When is heel pain not plantar fasciitis?



Many patients come in to the office and they have been dealing with what they think is plantar fasciitis for many months or many years, only to find out that the condition isn't plantar fasciitis.  Some of the more common conditions are calcaneal bursitis. This is a problem where you have inflammation around the bursa on the bottom of the heel that can sometimes be caused by a heel spur, but otherwise it is a liquid formation protecting the heel, and this is different than plantar fasciitis and can sometimes be found in conjunction with plantar fasciitis.  Another problem that is common with plantar fasciitis or similar is something called flexor hallucis longus tenosynovitis.  This is a problem where the tendon that bends down your big toe gets inflamed and painful around that area. Another condition that is somewhat common is a nerve entrapment on the inside of the ankle region or inside of the heel region. If there is a nerve entrapped, it can cause heel pain, and when you numb up the nerve the heel pain goes away.  Those are just some of the other causes of heel pain that aren't plantar fasciitis.  

To Your Health,
Dr. Donald Pelto

Why is correcting heel position so important with heel pain?


Many of my patients that I see in the office in Worcester, Massachusetts for heel pain or plantar fasciitis are in need of orthotics that can help correct the heel position. When I talk about heel position, it is when you look at someone from the back, you can see their heel. Normally you want to look at the Achilles tendon, which is the tendon that goes from the back of the heel up the leg. That should be very straight.  If it’s slanting to the right or to the left, that means that person is maybe flattening out too much, or going inward too much, and that can be a problem. If you are able to correct the heel position or put it to where it should be in the center, there is not excess movement in the foot that can put strain on the plantar fascia or on the tendons on the back of the leg. Therefore, correcting heel position with a good supportive sneaker and an orthotic is very important to help heal plantar fasciitis as well as prevent it from coming back. The absolute worst type of shoe to wear is a flip flop when you have heel pain because it does not allow for any stability.  

To Your Health,
Dr. Donald Pelto

Bone infection


Here’s an x-ray where you can see where the little pointer is at the second metatarsal, there is kind of eating away at the sides of the bone on both sides and this is causing a problem in there where the bone is kind of being eaten away and it’s difficult for the patient because there is a bone infection. The way to treat this is to cut out that infected bone and make sure you get enough of it so you get all the bad infected bone. This is called osteomyelitis. It is a bone infection and it is something that you don’t want and you try to avoid with people with diabetes which this patient had.

To Your Health,
Dr. Donald Pelto

Ulcer by sarcoidosis and neuropathy



There was a patient that showed up in the office. They had something called sarcoidosis. This caused a problem with neuropathy where they lack feeling in the bottom of the foot. They developed this wound or sore on the bottom of their right foot. It’s a challenging thing to deal with because they didn't feel this wound, it wasn't painful, and we had to find a way to keep them off of this utilizing special padding until this was healed. Just be aware that if you have sarcoidosis, you could develop some neuropathy or a lack of sensation and a wound is always something that is possible to happen.

To Your Health,
Dr. Donald Pelto

Children bunions



So a lot of children have bunions on their feet and the parents always want to know what to do with a bunion like this.  Here’s a little girl, she has a bunion, you can see that her growth plates are almost closing in foot, and they want to know what to do.  My recommendation is if it doesn't hurt we don’t do anything until she gets to be about 16, but if it does hurt we can certainly do a bunion procedure to help correct that.  The risk, though, is for recurrence with something like this so you want to make sure the bunion procedure is done along with orthotics afterwards to help reduce any of the abnormal motions that caused it such as flat feet.  

To Your Health,
Dr. Donald Pelto

Detached toenail



I frequently get questions with patients that have a toenail that looks like this. You can see that the toenail is detached and not reattaching to the top of the toe.  This can be caused by a number of things. It can be caused by nail fungus, it can be caused by injury, it can be caused by digging into the edge of the nail, and it’s one of the more frustrating things that we can treat. A few types of treatments are removing the whole nail, that’s one option. You can also, if you don’t want to remove the whole nail, remove a portion of the nail and do something we call a phenolization or nail plate procedure that re-adheres the nail. That’s where you cut the nail all the way back, apply a chemical, and hopefully as the nail keeps growing out it’s going to reattach.  It’s something that’s challenging, it doesn't always work, but it sometimes is the best option that we have for patients because they don’t like it when their nails don’t reattach.  The last option would be to totally remove the toenail and put on either a fake nail or something similar.

To Your Health,
Dr. Donald Pelto

Raynaud's Syndrome



This is a condition where the toes tends to get really red or even white in the wintertime when the feet are cold, and sometimes this can even happen in the cold of the summertime and you see all this redness to the tip of the toes. This can sometimes happen with people with Raynaud’s. There tends to be pain to the tips of the toes. The best type of treatment is to keep your foot warm. That is not always easy, though, here in Worcester, Massachusetts and so you can sometimes use some hand warmers in your shoes or an extra pair of socks that aren’t going to be too tight, but just be aware of this and try to stay out of the cold as much as possible to make yourself comfortable.

To Your Health,
Dr. Donald Pelto