You Do Not Have to Live with Heel Pain

Foot Doctor Treats Hearts on Valentine's Day

2012-01-18T16:08:00.001-05:00

Local Foot Doctor Mends Broken Hearts

Family Foot & Ankle Specialists in Piscataway and Hillsborough, NJ show their patients some appreciation each Valentine’s Day. The office passes out red flowers to each of their patients who come in for an appointment. Men and women alike get a flower just for being a good patient, a good friend and a good family member to the office.

In a world that seems to have lost their business ethics, we like to show our patients how much they mean to us. We consider our patients to be one of our family. Some of the doctors in the practice, especially Dr. Wishnie who has been practicing for 21 years, have patients they have been seeing for over 10 years…that’s more than some friends last in our lives!

Whether you have a Valentine or not, Family Foot & Ankle Specialists will be here to give you a flower on Valentine’s Day if you promise to come in and get your feet taken care…fair trade?

Advatages of Cryotherapy

2012-01-04T11:39:00.003-05:00

Dr. Peter Wishnie, an NJ Podiatrist, explains Cryotherapy in this video. Cryotherapy is a procedure used to treat many kinds of foot problems including heel pain, achilles tendonitis, neuromas and more. Cryotherapy is minimally invasive and virtually painless. Often performed in the office, cryotherapy requires no down time and a fast recovery and little to no side effects.

Why is My Heel Pain Back?

2011-09-19T11:54:00.009-04:00

Many of my patients ask me will my heel pain come back. Some people come to my office after years of not keeping their regular checks and wonder why their heel pain returned. Before I answer that question, let’s revisit why you got the heel pain in the first place.

There are many causes of heel pain but the most common cause is a condition called plantar fasciitis. This is an inflammation of a band of tissue, or ligament, which attaches to the heel bone and runs to the ball of the foot. The ligament gets inflamed because of a extreme pulling of this structure against the heel bone. This is usually due to poor biomechanics, or the way one walks. When you over-pronate, or turn your heel out excessively, the ligament is put under tension.

Treatment is usually conservative in nature and surgical intervention is only necessary in less than five percent of the cases. Icing, stretching, an occasional cortisone injection and orthotics usually take care of the problem. At times, physical therapy and use of a night splint might be needed. Most cases of plantar fasciitis can be eliminated in 6-8 weeks. Now that the condition has been resolved, let’s look at the reasons why plantar fasciitis can recur.

As I mentioned, the main cause of the plantar fasciitis is due to poor biomechanics. An orthotic is used to control the over-pronation. Even though most orthotics are very sturdy, they can change shape over time. There are several components to an orthotic. The orthotic refers to the shell, which can be made from different grades of plastic, ranging from flexible, semi-flexible, to rigid.

A lot of orthotics have a plastic heel, known as a post. The post provides stability and maintains your foot in a neutral position, which is where all the bones and joints are aligned. It is like a built-in chiropractor for your feet. This post can become wobbly over time, thus your foot is not maintaining the corrected position that the orthotic was intended. This is why it is important to keep your twice a year orthotic check ups.

The second reason, is that you stopped wearing your orthotics because you feel great. Orthotics are like eye glasses. If you put your glasses on, you can see, but once you take them off, your vision is blurred. The same goes for orthotics. When you wear them, they maintain the proper position of the foot, but the foot goes back to functioning improperly when you stop wearing the devices. The difference is with eye glasses, you know immediately that you are not wearing them. With orthotics, it can take days, weeks or even months before you start to feel the difference.

A lot of people stop wearing the orthotics in the summer since they want to wear sandals. So, it is common to have a recurrence of the heel pain during this period. You can combat this problem by wearing shoes with the orthotics only when you are doing a lot of walking. If you are going to a pool or to someone’s house, then by all means, wear your comfortable sandals. When walking in the malls or the super markets, you should to be wearing your orthotics.

In addition, there are comfortable and good looking orthotic sandals. We offer a great selection of these kind of shoes. Just call the office and speak to our pedorthist, Dawn. We are presently having an end of the summer sale.

Another reason your heel pain can recur is the too much, too fast, too soon syndrome. This is when you have decided that you are going to start exercising or you are going to increase it. You go all out, right away. You forget that your health is a journey, not a destination. You went from the couch to running a couple of miles, or you went from running a ten minute mile to an eight. It can just be that went from sitting at your desk, to going to NYC and walking like a New Yorker. You increased your stride and your speed. Your body needs to time to adjust to the new activity. Take your time and enjoy your new activity.

Another reason you still have the dreaded heel pain is your shoes. Worn out or improper shoes will make your feet unstable. Is the outside of your heel worn down? Are the sides of the shoes stretched out? Are the shoes so flexible you can bend them like a ballet slipper? Then these shoes are not providing the support that you need. If you wear the same shoe every day, then you need to change them every six months or at least refurbished. It is best to alternate shoes, in order to allow them to breathe and regain their shape. For dress shoes, use shoe trees to maintain their shape.

The last reason why your plantar fasciitis has recurred, you have gained weight. Extra weight will put a lot of pressure on your heels. So, get off the couch and start stretching and icing and visit your podiatrist. Then, when your heel pain dissipates again, start a gradual walking program and of course, get rid of the bad snacks in your house.

Is Your Foot a Chevy Volt or a Dodge Neon?

2010-10-29T11:30:00.001-04:00

While in my car this weekend, I listened to an old favorite: Car Talk on NPR. As the boys went on to diagnose the caller’s car problem, I realized our feet are a lot like cars. They both have the daunting responsibility of getting us where we need to be. We use and abuse the poor things until they breakdown and leave us stranded. A smart car owner gets frequent tune ups. What does a smart foot owner do?

One of your tires is low on air. You don’t notice. You keep driving for mile and miles. Days, weeks, months go by and you forget to check your tire pressure. The pressure continues to decrease. The other three wheels have to make up for the one wheels lack to carry his share of the weight. Eventually, you start to feel a pull to the right as you drive. You attribute it to the wind. Your entire car is trying to compensate for your darn tire. Your gas mileage goes down. Your car is working harder trying to correct for the floppy misfit. You notice funny noises but the car continues to work so you continue to drive. Even if the tire goes completely flat, you could still get around. More and more damage slowly takes over your car until your vehicle has had enough and quits!

It sounds ridiculous to drive around with a flat tire so why do we walk around with a painful foot? We ignore the first signs of pain. We come up with a list of excuses to pretend the pain is not real. It must have been my shoes. I’m not use to playing 18 holes of golf. We think the pain will eventually go away. Our back starts to hurt, our knees are stiff. It must be old age. I work too hard. If I could just rest, I would feel better.

Just like a car, our foot is made of many parts. Our frame consists of 28 bones that are supported and made functional by a vast number of ligaments, tendons, fascia, and muscles. If any one part starts to give out or stops caring its weight, the rest of the foot pays. Pain is like your check engine light. Sometimes it is something silly like loose gas cap or a stubbed toe, but it can’t always be ignored or you’ll end up in a warranty or insurance battle.

It may be time to get a tune up on your feet. Chronic pain is not normal. I don’t care how long you stand at work or how many miles you run, your feet should not hurt. Would you describe your feet as your teenager’s Dodge Neon or the new electric car that is everlasting and futuristic? It is time for an upgrade. Soak your feet, get a car wash and put the for sale sign up; because it is time to test drive your feet back into health.

Does Your Pump Bump Have One or Two Humps?

2009-10-28T19:09:00.003-04:00

It sounds like a catchy lyric from the Black Eye Peas or Beyonce, but “Pump Bump” is a common term used among podiatric physicians. Do you have pain behind your heel? Do shoes irritate areas behind your heel and cause pain? Do you feel an abnormal bump behind your heel? It may be a bump that is irritated by your pump and thus a pump bump!

Pump Bump may also be referred to as a Haglund’s deformity as well as a retrocalcaneal bursitis. Typically, women most commonly complain of the irritation due to their selected shoes designed for fashion rather than comfort. The pain is sharp and along the side of the Achilles tendon insertion into the heel. Many of my patients find significant relief when they wear athletic shoes or backless shoes, but additional treatment is often needed to be completely pain free.

Typically a pump bump is caused by some abnormality in the heel bone. It may be that the heel bone tilts slightly out or pronates. Or, the heel bone may be tilted upward in a high arch. The Achilles tendon is only attached to the middle one-third of the heel bone. The upper one-third of the heel normally allows a nice gliding motion of the tendon like a pulley. When the heel bone is mal-positioned, the gliding motion is less smooth. Eventually, the unusual rubbing of the Achilles tendon causes irritation and the body develops a bursa. The bursa then becomes inflamed and causes pain in the heel.

On examination, the back of the heel will appear red, slightly swollen and painful to the touch. X-rays or ultrasound will often reveal some degree of boney deformity or mechanical disruption.

When changing shoes does not resolve the painful symptoms, it is necessary to see a podiatric physician to begin a treatment regimen that will hopefully keep you out of surgery. A heel lift can be put in the shoe. This will elevate the heel and reduce the area of friction on the shoe. NSAIDs are also used to decrease the inflammation, but it should be noted that if the shoe is still rubbing hard up against the bump the drugs will not be of great effect. Some of my patients have seen great relief by stretching their Achilles tendon 2-3 times a day. In addition, cryosurgery, which is a minimally invasive procedure helps relieve the inflammation along the heel. In most cases, the pain at the back of the heel is due to the constant pulling of the Achilles tendon along a sack of tissue in this area. This is called bursitis. Cryosurgery requires a very small incision along the area and then a probe that sends liquid nitrous oxide at a temperature of (-) 72 degrees is placed into the inflamed area. This reduces the inflammation, thus relieving the pain permanently. One can walk right away after the procedure with their regular sneakers.

Depending on the cause of your bump, orthoses may be necessary to correct the mechanical problem of your heel. Sometimes, the bump is unable to be resolved by the treatments and surgical excision of the bone bump is necessary.

Children Get Heel Pain Too and They are Not Faking IT!

2009-10-28T17:32:00.004-04:00

Many of us think that foot problems are one of the aches and pains of aging. But heel pain is not normal nor is it isolated to only adults. I have seen my share fair of children and teens that are having difficulty playing sports or participating in gym classes because of heel pain!

Sever’s disease is the most common cause of childhood heel pain and usually affects children 8-14 years of age. Traditionally, the disease was thought to affect males much more predominately, but now that we are seeing more young women athletes, the incidence is nearing the same between genders. Sever’s disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate in the back of your heal. During development, all bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton. This process is referred to as ossification. The calcaneus, or heel bone, has two separate areas of ossification that are connected by the cartilaginous growth plate.

Because of overuse or tight muscles, these two ossification centers are pulled away from each other causing strain on the growth plate. Overtime simple activities such as running, jumping or even standing can cause severe heel pain. I will often see children limping into my office when they have this condition.

Luckily, this is a self limiting condition meaning it will eventually go away. Unfortunately, children will have to tone down their activity schedule to reduce the pain. It is important to make the children as comfortable as possible and keep them active in their favorite’s sports, but we also have to be reasonable in the treatment options. Physical therapy will help the child stretch the muscles to decrease the pull on the developing calcaneus and Thera-band exercises can be used to strengthen the area. Ice massages will also help decrease the inflammation which is the culprit of pain. Heel lifts placed in the shoes, to decrease the pressure of the Achilles tendon on the calcaneus , and orthoses can also bring relief. Occasionally, there is need for a cast to immobilize the area to ensure proper healing. Though NSAIDS can bring relief to pain, large does are not always recommended for children. Thus, I prefer to have children to try topical pain relievers first.

Since Sever’s Disease can last up to 18 months, it is important to treat it aggressively soon as possible. Thus the child is not stuck on the bench, disappointed in their inability to perform. It may be necessary to take a short break from vigorous sports or exercise to allow proper healing time, but that is much better than sitting on the bench for an entire year!

Eli Manning Out With Heel Pain?

2009-10-05T22:18:00.004-04:00

NY Giants quarterback, Eli Manning, was just diagnosed with plantar fasciitis. Plantar fasciitis is an inflammation of a ligament under the foot. This ligament is very strong and thick and runs from the heel bone across the arch and into the ball of the foot.

The question right now is should Eli play on Sunday and possibly risk the season. In the late 1930s, Yankee centerfielder, Joe DiMaggio, sat out three months with plantar fasciitis. Times have changed and medical treatments have greatly improved since then.

The condition can come about in several ways. Usually in the non-athlete it occurs between the ages of 35-55 and can come about from faulty foot mechanics. The foot moves in a direction called pronation and the ligament then stretches. When the foot over-pronates (the heel turning outward), the ligament will stretch excessively. Over time, this will cause the ligament to become inflammed.

For an athlete like Eli Manning, all that is needed is for him to turn his foot in the wrong direction, or to plant it and rotate the foot excessively, to bring about the condition.

Plantar fasciitis can be very painful. Imagine having pain in the heel or arch with every step you take. Then try to plant that painful foot and throw a football down field with some force. Now lets add another factor. Planting your painful foot and then moving real fast when some 300 pound linebacker is coming at you. This can lead to favoring the foot and now setting yourself up for another injury, such as a knee.

Treatment can consist of taping, steroid injections, shoe modifications, orthotic inserts, rest, ice and physical therapy. The good news is that the injury rarely needs an invasive surgical procedure. There are minor procedures such as cryotherapy or extracorporeal shock wave therapy. These treatments are meant for the chronic type of plantar fasciitis.

In my opinion, if Eli can't plant is foot fully and move quickly, he should take the week off and get ready for New Orleans.

The Doctors of Family Foot & Ankle Specialists have written three books that they offer for FREE! Got Feet?, You Do Not Have To Suffer With Heel Pain, and The Truth About Diabetes and Your Feet. Click here to have your FREE copy mailed right to your door!

You Are Not Alone if Suffering With Heel Pain

2009-04-21T18:21:00.004-04:00

A survey done by the American Podiatric Medical Association revealed that 64 % of people suffering from heel pain have never sought treatment from a podiatric physician. The survey also revealed that nearly 40 percent of the American population suffers from heel pain! With the economy on a downturn and unemployment rates over 12% in some state, American’s cannot afford being off of their feet. What if your feet hurt? How long can you stand at work before your feet need a break! If you are avoiding the doctor for heel pain because you are scared of the cost or surgery, you are being foolish!

The most common cause of heel pain is plantar fasciitis. This is a soft tissue injury that is commonly healed with conservative treatment, meaning no surgery! Though there are many reasons for heel pain, plantar fasciitis is by far the most common and is one of the most debilitating. It is often characterized as pain with the first step of the day. When stepping out of bed in the morning or a long car ride, the sufferer experiences pain with the first few steps. Many patients describe the pain as an achy bruise on their heel times ten!

To understand the treatment of plantar fasciitis it is essential to understand why and how this chronic pain occurs. The plantar fascia is a thick band of tissue that attaches to you calcaneus, the heel bone, and bones in your forefoot. The fascia supports the arch of your foot. When standing or walking, feet tend to pronate. This means the foot is tilting inward and elongating. This biomechanical positioning causes stretching and tearing of the plantar fascia which leads to inflammation. It is the inflammation process that causes the pain in the heel of the foot where the fascia attaches. The human body is masterpiece; thus, not everyone experiences plantar fascia damage. Our body will often adjust to compensate for abnormal stresses, but sometimes it just cannot take the stress put it through. One may experience plantar fasciitis during pregnancy or after gaining weight. It is also associated with an increase in activity. So, if you are taking on more shifts at work or began a new work out plan, you may start to feel some foot discomfort.

Since the pain is due to inflammation, many treatment plans flight this problem first. Corticosteroid injections is an antinflammatory that will give many suffers great relief. There are side effects associated with steroid injections, thus the number of injections that one can receive is limited and not everyone is eligible for an injection. Another primary treatment is orthotics. Orthotics helps control the pronation that leads to the stretching and tearing of the fascia. The orthotics will also help the fascia support the arch. Another essential portion of the treatment plan is stretching, exercising, and rest. Since this is a dynamic process, many podiatric physicians will recommend physical therapy to optimize the healing process. This treatment will also play a critical role in prevention in the reoccurrence of facial injury.

No foot pain is normal and no one should have to suffer from foot pain. It can be debilitating to your everyday life and many American’s cannot afford to slow down or stop for foot pain. The good news is that heel pain is often treatable without surgery. With the pain so excruciating and the treatment options so obtainable, it unacceptable that 64% of heel pain suffers are living with pain because they fail to seek help.

Stretching for Plantar Fasciitis

2009-03-24T19:13:00.005-04:00

Why is it so important?

You may remember your podiatrist telling you how important it is to stretch and ice for plantar fasciitis. The doctor may have given you a sheet of paper that described the stretches with pictures and everything. Who knows where that is now? Are you doing your stretches? Do you remember how to do them or maybe no one ever showed you how to perform them properly.
First, let us review why stretching is important. Plantar fasciitis is inflammation of the fibrous band on the underside of your foot. Imagine your foot arch as a hunting bow. Your foot arch is the wood portion and the string is your plantar fascia. If you place the string portion on the ground and push down on the wooding handle, you stretch out the string. This is very similar to the stress on your plantar fascia when you stand, walk, and run. Overtime, these overuses cause inflammation and heal pain. A common reason why some people are more prone to developing plantar fasciitis is due to tight calf muscles and weak foot muscles. This is easily corrected! You can improve your symptoms and decrease the chance of recurrence just by

doing a few simple stretches.

Stretching is so critical to the treatment plan, that many podiatric physicians will refer you to a physical therapist. This will speed up the recovery process and will help prevent reoccurrence!
When stretching for plantar fasciitis, you must be persistent and diligent. While sleeping, your muscles are not being used and they become tight. When the alarm goes off and you jump out of bed, you will often have excruciating heal pain with your first step. This is because your tight muscles are causing increased pull on your plantar fascia. The first thing you should do in the morning is stretch! You may experience similar pain after sitting for a long time. Once again, the first thing you should do is stretch. Stretching should be done about three times a day along with icing. No excuses. Some stretches are so easy you can do them while sitting at your desk working!

Push the wall to China exercise

Place both hands on the wall at shoulder height. With your toes facing strait forward, extend one leg backwards. Imagine you are trying to push the wall to china. You should feel your calf being stretched.

Towel Stretch

While watching TV, sit on the floor with your legs stretched out in front of you. Wrap a towel around your feet so you are hold on to the ends, one in each hand. Slowly pull the towel toward you keeping your back strait at 90 degrees. You should feel your calf muscles stretching.

Bottle or Tennis Ball Roll

Use a frozen water bottle or a frozen tennis ball for best effect. This is too simple. Roll your foot over the bottle or tennis ball.

Now you have no excuses! Now you know three easy stretches for your plantar fasciitis. Remember to be persistent and diligent and to talk to your podiatric physician about other treatment options to help relieve your pain.

For a video presentation, go to youtube.com/pwishnie and click on the stretching video.

Plantar Fasciitis and Heel Pain

2008-11-22T16:55:00.002-05:00

What is Plantar Fasciitis?
Do you have stabbing, burning heel pain? When you get out of bed or out of your car is your foot achy and painful to walk on? If yes, you may be suffering from Plantar Fasciitis.
Plantar Fasciitis is caused by inflammation of your plantar fascia, a band of tissue that supports your arch. It can arise for various reasons including improper shoe gear, overuse, or even your foot type. Anything that causes increased stress on the arch supporting ligament will cause this debilitating pain.

How is it treated?
For immediate pain relief, your podiatric physician can give you a cortisone injection. There are many conservative treatments for plantar fasciitis that when used accordingly are very successful. You should be icing and stretching the bottom of your foot daily. Your podiatric physician may refer you to a physical therapist to aid in your treatment and to teach you the most effective stretching techniques for your foot type and condition. You may also be advised to wear a night splint that stretches your tendons and fascia in your foot while you sleep. These treatments can significantly reduce the inflammation of your plantar fascia and thus reduce your pain. It is also necessary to address your shoe gear. You should be wearing shoes that properly stabilize your foot and support your arch. Your podiatric physician can provide you with a prefabricated or custom orthotic that would give your achy foot the support it need. Athletic shoes are easily broken down and lose their supportive capabilities and should be replaced on a regular basis. This is a common cause of heel pain in runners. Your podiatrist can properly advise you on proper shoe gear and how often you should replace your sneakers.
How fast will the pain go away?
Since the fascia or ligament in the bottom of your foot is injured, the pain will not go away over night. It takes time and therapy to improve the integrity of the tissue. If you are diligent with the treatment plan, your pain will subside. When your pain goes away, you should not stop wearing proper shoe gear and orthotics and continue to stretch because the pain can reoccur.
You do not need to wake up every morning with achy feet. You can get back to walking, running, or even daily activities with simple conservative treatment! When your pain is addressed one step at a time, you will see results.

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Dr. Peter Wishnie is a podiatrist who specializes in foot and ankle surgery. He is the senior partner at Family Foot & Ankle specialists located in Piscataway and Hillsborough,NJ. Their goals are to educate the public on the care of their feet and ankles and to get them functioning as quickly as possible. They are dedicated to foot and ankle health. For more foot health tips on heel pain, get a Free copy of their book, “You Do Not Have To Suffer With Heel Pain,” by visiting their website: http://www.stopfootpainfast .