Foot Doctor Treats Hearts on Valentine's Day

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

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?

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?

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?

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!

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?

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!