Posts for tag: Dr. Andrew Saffer
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:
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.
It is normal to have anxiety and concerns about potential foot surgery. I would like to ease this anxiety and provide a summary of common foot surgeries that our practice can offer if conservative treatment does not relieve your foot pain. Many changes have made over the past 10-15 years to make foot surgery more tolerable with a quicker recovery time.
Surgical techniques have improved considerably in the last ten years. Advances in foot surgery allow for a quicker recovery and more reliable results. The most common foot surgeries that our practice offers include foot conditions such as bunions, hammer toes, neuromas and chronic plantar fasciitis. Our foot surgeons keep up with the latest surgical techniques and stay current yearly with surgical courses around the country.
Our practice exhausts all conservative treatment before considering foot surgery. Most foot conditions fortunately can be treated with conservative treatment. You should understand that there is never any guarantees with any surgical procedure. Our foot specialists are both board certified in foot surgery and take great care and lengths to follow our patients closley from the preoperative to the end of the postoperative period. We want to be able to have our patient's get back to their own specific chosen activity after surgery with less pain and increased function.
These deformities are most commonly an inherited trait. Tight toe box shoe gear and high heel shoes can increase swelling around the bunion deformity and place pressure on the hammer toe prominence. Excessive flattening of the arch can contribute and increase the size of a bunion over time and make hammer toes more contracted. Conservative treatment consist of wider toe box shoes, bunion cushions, custom orthotics, hammer toe splints/gel sleeves and various padding. I do not recommend surgery for this condition unless conservative treatment has not alleviated pain and discomfort.
Surgical correction of a bunion typically involves cutting and repostioning the first metatarsal. This bone cut in the first metatarsal is fixated either with screws or a wire. Recovery from bunion surgery involves weightbearing in a walking boot for 6-8 weeks with a goal to return to sneakers about the 7 week mark. For more severe bunion deformities a different bone cut and placement may be required. This would involve a period of Non-weight bearing for at least two weeks. A low impact exercise program is typically recommended 6-8 weeks after surgery. The use of screws and in some cases plates over the past several years allows patient to become more mobile sooner without the need for extended time off the foot.
Surgical correction of hammer toes has advanced over the past 10 years. The advent of internal implants to keep the digits in a straight position rarely have to be removed and do not involve having an external wire that protrudes out of the digit. The surgery involves fusing the digit at the knuckle area (PIP) joint with either a K-wire or internal hammer toe implant. K-wires are used for more severely contracted hammer toes and are removed at 4-6 weeks in the office setting.
A neuroma is an inflammation of a digital branch that runs in between the third and four digits on the ball of the foot. Symptoms typically involve pain, burning, and shooting pain form the ball of the foot extending into the third and fourth digits. Less commonly is a 2nd web space neuroma with the same symptoms into the 2nd and 3rd digits. The culprit typically is reduction of fat padding on the ball of the foot as one ages, high heel shoes, and increased loads to the plantar forefoot. Conservative treatment consist of offloading padding, custom orthotics, change in shoe gear, oral NSAIDS, cortisone injections, and alcohol sclerosing agent injections. The advent of alcohol sclerosing agent injection has decreased the amounts of elective surgery for neuroma excisions in our practice over the past 10 years. The injection essentially causes degeneration fo the nerve fibers which results in decreased pain and discomfort.
Neuroma surgery involves removal of the digital braches to the third and fourth digits through either a dorsal or plantar incision. The surgery is an outpatient surgery and patient will be weight bearing in a surgical shoe for three to four weeks after surgery. Return to sneakers usually is about four weeks after surgery. Return to low impact exercise is usually after four weeks after surgery.
Plantar Fasciitis/Achilles tendonitis
Plantar fasciitis and achilles tendonitis are the most common heel pain complaints that we treat in our office. 90% of patients will have complete resolution of heel pain with conservative treatment. These conditions are usually an overuse injury from increased loads to the plantar fascia and achilles tendon over time. Conservative treatment involves icing, oral NSAIDS, cortisone injections, physical therapy, custom orthotics, stretching, and night splints.
Recalcitrant heel pain can sometimes lead to surgery. Our practice over the past 15 years utilizes a minimally invasive surgical procedure called Topaz. Topaz is an outpatient procedure under local and IV sedation. Needle holes are placed in a grid like fashion over maximal area of pain on the bottom or back of the heel. The Topaz unit is inserted into the needle holes and treated with short burst of electric enegry. Microscopic cutting of the fascia or tendon increases blood supply and break-up scar tissue. No sutures are needed and patient typically return into a sneaker within two weeks after surgery. The first two weeks patient wear a walking boot. Release of the plantar fascia ligament in the other options which we rarely have to perform and is only used for extreme cases of chronic heel pain.
In conclusion over the past 10-15 years our foot specialists at Carolina Foot Specialists have continued their passion of finding ways to minimize down time during foot surgery for our patients so that they can return to their chosen activity sooner and hopefully pain free.
The advent of newer internal fixation and less invasive bunion/hammer toe surgery, alcohol slcerosing agent injections for neuromas, and Topaz for various forms of heel pain have allowed our patient's to meet their specific goals if conservative treatment options have not relieved their specific foot pain.
For more information please refer to our website: carolinafootspecialists.net
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.
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
Baseball And Your Feet
Based on a document produced in cooperation with the: American Podiatric Medical Association.
For more than a century and a half, America has carried on a love affair with baseball. Kids slam fists in their first gloves, and dream of one day playing in the big leagues. For a few, the dream comes true. The rest of us keep the fantasy alive through youth leagues, on adult softball teams, or pickup games with friends. We pledge allegiance to our favorite major league team, sharing the triumph or agony of every win and loss.
More than following big league baseball, we all want to play the game ourselves--to hear the crack of a base hit, execute an around-the-horn double play, or shag a screaming liner. But like all vigorous exercise, baseball and softball should be played sensibly and safely. Improper preparation and technique can lead to injury, especially to the lower extremities, which take us around the bases and under fly balls.
Before the First Pitch
Most American kids begin playing organized baseball at age 6 or 7. If a child is in generally good health and has no preexisting physically compromising conditions, baseball is relatively safe with proper instruction in the game's fundamentals.
Weekend warriors who pick up the sport again in adulthood are less apt to be in optimum condition than younger athletes, and should take it slow before jumping right into a game. Anyone who is more than 40 years old, diabetic, a smoker, or has any physical disability should see a family physician before taking the field. People with existing foot problems should see a podiatric physician specializing in sports medicine, who can perform a gait analysis and assess any risk inherent in a sports regimen.
Because baseball and softball involve quick starts and stops, it's important to loosen up before the game. Even the youngest children should make sure to do some simple stretching, running and playing catch before the game to avoid muscle pulls or other problems.
Before playing pickup games, make sure the field is free of hazards like holes on the base path, which could cause a foot or ankle injury. Sticks, rocks, and other debris on the field cause players to trip, risking injuries, and should be removed.
Shoeing Up for Baseball
Young players will do well to wear molded cleats rather then steel spikes. They should be gradually introduced before being worn in a game. A young player needs to get a feel for cleats, which should not be worn off the field.
While the improved traction of cleats may enhance play, it also leaves the ankle more susceptible to twists and turns. Any child with preexisting foot conditions should see a podiatric physician before putting on cleats. Never put a child in hand-me-downs; ill-fitting cleats increase the danger of ankle injuries. When sizing cleats, make sure the feet are measured by a footwear technician, and always wear a game-size sock when trying them on.
In some competitive baseball leagues, the use of metal spikes is permitted for players more than 13 years old. Spikes must be understood as dangerous weapons on the base paths; they require a certain level of maturity to be worn safely. They are not necessary for casual play, and should not be worn unless in league competition.
Spikes, which technology has made lighter and more flexible these days, perform the same function as cleats, but engage the ground differently. They too should be worn on a limited basis until the feel of how they engage the turf is understood. Unfamiliarity with spikes can lead to ankle twists and turns in a competitive situation.
When wearing cleats or spikes for the first time, watch for irritation, blisters, or redness, which could indicate a biomechanical problem in the legs or feet. Pain is a clear indicator of a problem. If cleats cause pain, discontinue wear for two to three days; if it returns, see a podiatric physician specializing in sports medicine for evaluation.
Preventing Baseball Injuries
One of baseball's most exciting moments comes when a batter stretches a single into a double by beating the tag in a dust-kicking slide. Sliding is a fun part of the game at all levels, but proper technique is crucial to avoiding foot and ankle injuries, especially when bases are firmly secured to the infield. Coaches at all levels should make sure their players are well schooled in proper sliding. Careless slides can result in sprains and even fractures of the lower leg and feet.
Pitchers also need to be coached on the proper way to come off an elevated mound with their back foot and land on an incline with the front foot. The repetitive motion of pitching can lead to overuse injuries to the feet and ankles. Pitchers experiencing pain in their windup should take a few days off before returning to the mound.
Catchers too are susceptible to overuse injuries by squatting behind home plate for every pitch. Again, coaches should teach their catchers how to alter their stance to vary weight displacement.
Today's trend of trying to achieve perfection by year round sport participation may result in an overall increase in injury. This is not just a lower extremity phenomena but is often seen in young pitchers having both elbow and rotator cuff injuries serious enough to lead to surgery while still in high school.
Lower Extremity Injuries and Treatment
Contusions. A baseball will inevitably make contact with a player's foot and ankle, whether it's a pitched ball, foul tip, or line drive, and sliding base runners often run headlong into a infielder's legs. Usually this contact results in contusions, which are not often serious injuries. Ice packs and a few days' rest will usually help the contusions, or bruises, feel better.
Sprains and fractures. Stretched or torn ligaments, known as sprains, can occur from running the bases, or pivoting to make a play. Sprains may cause extensive swelling around the ankle just like a fracture. Immediate treatment from a podiatric physician is crucial to quick healing. Fractures, where the bone has cracked or broken, often require casting. After a sprain or fracture, a podiatric physician can prescribe a rehabilitation regimen to restore strength to the injured area before returning to the sport.
Plantar fasciitis. Catchers are particularly susceptible to arch pain, commonly traced to an inflammation called plantar fasciitis, on the bottom of the foot. A podiatric physician can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.
Heel Spur Syndrome. A related condition, to which catchers are also susceptible, is heel spur syndrome. Often related to plantar fasciitis, heel spur syndrome occurs when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. Many times the ligament pulling on the heel creates the symptoms, and not the spur itself, especially after getting up from resting. With proper warm-up and the use of supportive shoes, strain to the ligament can be reduced.
Achilles tendinitis. The stop-and-start of baseball often creates pain and tightness in the calf, and aggravation of the Achilles tendon. Again, regular stretching of the calf muscles gently and gradually before and after the game will help minimize the pain and stiffness.
Shin splints. Shin splints usually stem from an inflammation of the muscle and tendon attached to the shin, caused by stress factors. Treat shin pain with cold compresses immediately after a game to reduce inflammation. Proper stretching and strengthening exercises should prevent the onset of shin splints.