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Charlottesville Annual Shoe Drive

Charlottesville, VA podiatrist, Dr. Samuel Schustek is this year's co-chair of the Let Someone Fill Your Shoes campaign. Together, the Salvation Army of Charlottesville and the Charlottesville Podiatry Association have been collecting donated shoes to distribute to those in need for 28 years. During the month of January, gently used shoes will be collected for distribution at the Salvation Army on February 23rd. Approximately 30 years ago, the APMA started a National campaign for collecting shoes for the homeless. The Charlottesville Podiatry Association continued this effort through the years, now in their 29th year, collecting over 100,000 pairs of shoes. This year they plan on collecting 4-5,000 pairs. Five Charlottesville podiatrists in FASMA are a part of the association-- Kevin Murray, Stewart Chang, Robert Baglio, Colleen Law, and Samuel (Sandy) Schustek. If you wish to donate your gently worn shoes, you may drop them off at any Charlottesville podiatry office. They are looking for shoes of all sizes, but children's shoes are most in need. Dr. Schustek describes the importance of this campaign: "Recycling shoes allows those less fortunate to use these shoes in inclement weather, for jobs, and for daily use." If you do not have shoes to donate, but want to volunteer, you can still help out the effort by sorting and distributing the shoes on February 23. For more information, contact Dr. Samuel Schustek at 434-295-4443.  

Dr. David Levine Discusses Post-Op Orthoses in Podiatry Today

In the December 2018 issue 12 volume 31 of Podiatry Today, Dr. David Levine responds to questions regarding Post-Op Orthoses in an expert four panelist Q&A. Dr. Levine discuses for which conditions he recommends post-op orthoses and the type of benefits patients should expect to see. He indicates that when a patient has a procedure that changes their biomechanical function, orthotic devices should be a postoperative option, as orthotics are a great way to improve function and enhance comfort. Modifications and each orthotic device is specific to the type of surgery and underlying symptom. It is important to be properly evaluated by a podiatrist to find out the best option for your needs. For the full Q&A from all four experts, head over to the Podiatry Today website and learn even more!   Podiatrist Dr. David LevineDr. David Levine works in our Frederick, MD (Thomas Johnson Dr) 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. David Levine 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. David Levine 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. David Levine 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.

Keeping Your Feet Safe and Healthy in the Winter

The snow is starting to fall and the temperatures are dropping. Some people look forward to the chilly weather and others just keep hoping for Spring to come early. No matter which type of person you are, each one of us has to be careful with protecting our feet in the winter. In our region, it seems like it will be a snowy and wet winter which can lead to many hazards for our foot health. One hazard some of us have already had to deal with is the snow and below-freezing temperatures. When the snow starts to fall, many of us slip into our shoes and head out to our driveway to shovel. Snow creates a very wet and slippery environment which can cause many traumatic and thermal injuries. It is always important to remember to wear waterproof shoes/boots and thick warm socks. If you are traveling, make sure you bring an extra change of socks or shoes just in case your original pair gets wet, as this moisture can cause frostbite to occur sooner than it would in a dry environment. Depending on the temperature, wind speed, and amount of moisture, frostbite can take as long as 30 minutes but as quickly as 5 minutes to start affecting the skin of the feet. This can lead to pain, skin discoloration, nerve damage, wounds, or in a worst case scenario, gangrene. With these frigid temperatures comes snow and ice, and unfortunately, all too often we hear of people slipping and falling because of the conditions outside. Falling can be dangerous for people of all ages, and one bad fall can cause fractures, sprains, and other acute foot/ankle problems. If you are a fall risk, it is safest to stay inside until the conditions have improved. If you must go outside, make sure you are wearing shoes or boots with good traction and tread carefully and slowly. For those with diabetes or neuropathy (lack of feeling/sensation) to the lower extremities, it is safest to avoid any and all extreme temperatures. With lack of sensation, you are unable to appropriately sense whether the skin of your feet is safe. If you find yourself outside in the winter weather or snow, please make sure you are appropriately dressed with thick, warm socks and closed-toed, waterproof shoes. Also, make sure you limit the amount of time you are exposed to below-freezing temperatures. Once back in a warm environment, check your feet immediately for any changes, and call your doctor if there are any concerns. It is also important to remember that not only freezing temperatures can cause danger in the winter, but also heat thermal injuries as well. It is not uncommon for people to come back in from the cold weather and immediately want to warm up their feet. Sometimes this is done by dangerous methods such as using heating pads, fireplaces, blow-dryers or scalding hot baths. It is recommended that you avoid rewarming your feet with these methods as these can cause burns to the skin which may lead to serious complications. Lastly, when it's not snowing or sleeting, winter often brings a decreased humidity and dry air conditions, which can cause your skin to become dry and flaky. Sometimes all the layers we put on to keep our feet safe and warm can cause our feet to sweat and once exposed to the dry air can lead to cracking and fissures of the skin. This can be very painful at times and may even cause the skin to bleed. Therefore, in order to avoid these problems, it is important to appropriately moisturize your feet in the winter. When looking for a lotion or cream to use, try to find one that has a thicker base and is unscented. Sometimes it is necessary to apply lotion two times a day if your feet are prone to dryness. If you have any problems or concerns with your feet or ankles, the doctors at FASMA are here to help! Call your local FASMA location and we'll help you keep your feet safe and healthy during these cold winter months.  
Dr. Adam Grahn works out of three offices for your convenience: Greencastle, PA, Hagerstown, MD, and McConnellsburg, PA.
Dr. Brandy Grahn works out of two offices for your convenience: Gettysburg, PA and Hagerstown, 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. Drs. A. Grahn and B. Grahn 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. Drs. A. Grahn and B. Grahn 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 Drs. A. Grahn and B. Grahn 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.

Achilles Tendonitis

What is it?

The Achilles tendon is the largest tendon in the human body. It is a band at the back of the lower leg that connects the calf muscle to the heel bone. The most common injury to the achilles tendon is achilles tendonitis.  Achilles tendonitis is the overuse of the achilles tendon. It commonly occurs in high impact sports such as running, basketball, jumping and tennis.  

What will I feel?

Some beginning symptoms of achilles tendonitis are stiffness and tenderness in the back of the foot.  If overuse of the achilles tendon continues, the pain can become more severed. Some patients report mild pain in the morning, which usually subsides after mild activity occurs. Pain may be aggravated by going up and down stairs.  

What will they do?

During the physical exam, your doctor will gently press on the affected area. We will determine the location of pain, tenderness or swelling. He or she will also evaluate the flexibility, alignment and range of motion of your foot and ankle.They may be able to palpate a bone spur on the back of your heel. X-rays are ordered to determine if there is an associated bone spur. If a full or partial  tear or rupture is suspected, a MRI can be ordered to further guide treatment.  

Possible Treatment Options:

Achilles tendonitis generally responds very well to conservative treatment as long as it is diagnosed and treated early.
  • RICE (Rest, Ice, Compression, Elevation) is a good initial treatment to reduce pain. Icing will help decrease the inflammation and pain in the tendon.
  • Heel lifts in the patient's shoes.
  • Supportive shoe gear or a low heel.
  • Avoid barefoot walking
  • Non-steroidal anti-inflammatory drugs (NSAIDS) to calm the inflammatory process in the tendon.
  • Stretching exercises for the lower leg to help loosen the calf muscle and Achilles tendon so that the tendon is not under as much stress.
  • If the pain is particularly severe, a pneumatic walking boot can be used to immobilize the area to reduce pain and inflammation when walking.
  • Custom orthotics to reduce mechanical stresses in the area.
  • Physical Therapy can aid in decreased inflammation and increasing flexibility.
  • Alternative therapies. These therapies are worth considering for cases that have failed conservative treatment.
    • PRP (Platelet rich plasma)
    • Amniotic membrane
    • Pain lasers
  • If the tendon has been ruptured completely, surgery is available
 

How do I Avoid it?

  1. Always warm up thoroughly before any exercise.
  2. Stretch your muscles and tendons every day.
  3. Evaluate your shoe gear to ensure they are supportive and do not need to be replaced.
  4. Replace your shoes (especially athletic) yearly
  5. Do not continue to exercise through the pain
  6. Do not delay treatment
Podiatrist Dr. David FreedmanDr. Priya Parthasarathy works in our Silver Spring, MD (White Oak) 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. Priya Parthasarathy 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. Priya Parthasarathy 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. Priya Parthasarathy 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.

Doctor’s Soapbox: Don’t Rely on the Internet to Fix Your Running Injuries

The smartphone has not only irreparably altered our social interactions but also how we view and access healthcare. Dr. Google is instantly available to anyone at any time to diagnose and offer treatment advice for every ache and pain. Our frenetic schedules along with high patient co-pays and astronomic insurance deductibles encourage many to seek cheaper self-help options via the internet-- although it can be a valuable resource, it is important to understand what you can treat yourself and what requires a visit to your doctor. A doctor who regularly sees athletes has the experience and first-hand knowledge to diagnose injuries more accurately, ensure speedy healing and most importantly prevent recurrence. They are more likely for example, to treat a non-fractured ankle with a brace and physical therapy referral rather than to immobilize it in a cast with crutches. A resourceful sports medicine doctor will not order you to stop running when modifications such as lowering miles or adding cross training will suffice. These doctors can prescribe an array of diagnostic tests, such as x-rays, ultrasounds, MRI’s, and bloodwork to discover underlying problems. Pain and swelling in the lower leg can be a tendonitis caused by overuse, poor biomechanics, or ill-fitting shoes. It can also be caused by cholesterol- lowering meds, homeopathic compounds, peripheral venous insufficiency, tendon tears, or blood clots. An undetected blood clot or deep vein thrombosis (DVT) in the leg can migrate into the lungs and brain and be fatal if left untreated. Runners are susceptible to DVT’s post-race due to dehydration, trauma to the legs, and inactivity (driving or flying home after a race). Rather than spending time reading WebMD, runners with leg pain and swelling need prompt medical intervention with a venogram or doppler to quickly identify it and begin life-saving prescription blood thinners. Forefoot pain may be from a local nerve irritation or neuroma, but it may also be a tendonitis, or a metatarsal stress fracture that can be picked up by x-ray. Many runners are more susceptible to stress fractures due to suboptimal nutrition that can be seen in bloodwork or underlying osteopenia or osteoporosis which is diagnosed with a dexascan test. Female distance runners are more at risk after age 35, especially if they over train and do not rest sufficiently between races. Nerve pain in the foot may also resemble neuropathy and an early sign of diabetes. Everyone assumes that heel pain is due to plantar fasciitis; however, the pain could be due to nerve irritation, or possibly a stress fracture or bone cyst. Often it is the adjacent posterior tibial tendon that is the culprit and requires a different treatment approach. Arthritic diseases such as gout commonly cause heel pain as well. As Einstein once famously noted, “information is not knowledge!” The internet should be used as an adjunct not a substitute for an in-person physician assessment. If you have unresolved lower extremity problems, use your computer or smartphone to make an appointment. Then turn your smartphone off (the web says they may cause cancer anyways), look your friends in the eye and engage in live communication. You will feel better, guaranteed. Foot and Ankle Surgeon Dr. Adam SpectorDr. Adam Spector  works in our Rockville, MD (Shady Grove) and Wheaton, MD offices. 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. Adam Spector 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. Adam Spector 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. Adam Spector 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.

Diabetes: We Check Your Feet Like No One Else!

Diabetes Mellitus (Type 1 and Type 2) is a common condition that afflicts many Americans and is being diagnosed more each year! We see many patients who have very subtle symptoms which can be attributed back to early onset and detection of diabetes. Many patients say, “I have a sock balled up feeling under my foot” or “I have severe burning” or “I have tingling in my toes” or “The pain keeps me up at night”.  We have learned that these early symptoms or changes are often not being picked up at our patient's primary physician annual physical. The American Diabetes Association (ADA) publishes in their journal “Diabetes Care” annual standards of medical care which our doctors at Foot and Ankle Specialists of the Mid-Atlantic adhere. Additionally, our doctors go beyond the typical evaluation, we are tracking your hemoglobin A1c’s and classifying our patient’s foot risk category at each visit. We feel patients are sometimes seen more frequently in our offices than their primary care. This in turn, allows us an opportunity to be educators from a different perspective that the patient’s primary care physician does not have, more visits give us a unique opportunity to better determine any sensation or structural changes. A typical issue is the early onset of neuropathy, we routinely diagnose and treat this problem. We know that the quality of care provided to a diabetic can critically affect downstream costs both personally and to the healthcare system as a whole. According to Dr. David J. Freedman, it is apparent that ultimately there are potentially significant complications that go with long standing diabetes. Our priority is to provide the highest quality and most appropriate diabetic foot health care. We have learned that some insurance carriers are not evaluating doctors based on high quality, which we feel is a major mistake, but rather only looking at cost. I want our patients to know while this could hurt our profile with certain payers we are taking the high road to high quality. The insurance company’s often times don’t understand that the cost to provide diabetic patient’s with more frequent visits in the long run will greatly reduce costs to the healthcare system. We are evaluating for potential microvascular complications and rendering appropriate foot care. We know patients with diabetes typically may also be developing kidney disease and eye disease issues. We discuss these issues with our patients when appropriate. We are reminding our patients to get their annual eye exam to be tested for retinopathy. We are evaluating our patients for small fiber nerve changes by testing pinprick or temperature sensation changes. We use a 128-Hz tuning fork to test for vibratory changes and 10-g monofilament test to identify areas at risk for ulceration. Using these testing techniques, we are looking for advancing neuropathy changes which usually indicate large fiber changes when there is numbness and loss of protective sensations. We are evaluating and treating diabetic patients with foot deformities, foot ulcers and ultimately developing ways to prevent future complications on a patient by patient basis. While we can’t eliminate a patient’s advanced vascular changes, we do evaluate for PAD (peripheral arterial disease) and refer our patients to interventional and vascular specialists to assist in establishing better blood flow to our patients feet. This is just another reason why patients with diabetes need to see a doctor with Foot and Ankle Specialists of the Mid-Atlantic, according to Dr. David J. Freedman. We provide the necessary evaluations which is best to detect these early and later changes. We are in a unique position to provide this value added service to our patient’s feet. There is not a day that goes by that a diabetic patient who is at risk, has improper shoes.  We agree with the ADA’s recommendation of getting our patients into specialized therapeutic footwear. We provide self-care education to all our patients. We educate our patients that use tobacco products, why they must quit in order to reduce the increasing complications in their feet and legs. If you haven’t made an appointment to get your diabetic evaluation, make an appointment today with a podiatrist near you. Our care team is looking to reduce risks. We are evaluating more closely our patients that have been diagnosed as pre-diabetics as well as looking at BMI. Foot and Ankle Specialists of the Mid-Atlantic feels the reason to be seen by one of our doctors has to do with our ability to determine the risk factors associated with patients developing telltale signs of potential future advancing diabetes potential complications. Our thought process at Foot and Ankle Specialists of the Mid-Atlantic is to intervene earlier in an attempt to prevent the potential complications from the many issues that diabetes throws your way.   Podiatrist Dr. David FreedmanDr. David J. Freedman works in our Silver Spring, MD (International Dr) 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. David J. Freedman 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. David J. Freedman 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. David J. Freedman 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.

Your Feet Deserve Our Support

Arch supports, inserts, insoles, and orthotic devices -- what’s the difference and what do I need? Like any building or machine, the foundation of support is essential. Think how annoying it is to sit at a table that rocks back and forth because the base is out of balance. A simple packet of sugar or folded napkin under a table leg can make all the difference. The human body is no different - and that support and balance begins with your feet. The best place to start is with your shoes. Finding the right shoe is more than pinching them to find the big toe. Aligning the heel, arch and toe length will ensure proper fit and function. The goal is make the shoe work with the foot-- not against it. A simple test is to pick up a shoe and bend it. The break point - or where it bends -  should be where the toes bend. If it bends anywhere else, there could be a functional mismatch between the shoe and the foot. Once shoes have been selected, attention can then be focused on what is inside the shoe. Many shoes are made with removable insoles - the lining inside the shoe. These insoles are often soft, thin, and offer little to no support. This can frustrate many people who are in search of the perfect shoe. That’s why it is often necessary to replace what is inside the shoe with either an over the counter insert or custom orthotic devices. This is where there are similarities between your eyes and your feet. Glasses - frames and lenses - accommodate for your vision problems and help you see better. Shoes and inserts accommodate your feet and help you walk and feel better. Taking this analogy one step further, some people do well with over the counter, non prescription glasses, but many need prescription glasses in order to adjust for the differences between their eyes or because the simple corrections that the non prescription glasses offer are not sophisticated enough. The same is true with your feet. There are lots of different over the counter inserts available in stores and online. However, not only are everyone’s feet different, but there are often significant differences between the feet of one person. That is why prescription orthotic devices are often necessary. Made from impressions of your feet, orthotic devices are made to fit you and no one else. Taking into consideration all of your biomechanical issues, including the way in which your feet function, the way you walk (or run), your alignment  -- and whether there are other contributing factors such as a leg length difference - custom devices are designed and made in order to accommodate all of your unique characteristics. Helping to provide symmetry, function, and postural balance, will not only be more comfortable -- but custom orthotic devices will also go a long way in reducing pain or problems that may have led you down this path in the first place. The first step in this direction is to visit a podiatrist with Foot & Ankle Specialists of the Mid-Atlantic for an examination and guidance on what will make your feet feel and function the best that they possibly can. Shoe recommendations and orthotic devices are a great way to help make that happen. Make an appointment today.   Podiatrist Dr. David LevineDr. David Levine works in our Frederick, MD (Thomas Johnson Dr) 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. David Levine 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. David Levine 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. David Levine 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.

Stress Fractures

The fall season is a time where many of us are outside hiking, running or enjoying other exercise. With this increased exercise, problems may develop. Any time there is a sudden onset of pain and swelling of the foot or ankle without any recent known injury or trauma a stress fracture has to be considered-- a stress fracture is a small crack in the bone. Stress fractures are very common in the weight-bearing bones of the lower extremity with the 2nd metatarsal bone the most common.  Repetitive stress of these bones being the causative factor. Bone remodeling is the process where mature bone is removed and replaced by new bone.  This is a process occurring continually throughout our lives. If this process is not in balance a stress fracture can occur.   A rapid increase in activity (a new running or walking program, training for a race, increase in exercise frequency), a job requiring  standing and walking (nurses, teachers, factory workers), elderly patients whose bone strength has diminished are all common causes of stress fractures. Improper shoe wear may also play a role in the development of a stress fracture.  

Symptoms and Diagnosis

Pinpoint pain and swelling that increase with activity and as the day progress are often the initial complaint.  Stress fractures are usually diagnosed with x-rays. Stress fracture cannot be seen on x-ray until the bone begins to heal itself by forming new bone.  This is usually takes 2 - 3 weeks after the onset of pain. Infrequently, a bone scan or MRI is needed to help with the diagnosis.  

Treatment and Prevention

Stress fractures usually heal in 6 - 8 weeks provided proper care is given.  Most of the time a walking boot combined with reduced activity will lead to uneventful healing. Continued high activity can lead to a complete fracture of the bone and nonunion. In most cases once you have healed from a stress fracture normal activity may resume.  Wearing a good supportive shoe with adequate shock absorption should help in preventing this from happening again.  A gradual increase in activity when starting or resuming exercise is important in prevention as well. Podiatrist Dr. Kevin MurrayDr. Kevin Murray works in two offices for your convenience: Charlottesville, VA (Rio East Ct) and Fishersville, VA. 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. Kevin Murray 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. Kevin Murray 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. Kevin Murray 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.

What is the Cause of My Heel Pain?

Heel pain is a frequent ailment that podiatrists treat. One of the most common causes of heel pain is plantar fasciitis. The plantar fascia is a large ligament that extends from the heel to the toes and is a big supporter of the arch. When this ligament becomes inflamed and irritated, we refer to this as plantar fasciitis. One of the main symptoms of plantar fasciitis is pain that is worse when someone first gets up out of bed in the morning or gets up after a period of rest. This pain will initially start to improve after a few steps, but then will reoccur again after getting up from another period of rest. Symptoms can also occur after long periods of standing and also can worsen following exercise. Plantar fasciitis can occur in a variety of age groups. Some of the factors that can make patients more prone to developing plantar fasciitis are:
  • Those with a flat foot type
  • Those with tight calf muscles
  • Those who have a high arch foot type
  • Certain athletes such as distance runners
  • People who have occupations that require them to be on their feet all day long
  • Certain shoe gear and spending a lot of time barefoot can also trigger plantar fasciitis. Flip-flops are one of the most common culprits of plantar fasciitis in the summertime and shoes that are highly flexible with little support can also trigger it.
There are a variety of treatment options for plantar fasciitis and your doctor will be able to provide you with treatment options that could best suite you. The majority of plantar fasciitis cases can be resolved with conservative care without surgical intervention. Here are some of the treatment options that your doctor may suggest: Shoe gear: Your doctor will likely examine and discuss the shoes that you wear on a daily basis. It is important to wear shoe gear that has a good arch support and to avoid spending a lot of time barefoot. Your doctor will be able to suggest certain brands and styles to help you find supportive shoe gear for work, exercise and leisure. Sometimes even just changing the shoe gear can lead to significant improvement in plantar fasciitis symptoms. Arch Supports/Custom Orthotics: There are a variety of different arch supports that are marketed today. Some are better than others and your doctor will be able to provide you with a list of which ones to try. Your doctor may also discuss with you the option of custom orthotics, where an insert is made specifically for your foot and is superior to over-the-counter inserts. Some insurance plans will cover custom orthotics, while others do not. Ask your doctor if custom orthotics would be a covered benefit under your plan. Anti-inflammatories and Ice: Anti-inflammatories and ice can both help to reduce inflammation, which can help relieve pain. Sometimes your doctor can write you a prescription strength anti-inflammatory to help further reduce inflammation. It is recommended to ice your foot after any activity, and at the end of the day when dealing with plantar fasciitis. Some patients prefer freezing a water bottle and rolling it along the bottom of the foot. Calf Stretches or Physical Therapy: Having tight calf muscles can be a trigger for plantar fasciitis. If you do have tight calf muscles it is important to do daily calf stretches. Your doctor will be able to provide you with a list of stretches. Sometimes if calf stretches are not enough, your doctor may suggest wearing a splint at night that can stretch the calf while you are sleeping. Physical therapy is another option that your doctor may suggest to further help you with your flexibility. Injections: For patients that have significant pain and inflammation, your doctor may suggest a cortisone injection. The injection is given typically right where the plantar fascia attaches to your heel bone and helps to reduce inflammation in the area. Typically the injection given is a long acting steroid and can take a few days to start working. Even if the injection gets rid of all the pain, it is still important to make sure you continue to wear proper shoe gear, stretch and use the inserts your doctor suggested-- otherwise the plantar fasciitis can reoccur in the future. Extracorporeal Shockwave Therapy (EPAT): EPAT is a treatment option for those that suffer from chronic plantar fasciitis. EPAT is a non-invasive procedure which works by using pressure waves to increase blood flow and metabolism to the injured area in order to help accelerate the healing process. Most patients will undergo 3 different treatment sessions, over 3 consecutive weeks, with each treatment lasting about 10 minutes. During this treatment period your doctor will have you stop taking any anti-inflammatories and icing because this can interfere with the EPAT’s effectiveness. The best results from the treatment are usually seen about 6 weeks following the last treatment. Foot and Ankle Surgeon Dr. Colleen LawDr. Colleen Law works in 4 offices for your convenience: Charlottesville, VA (Abbey Road), Charlottesville, VA (Rio East Ct), Culpeper, VA, and Fishersville, VA. 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. Colleen Law 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. Colleen Law 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 Colleen Law 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.

Affects of Aging on the Feet

Yes, even as we age, we need to protect our feet and ankles! As part of aging, we gradually have an increased risk of developing foot problems. Our circulation, nerve conduction, muscle strength, flexibility and proprioception (balance), can all be affected individually or collectively as part of normal and abnormal aging.     Problem: Dry Skin As the skin ages, it can become dryer and therefore have a higher risk of developing fissures (deep cracks in the skin) which may become very painful, and even infected. Treatment The skin around your foot and ankle must be kept appropriately moisturized with a “foot moisturizer”, versus just using a standard body or hand lotion. Foot moisturizers contain ingredients designed specifically for the thicker skin on the soles of our feet. It is also important to remember to not apply moisturizers between the toes, where absorption may be diminished.  Poor absorption between the toes could progress to further cracking in the web spaces and fungal infections.   Problem: Wearing down of foot padding The fat padding on the soles of the feet may also wear down over time. This can lead to chronic pain, development of calluses and even wounds or ulcers. Treatment Preventing these problems, can be improved with using the proper foot gear, cushioned socks and cushioned insoles.   Problem: Blood vessels thicken and stiffen Aging can affect the circulatory system of the lower extremity in many ways. The blood vessels thicken and become stiffer.  This leads to slower exchange of appropriate nutrients and stagnation of waste products. As we grow older, our bodies accumulate more fat as muscle tone diminishes and overall we have less total body water. This can lead to anemia and reduced healing time when injuries occur in our feet.  Most of the overall number of white blood cells stay the same as we age. However, certain white blood cells important in fighting infection, (neutrophils) decrease, and thus we have a reduced ability to fight off infection. Collectively, these factors can be associated with an increase in the risk of blood clots, (deep vein thrombosis, DVT), peripheral vascular disease, (often presenting as intermittent pain in the legs when walking), varicosities (superficial prominent veins).   Treatment Having a detailed medical examination with your Podiatrist will help you lower the risks of developing these chronic problems.   Problem: Changes to our nervous system The process of aging causes our nervous system to undergo unique changes. The brain and spinal cord lose nerve cells and weight (atrophy). Nerve cells may begin to pass messages more slowly than in the past, (poor conduction). Gradual deterioration of your peripheral nervous system which may be seen in diabetes, vascular problems, or other primary neurological disorders can all affect your peripheral sensations in your feet, and in certain instances, can result in diminished appropriate reflex responses.  Neuropathy (disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness) can cause people with diabetes to lose the ability to perspire. Neuropathy may affect people with diabetes as well as other diseases. Diabetics can benefit from a thorough evaluation by a podiatrist to determine the exact cause and appropriate treatment before neuropathy worsens. Treatment Evaluation of the nervous system by a podiatrist for the lower extremity is very helpful. From here further testing can be done to determine the "cause" for the nerve problems. Accordingly the treatment plan can be determined to address the specific cause and symptoms.   Problem: Gait and balance deterioration In a 2006 study published in The Journal of American Geriatric Society, gait (ability to walk appropriately), disorders were detected in approximately 25% of persons age 70-74 and nearly 60% of those 80-84 years old. The most common causes of gait and balance disorders include arthritis and orthostatic hypotension.  However, multiple studies have also found that gait and balance disorders are multifactorial in 75% of older patients. Problems related to psychiatric issues, cardiovascular disease, infectious and metabolic disease, recent hospitalization, medication use, among others can all adversely affect a patient’s gait. Treatment Evaluation of gait and balance is an essential step in identifying persons at an increased risk of falling and preventing fractures. A team medical approach with your primary care physician and Podiatrist can help prevent problems that may occur with poor gait.  Your Podiatrist can provide the most appropriate assisted device that can help older patients prevent falls. Preventing falls and the complications related to them, help diminish the overall morbidity that can develop in our elderly patient population. Foot and Ankle Surgeon Dr. Kerry BeckerDr. Kerry Becker works in our Clarksville, 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. Kerry Becker 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. Kerry Becker 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. Kerry Becker 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.