It seems to be that time of year when people are becoming more active,engaging in sports and working hard to get in shape for the summer season. In our Mentor office, we have seen a recent increase in stress and overuse injuries over the last month or so, likely attributed to this increase in exercise and activity. Therefore, in the blog below we will discuss some of the most common injuries seen and preventive measures to keep you healthy and active.

Common stress and overuse injuries of the foot and ankle:

Sever’s Disease

Most commonly seen within children between the ages of 10 and 14.  This condition invovles heel pain that is due to inflammation of the growth plate at the back of the heel. The Achilles tendon, which is the largest and strongest tendon in the body, inserts into the back of the heel bone, just behind the growth plate. Kids in track, soccer, gymnastics and other sporting activities, who are spending several days a week in these activities will often develop this condition, know as “Sever’s disease” or “calcaneal apophysitis.”

Stress Fracture
Runners training for a marathon, or those walking on a treadmill several times a week can both develop a stress fracture. This often happens when someone abruptly increases their mileage or number of times per week they are exercising. A stress fracture is usually an overuse type of injury that produces acute bone swelling leading to a crack in the bone. It is due to either normal amounts of stress to a weakened bone (as in the cases of osteoporosis), or abnormal amounts of stress to a normal bone (such as with increased mileage). Pain is usually worsened with increased or repetitive activities. Stress fractures are usually not seen on initial x-rays, and sometimes require an MRI or a bone scan to confirm the diagnosis. They are treated with a period of non-weight bearing to the affected area, and usually require crutches and a cast and/or cast boot until the bone heals.
Tendinitis

Tendinitis, similar to a stress fracture, can develop with an increase in mileage or with any repetitive activity. In the foot and ankle, we commonly see tendonitis develop in the Achilles tendon, or on the inside or outside of the ankle depending on the foot type and mechanics. If you have an area of your ankle that swells up with activity, and becomes very sore, you most likely have a case of tendonitis. Controlling foot mechanics with the proper shoes and possibly with arch supports or custom orthotics, can often prevent or be used to treat a case of tendonitis.

Prevention of overuse injuries is the smartest approach. The following are some tips to keep yourself active and exercising, and will help you avoid a period of recovery.

• Foot and ankle stretching excercises are very import before and more importantly, after exercising.

• Appropriate shoes for your activity

• Make sure your shoes are not too worn

• Ease into an exercise program (going from no exercise to 7 days a week all of a sudden is unwise)

• Ice the affected area after a work-out

If you or someone you know if suffering from any of the above aliments, please give our office a call for evaluation and treatment, 440-946-5858.

Achy Feet?????

It's not uncommon to experience foot pain after a long day of work or a vigorous sport activity, especially as we age. A long day of shopping or yard work can leave feet tired, heavy, swollen and achy: A problem we can all relate to at one time or another.

Some factors which contribute to achy feet, include:
-Age
-Gender
-Dehydration

Some causes which contribure to this condition include:
-Strenuous walking or standing for long periods on your fee
-Ill-fitting, poorly padded shoes
-Tight socks, stockings and/or garters
-Reduced blood circulation to the ankles and feet also causes tired aching feet.

5 Simple Ways to Relieve Tired, Aching Feet:
1. Elevate your feet to heart level for 15-20 minutes
2. Soak your feet in warm water with epsom salts if possible for 15-20 minutes
3. Massage your feet or have someone massage your feet for you
4. Exercise your feet, to tones muscles, strengthen the arches and stimulate blood circulation
5. Wear OTC and/or custom insoles in your shoes. Please see your podiatrist for their recommendation.

When foot pain persists, it's important to visit our podiatric office for a thorough examination. The cause of your foot pain may be more serious than simple stress and over work and we will work with you to determine a treatment plan that will put an end to your tired, achy feet for good!

Achilles Tendon Injuries

There are many issues relating to the Achilles tendon. It does not always result in the wince-inducing highlight reels from professional sports. While the tears and ruptures are the most notable and produce the best stories, there are other types of injuries that are just as common and not as severe. Many go undiagnosed as basic soreness and temporary injuries.

The Achilles tendon is the largest and toughest tendon in the body and it connects the heel to the calf muscles. Because it connects those two, it is responsible for moving the foot up and down, which is a motion used in just about every movement of a standing body. Because of its usage, it is very susceptible to injury, but also usually easy to diagnose and treat.

There are three basic types of Achilles tendon injuries:

Achilles Tendinosis:
There are many different words used to describe this condition. It has been referred to as tendinosis and tendinopathy. In this condition, the terminology which will be used is a degenerative tendinopathy. This term is used because it is a chronic condition, and is associated with gradual degeneration of the Achilles tendon.

There are times when the Achilles tendon does not function correctly because of multiple, minor microscopic tears of the tendon and the limited ability of the tendon to heal and repair itself. The blood circulation to the Achilles tendon in some patients is not always as good as it should be and microscopic tears begin to occur inside the tendon approximately six-centimeters from the attachment on the heel bone. Because of poor blood supply, the ability to heal these microscopic tears is limited and tearing of the tendon continues. Eventually, the tendon begins to thicken and weaken, and gets quite painful.

Achilles Tendonitis:
This injury is a result of continual stress on the tendon over time and can affect athletes and those not-so-athletic. Tight calf muscles, bone spurs, and increased physical exertion can lead to increased pain in the heel.

Achilles Tendon Rupture:
This is the Achilles injury that is often seen sidelining professional athletes. This is when the tendon tears partially or completely, and can result in inability to walk or even stand. It is often a result of Achilles tendonitis.

If you or someone you know has any questions and/or is seeking treatment for an Achilles tendon injury please give the office a call, 440-946-5858, for a consultation.

Got Heel Pain?????

Heel pain is a common presenting complaint causing patients to seek a foot and ankle surgeon or doctor. One of the most common etiologies of heel pain is mechanical and/or repetitive overuse injury causing inflammation of the plantar fascia, termed Plantar Fasciitis.

Symptoms of Plantar Fasciitis can include:
• Pain on the bottom of the heel
• Pain in the arch of the foot
• Pain that is usually worse upon arising
• Pain that increases over a period of months
• Swelling around heel

Causes for Plantar Fasciitis Include:
• Repetitive loading or exercise
• Change in activity level, duration, or training surfaces
• Recent activity/long walking in un-supportive shoes or sandals
• Faulty structure of the foot.
• Recent weight gain or obesity
• Acute trauma or injury

Conservative treatment options for Plantar fasciitis include:
• Stretching of the Achilles tendon and plantar fascia complexes
• Avoid going barefoot.
• Ice.
• Limit activities.
• Custom orthotics or over-the-counter orthotics
• Supportive and comfortable shoes
• Oral anti-inflammatories
• Physical therapy modalities
• Heel injections
• Night splints

Plantar fasciitis generally resolves with conservative management, however, certain cases can fail 6 months of conservative treatment, therefore, require surgical intervention to help alleviate the symptoms. Podiatry Research has demonstrated that chronic injury and inflammation to the plantar fascia leads to micro-tears and degeneration of the plantar fascia, termed plantar fasciosis. Plantar fasciosis lacks acute inflammatory tissue, accordingly, rendering conservative options unsuccessful at times.

Surgical options for Recalcitrant Plantar Fasciitis and Plantar Fasciosis can include:
•Topaz (ArthroCare) Microdebrider
•Platelet Rich Plasma injection
•Shockwave therapy
•Open and Endoscpoic Realease

Topaz Coblation Microdebrider procedure is a minimally invasive surgical technique utilizing small holes to break up the scar tissue and attempt revascularization of the plantar fascia. By "burning holes" into the ligament, the Topaz will turn a chronic process into an acute inflammatory process to cause an influx of inflammatory healing cells directly into the ligament.

The procedure is performed in the operating room. The anesthesia team will administer sedation medications and then a local nerve block is performed by the foot surgeon. The surgeon will then mark the area of the plantar fascia and make holes in the skin. The topaz probe is then placed through these holes into the plantar fascia. The patient is then placed into a walking boot for a period of 2 to 3weeks during the healing process.

The procedure only requires small holes compared to a larger open incision and surgery. This lends to quicker healing and less pain and scar tissue and faster recovery.

Think the Topaz procedure might help you? For help with your heel pain, please contact our office, 440-946-5858, to set-up a consultation.