Do you feel a stabbing pain in your heel with your first steps out of bed in the morning? You’re not alone! Every day, thousands of Americans suffer from this condition. Plantar fasciitis, more commonly known as heel pain, is by far the most common complaint patients bring to podiatric physicians.

Aching heels can truly affect your lifestyle and disrupt essential activities and prevent you, to a large extent, from playing sports or simply going for a walk. An accurate expedient diagnosis of the cause of your symptoms will help you receive the appropriate treatment.

There are several causes of heel pain. The most common include:
*Plantar Fasciitis – Inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar) surface of the foot, from the heel to the ball of the foot. Both heel pain and heel spurs are frequently associated with plantar fasciitis.
*Heel Spurs – A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs can result from strain on the ball of the foot and repeated tearing away of the lining or membrane that covers the heel bone.
*Excessive Pronation – Excessive inward motion can create an abnormal amount of stretching and pulling on the ligaments and tendons that attach to the bottom back part of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
*Achilles Tendinitis – Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone.
*Tarsal Tunnel Syndrome – This syndrome causes a large nerve in the back of the foot to become entrapped, or pinched. Similar to carpal tunnel syndrome in the hand, tarsal tunnel syndrome can cause heel pain.

Other possible causes of heel pain include rheumatoid arthritis and other forms of arthritis (e.g., gout); Haglund’s deformity (a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone); inflamed bursa (“bursitis”), a small, irritated sac of fluid; neuromas (nerve growths) or other soft-tissue growths; and bruises or contusions, which involve inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

Some contributing factors associated with heel pain are age (with increasing age, often there is decreasing flexibility); any sudden change in activity (particularly activities that increase weight bearing or pressure on the foot); flat, pronated feet or high-arched feet; a sudden increase in weight; pregnancy; stress from an injury; a bruise incurred while walking, running, or jumping on hard surfaces; or medical conditions such as tarsal tunnel syndrome.

If you have any questions on heel pain, contact Dr. Bowman at Houston Foot Specialists.

Don’t know if you know it or not, but one of Dr. Bowman’s patients, Christi, has been keeping a blog through her experience with Dr. Bowman.  If you haven’t already, you should check it out and read her blog to hear straight from a patient what it’s like to have Dr. Bowman as your podiatrist.  See her testimonial by clicking here.

Christi has need several surgeries to correct the problems in her feet and ankles.  Where many other podiatrists told Christi that she had plantar fasciitis, but only offered injections to take care of the problem.  Dr. Bowman knew that something had to be wrong because of the amount of injections she had received, but the pain still remained.  So he guided her through the surgery process and even preformed the surgery for her. 

But after the surgery for the plantar fasciitis, Christi still had pain in another part of her foot.  After further inspection, Dr. Bowman figured out that Christi’s Anterior Tendon was damaged.  So another round of surgery by Dr. Bowman on Christi’s right foot.  Now she is healing up very nicely and by January, Christi was able to walk a 5k on the beach of Galveston!  Recently, Dr. Bowman also fixed her Achilles Tendon Rupture and she is doing great!

The funniest thing about this though is that Christi is a Ohio State Buckeye, while Dr. Bowman is a Michigan Wolverine.  If you read Christi’s blog, you’ll see the hilarious antics these two have done to support their teams.

If you have any questions on plantar fasciitis, Anterior Tendon damage or any other questions on foot or ankle pain, contact Dr. Bowman at Houston Foot Specialists.  Dr. Bowman would love to help you just like he helped Christi.

And thanks Christi for being such a great patient!  Oh and GO BLUE!!!

“Dr. Bowman, My referring doctor told me I had a Paronychia.  What is it?”  I get this question at least once a week.

A Paronychia is a skin infection that occurs around the nails and is often occur with an Ingrown Nail.  This condition is usually caused by an injury to the surrounding tissue of the nail from picking at the nail, improper trimming of the nail and trauma. 

The main symptom of a Paronychia is a painful, red area with swelling to the nail fold.  More often than not pus or drainage is present.  There may be pus filled blisters with a bacterial infection.  Acute Paronychia is typically caused by bacteria called Staphylococcus Aureus.

Treatment is often to perform a minor procedure in the office where the area is drained and a culture will be taken to determine the bacteria.  A small portion of the nail may need to be removed as well.  The patient will be given oral antibiotics and soaks with a topical antibiotic.

A chronic Paronychia is one that “comes and goes” or one that clears up on its own but then reoccurs. Chronic conditions can cause permanent damage to the shape of the nail and spread of infection to other areas, including tendons, bone, or blood stream.

If you see pus or drainage from a toenail, contact your local podiatrist right away before the condition spreads.

Dr. Bowman is a Foot and Ankle surgeon with Houston Foot Specialists and can be contacted at www.houstonfootspecialists.com  or by calling 713-467-8886.

Recently I wrote a blog on pre-operative tips before having foot and ankle surgery, and I got many requests to write about what to do after foot surgery.  These are general tips, and different procedures may require more individualized instructions.  Make sure your podiatrist gives you instructions for your specific needs.  Your actions the first 48-72 hours after surgery are critical to your healing and comfort.

Medications:  Take all prescriptions as directed.  Do not use any other medications including aspirin, Tylenol, or Ibuprofen unless you have consulted your podiatrist first.  Most patients will be given pain medication and antibiotics to help prevent infection.  Pain medications may cause constipation and you may want to discuss taking a stool softener with your doctor.  Do not drive or use dangerous equipment while taking pain medication.  Finish all antibiotics given as directed.

Walking:  Depending on what procedure you have, your podiatrist will tell you to stay off your foot for at least 48-72 hours following surgery.  You should limit your walking to just the bathroom during this time.  Some procedures require you to be non-weight bearing on crutches.  This is extremely important and means no weight on the foot at all, sometimes not even resting the foot on the floor while not walking.

Elevation:  The more you keep your foot elevated the less pain and swelling you will have.  If not elevated, you may feel throbbing pain and the bandages may feel tight.  Elevation above the heart is key. While lying down place 2 pillows under the foot; this is usually enough to get the foot above the heart.  It is important to keep your foot or ankle elevated whenever you are not on it. If you can keep it elevated for more than 48-72 hours you should do so.

Post-Op Shoe/Boot:  Always wear the post-op shoe or boot that is dispensed to you whenever you are walking.  Walking without the shoe/boot will cause damage to the surgical site and will cause an increase in pain, and the procedure may not heal correctly.

Keep Bandages Clean and Dry:  The bandages are in place for a purpose and will help to hold the surgical correction in place so it can heal.  If you get the bandages wet, your infection chances increase.  To help keep the bandages dry, get a waterproof cast protector usually available from your podiatrist’s office.  If your podiatrist’s office does not carry them, any medical supply house will have them.  Trash bags with tape do not work, so please do not use them.  The cast protector will fit over your shoe or boot and should be used every time you bathe.  Never remove the bandage without contacting your doctor’s office.

Ice:  Ice should be used for 48-72 hours following your procedure.  If using re-usable ice packs have two so one can be freezing while the other is being used.  Ice should be place on the foot or ankle for 20-30 minutes per hour during waking hours only.  You do not have to use it during the middle of the night.  Some podiatry offices use cold machines which work on their own, and you will be shown how to use it prior to or directly after surgery.  Ice will help reduce pain and swelling.

Blood:  It is normal to notice some blood on the bandage, so do not become alarmed if you see a small amount.  Free-flowing blood is not normal, and you should contact your surgeon’s office immediately.

Feeling Dizzy:  It is normal to feel dizzy or lightheaded the first few days following surgery.  If possible, use assistance when walking.  If you have been lying down, sit up slowly and remain sitting with your feet over the edge of the bed for at least one minute before standing.

Numbness:  The local anesthetic used during the surgery may last up to 48 hours.  This means you may not feel anything or be able to move your toes for this time period.  The numbness may make it hard to feel the effects of not following the directions.  If you have not elevated your foot above your heart, not walked only to the bathroom, not used cold to minimize swelling, or not taken your medication as prescribed, you may have more discomfort than anticipated once the anesthetic has worn off.

Swelling:  You will get a certain amount of swelling following any foot or ankle surgery.  Elevation above the heart will help reduce this.  If the bandage or cast feels too tight, touch the end of your toes to see if they blanch white then pink within a few seconds.  If so, then this is normal.  If it takes longer for the normal color to return or a blue color is noted, call your doctor’s office immediately.

Prevent Blood Clots:  Unless you are in a cast, it is good to move your foot at your ankle for a few minutes each hour.  If you feel severe pain to the back of the leg, knee, or upper leg with redness and heat call your surgeon’s office right away.

Fever:  It is normal to run a low-grade fever for up to 72 hours following surgery.  If the fever persists or exceeds 100 degrees, call your doctor’s office.

Keep all appointments:  It is essential to keep all follow up appointments with your podiatrist to ensure you are healing properly.  Redressing may be performed to your foot or ankle.

These are general tips to follow.  Your foot and ankle surgeon will likely give you his or her own written instructions.  If you have any questions at any time, you should contact your doctor.  As Dr. Bowman always tells his patients, “no question is too stupid to ask.”

Dr. Bowman at Houston Foot Specialists can be reached at www.houstonfootspecialists.com or by calling 713-467-8886

No, I didn’t really run with them.  If anything, I ran after them.  On Saturday January 14, 2012, I had the honor of serving on the medical team for the US Marathon Olympic Trials held in Houston.  The best runners in the United States gathered to vie for being the top three men and women to represent the USA Olympic Marathon Team this summer in London, England.  I treated many of these runners and talked with their coaches and found out how they take care of themselves after a race.  The answer came down to a pneumonic, PRICEMS.  This simple phrase can save you from a lot of pain and get you back running quicker.

Protection from further injury:  Walking as normal as possible will help keep from causing irritation in other areas of your body.  If you are limping, you need to rest your injury and see your local podiatrist.

Rest:  Pain is your body’s way of telling you that you are doing something you shouldn’t be doing, like further running the next day.

Ice:  It helps to decrease pain and swelling.  Place ice in a waterproof bag or use reusable ice packs and apply it directly over the injury site.  Apply the ice for 20-30 minutes three times a day.  Do not apply the ice directly to the skin; use a wash cloth or a small towel to protect the skin from damage.  Do not use ice when you sleep, as this may cause further damage not only to the skin but to the nerves in the foot.  Application of ice may sting or burn for 2-3 minutes which is to be expected then it will help to numb the area.

Compression to squeeze swelling from the foot or ankle injury:  Use an elastic bandage and apply gentle pressure to the area starting just behind the toes to a few inches above the ankle, or see your podiatrist as soon as possible to apply it in the correct manner.  You need enough pressure to help reduce the swelling; however, make sure it’s not so tight to slow the circulation.  

Elevation to help slow or minimize of the swelling to the site:  Remember, the foot and ankle are the lowest parts of your body, and to reverse swelling will require elevation.  We recommend elevation of the foot above the level of the heart by placing the foot on a couple of pillows while lying flat.

Motion or stretching an injured muscle:  Gentle stretching of a tight muscle will aid in recovery.  Never stretch to the point of pain. Hold your stretches for 25-30 seconds.  Proper form is a must, and your foot and ankle specialist can assist in showing you the exact form.

Strengthening an injured muscle, tendon or ligament:  Specific injuries are associated with strength problems. The injury will return if the underlying weakness is not corrected.

Depending on the injury and the severity, your foot specialist may recommend therapy, strapping, or anti-inflammatory medications.  X-rays and an MRI or other tests may be needed to help diagnose the exact problem.  Pain to the foot or ankle that lasts for more than 2-3 days following a marathon needs to be evaluated by your podiatrist.

Dr. Jeffrey Bowman, being a former runner, has a few marathons under his belt and can speak to your specific problems with experience.  Contact us at www.houstonfootspecialists.com or by calling 713-467-8886.