Heel pain and its details

Causes

Most frequently heel pain is not the result of any single injury, such as a fall or twist, but rather the result of repetitive or excessive heel pounding.

Plantar fasciitis is inflammation of the thick connective tissue on the sole of your foot that attaches to your heel. The pain is usually felt at the bottom of your heel and is often worse in the morning because of stiffness that occurs overnight. The following increase your risk of developing this painful problem:

• Shoes with poor arch support or soft soles
• Quick turns that put stress on your foot
• Tight calf muscles
• Repetitive pounding on your feet from long-distance running, especially running downhill or on uneven surfaces
• Pronation -- landing on the outside of your foot and rolling inward when walking or running; to know if you pronate, check the soles of your shoes to see if they are worn along the outer edge

Bone spurs in the heel can accompany plantar fasciitis, but are generally not the source of the pain. If you treat the plantar fasciitis appropriately, the bone spur is likely to no longer bother you.

Heel bursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendinitis is inflammation of the large tendon that connects your calf muscle to your heel. This can be caused by:

• Running, especially on hard surfaces like concrete
• Tightness and lack of flexibility in your calf muscles
• Shoes with inadequate stability or shock absorption
• Sudden inward or outward turning of your heel when hitting the ground

Home Care

• Rest as much as possible for at least a week.
• Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days.
• Take acetaminophen for pain or ibuprofen for pain and inflammation.
• Wear proper-fitting shoes.
• A heel cup, felt pads in the heel area, or an orthotic device may help.
• Night splints can stretch the injured fascia and allow it to heal.

Additional steps:

• Apply moleskin to avoid pressure if you have bursitis.
• See a physical therapist to learn stretching and strengthening exercises. These help prevent plantar fasciitis or Achilles tendinitis from returning.

When to Contact a Medical Professional

• Your pain is getting worse despite home treatment
• There is little progress after 2 to 3 weeks of home treatment
• Your pain is sudden and severe
• You have redness or swelling of your heel or you cannot bear weight

What to Expect at Your Office Visit

Your doctor will take your medical history and perform a physical examination, including a full exam of your feet and legs.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Have you had this type of heel pain before? If so, what was the diagnosis and what caused the problem?
• When did this episode of pain begin?
• Do you have pain upon your first steps in the morning or after your first steps after rest?
• Where exactly is your pain?
• Is the pain dull and aching or sharp and stabbing?
• Is it worse after you exercise?
• Is it worse when you are standing?
• Do you have any swelling or redness of your heel?
• Have you had a fall or have you twisted your foot recently?
• Are you a runner? How far do you run? How often do you run? On what type of surface do you run?
• Do you walk or stand on your feet for long periods of time?
• What kind of shoes do you wear?
• Do you have any other symptoms?

Diagnostic tests that may be performed include a foot x-ray, focusing on the heel.

If either plantar fasciitis or bursitis is diagnosed and if shoe changes and the use of orthotics have not been successful, cortisone injections may be tried. Surgery is a last resort and is seldom necessary.

If Achilles tendinitis is diagnosed, anti-inflammatory medicine may be prescribed. Heel lifts may be used. Stretching can be helpful. In particularly unresponsive cases, a walking cast or boot may be helpful. Surgery is usually not necessary.

Prevention

To prevent plantar fasciitis and Achilles tendinitis, maintain flexible and strong muscles in your calves, ankles, and feet. Always stretch and warm-up prior to athletic activities.

Wear comfortable, properly fitting shoes with good arch support and cushioning. If you pronate, look for athletic shoes with an antipronation device. If orthotics are prescribed by your provider, wear them in all of your shoes, not just while exercising.

Alternative Names

Pain - heel

Trigger Finger

Introduction

Introductory statement, definition & epidemiology

Trigger finger is a condition when one of your finger catches in a bent position. Your finger may straighten with a snap. The snap is similar to a trigger being pulled and release. In severe cases of trigger finger, your finger may become locked in a bent position.

It commonly affect thumb, middle and ring finger. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.

Causes

Trigger finger is caused by narrowing of the sheath surrounds the tendon. It is usually associated with repetitive repetitive gripping actions or repetitive usage of the fingers.

Trigger fingers are more common in women than men. They occur most frequently in people who are between the ages of 40 to 60 years. Trigger fingers are more common in people with certain medical problems such as diabetes and rheumatoid arthritis.

Signs and symptoms

• stiff finger especially in early morning
• small lump over the palm on the affected fingers
• locking or unable to straighten the fingers
• clicking sound when you move your fingers

Treatment

Treatment of trigger finger will depends on severity of the symptoms. In early phase, physiotherapy (strengthening exercise, soak in warm water, splinting, massage) is the recommended treatment.

Trigger finger isn't a dangerous condition, so the decision whether to proceed with surgery is a personal one based on the severity of your symptoms, usually in later stage. If the finger is stuck in a bent position, surgery may be recommended to prevent permanent stiffness. Surgery widens the opening of the tunnel so the tendon can slide through more easily. This is usually done through a small incision in the palm as an outpatient surgery.

Prevention

Take a break in between of activities that requires repetitive motion of the fingers (computer, sewing or writing)

Ear Infections

Ear infections (also called as Otitis media) are the most common illnesses in babies and young children. Most often, the infection affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid.

If your child does not yet talk, you need to look for signs of an infection:

• Tugging at ears
• Crying more than usual
• Ear drainage
• Trouble sleeping
• Balance difficulties
• Hearing problems

Often, ear infections go away on their own, but your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get frequent infections may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again.

Tips to help you eat whole grains

At Meals:

• To eat more whole grains, substitute a whole-grain product for a refined product – such as eating whole-wheat bread instead of white bread or brown rice instead of white rice. It’s important to substitute the whole-grain product for the refined one, rather than adding the whole-grain product.
• For a change, try brown rice or whole-wheat pasta. Try brown rice stuffing in baked green peppers or tomatoes and whole-wheat macaroni in macaroni and cheese.
• Use whole grains in mixed dishes, such as barley in vegetable soup or stews and bulgur wheat in casserole or stir-fries.
• Create a whole grain pilaf with a mixture of barley, wild rice, brown rice, broth and spices. For a special touch, stir in toasted nuts or chopped dried fruit.
• Experiment by substituting whole wheat or oat flour for up to half of the flour in pancake, waffle, muffin or other flour-based recipes. They may need a bit more leavening.
• Use whole-grain bread or cracker crumbs in meatloaf.
• Try rolled oats or a crushed, unsweetened whole grain cereal as breading for baked chicken, fish, veal cutlets, or eggplant parmesan.
• Try an unsweetened, whole grain ready-to-eat cereal as croutons in salad or in place of crackers with soup.
• Freeze leftover cooked brown rice, bulgur, or barley. Heat and serve it later as a quick side dish.

As Snacks:

• Snack on ready-to-eat, whole grain cereals such as toasted oat cereal.
• Add whole-grain flour or oatmeal when making cookies or other baked treats.
• Try a whole-grain snack chip, such as baked tortilla chips.
• Popcorn, a whole grain, can be a healthy snack with little or no added salt and butter.

What to Look for on the Food Label:

• Choose foods that name one of the following whole-grain ingredients first on the label’s ingredient list:
  
  

  “brown rice” “bulgur” “graham flour” “oatmeal” “whole-grain corn”

  “whole oats” “whole rye” “whole wheat” “wild rice”

  • Foods labeled with the words “multi-grain,” “stone-ground,” “100% wheat,” “cracked wheat,” “seven-grain,” or “bran” are usually not whole-grain products.
  • Color is not an indication of a whole grain. Bread can be brown because of molasses or other added ingredients. Read the ingredient list to see if it is a whole grain.
• Use the Nutrition Facts label and choose products with a higher % Daily Value (%DV) for fiber – the %DV for fiber is a good clue to the amount of whole grain in the product.
• Read the food label’s ingredient list. Look for terms that indicate added sugars (sucrose, high-fructose corn syrup, honey, and molasses) and oils (partially hydrogenated vegetable oils) that add extra calories. Choose foods with fewer added sugars, fats, or oils.
• Most sodium in the food supply comes from packaged foods. Similar packaged foods can vary widely in sodium content, including breads. Use the Nutrition Facts label to choose foods with a lower % DV for sodium. Foods with less than 140 mg sodium per serving can be labeled as low sodium foods. Claims such as “low in sodium” or “very low in sodium” on the front of the food label can help you identify foods that contain less salt (or sodium).

Whole Grain Tips for Children

• Set a good example for children by eating whole grains with meals or as snacks.
• Let children select and help prepare a whole grain side dish.
• Teach older children to read the ingredient list on cereals or snack food packages and choose those with whole grains at the top of the list.

Always Wear Shoes and Socks

Wear shoes and socks at all times. Don’t walk barefoot—not even indoors.

Wear shoes that fit well and protect your feet. Don’t wear shoes that have plastic uppers, and don’t wear sandals with thongs between the toes. Ask your health care provider what types of shoes are good choices for you.

New shoes should be comfortable at the time you buy them—don’t expect them to stretch out. Slowly break in new shoes by wearing them only 1 or 2 hours a day.

Always wear socks or stockings with your shoes. Choose socks made of cotton or wool—they help keep your feet dry.

Before you put on your shoes each time, look and feel inside them. Check for any loose objects, nail points, torn linings, and rough areas—these can cause injuries. If your shoes aren’t smooth inside, wear other shoes.

Car Seats reduses the Oxygen Supplies in Kids

Kids should be put in car seats only when traveling, not while sleeping or "hanging out" at home, child health experts warn.

That's because sitting upright in a car seat -- the position that's recommended -- can compress the chest and lead to lower levels of oxygen, according to a new study published online Aug. 24 in Pediatrics.

"There are people who have no baby beds and have their kids sleep in the car seat all the time," noted one expert, Dr. Iley Browning, an associate professor of pediatrics at the Texas A&M Health Science Center College of Medicine. "That's not a good choice. And dropping oxygen levels are going to get worse when children have colds so you're making your child worse by putting them in a car seat when they're sick. And I guarantee that parents do this more when their child is sick."

But experts agree that the new warning by no means dilutes the message that car seats are critical for protecting children from injury in a collision, just like seat belt restraints protect adults.

"Your child should be restrained properly even for the shortest ride," said Dr. Mike Gittelman, an associate professor of emergency medicine and co-director of the Comprehensive Children's Injury Center at Cincinnati Children's Hospital Medical Center. "You're 88 percent more likely to be saved in a motor vehicle collision if you're restrained. Car seats save lives."

In addition, Gittelman said, the changes in oxygen saturation detected in the study were "minimal."

Earlier studies on the subject focused primarily on more fragile, preterm infants, he said.

But the study's authors noted that airway obstruction in an infant, even if it's mild, has been linked with behavioral problems and lower IQ.

The researchers, from Slovenia and Boston, started looking at healthy newborns when they were 2 days old, measuring oxygen saturation and other indicators while the infants were in a hospital crib for 30 minutes, a car bed (also known as a "flat car seat") for 60 minutes and a car seat for 60 minutes.

For the 200 infants included in the study, the average oxygen saturation level was 97.9 percent in the crib, 96.3 percent in the car bed and 95.7 percent in the car seat.

Greater differences were seen in average minimal oxygen levels: 87.4 percent for the hospital crib, 83.7 percent for the car bed and 83.6 percent for the car seat.

Children in car seats and car beds spent more time with oxygen levels below 95 percent than did children in cribs, according to the study. And the longer the child was in the car seat, the worse the respiratory problem became.

Car beds may be safer in this respect than car seats, but even that is not ideal, the study noted.

In addition to keeping children out of car seats for long and unnecessary periods of time, the authors suggested that manufacturers consider modifications to the design of the seats.

"It's important for people to realize that doing some of these things is not benign and has potential risks involved," said Browning, who is also a pediatric pulmonologist at Driscoll Children's Hospital in Corpus Christi, Texas. "Use the car seats when you need to, but otherwise children need to be in a different setting."

The study still leaves many questions unanswered, such as whether the oxygen effect is long-term, said Dr. Judy Schaechter, associate professor of pediatrics at the University of Miami Miller School of Medicine and director of the Injury Free Coalition for Kids of Miami.

"Does this go away after a few days or does it last three months," she said. "Clearly, if it turns out to be real, we have to look at manufacturing of car seats."

The study was funded by the Japanese company Aprica, which makes child seats, strollers and other children's products.

Tips for Coping With Stress

Mass tragedies, including school shootings, workplace violence, and community violence affect different people in different ways. People exposed to these situations can experience physical reactions, such as cuts and bruises, as well as mental reactions, such as frightening thoughts and painful feelings. Common responses can include:

• Feeling a sense of loss, sadness, frustration, helplessness, or emotional numbness
• Experiencing troubling memories from that day
• Having nightmares or difficulty falling or staying asleep
• Having no desire for food or a loss of appetite
• Having difficulty concentrating
• Feeling nervous or on edge

If you or someone you know experiences any of these feelings after a traumatic event, get support from your family, friends, and co-workers. Talk with others about your feelings and take care of yourself by keeping your normal routine. Avoid using alcohol and drugs, which can hold back your feelings rather than letting them come out. Staying active, helping other people, or volunteering in your community can also help you feel better.

Keep in mind that returning to the way you felt before the event may take some time. Helping and healing can begin at the scene of the event, but may need to continue over a period of time. If your distress continues or you have trouble managing your feelings, talk to a psychologist, social worker, or professional counselor.

Tips for Parents

It's natural for children to worry. But talking with children about these tragedies, and what they watch or hear about them, can help put frightening information into a more balanced context. The CDC offers parents these suggestions to help children through their questions:

Reach out and talk. Create opportunities to have your children talk, but do not force them. Try asking questions like, what do you think about these events, or how do you think these things happen? After a traumatic event, it is important for children to feel like they can share their feelings and to know that their fears and anxieties are understandable.

Express yourself. Your children may be feeling different emotions at different times. Sadness. Anger. Fear. Confusion. These feelings are normal reactions to this tragedy. Don't be afraid to allow your children to express how he or she feels and share your feelings with them.

Watch and listen. Be alert for any change in behavior. Are children sleeping more, or less? Are they withdrawing from friends or family? Are they behaving in any way out of the ordinary? This may show that they are having trouble coming to terms with this event. Recognizing even small changes in behavior can give you an early warning that something is troubling them.

Share information with other parents. Get to know your children's friends and their parents. Make an on-going effort to check in and talk to other parents about any issues or stress. You don't have to deal with problems alone-the most effective solutions usually come from parents, schools, and health professionals working together to provide support for the health and well-being of your children.

Keep it going. Ask your children how they feel about the event in a week, then in a month and so on. Each child has his or her own way of coping under stressful situations. The best thing you can as a parent is to listen to each child and allow them to express their concerns and fears.

Tips for Kids and Teens

After a traumatic or violent event it is normal to feel anxious about your safety and security. Even if you were not directly involved, you may worry about whether this type of event may someday affect you. How can you deal with these fears? Start by looking at the tips below for some ideas.

• Talk to an adult who you can trust. This might be your parent, another relative, a friend, neighbor, teacher, coach, school nurse, counselor, family doctor, or member of your church or temple. If you've seen or experienced violence of any kind, not talking about it can make feelings build up inside and cause problems. If you are not sure where to turn, call your local crisis intervention center or a national hotline.

• Stay active. Go for a walk, volunteer with a community group, play sports, write a play or poem, play a musical instrument, or join an after-school program. Trying any of these can be a positive way to handle your emotions.

• Be a leader in making your school or community safer. Join an existing group that is promoting non-violence in your school or community, or launch your own effort.

• Stay in touch with family. If possible, stay in touch with trusted family, friends, and neighbors to talk things out and help deal with any stress or worry.

• Take care of yourself. Losing sleep, not eating, and worrying too much can make you sick. As much as possible, try to get enough sleep, eat right, exercise, and keep a normal routine. It may be hard to do, but it can keep you healthy and better able to handle a tough time.

Tips for School Personnel

Kids and teens that experience a traumatic event, or see it on television, may react with shock, sadness, anger, fear, and confusion. They may be reluctant to be alone or fearful of leaving secure areas such as the house or classroom. School personnel can help their students restore their sense of safety by talking with them about their fears. Other tips for school personnel include:

1. Reach out and talk. Create opportunities to have children talk, but do not force them. Try asking questions like, what do you think about these events, or how do you think these things happen? After a traumatic event, it is important for children to feel like they can share their feelings and to know that their fears and anxieties are understandable.
2. Watch and listen. Be alert for any change in behavior. Are students talking more, less? Withdrawing from friends? Are they behaving in any way out of the ordinary? This may show that they are having trouble coming to terms with this event. Recognizing even small changes in behavior can give you an early warning that something is troubling them.
3. Maintain normal routines. Keep a regular classroom and school schedule. This can be reassuring and promote a sense of stability and safety. Encourage students to keep up with their schoolwork and extracurricular activities but don't push them if they seem overwhelmed.
4. Express yourself. Your students may be feeling different emotions at different times. Sadness. Anger. Fear. Confusion. These feelings are normal reactions to this tragedy. Do not be afraid to allow your student to express how they feel and share your feelings with them.