All Specialty Services & Treatments

Plantar Fasciitis (Heel Pain) Treatments

Understanding Plantar Fasciitis

Plantar Fasciitis is one of the most common causes of heel pain. The plantar fascia is the band of tissue on the bottom of the foot that connects the heel to the toe. Heel pain can occur when the plantar fascia become inflamed, are tight, or partially torn. Usually this develops gradually and mostly often affects only one foot at a time.

Signs and Symptoms

  • Sharp, knife-like pain in the heel that feels worse when first standing in the morning
  • After standing, pain becomes dull, but may return after sitting for an extended period of time
  • Heel may hurt, feel hot, swell, or turn red from inflammation

Common Causes

  • Excessive physical activity can stress the heel bone and surrounding tissue
  • Abnormal walking pattern
  • Improper shoes (thin soles, soft soles, loose shoes)
  • Sports with quick turns (i.e. tennis, basketball)
  • Tight calf muslces
 

Treatments

Immediate Treatment Options

  • Develop a program of home exercise to stretch the Achilles tendon and plantar fascia
  • Cut back on activities that aggravate the heel
  • Apply pressure to the heel by rolling a golf or tennis ball with the arch of your foot while standing
  • Massage your foot
  • Anti-inflammatory medications (topical and/or oral) may reduce pain
  • Athletic taping/strapping

Other Medically Necessary Treatments

  • Orthotics
  • Night splints
  • Cortisone injections
  • Extracorporeal shock wave therapy (ESWT)
  • Surgery

Foot Surgery

The doctor will recommend if you need foot surgery and the best setting based on the surgery you will have, your age, medical history, and health plan.

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 flexibile 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
 

General Foot Care/Podiatry

At the Foot and Ankle Specialists of the Mid-Atlantic we use out expertise in podiatry to study, diagnose, and treat foot & ankle disorders. Feet and ankles are prone to a number of problems at different stages of life. Our doctors are fully prepared and highly trained to care for, diagnose, and treat all of your foot and ankle needs ranging from pediatric to geriatric care.

Gait Analysis

In the gait analysis lab, the FScan computer software is teamed with four closed-circuit TV cameras, to provide full-body analysis of your gait from various angles. Paper-thin sensors are placed in the shoes you wear. As you walk, reactive forces between your foot and the shoe are recorded, allowing the evaluation of alignment and biomechanical position.

Biomechanics & Orthotics

BioMechanics

Pedorthics 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.  

Orthotics

FASMA 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.  

Hammertoe Treatments

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.

Causes

  • Hammertoes are largely genetic
  • Wearing too tight of shoes or high heels that crowd the toes
  • Injury
  • Bunions that push the big toe against the other toes

Symptoms

  • Joint swelling in the toe that can result in pain
  • A corn or callus can develop on the top of the foot from rubbing
  • Infection
  • A callus can develop on the ball of the foot
  • Diabetics may develop an ulcer

Treatments

  • 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
  • Orthotics
  • 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

Bunion Treatments

Bunions are a bony prominence on the side of the foot, at the base of the big toe joint. This enlargement of the joint, spurring, bump or lump can be aggravated by sports and tight shoes. In some cases, surgery may be suggested. Our doctors can recommend the best treatment for you.

Trauma

Diabetic Foot Care

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.

Sports Medicine

Podiatrists have several options for treatments with sports medicine, ranging from nonsurgical to surgical options. Common sports injuries include ankle sprains, fractures, and tendinitis. Podiatrists of Foot and Ankle Specialists of the Mid-Atlantic treat many types of sports related injuries and athletes from all skill ranges and ages. Custom orthotic shoe inserts are one option that is noninvasive. For tissue injuries, extracorporeal shockwave therapy (ESWT) can be prescribed. It is a weekly treatment in the office that needs no anesthesia, needles, shots or pills. It’s slightly uncomfortable, but not painful. With ESWT, the soundwaves are applied to help stimulate a new healing response from your body to the injured tissue. The treatment takes 15-20 minutes, and you can go about your day afterwards. We do this weekly for 4-6 weeks to stimulate healing in the tissue. Our doctors take a holistic approach to sports medicine and will look at all aspects of your lifestyle to deepen their understanding of the entire process and get you back in the game. This encompasses the psychology and dieting needs from your activity.

Wound Care

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 Care

An 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 Diagnostic Imaging

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.

Laser Therapy

Laser Therapy is a procedure that uses lasers to penetration infected nails of fungal infections. This painless alternative is an excellent option for patients who do not want to take oral medication.

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.

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 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.

Testing for Peripheral Arterial Disease

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.

Cosmetic Surgical Services

We employ cosmetic surgical techniques to correct unsightly foot deformities, such as bunions and hammertoes. In addition, FASMA doctors are adept at revising unsightly scars caused by previous surgery.

Most importantly, feet should be functional and pain-free. 'Foot & Ankle Specialists of the Mid-Atlantic' truly understand patients' desire for a healthy balance between form and function. Feet can be beautiful, and FASMA doctors help patients to achieve their goals.

Clinical Research Department

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 Surgery

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.