My Heel Is Killing Me… It Hurts So Much… What Is It?

Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better. It’s estimated that more than 1 million persons in the United States suffer from heel pain at any … Continue reading “My Heel Is Killing Me… It Hurts So Much… What Is It?”

Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better.

It’s estimated that more than 1 million persons in the United States suffer from heel pain at any given time.

When a patient complains of heel pain, it must be clarified by history whether the pain is in the bottom of the heel or the back of the heel because the diagnosis and treatment are very different.

Pain in the bottom of the heel is often due to plantar fasciitis (PF). The plantar fascia is a tough band of tissue that begins at the medial (inside) part of the bottom of the heel and extends forward to attach at the ball of the foot. The fascia is responsible for maintaining the normal arch. When an excessive load is placed on the fascia, pain can develop at the origin (the heel) as well as the mid-portion (arch) of the fascia.

PF can develop in anyone but is more common in certain groups such as athletes, people older than 30 years of age, and obese individuals.

PF must be distinguished from other causes of bottom of the heel pain such as nerve entrapment, atrophy of the normal heel fat pad, stress fracture of the calcaneus (heel bone), rupture of the plantar fascia, bone cyst, bone tumor, and bone infection.

The history typically describes a gradual onset of symptoms with no prior trauma. The most telling symptom is severe pain in the bottom of the heel when taking the first morning step. Patients may report difficulty walking to the bath room. The pain tends to lessen with more walking. This “first step” pain is also present during the day if the patient has been sitting for awhile, then getting up to walk.

On exam, pain is noted with pressure applied to the medial bottom of the heel. Tenderness is worsened by pointing the toes and ankle toward the head. This is because the plantar fascia is being stretched. Pain in the arch may also be present.

One in older patients should be ruled out and that is heel pad atrophy. Normally the heel has a thick feeling to it. In older patients the heel pad may lose this thickness and flatten out. The pain is located more centrally.

Another “fooler” is entrapment of the lateral plantar nerve. Pain is felt in the medial heel but may be present at rest as well. There may be weakness spreading the toes.

Fracture of the calcaneus (heelbone) causes pain at rest that is worsened with walking. Tenderness is present along the sides of the heel. Magnetic resonance imaging (MRI) can confirm the presence if fracture.

But what about “bone spurs”? The presence of a bone spur by itself means nothing. They are very common and by themselves are not a cause of pain. Some patients with inflammatory forms of arthritis such as psoriatic arthritis, ankylosing spondylitis, or Reiter’s disease have a specific type of spur that should prompt further evaluation looking for systemic forms of arthritis.

Diagnostic studies such as ultrasound and magnetic resonance imaging can be used to confirm the presence of plantar fasciitis. Electromyography (EMG) may be needed to rule out lateral plantar nerve entrapment.

So how is this condition treated?

The first thing is to institute a stretching regimen. Most people with PF also have a shortened Achilles tendon and the ability to dorsiflex (point the toes up) is limited. The plantar fascia is continuous with the Achilles fascia. Stretching the plantar fascia and the Achilles decreases the tension in the plantar fascia and helps relieve inflammation.

A temporary reduction in activity is important in athletes, particularly runners. Cross training with swimming and cycling can help maintain cardiovascular fitness while sparing the plantar fascia from pounding. Runners should avoid hills and make sure that any foot abnormality be corrected with custom orthotics.

Ice massage with ice cubes applied to the plantar fascia can also be helpful.

Shoes with soft heels and inner soles can relieve discomfort. Rigid heel cups and arch supports are generally not recommended. The patient may gradually resume normal activities over an eight week period of time. Rushing rehabilitation is not advised.

If there is no improvement, a night splint which holds the ankle in 10 degrees of dorsiflexion prevents the shortening of the plantar fascia.

If the night splint fails or the pain does not lessen, injection of glucocorticoid (cortisone) using ultrasound guidance is recommended. Injections should be limited to a maximum of two given over four weeks.

Patients who do not get better need to be reevaluated for systemic disease or other conditions causing heel pain.

Surgery is the last resort. Transverse release of the plantar fascia is the procedure of choice. This can be done using arthroscopic guidance.

Pain in the back of the heel is an entirely different condition.

The major structure here is the Achilles tendon which extends down from the gastrocnemius muscle to attach at the rear of the calcaneus.

Inflammation of the Achilles tendon can occur, usually in athletes or in people in engage in overxuberant physical activity involving running or jumping. Patient who are overweight are also at risk. The pain is usually described as a soreness. There is localized swelling and tenderness. Ultrasound can be used to differentiate an inflamed Achilles tendon from one that is partially or fully torn. The treatment involves anti-inflammatory medicines, physical therapy, and stretching exercises. Glucocorticoid injection is not recommended because of the danger of weakening the Achilles tendon leading to rupture. Using a foam rubber lift to elevate the heel in a shoe can help with symptoms.

Achilles rupture is handled surgically and requires a long recuperation.

Haglund’s syndrome, which is a condition where a spur develops at the back of the calcaneus and is often associated with localized Achilles tendonitis can also cause pain in the back of the heel. Ill-fitting shoes are the most common cause. Typically a bump develops at the back of the heel. Because of its association with ill-fitting shoes, this is sometimes referred to as a “pump bump.” Physical therapy, anti-inflammatory medicines, and stretching can often be of benefit. Glucocorticoid injection should be sparingly employed because of the danger of Achilles rupture. Wearing proper fitting shoes are an obvious adjunctive treatment.

Bursitis involving the retrocalcaneal bursa (the small sack that lies between the Achilles tendon and the calcaneus is a cause of pain behind the heel. Treatment involves the use of physical therapy modalities such as ultrasound. Sometimes glucocorticoid injection may be needed. It is important to limit the injection to one because of the danger of possible weakening of the Achilles tendon leading to rupture. Ultrasound needle guidance is advised to ensure proper localization of the injection.

The diagnosis is made by history and physical examination. Both MRI and ultrasound can be used for confirmation.

ROLE OF REMEDIAL TEACHING

Role of Remedial Teaching

In order to improve mathematics, effective remedial teaching is a must. Let us discuss.

Remedial teaching is not re-teaching. Any remedy however costly or sophisticated is useless unless it cures the disease.

A remedial teacher should have a mentality of a sympathetic doctor who has love and care for his/her patients (students).

A. Identification:

a) Through academic achievement:

i) Class interaction: An under-achiever will give wrong answers frequently to the questions asked. He will appear to be confused. He may probably not respond to the questions asked in the class at all.

ii) Home assignment: An under-achiever will not do the homework. If pressurised to complete the work, he may resort to copying, which may be easily detected.

i)                    Unit tests and term tests: He will show poor performance consistently in tests. He will either not attempt the question(s) at all or, will do cuttings and overwriting. He may even try to copy the solution to the problems from his peers.

b) Through behavioural aspect:

i) Attitude towards academic activities: He will be disinterested in such activities. He will try to refrain himself from such activities. He will try to avoid discussion about academics with his peers or teachers.

ii) Class escapism: He will try to bunk classes for one reason or another. He will give excuses for not attending classes.

ii)                   Fiddle with notebooks instead of studying: He will be found to fiddle with notebooks and books instead of studying.

Once the under-achiever has been identified, the next step is the diagnosis of deficiencies.

B. Diagnosis of deficiencies:

a) Learning of concepts: His concept(s) related to a particular topic or formula is not clear. For example, the difference between 2×2 and (2x)2 may not be clear to him.

b) Computational Skill: He may not be good at computations and thereby may gives erroneous results frequently while performing basic arithmetical operations and simplification.

c) Procedure of solving problem: He is not clear about the procedure of solving problems and so he/she often gets wrong answers.

d) Application of knowledge: He may not be able to apply the learned knowledge in different situations. For example, in word problems, he may fail to translate sentences into equations or identify the variables.

Once, the deficiency has been diagnosed, let us explore the possible causes for the same.

C. Causes:

a) Memory: Individual capacity of memorising facts and figures.

b) Understanding: Lack of comprehension-he does not follow what he reads.

c) Presentation: Finds difficulty in expressing views-vocabulary is not sufficient.

d) Knowledge Gap: Incomplete coverage units in the previous class-long absence.

e) Parental background: Socio-economic status; education

f) Parental attitude: Indifference of parents towards studies; over-expectation.

g) School Based: Lack of suitable equipment and environment in school-overcrowded class.

h) Medium of instruction: Language problem.

i) Physical factors: Poor eyesight; poor audibility; illness and other problems.

j) Individual factors: Good in oral tests but does not prepare notes and does not do home work regularly; not sincere in studies; very anxious but is unable to concentrate on studies; lacks self confidence; inferiority feeling; fear of failure; wants company of students who avoid classes; emotional instability.

k) Teacher based: Lack of confidence in teacher; lack of time at teacher’s disposal; faulty method of teaching; does not encourage student participation in class; inadequate home assignments and problems for practice; improper way of correction of homework and of guidance to students at appropriate time and stage.; knowledge of the subject is not thorough; unable to clarify difficult concept; lacks in expression; unable to provide secure and affectionate climate in classroom and lack of understanding and acceptance for each individual child.

The causes having known let us now discuss about the possible cures and remedies.

D. Cures and Remedies:

a) Category wise remedial-not more than 5 to 10 students in each class.

b) Personal and individual attention by teacher.

c) No humiliation.

d) Special carefully devised UAA (under achiever’s assignment) – Simpler-Simple-Complex.

e) Read-Re-read-Write-Re-Write-Reproduce-Drill.

f) Group studies; group learning.

g) Micro-notes.

h) Teaching selected portion of syllabus only.

I now propose an action plan to be undertaken by a remedial teacher.

THE ACTION PLAN:

Out of two approaches of evaluation in vogue today, i.e. the process approach focusing on the performance of the teacher and the product approach focusing on the performance of the students with regard to specific objectives-here to get high score in the examinations in terms of marks and subject average, the latter is preferred for sure for obvious reasons. This process is based on the principle that what ever the teacher might have done in the class room is irrelevant unless the objective (of obtaining a high score in the examinations in terms of marks and subject average) is achieved. This then is the primary criteria of evaluation of both the teacher and the taught at all levels.

Herein lies the importance of diagnostic and remedial teaching, which is therefore, the primary responsibility of the teacher. This type of teaching involves:

i)                    Diagnosis of the specific difficulty of the student by conducting a suitable diagnostic test.

ii)                   Providing suitable remedial measures

iii)                 Providing ways and means for preventing them from reoccurring in future.

If a teacher is able to do justice to his primary responsibility then it may safely be presumed that the teaching profession has a bright future in store for sure.

For the benefit of teachers in general, I am now suggesting an action plan on these lines:

a)      Be an innovative and imaginative teacher with an open mind.

b)      Apply suitable diagnostic test to identify the weakness of each child.

  1. For this split the topic into several subtopics. For example, a topic in class X Mathematics “Linear simultaneous equations in two variables” –solution of equations can be split as:

i)                    Adding the two equations directly to find the value of the variables.

ii)                   Changing the sign and adding the equations to find the value of one variable.

iii)                 Making coefficients equal and using i) or ii) above to find the value of the variables.

iv)                 Substituting the value of one variable in the equation to find the value of the other variable.

  1. II. . Set at least 20 questions on each subtopic (They should preferably be      knowledge based)
    1. Take a test of each child. One subtopic to be tested at a time.
    2. As far as possible uniformity is to be maintained while evaluating the test.
    3. A student scoring less than 35% marks in this test is surely having difficulty in the subtopic.

c)      Explore the causes of weakness which may be:

i)                    Lack of understanding/misconceptions.

ii)                   Faulty teaching method.

iii)                 Fear of the subject

iv)                 Bad work study habits.

v)                  Physical and emotional factors like poor health, some mental shock etc.

vi)                 Teacher’s attitude.

d)      The cause(s) having been identified, suitable remedial measure (depending upon the cause) should be suggested which may be:

i)                    Re-teaching of the subtopic—should be resorted to only if the student has completely failed to understand the subtopic due to one reason or the other.

ii)                   Computer Aided Teaching—should be resorted to if the student has a vague idea about the subtopic and therefore finds it difficult to answer questions relating to it.

iii)                 Drilling of Problems—Should normally be prescribed to the weak child during examination times. For this the teacher should be able to design an effective study material containing objective questions, knowledge based problems; the practice/drilling of which will cure the weakness.

iv)                 Other Measures:

The work of the teacher does not end here. He/She must ensure that the student continuously practices upon them to ensure that the weakness does not reoccur in future.

To conclude, it may be said that this is indeed a gigantic task with immediate rewards a remote possibility; therefore requires zeal, enthusiasm and a sense of commitment on the part of the teacher to undertake this project.

Last but not the least; the institution has to play a pivotal role to achieve the ultimate objective. The difference between supervised study (study under the supervision of a teacher) and remedial teaching be clearly understood. The supervised study time table be framed in such a way that a teacher should be assigned at least two periods a week in Maths, Science, English and Social Studies (the subjects where maximum weakness is found). The teacher on his part should not just while away his/her time but should perform these activities as suggested above in letter and spirit and then and only then the ultimate objective can be achieved. He/She must remember that if a student fails then: the teacher has failed; the examination system has failed; the evaluation system has failed and by and large the education system as a whole has failed.

All seems well as regards the theoretical aspect of it is concerned. But when we come to its practical aspect we get confused as to what actually we are expected to do during remediation to achieve the desired quantitative result (Quality comes thereafter!). Therefore, until and unless we are clear about it, we cannot expect improvement in the results whatever strategies/action plans we may make/adopt to do so.

I have therefore decided to deal with it in the following pages taking Mathematics as the subject.

Based on my experience, I have noticed that the teachers of mathematics are unable to detect the basic weaknesses of children right from class VI onwards leave aside removing them and continue to teach year after year the topics to them based on the syllabi in-order to complete the same (for obvious reasons).

I have noticed that most of the students suffer from some basic weaknesses which are:

  1. Weakness in basic operations. Its removal will enable the students to negotiate with BODMAS rule thereby making simplifications easy. Algebra should also be easy for him/her as Algebra may be defined as “Arithmetic of unknown quantities”. Given that the student masters basic operations, the Arithmetic/Algebra/Statistics Portion of Mathematics should be easy to deal with.
  2. Weakness in identifying (understanding) shapes: Its removal will lead to an interest of student in Geometry. This will initiate the student to explore the properties of the shape (closed figures) formed by them leading to understanding of Geometry.
  3. Inability to distinguish between area and perimeter: Its removal will enable the student to solve most of the problems in mensuration.

The teachers can device certain worksheets which may be given to the students repeatedly to over-come their specific weaknesses once they are properly and correctly diagnosed on the basis of factors above.

Some tips for using these worksheets:

  1. The work-sheets should be attempted by HB pencil which is easy to erase later on.
  2. Each worksheet is to be attempted in 5 minutes except the last one which should take 15 minutes for completion.
  3. These worksheets are to be given once a week to each student.
  4. The teacher may use these worksheets during the first two months of the session (April and May) to create an interest for mathematics among the students before starting formal teaching.
  5. After the start of the formal teaching, the teacher should diagnose the weakness of the students (topic wise)-by preparing horizontal mark-sheet in unit tests.
  6. Once the teacher is able to diagnose the weakness of the child in a particular topic worksheets may be provided to the child on that topic during remedial periods to bring the child up to the desired level of competency in the topic. Minimum two work-sheets should be provided to each child and the performance in them is to be judged to ensure that the child has attained the desired level of competency in the topic.
  7. Now where and how to obtain these work-sheets?

I give below some guidelines for the teachers on this issue:

GUIDELINES TO OBTAIN WORK-SHEETS:

  1. Every teacher should create an email account (popularly called E-Mail ID).
  2. The teacher should logon to either: www. mytestbook.com or

www. softschools.com.

  1. He/ She will be asked to register.
  2. On clicking on this hyperlink he/ she will be asked to fill up a form.
  3. Finally he/ she will be asked to submit the same.
  4. On clicking the submit button, the registration will be confirmed and the logon information will be supplied on his/ her E-Mail ID.
  5. Thereafter the teacher may use the username and password provided by him/ her at the time of filling up the form for logon in future.
  6. It is an absolutely free account!
  7. Once the logon is successful, you should opt for automatic work-sheet generator and lo! You are provided with the variety of topics on which work-sheets may be generated.

8.  Click on the desired topic and obtain hundreds of worksheets.

How Does Dyslexia Affect Your Life?

Dyslexia in adults is more common then most realize, and it can have a number of significant impacts on a person’s life. For example, students often struggle the most with the condition. Dyslexia can take its toll on a student, and there are a number of effects that can occur.

For example, dyslexia can affect perception. While reading, it may appear to a person suffering with dyslexia that the letters on a page are dancing. Although to some this might seem “cool,” it can be the cause of very bad headaches. It also means that the person will usually give up reading, which is vital to learning.

Concentrating on anything can also be a difficult task. Memory problems also occur and it is often difficult for someone to be able to retain recently gathered information. Restlessness is also a common problem associated with dyslexia.

Obviously, spelling is significantly hampered. It can be a nearly impossible task to use right parts of speech, grammar and correct punctuation. Anyone who has suffered or is currently suffering from dyslexia can agree that the most difficult task is reading. Words that are spelled and look similar often get mixed up.

There are many other effects that occur from having dyslexia, and some are not as common as others. For example, someone might suffer from time management, have a hard time in writing down notes, and their handwriting can also be very poor.

Even though dyslexia is a common problem and it is widely researched and studied, there are still many misconceptions about the medical condition. It is a common problem for those that don’t understand the condition to consider those that suffer from it to be less intelligent or dumb. This becomes a very serious problem as it destroys any self confidence that the person with dyslexia might have. They often become depressed, and feel rejected and different from others.

Even though there are so many negative impacts of dyslexia, those that suffer from it often are advanced in other areas such as creativity. Most that have dyslexia are very creative and many have become famous for their creative ideas and personality. Many present their ideas in the form of images instead of text. They can often think in terms of pictures and have an amazing imagination. With the proper support, love, and care they can often excel to unimaginable heights.

As stated earlier, much study has been given this medical condition. It has been suggested that the brain of a dyslexic person functions differently. Obviously, the part of the brain that helps the person read is diminished. If you suffer from dyslexia it is highly recommended that you take an adult dyslexia test. The sooner the condition is diagnosed and treated, the better the chances of success in treatment are.

How to Get Rid of Gallstones without Surgery

How to get rid of gallstones without surgery.

When you consult your doctor about symptoms like persistent pain in the upper abdomen and pain in the stomach, if gallstones are confirmed after diagnosis, he will ask you to go in for surgery. Don’t panic, for one can get rid of gallstones without surgery and with home remedies.  Read on to know more about ‘how to get rid of gallstones without surgery’.

Gallstones are formed when bile gets trapped in the gallbladder and turn into pieces of stone-like material. Indigestion problems, nausea and vomiting, yellow skin and white of the eyes turning yellow and clay-like stools, accompanied by dark colored urine may also indicate formation of gallstones.

Being of female species, excess cholesterol, obesity, excess estrogen, being over 60 years and fasting are the causes of gallstones. Conventional or improvised home remedies can cure cholesterol, pigment and mixed stones which contain 80%, 20%and 20-80% of cholesterol respectively.

How to treat Gallstones without Surgery

Eat nuts and vegetables and avoid junk food and cut down on carbohydrates. One can have coffee and should drink 8-10 glasses of water every day. Retain healthy diet and do exercises regularly.

You will be able to pass stones on the third day if you drink apple juice for two days and take a mixture of fresh squeezed lemon and dark olive oil (3ounces each) on the second day night. Apples and citrus food contain Pection which helps fight this problem. Quebra Pedra, the herb can be taken in the form of tea to get relief.

Nature has all cures

Every one knows but rarely approaches nature for a cure .If you allow nature,she can dissolve stones in gallbladder .

Understanding Skene's Duct Cysts In Women

Understanding an illness is the first step towards conquering it. A woman needs to know the symptoms, effects, and treatment of an illness she’s afflicted with. Cysts in the reproductive system of women are one of the rare illnesses of which they should be aware.

Gynecologic cysts are cysts that grow in any part of the woman’s reproductive system like the uterus, cervix, and vagina. Cysts are closed sacs containing a gelatin-like material that grow separately from the surrounding tissues.

Skene’s duct cysts are cysts located in the Skene’s glands also called periurethral glands. This type of cyst develops because of obstructions in the ducts to the Skene’s glands due to infection.

The Woman’s Skene’s Glands

Skene’s glands are also called lesser vestibular glands and periurethral glands. They are located around the opening of the urethra on the upper portion of the vaginal area. These glands are composed of soft tissues connected to the clitoris. They are involved in sexual stimulation. During sexual arousal, blood fills these glands.

The Symptoms of Skene’s Duct Cyst

Small cysts may be asymptomatic, but large Skene’s duct cysts have symptoms. Urine may be retained resulting in urinary tract infection. When the urinary tract is infected, a woman with this condition may find herself having a frequent and pressing need to urinate. She may also feel severe pain when urinating. Also, she may find it hard to start urination. During urination, urine may drip onto the vaginal area. All these happen because the cyst blocks the flow of urine towards the urethra. Skene’s duct cysts may result in abscesses that are soft, causing pain and inflammation. With this condition, a woman may have fever. A woman who has a Skene’s duct cyst may also experience pain during sexual intercourse, which is technically called dyspareunia.  

The Diagnosis of Skene’s Duct Cyst  

Skene’s duct cysts may be detected during pelvic examination. In pelvic examination, the doctor may feel the cyst especially if the cyst is large enough. When a woman complains of the symptoms such as pain during urination or during sexual intercourse, this may lead to the diagnosis of Skene’s duct cysts. The images of Skene’s duct cysts maybe seen by using the method of ultrasonography. Cytoscopy or the insertion of a viewing tube may also be used for diagnosis.  

The Skene’s Duct Cysts Treatment

If the size of the cyst is small and it has no symptoms, treatment may not be necessary. However, if cysts are big and cause symptoms like pain in urination, it may be necessary to perform surgery or doctors may make a tiny cut on the cyst in order to remove the semisolid contents of the sac. Sometimes Skene’s duct cysts are big enough to cause discomfort. In this case a surgery in an operating room setting is needed to remove the cysts. These cysts sometimes swell and cause the formation of abscess. In this case, the doctor may recommend the use of antibiotics for several days. When the swelling disappears, the cyst is surgically removed.