Big Papi Grounded With Heel Pain

David Ortiz, also known asBig Papi, the designated hitter of the Boston Red Sox, is presently sidelined with heel pain.  Heel pain should not be taken lightly.  In matter of fact, JoeDimaggio, the great centerfielder of the New York Yankees, was on the disabledlist for three months with heel pain.  The difference is that Joe D suffered from a condition called plantar fasciitis, where Ortiz has Achilles tendinitis.

Plantar fasciitis is the mostcommon cause of heel pain, but if your pain is at the back of the heel, then the usual culprit is the Achilles tendon.  The Achilles tendon is that thick tendon at the back of the ankle and attaches to the heel bone.  This tendon becomes the calf muscle.

Achilles tendinitis is verycommon especially in athletes or in people over the age of 40.  Athletes tend to torque their bodies in such a way that it puts excessive strain on the tendon.  Achilles tendinitis will also occur in people who have very high arches.  In this case, the tendon becomes shorter and tighter.  So, any strenuous activities can lead to an inflammation of this tendon.  People with very flat feet also can get Achilles tendinitis because the heel is over-pronating, meaning it is turning outward excessively, causing the arch to collapse.  This leads to the torque of the tendon, which causes the pain.

Activities that make you runon the balls of your feet are also the culprit, such as runners who run on their toes, basketball and volleyball players who are constantly jumping, and sports that require ballistic movements such as baseball and football.  The key to prevention is to make sure one always stretches before and after the activity.  Caution: Never stretch a cold muscle or joint, so always warm up first.

Another cause of heel pain at the back of the heel is a condition called retrocalcaneal bursitis.  There is a bursa (sac of fluid) between the bone and the tendon.  This structure prevents excessive friction of the tendon from the bone when it moves.  In a lot of these cases, the heel bone will be thickened in this area with a prominent “bump.”  This irritates the bursa and now you have bursitis.  The bump is also called a pump bump, because it rubs against the back of pump style shoe. 

The main treatments for these conditions are rest, ice, and a compression sleeve.  A lot of times a heel lift will be applied into both shoes to allow for the Achilles tendon to rest.  This should only be used for a very short time, because the bottom line is that you want to stretch out the tendon, and not shorten it.  Physical therapy is an extreme necessity in most cases.

If the cause of the tendinitis is biomechanical, meaning the way the foot functions during gait,then a custom orthotic is very beneficial.  If the above treatments do not help, then there are many newer treatments and technologies out there that can help.  At Family Foot & Ankle Specialists inPiscataway/Hillsborough NJ, we employ most of these treatments.

The first one is extracorporeal shock wave therapy, also known as ESWT.  This is a non-invasive procedure that is done in the office.  After the area is numbed, the ESWT machinewill send deep, penetrating sound waves into the heel.  This will break down any scar tissue that might be present as well as to increase blood flow to the area.  The patient can walk immediately and will find relieve within the next couple of months.

In addition, the K-Laser is an FDA-approved laser for the use of pain resulting from all types of tendonopathies.  The procedure is also totally non-invasive and does not require any anesthetic.  The laser is painless and takes about five minutes.  Usually 10-12 treatments are required.  At Family Foot & Ankle Specialists, we have had wonderful results using this laser for these problems. 

The key is that if Achilles tendonitis is not treated quickly, scar tissue can result, making the treatments more difficult and increasing the liklihood of a less than optimum result.  So, you should not let the problem linger for too long.  Call your local podiatrist and get back into the game.  

Is Rex Ryan a Frustrated Podiatrist?

A video was just released showing Rex Ryan, the NY Jets football coach and his wife, depicting Rex of having a foot fetish. It is this video that made me think of the endless times I get asked, “Dr. Wishnie, why did you become a podiatrist? Do you have a foot fetish?”

Let me first answer that as simply as, absolutely not. I usually tell my patient, “Do you think a gastroenterologist has a butt fetish?” Then I ask, “What body part is beautiful? At least the foot is an external appendage that I don’t have to go digging into any holes.”

Well, why did I become a podiatrist? Podiatrists see many different types of patients. We see patients ranging from the age of infancy to the geriatric. On one day I can see both an 18 month old baby and a 104 year geriatric. I can see patients with sports injuries, like ankle sprains, Achilles tendinitis, fractures and dislocations. I see runners who don’t want to stop running, no matter how bad their foot hurts. Then I see little old ladies who remind me of my grandmother.

As you can see, I love the diversity that podiatry offers. I also love the fact that I can usually get people feeling better immediately. See, when you are not feeling well and you go to your family physician, they say, “Take this pill and you will feel better in a week.” Then the patient asks, “Hey doc, what happens if I don’t take the pill.” The doctor answers. “Then you will feel better in seven days.”

A lot of people are afraid of going to the doctors. They are afraid of the pain that might be inflicted upon them. Then what happens if they delay in making an appointment? The pain and the problem usually worsen. In podiatry, we can treat a problem many different ways. If a child comes in with a plantar’s wart, we usually use a topical medication to kill this virus. We usually don’t have to use any needles or do any cutting. If you have a corn, which is dead skin on a toe due to a deformity called a hammertoe, we can trim it painlessly. The patient leaves the office immediately feeling better. If you suffer from heel pain, we can tape the foot and give medication to relieve the pain. Many times we need to give an injection but then the patient is walking out the office feeling ten times better.

Getting patients better quickly and seeing almost immediate results is very satisfying. Podiatry is a wonderful profession and with millions of active baby boomers turning 65 on a daily basis, podiatrists will be very busy and will be an extremely necessary profession for many years to come.

Hey Rex, if this football coaching doesn’t work out, I can help you get in touch with my podiatry school professors.

Being In Love May Reduce Foot Pain?

The University of California Los Angeles recently did a study that showed thinking of a loved one decreased a person’s pain. While having heat applied to their forearm, 25 women were asked to rate their pain levels. When the women were shown pictures of their significant others or when they were allowed to hold their significant others hand their pain level consistently reduced.

Love is patient, love is kind, but is love an anti-pain medication? When one is suffering from a serious illness, it is obvious that having support from loved ones helps one get through the rollercoaster’s of pain and suffering. But, can love help with your everyday aches and pains? According to this study it can!

Medically, there is no definitive answer on why this may happen. Pain can only be measured by the person’s perception of the pain. Thus there is great variation in pain from one person to another. This is what we refer to as “pain threshold.” One may say they have a high pain tolerance, meaning it takes a lot before the pain “affects” them. I see this often in my clinic when I give a people injections. Some people are 100% calm, cool and collected and don’t even blink when I prick them with the needle. Others are jumping for the chandelier and screaming at the top of their lungs when all I am doing is putting a relatively small needle under their skin.

So can being in love increase your pain tolerance? Plantar fasciitis is one of the most common causes of heel pain. I see several patients a day with this common foot problem and when I ask the patients to rate their pain on a scale from 1-10, I can never predict their response. There is absolutely no consistency on how much pain this problem causes. The description is always the same “It hurts the most in the morning or after rest.” But since everyone perceives pain on a different threshold, not everyone rates it the same number. I have never dove into my patients personal lives to discover whether a pain rated a 10 actually means that they just lost the love of my life and as a result their foot hurts.

There is no doubt in my mind that having someone supportive in your life that makes you happy can help you deal with or handle your pain with slightly greater ease, but there is always a reason for the pain. .