All Specialty Services & Treatments

Plantar Fasciitis (Heel Pain) Treatments

Plantar Fasciitis is one of the most common causes of heel pain. The plantar fascia is a ligament that supports the arch of the foot. Plantar fasciitis occurs when this ligament gets over stressed, damaged and inflamed.

Cause: 

Some common causes of heel pain / plantar fasciitis 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:

The heel can be painful, red, and/or swollen. The 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 heel 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, after 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 pathology 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.
  • Gait exam to evaluate and address the underlying biomechanical problems.
 

Treatment:

  • Strapping
  • Stretching
  • Corticosteroid injection(s)
  • Regenerative Injections (ie: Amniotic and PRP)
  • Oral anti-inflammatory medication
  • Shoe gear change/modifications
  • Custom Orthotics
  • Night Splints
  • Immobilization with a cast or a walking cast boot
  • Extracorporeal Shock Wave Therapy (ESWT / EPAT)
  • Physical Therapy
   

Plantar Fasciitis can become a chronic condition if not treated. It is important to seek care when the problem first appears and to address the underlying cause rather than waiting for it to become worse.

Heel Pain in Children

As children go through “growth spurts” between the age of 11 and 14, the muscles and tendons in their legs can become tight as they try to keep up with the rapid growth in the long bones. Heel pain in children typically is the result of a tight Achilles tendon.

In children, there is a thin irregular shaped band of cartilage in the back portion of the heel bone called a growth plate (see x-ray image below). As the name implies, new bone forms within a growth plate, which is also found in other bones in the feet, legs, hands and arms.

As a child goes through a "growth spurt," the rapidly elongating leg bones stretch the Achilles tendon which in turn pulls tighter on its insertion into the heel bone. A tight tendon is usually not a problem. However, when a child is very active in sports, such as soccer, or basketball, the increased activity creates further tightening of the tendon. The result is a traction or pulling force which is absorbed into the heel bone (see illustration, below).

As cartilage is softer than bone, the growth plate frequently becomes irritated and painful as the traction force increases. This process is more commonly seen between the age of 8 and 13 years old.

On examination, one can reproduce pain by pressing both under the heel as well as compressing the heel bone (calcaneus) from side to side. Other causes of heel pain include a fracture or bone tumor, so x-rays are usually performed in evaluating this condition.

Treatment includes rest, ice and anti-inflammatory medication. An arch support and heel lift are both helpful. For severe cases, a non-weight bearing splint or cast may be applied. Long term treatment usually includes use of functional foot orthotics. The problem is self-limiting and goes away after the growth plate closes, around the age of 13 to 14 years old.

Foot Surgery

It is our goal at Foot and Ankle Specialists of the Mid-Atlantic to provide the best care possible to address your specific foot and ankle condition. Our doctors will provide our patients with a thorough understanding of their surgical and non-surgical options. If surgery is recommended, our experts will offer an individualized surgical plan to best address your condition and goals. Foot surgery is a well-planned, personalized event between you and your doctor. Selection of the proposed procedure, and the rehabilitation after surgery, is all part of the plan to help make you the best you can be.

Listed below is a sample of the conditions that our surgeons address:

  • Achilles Tendonitis
  • Ankle Instability
  • Arthritic Joints
  • Bone spurs
  • Bunion Deformities
  • Fractures
  • Ganglion Cysts
  • Haglunds Deformities
  • Hallux Limitus and Rigidus
  • Hammertoe deformities
  • LisFrancs Joint Injuries
  • Metatarsalgia
  • Neuromas
  • Osteochondral Defects
  • Plantar Fasciitis
  • Plantar Plate Injuries
  • Posterior Tibial Tendon Injuries
  • Sesamoid Injuries
  • Sports injuries
  • Tendon Ruptures

We want the experience of this procedure to be specialized for you. Generally speaking, your doctor will either do an office procedure or a hospital-based procedure. If it's in the office, we will make you comfortable, go over the risks and the benefits and talk about the recovery. We will discuss the numbing medicine, the procedure itself and what to expect. You will find yourself well-informed and leave the office in a timely manner with a plan for home care. If you have a hospital-based surgery, your doctor will meet you and your family member at the hospital ahead of time and talk about what to expect that day and the days to come. An anesthesiologist will help sedate you and make you comfortable.

The foot procedure itself should be relatively quick, less than an hour for most surgeries, but sometimes more. Some of our reconstructive surgeries can take several hours and may even require an overnight stay for monitoring or for pain control. However, with most of our hospital-based surgeries, patients are able to go home that same day with numbing medicine in the foot and a very comfortable day ahead. Now, of course, that numbing medicine will wear off and you will have some discomfort the next day. Your doctor will prescribe pain medication that you can take and will discuss how to monitor your discomfort. Your doctor will also discuss ways to monitor for infection and other adverse events. You will have emergency phone numbers in the unlikely event you need to contact the doctor.

Again, we want your surgery experience, whether it's foot surgery or ankle surgery, to be a positive one, where you feel well-informed and comfortable. Our goal is to have you back on your feet doing the things you love. Sometimes surgery is necessary. Hopefully, not too often. Please meet with our doctors. We want to help you have a successful outcome for your foot problem.

General Foot Care/Podiatry

The foot and ankle are a complicated network of nerves, blood vessels, bones, muscles, tendons, and ligaments. Every step involves an intricate series of interactions between these tissues. Foot pain can be a clue to overall health. For example, joint stiffness can be caused by arthritis. Numbness and tingling can be caused by diabetes. Swelling might indicate kidney, heart, or venous disease.

It is important to take care of your feet, so they can take care of you. They are needed to complete your work and keep you walking to keep you healthy, help circulation, reduce weight, increase strength and bone content. To keep feet healthy it is important to examine them regularly, wear comfortable shoes that fit, wash feet daily with soap and lukewarm water, and trim toenails straight across and not too short. Good foot care and regular foot checks are an important part of health care.

First, to protect the skin and the nails: Excessive moisture and darkness can result in fungal infections. Keep your shoes dry by not wearing the same pair two days in a row or use shoe trees. Use powder or antiperspirant to absorb moisture. Wear leather to let your feet breath. Do not sleep in socks. Dry well between toes to prevent interdigital moisture. Avoid going barefoot to avoid penetration by a foreign body.

Secondly, to help the musculoskeletal system: Wear a good supportive shoe when weight bearing. The shoe should have a good firm heel-counter and be replaced at one year or every 600 miles to maintain support and shock absorption. Shoes are designed for different foot types, high or low arch. See a Podiatrist if you are not sure of your foot type. They can also review exercises to improve foot function. Purchase shoes later in the day, when your foot is at the fullest to get a good fit.

If you have foot problems, be sure to call and make an appointment.

Gait Analysis

Gait analysis is of fundamental importance in the diagnosis and treatment of musculoskeletal conditions affecting the foot and ankle. Most foot and ankle specialists initially examine the patient in the seated position to determine position, range of motion and strength, leg length, and gross deformity. Then, the patient stands to enable assessment of the alignment of the feet, ankles, knees, legs, and hips. Finally, the patient is asked to walk and/or run to enable a more functional assessment of the lower extremity, as well as to measure the effects of body weight, form, and posture.

Gait analysis can be accomplished in a quiet hallway in the office, on a treadmill, or using more advanced techniques, such as computerized gait analysis. Often, gait will be recorded with slow motion video and reviewed. Your podiatrist will determine which method of examination is best for you.

For example, equinus (limitation of upward bending or dorsiflexion of the ankle), is commonly found in about 25% of the overall population, and has been associated with over 96% of biomechanically-related, repetitive motion foot and ankle injuries, as well as lower back pain. Limited ankle dorsiflexion may cause abnormal compensation during walking and running, including excessive internal or external rotation of the leg, knee, and hip, as well as excessive pronation (flattening) of the foot. The effect of equinus in gait occurs when body weight passes over the leg during mid-stance and is best seen during gait analysis. This condition can be particularly destructive in runners as the cadence slows and stride length increases. Once identified, these are treatable with physical therapy, proper shoe selection, and orthotics.

Gait analysis is fundamental in the accurate diagnosis and treatment of foot and ankle issues.

Biomechanics & Orthotics

Poor biomechanics can be debilitating for patients. It can cause chronic pain, which can significantly affect a patient’s quality of life. Podiatrists can change a patient’s life quality by altering their biomechanics to function more efficiently. Over-the-counter or custom orthotics are effective, common treatments.

Over-the-counter (OTC) orthotics can be a quick fix for a minor issue or an intermediary step when transitioning a patient into custom orthotics. Generally, patients who are of light to normal weight, have minimal deformity, a relatively neutral arch, and have a job that requires light weight-bearing benefit the most from OTC orthotics. These orthotics tend to be less expensive, softer, and fit in most shoe-types. There are some excellent choices in OTC orthotics and can offer choices that are similar in nature to custom devices. There are limitations to OTC orthotics. They are not a replacement for custom orthotics, as they do not address specific pathologies that may be present in a patient’s foot. If a patient has a severe deformity or has a heavy weight-bearing job, they would benefit more from a custom orthotic. However, when used appropriately, an OTC orthotic can drastically aid patient outcomes.

Custom orthotics, on the other hand, can be specifically designed for the needs of each patient, as well as individual feet. They can be used to manage specific deformities or gait abnormalities, such as: bunions, tendonitis or tendon dysfunction, arthritis, or plantar fasciitis. In general, the design of the orthotic is to accommodate these issues as well as allow the foot to function in a more neutral and proper position.

To develop the orthotic, the Podiatrist captures an image of the foot as accurately as possible. There are many ways to do this: plaster casting, foam box molding, pressure scanning, and 3-dimensional camera modeling. Customizations occur and vary based on each patient’s needs. The material the orthotic is made of is chosen by the Podiatrist based on exam and can range from flexible and soft to super rigid. The material needs to be supportive for the foot as well as comfortable enough to wear. Once the device is made, they usually require a break in period. This can take 2 - 4 weeks to become comfortable. Generally, a follow up appointment is scheduled to make sure the orthotic is managing the issues appropriately. In some cases, adjustments may be needed initially and in the future to best treat each patient.

Custom orthotics are a great treatment option for many podiatric conditions and can alleviate pain not only in the feet and ankles but also can help hip, knee and back pain by helping alignment issues in the lower extremities.

Hammertoe Treatments

Hammertoes are caused by muscle imbalances in the toe. Ligaments and tendons of the toe are tightened, which causes the joint to buckle and appear slightly deformed. Hammertoe deformities are fixed structural deformities affecting one or multiple toes of the feet. Each toe (except the big toe) consists of 3 separate joints. Hammertoes can affect one of multiple joints of each toe. Hammertoe deformities cause a bending of the toe which is created by ‘jamming’ of bones in toe joints, and is considered one of the most common foot deformities. Most often it is seen in the middle joint of the toe causing a bend. This ailment is more common in women than men at a rate of about 5:1 and the incidence increases with age. Treatment options vary based on severities and symptoms.

Causes:

  • Injury
  • Wearing too tight shoes or high heels that crowd the toes
  • Tightness of ligaments and tendons due to other foot deformities such as bunion, flatfoot, high arch foot, etc.
  • Muscle imbalance due to other neuromuscular diseases
  • Age

Symptoms

  • Joint swelling or redness in the toe that can result in pain and inflammation
  • A corn or callus can develop on the top of the toe
  • Pain or callus on the tip of your toe due to constant rubbing
  • Infection
  • Visible bending of the toe
  • A callus can develop on the ball of the foot
  • Diabetics may develop an ulcer which can lead to digital amputation

Treatments

Conservative treatment options are utilized to reduce symptoms and for better functionality in daily life.  
  • Shoes with a larger toe box
  • Modification of the shoes
  • Avoiding high heels, especially ones with pointed toes
  • Orthotics provide better support and stability to your feet
  • Wearing soft pads over symptomatic areas of corns or calluses
  • Using toe crest pads to relieve pressure on the tip of the toe
  • Using creams to soften calluses
  • For more severe cases, surgery may be necessary
    • Cutting or lengthening tendons
    • Transferring tendons
    • Shaving or removing bone
    • Fusing the joint
    • Release of joint capsules
    • Inserting pins or implants

Bunion Treatments

A bunion is a bump on the outside of the big toe joint. It is a misalignment of the bones in the foot. The bump is noted where your big toe meets the rest of your foot. The bump and deformity can gradually get worse over time making it difficult finding comfortable shoe gear. It also can cause other toes to become deformed when you have a bunion for a long time. Bunions can occur at any age, starting in childhood. The misalignment can be genetically inherited, meaning someone in your family also had/has a bunion. Specific foot types can predispose you to having a bunion including flat feet which cause the joints to move out of their normal position. Wearing improperly fitting shoe gear can also contribute to a bunion deformity.  

Bunion Causes:

  • Genetics - foot types are inherited and may predispose individuals to bunion development secondary to biomechanical abnormalities.
  • Long term use of poorly fitting, inappropriate footwear.
  • Joint instability.
  • Neuromuscular conditions
  • Rheumatologic disorders (i.e. inflammatory joint diseases)
  • Injury
  • Congenital deformities
 

Bunion Symptoms:

  • Abnormal bump to the side of the foot, which can grow larger.
  • Pain and tenderness at the bump or great toe.
  • Stiffness or restricted motion at the great toe joint.
  • Inflammation and redness.
  • Painful pressure of the great toe against the adjacent or second toe.
  • Callus or thickening of skin on the side of the foot or near the bunion.
  • Pain and swelling that can affect how the big toe joint moves and how you walk.
 

Tips to Help Manage Bunion Pain:

  • Purchase appropriately sized footwear, preferably those with a deep and wide toe box. Shop at a store with well trained staff that have the ability to correctly measure your feet. It is recommended to have your feet measured regularly.
  • Avoid high heeled shoes - these will likely put more pressure against the bunion.
  • Offload the pressure area: use of padding against the bunion is often helpful with pain relief. Make sure the pad is not so large as to cause the shoe to fit tighter, which may be painful.
  • Inserts or custom orthotics can be used in shoe gear to help the foot function properly and can slow the progression of the deformity.
  • Use of toe spacers may relieve pressure against the bunion as well as between the 1st and 2nd toes.
  • Apply ice to any inflamed areas.
  • If you are able to use over the counter pain medication, particularly nonsteroidal anti-inflammatory drugs, this may be helpful managing moderate pain. Speak with your podiatrist if pain lasts more than a few days.
If you find that you have a bunion which is causing you pain despite trying the above recommendations it is time to have an evaluation by a podiatrist. It is important not to ignore bunion pain, as it can result in other foot issues.   Surgery is the only way to remove the bunion deformity. A thorough exam, evaluation and x-rays are performed to determine the proper procedure that is needed to correct each bunion. Surgery options can include minimally invasive correction, cutting and realigning bones while securing them with screws, plates, etc, or fusing two bones together to remove excess motion or arthritis that may have formed. These procedures all have a different recovery period and will be explained by your surgeon. Contact your local FASMA office to schedule an appointment with one of our highly trained specialists.

Trauma

26 bones, 33 joints, and over 110 ligaments, tendons, and muscles - the foot and ankle is a complex system that, when functioning well, can provide a stable construct to support our daily activities. However, when one or more of these bones, joints, ligaments, muscles, or tendons becomes injured, it can have a cascade of negative side effects when left untreated.

Sprains, strains, and tears are common occurrences in the foot and ankle. These are usually the result of a misstep, a twisting of the foot/ankle, or trauma.

Fractures or breaks in the bone can also occur through direct or indirect trauma, such as slipping, falling, or having an object land on your foot with force.

Overuse injuries can lead to significant pain in the ball of the foot, front of your leg, heel, and ankle.

Early diagnosis and treatment in foot and ankle trauma is essential in achieving the best possible outcome. Our doctors at Foot and Ankle Specialist of the Mid-Atlantic will perform a thorough examination and evaluate for the presence of possible fractures, dislocations, sprains, or strains. This can result in the need for X-rays of the foot and/or ankle, and possibly the need for additional diagnostic imaging, such as a CT scan or MRI, to confirm a specific diagnosis.

Depending on the diagnosis, conservative and/or surgical treatments will be available. All of our doctors are well trained in foot and ankle injuries/trauma, and will provide the best care possible to ensure a proper recovery to have you back on your feet.

Diabetic Foot Care

Diabetic patients should make podiatric health a top priority in their lives. Diabetes is a devastating disease that affects multiple sites of the body, including your feet and lower extremities.

Two common systems that are affected in the feet are the Nervous and Vascular. Diabetes can damage the nerves of the body that can lead to burning, tingling and even numbness of the feet. This is called diabetic neuropathy. Diabetic neuropathy may lead to the development of ulcerations or wounds to the feet because cuts, lesions and irritations can go unnoticed due to the diminished sensation to the feet. Wounds to the feet are dangerous and may lead to serious limb and life threatening infections.

Diabetes may also affect the blood flow going to the foot. Diminished blood flow makes even the smallest cuts, sores, or wounds difficult to heal. This can also lead to loss of tissue and even limbs if the progression is severe.

Here are some helpful tips if you are a diabetic:

  • Inspection:  Perform daily foot checks. This can either be done by having a friend or family member look at all areas of your feet. If you are by yourself, place a large handheld mirror on the floor and check the bottom of the feet this way.
  • Moisturize your feet daily to avoid itching and cracking of the skin.
  • Shoes: Wear supportive shoes at all times and minimize barefoot walking. Always inspect your shoes prior to putting them on to look for foreign objects that may irritate or cause harm to your feet. Make sure you wear appropriate shoe gear for each season. In the Winter, make sure you wear warm socks and waterproof shoes to prevent frostbite. Your doctor may recommend diabetic shoes if you have certain risk factors.
  • Applying Heat: Never use heating pads, electric blankets or blow-dryers to warm your feet. These can create burns to the feet without you noticing. Do not place your feet in hot water without first testing the temperature with your hand.
  • Medical: Monitor your blood glucose levels routinely and let your primary care physician know if they get elevated. Let your podiatrist know if you begin to experience any burning, tingling, numbness, or changes in the appearance of your feet. Avoid smoking because this decreases blood flow to your feet. Getting proper daily nutrition and exercising are also part of living a healthier diabetic lifestyle.
  • Exams: Make sure you get periodic or routine foot exams by a podiatrist to prevent complications. Having routine care by a podiatrist can prevent and reduce the risk of diabetic foot complications like infections and amputations. Having your foot doctor treat any toenail issues or calluses immediately is highly recommended. Studies have shown that up to 80% of all amputations can be preventable by well-provisioned care.

Following these tips for caring for diabetic feet can end up saving a limb.

Sports Medicine

Sports medicine focuses on the treatment and prevention of injuries involved in athletics, exercise, and other types of physical fitness. Common injuries and problems of the foot and ankle include ankle sprains, tendinitis, shin splints, skin blisters, turf toe, muscle strains, and fractures.

Most sprains and strains or "soft tissue" injuries can be treated conservatively with "P.R.I.C.E." therapy (Protection, Rest, Ice, Compression, Elevation) for several weeks. Special strapping and taping techniques can also be utilized along with different types of bracing to provide support to the injured area as it heals. Another newer treatment for both acute and chronic soft tissue injuries is extracorporeal shockwave therapy (ESWT). This is a non-invasive technique that uses soundwaves to stimulate the body's natural healing response by increasing blood flow and tissue regeneration.

More serious injuries, such as torn ligaments, fractures, and joint dislocations, or problems that do not improve with conservative treatment may require surgery. Podiatrists work closely with physical therapists, athletic trainers, and coaches during the recovery process. The goal is to return to activity in a safe and timely manner and preventing further injuries.

Wound Care

Foot & Ankle Specialists of the Mid-Atlantic: Your wound healing partners!

Foot & Ankle Specialists of the Mid-Atlantic is committed to providing personalized, effective and advanced treatments to improve our patient's ability to heal their lower extremity wounds. Lower extremity wounds are often complex and challenging to heal. Foot and ankle specialists are a key component to your multidisciplinary wound care team.

One of the most important aspects of wound care management is having a full understanding of each individual patient. This is achieved by carefully listening to our patients, addressing our patient’s concerns, answering our patient’s questions, reviewing our patient’s past medical history and performing a thorough clinical exam. In doing so, this allows us to accurately assess each patient, determine the goals of treatment and formulate a personalized treatment plan for our patients.

Not all wounds are created equal. It is important to determine the underlying cause of a particular wound that is being treated. Having a full appreciation of our patients and the etiology of a wound permits us to identify and address factors that may be impeding wound healing. Corrective measures are then made to maximize a patient’s wound healing potential. This is done through educating our patients and treating any risk factors that negatively affect wound healing.

Maintaining and promoting a healthy wound environment and wound bed is essential for proper wound healing.

Etiology of wounds:

  • Trauma
  • Diabetic neuropathic wounds
  • Surgical wounds
  • Lower extremity ulcers (arterial ulcers, venous ulcers, mixed ulcers)
  • Skin tears
  • Radiation wounds
  • Pressure or decubitus wounds

Risk factors that impede wound healing:

  • Dietary or nutritional deficiencies
  • Compromised immune system
  • Uncontrolled diabetes
  • Smoking
  • Poor circulation
  • Pressure
  • Friction and/or shear forces on wounds
  • Excessive moisture
  • Lower extremity edema (swelling)

Maintaining and promoting a healthy wound environment:

  • Infection control
  • Use of antimicrobial dressings
  • Diligent wound care with proper cleansing
  • Debridement of wounds to remove debris or bioburden
  • Maintain moisture balance
  • Use of appropriate shoes or pressure relief devices (heel protectors, total contact casts)
  • Increase oxygenation of the wound environment (hyperbaric oxygen chamber)
  • Use of orthobiologics, skin grafts, allografts or skin graft substitutes

Your wounds are in good hands with Foot & Ankle Specialists of the Mid-Atlantic.

Ultrasound Diagnostic Imaging

Our physicians use ultrasound imaging in the office on a daily basis to assist in the diagnosis and the treatment of many foot and ankle conditions. Ultrasound allows the physician to see and diagnose problems with the soft tissues of the foot including plantar fasciitis, ligament tears or sprains, tendon tears or sprains, and soft tissue masses like neuroma or ganglion cysts. Many times, the use of an ultrasound can replace the need for an MRI or determine if MRI is needed for surgical planning. Ultrasounds are done in real-time in the office, allowing your physician to provide an image-based diagnosis to explain your symptoms. This allows same day treatment for confirmed soft tissue problems.

Ultrasounds can also be used in the office to assist with procedures. Injections are much more accurate and successful with the use of ultrasound guidance where the physician can see the needle and injection in real time as the medication is delivered to the injured area of the foot and ankle.

Laser Therapy

It’s likely that either you or a close friend or family member has struggled with a severe injury, chronic pain, or some type of degenerative disease and experienced the difficulty in managing the discomfort. The chronic symptoms can be debilitating and have major effects.  

What are our choices to combat the pain?  We have resorted to long-term use of anti-inflammatories or addictive narcotics for the discomfort.  Maybe even taking a leap of faith with surgery. Put the brakes on!  Fortunately, advances in medical research and technology have proven once again to offer effective relief.  Welcome to laser therapy.

Laser therapy is the use of specific wavelengths of light. Both red and near-infrared stimulate the body’s natural response to healing.  This will then draw water, oxygen and nutrients to the damaged area. Then, we will have an optimal healing environment to allow the following; expedite the healing time, decrease pain, muscle spasm and stiffness, cause an increase in the circulation and minimize swelling.

Through intensive research and with FDA approval, the various wavelengths emitted with use of the laser have been found to cause an increase in metabolic activity within the cell.  By improving the transport of nutrients across the cell membrane there is an increased formation in cellular energy (ATP). This then allows for the above benefits to begin.

The doctors at Foot and Ankle Specialists of the Mid-Atlantic (FASMA) are committed to offering our patients the latest in the fast paced technological advancements of medicine. As such, we are proud to offer specialty services such as laser treatment. Laser treatments come in many forms and can be used for many different ailments. Two laser treatments available to FASMA patients are the CoolTouch Laser and Cutera laser for toenail fungus and the Multiwave Locked System (MLS) Laser for pain and inflammation.

 

CoolTouch & Cutera Nail Laser are an FDA approved, non-surgical laser treatment for onychomycosis, or nail fungus. These nail lasers produce specific energy absorbed by water associated with collagen in the tissues of the nail matrix. Because the thermal energy of the laser can penetrate the thick nail plate, it is able to selectively reach the proper target leading to death of the fungus. The treatment then stops instantly and then the nail is cooled with a spray. This allows for fungal death without damaging the skin or the nail growth plate. This also allows fast, painless treatment sessions. Most patients prefer the laser treatment to avoid side effects from oral medications. Ask your doctor today if nail laser therapy is right for you.

 

In Summary, here's what you can expect:

  • Quick, painless treatments lasting approximately 10 minutes
  • No downtime
  • Easy, low maintenance sessions, once monthly, for an average of 6 months
  • Clear nail growth at base of nail and less discoloration in as little as 1 treatment
  • No side effects
 

Multiwave Locked System (MLS) is a non-surgical laser approved by the FDA which uses specific, dual wavelengths and pulsed emissions to decrease pain and inflammation on a cellular level. Extensive research by top institutions such as Harvard University has shown that cellular activity is stimulated to decrease inflammatory products like histamine and promote pathways which block pain signals. In addition, the laser wavelengths encourage angiogenesis, or increased blood flow and circulation to the treatment area which is essential for healing and recovery. For most patients, improvement is noted within three treatments, with the average full treatment being 6-10 sessions. The progress with each session is cumulative which is why it is not recommended to stop treatments sooner than recommended by your doctor. The sessions themselves are quick and painless, usually lasting around 10 minutes. Some patients experience a gentle warming sensation while others report no sensation at all. Because this treatment works on a cellular level to enhance natural body processes, there are many applications for MLS treatment.

These include, but are not limited to:

  • Soft tissue injuries such as strains and sprains
  • Tendonitis
  • Degenerative joint diseases such as arthritis
  • Stress fractures
  • Neuropathy and other nerve pain
  • Pre and Post surgical treatment

The MLS laser can reduce pain in chronic conditions while speeding recovery for more acute ailments such as trauma or injury. There has also been excellent results with post-operative pain. With this safe, quick, and effective treatment you don't have to worry about side effects as with oral medications. So whether you have been battling pain for years or recently experienced an injury, ask your doctor if MLS laser therapy can be implemented into your treatment plan.

 

In Summary, here's what you can expect:

  • Quick, painless treatments lasting approximately 10-15 minutes
  • No downtime
  • 6-10 sessions for full treatment
  • Decrease in swelling and pain in as little as 3 treatments
  • No side effects

We use laser therapy in our offices because we want to provide an effective and safe treatment option for our patients to heal quickly, recover fully and reduce pain effectively.  

Give us a call today and see first-hand the benefits of laser therapy.

Pediatric Foot and Ankle Care

Foot and Ankle Specialists of the Mid-Atlantic doctors are highly skilled in pediatric foot and ankle care. There are many types of children’s foot and ankle problems, both congenital and acquired, that FASMA doctors are highly qualified to diagnose and treat.

Some common foot conditions that we see in children include:

  • Ingrown toenails- This can present as an infection on the child’s toe. The edge of the nail grows down and into the skin. Treatments include soaking the toe, wider shoe gear or a minor office procedure to remove the ingrowing nail border.
  • Plantar warts- Approximately 10-20% of children in the US are affected. Various treatment options exist including over the counter topicals, laser therapies, surgical excision, as well as more aggressive topical therapies that are applied under a doctor’s supervision.
  • Flat feet- This presents as feet with low or no arches. Feet may appear to be rolled in. Pediatric flat feet fall under two categories, flexible and rigid. Most flat feet that are asymptomatic do not need further intervention except for supportive shoe inserts, but symptomatic flat feet are in need of a thorough examination to rule out congenital conditions.
  • Heel pain- Heel pain presents differently in children than adults. Children usually complain of pain when running or during activity and the heel hurts when it is squeezed. This is usually the result of inflammation of the growth plate and tightness within the achilles tendon.
  • Injuries/sprains/fractures- Fractures are different in children compared to adults because of the presence of growth plates. Growth plates consists of cartilage cells that eventually transform into solid bone as the child grows. Fractures seen in children are more commonly incomplete fractures because their periosteum is stronger and thicker compared to adults.
  • Accessory Navicular- This is a congenital condition which results in an extra bone or piece of cartilage which is located on the inner side of the foot just above the arch. This piece of bone is incorporated into the posterior tibial tendon which attaches there. It is common for symptoms to first appear during adolescence.
  • Juvenile Bunions- This is a hereditary condition which is similar to an adult bunion but is seen much earlier in life. Conservative treatment includes supportive shoe gear, custom orthotics, icing, medication, padding/strapping and taping.
  • Tarsal Coalitions- This occurs when there is an abnormal union between two or more tarsal bones which causes restricted or absent motion between the bones. Some signs and symptoms include pain, flat feet, rigidity and stiffness, and muscle spasms.
We understand the need for children to be comfortable and do our best to help them be at ease. We will take our time to diagnose these conditions using clinical exams and radiology when needed. We offer both nonsurgical and surgical options for pediatric care.

Peripheral Vascular Disease

Your body needs oxygen to survive. Oxygen is brought to your feet (and everywhere else) in your blood, which travels through your body from your heart through arteries. Arteries are like pipes that bring blood to your feet (and everywhere else). Peripheral vascular Disease (PVD or PAD) is a narrowing of blood vessels leading to decreased circulation in the lower extremity, which is similar to a pipe being partially or completely blocked. The blood vessels narrow due to plaque buildup or “hardening of arteries” causing decreased blood flow and oxygen to the lower limbs.

If blockages form they can cause changes in your feet and legs. Patients with PVD experience pain and aching in their legs, especially with activity. Common symptoms seen in patients with PVD are leg cramps increased by walking and relieved with rest, slow healing wounds, cold or cool temperature to the legs and feet, discolored nails and decreased hair growth on the feet.

Certain risk factors can increase the risk of getting PVD such as smoking, high blood pressure, high cholesterol, diabetes and greater than 60 years of age. A family history of vascular disease or stroke can also increase the risk of PVD. It is important to be aware of the common symptoms and risks as reduced blood flow increases the risk of gangrene and limb loss.

Early diagnosis and treatment is the first step to prevent life-threatening complications or limb loss. PVD is diagnosed with a history and physical exam as well as non-invasive vascular tests. Doing non-invasive vascular tests can give your physician more information about the blood flow into your legs. One such test is an arterial doppler that can be done in the office and uses sound waves to measure the blood flowing through your arteries.

Another more accurate testing procedure, called PVR and segmental pressures, is no worse than getting your blood pressure checked. These same type of blood pressure cuffs are put on your thighs, calves, ankles, feet, and sometimes your big toe.  The cuffs inflate and slowly deflate, recording the amount of blood that passes through your arteries. The entire procedure usually takes less than a half hour.

There are a variety of reasons that a doctor might order this type of testing such as:

  • a wound that will not heal
  • pain in your legs that limits how far you can walk
  • Inability to feel your foot pulse (your heartbeat) when they check your feet
 

The results of these tests determine the next steps in your treatment. Sometimes you may need to be referred to another physician such as a vascular surgeon or interventional cardiologist. Sometimes they need to do a procedure similar to a plumber unclogging a pipe. Some treatment options that may be discussed with you by the vascular specialist are stenting or angioplasty to balloon up the artery to increase blood flow. Open bypass may be considered to restore blood flow in severe cases. Other times you may only need to start a new medication and sometimes nothing more needs to be done. A discussion between you and your vascular specialist regarding the best treatment for you based on your history and condition is imperative.

There are lifestyle changes that can be made to help with PVD as well. These include quitting smoking and taking steps to control high blood pressure and diabetes. Other steps that you can take are exercising daily and eating a healthy diet. Making lifestyle changes can decrease complications from PVD and slow down its progression. Early detection and treatment of PVD can enable you to live a healthier lifestyle. Your podiatrist can help detect signs and symptoms of PVD from routine foot exams, so make an appointment with your foot doctor today. If you have any further questions please do not hesitate to ask your FASMA physician.

Cosmetic Surgical Services

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.

Clinical Research Department

What are clinical trials?

Clinical trials are scientific studies conducted to find better ways to prevent, screen for, diagnose, or treat disease. Clinical trial sites assist pharmaceutical companies working together with the Food and Drug Administration (FDA) to find new ways to help patients better manage their healthcare. Clinical trials produce high-quality data for healthcare decision making. 

These studies follow strict, scientific and ethical standards which protect patients who volunteer for clinical trials. The results are used to determine if a medication or device should be approved by the FDA. Our doctors are proud to be at the forefront of advancing medical and surgical care.

FASMA doctors run the following types of clinical trials:  

  • Bunion Removal Study - Patients that qualify for the study receive no cost bunion removal surgery by one of our board-certified podiatrists in our state-of-the-art surgery center. Patients that qualify for the study often receive no cost services and a stipend for participating.
  • Fungal Toenail Study – New medication or devices like lasers are used to treat this unsightly, annoying, and ever more common infection. Patients that qualify for the study often receive no cost services and a stipend for participating.
  • Diabetic Ulcer Study - New medication, devices or antibiotics are used in this study to treat this common and stubborn condition. Patients that qualify for the study often receive no cost services and a stipend for participating.

These are some of the more common studies performed amongst many others.

Arthroscopic Surgery

Arthroscopic surgery is a minimally invasive procedure, in which small fiber optic cameras are used to see inside a joint to assist with diagnosis, as well as treatment of various conditions. This can be useful when imaging techniques, such as X-rays and MRIs, are unable to identify pathology within the joint. By using an arthroscope, the surgeon can see inside the joint without creating a large incision.  

What Can be Treated with Arthroscopic Surgery?

Many joints in the lower extremity are amenable to arthroscopic surgery, including the ankle and subtalar joints. The procedure is used to treat conditions such as arthritis, bone spurs, torn cartilage, torn ligaments, certain types of fractures, joint infection, osteochondral defects, loose bodies, and following athletic injuries. More recently, arthroscopic surgeries have been utilized for larger reconstructive surgeries, such as ankle fusions and complicated fractures. Though most commonly used for joint pathology, arthroscopy can be used in other instances, such as surgical treatment for plantar fasciitis. Arthroscopic surgery also allows for more accurate diagnosis of any underlying conditions that may not show up on X-ray, MRI, or CT scan. Not all conditions can be treated arthroscopically, but in cases where arthroscopy is possible, the recovery time is often much quicker than those that require traditional surgery.  

Where Does the Surgery Take Place?

These procedures can be performed as an outpatient and allow patients to recover more quickly, have less scaring, lower chance of infection and bleeding, and can provide immediate pain relief. Surgery can be performed in an operating room at a hospital or surgery center.  

How is the Surgery Performed?

Arthroscopic surgery is typically done under general or regional anesthesia. One small hole (portal) is created for the arthroscope (camera). The arthroscope transmits an image of the inside of the joint, which is viewed by the surgeon on a video monitor in the operating room. Sterile fluid is circulated through the joint to distract the joint and create space while the joint is being visualized. Other small portals can also be created to insert small surgical instruments that can be used to clean up arthritic joints, or to repair damaged ligaments. Each portal may be closed with just one or two stitches. There will be some swelling and bruising after the surgery. Overall recovery time is determined by the exact procedure performed.    A thorough discussion between patient and surgeon is vital to talk about the best treatment course, as well as activity level and recovery goals post-operatively. Though arthroscopic surgery may not be appropriate for everyone, it is a great alternative to many procedures that require a bigger incision and longer recovery periods.