Enjoy Pregnancy without Foot Pain
"Oh my aching feet" is a phrase you hear often from pregnant women. But, are sore feet a symptom they just must deal with during pregnancy? The answer is "no." There are many remedies available to help alleviate foot pain.
Women often experience foot pain during pregnancy because of increased weight, foot instability and swelling. "In the last five years, I've seen an increase in pregnant women with foot pain because more women than ever before are active, even running marathons, during their pregnancies," We recommend the following guidelines to help reduce foot pain during pregnancy.
Painful, Swollen Feet -- Pregnant women often experience throbbing, swollen feet due to excess fluid build up (edema) in the feet from the weight and position of the baby. To reduce swelling, put feet up whenever possible, stretch legs frequently, wear wide comfortable shoes and don't cross legs when sitting.
Arch Pain -- Pain in the arch can be due to both arch fatigue or over pronation (or the flattening of the arch). Over pronation causes extreme stress to the ligament (the plantar fascia) that holds up the arch of the foot. The best way to prevent arch pain is to stretch daily in the morning and before and after any exercise, don't go barefoot and wear supportive low-heeled shoes.
Ingrown Toenails -- Excessive stress from tightly-fitting shoes causes painful ingrown toenails. Give your feet a break: wear wider shoes during the last trimester of pregnancy to avoid ingrown toenails. If you do experience an ingrown toenail, avoid attempting "bathroom surgery." Repeated cutting of the nail can cause the condition to worsen over time. It is best to seek treatment with a foot and ankle surgeon.
It is also not uncommon for women to experience a change in their foot size during pregnancy. "A permanent growth in a women's foot, up to half a size, can occur from the release of the same hormone, relaxin, that allows the pelvis to open to deliver the baby. It makes the ligaments in your feet more flexible, causing feet to spread wider and longer,"
Pregnancy and pending motherhood should be a joy. If foot pain persists, make sure you see a foot and ankle specialist. Relief with conservative treatments such as physical therapy, foot orthotics, supportive shoes and minor toenail procedures can relieve your foot pain and keep you active.

Sunscreen on Your Feet?
Prevent skin cancer on feet
When at the pool, beach, or lake we all lather up with sun screen to protect our skin from the harmful rays of the sun. But do we remember to apply sunscreen to our feet?

Many don't realize skin cancer can occur on the feet from unprotected sun exposure, and overlook applying sunscreen to the area. Skin cancer of the foot is prevalent and can even be fatal if not caught early.

While all types of skin cancer, including squamous cell and basal cell carcinoma, can be found on the foot, the most common is the most serious form, melanoma. Symptoms can be as subtle as an abnormal-looking mole or freckle found anywhere on the foot, and often go unnoticed without routine foot exams.

Early diagnosis is key to effective treatment for the condition. But because people aren't looking for the early warning signs or taking the same precautions they do for other areas of the body, often times skin cancer in this region is not diagnosed until later stages.

We recommend to regularly inspect your feet, including the soles, in between their toes and even under their toenails, for any changing moles or spots and to have any suspicious areas promptly examined by a foot and ankle specialist.

Carolina Foot Specialists will be presenting a Community Health talk on "Heal that Heel Pain" at the new East Cooper Hospital April 21st between 10AM-11AM. The presentation will be in the first floor classroom and is free to the public. To register please call (843) 884-7031.

David Quick from the Post and Courier created a video blog about common running injuries in the foot. Please go to the above web address and look for the video on "Common Foot Injuries" from March 16th.
Good information on three of the most common foot injuries we see in runners. If you are preparing for the bridge run there is good information on some preventative treatment you can do at home.
The video also includes an interview of a former patient that experienced plantar fasciitis and is now back to running.

It is possible to change your running technique, but it takes time to break inefficient habits. I have personally switched to the Chi Running techniques for the past 6 months and I have eliminated many of the nagging injuries I have been dealing with for years. Give it a try. Who knows you may find yourself running farther, faster and with less injuries than ever before. See you on the Bridge!

Carolina Foot specialists website/You tube icon

Look out for previous TV segments with Dr. Brown in the upcoming weeks on our You Tube icon.

Bridge run website

It's that time of year again. The Cooper River Bridge Run is only 2 months away. Many of you are thinking about starting a training program in preparation of the big run at the end of March.
Due to the large number of overuse foot injuries we see in the office following the Bridge Run, we have decided to write a Foot Injury Prevention Series to hopefully decrease the amount of heel pain, joint pain and ball of foot pain to our locals and out of town runners and walkers.
Two important factors can aid in proper training and prevention of overuse foot injuries. The first is a new pair of running shoes. As a shoe is worn over time it gradually loses its stability and cushioning, which would normally help decrease strain to the foot. Visit any of our knowledgeable running stores in Charleston to be fitted properly.
The second factor is a plan to gradually increase your mileage each week. If you are just getting off the couch and have not been very active then try a walk/jog program for the first week or two. I generally start my patients out with 3 minutes of walking and 2 minutes of jogging for a total of 15 or 20 minutes. If there are no increased aches and pains the following day then we will progress to 2 minutes of walking and 3 minutes of jogging and continue this pattern until you are able to jog for 20 minutes straight. Try to avoid consecutive training days if possible. I prefer for my patients to run 2 sessions at the same rate and distance before progressing to the next stage. A gradual increase over the next several weeks of short and long runs should have you ready for the Bridge Run.
If at any point in your training you begin to have constant aches and pains try returning to a time and distance of a previous run where no foot pain was present and try to progress at a slightly slower rate. If pain continues try taking several days off with rest and ice or see a foot specialist.
Good luck with your training. See you on the bridge!

Jimmy Clausen injury link ESPN.

The quarterback for the Notre Dame football team, Jimmy Clausen, recently underwent surgery to repair torn ligaments under his big toe joint. Twisting and flexing the joint caused a "pop" that was felt in a game early in the season. He continued to play with the injury which never fully healed.

"Turf toe" is a condition in which the big toe bends upwards to an abnormal degree, causing pain at the bottom of the big toe, damage to the ligaments that connect the foot to the big toe, and damage to the joint capsule. Usually, the front of the foot is flat on the ground and slightly flexed upwards, with the heel raised off the ground. With the heel in this position, an outside force, which is usually another player, forces the joint of the first toe upwards even more.

Initial treatment includes rest, ice and elevation. A stiff soled shoe can help decrease movement of the big toe joint while walking. Crutches and/or a walking boot may be necessary in a severe injury. If discomfort continues a custom orthotic device can be made to decrease strain to the bottom of the joint.

Jimmy Clausen underwent surgery only after an MRI revealed that he had completely torn ligaments under the big toe joint. This severe of an injury rarely occurs and most athletes can return to the field within several weeks of a "Turf Toe" injury.

Don't compromise your game!
The right foot gear will keep you performing your best and injury free.

By Dr. Andrew Saffer

During a ten mile run, the feet make approximately 15,000 strikes, at a force of three to four times your body's weight. Even strolling around your neighborhood for an evening walk puts about one and a half times your bodyweight on your feet. The average non-athletic person will log approximately 1,000 miles per year on their feet. Twenty six bones work with the foot's ligaments, muscles and tendons in two very small structures to support and balance the weight of your entire body. And you thought they were just feet.

Whether you're training for the Bridge Run, playing tennis, or even golf, it's essential to make sure that your feet are comfortable and protected. It's important to remember that foot problems are not only menacing to your feet but can also affect the proper functioning of other parts of the body, including the hip, knee, and back. Because these injuries are progressive, you are probably not even aware of the damage that you're doing.

Before we go any further let's discuss common foot disorders that could be problematic over time and some basic treatment options. A majority of foot pain is the result of a faulty relationship between the bones and muscles of the foot. Incorrect alignment can result in significant discomfort. This abnormal function can lead to foot disorders such as plantar fasciitis (heel pain), achilles tendonitis, bunions, hammertoes, and calluses.

Many of these common "overuse" injuries can be attributed directly or indirectly to improper shoes. Choosing appropriate footwear will not only help prevent injuries but will also let you participate to the best of your ability.

For example, with respect to running shoes it is essential that your specific foot type matches the construction of the running shoe. Pain can result when the shoes' construction doesn't match your foot type. All shoes are constructed from a "last" which is the inside shape of the shoe. Generally, running shoes have a straight last, modified last, or a curved last.

If you have been told that you have a flat arch then you would most benefit from a straight last shoe which maintains support beneath the arch. If you have a high arch foot you would benefit from a curved last shoe which provides more cushioning. If your feet are neutral then you should choose a modified last shoe. Fortunately, most athletic shoe stores employ people who have knowledge of the factors that go into choosing the right pair of shoes.

For some, the right shoe is only half the battle. Custom molded orthotics are prescription medical devices that can be made from various techniques such as plaster cast impression, foam boxes, and our new state of the art technique, "Three dimensional digital scanning."They are designed to control alignment and function of the foot in order to treat or prevent injury-causing forces on bones, joints, tendons, and ligaments. Often, orthotics are used to limit motions such as excessive pronation where your arch may tend to collapse inward. They also make activities such as running, walking, and standing more efficient. Orthotics work like shock absorbers to remove pressure and stress from painful areas in your foot and ankle. They can restore balance, improve sport performance and even alleviate pain in the knee, hip, and lower back. Orthotics are sport specific and different sports may require different orthotics (golf shoes, cycling shoes, tennis sneakers, ski boots, etc.)

Forgive my digression but it should also be noted that in addition to providing relief from painful foot problems or injury, custom orthotics may also benefit people who must walk or stand excessively on the job. In the case of overweight individuals, orthotics can help to counteract the extra stress on the feet, as minor problems are often magnified due to increased weight and stress.

Our new state of the art digial scanner system captures a digital scan of the feet, in a neurtal stance position. The three dimensional image is sent to our orthotic technicians via email. Based on our specific prescription, the technicians customize a device to meet the patient's specific needs.

The orthotic style most often used in athletes is semi-rigid. It allows for dynamic balance of the foot while running or participating in sports. By guiding the foot through proper functions, it allows the muscles and tendons to perform more efficiently. It is constructed of layers of soft materials, reinforced with more rigid materials.

You may be surprised to find that your insurance company will fully or partially cover custom orthotics. Many insurance companies are beginning to recognize that for some, orthotics can be an effective tool in eliminating pain and promoting the overall health and well being of the foot and therefore the rest of the body.

As you gear up for Spring, make sure that you have the appropriate shoes paired with an orthotic device (if necessary) so that the muscles, tendons and bones of your feet function at their highest potential.

You can find more information about this topic and others online at www.carolinafootspecialists.net.

Eli Mannings link on plantar fascial injury

NFL link plantar fascial injury

Heal that Heel Pain
By Dr. Andrew Saffer, DPM
Podiatric Medicine and Surgery

Do your first few steps out of bed in the morning cause severe pain in your heel? If so you may be suffering from "heel pain syndrome", often referred to as "heel spurs." The typical signs and symptoms for this condition are usually severe pain upon first rising in the morning. Resting can provide only temporary relief. Typically, the pain reoccurs after sitting or resting and then rising. The intermittent pain often can progress to a dull aching pain.

Arch pain is often caused by frequent stress on the plantar aspect, or bottom of the foot. The plantar fascia is a supportive, fibrous band of tissue running from the heel to the ball of the foot. When the fascia becomes injured, pain on the bottom of the foot results.

Heel Spurs

Heel spur syndrome, related to plantar fasciitis, occurs after calcium deposits build up on the underside of the heel bone. The spur itself is usually not the cause of pain; the pain is actually from the soft tissue injury to the fascia.

Conservative Treatment

A majority of patient's heel pain resolves completely with conservative treatment. Treatment includes rest from strenuous activity, application of ice, stretching exercises, foot strappings, night splints, foot orthotic devices, cortisone injections, immoblization with a walking boot, and physical therapy.

Shockwave Therapy (Non-invasive surgery)

Extracorporeal shockwave therapy, is a non-invasive treatment option for the intense, persistent heel pain associated with chronic plantar fasciitis. This non-invasive out-patient treatment represents a breakthrough for this condition. Using a unique process known as Orthotripsy shock waves are emitted, similar to those used to treat kidney stones, to increase blood flow and stimulate healing of the affected heel. Shockwave therapy usually allows for patients to return to their activities within a day of the treatment. Some patients report immediate pain relief after treatment, although it can take up to four weeks for pain relief to commence. Shockwave therapy takes approximately 30 minutes and is performed as an outpatient or office procedure. In conclusion most patients who suffer from plantar fasciitis fully recover. Patients who have not responded to conservative treatment may benefit from shockwave therapy. It is a reasonable option to consider prior to surgical intervention, which involves releasing the plantar fascial ligament. The potential side-effects of shockwave therapy are minimal. Therefore, shockwave therapy is a safe alternative to surgery when patients have failed a minimum six months of conservative treatment.

Have you ever experienced pain and swelling on the top of the foot? If you have you may have a condition called a stress fracture.
Stress fractures are small, hairline breaks that can occur in the bones of the foot. They can be caused without trauma to the foot. Typically stress fractures can be caused by overtraining, improper training habits, improper shoe gear, flatfoot or other foot deformities, and even osteoporosis. It is imperative that this injury is recognized and treated as soon as possible by a foot and ankle specialists.

Pain, swelling, and possibly bruising can be signs of a stress fracture. The fracture can occur almost anywhere in the foot. The metatarsal bones are one of the most common locations of stress fractures of the foot. X-rays and other studies 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 some cases, surgery may be required to stabilize the stress fracture or to repair a stress fracture that has progressed to a fracture.

Many of us are welcoming the warmer weather sporting flip-flop sandals; however, their popularity among teens and young adults is responsible for a growing epidemic of heel pain in this population.
We are seeing increasing cases of heel pain in the 15 to 25 years old, a group that usually doesn't have this problem. A major contributor is wearing flip-flop sandals with paper-thin soles everyday to school. Flip-flops have no arch support and can accentuate any abnormal biomechanics in foot motion, and this eventually brings pain and inflammation."
Our practice recommends wearing sandals with reasonably strong soles and arch support. Such as the "Chaco" style sandals.
Especially for girls and young women, thicker soled sandals with supportive arches might not be considered stylish, but if you want to wear sandals most of the time, you'll avoid heel pain if you choose sturdier, perhaps less fashionable styles.
It is estimated that 15 percent of all adult foot complaints involve plantar fasciitis, the type of heel pain caused by chronic inflammation of the connective tissue extending from the heel bone to the toes. Being overweight and wearing inappropriate footwear are common contributing factors.
The pain is most noticeable after getting out of bed in the morning, and it tends to decrease after a few minutes and returns during the day as time on the feet increases. Not all heel pain, however, is caused by plantar fasciitis. It also can occur from inflammation of the Achilles tendon, bursitis, arthritis, gout, stress fractures, or irritation of one or more of the nerves in the region. Therefore, diagnosis by a foot doctor to rule out other causes is advised.
Initial treatment options for heel pain caused by plantar fasciitis should include anti-inflammatory medications, padding and strapping of the foot and physical therapy. Patients also should stretch their calf muscles regularly, avoid wearing flat shoes and walking barefoot, use over-the-counter arch supports and heel cushions, and limit the frequency of extended physical activities.
Most patients with plantar fasciitis respond to non-surgical treatment within six weeks. However, surgery is sometimes necessary to relieve severe, persistent pain.

The question is: For the comfort and health of your feet, what is the maximum recommended heel height?
Carolinafootspecialists.net

Bunions are most often caused by an inherited faulty mechanic structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.
2. Do over-the-counter pads and splints really work?

Pads placed over the area of the bunion may help minimize pain from a bunion. However, padding and splinting cannot reverse a bunion deformity.
3. Will my bunion get worse?

Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike. Some bunions progress more rapidly than others.
4. Is it better to have it fixed now, or should I wait?

When the pain of a bunion interferes with daily activities, it's time to discuss surgical options with your foot and ankle surgeon. Together you can decide if surgery is best for you.
5. How can I avoid surgery?

Sometimes observation of the bunion is all that's needed. A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed, such as changes in shoes, padding, activity modifications, pain medications, icing, injection therapy, and orthotic devices.

When the pain of a bunion interferes with daily activities, it's time to discuss surgical options with your foot and ankle surgeon. Together you can decide if surgery is best for you.
6. Will my insurance company pay for the surgery?

In most cases, yes.
7. Is the surgery painful?

The amount of pain experienced after bunion surgery is different from one person to the next. Most patients will experience discomfort for three to five days. If you closely follow your foot and ankle surgeon's instructions, you can help minimize pain and swelling after your bunion surgery.
8. What type of anesthesia is involved?

Most bunion surgeries involve local anesthesia with intravenous sedation. That means your foot will be numb and you will be given medications to relax you during the procedure.
9. If I need surgery, how long will recovery take?

The length of the recovery period will vary, depending on the procedure or procedures performed. Your foot and ankle surgeon will provide you with detailed information about your recovery.
10. Will I be able to walk normally, or even exercise and run, after healing from bunion surgery?

In most cases, yes.
11. How soon can I walk after surgery?

It depends on your bunion and the surgical procedure selected for you.
12. How soon can I go back to work after surgery?

The length of the recovery period will vary, depending on the procedure or procedures performed.
13. How soon can I drive after surgery?

The length of the recovery period will vary, depending on the procedure or procedures performed.
14. Can the bunion come back?

Yes, there is a risk for bunion recurrence in some cases. Patients can help prevent this by following their doctor's instructions to wear arch supports or orthotics in their shoe.
15. If screws or plates are implanted in my foot to correct my bunion, will they set off metal detectors?

Not usually. It can depend on the device chosen for your procedure, as well as how sensitive the metal detectors are.

You don't have to be an accomplished athlete to suffer Achilles tendon injuries. They can happen from household tasks like climbing a ladder. Achilles tendon weakness is common in adults. But seeking treatment when symptoms occur can prevent more serious injury.
Achilles tendon injuries happen most often to less conditioned, "weekend warrior" athletes who overdo it. Ruptures of the Achilles tendon can occur from simply climbing a ladder quickly.
The Achilles tendon is the longest and strongest tendon in the body. It is subjected to considerable wear and tear. When the tendon becomes inflamed from overuse, or sudden stress, tendonitis can weaken it over time and cause microscopic tears.
People risk further deterioration and possible rupture when they don't seek medical care for Achilles tendon injuries. The main symptoms of Achilles tendonitis are pain, stiffness and tenderness. Pain occurs in the morning, improves with motion, but gets worse with increasing stress and activity.
Treatments for an acute Achilles tendon injury includes:
Immobilization with a cam walker boot to promote healing of the tendon.
Ice to reduce swelling.
Non-steroidal anti-inflammatory medication to reduce pain and inflammation.
Physical therapy to strengthen the tendon.
Surgery, if other approaches fail to restore the tendon to its normal condition.

To find out more about Achilles tendon injuries please refer to our website at: Carolinafootspecialists.net