Tuesday, September 21, 2010
Treatment includes rest, ice and anti-inflammatory medicines. Heel cups and pads can help, but your child may benefit from Orthotics. These are prescription inserts for shoes fabricated from plaster molds of the feet. They cup and cushion the heel as well as stabilizing and protecting the growth plate. Most insurances cover orthotics for this condition.
With proper protection your child should be able to continue participating in sports. In more severe cases, decreasing or even eliminating activity for a period of time may be necessary.
A thorough exam by our office can determine the best course of action to keep your child healthy and active!
Visit us on the web at www.yourfootdoctor.com
Tuesday, July 13, 2010
Have you been to Walmart and seen the kiosk for Dr. Scholl’s “revolutionary foot mapping technology” that promises “custom fit orthotics?” On the TV commercial you see “doctors” behind the machine like in the Wizard of Oz!
In reality, the “foot mapping technology” is a simple pressure pad. One steps on it and is told where they have high pressure areas and then it suggests a “custom fit orthotic”. First of all, a pressure pad can only tell you where there is more pressure when you are standing still. It knows nothing about what neutral position is, which is the ideal functioning position of the foot. This is the position your foot is captured in when a REAL custom orthotic is made. There is nothing “custom fit” about their process. A custom fit would require not only dispensing an orthotic made directly from a mold or 3D impression of both feet, but also a biomechanical exam including gait analysis. This is what allows a patient to wear an orthotic that is made specifically for their foot type AND gait pattern.
Yes, some people can find relief from and over-the-counter arch support. Claiming to provide custom orthotics without the biomechanical exam and gait analysis is nothing more than smoke and mirrors. Don’t believe everything you see on TV!
Visit us anytime at YourFootDoctor.com
Wednesday, July 7, 2010
The makers of those widely touted and over-hyped toning shoes continue to make claims that their shoes can create more shapely butts and tonier legs all without a workout. That's partly why toning shoes — which often have a rounded sole like a rocking chair, to stretch the wearer's leg muscles with each stride — represent the fastest-growing segment of the $17 billion-a-year athletic footwear industry.
Sketchers, the market leader, now has Pro Football Hall of Fame quarterback Joe Montana touting the shoes in an effort to attract men. Powell predicts that sales will explode 400% this year, to more than $1.5 billion.
Claims that toning shoes can significantly contribute to a person's fitness are "utter nonsense," says Barbara de Lateur, distinguished service professor of physical medicine and rehabilitation at John's Hopkins School of Medicine in Baltimore. De Lateur and other doctors warn that toning shoes create their advertised benefit by destabilizing how a person walks and say that wearing the shoes can result in strained Achilles tendons. De Lateur also says the shoes can be a particular problem for older consumers or those who have difficulty keeping their balance. The shoes have also been implicated in broken ankles as well as exacerbating knee problems in those people with pre-existing problems or knee instability.
There are elements of truth to the ads, according to doctors who have questioned the effectiveness and safety of toning shoes. But many of the doctors want more independent studies on the shoes, rather than industry-financed research. Other doctors, such as de Lateur, say they have seen enough to conclude that the shoes mostly represent hype.
The best shoe for extended periods of walking or exercise is still a well constructed athletic shoe, with a good balance of support and cushioning.
So, get out there and walk for exercise, but don’t fall prey to gimmicks and hype. Remember the Earth Shoe?!
You can always find good advice by visiting YourFootDoctor.com where “Healthy Feet Go Places!”
Thursday, April 15, 2010
As the summer approaches, many Americans are hitting the gym (and the pavement) to burn off the winter pounds and get into bathing-suit shape. But even more Americans are looking for a way to combat what many experts have targeted as the greatest threat to our health in the 21st century: obesity. Obesity has been linked to many of the leading causes of death and disability in America, from cardiac disease to diabetes to cancer. The combination of unhealthy fast foods and an increasingly sedentary lifestyle has left both adults and children with, on average, 17 pounds of extra weight. Those extra pounds can have many adverse effects on the feet and ankles as well. The reasons are simple; the more weight you carry, the more stress you place on the load bearing surfaces of your body and the more problems you will incur. But foot and ankle problems shouldn’t keep you from reaching your ideal, healthy weight.
The consensus among experts is that the most effective route to weight loss stems from a combination of healthy diet and an appropriate exercise program. A common “excuse” for not taking up and exercise program, or sticking to it, is the pain and difficulty that can result. Many of these aches and pains are located in the lower extremity, the knees, hips, ankles, and feet. But this should not ultimately be a deterrent to a successful exercise program. There are many options for exercise that can remove some, or all of the load placed on the lower extremity, yet still provide an excellent cardiovascular workout. Biking, swimming, rowing, and the elliptical machine all remove much of the joint stress of running while providing a comparable workout. Easing into an exercise program is important to avoid injuries as well as to keep from becoming discouraged by physical and psychological setbacks. Stretching, both before and after exercise, as well as warming up slowly is important to avoid muscle strains. Wear appropriate shoes for the activity. I recommend a reputable sport or specialty athletic shoe store. The staff will understand your goals and your foot type to fit you better. Shoes can be pricey, but consider them an important part of your athletic “gear”, just as you would a tennis racquet or golf clubs. Also, be sure to see your general physician to ensure that your cardiovascular system is healthy enough to undergo the increased strain from exercise.
Losing weight will both improve your overall health and decrease your incidence of foot and ankle problems. Foot and ankle issues should not stop you from reaching your goals. If you develop foot or ankle issues during your new exercise program, be sure to come in and let us help you. You can find us at www.yourfootdoctor.com .
Have a happy and healthy Spring and Summer!
Friday, April 2, 2010
Barefoot running has seen a rise in popularity over the last few years, though it is of course a much older form of running than the more popular shod running. Barefoot running is thought of as a more natural method of running, where the shoe is not able to influence the biomechanical functioning of the foot. Barefoot running also leads to a more forefoot running style (versus heel to toe running), which causes higher activation of the plantar flexor muscles. We will examine some of the arguments for and against barefoot running, and discuss some steps you can take if you would like to try this alternate training technique.
A quick search for barefoot running online will lead to hundreds of web sites and blogs dedicated to barefoot running. Like most other alternate, against the grain ways of doing things, barefoot runners are passionate about their cause. Getting past the issues that some of the bloggers have with the shoe industry and their ideas on conventional norms, you can get to the core of barefoot running philosophy: get back to doing what we are designed to do. We weren’t born with shoes on our feet, so we don’t need them now.
Empirical studies support many of the claims of the barefoot running crowd, but with the understanding that there are people and conditions where barefoot running is not recommended. A Harvard study (which can be found at www.barefootrunning.fas.harvard.edu) on barefoot running has focused on the importance of forefoot or midfoot strike in barefoot running. Approximately 75% of shod runners strike with the heel first, which several researchers have hypothesized can lead to some repetitive stress injuries. The Harvard team stresses, however, that no studies have proven that forefoot running will lead to fewer injuries than shod heel strike runners. There is also the possibility that barefoot running requires less energy than shod running, and not only because of the decreased weight. A study in the International Journal of Sports Medicine from 2005 (1) found that barefoot running increases the elastic energy storage of the ankle joint, which leads to more efficient running.
There are as many arguments against barefoot running as there are for. The most obvious of these arguments is the lack of protection that barefoot runners have on the plantar surface of the foot. This is especially important for diabetics or those with diminished wound healing capabilities. Barefoot running is less comfortable, and lacks the lateral support provided by running shoes that is important in preventing over-supination or over-pronation. Barefoot running also lowers the distance one can comfortably run, which may explain why we have yet to see elite-level marathoners remove their shoes.
Until more empirical data surfaces it will be difficult to recommend either for or against barefoot running. If you are considering a barefoot running program, be sure to follow some basic precautions. Be sure to run on a uniform, clean surface. Don’t run at night or if visibility is compromised. Take the transition slowly to avoid injury. Many shoe companies have come out with minimal footwear, a thinner more flexible shoe that mimics barefoot running. This is a good option for transitioning to a barefoot running program.
As always, if you develop foot or ankle problems after beginning this new program give us a call and come in for a visit. You can find us at www.yourfootdoctor.com . Enjoy the beautiful weather!
(1) C. Divert, G. Mornieux, H. Baur, F. Mayer, and A. Belli. "Mechanical Comparison of Barefoot and Shod Running." International Journal of Sports Medicine 26.7 (2005): 593-98
Monday, March 22, 2010
Flip-flops have for several years established themselves as the summer footwear of choice. Easy to slip on and off, open-aired, and resistant to the sand and surf, flip-flops seem to be the perfect summer shoe. But the damage done to your feet from continued flip-flop wearing may largely outweigh the benefits of this summer staple. Extended wearing has been associated with heel and arch pain, as well as other foot and ankle damage as a result of instability and poor foot protection.
The damage from flip-flops largely stems from the lack of support given to the foot, caused both by the design of the shoe and the materials used. Flip-flops are generally very flat with little arch support, and often cause the wearer to use the toes (either by pinching them together or flexing them upwards) to keep them on. This combination places a high amount of strain on the ligaments of the base of the foot. Extended wearing of flip-flops is a major contributor to plantar fasciitis (heel and arch pain). This is a problem that will generally occur with repeated wearing, but occasional wear can also cause a number of problems. Flip-flops are open-toed, which can cause painful stubbed toes, as well as vulnerability to cuts and scrapes. The thin soles can often fold over at the tip causing loss of balance. Flip-flops have zero ankle support, which can cause ankle sprains or even fractures.
There are advantages to wearing flip-flops in the summer. They can help to avoid burning your feet on hot sand, or cutting the bottoms on pieces of glass or rock. They can help your feet remain dry and avoid fungal infections…a must in public locker rooms and showers. But like any other painful fashion statement, they are best used in moderation.
Enjoy the beginning of summer and the increasingly beautiful weather, and while you’re inside at your computer visit us at www.yourfootdoctor.com !
Sunday, March 14, 2010
OK. I scoured the internet and did everything I was supposed to. I did the icing, the stretching, the arch supports, even custom orthotics. I bought the best shoes. I bought a night splint online. I took Ibuprofen. I went to the doctor and had a cortisone shot or two. I am still miserable! Now what?
This is a question that plagues about 20 percent of plantar fasciitis sufferers. In some cases, appropriate, well accepted conservative care simply fails to provide relief. For a few months, plantar fasciitis can be considered acute. During this early phase of the condition, the previously described care is usually very effective. But once the condition has gone on for 6 months or longer, it becomes chronic rather than acute. In the chronic state, there is no longer inflammation. The ligament becomes somewhat avascular. (It loses some of its blood supply). Previously healthy collagen tissue becomes infiltrated with scar tissue from repeated microscopic fiber tears. It is no longer healthy tissue. At this point, the body can’t heal itself because it no longer “realizes” that anything is wrong. Having passed the acute inflammatory phase, the body no longer knows to bring its healing factors to the area.
At this point, other treatment options may become necessary. Surgical cutting or release of the plantar fascia should be the LAST option. There are several other treatments available at this time. All three theoretically have the same goal: To turn a chronic condition back into an acute one, so the body can once again “know” that something is wrong and heal it.
Option 1: Extra-Corporeal Shock Wave Therapy. ESWT are high energy shock waves introduced on the surface of the heel designed to repeatedly traumatize the tissue. This treatment is similar to blasting kidney stones. This treatment does not break the skin. The high energy creates tissue inflammation which can signal the body that an injury has occurred and while healing this new injury, the plantar fasciitis is often healed as well. This is performed with or without anesthesia, in an office or surgical center setting.
Option 2: Topaz Radio Frequency Ablation, also known as Coblation. Topaz is an invasive procedure performed under anesthesia in a surgical center. Holes are burned in the affected area of the fascia at different depths, with a radio wave wand through multiple skin punctures. This is to encourage the in-growth of new circulation and the creation of a “plasma field” which liberates growth factors in the area to stimulate healing.
Option 3: Platelet Rich Plasma Therapy. PRP is the most exciting new treatment. This can be performed in one office visit under local anesthesia. Approximately 20cc’s of your own blood is drawn and spun down in a centrifuge to get 3cc’s of pure platelets. Platelets have many different growth factors and proteins necessary for tissue healing. Under ultrasound guidance, this concentrate is then injected directly into the damaged area of the fascia. PRP is like “supercharged healing”!
All three of these advanced treatments can take some time to be effective. Don’t forget, we are stimulating a healing process that can take weeks to be effective. While in some cases, re-treatment may be necessary, these procedures do not violate the integrity or function of the plantar fascia as surgical cutting does. They are excellent options if traditional conservative care has failed.
I hope this post has given you some food for thought.
Dr. Neil Levin
Check us out at http://YourFootDoctor.com
Sunday, March 7, 2010
With the weather getting nicer and the snow beginning to clear up, many of you will want to hit the streets running to burn off the holiday pounds. Poor planning can sideline your running or walking program before it begins. There are many steps that can be taken to get the most out of your running program, and the first of those is to choose the right shoe.
The first question to address is whether or not you need a new shoe. The usual lifespan of a shoe is 300 - 400 miles depending on factors such as running surface, body weight and running style. Older shoes have lost much of the cushioning and support that give them their function, and can cause a variety of ailments of the foot, ankle, and further on up the kinetic chain.
There are many considerations that go into finding the right shoe. The first and simplest is shoe size. Most people know their shoe size, and some may know it for each specific brand. It is important however, to not be stubborn in your desire to wear “your size” as not only are the sizes different from brand to brand but also from shoe to shoe. Most running shoes will also come in a variety of widths, so if a shoe you are trying on feels too tight on the sides of your feet be sure to ask for a wider width. The second consideration that goes into finding a new pair of shoes is the shape of your arch. Arches are classified into three different shapes (high arch, normal arch, and flat-footed), and can be measured using ink pads or computer connected electric pressure sensors. Since most of you won’t have these sitting around your house, you can get an idea of what kind of arch you have by looking at the foot print you leave after getting our of the shower or pool. The more of your footprint you can see on the floor, the lower arch you have. Most specialty running shoe stores have the pressure sensors and extremely experienced sales personnel. The third consideration in finding the right shoe is the type of runner you are. After heel strike each runner’s foot will follow a different path. Most runners will pronate slightly as the foot moves forward, but the foot can also supinate (rare) and over-pronate. Over-pronators need stability in their running shoes and supinators will need shoes with a lot of conditioning and flexibility. Your podiatrist can tell you what type of runner you are, but a quick at-home method is to look at your old running shoes. Neutral runners (slight-pronators) will have centralized wear on the ball and heel. Over-pronators will have wear patterns along the inside of the shoe, and supinators will have wear patterns along the outside of the shoe.
While the convenience of internet or big box athletics chains may seem appealing, it is important at least for the first new pair to visit a running specialty shop where your feet can get the personal attention they deserve. The little extra you may spend at these stores is more than worth avoiding the pain that can come from wearing a poor shoe. Asking fellow runners where they shop can be very helpful. As well, many of the running shoe stores have “clubs” where you can run with a group at your level.
Once you find a shoe you like that allows you to run relatively pain free, it is okay to order extras from the internet or at a chain store, but be aware that not every pair is going to be the same.
Be sure to consult your physician before starting a new exercise program. For any other questions or to make an appointment to evaluate your running style, visit us at www.YourFootDoctor.com .
Friday, February 26, 2010
Diabetes is the primary cause of a great number of secondary foot problems seen in the podiatric office. Foot problems secondary to diabetes include ulcerations, cuts, scrapes, and can include foot deformities such as bunions and hammer toes. These problems are due largely to a three-headed combination of the loss of peripheral sensation caused by diabetic neuropathy, decreased peripheral circulation, and the high frequency and impact placed on the foot on a daily basis. Small cuts, scrapes, etc. can become ulcerations and even lead to amputation if they are not taken care of. Because of the loss of protective sensation in the extremities caused by diabetic neuropathy, unless the minor skin traumas are viewed or the incident is significant enough to remember, these minor traumas can often go unnoticed. Often, the first sign of a problem is bloody or pus drainage seen on the socks.
Proper diabetic foot care is important to prevent a small injury from turning into something more serious. The first step is to follow the instructions your primary care doctor gives to keep your blood glucose levels under control. This can help to prevent the onset and less the severity of neuropathy in the extremities. The second and most important measure in foot care is daily inspection of every surface of your feet. Use a mirror or ask for help if you are not able to see the bottoms of your feet. Pick a time every day to inspect your feet and stick to that plan. Wear well-fitting, wide-toed shoes that do not pinch or squeeze on your feet. Never walk around barefoot, wearing shoes and socks as often as possible. Be careful in extremes of temperature, especially in water, to avoid burns. NEVER use heating pads or hot water bottles. Keep your feet moisturized to avoid cracking and blistering. Keep your nails neat and trimmed. If you cannot cut your nails yourself, many Medicare patients qualify for coverage to have this performed in a podiatrist’s office. It is important to remain active and avoid long periods of sitting or lying without moving your feet and ankles. Activity improves circulation to the extremities and can improve sensation as well as healing of minor cuts and scrapes.
These steps can go a long way towards avoiding major lower extremity complications due to diabetes. If you notice wounds on your feet that do not seem to go away be sure to make an appointment with your podiatrist to avoid serious complications.
For any other questions on diabetic foot care and foot problems in general, be sure to visit us at www.yourfootdoctor.com .
Friday, February 12, 2010
American Olympic skier Lindsey Vonn may have had her gold medal hopes dashed by a deep muscle bruise to her right shin. Vonn is considered by most to be the top downhill skier in the world, and is expected to medal in all five of her downhill events in the upcoming Winter Olympics. She has been limited of late by a deep muscle bruise to her right shin, a very painful condition which is made worse by the ski boots she must wear pressing up against the muscle.
A bruise, or hematoma, forms after trauma to tissue. In this case the muscles of the anterior compartment of the leg are involved, causing damage to the small blood vessels in the area and allowing blood to seep into the space. Bruises are generally harmless, but if the traumatic force is great enough they can lead to significant tissue damage. Bruises will begin as a localized dark blue/black and as the pooled blood cells begin to break down they will spread under forces of gravity and change colors to more green, yellow, and brown. This change in coloration is due to the breakdown of the blood cells. Bruises are painful not because of the pooling of blood but because of the underlying tissue damage that is causing the pooling.
Normal treatment of a bruise should follow the R.I.C.E method. Rest, Ice, Compression, and Elevation. Do not use heat on a bruise as it will increase the discoloration and the area that it covers, and actually promote more swelling. If the bruise does not begin to dissipate, or at least become less painful, after 48 hours consult your physician. This may be a sign of a serious underlying condition such as a fracture, severe sprain or blood clot. The use of blood thinning medication such as Coumadin can cause an increase in the frequency of bruising.Vonn will be racing against time even before she gets on the slope, hoping that her injury will have time to heal before she reports to the starting gate. She has begun to test the shin, walking around in her boot and going on a few runs. As disappointing as it would be to the fans of USA Olympic skiing to not have her go, we should all hope Vonn is at 100 percent before competing as the incredible speeds and control needed in her sport require it. Best of luck to Lindsey and all the Olympians preparing to represent their countries and live their dreams! After watching your favorite event be sure to check us out at www.yourfootdoctor.com.
Saturday, February 6, 2010
After a poor start to the season, the Chicago Bulls seem to be headed in the right direction. But the team’s goal of reaching the playoffs again may be derailed by an injury to the left foot of center Joakim Noah. Noah has been arguably the most effective player on the Bulls this season, being third in the league in rebounds and providing constant energy on both the offensive and defensive ends. Lately, however, Noah has been hampered by plantar fasciitis to his left foot.
Plantar fasciitis is an inflammation of the plantar fascia, a thick band of connective tissue that stretches across the bottom of the foot from the heel to the base of the toes. Plantar fasciitis is an overuse syndrome which can occur with repetitive pronation, or collapse of the arch of the foot. This stresses the attachment of the fascia to the heel. Small microtears develop which cause pain and inflammation.
Joakim Noah has attempted to work through the plantar fasciitis pain, which is a difficult task for anyone to attempt, let alone a seven-foot tall runner/jumper/cutter/pivoter. The quick stopping, starting and pivoting maneuvers cause unusual ballistic strain on the inelastic plantar fascia. After two weeks of trying to work through the pain, the Bulls coaches and their training staff have decided to provide Noah with a much needed break.
Plantar fasciitis is one of the most common causes of heel pain we treat in the office every day.
The general course of treatment for plantar fasciitis involves calf stretching, icing and support of the arch to prevent “bottoming out” of the fascia. This can be an extremely difficult condition to treat because even walking can place strain on the plantar fascia. In addition to stretching and icing, plantar fasciitis prevention includes avoiding barefoot walking, wearing well-fitting shoes, warming up before strenuous exercise, and easing yourself into a new exercise program. Understand the pain information your body is sending you. In shoe orthotics can also help to correct abnormal foot posture and motion that contribute to this often debilitating condition.
Hope this post has made the sports-news talk a bit more understandable, and be sure to visit us at http://www.yourfootdoctor.com .
Wednesday, February 3, 2010
Several foot and ankle injuries will have their say in who wins this weekend’s Super Bowl between the New Orleans Saints and the Indianapolis Colts. Five players between the two teams were limited or held out of practice over the last week because of foot or ankle related injuries.
The most significant and talked about of these injuries is to Indianapolis Colts defensive end Dwight Freeney. Freeney suffered in inversion-type injury during the Colts January 24th win over the New York Jets and has been held out of participation since. Freeney’s injury has been diagnosed as a grade III sprain involving the anterior talofibular ligament and calcaneofibular ligaments of the right ankle joint. A grade III injury is a complete tear of the ligament with significant swelling and instability.
Freeney has slept in a hyperbaric chamber (to increase oxygen concentration in his blood and therefore oxygen delivery to the ligaments), as well as used ARP (Accelerated Recovery Performance, an electric stimulation machine designed to speed the healing process) to improve his odds of playing this Sunday. As of Wednesday Freeney says the ankle is feeling better and he will likely play, which would be incredible given the severity of his injury. If Freeney is able to play it will say a great deal about his ability to cope with pain as well as the impact modern medical technology can have on sports.
For those of us who are not professional athletes with access to hyperbaric chambers and a team of athletic trainers, the usual course of treatment is one to two weeks of a protective long boot followed by two more weeks in an Aircast. After the two weeks in an Aircast, physical therapy and a functional brace are recommended for a period of up to six months. Suffice it to say, it would be a while before most of us would be back trying to get around the offensive line and tackle the quarterback!
Make sure to check us out at http://www.yourfootdoctor.com