Mark Smith, a medical receptionist at our Blue Ridge Foot & Ankle Waynesboro office, will be riding in local mountain bike races this Spring wearing Blue Ridge Foot & Ankle colors!
Mark is riding in the following races:
Chimney Chase at Walnut Creek Park
Paranormal in Earlysville
He is riding on a really “sweet” ride- The Cannondale Flash Alloy 29’ER 1. Check out more details on his bike HERE.
If distinguishing between all of these possible injuries to the heel isn’t perplexing enough, consider Baxter’s Nerve Entrapment. This tricky injury affects the outside part of the posterior tibial nerve as the nerve snakes around the bottom of the foot. When this nerve is compressed or pinched, the heel will be in pain and the bottom of the foot will be numb. Feet with Baxter’s Nerve Entrapment will become increasingly painful throughout the day, and can be aggravated by pronation.
Part of the reason why Baxter’s Nerve Entrapment is so difficult to diagnose is because of the complexity of the foot’s structure; Baxter’s Nerve Entrapment occurs in an intersection for multiple nerves, not to mention other surrounding tissues. It also occurs in a specific part of the posterior tibial nerve, after this nerve divides into two branches on the inside of the ankle. On top of that, this part of the foot is close to the bottom of the calcaneus where heel spurs may form, providing further opportunity to aggravate the nerve.
There are limited treatments for Baxter’s nerve entrapments. Over the counter or custom orthotics can be helpful in controlling pronation, flatfeet and other biomechanical issues. If surgery is a viable option, a procedure to surgically release the nerve, called external neurolysis, will often be conducted. Neurolysis identifies the physical irritation of the nerve, releases the strictures and allows the nerve to return to normal function. Dr. Murray and Dr. Chang have found success through conducting cryosurgical neurolysis, which is an out patient method using cold to ablate the Baxter’s nerve. Be sure to discuss the pros and cons of your this procedure with your podiatrist.
Haglund’s Deformity is a bony enlargement in the back of the heel. When this enlargement rubs against the Achilles tendon’s surrounding tissues, it can lead to painful bursitis. This is especially painful when wearing a shoe that is tight or rigid along the heel.
Heredity can cause Haglund’s Deformity in one or both feet. High-arched feet, a tight Achilles tendon and supination (the outward rotation of the foot and ankle while walking) can all aggravate the swollen bursae. Your podiatrist will be able to detect this because your heel will have a noticeable bump, and will be swollen and red near the inflamed tissue. Your podiatrist may also take an X-ray while conducting a diagnosis to understand the structure of the heel bone, and thereby find the best treatment options for you.
The first step to treating Haglund’s Deformity should be diagnosing the root cause behind its development. Until you identify the root cause it will be difficult to prevent the pain from Haglund’s Deformity in the long term.
The immediate treatment for Haglund’s deformity include the good-old home remedies of rest (but not completely, just enough to take the stress off of the affected area), ice two times per day for twenty minutes at a time, and ask your podiatrist about methods for compression to reduce the swelling. Your podiatrist will recommend that you take non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the swelling and to relieve pain. In extreme cases, cortisone injections may help relieve pain. However, be wary of using these injections long-term, as they are not curative, the only relieve pain and inflammation.
Additionally, your doctor will recommend appropriate footwear and inserts for your shoes: these include heel grip pads, heel lifts and heel pads. Backless or soft backed shoes can help minimize the irritation, and over the counter and custom orthotics can help support the arches of the foot to control the foot’s motion.
Finally, consult your podiatrist for exercises and stretches that will increase muscle strength and relieve tension from the Achilles tendon. Physical therapy can be a productive option, in which exercises can help prevent the pain long-term and ultrasound methods can reduce immediate inflammation.
In extreme cases, complete immobilization or surgery may be necessary. Surgery for Haglund’s deformity reduces the prominence on the back of the heel so that the pressure from the shoe does not occur. In this procedure, Achilles is retracted to reveal the calcaneus, and then some bone is removed, the calcaneus is shaped and rounded so that pressure does not occur. Another method is to take out a wedge of bone from the calcaneus, shortening it, a method called “wedge osteotomy”.
In order to prevent Haglund’s deformity, avoid wearing shoes with rigid heel backs. Use arch supports or orthotics to control the motion of your foot, avoid running excessively on hard surfaces or excessively uphill with pounding strides, and engage in strengthening and stretching exercises for the Achilles tendon and surrounding muscles in order to prevent the Achilles from tightening up and aggravating Haglund’s deformity symptoms.