Tag: heel

Drop foot can be a very frustrating problem, and there are many potential causes for it. Before we get into things, it is important to understand what drop foot is. It is the  lack of strength to pull your foot or toes upwards, or the ability to move your foot sideways away from your opposite foot. There are approximately five different muscles involved with the weakness that can create drop foot. We won’t be going over these muscle groups in this blog, but it’s important to understand that drop foot can affect both sideways and upwards motion to varying degrees. 

When you walk with a drop foot, it may be difficult for your foot to clear the ground. The foot may also want to slap against the ground when your heel hits the floor, or be in such a downward position that you must flex your knee upwards for your foot to clear the ground. This is referred to as a steppage gait and can make walking exceedingly difficult to the point where it has a significant effect on mobility. 

What Are the Causes? 

• Spinal-cord drop foot can be associated with your back, which is referred to as radiculopathy, caused from compression or irritation to the spinal nerves in the lumbar area.
• Strokes can be associated with drop foot. 
• Sciatic nerve trauma, usually caused from hip or knee surgery. 
• Trauma to the nerves in the leg that stimulate the muscles to contract
• Compression of the common peroneal nerve. Compression of this nerve tunnel may be associated with both diabetic and non-diabetic neuropathy. It is often assumed that the drop foot is from a sciatic nerve that was stretched and damaged from hip replacement surgery or knee surgery, because the common peroneal nerve tunnel becomes compressed. Anderson Podiatry Center has successfully reversed drop foot for many patients who were told it was from their back or from damage to the sciatic nerve. 

 What Is the Common Peroneal Nerve?

The common peroneal nerve is the most overlooked cause of drop foot. It is a branch of the sciatic nerve, and as the sciatic nerve courses down the back of your hamstring area, it divides. One branch goes towards the bottom of the foot, down the back of the calf, and the other branch goes around the outside of your leg, just below the knee. 

It’s in this area that the common peroneal nerve tunnel is located. Just beyond the nerve tunnel is the branches that send signals to the leg muscles to contract. When the tunnel is tight, the branches don’t send strong enough signals, and the muscles become weak. This is similar to carpal tunnel syndrome in the hand. This can be the case in diabetes, where there’s compression involved, or non-diabetic neuropathy, because the tunnel can become tight.

At Anderson Podiatry Center, we deal a lot with peripheral nerve disorders and evaluate peripheral nerve issues. Many doctors are not fully trained in the evaluation and treatment of peripheral nerve problems. So, for many of you reading this blog, the potential is that you may have been told there is nothing you can do. You may have had a hip or knee replacement surgery and your sciatic nerve was damaged, which has resulted in drop foot due to the common peroneal nerve. 

Treatment

To quickly answer the question as to what the best drop foot treatment is, it’s surgery (especially if the drop foot is significant). If there is high potential that the nerve is compressed, surgery would be the best option because it can give you the most profound improvement. 

If there is a delay in surgery, especially after trauma or a surgery that could have caused this, it could lessen the effectiveness of the drop foot surgery. Many say that if you have had a surgery, such as hip replacement, and drop foot occurs, you should wait around six months to a year to see if it improves. However, we strongly disagree with this approach and suggest that if it’s been 2-3 months since surgery, and there is no progression towards improvement, surgery on this nerve tunnel should be performed. Waiting may limit how much improvement the patient gets. 

• ESTIM: This is a non-surgical treatment that involves multiple visits and electrical stimulation. This is performed with local anesthetic injections, that in combination repair nerve damage and improve circulation to the nerves during treatments.
• Tendon transfer surgeries and joint fusions:  These surgeries have always been available in conventional surgical training to help stabilize the foot and ankle.
• Ankle bracing: there are many types of ankle braces that also may help. In most cases, these are prescribed by the doctor. 

In summary, the two most important aspects about drop foot treatment are: 

• If you’ve had surgery or an injury, and after the first two to three months you’ve not experienced improvement, do not put yourself in a position where you may lessen the effectiveness of the surgery by waiting. With that being said, we’ve also seen patients, years after a surgery caused by drop foot, that still still see improvement on their mobility from drop foot surgery.  When surgery is performed, most patients see significant improvement of their lifestyle, even if they have less than 100 percent improvement of their muscle strength.
• If you have neuropathy or back problems, don’t assume that you don’t have compression of the common peroneal nerve. It is commonly associated with diabetic and nondiabetic neuropathies. 
• To conclude, it is not always the case that surgery is the best treatment, but for those whose mobility is significantly impacted, proper assessment of the common peroneal nerve is important. The recovery time and risks are minimal, compared to other surgical options, and if surgery fails, the other options will always be there. When the drop foot is minimal other options such as ESTIM may be considered.  So if you or someone you know suffers from drop foot, please consider the common peroneal nerve tunnel as a potential cause. 

We are frequently asked, what is the most common foot complaint? Without a doubt, plantar fasciitis is at the top of the list. Oftentimes, it is referred to as heel pain, or heel spur pain. The symptoms of plantar fasciitis often occur first thing in the morning, as the pain exists on the bottom of the heel and is irritated with those initial morning steps. You may hobble to the bathroom, or to go make some coffee, and after a few minutes the pain wears off. However, as it becomes more severe, you may notice the pain throughout the day, and it can come on gradually or all at once.  

Plantar fasciitis is seldom caused by trauma. Although it could be caused by you falling on your foot and striking your heel, in most cases, it’s something that just happens and is unpredictable. Foot biomechanics can also play a role.  

While plantar fasciitis is a common foot problem, it rarely occurs in your teenage years or early twenties Why is this? One of the ideas is that the fascia loses its elasticity over time. The fascia runs from the ball of the foot to the heel, where it attaches. With every step you take, as the arch flattens, the fascia pulls from its attachment point (aka the heel). When your foot is not bearing weight, the arch is relatively high, but as soon as your bear weight the arch flattens and pulls on the fascia.

This pain from the common foot problem can become very disabling as it can go on for months, or even years in some cases. It is important to note that an x-ray can sometimes show a heel spur, where the fascia attaches to the heel. The old school idea is that this was the source of the pain, however this is seldom the case. If surgery is ever performed to eliminate your plantar fasciitis (using small incisions to partially release the fascia), nothing is done to the spur. Patients have a remarkably high success rate with this form of surgery, proving that it is not the spur. In fact, the spur could have been created by the fascia pulling from your heel.

What Can You Do For Plantar Fasciitis?

Since plantar fasciitis is one of the most common foot problems, it is also the one that has the most treatment options. It can get confusing because everyone, including your shoe salesman, will claim to have the solution.

But the actual treatment solutions for plantar fasciitis are limited. There are many options that can help a bit, as these are referred to as “band-aid approaches”. These band-aid approaches include anti-inflammatories, icing, and stretching. They are fine to try, and in some cases can help a lot, but it’s important to do these at the earliest stages of your heel pain. 

You can also try using supports, and if the shoes you wear for walking, hiking or running are worn down, consider replacing them. If these attempts fail, or if you find yourself having to go back to these approaches time and time again, it may be time to seek professional help.   

Orthotics 

Orthotics are one of the foundational things that a podiatrist will use. Orthotics help hold and support the foot better so that the fascia does not want to pull away from the heel. It is important that the orthotics being made utilizes either a casting technique, or a digital system by taking a non-weight bearing, impression of your foot. This captures the foot in its ideal functional position in order to get more precise control of your foot. Orthotics minimize how much that fascia is pulling from your heel by supporting your bony structure better.

Stem Cell Treatment

Podiatrists traditionally used cortisone injections to treat plantar fasciitis, but at Anderson Podiatry Center, we still do this on occasion, but recommended the consideration of stem cell treatment. It’s been known from recent studies that the fascia is not truly inflamed, but rather it’s tissue is breaking down and in need of repair. So what better way to do this than with stem cells (we typically use placenta cells). 

Shockwave Treatment and Laser

Shockwave sends powerful sound waves into the heel area. This traumatizes the heel, but puts your body into a repairative mode that helps repair the fascia. We also use a treatment called MLS laser which helps by improving  the functionality of the mitochondria in your cells to repair the fascia.  

Surgery

Surgery is done on occasion, but only after conservative measures have failed. It’s typically done with a scope, and we make a small incision on both sides of the heel. Patients can ambulate immediately, but usually have to wear a movable cast for approximately  two-four weeks. Success rate for this is quite high.

If your attempts to remedy your heel pain are not working, it may be time to move on to a more aggressive treatment plan. The longer you wait to see a podiatrist, the more time and treatment options you may need to eliminate the pain.