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Chronic Heel Pain

07-23-2014

Heel pain is not as simple as "plantar fasciitis."  Most cases of heel pain winds up being plantar fasciosis/fasciitis.  We really no longer use the term fasciitis anymore because it is not an inflammatory problem, it is a swelling problem.  The main reason people get swelling of the plantar fascia is because of a few factors that all cause an overstretching of the fascia.  This in turn causes swelling and pain.  These include: Having a tight Achilles tendon, obesity, very high arch or flat feet, working on hard surfaces all day and poor shoe gear.  

It is very important to make the proper diagnosis before proceeding with treatment.  The use of a diagnostic ultrasound machine (the same kind used to look at a baby in the womb) is an invaluable tool to make the proper diagnosis on the spot.  MRI is actually not as accurate and cost more money and requires the patient to go somewhere else and then have to come back to be treated. X-rays can be helpful and can often reveal a spur on the bottom of the heel.  But not all spurs are created equal!  A spur on the bottom part of the heel is almost NEVER the cause of the pain. It is simply as sign of chronic stretching of the plantar fascia.

Here at The Foot, Ankle, & Lower Leg Center we have an ultrasound machine onsite.  Within a few seconds we will know whether or not you have plantar fasciosis or not.  If you do have it then we have state of the art treatment of this very common problem.  This includes use of amniotic fluid (stem cells) to help permanently resolve this condition. 

Now, if you have a normal ultrasound of the heel then in all likelihood you have a nerve problem.  This is usually something called Tarsal Tunnel Syndrome, or it can be entrapment of the Medial Calcaneal nerve or you can have both.  These nerve problems can often mimic plantar fasciosis and if not identified properly can lead to unnecessary treatment by a doctor or therapist.  At least 50% of heel pain will have some nerve involvement.  Nerve pain will often radiate from the inside of the heel area and go into the arch whereas the plantar fascia pain is almost always isolated to to the bottom medial side of the heel.

Achilles/posterior heel pain:  This is when you have pain in the back of the heel where the Achilles inserts.  This again is caused by a pulling of a tight Achilles tendon and often times spurs or calcification will be present which can contribute to the pain unlike in plantar fasciosis.  Again, diagnostic ultrasound is a very useful tool in making the diagnosis.

What do plantar fasciosis and Achilles tendonosis have in common?  They both have poor blood supply which makes them prone to injury and they both do not really stretch too much.  So, the goal of treatment is to deliver better blood flow which can be done in many different ways as well as stretch the tissue.  In the case of plantar fasciosis 90% of all cases can be treated without surgery.  In Achilles cases that have large spurs about 50% of the time they will need surgery.

The use of Amniotic fluid has been the magic bullet we have all been waiting for.  It can actually heal damaged tissue and is a far better choice then using steroids.  We have it in our office and make it available to you the patient. (It is usually not covered by insurance)

Tarsal Tunnel Syndrome- This is very similar to Carpal Tunnel syndrome where the main nerve (the posterior tibial nerve) and the other branches can be pinched by the surrounding tissue.  This is often missed by many other doctors and why people with heel pain don't seem to get better.  Dr. Bregman has helped more patient's with this condition than any other doctor in Nevada.  He is an expert in peripheral nerve problems and teaches other doctors how to perform the surgery.  He also lectures all over the world on nerve conditions of the lower extremity.

Avoid these gross foot infections

07-01-2014

Ugh, plantar warts. They’re painful, deep, and unsightly.They magically appear on the bottoms of your feet, and then take ages to goaway. But we can save your soles. Read on to learn the easiest and fastest waysto destroy plantar warts—and prevent the nuisances from ever showing up again.

How you getthem

Plantarwarts are contagious viral infections caused by the human papilloma virus(HPV). Your skin has to come in direct contact with a surface containing thevirus—most of us contract it from bare floors, swimming pool decks, and lockerroom floors where the moisture allows the virus to thrive.

The virus infects skin cells and sits outside the body,which makes it hard for your immune system to properly fight the infection,says Pete Smith, vice president of the Pennsylvania Podiatric MedicalAssociation. They usually last a very long time, several months to a couple ofyears, and if left untreated, can spread. Due to pressure on the foot, they canalso be painful while walking, standing, or exercising.

Duct tapeworks—sort of ...

Placing duct tape over the wart is an old trick that canactually work sometimes. It’s not the tape itself that does the trick—it’s mostlikely the skin’s allergic reaction to the adhesive that stimulates the body’simmune system to kill the virus, says Smith. A 2007 study from the Universityof Minnesota found that duct tape was effective 21 percent of the time. If youwant to try it, follow these steps: Apply the duct tape over the wart, a bitbigger than the wart, to ensure the tape stays fixed to the skin. Leave it onsix and a half days, replacing if it falls off, and then let the skin restovernight. Repeat for several weeks, says Davis.

Try atopical

Medicinal lotions are the most common first-attemptstrategies. Most of these are salicylic acid-based products. Look for productswith the highest percentage, which will be the most effective, Smith says. Animportant part of topical treatments is to remove some of the excess, overlyingskin on the wart, so that when you apply the medication it can penetrate downto the virus faster. The skin on the bottom of your foot is 10-15 times thickerthan other places on your body, making it harder for the medication topenetrate.

Finally, sanitize your shoes with bleach or a strongvinegar solution if your bare feet have come in contact with them. Throw yourrunning shoes in the washer, or take out the insoles and let them completelydry out, Smith advises.

Your feet are magnets for fungal infections. Here arefour weird causes of athlete’s foot, and your best defenses against them.

Avoid theknife!

If you try to remove it yourself with a sharp object, youcould injure yourself, says Dr. Dawn Marie Davis, a dermatologist at the MayoClinic.

“Also, warts do easily spread by friction, so avoidtraumatizing your skin in an attempt to remove the wart,” she says.

This includes applying extreme heat or cold to the wartto try to resolve it. That not only risks severe skin damage, but it won'twork. Remember as well that taking a sharp object to it yourself could lead toa bacterial infection on top of your viral one. Skip it.

Prevention is the best way to save your soles. Stay awayfrom these six damage-inducing, foot-health traps.

Seek professionalhelp

Possibly the easiest way to get rid of the wart is bygoing to the podiatrist ordermatologist for treatment. There are a number of different prescriptiontopical treatments they can offer that are much stronger than over-the-countersolutions. The physiciancan also offer treatments including laser and surgical excision to get rid ofthe wart.

Avoidcontracting them again

Since the virus is contracted by skin-to-skin contact andby coming into contact with inanimate objects that have the virus, it isimportant to always have the feet protected from such contact, Smith says.Don't walk barefoot in public pools, gyms, locker rooms or showers wheresomeone with the virus may have been.Don't wear other people's shoes. Try not to get cuts or scrapes on yourfeet, which would allow easier access to the skin for the virus, Smith says.

Avoid these gross foot infections!

Men's Healthpublished by Emily Mitchell June 2014

The podiatry professionals atthe Foot, Ankle & Lower Leg Centerare pleased to welcome you to our practice. We want all our patients to beinformed decision makers and fully understand any health issues you face. Wehave 2 convenient locations to serve you in the Las Vegas and Henderson area. To take the first step to better foot health, call ouroffice at 702-878-2455. We encourageyou to visit our website @ www.FallCenter.comwhenever you have concern about your foot or ankle needs and to schedule yourappointment on-line. That’s why we’ve developed a website loaded with valuable informationabout podiatry and podiatric problems and treatments.

All Toes on Deck: Tips for Protecting Feet from the Heat

06-03-2014

One perk of a beach-bound vacation is knowing that instead of snow soaking through your Choos or having your feet feeling toasty in sweaty Uggs, you can lounge happily with your toes dangling in the warm weather, shoe-free with the sand at your feet. But alas, the dream does come with its own set of tootsie troubles. "Even if you are just lying still on your back soaking up the rays, your feet are still vulnerable," says American Podiatric Medical Association member Dr. Jane Andersen. "You can seriously sunburn your feet and no matter how upscale your hotel, athlete's foot can lurk in all public pool areas."

Wouldn't you rather spend time collecting sea shells than doctor's bills? No worries. There are ways to prevent these future foot predicaments so you can go back to your sun-kissed dreams and enjoy a liberated foot experience.

    1. Limit walking barefoot as it exposes feet to sunburn, as well as plantar warts, athlete's foot, ringworm, and other infections and also increases risk of injury to your feet.
    2. Wear shoes or flip-flops around the pool, to the beach, in the locker room and even on the carpeting or in the bathroom of your hotel room to prevent injuries and limit the likelihood of contracting any bacterial infections.
    3. Remember to apply sunscreen all over your feet, especially the tops and fronts of ankles, and don't forget to reapply after you've been in the water.
    4. Stay hydrated by drinking plenty of water throughout the day. This will not only help with overall health, but will also minimize any foot swelling caused by the heat.
    5. Keep blood flowing with periodic ankle flexes, toe wiggles, and calf stretches.
    6. Some activities at the beach, lake or river may require different types of footwear to be worn so be sure to ask the contact at each activity if specific shoes are needed. To be safe, always pack an extra pair of sneakers or protective water shoes. If your shoes will be getting wet, they should be dried out completely before your next wearing to prevent bacteria or fungus from growing.
    7. If you injure your foot or ankle while on vacation, seek professional medical attention from a podiatric physician. Many often only contact a doctor when something is broken or sprained, but a podiatrist can begin treating your ailment immediately while you're away from home. Use our Find a Podiatrist tool to get treatment wherever your travels take you!
    8. In case of minor foot problems, be prepared with the following on-the-go foot gear:
        • Flip flops – for the pool, spa, hotel room, and airport security check points
        • Sterile bandages – for covering minor cuts and scrapes
        • Antibiotic cream – to treat any skin injury
        • Emollient-enriched cream – to hydrate feet
        • Blister pads or moleskin – to protect against blisters
        • Motrin or Advil (anti-inflammatory) – to ease tired, swollen feet
        • Toenail clippers – to keep toenails trimmed
        • Emery board – to smooth rough edges or broken nails
        • Pumice stone – to soften callused skin
        • Sunscreen – to protect against the scorching sun
        • Aloe vera or Silvadene cream – to relieve sunburns

    Published by 2014 American Podiatric Medical Association, Inc.

    The podiatry professionals at the Foot, Ankle & Lower Leg Center are pleased to welcome you to our practice. We want all our patients to be informed decision makers and fully understand any health issues you face. We have 2 convenient locations to serve you in the Las Vegas and Henderson area. To take the first step to better foot health, call our office at 702-878-2455. We encourage you to visit our website @ www.FallCenter.com whenever you have concerns about your foot or ankle needs and to schedule your appointment on-line. That’s why we’ve developed a website loaded with valuable information about podiatry and podiatric problems and treatments.

In Women's Shoes, Pain does not Equal Gain

05-07-2014

highheels1High heeled shoes can cause pain, deformities and damage tothe feet that can last a lifetime. But doctors say there are steps women cantake to reduce high heel-related foot problems.

  1. Avoid shoes with pointed toes.
  2. Avoid heels taller than two inches.
  3. Recognize foot pain is a warningsign.

    High heeled shoes crowd the toes,force the body's weight onto the ball of the foot and disrupt the body'salignment. They can lead to a laundry list of problems for women and theirfeet:

    Bunions

    High heels do not cause bunions.Most women who develop bunions can blame their ancestors for passing down afaulty foot structure. But over time, wearing pointed-toe high heels can makebunions worse. Only surgery can correct this often painful deformity.

    Hammertoes

    Hammertoe1High heeled shoes that crowd the toes together cancontribute to hammertoes. This deformity occurs when the second, third, fourthor fifth toes become bent, like a claw. This can cause constant shoe friction,leading to painful corns. Severe hammertoes may require surgery to relievepain.

    Corns

    Corns usually form from repeatedpressure on the skin. Women with foot deformities, such as hammertoes, oftensuffer from corns because the tops of the bent toes rub against the tops orsides of shoes.

    Haglund's deformity, or "pumpbump"

    HaglundPump-style shoes often cause significant pain by irritatinga bony deformity some women have on the back of their heel, called a "pumpbump." This problem is common in young women who wear high heels almostevery day. In many cases it can lead to blisters, bursitis or Achilles tendonitis.

    Neuromas

    Pointed-toe and high heeled shoesare the most common reasons women develop painful neuromas. High heeled shoescan cause the toes to be forced into the toe box, which can compress and swellnerves in the foot, especially between the third and fourth toes. Neuromasymptoms appear gradually and include tingling, burning, numbness or pain.Without treatment, a neuroma can lead to permanent nerve damage, making itdifficult to walk without severe, shooting pain.

    Ankle sprains

    High heels increase the risk forankle sprains. Sprains occur when ligaments that connect bones together arestretched or torn. Left untreated, sprains can lead to chronic ankleinstability and potential arthritis.

    Back pain

    High heels force women to stand andwalk unnaturally, affecting the alignment of the ankles, knees, hips and lowerback.

    Foot and ankle surgeons saythe majority of their patients are women. But not all foot problems related towearing high heels require surgery. Luckily, many of these conditions can betreated non-surgically with changes in shoe wear, padding, orthotic (shoeinserts), pain medications and other measures.

    Women's high heeled shoes aren'tgoing out of style anytime soon. But by recognizing pain as a warning sign,wearing high heels in moderation and seeking medical care when problems are intheir early stages, women can stay fabulous on their feet.

    Copyright © 2013 , American Collegeof Foot and Ankle Surgeons (ACFAS),

    The podiatry professionals atthe Foot, Ankle & Lower Leg Centerare pleased to welcome you to our practice. We want all our patients to beinformed decision makers and fully understand any health issues you face. Wehave 2 convenient locations to serve you in the Las Vegas and Henderson area. To take the first step to better foot health, call ouroffice at 702-878-2455. We encourageyou to visit our website @ www.FallCenter.comwhenever you have concern about your foot or ankle needs and to schedule yourappointment on-line. That’s why we’ve developed a website loaded with valuable informationabout podiatry and podiatric problems and treatments.

Saturday appointments now available!

05-09-2013

With our busy lifestyles and having a hard-time to schedule a doctor’s visit during our work or the kids school schedules! We are excited to now offer Saturday appointments to our weekly schedule at Foot, Ankle & Lower Leg Center. Our hours for Saturday will be 8:00am to 1:00pm. On certain days of our weekly schedule, we now offer earlier & later appointments starting 7:30am to 6:00pm. Please call our office to schedule one of your new appointments with our convenient hours!