Tag Archives: Plantar Fasciitis

Angels’ Albert Pujols Out With Plantar Fascia Tear

29 Jul

pujolsLos Angeles Angels slugger Albert Pujols, who has been struggling with plantar fasciitis in his left foot for seven years (that’s right, 7 years!), is most likely out for the rest of the season after tearing his plantar fascia in Friday night’s game against Oakland. Angels’ Manager Mike Scioscia said that Pujols, who hit .258 with 17 home runs and 64 RBI’s despite being hobbled all season by the troublesome foot, will be out “for a significant amount of time.”

Back in April Pujols, 33, said of his plantar fasciitis, “I’m dying. It’s hurting real bad.”  He was considering off season surgery, and he sort of got his wish Friday night when he tore the ligament, achieving a similar result. In plantar fascia surgery, a podiatric surgeon cuts part of the plantar fascia ligament to release tension and relieve inflammation. The surrounding soft tissue attaches to the plantar fascia and helps it heal. Unfortunately for Pujols, he didn’t suffer a complete tear, so off-season surgery may still be an option.

The minimum recovery period for a plantar fascia tear is six weeks, but with the Angels all but out of playoff contention and a season-high 13 games behind Oakland in the American League West, there is no need to bring Pujols back for the final two weeks of the season. Instead of having surgery in October and spending most of the winter rehabbing, Pujols  can spend the rest of the summer recovering and come back healthy in 2014.

plantar-fasciitis diagramJust goes to show what we always say – don’t play through the pain, because it will always get worse, sometimes seriously.  It’s remarkable that even with the Angels’ state of the art sports medicine, highly paid trainers, and months to rest in every off season, Pujols’ plantar fasciitis never sufficiently healed. It’s a particularly difficult injury to treat in some cases.

Even if you’re an amateur athlete – especially you marathon runners – you may easily be exposing your feet to the same pounding an MLB player like Pujols does.  Any sign of pain – toes, heel, arch, or ankle – needs to be addressed immediately and given time to properly heal. Being out of the game temporarily, even for a full season, is much better than aggravating a minor condition into a serious injury which can sideline you for much longer.

Plantar Fasciitis Heel Pain Testimonial

21 Jun

Doctor Al Peters, a Lehigh Valley physician and amateur athlete, developed a terrible case of plantar fasciitis. When he wasn’t able to train anymore, much less compete, he visited Dr. Teichman at PA Foot and Ankle Associates for treatment. Watch Dr. Peters’ video testimonial of how Dr. Teichman was able to relive his heel pain without surgery.

Heel Pain in Children: Warning Signs For Parents

7 Jun

There’s simply no substitute for organized game play in a child’s physical, emotional and mental development. Even non-organized physical activity is important, like climbing trees, going for a swim on a hot Saturday, or riding a bicycle to a friend’s house.

child heel pain soccerBut kids are notorious for not complaining about their injuries, for any number of reasons. And injuries at such a young age can literally change the development of every muscle in their body, as the uninjured parts compensate for the injured parts. As a parent, you need a sharp eye to watch for changes in behavior or body language, even though we all know how hard that is.

Signs of possible unspoken injury to a child’s feet or ankles may include changes in their gait, occasional limping, favoring one foot over another, walking on their toes, problems running, or unusual fatigue.

The most common sports injury in children is heel pain. Many times this can be simple plantar fasciitis from overuse, usually controlled with pain medicine, rest, icing and if necessary, physical therapy and custom orthotics to be worn in their shoes. But it may also be a sign of Sever’s disease, an inflammation of the heel’s growth plate due to muscle strain and repetitive stress. This is especially common in highly active children and those carrying extra pounds.

Bear in mind that the symptoms of heel pain in adults are considerably different than heel pain in children. In adults, heel pain is usually worst in the morning upon rising, and subsides as the tissue warms up with light activity. But in children, heel pain usually doesn’t diminish as the child moves around – in fact it may get much worse.

If your child complains about heel pain, don’t take it lightly. Make an appointment with our office immediately for a thorough diagnosis, because early intervention is key to a continued healthy development.

Jenny’s story of how her terrible heel and arch pain was cured

8 May

Meet Jenny.

Jenny is an athlete – a marathon runner – and her chronic plantar fasciitis caused severe pain from her heel through her arch. Her plantar fascia tendon had developed tendinitis, causing pain with every step. She tried to push through it, but eventually had to reduce her training to a very minimal schedule.

Her podiatrist’s first treatment method was to inject the plantar fascia with cortisone to reduce the inflammation. This is a typical first approach, and is frequently successful.  The inflammation in the tendon is reduced by the cortisone, allowing the tendon to heal. Unfortunately for Jenny, the heel and arch pain returned after only a few weeks.

The second step in Jenny’s treatment was a PRP (platelet rich plasma) injection. At first, the PRP treatment reduced her pain considerably, but her tendon didn’t respond as her doctor had hoped, and her pain returned once again.

Jenny and her doctor then chose the FAST Technique to relieve her heel pain.

In her words, the procedure was “seamless”.  She had no pain at all during or after the very short procedure and her plantar fasciitis is now completely gone. Jenny has resumed her normal training schedule and is delighted that she can get back to her pre-pain level of activity.

The FAST Technique is a remarkable improvement for treating heel pain and has been found to be 95% effective in eliminating chronic pain resulting from tendinitis or tendinosis. East Penn Foot and Ankle Associates is the only podiatry practice in the Lehigh Valley to offer this innovative approach to relieving heel pain.

Read more about the FAST Technique on our website here.

Watch Jenny tell her story:

What is a Plantar Fascia Tear?

14 Feb

pau gasol plantar fascia rupture

On February 5, Los Angeles Lakers forward Pau Gasol was defending Brooklyn’s Brook Lopez when he came down on the Nets’ player’s foot. Gasol heard a “pop” in his foot and fell to the floor. He tried to stay in the game, but he ultimately exited the locker room on crutches.

The source of his foot pain? A torn (ruptured) plantar fascia, sidelining him for 6-8 weeks.

The plantar fascia is a thick ligament which extends from the heel to the ball of the foot. Its purpose is to stabilize the arch and resist arch collapse.

Tearing the plantar fascia is an extremely painful and uncommon injury. But last week, Gasol said he was playing through a pain level of eight out of 10 in his right foot. “I’ve been dealing with it for a couple months now,” Gasol said. “But I never felt anything like I did tonight.” And therein lies the most likely reason for Gasol’s more serious injury – playing with pain. He already had a sore and irritated plantar fascia, and when put under the additional strain of jumping and landing, the ligament tore. Most often the rupture occurs where the ligament attaches to the heel bone.

Athletes frequently experience plantar fasciitis, a common overuse injury that appears as heel pain or arch pain. As a matter of course, trainers inject the ligament with cortisone to kill the pain and get the player back in the game. Unfortunately this can contribute to the more traumatic and serious tearing injury.

But a torn plantar fascia is not only an athletic injury – arch problems, sudden weight gain, and obesity can contribute to the injury, too.

Video of Pau Gasol’s injury:

How do you know if you have a torn plantar fascia?

  • Pain in the heel or arch, active or resting
  • Possible swelling or bruising in the bottom of the foot
  • Tender spot or lump between the arch and heel
  • You heard or felt a “pop” in the arch when the pain started
  • Your arch feel like it’s collapsing

Treatment for a plantar fascia tear

A ruptured plantar fascia will most likely not get better on its own, and will be accompanied by excruciating pain, so medical attention is strongly advised. Surgery is usually not necessary, but your podiatrist will immobilize your foot with a cast or a walking boot and give you a pair of crutches to keep weight off the injured foot. Once the ligament heals, physical therapy will be prescribed and possibly custom orthotics to prevent re-occurrence of the tear.

In other injuries of the ligaments, steroids and cortisone are normally administered to decrease pain and inflammation. But in the case of a plantar fascia rupture, your podiatrist may avoid this treatment, as these medicines might actually delay healing.  Over the counter pain relievers will be the most likely route to reduce pain. PRP injections however, may be recommended to speed the healing process.

What is the benefit of custom foot orthotics?

5 Feb

Shoe inserts from a drug store or shoe store are not to be confused with custom made foot orthotics. Most everyone has tried over the counter shoe inserts at some time in their life, and most everyone has been disappointed with them. That’s because there’s no such thing as an “average foot”, so a one-size-fits-all solution for foot pain doesn’t exist.

custom made foot orthoticsOrthotics are custom made shoe inserts. They can only be ordered by a medical professional after an examination of your feet, your gait, your pronation, and an analysis of any pain you may be experiencing. Issues resulting from heel pain, bunions, plantar fasciitis, flat feet, high arches, abnormal biomechanics, or poor lower limb alignment can all be addressed with custom designed orthotics, which can be made to cushion sore areas and correct abnormalities. They can also be very helpful for athletes, especially runners who have recurring problems with their feet.

Orthotics are made from more durable materials than over the counter shoe inserts, and they last for years, not months. Orthotics are custom designed specifically for your foot to improve your running, walking, and balance by supporting the arch, cradling the heel and rotating your foot into a “neutral” position. This support and proper pronation helps the foot function at its maximum level. When your foot is balanced and supported correctly, you’re less prone to ankle or foot injury, knee pain, hip pain, and back pain as well. After all, your entire body is riding on your feet.

For athletes, foot orthotics can help reduce foot stress and fatigue, and may also increase agility. By balancing the foot, shock absorption will improve, diminishing before reaching your limbs.

How do I know if I’ll benefit from custom orthotics?
  • Look at the bottom of your shoes to see if they are worn evenly across the toe or heel area. Even wear-and-tear indicates your gait is normal, but if they wear out too quickly or unevenly, then you may benefit from orthotics
  • Do your feet hurt after being active? How about your ankles, knees, hips, or back?
  • Do you have unusually high arches?
  • Do you have flat feet?
  • Do you have tendonitis, shin splints, hammer toes?
  • Are your legs consistently tired or aching?
  • Do you have diabetic foot problems or a neuroma?
Only a podiatrist can tell if custom made orthotics are right for your feet, but most patients notice an immediate difference in comfort and stability, and their pain is sharply reduced or eliminated.

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…

 

What is a heel spur? Symptoms and treatment

27 Sep

Heel spurs can be the cause of significant heel pain. Believe it or not, you probably have bone spurs without knowing it, because most bone spurs themselves cause no symptoms.

But if a spur on your heel bone happens to rub on soft tissue like the plantar fascia, causing plantar fasciitis, or worse yet on a nerve, the tissue breaks down, causing swelling, pain, and tearing. Bone spurs in the foot can also cause corns and calluses as tissue builds up around the spur.

heel spur x ray

Spur shaped growth at back of heel is a heel spur

When your heel bone is exposed to repeated activities that put stress on your feet, downward pressure from being overweight, or stress from wearing poorly fitting shoes, calcium deposits form on the bottom of the bone. These deposits build on each other, eventually causing a spur-shaped deformity called a calcaneal spur (calcaneal is the medical term for your heel bone).  Those who are obese or have flat feet, and women who frequently wear high heels are most susceptible to heel spurs.

Although many people with plantar fasciitis have heel spurs, spurs themselves are not the cause of plantar fasciitis pain. In fact, one out of 10 people have heel spurs, but only 5 percent of these have foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without surgically removing the spur.

Read: FAST procedure relieves plantar fasciitis

What are the symptoms of heel spurs?

  • Pain on the bottom of the foot near the heel
  • Pain during the first few steps upon getting out of bed in the morning, or after a long period of rest. The pain subsides after a few minutes of walking
  • Increased pain after, but not during exercise or activity

How are heel spurs treated? 

Heel spurs do not require treatment unless they are causing pain or damaging other tissues. When indicated, treatment may be directed at the causes, the symptoms, or the spurs themselves. More than 90% of patients with plantar fasciitis caused by a heel spur will improve within 10 months of starting simple, non-surgical treatments.
foot diagram heel and plantar fascia

Rest: Decrease or stop the activities that make the pain worse, such as running on hard surfaces

Ice: 20 minutes 3 to 4 times a day

Weight Control: If the heel spur is due to obesity, losing weight will take some of the pressure off the foot

Over the counter medication: Non-steroidal anti inflammatory medicines such as ibuprofen (advil) or naproxen (aleve)

Better shoes and orthotics: Shoes with thick soles and extra cushioning can reduce pain.  Pre-made or custom orthotics (shoe inserts) are helpful as well as soft silicone heel pads to elevate and cushion your heel.

Night splints. Most people sleep with their feet pointed down, which relaxes the plantar fascia. This is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep and does not have to be used after the pain subsides

Physical therapy. We may suggest physical therapy to stretch your calf muscles, heel cord, and plantar fascia

Extracorporeal shockwave therapy (ESWT): High-energy shockwaves stimulate the healing process in damaged plantar fascia tissue. ESWT is noninvasive—it does not require a surgical incision.

If the bone spur continues to cause pain, we may suggest a steroid injection at the painful area to reduce pain and inflammation of the soft tissues next to the bone spur. If pain continues, surgical intervention may be recommended.

Remember, no pain is normal. If you have persistent heel pain, your body is telling you that something’s wrong.

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