Jaw Pain: Is It TMJ Disorder?

Jaw pain can be irritating and persist for a long time. You can't eat properly and you can't laugh out loud. If you have jaw pain on only one side, it can be due to the problem within the joint (temporomandibular joint - TMJ) or other structures around the joint.

TMJ is a joint that is involved in opening and closing our mouth. You can locate the joint by placing your finger directly in front of your ear and then open and close your mouth. The movement you feel is your TMJ in action.

       Temporomandibular joint

The problems within the TMJ that cause pain may arise from the joint itself, the bones that make up the joint, and the surrounding muscles/tendons. It is simply referred as TMJ disorder. In most cases, the joint is "damaged" and becomes sore and stiff due to various reasons. These reasons are usually associated with overuse or "abuse" of the TMJ, such as:

• habitual teeth grinding
• habitual fingernails biting
• excessive gums chewing
• always chew on one side
• misaligned teeth
• open the mouth too wide frequently
• aging of joint (arthritis)

This is the pure TMJ disorders and the pain is usually felt when you use your TMJ such as opening your mouth. When you do not move your mouth, there is usually no pain. The pain may be worse when you open your mouth after a long period of time resting it. Sometimes you can feel the clicking sound from the TMJ when you open your mouth. It can also be accompanied by headache, giddiness or ear pain.

As the causes of these TMJ disorders are overuse/abuse of the TMJ, you should identify the reason and try to correct or avoid it. Rest your jaw by avoid excessive chewing, chewing hard food or opening the mouth too wide. Cold & heat application and some regular jaw exercise by opening and closing your mouth gently may help to prevent stiffness and improve the pain.

The pain can improve and diminish within few days or weeks but sometimes it can last for months or years. You should seek advice from your doctor if in doubt.

However, if you have recent serious trauma or injury to your face, then the pain at TMJ could be due to fracture of the bone or dislocation. In this case, you should see your doctor for a scan.

Other reasons that can cause pain around the TMJ include:

• Toothache or tooth abscess - in this case the pain is usually persistent and accompanied by swelling around the area or fever. The pain may be worse when you knock on the problematic tooth. See a dentist if you suspect this.

• Ear infection - pain is usually persistent and may be aggravated by moving the jaw, as the external canal and middle ear are just next to the TMJ. Associated symptoms include ear discharge, hearing loss and tinnitus (ringing sound). A check into the ear by your doctor can confirm this.

• Headache - headache can cause pain around the TMJ area, but usually you will have pain at other area of the head too.

• Trigeminal neuralgia - this nerve disorder can cause severe pain that mostly originate from the jaw area and radiate towards your forehead, nose and chin. Touching the face may make the pain worse.

Of course there are other causes of jaw pain which are not mentioned here. You should consult your doctor if you think that the jaw pain is not a pure TMJ disorder.

Children With Foot Pain At Night: Growing Pain?

It is very worrying for parent whose child suddenly wakes up in the middle of the night crying and complaining of leg or foot pain, and it recurs few other nights. Young children may not describe the pain and locate the pain accurately, this makes the parent even more anxious.

It's not easy to diagnose leg/foot pain in children. The most important thing to do is to rule out serious illness or disorder associated with the pain.

There is a condition often referred to "growing pain", which is completely harmless and is a diagnosis of exclusion. The typical features for a growing pain are:

• Pain in foot or leg (one or both sides) mostly occurs at night only
• Occurs intermittently and not on every night
• Pain lasts for few minutes and the child can go back to sleep
• No swelling, redness over the pain area
• Not worsening by touching/pressing the pain area
• Completely well in the morning, without pain and limping

By using our common sense, if it is something more serious, it should be:

• Pain during both daytime and night time, almost everyday
• Pain getting worse and worse with time
• There is swelling or redness at the pain area
• The child resists someone from touching the pain area
• The child has other symptoms other than pain
• The child has limp and discrepancy in leg length

There are a few conditions to consider for foot or leg pain in children

Injury (bony fracture, ligament sprain, muscle strain)

• does the child has recent fall or trauma?
• pain exists all day long, not just night time
• there can be swelling, skin lesion and especially pain to touch
• limping is likely

Arthiris (juvenile idiopathic arthritis)

• typically having morning stiffness 
• commonly affects more than one joint
• can occur in any body parts
• pain may continue in daytime
• may have swelling in the joints
• may have other symptoms such as fever & skin lesion

Tumour (benign or cancer)

• pain during day and night time, though typically worse at night
• pain wosening with time
• can feel the swelling in later stage
• may have limp and discrepancy in leg length
• more common on long bones - femur, tibia (not foot)

Kohler's disease

• avascular necrosis of a bone in the foot (navicular bone)
• rare and benign condition
• may have pain during day and night time
• may have swelling

Thus, if your child with foot pain (either one foot or both feet) at some nights and is completely well during the rest of the day, with no swelling or deformity, then it is likely a "growing pain". It is also important to check whether your child has a normal foot arch.

Growing pain is believed to be a muscular pain and more common in age 2-8 years old. Though it is harmless, it is really painful to the child. You can massage or stretch the pain area or apply warm towel to try to relieve the pain. If the pain is intense, analgesics can be given for short term relief. 

However, it is possible that there is actually no pain but the child is just trying to seek parent's attention.

If you are not sure what is happening to your child with foot/leg pain, please consult your doctor. The doctor is likely to ask you the questions above and examine your child. In some cases, an X-ray may be required.

Heel Pain When You Step: Likely Plantar Fasciitis

There are many people complaining of foot pain when they make their first few steps after getting down from bed. If you have this problem, then you may have a condition calls "plantar fasciitis".

Plantar fasciitis is the commonest cause of foot pain or heel pain. The pain is sharp and can be so severe until you can't put your foot on the floor. 

Plantar fascia is flat sheet of ligament that supports our foot arch from toes to heel. When this fascia is inflamed, it will cause pain. There are many reasons for inflammation of plantar fascia, and almost all of them are related to injury to the fascia, especially at the heel area where the pain is commonest.

The injury to plantar fascia is likely to be caused by repeated minor trauma to the foot. The risk factors include

• overweight
• prolonged standing
• frequent walking, running, jumping esp on hard surface or bare-footed
• wearing ill-fitting or inappropriate shoes
• abnormal foot arch
• previous foot injury
• tight calf muscles

In many cases, the cause of plantar fasciitis is multiple factors.

The heel pain is more obvious when you start walking after the foot does not bear weight for some time, such as after sleep or prolonged sitting. It may be worse when climbing stairs or at the end of the day.

Nevertheless, not all heel pain is plantar fasciitis. Sometimes it can be due to other reasons such as foot bone fracture, nerve entrapment, bone pathology etc. Thus, a foot X-ray is sometimes essential when the diagnosis is in doubt.

As plantar fasciitis occurs after prolonged repetitive trauma, it also takes quite a long time to recover, as the damaged ligament takes time to heal. The healing time takes longer because we are unable to rest the plantar fascia completely for it to heal as we still need to walk everyday.

To facilitate healing or to relieve the heel pain, you may take the measures listed below, depends on what your problems are. If you wish to prevent plantar fasciitis before you have it, you may also do these.

• lose weight
• avoid prolonged standing
• reduce exercise intensity (walking, running, jumping)
• avoid exercise on hard surface
• avoid bare-footed on hard surface
• wear proper shoes
• replace worn-out shoes
• put proper shoes in-sole

Other methods to relieve heel pain

• ice therapy (for 15 min/day)
• stretching 
• toe stretching (extend the toes with your hand and hold for 30 sec)
• calf stretching (hands against wall with affected side knee straight & other side knee bend, hold for 30 sec)
• orthoses - custom made shoes or insole
• night splinting - ankle fixed at 90 degree
• medication
• oral anti-inflammatory drugs (NSAIDs, steroids)
• steroids injection
• surgery

The first few methods to do are usually ice therapy and stretching exercise for 6 weeks, apart from those preventive measures. If the pain does not get any better, then you can add in orthoses, night splinting & medication. If nothing works for a period of 12 months, then you may consider surgery.

Study shows that 90% of plantar fasciitis cases can heal within 12 months. It can heal by itself if you give your foot enough chance to rest.