The plantar fascia is made up of 3 distinct parts: the medial, central, and lateral bands. The central plantar fascia is the thickest and strongest section, and this segment is also the most likely to be involved with plantar fasciitis. In normal circumstances, the plantar fascia acts like a windlass mechanism to provide tension and support through the arch. It functions as a tension bridge in the foot, providing both static support and dynamic shock absorption.
Training on improper, hard and/or irregular surfaces as well as excessive track work in spiked shoes, or steep hill running, can stress the plantar fascia past its limits of elasticity, leading to injury. Finally, failure in the early season to warm up gradually gives the athlete insufficient time for the structures of the foot to re-acclimate and return to a proper fitness level for intensive exercise. Such unprepared and repeated trauma causes microscopic tearing, which may only be detected once full-blown plantar fasciitis and accompanying pain and debilitation have resulted. If the level of damage to the plantar fascia is significant, an inflammatory reaction of the heel bone can produce spike-like projections of new bone, known as heel spurs. Indeed, plantar fasciitis has occasionally been refereed to as heel spur syndrome, though such spurs are not the cause of the initial pain but are instead a further symptom of the problem. While such spurs are sometimes painless, in other cases they cause pain or disability in the athlete, and surgical intervention to remove them may be required. A dull, intermittent pain in the heel is typical, sometimes progressing to a sharp, sustained discomfort. Commonly, pain is worse in the morning or after sitting, later decreasing as the patient begins walking, though standing or walking for long periods usually brings renewal of the pain.
Most patients with plantar fasciitis describe a sharp or stabbing pain on the bottom of the heel that is most severe when they first get up in the morning or after a period of resting. Some may feel like the heel is bruised while others may describe tightness or even a pulling sensation on the heel or arch.
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose plantar fasciitis. Occasionally, further investigations such as an X-ray, ultrasound or MRI may be required to assist with diagnosis and assess the severity of the condition.
Non Surgical Treatment
Careful attention to footwear is critical. Every effort should be made to wear comfortable shoes with proper arch support, fostering proper foot posture. Should arch supports prove insufficient, an orthotic shoe should be considered. Fortunately, most cases of plantar fasciitis respond well to non-operative treatment. Recovery times however vary enormously from one athlete to another, depending on age, overall health and physical condition as well as severity of injury. A broad period between 6 weeks and 6 months is usually sufficient for proper healing. Additionally, the mode of treatment must be flexible depending on the details of a particular athlete’s injury. Methods that prove successful in one patient, may not improve the injury in another. Early treatment typically includes the use of anti-inflammatory medication, icing, stretching activities, and heel inserts and splints. Cortisone injections may be necessary to achieve satisfactory healing and retard inflammation. In later stages of the rehabilitation process, typically after the first week, ice should be discontinued and replaced with heat and massage.
In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.
Plantar fasciitis, also called “heel pain syndrome,” affects approximately 2 million people in the United States each year. Plantar fasciitis can come on gradually as the result of a degenerative process or sudden foot trauma. It can appear in one heel or both. It is generally worse on taking the first few steps in the morning or after prolonged sitting or non-weight-bearing movement. Symptoms can be aggravated by activity and prolonged weight bearing. Obesity, too, is hard on the feet-it can cause plantar pain or it can make that pain worse. The plantar fascia connects the calcaneal tubercle to the forefoot with five slips directed to each toe respectively. Other conditions, such as calcaneal fat pad atrophy, calcaneal stress fracture, nerve entrapment, and rheumatoid arthritis may also cause foot pain. These conditions may be found in combination with plantar fasciitis, or separate from it. A blood test can help pinpoint the cause(s).
There are several possible causes of plantar fasciitis, including wearing high heels, gaining weight, increased walking, standing, or stair-climbing. If you wear high-heeled shoes, including western-style boots, for long periods of time, the tough, tendonlike tissue of the bottom of your foot can become shorter. This layer of tissue is called fascia. Pain occurs when you stretch fascia that has shortened. This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning. If you gain weight, you might be more likely to have plantar fasciitis, especially if you walk a lot or stand in shoes with poor heel cushioning. Normally there is a pad of fatty tissue under your heel bone. Weight gain might break down this fat pad and cause heel pain. Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts. It can also occur with a change in exercise surface or terrain, or if your shoes are worn out and don't provide enough cushion for your heels. If the arches of your foot are abnormally high or low, you are more likely to develop plantar fasciitis than if your arches are normal.
Patients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. In less severe cases, patients may only experience an ache or stiffness in the plantar fascia or heel that increases with rest (typically at night or first thing in the morning) following activities which place stress on the plantar fascia. These activities typically include standing, walking or running excessively (especially up hills, on uneven surfaces or in poor footwear such as thongs), jumping, hopping and general weight bearing activity. The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with this condition may also experience swelling, tenderness on firmly touching the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.
Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.
Non Surgical Treatment
About 80% of plantar fasciitis cases resolve spontaneously by 12 months; 5% of patients end up undergoing surgery for plantar fascia release because all conservative measures have failed. For athletes in particular, the slow resolution of plantar fasciitis can be a highly frustrating problem. These individuals should be cautioned not to expect overnight resolution, especially if they have more chronic pain or if they continue their activities. . Generally, the pain resolves with conservative treatment. Although no mortality is associated with this condition, significant morbidity may occur. Patients may experience progressive plantar pain, leading to limping (antalgic gait) and restriction of activities such as walking and running. In addition, changes in weight-bearing patterns resulting from the foot pain may lead to associated secondary injury to the hip and knee joints.
In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.
It is not always possible to prevent heel pain, but there are measures you can take to help avoid further episodes. Healthy weight. Being overweight can place excess pressure and strain on your feet, particularly on your heels. This increases the risk of damaging your feet and heels. If you are overweight, losing weight and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet can be beneficial for your feet. You can calculate your body mass index (BMI) to find out whether you are a healthy weight for your height and build. To work out your BMI, divide your weight in kilograms by your height in metres squared. A BMI of less than 18.5 means that you are underweight, 18.5-24.9 means that your weight is healthy, 25-29 means that you are overweight, 30-40 means that you are obese, over 40 means that you are morbidly obese. You can also use the BMI healthy weight calculator to work out your BMI. Healthy feet. You should always wear footwear that is appropriate for your environment and day-to-day activities. Wearing high heels when you go out in the evening is unlikely to be harmful. However, wearing them all week at work may damage your feet, particularly if your job involves a lot of walking or standing. Ideally, you should wear shoes with laces and a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.
The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to insert into the deep, short transverse ligaments of the metatarsal heads, dividing into 5 digital bands at the metatarsophalangeal joints and continuing forward to form the fibrous flexor sheathes on the plantar aspect of the toes. Small plantar nerves are invested in and around the plantar fascia, acting to register and mediate pain.
When the foot moves, the plantar fascia stretches and contracts. Plantar fasciitis is caused by the repetitive overstretching of the plantar fascia. If the tension on the plantar fascia is too great, this overstretching causes small tears in the plantar fascia. This in turn causes the plantar fascia to become inflamed and painful. Factors that contribute to the development of plantar fasciitis include having very high arches or flat feet, gender, while anyone can develop plantar fasciitis, it tends to occur more commonly in women, exercises such as running, walking and dancing, particularly if the calf muscles are tight. Activities or occupations that involve walking or standing for long periods of time, particularly on hard surfaces, wearing high heeled shoes or shoes that do not offer adequate arch support and cushioning, being overweight, additional weight increases the tension on the plantar fascia, poor biomechanics, extra tension is placed on the plantar fascia if weight is not spread evenly when standing, walking or running. Some cases of plantar fasciitis may be linked to underlying diseases that cause arthritis, such as ankylosing spondylitis.
Symptoms of plantar fasciitis include pain in the heel of the foot. Some people complain of a sharp stabbing pain especially with walking. Others describe the pain as a dull ache after prolonged standing. The pain of plantar fasciitis is often worst in the morning or following activity.
Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.
Non Surgical Treatment
In general, plantar fasciitis is a self-limiting condition. Unfortunately, the time until resolution is often six to 18 months, which can lead to frustration for patients and physicians. Rest was cited by 25 percent of patients with plantar fasciitis in one study as the treatment that worked best. Athletes, active adults and persons whose occupations require lots of walking may not be compliant if instructed to stop all activity. Many sports medicine physicians have found that outlining a plan of “relative rest” that substitutes alternative forms of activity for activities that aggravate the symptoms will increase the chance of compliance with the treatment plan. It is equally important to correct the problems that place individuals at risk for plantar fasciitis, such as increased amount of weight-bearing activity, increased intensity of activity, hard walking/running surfaces and worn shoes. Early recognition and treatment usually lead to a shorter course of treatment as well as increased probability of success with conservative treatment measures.
More invasive procedures to treat plantar fasciitis are usually sought only after other treatment has failed to produce favorable results. Corticosteroid injections deliver medicine into the injured fascia to reduce pain. However, this treatment may weaken the plantar fascia and result in further damage. In addition, extracorporeal shock wave therapy (ESWT) is a treatment where sound waves are sent through the damaged tissue in order to stimulate the damaged tissue and encourage healing. This method is relatively new in treating plantar fasciitis and your doctor will be able to tell you if it is the right method for you. Lastly, surgery is the last option for those suffering from chronic or severe plantar fasciitis.
Orthotics are shoe insoles, custom-made to guide the foot into corrected biomechanics. Orthotics are commonly prescribed to help with hammer toes, heel spurs, metatarsal problems, bunions, diabetic ulcerations and numerous other problems. They also help to minimize shin splints, back pain and strain on joints and ligaments. Orthotics help foot problems by ensuring proper foot mechanics and taking pressure off the parts of your foot that you are placing too much stress on. Dr. Cherine's mission is to help you realize your greatest potential and live your life to its fullest.
Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.
On the other hand, the surgical hip pain treatment includes total hip bone replacement surgery. Although it is always advisable to consult the doctor if you experience pain in the hip that lasts for more than a couple of hours, you can try some home remedies to temporarily get rid of the sharp hip pain. One should note that these home remedies are not to be substituted for proper medical treatment. Ice packs and cool compresses are helpful to ease pain and inflammation on various parts of the body. Rest and ice the sole of your feet.
Junctional Epidermolysis Bullosa: A condition that causes blistering of the skin because of a mutation of a gene which in normal conditions helps in the formation of thread-like fibers that are anchoring filaments, which fix the epidermis to the basement membrane. Kanner Syndrome: Also referred to as Autism, this is one of the neuropsychiatric conditions typified by deficiencies in communication and social interaction, and abnormally repetitive behavior. Kaposi's Sarcoma: A kind of malignancy of the skin that usually afflicts the elderly, or those who have problems in their immune system, like AIDS. For example, a year of perfect health is regarded as equivalent to 1.0 QALY.
OUCH! Foot pain is a typical problem suffered by any ages of adults. Today, getting with the day is difficult enough; painful feet will just make it tougher. If you discover yourself with foot discomfort when attempting to accomplish your everyday routine, you could desire to check out arch supports. If you are on your feet for extended periods of time, you require a pair of shoes that is pleasing to your feet Absence of arc support can bring about fallen arcs and too much artificial arch can cause just as much discomfort as having not nearly enough arc support. So, what is the very best arc support? The plantar fascia supports the bones of the heels and keeps the arch of the heel. The heel stimulates is a bony projection that leads away from the plantar fascia into the surrounding tissues of the body. More commonly than not, heel stimulates and plantar fasciitis together trigger sharp discomfort in the foot The serious foot pain experienced by you, when you put your weight on your foot , while taking first action, is since of the heel spur poking into the surrounding living mass of tissues, nerves, tendons and muscles. Your physician may recommend you to take an X-ray of the feet to spot the heel stimulate. I bought Erin a pair of hot pink Vibram Fivefingers and put her on an extremely gradual buildup on the treadmill during the winter of 2010-2011. All was going really well – she was running pain-free on the treadmill, and she didn’t seem to be having much trouble adapting to the minimal shoes. This was very encouraging to both of us. Symptoms initially begin as burning, sharp shooting pains and temperature changes from feet feeling very cold to burning hot. As peripheral neuropathy progresses, the symptoms may travel up your legs and muscle weakness and lack of coordination may set in. Eventual complete numbness may result. At the modern world, it is fashionable to choose high heel shoe. However, you should remember that high heels or the shoes with little or no arch support may be the actual reason for your feet's pain. It can hurt your feet. So always use at least 3 orb 4 pairs of shoes that are designed to the cushion your foot bed and alleviate the pain. Pushing the bed while she frowned and prodded the side of my foot , eye couldn't assist sensation foolish. Below eye was, having my feet pummeled to deal with a problem at the other end of my body. Was eye severe? Treating foot pain can be as easy as regulating a walking and standing patterns. Perform these moderate exercises in minutes daily at home. Make sure you have good appropriate shoes, dry socks, and insoles are simple and basic necessities to stop many of the common ailments like joint pain , fungus, and dry feet from occurring. Whenever the pain is still severe after a couple of days, and there bruises or darkness and discoloration is visible in the affected area immediately seek out a doctor's help. Foot pain , at most time isn't grave or life threatening yet can be severe if not given proper attention and treatment in time. Just about all fantastic starting ideas for your current first skin icon. These areas usually are simpler to tattoo mainly because your skin layer is usually tight. The actual more tightly the skin, the better the needle penetrates and the a shorter time it takes to do your tattoo. The placement of the body image within these places can even alter the pain level. Within the arm and leg have looser skin and are commonly a lot more sensitive, a lot of these regions can also take a little more time. This technique aims at easing the pain in the coccyx area. The anal lock can also be used as a treatment for other conditions such as pain in the lumbar and the sacral area, sacral iliac discomforts as well tailbone pain. The exercise involves the person gently contracting his anal sphincter muscle tissue. Then hold the contraction for about 10- 12 seconds, without resulting in discomfort. Then release the contraction as you exhale. That is one round, go for about 3-5 as you begin; later on you should aim at 10-15 rounds several times a day. Pain in the foot is one of the most common problems experienced by people at some time or the other in their life. There are several causes of foot problems or foot pain and the pain in foot is usually observed in the toe, top of the foot or the heel region. Here we will see more on the causes of pain on top of foot in detail. All the causes of pain on top of foot can be treated effectively with the help of physical therapy, medications or surgery. One is advised not to ignore the symptoms but consult the doctor and get the condition treated immediately. Take care! Water conservation is a must these days because even if it is abundant, this is something we have to pay for as reflected in the water bill. Just like electricity and gas, this may go up or down on a monthly basis so you should know the different ways to save money for this utility.
To get lower back pain relief, we can use the spine more consciously with our internal awareness instead of using the back unconsciously and not paying attention to it. Merely honing in on the present feelings of your spine while your doing an activity begins the process of lower back pain relief. Really feel your whole spine from bottom to top and top to bottom when you move. As you move, feel both sides of your back. Does your left side or your right feel different or the same? When you feel your spine, can you feel the front side of it, the side closer inside of you? Injury that occurs to your discs, ligaments and muscles are the most common causes of lower back pain. When you experience back pain, your body tries to compensate by using different muscles to perform the same daily activities, and this can often strain other muscles, compounding your pain and injury. Over time, an untreated injury can make you more prone to further injury or back problems. Inversion tables are gaining a lot of popularity these days in homes and clinics all around the world. Everyone from athletes to weekend warriors to recreational golfers are resorting to this contraption for comfort, pain relief and just all around well-being. The relationship between good posture and good health is a vital part of everyone's life. The spinal column protects all of our nerves. Improper positioning or stress for a prolonged period of time puts pressure on the nerves, causing pain in the back, neck and shoulders, head and even arms. Many different types of support products are available to help alleviate painful posture problems. As a last resort, surgery may be necessary, especially if pain is radiating down the back of the leg, or if you feel weakness on one side. This could mean that the spinal nerves are compressed. You will find various other forms of other prescription drugs that may be used, even though there isn't robust evidence that indicates they might help. These medications incorporate anticonvulsants, Botox injections shots, and Pain -killer or anabolic steroid shots. It should also be observed that drugs that work for many patients may well not always work for other individuals. In the event you haven't discovered any modify after getting specific medications in excess of a long period of time, it would be greatest to tell your doctor to ensure another medication could be approved to suit your needs. If you are suffering from upper back pain, with or without chest pain. Pay attention to any other symptoms. Do you have shoulder, arm or jaw pain accompanied with the back pain? What about your heart rate. You may feel an irregular heart beat. This is very noticeable for many people who experience it. You can feel your heart beating erratically. You may also feel your pulse and feel irregular and missed beats. Don't wait to make an appointment with your doctor if you are feeling this kind of pain, because you could be having a heart attack. Conventional health care practitioners are quick to prescribe medications like non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and even opioids for chronic pain. But even if these medications can provide immediate back pain relief, their effect is only temporary – the pain will come back sooner or later and in some cases will cause hyperalgesia, or increased sensitivity to pain! One of the best tactics to help treat back pain is to see a qualified chiropractor. I am an avid supporter of the chiropractic philosophy, which puts great emphasis on your body's innate healing wisdom and does not rely on “Band-Aids” like drugs and surgery. The golden rule is to get up and walk around every 15-20 minutes. When on a long drive, get out of the car, walk around, stretch you limbs after every two hours. While driving, the back of the car seat should not recline beyond 30 degrees and ideally the seat bottom should be tilted up slightly in front. The modern-day stress epidemic is another factor since back pain can be psychosomatic. Stress/emotional problems both cause back pain and aggravate any existing pain. Yoga and meditation sessions are effective in such cases. When lifting any kind of object, whether they are heavy or light, you must use the correct lifting technique. When you are lifting objects, always bend at your knees and not with your back, also try to keep the object as close to you as possible to prevent you from lifting away from your body. Never twist or turn your back at any time while lifting. If for any reason you are taking medication for pain, try to use this sparingly as it will not help any problems you have with your back, but will only hide the pain, while any warning signs may go unnoticed. The first essential of stretching is knowing how to stretch. The most common stretch is called an isometric stretch. This is where you hold the muscle in a state of tension for about a minute. However this is the least effective way to stretch if you have back problems. IT takes too long to do and is less effective at reducing muscle tension. For example, if you have neck pain , it can be caused by your lower back being tight. The same applies for your lower back , it may be caused by your muscles in the lower leg and postural changes have occurred which allows lower back pain If you are experiencing back pain that eases when you sit down and lean forward, you could have spinal stenosis. This condition can cause pain in other parts of your body, including your feet. Inversion tables are fitness devices that allow users to position their feet at a higher elevation than their head. The body can even be suspended fully upside-down on some units. While the health benefits of inversion tables are often debated, some users believe these devices help with back pain and other health issues. To find the best inversion table, consider factors such as price, storage, quality and comfort before making your purchase.
Afflicted toe -nail soaked in vinegar aids in preventing the infection from increasing and propagation inside the claw Relax the claws in the vinegar solution vinegar and (hot water in equivalent proportion) for 20 minutes. Make sure to remove claws and well the feet with a clear and dry towel. This would be achieved twice-daily before symptoms disappear. For a softer and exfoliating effect, an apple-cider vinegar is advised. It will help soften the skin and be rid off at the same time and take away the dead skin cells while allowing the fungus to become attained. Toe deformities are often congenital, occurring for example, in some people with muscular dystrophy. People with high arches, or those who have a tendency to rotate their feet inward while walking are susceptible to deformities of the toes, as are those with rheumatoid or osteoarthritis and people with diabetes. Proper evaluation is the first step in understanding toe deformities and the problems they present. Seeking early evaluation for disorders of the toes and feet is always a good choice, and can make a significant difference in controlling the condition. Contact us Essentially a person is said to have claw toes, if his/her toe is contracted at the middle and end joints. This can lead to severe pain and pressure. Caused by the tightening of the ligaments and tendons that curls down the toe joints. Except for the big toe , other toes can be deformed into a claw toe Based on the mobility of toe joints, claw toes are classified by flexibility. They are broadly categorized as flexible and rigid. In case of a flexible claw toe , the joint has the ability to move and can be manually straightened. Corns are sometimes the result of another common foot deformity that affects the little toe – hammertoe or claw toe This deformity occurs when the joint of the little toe becomes permanently contracted. It is often caused by high heels or narrow-toed shoes that force the toes into a bent position. If the toes remain in this position consistently, the joints and bones of the toes become permanently affected. The deformity can either be flexible or rigid, with a rigid deformity being much more difficult (if not impossible) to reverse. Note any hyperkeratosis over the joint, ulcers, clavi (dorsal PIPJ, metatarsal head ), adventitious bursa, erythema, or skin breakdown (2). All families and all cats are unique. After educating myself, I decided not to declaw my cat. The possibility of my cat living in pain, unable to stretch her muscles, or experience a change in her personality was not worth the risk. Before making a decision that could affect the happiness and well-being of your cat, make sure to educate yourself with all the risks involved and decide whether the benefits outweigh those risks. In Hair Clips Heaven at Ping's Tibet, you can find all kinds of gorgeous alligator hair clips, banana clips, hair clamps, beak clips, claw clips and hair sticks. read more Clots can also be caused by atherosclerotic plaque or fatty build up in your arteries caused by too high levels of cholesterol. The two main carotid arteries that supply blood flow to the brain can become blocked by plaque causing the blood flow through them to be turbulent and slow down, making blood clot formation more likely. * see treatments below This 6 song howl from the depths is out on Criminal IQ Records, Darius’ long-running record label. A tip of the hat is given to former label mates and early naughts Chicago punk destructors, The Functional Blackouts with a blown out, rusty razor take on the F.B.’s classic “Kamikaze”. Use care when trimming the nails — toe nails need to be trimmed in a straight line outside the nail bed, not in a semicircular manner; which may encourage in-growing of the toe nails, a condition where corners of nail burry into the tissue below and may cause sepsis. File the nails to remove any sharp edges. Not to cut the cuticles nor open blisters; rather better to take help of a healthcare provider or podiatrist for seemingly minor problems. Treatment of superficial ulcers (involving only the top layers of skin) usually needs cleaning; removal of dead skin and tissue (debridement) by a healthcare provider. While most toe deformities are a result of poorly fitting shoes, a claw toe is caused by muscle imbalance, and the imbalance may be due to conditions like rheumatoid arthritis, polio, neuromuscular disorders, a stroke or other conditions. A claw toe is a toe that is contracted at the middle and end joints and can occur in any toe except the big toe. It can lead to severe pain and pressure. The toe curls downward due to tendons and ligaments that have tightened. The top part of the toe rubs against the shoe causing discomfort at the top and the end of the toe. Another time, this comedian also showed a scientific bent. While a friend was showing me an old reel to reel audio tape and how it worked, the cat silently jumped to the table top beside the apparatus, observed it, and slowly extended one paw like a fist, with a single toe and claw sticking out. He stuck that claw inside the moving tape and sent the tape unwinding on the real out into the air. I have not seen such a thing before or since. Despite the popular belief among paleontologists, Troodon has no feathers. In fact, every member of Troodon’s family has naked, scaly skin - characteristic of dinosaurs.