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Heel Pain in Children

Heel pain is a common complaint in adults. Heel pain can also occur in childhood but it is typically produced by a different mechanism. As children go through “growth spurts” between the age of 11 and 14, the muscles and tendons in their legs can become tight as they try to keep up with the rapid growth in the long bones. Heel pain in children typically is the result of a tight Achilles tendon. In children, there is a thin irregular shaped band of cartilage in the back portion of the heel bone called a growth plate (see x-ray image below). As the name implies, new bone forms within a growth plate, which is also found in other bones in the feet, legs, hands and arms. As a child goes through a "growth spurt," the rapidly elongating leg bones stretch the Achilles tendon which in turn pulls tighter on its insertion into the heel bone. A tight tendon is usually not a problem. However, when a child is very active in sports, such as soccer, or basketball, the increased activity creates further tightening of the tendon. The result is a traction or pulling force which is absorbed into the heel bone (see illustration, below). As cartilage is softer than bone, the growth plate frequently becomes irritated and painful as the traction force increases. This process is more commonly seen between the age of 8 and 13 years old. On examination, one can reproduce pain by pressing both under the heel as well as compressing the heel bone (calcaneus) from side to side. Other causes of heel pain include a fracture or bone tumor, so x-rays are usually performed in evaluating this condition. Treatment includes rest, ice and anti-inflammatory medication. An arch support and heel lift are both helpful. For severe cases, a non-weight bearing splint or cast may be applied. Long term treatment usually includes use of functional orthotics. The problem is self-limiting and goes away after the growth plate closes, around the age of 13 to 14 years old. - Seth Rubenstein, DPM Dr. Rubenstein practices in the Reston (703-391-0211) location. 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. Doctor Rubenstein and Foot and 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.  Doctor Rubenstein and Foot and 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 Doctor Rubenstein and Foot and 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.   If you are feeling ill, please call your primary care physician, or other healthcare provider.  In the case of an emergency, please go to the nearest hospital.

Sesamoid Injuries of the Great Toe Joint

Spring is upon us, and choices of shoe gear change, as well as increased levels of outdoor weight-bearing activities, which can set us up for sesamoid injuries of the great toe joint.  Sesamoid injuries are common, but often overlooked injuries to the great toe joint.  Proper diagnosis and early treatment intervention is essential.   Most people experience pain in their underlying great toe joint made worse with weight-bearing activity. So what exactly are sesamoids? Sesamoids are accessory bones found throughout the body.  They are found embedded in tendons and act as pulleys to increase the power and efficiency of those tendons and their neighboring joints. The kneecap is the largest sesamoid bone in the body and increases the strength of the quadriceps tendon during knee extension, enabling us to walk, jump and climb with greater power. In the foot, there are two sesamoid bones present in the flexor tendon beneath the great toe joint.  They are about the size and shape of peanuts. Their job is provide us with greater propulsion when walking, running and jumping. Certain activities and biomechanical factors can contribute to sesamoid injuries.
  • High arches place more force on the heels and sesamoid bones.
  • Bunions change the weight bearing distribution on the sesamoid bones.
  • High heeled shoes.
  • Sports such as running, basketball, ballet, football and tennis.
What types of sesamoid injuries do we typically see?
  • Sesamoiditis:  This is an overuse injury of the sesamoid bones, caused by a repetitive bruising of the bones. The symptoms will quickly improve if the pressures on the sesamoids can be reduced.  
  • Fracture:  The fracture is often from a memorable event, but sometimes can result from prolonged overuse.  Unlike most bones, the sesamoid bones of the foot have poor blood supply leading to prolonging or non-healing.
  • Avascular necrosis:  Blood supply to the sesamoid bone is lost leading to degeneration and chronic pain.
  • Turf toe:  This is an acute hyperextension injury of the great toe joint seen in high energy sports such as football.  The ligaments and tendons around the sesamoids are strained.
Minor injuries, such as sesamoiditis may be managed simply with changes in shoe gear or custom orthotics, however, more serious injuries may require immobilization or even surgical intervention. As with most injuries, proper and early diagnosis is essential. - Lee Firestone, DPM Dr. Firestone practices in the K Street NW (202-223-4616) and Chevy Chase (301-913-5225) locations. 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. Doctor Firestone and Foot and 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.  Doctor Firestone and Foot and 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 Doctor Firestone and Foot and 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.   If you are feeling ill, please call your primary care physician, or other healthcare provider.  In the case of an emergency, please go to the nearest hospital.  

Dr. Kyle Scholnick Featured in PM Magazine

Foot and Ankle Specialists of the Mid-Atlantic, LLC (“FASMA”) podiatrist Kyle Scholnick, DPM, was recently published in the January and February 2016 editions of Podiatry Management Magazine. Dr. Scholnick's articles, "Anterior Ankle Impingement Syndrome" and “The Effects of Renal Disease on Wound Healing” were chosen as featured articles for the magazine's continuing medical education (CME) program. Dr. Scholnick completed his three-year foot and ankle surgical residency at Yale-New Haven Hospital in New Haven, Connecticut, where he served as Chief Resident. His areas of interest include forefoot and rearfoot reconstructive surgery, diabetic limb salvage, sports medicine, and trauma. As a published author, he has written about osteomyelitis, wound healing, chronic venous insufficiency, tarsal tunnel syndrome, ankle impingement, and plantar fasciitis. Dr. Scholnick practices at the Kensington and Columbia offices with staff privileges at MedStar Montgomery Medical Center and Howard County General Hospital. Foot and Ankle Specialists of the Mid-Atlantic, LLC, has 22 locations in DC, Maryland, Pennsylvania, and Virginia.  To find a location near you, and to request an appointment online, please visit our website at www.footandankle-usa.com.

FASMA Participates in Local Health Fair

Foot and Ankle Specialists of the Mid-Atlantic, LLC (“FASMA”) podiatrists Caitlin Madden, DPM and Adam Spector, DPM attended the Health & Wellness Fair at Wheaton Mall, hosted by Holy Cross Hospital,  in January to answer questions about common foot ailments and promote general foot health. Drs. Spector and Madden are very active in the community and participate in a variety of health fairs and events throughout the area. Dr. Adam Spector received his Doctorate in Podiatric Medicine from Temple University of Podiatric Medicine, PA, in 1989. He then completed a surgical residency at Roseland Surgery Center and St. Michael’s Medical Center in New Jersey. He is Board Certified by the American Board of Foot and Ankle Surgery (ABFAS) in foot and ankle surgery and is a fellow and founding member of the American Society of Podiatric Surgeons. Current, Dr. Spector is the chief of podiatric surgery at Holy Cross Hospital, and director of the only in-office JCAHO-certified ambulatory surgery center in the DC/MD/VA area. Dr. Caitlin Madden received her Doctorate of Podiatric Medicine from Temple University School of Podiatric Medicine in 2011. She completed 4 years of residency at Penn Presbyterian Medical Center;extensive forefoot, rearfoot and ankle surgical experience, including acute foot and ankle trauma, reconstructive principles, diabetic limb salvage and wound care, along with multiple non-podiatric medical and surgical rotations. Dr. Madden is an Associate of the American College of Foot and Ankle Surgeons and a member of the American Podiatric Medical Association and the Maryland Podiatric Medical Association. She graduated from the University of Notre Dame in 2007 with a Bachelor of Science degree. She is a native of southern New Jersey, and grew up learning about podiatry from her father, a well-respected podiatrist, professor and administrator. To make an appointment with Drs. Spector or Madden, call the Wheaton office at 301-949-3668 or the Shady Grove office at 240-268-7450, or use our online appointment request form.

Dr. Mo Esmaili Board Certified by American Board of Podiatric Medicine

Foot and Ankle Specialists of the Mid-Atlantic, LLC (“FASMA”) is proud to announce that podiatrist Mo Esmaili, DPM, is now Board Certified by the American Board of Podiatric  Medicine. Dr. Esmaili practices in the Kensington office. Dr. Esmaili received his Doctorate of Podiatric Medicine from Temple University School of Podiatric Medicine in 2009. He then completed three years’ post-graduate training in podiatric medicine and surgery, at Virtua West Jersey Hospital in Voorhees, New Jersey where he was Chief Resident.  As Chief Resident, Dr. Esmaili was selected to participate in a surgical mission trip to El Salvador, where he used his training in residency to surgically treat children with congenital deformities, such as flat foot, club foot, and cavus foot-type deformities. He has held expertise in Reconstructive Foot and Ankle Surgery, Trauma, Diabetic Foot Care, Limb Salvage, Sports Medicine, Acute and Chronic Tendon Rupture. Dr. Esmaili enjoys traveling, playing tennis, and spending time with his family. Dr. Esmaili is fluent in Farsi and English.  He enjoys giving back to the community and is involved with Catholic Charities to provide care to the less fortunate. Congratulations, Dr Esmaili, on your Board Certification! To schedule an appointment with Dr. Esmaili, call the Kensington office at 301-949-2000 or request an appointment online.

Mid-Atlantic Podiatry Supergroup Adds a New Podiatrist

Foot and Ankle Specialists of the Mid-Atlantic, LLC (“FASMA”) welcomes Stacia Jones, DPM, to its Greenbelt and Annapolis Divisions on April 1, 2016. Dr. Jones received her doctorate from Temple University School of Podiatric Medicine.  She completed 3 years of extensive surgical training in foot and ankle reconstructive surgery in New York City.  During her senior year, Dr. Jones had the distinction of being named Chief Resident. Upon graduating from the residency program, Dr. Jones moved to Harrisburg, PA, where she spent 3 years providing podiatric medical and surgical services to patients in Central Pennsylvania.  Dr. Jones relocated to Maryland to be closer to her family and friends. Her areas of expertise include management of diabetic wound care, forefoot reconstructive surgery, pediatrics, and sports medicine injuries. Dr. Stacia Jones is a diplomate of the American Board of Podiatric Medicine. To schedule an appointment with Dr. Jones, call the Greenbelt office at 301-577-4464 or the Annapolis office at 410-266-7575, or use our online appointment request form.

Dr. Lee Firestone Featured at RunFest 2016

Foot and Ankle Specialists of the Mid-Atlantic, LLC (“FASMA”) podiatrist Lee E. Firestone, DPM, was featured as a local expert for the second annual RunFest event, hosted by Run Farther and Faster and ProAction Physical Therapy. The event, held at EVEN Hotels in Rockville on February 7, 2016, featured panel discussions on training and race strategy, injury prevention, and nutrition; gait analysis; nutritional mini-consults; local area fitness class samples; and a keynote speech by CNN correspondent Tom Foreman. Proceeds from the event went to cancer research and treatment at Memorial Sloan Kettering. Dr. Firestone discussed how to run strong as you get older in a panel discussion titled “Unlocking the Keys to Running Strong Through the Ages.” Foot and Ankle Specialists of the Mid-Atlantic, LLC, has 24 locations in DC, Maryland, Pennsylvania, and Virginia.  To read more about Dr. Firestone’s involvement in the local running community, and to find a location near you, visit our website at www.footandankle-usa.com.

​Treating Bunions Conservatively

No matter what season it is, you may be thinking it’s time to do something about that large bump coming out of the outside of your big toe joint. In medical terms, that bump is called a bunion or hallux valgus. Bunions form when the metatarsal bone starts to shift out of place. Day after day, you walk thousands of steps on your feet. With years of this repetitive insult to your feet, it is not hard to imagine why bunions can cause such debilitating pain. The joint may even become so stiff, arthritic and sore that shoes are too painful to wear. There are many different causes of bunions and they differ for each person. However, the most common causes are genetics, tight fitting shoes, flat feet, lax ligaments, hypermobile joints and even a tight Achilles tendon. Years of abnormal motion and pressure on the big toe joint along with the aforementioned predisposing factors will cause your bunion to form.

Treatment Without Surgery

Bunions are structural deformities, meaning they are caused by shifting of bones. Unfortunately, they are permanent and no conservative treatment will remove the bunion. Only surgery can permanently correct the bunion. However, there is some treatment to make you more comfortable and decrease the progression of the bunion. These are some of the conservative measures I use to treat my patients with bunions:
  • Wear proper fitting and comfortable shoes with less than 2 inch heels and provide plenty of space for your toes and forefoot. Have your feet professionally measured
  • Protect the bunion with a moleskin or gel-filled pad
  • Use toe spacers between the 1st and 2nd toes
  • Use orthotics to help position the foot and redistribute weight correctly
  • Night splint to hold the toe straight, stretch the soft tissue and ease discomfort
  • Anti-inflammatories
  • Steroid injections into the joint
  • Use warm soaks, ice packs, Whirlpool, ultrasound and massage
  • Maintain a proper weight
​I want to reiterate that none of the above will permanently correct the structural bunion, but may limit the progression of the deformity and decrease pain. If the above conservative treatment does not relieve your pain, then surgery should be considered. Many podiatrists will only consider surgery after 3-6 months of conservative care. I personally will work with my patients lifestyles and do what is best for them at that specific time. There are over 100 types of bunion procedures and the best one for you will depend on the severity of your bunion, arthritis present, chronicity, mobility of surrounding joints and the primary cause of the bunion. Bunions are important to treat because they can lead to other painful foot problems. The bunion may throw off the mechanics of your normal gait pattern and lead to conditions like nerve impingement, hammertoes, joint pain and plantar fasciitis to name a few. Many times patients will come in with a foot problem that is indirectly related to the bunion and may warrant treatment of the bunion in conjunction with the other foot problem in order to have the best pain relief and prevention of recurrence. Until next time, thanks for your time and interest! - Dr. Kyle Scholnick practices in the Kensington (301-949-2000) and Columbia (410-730-2623) divisions. 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. Doctor Scholnick and Foot and 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.  Doctor Scholnick and Foot and 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 Doctor Scholnick and Foot and 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.   If you are feeling ill, please call your primary care physician, or other healthcare provider.  In the case of an emergency, please go to the nearest hospital.

Confusion Over Over-The-Counter Inserts and Prescription Orthotics

The ongoing confusion involving expensive prescription custom orthotics and relatively inexpensive over-the-counter arch supports lies not only in their purported efficacy but in the plethora of choices offered on-line and in retail stores as well as in medical offices.  Foam molds to make foot impressions are available from on-line marketers, and Amazon lists no fewer than twenty different arch supports, wraps, and braces proven to resolve your foot pain. A Parade Magazine advertisement touts a reflexology- like device guaranteeing weight loss with frequent use. CVS stores have partnered with Dr. Scholl’s to prescribe a specific arch device based on data obtained from stepping on an in-store pressure measuring machine. There are also many varieties of prescription custom orthotics that are made at ski shops by boot fitters, in specialty shoe stores by shoe salesmen or orthotists, by chiropractors, physical therapists, or podiatrists. Over-the-counter (“OTC”) arch supports are often sought out or recommended as a first line of treatment since they are much less expensive and readily accessible. The best OTC devices are the ones modelled after prescription ones; but their limitation is an inability to modify it to address a person’s specific pathology. OTC’s may also need to be replaced every few months compared to most prescription orthotics that last for years with minimal refurbishment, so custom orthotics may actually be more economical. Prescription orthotics are usually classified as accommodative (more flexible) or functional (more rigid), and are patient-specific, prescribed to address more serious problems derived from a detailed clinical and biomechanical exam. The orthotic fabrication is usually done at an outside lab from both the prescription as well as an impression of the patient’s foot.  Different professionals accomplish this utilizing different methods with varying degrees of success.  I have found that many so-called prescription orthotics are really "pseudo prescription-like," such as those typically dispensed widely by chiropractors, that although expensive are actually no better than generic soft insoles.  The pressure plate at CVS has potential to individualize arch supports for each patient's needs, but their devices reveal little perceptive differences and are no better than other mass produced cushion insoles - a far cry from custom. Many ski shops and specialty shoe stores commonly use more supportive and rigid materials made from a foot impression, but without a medical professional to take into account specific patient issues, produce devices that often lack functionality. When discussing orthotics with my patients, I commonly use the ‘OTC reading glasses’ versus ‘prescription glasses’ analogy. Minor needs may be improved with a quick, easy off- the-shelf fix, whereas more significant issues need to be addressed with a prescription.  More specifically, OTC arches are effective with the average person (average weight, foot type, low activity and minor symptoms) and prescription orthotics are preferred in those with higher or lower arches, higher weight, greater activity, specific shoe fit issues, or significant bone or tendon problems. Both types are meant to be an integral part of a comprehensive treatment plan to get patients better.  With so many options available to the public, it is difficult to do it alone.  Before wasting a lot of time and money on inappropriate products, see a podiatrist, who remains the expert in foot biomechanics and can best help figure out what is ideal for each individual. – Adam Spector, DPM Dr. Spector practices in the Wheaton (301-949-3668) and Shady Grove (240-268-7450) locations. 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. Doctor Spector and Foot and 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.  Doctor Spector and Foot and 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 Doctor Spector and Foot and 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.   If you are feeling ill, please call your primary care physician, or other healthcare provider.  In the case of an emergency, please go to the nearest hospital.

Foot and Ankle Specialists of the Mid-Atlantic, LLC Podiatrists Selected as 2016 Top Doctors in Northern Virginia Magazine

Foot and Ankle Specialists of the Mid-Atlantic, LLC (“FASMA”) is proud to announce that two of its podiatrists, Seth Rubenstein, DPM, and Eric Masternick, DPM, were recently selected by Northern Virginia Magazine as 2016 Top Doctors. This is the third consecutive year that Dr. Masternick has been chosen for this award, and the fourth consecutive year for Dr. Rubenstein. The annual list is made up of over 1,000 peer- and hospital panel-nominated doctors ranging from allergists to vascular surgeons. The Top Doctors list is carefully compiled and selected each year. “Along with asking all the doctors in Northern Virginia who, in their expert opinion, should be dubbed a Top Doctor, we take the process a step further by working with local hospitals and Kaiser Permanente/Mid-Atlantic Permanente Medical Group to put together panels to discriminately look at doctors who are affiliated with their institutions,” said Lynn Norusis, Managing Editor. “We asked the panels to nominate doctors based on internal evaluations, patient reviews and overall quality of care." Congratulations to our doctors!