Treatment options for chronic heel pain in runners

Epidemic of Heel Pain in the running population

Heel pain is the most common complaint that we see in our office. The typical ages of complaints of heel pain are between the age of 40 and 60, which is the largest age segment in our population.

There is a growing consensus of opinion that plantar fascitis is best treated non-surgically with the vast majority of patients becoming asymptomatic within twelve months of the onset of symptoms.

During this time of the year many of our patients are training for upcoming races such as the Cooper River Bridge run and various ½ and full Marathons. We would like to discuss our experience with treating heel pain in our running population and state of the art treatments if heel pain is a chronic issue.

PATHOMECHANICS

Contributing factors are tightness of the achilles tendon, overload of the soft tissues, leg length inequality, excessive flattening of the arch, high arched feet, and high impact sports. It is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot.

TREATMENT STRATEGIES FOR THE ATHLETE

In most cases, the goal of the athlete ie. runners is to quickly return to activities to minimize loss of fitness and performance. In our practice we see a high volume of recreational and seasoned competitive runners

1) Assignment to alternative activity

The athlete must be encouraged to maintain cardiovascular fitness during rest from damaging activities that may delay healing. For the running population that suffers from heel pain we try to encourage cross training to lessen the load on the feet. The goal should be assigned to alternative cardiovascular fitness activities that minimize impact and loading on the plantar fascia including stationary cycling, swimming, yoga, pilates, upper body weight machines, and low resistance flat-footed stair master machines These activities help to maintain physical aerobic fitness as well as keep the ligaments and tendons flexible. In addition if you are currently training for a road race lessening the amount of days with respects to your running schedule can be a big help. Personally I was suffering with some minor heel pain and was training for the Charleston ½ Marathon. I changed my frequency of training during the week in which I ran two shorter runs during the week and a longer run on the weekend. This was a three day a week training schedule for 8 weeks and it made all the difference in the world for me.

2) Change and modulation of footwear

Footwear analysis is critical for evaluating athletes with chronic heel pain. The footwear may be a contributory factor and can be utilized as a powerful treatment modality. Athletes should be placed into shoes that have a minimal 1" heel height with a strong stable midfoot shank and relative uninhibited forefoot flexibility. The American Academy of Podiatric Sports Medicine has a list of recommended footwear for the athlete that can be obtained on their web site: www.aapsm.org.It is well recognized that recent trends in athletic footwear have actually predisposed to greater frequency of plantar fascitis due to the fact that athletic shoes have weaker midsoles with newer designs. The popular "two-piece" outsoles with an exposed midsole cause a hinge effect across the midfoot placing excessive strain on the plantar fascia in the running and jumping athlete. These shoes must be eliminated if the injured athlete is wearing them. We recommended around the house to wear oofos or vionic sandals especially if you have hard wood floors.

3) Home therapy

Runners are accustomed to designing and participating in their own training programs. They are willing participants in their own treatment programs. Heel cord stretching is central to the rehabilitation process to decrease load on the plantar fascia and encourage healing. The use of plantar fascia night splints has been well proven to be a treatment adjunct for plantar fascitis by placing the heel cord and the plantar fascia on a sustained static stretch during sleeping hours while preventing the normal contractures that occur in the relaxed foot position during sleep. We recommend runners roll or massage their foot on a golf ball or tennis ball is helpful to improve blood flow and break down adhesions in the injury site.

4) Custom foot orthoses

Intervention with semi-rigid custom foot orthoses has been well proven in many prospective and retrospective studies showing successful outcomes in patients with plantar fascitis. In the athlete, the use of foot orthoses should be considered earlier than in the average sedentary patient because of the fact that the athlete will be subjecting their feet to greater stresses during treatment and certainly after return to activity. Athletic footwear is more amenable to semi-rigid and rigid orthotic therapy than are casual shoes worn by sedentary patients. We like our runners to be fitted for plantar fascial and achilles foot sleeves which help to take the strain and stress off the plantar fascia while running.  We also teach our patient about specific taping methods such as low dye taping that can be applied on the bottom of the foot to take the strain off the plantar fascia.  arch taping procedures.

5) Physical therapy

Physical Therapy is an effective modality for runners because investing this time can help to maintain and increase flexibility. We are big fans of ultrasound, cupping, dry needling, and iontophoresis.

6) Anti-inflammatory medication

Anti-inflammatory medications and cortisone injections can be used in the right situations to decrease inflammation and reduce soft tissue swelling. We typically will start with a short term course of oral NSAIDS and if the heel pain is severe enough will consider a series of cortisone injections to not exceed three in a given year.

7) EPAT (Shockwave Treatment)

The EPAT procedure is a state of the art non-invasive treatment for chronic plantar fasciosis and achilles tendonitis. The procedure is performed in the office setting without anesthesia. The procedure involves sending high energy sound waves into the heel to break up scar tissue and increase circulation so that the body heals itself. This is becoming the standard treatment for chronic heel pain and has a 85% resolution of heel pain 8-10 weeks out from the initial treatment. We have had a great number of runners suffering from chronic heel pain over the past few years do very well with this in office procedure.

CONCLUSION:

Runners presenting with plantar fascitis must be treated aggressively because they have immediate needs and long-range goals that are different than those seen in the average sedentary patient with heel pain. It is important to be aggressive and employ a variety of modalities and treatments when formulating a treatment plan for the athlete

The cornerstone of plantar fascitis treatment for the athlete is biomechanical. Podiatric practitioners possess the greatest skill set and knowledge available in medicine today to adequately address the pathomechanics of plantar fascia overload. The use of properly casted and designed custom foot orthoses should be the cornerstone of non-surgical treatment of subcalcaneal pain in the athlete.

Please check out this very informative blog that discusses heel pain in adolescents. We see many young athletes that present in our offices with heel pain. A good majority of the time it is a growth plate injury of the heel called Calcaneal apophysitis or Sever's disease. Fortunately this is a treatable condition if recognized early.
If your child is suffering from heel pain that has not improved after a few weeks please call our offices so that we can resolve this specific injury.

http://www.drblakeshealingsole.com/2011/11/severs-disease-growth-plate-injury-in.html

Do heel spurs causes heel pain?

https://www.verywellhealth.com/heel-spur-diagnosis-and-treatment-2548574

Baseball And Your Feet

Baseball And Your Feet

America's Pastime

For more than a century and a half, America has carried on a love affair with baseball. Kids slam fists in their first gloves, and dream of one day playing in the big leagues. For a few, the dream comes true. The rest of us keep the fantasy alive through youth leagues, on adult softball teams, or pickup games with friends. We pledge allegiance to our favorite major league team, sharing the triumph or agony of every win and loss.

More than following big league baseball, we all want to play the game ourselves--to hear the crack of a base hit, execute an around-the-horn double play, or shag a screaming liner. But like all vigorous exercise, baseball and softball should be played sensibly and safely. Improper preparation and technique can lead to injury, especially to the lower extremities, which take us around the bases and under fly balls.

Before the First Pitch

Most American kids begin playing organized baseball at age 6 or 7. If a child is in generally good health and has no preexisting physically compromising conditions, baseball is relatively safe with proper instruction in the game's fundamentals.

Weekend warriors who pick up the sport again in adulthood are less apt to be in optimum condition than younger athletes, and should take it slow before jumping right into a game. Anyone who is more than 40 years old, diabetic, a smoker, or has any physical disability should see a family physician before taking the field. People with existing foot problems should see a podiatric physician specializing in sports medicine, who can perform a gait analysis and assess any risk inherent in a sports regimen.

Because baseball and softball involve quick starts and stops, it's important to loosen up before the game. Even the youngest children should make sure to do some simple stretching, running and playing catch before the game to avoid muscle pulls or other problems.

Before playing pickup games, make sure the field is free of hazards like holes on the base path, which could cause a foot or ankle injury. Sticks, rocks, and other debris on the field cause players to trip, risking injuries, and should be removed.

Shoeing Up for Baseball

Young players will do well to wear molded cleats rather then steel spikes. They should be gradually introduced before being worn in a game. A young player needs to get a feel for cleats, which should not be worn off the field.

While the improved traction of cleats may enhance play, it also leaves the ankle more susceptible to twists and turns. Any child with preexisting foot conditions should see a podiatric physician before putting on cleats. Never put a child in hand-me-downs; ill-fitting cleats increase the danger of ankle injuries. When sizing cleats, make sure the feet are measured by a footwear technician, and always wear a game-size sock when trying them on.

In some competitive baseball leagues, the use of metal spikes is permitted for players more than 13 years old. Spikes must be understood as dangerous weapons on the base paths; they require a certain level of maturity to be worn safely. They are not necessary for casual play, and should not be worn unless in league competition.

Spikes, which technology has made lighter and more flexible these days, perform the same function as cleats, but engage the ground differently. They too should be worn on a limited basis until the feel of how they engage the turf is understood. Unfamiliarity with spikes can lead to ankle twists and turns in a competitive situation.

When wearing cleats or spikes for the first time, watch for irritation, blisters, or redness, which could indicate a biomechanical problem in the legs or feet. Pain is a clear indicator of a problem. If cleats cause pain, discontinue wear for two to three days; if it returns, see a podiatric physician specializing in sports medicine for evaluation.

Preventing Baseball Injuries

One of baseball's most exciting moments comes when a batter stretches a single into a double by beating the tag in a dust-kicking slide. Sliding is a fun part of the game at all levels, but proper technique is crucial to avoiding foot and ankle injuries, especially when bases are firmly secured to the infield. Coaches at all levels should make sure their players are well schooled in proper sliding. Careless slides can result in sprains and even fractures of the lower leg and feet.

Pitchers also need to be coached on the proper way to come off an elevated mound with their back foot and land on an incline with the front foot. The repetitive motion of pitching can lead to overuse injuries to the feet and ankles. Pitchers experiencing pain in their windup should take a few days off before returning to the mound.

Catchers too are susceptible to overuse injuries by squatting behind home plate for every pitch. Again, coaches should teach their catchers how to alter their stance to vary weight displacement.

Today's trend of trying to achieve perfection by year round sport participation may result in an overall increase in injury. This is not just a lower extremity phenomena but is often seen in young pitchers having both elbow and rotator cuff injuries serious enough to lead to surgery while still in high school.

Lower Extremity Injuries and Treatment

Contusions. A baseball will inevitably make contact with a player's foot and ankle, whether it's a pitched ball, foul tip, or line drive, and sliding base runners often run headlong into a infielder's legs. Usually this contact results in contusions, which are not often serious injuries. Ice packs and a few days' rest will usually help the contusions, or bruises, feel better.

Sprains and fractures. Stretched or torn ligaments, known as sprains, can occur from running the bases, or pivoting to make a play. Sprains may cause extensive swelling around the ankle just like a fracture. Immediate treatment from a podiatric physician is crucial to quick healing. Fractures, where the bone has cracked or broken, often require casting. After a sprain or fracture, a podiatric physician can prescribe a rehabilitation regimen to restore strength to the injured area before returning to the sport.

Plantar fasciitis. Catchers are particularly susceptible to arch pain, commonly traced to an inflammation called plantar fasciitis, on the bottom of the foot. A podiatric physician can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.

Heel Spur Syndrome. A related condition, to which catchers are also susceptible, is heel spur syndrome. Often related to plantar fasciitis, heel spur syndrome occurs when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. Many times the ligament pulling on the heel creates the symptoms, and not the spur itself, especially after getting up from resting. With proper warm-up and the use of supportive shoes, strain to the ligament can be reduced.

Achilles tendinitis. The stop-and-start of baseball often creates pain and tightness in the calf, and aggravation of the Achilles tendon. Again, regular stretching of the calf muscles gently and gradually before and after the game will help minimize the pain and stiffness.

Shin splints. Shin splints usually stem from an inflammation of the muscle and tendon attached to the shin, caused by stress factors. Treat shin pain with cold compresses immediately after a game to reduce inflammation. Proper stretching and strengthening exercises should prevent the onset of shin splints.

- See more at: carolinafootspecialists.net

The three most common foot injuries in athletes

Here are the top 3 foot injuries in athletes, so you’ll know what to look for.

1. Turf Toe

Does the joint of your big toe hurt when you push off to sprint or jump? This is commonly known as turf toe, a condition that results in painful running and activities. The good news? Ice and rest can remedy the condition. There’s also ways to tape your turf toe to reduce pain and protect yourself from further injury.

2. Bunions

Bunions aren’t just associated with high heels anymore. Tight athletic shoes can put pressure on the joint of the big toe, leading to painful bunions. Proper arch support can help you avoid this problem by making sure you aren’t pushing off using ligaments that can lead to flatfeet. If you push off using the ball of your foot instead of your big toe, it can lead to bunions.
If you suspect you have a bunion, seek treatment because once it is fully formed, only surgery can correct the problem.

3. Plantar Fasciitis

Heel pain is nothing to joke around about. Athletes with plantar fasciitis will usually experience pain when they first wake up and take a few steps. Advanced plantar fasciitis can cause pain even when the athlete is not weight bearing on that foot.
Depending on the degree of degeneration of the plantar fascia, surgery may be required. Dr. Saffer and Dr. Brown are keep up with the latest minimally invasive state of the art treatment for chronic heel pain. The Doctor's utilize Topaz and the instep plantar fasciotomy as minimally invasive surgical techniques and are looking at treatment options with Biologics such as PRP, BioD restore (placental tissue allograft), and the Tenex procedure.
If you suspect you have a foot injury, get treatment immediately. Waiting can cause foot injuries in athletes to worsen due to the amount of activity and stress put on the injury. To schedule a consultation contact our offices for a consultation:
Charleston with Dr. Brown (843-225-5575)
Mount Pleasant with Dr. Saffer (843-654-8250)

2015 Has Started On the Right Foot

2015 has gotten off to a great start for Carolina Foot Specialists! Since the first of the year we have launched a new & improved website, added three digital scanners for our custom orthotics AND have added an online appointment booking system through our website and Facebook page.

We are very excited about the things to come in 2015 and are looking forward to another year of giving BEST treatment options to our patients throughout Charleston and beyond.

Visit our new website and tell us what you think~
http://www.carolinafootspecialists.net/

Check out the new options on Facebook such as Appointments & Locations ~
https://www.facebook.com/pages/Carolina-Foot-Specialists/

Our goal is to make seeing us a simple part of your day, from scheduling straight through your visit, we want all our patients to know we put them first. Whatever your aches, pains, injuries or concerns visit Carolina Foot Specialists for all your foot & ankle problems.

Charleston Office~Dr. Adam Brown, 
615 Wesley Dr. Ste 340 Charleston, SC 29407 (843)-225-5575

Mt. Pleasant Office~Dr. Andrew Saffer
501 Bramson Ct. Ste 301 Mt Pleasant, SC 29464 (843)-654-8250

The Dreaded Shin Splints

Shin splints seem like a normal side effect to activity, but the truth is a few simple precautions can stop your pain. Shin splints refer to pain on either side of the leg bone that is caused by muscle or tendon inflammation.

Shin splints are often related to a collapsing arch (flat foot), but may be caused by a muscle imbalance between opposing muscle groups in the leg due to increasing intensity or distance of workouts, or due to a lack of cross training (strengthening all your muscles not just the ones used in your sport).

At the other extreme are people with "high arch feet". These feet are very tight-jointed and do not yield enough upon impact. Common rigid foot running injuries are stress fractures, ball of the foot pain, and shin splints.

In addition, wearing the wrong time of athletic shoe for your feet or not replacing shoes at the proper time can also increase the risk of getting shin splints. Proper stretching before and after exercise and sports can help to alleviate the occurrence of shin splints and to reduce the pain in already existing ones.

In severe cases we recommend corrective shoes, or orthotics (corrective shoe inserts) to help prevent shin splints.

As you can see many people across the board suffer from this issue. Being proactive with your footwear and proper stretching can save you a lot of down time, corrective measures, money and pain in the long run. If you are suffering from pain or would like ideas on stretches and preventative measures please contact us today.

Preparation is Key

It’s the most wonderful time of the year- racing season!
Many of you here in Charleston are beginning your rigorous training schedules for 5ks, 10ks, halves and full marathons. It’s hard to resist the urge to get outside and run as the weather turns nice, but we suggest you make sure your feet are race ready before hitting the pavement. Preparation is always key.

1- Get the right equipment.
This doesn’t mean buying the most expensive, professional running gear, but we always suggest investing in new shoes (or being refitted to make sure yours are correct for your feet) and grabbing some drifit/moisture wicking socks to prevent prolonged moisture as well as blisters.

2- Visit a podiatrist for pre-competition evaluations.
Making sure you don’t have any pre existing conditions is huge, especially when training for a longer endurance event. Discussing your foot form, running strides and any current issues can help Dr. Brown or Dr. Saffer direct you on the best path for safe training.

3- Utilize our Pre and Post Race Physical Therapy.
Strengthening specific muscles and muscle groups as well as proper stretching is vital to not only a successful race day, but also to injury free training.

For upcoming races around Charleston visit here.

Looking for a destination race? Visit here. 

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.