Dancer’s, Let’s Tango: Heel Spurs, Hematoma and Infection

 

A heel spur is a bony overgrowth in the heel and typically forms on the medial side of the calcaneus, or heel bone, on the plantar aspect. It occurs on the tuberosity of the bone where the plantar fascia, the sole of the foot’s thick connective tissue, originates.

The cause of a heel spur stems from an abnormal pull of the plantar fascia. As the fascial band pulls, fibers start to tear off the attachment in the calcaneus. The body compensates by filling these tears with new bone. It’s also trying to shorten the stretch on the plantar fascia by shortening its distance. The pain from a heel spur is from the formation of new bone. Bursitis, also referred to as inflammation, forms or nerve entrapment occurs. A fully formed heel spur usually becomes asymptomatic and takes years to accumulate. Pain can be severe during this period.

Heel spurs are usually associated with a complete syndrome that includes bursitis and plantar fasciitis. If the initial treatment of plantar fasciitis incorporates the use of elastic tension and compression to secure the fascia ligament and stop it from pulling of off the calcaneous then pain, inflammation and developing heel spurs will subside. A foot brace that incorporates elastic tension, compression and cold therapy is the recommended treatment and will resolve approximately 80% of cases within 3 to 6 weeks. Stretching exercises and cold therapy also aid in recovery and help stop the development of painful heel spurs. NSAID medication or a topical analgesic will relieve pain and inflammation as well.

Heel spurs are the result of faulty foot mechanics. Excessive pronation causes the abnormal pulling of the plantar fascia. Securing the fascia ligament from pulling or correctly aligning the feet prevents this abnormal force and within a several weeks the pain will subside and the condition resolve. With proper corrective therapy, surgery is will be unnecessary. Approximately 5% of the population doesn’t respond to conservative measures and will require surgical removal of the bony spur and cutting of the fascia band. For plantar fasciitis that has gone unchecked and for heel spurs that are fully develop consider radial shockwave therapy as a surgical alternative. Resolution with radial shockwave therapy is 77% compared to 78% for surgical removal of spurs.

Dancing will likely stop for at least a few weeks to allow the area to rest. If treated early and properly, however, only a couple of days of dancing will usually will be lost. Certain movements of the foot cause excessive pronation and should be avoided, pliés and lands from jumps involving the heels top the list and are movements to avoid.

A hematoma, or blood clot, is an accumulation of blood in an defined area. A capillary will break, usually because of trauma, repetitive force or friction. The blood spills stays in the area without any external bleeding. The primary area in the foot affected by a hematoma is the toes and toenails. Hematomas in the toes usually occur because of quick stops. The toe and toenail are jammed into the end of the shoe. A dancer in an improperly fitted shoe is more susceptible to this condition as the nail becomes disfigured from the pressure and can be completely lost.

When the accumulation of blood is under the toenail, it’s called a subungual hematoma. Subungual hematomas are extremely painful. Pressure is exerted on the nail bed from accumulation of blood. To stop the pain the pressure must be released. A hole is made in the nail to allow the blood to escape. The pain usually will disappear instantly. Antibiotics and a dry, sterile bandage will prevent infection, dancing may resume immediately following treatment .

Hematomas in other parts of the foot should be treated with heat. Apply heat to the area for 10 to 15 minutes every hour, moist heat works better than dry heat. Protect the area to disperse weight off of the the hematoma, dancing can continue without any interruption unless pain persists. Prevention is easier than treatment Keep nails cut shorts and even and make certain to cut nails straight across without cutting the sides. Aways wear properly fitted socks and footwear.

Infections of the foot are caused by bacteria. The bacteria enters through a break in the skin. Once infected, the area will appear red, hot, and swollen, and pus may be present. Elevated body temperature is common as white blood cells battle the bacteria. Infections around nail beds and on the plantar aspect of the foot are especially painful, they can easily cause loss of dance time due to pain.

Infections are also very dangerous as bacteria can spread up the ankle into the leg and through the entire body. This condition is called ascending cellulitis, leading to a septic condition, or blood poisoning. Infections caused by foreign bodies are especially dangerous. Tetanus, for example, is life threatening and because of the frequency of barefoot dancing, tetanus immunization is particularly important for dancers.

Immediate attention is necessary for any infection. Soaking with Epsom salts and warm water as well as topical antibiotics applied to the area and covered with a dry sterile dressing. An oral antibiotic should be taken to prevent further spread of infection. An incision and drainage is necessary to allow the area to heal. If the infection is caused by an offending nail particle or foreign body it will need to be removed, relief will be immediate. A return to dancing will take a day or two.

The corner of a nail can grow into the skin, causing an ingrown nail. Any pressure across an ingrown nail will elicit pain, if the nail punctures the skin, an infection will develop called paronychia.

Ingrown nails are caused by improper or ill-fitted footwear. This causes pressure on the nail plate and changes the normal growth of the nail. Cutting nails incorrectly is another leading cause of ingrown nails. Cutting into the corner of the nail can leave an edge that grows into the skin, always cut nails straight across and soaks nails with warm water and Epsom salts.