Fascitis plantar y protuberancias óseas (Plantar Fasciitis and Bone Spurs) - OrthoInfo - AAOS (2023)

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La fascitis plantar es la causa más común de dolor en la base del talón. Cerca de dos millones de pacientes son tratados por esta condición cada año.

La fascitis plantar ocurre cuando la banda fuerte de tejido que sostiene el arco de su pie sufre irritación e inflamación.

Fascitis plantar y protuberancias óseas (Plantar Fasciitis and Bone Spurs) - OrthoInfo - AAOS (2)

Anatomía

La fascia plantar es un ligamento largo y delgado que se encuentra directamente debajo de la piel en la base de su pie. Este ligamento conecta el talón con la parte frontal de su pie y da soporte al arco de su pie.

Causa

La fascia plantar está diseñada para absorber la gran presión y esfuerzo que le exigimos a nuestros pies. Pero a veces demasiada presión daña o desgarra los tejidos. La respuesta natural del cuerpo a la lesión es la inflamación, que resulta en dolor del talón y rigidez por fascitis plantar.

Factores de riesgo

En la mayoría de los casos, la fascitis plantar se desarrolla sin una razón específica ni identificable. Hay, sin embargo, muchos factores que a usted lo pueden hacer más propenso a esta condición:

Fascitis plantar y protuberancias óseas (Plantar Fasciitis and Bone Spurs) - OrthoInfo - AAOS (3)

  • Músculos de la pantorrilla tensos que dificultan la flexión de su pie y tiran de sus dedos acercándolos a la tibia
  • Obesidad
  • Arco muy pronunciado
  • Actividad de impacto repetitivo (correr/deportes)
  • Actividad nueva o aumentada

Espolones del talón

Aunque muchas personas con fascitis plantar tienen espolones del talón, estos no son la causa del dolor que provoca la fascitis plantar. Una de cada 10 personas tiene espolones del talón, pero solo una de cada 20 personas (5%) con espolones del talón tiene dolor en el pie afectado. Debido a que el espolón no es la causa de la fascitis plantar, el dolor puede tratarse sin remover el espolón.

Síntomas

Los síntomas más comunes de la fascitis plantar incluyen:

  • Dolor en la base del pie cerca del talón.
  • Dolor al dar los primeros pasos después de levantarse de la cama en la mañana, o después de un largo período de reposo, como después de un viaje largo en automóvil. El dolor cede después de caminar unos pocos minutos.
  • Mayor dolor después del ejercicio o la actividad (no durante).

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Examen médico

Después que usted describe sus síntomas y discute sus inquietudes, su médico le examinará el pie. Su médico buscará estos signos

  • Un arco pronunciado.
  • Un área de máximo dolor a la palpación en la base del pie, frente al hueso del talón.
  • Dolor que empeora cuando usted flexiona el pie y el médico hace presión en la fascia plantar. El dolor mejora cuando usted pone sus dedos rígidos y trata de moverlos hacia abajo.
  • Movimiento "hacia arriba" limitado de su tobillo.

Exámenes

Su médico podría pedir estudios por imágenes para ayudar a confirmar que el dolor en su talón es causado por fascitis plantar y no por otro problema.

Radiografías (rayos X)

Las radiografías aportan imágenes claras de los huesos. Son útiles para descartar otras causas de dolor del talón, como fracturas u osteoartritis. Los espolones del talón pueden verse en una radiografía.

Otros estudios por imágenes

Otros estudios por imágenes, como la imagenología de resonancia magnética (MRI) y el ultrasonido, no se usan de rutina para diagnosticar la fascitis plantar. Rara vez se indican. Una MRI podría usarse si el dolor del talón no se alivia con los métodos de tratamiento iniciales.

Tratamiento

Tratamiento no quirúrgico

Más del 90% de los pacientes con fascitis plantar mejorarán en un plazo de 10 meses de comenzar con métodos de tratamiento simples.

Reposo. Reducir o incluso suspender totalmente las actividades que empeoran el dolor es el primer paso para reducir el dolor. Usted podría necesitar suspender actividades atléticas en las que sus pies impactan sobre superficies duras (por ejemplo, correr o step aerobics).

Hielo. Pasar sus pies sobre una botella de agua fría o hielo durante 20 minutos es efectivo. Esto puede hacerse 3 a 4 veces por día.

Medicamentos antiinflamatorios no esteroideos. Los medicamentos como el ibuprofeno o el naproxeno reducen el dolor y la inflamación. El uso de medicamentos durante más de un mes debe revisarse con su médico de atención primaria.

Ejercicio. La fascitis plantar es agravada por músculos tensos en sus pies y pantorrillas. El estiramiento de sus pantorrillas y fascia plantar es la manera más efectiva de aliviar el dolor que provoca esta condición.

Fascitis plantar y protuberancias óseas (Plantar Fasciitis and Bone Spurs) - OrthoInfo - AAOS (5)

  • Estiramiento de la pantorrilla
    Apóyese hacia adelante contra una pared con una rodilla recta y el talón en el suelo. Coloque la otra pierna por delante, con su rodilla flexionada. Para estirar los músculos de la pantorrilla y el ligamento del talón (talón de Aquiles), empuje sus caderas hacia la pared de una manera controlada. Mantenga la posición durante 10 segundos y relájese. Repita este ejercicio 20 veces para cada pie. Debería sentir un tirón fuerte en la pantorrilla durante el estiramiento.
  • Estiramiento de la fascia plantar
    Este estiramiento se realiza sentado. Cruce su pie afectado sobre la rodilla de su otra pierna. Tome con sus manos los dedos de su pie adolorido y lentamente llévelos hacia usted de manera controlada. Si le es difícil llegar al pie, envuelva una toalla alrededor del dedo gordo de su pie para ayudar a tirar los dedos de su pie hacia usted. Coloque su otra mano en la línea de la fascia plantar. La fascia debería sentirse como una banda tensa longitudinal en la base de su pie cuando se estira. Mantenga el estiramiento durante 10 segundos. Repita 20 veces para cada pie. Este ejercicio se realiza mejor en la mañana antes de ponerse de pie o de caminar.

Inyecciones de cortisona. La cortisona, un tipo de esteroide, es un medicamento antiinflamatorio potente. Puede inyectarse en la fascia plantar para reducir la inflamación y el dolor. Su médico puede limitar sus inyecciones. Múltiples inyecciones de esteroides pueden causar que la fascia plantar se rompa (se desgarre), lo que puede llevar a pie plano y dolor crónico.

Zapatos de sostén y elementos ortopédicos. Los zapatos con suelas gruesas y almohadillado adicional pueden reducir el dolor cuando la persona está de pie y camina. Cuando usted da pasos y el talón golpea contra el suelo, hay una cantidad significativa de presión en la fascia, lo que causa microtraumatismos (desgarros diminutos en el tejido). Un zapato almohadillado o una plantilla reduce esta tensión y el microtraumatismo que ocurre con cada paso. Las almohadillas para talón de silicona suave no son caras y trabajan elevando y almohadillando el talón. También son útiles los elementos ortopédicos (plantillas para zapatos) disponibles comercialmente o hechos a medida.

Fascitis plantar y protuberancias óseas (Plantar Fasciitis and Bone Spurs) - OrthoInfo - AAOS (6)

Las almohadillas suaves para el talón pueden proveer soporte adicional.

Férulas para la noche. La mayoría de las personas duermen con las puntas de sus pies hacia abajo. Esto relaja la fascia plantar y es una de las razones de dolor del talón en la mañana. Una férula para la noche estira la fascia plantar mientras usted duerme. Aunque puede ser difícil dormir con una férula, esta es muy efectiva y no hay que usarla después que desaparece el dolor.

Terapia física. Su médico podría sugerir que usted trabaje con un terapeuta físico en un programa de ejercicios que se concentre en el estiramiento de los músculos de su pantorrilla y la fascia plantar. Además de ejercicios como los mencionados arriba, un programa de terapia física podría incluir tratamientos especializados con hielo, masajes y medicamentos para reducir la inflamación alrededor de la fascia plantar.

Terapia extracorpórea de impulsos eléctricos (ESWT). Durante este procedimiento, impulsos eléctricos de alta energía estimulan el proceso de cicatrización en el tejido dañado de la fascia plantar. La ESWT no ha presentado resultados coherentes y, por lo tanto, no se realiza comúnmente.

La ESWT no es invasiva (no requiere una incisión quirúrgica). Dado el riesgo mínimo involucrado, a veces se prueba la ESWT antes de considerar la cirugía.

Tratamiento quirúrgico

La cirugía solo se considera después de 12 meses de tratamiento no quirúrgico agresivo.

Recesión de los gemelos (gastrocnemio). Este es un alargamiento de los músculos de la pantorrilla (gemelos o músculo gastrocnemio). Debido a que los músculos rígidos de la pantorrilla imponen mayor presión en la fascia plantar, este procedimiento es útil para pacientes que siguen teniendo dificultad para flexionar sus pies, a pesar de un año de estiramientos de pantorrilla.

En la recesión de los gemelos, uno de los dos músculos que forman la pantorrilla es alargado para aumentar el movimiento del tobillo. El procedimiento puede realizarse con una incisión abierta tradicional, o con una incisión más pequeña y un endoscopio, un instrumento que contiene una cámara pequeña. Su médico discutirá el procedimiento que se adecue mejor a sus necesidades.

Las tasas de complicación para la recesión de los gemelos son bajas, pero pueden incluir daños de los nervios.

Liberación de la fascia plantar. Si usted tiene un rango normal de movimiento del tobillo y dolor continuado en el talón, su médico podría recomendar un procedimiento de liberación parcial. Durante la cirugía, el ligamento de la fascia plantar se corta parcialmente para aliviar la tensión en el tejido. Si usted tiene un espolón óseo grande, este también será removido. Aunque la cirugía puede realizarse endoscópicamente, es más difícil que con una incisión abierta. Además, la endoscopia tiene mayor riesgo de dañar los nervios.

Complicaciones. Las complicaciones más comunes de la cirugía de liberación incluyen alivio incompleto del dolor y daño de los nervios.

Recuperación. La mayoría de los pacientes tienen buenos resultados de la cirugía. Sin embargo, debido a que la cirugía puede resultar en dolor crónico e insatisfacción, solo se recomienda después que se hayan agotado todas las medidas no quirúrgicas.

FAQs

Are bone spurs and plantar fasciitis the same thing? ›

But, are heel spurs and plantar fasciitis the same? Long story short, no, they are different issues. The difference between a heel spur and plantar fasciitis is that one is a calcium deposit, or bone growth (spur), and one is inflammation of a ligament.

Can bone spurs cause plantar fasciitis? ›

Since heel bone spurs are not the cause of plantar fasciitis, plantar fasciitis pain can be treated without removing the spur. Heel spurs do not cause plantar fasciitis pain.

Can plantar fascitis last for years? ›

Far from being a permanent or chronic condition, plantar fasciitis typically responds well to treatment. Most people recover completely with a few months of conservative treatment. And, you have lots of options available to you. Many cases of plantar fasciitis respond positively to conservative treatment strategies.

What does a podiatrist do for bone spurs? ›

There are a number of treatments for heel spurs. Your foot doctor may inject the area with cortisol, apply a friction massage, or call for a custom orthotic. A custom orthotic provides cushioning so that the heel spur does not bear weight.

What kind of doctor does bone spurs? ›

You'll likely first see your family doctor, who might refer you to a doctor who specializes in the diagnosis and treatment of joint disorders (rheumatologist). Here's some information to help you get ready for your appointment.

Are bone spurs in feet a disability? ›

Bone Spurs and Qualifying Criteria

Unfortunately, bone spurs do not have their own listing in the SSA's Blue Book. However, you may still be able to receive SSDI or SSI benefits if your case of bone spurs is severe.

What problems can bone spurs cause? ›

These bone spurs can pinch the spinal cord or its nerve roots and can cause weakness or numbness in your arms or legs. Hip. Bone spurs can make it painful to move your hip, although you might feel the pain in your knee. Depending on their placement, bone spurs can reduce the range of motion in your hip joint.

What vitamin is good for bone spurs? ›

Vitamins and minerals are an important defense against bone spurs. If you have osteoarthritis, it is important to make sure you are not deficient in calcium. Since magnesium and vitamin D are essential for the absorption of calcium, you will also want to be sure your levels of these are not low.

Can I get disability for plantar fasciitis? ›

Plantar fasciitis can be both a medical disability and a legally-protected disability that may qualify you for medical treatment, insurance coverage, or disability benefits, depending on a few different factors.

What percentage disability is plantar fasciitis? ›

Ratings For Plantar Fasciitis

40% – Veterans who lose the use of a foot because of plantar fasciitis can be awarded a 40 percent rating under diagnostic code 5167. 30% – Veterans can receive the 30 percent rating for plantar fasciitis that affects both feet and is not responsive to treatment.

What's the longest plantar fasciitis can last? ›

Plantar fasciitis can typically take anywhere from 3-12 months to get better. But how fast you heal depends on your level of activity and how consistently you're using at-home treatments. But again, if you're not feeling relief, don't wait to get care. Make an appointment with a podiatrist.

What autoimmune diseases cause plantar fasciitis? ›

The fact that RA is a chronic autoimmune disease that causes joint pains and inflammation, people diagnosed with RA are more prone to plantar fasciitis. These two conditions are connected because RA makes your joints vulnerable to pain, and the slightest tear may just result in a plantar fascia tear.

What aggravates plantar fasciitis? ›

Activities that can increase the force through your feet and aggravate plantar fasciitis include: Running, walking or standing a lot in unsupportive shoes. Running, walking or standing on hard surfaces like concrete. Carrying a heavy object or gaining weight.

What symptom is very common with plantar fasciitis? ›

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up from sitting.

What happens if bone spurs are left untreated? ›

If left untreated, the pressure on the nerves can lead to complications. Long-term nerve compression can develop into muscle weakness and even loss of function. Pain can also be caused by the bone spurs irritating the surrounding tissues, leading to inflammation and friction.

Can you walk on your foot after bone spur surgery? ›

After surgery, your foot will be bandaged. But you can often walk on it right away. In some cases, you may need to wear a surgical shoe for a few weeks.

Do all bone spurs need surgery? ›

In most instances, removing the spur is not required to alleviate the discomfort, but when necessary, a surgical solution called an osteophytectomy (bone to bone connection) or exostectomy (tendon to bone connection) may be performed.

What is the best treatment for bone spurs? ›

How are bone spurs treated?
  • Ice to reduce swelling.
  • Over-the-counter pain relievers, such as acetaminophen or NSAIDS like ibuprofen.
  • Rest.
  • Supportive shoes or shoe inserts.
  • Weight loss to decrease joint and bone stress.
16 Nov 2020

When should bone spurs be removed? ›

Bone spurs do not require treatment unless they are causing pain or damaging other tissues.

Can bone spurs be cancerous? ›

Trauma, particularly in children—an injury to a growth plate can misalign the plate, which causes a bone spur when it fuses. Certain conditions such as rheumatoid arthritis or Charcot osteoarthropathy. An underlying condition such as cancer in the bone, though most bone spurs are not cancerous.

What deficiency causes bone spurs? ›

Vitamin K2 plays an important role in joint health. When soft tissue or joints are damaged due to injury or stress, the body responds with inflammation and repair. This process can result in scar tissue accumulation and over many years can build up causing bone spurs and permanent damage.

What conditions automatically qualify you for disability? ›

Some of the conditions that may automatically qualify the policyholder for social security disability benefits include:
  • Musculoskeletal system and connective problems including: Arthritis. ...
  • Mental disorders including: ...
  • Cardiovascular conditions and circulatory disorders: ...
  • Cancer.
  • Nervous system and sense organs conditions:

Can I get disability with bone pain? ›

If your joint pain or immobility is severe enough to meet or equal the listing, you will be considered disabled. The listing for major dysfunction of a joint is 1.02. It has 2 parts: A and B. You will meet the listing and be eligible for Social Security disability benefits if you meet either of the two parts.

Can bone spurs cause permanent damage? ›

It's true that when you delay treatment for pain, there's always a risk of permanent irreversible damage. However, it takes time for bone spur symptoms to cause permanent nerve damage. When people are in pain, they don't typically delay medical intervention.

How do you get rid of bone spurs without surgery? ›

Nonsurgical treatments include:
  1. Medications. Medication, such as nonsteroidal anti-inflammatory medications (NSAIDs) and muscle relaxants may be recommended. ...
  2. Short periods of rest. ...
  3. Physical therapy and exercise. ...
  4. Spinal manipulation. ...
  5. Weight loss. ...
  6. Injections. ...
  7. Bone spur removal. ...
  8. Laminectomy.

Do bone spurs keep growing? ›

Over time, a bone spur may continue to grow, leading to painful irritation of surrounding soft tissue like tendons, ligaments or nerves. Bone spurs tend to be most painful at the bottom of the heel due to the pressure of body weight.

What dissolves a bone spur? ›

Although there are lots of supplements that claim to dissolve bone spurs, there is nothing that will make a bone spur go away. If you have a bone spur that is causing symptoms and has not responded to home remedies, the only treatment is surgical removal.

Can Epsom salt dissolve bone spurs? ›

Epsom salt is a natural home remedy. By adding Epsom salt to a small tub of warm water, it is possible to soak feet and relieve some of the inflammation from the heel spurs. It is only necessary to add 1 cup to a foot soak.

What foods cause bone spurs? ›

Dairy products. Processed foods, especially those containing refined sugar and white flour. Caffeine. Vegetables from the nightshade family (tomatoes, potatoes, eggplant and peppers)

Who is the best person to treat plantar fasciitis? ›

Plantar fasciitis is pain on the bottom of your foot, around your heel and arch. You can usually ease the pain yourself but see a GP if it does not improve within 2 weeks.

What foot problems qualify for disability? ›

Hip, leg, knee, ankle and foot conditions and injuries such as arthritis, crush injuries, avascular necrosis, heel spurs, plantar fasciitis, and tendon, ligament and cartilage damage.

When is surgery needed for plantar fasciitis? ›

Experts suggest that you try at least 6 months of other treatment before you consider surgery. Surgery may be right for you if you keep having bad heel pain after 6 to 12 months of home treatment. You might also think about surgery if heel pain is affecting your ability to work or do moderate exercise.

How much disability do you get for foot pain? ›

If you have unilateral pes planus (affecting one foot), you can receive a VA disability rating for foot pain of 20%. If it is bilateral (affects both feet) then your disability rating may be 30%.

Does foot pain qualify for disability? ›

If you have suffered a foot- or ankle-related injury, you may qualify for federal disability retirement benefits if the condition impacts your ability to do your job.

What can you not do with plantar fasciitis? ›

Bad Habits That Are Making Your Plantar Fasciitis Worse
  • Ignoring your weight.
  • Not wearing supportive shoes.
  • Sitting or standing for long periods.
  • Pushing through the pain.
  • Not stretching or using supports.

Does plantar fasciitis hurt all day? ›

Plantar fasciitis pain usually comes and goes throughout the day. It might feel better after walking a bit, then painful again if you've been sitting then stand up to walk, or if you've been on your feet for an extended period.

What surgery is done for plantar fasciitis? ›

The most common surgery performed for plantar fasciitis is an Endoscopic Plantar Fasciotomy (EPF). This is an outpatient surgery that takes 15 to 20 minutes to perform and can be done with general anesthesia or sedation (twilight sleep).

Do compression socks work for plantar fasciitis? ›

Compression socks are considered good for plantar fasciitis as they reduce the mobility of your feet by providing support to arches and ankles. Thus your alignment gets improved, and feet tissues don't get stressed. They also help in preventing injuries due to exercising in bad posture.

Is plantar fasciitis a serious condition? ›

Over time, the inflammation and stress to the plantar fascia can result in small tears in the fascia. This will cause your pain levels to increase gradually and if left unaddressed, these tears might grow in size and number, making the plantar fascia more vulnerable to rupture and debilitation.

Can emotional stress cause plantar fasciitis? ›

While depression or anxiety can certainly be byproducts of chronic pain, there's some evidence suggesting that emotional stress can increase your chances of developing plantar fasciitis.

Can magnesium deficiency cause plantar fasciitis? ›

Magnesium. Magnesium is also a vital nutrient in managing plantar fasciitis and foot health. The body needs magnesium in order to properly absorb calcium. In fact, people who eat large quantities of calcium without an accompanying intake of magnesium may develop a calcium deficiency.

Is there food and drinks that should avoid with plantar fasciitis? ›

Plantar fasciitis can actually get worse when certain foods are consumed in excess, including: Animal protein sources with too much saturated fat, such as red meat. Prepared foods with refined grains, sugar and trans-fats. White flour that you find in pasta, snacks and desserts.

Should walking be avoided with plantar fasciitis? ›

In fact, walking may actually inflame the plantar fascia more, leading to an extension of your treatment. While it's not walking alone that could further inflame the ligament, if you're not wearing the right shoes or are exerting yourself too much, the plantar fasciitis can flare up.

What does severe plantar fasciitis feel like? ›

What Does it Feel Like? Patients with plantar fasciitis usually feel pain under the ball of the heel and it can represent a stone bruise sensation. Arch pain is less common but is also a key symptom of the condition.

What are bone spurs also called? ›

Osteophytes are bony lumps (bone spurs) that grow on the bones of the spine or around the joints. They often form next to joints affected by osteoarthritis, a condition that causes joints to become painful and stiff. Osteophytes can grow from any bone, but they're most often found in the: neck.

How do you get rid of heel spurs from plantar fasciitis? ›

Most people who have plantar fasciitis recover in several months with conservative treatment, such as icing the painful area, stretching, and modifying or avoiding activities that cause pain.
...
Therapies
  1. Physical therapy. ...
  2. Night splints. ...
  3. Orthotics. ...
  4. Walking boot, canes or crutches.
20 Jan 2022

Is walking good for heel spurs? ›

Is walking good for heel pain? Depending on your specific circumstances, walking may help your heel pain, or make it worse. If you experience excruciating pain while walking, try to rest as much as possible until the pain subsides.

What does bone spurs in foot feel like? ›

Bone spurs can feel like a hard lump or bump underneath the skin. The chances of developing a bone spur in the foot increases with age. It's impact on your everyday routine depends on the severity. Some people don't even notice a bone spur on their foot.

Does Epsom salt dissolve heel spurs? ›

SOAK FEET IN EPSOM SALT

Epsom salt is a natural home remedy. By adding Epsom salt to a small tub of warm water, it is possible to soak feet and relieve some of the inflammation from the heel spurs. It is only necessary to add 1 cup to a foot soak.

Does walking make plantar fasciitis worse? ›

In fact, walking may actually inflame the plantar fascia more, leading to an extension of your treatment. While it's not walking alone that could further inflame the ligament, if you're not wearing the right shoes or are exerting yourself too much, the plantar fasciitis can flare up.

What makes a heel spur worse? ›

Walking gait abnormalities,which place excessive stress on the heel bone, ligaments, and nerves near the heel. Running or jogging, especially on hard surfaces. Poorly fitted or badly worn shoes, especially those lacking appropriate arch support. Excess weight and obesity.

How do people live with heel spurs? ›

What's the treatment for heel spurs?
  1. Resting your heel. If you run or jog, taking a break will help your heel pain.
  2. Using cold packs or ice. ...
  3. Taking oral anti-inflammatory medicine.
  4. Wearing footwear or shoe inserts that support your arches and protect your plantar fascia by cushioning the bottom of your foot.
19 Oct 2021

What foods aggravate heel spurs? ›

Diet for Heel spurs
  • Red meats, pork and bacon.
  • Dairy products.
  • Processed foods, especially those containing refined sugar and white flour.
  • Caffeine.
  • Vegetables from the nightshade family (tomatoes, potatoes, eggplant and peppers)

Are bone spurs a big deal? ›

Most bone spurs don't cause problems. But if they rub against other bones or press on nerves, you might experience pain and stiffness.

Are bone spurs serious? ›

A bone spur, or osteophyte, is a growth of extra bone. Bone spurs by themselves aren't dangerous or harmful, but they can cause problems if they interfere with surrounding tissue, nerves, or other bones. Protuberances of extra bone can put pressure on surrounding tissue or nerves, leading to pain.

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