Posts for tag: Pain

By The Foot & Ankle Institute
October 30, 2015
Category: Uncategorized

Tips to Keep Feet Warm and Cozy All Winter Long

Whether you're slogging through deep snow and sub-zero temperatures in the north, or contending with dampness, chill, and muddy conditions in the south, it's important to take care of your feet all winter long. You'll want them to be healthy and ready for action when spring finally arrives.

Most Americans will have walked 75,000 miles by the time they turn 50. Is it little wonder, then, that APMA's 2010 foot health survey found that foot pain affects the daily activities—walking, exercising, or standing for long periods of time—of a majority of Americans?

"Each season presents unique challenges to foot health," said Matthew Garoufalis, DPM, a podiatrist and APMA past-president. "Surveys and research tell us that foot health is intrinsic to overall health, so protecting feet all year long is vital to our overall well-being."

APMA offers some advice for keeping feet healthy in common winter scenarios:

  • Winter is skiing and snowboarding season, activities enjoyed by nearly 10 million Americans, according to the National Ski Areas Association. Never ski or snowboard in footwear other than ski boots specifically designed for that purpose. Make sure your boots fit properly; you should be able to wiggle your toes, but the boots should immobilize the heel, instep, and ball of your foot. You can use orthotics (support devices that go inside shoes) to help control the foot's movement inside ski boots or ice skates.
  • Committed runners don't need to let the cold stop them. A variety of warm, light-weight, moisture-wicking active wear available at most running or sporting goods stores helps ensure runners stay warm and dry in bitter temperatures. However, some runners may compensate for icy conditions by altering how their foot strikes the ground. Instead of changing your footstrike pattern, shorten your stride to help maintain stability. And remember, it's more important than ever to stretch before you begin your run. Cold weather can make you less flexible in winter than you are in summer, so it's important to warm muscles up before running.
  • Boots are must-have footwear in winter climates, especially when dealing with winter precipitation. Between the waterproof material of the boots themselves and the warm socks you wear to keep toes toasty, you may find your feet sweat a lot. Damp, sweaty feet can chill more easily and are more prone to bacterial infections. To keep feet clean and dry, consider using foot powder inside socks and incorporating extra foot baths into your foot care regimen this winter.
  • Be size smart. It may be tempting to buy pricey specialty footwear (like winter boots or ski boots) for kids in a slightly larger size, thinking they'll be able to get two seasons of wear out of them. But unlike coats that kids can grow into, footwear needs to fit properly right away. Properly fitted skates and boots can help prevent blisters, chafing, and ankle or foot injuries. Likewise, if socks are too small, they can force toes to bunch together, and that friction can cause painful blisters or corns.

Finally—and although this one seems like it should go without saying, it bears spelling out—don't try to tip-toe through winter snow, ice, and temperatures in summer-appropriate footwear. "More than one news show across the country aired images of people in sneakers, sandals, and even flip-flops during the severe cold snap that hit the country in early January," Dr. Garoufalis said. "Exposing feet to extreme temperatures means risking frostbite and injury. Choose winter footwear that will keep your feet warm, dry, and well-supported."

Content Courtesy of APMA

By Dr. Brad Legge
October 30, 2012
Category: Uncategorized

What is it?
The Achilles tendon is the largest and strongest tendon in the body. It can support up to 12x your body weight! It is made up of two muscles: the Gastrocnemius and the Soleus. The Gastrocnemius muscle inserts above the knee and the Soleus muscle below the knee. Tightness in the Achilles tendon (called Equinus) can lead to pathology usually manifesting as pain in the tendon about 2-6cm above its insertion into the back of the heel (Non-insertional Achilles Tendonitis) or at the insertion itself (Insertional Achilles Tendonitis).  Sudden increases in the intensity or amount of exercises can also lead to pain in the Achilles tendon.

Common symptoms of Achilles tendinitis include:

  • Pain in the Achilles tendon with the first few steps in the morning
  • Pain with increased activity
  • Thickening of the tendon which you can feel  approx. 2-6 cm above the insertion
  • Bone spur on the back of the heel which you can sometimes feel if it is large
  • Swelling and pain which worsen throughout the day

Diagnosing Achilles Tendonitis
The following are usually required for the physician to make an accurate diagnosis: a complete history of the complaint; a lower extremity physical exam including: assessing the Achilles range of motion (specifically a decrease in ankle joint dorsiflexion), palpation for signs of thickening of the Achilles and bone spurs, finding the point of maximum tenderness etc …

X-rays are helpful to assess for heel spurs and to rule out other causes of heel pain including stress fracture.  Ultrasound examination can give the physician a dynamic view of the Achilles tendon. The thickness of the tendon, any possible tearing, or the existence of an inflamed bursa can be assessed with the ultrasound.  MRI is also sometimes useful and can give a full picture of the tendon and the degenerative changes that may exist.

Treating Achilles Tendonitis
Treatment depends on severity. Most of my patients have already tried some kind of home therapy including anti-inflammatory medications, ice, rest, stretching etc… In some mild cases of Achilles tendonitis these treatments may be sufficient, but in many cases they are not. A physician may treat Achilles tendonitis with heel lifts, orthotics, adaptive shoe gear, a below knee cast or walker, NSAIDs, Medrol Dose Pak, Physical Therapy, etc… The average recovery time is 3-6 months. 

If conservative care fails then surgical treatment may be an option. For insertional Achilles tendonitis this usually involves removal of the heel spur, debridement of the Achilles (removal of diseased portions), with or without lengthening of the Achilles (Gastrocnemius recession). To remove the heel spurs, the Achilles must be partially or completely released from its insertion into the calcaneus (heel bone).  Following this release, strong anchors are placed in the bone to reattach the Achilles. Following surgery, a period of non-weight bearing is required which is usually anywhere from 4-8 weeks.  Sometimes physical therapy is required as part of the recovery process.  Statistically, Achilles tendon repairs have a high success rate and are a good alternative to living in pain.

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