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Tarsal Tunnel Syndrome (TTS) Surgery – Patient Testimonial

18 Sep

Charlene Ninni of Center Valley, PA suffered with excruciating and debilitating pain which would travel from the inside of her ankle, throughout her foot, and sometimes all the way to her hip. For almost 2 years, she sought the advice of a number of orthopedic surgeons, none of whom were successful in relieving her foot and leg pain, or her swollen ankle.

tarsal tunnel syndrome surgery

The tarsal tunnel is found along the inner leg behind the bump on the inside of the ankle.

The simple things most of us take for granted, like walking up the stairs or food shopping, had become difficult to impossible for Charlene. She had learned to wait as long as possible before doing anything that required walking, and she asked frequently for assistance from friends and family. With one of her ankles all but useless, and in almost constant pain, life had become challenging.

One night at a Lehigh Valley IronPigs game, while paging through that night’s program, she saw an ad for a seminar that Dr. Adam Teichman of PA Foot and Ankle Associates was conducting on foot health. When Charlene showed up at the seminar in the walking boot her most recent orthopedic physician had given her, Dr. Teichman couldn’t help but start a conversation with her. They discussed her symptoms, he ballparked a few possible reasons for her condition, and he recommended she see him for an exam and diagnosis.

After Charlene’s exam in the PA Foot and Ankle Associates office, Dr. Teichman’s diagnosis was tarsal tunnel syndrome. He recommended surgery as the best treatment option to relieve Charlene’s pain. Charlene agreed to the surgery, and today she couldn’t be happier with the outcome.

Watch Charlene’s video testimonial below in which she discusses her symptoms and tells us how great she’s feeling now compared with 2 years ago.

About Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot condition.

The tarsal tunnel is found along the inner leg behind the bump on the inside of the ankle. Through this tunnel passes a collection of arteries, nerves, tendons, and muscles. Inside the tarsal tunnel, the tibial nerve splits into three segments – one segment continues to the heel, and the other two continue to the bottom of the foot.

When the tibial nerve becomes entrapped or “pinched” in the tarsal tunnel due to inflammation or swelling, numbness may be felt in the foot radiating all the way to the big toe and the first 3 toes. Additionally, pain, burning, tingling, and electrical sensations may be felt in the base of the foot, ankle, or heel.

Visit the PA Foot and Ankle Associates website for more information on Tarsal tunnel syndrome.

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I Have Pain In My Heel – How Can I Treat It?

9 Sep

At one time or another during your life, you’re probably going to experience some degree of heel pain – just about everyone does. It might develop from playing basketball, not allowing enough time to rest in between runs, or even from doing nothing at all out of the ordinary. And you can develop heel pain at any age, including adolescence.

my heel hurts

The most common cause of heel pain in adults is Plantar Fasciitis.

The most common cause of heel pain is irritation or damage to the plantar fascia, the tendon that connects your heel to your arch. But heel pain can also be the result of damage or strain to the achilles tendon, which connects your heel to your calf muscle.

In children, heel pain is frequently associated with Sever’s Disease, a bone disorder caused by inflammation of the growth plate in the heel. Heel pain can also be the result of arthritis, bursitis, gout, a pinched nerve, a heel spur, a stress fracture to the heel bone (calcaneus) or other conditions. Because the possibilities are so numerous, it’s essential that you have your heel pain diagnosed by a podiatrist so that a proper course of action can be prescribed to heal your foot as quickly as possible.

The most common causes of heel pain

Plantar Fasciitis is by far the most common reason for heel pain. The classic sign of PF arrives first thing in the morning when you step out of bed – a sharp pain in your heel, which gradually fades as the tendon warms up with movement. But the pain may return if you exercise or stand for long periods. Read more about Plantar Fasciitis.

The Achilles Tendon is responsible for every step you take, and you couldn’t make a jump shot without it. When we demand too much of the achilles tendon, it becomes irritated or ruptured, causing pain that can be felt anywhere along the rear of the ankle, including the heel. Read more about injuries to the achilles tendon.

In children, Sever’s disease, known as calcaneal apophysitis, is the most common cause of heel pain. The inflammation of the heel’s growth plate is quite painful, and should never be ignored. Sever’s Disease is very common in obese children and those who play lots of sports, and most commonly occurs during growth spurts in adolescence.  Read more about heel pain in children.

How you can treat heel pain at home

Like the old saying goes, your best defense is a strong offense, and this is especially true when it comes to protecting your feet from heel pain. Always perform simple exercises to warm up your legs and feet before exercising. When tissues and bones are gently stretched before your game or workout, they’re better able to handle the load you’ll be demanding of them, and the less likely they are to become irritated or ruptured. See simple stretching exercises here. It’s also a good idea to slowly work up to your maximum, and not start out at full speed. And you should always wear a sturdy, supportive pair of athletic shoes to support your feet when exercising.

If you already have a mild case of heel pain, try:

  • Resting. Avoid doing the activity which caused the heel pain.
  • Stretch. Simple, gentle stretching exercises performed in the morning or evening can relax and strengthen the tissues which surround the heel bone.
  • Ice packs applied to your heel for 20 minutes at a time can reduce inflammation and pain.
  • Anti-inflammatory medicine like advil (ibuprofen) or aleve (naproxen) can be used to manage pain and reduce inflammation.
  • Do your shoes fit properly? In some cases, switching to a new pair of athletic shoes with excellent support of the arch and heel reduces symptoms considerably.
  • Download our free guide on treating your heel pain at home.

If you have heel pain that won’t resolve with in-home treatment, make an appointment with your podiatrist for a diagnosis and treatment plan. He or she may choose to treat your heel pain with steroid injections, immobilization, physical therapy, custom in-shoe orthotics, or other non-invasive procedures. If your heel pain is serious and chronic, surgery may be recommended.

Which physician is best to treat foot and ankle pain?

25 Jun

We sure take our feet and ankles for granted, don’t we?

best doctor for foot pain ankle pain toe pain

That is, until the Millenium Falcon breaks our ankle, or a foul ball clips our right foot. Ouch.

When your feet are painful, you’re miserable. Your lifestyle is instantly affected – pain forces you to dial back or give up walking, running, dancing, standing, or your favorite sports. Prolonged pain might even cause you to go from star athlete to couch potato.

It’s appropriate to visit the ER if you have an unusual amount of pain in your feet or ankles, especially if the pain is sudden and intense, is accompanied by bleeding or swelling, or if your foot and ankle have been involved in a trauma like a fall down the stairs. Or if you tried to break a cement block in half with absolutely no martial arts training.

For less painful events, like a suspected fracture, or wounds that won’t heal, many people choose to see their primary physician, which may or may not be a good choice, depending on that  physician’s field of expertise.

And for even less worrisome injuries, like a minor sprain, or minor heel pain, some seek no medical attention at all – which is never a good idea, as both injuries can develop into more complicated conditions, especially for athletes.

Which doctor is expert in treating foot and ankle problems?

When you have trouble with your ears, you should see an ENT. Trouble with your knees, an orthopedist. When you have pain or discomfort in your feet, toes, or ankles, you should see a podiatrist.

Podiatrists and podiatric surgeons are trained exclusively in the treatment of foot and ankle disorders – they do nothing but study the foot and ankle, it’s diseases and deformities. After all, 1/4 of all of the bones in your body are in your feet, and there are many conditions unique to this area of the body. That’s a lot of ground to cover in med school. If they choose to be a podiatric surgeon, they complete further schooling to study surgical techniques to correct these problems.

In 99% of cases, a podiatrist can resolve your ankle, toe, or foot problem much faster than a general physician. Podiatrists are also expert at spotting the early signs of diseases you can easily overlook, like diabetic foot disorders, rheumatoid arthritis and cardiovascular disease.

Without your feet in good working order, your life can be…. well, challenging. Don’t take them for granted.

If there was a report card for foot care, you’d get an F

11 Jun

Unfortunately, when it comes to foot care, most of you are failing miserably. Well maybe not YOU, because you’re reading this, but everyone else is failing…

foot pain foot health

The American Podiatric Medical Association has released a very illuminating survey on American’s attitudes and experiences concerning their foot health. The results are very surprising to us in some ways, and completely predictable in others, based on the patients we see. Unfortunately, your feet continue to rank low on the list of body parts you consider important to your well-being, and you’re paying less attention to them than you should.

The survey, released in March, shows that 8 out of 10 of you have experienced foot pain at some time in your life. Those of you who’ve experienced foot pain on a regular basis, also report regular issues with other health complications, primarily back pain, eyesight issues (probably diabetes-related), arthritis or other joint pain, weight issues, knee pain, and heart and circulatory disorders.

Half of you said that foot pain has restricted your activities in some way: walking, standing for long periods, exercising, sleeping, going to work, or playing with your children or grandchildren.

You said that you understand how important foot health is, and that consistent or chronic foot pain can indicate other health problems.  You also said that you understand what a complex mechanism the foot is and that a podiatrist is best qualified to treat your foot pain.

However….

You also reported that you have little knowledge of or experience with podiatrists. When a foot problem arises, you’re more likely to visit your primary care physician for help, or try and treat it on your own. But those of you who have visited a podiatrist give them high marks for care and are more satisfied with the outcome than those of you who were treated by your primary care physician.

This last fact highlights a common misperception about the healthcare system – that your primary care physician is some kind of wizard who knows how to treat every conceivable ailment. While we respect our fellow physicians, every MD’s training is different. Primary care physicians are a sort of first line of defense and are trained to identify and treat the most common illnesses and complaints in the population. They’re also trained to flag unusual symptoms and to refer out injuries and disorders which are best treated by a specialist. Yet 60% of you say that you would talk to your PCP about a foot condition before seeking advice from a podiatrist (we understand however, that some insurance plans require this). Hello? Podiatrists know more about foot and ankle injuries and disorders than any other physician. When given the choice, always opt for a specialist.

Shame on you: Only 32% of you report doing foot, ankle, or leg exercises to keep them strong, and only 43% wear proper, supportive footwear (that explains all of the comments/questions on our blog post about why your feet hurt). Speaking of footwear, 71% of women who wear high heels experience foot pain which they directly attribute to wearing high heels. Yet they own NINE PAIR (!).

Unfortunatley, nearly 50% of you experiencing foot pain wait until it’s severe to see a podiatrist. Most of you don’t even consider a visit to a podiatrist for conditions like persistently sweaty or odorous feet, blisters, pain from high heels, hammertoes, problems with your toenails, or even diabetic wound care. Yet each of these conditions can indicate a more serious potential problem or set of problems. Treated early and properly by a podiatrist, your pain and discomfort can be relieved without further complications. In fact, 34% of you said that a podiatrist helped you identify other health issues such as diabetes, circulatory issues, or nerve damage.

But what is up with the fact that only 74% of you report keeping your toenails trimmed?  OMG! What are the other 26% of you doing? Do you have man servants to trim your toenails for you? Or extra long shoes to accommodate your lavishly long toenails?

Click here to read the entire APMA survey.

What Your Feet Tell You About Your Health

28 May

foot health

Seems to us that every general physician should ask you to take your socks off. Even if you’ve gone to see your doctor complaining of a chest cold, an inspection of your feet might inform them of the early symptoms of many conditions.

Our feet are farthest from our hearts and spine, so in many cases they’re the first area to indicate problems with the nerves or circulatory disorders. The brain and internal organs receive blood before our toes and feet do, so our appendages are the first to suffer.

Nine health problems which first show up in your feet

1.Always cold feet could be a sign of hypothyroidism, a condition in which your thyroid gland is underperforming. Most common as we approach middle age, hypothyroidism can also cause hair loss, fatigue, weight gain, and depression. A simple blood test ordered by your doctor can confirm this condition, and daily oral medication can get your thyroid gland functioning properly.

2. Suddenly hairless toes and feet could be a sign of a circulatory disorder, as your feet may not be receiving enough blood flow to sustain hair growth. Your doctor should check for a pulse in your feet, and if she has any doubts, should order a thorough cardiovascular screen.

3. Foot cramps that won’t quit may indicate a nutritional deficiency or dehydration. Sure, everybody’s feet cramp up now and then, but what matters is how often and how severe. If you exercise a lot, make sure you drink plenty of water to hydrate your muscles. You also should eat a balanced diet with plenty of potassium, magnesium, and calcium, as a lack of these nutrients can also cause cramping (good sources are nuts, leafy greens, and dairy). To relieve cramps in your feet, stretch your toes up, not down. If the cramping in your feet just won’t let up, see your podiatrist so that he or she can test for circulation issues or nerve damage.

4. Yellowing toenails is a sign of aging, but may also indicate a fungal infection. Yellowing can also occur when you wear nail polish for months without a break. If your toenails are flaky or brittle, you probably have a fungal infection and should see a podiatrist for treatment.

5. Flaky, itchy, or peeling skin between your toes is a sure sign of athlete’s foot. Even if you’re not an athlete, it’s easy to pick up a case of athlete’s foot if your feet are crammed in shoes all day or you walk barefoot in common areas like a sauna or swimming pool. Use an over the counter creme to relieve the symptoms, but if your flaking, itching, or peeling continues, you may have psoriasis or eczema. Your podiatrist can determine which is which and suggest a course of treatment.

6. Your big toe suddenly becomes swollen and painful. This is an almost sure sign that you have gout, a condition that inflames the joint. But it might also indicate inflammatory arthritis or infection. If it’s due to trauma, like someone landing on your foot after a jump shot, well, you’ll probably figure that one out.

7. A sore on your foot that won’t heal is a common side effect of diabetes, skin cancer, or circulatory disorders. In the case of diabetes, blood glucose levels that have raged out of control for long periods lead to nerve damage and small blood vessel damage, which in many cases appears first in your feet.  If the sore gets infected, it can lead to an amputation. But a sore on your foot – even between your toes – can also indicate certain kinds of skin cancer, so be sure to have it checked out by your podiatrist as soon as you discover it.

8. A slowly enlarging “growth” aside your big toe is probably a bunion. Faulty, inherited foot structure leads to this common foot deformity, which can be exacerbated by poor choices in footwear like high heels and flip flops. Unfortunately, bunions rarely stop growing, so that small, slightly sore bump today may be quite large and painful years from now. The only sure way to correct a bunion is with surgery. Splints, toe separators, and the like are temporary measures which will relieve symptoms, but won’t stop the deformity from becoming worse.

9. Pain in your heel may indicate plantar fasciitis, an inflammation of the tissue which connects your heel to your arch. If you have a sharp pain in your heel when you get out of bed in the morning, which slowly subsides as you move around, you probably have PF. There are many causes of plantar fasciitis, but primarily poor footwear, obesity, or working out too aggressively are to blame. To relieve minor symptoms of plantar fasciitis, ease up on your exercise program, lose weight, or wear shoes which support your feet properly. If symptoms persist, see your podiatrist for treatment.

Landscaping: How To Protect Your Feet From Injuries

15 May

Which would you rather say to your podiatrist?

“I got this monumental ankle sprain when I was pushing my lawnmower and rolled my foot in a gopher hole.”
or
“I got this monumental ankle sprain when I rolled my foot AFTER THE MOST SPECTACULAR JUMP SHOT EVER!

If you picked “gopher hole”, you’re in the minority.

Landscaping – and even gardening – cause their share of foot and ankle injuries, especially in spring when we’re out of shape. We tend to jump right in where we left off in October, and our bodies just aren’t up to it. Bending, twisting, and lifting or pushing heavy and sharp equipment can cause an injury quite quickly if you don’t take a few precautions.

chainsaw

We hope he’s wearing a good pair of work boots

Wear proper footwear.

It may have been fine when you were a teenager to wear worn-out sneakers when you cut the lawn. As an adult, you should wear athletic shoes which support your feet well and will protect them if you step on a rock you didn’t expect to be there. Or in the groundhog hole which magically appeared overnight.

If your ankles or feet have been subject to injuries in the past, or if you’re landscaping with sharp equipment, wear a quality pair of work boots (not garden boots, which offer little protection beyond moisture). If you’re a landscaper, work boots with good support and metal-tipped toes should always be on your feet. Work boots will also protect your feet in the event you accidentally drop any equipment with sharp blades or heavy bottoms (like a tamper).

Don’t work on a wet lawn.

When grass is even a little wet, it can be very slippery. If you have a slope or hill on your lawn, cutting it when wet can be especially dangerous. Wait to mow your lawn until the turf is completely dry.

Use equipment with safety shutoffs.

Decades ago, equipment with sharp blades only stopped turning when you intentionally shut it off, which allowed chainsaws to run out of control, and feet to slide under lawnmowers while the blades were still turning. Fortunately, most modern lawnmowers, edgers, tillers, cultivators, post hole diggers, chain saws, and other equipment with high speed, rotating blades or teeth, stop as soon as you let go of the handle or trigger. If you’re still using decades-old equipment which doesn’t have a shutoff feature, it’s time to upgrade.

Shovels and other step-on equipment can cause surprising damage to your feet.

If you’re doing a project that requires a lot of digging, or using equipment like manual aerators for your lawn, wear quality work boots at all times. The repeated stepping-on-with-force required with these tools can cause injuries like sesamoiditis, plantar fasciitis, sprains and fractures.

If you have ankle, foot, leg, or back issues, stretch before you start.

In gardening and landscaping, lots of bending, squatting, twisting and turning is required, sometimes while holding or moving heavy equipment. Injuries happen remarkably quickly when your body isn’t prepared for them. We recommend that those who have previous injuries of the back, hip, legs, feet, or ankles, or are over 50, stretch before they begin their activities.

Taking these precautions and wearing work boots when you garden or landscape may not make you look like the coolest guy or girl on the block, but they’ll keep you out of the podiatrist’s office. Or the ER.

 

Why You Should Skip the Flip-Flops This Summer

7 May
Flip-flops are just so easy – slip ’em on and run out the door. Seems like everybody starts wearing them as soon as outdoor temps climb above 50 degrees.

flip-flops-bad-for-your-feet

Unfortunately, flip-flops are just about the worst thing you can wear on your feet. In fact, there is a growing problem of heel pain among teens and young adults, which podiatrists are attributing to wearing this paper-thin footwear (no doubt intensified by the obesity epidemic).

Walking barefoot is better for your feet than walking in flip-flops. If your feet have any abnormal biomechanics, flip-flops can accentuate these problems, leading to plantar fasciitis and accelerating other foot problems.

Think about it: the bones in your feet are the base of your skeleton and your body weight is riding on them. If your feet aren’t supported correctly, the rest of your bones, joint, tendons, and muscles have to make up for it. The stress shifts elsewhere and that leads to foot pain, heel pain, leg pain, hip pain, bad knees, sore back, and any number of other ailments.

Naturally, wearing flip-flops in the sauna, locker room, or by the pool won’t cause any harm. But as everyday footwear, we suggest you make a smarter choice.

So how exactly do flip-flops affect your feet?

Toes: That little thong that slips between your toes actually makes the muscles in your feet work overtime. The perpetual gripping this requires of your feet can lead to a nasty case of tendinitis, hammertoes, and bunions. Additionally, bare skin rubbing against the plastic or leather thong can lead to nasty blisters.

Fractures: With no support under your feet, all of that pressure from your body weight can create stress fractures in the bones of your feet. If you spend a lot of time on your feet in flip-flops, this is very likely to occur.

Bottom of your feet: The flip-flop isn’t stationary on your foot like an athletic shoe is. Since the bottom of your foot is in a constant sliding motion against the material, it can create a burning feeling or blisters, especially on hot days.

Arch and heel pain: If your footwear doesn’t support your arch, you run an excellent chance of developing plantar fasciitis, the inflammation of the band of tissue which runs along the bottom of your foot, connecting your heel to your arch. Pain may be felt anywhere along the plantar fascia.

For summer footwear, we suggest that you always wear athletic shoes that fit properly or a solid, rugged pair of sandals with significant arch support and a heavy sole.

Thanks to Huffington Post for this excellent infographic on what happens to your feet when you wear flip-flops.

flip flops

Mark Trumbo’s Foot Injury: Why playing through pain is always a bad idea

25 Apr
From any podiatrist’s point of view, it was just a matter of time. Mark Trumbo of the Arizona Diamondbacks developed plantar fasciitis in spring training. Ignoring the pain, he continued to play. This week, Diamondbacks manager Kirk Gibson announced that Trumbo is on the 15 day DL with a stress fracture in his left foot – the same foot which developed the plantar fasciitis.

trumbo foot injury

In hindsight, Trumbo’s stats suggest that the pain from his plantar fasciitis was affecting his play. From Bleacher Report: Trumbo got off to a red-hot start for Arizona with five home runs in his first nine games of the new season. His play has dropped off considerably after that early surge, however. His on-base percentage has dipped to .264 and he’s only chipped in two more homers since April 6. 

Trumbo said,  “The plantar (fasciitis) at times has been pretty bad but manageable. That’s what you have to do. You’ve got to earn a living and play. This was to the point where I severely had to compensate running-wise to the point where I probably wouldn’t be much of an asset on either side.”

We disagree that Trumbo had to play through the pain. But we do agree that most likely, the compensation resulted in the stress fracture. If Trumbo and his trainers would have addressed the plantar fasciitis at its onset, he would have had to sit out 3-4 weeks while he rehabbed (depending on its severity), but he could have avoided the more severe stress fracture injury. Bleacher Report also notes that: “…the slugger had a similar issue in the opposite foot three years ago and it took more than five months to recover. Although this injury isn’t as serious, there’s no timetable for his return to the Diamondbacks lineup.” 

As we always say, NO pain is normal.

Plantar fasciitis is no joke. In its early stages, some might consider it a minor injury, but PF can quickly turn into an extremely painful, almost crippling condition. Taking that first step after getting out of bed can send shooting pain through your heel. While the pain tends to diminish as the tendon warms up, professional athletes, who place a great amount of stress on their feet, must address their plantar fasciitis early. If they continue to play, the PF will become much worse, or due to compensation, a more severe injury develops – like a stress fracture.

When you feel pain in your foot, it’s an indication that something is wrong. Address the symptoms early, and the sports injury experts at PA Foot and Ankle Associates will develop a plan to get you back in the game with minimum bench time.

 

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