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Tuesday, January 10, 2012

Email Advice: Calf Atrophy, Bunions, Foot Swelling

This is an email I just received with many interesting points to discuss.

Dr. Blake,

     My name is Robin and I just made an appointment to come in to see you. I wanted to reach out and see if there is anything I can do to help my foot until then.
Here's my situation:

      Last night, I started feeling like I have a splinter in the ball of my right foot, especially when I'm walking, when I press the foot on the floor or when I lift my toes up. I'm nine weeks pregnant and wondering if I perhaps have developed planter faciitis.

      Since April, I also have developed a bit of atrophy in my right calf near my knee that I wanted to get checked out as well (I've had an MRI of it and have been to an orthopedist and the conclusion was that it's just atrophy, possibly from sitting cross legged).

      I also have a bunion developing on my right foot, however, and I believe I also have a bunion developing on the top of my right foot under my big toe so I'm wondering if I perhaps am developing hallux rigidus (I've read that calf atrophy can be a sign of this) or if the atrophy is from my patella femoral syndrome.
Here's a bit about my history: 

     I used to wear orthotics (got them about six years ago) for my patella and one foot being longer than the other (I was in pain at that time and wanted to be able to run again, which I eventually was), but I stopped wearing the orthotics earlier this year when I was worried they were worn out and potentially causing other problems. 

     That's about the time I started developing the calf atrophy. I also have stopped running and doing major aerobic/weight lifting activity (outside of walking) since becoming pregnant so I'm wondering if that is contributing to what's happening with my foot.
     In sum, I'm wondering if there is anything I can do in the next week before I come in to help my foot (I started wearing the orthotics again today). I really appreciate the help and look forward to meeting you.
Best,
 Robin

Dear Robin, Thank you for the email and I look forward to seeing you. 

     1. Plantar Fasciitis tends to feel sore in the am when arising and primarily in the heel, although there are cases of it in the arch, and sometimes in the metatarsal area. Starting using an ice cube to massage the area in circular motion 3 times per day to reduce the swelling. Use can also look on the blog for the rolling ice massage technique with a frozen sports bottle. If there is swelling, use could try contrast bathing (also listed in a separate post) to reduce the swelling once per day. It is a 20 minute soaking process. Because it is an usual place for plantar fasciitis, it is more likely a bone bruise or stress reaction to one of the metatarsals. See the video on the KISS principle in designing a float or accommodation for the sore area. You can go straight to my youtube channel drblakeshealingsole. Check that area in all the shoes you normally wear to see if there is any rough spots. Do you think it is sports related? If you are right handed, and a tennis player for instance, you may pivot across this area more than on the left. Check the wear in old shoes on the shoe insoles to see if this area tends to always wear down faster. Check the skin for signs of the callus, wart, corn, etc.

     2. In regards to the atrophy, it usually a sign of low back disc problems or muscle injury. A neurologist or physiatrist or chiropractor can evaluate this for neurological cause. Since you are pregnant, they will not do a low back MRI. The muscle involved should be weaker than the opposite side. Does it affect strength in any way? Look at the post/video on 2 positional calf strengthening and test the strength of the gastrocnemius and soleus on both sides. See if by doing straight and bent knee heel raises you can can find a difference that can be worked on. Use a tape measure and measure the calf size in the same place below your knee on both sides. See if you can record the difference to use as a reference point. If you have calf atrophy now of unknown cause, we have to assume it may get worse before it gets better. Atrophy can be from lack of use like with pain, or with abnormal function (like produced with hallux rigidus).

     3. I will have to evaluate the bunion area for you. Do you have stiffness in the right big toe joint that is not in the left big toe joint? Do you have a history of pain near your big toe joint? Definitely wear your orthotics as much as possible until I see you to give me an idea how they work and feel for you. Read my posts on what to do for bunions, like toe separators and yoga toes. Definitely the pregnancy could cause some symptoms, but you would think that they would be symmetrical. It will be fun playing Sherlock Holmes, definitely one of my heroes. 

I hope this helps you a little. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.