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Posts for category: Sports Injuries

Plantar fasciitis is one of the most common complaints that we see in our practice.  The number of patients known to have the problem is estimated to be between six and seven million.

Many patients attempt to treat the problem at home prior to seeking treatment from a doctor which is fine unless the problem has been present for an extended period of time, usually between 3-6 months. That is when they often learn about Plantar Fasciopathy for the first time.

WHAT’S THE DIFFERENCE BETWEEN PLANTAR FASCIITIS AND PLANTAR FASCIOPATHY?

 

Plantar fasciitis is actually divided into conditions with two different treatment requirements. Acute plantar fasciitis is an inflammatory condition and is associated with irritation and inflammation of the plantar fascia at its insertion on the heel region.

After six months this develops into chronic plantar fasciitis, the problem actually changes and and is referred to as plantar fasciopathy. Plantar fasciopathy is non-inflammatory and there is a lack of blood supply to the region and the body thinks of the problem as being normal. This lack of blood supply results in the body not responding to the condition and therefore a lack of healing potential in the region.

IS PLANTAR FASCIITIS AND PLANTAR FASCIOPATHY TREATED DIFFERENTLY?

Treatment for these two conditions is very different and we would like to educate you on new and improved treatments for chronic plantar fasciopathy.

If plantar fasciitis is treated early and aggressively, it is often not very difficult to treat. Treatment options include stretching, night splints, oral NSAIDS, shoe modifications to a stiffer and stronger sole, added arch support or custom orthotics, physical therapy and cortisone injection therapy.

Chronic plantar fasciopathy, there is NO inflammation present and there is a chronic scar tissue formation in the heel region with the body not responding to the region. The goal of treatment is to INCREASE inflammation and return the body’s blood supply to the region to help with healing.

Typically conservative treatments used for acute plantar fasciitis do not usually work well in these situations.

CHRONIC PLANTAR FASCIOPATHY TREATMENTS

Our common treatments in chronic plantar fasciopathy include aggressive physical therapy with additional custom arch support and shoe modifications. However, in many cases, there is a need for noninvasive and minimally invasive therapy to increase blood to the region.

Treatment options plantar Fasciopathy

Treatment options cause an irritation of the region of the plantar fascia that’s non-responsive and lacking the healing blood supply. This will result in a return of blood to the area and take the chronic condition and make it more acute which can then allow the body to heal the region.

Shockwave Therapy (EPAT)

Shockwave therapy has been around for about 30 years and is basically a small jack hammer that is hitting the heel area and breaking up scar tissue. Much like someone hitting your shoulder over and over with a punch which causes inflammation, the concept of shockwave therapy is to cause minor damage to the region and increase blood supply. It is a treatment that can work well but is somewhat obsolete. The main benefit is that the treatment is fairly simple and does not involve injection or internal treatment.

Platelet Rich Plasma and Amniotic Injections

PRP and amniotic injections are used to bring the patient’s own blood cells and healing cells to the region of chronic injury. Both treatments help recruit cells necessary to heal and have a very strong result in our hands. These treatments work well but can be somewhat painful and moderate to severe cases of scar formation may not respond well to this treatment.

Radio Frequency Ablation (TOPAZ)

There is a group of patients who have such extensive plantar fasciopathy that the PRP and amniotic injection are not strong enough to treat. In such cases, radio frequency ablation was used to break up the scar tissue with a small needle probe. The previous treatments such as Topaz used approximately 20-30 small needle holes made through the skin on the bottom of the foot to break up the scar tissue on the sole of the foot.

 

The Tenjet System for Chronic Plantar Fasciopathy (Our practice is currently researching this new technology and looking at long term studies)

 

The Tenjet system releases a high-power water jet into the region of the plantar fascia scar tissue and damage. The system is used under ultrasound guidance and the water jet which breaks up the scar tissue is connected to suction and the scar tissue is sucked out after it is broken up by the water jet.

WHAT’S THE BEST TREATMENT OPTION FOR CHRONIC PLANTAR FASCIITIS TREATMENT?

The best treatment always depends on the patient and their individual condition. So the first thing we do is separate patients into two distinct groups, those with acute plantar fascia (suffering less than six months) and those that have truly chronic plantar fascia issues.

Acute treatment for Plantar Fascia patients includes:

  • Shoe modification/recommendations
  • Custom Orthotics
  • Physical therapy
  • Tapings
  • Oral NSAIDS
  • Possible steroid injection

In conclusion, if you have been suffering from acute or chronic heel pain then please visit our Sports Podiatrist at Carolina Foot Specialists so that we can figure out the cause of your heel pain and work on solutions to resolve your pain.

Dr. Andrew Saffer-CFS Mount Pleasant 843-654-8250

Dr. Adam Brown-CFS Charleston 843-225-5575

www.carolinafootspecialists.net

Modern-Plantar-Fasciitis-Treatment-Options-Explained

I wanted to spend some time today addressing a common athletic foot injury that I see very commonly in women. The injury that I frequently see is a metatarsal stress fracture. This short blog will give you valuable information of how to recognize and treat this common sports related injury.

Typically a metatarsal stress fracture will presents acutely with pain and swelling on top of foot just at the base of the lesser toes. The most common symptom is pain and swelling to the dorsal forefoot with or without trauma. Stress fractures often result from increasing the amount or intensity of an activity too quickly. This could be due to increasing the amount of mileage associated with walking or running while training for a road race. Other factors found more commonly in women would be poor bone density (osteoporosis), low body weight,  and menstrual disturbances.

Oftentimes I will see patient's that present with pain four weeks prior and they may have initially had a X-ray that was negative for a stress fracture. When we see a patient for the first time four weeks after the symptoms manifested we then take a repeat X-rays which shows a stress fracture. It may take 10-14 for a stress fracture to be visible on X-ray examination. Typically bone callus on both sides of the metatarsal will confirm the stress fracture is healing. If a metatarsal stress fracture is not promptly treated with immobilization with a cam walker and reduction of activity this could lead to further swelling/pain and possible delayed healing of the fracture.

Stress fractures take 6-8 weeks to heal and are treated with either a surgical shoe or cam walker boot. We do advocate low impact non-weight bearing activity to keep patient's active such as swimming or biking during the healing phase.

A protein deficiency, along with an overall calorie-deficient diet can relate to associated medical problems. One of these could include loss of regular menstrual cycles. Estrogen levels decline when menustration stops. This drop in estrogen leaves the bones in the body more prone to a stress fracture.

I usually recommend that women over 40 follow up with their family doctor for a bone density test. Certain blood work can be ordered such as determination of calcium, potassium, and magnesium levels which are vital for proper bone health.

If you have noticed increased pain and swelling on the top of your foot this could be a stress fracture. This is not normal and it is essential that this be treated to ensure the fracture heals correctly.

Dr. Brown and Dr. Saffer have all the available clincial and diagostic tools to diagnosis this condition correctly and can expedite the healing of this common sports related foot injury.

If you have suffered from chronic heel pain and your symptoms have not improved with traditional conservative treatments options then we may have a solution that will cure your heel pain for good.

We are offering a new treatment modality for chronic heel pain called (EPAT) Extracorpeal pulse activation technology. Intense pulse sound waves are introduced into the soft tissues to break up scar tissue and increased blood flow to the injured area. This procedure reduces pain and inflammation as well as stimulates your own bodies healing mechanism. 

The advantages of this procedure are:

1)Painless

2)No down time

3) No anesthesia

4) In office procedure

Typically, the procedures takes 5 minutes and is done weekly for three weeks.

After the treatment you will experience decreased pain and begin to have relief from symptoms which continues to improve over a 3-5 week period.

So, if you experience chronic heel pain make an appointment with our practice to see if you are a candidate for EPAT.

https://www.carolinafootspecialists.net/heel-pain.html

Foot blisters can be a frustrating foot condition. Foot blisters are caused by friction, usually your shoes or socks rubbing against your skin. Anything that intensifies rubbing can start a blister, including increasing your pace, poor-fitting shoes, and  improper socks.  Heat and moisture intensify friction by making your feet swell. That explains why many runners only suffer blisters during races, especially marathons.

The body responds to the friction by producing fluid, which builds up beneath the part of the skin being rubbed, causing pressure and pain. While most blisters don't pose a serious health risk, they can have a negative impact on your exerices routine.

First Aid

If you have a large blister that is painful you can drain it with a sterile needle. If you don't drain it, your blister will hurt, and it could puncture on its own or cause a potential infection. To drain a blister first wash your hands, then wipe a needle with alcohol to sterilize it. It is not recommended to heat the needle.Once you've punctured the blister, carefully drain the liquid by pushing gently with your fingers near the hole. Then cover the blister with a tight bandage to keep bacteria from getting in. You can take the bandage off periodically and soak your foot in warm water and Epsom salts to draw out the fluid. After soaking, put on a fresh bandage. If you have a small blister that is not necessarily painful leave it intact. The skin acts as a protective covering over a sterile environment. Furthermore, if the fluid amount is small and you try to pop it, you could cause additional problems by making it bleed.

Blister prevention tips:

Choose blister-free socks. Synthetic socks wick moisture away from the skin. Cotton may be lighter, but it retains fluid. It is well worth spending a little extra money on this type of sock at a local sporting goods or running store.

Run with slick skin. Coat your feet with Vaseline or another lubricant before you run. Or use Second Skin, a padded tape that stays on even when wet. Both methods form a protective shield between your skin and sock.

Wear shoes and socks that fit. Shoes that are too small will cause blisters under the toes and on the ends of the toenails. There should be a thumb's width of space between the toes and end of the toe box. Your socks should fit smoothly, with no extra fabric at the toes or heels.

Products over the counter for blister care: Moleskin, Body glide, Foot Glide, Compeed blister pads, Blister shield, gold bond powder, and aquaphor healing ointment.

If you have any upcoming races and have experienced chronic foot blisters please contact at: Carolinafootspecialists.net