The recent withdrawals of the prescription medications Vioxx and Bextra from the marketplace have many people concerned. Studies show that the use of Vioxx could increase the likelihood of strokes and heart attacks; Bextra carries those same risks and also increases the chances of contracting Stevens-Johnson Syndrome, a potentially fatal skin disease. Frequently prescribed to minimize the inflammation and pain of arthritis, these prescription drugs belong to a family of non-steroidal anti-inflammatory drugs known as COX-2 inhibitors.

COX-2 inhibitors are a relatively recent breakthrough in medicine; they interfere with the COX-2 enzyme, which causes pain and inflammation, without interfering with COX-1, which protects the stomach lining.. Previous anti-inflammatory drugs eased the symptoms, but also interfered with COX-1, leaving many patients suffering from gastric discomfort.

While everyone who has been taking either Vioxx or Bextra would be well advised to see their doctor immediately, they might also wish to consider whether or not they should seek an attorney. While most people who have been taking these drugs have not suffered from adverse effects, anyone who has suffered from a heart attack, stroke, or other unusual symptoms while taking these medications may have grounds for a lawsuit. People who believe that they have been harmed by their use of Vioxx have already filed numerous lawsuits; similar suits involving Bextra are now being prepared. These suits are generally brought forth by attorneys who are experienced in drug litigation. A meeting with such an attorney, along with information from your physician, can probably help determine whether or not a prescribed COX-2 inhibitor may have harmed you. He or she can also advise you as to whether it would be in your best interest to either file a lawsuit or participate in a class-action suit, in which you and a number of other people with similar claims would file a suit as a group.

Have you ever taken the drug Vioxx or celebrex? In September 2004 the drug manufacturer Merck decided to recall the product after long term data suggested a serious potential side effect.

This drug and others like it such as as ‘Celebrex’, ‘Bextra’ and ‘Arcoxia’ are part of a family of drugs known as “COX2 drugs” or “COX2 inhibitors”

They have been developed with, ironically, patient safety in mind.They are typically used in treatment of arthritis, though high dose vioxx was promoted for short term relief of acute muscular/skeletal pains.They were anti-inflammatory drugs.

The serious side effects were in connection with the heart suggesting risk of heart disease or heart attack.In medical circles it was referred to as “..adverse cardiovascular effects.”

There are other drugs used to treat inflammation that have been around for many years.YOu may have heard of products such as Advil or Nurofen which contain the ingredient Ibuprofen.Other older anti-inflammatory drugs include such brands as Voltarol or Naprosyn.

What’s the difference between these older drugs and the recent treatments know as “COX2 drugs”?

The newer drugs such as Arcoxia,Celebrex and Vioxx were designed to be much more specific in their mode action than old drugs like Ibuprofen.The idea was to limit the associated problems in long term treatment.

When we get older we all seem to get more sensitive to side effects of drugs.Often this is complicated even more by the fact that we may suffer from more than one problem or disease at the same time.

At this point we take more medication in the last five to ten years of our lives than in all the other years put together! Is it any wonder we might feel under the weather, a little off colour even?

You could have asthma and high blood pressure. Anxiety and lack of sleep every night. Panic attacks and depression.

If you take an anti-inflammatory drug for a given length of time, your doctor/physician will no doubt tell you about one major problem.

Ulceration of the stomach or intestines…..

It was hoped that the newer COX2 drugs would not cause this problem at all.Therefore it would avoid the risk of someone suffering internal bleeding which could become fatal.

The older you become the greater the risk of this occuring. It could be a slow blood loss or a sudden episode of an ulcer bleeding more profusely.

So when people got the signs of ulcers, they got treatment for an ulcer. Some would stop taking medication and others would take a maintenance dose to prevent ulcers coming back while continuing to take the old ibuprofen drugs for their arthritis.

It was hoped drugs like vioxx would stop this, but ulceration still remains a possibility. Doctors routinely consider offering anti ulcer drugs to reduce the probability of this happening.

So what is the all the recent fuss about ? Where did it all suddenly seem to unravel after all that hope and expectation ? A new long term study seemed to indicate some degree of risk to the heart some 18 months or so after starting treatment.

So if you took vioxx for a week or a couple of months, this potential problem did not appear.It has only been spotted after taking the medication for a longer period such as 18 months.

What can you do? Are there ways to reduce risks? This is something you need advice on as only your doctor will have your medical history.There is much to consider and such a problem can in some circumstances be minimised.

Of course if you smoke you increase the risk of stomach or intestinal ulceration if you also take anti-inflammatory drugs such as Ibuprofen.Why not quit instead?

If you take other medication for depression or anxiety then these drugs can increase the risk of bleeding with any anti-inflammatory drug being taken at the same time.

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When Dorothy followed the yellow brick road, she was told to do so by those who wanted her to get where she wanted go. Well as humans when we blindly follow recommendations even by individuals who have good intentions, it may not always be your best option. So I’m preparing this article to compare and contrast what are known as traditional treatments vs. complementary or alternative treatments for back pain. Remember there is rarely only one reason for your back pain and almost never one silver bullet fix? you may need to try several approaches till you find what works for you.

So when reading this article and thinking back on your visits to medical professionals, did you have the big picture or were you just following that yellow brick road? If you have been down that road, or if you are just starting to suffer from back pain it’s never too late to seek out new and more encompassing information about your condition when trying to find a solution that works for you. Don’t say you’ve tried everything because you haven’t… your solution is out there and you just have to find it!

Orthopedic Care

One of the first places many people go when they experience back pain is the orthopedic specialist (surgeon) and a visit usually last 5-10 minutes. They will typically look at the problem/symptomatic area and often fail to look at the body as a whole. If you’ve been to an orthopedic specialist for your back pain, did they do a full body physical evaluation (takes 30 mins. or more)??? Not likely.

Here are some of the common treatments used / prescribed by orthopedic specialists:

Cortisone Shots

Cortisone is a catabolic steroid which is intended to reduce inflammation by killing off the tissue in the inflamed area? now let me ask you, does that make any sense to you at all?

Not only are these injections quite painful, but they rarely result in any pain relief and if they do it is short lived, usually 1-2 weeks if at all. Plus, it does NOTHING to identify or address the cause of the pain? it is only intended to treat the symptom. It’s for those reasons that we do not recommend them.

Anti-inflammatory Drugs

Just the name should scare you away? just like cortisone shots, anti-inflammatory medications do not identify or address the cause of your pain and for many people, they deliver little pain relief. These medications also deliver serious side effects! The main reason they are prescribed is money? and if you don’t believe me, do the research and you’ll see for yourself. The drug industry is huge and unfortunately, they have a huge influence on the whole medical community, including the doctors.

I challenge you to find a drug that will fix your back problem? you’ll be looking forever because there is no way a medication can fix a physical problem so avoid medications at all costs!

Back Surgery

Surgery for back pain is very common and more often than not, the individual still has pain afterwards (or it returns within weeks) and sometimes even new problems! Very rarely is a surgery the answer…

for example, many people have surgery for herniated discs. The logic behind the surgery is if you remove the piece/portion of the disc that is putting pressure on the nerve the problem is solved. Unfortunately, the same forces that forced that disc to protrude or bulge will likely force more of the disc out, or another disc out.

Surgery should always be the last resort… and even then I’d question it!

Physical Therapy

Physical Therapy is traditionally the next step after seeing an Orthopedic Doctor. That is if surgery is not recommended. So what should you expect? The process will start with an evaluation and here may be the start of the problem? here is why?. the doctor has to write a prescription with a diagnosis on it. You give the prescription to the PT and he or she will perform an evaluation… chances are the PT will simply confirm the diagnosis from the doctor, however the hope should be that they take the extra step to look for the root cause of your pain. They may but chances are they have several other clients in the office at the same time and simply do not have the time.

So without a comprehensive evaluation to identify the root cause of you pain they will simply treat your symptoms. We have just identified the second problem. The health care industry is required to show improvement with each and every session so the push is to reduce your symptoms to show progress in order for them to get paid. The long and short of it is that yes your pain can be reduced but the root cause rarely gets addressed, meaning that the pain and your suffering will return again and again.

So what should you do? When selecting a Physical Therapy office you may want to ask how many patients the office sees in a day and how many PTs they have on staff… then ask how many patients can a PT work with in an hour. Do not be surprised to hear that a PT can see up to three patients in an hour. That’s you and two others at the same time. Do you think you will get the attention and proper treatments you need? I doubt it.

There is a little joke in Physical Therapy when treating patients and it has to do with what course of modalities you will get. The joke is called Shake and Bake and it refers to everyone gets the same treatment protocol? that way it can be timed so that your PT can see other people simultaneously. What goes into a shake and bake treatment? It may start with a spin on a stationary bike or a trot a treadmill than you will get a 3 to 5 minute Ultrasound over the effected area followed by Electrical Stimulation to the area with a little Ice strapped to your body and to finish off your session you will get a hand out with exercises you should do at home. Certainly not a recipe for success!

Chiropractic Care

One of the most common treatments for back pain is Chiropractic Care. The approach consists of physical manipulations of bones and joints in an attempt to line things back up and it’s recommended typically 2-3 times per week.

The problem with this approach is that the same forces (muscles, tendons, and ligaments) will likely pull the bones and joints right back out of place again. Also, most (not all) chiropractors will spend 15 minutes with you if your lucky.

Ask people who see a chiropractor how long they’ve been going? I hear of people who have been going for 10-15 years and still don’t have a healthy back. Look, the fact is chiropractic care is lacking?

Unless the chiropractor combines the two approaches, it doesn’t make sense?

The ONLY way chiropractic care makes sense is if you are addressing the muscle imbalances that are pulling the bones and joints out of place to begin with and that requires strengthening and stretching exercises that are chosen specifically to correct your muscle imbalances.

Alternative Treatments for Treating and Eliminating Back Pain

Massage Therapy

Massage therapy, if done correctly can work wonders for people with back pain. This is not to say that it is the best choice and that it will work for everyone? however, most people will get great results from it if the massage therapist has a good understanding of muscle imbalances and how to work on them.

NOTE: Not all massage therapists are the same! Just like any profession, there are varying degrees of training and qualifications. When selecting a massage therapist please check to see if they are licensed and insured in the state where you will be seeing them. You should also ask the massage therapist if they have training in one of the following areas: Orthopedic massage, Medical massage, St. Johns technique and/or has a comprehensive knowledge of muscle imbalances relating to back pain. With that said the benefits are as follows. The root cause will be identified, your discomfort will be addressed and you root cause will be corrected all in an attempt to make you pain free and give you the tools you need to keep you that way. What to expect when you see a massage therapist.

All massage sessions are one on one allowing you the opportunity to converse with the therapist as well as get the attention you need to get results. You can ask questions about how you compare to other people. Feel free to ask the therapist what approach they will be taking so that you know what to expect. The massage therapist has many different techniques they can use when to dealing with you back pain and some are better than others. On the down side sometimes a therapist can get distracted with other problem areas, it is in your best interest to keep them focused on you back and associated problem areas. Like anything else you may need to try several different therapists before finding the one that works best for you and with you.

Post-rehabilitation Fitness Training

Another overlooked form of treatment that is very effective is post-rehabilitation fitness training. This includes targeted strength and flexibility work to correct / improve the individuals muscle imbalances. This service can only be performed by certified post-rehab fitness trainers and there are limitations to what they can do for you. For example, they can not diagnose a condition, prescribe any medications take x-rays, etc? however, if they are well trained they can pinpoint your muscle imbalances quickly and get you started on a fitness program that will restore balance to your body and likely eliminate your back pain.

Often times this can be combined with massage therapy and/or manual physical therapy for a total solution. If you decide to go this route, which I recommend you do, be sure to thoroughly check out the fitness trainer and ask to see their certification, insurance, references, etc.

Manual Physical (muscle) Therapy

Manual Physical Therapy is NOT the same as regular physical therapy? there are some major differences and here are just a few:

1. Manual therapy consists of hands on muscle work primarily whereas traditional physical therapy consists of heat, ice, ultrasound, electrical stimulation, etc

2. Manual therapist will typically perform a much more thorough physical evaluation

3. Manual therapists will usually be able to spend more time with each patient

4. Manual therapy is more holistic in it’s approach and focuses the body as a whole unit? something lacking from nearly all traditional treatments for back pain.

So before you say, “I’ve already tried physical therapy”? did you try manual physical therapy? They are two very different treatment approaches and I highly recommend you consider manual physical therapy.

Conclusion

As you can see traditional treatments are the main stay of modern medicine? not necessarily for the patients benefit, but it’s just how the system works best for itself. The system will not change until the system is confronted with a very powerful competitive force. That force may well be complementary or alternative care from the likes of Personal Trainers, Acupuncturists, Massage Therapists, Manual Physical Therapists, and the like.

So that’s what we’ve tried to do? force change. The traditional treatments that people have been receiving for decades just doesn’t work, and we have found a combination approach that not only works the best, but it’s safe, natural, and inexpensive. Check out our “Lose the Back Pain” video now? it will show you how to identify the cause of your back pain and the show you the exact combination of steps to take to eliminate it.

If you have tried other treatments with little or no relief/improvement, you owe it to yourself to try this approach? so take charge of your health and get started now working towards not only a pain free back, but a healthy and balanced body! Only you can fix your back? all you need is the right approach!

Warning: This article is not intended to be medical advice however its intent is to make you a better, smatter and more informed client. The more you know and understand about your medical condition the better off you will be when it comes time to make the hard choices. As well as communicating with medical professionals…. believe me it will make a world of difference.

When you ask what arthritis is, professinals will tell you it’s inflammation of one or more joints. But you know it better as pain, swelling, stiffness, deformity, and/or a diminished range of motion of those joints! It’s estimated that over 50 million Americans suffer from osteoarthritis, rheumatoid arthritis and other related conditions.

Osteoarthritis is the most common form of arthritis. Osteo arthritis seems to come with the wear and tear of aging and affects nearly three-quarters of those over 50. The onset of arthritis is marked by morning stiffness, crackling joints, and perhaps some pain. As it progresses it causes discomfort, more pain, and some disability. It also causes an enormous consumption of painkillers and anti-inflammatory drugs that can have undesirable long-term effects.

If left untreated, osteo and rheumatoid arthritis, along with other forms of rheumatoid disease, can become progressively worse… painful crippling can result. This is particularly true of rheumatoid arthritis, which can destroy joints, unless effective treatment is administered in time.

Modern medicine doesn’t have much to offer for these chronic conditions… offering only symptomatic temporary relief. True, painkillers along with the so-called NSAIDs, non steroidal anti-inflammatory drugs, are effective in reducing symptoms quickly. However,these often cause serious side effects such as ulcers and gastrointestinal bleeding, and they don’t stop the progression of the disease. In the long run they have actually proven to worsen the condition by accelerating joint destruction.

Coping with the chronic pain of arthritis can be frustrating. You get the feeling you’re all alone facing the daily challenges caused by your arthritis symptoms. And, the traditional treatments leave a lot to be desired. It doesn’t have to be this bad!

The last few years of research on arthritis have brought some hope to this dismal picture. Old herbal remedies such as ginger, nettle, and willow bark, as well as fish oils and the already well-known cartilage constituents glucosamine sulfate and chondroitin sulfate, are about to revolutionize the treatment of arthritis. These substances not only give symptomatic relief, but, actually intervene at the root of the arthritis problem and help the body to rebuild functioning joints.

As they quickly sooth your pain, these powerful creams help repair, restore and regenerate cartilage, tendons, muscle and ligaments. Fast acting, these creams increase mobility and optimal repair of joint structures as they help reinforce the body’s protective linings and lubricating fluids by recovering cell stability and function to stop further damage. Really powerful stuff. You can learn more about this non-traditional arthritis treatment at our website.

Tendons are ropes of fibrous tissue that connect muscles to bones. It is this connection that permits joint motion. When muscles contract, they pull on the tendons which cause the bones to move. In order for tendons to glide they move inside a lubricated sheath of tissue that is lined with synovial tissue. This synovial tissue is the same type of tissue that lines the inside of joints. Tendonitis refers to a condition where the sheath through which a tendon glides becomes inflamed. This leads to severe pain. The pain usually gets worse with use of the affected joint. However, when tendonitis becomes severe, there may be pain at rest.

Since muscles and tendons surround most joints, tendonitis is rather common. The diagnosis of tendonitis is relatively simple for the experienced clinician. Genrally, the diagnosis is made by history and physical examination. In difficult diagnostic cases, magnetic resonance imaging is helpful in confirming the diagnosis.

Some of the more common types of tendonitis are:

Shoulder tendonitis. The tendons in the shoulder that are most often affected are the rotator cuff and the biceps tendon. The rotator cuff consists of four tendons that sit on top of the upper arm bone. The location of these tendons and the muscles they attach to are what give the shoulder such an expansive range of motion. Rotator cuff tendonitis may occur as a result of repetitive activity or tendon degeneration. Pain is felt with most movements and is located on the outside part of the shoulder. The biceps tendon allows the arm to be flexed at the elbow. Biceps tendonitis also occurs due to repetitive activity and pain is felt in the front of the shoulder. Shoulder tendonitis can be treated successfully with anti-inflammatory medication, physical therapy, and occasionally glucocorticoid injection.

Tendonitis in the elbow is usually located either on the outside and is called lateral epicondylitis or tennis elbow. It may also occur along the inside part of the elbow- medial epicondylitis. This is called golfer’s elbow. Treatment consists of physical therapy, stretching and strengthening exercises, splints, and injections. Rarely, surgery is required.

Tendonitis in the wrist arises because of repetitive motion. A special type of tendonitis, called Dequervain’s tendonitis, is felt on the out side of the thumb. Tendonitis in these areas is managed with glucorticoid injections and immobilization with a splint. Other physical therapy modalities may be helpful. Sometimes surgery is required. Tendonitis in the fingers can lead to catching of the fingers. This is termed “trigger finger.” Trigger finger usually responds to injection but may require operative intervention.

Tendonitis in the knee may affect the patellar tendon. This is the tendon that connects the knee cap to the tibia (lower leg bone). Patellar tendonitis usually occurs because of excessive jumping and is actually called “jumpers knee.” This is treated with rest, anti-inflammatory medications, and physical therapy.

Tendonitis in the ankle can occur along the outside of the ankle (peroneal tendonitis), the inside of the ankle (posterior tibial tendonitis), or at the back of the ankle (Achilles tendonitis). The tendonitis that occurs along the outside or inside of the ankle can occur because of trauma or because of mechanical instability. Another potential cause is an underlying arthritis condition. Achilles tendonitis often occurs as a result of excessive stress and repetitive trauma. The Achilles tendon is the thick cord at the back of the ankle that connects the heel bone to the calf muscle. Treatment involves rest, elevation of the heel to take the tension off the Achilles tendon, and physical therapy. Glucocorticoid injection should be avoided because of the danger of Achilles tendon rupture. Anti-inflammatory medication may be helpful.

Heat has long been used to provide temporary relief of arthritis pain, and is used in many different forms. Contrast baths, whirlpools, electric pads, microwaveable gel packs, hydrocollator packs, infrared lamps, and hot showers are some of the different techniques used. Even warm tap water probably will meet some of your needs for heat therapy at home.

Heat can provide temporary relief of pain and stiffness, and can prepare you for physical activity or exercise. For example, morning stiffness is a common problem for many people with rheumatoid arthritis. Because your body has been still during the night you may need special help to get going in the morning. The following combination of techniques using heat can reduce the length and the severity of morning stiffness:

1. Sleep in a sleeping bag (which helps retain body heat) or with an electric blanket (following the manufacturer’s instructions).

2. Take your aspirin or other anti-inflammatory medication an hour before you get out of bed in the morning. (Keep a few crackers at your bedside to take with the medication to avoid stomach irritation.)

3. Take a warm shower or bath immediately after you get up.

4. Then do limbering-up exercises after your shower or bath while you still feel warm.

Safety is important in choosing the form of heat you use. You should take great care to avoid burns or electric shocks. Heat must be used with much caution on any area of the body with poor circulation or where you cannot feel heat or cold normally. It should not be used over areas where your skin is fragile or broken.

Only mild heat is necessary to get results. You are aiming for a temperature just slightly above body temperature, and you do not have to apply heat for a long time. You will get full benefit by using heat for 20 minutes each time.

Moist heat is any technique in which water is used to conduct the heat, such as a bath or shower or hydrocollator packs. People with arthritis prefer moist rather than dry heat, such as a heating pad. Moist heat penetrates more deeply than dry. You will have to try both and see which is more effective and convenient for you.

Heating pads are available which provide either moist or dry heat, but they should be chosen and used with care. Make sure the pad is approved by the Underwriter’s Laboratory. Look for those which have temperature control switches; those without temperature settings get hotter and hotter until you switch them off.

When using a pad, never lie on top of it and make sure you do not fall asleep while it is on. Severe burns can result! It may be wise to use a timer during the treatment. Check the instructions on use carefully. Regularly inspect the pad for any cracks in the plastic cover.

Hydrocollator packs are canvas bags containing silicone gel which retain heat for a long time. You can buy them in different shapes at pharmacies. Some people like them because they lose heat more slowly than most wet compresses. The pack is heated in water, wrapped in 8 to 10 layers of heavy toweling and placed over the painful joint.

The pack is heated in a large pot of water and placed on heavy towels. Place the surface with the thickest layer of toweling over the part to be treated.

Keep in mind that hydrocollator packs do have drawbacks. They are not practical if heat is needed for several joints, because each pack can be used for only one part at a time. They are also cumbersome to use and may be too heavy placed over a painful joint. If your hands are affected by your arthritis, it may be difficult for you to remove the heavy pack from the water with the tongs. So you may need help. Again, you must be very careful about burns. If you decide to try such a pack, follow the manufacturer’s instructions carefully.

Microwaveable gel packs are popular. Follow the instructions carefully or else the bag containing the gel may leak? or even worse explode and cause serious burns!

Physical therapists sometimes use melted paraffin as a means of applying heat, particularly to the hands. There are units available for home use as well. Because they involve high temperatures, paraffin baths should be used with caution. Patients with osteoarthritis or rheumatoid arthritis involving the hands often find paraffin to be helpful.

You can buy nylon and spandex gloves which can reduce morning stiffness of the hands for some people when worn at night. The gloves are available in both men’s and women’s sizes.

It is important to wear adequate, warm clothing in cold weather. Some people find that knitted, woolen or fleece pullover cuffs on painful joints, especially the knees, ankles and elbows are helpful in keeping the joints warm and more comfortable in cold weather.

Some people with arthritis find that heat does not help them. In fact, the reverse is often best-cold compresses. Cold may be especially effective when active inflammation produces severe pain and joint swelling. Only trying different modalities will enable you to find out which is best for you.

It is easy to make a cold pack by filling a small plastic bag with a few ice cubes. A bag of frozen vegetables wrapped in a towel can be used. Place any cold pack over the painful joint with a layer of terry cloth toweling in between. The same precautions that apply to the use of heat should be observed when using cold. The maximum benefit is achieved in less than 20 minutes. You may wish to repeat this application several times a day.

For many people with arthritis an effective approach is alternating warm and cold water applications, a process called contrast baths. It is most useful for a hand or foot which can be dipped in a large pot filled with water. If you decide to give it a try, use a thermometer to check temperatures.

1. Fill one container 2/3 full with 110 degree F water.
2. Fill a second container 2/3 full with 65 degree F water.
3. Put your hands or feet completely into the warm water for three minutes; then put them into the cold water for one minute.
4. Repeat step #3 two more times.
5. End the treatment with three more minutes in the warm water; then carefully dry the hands or feet.

“As an arthritis specialist, one area that I see people complain about more often than almost any other, is their feet.” So says Dr. Nathan Wei, Clinical Director of The Arthritis and Osteoporosis Center of Maryland. “This is too bad because there are many treatments that can be helpful,” Dr. Wei adds.

The foot is made up of 26 bones and 39 muscles…
The foot and ankle are designed to bear weight. The multiple joints in the feet are capable of adjusting to almost any terrain and the padding in the feet are designed to absorb shock.. The ankle joint allows the foot to move up and down, side to side, and inward and outward (inversion and eversion).

Not All Foot Pain Comes From The Foot!
Careful examination of the low back, hip, and knee should be performed because pain from these areas may affect the foot and ankle. In particular, pinched nerves in the low back can cause foot pain and weakness.

Ankle sprains are common- 25,000 people sprain an ankle every day! The goal of treatment is to relieve pain and prevent instability. Treatment of an acute sprain consists of rest, ice compression and elevation (”RICE”). Exercises to help stabilize and strengthen the ankle should be started.

Arthritis of the ankle may cause recurrent pain and swelling. Pain from arthritis typically is made worse by weight-bearing particularly on uneven ground. What this means is you should try to avoid excessive walking or running on uneven ground. Anti-inflammatory medication and proper foot support can do wonders.

Pain in the ball of the foot has many causes…

• Foot strain occurs when a person “overdoes it.” And the treatment is pretty straightforward. Rest.
• Morton’s neuroma (a benign nerve tumor usually located between the 3rd and 4th toes)
• Tarsal tunnel syndrome (pinched nerve in the ankle)
• Arthritis.

Other common causes of foot pain include:

• Stress fractures may occur after excessive walking.
• Achilles tendonitis causes pain in the back of the heel. Treatment consists of anti-inflammatory medicines, rest, a heel lift, and gentle stretching.
• Plantar fasciitis causes pain in the bottom of the heel. Treatment includes rest, anti-inflammatory medication, heel cup, orthotics, stretching, and local steroid injection.
• Flat foot.

Muscle strengthening exercises and orthotics are helpful. Two other common problems are:

• Osteoarthritis, particularly common in the big toe. The big toe will point out to the side. When bursitis alongside the great toe joint develops, this condition is referred to as a bunion. Treatment involves proper padding and footwear. In extreme cases, surgery is required.
• Neuropathy. This painful condition is particularly common in diabetics. This occurs when the small nerves in the feet are damaged. Symptoms include burning, tingling, and pain in the feet - worse at night.

Well fitted orthotics (arch supports) can alleviate not only foot and ankle pain but pain in the knees, hips, low back, and neck!!

We often take the ability to walk for granted. This ability involves the use of two engineering marvels- our feet and ankles. Because of the tremendous amount of force transmitted to the feet with walking, unique problems may develop. Attention to proper preventative care, i.e., comfortable shoes, sox, hygiene, support, along with proper prompt medical care can really put the brakes on foot pain.

The most common cause of heel pain is plantar fasciitis (plan * tar fash* ee * I * tis). If you experience a sharp pain in your heel when you first step down in the morning, it is most likely due to plantar fasciitis. This type of heel pain may also occur as achiness at the end of the day in the heel or even burning pain in the arch. Plantar fasciitis can be associated with a heel spur, but this is not the cause of the pain. When the long ligament like structure (plantar fascia) on the bottom of the foot pulls on the heel bone over a period of time, a spur is formed. Only 50% of individuals with plantar fasciitis have a bone spur in their heel. The spur will never go away, but the plantar fasciitis will. Plantar fasciitis is typically caused by a new activity, a new pair of shoes, a worn out pair of shoes, a change of routine or change in job. Individuals with flatfeet or abnormal motion in the feet may have a higher chance of developing plantar fasciitis. Once you develop plantar fasciitis, you may find it very difficult to treat.

1. Identify the cause: There is typically a reason for the development of plantar fasciitis, but since the condition is not typically associated with an acute injury it may be hard to remember. Once the cause is identified, try to stop or modify the activity.

2. Decrease aggravating activities: Climbing up and down stairs, walking or running on hills, squatting, carrying heavy items and walking on uneven terrain all place excess stress through the feet. Decrease these activities by asking your spouse, significant other or friend for help with the kids or carrying heavy items. Avoid multiple trips up and down the stairs at work and home. Limit gardening to flatter more even terrain. Stop running and walking for exercise and try biking or swimming. Avoid the stair stepper, the treadmill and the elliptical machine at the gym.

3. Stop running or walking: Keeping up aerobic activity is important and cross training can help. Try biking or swimming. Most walkers hate the stationary bike at the gym, but this isn’t forever. Don’t drop your heel when you bike and try to avoid standing and climbing steep hills if you cycle outdoors. If you participate in spin classes, you may need to modify the class to avoid further injury to the foot. The recumbent stationary bike may place excess stress through the arch because of the position. The classic stationary bike may be more appropriate.

4. Try using an ice massage: Freeze a sports water bottle and place it on the floor. To decrease inflammation and pain in your arch, roll your foot over the water bottle for at least 20 minutes twice a day. Alternate between the frozen water bottle and a heating pad, at 5 minute increments, for 20-30 minutes a day, three to four times a week.

5. Stretch your calf: Before you get out of bed, wrap the towel or belt around the ball of your foot. Pull the foot towards you, keeping your leg straight. You should feel a stretch in the back of the calf, and this will also stretch the bottom of the foot. Stretch your calf throughout the day with the runner’s stretch and spend 5-10 minutes every evening stretching your calf.

6. Take anti-inflammatory medications: Anti-inflammatory medications will help decrease the inflammation that occurs in the fascia as a result of the stress and tearing. Make sure you decrease your activity level and stretch and ice as much as possible during the time you are taking these medications. Otherwise, you may end up only masking the pain. Take the medication with food and stop taking the medication if you experience stomach discomfort.

7. Wear supportive shoes: A supportive shoe will only bend at the toes. This step may seem logical, but many individuals don’t realize that their comfortable shoes lack support and may be contributing to their pain. Test your shoe by taking it, flipping it over and grabbing the toe area and the heel. Attempt to fold the shoe in half. If the shoe bends in half, then the shoe is not supportive. Don’t go barefoot. See the American Podiatric Medical Association’s (APMA).

8. Strengthen the muscles in your feet: Place a small towel on the floor and curl your toes on the towel as you bring the towel towards you. Place marbles on the floor and pick them up with your toes and place them in a bowl.

9. Wear orthotics: Prefabricated orthotics are inserts that fit into the shoe to help control motion in your feet. Controlling abnormal motion in the feet can decrease the stress and help the plantar fascia heal. Soft inserts available at the drug store may be comfortable, but they will not help control abnormal motion. Make sure the orthotics you buy are rigid or stiff from the heel to the ball of the foot.

10. See a podiatrist: If your symptoms persist, make an appointment with your podiatrist. Other treatments include prescription anti-inflammatory medications, steroid injections, night splints, physical therapy, cast boots, shock wave therapy and surgery. Luckily, very few individuals need surgery.

There are many different causes of heel pain, but the most common cause is plantar fasciitis (plan * tar fash* ee * I * tis). If you experience a sharp pain in your heel when you first step down in the morning, it is most likely due to plantar fasciitis. This problem is a result of excess stress through a long ligament type structure (the plantar fascia) in the bottom of the foot. The excess stress causes tearing and results in inflammation and pain. The classic symptoms are pain in the heel at the first step in the morning, or upon rising after long periods of rest. Many will complain of a sharp pain in the heel when they step out of their car or after finishing their lunch break. Other individuals only experience heel pain at the end of the day or during certain types of activity like running, soccer or tennis. The pain may extend into the arch and feel achy at the end of the day.

Individuals develop plantar fasciitis for a variety of reasons. One of the most common reasons for the development of plantar fasciitis is wearing poor quality or worn out shoes. Another common reason is starting a new activity, such as walking or running, after a period of inactivity. Many active individuals develop plantar fasciitis after incorporating hills, stairs or uneven terrain into their training routine. A new job that requires standing all day or switching to a job with a harder surface, like cement floors, may contribute to it’s development. Individuals with flatfeet or excess pronation (rolling in of the feet) may have a natural predisposition for plantar fasciitis. Regardless of how the problem started, the treatment is aimed at decreasing the stress on the arch and decreasing the inflammation.

1. Identify the cause: There is usually a reason for the development of plantar fasciitis, but since the condition is not typically associated with an acute injury it may be hard to remember. The pain may have gradually developed after starting a new training routine, changing the routine, running or walking on a new surface, switching shoes, wearing worn out shoes or starting a new job. Once the cause is identified, stop the activity or modify it.

2. Avoid aggravating activities: Going up and down stairs, walking or running on hills, squating, lifting heavy items and walking on uneven terrain all aggravate this condition. Try to decrease these by limiting the number of times you go up and down the stairs and avoiding hills. If you must squat down, keep the affected foot in front and flat on the ground. Do not lift or carry heavy items including your kids. Use a stroller or have your spouse, significant other or friend carry them.

3. Stop running or walking: Aerobic activity is important to maintain and cross training can help. Try biking or swimming. Most walkers hate the stationary bike at the gym, but remember this isn’t forever. Don’t drop your heel when you bike and try to avoid standing and hills if you cycle outdoors. If you participate in spin classes, you may need to modify the class to avoid further injury to the foot. The recumbent stationary bike may place excess stress through the arch because of the position. The classic stationary bike is more appropriate.

4. Use an ice massage: Freeze a sports water bottle or a juice can and place it on the floor. Roll your foot over the water bottle for at least 20 minutes twice a day. This helps decrease the inflammation in the foot while stretching out the arch.

5. Use a contrast bath: Icing helps decrease inflammation occurring within a 48-72 hour period. To help decrease chronic inflammation, try contrasting between ice and heat. Start with an ice pack on the heel and/or arch for 5 minutes. Switch to a heating pack or a hot water bath for 5 minutes. Alternate between the two for 20- 30 minutes 3-4 times a week. This may be more time consuming than the ice pack alone, but can bring considerable relief.

6. Roll a ball under your foot: Take a tennis ball, soft ball or even a rolling pin and roll your foot over it to help stretch out the plantar fascia. This can be done while watching TV or reading the paper. Rolling the foot over the tennis ball can also be done at work if you have a desk job or during a lunch break. (This should not cause pain. Don’t continue if you have pain).

7. Stretch your calf in the morning: If you have pain in the morning upon waking, place a towel or a belt on your dresser. Before you get out of bed, wrap the towel or belt around the ball of your foot. By pulling the foot towards you and keeping your leg straight, you should feel a stretch in the back of the calf. This will also stretch the bottom of the foot. This is not time consuming or difficult to do, but it does require adjusting to a new routine.

8. Stretch your calf throughout the day: Spend about 5-10 minutes each evening stretching the calf as described above or with the runner’s stretch. To really help keep the calf and the bottom of the foot stretched out, try and stretch for 30 seconds, 10 times a day.

9. Take anti-inflammatory medications: Anti-inflammatory medications, like naproxen or ibuprofen, will help decrease the inflammation that occurs in the fascia as a result of the tearing. You don’t want to mask the pain with these medications. If you decrease the pain with the anti-inflammatory medications but continue to participate in an activity which causes tearing and inflammation of the plantar fascia, you are not healing. Continue resting, icing and stretching while you take the medications. Take the medication with food and stop taking the medication if you experience stomach discomfort.

10. Lose Weight: This is probably the last thing you wanted to hear. In fact, there is a good chance that you have gained some weight since the onset of your heel pain due to a decrease in activity. But, there is no way around the fact that increased weight on the body transmits to the feet. Increasing the stress on the plantar fascia can worsen plantar fasciitis, making it more difficult to treat. Eat smart and try to incorporate aerobic activity which decreases the impact on the feet.

11. Wear supportive shoes: This step may seem logical, but most individuals don’t realize how many shoes lack support. A supportive shoe will only bend at the toes. Test all of your shoes and don’t assume your running shoe is a supportive shoe. Take your shoe and flip it over. Grab the toe area and the heel and try to fold the shoe. If the shoe bends in half, then the shoe is not supportive. Don’t go barefoot. Get up in the morning, do your stretch and then slip your feet in a supportive slipper or clog. See the American Podiatric Medical Association’s (APMA)

12. Try anti-fatigue mats: These mats help to decrease the stress through the heel and add some shock absorption to the floor. The mats can be a great asset for employees who work on a hard surface. You may want to consider them for home if you spend many hours standing in a workshop or in the kitchen. See the APMA’s list of approved anti-fatigue mats at www.apma.org/ seal/sealaccategory.html.

13. Strengthen the muscles in your feet: Place a thin towel on your kitchen floor. Place your foot over the base of the towel closest to you. Bring the towel towards you by curling the toes and gripping the towel as it slides under your foot. Place marbles on the floor and pick them up one by one with your toes and place them in a bowl.

14. Wear orthotics: Prefabricated orthotics are semi-rigid inserts that fit into the shoe to help control motion in your feet. Controlling abnormal motion in the feet can decrease the stress in the plantar fascia. Soft inserts available at the drug store may be comfortable, but they will not help control abnormal motion.

15. Try a night splint: A night splint holds the foot at 90 degrees while you sleep. This keeps the foot and the calf stretched out all night long. Night splints are an effective treatment, but can be quite uncomfortable. Some individuals have more luck with the sock night splints than with the rigid splints. These devices are available online, but may be covered by your insurance when dispensed by your doctor.

If your symptoms persist, see a podiatrist.