Merry Christmas!

Merry Christmas from all of us at Carolina Foot Specialists! 

We understand that you may start a new fitness regimen in the new year. Please remember to take it slowly at first and be sure to have good athletic shoes.

To see our athletic shoe guidelines, CLICK HERE.

Have a safe and happy new year!

Cheers!
Dr. Adam Brown, Dr. Andrew Saffer and the Staff at Carolina Foot Specialist

My feet are on FIRE!

Do your feet feel like they're burning? 

Burning feet are a common complaint among many groups of people, most commonly those over 50 years of age and in diabetics. There are many causes. Heavy alcohol use may lead to the condition. Neuropathy and loss of sensation often are contributors as well. Other causes include thyroid dysfunction and gastric restriction in obesity. Some infectious diseases, such as leishmaniasis, a rarely reported neurologic change secondary to a bacteria, also may cause burning feet. 

Dr. Andrew Saffer of Carolina Foot Specialists in Mount Pleasant, SC has seen cases of burning feet often. Call to schedule an appointment with him today. 843-654-8250. 

When to call Carolina Foot Specialists?

We are often asked, "When is the right time to call you?" First, if you have that question, call us immediately. Foot pain is not normal, especially if it has lasted for more than a day or two.
Please contact our office if you experience one of the following:

Persistent pain in your feet or ankles.
Changes in the nails or skin on your foot.
Severe cracking, scaling, or peeling on the heel or foot.
Blisters on your feet.

There are signs of bacterial infection, including:

Increased pain, swelling, redness, tenderness, or heat.
Red streaks extending from the affected area.
Discharge or pus from an area on the foot.
Foot or ankle symptoms that do not improve after two weeks of treatment with a nonprescription product.
Spreading of an infection from one area of the foot to another, such as under the nail bed, skin under the nail, the nail itself, or the surrounding skin.
Thickening toenails that cause discomfort.
Heel pain accompanied by a fever, redness (sometimes warmth), or numbness.
Tingling in the heel; persistent heel pain without putting any weight or pressure on your heel
Pain that is not alleviated by ice or over-the-counter painkillers (such as aspirin, ibuprofen or acetaminophen).
Diabetics with poor circulation who develop Athlete's Foot.

Charleston Office
843-225-5575
Mount Pleasant Office
843-654-8250

You can also fill out one of our appointment requests online here. 

Hitting the Links can Hurt Your Feet

We're pretty lucky to be able to live in Charleston, where the weather is mild about 9 months of the year so we can hit the links often. But believe it or not, we see plenty of men who complain about the pain their golf shoes are causing them. Common foot injuries and problems associated with golf are related to overdoing it, particularly if an underlying structural problem exists in your feet. This includes tendonitis, capsulitis, and ligament sprains and pulls, which can keep a golf enthusiast off the green. Improper shoes can bring on blisters, neuromas, and other pain in the feet.

Remember that you'll spend a lot of time on your feet standing and walking during golf, so look for shoes that are comfortable. Golf shoes come in a variety of types, from the traditional oxford-style to sandals and even boots. Whichever style you choose, look for shoes that are lightweight, well-cushioned in the soles and heels, made from a breathable material, water resistant and offer traction. The middle of the shoe should feel a little tighter than your everyday shoes to support your swing. Be sure to try on golf shoes with the socks you will normally wear to make sure to get the right fit.

Need to know more? Call us for a consult. Dr. Adam Brown and Dr. Andrew Saffer can help.

Charleston Office
843-225-5575
Mount Pleasant Office
843-654-8250

Going Barefoot at Turkey Day Run 2013

To barefoot or not. That was the question I asked myself this morning when the temperature was sitting at 34 degrees as I left the house for the Turkey Day Run. My wife and 3 boys were joining me in the run for the first time so I figured I could shed my shoes and overcome the elements. My feet were numb on the short walk from our car to Marion Square. I fully expected them to return to normal 10-15 minutes into the run. Not on this day. I figured when the feeling had not returned by the 2 mile marker that it was either a blessing or a curse. I could get through the race without feeling any discomfort from acorns, rocks or the rough road along the Battery which would be great. On the other hand, the bottom of my feet could have been torn to shreds and I would not have a clue until later when the numbness wore off. I relied on my barefoot running technique which I have been working on to carry me through. To my surprise, I have almost no discomfort as I sit here several hours later following a great Thanksgiving dinner with our family. Even my 7 year old ran the kids run without any shoes. He came in 2nd place. Great job Matty. Once again I am amazed at what the body (and feet) can accomplish. Whether it is barefoot running, healing a foot injury or strengthening a weakened part of the lower extremity all you need is a plan. Your body will take care of the rest. 

Adam Brown, DPM Carolina Foot Specialists

Run that Extra Stuffing off with the Right Shoe

Heading out to exercise off that extra stuffing you might gain after Thanksgiving. Make sure your walking or running shoes are in good shape. Dr. Adam Brown is an avid runner and always has tips. Here's what to look for.

Athletic shoes need to be replaced after one year, whether or not they are worn, and after a certain amount of repetitive load is placed on them and wears them down.

The American Academy of Podiatric Sports Medicine advises replacing running or walking shoes after 300 to 500 miles of wear, and replacing aerobic, basketball, and tennis shoes after 45 to 60 hours of wear.

Athletic shoes should also be replaced if they show signs of unevenness when placed on a flat surface, display noticeable creasing, and/or when the heel counter breaks down.

Dr. Adam Brown, Podiatrist, Carolina Foot Specialists 

What's that smell? Getting to the bottom of stinky feet

Did you know...The feet and hands contain more sweat glands than any other part of the body, with roughly 3,000 glands per square inch.

Smelly feet are not only embarrassing, but can be physically uncomfortable as well. But it's not something we at Carolina Foot Specialists can't treat.

Feet smell for two reasons: 1) shoe wear, and 2) sweating of the feet. The interaction between the perspiration and the bacteria that thrive in shoes and socks generates the odor. Therefore, any attempt to reduce foot odor has to address both sweating and footwear.

Smelly feet or excessive sweating can also be caused by an inherited condition, called hyperhidrosis, which primarily affects men. Stress, some medications, fluid intake, and hormonal changes also can increase the amount of perspiration our bodies produce.

Call Dr. Adam Brown today if you've tried everything for your stinky feet, he can help. 843-225-5575

What should people with Diabetes look for when buying shoes:

As a general rule, people with diabetes should choose shoes that:

Accommodate, stabilize, and support deformities, such as Charcot Foot, loss of fatty tissue, hammertoes, and amputations. Many deformities need to be stabilized to relieve pain and avoid further damage. In addition, some deformities may need to be controlled or supported to decrease further progression of the deformity.

Limit motion of joints. Limiting the motion of certain joints in the foot can decrease inflammation, relieve pain, and result in a more stable and functional foot.

Reduce shock and shear. A reduction in the overall amount of vertical pressure, or shock, on the bottom of the foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear.

Relieve areas of excessive pressure. Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high pressure areas, and therefore reduce the occurrence of related problems.

Make your appointment with Dr. Andrew Saffer at our Mount Pleasant office:
501 Bramson Ct.
Suite 301
(Across from Belle Hall Shopping CTR)
Mount Pleasant, SC 29464
843-654-8250

www.carolinafootspecialists.net 

What are your shoes saying?

What are you shoes saying about you?

Sometimes it's that they've overstayed their welcome and it's time for a new pair. The wear patterns of your shoes explain it all.

Look for these signs:
A bulge and wear to the side of the big toe means too-narrow fit or you have a bunion.

Outer sole wear means you turn your foot out. Orthotics may help.

Toe-shaped ridges on the upper means your shoes are too small or you have hammertoes.

Wear on the ball of the foot means your heel tendons may be too tight.

Wear on the inner sole means you pronate or turn your foot inward. Inner liners or orthotics may help.

Wear on the upper, above the toes means the front of your shoe is too low.

For more helpful tips, check out www.carolinafootspecialists.net 

Women and Bunions

Women suffer with bunions more frequently than men because of tight, pointed, high-heeled shoes that confine and restrict the foot. Dr. Brown and Dr. Saffer accurately diagnose and treat bunions by recommending steps to slow their progress or to repair the joint. If more conservative measures don’t bring relief, Dr. Brown or Dr. Saffer may suggest surgery.


Check out more at our website at www.Carolinafootspecialists.net 

Ingrown toenails in children

Ingrown toenails occur when the toenail starts to curve into the skin along the side of the nail.  There a number of reasons that ingrown toenails can develop. Just like you inherit genes for eyes and hair color you can also inherit that way your toenails grow. The way your toenail is shaped can cause you to be more prone to developing ingrown nails. 

 Playing sports and wearing a tighter toe box shoe can also cause ingrown nails from the constant pressing of the skin into the nail.  If you notice your child complaining of pain around their toenail, look for signs of an ingrown nail such as swelling and  redness around the skin surrounding the nail.  

Initially home treatment such as soaking in Epsom salts and applying antibiotic ointment can help to soften the skin surrounding the nail.  Using a band-aide can help to protect and alleviate pressure in shoes which could increase the severity of pain.  If the puffiness or redness in the skin persists, then you should call and make an appointment. Attempting to remove the ingrown nail at home bathroom surgery) is risky and could potentially cause an infection. 

Feel free to contact us at our West Ashley or Mt. Pleasant offices for same day/week appointments. Carolinafootspecialists.net

Charleston Office
843-225-5575
Mount Pleasant Office
843-654-8250

More from Dr. Saffer on running with flat feet

Now that you have your correct running shoe, orthotic, and have been warming up with stretching exercises you are ready to hit the pavement. If you are new to running I would suggest slowly and gradually increasing your pace and mileage. I would not recommend "Barefoot Running" if you suffer from flatfeet. I have seen many cases in my offices of achilles tendontis, plantar fasciitis, stress fractures, and posterior tibial tendonitis with barefoot shoes and vibrams, I would advocate barefoot running for the experienced runner, with excellent running technique and arch height.

One style of running that I feel can help you run more mileage without suffering pain or injury is adopting the style of ChiRunning. ChiRunning is a running technique that improves efficiency and performance.  Now you do not have to take Tai Chi as a class but some of the concepts of Tai Chi are brought to the running technique. The main principles of ChiRunning include:

Relaxation
Correct alignment and posture
Shorter strides
Landing with a midfoot strike
Using a "gravity-assisted" forward lean
Engaging core strength for propulsion
Connecting the mind and body to prevent injury.
Slowly increase your mileage each week. I would recommend running two to three days a week. Running on grass or softer surfaces can tend to decrease pressures on the flattened arch. Cross training is key making sure to especially stretch the achilles tendon, plantar fascia, and hamstrings before and after running. If you are having pain in the arch after running I feel that icing with a frozen gel pack for 20 minutes and soaking in warm water and epsom salts helps to naturally reduce inflammation.

As your mileage increases week by week you may begin to get more aches and pains in your arches. I would recommend if you are than to back off of your running that specific week in order for your musles, tendons, and ligaments to heal. You can swallow your pride as well and do a walk run technique which can still give you the necessary cardio workout during this recovery period.

Lastly keeping your weight under control. The more weight you have the more pressure on the flattened arches. I don't like to always blame foot pain on being over weight but it does contribute to foot discomfort. Look to have a well balanced diet and cross train if you feel at first you can not run for long periods of time. As the weight comes less pressure is on the feet which should allow you to run longer distances.

These are some of my tips and experiences with personally having flatfeet. I feel that the soft tissues of your individual internal foot structure are very adaptive and can withstand incredible forces over time. If you still are suffering from flatfeet and continue to have discomfort for your given activity please contact us at: Carolinafootspecialists.net

What your shoes say about you...

Examining old shoes before buying new ones can help you evaluate your wear patterns and buy new shoes with a better fit and style that compensates for the stresses you place on shoes.

What are your shoes trying to tell you? Here is a translation of basic wear patterns:

A bulge and wear to the side of the big toe means too-narrow fit or you have a bunion.

Outer sole wear means you turn your foot out. Orthotics may help.
Toe-shaped ridges on the upper means your shoes are too small or you have hammertoes.

Wear on the ball of the foot means your heel tendons may be too tight.

Wear on the inner sole means you pronate or turn your foot inward. Inner liners or orthotics may help.

Wear on the upper, above the toes means the front of your shoe is too low. We have two locations to help you! 

Charleston Office
843-225-5575
Mount Pleasant Office
843-654-8250

Stretch it out!

The best way to stretch the Achilles and the attaching muscles is to put the foot against a step with the heel on the ground and slowly lean forward, feeling the stretch at the top of the calf. Repeat with a bent knee, feeling the stretch lower down toward the heel. Ideally, this stretch is done daily, before and after exercise. 

Orthotics also can help correct the anatomic alignment. With Achilles pain, the key is to get it checked out early and avoid the chronic tear.

Speaking of stretching....hope you are stretching and getting ready to run as the 37th Annual Cooper River Bridge Run on April 5, 2014 will be here before you know it. We're loving the new poster for this year! Stay tuned to our blog as we get you ready to run. 

Want to see the poster? Click HERE! 

Hammertime! What is Hammertoe?

Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and painful, requiring surgery.

Hammertoe surgery can be done on an outpatient basis in the doctor's office or a surgery center using a local anesthetic, sometimes combined with sedation. The surgery takes about 15 minutes to perform. Up to four small incisions are made and the tendons are rebalanced around the toe so that it no longer curls. Patients usually can walk immediately after the surgery wearing a special surgical shoe. Minimal or no pain medication is needed following the surgery.

Icing and elevation of the foot is recommended during the first week following the procedure to prevent excessive swelling and promote healing. It is also important that the dressing be kept clean and dry to prevent infection. Two weeks after the surgery, the sutures are removed and a wide athletic shoe can replace the post-operative surgical shoe. Patients can then gradually increase their walking and other physical activities.

Call our office today: 

Charleston Office

843-225-5575

Mount Pleasant Office

843-654-8250

Ingrown Toenails: What to do and what NOT to do

One of the most common foot conditions that we see in our Charleston and Mount Pleasant practice in adults and children are ingrown toenails. An ingrown toenail most commonly affects the big toe, known anatomically as the Hallux. When an ingrown toenail occurs, the nail grows abnormally into the skin and flesh of the toe. This leads to pain and the overgrowth of skin tissue at the side of the nail.

Sometimes the edge of the toenail pierces the skin outside of the nail groove, beginning to act as a foreign body. Sometimes a nail is ingrown not only at the corner of the nail plate, but all the way down. The first signs of either condition are pain and swelling. The area of penetration may bleed or become infected, producing pus.


Causes of an Ingrown Toenail?

The condition is caused by any of several factors. The most common of which is probably improper nail trimming, cutting the nail too much, so that when it begins to grow back it grows out of the “nail groove” directly into the flesh of the toe.

In addition, some people are hereditarily predisposed to developing the condition.


Symptoms of an Ingrown Toenail?

Severe pain, infection, swelling, sometimes pus, are major symptoms of the condition. It is normally obvious with a visual inspection, which will show that the nail is in fact growing into the skin and flesh of the toe, and that an infection is present.

Treatment for Ingrown Toenail?

If you have an ingrown toenail, it is best to see your foot specialists for advice. Any toenail that is bleeding, excreting pus, or swollen should be examined by a doctor. Many people with ingrown toenails delay treatment, or make matters worse by resorting to home remedies that may be more painful than medical attention.

Painless Surgery for an Ingrown Toenail?

If the condition has resulted in permanent overgrowth of the tissue surrounding the nail margin, or in recurring infection, surgery may be required to treat the condition. Surgical treatment varies slightly depending on the particulars of each individual case.

In mild cases, removal of a portion of the tissue at the side of the nail groove may reduce pressure and irritation. In this procedure a wedge of tissue is removed and the healing process allows the groove to reform itself.
Sometimes surgery involves use of a local anesthetic and removal of a portion of the toenail and its root. Patients with recurrent ingrown nails may require the use of a medication known as liquid phenol, which permanently removes lateral portions of the nail matrix

In our practice we use a  topical anesthestic before the injection called Ethly Chloride which freezes the skin to make patient's more comfortable.

Surgery for ingrown toenail is painless and easy to perform in the office setting. Patients should be able to put weight on their feet immediately after surgery but walking is uncomfortable. In most cases, toenails grow normally after surgery without imbedding themselves into the skin.

It is important to carefully follow instructions before and after any surgical procedure in order to have the best results and quicker recovery time. Changing the style of footwear you use is very important such as wearing a wider toe box shoe.

Our practice is proud to introduce a convenient post surgical kit for ingrown toenail surgery after care. The Amerigel Post-Op surgical kit is offered to every patient who has undergone a permanent nail matrixectomy. This wound healing kit allows for quicker healing times, eliminates the need for soaking after nail procedures, and aids in compliance by our patients.

The Amerigel Post-Op Surgical Kit has allowed our patients to obtain an effective wound healing product with all the dressings right at the time of service.

From Dr. Saffer Regarding his own flat feet....

I personally have had flat feet my entire life. Luckily I was treated by a Podiatrist at a young age with custom orthotics to assist in arch support. I also learned some techniques over the years to allow me to participate in competitive sports and most recently over the past few years long distance running.  I have been able to run in the Cooper River bridge run the past four years without injury.  So I would like to offer my best advice, based on my own experience, on how to care for your flat feet and run without pain or discomfort.

This will be a two part series first focusing in on finding the proper motion control running shoe, being evaluated for orthotics, and stretching.

Part two will focus on starting a running program and tips to ease discomfort in your flat feet during and after your runs.

Things You'll Need
The correct running shoe
Over the counter or custom foot orthotics
Consistent stretching exercises
If you have flat feet then starting with the proper running shoe is the first step

1) It is worth your time and money to go to a specialty running store to be fitted for running shoes. You should first have your foot measured to make sure you haven't changed shoe sizes over the years. The next step is looking for a anti-pronation running shoe or "Motion control" running shoe. In my experience you need to try on these running shoes in the store and go outside and jog in place to see if they feel comfortable. The "Brooks Beast" in my opinion offers the most motion control but is to heavy and bulky for me. The running shoe that I have used over the past four years has been the "Mizzuno Alchemy". I really leave it up to the individual because if you suffer from flatfeet you may be more of a degree of pronation than others. I personally am as flat as one can be so this specific shoe has worked for me. In addition while your are at the running store look for a moisture wicking sock which well help to "wick" away moisture from your feet to help prevent blister formation.

It is almost equally important to be evaluated by your local Sports Podiatrist if you suffer from flatfeet. X-rays and clinical evaluation are essential steps in having the proper diagnosis and treatment plan. X-rays would be able to give information with regards to degree of flattening of the arch and if arthritis, stress fractures, or bone spurs are presents. In addition it is important to evaluate if your flat arch is flexible or rigid which can be easily tested in the office. At the time of the office visit it will be determined if you need a really good over the counter orthotic or custom foot orthotic. The custom foot orthotic is typically the best treatment and can be made according to the given sport you participate in. The orthotic is made from a plaster impression of the feet and a specific prescription is written out for the type of sports orthotics to be fabricated. Most insurances do cover custom orthotics and they take two weeks to be made.

So now that you have the proper running shoe and orthotic the next step is stretching. I personally like three stretching exercises to begin with. The first stretch involves taking a stretching band or towel and placing it on the balls of your feet. Pull the stretching band or towel towards you and hold for three sets of thirty seconds. The next stretch is the runners stretch. Same hold three sets for thirty seconds. The third stretch is placing our feet against a stair and leaning forward for three sets of thirty seconds. These three stretching exercises stretch the achilles tendon and plantar fascia ligament to get you warmed up.

Another stretching device that our practice utilizes is the plantar fascia/achilles night splint. The night splint assist in stretching the plantar fascia ligament and achilles which in turn helps to prevent plantar fasciitis and achilles tendonitis. Our practice has tested various night splints and we are able to offer them at each of our two locations West Ashley and Mount Pleasant.

RICE it up when it comes to Foot Pain

If you've hurt your foot or ankle, it's best to err on the side of caution. The acronym RICE can help you remember what to do:

Rest—Rest the affected area. Stay off the injured foot or ankle until it can be fully evaluated. Walking, running, or playing sports on an injured foot or ankle may make the injury worse.

Ice—Apply ice to the affected area as soon as possible, and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.

Compression—Wrap an elastic bandage (such as an Ace® wrap) around the affected foot or ankle. The wrapping should be snug, but not so tight as to cut off circulation.

Elevation—Elevate the affected extremity on a couple of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

Dr. Andrew Saffer of the Carolina Foot Specialists office in MT Pleasant can help if foot pain is hindering your daily activities.

His office is located at 501 Bramson Ct, Suite 301 in Mount Pleasant. Call him today at 843-654-8250

Dr. Andrew Saffer, DPM 

More Tips for Healthy Feet

Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; this can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet, because they are more prone to infection.

Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.
Select and wear the right shoe for each sport or activity that you are engaged in (e.g., running shoes for running).

Alternate shoes—don't wear the same pair of shoes every day.

Avoid walking barefooted. Your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet.

Be cautious when using home remedies for foot ailments. Self-treatment may turn a minor problem into a major one.

If you are a diabetic, please contact our office and schedule a check-up at least once a year.

Tips for Healthy Feet

Don't ignore foot pain. It is not normal. If you experience any type of persistent pain in the foot or ankle, please contact our office.

Inspect your feet regularly. Pay attention to changes in color and temperature. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet may indicate Athlete's Foot. Any growth on the foot is not considered normal.

Wash your feet regularly, especially between the toes, and be sure to dry them completely.

Diabetes and Your Feet

Diabetics are more prone to various foot problems than those without diabetes due to the development of painful nerve damage called peripheral neuropathy. Neuropathy can affect your entire body, but most often the legs and feet are the most prone areas to serious health complications.

The damage to your nerves can cause the loss of feeling in your feet, making it difficult to detect extreme temperatures and pain as easily, or readily, as someone who does not have diabetes. As a result, you could sustain a serious cut or wound and not even notice your foot is injured until an infection begins. Many diabetic foot problems can be prevented in some measure with improved blood sugar control and a strengthened immune system.

If you are among one of the millions of people in the United States with diabetes, it is important to visit us at Carolina Foot Specialists for regular foot examinations in order to maintain healthy feet and a strong body.

Heel pain isn't normal

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation. Dr. Adam Brown of Carolina Foot Specialists in Charleston, SC explains in this video. 

Boston Celtics Rookie Kelly Olynyk Has Plantar Fasciitis

 Kelly Olynyk a first round draft pick of the Boston Celtics has just recently suffered from an acute case of plantar fasciits. We have recently see a large number of cases of plantar fasciits in professional athletes.

Plantar fasciitis is an inflammation of the fibrous band of tissue on the bottom of the foot which is called the plantar fascia. Plantar fasciitis can presents as pain first step out of bed in the morning in the heel. It can also presents during or after athletic activity. The pain is typically a sharp sensation and can also present on the entire length of the sole of the foot. 

In acute cases rest, NSAIDS, custom orthotics, immobilization with a cam walker boot, night splints, and aggressive physical therapy are initial conservative treatments for plantar fasciitis.

Rarely does this procedure involve surgical intervention.

Topaz and PRP injections are some of the newer minimally invasive procedures for chronic cases of plantar fasciitis that have not resolved with conservative measures.

http://sports.yahoo.com/news/report-boston-celtics-rookie-kelly-olynyk-plantar-fasciitis-201900742.html

Running Injuries & How to Avoid them

Dr. Adam Brown of Carolina Foot Specialists in Charleston, SC explains how running can affect your feet and how you can avoid running injuries in this video.

Plantar Plate Tears

What Is the Plantar Plate?

The plantar plate is a soft tissue structure on the bottom of the foot under the metatarsal head. The plantar plate is composed of type 1 collagen and fibrocartilage. The plantar plate attaches to the base of the toe and the metatarsal

What Is the Function of the Plantar Plate?

The plantar plate cushions the bottom of the metatarsal head while walking and running. In addition, the plantar plate helps bring the toe to the floor while standing.

What Are Causes of Plantar Plate Tears?

The following are causes of plantar plate tears:

• A long first metatarsal, short second metatarsal
• Biomechanical abnormalities ie. Bunions, hammer toes, flatfeet
• Arthritis of the big toe
• Cortisone injection into the area
• Excessive use of high heel shoes
• Trauma

What Are the Symptoms of a Plantar Plate Tear?

The following problems can be symptoms of a plantar plate tear:

• Pain in the ball of the foot that has persisted despite changes in shoes and activities
• A second or third toe that appears to be changing position over time
• A diagnosed ‘neuroma’ that has not been responsive to treatment

How Do You Diagnose a Plantar Plate Tear?

The proper diagnosis of a plantar plate tear as well as any underlying foot deformity starts with a physical exam. Your Carolina Foot Specialists doctor will take a thorough history of your foot problem as well as clinical exam and look for:

• Pain at the metatarsal head typically the 2nd metatarsal
• Swelling in the area of the plantar plate
• Instability of the toes
• Hammer toe deformity
• Previous diagnosis of a neuroma

X-Rays

In house X-rays will be ordered of the feet to assess the quality and alignment of the bones of the foot. X-rays are taken to rule out the possibility of fractures or arthritis in the foot.

Magnetic Resonance Imaging (MRI)

If your Carolina Foot Specialists doctor suspects that you might have a plantar plate tear, they may order an MRI. Magnetic resonance imaging is one of the most sensitive imaging techniques for this particular problem. MRI's are one of the best imaging techniques to evaluate the integrity of the plantar plate and to rule out a tear.

Ultrasound

Ultrasound is another diagnostic test that each of our Carolina Foot Specialists locations offer to evaluate the plantar plate and to rule out a neuroma.

Non-Surgical Treatment Options

Non-surgical treatment options for this pathology are initiated to help alleviate any discomfort in the foot. They include:

• Rest
• Ice
• Anti-inflammatory medication
• Offloading metatarsal padding.
• Cross over taping of the digit to take pressure of the joint
• Custom foot orthotics to accomodate for a biomechanical issue with the feet.
• Changes in Shoes: Avoiding shoes that aggravate this problem (high heels and tight shoes)

When Is Surgical Treatment Necessary?

Surgical treatment is suggested when non-surgical measures fail to alleviate pain and begin to limit your lifestyle.
Surgically this problem is addressed by a direct repair of the plantar plate via a dorsal or plantar incisonal approach, metatarsal osteotomy, and repair of a deviated digit (hammer toe repair).

Aggressive physical therapy and close follow up after surgery are the goals that Carolina Foot Specialists employs to return to activity as quickly as possible after surgery if needed.

Bunions and Your Feet

Bunions—misaligned big toe joints that swell and become tender, causing the first joint of the big toe to slant outward and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery is frequently performed to correct the problem. Dr. Andrew Saffer of Carolina Foot Specialists in Charleston, SC explains more in this video. 

Putting Your Feet First in Charleston, SC

Is heel pain ruining your life? Do bunions hinder you from wearing your favorite shoes? Carolina Foot Specialists in Charleston, South Carolina is putting your feet first. Find out how here: 

Recovery after the Topaz procedure

Topaz Coblation for Planter Fasciitis & Heel Pain

Topaz Coblation Procedure

TOPAZ is a quick, simple, procedure that Carolina Foot Specialists offers for chronic heel pain that is unresponsive to conservative treatment. The TOPAZ MicroDebrider utilizes patented Coblation® technology, designed to specifically treat tendons and fascia. The TOPAZ technique has been associated with quick return to daily activities allowing for significant improvement in patient outcomes.

How TOPAZ Works

Through a small incision, approximately and inch long, the TOPAZ MicroDebrider is applied on and around the tendon for half-second duration treatments placed a quarter inch apart to form a grid-like pattern. With every fourth application, the device is inserted deeper into the tendon - approximately a quarter inch in depth. Small amounts of tissue are removed as a light application of radiofrequency energy is guided into the tissue. TOPAZ treatment typically takes less than 20 minutes to administer. Patients are ready to leave the clinic once recovered from local or light sedation.

Patient Selection

• Fascia with partial tears may be at an increased risk of rupture
  
• Patients with chronic heel pain that has been unresponsive to conservative treatment.
  

Patient Preparation

Access can be approached through tiny poke holes made through the skin with the use of a .062 K-wire under IV and local sedation. Procedure takes 20 minutes without the need for skin sutures.

Post Operative Care and Rehabilitation

First week

• Immobilize with cam walker boot or surgical shoe.
• Dressing changes performed by the patient after first postoperative visit

Week 2-Week4

• Passive and active range of motion exercises
• Night splint-Cam walker as appropriate
• Sneaker with custom orthotic

1-3 months

•  Low impact exercising with slow progression into higher impact exercising
• Routine at home or work is okay at the discretion of a surgeon

Carolina Foot Specialists: Neuromas

Neuromas are enlarged benign growths of nerves, most commonly between the third and fourth toes. Neuromas are caused by tissue rubbing against and irritating the nerves. Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Depending on the severity, treatments may include orthotics (shoe inserts), cortisone injections, and, in extreme cases, surgical removal of the growth.

Dr. Andrew Saffer of Carolina Foot Specialists explains more in this video. 

Cooper River Bridge Run Training Tips

The Cooper River Bridge run is right around the corner! Are your feet ready for the race?  Here are some LAST MINUTE TIPS to keep your feet in shape and prevent problems that could slow you down the day of the race.

1. Prevent excessive sweating or moisture in your shoes to prevent blister formation on the toes and heels.  Use anti-sweat powders and look for acrylic running socks such as cool max that “wick” away moisture and prevent blisters.
2. Stretching is important to prevent muscle strains and heel pain.  Stretch every day, before and after your runs. The runners stretch against the wall and sitting on the floor touching the toes with the legs extended are excellent stretches to warm you up.
3. Make sure your running shoes are not too old. Typically a good rule of thumb is changing your running shoes every 300-350 miles or every six months.
4. If you are having heel pain, flatfeet, or any other foot ailments you may be a good candidate for a professional sports custom orthotic. We are able to fabricate orthotics in each of our offices.
5. Finally if you are experiencing pain in your feet or ankles that is not resolving on its own, come see us now rather than waiting until after the race.  The longer you push through an injury or pain in your foot or ankle, the harder it is to treat.

So as the Bridge run approaches don’t forget that Carolina Foot Specialists is here for any foot pain you’re experiencing before or after the race. 
For more information on training for the Bridge run please refer to our blogs at carolinafootspecialists.net

Barefoot Running

If you are your training for the upcoming Bridge run you may see on race day a few runners without shoes. Barefoot running over the past several years has become more popular. This style of running has been propelled in part by the success of the bestselling book , Born to Run. The theory is that running barefoot may minimize the stress on the body.

Dr. Brown has just recently run barefoot during a local 5K race at Thanksgiving and will be running the bridge run barefoot as well. Dr. Brown and Dr. Saffer highly recommend that the transition to barefoot running should go at a very slowly pace at first and gradually increase mileage in order to avoid potential stress injury in the foot. We also feel that having a solid arch structure is paramount to consider if you are the right candidate to barefoot run.

Barefoot running involves forefoot and midfoot striking, which is supposed to minimize the impact of your body colliding with a surface. Striking the ground with your heel first, on the other hand, falls in line with running in regular shoes.


Previous research has shown that striking on the heels might mean hitting the ground with three times more weight than barefoot running. Daniel Leiberman, a Harvard University professor known for his research on barefoot running, has found that forefoot-striking runners have lower risks of repetitive stress injuries, and that going barefoot is more energy efficient.

The Associated Press, however, reported last spring that doctors have noticed an increase in the  number of associated running injuries including achilles tendonitis and metatarsal stress fractures. It was also noted that those injuries were mainly said to be found in people who took up barefoot running quickly, rather than slowly building their up their mileage over time. Another issue with barefoot running is stepping on foreign objects. I have seen in my practice a greater number of foreign bodies in the foot from stepping on foreign objects while running.

If you are considering barefoot running or have been barefoot running and would like to be evaluated please contact us at our office for an appointment.

Bridge Run 2013 training tip

We are about three weeks away from the Bridge run 2013 and we would like to offer weekly tips to help you get through the run. It is essential that your running shoe is not to worn down. A good rule of thumb is to change your running shoes every 300-350 miles or every four to six months. In addition you need to ensure you have the right type of training shoe for your particular foot. First figure out if you're an overpronator (you use the inside of your foot more) or underpronator (you walk on your foot's outside edge) by taking the "wet footprint" test. Simply wet the bottoms of your feet, and then step on a piece of flattened cardboard. If you overpronate, the imprint will be that of a nearly complete foot with your arch coming in contact with the cardboard. If you underpronate, you'll see mostly the toes, heel and outer edge of your foot on the cardboard.

Other things to look for in a good running shoe are that your heel doesn't rub in the back and that there's still room in front of your big toe (make sure you have about a 1/2 inch between the toe box and your great toe). The running shoe is lightweight and breathable, and, most importantly the shoe feels good when you put it on.

It is worth it to spend a little extra money at one of your local professional running stores to ensure that you are fitted with the correct shoe. Make sure that your foot is measured in both length and width. It is also important to purchase a moisture wicking sock such as cool max to prevent blisters from forming.

Cooper River Bridge Run Training Tips

Run Training Schedule/Running Tips

As you train for the upcoming Cooper River Bridge run Carolina Foot Specialists would like to provide training schedules and tips to help you reach the finish line. These training schedules are divided into beginner, intermediate, and advanced beginner. The 10K (6.2 miles) distance is very popular with runners, especially those who have done a 5K race, but don't feel they're quite ready to take on the half-marathon.
Stretch & Strength: Mondays are days we advise you to do some stretching along with strength training. This is actually a day of rest following your long run on Sundays. Do some easy stretching of your running muscles. This is good advice for any day, particularly after you finish your run, but spend a bit more time stretching on Mondays. Strength training could consist of use of free weights, push ups, yoga, or working out with various machines at your local health club. It is typically more beneficial to lift light weights with a high number of repetitions, rather than lifting heavy weights.
Running workouts: Ideally, you should be able to run at a pace that allows you to converse comfortably while you do so. This isn't always easy for beginners, so don't push too hard or too fast. Under this workout plan, you run three days of the week: Tuesdays, Thursdays and Sundays, Sundays being a longer run.
Cross-Training: On the schedule, this is identified simply as "cross." What form of cross-training works best for runners preparing for a 10-K race? It could be swimming, biking, yoga, walking, or other forms of aerobic training. Cross-training days should be considered easy days that allow you to recover from the running you do the rest of the week.
Rest: The most important day in any running program is rest. Rest days are as important as training days. They give your muscles time to recover so you can run again. Actually, your muscles will build in strength as you rest. Without recovery days, you will not improve.
Long Runs: The longest runs of the 8-week schedule are planned for Sundays, since you probably have more time to do them on the weekends. If Sunday isn't a convenient day for your long runs, feel free to do them on Saturday--or any other day of the week for that matter. What pace should you run? Go slow. There is no advantage to going fast during your long runs, even for experienced runners.
Walking: Walking is an excellent exercise that a lot of runners overlook in their training. In the training schedule below, we don't specify walking workouts, but feel free to walk during your running workouts any time you feel tired or need a break. Nobody cares whether you run the full 10-K, they're more concerned that you finish. If this means walking every step in practice and in the race, do it!
Below are a few eight-week training schedules to help get you to the finish line. It assumes that you can already run at least 2 miles. This 10-K training schedule is only a guide. Feel free to make minor modifications to suit your work and family schedule.
Beginner Runners' 10K Training Schedule

Week	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
1	Rest	1.5 m run	CT or Rest	1.5 m run	Rest	2 m run	25-30 min EZ
2	Rest	2 m run	CT or Rest	2 m run	Rest	2.5 m run	25-30 min EZ
3	Rest	2.5 mi run	CT or Rest	2 m run	Rest	3 m run	30-35 min EZ
4	Rest	2.5 m run	CT or Rest	2 m run	Rest	3.5 m run	35 min EZ
5	Rest	3 m run	CT or Rest	2.5 m run	Rest	4 m run	35-40 min EZ
6	Rest	3 m run	CT	2.5 m run	Rest	4.5 m run	35-40 min EZ
7	Rest	3.5 m run	CT	3 m run	Rest	5 m run	40 min EZ
8	Rest	3 m run	CT or Rest	2 m run	Rest	Rest	10K Race!

10K Advanced Beginner Schedule

Week	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
1	Rest	3 m run	CT	2.5 m run (race pace)	Rest	3 m run	30 min EZ
2	Rest	3 m run	CT	3 m run (race pace)	Rest	3.5 m run	35-40 min EZ
3	Rest	3.5 mi run	CT	3.5 m run (race pace)	Rest	4 m run	35-40 min EZ
4	Rest	4 m run	CT	3.5 m run (race pace)	Rest	4.5 m run	40-45 min EZ
5	Rest	3 m run	CT	4 m run (race pace)	Rest	5 m run	40-45 min EZ
6	Rest	3.5 m run	CT	3.5 m run (race pace)	Rest	6 m run	40-45 min EZ
7	Rest	4 m run	CT	4 m run (race pace)	Rest	7 m run	40-45 min EZ
8	Rest	3 m run	CT or Rest	3 m run	Rest	Rest	10K Race!

10K Training Schedule for Intermediate Runners

Week	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
1	CT or Rest	4 x 400 IW	3 m run	30 min tempo	Rest	4 m run	30 min EZ
2	CT or Rest	5 x 400 IW	3.5 m run	35 min tempo	Rest	5 m run	35 min EZ
3	CT or Rest	6 x 400 IW	3.5 m run	35 min tempo	Rest	6 m run	35 min EZ
4	CT or Rest	7 x 400 IW	4 m run	40 min tempo	Rest	6 m run	40 min EZ
5	CT or Rest	8 x 400 IW	4.5 m run	40 min tempo	Rest	7 m run	40 min EZ
6	CT or Rest	8 x 400 IW	4.5 m run	40 min tempo	Rest	7.5 m run	45 min EZ
7	CT or Rest	6 x 400 IW	4 m run	40 min tempo	Rest	8 m run	45 min EZ
8	CT or Rest	3 m run	40 min tempo run	3 m run	Rest	Rest	10K Race!

Question: When Should I Replace My Running Shoes?
A good rule of thumb is to replace your running shoes every 300 to 400 miles, depending on your running style, body weight, and the surface on which you run. Smaller runners can get new running shoes at the upper end of the recommendation, while heavier runners should consider replacement shoes closer to the 300 mile mark. If you run on rough roads, you'll need to replace your running shoes sooner than if you primarily run on a treadmill.
About halfway through the life of your running shoes, you might want to buy another pair of running shoes to rotate into your runs. Your shoes will last longer when you allow them to decompress and dry out between workouts. Also, having a fresh pair of shoes as a reference will help you notice when your old ones are ready to be replaced.
Choosing the right running shoes is one of the most important decisions you'll make as a runner, especially if you're just getting started. Taking the time to find the best running shoe will help keep you comfortable and injury-free.
Here's How:

1. Go straight to the experts at a running specialty store. Plan on spending some time there because the salesperson should ask you lots of questions and have several running shoe options for you to try out.
2. Make sure the salesperson looks at the shape and arch to figure out what type of foot you have. Determining your foot type is key to making sure you get the right running shoes. The salesperson should also measure your foot. Your running shoes should be 1/2 to a full size bigger than your regular shoe size because your feet will swell when you run and you need plenty of room in the toe-box. If your toes are crammed in the front of the running shoe, you could develop bruised or black toenails.
3. Have the salesperson do a running analysis for you. He'll watch you run in the running shoes, either outside or on treadmill, and determine your running style. He'll observe whether you're overpronating (your foot rolls inward) or supinating (your foot rolls outward) when your foot strikes the ground.
4. Give the salesperson information that will help him with his running shoe recommendations. He should be asking you questions about what type of running you do, how often you run, where you typically run, and what type of surfaces you run on.
5. Run in the running shoes that the salesperson recommends for you. Run in each pair of shoes to test for fit, function, and comfort before making your final decision.
6. Test your running shoes by running in them for a week. If you quickly develop blisters or foot pain, they may not be the right shoes for you. Many specialty running stores have liberal exchange policies and allow you to return running shoes even if you've been running in them for a week or more. Take them back and exchange them for another recommended pair of running shoes.
7. After you've found your perfect running shoes, you don't have to keep going back to the specialty running shop. You'll need to replace your shoes every 300 to 400 miles f you want to save some money, you may be able to find your running shoes online.

For any other information on running or foot conditions you can refer to our website: Carolinafootspecialists.net

Plantar fascial tear NBA basketball player follow up

Paul Gasol NBA basketball player for the LA Lakers suffered a torn plantar fascia earlier this month. The typical treatment for a torn plantar fascia in professional athletes and recreational athletes is typically a period of immobilization with crutches and a walking boot for 4-6 weeks then aggressive physical therapy.
Paul Gasol for the past four weeks has been non-weight bearing with crutches and will now continue to have daily physical therapy.

The majority of literature doesn't not support surgically repairing the plantar fascia.
We will keep you updated on his progress over the next month.

http://www.latimes.com/sports/lakersnow/la-sp-ln-pau-gasol-finally-off-crutches-20130226,0,4409235.story

Plantar fasciitis in NBA basketball player

Plantar fasciitis is one of the most common foot conditions that we see in our practice. The plantar fascia is an important structural ligament of the foot. The plantar fascia's origin is the heel bone and inserts into the base of the toes.
Paul Gasol who is a professional basketball player for the LA Lakers has been suffering from plantar fasciitis for the past several months. Typical treatment for a high level professional athlete involves aggressive Physical therapy, foot tapings, NSAIDS, custom orthotics, cortisone injections, ice, and for chronic cases immobilization with a cam walker boot.
Paul Gasol suffered a greater injury to his plantar fascia at his most recent game and will now undergo a MRI to rule out a plantar fascial tear.
Plantar fascial tears are typically treated with a period of immobilization non-weightbearing in a cam walker boot or cast for 6-8 weeks. 

http://www.newsobserver.com/2013/02/06/2658476/lakers-gasol-suffers-foot-injury.html

Topaz Procedure for Chronic Heel Pain

The Topaz Procedure: Carolina Foot Specialists utilizes the latest technology in cases of chronic heel pain that fails to respond to other conservative treatments. This procedure involves inserting a treatment wand into the plantar fascia through small stab incisions on the bottom of the heel.  The procedure is done under local anesthesia with IV sedation at a surgery center. An electrical current is applied to the treatment wand that causes an increase in blood flow to the ligament, reduction in the thickening, and a dramatic decrease in pain in the plantar fasciitis. The procedure take approximately 20 minutes. After the Topaz procedure, most patients are able to return to shoes with orthotics in a week and to most all other activities in 3-4 weeks.
If you or someone you know suffers from chronic heel pain please contact our office either in West Ashley or Mount Pleasant for a consultation.