Q: I have pain in my heel. What could this be? (heel pain, plantar fasciitis)
A: There are several different causes of heel pain, but the most common by far is plantar fasciitis. This is an inflammation of the band of fibrous tissue (fascia) running along the bottom of the foot, from the heel to the ball of the foot. The typical patient with plantar fasciitis complains of pain that is significant in the mornings when they get up and almost every time they get up from sitting or resting for a prolonged period of time. The presence or absence of a heel spur does not matter (believe it or not!).
Heel pain is generally the result of faulty biomechanics that place too much stress on the heel bone and the soft tissues that attach to it, injuries, wearing improper shoe gear or being overweight.
The good news is that most patients do very well with treatment for plantar fasciitis. Treatment may include steroid injections, medicines, physical therapy or custom-made arch supports called orthotics. Other less frequent causes of heel pain may include a stress fracture of the heel bone, different types of arthritis, spurs, tendonitis or bursitis, to name a few.
Q: Is foot/ankle surgery painful?
A: This is a very frequent question that many patients ask. There have been tremendous advancements in foot and ankle surgery and in postoperative pain management. These advancements have made it much more comfortable now to have these types of surgeries and are not nearly as uncomfortable as they used to be.
There is some initial postoperative discomfort, as you can imagine, but we provide each patient with the necessary medicine to manage their postoperative pain.
Q: What is an ankle sprain, and how should it be treated?
A: An ankle sprain occurs during a traumatic incident in which the ankle is usually "twisted" inwards. The outside of the ankle is supported by a unique network of three ligaments (soft tissue structures that connect bone to bone). During this injury, a patient will injure one to all three of these ligaments.
Immediately afterward, patients should rest the area, put ice on the ankle, apply some form of compression and elevate the injured limb. It is highly recommended that these patients should seek the help of a health professional soon after this, because there is a possibility of other subtle and less obvious injuries that may have occurred. These may include fractures (broken bones), cartilage damage, tendon injuries, etc.
Treatment for ankle sprains will include an aggressive physical therapy regimen. Therapy is very important in the rehabilitation process for several reasons. Frequently after this injury, patients may complain that their ankle feels "unstable” – this is most likely due to the ligamentous damage that occurred. Therapy is important in helping these patients "stabilize" their ankles and prevent problems of this nature in the future. Therapy also helps with controlling the swelling and strengthening the ankle. We will frequently dispense a high-quality ankle brace to these patients to help them in their rehabilitation process.
Sometimes patients, months or even years after the injury, still complain of pain that never went away. This may be indicative of cartilage or tendon damage that occurred during the injury.
Q: My child appears to be flat-footed. What should I do?
A: This is a frequent concern of many parents. I see children of all ages with their parents concerned about the future of the child's feet if left untreated. The feet of a child are normally relatively flat at birth and will gradually develop an arch as they continue to grow. Research has shown that a child's arch continues to change in architecture until the age of seven or eight. After this age, you will probably see minimal changes in the arch.
The question that I am frequently asked is whether or not to treat the apparent flat feet of a child. If the child is without any pain or discomfort, studies have indicated that is probably best to let the child continue to grow without any treatment. If, however, a child presents to my office complaining of symptoms that are most likely due to flat feet, then treatment is indeed indicated. These symptoms would include things like arch pain, cramping in the calves and pain to the outside of the ankle.
Treatment for juvenile flat feet includes custom-made arch supports (orthotics) and medicines, and if these treatments fail, surgical correction can be performed. It is very important to me to try all forms of care outside the surgical arena before I consider operative treatment.
Q: Can shoes really cause foot and ankle problems?
A: Yes, most definitely. Shoe gear is the most contributing factor in the long-term development of several types of foot and ankle deformities. They affect the foot more than the ankle.
There was a study done several years ago in a South American community where none of the natives wore any type of shoe gear. The researchers found nearly no signs of any structural deformities in the feet of these natives when compared to a similar population where shoes were worn daily. The researchers concluded that it is most likely that shoes do play a most significant role in the development of many foot problems.
The ones most at risk are women. The pressure of looking good and stylish in today's society has encouraged women to continue to wear narrow, pointed, high-heeled and, most likely, ill-fitting shoes. Although they probably look good, individuals who consistently wear these types of shoes may have problems in the future, if not the present.
If you would like a copy of my personal suggested shoe gear list, send us a note, and we will gladly send you this list. If you have any questions that you would like to see answered, send your questions also, or give us a call at one of our three locations.
Q: I am diabetic. What concerns should I have with my feet and ankles?
A: Diabetics have to take extra-special care of their feet. Patients with diabetes are at risk for different kinds of foot problems. These include circulatory problems that may worsen over time, loss of sensation (feeling) in your feet and slower healing times for different types of wounds.
All of these factors put a diabetic at risk for open wounds (ulcers), ingrown toenails and wound-healing problems that can pose a limb-threatening situation in an extreme situation. Many times, I will see these patients after a problem has already set in, such as an infection. It is for this reason that diabetic people should check their feet daily for any open areas or "breaks" in the skin. Any signs of infection (redness, swelling, foul odor) should not be taken lightly, and one should seek medical help as soon as possible.
Prevention of diabetic problems truly is the key to avoiding these complications. I encourage every diabetic to see their foot doctor every two to three months for a checkup and treatment if needed. Patients with diabetes should not be lazy and should check their feet every day. This simple task takes all of two minutes a day and may save a limb.
Check your feet every day. Look for cuts, sores, bumps and red spots. Use a mirror or ask a family member for help if you have trouble seeing the bottom of your feet.
Wash your feet in warm (not hot) water every day. Use a mild soap. Do not soak your feet. Dry your feet by patting them with a soft towel, making sure to dry gently between your toes.
Apply an alcohol-free moisturizing lotion after washing your feet. Do not put lotion between your toes.
Cut your toenails straight across. Do not leave sharp edges that could cut into the next toe.
Do not cut calluses or corns yourself. Do not use wart removers on your feet. If you have warts, corns or calluses, see a podiatrist (a doctor who specializes in foot problems) and tell him you have diabetes.
Wear thick, soft socks and make sure they fit well. Do not wear mended socks or socks with holes or seams that might rub or irritate your feet.
Check the inside of your shoes before you put them on to make sure that they have no sharp edges or objects such as rocks in them.
Wear shoes that fit well and let your toes move. Break in new shoes slowly. Do not wear flip-flops, shoes with pointed toes or plastic shoes. Never go barefoot.
Wear socks if your feet are cold at night. Do not use heating pads or hot water bottles on your feet.
Have your doctor check your feet at every visit.
See a podiatrist if you can't take care of your feet yourself.
If you do notice any cuts, blisters or wounds that won't heal, call your doctor right away. It could save your foot from amputation.
Any questions? Please submit them to us!