Posts Tagged ‘Plantar Fasciitis’

TOP 5: Our Favorite Summer Sandals

August 6th, 2018 by Dr.Chang

Summer is the season for everything outdoors. To name a few activities: hiking, amusement parks, shopping, evening strolls, and so much more. All of these things require sandals or shoes of some sort. That’s where we come in. Here are our top 5 picks for your summer sandals.

1. Birkenstocks

Photo courtesy of Birkenstock website

You see these sandals everywhere. People rave about how comfortable they feel on their feet. While they aren’t the easiest to break in, they form to your feet and offer great support. They come in many different styles in their iconic leather. Pictured above is the Arizona, their most popular design. Birkenstocks, or ‘Birks,’ are durable and last for years. They are a good investment if you want a shoe that will keep your feet happy summer after summer. Check out all the styles on their website here!

2. Teva

Photo courtesy of teva-sandals.com

Slightly less expensive than Chaco, Teva sandals are colorful and supportive. These sandals pack a solid rubber sole in a variety of colors and styles. Built for adventure and fun, a Teva sandal is perfect for the hiker or explorer. Teva is branching out in terms of their styles. With great arch support and secure straps, Teva will keep your feet from aching after a lot of adventures. Look at their variety of sandals here!

3. Keen

Photo courtesy of REI.com

KEEN is a great option for those that love to cover their toes. Their styles offer the openness of a sandal while also providing the security of a closed-toe shoe. Their sandals offer a sturdy rubber sole with colorful design options. They’re also structurally supportive, much more so than your average sandal. See your KEEN options on their website here!

4. Vionic

Photo courtesy of Vionic website

Vionic’s wide selection of sandals offers a variety of styles and colors. The company is focused on the aesthetic quality of the shoe while also maintaining the supportive structure your foot needs. They stress “comfort and style” in their designs, keying in on arch support. So, if you’re looking for supportive but fashionable sandals, Vionic may be the sandal for you this summer! Visit their website here!

5. Merrell

Photo courtesy of Footwearark.com

 

Merrell’s sandals are a healthy mixture of adventure and style. With a large selection of neutral colors, you can wear these sandals with anything. From stylish leather to adventuring colors, Merrell offers practically any style you can imagine. With an emphasis on comfort, there’s no doubt your feet will be content with a sandal from Merrell. Visit Merrell’s site here!

Did you like our picks? Do you have any other favorites?

          Visit our Facebook page here , find the link to this blog and let us know your favorite Sandal choices.

What is Plantar Fasciitis?

July 26th, 2017 by Lindsay Lopez

One of the most common causes of heel pain on the bottom of your foot is plantar fasciitis. Plantar fasciitis is pain along your heel and arch due to inflammation of the plantar fascia. The plantar fascia is a large band on the bottom of your foot that goes from the heel bone and attaches to each of the toes. This band helps support your arch as you walk. Plantar fasciitis can affect a variety of people including athletes or those who spend a lot of time on their feet at work. The pain is typically described as severe with the first couple of steps out of bed in the morning or with the first couple of steps after sitting for a long period of time. The pain generally starts to feel better as you start to take more steps, but some people also develop worsening pain or feeling of fatigue in their foot as the day goes on.

There are several different types of treatments for plantar fasciitis. One of the most important things when dealing with plantar fasciitis is supportive shoe gear. Flip-flops and flexible shoes without much support can exacerbate the condition. Also calf stretches, anti-inflammatories, and ice at the end of the day or after activities are helpful to try and calm down the inflammation. Freezing a water bottle and rolling it along your arch is a good option when it comes to icing. If these basic measures fail than steroid injections, arch supports, or night splints can also be utilized.

–Dr. Colleen Law

Common Running Injuries-Plantar fasciitis

April 20th, 2017 by Dr.Chang

Common Running Injuries-Plantar fasciitis

Plantar fasciitis is a common injury that many runners experience. Below is a brief description of the injury, and what you may be able to do to prevent plantar fasciitis.
Plantar fasciitis (arch pain)—Arch Pain is often caused by frequent stress on the plantar aspect, or the bottom of the foot. When the plantar fascia, a supportive, fibrous band of tissue running from the heel to the ball of the foot, becomes injured, pain on the bottom results. Forefoot or rear-foot instability with excessive pronation may result in plantar fasciitis. Overtraining may contribute. Shoes with good mid-foot stability may prevent plantar fasciitis. If pain persists, visit us at Blue Ridge Foot & Ankle!

Plantar Fasciitis: Treatment Pearls

February 10th, 2014 by Dr.Chang

Plantar Fasciitis: Treatment Pearls

by Douglas Richie, Jr. D.P.M., President Elect AAPSM (2003 – 2004)

Epidemic Of Heel Pain:

Heel pain is the most common musculoskeletal complaint of patients presenting to podiatric practitioners throughout the country. It is well-recognized that subcalcaneal pain syndrome, commonly attributed to plantar fascitis, is a disease entity that is increasing in its incidence, owing partly to the fact that it has a predilection for people between the age of 40 and 60, the largest age segment in our population.

The orthopedic and podiatric literature have been filled with original scientific investigations and anecdotal reports about the appropriate surgical and non-surgical approach to plantar fascitis. The vast majority of these scientific articles deal with the general patient population presenting with heel pain. 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.

While patience, rest and tolerance of pain are virtues recommended to the patient presenting with plantar fascitis, different treatment strategies must be employed when dealing with the athlete.This article will focus on the differences in treating plantar fascitis in athletes vs. the general, sedentary population.

PATHOPHYSIOLOGY

Subcalcaneal pain syndrome in athletes is thought to be brought on by an overload of the plantar fascia.However, the mechanism of this overload is debated.Overload causes micro-tears at the fascia-bone interface of the calcaneus or within the substance of the plantar fascia alone.The central band of the plantar fascia is primarily affected where a hypercellular, inflammatory response occurs within the fibers of the fascia, leading to degenerative changes.

A spur may result from further inflammation but is not implicated as the primary source of heel pain.Many studies have shown the presence of spurs on the heels of asymptomatic patients.One study found that only 10% of all calcaneal spurs visible on x-ray were actually symptomatic.

Other authors have attributed “painful heel syndrome” to an entrapment of either the medial calcaneal nerve or the first branch of the lateral plantar nerve.However, the mechanism of entrapment proposed by these authors is still related to overload of the soft tissue and fascial structures on the plantar and medial aspect of the calcaneus.

PATHOMECHANICS

Although heel pain is common, there is no commonality of opinion of the biomechanical etiology of this syndrome.Contributing factors reported in the literature include leg length inequality, pronation of the subtalar joint, restricted ankle joint dorsiflexion, weakness of plantar flexion, high arched feet, low arched feet and heel strike shock.Studies have shown that decreased arch height has shown no correlation to the development of plantar fascitis in runners.In fact, it is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot.

Scherer and coworkers have given the best insight into the pathomechanics of plantar fascitis.Their study proposed that supination around the longitudinal axis of the midtarsal joint is a common feature in over 100 feet presenting with heel pain.Supination about the longitudinal axis of the midtarsal joint can occur in two primary situations:when the heel everts past perpendicular (heel valgus) or when a forefoot valgus deformity is present (sometimes accompanied by rearfoot varus).

TREATMENT STRATEGIES FOR THE ATHLETE

In most cases, the goal of the athlete is to quickly return to activities to minimize loss of fitness and performance.This will put pressure on the treating practitioner to be more aggressive than treating cases of more sedentary patients.

A survey was conducted by this author of the board members of the American Academy of Podiatric Sports Medicine two years ago to compare treatment protocols for athletes vs. standard population.The following treatment pearls were elicited:

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 runner, dancer or volleyball player, this means a complete cessation from running and jumping activities until acute symptoms subside.On the other hand, the athlete should be assigned to alternative cardiovascular fitness activities that minimize impact and loading on the plantar fascia including stationary cycling, swimming, upper body weight machines, and low resistance flat-footed stair master machines.

2) Change and modulation of footwear

Footwear analysis is critical for evaluating athletes with subcalcaneal pain.The footwear may be a contributory factor and can be utilized as a powerful treatment modality.Athletesshould 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.Careful attention must be paid to having the athlete keep shoes on in the house and during all standing and walking activities.Barefoot and sandal-wearing activities are prohibited.

3) Home therapy

Athletes 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.Having the athlete 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.Sports podiatrists are more likely to employ arch taping procedures as a precursor to or adjunct to orthotic therapy.Athletes respond very favorably to the immediate intervention and relief obtained by expertly applied arch taping procedures.

5) Physical therapy

Athletes are amenable to referral for physical therapy because they are willing to invest the extra time to expedite recovery.Many athletes are used to going to the training room for hands on rehabilitation.Athletes appreciate a partnership between the sports podiatrist and the physical rehabilitation specialist.

6) Anti-inflammatory medication

Sports podiatrists should be cautioned against over-aggressive use of anti-inflammatories in treating the athlete.While it is tempting to utilize corticosteroid injections to expedite healing, athletes are often skeptical of receiving this treatment and are certainly at greater risk for sequela of over-ambitious use of steroid injections.There are reports in the literature of athletes undergoing spontaneous rupture of the plantar fascia after even single injections of their plantar fascia with corticosteroid.The conservative, biomechanical interventions outlined above should be implemented before considering injection therapy.

CONCLUSION:

Athletes 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.At the same time, caution should be made about the overzealous use of quick fixes, including corticosteroid injections because of the potential deleterious effect on 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.

Resistant Plantar Fasciitis Treatment Program (Initial)

Contributed by Richard Bouche D.P.M. , William Olson, D.P.M., Stephen Pribut, D.P.M., Douglas Richie, Jr,. D.P.M.

PHASE 1- Acute Phase:

  • Goal decrease acute pain and inflammation:
  • absolute or relative rest- Decrease sports activity to avoid rebound pain
  • ICE: 2 appliations of 20 minutes per day
  • NSAIDS

PHASE 2- Rehabilitation Phase:

  • Further decrease pain and inflammation:
    • ultrasound
    • phonophoresis
    • neuroprobe
    • contrast baths
  • Maintain/increase flexibility of injured (and surrounding) tissue:
    •  gentle stretching exercises: calf, hamstring, posterior muscle groups

PHASE 3- Functional Phase:

  • Functionally strengthen intrinsic muscles of the foot
    •  closed chain therapeutic exercise
      •  Doming of Arch (towel toe curl)
  • Protect injured area during functional activity
    • taping
    • stability running or other appropriate athletic shoes
    • orthoses as needed

Note: this is probably the most important phase because it prepares the patient for their return to activity. Care needs to be taken at this stage not to allow the patient to overdo these exercises and stay within their limits as re-injury can easily occur.
PHASE 4- Return To Activity

Return to desired sport activity: gradual, systematic, “to tolerance”
Initiate preventive strategies:
orthoses PRN
appropriate athletic shoewear
functional exercises (i.e., pilates, plyometrics)
revise training program

Note: Be careful in the first months return to exercise to avoid recurrence of pain.

Consider shock wave therapy if there is a 6 month failure and a failure after repeated modification and remaking of orthotics.

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.

Physical Activities In Our Community

June 27th, 2013 by Dr.Chang

Blue Ridge Foot and Ankle Clinic enjoys promoting physical activity in our community. We believe physical exercise is the best CHANGkpmCCskiCROPmedicine available. Charlottesville and the Shenandoah Valley are fantastic areas to enjoy the outdoors. Our clinic sponsors the 2013 Virginia Off-Road Series mountain bike races and some of the Devils Playground fun runs at Devils Backbone Brewery in Roseland, VA. We want to encourage you to find local events this summer to participate in. Your participation is a healthy choice and helps promote physical activity to others by being a role model.kindra

amyOur staff participates in many physical activities year round. Dr. Murray and Dr. Chang enjoy activities such as cycling, hiking, skiing, and ice hockey. Kindra Jones, medical assistant, hits the gym regularly. She’s expecting an addition to her family this fall and now exercising for two. Congratulations Kindra! Mary Mead, billing specialist, and her husband walk all over the streets and trails of Charlottesville. Our jack of all trades, Amy Flevarakis, participates with her family in events such as the March of Dimes Walk. Newbie, Teresa Thompson, enjoys hiking and running the trails in and around Staunton and wants to run her first 5k race this year. Welcome to our practice Teresa.TERESA RUN MalloryMallory Snow, Charlottesville receptionist, stays fit by running while her kid participates in dance class. Mallory and Amy are running the Color Me Rad 5K in Virginia Beach this fall. Mark Smith, Waynesboro receptionist, rides his bike daily and competes in local mountain bike and running races. Aside from keeping our offices running smoothly, Mary Ishee – office manager, walks with her daughter and has participated in the Charlottesville Women’s Four Miler for the last two years.

We hope you join us this summer in some of the fun activities and events our communities have to offer. Let us know if there is anything we can do for your feet or ankles to option2help you be a role model to you family and friends.mary ishee

 

 

 

 

 

Here are some sites to help you find local activities:

Waynesboro:

http://www.runthevalley.com/

http://www.waynesboro.va.us/pr-madanthonymudrun.php

http://milepostzero.homestead.com/

http://www.elevationsallstars.com/#

http://www.visitwaynesboro.net/outdoors-your-way/

http://www.wintergreenresort.com/

Nelson county:

http://dp.cycleva.com/

http://www.nelsoncounty-va.gov/departments/parks-recreation/outdoor-recreation/

http://www.blueridgelife.com/

http://www.wintergreenresort.com/

Staunton:

http://www.visitstaunton.com/attractions/attractions_outdoor.htm

http://www.wildernessadv.com/

http://www.blackdogbikes.com/

http://www.blueridgerr.com/

http://shenandoahbike.org/

Harrisonburg:

http://www.harrisonburgva.gov/parks-recreation

http://svbcoalition.org/

http://www.shenandoahbicycle.com/

http://www.valleytrack.org/

http://www.bryceresort.com/Home.aspx

Charlottesville:

http://blueridgecyclery.com/

http://www.raggedmountainrunning.com/
http://blueridgecyclery.com/

http://www.cambc.org/

http://www.visitcharlottesville.org/visitors/things-to-do/outdoors/

Lexington:

http://www.lexingtonvirginia.com/hiking.htm

http://lexingtonva.gov/parks.htm

 

Bike rides and racing:

http://vors.cycleva.com/2013/cal.html

http://www.virginiaenduranceseries.com/

http://alpineloopgranfondo.com/

http://shenandoahbike.org/

http://www.cspdc.org/bikeva/

http://www.bryceresort.com/Home.aspx

http://www.wintergreenresort.com/

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.

Treatment for Plantar Fasciitis

March 3rd, 2010 by Dr.Murray

This blog is a sequel to last week’s blog that discussed the epidemiology of plantar fasciitis. We will touch briefly on treatments/prevention used by podiatrists and discuss treatment pearls podiatrists tend to follow when athletes and dancers present to their office with plantar fasciitis.
Alternative Physical Activity is one of the first steps to treatment. It is important to change the cardiovascular fitness routine to one that avoids high impact on the plantar fascia. This means limiting running and jumping and pursuing swimming and upper body weights as an alternative method of cardiovascular fitness. This is often called a period of “Relative Rest”
Changing footwear is another critical treatment step. Barefoot and sandals should not be worn while trying to treat this condition, instead shoes with a slightly elevated heel and a strong mid-shaft insole, should be worn inside and outside the house. We favor the use of plantar arch strapping (taping) which proves to be very successful, especially in athletes and active people who want to maintain their busy lifestyle.
Home Therapy consists of stretching the heel cord to encourage healing, and massaging the foot to increase blood flow. Night splints are also indicated for plantar fasciitis as it maintains the foot in a passive stretch position to encourage healing. This prevents unwanted re-tightening of the fascial band during the night and reset of stretch receptors that trigger pain activation.
Customized orthotics is an important long term strategy in the management of patients with this condition. Additional adjuncts to expedite recovery include: physical therapy which proves to be useful in alleviating pain associated with plantar fasciitis, and anti-inflammatory drugs which are given to control pain when appropriate for the patient.
These conservative methods typically suffice when treating plantar fasciitis in up to 90% of people with this condition, however when not successful, corticosteroid injections are considered for the more severe cases. Along with these treatments, rest and the maintenance of a healthy weight can also limit predisposal to plantar fasciitis so it is highly encouraged. If pain persists and all conservative treatments are unsuccessful, surgery may be required to release tension on the plantar fascia ligament. We are also using the Topaz radio frequency coblation technique with great success on our patients. If you suffer from plantar fasciitis or know someone who does, Drs Murray and Chang, can offer complete evaluation and tailor an appropriate treatment plan designed around the persons needs.

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