Tag Archives: Achilles tendon

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.


What Is Sever’s Disease?

10 Oct

Sever’s disease, known as calcaneal apophysitis, is the most common cause of heel pain in children.  It’s a painful bone disorder created by inflammation of the growth plate in the heel, usually from muscle strain and repetitive stress. 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.  For girls, this is usually between 8 and 13 years of age, and for boys, between 10 and 15.

heel pain children

The heel is especially susceptible to injury in children. The foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. The growth plate is a soft area at the end of the heel bone where cartilage cells change into bone cells, and it eventually fuses with the heel bone.

During the early part of puberty, the heel bone sometimes grows faster than the leg muscles and the Achilles tendon, which attaches the calf to the heel bone. When this unequal growth occurs, the muscles and tendons become very tight, which makes the heel less flexible, placing a lot of stress on the growth plate. The Achilles tendon, when stretched too tightly, becomes swollen, tender, and painful where it attaches to the growth plate. This injury, a result of repetitive stress on the Achilles tendon, is Sever’s Disease.

If  a child is active, doing a lot of running, jumping, and playing on hard surfaces, they can put a lot of stress on those too-short muscles and Achilles tendon, resulting in heel pain. Other factors which can contribute are:

Severs-Disease heel pain children

  • Long periods of standing which put constant pressure on the heel
  • Pronated foot (a foot that rolls inward when walking). Pronation tightens and twists the Achilles tendon and pulls on the growth plate
  • Flat feet or a high arch. This again cause the Achilles to be overstretched
  • Short leg syndrome, in which one leg is shorter than the other. This causes the foot on the short leg to bend downward, putting stress on the Achilles
  • Obesity  – weight puts pressure on the growth plate

Symptoms of Sever’s Disease

  • Pain or tenderness in one or both heels. Pain is usually felt at the back of the heel, but may also be felt along the sides and bottom of the heel, all the way to the arch.
  • Swelling and redness in the heel
  • Feet are stiff upon waking
  • Difficulty walking or running
  • Child may walk on tiptoes or with a limp to avoid putting pressure on the heel
  • Pain may increase with activity

To relieve symptoms

  • Rest to relieve pain
  • Curtail athletic activities
  • Wear athletic shoes that fit properly and provide cushioning
  • Ice and elevate the sore foot to reduce swelling
  • Stretching exercises for the heel and hamstring
  • No high heeled shoes
  • Over the counter pain medicine (check with your doctor first)
  • If symptoms are caused by obesity, a weight management plan

Sever’s Disease fortunately is a temporary condition. With proper care and treatment, symptoms will usually go away within 2-8 weeks, and it will have no long term consequences. If the condition recurs due to the child having a pronated foot, or a flat or high arch, your podiatrist may recommend custom orthotics to position the foot correctly inside the shoe and reduce stress on the heel.

The risk of recurrence of Sever’s Disease diminishes with age, and as a rule won’t occur after the age of 15. By that time, foot growth is complete and the growth plate has fused to the rest of the heel bone.

Why Does My Heel Hurt?

2 Jul

Heel pain affects nearly everyone at one time or another. Sedentary or active, man or woman, overweight or desired weight, heel pain is not discriminating.

If you’re not an athlete subjecting your feet to extraordinary stress, then your heel pain is most likely due to one or a combination of factors: carrying too many pounds on your frame; having a job which requires long periods on your feet; faulty biomechanics of your foot; flat feet; high arches; dress shoes or athletic shoes which don’t support and cushion your feet correctly; or overuse, such as doing too much too soon in a new exercise program, or not warming up your legs before exercising.

The most common reasons for heel pain are:

Plantar Fasciitis

The tissue that connects your heel bone to your arch is called the plantar fascia, and in the majority of heel pain cases, this is the culprit. The plantar fascia connects at the bottom of the heel bone and wearing shoes which don’t support your arch correctly, playing sports repeatedly on hard surfaces, or carrying extra weight, puts unusual stress on the plantar fascia, and it becomes irritated at this juncture. The irritation is called plantar fasciitis. Read more about plantar fasciitis

Achilles Tendinitis or rupture

The Achilles tendon is the largest tendon in our body, connecting the heel to the calf. Whenever you jump, walk, or run, your Achilles is hard at work. Because it’s used constantly, it’s also the tendon in your body most likely to be injured. The pain from achilles tendinitis or a rupture of the tendon is felt anywhere in the area behind your ankle. Read more about achilles tendon injuries.

Haglund’s Deformity

Also known as “pump bump”, this form of heel pain is fairly obvious, as a small bump becomes red and sore on the back of your heel, right about where the hard backs of shoes rub, hence it’s nickname. Read more about Haglund’s deformity.

Heel spurs

A bone spur is a bony growth that forms along the edge of a bone in response to wear and tear. When it appears in the heel, it causes heel pain by rubbing on the achilles tendon or other soft tissues. Read more about heel spurs here.

Other, less frequent causes of heel pain are bursitis, stress fractures, and tarsal tunnel syndrome.

To learn more about heel pain, order our free download, The End Of Heel Pain.

Carry That Weight: Every Step Depends On Your Achilles Tendon

17 Jan

Running, walking, dancing, hopping, jumping. You couldn’t do any of it without your achilles tendon.  When you don’t take care of this tendon and injure it, the result is heel pain or ankle pain, and depending on the injury, anywhere between a few days to 12 weeks of rest and recovery.

achilles_tendon_movementYour achilles tendon connects your calf muscle to your heel bone, and is responsible for every movement of your lower leg. When you contract your calf muscle, it pulls up on the achilles tendon, which forces the front of your foot down. This connectivity enables you to stand on your toes, walk, run, and jump. When you push off a surface, each achilles tendon has to handle 3-12 times your body weight. It’s a tendon with a lot of responsibility.

And that’s why it’s so easily injured when you don’t take care of it. The major causes of injury are overuse, misalignment of your leg, improper footwear, and accidents. These injuries usually show up as Achilles tendonitis or an achilles tendon rupture or tear.

Symptoms of achilles tendon injury

Achilles tendonitis (aka achilles tendinosis): 

Soreness or stiffness usually just behind the ankle, which comes on gradually and continues to worsen. This is a very common injury among athletes, especially long distance runners.

Achilles tendon rupture

There usually is little mystery when this happens. This partial or complete tear of the achilles tendon happens quickly, often with a popping sound, and is very painful, usually described as a knife-like pain. A complete tear is self-evident by the inability to properly coordinate the movement of your foot and leg, but a partial tear may be a bit more mysterious. This is most common in middle age athletes who don’t do proper warmups (stretching) before exercising.

Preventing Achilles tendon injury

You get what you pay for in athletic shoes. A shoe which fits your arch, is matched to your pronation, and is sufficiently cushioned, is key in keeping your Achilles healthy, especially as we age. In fact, just a little padding under the heel can be of tremendous benefit to those who suffer from repeated injuries to the achilles. That’s because the padding actually shortens the length of the stretch of the tendon with every step. Custom made orthotics (shoe inserts) are also very helpful in healing the achilles tendon and preventing injury.  And as always, stretching before exercise is key in avoiding many injuries of the foot and ankle – and elsewhere.

Treating an achilles tendon injury

Fortunately, treating an achilles injury under a podiatrist’s supervision is usually successful. Depending on the severity of your injury, your podiatrist may recommend rest, a change in footwear, orthotics, over the counter anti inflammatory pain medicine, and stretching exercises via physical therapy. If your achilles is ruptured or torn, surgery or immobilization with a walking boot or cast may be necessary to repair it.

Early treatment by a podiatrist is key in healing the achilles tendon correctly and preventing more serious injury. Even in mild cases, it can take weeks or months until you’re able to get back to your regular routine.

Most Common Foot and Ankle Injuries For Runners

4 Jan

foot and ankle injuries for runnersFew sports make one feel better than running: the challenge to go the next mile, to better your speed, to increase endurance. There are also few exercise programs better or more natural than running, except for perhaps swimming (gets the edge because of low impact on joints and it uses every single muscle).

But as all of us runners know, a foot injury can put us out of the game for days, weeks, even an entire season. According to the Rice University Sports Med Web,

“…studies show that experienced runners have about the same rate of overuse injuries as beginners. It is not that experienced runners never learn. Certainly some do not and constantly run, and rerun, into the same injury pattern. However, it is likely that a larger percentage cure one injury then develop and improve until they stumble into the next. This is probably because as one area gets stronger the stress load is subsequently re-applied elsewhere. Injuries, thus, tend to march along what is referred to as the “kinetic chain”.  Each runner, however, tends to march to the beat of a different drummer. The specific location for an overuse injury is determined by a multitude of factors (e.g., genetics, previous injuries, training factors, etc.)… Knowledge and early warning are a runner’s best friends.”

Did you get that part in the middle? Strength conditioning doesn’t bring every muscle and tendon along at the same rate and the weaker parts tend to get injured. And it’s different for every runner. Here then, is a list of potential foot injuries you may experience when running. Forewarned is forearmed.

Heel Area Injuries

The most common source of heel pain for runners is Plantar Fasciitis, an overuse injury that inflames the fascia on the bottom of the foot. Pain is usually felt in the heel, but may also be felt in the arch. This may heal on its own with rest, ice, and pain medicine, but persistent pain indicates an injury that needs medical treatment.

Pain in the heel may also indicate a Calcaneal Stress Fracture, a thin crack in the heel bone. This is a more serious injury that needs attention from a podiatrist.

Pain from Achilles Tendon injuries typically appears in the heel area, but also may be felt behind the ankle. Mild pain could be the result of irritation of the tendon, but severe pain may be due to a full-on tear (rupture) needing surgery.

Bottom of the foot injuries

On the bottom of your foot, in the area commonly called the “ball” of your foot are the sesamoid bones, located just behind the big toe. The tissue surrounding these tiny bones can become irritated from overuse, a condition called sesamoiditis. Additionally, the bones may actually fracture. Pain can be anywhere from “just hurts a little” to “I can’t even take a step without screaming”. Just as with Plantar Fasciitis, minor pain can be treated with rest and anti inflammatory pain meds, but more significant, persistent pain needs the attention of a podiatrist.

Top of the foot injuries

If you feel pain in the top of your foot, right about at the halfway point, you might be experiencing Extensor tendinitis, an inflammation of the tendons that run along the top of the foot.

Pain in the top of the foot can also be due to a metatarsal stress fracture. The metatarsals are the five long bones in your foot that connect with your toes.

Toe Area Injuries

If you’re experiencing a “pins and needles” sensation between your 3rd and 4th metatarsals near your toes, you’ve probably irritated the interdigital nerve. This is called Morton’s Neuroma.

If you have a sore or discolored toenail, you may be experiencing a subungal hematoma, which happens when your toe is constantly jammed against the inside of your shoe. This action leads to bleeding underneath the nail, creating the discoloration. Buy running shoes that fit properly.

Ankle Injuries

You usually know it when you’ve sprained your ankle. The tissue around your ankle discolors, and the joint is stiff and painful. This injury is not to be taken lightly – you should always have a sprained ankle thoroughly evaluated by a podiatrist. Sprains treated incorrectly (or not at all) may not heal sufficiently and are notorious for re-injury, weakening the ankle and leading to arthritis after middle age.

Soreness (without discoloration) on the inside or outside of your ankle could be inflammation of the Posterior tibialis tendon or the Peroneal tendon. With these injuries, pain may also be felt along the outside or inside of the foot.

Treating tendinitis and minor irritations

Treatment of a sore area with minor pain should always start with a period of rest, ice and anti inflammatory pain meds like aleve. When and if the pain subsides, don’t jump right back in to the same running routine, because you’ll probably injure the same area once again, but this time more seriously. A damaged tendon is a weakened tendon and needs to be reconditioned before placing maximum load on it.

To recondition the muscle or tendon, start with simple stretching exercises. If there is any pain at all while stretching, the injury is not yet healed and needs more rest. Only start running again when there is absolutely no pain in the damaged area. Warm up with proper stretching exercises and start with a light routine to get the foot and ankle working correctly again. Slowly increase speed and distance.

Whenever foot and ankle pain persists, or is severe, you should seek the attention of a podiatrist for a thorough evaluation and proper treatment. Take good care of your feet and you’ll still be able to run marathons into your 80’s. But much slower, of course…


New FAST Technique Relieves Heel Pain and Arch Pain

6 Sep

fast relief for heel pain

PA Foot and Ankle Associates in Allentown stands on the cutting edge of successful, reliable medical technology and sports medicine. We’re proud to announce that we now offer the FAST Technique for patients suffering heel pain and arch pain associated with chronic tendinitis or tendinosis.

In the past, if you had chronic pain in your Achilles tendon (at your heel) or plantar fascia (arch of your foot), treatment options would include ice, rest, elevation and over the counter pain meds. If that failed to work, your podiatrist may have used a shot of the steroid hydrocortisone to relieve your pain and physical therapy. If the pain returned, open surgery to remove the damaged tendon may have been recommended.

There’s now an alternative to the open surgery option: The FAST Technique, a minimally invasive alternative to open foot surgery for these conditions. FAST is an out patient procedure performed with only local pain medicine, no anesthesia, and you return home that same day.

FAST uses ultrasound imaging, similar to the ultrasound used to visualize babies in the womb, to guide the physician during the procedure. Once the damaged tendon is identified, the podiatric surgeon delivers high frequency energy through a needle only the size of a toothpick, which breaks down the damaged tissue and removes it. The entire procedure takes less than 15 minutes.

This is a really exciting new procedure, because 95% of patients experience pain relief within one week. Visit the FAST Technique page on the PA Foot and Ankle  Associates website to learn more about eliminating heel pain and arch pain caused by chronic tendinitis or tendinosis.

Red Sox’ David Ortiz to undergo PRP Therapy for Achilles injury

29 Aug

David Ortiz (aka “Big Papi), the Designated Hitter for the Boston Red Sox is back on the 15 day DL. The right Achilles tendon injury which benched him for 35 games this season was aggravated during Friday night’s game against Kansas City, in which he went 2 for four with a double. Ortiz, who has a career batting average of .285 with 401 homeruns and 1,326 RBI’s, will have a PRP (platelet-rich-plasma) injection this week, in an attempt to heal the injury without surgery.


According to the Boston GlobeOrtiz said he… hoped [the PRP injection] would give him a “60-70 percent’’ chance of getting back to make a contribution during the final 33 games of the season.

“You guys know I live for this [game],’’ he said. “And there’s not one thing that I would like to do more than be out there performing for our fans. I had one [PRP injection] done before and I believe in that big-time.” (His previous PRP injection was in 2007 to help heal a knee injury).

What is a PRP injection?

PRP stand for Platelet Rich Plasma, a treatment which involves using the patient’s own blood to speed healing.  PRP is used to treat Achilles tendon injuries, arthritis,  muscle tears, plantar fasciitis, scar tissue and certain other painful conditions.

How PRP works

A small amount of the patient’s blood is drawn and then run through a centrifuge, which draws off and concentrates the platelets and some white blood cells, creating the Platelet Rich Plasma. This is then injected into the injured area to speed up the healing process. Depending on the severity of the injury, the treatment may require 3-7 injections 4-6 weeks apart.

“I thought I was going to be OK until I hit that double and I had to rush out to second base,’’ Ortiz said. “I felt that pain because I was running with the game intensity. The way I feel right now, it wasn’t right.’’

“I want to be careful with it because… if you’re sore, you know your body’s telling you something, and if you continue doing damage on top of it from what you already have, then it costs you a surgery. That’s why we’re trying to be careful.”

Listen to Big Papi! Pain is the body’s way of telling you that something’s wrong.

PA Foot and Ankle Associates is the Lehigh Valley’s leader in treating foot and ankle-related sports injuries. PAFAA may recommend Platelet Rich Plasma injections when other therapies and anti inflammatory medicines are unsuccessful in eliminating pain.


Is the pain from high heels worth the fashion statement?

25 Jul

I was recently asked by a journalist to comment on how high heels wreak havoc with women’s feet. I know how you like a beautiful pair of pumps, but I have to be honest with you – feet damaged by those instruments of torture will keep me in business until I decide to retire.

How exactly do high heels damage your feet?
high heeled foot and leg xray

Note the unnatural angle of the foot, ankle and leg

When you wear high heels, your foot points downward, with the majority of stress placed on the forefoot (see the pic). The more you subject your feet to this position and stress, the more likely you’ll be to develop bunions, corns, calluses, pinched nerves (neuroma), hammertoes, and pain in the foot called metatarsalgia. Not only that, but the position of your feet in heels also affect your calf muscles, effectively shortening them. When these muscles are shortened, you have less power pushing off the ground when you walk. That’s why your legs get so tired in heels.

If that weren’t enough, the Achilles tendon also is shortened in this position, which can lead to a condition called Insertional Achilles Tendonitis, an irritation of the tendon where it inserts into the heel bone, causing heel pain.

But wait, there’s more…

With all of that pressure and squeezing at the front of the foot, you can also develop toenail issues, like ingrown toenails, nail infections and toenail fungal infections. Not to mention the occasional sprained ankle when that heel gets stuck in the pavement.

What can I do to relieve pain from high heels?

The first step in recognizing a problem is admitting there’s a problem. So first say out loud, “Pain from footwear is not normal”. Repeat 3 times to make it stick.

Here are a few ideas on how to relieve your high heel pain

lady gaga in heels

Lady Gaga will need an entire team of podiatrists when she hits middle age

  • Don’t be a slave to fashion – swap high heels for flats as often as possible
  • Avoid high heels with pointy toes – there’s no room for your feet in there
  • If you have wide feet, buy wide shoes
  • If you have pain in your feet when you wear high heels, try using a gel insole or metatarsal pad for extra comfort
  • Visit my office for an exam, where I’ll tell you to stop wearing high heels

High heels can also cause pain in your ankles and back, including pinched nerves. So if you have pain anywhere that you believe might be related to your high heel habit, switch to flats right away and whenever possible, wear athletic shoes to give your feet additional support and comfort.

Then visit Allentown’s top podiatrists for a thorough examination to make sure you don’t have long lasting problems with your feet.

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