Roseanne Atleh

The Most Effective Feet Care Site Ever

Factors That Cause Functional Leg Length Discrepancy

Overview

Leg shortening is employed when LLD is severe and when a patient has already reached skeletal maturity. The actual surgery is called an osteotomy , which entails the removal of a small section of bone in the tibia (shinbone) and sometimes the fibula as well, resulting in the loss of around an inch in total height. Leg lengthening is a difficult third option that has traditionally had a high complication rate. Recently, results have improved somewhat with the emergence of a technique known as callotasis , in which only the outer portion of the bone (the cortex ) is cut, (i.e. a corticotomy ). This allows the bone to be more easily lengthened by an external fixation device that is attached to either side of the cut bone with pins through the skin. The ?ex-fix,' as it is sometimes called, is gradually adjusted by an orthopaedic surgeon, and healing can occur at the same time that the leg is being distracted , or lengthened over time. Unlike epiphysiodesis, leg lengthening procedures can be performed at almost any skeletal or chronological age.Leg Length Discrepancy

Causes

The causes of LLD are many, including a previous injury, bone infection, bone diseases (dysplasias), inflammation (arthritis) and neurologic conditions. Previously broken bones may cause LLD by healing in a shortened position, especially if the bone was broken in many pieces (comminuted) or if skin and muscle tissue around the bone were severely injured and exposed (open fracture). Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. Also, a break in a child?s bone through a growth center (located near the ends of the bone) may cause slower growth, resulting in a shorter extremity. Bone infections that occur in children while they are growing may cause a significant LLD, especially during infancy. Bone diseases may cause LLD, as well; examples are neurofibromatosis, multiple hereditary exostoses and Ollier disease. Inflammation of joints during growth may cause unequal extremity length. One example is juvenile rheumatoid arthritis. Osteoarthritis, the joint degeneration that occurs in adults, very rarely causes a significant LLD.

Symptoms

The most common symptom of all forms of LLD is chronic backache. In structural LLD the sufferer may also experience arthritis within the knee and hip are, flank pain, plantar fasciitis and metatarsalgia all on the side that is longer. Functional LLD sufferers will see similar conditions on the shorter side.

Diagnosis

The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.

Non Surgical Treatment

Treatment of leg length inequality involves many different approaches, such as orthotics, epiphysiodesis, shortening, and lengthening, which can be used alone or combined in an effort to achieve equalization of leg lengths. Leg length inequality of 2 cm or less is usually not a functional problem. Often, leg length can be equalized with a shoe lift, which usually corrects about two thirds of the leg length inequality. Up to 1 cm can be inserted in the shoe. For larger leg length inequalities, the shoe must be built up. This needs to be done for every shoe worn, thus limiting the type of shoe that the patient can wear. Leg length inequalities beyond 5 cm are difficult to treat with a shoe lift. The shoe looks unsightly, and often the patient complains of instability with such a large lift. A foot-in-foot prosthesis can be used for larger leg length inequalities. This is often done as a temporizing measure for young children with significant leg length inequalities. The prosthesis is bulky, and a fixed equinus contracture may result.

LLL Shoe Insoles

what is a functional leg length discrepancy?

Surgical Treatment

Surgical operations to equalize leg lengths include the following. Shortening the longer leg. This is usually done if growth is already complete, and the patient is tall enough that losing an inch is not a problem. Slowing or stopping the growth of the longer leg. Growth of the lower limbs take place mainly in the epiphyseal plates (growth plates) of the lower femur and upper tibia and fibula. Stapling the growth plates in a child for a few years theoretically will stop growth for the period, and when the staples were removed, growth was supposed to resume. This procedure was quite popular till it was found that the amount of growth retarded was not certain, and when the staples where removed, the bone failed to resume its growth. Hence epiphyseal stapling has now been abandoned for the more reliable Epiphyseodesis. By use of modern fluoroscopic equipment, the surgeon can visualize the growth plate, and by making small incisions and using multiple drillings, the growth plate of the lower femur and/or upper tibia and fibula can be ablated. Since growth is stopped permanently by this procedure, the timing of the operation is crucial. This is probably the most commonly done procedure for correcting leg length discrepancy. But there is one limitation. The maximum amount of discrepancy that can be corrected by Epiphyseodesis is 5 cm. Lengthening the short leg. Various procedures have been done over the years to effect this result. External fixation devices are usually needed to hold the bone that is being lengthened. In the past, the bone to be lengthened was cut, and using the external fixation device, the leg was stretched out gradually over weeks. A gap in the bone was thus created, and a second operation was needed to place a bone block in the gap for stability and induce healing as a graft. More recently, a new technique called callotasis is being use. The bone to be lengthened is not cut completely, only partially and called a corticotomy. The bone is then distracted over an external device (usually an Ilizarov or Orthofix apparatus) very slowly so that bone healing is proceeding as the lengthening is being done. This avoids the need for a second procedure to insert bone graft. The procedure involved in leg lengthening is complicated, and fraught with risks. Theoretically, there is no limit to how much lengthening one can obtain, although the more ambitious one is, the higher the complication rate.

Heel Ache The Causes, Signals And Therapy Possibilities

Overview

Foot Pain

Plantar Fasciitis, also known as heel pain or a heel spur, is a musculoskeletal condition causing pain under the heel or into the inner arch of the foot. The condition is commonly mistaken for an impact trauma or heel bruise but in fact it is caused by mechanical overstretching of the fibrous tissue in the arch. Heel pain can develop suddenly or evolve gradually over time. It can affect people of all ages, but is more common beyond the 4th decade of life, those in standing occupations, overweight individuals and those involved in regular strenuous exercise.

Causes

Some of the many causes of heel pain can include abnormal walking style (gait), such as rolling the feet inwards. Obesity. Ill-fitting shoes. Standing, running or jumping on hard surfaces. Injury to the heel, such as stress fractures. Bursitis (inflammation of a bursa, bursae are small sacs that contain fluid to lubricate moving parts, such as joints and muscles). Neuroma (nerve enlargement). Certain disorders, including diabetes and arthritis.

Symptoms

Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis. The inflammation maybe aggravated by shoes that lack appropriate support and by the chronic irritation that sometimes accompanies an athletic lifestyle. Achilles Tendinopathy, Pain and inflammation of the tendon at the back of the heel that connects the calf muscle to the foot. Sever?s, Often found in children between the ages of 8 - 13 years and is an inflammation of the calcaneal epiphyseal plate (growth plate) in the back of the heel. Bursitis, An inflamed bursa is a small irritated sack of fluid at the back of the heel. Other types of heel pain include soft tissue growths, Haglunds deformity (bone enlargement at the back of the heel), bruises or stress fractures and possible nerve entrapment.

Diagnosis

Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.

Non Surgical Treatment

Treatment of heel pain depends on its cause. Plantar fasciitis. Most doctors recommend a six- to eight-week program of conservative treatment, including temporary rest from sports that trigger the foot problem, stretching exercises, ice massage to the sole of the foot, footwear modifications, taping of the sole of the injured foot, and acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin and others) for pain. If this conservative treatment doesn't help, your doctor may recommend that you wear a night splint or a short leg cast, or he or she may inject corticosteroid medication into the painful area. Surgery is rarely necessary and is not always successful. Heel spur. Conservative treatment includes the use of shoe supports (either a heel raise or a donut-shaped heel cushion) and a limited number of local corticosteroid injections (usually up to three per year). As in plantar fasciitis, surgery is a last resort. Calcaneal apophysitis. This condition usually goes away on its own. In the meantime, conservative treatment includes rest and the use of heel pads and heel cushions. Bursitis. Treatment is similar to the treatment of heel spurs. Changing the type of footwear may be essential.

Surgical Treatment

When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.

pain in back of heel

Prevention

Foot Pain

Heel pain is commonly caused from shoes that do not fit properly. In addition, shoes need to have ample cushioning and support, particularly through the heel, ball of the foot, and arch. Shoes should also be replaced if they become too worn. One sure sign of wear and tear is overly worn areas of a shoe's insoles. If the heel or ball of the foot is particularly worn, damage could easily occur since the bottom of the foot is not getting the cushioning it needs.

Mortons Neuroma Treatments

Overview

interdigital neuromaMorton's neuroma is a swollen or thickened nerve in the ball of your foot. When your toes are squeezed together too often and for too long, the nerve that runs between your toes can swell and get thicker. This swelling can make it painful when you walk on that foot. High-heeled, tight, or narrow shoes can make pain worse. Sometimes, changing to shoes that give your toes more room can help.

Causes

The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon. Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour.

Symptoms

Morton?s neuroma is a progressive condition which means the symptoms typically get worse over time. Initially people often complain of a tingling or numbness at the base of their toes, typically in the space between the third and fourth toes, or, less commonly , between the second and third toes, which feels a bit like pins and needles. Over time the pain progresses and can feel like a stabbing or burning sensation in the ball of the foot under the toes. Some describe it as feeling as if they are standing on a stone. Normally the pain will get worse when you wear tight fitting shoes. Doing exercise that impacts on the foot such as jogging can also make the symptoms worse. The extent of the pain varies from person to person but in some cases it can be so intense that every step can feel acutely painful.

Diagnosis

Morton?s neuroma can be identified during a physical exam, after pressing on the bottom of the foot. This maneuver usually reproduces the patient?s pain. MRI and ultrasound are imaging studiesthat can demonstrate the presence of the neuroma. An x-ray may also be ordered to make sure no other issues exist in the foot. A local anesthetic injection along the neuroma may temporarily abolish the pain, and help confirm the diagnosis.

Non Surgical Treatment

In most cases, initial treatment for this condition consists of padding and taping to disperse weight away from the neuroma. If the patient has flatfeet, an arch support is incorporated into footwear. The patient is instructed to wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered. The patient is advised to return in a week or 2 to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient's foot and the type of shoes the patient wears. It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position. Another type of therapy that may be used is alcohol sclerosing injections. In this treatment, the doctor injects a small amount of alcohol in the area of the neuroma area to help harden (sclerose) the nerve and relieve the pain. Injections are given every 7-10 days and, in many cases, 4-7 injections are needed for maximum relief. Please ask your physician for more information regarding this type of treatment.Morton

Surgical Treatment

The ultimate success of a Morton?s neuroma treated surgically can be variable. In cases where the underlying problem is only an irritated nerve (a true Morton?s neuroma), then surgery will probably be curative (although it may take a few months for the foot to fully heal). But in many cases, forefoot pain is more complex. There may be an irritated nerve or two causing pain, but the real problem is often excessive loading of the lesser metatarsals. The generic term for this condition is metatarsalgia. When considering surgery, identifying and addressing these problems may lead to a better end result.

The Solution To Leg Length Difference Is Shoe Lifts

There are actually not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is structurally shorter in comparison to the other. As a result of developmental periods of aging, the brain senses the gait pattern and recognizes some variation. The entire body typically adapts by tilting one shoulder over to the "short" side. A difference of less than a quarter inch isn't really uncommon, doesn't need Shoe Lifts to compensate and in most cases won't have a profound effect over a lifetime.

Shoe Lift

Leg length inequality goes mainly undiscovered on a daily basis, yet this problem is simply solved, and can reduce numerous cases of chronic back pain.

Therapy for leg length inequality commonly consists of Shoe Lifts. Many are very reasonably priced, typically being under twenty dollars, compared to a custom orthotic of $200 plus. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Chronic back pain is the most common condition afflicting men and women today. Over 80 million men and women suffer from back pain at some stage in their life. It's a problem which costs companies millions yearly on account of time lost and productivity. Innovative and superior treatment solutions are continually sought after in the hope of decreasing the economical influence this issue causes.

Shoe Lifts

Men and women from all corners of the earth suffer from foot ache as a result of leg length discrepancy. In a lot of these situations Shoe Lifts are usually of very helpful. The lifts are capable of eliminating any discomfort in the feet. Shoe Lifts are recommended by many expert orthopaedic physicians.

To be able to support the body in a balanced manner, the feet have a significant role to play. Irrespective of that, it is sometimes the most overlooked zone in the body. Some people have flat-feet which means there may be unequal force placed on the feet. This causes other body parts such as knees, ankles and backs to be affected too. Shoe Lifts make sure that appropriate posture and balance are restored.

Calcaneal Spur Causes

Calcaneal Spur

Overview

A heel spur is a hooked bony growth protruding from the calcaneus or heel bone. It often occurs alongside plantar fasciitis, and as such the two conditions are often confused, however they are not the same.

Causes

One frequent cause of heel spurs is an abnormal motion and mal-alignment of the foot called pronation. For the foot to function properly, a certain degree of pronation is required. This motion is defined as an inward action of the foot, with dropping of the inside arch as one plants the heel and advances the weight distribution to the toes during walking. When foot pronation becomes extreme from the foot turning in and dropping beyond the normal limit, a condition known as excessive pronation creates a mechanical problem in the foot. In some cases the sole or bottom of the foot flattens and becomes unstable because of this excess pronation, especially during critical times of walking and athletic activities. The portion of the plantar fascia attached into the heel bone or calcaneous begins to stretch and pull away from the heel bone.

Calcaneal Spur

Symptoms

Symptoms may be similar to those of plantar fasciitis and include pain and tenderness at the base of the heel, pain on weight bearing and in severe cases difficulty walking. The main diagnosis of a heel spur is made by X-ray where a bony growth on the heel can be seen. A heel spur can occur without any symptoms at all and the athlete would never know they have the bony growth on the heel. Likewise, Plantar fasciitis can occur without the bone growth present.

Diagnosis

Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts. X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.

Non Surgical Treatment

Exercise. If you think your pain is exercise-related, change your exercise routine, environment, or foot-ware, and emphasize movements and/or body parts that do not cause pain. Mind/Body. Occasionally foot pain can be related to stress. The body may respond with generalized tension that contributes to pain in many areas, including the feet. Hypnosis and guided imagery are worth exploring if an anatomical problem is not apparent. Supplements. Natural anti-inflammatories can be just as effective as ibuprofen or other over-the-counter pain relievers with fewer side effects. Try one of the following. Ginger (Zingiber officinale) standardized to 5-6% gingerols and 6% shogoals, take one to two 500 mg tablets three to four times daily. Turmeric (Curcuma longa) standardized to 95% curcuminoids, take 400-600 mg three times daily. Also, be sure that you're wearing well-fitting shoes, the proper shoes for each activity, and that you buy new foot-ware as soon as you notice signs of wear. You can also take the pressure off your heel with a donut-shaped heel cushion or a heel-raising pad placed in your shoe. Acupuncture can also relieve the pain, as can for some sufferers, magnetic shoe inserts, although the evidence behind their effectiveness is not conclusive. Osteopathic or chiropractic manipulation can help with soft tissue pain in and around the feet.

Surgical Treatment

Almost 90% of the people suffering from heel spur get better with nonsurgical treatments. However, if the conservative treatments do not help you and you still have pain even after 9 to 12 months, your doctor may advise surgery for treating heel spur. The surgery helps in reducing the pain and improving your mobility. Some of the surgical techniques used by doctors are release of the plantar fascia. Removal of a spur. Before the surgery, the doctor will go for some pre-surgical tests and exams. After the operation, you will need to follow some specific recommendations which may include elevation of the foot, waiting time only after which you can put weight on the foot etc.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don't underestimate your body's need for rest and good nutrition. If obese, lose weight.

Working With Posterior Calcaneal Spur

Inferior Calcaneal Spur

Overview

Heel spurs are a condition that usually makes its presence known first thing in the morning via heel pain. Discomfort is typically felt in the front and bottom of the heel (calcaneal). Pain can be constant for several months or intermittent for lengthy periods of time.

Causes

The pain caused by heel spurs can be a sharp, stabbing pain when using the foot after a long period of rest. Sometimes it then reduces to a dull throb that can worsen when engaging in activities like jogging or jumping. People sometimes describe the pain of heel spurs and plantar fasciitis as a pin sticking into the bottom of the foot when they first stand up in the morning, this pain later turns into a bearable ache. The cause of the pain is generally not the heel spur itself, but the soft-tissue buildup associated with it. People often complain that the sharp pain returns after they stand up following sitting for a prolonged period of time.

Heel Spur

Symptoms

Most bone spurs cause no signs or symptoms. You might not realize you have bone spurs until an X-ray for another condition reveals the growths. In some cases, though, bone spurs can cause pain and loss of motion in your joints.

Diagnosis

Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products such as Advil or Ibuprofin are helpful in eradicating the pain. Pain creams, such as Neuro-eze, BioFreeze & Boswella Cream can help to relieve pain and help increase circulation.

Non Surgical Treatment

Over-the-counter or prescription-strength anti-inflammatory medications can help temporarily, but can cause side effects with prolonged use - the most significant being gastrointestinal upset, ulceration and bleeding. Deep tissue massage, taping and other physical therapy modalities can also be helpful. Arch support is highly recommended, either with shoe inserts or custom orthotics made by podiatrists. If pain continues, a steroid injection at the site of pain may be recommended; however, many physicians do not like injecting around the heel. The side effects of steroids injected in this area can be serious and worsen symptoms. Complications can include fat necrosis (death of fatty tissue) of the heel and rupture of the plantar fascia.

Surgical Treatment

More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

Prevention

You can help prevent heel spur symptoms from returning by wearing the proper shoes. Customized orthotics and insoles can help relieve pressure. It is important to perform your exercises to help keep your foot stretched and relaxed.

Bursitis Immediately After Foot Surgery

Overview

This is a very common condition that leads to foot pain . Once you understand what it actually is you will wonder why it does not occur more often, particularly in the foot. It is an inflamed bursal sac. A bursal sac is a sac filled with fluid that acts to lubricate and reduce the friction between two surfaces in the body, usually muscles and tendons as they glide over bony prominences, however their purpose in not limited to just muscles and tendons. The body contains literally hundreds of bursal sacs but in the foot there is just one naturally occurring (adventitious) bursal sac. It is located between the Achilles tendon and the heel bone (calcaneaus), otherwise known as an achilles tendon bursal sac.In this instance the Achilles tendon is protected from the pressure of the heel bone pressing against it when we walk.

Causes

Bursitis occurs when the bursae become irritated or infected, often causing pain on movement. When infection is involved, medical intervention is necessary to fight the underlying infection and prevent it from spreading, when infection is not involved, prompt medical attention can prevent the condition from becoming worse over time.

Symptoms

Unlike Achilles tendinitis, which tends to manifest itself slightly higher on the lower leg, Achilles tendon bursitis usually creates pain and irritation at the back of the heel. Possible signs of bursitis of the Achilles tendon include difficulty to rise on toes. Standing on your toes or wearing high heels may increase the heel pain. Inflammation and tenderness. The skin around your heel can become swollen and warm to the touch. Redness may be visible. Pain in the heel. Pain tends to become more prominent when walking, running, or touching the inflamed area. Stiffness. The back of your ankle may feel a little stiff due to the swelling of the bursa.

Diagnosis

Carrying out a diagnosis for bursitis is fairly straightforward. The doctor will examine the affected area and ask the patient some questions about his/her recent activities. If the patient has a high temperature the physician may take a small sample of fluid from a bursa near the affected body part. The sample will be tested for bacteria, and perhaps also crystals. If the patient does not get better after treatment the doctor may carry out further tests so that he/she can eliminate the possibility that the symptoms might not be due to something else. These may include an x-ray, to make sure no bones are broken or fractured. Blood tests, to check for rheumatoid arthritis. A CT scan or MRI scan to see if there is a torn tendon.

Non Surgical Treatment

Here are some of the most effective treatments for infracalcaneal bursitis Temporarily avoiding weight-bearing activities that put stress or strain on the heel bone can very helpful in treating infracalcaneal bursitis. PRICE (protection, rest, hot/cold contrast compresses, compression, and elevation) is another good acute management technique for this foot problem. Changing footwear is an effective long-term prevention and treatment tool for infracalcaneal bursitis. Shoes that possess a flat support base from heel to toe, a sufficiently wide toe box to accommodate natural toe splay, and a flexible sole that can be easily bent or twisted are best for preventing and managing infracalcaneal bursitis. An integrated approach to this problem usually involves the use of padded socks or heel cups to help reduce pressure, friction, and inflammation under the heel. Natural anti-inflammatory agents can also be helpful in quelling inflammation, reducing pain, and improving treatment times for infracalcaneal bursitis. In rare cases, more aggressive treatment methods may be required, such as cortisone injections or surgery to drain the bursal sac. Always consult your physician before beginning any healthcare regimen designed to treat infracalcaneal bursitis.

Surgical Treatment

Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.

Prevention

Once your pain and inflammation is gone, you can prevent retrocalcaneal bursitis deformity by wearing the best shoes for your foot type. You should high-heels and pumps if possible. Wear orthotics (custom arch supports) or over-the-counter orthotic devices. Perform frequent Achilles tendon stretching exercises to prevent it from becoming tight agian. Avoiding running uphill when training. Try to run on softer surfaces and avoid concrete.