Foot pain contributes around 3-5 % of patients visiting Orthopedic OPD, with heel pain being predominant complaint. Heel pain commonly involves the underside or back of your heel. Although not a symptom of a serious condition, it s disabling as it can interfere with your routine activities.

Plantar fasciitis, Achilles tendinitis, Heel spur, Retrocalcaneal bursitis are few common conditions causing heel pain.

The below few conditions which are prone to developing heel pain like:

Abnormal walking style (gait)/altered alignment of the foot
Obesity
Ill-fitting shoes/ badly-worn shoes
Standing, running or jumping on hard surfaces
Injury to the heel, such as stress fractures
diabetes and arthritis
The most common causes of heel pain are plantar fasciitis (bottom of the heel) and Achilles tendinitis (back of the heel).

Presenting complaints:

Pain which is usually intense in the mornings or after a long period of res,
Discomfort or swelling in the back of your heel
Skin on your heel overly warm to the touch
Burning sensation over heel
Numbness or tingling in your heel
Swelling around ankle etc
Remedies you can try:

Avoid activities that aggravate your heels, such as running, standing for long periods or walking on hard surfaces.
Ice application on your heel for 10-15 minutes at least three times a day.
Well fitting shoes.
Non-steroidal antinflammatory drugs can reduce inflammation and pain
A splint is worn at night
Flexibility exercises
Prevention of heel pain:

Wear a well-fitting & comfortable shoe
Always warm up and cool down when exercising or playing
Silicone insoles
Consult your doctor immediately if, Heel pain persists in spite of home remedies. Try these tips to put Heel pain at rest!

Heel Pain - Effective Ways To Put It At Rest!

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Vaginismus is a condition characterized by significant pain in the vagina generally during sexual intercourse. This pain occurs on penetration due to the contraction of the vaginal muscles.

Causes

The exact cause of Vaginismus is not exactly known to the doctors. But some researchers suggests that the pain might result from severe anxiety or illogical fears before sex.

Vaginismus can be primary or secondary depending on the concerned woman s previous sexual experiences. Vaginismus can be linked to an earlier sexually painful experience, sexual trauma or psychological factors. In some cases, the pain tends to exist without any direct physical cause. The causes of the pain might vary from women to women and might occur in some cases with only one specific partner and not with others.

Sometimes the pain might stem from underlying infections or any other underlying complications.

The symptoms of Vaginismus are as follows:

Severe pain during intercourse.

Severe pain during insertion of tampons or during any medical check-ups.

The following treatments can be useful to treat Vaginismus:

If the pain arises due to anxiety or fear, counselling sessions can help you to a remedy.

If the pain arises whenever something penetrates the vaginal walls, progressive desensitization can be useful to treat the pain. The process aims to loosen the vaginal muscles so that you don t experience any pain during sexual intercourse.

Kegel exercises (at least 20 of them) can help in the initial stage to relax the vaginal muscles. After you exercise for a few days, you should try inserting one finger inside your vagina while doing the exercises. Try doing it gently and if it still hurts, try doing it with a lubricating jelly. This continuous procedure will help in the contraction of the vaginal muscles which eventually relax.

Vaginismus - Things You Should Be Aware of 

Fibromyalgia is a musculoskeletal disorder that is more prevalent among women (in the age group between 25 - 60 years) than men. The condition often results in muscular and joint pain along with extreme tiredness. Further, there may be severe headaches, body stiffness, insomnia or sleeping disorders, high sensitivity to extreme temperatures, abdominal pain, Irritable bowel syndrome and also Fibro Fog ( a condition triggered by Fibromyalgia, whereby an individual is unable to concentrate on anything). In some, the condition can trigger severe anxiety, stress, and depression.

While discussing Fibromyalgia, it is important to mention about the Tender Points or Trigger Points. These are delicate points and areas located throughout the body where even a gentle tap or pressure is enough to cause pain. Some of these trigger points in Fibromyalgia include:

upper chest.
back of the head.
knees.
top of shoulders.
outer elbows.
hips
Some of the common factors that play a significant role in triggering Fibromyalgia are

Stress and Trauma: Fibromyalgia may be an outcome of extreme physical, mental and emotional turmoil (which often creates a hormonal imbalance) or Post-Traumatic Stress Disorder.
Fibromyalgia may be linked to genetics and hereditary. People with a family history of Fibromyalgia are more susceptible to the painful condition.
In some individuals, an autoimmune disorder such as Lupus or Rheumatoid Arthritis can also be a contributing factor resulting in Fibromyalgia.
Acupressure to treat Fibromyalgia

People often opt for Alternative Therapy to treat Fibromyalgia. Individuals with Fibromyalgia benefit immensely from Acupressure. Acupressure is a popular alternative therapy that finds its origin in China. It channelizes upon the use of pressure at certain points in the body to ease the pain. Some of the acupressure points that are often used to relieve the pain, especially related to the Post-Traumatic Stress Disorder, in Fibromyalgia include:

Stomach 36 (ST 36): ST 36 holds great significance in providing a soothing and calming effect in people with extreme stress and anxiety (one of the critical symptoms associated with Fibromyalgia). ST 36 is located in the depression of the tibia (lateral side), at a distance of about four fingers downwards from the patella or the knee. Gently and slowly massaging the point for 3-4 minutes is said to provide great relief.
Ren 17: Another acupressure point that goes a long way to lower the anxiety and physical stress is Ren 17 or the chest center. This acupressure point is the middle of the chest (anterior midline), at the fourth intercostal space from the second rib downwards.
Ear Shen Men: The Ear Shen Men is an important acupressure point in the triangular fossa, at the upper region of the ear. People with physical and emotional stress benefit from this acupressure point.
Pericardium 6: The Pericardium 6 is in the mid arm region (lower and inner part of the arm) between the two tendons at a distance of four fingers from the wrist crease. In addition to a great soothing effect, Pericardium 6 is beneficial for people with nausea.
Yintang: Nothing works more like the Yintang to relieve stress and anxiety. The acupressure point in between the eyes at the eyebrow level.

Role Of Acupressure In Treating Fibromyalgia

Back pain is a common source of pain and can be acute, sub-acute or chronic in nature. Back pain is classified along the segments of the spine and can be divided into neck pain, middle back pain, lower back pain and coccydynia or tail bone pain. Back pain can be quite troublesome as it disables a person to move about freely due to constant ache.

Here are some procedures for the treatment of back pain.

    Give your back some rest: Most people who get back pain become obsessed with it and end up getting MRI scans and x-rays done. Some even take injections and other such measures without recognizing the intensity of the pain. It is advised not to rush into the matter immediately and the simplest way to cure the pain is by resting. 90% of pains in the back resolve by themselves in 6 weeks and so you must give your back a break instead of taking medical actions and let time do the healing.
    Pills: While you let time treat your back pain, sometimes the pain increases and gives you a bad time. In this case, you can take anti-inflammatory medicinal pills such as ibuprofen or naproxen. These pills will help you ease the pain. However, using such pills for a continued period of time causes side effects such as gastrointestinal disorders. Hence, you should not take them for more than ten days at a stretch.
    Hot and cold compress: Apply a bag of frozen peas or an ice pack to the affected area for 48 hours after the pain appears. Every session should be about 20 minutes, and you should take more than two sessions each day. After two days, repeat the same procedure using a heat pad instead of ice. The cooling procedure shuts down your blood capillaries and reduces the flow of blood to that area. The swelling is eased as a result. The heating, on the other hand, loosens tight muscles and increases the blood circulation, providing extra oxygen.
    Change your mattress: People who sleep on firm mattresses and cushions on their beds are at a higher risk of having a back pain. According to studies, it has been observed that people sleeping on medium-firm mattresses have healthier backs. In case your mattress in sagging or is over 8 years old, you should replace it.
    Acupuncture: When your back pain is very severe, you can resort to acupuncture, which provides efficient pain relief. The procedure changes the way your nerves react and reduces inflammation.

Back pain arises from various reasons and should always be taken care of. Unattended back pain worsens and makes the affected person suffer.

Suffering From Lower Back Pain - 5 Ways You Can Treat it

Bursitis is a disorder that is characterized by inflammation of a fluid filled sac called the bursa. Bursa is present in between various tissues such as muscles, tendons and bones where friction may occur. This sac cushions the tissues and prevents friction. The usual areas that are affected by this condition are hip, shoulder and the elbows.

The symptoms of bursitis are:
1. You will experience pain in the affected area
2. Tightness and stiffness in the area
3. Local swelling of the muscle
4. Redness of the area
5. Any physical contact with the area causes pain

Bursitis may also occur due to the following reasons:
1. Ageing results in loss of elasticity of the tendons, thus impairing their ability to tolerate any stressful activity
2. Sports such as baseball where you are required to throw the ball with force may lead to bursitis
3. If you do tasks that require kneeling down on a regular basis
4. Sitting on hard surfaces for extended periods of time
5. Abnormalities such as improperly placed joints
6. Inflammation from other conditions such as gout, thyroid disorders and rheumatoid arthritis may lead to bursitis

Treatment
The condition is treated by using a variety of methods such as exercise and medication. Antibiotics are used to treat any underlying infection causing bursitis. Injections may be administered to reduce inflammation in the affected area along with exercises to strengthen the affected muscle. In severe cases, the doctor may resort to surgery to treat this condition.

Prevention
You may use certain preventive measures to stay clear of bursitis. Some of them are
1. Lift with proper form: If you are lifting something heavy, then make sure you keep the spine straight and bend your knees slightly.
2. Take breaks: Don t remain in the same position for long duration, take small breaks and walk around to release the stress from your legs.
3. Exercise: Do strength building workouts to build strength in the joints. Include mobility and flexibility stretches in your routine to keep your joints healthy, thus increasing the range of motion.
4. Maintain optimal weight levels: If you are obese, then take steps to reduce your weight. Maintain a proper diet to check your waistline.

Bursitis - 4 Ways You Can Prevent it

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