Ankle condition similar to wrist problem

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DEAR DR. DONOHUE: I walk briskly on a treadmill for a full hour, five or six days a week, and I have been doing this for three years. It has kept the weight off me, and I feel great. About a month ago, I began to feel pain under my right heel. What is it, and what should I do for it? – K.J.

ANSWER: It could be tarsal tunnel syndrome. Have you ever heard of carpal tunnel syndrome, the common wrist problem? It’s due to pressure on a large nerve that passes through the wrist into the hand. The tunnel is made of bones and ligaments. If the tunnel narrows – and it can do so for a number of reasons – pressure is applied to the nerve. The result is pain or numbness in the fingers.

Tarsal tunnel syndrome is the ankle’s equivalent of carpal tunnel syndrome. A large nerve from the leg passes through a tunnel of bone and ligaments in the ankle on its journey to the sole of the foot. Pressure on that nerve due to a constricted tunnel makes for pain or numbness, or peculiar sensations on the sole of the foot and bottom of the heel. The pain often worsens at night.

Mild symptoms are treated with rest. You have to forgo the treadmill for a while. Anti-inflammatory medicines like ibuprofen can help. A padded shoe insert is another way to ease the pain.

If these measures don’t bring relief, a cortisone injection into the tunnel would be the next step.

In extreme cases, surgically releasing the nerve from the pressure in the tunnel is necessary.

There are many conditions that cause pain on the bottom of the heel. Inflammation of the tough tissue that attaches to the heel bone and spreads out toward the toes is a common source of pain. That’s plantar fasciitis. I am not positive of your diagnosis, so if the matter doesn’t resolve itself quickly, see the family doctor.

DEAR DR. DONOHUE: My son is an excellent golfer. He is right-handed. I noticed that his right shoulder blade was sticking out. I had a doctor-friend look at my son, and he said that the boy has serratus anterior syndrome. Would you explain this for us, and is there anything besides rest to treat it? – J.B.

ANSWER: The serratus anterior muscle is a thin sheet of muscle that is attached to the ribs in the front of the chest. It sweeps around the side of the chest to insert on the border of the shoulder blade. That border is the edge of the shoulder blade, close to the middle of the back.

One action of this muscle is to keep the shoulder blade close to the chest wall.

Injury to the nerve that supplies this muscle causes the shoulder blade to swing outward.

Rest is the prescribed treatment. Nerves take a long time to heal, so your boy should not expect to play golf this summer. If the boy cannot move his shoulder blade closer to his chest within a few weeks, take him to an orthopedic doctor for a confirmation of the diagnosis.

DEAR DR. DONOHUE: I am a newcomer to the world of exercise. I have joined a health club. During my first visit, the instructor had me doing sit-ups with my hands on my chest. When I watch others doing this exercise, I see their hands in various positions. Which is the best place to hold them during this exercise? – O.W.

ANSWER: As a novice, keep your hands flat on the floor alongside your body. With the hands in that position, the sit-up is as easy as it gets. When you can do three sets of 10 sit-ups, then move your hands to your chest. That increases the difficulty of the exercise. When you’ve mastered the sit-up with hands on chest, move them to behind your head. Having the hands in that position provides the greatest intensity to the exercise.

If you want to go further, you can do sit-ups with hands holding a light weight behind the head.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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