Heel Pain: Stone bruise, Bone Spur, or Something Else?

A great deal of heel pain is attributed to self-diagnosed causes, such as a heel spur or stone bruise, but a more common explanation is an inflammatory condition known as plantar fasciitis. The structure affected, the plantar fascia, is a ligament that connects the heel to the front of the foot and serves to support the arch of the foot The most common symptoms associated with plantar fasciitis are:

• Pain on the bottom of the foot toward the front of the heel.
  
• Pain when taking the few steps after getting out of bed in the morning or after a period of rest such as sitting in a chair.
  
• Heel pain that is worse after, instead of during, exercise or activity.
  

What causes plantar fasciitis? The function of the plantar fascia is to absorb the stress and impact placed on the feet when walking or running. With injury or overuse, the plantar fascia can be torn or damaged. Examples of how this could occur are when someone has to be on their feet for long periods of time while working or when someone is increasing their mileage while training for a marathon. Inflammation, the body's natural response to injury, sets in following the injury, leading to the classic symptoms of plantar fasciitis. Besides activity, other predisposing factors in the development of plantar fasciitis include flat feet, high arches, weight gain, and shoes that lack proper support.

Aren't heel spurs and plantar fasciitis the same thing? Approximately 10% of people with plantar fasciitis do develop heel spurs. These result from calcium deposits related to chronic inflammation. Most people with plantar fasciitis, however, do not have heel spurs, and many people with heel spurs seen on x-ray do not have plantar fasciitis. In any case, treatment of plantar fasciitis is directed toward the inflammation and predisposing factors, rather than toward the spur itself.

How is plantar fasciitis treated? The great majority of people with plantar fasciitis can be treated conservatively, that is, without surgery. The following are the most commonly employed self-care measures:

• Rest. Discomfort should be your guide in this regard. You should decrease or stop activities that are painful. If running causes pain, you may be able to walk or cycle instead. If this is an occupational injury, a temporary reassignment to a job that does not require as much time on the feet may be necessary. 
• Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen, help to reduce inflammation and pain associated with plantar fasciitis. Generally, it is best to take the NSAIDs on a regular basis (2 to 4 times a day depending on the medication) but limit its use to a couple of weeks.
  
• Application of ice helps to reduce pain and inflammation. It is especially beneficial after activity or being on your feet. Typically an ice pack is applied to the heel region for 20 minutes or so. This can be done several times a day.
  
• Heel and foot stretching exercises. Tight hamstring muscles and heel cords often set the stage for the development of plantar fasciitis. Stretches, as described in this link, help to stretch these muscles and tendons, relieving tension on the plantar fascia. Stretching should be started once the pain has begun to resolve and is best performed several times each day.
  
• Silicone heel pads or heel cups can help by cushioning and redistributing pressure over the painful region of the heel. Off-the-shelf arch supports (shoe inserts) may also be helpful, particularly when flat feet have contributed to the development of the fasciitis.

While most people will improve with some combination of the above, a few will require more aggressive treatment. Physician-guided options beyond these self-care measures include: a) cortisone injection in the region of the plantar fascia attachment to the heel, b) iontophoresis, a physical therapy modality that uses electrical current to deliver cortisone to the inflamed fascia, c) nighttime splints that stretch the plantar fascia while sleeping, and d) extracorporeal shockwave therapy that uses high-energy shockwave impulses to stimulate healing of damaged plantar fascia tissue. Surgery to release the plantar fascia is rarely required, and is usually reserved for those in whom the above treatments were unsuccessful.

Pets and our Health--The Good, the Bad, the Ugly: Part 2

Last week we looked at "good" aspects of pet ownership, ways that pets can contribute to our health and well-being. This week, we'll look at animals that many authorities consider to be inappropriate as pets. We'll also consider some of the illnesses that can be transmitted from animals to humans.

The Bad-Inappropriate Pets: According to the American Academy of Pediatrics (AAP), all of these are considered to be inappropriate as pets for kids under age 5:

• Reptiles (turtles, snakes, lizards, iguanas)
• Rodents (hamsters, gerbils, guinea pigs, chinchillas, hedgehogs, prairie dogs, mice, rats)
• Amphibians (frogs, toads, salamanders)
• Ferrets
• Baby poultry (chicks, ducklings, goslings, turkeys)
• Monkeys
• Illegal exotic animals

AAP concerns include the potential for these animals to bite, trigger allergies, or spread disease and infection. Likewise, even though veterinary science is dedicated to the care of all animals, a policy statement from the American Veterinary Medical Association (AVMA) states that it "has concerns about animal welfare, husbandry, infectious diseases, public health and safety, and environmental impacts relative to ownership of wild animal species and their hybrids." A specific concern of the AVMA is that people may find that they are unable to care for a wild species with the possibility that the animal will become neglected or released into the environment.

The Ugly-Human illnesses related to animal contact: The following are illnesses that can spread from infected animals to humans. Fortunately, these diseases occur infrequently, and are more likely to occur from exposure to feral animals or those animals considered to be less appropriate as pets.

Toxoplasmosis is a parasitic disease that is of particular concern in pregnant women. If the disease spreads from an infected mother to her fetus, there is the potential for developmental malformations or miscarriage. Toxoplasmosis can be passed to people from contaminated cat feces, so pregnant women are advised to avoid cleaning cat litter boxes or coming in contact with dirt where cats may have been. Most people who get toxoplasmosis do not get sick, but some people will get swollen glands, muscle aches and feel as though they have the "flu". Others who are more likely to get sick with toxoplasmosis include young children, organ transplant patients, people with HIV/AIDS and people getting treatment for cancer.

Rabies is a rare disease caused by the rabies virus. People think of dog bites being a common method of contracting this disease, but actually, most cases of rabies are due to bites from wild animals, especially raccoons, skunks, bats, foxes, and coyotes. In recent years, most of the cases of human rabies attributed to dog bites in Americans were contracted in foreign countries. The reduced prevalence of rabies in pets can primarily be attributed to mandatory vaccination policies in this country. It can take several weeks for symptoms to develop following exposure, but once they do, the disease is usually fatal. Early signs include fever or headache, which can progress to neurological symptoms such as confusion or agitation.

Cat scratch disease is a bacterial disease that can develop as a result of being bitten or scratched by a cat. Swelling of the lymph nodes, especially those around the head, neck, and upper limbs, is a common feature of this illness. People with cat scratch disease may also develop fever, headache, fatigue, and poor appetite. Kittens are more likely to carry the bacteria, so avoiding any activity that may lead to cat scratches and bites is important in preventing the occurrence of this disease. Cat bites or scratches should be addressed immediately and by washing with soap and water. Should signs of an infection develop (swelling, redness, drainage, etc.) medical attention for the consideration of antibiotic treatment should be sought.

Leptospirosis is a bacterial disease that is spread through the urine of infected animals. Many animals including cattle, pigs, horses, dogs, rodents, and wild animals can harbor these bacteria without showing any signs of the disease. Humans are usually exposed to the bacteria through contact with water, soil, or food contaminated with the urine of infected animals. Initial symptoms in humans include fever, chills, headache, muscle aches, vomiting, and diarrhea.

Salmonellosis is a diarrheal disease caused by the bacterium Salmonella. Salmonella is most commonly transmitted through contaminated food, but it can also be spread by a number of animals including reptiles (turtles, snakes, and lizards), amphibians (frogs and toads), and poultry (chicks, chickens, ducks ducklings, geese, turkeys), "pocket pets" (guinea pigs and hamsters), dogs, cats and birds (including pet and wild birds). This illness, which can include diarrhea, fever, and stomach pain, typically resolves on its own after a week. The best ways of preventing salmonellosis are to avoid handling or touching high-risk animals (e.g., turtles, water frogs, chicks, ducklings, etc.) and to wash hands thoroughly after touching potentially infected animals.

Psittacosis also known as ornithosis or parrot fever is an infection caused by a Chlamydia bacterium. Psittacosis is usually spread by inhaling dust from dried droppings from birdcages and by handling infected birds in slaughterhouses. All birds can potentially carry the bacterium, although pet birds (parrots, parakeets, macaws, and cockatiels) and poultry (turkeys and ducks) are most frequently involved in transmission to humans. Symptoms in humans include fever, chills, headache, muscle aches, and a dry cough with evidence of pneumonia on x-ray. Antibiotics such as tetracycline or doxycycline are often prescribed for treating infected people.

Most people would agree that the benefits of having a companion animal, particularly dogs or cats, far outweigh the potential risks. It is important, however, to understand that some pets are more appropriate than others and that even appropriate pets can harbor disease-producing organisms. Conscientious pet care, including providing all appropriate immunizations, is the best way to minimize the risk of contracting animal-borne diseases.

Pets and our Health--The Good, the Bad, the Ugly: Part 1

The U.S. is a pet-loving country, with around two-thirds of all households reporting owning a dog or cat. To put this into perspective, this amounts to approximately 78.2 million dogs and 86.4 million cats owned by Americans. A cancer specialist affiliated with the Mayo Clinic once noted that "a pet is a medication without side effects…." Indeed there are many ways that pets can contribute to our health and well-being. The following are research-based benefits of pet ownership, broken down into their effect on children, adults, and the elderly.

Children:

• Lowered rates of respiratory disease in children. Children who are around dogs and cats during the first year of life have been shown to have fewer respiratory infections, especially ear infections, than children without exposure to these animals. The strongest protective effect was seen in children whose families allowed their dogs to spend time indoors.
  
  
• Reduced risk of developing allergies. Research has shown that children growing up in a home with a dog or cat are less likely to develop allergies. This also applies to children who live on a farm or ranch with large animals.
  
  
• Improved sense of responsibility. Children who accept responsibility for pet care learn important organizational skills as well as respect for other living beings.

Adults:

• Help with meeting daily exercise recommendations. People who own dogs tend to be more physically active than those who don't. Walking briskly with a dog for 30 minutes a day will help meet the current cardiorespiratory exercise recommendation from the American College of Sports Medicine. By encouraging their owners to walk, dogs can also be a tool for weight loss. As a weight-bearing exercise, walking has the additional benefit of maintaining bone integrity to help prevent osteoporosis.
  
  
• Better blood pressure control. Being around a pet appears to provide a "calming effect" in people with medication-controlled hypertension. One study has demonstrated that the presence of a pet reduces blood pressure rises associated with psychological stress. Another study has shown that borderline hypertension can be controlled with a pet dog, without the need for drug therapy.
  
  
• Enhanced mental health. Spending time with a pet--walking, grooming, and playing--can boost levels of the mood-enhancing brain chemicals serotonin and dopamine. Some psychotherapists "prescribe" pets as a way of dealing with depression. Pets also encourage interaction with others, since most pet owners love to talk about their pets.
  
  
• "Serving" pet owners with medical problems. Service animals are used to assist people with various diseases or disabilities. The best known examples are the specially trained dogs that serve as the eyes or ears for people who are visually or hearing impaired. A "seizure dog" is one that has been trained to bark and alert others that their owner is having a seizure. In some cases, the dog can detect that a seizure is getting ready to occur, giving the person time to lie down or move away from a dangerous place. Specially trained dogs can also assist people with neurological diseases, such as Parkinson's or Alzheimer's disease to help them live more independently. Some dogs are even able to alert diabetics of a sudden drop in their blood sugar in time for them to eat a snack and avoid becoming severely hypoglycemic.

Seniors:

• Easing the effects of bereavement. People with a strong relationship with their pets experience less depression after the loss of their spouse.
  
  
• Improving general health. It has been reported that elderly dog owners visit the doctor less often and require less medical attention for minor health issues as compared to non-dog owners. Older people who walk dogs are more likely than those who walk with a human companion to engage in regular exercise. Improved psychological well-being and higher one-year survival rates following coronary heart disease have also been reported in seniors with companion animals.
  
  
• Assisting in the treatment of Alzheimer's disease. The use of a therapy dog with persons with Alzheimer's disease can result in increased socialization, improved social behaviors, and decreased agitation.
  
  
• Help with feelings of loneliness. Pets promote social interaction and help seniors to become more involved in daily activities and socializing. Many nursing homes have opened their doors for animal visitation with their residents.

While there are numerous benefits to pet ownership, there are drawbacks also. Next week we'll look at the "Bad" and the "Ugly" of pet ownership--animals that should be discouraged as pets and some of the medical issues that can develop as a result of living with animals.