Achilles Tendonitis

The Achilles tendon is the large tendon that attaches the powerful calf muscles to the back of the heel bone. It is important for stabilizing the foot during jumping and running and is a common area where injury occurs. Achilles tendonitis typically occurs at the tendon's weakest spot which is a few centimeters above the heel bone. This is also the area where weakening and tearing of the tendon usually occur(tendinosis).

Achilles tendonitis/tendinosis can be aggravated or caused by tight calf muscles. Calf muscle stretching on a daily basis can help prevent tendon problems. Adding heel lifts to shoes helps reduce strain on the Achilles tendon. Be sure to add heel lifts to both shoes to maintain postural stability.

Achilles tendon pain may not mean inflammation is present. Tendon pain is often caused by micro-tears and weakening of the collagen within the tendon and shows minimal (if any) inflammation at the cellular level. This gives insight as to why anti-inflammatory drugs may not alleviate the pain.

Pain at the heel bone where the tendon attaches, is more than likely not tendonitis and/or tendonosis, but bursitis. Bursitis is inflammation of a pocket of fluid (bursa) near the bone.

For more information about common types of tendonitis that affect the foot and ankle, please visit our website, www.drrobertrosenstein.com and/or give our office a call, 440-946-5858, for a consultation.

High Heels....Dangerous for Women

As a podiatrist, much of my day involves treating fellow ladies who have fallen victim to fashion with frequent wear of high heel shoes.

The human foot was once described by Leonardo Da Vinci as “a masterpiece of engineering and a work of art”, and this is evidenced by our ability to walk, run, jump, and play. However, it doesn’t take much to upset the fine balance between precision function and disaster. High heels, by their nature shift the body’s anatomy into foreign territory, causing marked postural and alignment strain.

By elevating the heel bone (calcaneus) there is an immediate change in the distribution of weight under the feet from the heel to the forefoot – the percentage of which is directly proportional to the height of the heel. With regular use, the calf muscles in the lower leg can permanently shorten, leaving you unable to comfortably wear flat shoes and further increasing pressure under the ball of the foot.

Habitual high heel wearers will invariably, at some point, suffer pain and disability because of this alteration in the way our body adapts to the ground and distributes weight.
Common complaints can include calluses, corns and blisters to more permanent deformities including bunions, hammer toes and acquired flat feet. It additionally can contribute to increased incidences of fractures of the ankle and metatarsals (forefoot), arthritis, pinched nerves, tendonitis and other soft tissue injuries and inflammation.

Before you lose faith and trust in all things fashionable, here’s some tips on how to minimise risk while wearing your heels:

• Moderation is the key: Avoid wearing heels when walking to and from work. Also, kick off the pumps in the office and replace with flats.
• Pick shoes that suit the activity for the day: Flats or shoes with only a slight heel are best for standing and walking, whereas heels may be suitable during a seated meeting or dinner date.
• Keep the heel height sensible: Anything over 5cm is hazardous and should be for only special occasions.
• Stilettos: A dangerous shoe for ankle sprains and fractures. Try broader heels with more stability and tread on the ground.
• Stretch your calf muscles regularly to improve fl exibility and reduce the likelihood of muscle contraction.

Seek immediate assistance from our office, should you experience pain, swelling or a change in shape of any part of your foot. Our office number is 440-946-5858.

March is Women's Health Month

In spirit of March being Women's Health Month, I have a created a list of 10 things all women should know before they go to pamper them self with a pedicure at their local salon.
1. Bring Your Own Instruments:
This will help decrease the risk of catching viruses, bacteria and fungus. Things to bring include: nail nipper, cuticle nipper, cuticle pusher and curette cleaner.
2. Ask About Instrument Cleaning:
Does the salon sterilize their instruments or do they just disinfect? Sterilization of instruments by autoclaving is the better choice.
3. Ask What Type of Foot Bath is Used:
Usually the whirlpool foot bath is either piped or pipe-free. It is thought that pipe-free is better because piped whirlpool foot baths have been found to contain bacteria in their pipes, jets and water filtration systems. The pipe-free whirlpool foot baths can easily be removed for cleaning. If the foot bath uses a liner, make sure that a new liner is being used each time.
4. Ask If Disposable Items Are Used Only Once:
Items such as nail files, foot files, buffers and toe separators should be used only once. You may want to consider bringing your own disposable items with you.
5. Make Sure Technician's Hands Are Clean:
The nail technician should wash their hands in between clients. If they do not wash their hands, request that they do or that they wear gloves. Be cautious of a technician with fake (artificial) fingernails. It is hard to clean the area between the fake fingernail and the real fingernail.
6. Ask If the Salon and Technician Are Licensed:The salon and technician should both be licensed by their state governing board. Usually the board of cosmetology. The licenses should be clearly displayed at the salon.
7. Don't Shave Legs 24 Hours Before Appointment:Nicks and cuts from shaving create small openings in the skin where bacteria can enter. If you have any open sores, wait until they heal before getting a pedicure.
8. Tell Technician Your Medical Conditions and Medications:
Certain medical conditions and medications can increase the risk of infection. Examples include: diabetes, lymphedema, peripheral vascular disease (PVD), neuropathy, HIV and autoimmune diseases like lupus. Examples of medications include: chemotherapy agents and blood thinners such as coumadin.
9. Check If the Salon is Clean:
The salon itself should be clean and well kept. This is usually a good indicator of how well they take care of their instruments and other salon equipment.
10. You Should Have No Pain:
Getting a pedicure at the salon should not be a painful experience. Just like any business, there are good salons and not so good salons. Find a pedicure salon that follows strict sterilization procedures and find a technician who does not cause pain or bleeding.

Please keep the tips listed above in mind when treating yourself to a mani/pedi. However, if you fall victim to a bad experience resulting in a nail and/or toe issue, please give our office a call for consultation, 440-946-5858.

Stabbing Pain in Your Heel????

Do you feel a stabbing pain in your heel with your first steps out of bed in the morning? You’re not alone! Every day, thousands of Americans suffer from this condition. Plantar fasciitis, more commonly known as heel pain, is by far, the most common complaint seen in my office.

Aching heels can truly affect your lifestyle and disrupt essential activities and prevent you, to a large extent, from playing sports or simply going for a walk. An accurate and expedient diagnosis of the cause of your symptoms will help you receive the appropriate treatment.

There are several causes of heel pain. The most common include:
Plantar Fasciitis – Inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar) surface of the foot, from the heel to the ball of the foot. Both heel pain and heel spurs are frequently associated with plantar fasciitis.
Heel Spurs – A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs can result from strain on the ball of the foot and repeated tearing away of the lining or membrane that covers the heel bone. Contrary to popular belief, heel spurs are generally not the cause of pain—the pain you may feel is from inflammation of the plantar fascia.
Excessive Pronation – Excessive inward motion can create an abnormal amount of stretching and pulling on the ligaments and tendons that attach to the bottom back part of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Achilles Tendinitis – Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone.

Other possible causes of heel pain include rheumatoid arthritis and other forms of arthritis (e.g., gout); Haglund’s deformity (a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone); inflamed bursa (“bursitis”), a small, irritated sac of fluid; neuromas (nerve growths) or other soft-tissue growths; and bruises or contusions, which involve inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

Some contributing factors associated with heel pain are:
-Age: With increasing age, often there is decreasing flexibility.
-Any sudden change in activity: Particularly activities that increase weight bearing or pressure on the foot
-Flat, pronated feet or high-arched feet
-A sudden increase in weight: Such as pregnancy
-stress from an injury: A bruise incurred while walking, running, or jumping on hard surfaces

Seeking medical attention is the first line of defense in treating heel pain. However, there are several steps you can take to avoid heel pain in the first place:
-Wear shoes that fit well and have shock-absorbent soles, rigid shanks (the part of the shoe that supports the foot and helps give a shoe its structure), and a supportive heel counter (the rear-most part of the shoe, at the back of the heel above the sole)
-Wear the proper shoes for each activity
-Do not wear shoes with excessive wear on heels or soles
-Begin exercises slowly
-Wear athletic shoes with good shock support in the heels
-Purchase shoes that fit
-Avoid activities that may put constant strain on the foot
-Avoid going barefoot on all surfaces

A variety of treatment solutions are available to provide short and long-term pain relief. Begin treating heel pain by avoiding all sorts of pressure or tension on the inflamed area, giving your feet ample rest. Applying ice and heat packs in alternating fashion will greatly accelerate the process of healing. Another option is the use of custom insoles. Custom insoles may assist with treating active conditions of heel pain and likewise reduce the risk for reoccurrence. The custom insole will restore body balance and prevent the plantar fascia from experiencing strain when you walk. If all non-invasive treatment solutions do not work, surgery is probably the best next option.

Regular exercise for calf muscles and the plantar fascia is necessary to alleviate pain and improve flexibility of the affected muscle. These exercises are advised for both legs even if the pain is in one heel only. Some of the most beneficial exercises are:
Towel stretches – This exercise should be done every morning before you leave your bed. Make a loop with a towel and use it to pull your toes toward your body, while keeping the knee straight. Stretch each foot three times, and hold each stretch for 30 seconds, if possible.
Stair stretches – Stand tall on a staircase with the balls of both feet on
the edge of the step. Place hands on the railing or the wall for balance and support. Slowly lower heels toward the floor until you feel a stretch in your lower leg and heels. Maintain the stretch for 10 to 15 seconds. Repeat this exercise six times, and perform the stretches twice every day.
Wall-leaning Stretch – Stand an arm’s length away from a wall, place both hands on the wall at shoulder height, with the feet slightly apart and one foot in ront of the other. Your front knee should be bent, but the back knee should be straight while you lean toward the wall. Hold the position for 10 seconds at a time for up to 15 or 20 repetitions per leg.

If you are unsure of the cause of your symptoms, if pain is severe, or if you have the following symptoms, please call our office immediately:
_ Inability to bend your foot downward.
_ Inability to rise on your toes.
_ Inability to walk comfortably on the affected side.
_ Swelling or discoloration of the back of the foot.
_ Heel pain that occurs at night or while resting.
_ Heel pain that persists beyond a few days.

Heel pain does not always subside quickly after medical attention is received. Unfortunately, it may take several months before the pain is actually gone. In most cases, heel pain can be treated at home under a podiatric physician’s supervision.

If you or someone you know is suffering from heel pain, please give our office a call for consultation, 440-946-5858.

Ankle Sprain......Common Atheletic Injury....Ask Daniel "Boobie" Gibson

Daniel "Boobie" Gibson, a guard for the Cleveland Cavaliers, is benched with an ankle sprain. An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue – like rubber bands – that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface. In Boobie's case, it was during a basketball game.

The symptoms of ankle sprains may include pain or soreness, swelling, bruising, difficulty walking and/or stiffness in the joint. These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains. Instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if there is no pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain – whether it’s your first or your fifth – requires prompt medical attention.

There are four key reasons why an ankle sprain should be promptly evaluated and treated. First, an untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a “giving way” of the ankle. Weakness in the leg may also develop. Second, a more severe ankle injury may have occurred along with the sprain. This might include a serious bone fracture that, if left untreated, could lead to troubling complications. Third, an ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far. Fourth, rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.

When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins.The available treatment options include:

•Rest: Stay off the injured ankle. Walking may cause further injury.
•Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
•Compression: An elastic wrap may be recommended to control swelling.
•Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.
•Early physical therapy: A rehabilitation program will be started as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
•Medications: Non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.

In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments.

If you or someone who know has sustained an ankle sprain and/or commonly "rolls their ankle" please give our office a call, 440-946-5858, for evaluation and treatment, so you are not benched.

Foot Facts

* 3 out of 4 Americans experience serious foot problems in their lifetime.

* The foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles.

* 1/4 of all the bones in the human body are down in your feet.


-When these bones are out of alignment, so is the rest of your body.

*Only a small percentage of the population is born with foot problems.
-It's neglect and a lack of awareness of proper care-including ill fitting
shoes that bring on problems.

* Women have about four times as many foot problems as men.
-High heels are partly to blame.

* The average person takes 8,000 to 10,000 steps a day, which adds up to
about 115,000 miles over a lifetime.
-That's enough to go around the circumference of the earth four times.

* Women on average walk 3 miles farther per day than the opposite sex.

* There are 250,000 sweat glands in a pair of feet.
-Sweat glands in the feet excrete as much as a half-pint of moisture a day.

* Your two feet may be different sizes.
-Buy shoes for the larger one.

* Your feet mirror your general health.
-Conditions such as arthritis, diabetes, nerve and circulatory disorders can show
their initial symptoms in the feet. Therefore, foot ailments can be your first
sign of more serious medical problems.

* Walking is the best exercise for your feet.
-It also contributes to your general health by improving circulation,
contributing to weight control and promoting all-around well being.

If you or someone you know is having foot problems, please give our office a call at 440-946-5858.

February is Heart Month.....So Please Read Article Below

Do you get pain in either leg when you walk?

Does the pain go away when your stop walking (within 10 minutes)?

According to the World Health Organization if you answered yes to both of these questions your likelihood of PAD is 95%

What is PAD you ask?

Commonly referred to as “poor circulation,” Peripheral Arterial Disease (P.A.D.) is the restriction of blood flow in the arteries of the leg. When arteries become narrowed by plaque (the accumulation of cholesterol and other materials on the walls of the arteries), the oxygen-rich blood flowing through the arteries cannot reach the legs and feet.

The presence of P.A.D. may be an indication of more widespread arterial disease in the body that can affect the brain, causing stroke or the heart, causing a heart attack. According to The Journal of Vascular Surgery, 60-80% of patients with PAD have blockage in one coronary vessel and 21% of these patients will have a MI, stroke, cardiovascular death or hospitalization within 1 year.
Based upon the guidelines of the American Heart Association and American College of Cardiology, the following individuals would benefit from an ABI test:

- Exertional leg symptoms
- Non-healing wounds
- Asymptomatic patients at high risk
o Adults 70 years old
o Adults 50 years of age with diabetes or tobacco use

Testing for this condition is non-invasive: It utilizes blood pressure cuffs and is painless. If interested in being tested, please call our office to schedule an appointment.