. The alarm should be beaten if numbness occurs “out of the blue.” And see a doctor immediately.

4. Blackheads or stripes under the nails

Foto: Shutterstock

If your foot is squashed, darkening may appear under your nails – and this is absolutely normal. However, if such blackouts appear for no reason, and even in more than one quantity, you need to go to the doctor.

Dark vertical lines – a sign of latent melanoma, skin cancer.And individual dots are a sign of a fungal infection. The second, of course, is not a critical condition for life, but there is nothing good in the fungus either.

5. Pain in the legs in the morning

If you are greeted first in the morning by a burning or “shooting” pain in your legs, this may be a sign of several problems at once. For example, rheumatoid arthritis, which occurs in the ligaments. The disease is unpleasant, but its symptoms are well controlled with medications – ask any doctor.

Plantar fasciitis, a condition caused by inflammation in the part of the foot that connects the heel to the toes, can also be responsible for this pain.Finally, muscle cramps may also be the cause. By itself, it is not dangerous, but it is a clear sign of a lack of moisture in the body and an unbalanced diet.

90,000 What is phantom pain, where does it come from and how to treat it

Afisha Daily spoke with a neurologist, rehabilitologist and people who struggle with phantom pain, about how real this phenomenon is and what science can offer in the fight against it.

© Illustration by Marie Bertrand / Getty Images

What is phantom pain

These are unpleasant sensations of varying degrees and nature in parts of the body that are no longer there, or where sensitivity is lost due to illness.Most often they occur after the amputation of a limb or part of it. Such pain develops in 60–85% of amputations. For example, a person experiences pain in a missing leg. It can be seconds, minutes, hours, or days. More often it stops bothering six months after amputation, but it can become chronic.

The reasons for its occurrence can be explained by the fact that the brain and spinal cord continue to receive impulses from the limb along the nerve fibers, but their character is changed, and they are transformed into painful sensations.Also, in many nerve fibers damaged during amputation, their function is impaired. Over time, “tangles” of growing nerves are formed, which try to restore their length, which can also cause pain.

Phantom pains by nature can be burning, aching, itching, constricting, throbbing, stabbing, shooting, like electric shocks. Possible painful sensations of tingling, squeezing, temperature changes. In addition to pain, there may be phantom non-pain sensations: a feeling of the presence of a limb, its heaviness, a certain position in space, itching, movement, warmth.

There is now evidence that the brain over time rebuilds its sensitivity map and the area that previously collected signals from the lost part of the body is moved to another existing one. The pressure on the cheek can then be felt, for example, as touching a leg that is no longer there .

Can phantom pains be cured

Medicinal and non-medicinal methods are used to treat phantom pain. Until now, there are no special drugs for relieving phantom pain, but pain relievers with different mechanisms of action can help.

Simple analgesics, NSAIDs (non-steroidal anti-inflammatory drugs), some antidepressants, antiepileptic drugs, narcotic analgesics are prescribed.

Non-medicinal methods include:

Any pleasant activity aimed at distracting from this pain.

Physiotherapy exercises using a mirror device, in which a person sees a reflection of a healthy limb instead of an absent one, thereby deceiving the brain.This regular exercise can help reduce pain.

Using virtual reality glasses, which allow you to see the missing limb in the same place and “perform” any movements for it.

Percutaneous electroneurostimulation with a special portable device. A low current is used to influence the nerve fibers through the skin, the effect of “intercepting” pain impulses to the brain occurs.In this case, the electrodes are installed on a healthy limb in the pain zone on the absent one.

Acupuncture in the hands of an experienced professional can provide good pain relief.

Cognitive-Behavioral Psychotherapy has been shown to be very effective in dealing with chronic pain.

Biofeedback.It is a method of teaching self-control over certain physiological functions. At the same time, a person receives on the monitor screen data from sensors installed on his body, and trains to influence them with an effort of will. For phantom pain, data on muscle tension and temperature from the rest of the limb are used. The ability to reduce muscle tone and increase temperature through general relaxation and visualization of heat helps to avoid these pain provocateurs.

Operation to install electrodes and a special device for electrical stimulation of the spinal cord.When these electrodes are stimulated with a current of a certain frequency, pain impulses entering the brain are blocked.

In severe cases, if other methods are ineffective, deep electrical brain stimulation can be performed. For this, an operation is performed, during which special electrodes are installed directly to the deep parts of the brain and an electric pulse generator under the skin on the body, then the characteristics of the current are selected.

Other methods with less efficiency are used (massage, magnetotherapy, listening to music).

What to do if you feel phantom pain

It is imperative to tell the doctor about these pains, not to hide them in view of their unusualness. Patience is needed when choosing therapy. Sometimes the selection of the drug and dose can take a long time and several attempts.

Then it is important to follow the doctor’s recommendations and maintain contact with him in order to adjust the treatment in time.You need to be aware of the possibility of surgical treatment of pain when drugs are ineffective. Do not neglect non-drug pain relief methods. A well-fitted prosthesis is also important for the prevention of phantom pain . It is important to communicate with people with a similar problem in order to share emotions and not be alone with this pain.

This diagnosis belongs to a type of chronic pain, which is a huge problem in modern medicine. The causes of this pain are really not fully understood.But in almost every disease in the literature, you can find such a formulation in the description of the causes. However, ignorance of all the causes of this phenomenon does not absolve medicine from responsibility towards people who experience them and need treatment.

Ibragim Ibragimov, 25 years old

Survived leg amputation after terrorist attack, @ibragim_ibragimoov

Now I am 25 years old. At the age of 16, I went to the Stavropol Palace of Culture for a concert by a local dance ensemble.An explosion thundered, as a result of which I lost my leg (the terrorist attack took place in 2010 at the Palace of Culture, where a concert of a Chechen dance ensemble was planned on that day; as a result, eight people died, 57 were injured. – Approx. Ed. .).

I managed to work in my specialty as an economist, but I quickly realized that office work was not for me. Then I decided to do what I know well from my own experience – prosthetics, and went to study in St. Petersburg. Today I work as a prosthetist for one of the leading prosthetics companies.

When the amputation happened, I was a teenager, so, one might say, I quickly got used to changes in my body. And life somehow immediately began to be filled with events – brothers and friends constantly visited, then they had to enter the university. There was no time to grieve, especially since I felt the tremendous support of my loved ones. But all the same, the first six months or a year was a very difficult time.

I first felt phantom pains in intensive care, during treatment.They were different in character and strength – piercing, pulsating. This can be compared to any severe pain in an ordinary person. The only difference is that the leg can no longer be touched.

Later I learned that the nature of the pains and their duration depend on how professionally the amputation was performed. I know of examples when, 5-10 years after amputation, people felt terrible pain. Now I feel them much less often, but they have not completely passed.

I have never experienced disbelief or judgment about feeling phantom pain.Everyone in my environment knew that this phenomenon was a scientific fact. Another question is that it is still not known how to treat them. I was lucky because all the doctors on my way were professionals with a capital letter. But even they admit that this problem has not yet been resolved. Yes, I’ve heard of the success of “mirror therapy” and augmented reality simulations. But then again, it is impossible to constantly walk with a mirror or in a VR helmet. Sooner or later you will have to return to reality . There is also a pharmacological solution, pills, but their side effects are often much more destructive.

I thought that amputation, prosthesis, phantom pain – all this would interfere with my personal life. But now there are no problems with this. I think that relations with others after such tests depend on the person himself. If you get out of this with resentment, aggression, then the people around will behave the same way.

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Irina Skachkova, 35 years old

Survived leg amputation after an accident, @iren_ne_iren

I got into an accident in 2005.She received severe damage to blood vessels, blood poisoning, so she had to amputate her leg. Now I do fitness, wakeboard, go to festivals, concerts, lead a normal active life.

My husband died in an accident, and at first I was worried only because of this, there was no time to accept the changes in my body. I was only 21 years old, I saw amputation only in the movies and was sure that everything was fixable. Such are the rose-colored glasses. I was ready to go to work, start an active life right away, on painkillers.

I felt phantom pain almost immediately after the amputation. After I was discharged, about a month later, I tried to find pain relievers myself, because no one told me how to deal with them.

It was a very difficult period. I did not sleep, there were thoughts of suicide. Then I learned not to show that I was in pain.

After the prosthesis was placed, the pain began to occur less frequently. But they do not completely pass. Even now, during the interview, I feel pain . It’s just that I no longer perceive it as pain, but as a given.

When I started doing fitness, the pain attacks decreased. Phantom pains come in periods. Weather, nervous exhaustion also affect this condition. Previously, attacks were frequent, but in the last two years I have felt them less often.

I have not encountered distrust of pain, but the problem is different – everyone just doesn’t give a fuck, especially the doctors .In the clinics they told me one thing: “Be patient.” Even the prosthetic company did not know what to do with it. On my own I have found sedatives that help me best.

In my city (I live in Lipetsk) there are no competent doctors in this area. After the accident, I was taught that the pain just needs to be endured, it cannot be treated and will never go away. After a long time, I learned that pain depends on the quality of the amputation. Doctors in St. Petersburg advised me to do another amputation, they said that the first one was performed poorly, but I did not dare to do it.

On my own, I tried mirror therapy. It does help, but for a while. We also have no rehabilitation centers. And there is only one feeling from going to medical institutions – everyone thinks only about how to get rid of you.

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Dario, 41 years old

Lives in Italy, lost leg due to ischemia, @darioboccone

A year ago, I was dying in a clinic in my country.The doctors did not determine the reasons for the hospitalization, although they did their best to do this and support me. I was in a coma for about a month, and among the complications I had leg ischemia, which soon turned into gangrene of the left leg. As soon as I came out of the coma, they amputated her.

When I was hospitalized, I lived alone, and a day later my best friend found me, who had to break through the cordon of doctors and nurses to see me. When I came out of the coma, I was very upset about what had happened.But I agreed to the amputation because it was liberation.

The piece of the body was dead, it stank, and the brain no longer considered it a limb, so I hoped to cut it off as soon as possible.

After the operation, I began to learn to walk with crutches, and then with a prosthesis. The pains I experienced were many and varied. First of all, I got used to the fact that I no longer have a body part.

I could not sleep or relax for a minute because of phantom pains.The doctors told me that they still do not understand this phenomenon, do not know how to treat it, except for a few powerful drugs. Phantom pains are like electric shocks that just drive you crazy if they don’t go away quickly. I take some medications that have more contraindications than beneficial effects, but if I don’t drink them, the phantom pains get worse.

When all this happened to me, my relationship with my family deteriorated and became tense. I didn’t feel their support for many years after the amputation.

In fact, this is not easy, because it takes a lot of strength to do everything on your own. Even with a modern prosthesis, problems often arise. For example, a month ago I fell, broke my arm and dislocated the other. It’s hard, but I don’t despair and continue to fight.

Not having the support of loved ones is difficult. But I hope that my efforts will help me move forward and that effective remedies will soon be created to combat phantom pains that will allow me to live life to the fullest.

I want to share my experience with everyone who faced similar problems in different countries, because there are still many stereotypes and ignorance around amputations. Most people either minimize the effects of phantom pain or exaggerate the negative side of living with it. And the truth is somewhere in between. We just try to live our normal lives.

Ekaterina Danilevich

Rehabilitation specialist of the medical center “Three sisters”

How real is phantom pain

It is important to understand that phantom pain is not fiction.Figuratively speaking, this is a short circuit in the central nervous system. Awareness sometimes helps patients cope with what is happening and see a doctor in time. Psychological factors such as stress and depression affect the development and intensity of phantom limb pain, so self-help skills can help a lot.

Any pain a person experiences is a real problem.

For the suffering consciousness, it makes no difference whether a person or his brain “invented” his pain – or it is torment, the cause-and-effect relationship of which is clearly explainable and traced by others.There is such a saying No brain no pain (translated from English. “No brain – no pain.” – Approx. Ed. ). I always try to explain: pain is a conscious phenomenon, and it doesn’t matter what kind of pain we are talking about. When someone cuts a finger and says “it hurts”, there is no doubt about it. The pain fulfilled its function and signaled trouble. But when the “cut has healed,” and the person continues to experience pain at the site of the injury, , for some reason, we tend to distrust such complaints from . And in vain, because this problem is more complex and often more serious.Pain is not a man’s invention or fiction. And a person with pain syndrome needs not only the help of doctors, but also the support of others.

How new technologies are helping in the treatment of phantom pain

No serious scientific research has revealed to date an effective method for getting rid of phantom pain. If the methods of treating phantom pain are approached critically and refer to research and systematic reviews, then there are no reliable recommendations. Pharmacological drugs, mirror therapy, and even virtual reality are prescribed to relieve phantom pain, but research does not suggest that any of these methods are most effective.However, new methods are being developed. For example, an approach is being developed using sensory feedback from a special prosthesis. More recently, a group of European scientists have created the first hand prosthesis that is capable of transmitting tactile sensations. That is, the patient will feel and sense objects. This is likely to reduce the perception of pain, although it is not yet possible to say for sure.

Young Russian scientists have proposed an innovative method of treating such pains (a 3D copy of a lost limb “deceives” the brain, and a patient using augmented reality helmet can reduce pain.- Approx. ed. ). And that sounds really great. Augmented reality techniques are widely discussed in connection with the indications of their effectiveness. The methodology described by scientists sounds very convincing – because based on photographs you can make such a model of a limb (including tattoos and other features) that the brain will definitely believe . But let’s not jump to conclusions, too little research has been done on this topic.

What results are already available today

Despite the fact that a reliable method has not yet been found, there is still a positive trend in working with phantom pain.It is very encouraging when your patient says that he has returned to his usual life. There was a very good example in my colleague’s practice. A 38-year-old man who had been suffering from phantom pains in the cult for a long time was able to get rid of them. He rated pain 9-10 out of 10.

He was literally on the edge. His family was crumbling, he could not communicate with children, everything annoyed him. The pain caused negative feelings towards loved ones, and this made him even harder – it was a vicious circle.

The therapy was very diverse, and now it is difficult to say what exactly helped. The practice of mirror therapy was also used – the patient is sure that it was she who helped. I do not undertake to draw any conclusions here. But this case is really encouraging.

What can I say for sure: it is impossible to convince myself that the pain is imaginary, . How often have you, for example, been able to convince yourself that a tooth does not hurt? I think there will be few cases.It’s really hard. Probably, the main self-help here consists in timely access to specialists and taking care that there are no reasons for the occurrence of any pain at all.

Questions to the rheumatologist | MC Health

Question

Hello, I’m 29 years old. I have a sharp burning sensation on the ring finger of my left hand, then on my little finger, as if it burned. But then I saw that the vein on my finger was swollen and seemed to be pulsing.Then in this area the finger turned blue, as if a hemorrhage had occurred under the skin. I certainly did not receive any injuries. What can this be connected with? Can this be a signal for any disease? Which doctor should I go to? Thank you in advance for your answer.

Answer

Hello, Lyudmila, MRI of this area can help to establish a diagnosis in your case. Depending on its results, the specialization of a doctor who can help you is determined.

Question

Good afternoon.In the analyzes of antinuclear antibodies (ANA-screen) – positive. Double-stranded DNA (ANA screen) -50.0

Does this mean SLE.

Answer

Hello Andrey, no, it doesn’t mean. An isolated change in laboratory parameters alone can never be the equivalent of a diagnosis. The whole spectrum of clinical, anamnestic, laboratory and instrumental changes is evaluated. Best regards, Svetlana Anatolyevna Tripolka

Question

Good afternoon! Half a year ago in the gym, without warming up the muscles, doing the squat exercise with a barbell, I pulled the groin muscle on the right side, which hurt me for several days.About a month and a half ago, literally a couple of days, there were slight pains in the lower back, which were accompanied when walking by a slight pain in the area of ​​the right buttock (shooting pain), after an intramuscular injection of an anesthetic, everything went away … Two weeks ago, while on duty (I work in the police), according to the event plan -the interception had to stand for 5 hours in one place in bulletproof vests, after which the legs were buzzing … and literally a couple of days later there was pain in the right groin, the pain appeared suddenly when the thigh of the leg was deployed in the farthest position, the pain was not great, the next two days I had a lot of physical exertion on my legs, namely constant walking (on business), after that the pain began to intensify, at one certain moment after a long sitting I could hardly get up, the pain was already felt not only when the leg was spread, but also simply with any movement in the area of ​​the hip joint, somehow I crawled to the pharmacy, where I was advised the ketorol ointment, which literally within one minute took off all the pain, though not for long – for two hours, then the pain began to reappear, although it was already small, I had to smear it with this ointment before visiting the attending physician of the police department of the police department, to which I was assigned, every 6 hours (as per the instructions).In the polyclinic, the neuropathologist whom I first turned to, considering that I might have a pinched sciatic nerve, he refuted my guesses, concluding that I had coxarthrosis of the hip joint and referred me to a rheumatologist, who in turn made his diagnosis – inflammation of the tendon … and sent me for an ultrasound. As it turned out, an ultrasound scan can be done only after a month and a half (there are huge queues in our clinic of the Central Internal Affairs Directorate), I decided to contact my therapist, who, in turn, considered that I had a pinched sciatic nerve and recommended to check first of all the spine (lumbosacral region) , with x-rays we seem to be in order in queues, but I decided to do an MRI of the spine (lumbosacral spine) for a fee at the Institute of Neurology of the Russian Academy of Medical Sciences.Having done an MRI, I was told that, thank God, I have no pathologies with the spine and, accordingly, no pinches either … The doctor who made the conclusion on the MRI after listening to me (background) said that it was not a joint but a tendon that I damaged half a year ago. While at the Institute of Neurology of the Russian Academy of Medical Sciences, I nevertheless decided to seek advice from a neurosurgeon (Ph.D.), who, having listened to me completely, still decided that I had coxarthrosis and recommended a course of treatment, namely 1. Trental 400 (1 tab.2 times a day for 1 month), 2. Alflutop (1 vial intramuscularly No. 10-15), 3. Arta (2 tab. 2 times a day for 1 month) then (1 tab. 2 times a day for 2 months), 4. Milgamma (2 ml. Intramuscularly 1 time per day for 20 days), 5. Physiotherapy – magnetotherapy, 6. Massage, exercise therapy. After all that has been said, I decided to shovel the Internet and, judging by my symptoms, it turns out that I may not have coxarthrosis, but tendinosis of the tendon of the long adductor muscle. What can you say about this, and if this is a tendon, then how can you check it?

Answer

Hello, Alexander.It is impossible to answer your question in absentia. I advise you to contact a specialist in sports medicine (there is such a medical specialization), I hope they will be able to help you professionally. Best regards, Svetlana Anatolyevna Tripolka.

Question

Good afternoon. Please tell me how my husband’s intake of sulfasalazine might affect our planned pregnancy. Does this medicine only affect sperm motility or does it affect the future fetus? How long should you wait before conception if you cancel the drug.

Answer

Hello Elena. Sulfasalazine affects the quantity and quality of sperm. Its influence on the future fruit has not been proven. During pregnancy (the first 6 months), taking the drug is permissible under strict indications. Based on this, when planning a pregnancy, it is advisable to cancel the drug so that it can occur. There are no clear terms (for how long before the planned pregnancy) until the spermogram indicators are normalized. Then, according to indications, you can continue taking it for up to 24 weeks, after which the drug must be canceled until breastfeeding is stopped.Best regards, Svetlana A. Tripolka

Question

hello! Please tell me how you feel about a raw food diet and refusal of meat in case of rheumatoid arthritis / I am 49 years old / is it contraindicated? thanks

Answer

Hello Elena! The influence of a raw food diet and refusal of meat on the course of rheumatoid arthritis has not been studied, I also have no personal experience of such an influence. You can share your experience. Best regards, Svetlana Anatolyevna Tripolka.

Question

Hello! I have rheumatoid (reactive) arthritis. The doctor prescribed me salazopyrin, as well as other medications, but earlier I had an allergy to salazopyrine. Is it possible to replace salazopyrine with some kind of analogue (for example, sulfasalazine) to prevent allergies? Thank you Zararie for your answer.

Answer

Hello, Love! There is no point in replacing sulfasalazine with salazopyrine. It is necessary to select another basic drug, which can be carried out by a rheumatologist based on examination data, anamnesis, an assessment of laboratory activity and X-ray manifestations of the disease.Best regards, Svetlana A. Tripolka

Question

Hello. I’m 21

at the age of 14 had rheumatism of large joints (a side effect of taking antibiotics), the knee joints hurt most of all, and especially badly when going down the stairs. They pierced the pinicelin and something else, everything seemed to have passed. After that, the knees were rarely bothered. mainly a reaction to the weather or after a long walk / run.

about a week ago began to disturb the knee joints, especially going down stairs and squatting.

I work in a semi-basement room with rather thick walls, so it is cold enough when the heating is turned off. I have been working there since winter (at this time it is hot there), so I assume that when working in such a room with coolness and humidity after turning off the heating, it is because of this that my knees began to bother

Is this assumption correct? maybe to some extent the lack of calcium makes itself felt?

in the week I want to take a rheumatic test for calcium, is that enough?

Answer

Hello Daria, It is unlikely that this kind of symptoms can be associated with the level of calcium in the blood.It is necessary to be examined by a rheumatologist. The causes of joint pain can be many, ranging from manifestations of rheumatic heart disease and ending with a variety of dysplasias. It is possible to make a diagnosis and figure it out only with an in-person consultation.

Question

Hello, I am 26 years old, once I noticed that when going up and down stairs, a slight pain appears in my knees, a few months later, ringing clicks appeared in my left knee with the same movement.All this despite the fact that when walking, nothing unpleasant is felt. What could it be? Thank you …

Answer

Hello, Natalya, it’s hard to judge in absentia. This is fortune telling on the coffee grounds. Contact a rheumatologist or arthrologist. Best regards, Svetlana Anatolyevna Tripolka

Question

Hello, a few months ago my leg was swollen, the swelling does not go away, sometimes it decreases, then it increases. An ultrasound of the lower vessels of the lower extremities passed, they said that everything was in order with the vessels, there were problems with the outflow of lymph.please tell me how you can remove the swelling?

Answer

Hello, Julia! Your problem should be addressed to a vascular surgeon. Best regards, Svetlana Anatolyevna Tripolka

Question

Good afternoon! I am 23 years old. For several years my knee hurt. Recently, I can’t bend my knee to the end, it hurts, it crunches and seems to creak (when you bend the creak occurs or the crunch is very quiet, does it feel like something inside is rubbing against something? at night if she is constantly bent or straightened.I went for an ultrasound scan, they wrote that there was a physiological amount of excess fluid in the joint cavity. The fibrous capsule of the joint is neither thickened nor compacted. The synovium is not differentiated. Hyaline cartilage: thickness in the area of ​​the patellofemoral support 2.6 mm, in the area of ​​the medial condyle BK-1.9 mm, above the lateral condyle 2.0 mm. The echogenicity of the cartilage is slightly increased, the structure is homogeneous, the contour is clear and even. Subchondral layer with a smooth, indistinct contour. The joint gap is not narrowed, Mennisk is normal, in the popliteal fossa without features.Conclusion – signs of structural changes in the cartilage of the knee joints. I made an appointment with a rheumatologist, I will go to the appointment in a month. The ultrasound doctor said that something needs to be injected so that the cartilage does not completely decrease. Please tell me what needs to be done, what tests need to be passed. Why could this happen, after all, I have never been involved in sports especially. And what should I do so that this does not lead to arthrosis and how to preserve the cartilage? After all, I am only 23 years old, and what will happen in the future !!!

Answer

Hello Anna.You need to conduct an MRI of the knee joints to clarify the integrity of the intra-articular formations and an X-ray examination to clarify the degree of arthrosis. Based on the data received, make a decision on treatment tactics.

Question

Hello! Since October 2012, the feet have been sore, no one can make a diagnosis. Tests completed:

sugar – 4.7 mmol / l, Hb – 116 g / l, RW – negative, HIV – negative, urine acid – 5.9 mg / dl (repeat.- 299 umol / L), rheumatoid factor – negative, antistreptolysin-O – negative, C-reactive protein – 54 mg / ml (repeat – 54.4mg / L), COE – 40 mm / h (repeat – 50 mm / h, antibodies to cyclic citrulline peptide (anti-CCP) –

Answer

Hello, Irina. I cannot diagnose in absentia, contact our center, I will try to help you. Best regards, Svetlana Anatolyevna Tripolka

Question

good days. Call me Yulia for 21 ric, last day I was diagnosed with reactive arthritis of the left corner of the leg.They dabbled with droppers from dexamethasan, that pill of sulfasalazin, it became more beautiful for me, my leg didn’t work, but the axis of the day didn’t, after some time, I pampered the snow, I didn’t mind a little bit of bad luck. Maybe I’m afraid I’m afraid of dexamethasone, but I’m afraid it’s not good for me, for the one who hasn’t given birth yet, please me, be a weasel.

Answer

Hello, Julia, in your situation at the moment there are no indications for the use of hormone therapy, since, according to your words, there is no disease activity.To relieve pain, use non-steroidal anti-inflammatory drugs, which a rheumatologist can help you choose. For the future, I do not advise using dexamethasone, there are new glucocorticoid drugs with fewer side effects, such as methylprednisolone. Best regards, Svetlana Anatolyevna Tripolka.

Question

Hello! I have rheumatoid arthritis, I am giving a method injection, the instructions in the contraindications section say alcoholism, please tell me how to understand this? Is it possible to use, for example, a glass of wine or champagne once a week or is it categorically forbidden? And what will happen if you do not follow the instructions? Thanks for earlier

Answer

Hello, Svetlana.Alcoholism (as opposed to the occasional use of the amount of alcoholic beverages described by you) is a disease, a type of substance abuse, characterized by a painful addiction to alcohol, physical and psychological dependence on its use. I hope this is not the case in your situation. It is advisable to refrain from drinking alcohol while taking methotrexate. Of course, there will be no tragic consequences from occasionally rare receptions, but the load on the liver will increase. Respectfully yours, Svetlana Anatolyevna Tripolka.

Question

Hello. Two and a half months ago (January 9), after a load in the gym, pain began in the knee joints (both) at the same time. There was swelling in the knees, but there were no external manifestations. Within a month, all joints began to hurt without any external changes, only a crunch appeared. Complete blood count and biochemical blood are normal. Ultrasound of internal organs is normal. X-ray joints – no pathologies. Antibodies M to chlamydia – negative.Antibodies J to chlamydia – positive (7.6 with an acceptable level of 1.2).

(Unfortunately, the results of all analyzes and a description of the disease process do not fit into the set number of question marks). In the course of treatment with antibiotics, non-steroidal anti-inflammatory and other medications, the condition did not improve, it even became worse: the skin, muscles, eyes began to burn without any external changes. Body temperature does not exceed 37. Consulted by a neurologist, psychiatrist, etc.doctors, no pathologies were identified. At the moment, the diagnosis has been made – Reiter’s disease, subacute course. Can you tell me if this is the correct diagnosis and why 35 days of treatment did not bring any positive results?

Answer

Hello, Oleg. The description of the disease does not fit into the set number of characters, and the “” magic solution “” “to your disease, nevertheless, you expect to receive an online consultation. It is possible to diagnose and prescribe treatment only after direct examination of the patient.Respectfully yours, Svetlana Anatolyevna Tripolka.

Question

Hello. I’m 25 years old. For more than a year now I have been worried about joint pain. It all started with the big toe of the left foot. There was a terrible pain, redness, swelling. It was first treated like gout. A few months later, the rest of the toes began to hurt. The foot was slightly deformed and the ankle bone began to hurt very badly. A few months later, the joint of the right hand and the right knee became ill.All this time she drank diclofenac, ibuprofen, movalis, glucosamine. There was not much relief. Having passed all possible blood tests and not only (PCR, ELISA-toxoplasma, mycomlasma, ureplasma, chlamydia – everything is negative, rheumatic tests-neg, HLA-B-27-passed three times – all neg, X-ray did not show abnormalities, MRI of sacroiliac no abnormalities were detected) of all deviations, only CRP-6.28 mg / l at a rate of less than 5, ESR-20mm / hour at a rate of 15. Ultrasound result: signs of pandenitis combined with tenosynovitis of the tendons of the left foot, multiple erosions and a pronounced periosteal reaction …The doctor diagnosed reactive arthritis and prescribed 3 months. drink sulfasalazine according to the scheme. I drank it, but there was no result, all the same swelling, pain, a bump on my arm and leg. And what else should be the cause of reactive arthritis, but they did not find any traces of infection in me, although I was tested several times in several places. Is this really reactive arthritis? Why is he then? How to treat it further? Thanks.

Answer

Hello, Marina. It is not possible to answer your questions in absentia.It may be reactive arthritis, or it may not. Laboratory examinations are carried out for the most common pathogens, but not all. For example, viruses, shigella, yersinia, etc. can be the cause of reactive arthritis. I cannot prescribe treatment by correspondence consultation. Contact our center, we will try to help you. Respectfully yours, Svetlana Anatolyevna Tripolka.

Question

Hello. From the age of 18, crunching in the joints – knees, wrists, spine, feet, neck.Now 22 years old, there is pain when bending the knees, knees ache in the weather, sometimes it hurts to walk. Please tell me what kind of disease it can be?

Answer

Hello, Kira, I cannot diagnose in absentia. There may be arthralgia against the background of osteochondrosis, there may be a debut of rheumatoid arthritis. In any case, this is fortune telling on the coffee grounds. Respectfully yours, Svetlana Anatolyevna Tripolka.

Question

Hello. I have rheumatoid arthritis since I was 5 years old, and I have been prescribed methotrexate 15 mg per week.In pharmacies I did not find methotrexate and bought methotab, in pharmacies they said that it was the same thing. Is it correct that I drink methotrexate, in the same dosage as methotrexate was prescribed and is it normal for mild nausea and dizziness on the day of taking the medicine?

Answer

Maria, methotab and methotrexate are one and the same. Nausea and dizziness are possible, try 10 mg in the evening and 5 mg in the morning. Respectfully yours, Svetlana Anatolyevna Tripolka.

Question

Hello.I was prescribed methotrexate (not for the first time) at a dose of 15 mg. I found in pharmacies and bought only methotab. I was told that this is the same thing. Am I doing the right thing that I take methotab and is it normal for mild nausea and dizziness on the day of taking? (I drink folate every other day)

Answer

Maria, methotab and methotrexate are one and the same. Nausea and dizziness are possible, try 10 mg in the evening and 5 mg in the morning. Respectfully yours, Svetlana Anatolyevna Tripolka.

Question

Hello! I am 45 years old.I was diagnosed by MRI: Left-sided aseptic sacroilitis, lipoid dystrophy of the sacrum and iliac bone marrow, scoleosis. Tell me in more detail whether this disease is dangerous and how to treat it? What kind of exercises, what kind of sport, what is possible, my doctor does not say anything specifically. Thank you so much for your help!

Answer

Hello Marina! It is necessary to clarify the origin of sacroiliitis. To do this, first of all, you need to be examined for urogenital infection, since it is she who most often causes such changes.It is also necessary to exclude the debut of ankylosing spondylitis and the spondyloarthritic form of psoriatic arthritis. Each of these conditions is treated differently. Contact our center and we will try to help you. Best regards, Svetlana A. Tripolka

Question

Hello, I’m worried about the stiffness of the joints of the fingers in the morning, after waking up, for about 20 minutes. Then everything comes back to normal. No temperature, rheumatic factor

Answer

Hello, Svetlana, what is the essence of your question? Best regards, Svetlana Anatolyevna Tripolka.

Question

I am 25 years old, 11 have psoriasis. Since the end of summer, my legs just started to hurt. I came to the doctor, immediately – “psor.arthritis”. The legs did not swell, there were no deformities of the limbs, there was no “morning stiffness”. Rheumatic tests ruled out rheumatism, and there was no gout either. Psoriasis is almost perfect. Since September, sometimes it just hurts my legs and arms (not much). Extremities ache in different places (and in the fingers and toes) and at different times – there is no disposition to certain conditions in the pain.Sometimes the joints of the feet crunch. I can walk and run as much as I want. My back does not hurt, I can withstand physical activity normally. The rheumatologist took pictures of the hands, lower back – the norm, he advised me to be tested for chlamydia, the result is positive, a course of antibiotics, again tests – no chlamydia. A week has passed and my legs are aching again. Not as much as before. The last 3 days began to tingle and under (between) the shoulder blades, in the shoulder. Maybe this is not psor. Arthritis (I would not like to become disabled)? How can I do the right thing or do nothing (it will pass by itself)?

Answer

Hello Sergey, Based on the data described by you, the diagnosis of psoriatic arthritis raises great doubts.To make this diagnosis, it is necessary to identify completely clear and characteristic of this type of arthritis visual changes in the joints, as well as radiological signs characteristic of psoriatic arthritis. According to you, you do not have these manifestations. Leg pain is not the equivalent of a diagnosis. Of course, in the early stages of arthritis, only they can be its first symptom. I can more clearly answer your questions after the inspection and analysis of your changes. Respectfully yours, Svetlana Anatolyevna Tripolka.

Question

Hello! If possible, please comment on the analyzes of my son (21 years old): REUMAPROBES: SRB-33.6, rheumatic factor-neg., Antistreptolysin O-220, cold antibodies 1: 8, total immune complexes-78, large-molecular fractions-26 , medium-molecular-40, small-molecular-34, cytotoxic AG-2.84, cytotoxic AT-0.35. total protein – dash. GENERAL BLOOD ANALYSIS (on the same day): erythrocytes-5.16, hemoglobin-165, color index-0.96, platelets-280, leukocytes-6.0, stab-1, segmented-26, lymphocytes-56, monocytes -11, eosinophils-4, basophils-2, ESR-3.Bacterial culture from the pharynx and nose – staphylococcus aureus. DIAGNOSES: chronic decompensated tonsillitis, chronic granulosis, pharyngitis in the acute stage, chronic thyroiditis, euthyroidism. Heart complaints, no joints. Please tell me if you need to refer to rheumatology or these analyzes are typical for these diagnoses. I would be very grateful for your advice!

Answer

Hello Angela, Your son has increased CRP, which can be typical for both chronic tonsillitis and its complications from the heart.It is necessary to clarify the state of the cardiovascular system, conduct an examination (auscultation of the heart to detect murmurs), as well as an ECG and ECHO-CS study. Not always complications from the heart, developed against the background of chronic tonsillitis, immediately manifest themselves in complaints. Sometimes they are asymptomatic. You need to consult a rheumatologist to exclude complications from the heart that may develop against the background of chronic tonsillitis. Best regards, Svetlana Anatolyevna Tripolka.

Question

Hello, I have arthrosis in both legs, some cartilage has come off in my left knee, fluid is collecting in both cups.help: what to do, how to treat, where to find a specialist?

Answer

Hello, Svetlana! To clarify the integrity of “” some cartilage “, etc. You will need to have an X-ray and an MRI scan of your knee joints. In our center there is an opportunity to help you. Please make an appointment with a rheumatologist and we will try to understand your problem. Best regards, Svetlana Anatolyevna Tripolka.

Question

Hello.

1.Is the value 459 (uric acid) decisive for the diagnosis of gout? The nature of the disease has completely changed, NSAIDs have ceased to help, on the contrary, they provoke pain and swelling. Cortisone and NSAIDs relieve inflammation a little, at the end of the course everything starts all over again. A recent clinical blood test shows (values ​​in excess of the standard are given):

Cholesterol-6; LDL-4.15; Uric acid-479; Urea-9.60; Creatinine-135; CPK-544; C-reactive protein-59; Rheumatoid factor-120; Hemoglobin-120; Leukocytes-11.6; ESR-57; Segmented-78; Lymphocytes-10; Leukocytes-3

This is an oil painting … Do you think this is proof of rheumatism? arthritis or reactive arthritis? Is antibacterial treatment necessary in this case? I would like to hear your personal opinion. Thank you, Best regards, Gregory.

Answer

Hello, Gregory! An increase in uric acid is not decisive for the diagnosis of gout, it is the nature of the articular syndrome that is decisive. The laboratory data provided by you may be typical for several types of arthritis, including those listed by you.For an accurate diagnosis and treatment recommendations, it is necessary to conduct an examination, collect anamnesis and evaluate radiological changes in the joints. Contact our center, we will try to help you. Best regards, Svetlana Anatolyevna Tripolka.

Question

Hello, I am 31 years old and for a long time I have been bothered by pain in the joints of my legs, especially the gouty bone on my foot. It grows and hurts. Can your specialists help me, and if so, how: promptly or with a laser (I heard this too) or are there other real methods of treatment.Thanks in advance for your attention.

Answer

Hello, Ekaterina Vladimirovna, the question of the nature of the treatment can be resolved after examination and laboratory and X-ray examination. Our center has such opportunities, please contact us. Best regards, Svetlana Anatolyevna Tripolka.

Question

Good afternoon. For the second time in a month, my 6 year old son has a temperature rise to 37.8 without visible symptoms. The last time the son complained of pain in his legs.Rheumatic tests were done. The results are as follows:

Antistreptolysin-O (ASL-O) -27 IU / ml

C reactive protein (CRP) -12.82 mg / l

Rheumatoid factor -11.5 IU / ml

Does my 6-year-old son have rheumatism? In June, only an ultrasound of the heart and a cardiogram (with and without exercise) were done, everything was within normal limits. Which doctor should I contact with our problem?

Thank you for your attention))

Answer

Dear Natalia. Leg pain is not the equivalent of rheumatism, even when combined with fever.An increase in temperature can be due to a variety of reasons, ranging from a banal SARS. Against the background of an increase in temperature, intoxication often develops, a symptom of which can be pain in joints and muscles. First of all, you need to contact a pediatrician who will help you deal with the cause of the rise in temperature. Best regards, Svetlana Anatolyevna Tripolka.

Question

Hello! My child is 1g6month. We have been sick for six months already, the child has gone through an operation (part of the intestine was cut off), the doctors said that we have one of the autoimmune diseases, which one is not clear, treatment with a hormonal drug has already begun, so it makes no sense to take tests, because.Because they will be unreliable, now the child is fevering for half a day, we do not know what to do anymore, it turns out that the treatment does not help, the ESR began to grow again, help, please, take a little time and read the case history: https: // vikapro. blogspot.com/

Answer

Hello Elena, Unfortunately, I cannot help you in your situation, since children’s doctors are involved in treating children, and I have a specialization in adult rheumatology. The course of pediatric pathology, and even more so autoimmune, has its own specificity, and its diagnosis and treatment is a separate specialization in pediatrics.Best regards, Svetlana A. Tripolka

Question

Hello! My mother is 75 years old. Knee pain. the right leg, which extends to the calf muscle. Has been worrying for more than two months. Tell. please, where to go to make the correct diagnosis and prescribe the right treatment. In the district polyclinic, they turned to a therapist and a surgeon. The diagnosis was made – gonoarthrosis of the right knee joint. They pierced the medication. rubbed the ointment.but it helps weakly. if possible, please reply. I will wait.

Answer

Hello, Natalia! You can contact a rheumatologist at our center, I think we can help your mother. Best regards, Svetlana Anatolyevna Tripolka.

Question

Has taken tests for rheumatic tests. My name is Tatiana, I am 28 years old. She suffered from rheumatism, and has not bothered for 5 years. But there was a pregnancy, the fetus had many defects, incl. heart disease. We plan to try again, but I’m worried that everything happened because of rheumatism.

* Antistreptolysin-O (ASL-O) 124 IU / ml Adults: up to 200.0

* C-reactive? protein (CRP)

Answer

Hello, Tatiana, what is your question, you have not formulated it. Respectfully yours, Svetlana Anatolyevna Tripolka.

Question

What can a blood test say C-reactive protein-18.0, and RF-negative.

Answer

Hello Olga! Again a question-answer from the series “Fortune-telling on the coffee grounds”, such an analysis can say a lot, or maybe nothing.You need to start a conversation not with an analysis, but with clinical symptoms: complaints, anamnesis, examination. Analyzes by themselves do not say anything in particular. Best regards, Svetlana Anatolyevna Tripolka.

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