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When Pain Becomes a Problem

Pain -- we have all experienced it at some point in our lives. That unpleasant sensation of a sunburn, headache, or a stubbed toe on the bedpost. Pain, whether acute or chronic, varies from person to person. Early identification and treatment of the underlying cause of pain is important to reduce the prolonged, debilitating effects of pain.  

Pain Relievers

There are many different modalities for managing and treating pain. Often times, over the counter pain medications such as Tylenol, Advil, and Aleve, and are readily accessible and therefore become the treatment of choice for pain relief.  While these medications are generally safe, if taken as directed and at the recommended dose, they also carry risks. This includes side effects such as gastrointestinal bleeding,  drug interactions, or accidental overdosing that can turn fatal. As a precaution, it is important to carefully read the label prior to taking the medication or to consult your healthcare provider prior to taking the medication.  

Risk of Over Medicating

Opioids, such as Percocet or Vicodin, are a powerful class of drug that may be prescribed by your doctor to treat pain, if indicated. Opioids are notorious for causing drug dependency, addiction, respiratory depression, or death if used inappropriately. According to the Centers for Disease Control and Prevention, the United States is in the midst of an opioid overdose epidemic as these drugs have killed a record high of more than 42,000 people in 2016. The best ways to prevent opioid overdose deaths are to improve opioid prescribing, reduce exposure to opioids, prevent misuse, and treat opioid use disorder.   Whether you have been in pain for a few days or for several months, it is important to seek medical professional help.  Your podiatrist can play an important role in diagnosing and treating your foot and ankle pain. Schedule a visit with one of our many foot and ankle specialists today. Foot and Ankle Surgeon Dr. Michelle LeDr. Michelle Le works in our Rockville, MD office. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Michelle Le and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Michelle Le and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Michelle Le and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

Taking on Chronic Heel Pain- a Fresh Option

When that Achilles Tendonitis or Plantar Fasciitis just will not resolve  

Tendon injury is extremely common and can occur with trauma, overuse and aging. Symptoms typically include pain, inflammation and dysfunction. Tendon healing can be very slow, and normal healing can take up to ten weeks. Most people will have relief with conservative measures, including orthotics, anti-inflammatory medication, cortisone injections, and physical therapy. But there are cases where tendons fail to regain full function with conservative management. Even with surgery, tendons may heal with fibrosis and scar tissue, leading to less strength and a higher rate of re-injury. These chronic tendon injuries may show tendon cell depletion, collagen breakdown and a high potential for failed healing. Though it may seem that inflammation is present (which is required for normal healing), the mediators that help progression of the healing process are absent. In these situations the body’s inflammatory response stops and there may be no further healing.    

Amniotic membrane and stem cell allograft  

Amniotic membrane allograft comes from the innermost layer of the amniotic sac, which surrounds the fetus. The amniotic membrane is harvested from a consenting donor during scheduled cesarean section.  This collection poses no ethical concerns because it is normally discarded after birth and there is no harm or danger to the fetus or mother when it’s extracted. After it is gathered, the amniotic fluid is sent to an FDA approved lab where it is processed and the fluid is cryogenically frozen and stored. Amniotic fluid and stem cells are not immunologically reactive, so there is no reaction between unrelated donors and recipients. Amniotic membrane synthesizes cytokines and growth factors (chemicals needed for proper healing), and amniotic stem cells can develop into different types of tissue. This ability of cells to differentiate into new tendon cells can generate new tendon tissue, while tendon repair may be stimulated by the production of growth factors and cytokines.  

What to expect when your doctor uses this regenerative medicine  

In the office setting, amniotic membrane allograft can be injected into the injured tendon or plantar fascia.  There may be some discomfort associated with the injection, but most practitioners will mix it with a local anesthetic to help limit pain.  It is important that no non-steroidal anti-inflammatory medications be taken for a month before this injection and for a few months following. A period of rest of up to a month for the tendon or plantar fascia is necessary after the injection is given. Many times a positive response to the injection will mean surgery can be avoided. But amniotic stem cell use can be a planned part of a surgery, leading to better long-term healing. Amniotic membrane and stem cell use is a safe option to discuss with your podiatrist if your plantar fasciitis or tendonitis has not resolved with other conservative management.                    Foot and Ankle Surgeon Dr. Erika SchwartzDr. Erika Schwartz works in two offices for your convenience-- Washington, DC (K Street) and Chevy Chase, MD. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Erika Schwartz and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Erika Schwartz and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Erika Schwartz and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.