All Specialty Services & Treatmentsis one of the most common causes of heel pain.
Cause:Plantar fasciitis can occur due to tightening and inflammation in the thick connective tissue that extends from the heel all the way to the toes. The plantar fascia is a weight bearing tissue that supports the arch of the foot. Some common causes of heel pain include but not limited to:
- Weight gain
- Excessive physical activity
- Abnormal (gait) walking pattern
- Improper or ill-fitting shoes
- High impact activities (i.e. repetitive jumping, certain sports like tennis, basketball and certain exercise programs)
- Tight calf muscles and achilles tendon
Presentation:Heel can be painful, red, and/or swollen. First steps out of bed or after a period of prolonged rest are very painful. Sometimes, it is described as a sharp, knife like pain in the heels with that first step in the morning. The pain improves but does not go away after those first few steps. At the end of the day of prolonged standing or walking, the pain can get worse. This can occur in one foot or both feet.
Diagnosis:X Rays are taken to evaluate the heel bone for a spur and to rule out other pathologies such as fractures. Ultrasound can be used as needed to assess the thickness of the plantar fascia and assess for any plantar fascia tears. Clinical examination will be done to assess the heel, foot, and also the achilles tendon which plays a significant role in the inflammation of the plantar fascia.
- Corticosteroid injection(s)
- Oral anti-inflammatory medication
- Shoe gear change/modifications
- Gait exam to evaluate/address the underlying biomechanical problems
- Custom Orthotics
- Night Splints
- Immobilization with a cast or a walking cast boot
- Extracorporeal Shock Wave Therapy (ESWT)
- Physical Therapy
A Look at Common Foot Surgeries
Surgery for Bunions
- Positional bunionectomy: This is a bony growth on the base of the big toe that enlarges the joint. In surgery, the doctor will remove the bump and may release soft tissue that has tightened.
- Metatarsal head osteotomy: Sometimes bony growths may form, resulting in irritation and swelling. This results in the angle of the first and second toe bones increasing beyond normal and can be correct by surgery. A surgeon performs a metatarsal head osteotomy to cut and reposition the bone and any bumps are remolded.
- Metatarsal base osteotomy: If the angle between the first and second toe bones is excessive, a surgeon may conduct a metatarsal base osteotomy. In this procedure, a wedge of bone is removed from the base of the big toe bone and the bone is repositioned and wires or screws may be inserted to stabilize the bone.
Surgery for Hammertoes
- If you have a flexible hammertoe, the doctor will reposition the tendons to allow the toe to lie flat. Afterward, the doctor may recommend that you wear a surgical shoe for several weeks.
- For a rigid hammertoe, several types of treatments are available:
- Arthroplasty: The doctor removes a portion of the joint and straightens the toe.
- Fusion: The doctor removes cartilage between the two toe bones so that the bones fuse to form one longer bone.
- Implant: In some situations, the doctor will remove a portion of the bone and replace it with an implant.
Surgery for Arthritis
- Arthritis is a condition characterized by inflammation and swelling of the joint lining and degeneration of the cartilage. Fluid usually accumulates in the joints. Arthritis can affect the big toe joint, causing pain and reduced motion. A bunion-like protrusion also may be present. There are a variety of surgical procedures to treat this condition.
Surgery for Neuromas
- A neuroma is a benign growth that occurs as a result of an enlarged nerve that has been compressed between two toe bones. When a neuroma is removed or "excised," a small portion of the nerve is cut out.
Surgery for Ingrown Toenails
- A nail becomes ingrown when it curves down at the sides and grows into the skin. This can be repaired in a procedure called a partial surgical matricectomy. The doctor removes a section of the toenail and the underlying nail matrix (cells that make the nail). This can be done through surgical excision, chemical, or laser destruction.
When to call the doctor:Follow your doctor's instructions for continued care of your foot and remember that every individual recovers differently. Call your doctor if you have any of these symptoms:
- Blood appears on the bandage (a small amount is to be expected)
- Your dressing becomes tight or your foot is cold or numb
- You develop a temperature of 101 degrees or more
- Your cast or bandages get wet
- You experience persistent pain
BioMechanicsPedorthics is the science of evaluating, fabricating, and delivering footwear to prevent or improve foot and ankle conditions both congenital and acquired. At FASMA, pedorthists, or "shoe fitting specialists" will use technology to produce high quality orthotics or customize the fit of your shoes. Customizing the fit of the shoe can often solve the foot problem. Orthopedic shoe modification by trained staff can aid in providing you with the help you need. It is a fact that the position of bones in the feet actually changes as we age. Moreover, research shows that many back problems result from foot imbalance or from one leg being longer than the other. Something as simple as a lift in or on the shoe can be an effective solution.
OrthoticsFASMA incorporates the latest computer technology to fabricate orthotics. We use infrared laser scanning to offer our patients the most technologically advanced orthotics available. This 3D scanning technology allows us to capture the shape and contour of the foot for the best treatment results and the highest quality orthotics. It is much more accurate and reliable than information captured by stepping on a mat or pressing the foot into a foam box. The digital cast and prescription is electronically transmitted to the lab. This means that your orthotics can fabricated for you in days, rather than weeks.
The main cause of hammertoes is genetics. The middle joint of the toe is affected and results in a bending deformity. Ligaments and tendons of the toe are tightened, which causes the joint to buckle and cock upward instead of lying flat.
- Hammertoes are largely genetic
- Wearing too tight of shoes or high heels that crowd the toes
- Bunions that push the big toe against the other toes
- Joint swelling in the toe that can result in pain
- A corn or callus can develop on the top of the foot from rubbing
- A callus can develop on the ball of the foot
- Diabetics may develop an ulcer
- Shoes with roomy toe boxes
- Avoiding high heels, especially ones with pointed toes
- A pedorthist can help find the right shoe fit for your needs
- Wearing soft pads over symptomatic areas of corns or calluses
- Shaving thickened skin with a file or pumice stone
- For more severe cases, surgery may be performed
- Cutting or lengthening tendons
- Transferring tendons
- Shaving or removing bone
- Inserting pins or implants
The American Diabetes Association reports that about 15.7 million people (5.9% of the U.S. population) have diabetes. Neuropathy, nervous system damage, affects about 60-70% of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet. Diabetics must constantly monitor their feet or face severe consequences, including amputation.
If you have diabetes, something small like a wound or blister could potentially cause a lot of damage. This is due to the decreased blood flow, so injuries are slow to heal. If a wound is not healing, it's at risk for rapidly spreading infection. If you have diabetes, you should inspect your feet every day for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror to inspect daily.Basic Diabetic Foot Care Advice:
- Always keep your feet warm, but don't soak your feet.
- Don't get your feet wet in snow or rain.
- Don't put your feet on radiators or in front of the fireplace.
- Don't smoke or sit cross-legged because you'll experience a decreased blood supply to your feet.
- Don't use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
- Trim your toenails straight across and avoid cutting the corners. Use a nail file or emery board to smooth. If you find an ingrown toenail, contact one of our offices.
- Use quality lotion to keep the skin of your feet soft and moist, but avoid putting any lotion between your toes.
- Wash your feet every day with mild soap and warm water.
- Wear loose socks to bed.
- Wear warm socks and shoes in winter.
- When drying your feet, pat each foot with a towel and be careful between your toes.
- Wear appropriate shoes:
- Buy shoes that are comfortable, without a "breaking in" period.
- Check how your shoe fits in width, length, back, bottom of heel, and sole.
- Avoid pointed-toe styles and high heels.
- Try to get shoes made with leather upper material and deep toe boxes.
- Wear new shoes for only two hours or less at a time.
- Don't wear the same pair of shoes every day.
- Inspect the inside of each shoe before putting it on.
- Don't lace your shoes too tightly or loosely.
- Choose socks and stockings carefully:
- Wear clean, dry socks every day.
- Avoid socks with holes or wrinkles.
- Thin cotton socks are more absorbent for summer wear.
- Square-toe socks will not squeeze your toes.
- Avoid stockings with elastic tops.
For most people, cuts and scratches are able to heal naturally within days or weeks. Others, such as in the case of diabetics, require specialized care.
Doctors of the Foot & Ankle Specialists of the Mid-Atlantic specialize in the care of lower extremity wounds. Using state-of-the-art wound care therapies, and surgery when necessary, FASMA doctors can help you to heal your wound.
Ulcer CareAn ulcer is a type of venous wound that is a sore which may develop on the feet or legs. Conditions that effect circulation and sensation to the lower extremities, in particular diabetes may put a patient at greater risk of developing an ulcer. If ignored, an ulcer has the potential to become a more severe issue. Your Podiatrist will determine the root cause of the ulcer and provide a proper treatment plan.
Ultrasound imaging allows FASMA doctors to confirm a diagnosis in real time, and therefore prescribe a treatment plan faster than by traditional methods.
Ultrasound imaging can be used in the diagnosis of soft tissue problems, such as plantar fasciitis, soft tissue masses, foreign bodies, and neuromas, to name a few common conditions. Ultrasound can also be used to guide injections.
The first clinically proven laser device for the temporary increase of clear nail in patients with onychomycosis, or nail fungus.
Stop suffering the pain and embarrassment of unsightly nail fungus. Laser Therapy is the easy and convenient treatment that helps to turn your discolored or disfigured nails into clearer, healthier-looking nails.
Safe and effective, this in-office treatment is pain-free, has no harmful side-effects, and, typically, takes only about 30 minutes to complete.
There are several types of children’s foot and ankle problems, both congenital and acquired, that FASMA doctors are highly qualified to diagnose and treat.We offer both nonsurgical and surgical options for pediatric care including general care, orthopedics, and foot and ankle surgery.
Peripheral Arterial Disease (PAD) is a serious circulatory condition where clogged or narrowed arteries cause poor circulation to the arms, legs, brain or kidneys. It occurs most often in the lower extremities, causing decreased blood flow to the legs and feet. Just like build-up in the heart, clogged arteries in the lower extremities can cause a stroke or a heart attack. Eight to twelve million Americans have PAD and, if left untreated, it can be fatal.
Fortunately, today there is a non-invasive technology that can determine the presence of PAD. PAD-net™ is a PAD test that can be completed in 15 to 20 minutes during a regular office visit.
For patients with increased risk factors, including those of 65 years of age or older with a history of diabetes, high blood pressure, high cholesterol or smoking, being informed about this arterial disease is essential. Leg pain and discoloration of the toes or feet are possible symptoms of PAD. It is important to note, however, that many people with PAD do not experience any symptoms. Testing can help to determine whether you have PAD, and whether medical or surgical treatment is necessary.
Our primary goal as foot and ankle specialists is to treat painful foot and ankle deformities by improving and optimizing foot and ankle function. Surgery is often performed to correct the underlying deformity and may concurrently improve the aesthetic and cosmetic appearance of the foot and ankle.
Our services include, but are not limited to: bunion correction, hammertoe correction, and scar revision. Early evaluation and treatment is key to prevent the progression of the foot or ankle deformity.
Often times there is more to your foot and ankle than meets the eye. Schedule an appointment with one of our foot and ankle specialists for an evaluation today.
The Baltimore office is affiliated with Chesapeake Research Group LLC. Dr. Gottlieb was the founder of the clinical research trial site. They perform clinical trials, helping pharmaceutical companies and medical device manufacturers to develop the latest medications and devices.
FASMA doctors consult with CRG, and assist in the completion of these clinical trials.
Arthroscopic procedures can be performed either to evaluate or to treat many orthopedic conditions, including torn floating cartilage, torn surface cartilage, and to trim damaged cartilage. During surgery, an arthroscope is inserted into the joint through a small incision. The surgical instruments used are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage.Ankle arthroscopy is a minimally invasive surgical procedure that orthopedic surgeons use to treat problems in the ankle.