Plantar Fasciitis

                                                   PLANTAR FASCIITIS

 

     Have you ever stepped out of bed in the morning and had heel pain? Or after a full day of activity, had difficulty stepping on your heel?

It’s likely that you have a case of plantar fasciitis!

 The plantar fascia is a tight tendon band that runs from your heel to the base of your toes. Every step puts a stretch on this band. If this band stretches too much, it tends to pull and tear at its attachment in the heel.

      This can occur as a result of not enough support to the foot or excessive stretch as a result of too much weight. Age also plays a role since tendons tend to lose some elasticity as we age and will fray rather than stretch (like an old rubber band).

      The goal in treating plantar fasciitis is to reduce the excessive stretch to the plantar fascia and alleviate the inflammation.  Changing shoe gear and adding an over-the-counter arch support may be helpful as well as stretching before weightbearing, ice message, and anti-inflammatory  medications.

      If this is not effective, professional treatment is advised. Treatment can include local cortisone injections, supportive tape strappings, night splits and custom orthotic devices.

      Physical therapy plays a very important roll in reducing the inflammation and stretching the limb to prevent recurrence and to avoid more invasive procedures.

      If all conservative treatment is not effective, other modalities, including Extracorporeal Shockwave Therapy and Platelet Rich Plasma and surgical correction may

be necessary.

      Remember, do not let heel pain keep you on the couch! Seek treatment for this debilitating and nagging condition as soon as it starts!

 Visit our website for more information on plantar fasciitis and other foot and ankle conditions: adultandchildfootcare.com

 

             William A Sachs, D.P.M., FACFAS

                   Adult and Child Footcare

  167 Ave at the Common         10 Kettle Creek Rd

  Shrewsbury, NJ                       Toms River, NJ

    732-389-2555                              732-255-7070

 

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Travel Tips to Prevent Deep Vein Thrombosis

The travel season is upon us and whether you are riding in a car or travelling by plane, remember to stretch those legs to help prevent deep vein thrombosis(DVT)

DVT is a condition in which a blood clot forms in a vein located deep within the leg. These cots most commonly occur in the vein in the leg but can occur in other parts of the body. If a clot breaks loose and travels through the blood stream, it can lodge in the lungs. This blockage in the lung is called a pulmonary embolism and can make it difficult to breath and can potentially be fatal.

Come people are at greater risk than others to develop DVT. Risk factors include varicose veins,pregnancy and recent  childbirth, obesity, birth control use, tobacco use and heart disease. People that are over 40 years old, those who have had recent surgery or those who are immobilized though inactivity or wearing a cast are also at greater risk to develop a DVT.

People with DVT in the leg may have no warning signs or their symptoms may be vague. If any of the following warning signs occur, it is important to seek immediate medical attention:

Swelling or pain in the back of the leg

Pain in the calf or thigh

Warmth or redness of the leg

If you have any of the risk factors mentioned above, and you are planning a long trip, the folowing tips may help prevent a DVT.

Exercise legs every 2 to 3 hours to get the blood flowing back to the heart. Walk up and down the aisle of a plane or train, rotate ankles while sitting, and take regular breaks on road trips.

Stay hydrated by drinking plenty of fluids, avoiding alcohol and caffeine

Consider wearing compression stocking for very long trip

Enjoy this holiday season with family and friends

Dr. William a Sachs

adultandchildfootcare.com

Morton”s Neuroma

A neuroma is a benign growth of nerve tissue that can develop in various parts of you body.

The most common location of a neuroma in the foot is between the third and fourth metatarsal interspace.  The condition is actually a thickening of fibrous tissue around one of the nerves which causes it to get pinched between the metatarsal bones. This causes a sharp, burning pain in the ball of the foot which often radiates to the sides of the toes. It is often described as an ‘electric shock’ radiating to the end of the toe.

The cause of a neuroma is not fully understood. It is generally dscribed as trauma to the nerve which causes an inflamatory reaction and thickening round the nerve. Once this thickening becomes large enough,, the nerve then gets pinched within the corresponding metatarsal heads.  This often will occur in patients that wear thin soled shoes or high heels as well as those invovled in high impact athletic activities.

The diagnosis of a Morton’s neuroma is made by the clinical description of the problem as well as pain with palpation to the interspace as well as a ‘clicking’ (Mulders sign) of the nerve as it gets caught between the metatarsal heads when the front of the foot is manually compressed.

Treatment of Morton’s neuroma is dependent upon the severityof the symptoms. The most conservative treatment includes wearing wider, softer shoe gear as well as reducing inflamation with ice and anti-inflamatory medication.  If the pain is more severe, a corticosteroid injection may be necessary.  When conservative treatment is not effective, the nerve can be sclerosed with a series of concentrated alcohol injections or a portion of the nerve may be removed surgically, effectively eliminatiing the problem.  This procedure is highly successful in eliminating the painful symptms of the neuroma, however it may result in some permanent nubness between the affected toes.

For more information contact:

Dr. William A Sachs

adultandchildfootcare.com

Hallux Limitus-When a Bunion is Not a Bunion

An enlarged  and painful first metatarsal phalangeal joint( big toe joint) is not always a bunion deformity.  Bunions are usually the result of a drifting of the first metatarsal and enlarging of the medial side(inside) of the first metatasal head.  Hallux limitus on the other hand is a stiffening of the first metatarsal phalangeal joint with excessive bone growth surrounding the joint.  This causes an enlarged joint which may rub and be irritated by shoe pressure on top of the joint.

Most people with hallux limitus complain of pain with movement of the joint during walking or exercising.  It is also difficult to bend the joint and therefore squating or raising up on ‘tip-toes’ can be difficult and painful, as well.

Hallux limitus can occur as a result of a number of factors.  There may be trauma , such as having dropped a heavy object  on the joint or jamming the joint causing micro-fractures that mature into an arthritic, stiff and painful joint.  A more common reason for the occurrence of hallux limitus is due to the structural anatomy of the bones.  If the first metatarsal is excessively long or in a fixed elevated position relative to the other lesser metatarsals the joint will jam and become irritated which can lead to stiffness and arthritis.

Treatment for this painful condition is multifaceted.  Conservatively, the goal is to control the jamming of the joint and reduce the inflammation.  This can be done with gait orthotics and NSAIDS in the less severe cases.  This will not alter the underlying arthritic changes in the joint.  In more severe and painful cases of hallux limitus surgical intervention is required.  The goal is to remove the bone spurs and reposition the metatarsal so that there will be less compression and jamming of the joint.  In cases where the joint is rigid and there is severe arthritis and loss of cartilage,  joint replacement surgery may be indicated.

Dr. William A Sachs

adultandchildfootcare.com

Achilles Tendonitis

The achilles tendon is the largest tendon in the body and can withstand forces in excess of 1000 lbs.  It is also one of the most injured tendons and susceptible to rupture.  This is seen not only in the elite athlete, but also in the  weekend warrior.

 The achilles tendon may become injured from rapidly increasing your running speeed or milage or running up hills or steep inclines on the treadmill. It may be the result of a quick burst of speed as in tennis or basketball or a chronic degeneration in the tendon as a result of the aging process or medications(steroids or certain antibiotics such as Cipro or Levaquin)

Symptoms of achilles tendonitis include pain in the back of the heel where the tendon attaches to the heel or in the area approximately 2-3 inches above the attachment in the so called watershed area.  Pain is usually most intense with initial weightbearing from a sitiing or lying position.  There may also be a feeling or weakness and a palpable bulge in the tendon itself.

Treatment is aimed at reducing the inflamation and controlling the excessive stretch to the tendon. This is accomplished with ice and anti-inflamatory medication.  Gentile stretching exercises prior to weightbearing and the use of a nightsplint can also be helpful. Heel cups or gait orthotics may be worn in the shoe to reduce the pull of the achilles and physical therapy may also be helpful.

Recent non surgical advances including ESWT(extracorporeal shockwave) and PRP(platelet rich plasma) have also helped heal this painful and sometimes chronic condition.  In rare instances surgical intervention may be necessary after all conservative measures have been exhausted.

For more information contact:

Dr William A Sachs

adultandchildfootcare.com

Skin Cancers of the Feet

Skin cancers of the feet have several features in common. Most are painless and often have a history of cracking, bleedng, or ulceration. Frequently individuals discover their skin cancer after unrelated ailments near the affected site. Some of the most common skin cancers of the feet are:                                                                                                                                                                                        

Basal Cell Carcinoma is  generally seen on areas exposed to the sun.This form is one of the least aggressive forms of cancer. Basal cell cancers may appear as a pearly white bump or patch which may ooze or crack.

Squamous Cell Carcinoma is the most common form of skin cancer of the feet. This form of cancer often begins as a scaly bump or plaque, which may appear inflamed. Although squamous cell cancer is painless it may be itchy. It may resemble a wart,eczema or ulcer or other skin lesions.

Malignant Melanoma is one of the deadliest skin cancers known. Nonsurgical treatment is rarely effective. This type of cancer must be detected early to ensure patient survival. Melanomas occur on the skin and occasionally under a toenail.  They are found on the soles and top of the feet.  This cancer commonly begins as a small brown or black spot or bump.  About one third of the cases will lack the brown pigment and appear red or pink.  They may resemble common moles, however close inspection will reveal asymmety, irregular borders, alteration in color and or a diameter greater than 6 mm.  Since these lesions can be very lethal, early detection and treatment can not be emphasized enough.

In conclusion, make it a point to inspect your feet and legs regularly and seek treatment if you notice any new skin lesions or changes in existing lesions.

Dr William A Sachs

adultandchild footcare.com

Bunions-What to do

How many times have you heard of a “bunion” being part of a punch line to a bad joke?  For those of you who suffer from this often-times painful deformity, you know it is not a laughing matter.

Bunions can be a very painful and debilitating deformity that makes walking and shoe wear a painful experience.  A bunion is a deformity that occurs as a result of an imbalance in the foot that causes an instability of the supporting structures . The first metatarsal bone then deviates and the hallux (big toe) moves towards the lesser toes. The side of the first metatarsal also enlarges causing a protuberance on the inside of the foot.  This causes irritation with shoes and can also cause painful stiffness and arthritis as a result of the joint no longer lining up properly. Bunions occur equally in men and women, however women are more likely to have difficulties due to the type of shoes they wear. There is also a heredity factor whereby certain foot types are more predisposed (e.g. pronated or flatfeet).

There are many options for treating a bunion.  It can be treated conservatively with accomodative pads, wider shoes, even cortisone injections to alleviate irritation.  Custom orthotics can help rebalance the foot to slow the progression of the deformity.  Surgical treatment is directed at realigning the metatarsal and balancing the joint. If addressed early,  the chances of long term disability and arthritis can be  reduced.

For more information visit: http://www.adultandchildfootcare.com

William A Sachs, D.P.M., FACFAS

Running Injuries- Dr William Sachs

Spring is a great time to get back to your running routine.  But remember, it is always important to take it slowly and to train carefully with the advice of  an expert to avoid injuries.

Before you get started it is always important to stretch before and after running to minimize injury. Choosing proper fitting shoe gear is very important as well. You must have the correct shoe for the type of activity you  participate in. Finally, you want to consult with your Sports Podiatrist should you begin to develop any pain or difficulties when you begin your program.  The foot is a complicated structure that must not only support you,  but it must also be a mobile adapter and shock absorber for the many surfaces you exercise on.  If your feet are not functioning effectively many injuries such as the ones listed below can occur:

Shin Splints are quite painful and occur on the front and inside of the leg.  They are usually a result of running on hard surfaces, overstriding, muscle imbalance or overuse. Treatment consists of stretching, rest, ice therapy, NSAIDS, and rebalancing the foot with and orthotic device.

Plantarfaciitis is the result of an excessive stretch of the tight muscle band on the bottom of the foot(s).  This can result from overuse, poor footgear, or muscle imbalance.  Treatment is  at supporting the foot and reducing inflammation.  These include rest, OTC support , NSAIDS, stretching and custom orthotics.

Stress Fractures occur from overuse or lack of support.  This is an incomplete fracture that can go on to a complete fracture. 
An xray or bone scan is needed to diagnose this fracture.  Treatment includes rest and immobilization in a surgical shoe or walking boot until this fracture heals.

Blisters and Nail Problems can be annoying or debilitating if not cared for properly.  It is common to experience blisters or nail problems due the constant pounding and friction created in the shoe when running.  Blisters result from friction created by an ill fitting shoe or a prominence on the foot.  If a blister occurs it is helpful to drain the blister at its edge and cover with an antibiotic cream and bandaid or moleskin.  Ingrown toenails are caused by improperly trimming the nail or by shoe pressure, injury or poor foot structure.  If an ingrown nail occurs and  becomes red and tender, seek treatment from your Podiatrist.

 The spring is an excellent time to renew your commitment to good health.  Be sure your feet are in good shape so you can reach your goals pain free!

Dr William Sachs

adultandchildfootcare.com

Heel Pain

Do you have pain in your heel when you get out of bed or when you stand after sitting for a while? It is possible you suffer from PLANTARFASCIITS.  This is caused by an exceessive pull of the tight muscle band that connects your heel to the ball of the foot.     It is usually a result of not enough support to your arch or too much stress( activity, weight, age)

The goal of treatment is to reduce the inflamation and support the foot. We can do this with cortisone injections, anti-inflamatory meds and supportive innersoles(orthotics)

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