Common Causes of Heel Pain

Foot specialist Sean Peden, MD, an orthopedic surgeon at ONS, gets to the bottom of the question, Why does my heel hurt?

The foot has more than 30 different joints. If you consider the tons of stress your feet endure from walking and standing day in and day out, it’s a wonder everyone doesn’t suffer from some sort of heelpainheel pain, which is the most common problem affecting the foot and ankle.

Feet are physiologically designed to handle the pressure … to a point. Repeated pounding on a hard surface while running, participating in another sport, or wearing ill-fitting shoes that inflame the foot’s tissues can cause pain on the bottom of your heel or behind it. Arthritis, wear and tear, or a build-up of uric acid in the small bones of the feet known as gout, can also cause heel pain.

In most cases, heel pain can be relieved without surgery. Rest, stretching exercises, and possibly anti-inflammatory medication can usually do the trick. If left untreated, however, a sore heel will only worsen and can develop into chronic and more problematic conditions.

For that reason, it’s important to consult with a physician or specialist to determine the underlying cause of pain in your heel that lasts more than a few days, particularly if it intensifies when you put weight on the foot, if there are signs of infection or injury, such as swelling, discoloration or fever, or if your heel is warm to the touch.Foot picture

Some Common Causes

Pain centered under your heel could occur if you’ve bruised the heel pad by stepping on a hard object such as a rock, or from repetitive pounding on hard surfaces during sports. This pain usually goes away over time with rest.

If the pain beneath your heel is mild at first but then flares up when you take your first steps in the morning, you may have plantar fasciitis, which is inflammation of the tissue band (fascia) that connects the heel bone to the base of the toes. Plantar fasciitis is the most common condition causing heel pain. If plantar fasciitis is left untreated, a painful heel spur (calcium deposit) can develop where the fascia attaches to the heel bone.

PAchilles Tendonain from behind the heel could indicate inflammation of the bursae and the Achilles tendon at the point where the tendon goes into the heel bone. Achilles tendonitis and associated pain from retrocalaneal bursitis can build slowly over time, causing the skin to thicken, become red and/or swell. In some cases, a bump that feels warm to the touch can develop at the back of the heel. If pain increases with the start of an activity after a period of rest or if it is too painful to wear shoes, your physician may order an X-ray to determine if a bone spur has developed.

Injuries to the nerves in the foot can also produce heel pain. Neuropathy, or nerve damage, and Tarsal Tunnel Syndrome, in which the large nerve in the back of the foot becomes pinched and inflamed, are the two most common nerve-related conditions.

If you experience pain that makes it difficult to walk or enjoy your everyday activities, schedule an appointment at ONS with one of our foot and ankle specialists, Sean Peden, MD or Michael Clain, MD by calling 203-863-1145 or request an appointment here.

Your Aching Feet: Common Causes and Treatments for Foot Pain

PedenMD_BlogFoot massages are a great way to ease foot pain, but the relief won’t last long if an underlying condition is the cause of your discomfort. Orthopedic surgeon Sean Peden, MD, a foot and ankle specialist at ONS, will discuss common foot ailments including plantar fasciitis that result in pain in the heel and bottom of the foot and metatarsalgia, inflammation at the ball of the foot. The informative presentation will include evidence-based treatments including effective home remedies and non-surgical care. He will also highlight some the new technological advances in foot care, including developments in regenerative medicine that helps promote self-healing.

 

Can high heel boots be dangerous?

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Trendy high heeled boots may be the height of winter fashion, but they are a disaster waiting to happen for women wearing them, according to orthopedic surgeon, Sean Peden, MD, a foot and ankle specialist with Orthopaedic & Neurosurgery Specialists (ONS) in Greenwich and Stamford, CT.High Heeled boots for web 3

“Any high heel worn with regularity can damage the structure of the foot and weaken the ankle. High heeled boots do the same kind of damage and they don’t provide adequate stability on snowy and icy surfaces,” he said.

Now that temperatures are dipping below freezing, icy patches on sidewalks and steps are presenting a serious threat to firm footing. According to the American College of Foot and Ankle Surgeons, slips and falls from high heeled boots account for hundreds of injuries each year, including sprained and broken ankles, toes and metatarsal bones. Elsewhere in the body, falls from spikey boots commonly result in broken wrists as well as strains in the leg, back and neck muscles.

Infographic_HighHeelsEven on dry land, the physical hazards of wearing high heels are well known. Beyond pinched toes, blisters and aching arches, Dr. Peden noted wearing heels over a prolonged period of time can damage muscles, tendons and nerves in the feet. Wearing heels also seem to play a role in the development and worsening of bunions and they wreak havoc on balance and posture. A recent study conducted by researchers at Hanseo University in South Korea followed a group of young women training to become airline stewardesses who were required to wear high heels throughout their four year program. When compared to incoming freshmen, the ankle muscles of women who were seniors were misaligned and considerably weaker, Additionally, the senior women had dramatically worse balance.

Foul winter weather makes wearing heels all the more precarious. Dr. Peden warned, “All it takes is one misstep to end up with a serious injury, lost time from work and possibly even surgery.”

If you do hurt yourself falling off those stylish heels, advised Dr. Peden, immediately use the RICE method – rest, ice, compression and elevation – to help reduce the pain and swelling. Even if you can walk on the injured foot, seek a medical evaluation if there is swelling and bruising as those symptoms can indicate a serious injury, Left untreated, injuries can result in long term complications such as chronic ankle instability, pain, arthritis and deformity.

A safer bet, however, is to opt for more appropriate foul weather boots with a wide heel, no higher than an inch, and a treaded heel and sole. They may not be the most fashionable accessory, but then again, a cast and crutches aren’t either.

Ready for Spring Sports?

Golfer

Foot and ankle, hand and wrist injury prevention tips by orthopedics specialists

When: February 25, 2015 at 6:30 p.m.
Where: Noble Auditorium, Greenwich Hospital
SpeakersSean Peden, MDMark Vitale, MD, and Paddle and Tennis Professional Patrick Hirscht

If golf or racket sports are in your plans for the spring you will want to hear tips from fellowship trained orthopedic foot and ankle specialist Sean Peden, MD and fellowship trained hand/wrist/elbow specialist Mark Vitale, MD, MPH who will discuss common injuries seen in golf and racket sports. Special guest and local tennis pro Patrick Hirscht will also speak. Learn about common injuries, and how to choose footwear, braces and exercises to prevent injury and play your best; whether it’s the foot, hand, wrist or elbow, they’re all at risk for injury when you’re active. Dr.Peden and Dr.Vitale will discuss nonsurgical and surgical treatments, along with ailments particular to racquet sports. You will have the opportunity to ask questions at the conclusion of the talk. The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

The Fragile Feet: A Ballerina Story (Part I)

Ballerina
Ballerina in en pointe position

Dr. Peden of ONS and Greenwich Hospital is an orthopedic surgeon specializing in foot and ankle surgery and treatments for adult foot conditions as well as youth sports injuries in field athletes, gymnasts and ballet dancers. He shares a two-part blog about conditions to be aware of for ballet dancers and gymnasts.

Ballet dancers feet are much like a musician’s handsthey earn a living with them. In addition to putting an amazing amount of stress on their feet, they also are often well below an ideal body weight – either because of the stress of an enormous amount of training or because of unrealistic expectations placed on them by the ballet community. This leads to several different and often unique foot and ankle conditions.

One fairly unique foot and ankle condition in ballet is caused by the en pointe position. In this position an enormous amount of strain is put on the dancer’s great toe, as it is essentially holding up the entire body weight through a small joint. The main flexor tendon of the toe, called the flexor hallicus longus – normally quite small, takes over the job of the largest tendon in the body, the Achilles. The flexor hallicus longus hypertrophies well in compensation for its new job, but unfortunately this tendon is forced through a tight tunnel in the back of the ankle. When it gets too large it will get pinched in the posterior ankle joint. Patients develop painful irritation of the bones and soft tissues in the posterior ankle. An extra bone in the posterior ankle called the os trigonum, which present in about 10% of all people, can be become very painful and irritated in many ballerinas. This constellation of problems is called posterior impingement of the ankle, and it is noticed by the patient as a vague deep pain in the posterior part of the ankle, in front of the Achilles, that is felt with plantarflexion, the position of pointing the foot and toes downward.

Ballet dancers suffer from numerous other problems of the foot & ankle, many of which are not unique. One of the less glamorous problems they deal with are corns, calluses, and blisters. These are necessary adaptations to allow a high level dancer to compete.

Similar to posterior impingement, which arises from dancers spending an inordinate amount of time and stress in an extreme position at the ankle, ballet dancers will develop anterior impingement at the ankle. This comes from repetitive forceful dorsiflexion – pulling the foot and toes upward, toward the shin. Landing from jumps and deep knee bends exacerbate this problem. Pain is felt in the anterior ankle.

Treatment for the above condition is customized to the patient. Often a minor activity modification, or period of rest, can dramatically improve the symptoms. Unfortunately, rest is not easy to come by in the competitive living of a gymnast. Many dancers will treat the symptoms with a combination of anti-inflammatory medications and occasional steroid injections in the region of maximal tenderness. Surgery is a last resort option for any ballerina – when symptoms persist for many months and are limiting, despite all other efforts. Surgery is typically very successful in these patients and can be done with arthroscopic or minimally invasive techniques.

The most common orthopaedic injury of all is also very common amongst ballet dancers: the lateral (traditional) ankle sprain. The mainstay of treatment for ankle sprains is rest, ice, compression, and elevation – mnemonic RICE. A short period of rest and immobilization (1-2 weeks) is followed by aggressive physical therapy, with strengthening of the muscles that stabilize the ankle. Recent research has pointed to improved short and long-term outcomes when early motion and weight bearing is initiated. There is promising early research on the role of stem cell injections – harvested from the patient’s own blood or bone marrow – in the setting of an acute ankle sprain. This is a technique we will offer for the highest level athletes and dancers in certain situations, understanding that the research data on this intervention is still in development.

… to be continued in the next segment, The Fragile Feet: A Gymnast Story (Part II)

Want to learn even more? Dr. Peden will be giving a seminar on “Solutions for Foot and Ankle Pain: Beyond a Foot Massage.”  The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

What do you do when you are diagnosed with an old (chronic) Achilles tendon rupture?

Sean C. Peden, MD
Sean C. Peden, MD

Sean Peden, MD is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Peden has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes.  His practice will also focus on youth athlete sports injuries and the types of injuries seen in field athletes, gymnasts and ballet dancers.

Achilles tendon ruptures will often not be discovered for months after the injury. In the months between injury and showing up at the doctor’s office, the torn tendon develops scar tissue which decreased the quality and elasticity of the tissue. Because of this, directly repairing the torn tendon, as is done in an acute injury, becomes is less than ideal. In this situation, we will supplement the tendon repair with a tendon transfer. Essentially, we borrow a tendon that bends the big toe (there is another tendon that compensates when it is borrowed), reroute it, and reattach it to the heel bone. This does two very important things:

 

1. It supplements the strength of the torn Achilles, allowing a quicker and better recovery.

2.It provides improved blood supply to the Achilles repair, providing healing factors to the area of diseased tendon.

In summary, ruptures of the Achilles Foot_AnklePictendon are increasingly common in our aging yet increasingly active population. In cases where an Achilles rupture is missed or the rupture cannot be repaired directly under normal tension, adding the flexor hallicus longus tendon transfer allows for significantly improved results with a shorter recovery.

If you suffer from foot and ankle pain and would like to attend a free seminar, Dr. Peden of ONS and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage is an orthopedic surgeon specializing in foot and ankle surgery. He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.

Suffer from Bunion Pain? Dr. Clain Offers Solutions

Michael Clain, MD
Michael Clain, MD

Bunions are a common deformity encountered in the foot where the big toe is out of alignment. This creates pain in that toe and often in the lesser toes as well. The deformity makes it difficult to find shoes that fit comfortably.  Ill-fitting shoes can contribute to the situation but the underlying deformity is genetic. This is why most patients can recall a parent or grandparent that had the problem.

In consultation, I often tell patients that the options are to accommodate the foot with wider shoes, gentle arch supports and sometimes padding or I encourage them to consider surgery.  The decision to proceed with surgery should be based on the overall level of discomfort and deformity.  This will differ from patient to patient.  It is rare that the patient that must have bunion surgery.  Most people will choose surgery due to the accumulation of annoyances, discomfort, pain and deformity in other toes.

Actual X-ray of patient of Dr. Clain before bunion surgery
X-ray of patient of Dr. Clain before bunion surgery
Same Patient. Post-Bunionechotmy
Same Patient. Post-Bunionechotmy

It is very important, from my point of view, to communicate realistic expectations for the procedure and the ultimate result. I try hard to be very specific about the time involved in recovery and give every patient a written “expected surgical recovery.” It is obviously difficult to remember everything when you as the patient are given a great deal of information so it’s helpful to have a summary to refer to.

Not all bunions are the same. Routinely, I perform about six different surgical procedures.  The goal is to do the most appropriate operation for your particular foot and circumstance.  With careful communication and a well thought-out plan it is highly likely that we should be able to get a great result for almost any foot.”

For more information about Dr. Clain, click here.

If you suffer from bunions and would like to attend a free seminar on foot pain Dr. Peden of ONS and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage is an orthopedic surgeon specializing in foot and ankle surgery. He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.

Do You Experience Foot or Ankle Pain?

Sean Peden, MD will be speaking at the Noble in Greenwich Hospital December 9th at

Sean Peden, MD
Sean Peden, MD

6:30pm to address Solutions for Foot & Ankle Pain: Beyond Foot Massage. Here is a summary of what he will present:

A painful foot or ankle condition can limit a patient’s function and quality of life with every step. Conditions from the toes to the Achilles tendon will be discussed with emphasis on surgical and nonsurgical options, including old standards and the most cutting edge new technologies. Topics covered will include foot and toe deformities such as bunions, hammertoes, flat feet, and high arches, with special attention to when and how these conditions should be treated or when they should be left alone. Plantar fasciitis and Achilles tendonitis will be discussed in detail with emphasis on the natural progression of the disease, what we know works and what is experimental. Arthritic conditions of the foot, ranging from the big toe to the ankle will be included.

A team approach is an important aspect of foot and ankle care. ONS physical therapist Alicia Hirscht, DPT, SCS, CSCS will discuss and answer questions about the role of physical therapy to improve foot and ankle pain and dysfunction.

ONS Senior Clinical Specialist Alicia Hirsch
ONS Senior Clinical Specialist Alicia Hirsch, DPT, SCS, CSCS

Dr. Peden will introduce an orthotic maker he typically works with and will discuss when and how orthotics are used, from inexpensive over-the-counter inserts to custom molded prostheses. Other options to be discussed will include stem cell technology and image-guided injections.

Dr. Peden will open up a question and answer session following the seminar. This event is free registration requested, call (203) 863-4277 or (888) 305-9253, or register online at:  https://www.greenhosp.org/CREG/ClassDetails.aspx?sid=1&ClassID=7253

Foot Ankle Pain Brochure

Foot and Ankle Surgeon and Physiatrist join ONS

Specialists in foot and ankle surgery and physiatry added to growing practice.

We are pleased to announce that orthopedic surgeon Sean Peden, MD and interventional physiatrist Christopher Sahler, MD have joined the ONS team.

Sean Peden, MD
Sean Peden, MD Foot and Ankle Surgeon

Dr. Peden earned his medical degree at Washington University in St. Louis School of Medicine. He did his residency in orthopedic surgery at The George Washington University in Washington, DC and completed fellowship training in operative and non-operative care of the foot and ankle at Michigan International Foot and Ankle Center, Pontiac, MI.

Dr. Peden has expertise in treating a variety of foot pain and deformity related conditions including achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes.  His practice also focuses on youth-athlete sports injuries and the types of injuries seen in field athletes, gymnasts and ballet dancers.

Christopher Sahler, MD
Christopher Sahler, MD Physiatrist

Dr. Sahler completed his residency in physical medicine and rehabilitation at the Mount Sinai Hospital in Manhattan where he was elected Chief Resident. He continued his training at the Mount Sinai to complete a fellowship in sports medicine and interventional spine treatments. During that time, he also served as team physician for the Globe Institute Junior College sports teams, and was a physician and team captain for the New York City Marathon. He is board certified in sports medicine.

Dr. Sahler uses biomechanical assessments and diagnostic ultrasound to determine the precise source of a problem. He applies non-operative modalities to treat musculoskeletal injuries and restore proper function including ultrasound and X-ray guided steroidal injections, viscosupplementation and PRP (Platelet Rich Plasma) to treat pain and restore proper mobility. Both doctors are in network with Aetna, Oxford/United Healthcare, and Yale New Haven Anthem. “We are pleased to bring two new sub-specialty trained physicians into our practice to meet the growing demand for musculoskeletal care in Fairfield and Westchester counties,” said Dr. Seth Miller. “Dr. Peden and Dr. Sahler are both highly trained and will be great assets to our practice.”

Upcoming Events at Greenwich Hospital

  • On Tuesday, December 2, from 6 to 7 p.m., Dr. Sahler will speak about exercise as a treatment for chronic pain.
  • On Tuesday, December 9, from 6:30 to 7:30 p.m., Dr. Peden will talk about solutions for foot and ankle pain; beyond foot massage.

Both talks will be held in the Noble Conference Center and are open to the public. ONS is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma.