• Stretching is key for runners, who are naturally prone to developing tight hamstrings and Achilles tendons.  Performing sustained stretching before, and after the bridge run will keep the lower extremity muscles and tendons flexible and prevents injury.
• If you have a current injury don't  push it to much. Seeking proper evaluation and treatment is essential for healing an injured foot. Even though you’ve finished your run without increasing your time, you can cause major long term damage to the ligaments, tendons or bones in the foot continuing to run with an injury.
• Proper running shoes and custom orthotics 
• Wearing the correct running shoe for your foot type is key to keeping your foot healthy.  However, sometimes a good shoe is not enough for patients that do not have a normal foot type.  Flat feet, high arches, and tendinitis can all cause different types of pain in the feet and ankles.  In those cases custom orthotic are made to provide additional stability and arch support for those that need it.
• Remember that concrete and asphalt are less desirable surfaces to run on compared to dirt or traditional tracks.  Concrete and asphalt do not have the shock absorption that dirt trails and tracks have.  If you are running on harder surfaces, expect increased stress on the lower extremities and be aware of how your body is responding to it.  Try to get in a few long runs of the Bridge this week so that your body is used to the steep inclines of the bridge.
• Choose a moisture wicking sock made of acrylic to help prevent blisters during the run. Specialty running stores have these specialized types of running socks. They may cost a little more than a cotton style sock but it is well worth it.

These are a few suggestions to help prepare you for the upcoming Cooper River Bridge Run 2013. If you are preparing for the race and have a current nagging foot injury, don't hesitate to see us at Carolina Foot Specialists so that we can help you with all of your foot and ankle concerns. 

Good luck this Saturday on your run!

Below is the link:

http://bleacherreport.com/articles/1585523-kobe-bryant-injury-updates-on-lakers-stars-foot

http://www.postandcourier.com/article/20130326/PC1211/130329508/quick-column-unlikely-proponent-of-barefooted-running-a-podiatrist

If you have been training for the upcoming Bridge run over the past few months I wanted to give a few tips about running up hill which may help make it easier for you during the race. 

Try to slightly lean forward into the up slope as you run up the bridge. Running shorter strides makes your running technique more efficient. Keep your head and eyes focused ahead, but not all the way up. Make sure you don't lean over at the waist which may cause strain on the lower back and overworks the hamstrings. When you run up hill on the bridge try to stand tall which will engage your glutes to help power you up more efficiently.

Lastly it is very important to get out over the next few weeks and do some practice runs on the bridge which will help you to get used to running on such a big incline and help to decrease the chance of injury.

Anatomy

The midfoot is the middle region of the foot, where a cluster of small bones forms an arch on the top of the foot. Five long bones (metatarsals) extend to the toes. The bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal. A twisting fall can break or shift (dislocate) these bones out of place.

The midfoot is critical in stabilizing the arch and in walking (gait). During walking, the midfoot transfers the forces generated by the calf muscles to the front of the foot.

The Lisfranc joint complex has a specialized bony and ligamentous structure, providing stability to this joint.

Symptoms

The most common symptoms of Lisfranc injury include:

• Swelling and tenderness on the top of the foot.
• There may be bruising on both the top and bottom of the foot. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury.
• Pain that worsens with standing or walking.

Treatment for a Lisfranc injury depends on the severity of the injury. If the bones have not been forced out of position, a cast or cam walker boot will need to be worn for four to six weeks. When the cast is removed, you may have to wear a custom orthotic. 

Often, operative treatment is needed to stabilize the bones and hold them in place until healing is complete. Pins, wires or screws are options for fixation. Afterwards, you will have to wear a cast and limit weightbearing on the foot for six to eight weeks. In some cases, if arthritis develops in these joints, the bones may have to be fused together.

BELOW IS A LINK ABOUT A PROFESSIONAL BASKETBALL PLAYER WHO SUSTAINED A LISFRANCS SPRAIN AND WILL BE OUT FOR 4-6 WEEKS.

http://www.kansascity.com/2013/03/07/4106528/suns-gortat-out-with-foot-sprain.html

1.  Keep the foot clean and dry and leave the dressing on for one day.

2. Minor bleeding is normal and can be controlled by elevating the foot or applying ice to the area.  Do not remove the dressing if it bleeds; apply additional gauze instead.

3. The anesthesia will wear off in 1-2 hours.  Most people require no pain medication at all, but Tylenol, Aspirin or Ibuprofen work well when needed.

4a. The day after surgery, begin soaking your foot according to the following (if not a permanent nail procedure with chemical)

•  Prepare soaking solution by dissolving 1 tbsp. of table or Epsom salt per pint of warm water.
•  Soak your foot for 10 to 15 minutes once a day for two weeks.
•  After soaking, remove the bandage, pat dry and apply 1-2 drops of the antibiotic solution prescribed into the groove where the nail was removed.
• Replace the previous dressing with a Band Aid.

4b. If using Amerigel wound kit (For permanent nail procedure with chemical)  simply apply Amerigel medication to Band Aid and change daily for two to three weeks.

5.  Some drainage from the nail surgery site is normal and desirable because this is the way the body rids itself of the toenail "root cells" that we killed.  Moderate redness around the nail surgery site is also normal unless the amount of redness increases dramatically.

6.  In approximately 5% of patients or less, the nail will grow back or continue to curl.  If that happens, a repeat procedure is usually done.

Patients that are involved in walking, running, or athletic activity can typically return to activity within 2-3 days for removal of infected toenail and 5-7 days for a permanent nail procedure with chemical application.

The Amerigel Post-Op Surgical Kit has allowed our patients to obtain an effective wound healing product with all the dressings right at the time of service.

For more information on Painless ingrown toenail surgery please refer to our website at carolinafootspecialists.net

One of the most common foot conditions that we see in our practice in adults and children are ingrown toenails. An ingrown toenail most commonly affects the big toe, known anatomically as the Hallux. When an ingrown toenail occurs, the nail grows abnormally into the skin and flesh of the toe. This leads to pain and the overgrowth of skin tissue at the side of the nail.

Sometimes the edge of the toenail pierces the skin outside of the nail groove, beginning to act as a foreign body. Sometimes a nail is ingrown not only at the corner of the nail plate, but all the way down. The first signs of either condition are pain and swelling. The area of penetration may bleed or become infected, producing pus.
 

Causes of an Ingrown Toenail?

The condition is caused by any of several factors. The most common of which is probably improper nail trimming, cutting the nail too much, so that when it begins to grow back it grows out of the “nail groove” directly into the flesh of the toe.

In addition, some people are hereditarily predisposed to developing the condition.
 

Symptoms of an Ingrown Toenail?

Severe pain, infection, swelling, sometimes pus, are major symptoms of the condition. It is normally obvious with a visual inspection, which will show that the nail is in fact growing into the skin and flesh of the toe, and that an infection is present.

Treatment for Ingrown Toenail?

If you have an ingrown toenail, it is best to see your foot specialists for advice. Any toenail that is bleeding, excreting pus, or swollen should be examined by a doctor. Many people with ingrown toenails delay treatment, or make matters worse by resorting to home remedies that may be more painful than medical attention.

Painless Surgery for an Ingrown Toenail?

If the condition has resulted in permanent overgrowth of the tissue surrounding the nail margin, or in recurring infection, surgery may be required to treat the condition. Surgical treatment varies slightly depending on the particulars of each individual case.

In mild cases, removal of a portion of the tissue at the side of the nail groove may reduce pressure and irritation. In this procedure a wedge of tissue is removed and the healing process allows the groove to reform itself.
Sometimes surgery involves use of a local anesthetic and removal of a portion of the toenail and its root. Patients with recurrent ingrown nails may require the use of a medication known as liquid phenol, which permanently removes lateral portions of the nail matrix

In our practice we use a  topical anesthestic before the injection called Ethly Chloride which freezes the skin to make patient's more comfortable.

Surgery for ingrown toenail is painless and easy to perform in the office setting. Patients should be able to put weight on their feet immediately after surgery but walking is uncomfortable. In most cases, toenails grow normally after surgery without imbedding themselves into the skin.

It is important to carefully follow instructions before and after any surgical procedure in order to have the best results and quicker recovery time. Changing the style of footwear you use is very important such as wearing a wider toe box shoe.

Protecting your feet during the hot summer months is essential to preventing foot related injuries.

There are numerous ways to prevent future foot predicaments so you can have an enjoyable time at the beach or the pool during the summer months.

Limit walking barefoot as it exposes feet to sunburn, as well as plantar warts, athlete's foot, and other infections and also increases risk of injury to your feet.

1. 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.
2. 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.
3. 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.
4. Keep blood flowing with periodic ankle flexes, toe wiggles, and calf stretches.
5. 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.
6. 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.
7. 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

1. If you have a positive MRI for calcaneal (heel) fracture, the treatment is 3 months in a removable boot. 
2. If you have a positive MRI for plantar fascial tear, the treatment is 3 months in a removable boot.
3. If you have a positive MRI for intense inflammation only, the tapered cortisone course, with contrasts and ice, with a short course of removable boot, with some PT or accupuncture are all helpful.
4. If you have a positive MRI for any of the above, you may still have nerve trauma/sensitivity concurrently. The pain from nerves is difficult to treat, and has been solutions.
5. If you have a negative MRI, then you have plantar heel bursitis (may not show well on MRI) or nerve trauma, or both. If I think there is bursitis, with a negative MRI, I like ice massage, physical therapy, or cortisone shots (which you correctly are not a fan of, but may be crucial).

For more information on heel pain please refer to our website at carolinafootspecialists.net

The toenails typically will have a yellow, thick appearance that makes it difficult to trim. This condition can progress at a fast pace if not diagnosed and treated promptly. We offer conservative treatment such as professional nail debridment, filing, topical antifungal treatment, and for certain more advanced cases oral Lamisl three month course. Our practice is investigating new state of the art options such as laser treatment for fungal infected toenails.

If you feel like you may have a fungal infection of your toenails please contact our office at carolinafootspecialists.net

For more information on bunions and bunion surgery please refer to our website at carolinafootspecialists.net.

We employ many conservative treatments for neuromas. Conservative treatment consist of custom orthotic and pads to take pressure off the nerve, cortisone injections, antiinflammatory mediation, alcohol sclerosing agent, consultation of appropriate shoe gear/training modification and as a last resort surgical excision of the neuroma.

If you feel like you have any of the symptoms of a neuroma please contact our office.

For more information on Neuromas you can refer to our website at www.carolinafootspecialists.net

PRP (Platelet Rich Plasma)

A new state of the art treatment for chronic heel pain is PRP (Platelet Rich Plasma) injections. A small amount of blood from the patient, similar to giving blood for a routine test. The vial of blood is subjected to very high speeds in a machine called a centrifuge. A yellow material is obtained containing cells called platelets, that are very abundant with factors that aid in healing. These growth factors are believed to decrease the inflammation causing plantar fasciitis. The platelets from the patient's own blood is injected into the area of pain in the heel. Patients are then fitted for a removable walking boot, and will use crutches to prevent putting any weight on the heel for one week or less. After that, they advance to sneakers, and although the range of time for pain relief is variable, it can be appreciated as early as 10-14 days.

For more information please contact our office at carolinafootspecialists.net

http://probasketballtalk.nbcsports.com/2011/04/27/bulls-carlos-boozer-feels-%E2%80%9Cpop%E2%80%9D-in-foot-has-turf-toe-injury/related/

Turf toe is a common injury in professional and weekend athletes. Turf toe can occur after a very vigorous upward bending of the big toe. It got it's name due to the fact that it occurs frequently in people who play games on artificial surfaces. The shoe grips hard on the surface and sticks causing bodyweight to go forward and so bending the toe up. It is also common in martial arts. Y

Symptoms of turf toe include:

• Swelling and pain at the great toe joint and metatarsal bone in the foot.
• Pain and tenderness on bending the toe or pulling  it upwards.

What can the athlete do to treat turf toe?

• Ice the injury immediately.
• Apply a compression bandage.
• Seek a sports medicine specialists or sports podiatrist.
• Rest, which might include crutches to take the weight off the toe.
• Use a protective cam walker boot or wooden shoe to take pressure of the joint.

What can a sports injury professional do?

• X-rays to rule out a fracture.
• Application of ultrasound.
• Taping of the toe to prevent movement.
• After 2 to 4 days the athlete may be able to weight bear again.
• Advise on a rehabilitation and strengthening program

Recovery of this injury can take four to six weeks depending on how bad the sprain is. If the athlete does not look after this injury then it may develop into Hallux Limitus. This is a decreased range of motion due to arthritis around the joint. This can cause problems in the rest of the foot or lower limb due to changes to your walking cycle (gait).

NFL quarterback Tom Brady recently suffered a stress fracture of his foot in a playoff game.
Stress fractures are small, hairline breaks that can occur in the bones of the foot. Typically stress fractures can be caused by overtraining, improper training habits, improper shoe gear, flatfoot or other foot deformities, and even osteoporosis. Tom Brady's injury was more likely due to trauma from blunt force on his foot.

Pain, swelling, and possibly bruising can be signs of a stress fracture. The metatarsal bones are one of the most common locations of stress fractures of the foot. X-rays are used to diagnose stress fractures. Stress fractures may not be visible for 10 to 14 days on x-ray examination. Possible treatments include rest and possible immobilization of the foot ( with a cam walker walking boot/or below knee cast). In Tom Brady's case he may have a fracture that is not in a proper alignment or a fracture that is in a location that won't allow it to heal properly. His surgery will more likely involve screws and possibly a plate to stabilize the fracture. Fractures can take between 6-8 weeks to heal.