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.  

Aaron Rodgers and Brett Favre: The Foot Comparison!

You cannot watch football this season without hearing about Brett Favre and Aaron Rodgers. They have been over analyzed in every way possible. So much attention surrounds the legend and the rising star who replaced him. They have faced each other twice already this season, both with a Favre victory, yet the discussions don't seem to subside for a moment. So, to add on to this intense analysis, let us explore the foot injuries of the two athletes!

Prior to the Viking and Packer game, Favre had his first report on the Viking's injury list with foot pain. Nothing more was said about the issue other than that he had a sore foot. The irony of the situation is that after the game, Rodgers suffered from a foot and a toe sprain. Is this the beginning of the end? Did Favre get the last word through foot injuries?

A sprain describes an injury in which a ligament between two bones is stretched, damaged or torn. A Grade 1 injury is fairly mild with only minor damage to the ligament. A Grade 2 injury is a partially torn ligament and a Grade 3 is a ligament that is completely torn. With a grade 1 injury, the recovery time is short with very few possible complications.

On the other hand, a grade 3 can takes months to heal and is often extremely painful. Foot sprains are rare in the general population, but are common in sports that put the foot in abnormal twisting positions. Such injuries usually result in a grade 1 or grade 2 damage and complete recovery can be seen within the season with much improvement in only weeks.

Treatment consists of rest, icing, strapping, and anti-inflammatory drugs. A sprained big toe is better known as turf toe. This usually results when the big toe is abnormally hyper-extended. This injury can often be more debilitating than a foot sprain because of the important role the big toe plays in pushing off the ground when running. The grading system is the same as a foot sprain with Grade 1 being a minor injury and grade 3 being more severe.

To prevent further damage with the ability to continue activities, taping techniques have been proven quite effective. The severity of the foot injuries of Favre and Rodgers has been downplayed and seeing their continued performance on the field allows us to assume they are minor.

Still, these injuries can be very painful and increases the risk for a more severe injury. To prevent further injuries, both players should be undergoing physical therapy and switch to a more stable shoe gear. The cleats and the flexibility of football shoes increase the chance that the foot will be twisted in a position that could worsen the injury.

Rodgers' first line of treatment should be to have more protection on the field. It is likely that the injury resulted after one of his many sacks this season. Favre, has age working against him. Younger athletes tend to recover better and faster than older athletes, but Favre has proven that age does not define his ability to play football. Only time will tell if these injuries will advance to a more serious problem that will take them off the field.

The likelihood of these injuries progressing is unlikely since they seem to be only presenting with minor symptoms. Thus, the live football drama series of Favre versus Rodgers will continue.

The Effect of Ankle Injuries on Your March Madness Office Pool

There are two things for which March is known: green beer and basketball. This week, Americans are enjoying both. Whether you are a twelve year old boy or a grandma involved in the nursing home pool, it seems like everyone is talking about March madness. But did you know that just the last week there were five foot or ankle injuries among the players competing in the NCAA tournament. Before you turn in your bracket, you may want to take some of these injuries into consideration.
Robert Sacre, Gonzaga Bulldogs; Liam mcMorrow,Marquette Golden Eagles; Ty Lawson, North Carolina Tar Heels; Teondre Williams, Oregon Ducks; and Jonnie West, West Virginia Mountaineers have all had foot or ankle injuries within the last week and all of their teams have advanced into the tournament. Whether or not these injuries will affect the teams is questionable, but what we should be asking is why these injuries are happening so late in the season. At this point, the athletes should be at their prime strength, so why are the falling apart?
Basketball, like all sports, puts significant stress on your body especially your foot. Running causes an increase in forces on your foot and ankle three to six times your body weight. When a forward goes up for a rebound, they come down to contact the ground with a forces six times their body weight. Our body is designed to compromise and adjust for these forces, but if we do them too fast, we can cause damage to our body. This is why athletes go through training. Even with the best training, such as that provided to college athletes, your body can still get injured!
Ankle sprains are the injury seen most often on the court. Once an athlete has one ankle sprain, they are much more likely to have another one because the ligaments are weekend. Ligaments are small fibrous bands of tissue that connect bones to other bones. This along with muscles allows the skeletal system to have a considerable amount of stability. If a ligament gets stretched or injured, it will never recover to have the same amount of strength that it did before the injury. Therefore, once you have an ankle injury, you are much more prone to have one in the future.



So why aren’t athletes spraining their ankles every day.
Physical Therapy helps your body regain as much strength and function as possible. Since muscles also contribute to stability, a physical therapist will adjust the patient’s exercises to strengthen the muscles in the areas prone to injury. This type of therapy is the most beneficial and is why your podiatrist often suggests physical therapy for most types of injuries.
Basketball shoes are quite a bit different than the cross trainers or running shoes we all have stashed away in our closets. Basketball shoes or high tops come up higher to give your ankle more support. You put a lot of stress on your body jarring back and forth, running up and down the court and jumping up for the rebound. Simply changing your shoe gear can do wonders to reducing injuries on the court.
In addition, some people are more prone to ankle sprains due to biomechanical weaknesses, or simply put, the way their foot and ankle moves when they walk or run. This can innate weakness can be eliminated with a properly made custom orthotic that controls excessive foot motion.
Though the NCAA offers some of the best training and resources to their athletes, some injuries are inevitable. If you ever roll your ankle, take a stumble, or hear a POP, make sure to contact your podiatric physician as soon as possible. The earlier you seek medical attention by a highly trained doctor in the foot and ankle or a podiatrist, the better the outcome of your injury will be.

What is That Tingling, Burning Feeling in My Feet?

Morton’s Neuroma

A neuroma is a thickening of a nerve and can occur anywhere in the body, even the foot. Morton’s neuroma describes a neuroma of a specific location in the foot, between the third and fourth metatarsals. This is located on the balls of foot between the third and fourth toes. Clinicians may refer to this benign growth as a tumor. In medical terms this is a correct description but this is not an indication of cancer. The enlarged nerve is benign, meaning it will not become invasive or become cancerous.

Though a morton’s neuroma is not a medical emergency, it can cause severe pain and impede on your daily life. Some patients describe the pain as walking on a marble, but the most often complaint is a burning, sharp pain. Tingling and numbness is also common.

It is thought that the nerve becomes enlarged due to repetitive irritation or pressure. Over time, this irritation leads to a neuroma and pain. Wearing shoes that are tight, too small, or with a heel can aggravate the pain because it causes increased irritation. The pain may also be caused by running or other sports. Flexing and relaxing your toes causes compression on the nerve, and the balls of your foot takes on the most weight during walking or running. Since this is the area where the neuroma is located, doing such activities can elicit a lot of pain.

The podiatric physician will take x-rays of a patient with such pain to rule out a fracture or other foot disorders. The doctor will also attempt to elicit the pain by squeezing the foot. This will not only cause pain, but there the doctor will also hear a clicking sound due to the neuroma shifting between the bones.

There treatment ranges from conservative treatments to surgery. Like all treatment plans, surgery should be a last resort for when all other treatments fail. The pain may be greatly reduced by changing shoe gear, but this is often not enough. It is very common for your podiatric physician to prescribe a custom orthotic. Many patients find relief by not only wearing orthotics but also wearing a pad under the balls of their foot. A podiatric physician can properly fit and provide such padding. Non-steroid anti-inflammatory drugs, such as Advil, can also be used to help reduce the pain but should not be used long term. Your doctor may also suggest a steroid injection which has a greater effect on relieving the pain. Stretching, massages, and icing has also shown to relieve pain.

If the pain has increased due to physical activity, it is suggested to take some time off from the activity to allow your foot to rest and heal. It may be better to take on activities that cause less impact on the foot. Excises’ such as swimming or bicycling may be good alternatives.
Neuromas are not life threatening, but they do cause alterations in your life. You should consider wide toed shoes with plenty of room for your toes to wiggle. The pain most often subsides with conservative treatment, but in rare cases surgery is necessary. Unfortunately, the procedure removes the entire nerve and will leave numbness of the effected toes. Thus, you and your podiatric physician should try to avoid surgery if possible.