Why are “Heel Spurs” Important When it Comes to Military Service?

The New York Times released an  article  today that claims President Trump was given the diagnosis of “heel spurs” so he would be exempt from military service.  Putting aside the ethical, moral and political components of this story; one might wonder why heel spurs would disqualify someone from service.

A heel spur is actually an abnormal outgrowth of bone of the calcaneus (heel bone).  They may occur on just one foot or both.  The tissue on the bottom of the foot called the plantar fascia attaches to the bottom of the heel bone and when stressed, can produce a spur of the bone due to the traction that is occurred with the stress of the fascia attachment.    It is the plantar fascia that actually causes the pain.

Heel pain is VERY common.  One estimate is that there are 5 million Americans that have heel pain at a given time.  Approximately 35-40% of patients at Family Podiatry Center present with the complaint of heel pain.

Plantar fasciitis developed as a diagnosis to more accurately define the source of the pain over time and it takes on definite course with consistent symptoms of pain in the morning and after periods of rest. More recently, some podiatric physicians that specialize in heel pain recognize that there are two forms of plantar fasciitis including a chronic version called plantar fasciosis.   The plantar fascia is much easier to treat before it becomes chronic and it’s important to seek treatment from a qualified podiatrist once the pain cycle changes.  Chronic plantar fascial damage will not respond to the traditional treatments and may require regenerative medical treatments.

So why did “heel spurs” exempt people from military service?  Aside from being very painful, heel pain was often associated with “flat feet” which tire easily.  Nowadays, both flat feet and heel pain are easily maintained using custom orthotic devices and no long pose a threat to our soldiers. 

When Your Feet Still Hurt AFTER You Take Your Heels Off!

High Heels - some people love them, some people leave them.  Most women are like myself, wear them on occasions.  Granted, most women will admit that their feet hurt while they are wearing their heels, but what does it mean if your feet hurt after you take them off?

Pain at the ball of the foot, most commonly felt while wearing high heels, can be more of a problem then direct pressure from shoes.  Wearing heels, even occasionally, can cause tearing in one or more of the ligaments that are on the bottom of the joints located at the ball of the foot.  Pain at the ball of the foot is usually due to inflammation, scar tissue or a partial tear of this ligament.  The pain remains even when wearing flat shoes or without shoes because damage has occurred.

This ligament, known as the plantar plate, is responsible for keeping the toes straight.  When torn even partially, the ligament causes the toe to rotate or displace over time with or without pain.  Even without pain, there are can be swelling on the top of the foot in that region.   But its not just pain, swelling and damage to the ligament that you need to worry about.  It is not uncommon to develop hammertoes because of a disruption of this ligament. 

Treatment for this problem is dependent on when you seek treatment and how much damage there is to the tissue.  Sometimes extended physical therapy and taking the pressure off the ligament can allow the tissue to heal.  Often, using some of the newer forms of regenerative medicine can result in a quicker resolution.  Finally, surgery may be necessary as a last resort.

One thing to caution you on pain in this area.  NEVER have a cortisone injection unless you have ruled out damage to this ligament.  Cortisone, often used for inflammation in the area and/or neuromas in the area can weaken the ligament and cause further damage.

Resolution #2: Never be caught with your shoes off if you have heel pain.

Heel pain is very common and makes up 35% of our practice. Wearing shoes with a firm heel counter is very important in controlling plantar fasciitis, the leading cause of heel pain. If left untreated, this inflammatory problem can progress to a much more severe problem of tearing and scar tissue. Having proper heel support is the first step in controlling the progression of heel pain. Heel pain lasting longer than two months should be evaluated by one of our podiatric physicians. We specialize in chronic heel pain and have been innovative in advanced and noninvasive treatments.

I have my patients start with the basics - no matter how long they have had the heel pain or even if they have been treated elsewhere because I believe in them so much! Proper heel support, stretching of the fascia and the Achilles and education on shoe wear is the basis for anyone with heel pain.

For those with chronic heel pain (more than a few months), there is great hope! I have been using radiofrequencywith great success.

Resolution #1: If the shoe doesn’t fit, don’t wear it!

It’s so tempting for women to buy shoes that don’t necessarily fit - especially if they are on sale or perfectly match an outfit. Do your feet a favor and resolve to only buy shoes that do not pinch, squeeze or slip when you try them on. And don’t just try on a potential new pair of shoes; get off the carpeted area of the shoe store and really walk around in them to determine if they are a good fit.

Other shoe shopping tips to remember:

-shop for shoes at the end of the day so that any naturally occurring swelling has already occurred

-wear the appropriate hosiery for the shoes you are buying

-know your foot type before shopping for athletic shoes - a podiatrist can help you determine your foot type

-know your heel height limit, some women can wear 4" heels, but others may have to settle for 3"

2011 Resolutions to Walk With

There are resolutions for everything from weight loss to self-betterment to political correctness - all intended to take you to a better place in 2011. Why not for your feet? You can’t go anywhere in 2011 without your feet taking you every step of the way!

For the next 11 days, I will post a resolution sure to keep you on track and walking in the right direction!!

Coming on Monday - Resolution #1: If the shoe doesn’t fit, don’t wear it!

Traveling in 2010

A woman I met this week was telling me the worst thing about traveling for her is not the security, not the lack of snacks given on the plane, not the lack of a pillow on morning flights - but the problems with her feet when she travels!! I don't think she even knew I was a podiatric physician (podiatrist)!!

She was complaining that her feet sweat a lot and that she is very uncomfortable when flying. She is bothered when she has to take her shoes off and expose her feet and feels very constrained when in the air. This was the first time I have heard someone listing their feet as their main problem with flying!!

Here are some tips to keep your feet healthy and comfortable when flying.

1) ALWAYS WEAR SOCKS!! It is just too gross to think about all those people who take their shoes off to go through security. Even if you just wear socks until you get to the other side of security. I keep a pair of white cotton ankle socks in my purse to slip on as I slip off my shoes.

2) Don't wear nylons when you fly. Several reasons - first of all, nylon holds moisture so your feet will feel sweaty. Second, your feet will feel restricted in them, especially if your feet swell while you are on the plane which is very common. Finally, and I heard this on the Oprah show and it made an impression on me, if you are in a plane crash that involves fire, nylons will spread the flames!

3) Wear shoes that you can run in, walk in, and run in! You never know when you will be running to a gate! I like to wear shoes that are easy to get off and on to make security go smoothly. I also put my shoes down the conveyor belt first so that they are there ready for me to put back on while my other things are still going through the x-ray. Low heeled boots with a zipper are perfect for travel!

4) Put your feet through a range of motion while you are in your seat. Making circles or even spelling out letters with your feet will help keep swelling and stiffness down.

5) Enjoy your flight and hopefully the feet will be the last thing on your mind as you fly over the Grand Canyon!!

New Flip Flop Danger

So I thought I have heard all the flip flop injury stories: getting one caught on an escalator, losing a flip flop when running, tripping over the end of the shoe, having the flip flop get stuck in bicycle spokes... and then until the other day I heard a new one!

A patient told me he tripped on the gas line while at a gas station! He fell, sprained his ankle AND broke a bone in his foot! He went to the ER for his ankle, but they totally ignored his foot pain.

Its not that uncommon to injure your foot when you sprain an ankle. The twisting can not only stretch the ligaments of the ankle, but can also cause a tendon to pull off one of the bones on the outside of the foot. Most emergency rooms will focus on the obvious - the ankle sprain and few ER doctors are even aware of the related injuries that can happen to the foot.

Whether its due to a flip flop injury, fall on the ice, or soccer injury, the BEST place to go after an ankle sprain is NOT the ER, but the office of a podiatric physician! Today's Podiatrists have the education, training and experience to properly evaluate ankle and foot injuries like no other physician. With almost all podiatrists having in office x-rays and many having diagnostic ultrasound, all your bone and soft tissue injuries can be identified properly the first time around! AND make sure you have the proper treatment - not just an ace wrap and crutches!

Heels and Uneven Floors do NOT Mix!

I was in Las Vegas last weekend and had to walk from the hotel to the convention center. The path for the 20 minute walk was a floor that was uneven, shinny, super smooth and made to look like cobblestone. It was TORTURE! Certainly not designed by a woman or even with women in mind. I struggled with each step of my kitten heels (1 1/2 inch) and worried about all the women that tried to walk this walk in real heels!

It brought me back to my trip to Prague and the cobblestone streets which were even difficult to navigate in sneakers!

I think its time more women designed walk ways, shoes and maybe even cities!

Those Skinny Heels

I have dreamed of skinny for years.

Skinny legs, skinny thighs - but never again of skinny heels! I recently slipped while wearing a pair of skinny heeled shoes (not too high, mind you) and sprained my knee. Okay, I'll admit it - I actually slipped TWICE before deciding not to wear them again!

The thinner the heel, the more unstable the shoe, regardless of the heel height. Slipping on smooth surfaces is an easy thing to do. Wider, chunkier heels can be just as appealing as the skinny heels and a lot safer to walk in.

If you must wear that favorite pair of shoes that happen to have a skinny heel, please make sure the very bottom of the heel is not worn out as this will really cause you to slip! Have your shoe maker replace the heel and ask them to use a slightly thicker material in the process. Your knees will thank you later!

Platforms - Are They Better Than Heels??

I just answered a post on Zappos.com which asked this exact question. The answer is yes, and no.

Platform shoes do give you height without some of the problems of heels, but platform shoes have their own set of problems. The human foot is meant to go through a specific pattern of walking called the gait cycle. Shoes should allow normal gait unless there is a specific reason not to allow normal gait.

Normal gait includes the foot bending at the ball of the foot to allow propulsion of the body forward. The toes work in conjunction with the rest of the foot to stabilize while moving forward. Many people with arthritis find that normal propulsion is painful if their joints at the ball of the foot are arthritic. For these people, we recommend shoes that limit motion in that area.

Most of us do not have significant arthritis and have no reason to not allow that normal motion. Any shoe that does not bend at the ball of the foot does not allow normal motion. Most platform shoes fall into this category.

Platform shoes that are made of rigid materials stop the foot from its regular function and force the tendons and muscles to work abnormally. This can cause some muscles to be over used and others to be under used. Tendon pain, inflammation and irritation can occur if this is allowed for an extended length of time. If shoes worn on a regular basis cause the toes to grip the shoe excessively, hammertoes can even develop!

Listen to your feet. Foot pain is never normal and any shoes that cause pain or discomfort when wearing them or immediately afterwards should not be worn for any length of time.

SHOES!!!!

I am always answering questions about shoes so I thought it was time that I began to write about shoes and how they can help or hurt your feet.

Lets start with everyone's favorite shoes - High Heels!!

High heels are simply not good for your feet! True, women with higher arches can wear them more comfortably and with more stability, but down the road they can cause problems at the ball of the feet. Torn ligaments, inflammation and stress fractures can occur from constant high heel use. Heels over three (3) inches put seven times the pressure on the ball of the foot and that pressure wears out the normal tissue. Many women as early as their late 20's start having problems at the ball of the feet.

I am realistic, however, and know women are going to continue wearing heels. So here is what you need to do:

1) Alternate your heel height daily, even if its from a 4" heel to a 3 1/2" heel. That will change the force on the bones daily.

2) When trying on shoes, get off the carpeted area. You want to see what type of padding the shoe itself gives - not the padding the carpet has!

3) Never wear a shoe that you feel unstable in. Many women sprain their ankles when they wear heels that are too high for them

4) Try to find a heel that is wide if you feel unstable.

5) Go for the kitten heels! Same look as heels but without the dangers

6) Height is an illusion! Stand tall, throw your shoulder back and go for the 1 1/2" heel instead of the 3" heel!



Next up - platform shoes!!

Me: in focus for women in Chicago

I just got my issue of

Me: in focus, the magazine for Chicago women and found myself on page 19! Check it out:

http://meinfocusmag.com/2009/07/body-in-focus-dr-marlene-reid-on-preventing-footankle-injuries/

Feet: The Good, the Bad and the Ugly

When is Foot Surgery Simply Cosmetic and When is it Medically Necessary

Women – feet – shoes- they are a natural triad, a trinity to some and a piece of modern day life.

Women – feet – shoes- a passion many women have. I hesitate to say most; but certainly many women are fixated on their feet almost as much as their shoes. Most of my female patients evaluate and critique their feet as they would any other body part. Many women feel embarrassed to show their feet and I can’t tell you how many women have told me that they feel as if they are going to the gynecologist when they have to take off their shoes!

Many foot problems are unsightly. Hammertoes produce crooked toes. Bunions and other deformities cause disfigurement. Masses of fat tissue generate bulging of the ankles. Problems with the arch tendon can produce flat feet. Fungus cause thick toe nails.

Many unsightly foot issues become medical problems. Long toes can result in jamming in shoes and eventually produce hammertoes, pain at the ball of the foot and even tearing of ligaments. Deformities such as bunions and hammertoes can cause arthritis. Fat deposits become symptomatic with irritation of the nerves. Flat arches can instill pain, fatigue and tearing of the arch tendon. Thick nails can cause infection.

While most foot problems are hereditary, shoes certainly have a role in the affect they have on our daily lives. This is especially true for women. Women love shoes - although I can’t say that shoes love women! Many shoes inhibit the natural motion of the feet and can contribute to the development of deformities and other foot problems. Nonetheless, women love their shoes and most women will simply not give up the style, look and elegance that their carefully selected shoes provide!

Health feet, desired shoe wear and daily life styles represent a trinity to the sole of many women! Podiatric physicians that are sensitive to these three aspects of life can assist women in making the right choices to satisfy the heart, body and sole!

Treating foot problems is a challenge for many primary doctors, but podiatric physicians are trained in the biomechanics or function of the foot. The weight we bear and steps we take everyday directly influence the conditions, abnormalities and appearance of our feet. And because we walk on our feet, many foot problems are progressive. Usually, conservative treatment is enough to balance these factors and render our steps pain free, but often surgery is needed to correct a problem and/or prevent future problems.

Foot surgery, when performed by a qualified podiatric surgeon, is safe and usually uncomplicated. Foot surgery, of course, carries the same risks that other elective surgeries have, but most surgeries involving the foot get you back on your feet within weeks if not days. Foot surgery is performed for all different problems including those that cause unsightly conditions.

Despite their shoe wear, women are entitled to feet that are healthy, feel good and look great! It is the job of the treating podiatrist to determine which treatments will be most successful. Treatments may involve surgery and it is important to understand the risks. Surgery has a role in the management of foot problems associated with foot structure, shoes and daily life style. Foot health is intimately tied to foot structure and when it comes to the feet, it is often difficult to separate the truly cosmetic procedures from those that are medically necessary.

Ankle Pain - Not What You Think!

Most people associate ankle pain with an ankle sprain - pain at the outside of the ankle. But does anyone ever experience pain along the inside of the ankle?

Gradual or occasional pain behind the ankle bone on the inside of the ankle could be the start of a serious problem with the tendon that supports the arch. Many women, as they enter their 40's, begin to have excessive pressure on the posterior tibialis tendon, the strong tendon that helps hold up the arch.

Extra weight, increased activities, flat feet, and shoes with a lack of arch support all contribute to this problem. If untreated and allowed to progress, the tendon can become inflammed, tear and even rupture. This is one condition that pays to treat it early on!

Treatment differs depending on the stage of progression it is in, but will always include reducing the stress on the tendon. Pain or discomfort may be present but one common sign is that your arch seems to have "fallen."

I should know! Not only do I treat Posterior Tibial Tendon Dysfunction (PTTD), but I have started to show signs of it as well!!

Heel Pain Keeps Walking In!!

Heel pain remains the #1 complaint we see in our Naperville Podiatry Office - Family Podiatry Center.

Check out this video I did for the APMA on a new treatment.

Topaz for heel pain

Have Heel Pain???

Be sure to tune in to the Real Women on Health - an internet Radio show - this Saturday morning at 9:30 EST. I will be speaking on how to treat and take care of those painful heels. See below!!





Dr. Marlene Reid
Private Practice Podiatric Physician & Surgeon
Spokesperson, American Podiatric Medical Association


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what a pain in the....heel! (find out what the pain is...and what it's not!)
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