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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 ailments that podiatrists treat. One of the most common causes of heel pain is due to 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 of walking, 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 shoegear 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.

Back to School Shoe Shopping

It’s that time of year again - the weather is starting to change and the kids are returning to school. This means new classes, new school supplies, and new shoes. While children may be focused on style, there are a few other things to keep in mind when choosing a proper shoe that will help keep your child’s feet healthy and happy:  
  1. Fit is key: Children's feet are constantly growing, typically changing every few months. A shoe that is too large or too small can cause pain, blisters, and potentially other short and long term problems. Make sure to have their feet properly measured by a professional before purchasing any foot wear. Don’t forget to bring socks when shoe hunting.
  2. Buy for the larger foot: Feet are rarely the exact same size. Purchase shoes fitted for the larger foot. Try to avoid shopping for shoes first thing in the morning, as feet tend to swell over the course of the day.
  3. Not all shoes are created equal: Especially when buying for sports, a shoe should have a sturdy heel. The shoe should also have structure, bending primarily at the ball of the foot, not the arch.
  4. Say no to sharing footwear: Much like adults, even though two children may measure the same size, the shape of their feet may differ, and a previously worn shoe has likely conformed to its original owner. Older shoes will also lose their support and cushioning. Sharing can also spread athlete’s foot or nail fungus.
  5. Shop together: Let your child participate in shopping for their shoes. This promotes healthy foot habits as they age and helps ensure a proper and comfortable fit. Try to avoid shopping online to avoid issues with fit and sizing - there is no replacement for walking in the shoes at the store to help assess comfort.
  6. No “break-in” needed: Childrens shoes should fit appropriately and be comfortable immediately.
  Be mindful of areas of irritation, blistering, and uneven shoe wear. Less obvious signs that there may be an underlying issue include tripping, falling, and decreased participation in sports. A podiatrist is specially trained and experienced in treating lower extremity conditions and ailments. Please contact your local FASMA provider if you have any concerns that may require evaluation. For students who wear adult sizes, Richey & Co. Shoe stores have trained associates who can fit your child into proper fitting footwear.   Foot and Ankle Surgeon Dr. Man ChoDr. Man Cho works in our Reston, VA 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. Man Cho 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. Man Cho 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. Man Cho 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.

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.

Keeping Your Feet Safe on Vacation

My dad is a podiatrist, and every summer when we were at the beach or the pool, he pestered me (and my brothers) to put sunscreen on our feet. I certainly did not understand at the time just how important it is to protect your feet from the sun. But now I know that it takes even more than sunscreen to keep your feet safe during the long summer days. No matter where you go on vacation, there are some important things to do and to watch for to help keep your feet comfortable. The first thing, of course, is sunscreen. My dad was right to pester us kids- both the top and bottom of your feet can get sunburned. In addition, the skin on your feet can be more susceptible to melanoma (along with other types of skin cancer), especially if you have a family or personal history, or if you already have moles on your feet. If your feet spend any time in a pool or ocean, make sure to apply the sunscreen on them afterward. The beach brings other dangers besides the sun too- it feels nice to walk barefoot on the sand, but shells, glass, wood, and other objects that might lay hidden can all cause cuts or injuries to your feet. If you have gotten a cut on your foot, going in the water can invite bacteria and other organisms to cause infections. Wearing sandals on the beach can help protect you, and checking your feet before you head for a swim can prevent you from swimming with an open cut that you didn’t notice before. If you’re spending a lot of time in a pool, ocean, or lake, investing in a pair of water shoes goes a long way for protecting your feet.   Of course there are other places to vacation besides the water. If you’re spending time camping, hiking, or touring a new city or country, make sure to wear good shoes that protect you from the elements and from the miles. Always give your hiking boots or walking shoes a good test run to make sure they fit well and won’t give you blisters. Keep in mind that feet swell when you’re standing and walking, so you might need a larger size in a hiking or walking shoe. Good arch support can help prevent fatigue and strain in your feet and ankles. If you’re spending time outdoors, always check your feet for insect bites. We’re all pretty familiar with mosquitoes, but keep an eye out for bites or stings from other critters. Ticks, chiggers, bees or wasps, spiders, even crabs or jellyfish can spell trouble. If you’re concerned about the appearance of an insect or animal bite, see a doctor right away.   Summer vacation is a great time for rest and relaxation, adventure and exploring. Remember these tips to keep your feet safe and healthy, so you can enjoy your vacation to the max. Have a great time this summer- and don’t forget the sunscreen! Foot and Ankle Surgeon Dr. Caitlin MaddenDr. Caitlin Mahan Madden 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. Caitlin Mahan Madden 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. Caitlin Mahan Madden 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. Caitlin Mahan Madden 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.

MoCo365 Features FASMA

Dr. David Freedman, a founding member and Vice President of Foot and Ankle Specialists of the Mid-Atlantic, is featured on MoCo365. This initiative highlights businesses from all sectors of Montgomery County, Maryland with the purpose of showing the diversity of the area through the stories of successful leaders, entrepreneurs, and inventors. While FASMA began in MoCo, it has expanded throughout the Mid-Atlantic with 35 offices reaching from Pennsylvania to North Carolina. Learn more about our history and what makes us unique by watching this video.  

Injuries to Your Toenails

What are some possible causes of toenail injury?

Everyday injuries can cause your toenail to fall off. Hitting your toe on a chair or bedpost, dropping something on your foot, or simply pulling your socks on too fast can damage your toenail. Toenail Injury Injuries to the nail may lead to a subungual hematoma, which causes blood to collect under your injured toenail. This can delay growth of the toenail and be painful for the first few days or weeks. If it can be tolerated, the best way to treat it is to soak the area in cold water for 15 minutes, clean the area with betadine or an alcohol swab, apply antibiotic cream, and trim straight across the toenail. If the subungual hematoma extends to a little over a quarter or half of your toenail, then you must seek treatment at a doctor’s office. If you experience throbbing or severe pain near the hematoma, your doctor will determine if the hematoma needs to be drained to relieve the pressure.  X-rays may also be taken to make sure a fracture has not occurred. In diabetics, or immune-compromised patients, care is important so that infections do not occur. Keep in mind, toenail growth will slow down significantly after the injury. It can take anywhere from six months to two years for the nail to completely grow back. Pressure on the toenail can cause it to weaken and lift off the nail bed. Make sure other toenails are trimmed neatly and wear well-fitting shoes to prevent any future injuries. A half centimeter of room should always be present in the front of shoes to prevent pressure of toenails. A good shoe store can help fit your shoes and make sure you are not feeling extra pressure around your toenails. It is also possible to develop a fungal infection of the nail after a toenail injury. The injury provides an invitation for fungus to grow between the nail bed and loose toenail. If this occurs, your doctor should take a sample of your toenail to confirm that it is fungus, and then treat accordingly. Your doctor will discuss when antifungal medications are necessary on a case by case basis, depending on the results of a nail biopsy. People who have athlete’s foot and diabetes are prone to fungal infections. Diabetic patients have a harder time fighting off a fungal infection and must take extra precaution. Another cause of toenail detachment is psoriasis, an autoimmune condition. With psoriasis, the skin cells begin to build up at a faster rate and cause the toenail to lift off. Many cases of nail psoriasis are mild and don’t persist. Some of the symptoms may include thickening/pitting of nails, unusual nail shape, yellow-brown discoloration, or a chalky-like buildup. If the foregoing remains an issue, your doctor may prescribe topical steroids to rub into your toenail and cuticle.  

What to do when your toenail is injured or falls off.

Step one: Don’t panic. If your toenail starts to fall off, you must follow a few basic tips to avoid worsening your prognosis.
  • First, clean the area with an antiseptic agent as tolerated.  
  • Second, apply an antibiotic ointment with a band-aid. If part of your toenail has fallen off or is detached, it is wise to let a doctor remove the remaining portion to avoid more pain or exposing your nail bed to infection.  
    • Do not lead the band-aid on all day and night-- leave the band-aid on during the day, but leave your toe open at night to let the area get some air.
    • Change your band-aid regularly regularly-- a dark, moist environment creates a way for infection and fungus to form.
  • Also, the doctor will determine how much of your toenail to remove, depending on how much of the toenail is detached.
Do not wait to seek treatment until your entire toenail falls off. While these tips provide a basic understanding of toenail injuries and detachment, they are not substitutes for medical treatment, especially if the pain persists or you are unsure about how to proceed. In such cases, please contact your doctor.   Foot and Ankle Surgeon Dr. Reema DuaDr. Reema Dua 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. Reema Dua 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. Reema Dua 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. Reema Dua 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.