Innovative treatment for chronic heel pain

PRP (Platelet Rich Plasma)

A new state of the art treatment for chronic heel pain is PRP (Platelet Rich Plasma) injections. A small amount of blood from the patient, similar to giving blood for a routine test. The vial of blood is subjected to very high speeds in a machine called a centrifuge. A yellow material is obtained containing cells called platelets, that are very abundant with factors that aid in healing. These growth factors are believed to decrease the inflammation causing plantar fasciitis. The platelets from the patient's own blood is injected into the area of pain in the heel. Patients are then fitted for a removable walking boot, and will use crutches to prevent putting any weight on the heel for one week or less. After that, they advance to sneakers, and although the range of time for pain relief is variable, it can be appreciated as early as 10-14 days.

For more information please contact our office at carolinafootspecialists.net

Plantar fascia night splints for heel pain

A majority of patients that suffer from plantar fasciitis can have a dramatic improvement with the use of plantar fascial night splints. This type of device is used to stretch the plantar fascia and achilles tendon as you sleep to give you more flexibility and help to resolve acute heel pain. Plantar fascial night splints are easy to use and the time frame of use is typically 4-6 weeks. Plantar fascial night splints have settings of 5 and 10 degrees. We usually start our patients at 5 degree stretch and move it to 10 degrees after one week. This device is especially helpful if you suffer from heel pain first step out of bed in the morning.
A majority of insurances cover plantar fascial night splints and we are able to dispense this product at both our West Ashley and Mt. Pleasant locations.

Foot injury forces Professional tennis player Kim Clijsters to withdraw from Wimbledon

 Professional tennis player and former number one ranked tennis player in the world Kim Clijsters had to withdraw from Wimbledon this week because of a recent foot injury. Reports have indicated an injury to a ligament or tendon injury on the bottom of her foot. This injury is more than likely involving the abductor hallucis muscle/tendon (major tendon on the inside of the foot)or inside band of the plantar fascia ligament. This injury can take anywhere from 6-8 weeks to heal. The course of treatment typically involves immobilization with a cam walker boot and aggressive physical therapy. Below are two links on information on this injury and treatment options.


http://www.nytimes.com/2011/06/16/sports/tennis/wimbledon-foot-injury-sidelines-kim-clijsters.html
http://www.youtube.com/watch?v=9XGGq78c0Vk

Achilles tendon pain/Tiger Woods

Achilles tendon injuries are common heel complaints in both the recreational and professional athlete. Golf professional Tiger Woods has had a history of achilles tendonitis as well as a partial tear of his achilles in the past few years. It can be a frustrating injury and can take many months to heal. Golf places an incredible amount of stress on the achilles tendon from walking on uneven terrain to stress from the golf swing position.
Treatment typically involves rest, ice, oral anti-inflammatory medication, immobilization with a walking boot, physical therapy, custom foot orthotics,and as a last resort surgery.
Newer surgical options such as Extracorporeal Shockwave treatment can be utilized to speed up recovery time. This procedure is a noninvasive surgical technique that utilizes high energy soundwaves to break up inflammation and speed up recovery time.


http://www.tanglewoodfootspecialists.com/blog/achilles-tendon-injury-is-keeping-tiger-woods-out-of-the-game.cfm

Heel pain in Children

Heel pain in children (Calcaneal apophysitis) is a painful inflammation of the heel’s growth plate. It is a common condition that we see in our practice. It can affect children between the ages of 8 and 14 years old, because the heel bone is not fully developed until at least age 14. Repetitive stress on the growth plate of the heel can develop into inflammation and pain.
It is the most common cause of heel pain in children, and can occur in one or both feet. Typically the pain resolves fairly quickly with conservative treatment.

Causes:

Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The growth plate of the heel is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. Children involved in soccer, tennis, or basketball are especially vulnerable.
Other potential causes of calcaneal apophysitis include a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

Symptoms:

• Pain in the back or bottom of the heel
• Limping
• Walking on toes
• Difficulty running, jumping, or participating in sports
• Pain when the sides of the heel are squeezed

Diagnosis:

To diagnose the cause of the child’s heel pain and rule out other more serious conditions, we will take a thorough medical history and perform a detailed clinical exam. X-rays are often used to evaluate the condition and visualize the growth plate of the heel.

Treatment:

• Reduce activity. Reducing or stopping any activity that causes pain will help to decrease inflammation.
• Support the heel. Temporary shoe inserts, heel lifts, or custom orthotic devices may provide support for the heel.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.
• Immobilization. In some severe cases immobilization with a cam walker boot may be needed for 4-6 weeks.

Typically calcaneal apophsitis resolves with conservative treatment. If your child has a repeat bout of heel pain, be sure to make an appointment with our doctors at Carolina Foot Specialists.

Heal your heel pain post Cooper River Bridge Run

Congratulations to all of you that participated in the 2011 Cooper River Bridge run. We sponsored 40 patients this year for the run and we hope to sponsor even more for next year. 

If you  are now experiencing any pain in your feet a few weeks after the race we would like to review some simple treatments you can do at home to hopefully alleviate your pain. We recommend that you initially ice the area of your foot that may be tender for 20 minutes a day. Stretch the achilles tendon with the runners stretch daily. You can take anti-inflammatory medication such as Ibuprofen up to 800mg three times a day with food. Low impact exercising such as biking or swimming will let the injured area of your foot rest and heal.

If not improved over a week or two it would be a good idea to come and see us at either our Mt. Pleasant or West Ashley location. We see many running injuries especially after the bridge run. The most common being plantar fasciitis (pain on the supportive ligament on the bottom of the foot), achilles tendonitis (inflammation of the tendon on the back of your heel, blisters (possibly from wearing improper socks or shoes) and stress fractures (tiny cracks in the bones of your feet with the 2nd metatarsal being the most common). We have digital x-ray in our offices, diagnostic ultrasound to look at the soft tissues in your foot, digital orthotic scanning, and follow a aggressive conservative approach to getting you back as soon as possible to the activities that you enjoy.

Diagnosis/Treatment of Plantar fasciitis with Diagnostic Ultrasound

Diagnostic Ultrasound is a modality that we use in our practice that can lead to a more accurate diagnoses and aid in the treatment of plantar fasciitis. Diagnostic Ultrasound technology for heel pain uses sound waves to create a visual picture of the anatomical structures of the heel. We are able to measure the thickness of the plantar fascia, determine if there is a partial tear of the plantar fascia, visualize fluid accumulation, locate bone spurs, and rule out stress fractures of the heel. In addition to seeing the anatomy of the inside of the heel we can also when needed perform more precise cortisone injections to the targeted area of the heel.
Carolina Foot Specialists has diagnostic ultrasound available in both the Mt. Pleasant and West Ashley offices. We can not only confirm the diagnoses of plantar fasciitis with ultrasound but can also visualize neuromas, stress fractures of the boot, and locate foreign bodies.

Dr. Andrew Saffer, DPM
Carolina Foot Specialists

Heel pain is not always Plantar Fasciitis

If you experience heel pain first step out of bed in the morning or pain after long periods of sitting than standing than you may have plantar fasciitis. Although these are common symptoms of plantar fasciitis there can be other causes of heel pain. Some of these include a stress fracture of the heel, nerve entrapment, achilles tendonitis, growth plate injury in children, and arthritic conditions.
It is very important to be evaluated by your foot specialists as soon as possible if you have heel pain that doesn't go away after a couple of weeks. An undiagnosed stress fracture of the heel for example can lead to surgery if not treated the right way.
Initially ice, NSAIDS, and rest are conservative treatments you can do at home. If these simple treatments do not help you may need to be evaluated by your local foot specialists. We can correctly diagnose the foot condition that you may have by clinical evaluation as well as diagnostic evaluation via digital x-rays and ultrasound exam. X-rays and diagnostic ultrasound are available at both our West Ashley and Mt. Pleasant offices. We offer conservative and surgical options for heel pain with 95% of our patients responding to conservative treatment without the need for surgery. Call us today if you any lingering heel pain which is keeping you from staying active.

Andrew Saffer, DPM
Carolina Foot Specialists

Heel Pain (Annual Bridge Run Injury)

Bridge Run training has begun for those runners who are looking to avoid injury by gradually increasing their mileage over the next 2 months. With the best of intentions in starting your training early it sometimes seems that the same aches and pains keep showing up on the same side of the body year after year. Heel pain, knee pain and lower back pain are the most common one-sided injuries.
A recent study in the Journal of the American Podiatric Medical Association showed a strong correlation between limb length difference and heel pain (plantar fasciitis). The longer limb receives increased loads while walking or running which can lead to overuse injuries of the plantar fascia. If one-sided foot, knee or back pain keeps returning each year while training for the Bridge Run then it may be due to limb length difference. In the next blog I will discuss the different types of limb length difference (functional vs anatomical) along with the causes and treatments. Until then good luck with your training and remember to start slow and progress gradually over the next 2 months.

Adam Brown, DPM
Carolina Foot Specialists

Minimally invasive foot surgery for chronic heel pain

We would like to focus this blog on two minimally invasive state of the art procedures that have quicker recovery times and excellent results. These procedures are excellent options if you have suffered with plantar fasciitis that hasn't improved with various conservative treatments.
1) Extra Corporeal Sound Wave Treatment (ESWT): This procedure can be performed in the offfice under local anesthesia and takes 20 minutes. This technology originally known as Lithotripsy, was used to break up kidney stones. Sound waves utilize a high intensity sonic pulse which is focused on the heel. It is believed that micro-trauma will repair and increase blood supply to the plantar fascia. ESWT is thought to break up scarring and allow the body to regenerate new and improved tissue to the area.The procedure is noninvasive with no cutting of the skin, patients can walk home in sneakers after the procedure. The day after the procedure patients are able to resume normal activities.
2) Topaz Procedure: This procedure uses Bipolar radiofrequency which is quick, simple, and minimally invavsive. Numerous small 5mm puncture holes are placed in the area of maximal tenderness in the heel in a grid like fashion. Microtenotomy of the plantar fascia is performed by placing a Topaz wand through the small puncture holes and radiofrequency is applied. No sutures are needed. Steri strips (medical band-aids) are placed on the puncture sites with a small dressing. Patients wear a boot for two weeks and then transition back into a sneaker. Patients are typically back to full activities at 4-6 weeks.
For more information on plantar fasciits please refer to our website:
carolinafootspecialists.net

Free Health Talk

Join Dr. Saffer tomorrow at 11am for a free health talk "Heal the Heel & Foot Pain" at the new Roper Mount Pleasant Hospital Medical Offices, Suite 200 right off Highway 17 in Mount Pleasant. It's great info for your aching feet! And stay tuned to our website, facebook and twitter pages for more upcoming talks.