Archive for the ‘Achilles Tendon’ Category

Wondering when you should replace your athletic shoes?

August 18th, 2015 by Mallory Snow

There are a few things that come into play when deciding if it is time to replace your athletic shoes.  Three ways to determine if they need to be replaced are amount of usage, signs of wear, and the age of the shoe.  The components of an athletic shoe that can break down and wear out are the outer sole, midsole, and heel.

The outer sole is typically made of carbon rubber, which is very abrasion resistant and also consists of 2 components.  Most athletic shoes will have a harder and more resilient rubber in the heel of the shoe since this is where most of the wear will occur.

The mid-sole is normally composed of a foam material, such as ethylene vinyl or polyurethane, sometimes even a blend of these materials.  This area of the shoe is intended to be shock absorbing and in some shoes, controls excessive foot motion.  The midsole will begin to compress over time, because of the repetitive load that is placed on that area.  The shoe will no longer absorb shock, or control the foot as well as it did when new.  Sometimes the midsole can compress and deform unevenly which can create alignment changes in the foot.  This can ultimately lead to injuries associated with over-use, such as achilles tendinitis, stress fractures, plantar fasciitis, and metatarsalgia.

Midsoles should be considered worn out if any of the following occur:

  1. After 300-500 miles of running or walking.
  2. Shows signs of unevenness when placed on a flat surface.
  3. Display noticeable creasing

The heel counter of the shoe helps hold the heel on top of the midsole and prevents excessive heel motion.  This area is considered broken down when it feels flexible, when compressed side to side, or appears to lean to one side or the other when viewing from the rear of the shoe.

It is typically best to replace athletic shoes that are over a year old, whether they are worn out or not.  Replacing athletic shoes when necessary may be costly in the short term, but can help prevent injuries and keep you active in “the long run”.

Custom Functional Orthotics

Custom orthotics are the best decision people can make to improve their foot health and function. Custom orthotics are unique and specially made to your feet.  Orthotics treat and correct individual foot ailments. Proper shoes fitted with custom foot orthotics are the best insurance that we can give ourselves to protect our feet.

Your orthotics are manufactured by a state-of-the-art fabrication facility utilizing the latest advancements in machinery and technology available today.  The fabrication starts with an analysis of your feet and a laser casting.  The image produced from this scan is sent to our lab where your device is “born”.  The technicians analyze these scans and make subtle adjustments to ensure a precise fit and form. Exact models of your feet are created on an automated CAD/CAM milling machine.  These models are used to form your orthotics with a high temperature pressure fit system.  Then they are assembled by hand and laminated.  The result is a set of orthotics made to your feet with Dr. Murray’s or Dr. Chang’s specific instructions and modifications to optimize your foot function.  This process typically takes 2 weeks and you will be called when they are ready.

Please bring the shoes you plan on using the orthotics with so one of our assistants can check for a proper fit. You will be given instructions to use with the orthotics during the “breaking-in” period. A follow up appointment will be made to discuss with the doctor how the orthotics are working for you. Some patients may need more time to get used to their orthotics and some orthotics may require adjustments.  Although most patients are happy with their devices immediately, we want you to appreciate the uniqueness of the human body and understand this process can sometimes take time to make the proper adjustments. Our goal is to help treat and correct your ailment so you can live a healthy and active lifestyle. Therefore, we include free adjustments for 90 days.  

One set of orthotics may suffice for many of our patients, but different activities require different accommodations. Therefore, some of our more active patients order multiple pairs of orthotics. Here are a few of the reasons why:

Custom Orthotics by Blue Ridge Foot and Ankle Clinic

Blue Ridge Foot and Ankle Clinic Custom Orhotics

I need a second set of orthotics for when my other pair gets wet.” – Local runner

I need orthotics for standing on a concrete floor all day and another pair for hiking with my family.” – Factory worker

My orthotics really help in my athletic shoes. I wish they worked in my dress shoes.” – Local business woman (we offer the Cobra, which is an orthotic designed to work with many casual and dress shoes)

Most of our orthotics are designed to last 5 to 10 years. Depending on your particular ailment, activity, and amount of use, your orthotics may need to be refurbished (re-covered) during this time period.

Cost:

First set – $395.00

Additional set – $300.00

Refurbishment – $75.00

These are the prices for non-covered orthotics; when covered by insurance, the prices are predetermined by the terms of the insurance plan.

Insurance coverage: Please verify with your insurance company that custom orthotics are a covered benefit and how your deductible and coinsurance apply.

Welcome to the Blue Ridge Foot and Clinic team. We look forward to helping you stay healthy and active.

 
Blue Ridge Foot and Ankle Clinic
 
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887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
New office in Fishersville will open early 2015 @
66 Parkway Lane Suite #102
Fishersville, VA 22939
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
rsz_running_card

 

Achilles Tendonitis and Achilles Tendonosis

July 21st, 2014 by Dr.Chang

Achilles Tendonitis and Achilles Tendonosis

The Achilles tendon connects the calf muscle to the heel bone and is the thickest and strongest tendon in the body in humans. While helping raise the foot off the ground with each step, the Achilles tendon can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running. Despite its ample strength, the Achilles tendon is prone to injury. The most common Achilles injuries are Achilles tendonitis and tendonosis, the former being inflammation of theachil Achilles tendon and the latter being degeneration of Achilles tendonitis. The inflammation from Achilles Tendonitis is usually short-lived. Over time, if tendonitis is not treated, it can degenerate into a worse condition called tendonosis, marked by tears in the tendon. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

Repeat after me: I will not run through my Achilles injury. The Achilles will not heal if you keep running on it. When you hurt your Achilles, it is time to start cross training and being gentle with it. The most common risks to the Achilles are sudden increases of repetitive activity without giving it enough time to repair itself. Intense activity causes micro-injuries in the tendon fibers, which require time to heal. Additionally, athletes and runners with inconsistent workout schedules, such as weekend warriors and those who increase their workout intensity and volume too quickly, are prone to Achilles injuries. Achilles injuries may also be due to physiological reasons such as excessive pronation and flat feet, which put extra pressure on the tendon while walking or running.

Achilles tendonitis and tendonosis will result in pain, aching and tenderness along the tendon’s path, increasing when the sides of the tendon are squeezed, but with less pain in the back of the tendon. To diagnose Achilles injuries, your podiatrist will examine the foot, its range of motion, and conduct further assessment with imagining techniques such as X-rays. Initial treatment will include rest. Using heal lift inserts on both feet, or wearing high-heeled shoes with an open back, can help relax the tendon and give it the rest it needs.

Treatment plans will focus on reducing force on the Achilles tendon by means of a cast or walking boot, reducing swelling with ice and oral medications, long term preventative strategies such as custom-made orthotics and night splints, and gradually building a physical therapy regimen that includes stretching and strengthening exercises, soft-tissue massage and mobilization, and ultra-sound therapy. Eccentric stretching and strengthening of the Achilles – that is, elongating the Achilles while doing exercises – are key to long-term rehab. Examples include, first, doing calf stretches in a small lunge with your hands pressing against a wall, second, sitting with one leg straight in front of you while flexing and pointing your toe, or, finally, doing toe raises at the edge of a step or stair. You may even want to consult your podiatrist and physical therapist about working on your gait and stride while running, as gait abnormalities can lead to Achilles tendon and other injuries.

To prevent Achilles tendon injuries, be sure that you strengthen and stretch your calf muscles daily, maintain proper footwear, and use custom-made orthotics if you have flat feet or pronate.


 

EXCITING NEW TECHNOLOGY NOW AVAILABLE

March 14th, 2014 by Dr.Chang

20140314_104101

Microlight ML830 Cold Laser

Cold laser therapy is a relatively new technology (30 years old) when compared to acupuncture which has been used since 8000-3500 B.C. Just like the abacus evolved into the computer, slowly needles are evolving into light. Recent innovations in low-level lasers now make it possible for the average physician or consumer to own cold laser equipment. Cold lasers are sometimes called Low Level Lasers (LLL) or soft lasers.

In general, cold lasers can be used in 2 distinct ways:

  • Targeting acupuncture trigger points (similar to acupuncture but without the needles)
  • Broad coverage of deep tissue with laser photons to stimulate changes in the tissue

Cold Laser therapy offers a non-intrusive option to acupuncture and surgery. It also provides a non-addicting treatment that eliminates the complications of long-term drug treatment programs. Cold laser are widely use for treatment of:

  • Acute and chronic pain
  • Ligament sprains
  • Muscle strain
  • Soft tissue injuries
  • Tendonitis
  • Arthritis
  • Tennis elbow
  • Back pain
  • Bursitis
  • Carpal Tunnel Syndrome
  • Fibromyalgia

pic_ml830Healing With Cold Lasers

The cold laser produces an impulse of light at a wavelength (approximate 900nm) that maximized the energy (in photons) at a desire depth, usually 10-13cm (4-5 inches) deep. This may be combined with other laser diode with a shorter wavelength (875nm) to add photons to the shallower levels of tissue. In addition, red light diode with a wavelength of 660nm may be used to add energy to even shallower levels of tissues.

The goal of laser therapy is to deliver light energy units from infrared laser radiation, called photons, to damaged cells. It is the consensus of experts is that photons absorbed by the cells through laser therapy stimulate the mitochondria to accelerate production of ATP. This biochemical increase in cell energy is used to transform live cells from a state of illness to a stable, healthy state.

Over 4000 studies have been conducted in recent years to validate the effectiveness of cold laser therapy. Cold lasers treatment systems may be cleared by the FDA.

Benefit of Cold Lasers

  • Easy to apply
  • Extremely safe
  • Non-Toxic
  • Non-Invasive
  • No side effects or pain
  • Cost effective for both the practitioner and patient
  • Highly effective in treating ailments (more than 90% efficacy)
  • Superior alternative to analgesics, NSAID’s and other medications
  • Reduces the need for surgery

General Therapeutic Laser Biological Effects

  • Increased Cell Growth: Laser photons accelerates cellular reproduction and growth.
  • Increased Metabolic Activity: Photons initiate a higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells and thus greater production of the basic food source for cells, Adenosine Tri-Phosphate (ATP).
  • Faster Wound Healing: Cold laser photons stimulates fibroblast development and accelerates collagen synthesis in damaged tissue
  • Anti-Inflammatory Action: Laser photons reduce swelling caused by bruising or inflammation of joints resulting in enhanced joint mobility.
  • Increased Vascular Activity: Laser photons induce temporary vasodilation that increases blood flow to effected areas.
  • Reduced Fibrous Tissue Formation: Laser photons reduce the formation of scar tissue following tissue damage from: cuts, scratches, burns or post surgery.
  • Stimulated Nerve Function: Laser photon exposure speeds the process of nerve cell reconnection to bring the numb areas back to life.

Types of Cold Lasers

Class I – III continuous and modulated lasers20140314_104154

The fixed level of power is too low to deliver photons beyond the surface of the skin, making them ineffective in delivering photons to deep tissues. This includes laser pointers and other low cost laser diodes.

Class IV Continuous Lasers

The increase in the power of class IV continuous wave lasers increases the photon delivery to deep tissues. Unfortunately, it also increases the amount of the heat generated. This heat increases the potential risk of destructive thermal effects. Class IV laser may result in damage to the retina requiring clinicians to exercise additional FDA implemented controls to ensure patient and practitioner safety. This can include a safely lock on the device to prevent accidental exposure.

Modulated Lasers (Class II to IV) Modulating or super-pulsing the laser output power (turning it on and off in less than 1 billionth of a second) provides a unique combination of benefits. It allows the use of very high power levels (up to 50 watts) while insuring that there is no heat or damage. The ratio between the on and off times is call the duty cycle. In general a super pulsed laser class II laser can provide more power to the treatment area than a class IV continuous lasers without a risk of damage. Modulated lasers provide a good combination of safety and power.

20140314_104226Summary

Today, lasers are used extensively in the medical industry for everything from cosmetic surgery, eye surgery and heart surgery. The ability to put just the right amount of energy into a critical area of the human body has been a huge advancement in the medical field. Cold lasers are an important addition to these other established medical laser treatments and the recent development of low-cost professional cold lasers means that cold laser therapy will be a rapidly growing medical treatment option.

Source: ColdLasers.org

cycle

Common cycling injuries are often due to trying to do, “too much, too soon”, but may also be due to improper equipment, biomechanics, technique, or bike fit.  As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.

Foot Pain

1. “Hot foot” (numbness and burning in the ball of the foot)

Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling which results in numbness, tingling, or burning, or sharp shooting pains into the toes.  Loosening shoe toe straps, wearing wider shoes with a stiffer sole and using anatomical footbed with a metarsal pad will help alleviate the problem.

Besides tight shoes, another risk factor is small pedals, especially if you have large feet.  Small pedal surfaces concentrate pressure on the ball of the foot.  Switching to larger pedals may be the cure.  Re-focus the pressure on the ball of the foot by moving the cleats towards the rear of the shoe.  If your cycling shoes have flexible soles like most mountain bike shoes, they’ll be less able to diffuse pressure.

Physician-designed custom orthotics provide biomechanical benefits and can be made with built-in “neuroma pads”.  Cycling orthotics are different than those for runners, as cycling is a forefoot activity, not a heel-strike activity.mt climb

Cortisone injections occasionally may be helpful for symptomatic relief, but they do not address the cause of the pain.

2. Sesamoiditis:

The sesamoids are two small “seed-like” bones found beneath the big toe joint.  Injury to these tiny bones can result in inflammation or even fracture, leading to debilitating pain and inactivity. Sesamoiditis can be relieved with proper shoe selection, accommodative padding, and foot orthoses.

Leg Pain

1. Achilles tendonitis

Irritation and inflammation of the tendon that attaches to the back of the heel done can be caused by improper pedaling, seat height, lack of a proper warm-up, or overtraining.  This condition is usually seen in more experienced riders and can be treated with ice, rest, aspirin, or other anti-inflammatory medications.  Chronic pain or any swelling should be professionally evaluated.  Floating pedals which allow excessive foot pronation may also worsen this condition.

2. Shin splints

Pain to either side of the leg bone, caused by muscle or tendon inflammation, which may be related to a muscle imbalance between opposing muscle groups in the leg.  It is commonly related to excessive foot pronation (collapsing arch).  Proper stretching, changing pedals, and corrective orthoses that limit pronation can help.

Knee Pain

Some intrinsic knee problems like swelling, clicking, or popping should be immediately evaluated by a sports medicine specialist.  Cartilage irritation or deterioration, usually under the knee-cap, can be caused by biomechanical imbalance, improper saddle height, or faulty foot positioning on the pedals.  Riding in too high a gear “mashing”, excessive uphill climbing, or standing on the pedals all may aggravate the problem.  Cleated shoes or touring shoes with ribbed soles that limit side-to-side motion can cause knee pain if the knees, feet, and pedals are misaligned.

1. Chondromalacia

Pain under the kneecap.  Most chondromalacia sufferers can ride at some level no matter how sever the degeneration.

2. Patellar Tendonitis

Strain of the tendon which attaches the kneecap to the leg, this injury often occurs in the novice cyclist or early in the cycling season.  The first sign of a problem may be an ominous twinge after cycling in too hard a gear.mark_1

Cycling tips

Bike fit is key; have a professional check your fit and make bike modifications as needed.

Carefully choose the shoes you will wear in cycling.

Train properly using adequate warm-up and cool-down. If you are doing “too much, too soon” and start having pain, reduce training frequency, intensity, and time.

Pain is not normal and may indicate a medical condition. Seek medical attention from a sports medicine specialist.

Before beginning any exercise program, be sure to check with your physician.

-The American Academy of Podiatric Sports Medicine (AAPSM)

 

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro, VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years.  Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming
you to our practice.

POWERSTEP CONTROLBlue Ridge Foot and Ankle Clinic is throwing in five pairs of Protech Powersteps as prizes at the Devils Playground steeple chase run on Sunday May 19th.  Come out and enjoy the fun.  Devils Backbone Brewing Company is a great place to eat, have a beer and enjoy the mountains.  Register here: https://www.runreg.com/Net/3555.  We’ll see you there.
 
 
 
 
 
 
 
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
 
 
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980       (540) 949-5150
                            
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

Achilles Tendonitis

March 27th, 2013 by Dr.Chang

achilles     If you are experiencing achilles tendonitis, you are not alone. In the United States, there are an estimated 250,000 sports-related achilles tendonitis cases per year. Many of these cases arise from nagging, and often neglected, pain in the back of the ankle. This blog will provide more information about achilles tendonitis: what it is, why can it cause recurring pain, and how can you work to prevent and heal your achilles tendonitis.
     The achilles tendon is a band of tissue that connects your calf muscles to your heel bone. When your calf muscles contract, the achilles tendon enables your heel to rise. Likewise, it helps decelerate your foot as it hits the ground during walking, running, or jumping, incurring a lot of impact while doing so. In fact, the achilles tendon can take on a load up to 4 times your body’s weight during a running or jumping activity! The achilles tendon is an active an crucial component of any standing movement or activity.
     There are different types of achilles tendon disorders and injuries. Achilles tendonitis is caused by the breakdown of the achilles tendon, which leads to inflammation and micro-tears in the tendon itself. When your tendon tears at a rate faster than the body can heal it, achilles tendonosis occurs, which is a chronic and irreversible tearing and inflammation of the tendon. Other achilles injuries include tenosynovitis, an inflammation of the tissue sheath that surrounds the achilles tendon, which can occur with, or lead to, chronic problems and irreparable tears in your achilles tendon. Retrocalcaneal bursitis is another commonly occurring achilles disorder, an inflammation of the fluid-filled cushion, called a bursa, under the achilles tendon. And, finally, an achilles rupture is a partial, or often complete, tear of the tendon.
     Most frequently, achilles tendonitis is a progressive injury, with a gradual onset due to overuse rather than being caused by a specific traumatic injury. It can be caused by weakness or lack of flexibility in the calf, or weakening due to age, and, most likely, by repetitive stress on the tendon and calf muscle. Achilles tendonitis is common among weekend warrior athletes, runners who have suddenly increased their mileage or increased it too quickly, or other athletes, such as tennis players, who put a lot of repetitive stress on their calves. Achilles tendonitis is also seen among those who have experienced rapid weight gain, those whose feet are flat or pronate excessively, and even those who wear poorly fitted shoes.achilles pain
     Symptoms of achilles tendonitis often begin with stiffness and creaking when getting out of bed in the morning, a mild ache in the back of the leg or above the heel after running or sporting activities. Light pinching of the sides of the achilles tendon will cause pain or soreness. Episodes of more severe pain may occur after prolonged running, stair climbing, or sprinting. Because achilles tendonitis symptoms are bound to worsen without treatment, it is paramount that you treat it early with a combination of working with your doctor, and learning self-maintenance strategies.
If you are experiencing persistent pain around the achilles tendon, contact your podiatrist. Dr. Chang and Dr. Murray at Blue Ridge Foot and Ankle Clinic are experienced and highly successful at treating achilles tendonitis.
     When you make an appointment with Blue Ridge Foot and Ankle to discuss your achilles tendon pain, be sure to think through what information will be crucial for your doctor to properly diagnose your achilles pain. Did your pain begin suddenly or gradually? When are your symptoms worst? What types of shoes do you wear regularly during the day, and what types of shoes do you wear for exercise? Have there been any dramatic changes in your lifestyle recently? Where exactly is the pain, and does any activity or movement trigger it? Does the pain lessen with rest? Have you tried any home remedies (such as Advil or Ibuprofen, ice, compression, or rest), and how has your achilles tendon felt in response? You doctor will consider this info, as well as conducting a physical exam of the area to identify pain, tenderness and swelling, as well as testing the raninflammed achillesge of motion, alignment and reflexes of your foot and ankle. If a tear is likely or suspected, your doctor will order an MRI to produce images of your achilles tendon.
     There are various measures your doctor and you can take to make your ankle repair and stop hurting, so you can get back to the activities that you love. Most cases of achilles tendonitis respond well to self-care: over-the-counter pain medications such as ibuprofen, rest, ice, compression, elevation, home exercises, even better fitting (more appropriately supportive) shoes. Your doctor may prescribe heel lifts, orthotic devices, physical therapy, and, if it does not heal over several months, possibly even surgery to repair tears in your tendon.
     To prevent injuries such as achilles tendonitis, remember to increase your activity level gradually. Cross-train and be sure to do exercises that specifically strengthen your legs and calves without putting undue stress on them. Stretch daily, after exercise. Keep your body hydrated and consume nutrient rich foods, which increase circulation and the rate of healing. Avoid smoking, which weakens tendons by reducing the rate of healing at a cellular level. Wear well-fitted shoes (with adequate cushioning for your heel and a firm arch support), which you can find in Charlottesville at Ragged Mountain Running or Richey and Co. Shoes . And, most importantly, rest (slow down or stop) when you start feeling the pain come back.
Dr. Chang and Dr. Murray to have decades of experience successfully treating achilles tendon injures. So contact us at Blue Ridge Foot and Ankle to help you solve your achilles pain.
 
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
 
 
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
 
 
 
 
 
 
 

ds

The Achilles tendon connects the calf muscle to the heel bone and is the thickest and strongest tendon in the body in humans. While helping raise the foot off the ground with each step, the Achilles tendon can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running. Despite its ample strength, the Achilles tendon is prone to injury. The most common Achilles injuries are Achilles tendonitis and tendonosis, the former being inflammation of the Achilles tendon and the latter being degeneration of Achilles tendonitis. The inflammation from Achilles Tendonitis is usually short-lived. Over time, if tendonitis is not treated, it can degenerate into a worse condition called tendonosis, marked by tears in the tendon. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

Repeat after me: I will not run through my Achilles injury. The Achilles will not heal if you keep running on it. When you hurt your Achilles, it is time to start cross training and being gentle with it. The most common risks to the Achilles are sudden increases of repetitive activity without giving it enough time to repair itself. Intense activity causes micro-injuries in the tendon fibers, which require time to heal. Additionally, athletes and runners with inconsistent workout schedules, such as weekend warriors and those who increase their workout intensity and volume too quickly, are prone to Achilles injuries. Achilles injuries may also be due to physiological reasons such as excessive pronation and flat feet, which put extra pressure on the tendon while walking or running.

Achilles tendonitis and tendonosis will result in pain, aching and tenderness along the tendon’s path, increasing when the sides of the tendon are squeezed, but with less pain in the back of the tendon. To diagnose Achilles injuries, your podiatrist will examine the foot, its range of motion, and conduct further assessment with imagining techniques such as X-rays. Initial treatment will include rest. Using heal lift inserts on both feet, or wearing high-heeled shoes with an open back, can help relax the tendon and give it the rest it needs.

Treatment plans will focus on reducing force on the Achilles tendon by means of a cast or walking boot, reducing swelling with ice and oral medications, long term preventative strategies such as custom-made orthotics and night splints, and gradually building a physical therapy regimen that includes stretching and strengthening exercises, soft-tissue massage and mobilization, and ultra-sound therapy. Eccentric stretching and strengthening of the Achilles – that is, elongating the Achilles while doing exercises – are key to long-term rehab. Examples include, first, doing calf stretches in a small lunge with your hands pressing against a wall, second, sitting with one leg straight in front of you while flexing and pointing your toe, or, finally, doing toe raises at the edge of a step or stair. You may even want to consult your podiatrist and physical therapist about working on your gait and stride while running, as gait abnormalities can lead to Achilles tendon and other injuries.

To prevent Achilles tendon injuries, be sure that you strengthen and stretch your calf muscles daily, maintain proper footwear, and use custom-made orthotics if you have flat feet or pronate.

 

Are you sick and tired of chronic pain and injuries that won’t go away? Don’t lose hope! Blue Ridge Foot and Ankle is now offering Extracorpeal Pulse Activation Treatment (EPAT), a cutting edge technology proven to increase the rate of healing for soft tissue injuries.

EPAT, also called Shockwave Therapy, was developed in Europe by the company CuraMedix, but is now being used by doctors world wide. EPAT is an FDA approved emerging technology that delivers non-invasive low frequency (8-11 Hz) acoustic sound waves into a localized area. The sound waves act as pressure, and penetrate deep through your soft tissue. The energy emitted causes the cells in your soft tissue to release certain biochemicals that intensify the body’s natural healing process. These biochemicals allow for the building of an array of new microscopic blood vessels in your soft tissue. Overall, EPAT increases the nutrient flow to the chronically injured tissue, stimulating your cell metabolic rate, and giving hope for those who are considering surgery as their only option.

EPAT studies promise that, with EPAT treatments, you will have your cake and eat it too: first off, you can continue the activities that you love through treatment. Secondly you will not need surgery. Finally, you will still reap positive results – many times, more positive results than any other available treatment. In fact, the results of other treatments such cortisteroidal injections, orthoses, e-stim, and even surgery, seem to be significantly less effective in research studies than EPAT.  Moreover, more than 80% of patients who have failed to respond to anything other treatment are relieved of their pain after being treated with EPAT. Furthermore, While studies on ultrasound methods have been conflicting (Alexander, L.D. et al 2009), EPAT therapy studies, even when conducted by skeptics of EPAT, have seen resounding success in EPAT effectiveness to cure soft tissue maladies (Saxena 2011; Gerdesmeyer, L. 2008; Ibrahim, I. M. in press; Rompe, J.D. 2009; Rompe, J. D. 2008; Rompe, J. D. 2007; Rompe, J. D. 2009; Rompe, J. D.  2009; Furia, J. P. 2009).   These studies, with high standards of wellness and success rates, show between 75% – 95% success with EPAT.

After trying other types of treatment (cortisone injections, stretching, anti-inflammatories, night splints, physical therapy, and orthotic devices), you might be disheartened to start considering surgery for your injury. However, consult Dr. Murray and Dr. Chang about EPAT, since it might be a viable option instead of invasive surgery. EPAT is a small machine with a trigger end that looks like an ultrasound. It is administered once a week for a series of three weeks (up to five weeks), each taking approximately fifteen minutes (depending on the area of injury). Dr. Murray and Dr. Chang will apply coupling gel and use the EPAT on the area, in essence, breaking the soft tissue down and providing an opportunity for your cell responses to quickly get rid of dead cells and regenerate new ones. In essence, this is the most rapid stimulation of cell generation, known to have the most rapid healing rate of any technology out there.

EPAT can be used for acute and chronic musculo-skeletal pain – even knots, dysfunction, plantar fasciitis, Achilles Tendonitis and tendonosis, chronic heel pain, tendonal insertional pain, acute and chronic muscle pain, myofascial trigger points, and the list goes on. There have been very few side effects reported – in few cases, skin bruising may occur, and patients may feel sore afterward, as though they have worked out. Patients who choose EPAT treatment should not take NSAIDs (including ibuprofen, Motrin, Advil, Naproxen, Aleve, and Aspirin) for two weeks prior to and one month after the administration of EPAT, as they interfere with the hormones that regenerate your cells.

EPAT is available for a wide range of patients. Research suggests to postpone EPAT treatment for pregnant women, for deep venous thrombosis or malignancy cases, or if you are taking blood thinners. These studies suggest that women should wait until four months after pregnancy to receive EPAT treatment, waiting for regular swelling in the feet to go down, and for the hormones that act as muscle relaxants during pregnancy to level out.

While the initial fees for EPAT are expensive, you can rest assured that they are cost-effective in the long run. EPAT is not covered by insurance. You can expect to pay $500 for a series of three treatments, not including the fee of a co-pay for your initial office visit and evaluation charge, (after which there will be no co-pay). Inquire with your qualified health savings account or your employer’s flexible payment medical savings account, as these can usually be used to pay for the treatment. If a 4th and 5th treatment is necessary, you can expect to pay $150 per treatment. Despite these initial costs, remember that surgery is much pricier, and that EPAT is proven to be much more effective than other treatments. Additionally, patients treated with EPAT are immediately fully weight bearing, have no incision, no risk of infection or scar tissue, experience very few (if any) side effects, and do not need to be put under anesthesia. Overall, EPAT is sure to save money and time, and to accelerate your road back to having healthy feet!

So inquire with Dr. Murray and Dr. Chang to see if EPAT is the right treatment for you. Blue Ridge Foot and Ankle is excited to bring such an effective and preeminent technology to the office, in order to serve you with top quality and cutting edge medical care!

Comment on this post to share your sesamoid injury story or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic

Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116

Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

 

Treating Heel Pain: Achilles Tendonitis

December 28th, 2011 by Dr.Chang

Injuries to the Achilles tendon, the tissue that connects the calf muscle to the heel bone, can cause considerable heel pain. The most common Achilles injuries are Achilles tendonitis and tendonosis, the former being inflammation of the Achilles tendon and the latter being degeneration of Achilles tendonitis. The inflammation from Achilles Tendonitis is usually short-lived. Over time, if tendonitis is not treated, it can degenerate into a worse condition called tendonosis, marked by tears in the tendon. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

The most common risks to the Achilles, similar to the prognosis for stress fractures, are sudden increases of repetitive activity without giving the Achilles tendon the proper time to repair itself from the micro-injuries to the tendon fibers caused by intense activity. Additionally, Achilles injuries may be due to physiological reasons such as flat feet, which put extra pressure on the tendon while walking or running.

Achilles tendonitis and tendonosis will result in pain, aching and tenderness along the tendon’s path, increasing when the sides of the tendon are squeezed but with less pain in the back of the tendon. To diagnose Achilles injuries, your podiatrist will examine the foot, its range of motion, and may conduct further assessment with imagining techniques such as X-rays.

Treatment plans for Achilles tendonitis and tendonosis will focus on reducing force on the Achilles tendon by means of a cast or walking boot, reducing swelling with ice and oral medications, long term preventative strategies such as over the counter and custom orthotics and night splints, and gradually building a physical therapy regimen that includes stretching and strengthening exercises, soft-tissue massage and mobilization, and ultra-sound therapy.

One major factor in Achilles injuries is excessive tightness of the posterior leg muscles and even connected tendons, so physical therapy and long term maintenance will include light calf stretches, hamstring stretches, and plantar stretches after warming up, to ensure the health of your Achilles. You may even want to consult your podiatrist and physical therapist about working on your gait and stride while running, as gait abnormalities can lead to Achilles tendon and other injuries.  Your training plan might need to be altered – working out for fewer hours per week, cutting down on speed work, hill repeats, strengthening and plyometric work, and avoiding excessive stretching. Specific methods of taping may also help to take pressure off the Achilles and to increase blood flow to the affected area.

Additionally, your doctor will suggest the proper footwear for you to recover or point you toward shoe experts. For example, soft cushioned soles or air filled heels can contribute to Achilles injuries since they make the foot sink lower in the shoe to absorb the shock of heel strike, thereby stretching the Achilles tendon with each stride more than a firm-soled shoe would.

Achilles ruptures are usually treated with surgery. This surgery will effectively stitch the lesion in the tendon. Brace yourself – after an Achilles rupture you’re in for a long recovery. Achilles injuries are often followed by at least 12 weeks of casts, braces and splints. Current research suggests that, depending on the degree of injury and individual constraints, early motion can be an acceptable form of rehabilitation (which would include light physical therapy immediately after the surgery). In either case, your podiatrist will probably suggest that you wear a heel lift for up to one year after the removal of the cast. In recovery, a range of care will be required that includes physical therapy, icing, taping, non-steroidal anti-inflammatory drugs. Consult your podiatrist for the appropriate treatment plan for your ankle pain.

Catching and treating Achilles injuries early is key to healing successfully. Once you start feeling Achilles pain do not ignore it. Visit Dr. Murray and Dr. Chang, your Charlottesville and Waynesboro podiatrists, and they can help you construct a treatment plan and all sorts of preventative exercises that are right for your individual injury. In many cases, there are preventative measures within your control before a severe Achilles injury stops you from running or engaging in your day-to-day activities.

 

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