Runners: More Foot Injuries that may Plague you!

Foot injuries in runners. Not listed in any particular order, nor is this list all-inclusive. 1. Plantar fasciitis - heel pain caused by inflammation of the tough fascia on the bottom of the foot, usually right where the fascia attaches into the heel. 2. Calcaneal stress fracture – an overuse fracture of the “heel bone” 3. Achilles tendon bursitis – inflammation of the bursa located at the attachment of the Achilles tendon to the heel. (NOTE: Although not defined as a foot injury there is also a separate condition involving inflammation of the Achilles tendon itself, higher up the ankle, referred to as Achilles tendinitis. 4. Extensor tendinitis – inflammation of the tendons on the top of the foot, usually midway along the foot. 5. Sesamoiditis -- inflammation of those tiny little free-floating “sesame seed” bones, which are located in the ball of the foot near the base of the big toe. 6. Metatarsal stress fracture – an overuse fracture of one of the metarsals. These are the long bones that start at the midway point of the foot and run right up to the base of the toes. There are 5 in each foot. 7. Morton’s neuroma – a condition caused by the chronic irritation of the interdigital nerve, usually between the 3rd and 4th metatarsals, near the toes. Runners often experience a “pins-and-needles” or “electric shock” pain. 8. Posterior tibialis tendonitis – this tendon passes underneath the medial malleolus (the inside “ankle bone”) and attaches into the medial aspect of the foot (navicular bone). Runners usually experience pain below the inside of ankle or slightly further along the inside of the foot. 9. Peroneal tendonitis – this tendon passes underneath the lateral malleolus (the outside “ankle bone”) and attaches on the lateral aspect of the foot (cuboid and base of 5th metatarsal). Runners usually experience pain on the outside part of the ankle or lateral edge of the foot up to the base of the 5th metatarsal. 10. Subungal hematoma -- bleeding underneath the nail from the chronically jamming the toe(s) into the shoe. Also may happen acutely if you drop something heavy on your toes(s). NOTE: This is just one type of toe condition – there are many others (e.g., ingrown nail). I just wanted to mention one so that the toes didn’t feel left out in the foot discussion. Should these and any other injuries persist, please do not hesitate to make an appointment with one of our Podiatrists at Advanced Foot & Ankle Center, Inc!!!!

Runners: 4 Common Foot Injuries that can easily be Prevented!

4 Common Foot Injuries that Plague Runners but can easily be Prevented!

1. Black Toenails: If sneakers do not fit properly, your foot can slide forward with each step. The constant tapping against the toenail can make it bleed underneath, also known as subungual hematoma. It can cause pain and eventually loss of the nail.

Prevention: Make sure your sneakers fit not too snug or loose. There should be about a thumbs-width distance between your big toe and the end of your shoe, without the heels sliding up and down. Also keep your toenails trimmed!

2. Plantar Fasciitis: One of the most common causes of heel pain and affects women more than men. The plantar fascia is the flat ligament that connects your heel bone to your toes. If it gets stretched too far and tears, it causes inflammation and can cause pain.

Prevention: Find a pair of sneakers that support your specific type of foot. People who have pronation (feet roll inward), high arches, and flat feet are more prone to this condition. Running long distances on hard surfaces can cause heel pain as well; try running on softer dirt trails.

3. Blisters: The skin on your feet can collect fluid between the top and bottom layers of the skins from constant friction, moisture, and heat. The fluid in a blister actually acts as a cushion, but it can be painful if the blister breaks open and could lead to infection.

Prevention: Breaking in new sneakers can lead to blisters. Try breaking in your sneakers gradually over a few weeks. Walk around in the shoes first and when you do start running, keep it to shorter distances. If you do notice a blister starting to form, apply a band-aid or piece of tape on the area to help prevent further irritation.

4. Heel Fissure: When the skin of the feet become extremely dry and the constant motion of running can cause it to crack. If the crack is deep enough, it can bleed and get infected.

Prevention: Try using a pumice stone to gently slough off dead skin cells and follow up with a thick moisturizer. When you are not running, try to avoid shoes that expose your skin, like sandals, that could dry out your skin more.

If these ailments persist or do not get better with treatment at home please contact Advanced Foot & Ankle Center, Inc. and discuss further treatment with Drs. DiPretoro & Caristo!

Runners: Don't Fear the Knife!

Don't Fear the Knife

Foot surgery for runners is no longer the last resort

By

Brian Fullem, D.P.M.

Published

November 9, 2010

Paula Radcliffe first noticed pain from a bunion (see photo, below right) after she won the 2005 world championships marathon. Over the next four years, the world record-holder in the marathon suffered a series of injuries, and despite occasional bright spots, such as winning the 2007 and 2008 editions of the New York City Marathon, she was in rehab more often than not. Finally, in May 2009, Radcliffe underwent bunion surgery.

"When we sat down and looked at my injury history prior to the surgery in 2009, we realized that every injury, bar one, since 2004 had been caused directly or indirectly by the bunion," Radcliffe says. "Even the femoral stress fracture was related to my bunion pain, as it came from imbalances caused by modifying my orthotics to enable me to run on the right foot without significant pain."

Could Radcliffe have returned to normal running sooner by taking the counterintuitive step of opting for surgery earlier? While foot surgery should usually be considered a last resort after conservative treatment has failed, there are times when surgery may allow a runner to return to training faster. As in Radcliffe's case, surgery can often provide a cure, while conservative treatment may only be treating the symptoms. Surgical techniques have improved considerably in the last decade; advances that allow for faster recovery and more predictable results can mean that the runner's traditional avoidance of surgery is based on outdated thinking.

Let's look at four common running injuries -- bunions, neuromas, Achilles tendon problems and plantar fasciitis -- in terms of when to consider surgery over more conservative treatment. First, though, these caveats: You should always understand that there aren't any guarantees with any surgical procedure. Even the best surgeon in the world has poor outcomes. It's also important to note that some people take longer than average to heal while some can return to activity faster.

Bunions

The medical term for a bunion is Hallux Abducto Valgus (HAV). The hallux (big toe) deviates towards the second toe, and the first metatarsal head protrudes in the opposite direction. The most common complaint associated with this deformity is pain at the medial aspect of the joint.

The deformity is commonly considered an inherited trait, and there is no scientific evidence that a bunion can be prevented with conservative treatment. Conservative treatment starts with making sure your shoes are wide enough. Occasionally treatments such as cortisone injections, custom orthotic devices and various paddings and splints can help to treat the symptoms, but surgery is the only option to correct this problem. I don't recommend surgical correction unless the patient has pain, but as in Radcliffe's case, some injuries elsewhere may be indirectly related to the lack of proper function of the big toe joint due to HAV.

Surgical correction typically involves cutting and repositioning the first metatarsal with the use of screws or pins to hold the bone in the proper position while it heals. Depending on the severity of the deformity, the bone may need to be cut at different spots. The severity of the bunion determines what procedure is required; larger deformities require more extensive correction, leading to a longer recovery time. Expect to miss a minimum of six to eight weeks from running and at least 12 weeks before the foot begins to function normally. The use of newer and better screws has shortened the recovery time considerably. Some screws have a lower profile, which often eliminates any discomfort associated with the head of the screw and allows the screw to remain in place permanently.

A new procedure known as "the mini-tightrope" uses a pulley system and shows great promise. The technique involves using suture material attached to the first and second metatarsals, with the first metatarsal being "pulled" toward the second metatarsal. The great thing about this procedure is that, because the bone isn't cut, recovery time is drastically reduced. However, because the second metatarsal is much smaller than the first metatarsal it doesn't always serve as an ideal anchor. This procedure is not for all bunions, as there is a risk of fracture of the second metatarsal.

Neuromas

A neuroma is inflammation of the nerve in the ball of the foot, most commonly involving the area between the second and third metatarsal heads or the third and fourth metatarsal heads. Symptoms include pain in the area directly before the toes, shooting pain into the toes, numbness in the area and sometimes a feeling of walking on a marble.

The majority of the time, conservative treatment, consisting of wider or more cushioned shoes, custom orthotic devices, cortisone injections and padding around the area, can alleviate the pain. One last resort before considering surgical intervention is a series of injections using a 4 percent solution of alcohol mixed with local anesthetic, a procedure known as sclerotherapy. The alcohol causes degeneration of the nerve fibers. The protocol involves a series of three to seven injections performed weekly. One study purported an 89 percent success rate with the procedure. I've not found anywhere close to that level of success, but there are no apparent negative side effects to sclerotherapy.

One runner I treated tried all of the above, including sclerotherapy, to deal with pain in her foot that was bad enough to interfere with her training. When none of the conservative treatments brought relief, she elected to undergo surgical excision of the nerve. Like most foot surgery, hers was performed on an outpatient basis. She was running within four weeks of her surgery. Nine years later, she's still pain-free at her former neuroma location.

A newer technique called Endoscopic Decompression of Intermetatarsal Neuroma (EDIN) is a much simpler surgery. Neuromas are close to the base of the toes, which have a ligament on the top and bottom. EDIN involves making a very small incision between the toes in the interspace, then inserting a small camera to visualize and cut the top or dorsal ligament. The theory is that this "decompresses" the nerve, thereby relieving the pain. There's little downside to this procedure. If pain persists after this surgery, then the nerve can be excised in the traditional manner.

Achilles Tendon Problems

Achilles tendinitis is one of the more difficult injuries any athlete can encounter. Within two weeks of Achilles inflammation, the tendon fibers begin to degenerate.

One of the best conservative treatments for this injury is eccentric strengthening exercises. I find that eccentric strengthening combined with a core exercise program is the most effective treatment plan for chronic Achilles tendinosis.

Shock wave therapy (ESWT) is also an excellent conservative treatment for chronic Achilles issues. ESWT sends sound waves deep into the tissue, promoting neovascularization (that is, the production of new blood vessels to allow the tissue to heal). The treatment can be expensive and the full effect isn't seen for up to three or four months. There are almost no negative side effects to ESWT, but the treatment isn't typically covered by insurance and can cost in excess of $1,000. In my practice I use the D-Actor 200 from Storz Medical, and have seen over a 70 percent success rate when used to treat Achilles tendinosis.

PRP (Platelet Rich Plasma) is a newer treatment involving giving a sample of your own blood, which is then processed to extract the plasma and injected back into the injured tendon or muscle. The treatment is costly and not covered by insurance, and scientific studies haven't shown it to be much more effective than a placebo. In a review of all the medical studies published in the British Medical Bulletin on the use of PRP, the authors found just three high-quality studies among all the literature published, and none of these studies showed any statistically significant improvement.

Surgery for Achilles pain may involve surgery on the tendon itself or, more commonly, closer to the attachment in the back of the calcaneus (heel bone) where patients may commonly have a bone spur known as a Haglund's deformity. The use of anchors has further enhanced surgery involving the back of the heel, allowing the tendon to be detached to remove any bone spurring and then reattached with the use of an anchor. Recovery involves being in a short leg cast initially, then a removable cast followed by physical therapy with a return to running in roughly three months. World championships marathoner Keith Dowling had pain for the last two years of his competitive career from a Haglund's deformity(pictured, above). After failed conservative treatment I operated on Keith using anchors. He doesn't compete anymore but is able to run with no pain in the back of his heel.

Plantar Fasciitis

This injury typically resolves over 90 percent of the time with conservative treatment. The most important factor in treating this very common injury is early intervention. Calf stretching, icing with a frozen water bottle 20 to 30 minutes two or three times per day, taping and massage are the initial treatments, and work well for up to half of patients with this injury. When those treatments don't help, then cortisone injections, over-the-counter and custom orthotic devices, Active Release Therapy and physical therapy are the next wave of treatments.

One area of treatment that deserves more attention is strengthening the foot. Weakness of the intrinsic musculature accompanies plantar fasciitis. Early introduction of restrictive shoe gear in Westernized cultures may contribute to atrophy of these muscles. As part of the rehabilitation from this injury, it is important to add a strengthening and proprioception protocol to the treatment plan following the reduction of pain. Grabbing a towel with the toes, balancing on one foot and progressing to the use of a balance board can facilitate foot strengthening. After performing these exercises athletes can progress to barefoot running in the grass. Many of the shoe companies are now making minimalist shoes that are a nice adjunct to the treatment plan when used initially in moderation.

Shock wave therapy has been found to resolve plantar fasciitis in up 70 percent of cases that didn't improve with more conventional treatments.

TOPAZ and platelet-rich plasma therapy are two other pertinent treatments, but again, neither has a significant amount of medical literature reviewing its effectiveness. Sedation and local anesthesia in the operating room are necessary to perform TOPAZ. Needle holes are placed in a square pattern on the medial and central bands of the fascia on the bottom of the heel at the area of greatest pain. The TOPAZ unit is inserted into the needle holes, and the fascia is treated with a short burst of electric energy, resulting in microscopic cutting of the fascia, increased blood supply and break-up of the scar tissue. There also seems to be an increase in strength to the fascia with this procedure. The drawbacks are the need for surgery, the cost of surgery and the fact that scar formation from the multiple incisions may be a source of pain. Although scar formation is very rare, there's a need for additional downtime with this procedure, and recovery is usually slower and more painful.

It's crucial that your physician rule out other causes of heel pain, such as nerve entrapment, before considering surgery; often an MRI should be ordered to confirm the proper diagnosis. Other surgical approaches include endoscopic plantar fasciotomy, in which the fascia is cut at the insertion point; ideally there's minimal trauma to the tissue due to the use of arthroscopy. A traditional open approach allows the surgeon to examine for nerve entrapment, but it involves a larger incision, creating the possibility of more scar tissue, which can, ironically, cause nerve entrapment. Another approach, known as an instep fasciotomy, involves making the incision right in the arch. This procedure has the advantage of causing less scar tissue.

The most worrisome complication involves creating instability of the foot. Most surgeons won't cut the fascia completely; they often leave the outside portion of the fascia intact. Calcaneal cuboid syndrome is one possible complication that can be extremely difficult to resolve. Of all the surgeries in the foot, this is the one that should absolutely be considered as the last resort.

When deciding whether surgery makes sense, here's an important question to answer:
Have you exhausted more conservative treatments that will cure your problem instead of just treating its symptoms? The best person to answer these questions with you is your local sports podiatrist at Advanced Foot & Ankle Center, Inc.!. 

Information on Orthotics: "You Don't Have to Live with Foot Pain-Orthotics Can Help!!"

Information on Orthotics 

"You Don't Have to Live With Foot Pain Orthotics Can Help"

Faqs about orthotics

What are orthotics?

Orthotics refers to custom-made shoe inserts prescribed by your Podiatrist at Advanced Foot and Ankle Center, Inc..   Orthotics are designed to accommodate or correct an abnormal or irregular walking pattern.

How do orthotic devices work?

Orthotics make standing, walking, and running more comfortable and efficient by altering the angles at which the foot strikes the ground. Orthotics placed inside your shoes can absorb shock, improve balance, and take pressure off sore spots. Doctors of podiatric medicine pioneered and are developing more high-tech orthotics.

Foot pain isn't normal.
See your Podiatrist at Advanced Foot and Ankle Center  for help.

Aren't orthotics just for runners or other athletes?

Runners and athletes have special needs, but orthotics can help non-athletes, as well. An imbalance in your feet–even a small one can change your posture and affect your entire body. Orthotics might help you if:
One side of the sole of your shoe wears out faster than the other.
You frequently sprain your ankle.
You have chronic heel, knee, or lower back pain.
Your toes are not straight.
Your feet point inward or excessively outward when you walk.

What about shoe inserts and arch supports sold at retail outlets?

Arch supports and shoe inserts made for standard shoe sizes are generally affordable and may be helpful, but are not suitable for everyone. Improper orthotics can injure healthy biomechanics, gait, and posture.

My legs hurt, not my feet. could orthotics help?

Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal foot mechanics or slight differences in the length of the legs. Orthotics may be helpful.

Can orthotics prescribed by a Podiatrist really make a difference?

Properly prescribed orthotics have relieved debilitating pain for thousands of people. Many people who could not take a step without pain are walking normally and living more active lives because of orthotics. Anyone can provide mass-produced inserts, but only doctors are trained and licensed to diagnosis medical conditions and prescribe orthotics.

Can orthotics take the place of foot surgery?

Dr. DiPretoro & Dr. Caristo often recommend orthotics and other conservative care for many foot and ankle problems before considering podiatric surgery.

What about people with diabetes?

For people with diabetes, arthritis, or other conditions, orthotics that do not fit properly can be dangerous. People with diabetes especially need proper diagnoses and prescriptions from their Podiatrist at Advanced Foot and Ankle Center, Inc.!

Hammer Toe Repair!

A hammer toe is a toe that stays in a curled or flexed position. It can be caused by a muscle imbalance, arthritis, or shoes that do not fit well.      

Hammer toe can occur in more than one toe.

Description

Several different kinds of surgery can repair hammer toe. Your Podiatrist at Advanced Foot & Ankle Center, Inc. will recommend the kind that will work best for you. Some of the surgeries include:

• Remove parts of the toe bones.
• Cut or transplant the tendons of the toes (tendons connect bone to muscle).
• Fuse the joint together to make the toe straight and no longer able to bend. 

After surgery, you may have surgical pins or a wire (Kirschner, or K-wire) to hold the toe bones in place while your toe heals.

Why the Procedure is Performed

When hammer toe is starting to develop, you may still be able to straighten yourtoe. Over time, your toe may get stuck in a bent position and you can no longer straighten it. When this happens, painful, hard corns (thick, callused skin) can build up on the top and bottom of your toe and rub against your shoe. 

Hammer toe surgery is not done just to make your toe look better. Consider surgery if your hammer toe is stuck in a flexed position and is causing:

• Pain
• Irritation·
• Sores

Skin infections 

Surgery may not be advised if:

• Treatment with paddings and strapping works
• You can still straighten your toe
• Changing to different shoe types can alleviatesymptoms

Risks

Risks of hammer toe surgery are:

• Poor alignment of the toe
• Allergic reactions to medicines you receive before or during surgery
• Bleeding
• Infection in the bones of the toe
• Injury to nerves that could cause numbness in your toe
• Scar from surgery that hurts when it is touched
• Stiffness in the toe or a toe that is too straight

Before the Procedure

Always tell Dr. Raymond A. DiPretoro, Jr. what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen, (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your Podiatrist which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow healing.
• Always let your doctor know about any cold, flu, fever, or other illness you may have before your surgery.
• You will usually be asked not to drink or eat anything for 6 - 12 hours before surgery.

If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.

After the Procedure

Most people go home the same day they have hammer toe surgery. Your doctor at Advanced Foot & Ankle Center or nurse will tell you how to take care of yourself at home after surgery.

Alternative Names

Flexion contracture of the toe

Happy Veterans Day!!!!!

Happy Veterans Day from our staff at Advanced Foot & Ankle Center Inc.!!!

  Thank you for serving our country and protecting our freedoms.  This Veteran’s Day, stand with our American heroes, and our wounded warriors.  Give them and show them the respect that they deserve.

Athlete's Foot: 13 Interesting Facts!

13 Interesting facts about athletes foot

Written by Kevin on January 5, 2012

• Probably one of the most interesting facts about athletes foot is that men get athletes foot more frequently than women.

• You may not be acquiring athletes foot from other people, you may be acquiring it from your pet. You may decide to treat your pet at the same time you are treating   athletes foot yourself. Frequently pets may respond well to treatment.

• To kill athletes foot try placing your athletes foot sneakers in a baggie, tightly close and place  them in your freezer for 24 hours to try and kill foot fungus.

• Athletes foot faq Will clorox kill athletes foot? The answer is yes. The clorox should be mixed with water and not mixed with any other cleaning agents. This may kill   foot fungus.

• If you are pregnant you should not be applying any treatment to the skin without the approval of your doctor. You may decide to use a natural treatment such as  soaking the feet in diluted apple cider vinegar for good results.

• It happens that sharing towels can spread athletes foot. Give yourself a different clean towel daily.

• Leave the feet uncovered in flipflops to allow the feet to breath. 

• Try not to dismiss advanced athletes foot for eczema as the two may look similar.

• Those with circulatory diseases may be more susceptible to athletes foot and show signs of needed therapy.

• In the 19th century scientists discovered treating athletes foot. Changing history shows that athletes foot is not caused by bug bites.

• A similiar interesting fact about athletes foot is that the same fungus that causes athlete foot is the same fungus that causes Jock Itch.

• Different facts about treating athletes foot is that it is more common in warm weather because sweat aids fungus growth.

• There are many product options that cure athletes foot fast. For getting rid of athletes foot see our athletesfootshop categories treatment section for a range of helpful  athletes foot  fungus solutions.

There are Natural Home Remedies that may work for some people.