Monday, March 22, 2010

Flip-flop Advice for Summer

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 !

Sunday, March 14, 2010

Plantar Fasciitis – Now that conservative therapy has failed

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

Family Podiatry

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Sunday, March 7, 2010

Choosing the Right Running Shoe

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 .