What Is Plantar Fasciitis

Overview

Plantar fasciosis is pain at the site of the attachment of the plantar fascia and the calcaneus (calcaneal enthesopathy), with or without accompanying pain along the medial band of the plantar fascia. Diagnosis is mainly clinical. Treatment involves calf muscle and plantar soft-tissue foot-stretching exercises, night splints, orthotics, and shoes with appropriate heel elevation. Syndromes of pain in the plantar fascia have been called plantar fasciitis; however, because there is usually no inflammation, plantar fasciosis is more correct. Other terms used include calcaneal enthesopathy pain or calcaneal spur syndrome; however, there may be no bone spurs on the calcaneus. Plantar fasciosis may involve acute or chronic stretching, tearing, and degeneration of the fascia at its attachment site.




Causes

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.




Symptoms

Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.




Diagnosis

Your doctor may look at your feet and watch the way you stand, walk and exercise. He can also ask you questions about your health history, including illnesses and injuries that you had in your past. The symptoms you have such as the pain location or when does your foot hurts most. Your activity routine such as your job, exercise habits and physical activities preformed. Your doctor may decide to use an X-ray of your foot to detect bones problems. MRI or ultrasound can also be used as further investigation of the foot condition.




Non Surgical Treatment

Check your shoes to make sure they offer sufficient support and motion control. They should bend only at the ball of the foot, where your toes attach to the foot. This is very important. Avoid any shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither should a shoe be designed to do this. You may also strengthen the muscles in your arch by performing toe curls or "doming". Toe curls may be done by placing a towel on a kitchen floor and then curling your toes to pull the towel towards you. This exercise may also be done without the towel against the resistance of the floor. Plantar fasciitis is usually controlled with conservative treatment. Besides surgery and cortisone injections, physical therapy modalities such as electrical stimulation and ultrasound can be used. Often the foot will be taped to limit pronation. Following control of the pain and inflammation an orthotic (a custom made shoe insert) can be used to control over-pronation.






Surgical Treatment

The most dramatic therapy, used only in cases where pain is very severe, is surgery. The plantar fascia can be partially detached from the heel bone, but the arch of the foot is weakened and full function may be lost. Another surgery involves lengthening the calf muscle, a process called gastrocnemius recession. If you ignore the condition, you can develop chronic heel pain. This can change the way you walk and cause injury to your legs, knees, hips and back. Steroid injections and some other treatments can weaken the plantar fascia ligament and cause potential rupture of the ligament. Surgery carries the risks of bleeding, infection, and reactions to anesthesia. Plantar fascia detachment can also cause changes in your foot and nerve damage. Gastrocnemius resection can also cause nerve damage.




Prevention

The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. Take care of your feet. Wear shoes with good arch support and heel cushioning. If your work requires you to stand on hard surfaces, stand on a thick rubber mat to reduce stress on your feet. Do exercises to stretch the Achilles tendon at the back of the heel. This is especially important before sports, but it is helpful for non-athletes as well. Ask your doctor about recommendations for a stretching routine. Stay at a healthy weight for your height. Establish good exercise habits. Increase your exercise levels gradually, and wear supportive shoes. If you run, alternate running with other sports that will not cause heel pain. Put on supportive shoes as soon as you get out of bed. Going barefoot or wearing slippers puts stress on your feet. If you feel that work activities caused your heel pain, ask your human resources department for information about different ways of doing your job that will not make your heel pain worse. If you are involved in sports, you may want to consult a sports training specialist for training and conditioning programs to prevent plantar fasciitis from recurring.

What Can Cause Pain In The Heel To Flare Up

Overview

Plantar fasciitis is a condition that causes heel and arch pain through inflammation on the bottom of the foot. The part that’s inflamed (swollen) is actually the plantar fascia, which is the connective tissue or ligament that stretches from the base of the toes, across the arch of the foot, and inserts into the heel bone. This painful condition can interfere with your daily activity and severely decrease your quality of life.




Causes

You are at a greater risk for developing plantar fasciitis if you are overweight or obese. This is due to the increased pressure on your plantar fascia ligaments, especially if you have sudden weight gain. Women who are pregnant often experience bouts of plantar fasciitis, particularly during late pregnancy. If you are a long distance runner, you may be more likely to develop plantar fascia problems. You are also at risk if you have a very active job that involves being on your feet often, such as a factory worker or a restaurant server. Active men and women between the ages of 40 and 70 are at the highest risk for developing plantar fasciitis. It is also slightly more common in women than men. If you have foot problems, such as very high arches or very flat feet, you may develop plantar fasciitis. Tight Achilles tendons (the tendons attaching the calf muscles to the heels) may also result in plantar fascia pain. Simply wearing shoes with soft soles and poor arch support can also result in plantar fasciitis. Plantar fasciitis is not caused by heel spurs. A heel spur is a hook of bone that can form on the heel bone (calcaneus) of the foot. One out of every 10 people has a heel spur, but only one out of 20 people with heel spurs experience pain, according to OrthoInfo.




Symptoms

The heel pain characteristic of plantar fasciitis is usually felt on the bottom of the heel and is most intense with the first steps of the day. Individuals with plantar fasciitis often have difficulty with dorsiflexion of the foot, an action in which the foot is brought toward the shin. This difficulty is usually due to tightness of the calf muscle or Achilles tendon, the latter of which is connected to the back of the plantar fascia. Most cases of plantar fasciitis resolve on their own with time and respond well to conservative methods of treatment.




Diagnosis

After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.




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.






Surgical Treatment

When more-conservative measures aren't working, your doctor might recommend steroid shots. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective. Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.




Prevention

Preventing plantar fasciitis is crucial. There are many choices to help prevent the occurrence of this condition, and keep it from returning. One of the most important is maintaining a healthy weight in order to reduce tension on the plantar fascia. In addition, shoes are very important, and should fit well and provide ample cushioning and support throughout the heel, arch, and ball of the foot so that weight is distributed evenly throughout the foot. Try to avoid walking barefoot on hard surfaces and replace old shoes before they wear out, especially shoes that you run or exercise in. When exercising, start off slow and ease into new routines to prevent sudden or excessive stress on tissue. Lastly, keep your calf muscles and the tissue of your feet stretched. Greater flexibility in the tissue makes them less susceptible to damage.

What Leads To Heel Discomfort And The Ways To Successfully Treat It

Overview

The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus and runs forward to form the longitudinal foot arch. The function of the plantar fascia is to provide static support of the longitudinal arch and dynamic shock absorption. Individuals with pes planus (low arches or flat feet) or pes cavus (high arches) are at increased risk for developing plantar fasciitis.




Causes

A variety of causes exist for plantar fasciitis. Some of the most common causes include excessive weight load on the foot due to obesity or prolonged standing, mechanical imbalances of the foot, osteoarthritis and rheumatoid arthritis, sudden increase in body weight (e.g., pregnancy), sudden increase in walking or running, tight calf muscles is a very common cause of the disorder, wearing shoes with poor support, including flip-flops. Another cause of pain is the shortening of the plantar fascia overnight due to the ankle bending, causing the toes to point towards the ground. The plantar fascia stretches in the morning when you stand. The act of lengthening it causes a great deal of pain. However, this is not limited to an overnight occurrence, it can happen any time the foot is flexed (i.e., pointed) for extended periods of time. For example, driving in the car for long periods can cause fasciitis in the right foot, which steps on the accelerator.




Symptoms

The condition typically starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs right after getting up in the morning and after a period of sitting. If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity, and you may develop symptoms of foot, knee, hip and back problems because plantar fasciitis can change the way you walk.




Diagnosis

X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more rare problems, stress fractures, bone tumors-are contributing to your heel pain.




Non Surgical Treatment

There are a number of treatments that can help relieve heel pain and speed up your recovery. These include resting your heel, try to avoid walking long distances and standing for long periods, regular stretching, stretching your calf muscles and plantar fascia, pain relief, using an icepack on the affected heel and taking painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDs) wearing good-fitting shoes that support and cushion your foot, running shoes are particularly useful, using supportive devices such as orthoses (rigid supports that are put inside the shoe) or strapping. Around four out of five cases of heel pain resolve within a year. However, having heel pain for this length of time can often be frustrating and painful. In around one in 20 cases, the above treatments are not enough, and surgery may be recommended to release the plantar fascia.






Surgical Treatment

Surgery is rarely used in the treatment of plantar fasciitis. However it may be recommended when conservative treatment has been tried for several months but does not bring adequate relief of symptoms. Surgery usually involves the partial release of the plantar fascia from the heel bone. In approximately 75% of cases symptoms are fully resolved within six months. In a small percentage of cases, symptoms may take up to 12 months to fully resolve.




Prevention

Every time your foot strikes the ground, the plantar fascia is stretched. You can reduce the strain and stress on the plantar fascia by following these simple instructions: Avoid running on hard or uneven ground, lose any excess weight, and wear shoes and orthotics that support your arch to prevent over-stretching of the plantar fascia.

Symptoms Of Black Toenails

If your Mallet Toe feels like a bruise or a dull ache, you may have metatarsalgia People with metatarsalgia will often find that the pain is aggravated by walking in bare feet and on hard floor surfaces. Pain in the ball of your foot can stem from several causes. Ball of foot pain is the pain felt in the ball of foot region. Metatarsalgia is a condition characterized by having pain in ball of foot. The average adult takes about 9,000 steps per day.

U-Shaped portion surrounds sore callus and reduces pain by transferring pressure from callus to the cushion. Soft orthotics cushion the ball and arches of the feet and protect them from injury and pain, while rigid orthotics correct abnormal foot angles and movements that can cause or worsen pain in the ball of the foot. Many insoles fit inside of slippers so that people suffering from pain in the ball of the foot can walk more comfortably inside their homes as well as outside. In addition, some insoles include added deodorizers to help decrease foot odor. While gel or foam insoles are sold at pharmacies, grocery stores and sporting-goods stores, orthotics require a visit to a podiatrist, who will make a cast of the foot and build a custom-fit insole from the cast. Foam, gel and soft orthotics require replacement once a year or more as the cushioning wears out. Rigid orthotics rarely need replacement. Hip bone spur can cause a lot of discomfort.

Pain often occurs suddenly and mainly around the undersurface of the heel, although it often spreads to your arch. The condition can be temporary, but may become chronic if you ignore it. Resting usually provides relief, but the pain may return. Heel spurs are bony growths that protrude from the bottom of the heel bone, and they are parallel to the ground. There is a nerve that runs very close to this area and may contribute to the pain which occurs.

Rheumatoid arthritis causes forefoot deformity and often may cause displacement and even dislocation of the metatarsal joints themselves. Morton's Neuroma can also be a source of metarsalgia and is characterized by pain in the forefoot. Sesamoiditis is located on the plantar surface of the foot and will be located near the first metatarsal phalangeal joint.

Went to Podiatrist after receiving pain pills to move, got MRI and he told me I have severe tear in plantor faciitis tendon. Have swelling or what I call a fatty feeling, as I have always had on ball of foot below left most two toes. And it seems to feel a little more fatty since I walked for the first time today after putting on a good pair of ankle boots. Any idea what the fatty feeling is on ball of foot. Lastly, I took the boot off at my stairs into my house 2 days ago and took a step using ball of left foot and it did not pop.

Common Foot Disorder By Patrick A.DeHeer

If you look at the two x-rays below the one on the left is the preoperative x-ray. The goal of surgery as represented by the horizontal arrow is to move the first metatarsal bone closer to the second metatarsal. The x-ray on the right is the postoperative view and you can see the "tightrope" that has been drilled through both the first and second metatarsal bones and is held together by the black anchors. If any of you reading this section are contemplating having this procedure done, please discuss these potential complications with your surgeon. Bunions are bumps at the base of the big toe, on the outer side of the toe. They form when the big toe turns inward toward the second toe, gradually altering the big toe's skeletal structure, explains the American College of Foot and Ankle Surgeons. The angle of the bone causes a protrusion, and inflammation and pain may result. Bunions can make running particularly painful and difficult. Causes A bunion occurs as a result of a deformity in the big toe known as 'hallux valgus'. This is when the bone inside the foot which joins the big toe becomes displaced outwards and the joint rubs against the inside of footwear. The angle formed between the yellow and green line represents the hallux abductus angle or the deviation of the big toe (hallux) relative to the first metatarsal bones. If this angle is too large there are osteotomy procedures available (surgically breaking and re-aligning bone) to fix this angle as well. The next video demonstrates implant surgery for correction of a bunion. As just mentioned, this is generally done when your doctor determines that the cartilage is too worn out to be salvaged and is then replaced by an artificial joint. This procedure is sometimes performed in conjunction with an osteotomy procedure to realign the metatarsal and toe bones. Adequate physical examination to determine the etiology and specific deformity is necessary for treatment planning. Medical therapy can be used to address its cause, but it cannot change the irreversible cartilage, bony, and soft-tissue adaptations of the deformity. Consequently, most medical therapies are aimed at relieving the symptoms. Surgery to correct the underlying bone deformity may be indicated for bunions that do not respond to conservative treatment. Surgery is recommended if a bunion causes severe pain or if there is neuritis/nerve entrapment, the great toe overlaps/underlaps the second toe, or ulceration is present. Contraindications to surgery include active infection and extensive peripheral vascular disease. Tailor's bunion, also called a bunionette, occurs when the fifth metatarsal bone at the base of the little toe starts to expand outward forming a hard bony knot near the little toe, according to the website Foot Health Facts. This type of bunion is usually caused when pressure is continuously placed on the little toe joint due to a genetic foot abnormality or poorly fitted shoes. Wearing shoes that are too narrow in the toe can aggravate the bunion causing redness, swelling and pain at the site of the enlargement. Treatment usually consists of shoe modification padding, medication icing, corticosteroid injections and/or custom orthotic devices. Acute Bunions

Radiographic Evaluation Of Hallux Valgus — UW Radiology

Please concerned about the slope or tilt angle of high heels. The transition of the slope should fit your feet. Should be gradual over the steepness of the slope, the curvature of the arch to be consistent with the high heels of the arch for arch wear high heels high heels can cause foot pain reduction.Wearing open-toed high heels to reduce pressure stimulation and void corns and calluses. You need to see a doctor if corns and calluses grown, cancel and correct the cause of foot pain with their help. You can choose open-toed high heels to make the release of pressure on the area of inflammation. In medical terms a bunion is known as a hallux valgus deformity. As a bunion develops, the first metatarsal bone begins to angle outward while the great toe, the hallux, moves in the direction of the second toe. This deformity gradually worsens over time. A common misconception is that tight shoes can lead to bunions. In reality, while tight shoes can make a bunion worse, they rarely are the initial cause. If you have a bunion, blame your family. This deformity seems to be inherited. Some people are simply born with a foot type that will develop this problem. A 2-mm incision is made in the medial side of the great toe, approximately 5 mm plantar to the proximal edge of the nail (Figure 1). The wire entrance may be located dorsally when plantar metatarsal head displacement is desired, and plantarly if dorsal metatarsal head displacement is chosen. A second incision is made at the subcapital region of the first metatarsal, equidistant between the dorsal and plantar aspects of the bone (Figure 2). A 2-mm Kirschner wire is inserted retrograde from the first to the second incision (Figure 3). The K-wire must be placed subcutaneously and extraperiosteally to perform the metatarsal head displacement at the osteotomy site. A novel study reports that white men and women of European descent inherit common foot disorders, such as bunions (hallux valgus) and lesser toe deformities, including hammer or claw toe. Findings from the Framingham Foot Study—the first to estimate the heritability of foot disorders in humans—appear in Arthritis Care & Research , a journal published by Wiley on behalf of the American College of Rheumatology (ACR). Measure the severity of the deformity (including any pronation of the great toe) Assess the size of the medial eminence and the state of the overlying skin, especially any evidence of infection A Morton's neuroma is an inflamed nerve that causes pain, tingling and numbness in the ball of the foot. Many complain of a bunched up sock under the ball of the foot, while others complain of walking on a lump, a large pebble or a lamp cord. Some describe a "twang", like a guitar string, in the ball of their foot. read more Fortunately, a bunion splint is available to relieve the pain that bunions cause. Wearing this tool and making some basic changes to your shoes, can help to treat these lumps and prevent them from occurring in the future. You can easily find these splints on the Internet. A bunion, or hallux valgus , is a deformity of the big toe joint. This type of pathology is usually manifested as a “bump” on the inside of the foot just behind the big toe. The bump can be very small or reasonably large; the size of which is not necessarily proportional to the amount of pain one can experience. Along with this bony bump there can be an associated bursitis which is a “cushion” that the body originally creates to protect an area from pressure or friction, but after a while this cushion can also become inflamed and painful. HV angles on radiographic images of 32 patients were first measured using the Pi-View Star software on a digital workstation with these values being set as the reference standard. Two attending orthopedic surgeons, blinded to the computerized measurements, utilized the iPhone running the Hallux Angles application to measure the angles on images displayed on a parallel-positioned computer monitor. Decision-making regarding the myriad surgical options to correct hallux valgus is a complex procedure involving radiographic assessment of standardized angles that define severity. When performed manually, these measurements show a great deal of variability between-and are highly error-prone. Computerized assessment is the current standard, utilizing a software program to calculate the angles. Bunions are painful bony conditions that has an underlying condition called hallux valgus (change in the angle of the fist toe). You can be born with this, or it can develop over time due to improperly fitting shoes or an inflammatory condition like arthritis. It is important to monitor for other foot changes that can develop as well. Knowing the symptoms as well as simple home treatments can help to keep the pain down. Symptoms Jul 26, 2010 By Aubri John Photo Caption Inflammation and pain can accompany various foot disorders. Photo Credit feet in the bath image by Ivonne Wierink from Fotolia.com There is also a condition called tailor’s bunion or bunionette. This type of bump differs from a bunion in terms of the location. A tailor’s bunion is found near the base of the little toe on the outside of the foot. What are the symptoms of bunions? Bunions may be hereditary, as they often run in families. This suggests that people may inherit a faulty foot shape. In addition, footwear that does not fit properly may cause bunions. Bunions are made worse by tight, poorly-fitting, or too-small shoes. Bunions may also happen due to inflammatory conditions such as arthritis. Who gets bunions?

Bunions And Hammer Toes

Today’s diagnosis is Phalangeal Head Resection, better known as, Arthroplasty for the Toe Joint Deformities. Surgeons often use phalangeal head resection to correct hammer, claw and mallet toes. In this procedure, the surgeon actually removes part of the toe bone, the phalangeal head, so the toe can lie flat again. The tendons are cut and then reattached to conform to the new, correct flat toe position. A wire or tape then holds the straightened toe into place until it has healed. when this is the case look for a dynamic deformity, ie., the hammer toe is worse when the patient stands or walks; Bruce told me that he previously had surgery on his good foot but needed a surgery on his stroked foot. He said that the doctors wanted to break two toes and put them back "in the proper way." He wasn't able to have the surgery because he would need to stay off the foot for up to six weeks. For able-bodied people, this would mean the use of crutches or a walker. For Bruce, this was very nearly out of the question. One arm and hand along with one leg and foot were unable to function properly under the best of circumstances. The wedges are often referred to as the 'scoring clubs' as they are used to hot a short shot close to the flagstick. As a beginner a pitching wedge is sufficient and you will definitely want to add the sand wedge to your collection once you get a hang of and become addicted to the game of golf. Machine made from your smooth 303 steel material regarding smooth really feel and appear the new Scotty Cameron Ca Sonoma Golf putter is a school behave. Integrating Scotty's basic layout rules, using its stream-lined vast bodied mallet style brain shape, read more Use bandages, soft foam padding, or silicone sleeve over the affected area to decrease friction on the skin and promote healing with digital clavi. Use of salicylic acid corn plasters can cause skin breakdown and ulceration in patients with thin, atrophic skin; diabetes; and those with vascular compromise. The skin surrounding the callus will often turn white and can become quite painful. Shaving or cutting off hardened area of skin using a chisel or 15-blade scalpel. For corns, remove keratin core and place pad over area during healing. You may now Mix & Match your purchase of items sold with bulk discounts to get a higher level (bigger bag) discount. it has been suggested that pressure on the plantar aspect of the metatarsal heads will cause toe extension in supple hammer toes; if deformity is of recent onset, one can use pads over corns & have patient perform daily stretching of the PIP joint; must be corrected prior to correction of hammer toes (pressure from the big toe is deforming force for hammer toes); it is controversial as to whether the FDL tendon should be exposed, split in half, and transferred around either side of the phalangeal neck; Whether your corns are due to hammertoes, mallet toes, spurs or other bone problems, you do not have to live with them. Do you have any toes that are knocking up against your shoes? This could be due to a mallet toe. Mallet toes can be a result of wearing shoes that are too tight. When they are too small, they allow your toes to bump up against the end of your shoes forcing your toe to push down to allow more room. This means that the joint that is at the end of your toe is bent downward. Since it is bumping up against the end of your shoe, this can cause a great amount of pain. A mallet toe can also be as result of a genetic component. Hybrids are a recent innovation to golf. A hybrid is a combination of an iron and a wood and is an easier to hit alternative to a long iron. Hybrids are versatile enough to be used in any situation. Hybrids come in a range of four lofts - 16 (#2), 19 (#3), 22 (#4) and 25 (#5) Degrees. Hybrids replace their equivalent number long iron, e.g. a #3 hybrid will replace a #3 iron and a #2 hybrid can be used to replace a #5 fairway wood. The Ghost Series offers a variety of options when it comes to head styles and toe hangs. All of which retail for $149.99.