My Blog

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.

Bunions/Hammer toe

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:




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:


This weekend I was able to attend my daughter Taekwondo tournament. I was able to witness and help treat a few minor foot injuries of the participants. I would like to take a moment to discuss common Martial arts foot injuries as well as review how to avoid and treat them.

Martial arts, such as karate and tae kwon do, have become very popular in recent years for both adults and children. Karate and tae kwon do have been promoted as excellent activities for maintaining good health and fitness. People frequently perform these activities after school or work.    Given that the foot and ankle account for at least 10 percent of the total injuries sustained in the martial arts — and may even be higher due to the lack of reporting of many digital injuries such as contusions, toenail trauma and uncomplicated fractures — most podiatrists are likely to encounter these athletes in their offices.    Students of the martial arts practice kicking and punching to improve their techniques and power. Students start with simpler kicks and work up to more difficult techniques. Attempting a more difficult kick without the appropriate training will often cause injury. Sparring too early without the proper training is also a common cause of injury.    The student becomes injured due to either a lack of balance, flexibility, strength or speed. For example, one can kick and punch while standing in one location or while moving. A lack of balance while performing this move will cause the support foot to be loaded without stability. This can produce sprains or strains of the foot and ankle

What Causes Common Types Of Martial Arts Injuries?

Blunt force trauma and sprains are the two basic categories of martial arts injuries that occur in the foot. Blunt force trauma injury is a direct result of the foot hitting another solid object. The object could be a sparring bag, a board, an opponent or other firm objects used in the practice of martial arts. Students frequently use heavy canvas sparring bags for kicking and punching in order to improve strength and technique. Boards varying from 1/2 inch to 1 inch in thickness are used as part of promotion tests as a student passes to the next level throughout the training experience. The boards are lined up (either singularly or in multiples) and students use their hands or feet to break them. If the student has not built up the power, speed or accuracy to strike the board with the correct technique, there can be resulting trauma to the foot or hand. Martial arts instructors assess each student to determine the level of breaking skill. Inappropriate execution on the part of the student can be very painful.    Misjudging the opponent’s intended next move can result in trauma. Normally, students step back from the kick and prepare to counter the kick with another kick. This cannot always be executed as trained due to the speed of the opponent. The consequences of missing a step or inappropriately positioning the foot while attacking or retreating from an opponent can be trauma to the ankle and foot, resulting in a sprain or fracture.

A Guide to Treating Fractures

   As a result of blunt force trauma, the martial arts student may suffer a fracture, a contusion or a laceration. Fractures require early diagnosis and immobilization to expedite healing. The most common foot fractures occur as spiral oblique injuries of either the digits or the metatarsals. They are usually the result of the torsion generated by the impact of the moving foot hitting a fixed object such as an opponent.    If one suspects a fracture, do not allow the athlete to continue the competition. Further trauma from competition can convert a simple non-displaced fracture into a displaced, comminuted fracture or even a compound fracture. If one suspects a fracture, immobilize the injured part or at least move the athlete without moving the injured area. Apply ice and elevate the limb after achieving initial immobilization. The marital artist should not go back to martial arts activity until the specific fracture is completely healed, which is usually eight weeks.

Addressing Common Contusions

   Contusions, which are usually less severe than fractures, are a common result of sparring or board breaking. This weekend I witness a severe contusion to the foot while two fifth degree black belts were sparring. One of the participants blocks a side kick but hit the top of his opponent’s foot in an awkward way. A severe contusion occurred with pain, bruising, and swelling to the top of the foot. While sparring, the student wears a chest protector, a helmet and a mouth guard as well as pads on the arm, hand, foot and lower leg. During sparring, one must perform each kick and punch in a fraction of a second to be effective. From a tactical standpoint, when students see an opening in the opponent’s defense, they will usually execute three to four moves sequentially to further reduce the opponent’s defenses. However, the opponent will also counter the attack. Both participants are vulnerable when each is trying to anticipate the other’s move.    Advancing opponents often cut short well-intentioned kicks, which land in an unintended area. A kick meant for the opponent’s torso might land on a non-padded upper thigh area, resulting in a thigh contusion. Any non-padded area such as the thigh or knees can now be a vulnerable target. Accordingly, the common areas to receive contusions are the top and sides of the feet as well as the toes. Contusion injuries may have symptoms for up to six weeks although one can usually recommend an early return to martial arts activities.

Key Pearls on Treating Sprains

   Ankle sprains occur most often in the martial arts during sparring when the student is changing positions rapidly. The most common type is the lateral ankle sprain. Sudden changes in direction during sparring can result in the student being caught off balance. A slow progression of training is essential to promote increased balance, flexibility and strength while reducing the risks of foot and ankle sprains. Pay careful attention to the sprain in order to rule out a fracture. It is essential that all ankle injuries be totally healed before permitting the martial arts athlete to return to rigorous activities such as performing difficult maneuvers or competitive sparring. A common sprain to the foot is a hyperextension injury to the first MPJ (Big toe joint). This sprain is usually the result of sparring and changing directions rapidly. The Great toe becomes forcibly moved up while the athlete lunges forward to attack an opponent, resulting in a sprain of the first MPJ.    While most of these injuries are mild, be aware there are severe cases in which the sesamoids may be partially or completely torn from their bed. A forced movement up of the great toe against the first metatarsal head may also result in a fleck of cartilage being shorn from the metatarsal head. A hyperextended first MPJ (Great toe joint) sprain can last up to four months or longer. During this time, one should follow initial immobilization (Walking boot) with physical therapy as this is essential for maximum recovery.


This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.