Archive for the ‘Foot Pain’ Category

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Foot Injury: Tips and pointers.

April 27th, 2016 by Dr.Chang

Sneakers

Here is the latest copy of the APMA Newsletter “Footprints”. Focus on Foot Injury: Identification, management and protection tips from future injury.

APMA Footprints April 2016 Newsletter

Elaine Allen, DPM joins Blue Ridge Foot and Ankle Clinic
Elaine Allen, DPM joins Blue Ridge Foot and Ankle Clinic

Blue Ridge Foot and Ankle Clinic is pleased to announce Dr. Elaine Allen will be joining our practice. Dr. Allen is Board Certified in Foot Surgery by the American Board of Foot and Ankle Surgery. Dr.  Allen has been actively practicing podiatry and foot & ankle surgery in Virginia and Georgia for 8 years.  She will be seeing patients in our newly built Fishersville office beginning September 14, 2015.

Call our Fishersville office at (540) 949-5150 or schedule and appointment online at Schedule Appointment to consult with Dr Allen on your foot and ankle injury or concern.

WELCOME DR ALLEN !!!

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.
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We Offer Custom Functional Orthotics

September 22nd, 2014 by Dr.Chang

Orthotics are commonly suggested aides to recovery and injury prevention. Orthotic shoe inserts control the motion between the forefoot and the rear foot, evenly distributing the weight and pressure exerted on the foot. They reduce excessive motion that may occur in certain feet, they can act as a binding force that absorbs strain as pressure is exerted on them, and they can accommodate and cushion painful or injured areas. “While not everyone needs orthotics,” Dr. Murray notes, “they are a highly successful conservative treatment strategy for certain types of feet and foot conditions.” For problems ranging from structural deformities, such as bunions, to conditions such as posterior tibial tendonitis, orthotics are an economic way to both treat pain and prevent further injuries.orthotic pic reduced

Through their forty years of combined experience in working with Charlottesvillian feet, Dr. Murray and Dr. Chang have found resounding success in prescribing and fitting orthotics to fit a variety of foot types and injuries. The process for getting orthotics takes some time, primarily because Dr. Murray and Dr. Chang want to make sure that orthotics are right for the health of your feet.

If you suspect that you need orthotics or if you have foot pain, a first visit will include a foot examination, as well as an examination of your shoes. That’s right, bring your shoes to your appointment. The reason being is that the number one cause of foot pain and related injuries is worn out shoes. “Shoes are just not made to be worn forever,” comments Charlottesville shoe guru, Mark Lorenzoni of Ragged Mountain Running. Lorenzoni, a veteran runner and long-time shoe salesman, argues that you should be just as wary of your daily shoes as you are of your athletic shoes. Shoes should be sized properly in regard to the width of the different parts of your foot as well as your gait, your arch, and any propensities your foot may have to pronate. Shoes support your foot by guiding its motion.

If you did not consider which shoes are best for your individual feet, or if you wore out your shoes and kept using them, you may be experiencing a host of problems. Shoes that are too loose can cause blisters or problems with your Achilles tendon; shoes that are too tight could cause plantar fasciitis or aggravate bunions and bursitis; shoes too wide could cause problems in the ankle of people who pronate, and shoes too tight could cause ankle pain in a supinator. So if you come in telling Dr. Chang and Dr. Murray that you have kept working out in over-worn or ill-fitted shoes, they may just send you back to Lorenzoni’s shop. There, a number of trained shoe experts will conduct a gait analysis and draw on their years of expertise in the industry to match your feet to the proper shoe. And a time-saving strategy may be just trying new shoes and replacing your shoes every 200-400 miles, according to the chart below. The good news is that purchasing new shoes is often a complete solution to burgeoning foot pain! The shoe mileage chart below, created by the family at Ragged Mountain Running Shop, can help you sort out when to replace your shoes.

Shoe Mileage Chart

Over half the injuries runners and walkers experience can be directly attributed to “worn out shoes”. Worn out refers to the midsole (engine) of the shoe, which is the most important component of an athletic shoe. Don’t use the outsole/tread wear as a way of determining how much life is left in your shoes! This midsole component generally lasts about 375-450 miles of athletic use. Cut that mileage rating in half if you choose in addition to use your shoes for anything other than your running or walking exercise (i.e. “wearing around”). Here is a sample mileage chart to determine how often you might need to replace your exercise shoes.

Exercise miles/week5 miles/week10 miles/week15 miles/week

20 miles/week

25 miles/week

30 miles/week

35 miles/week

40 miles/week

50 miles/week

When to replace shoesEvery 18 months-two yearsEvery 10 months-1 yearEvery 6-9 months

Every 5-7 months

Every 4-6 months

Every 3-4 months

Every 3 months

Every 2.5-3 months

Every 2-2.5 months

*Created by the family at Ragged Mountain Running Shop*

New shoes, however, may not solve all your foot pain. If you still feel pain after you try out your spiffy new, well-fit shoes, it is time to visit your Charlottesville podiatrist. To get closer to the root of your foot pain problem, Dr. Murray and Dr. Chang are likely to suggest that you wear an over-the-counter shoe insert for a couple of weeks. These inserts cost between $35 and $60, and test whether your foot needs a little extra support or more specific support from an orthotic. If pain still occurs, upon the next visit Dr. Murray, Dr. Chang and their staff will assist you with taping your foot. The tape, in addition to the over-the-counter shoe inserts, will help to redistribute weight throughout the whole foot, binding it in a way similar to an orthotic to test whether a pair of custom-made orthotics will help you. Orthotics last about 5 years (depending on use), they lessen the likelihood of injuries, reduce doctors visits, and relieve pain.

The prescription for your orthotics will depend on your foot type, your condition or injury, and the intended purpose of the orthotic. To this effect, there are different kinds of orthotics. Orthotics are mainly grouped into two categories: functional and accommodative. Functional orthotics correct for excessive motion of the foot, preventing pain during ambulation. Accommodative orthotics are used to distribute weight away from a painful or injured area. Dr. Murray and Dr. Chang will scan your foot and write a customized prescription for your orthotics to fit your orthotics’ purpose and your intended activities. They will consider materials used, the rigidity of the device, and the shape of the heel or head to ensure you go home with the right product.

The process to begin wearing orthotics is gradual. It takes 2-3 weeks to work up to wearing an orthotic full time since the adjustments they make with your foot function could cause initial soreness or pain in the feet, ankles, knees or hips. It takes several months before athletes can run in orthotics comfortably. Be attentive to any pain that may surface in the initial weeks, as adjustments to your orthotics are free under a six-month warranty with the lab that makes them.

IMG_1762But it all comes back to shoes. Truth be told, orthotics are only as good as the shoes in which they are inserted. Make sure that your footwear is foot-friendly and accommodates orthotics. It is important to recognize that worn out shoes will negate the work of the orthotic. Note that not all shoes are made to accommodate orthotics, no matter the brand, style, or cost. Consult your podiatrist or local shoe store for more information on which shoes are compatible with orthotic devices. Although one pair of orthotics can be used in multiple pairs of shoes, most patients purchase multiple pairs of orthitcs to fit a variety of shoes.

As sand and dirt can abrade them, reducing their functional period, wash your orthotics every two weeks with mild soap and lukewarm water, letting them dry overnight before reinserting them. If you find that your orthotics squeak, remove them from your shoes and sprinkle talcum or baby powder on them, which should prevent the squeaking.

Your orthotics will work to restore your gait, posture, and to prevent a host of injuries that could be caused by your foot condition. Orthotics are affordable and last for years, and prevent a host of conditions, from runner’s knee to lower back pain. They are a highly effective, cost efficient, non-invasive, and all-around successful treatment technique. Orthotics are only helpful when used, so Dr. Murray and Dr. Chang suggest that you wear orthotics continually to reduce pain and to improve your posture and alignment.

Click here for a free book offer.

 
Blue Ridge Foot and Ankle Clinic
 
887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 
417 South Magnolia AveWaynesboro, 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.
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What is Morton’s Neuroma?

September 19th, 2014 by Dr.Chang

 A neuroma is a growth or thickening in the nerve tissue due to compression or irritation of the nerve. While neuromas can develop in different parts of the body, they are most commonly found in the feet between the third and fourth metatarsals and called Morton’s Neuroma, or intermetatarsal neuromas. Populations who wear restrictive shoes, or have foot abnormalities such as bunions, hammertoes, flat feet, or more flexible feet, are at a higher risk of developing this type of nerve damage. If you suffer from Morton’s neuroma, you probably already know this by the instant relief from the burning and aching toe pain once you take off your shoes. That’s because the width of your shoes often aggravate an already irritated nerve.

Neuromas have a variety of symptoms that vary from pain to tingling, burning or numbness, and even feeling as if something is inside the ball of the foot. Symptoms often have a gradual onset, first only flaming up when wearing shoes with a tight toe box or while engaging in activities that stress the ball of the foot. Initially, symptoms can be relieved by removing a constricting shoe, massaging the tender area, and by avoiding aggravating activities. However, as time passes, symptoms will get progressively worse. If untreated, neuromas can lead to permanent nerve damage, so consult your podiatrist early about your neuroma.

Treatment and prevention vary. First, make sure you have the proper shoes for your feet! Your podiatrist may suggest special padding techniques to relieve the pressure from the affected area. Additionally, icing, using over the counter or custom made orthotics, modifying activities that aggravate the injury, taking NSAIDs, or even cortisone injections can help. In more severe cases, surgery will be a viable option to remove the neuroma altogether.

Click here for a free book offer.

 
Blue Ridge Foot and Ankle Clinic
 
887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 
417 South Magnolia AveWaynesboro, 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.
rsz_running_card

 

Treatment of Fungal Nails

August 25th, 2014 by Dr.Chang

Toe nail fungus cures can include both oral and topical medication treatments. The gold standard for treating onychomycosis in an otherwise healthy individual is the oral therapy. The most widely prescribed medication today is Terbinafine ( Lamisil – Novartis). Newer oral medications are currently in development and clinical testing. Oral antifungals, like Terbinafine, are very safe medications if properly used. Terbinafine tablets has adverse response rate of less than 3 percent. Typically, the dosing for Terbinafine is one tablet per day for three months. Blue Ridge Foot and Ankle Clinic will take blood test to verify norFungus2mal liver function prior to starting this medication.

Dr. Murray and Dr Chang may also take a sampling of the nail and have it lab tested to confirm that it is true nail fungus. Visual inspection is adequate to make a diagnosis, but when uncertain or as required by insurance companies’ lab confirmation may be required. Sometimes a thickened nail is nothing more than hyper-keratinization of the underlying nailbed from repeated trauma. Nail thickening alone does not automatically make an Onychomycosis diagnosis. However, a thickening nail from thickened skin and repeated trauma makes is a good focal point for fungus to establish.

In addition to oral mediation, at the Blue Ridge Foot and Ankle Clinic we will also use topical antifungal medications to treat the infection from the outside. We also have very effective regimens of topical treatments which does help to reduce the fungal infection of the nails and help prevent this aggressive condition from getting worse. When attempting topical therapy, serial aggressive nail debridements by your podiatrist are recommended to enhance the outcome.

The best way to use topical medication is to see a foot specialist who will thin down and cut away as much of the diseased nail as possible (a painless procedure), so that the topical medication will penetrate to the live fungus more readily. The topical medications then are applied once to twice a day by the patient. The nail has to be maintained or kept thin on a regular basis. Depending on the degree of fungus this process can take upwards of a year for new healthier nail to grow out. We have seen some very gratifying results with the combination of oral and topical medication.

Laser treatment of toenail fungus is becoming more common. Laser treatment is indicated and recognized by FDA for temporary clearing of toenail fungus. It is not a covered by nearly all medical insurance companies and can be very expensive. The doctors at Blue Ridge Foot and Ankle Clinic do not advocate this form of treatment for toenail fungus.

As with any medial condition, there sometimes there can be unsuccessful results using either topical or oral medication but it is important to follow all of the directions for the best results possible. The outcome will often be dictated by the severity of the condition upon initiation of treatment. Returning toenails to a perfect pristine state is nearly impossible. Making toenails less ugly, less discolored, less thick and fungus free is an obtainable goal. 

Click here for a free book offer.

 
Blue Ridge Foot and Ankle Clinic
887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 417 South Magnolia AveWaynesboro, 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.

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Fungal Nails (Onychomycosis)

August 14th, 2014 by Dr.Chang

Fungal infection of the toenail, or onychomycosis, is characterized by a progressive change in a toenail’s quality and color, which is often ugly and embarrassing. It is often ignored because the infection can be present for years without causing any pain.Fungus2

This condition is an infection underneath the surface of the nail caused by fungi. The fungus that attaches to our toenails is ubiquitous in our environment and a natural inhabitant of our skin in very low concentration. When these tiny organisms take hold, the nail plate becomes darker in color and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails. If ignored, the fungi infection of the nail can spread and further distort nail shape and form. These often thicker nails are difficult and painful to trim and make walking painful when wearing certain shoes. Onychomycosis is often accompanied by a secondary bacterial or yeast infection in or around the nail plate.

Our toenails are especially vulnerable, since they are often around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers. Additionally, injury to the nail bed, such as repeated contact with a shoe, may make it more susceptible to all types of infection, including bacteria and fungus. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors are a history of athlete’s foot (skin fungi infection) and excessive sweating. Excessive sweating and contamination of interior surfaces of shoes can be treated with the application of safe topical medications provided in our office.

The podiatric physicians in Blue Ridge Foot and Ankle Clinic have been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.

Prevention

  • Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.

  • Clean and dry feet resist disease.

  • Washing the feet and toes with soap and water, remembering to dry thoroughly, even between the toes, is the best way to prevent an infection.

  • Shower shoes should be worn when possible in public areas.

  • Shoes, socks, or hosiery should be changed at least once daily or more often as needed.

  • Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.

  • Wear shoes that fit well and are made of materials that breathe.

  • Avoid wearing excessively tight hosiery, which promote moisture retention.

  • Socks made of synthetic fiber tend to “wick” away moisture faster than cotton or wool socks.

  • Disinfect instruments used to cut nails.

  • Disinfect home pedicure tools.

  • Don’t apply polish to nails with suspected of infection, occlusion of sunlight allows fungus to flourish.

Click here for a free book offer.

 

Blue Ridge Foot and Ankle Clinic
 
887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 
417 South Magnolia AveWaynesboro, 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.
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.


 

Construction Pictures

July 16th, 2014 by Dr.Chang


Work has started on our NEW Fishersville podiatry clinic. Stay tuned for more exciting news and progress pictures.

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11/18/2014

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Construction 10.22.14

Construction 10.22.14

Fishersville Office 10.22.14

Fishersville Office 10.22.14

The internal walls are framed.

The internal walls are framed.

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10/13/2014

Walls are going up! 10.8.14

Walls are going up! 10.8.14

FOUNDATION 8.18.14

August 2014

BRFAA Fishersville Map2

66 Parkway Lane Fishersville, VA

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WWW.BRFOOTANDANKLE.COM

 

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