Heel Pain in Children

Calcaneal Apophysitis also known as Sever’s Disease is a very common problem among active children from the age of 6 to 16.  This condition occurs when there are microtraumas to the growth plate that is located on the back of the heel in a growing child.  Inflammation and pain may occur during, or following sports. This pain usually will subside with rest, but returns with activity.  Radiographs of the heel often show fractures within the growth plate at the areas of tenderness.  Treatment consists of Custom Orthotics which are shoe inserts with special custom modifications. They are created from a scan or mold of the child’s feet. Usually once a child is fitted for these devices they are able to continue with their sports activity without any significant pain.  Growth spurts naturally become a factor with these medical devices, they are only correcting the problem while they fit properly.  For immediate treatment the parents can ice the heels and place the child on children’s Ibuprofen.

Ingrown toenail? Treat it today

Ingrown Toenails

Ingrowing toenails are very painful and can occur on any nail, but most often it is the hallux or great toenail that is involved. It is important to note that if left untreated the infection along the side of the nail will enter into the bone and cause a condition called osteomylitis. Bone infection may require long term antibiotics or even in severe cases amputation.  Diabetics with limited sensation in there feet, often lose a limb to an untreated ingrown toenail.  Nevertheless, the majorities of patients with ingrown nails are easily treated and first present with pain along the side of the nail.

There are a variety of conditions that may cause an ingrown nail to form but by far the most common is a genetic tendency.  The shape of the nail is directly related to the shape of the underlying bone.  If your parents and grandparents had a proclivity to forming ingrown nails than the likelihood is that their children will also have similar problems.  Another very common cause of this condition is injury.  The great toe is often stubbed or injured which can lead to the formation of a small bony growth under the nail; this in turn causes a curvature to the nail leading to ingrown nails. Tight shoes or stockings, that maintain a constant pressure on the nails, may over time push the sides of the nail into the skin. 

 Treatments:

If your nails are curved in and are not painful LEAVE THEM ALONE.  A true ingrown nail is very tender.  Over the years I have seen nails that appeared almost normal but were excessively tender to touch and when I surgical removed the ingrown section I was amazed at how deeply they were embedded into the skin.  Trimming the side of the nail may alleviate the problem, soaking in warm water, which has a splash of vinegar or some Epsom salt, may help ease the pain. Avoid over the counter remedies such as outgrow which is acid and eats away at the nail and the skin, this is rarely a cure and may even add to the infection. Nevertheless, a true ingrown nail can not be corrected via bathroom surgery and if left untreated the side of the nail becomes red and swollen and infected. Overtime, the nail itself will become deformed in appearance. Antibiotics alone may help reduce the infection but will not cure the problem.  A small section of nail needs to be excised.   DO NOT have the entire nail removed, this does not eliminate future ingrown nails and when the nail returns it is often ingrown again, as well as thick, discolored, crumbly and quite ugly.  A podiatrist is the only specialist that has the expertise and equipment needed to correct this problem.  I have personally treated thousands of nails and on an average day remove several ingrown nails permanently. 

 Partial Matrixectomy:

There are several specific factors that make our nail surgery unique. First, when a section of nail is being removed the toe needs to be anesthetized via a toe block.  We use a cold spray called Ethyl Chloride to freeze the skin so the initial stick of the needle is minimal; we then use a 30 gauge needle to introduce the numbing agent.  The needle itself is so thin that it can only be used with a few injectables.  This procedure is done slowly and precisely reducing the pain to a slight pressure.  Second, once the toe is asleep a very small section of the nail is removed, just enough to correct the problem without causing the nail to look deformed.  Unfortunately, if the problem has been chronic or has had previous surgery, a larger section of nail must be removed.  Most often the nail will look completely normal when it has healed; of course this depends on the initial level of infection and deformity.   Lastly, we use a combination of a radiowave surgitron and chemical cautery to destroy the nail matrix cells at the root to insure the least amount of regrowth.  Overall, we see a very small percent of recurrence with this procedure and very few complications.  For detailed post operative instructions see section on Office Forms.

Walking towards Health

Every healthcare professional in the world advocates a good balanced diet and regular exercise to reduce health risks and improve quality of life.  The problem of course is how can you exercise when every step causes pain somewhere in the body.  The answer is not to stop exercising but to learn what is causing the pain and what can be done to reduce or eliminate that pain.  The foot is a very complex entity, it needs to support more than just the body’s weight, it also needs to align the body correctly to avoid ankle, knee, hip and back problems not just during stance but throughout propulsion.  In other words, the foot undergoes constant adjustments as we propel through our gait.  If there is a biomechanical problem which changes the way in which the foot supports the lower leg, then pain can occur anywhere from the ankle to the back.  Think of a house being constructed on a broken, uneven, collapsing slab.  Walls will be uneven, windows will be difficult to open and the roof will most likely crack, basically if the foundation is poor the structure will be weak.  Our bodies are much more complex but the same principle can be applied, if our feet are misaligned then our ankles need to compensate, which causes the knees to adapt, the hips to adjust and finally the back (usually the lower back) has to modify as well.  Pain may occur from the foot to the back and in any or all of the involved joints.  Chiropractors can realign the spine and reduce much of the pain, but with activity the problem will recur without the proper correction to the feet.   A functional orthotic is a custom insert that is built to properly support the foot, to correct the individuals problem and correctly realign the ankles, knees, hips and back.  If a shoe insert can be bent and twisted then it is merely a cushion, a true functional orthotic has a hard core that corrects the feet during stance and gait and needs to be designed to an exact image of the foot.  At our office, we use the Metascan by Footmaxx which measures the various stages of the foot during gait.  This remarkable scanner is capable of recording over a 140 images a second, capturing much more than the physician’s eyes can ever assimilate.  If you are embarking on an exercise program then functional orthotics may be an excellent way of avoiding problems from manifesting.  Many insurance companies cover the cost of functional orthotics. 

The Diabetic Foot

Feet, being the furthest from the heart, typically have the poorest circulation of the body. Changes in blood flow, within both the small and large blood vessels, may progress at different rates.  There can be palpable flow to the arteries in the feet, and simultaneously, complete occlusion to the digits, due to deposits of plaque within the capillaries feeding the toes.  On the other hand, there may be no palpable pulses noted in the foot and yet circulation is still excellent due to collateral propagation of vessels.  As a podiatrist that routinely treats diabetics, I have found that a diagnostic tool called a Doppler can, within a few minutes, determine the blood flow from the lower leg to the foot and from the foot into the digits.  Diabetics run a higher risk of calcification or hardening of the arteries, especially in the lower extremity, which will severely decrease blood flow to the foot.  Podiatrists work closely with Vascular Physicians in a joint effort to reduce the amputation rate amongst diabetics.  This collaboration, over the past decade, has significantly reduced the number of diabetic lower leg and foot amputations, due to earlier intervention, and new techniques in correction of peripheral arterial disease. 

Circulatory changes within a foot can also lead to a higher infection rate.  When blood vessels can’t deliver important nutrients or medications to an area, that area will be slow to heal.  Concurrently, a higher level of glucose in the diabetic patient will make them susceptible to various infections. With the reduction of circulation, the increase in vulnerability to infections, and finally the decrease in sensation called neuropathy, the diabetic foot is a disaster waiting to happen.  

Diabetic peripheral neuropathy is a condition that causes changes in the nerves within the foot, lower leg, and occasionally the hands and arms.  This condition may present as a tingling, or burning sensation in the toes or feet, numbness, or pain that may be more evident at night.  The cause of diabetic neuropathy is still under investigation but is likely due to a combination of several factors.  Most researchers agree that neurovascular changes can lead to damage within the blood vessels that carry oxygen and nutrients to the nerves. High blood glucose, abnormal blood fat levels, even low levels of insulin may affect the nerves.  Autoimmune factors that can cause inflammation to the nerves, inherited traits that increase susceptibility to nerve disease and lifestyle choices, such as smoking and drinking have an adverse effect on the chemical composition of nerve fibers.  Not only do diabetics have a tendency for higher infections, peripheral vascular disease and neuropathy, but since all parts of the body are involved, the skin, bones, soft tissue, ligaments, muscles are all susceptible to changes.  For the diabetic foot that means there can be physical changes such as bunions, hammertoes or even a complete breakdown of the medial arch.  A diagnosis of diabetes is distressing but with proper treatment, education and determination complications can be avoided.

Call Dr. Braun at Eastern Shore Foot Center and schedule your appointment today. Need diabetic shoes? Eastern Shore carries a wide variety of styles. Want more information? Visit us on the web. www.easternshorefootcenter.com or "Like" Us on facebook

Dr. Randell Braun - Eastern Shore Foot Center - 1913 US Hwy 98, Daphne, AL 36526

251-626-5065

 

Finding the Right Shoes

The wrong shoes can cause or aggravate foot ailments.  The right shoes can often prevent problems.  So wearing the right shoes is vital to foot health.  Follow this checklist when you buy shoes. Be sure they measure up.

Construction

Leather is the best material because it breathes like skin and molds to your foot.  Athletic shoes with netting also allows the feet to breath and is usually less binding as the foot swells during activities.  Canvas can be a good alternative to leather but if you are very active make sure that there are no pressure points that can cause blistering or irritation. NEVER wear plastic shoes, they can cause sweating that may lead to fungal infections, they do not breathe, they do not conform to the foot and do not absorb the jolts of walking on hard surfaces.

Insoles should be cushioned, if you are wearing high heels add a gel or foam metatarsal pad to the area under the ball of the foot to help reduce the pressure on the area and decrease the formation of calluses.  If the insoles in a pair of shoes have wear or even holes, in most cases the shoes need to be replaced.

Arch supports distribute weight over a wide area. They help reposition the foot to a proper alignment to alleviate various biomechanical problems.  Arch supports placed in flimsy shoes will not work properly; they need a shoe with a solid shank to hold them in the correct position.  Over the counter supports are generic and may help reduce problems but every foot is slightly different and only a true custom orthosis can accommodate a patient’s individual needs.  Custom functional orthotics are made from a computer image during gait and offer the best support.

 Fit

Only you can tell if shoes fit.  If they aren’t comfortable, don’t buy them.  If they do not fit properly they will create pressure areas on the feet, this often leads to blisters, bursitis, corns, neuromas and cramping.  Do not trust sizes, different models of shoes are made from molds that may differ from one manufacturer to the next.  Shoes can run wide, narrow, long, short or any combination and so it is important to try on both shoes for proper fit.  Most people have one foot that is slightly larger than the other; therefore, it is very important to try on both shoes. .  If you are having your feet measured, always check both feet for size.   Always fit the larger foot.   If you own shoes that feel tight have them professionally stretched by a shoe repair shop.

Feet spread with age, sizes change, often over time feet become wider.   A pair of shoes that may have fit a year or two ago may no longer be the proper size today.  Go shoe shopping at the end of the day when your feet are already tired, achy and swollen; then if you find a comfortable pair of shoes, buy them in every color if possible.  Too often people by shoes that felt wonderful in the shoe store to later discover they can’t walk in them.   Remember size depends on shoe make and style.  Don’t insist you always wear one size if the next feels better.  Most shoes are manufactured overseas and their forms may be sized slightly smaller.   The toe box should be roomy enough to wiggle all your toes.   Your foot should not be wider than the shoe.  The heel should fit without gapping and the instep should support your arch. 

 It is difficult to find shoes that fit all the above criteria.  The important area to fit is the forefoot, if the heel is too loose than moleskin can be applied within the shoe to make if fit your foot.  It is always easier to reduce the heel area with pads then to wear shoes that are constricting the forefoot.  If you can find shoes that fit both the heel and the forefoot that is the ideal situation, if the heel fits and the forefoot is just a little snug but not too tight, then a shoe repair shop can stretch the forefoot area. 

Children’s Shoes

Children’s feet grow very rapidly and so constantly check the shoes by pressing down on the distal aspect of the shoe, it should be at least ½ inch space from the tip of the shoe to the toes. If the toes are jammed right to the end of the shoe then they are much too small.  Shoes should be flexible and made of leather or canvas not plastic.  Children should be able to wiggle their toes inside the toebox of the shoe.  The orthopedic stiff leather shoes of the 50’s were too constricting, all studies in the past decades agree that today’s sneakers are the best shoes a child can wear.  Shoes protect the feet during walking; therefore shoes are unnecessary until a child begins to walk.  It is important to check the socks; tight socks can constrict the toes. 

 Passing shoes from one child to the next may be problematic.  If your child is wearing used shoes, firstly make sure there is no obvious wear inside or out that can cause problems, secondly treat the inside area of the shoes with an antifungal if you are unfamiliar with the previous owners foot conditions.  Although I do not recommend children wearing used shoes, I realize there are economic concerns that may necessitate the hand me down scenario.  Furthermore, with children’s rapidly growing feet, it is expensive and difficult to keep a child in a dress shoe that is only worn occasionally.  There are many advocates of not wearing used shoes, I am not one of them.  Children’s shoes, like their clothing, are often outgrown way before any wear is evident.   Just be meticulous in the inspection of a shoe that was previously worn by another, and make sure the fit is comfortable for the new owner. 

Cryopen

CRYOPEN

The CryoPen is a complete system that is simple, safe and effective for the treatment of skin lesions including warts, actinic keratoses, seborrheic keratosis, porokeratomas and skin tags to name just a few.  The CryoPen is safe because it delivers results without scarring or burning of surrounding tissue and because it does not require the use of dangerous cryogenic liquids and gases like liquid nitrogen.

The destruction of lesions using this system does not require local anesthetics; therefore, painful needles are no longer an issue.  The instrument is applied directly to the lesion for 1-4 minutes and this freezes the area. Afterward the area may be tender for a day or two so we place the patient on a cream that relieves the discomfort.  It does still take a few weeks to see if the lesions are completely eradicated. Occasionally the procedure needs to be repeated for stubborn lesions.

Schedule your appointment today with Dr. Braun at Eastern Shore Foot Center. Dr. Braun will go through all options with you; find out if Cryopen is the right procedure for you. 251-626-5065. Want more information? Visit us online at www.easternshorefootcenter.com

Ask for a second opinion

You Can Say NO

Pain is most often a warning sign.  Naturally, there are times that we all ache or hurt, but these are limited.   If you have recurring or constant pain, then it is your body telling you something’s wrong.  Most of us hate seeing a doctor; we dread the exam, the tests, and mostly the unknown.  When a problem is at its early stage, whether the pathology is simple or complex, it is easier to treat, reverse, cure or eliminate.  Too many people suffer for months, even years out of fear of a costly and painful treatment.  I realize fear is a basic human emotion that most of us share when it comes to our health.  The thought of surgery, injections, and medications that have side effects, and treatments that can be painful and expensive, seems to paralyze so many of us that we convince ourselves that the problem will just go away with time.  You need to realize one very important fact.  If you don’t like what a doctor suggests, if you don’t want the surgery or injection, if the treatment that is offered is not what you want, just say NO. Getting second and sometimes third medical opinions is prudent. There are many doctors to choose from, always remember in a sense you are the client not just the patient, you need to be involved in your health care decisions.  Ask questions, weight the choices and make an educated decision when it comes to your health. 

 If you are hurting and would like to see a board certified Podiatrist with over 30 years of medical experience in Podiatry;Please call us. Dr. Braun is knowledgeable, experienced and will refer you to another doctor if she feels she can not successfully solve your foot ailments. Visit www.easternshorefootcenter.com or call 251-626-5065.

Heel Pain?

What Does Heel Pain Feel Like? Is This Normal?

No, this is not normal. Foot pain is never normal.

Plantar Fasciitis ( or heel pain ) is very common. It feels like a dull ache most of the time, but when the patient first gets out of bed in the morning, or when getting up after sitting for a period of time during the day, the pain in the heel is impressive. It almost feels like the heel has been bruised, from falling on a rock barefoot, but it is worse.

Plantar Fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. It is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. There is a tight ligament that stretches across the arch, from the ball of the foot to the heel bone, called the Plantar Fascia. When we walk, our feet have a tendency to roll inward, toward each other, in a moth that we call pronation. When feet pronate, they flatten, stretch out and the arch elongates. This causes excessive pulling on the Plantar Fascia ligament and attachment of the ligament to the heel bone begins to separate. An injury occurs where the ligament progressively tears off of the heel, fiber by fiber. Bleeding occurs next to the bone and inflammatory fluids accumulate between the ligament and the bone, forming a Bursitis, or fluid-filled sack.

Over time, the body lays down scar tissue, in an attempt to "glue" the detached ligament fibers back on to the bottom of the heel bone.  Over the course of 3-5 years the scar tissues calcifies and this calcium deposit eventually becomes visible in x-rays as the heel spur. This inflammation of this Plantar fascia ligament is called Plantar Fasciitis, and in addition to the Bursitis, is what causes pain.

If you experience heel pain give Eastern Shore Foot Center a call. Schedule your appointment with Dr. Braun today and find out your options to alleviate pain. 251-626-5065. Visit our website, www.easternshorefootcenter.com

Why do feet hurt during pregnancy?

Why do your feet hurt now that you're pregnant?

Pregnancy triggers many different changes in the woman's body. Due to the natural weight gain during pregnancy, a woman's center of gravity is completely altered. This caused you to stand differently, adding pressure to the knees and feet. Two of the most common foot problems are over - pronation and edema.

Over-pronation (flat feet) is when the arch flattens out upon weight bearing and feel roll inward when walking. This can create stress or inflammation on the fibrous band of tissue that runs from the heel to forefoot. The reason many pregnant women suffer from over-pronation is the added pressure on the body as a result of weight gain.

Edema (swelling in the feet) normally occurs in the latter part of pregnancy. Edema results from the extra blood accumulated during pregnancy. The enlarging uterus puts pressure on the blood vessels in the pelvis and legs causing circulation to slow down and blood to pool in the lower extremities. The total water fluid in the body remains the same as before pregnancy, however, it becomes displaced.

TREATMENT AND PREVENTION

There are EFFECTIVE ways to treat both over-pronation and edema during pregnancy.

Over-pronation can be treated with orthotics. In our office we can take digital scan of your feet to detect pressure points, and have a pair of customer inserts ready in less than 2 weeks.

 Edema in the feet can be minimized by:

• Elevating feet as much as possible
• Wearing proper footwear
• Drinking plenty of water
• Have your feet measured several times throughout your pregnancy, as they will probably change sizes.

 If you are pregnant call Eastern Shore Foot Center today and schedule an appointment for a foot exam. We can get you in custom orthotics right away to prevent foot problems during pregnancy. Check us out online www.easternshorefootcenter.com , call us 251-626-5065. Follow us

The body's healing process

The Body's Healing Process

From the moment an injury occurs whether it is a broken bone, torn ligament, severe sprain or even a  surgically invasive procedure, your body goes to work to repair the damage.  There a several stages in the healing process the following is a simplification of the various stages:

At the moment of injury: Chemicals are released from the damaged cells which trigger inflammation. Blood vessels at the injury site become dilated; blood flow increases to carry nutrients to the site of tissue damage.

Within hours of injury: White blood cells (leukocytes) travel down the bloodstream to the injury site where they begin to tear down and remove damaged tissue, allowing other specialized cells to start developing scar tissue.

Within days of injury: Scar tissue is formed on the skin or inside the body. The amount of scarring may be proportional to the amount of swelling, inflammation, or bleeding within. In the next few weeks, the damaged area will regain a great deal of strength as scar tissue continues to form.

Within a month of injury: Scar tissue may start to shrink, bringing damaged, torn, or separated tissues back together. However, it may be several months or more before the injury is completely healed.

Bone healing:  Healing of broken bones whether due to a fracture of surgery is the same. There are three basic stages including Inflammation which starts immediately and can last for several days.  This begins with bleeding in the area which clots at the fracture site providing the initial structural stability and blueprint for producing new bone. Second stage is bone production; the clotted blood is replaced with fibrous tissue and cartilage.  This is also referred to as soft callus and is not seen on x-rays, within several weeks this soft callus is replaced by hard bone called hard callus and can be seen on the x-rays. Finally we have bone remodeling, this goes on for several months, bone continues to form and becomes compact and the bone appears similar to its original shape. Weight bearing such as standing or walking encourages bone remodeling.

What’s a bump in the back of the heel?

What’s a bump in the back of the heel?

The bump on the back of the heel is called a Haglund’s Deformity.  It is actually an enlargement of the bone, usually due to spurring of the posterior (rear) aspect of the heel.  Many years ago this was called a “Pump Bump” because it was noted in women who wore certain shoes.   This condition is not gender specific, it is inherited.  Many people have an enlargement behind their heels and never noticed it, nor have they had any problems.  Some people find certain boots or shoes rub and irritate the area, so they elect to choose more comfortable, accommodating shoes.  Finally, there are some who suffer with constant pain in the area and will require surgical excision of the boney protuberance. 

I did all the exercise for Plantar Fasciitis and now I can’t walk?

I did all the exercise for Plantar Fasciitis and now I can’t walk?

If you have been stretching the band underneath your foot by hanging off a step, pushing against a wall, pulling your toes back, or even rolling a can with your foot because you read it on the internet or your doctor told you to, you may actually be doing more harm than good.  When your feet feel a little “tight” in the morning, stretching will be fine, but if you really have Plantar Fasciitis you may be irritating the heel.  The band that is attached to the heel becomes thickened over time, it no longer can flex so pulling and releasing the band at the attachment to the heel will cause irritation to the area.  Think of a thick rubber band attached to a bone, a slow consistent stretch that lasts an hour or more is fine, but a pull and release over and over is like taking a rubber band and snapping it against a painful area.  Doing the repetitive short stretches will only cause micro tears in the band leading to severe pain.  If you have heel pain and you are attempting to reduce it by stretching then get a Night Splint, these are medical devices that give a consistent even stretch to the plantar fascia allowing it to slowly stretch out over time.  Wear the splint for at least an hour a day and stop irritating your foot with inconsistent stretches.  If you do get a night splint please READ our instructions on how to wear it, there is an article on our website that explains how to wear one and why it works. 

Need more informaton? Come see Dr. Braun at Eastern Shore Foot Center. Visit us on Facebook and follow us on twitter

The back of your heel tender?

The back of my heel is tender.

The Achilles tendon attaches to the back of the heel.  When you have been very active this tendon can become strained and tender. It is actually noted to be one of the most injured tendons in the human body. Rest, ice and elevation may be all you need to reverse the tenderness.  If this is a persistent problem then there is a chance you are placing too much strain on your feet with activity so you might need heel lifts or functional orthotics.  The heel lifts are placed into your shoes to take the pressure off the Achilles tendon, but entire support for the entire foot is preferable.  If the area is just tender, not truly painful, then we recommend a product called BioFreeze, it helps reduce the inflammation.  If the condition is severe please get to a podiatrist, you may have torn or partially torn the tendon. 

My child limps after they have been running around, why?

My child limps after they have been running around, why?

Many children have a condition called Sever’s Disease, also called Calcaneal Apophysitis.   A heel becomes a solid single bone over many years, by the time a person is 16 usually the calcaneus (heel bone) has matured completely.  But, from the age of 6 on, the bone has a growth plate located just behind the heel.  This growing portion of bone has not fused with the main body of the heel; therefore it is vulnerable to trauma during any sports activity.  X-rays often show small fractures in the area.  Treatment is typically a custom insert that stabilizes the heel and takes pressure off the growth plate, allowing the child to maintain a busy sports schedule with minimum to no down time.  As a parent you should ice, elevate and rest the heel after a sport and bring your child to a podiatrist, they are the best equipped to reverse this condition and keep your child active.

Want more information? Visit www.easternshorefootcenter.com

Red tender heel that is very swollen, what’s wrong?

Red tender heel that is very swollen, what’s wrong?

There are several conditions that can cause redness and swelling in the heel.  If it is the entire heel the problem may be acute gouty arthritis, although gout usually occurs in the big toe, it also affects the knees, shoulders, elbows, ankles and heels.  If there is history of gout in your family, or if you have had multiple gout attacks in other joints than the likelihood this is gout has increased.  The most common area to be red and swollen is just behind the heel, at the attachment of the Achilles tendon.  There is a bursal sac in the area that may have become inflamed, most people are aware of bursitis affecting shoulders, knees and hips, but this also is a problem in feet.  Retro-calcaneal bursitis is basically a condition that occurs when the bursa (fluid filled sac that cushions the area between the Achilles tendon and the heel bone) becomes irritated from over use or an injury.  Ice, elevation and especially rest are important, but it is also wise to avoid any shoes, or even a sock touching the area till it reduces.  Anti-inflammatories such as Aleve, Motrin, and Aspirin are all helpful but if it is very tender it’s time to see the podiatrist. 

Visit Eastern Shore Foot Center... 251-626-5065 Stop hurting today
www.easternshorefootcenter.com

Electrical sharp pain from the heel into the ankle, what’s going on?

Electrical sharp pain from the heel into the ankle, what’s going on?

If you are feeling sharp, radiating, stabbing pains that may start in the heel but usually involves the ankle, you may have a condition called Tarsal Tunnel.  Just like its counterpart in the wrist Carpal Tunnel, this is a condition in which the nerves become entrapped in the fibrous tissue surrounding the area, when the nerve becomes compressed or squeezed a burning sensation may occur. Typically the nerve that runs along the inside of the ankle, called the Posterior Tibial Nerve, becomes entrapped in the Laciniate ligament in the ankle.  The pain occurs with movement in the ankle and can be very debilitating.  There is also another condition that presents similarly, which occurs when a simple heel problem goes untreated for a long time, the problem can escalate and the medial plantar nerve becomes embedded in the plantar fascia, in turn causing the neural pain described above.   Of course there are systemic conditions that may cause this problem but the two mentioned are the most common seen today.  Treatment is dependent on the severity of the problem, immobilization, oral and topical anti-inflammatories, functional orthotics, series of anesthetic blocks, Laser therapy and of course surgery. 

Visit Eastern Shore Foot Center's website for more information about foot conditions or to request an appointment

Eastern Shore Foot Center

Do heel injections work?

Do heel injections work?

Injections for heel pain consist of various anesthetic agents and steroids.  There are a variety of short and long acting steroids that are typically used.  There are some basic problems with heel injections, firstly in most cases the results are temporary and the pain reoccurs unless other treatments are being offered in conjunction with the steroid injection.  You may know someone that said they had the injections and they worked great, but if the injections alone alleviated the problem then less painful and less invasive measures may have also worked.  Steroid injections can be painful and can cause various systemic problems from allergic reactions (which are rare), rise in blood glucose levels, weakening of the muscles, ligaments and tendons in the area of the injection, and finally in some cases temporary worsening of symptoms. The cost of a steroid injectable has skyrocketed in past years causing some doctors to use weaker or lower strength steroids that are not as potent because of the cost.   There are less invasive and longer lasting treatments available, nevertheless,  heel injections are sometimes necessary, but should be performed as an adjunct to other therapies. 

What shoes will help your heels

 What shoes will help your heels?

Amazingly, any shoe with a slight heel can help alleviate heel pain.  For men this often means a cowboy boot, for women a slight heel in a dress type shoe.  As far as various running shoes there are a number of them that have a built in arch support.  Nevertheless, it is impossible to suggest one brand over another.  Feet vary in many ways, not just how high or low an arch is, but each person’s gait is unique and needs to be accommodated differently.  Furthermore, life style makes a great deal of difference.  A marathoner will have different needs than a tennis player, likewise a dress shoe to be worn throughout the workday will be very different than one meant for a special occasion.  Use logic, if a shoe is comfortable, is constructed of leather or breathable canvas not plastic, and has adequate cushioning and tread, and offers good support, that is great, but the most important feature is how it feels on your foot.   Regardless of the shoes you try, heel pain may continue and you may need to stop spending money on trying to alleviate the pain with various shoes and just get to a podiatrist.  Most likely a functional orthotic that will go from one shoe to the next can alleviate the problem.  Visit Eastern Shore Foot Center today. Dr. Braun and her staff will get you in the right shoes.

Heel pain only at night, is this still Plantar Fasciitis?

Heel pain only at night, is this still Plantar Fasciitis?
Although most people experience heel pain following rest, which typically is first step in the morning, there are some that only note it by the end of the day.  The pain occurs because they have been active, standing and walking all day. The Plantar Fascia (the band under the foot) may get irritated from overuse, just like any part of the body.  Sometimes, the pain is just basically tired feet, which ease with elevation.  Nevertheless, if after rest you attempt to stand up and walk and note a pain in the arch or heels then you may be developing Plantar Fasciitis.  Treat it now; don’t wait till it is bad.  Early treatment of this condition is preferable because typically custom functional orthotics and in some cases even over-the-counter inserts may quickly reverse the problem.  Avoid walking barefooted for a while, stop wearing non-supportive flip-flops, and make sure the shoes you wear all day have some support built in.  Order customer crocs through Eastern Shore Foot Center or call and schedule an appointment; Dr. Braun will get you in a pair of custom orthotics. 251-626-5065 Visit Our Store

Do you experience Sharp pain in your heels when you first get up?

Sharp pain in heels when you first get up?

One of the most common foot problems is Plantar Fasciitis. Plantar Fasciitis often presents with a stabbing pain under the heel with the first step after rest.  Picture a rubber band stretching from your heel to the toes and flexing with each step, if this band thickens at the attachment to the heel, it will no longer be capable of flexing.  After sleeping, when your foot has been in a relaxed position, you step down and rather than the band flexing it tears and pulls.  The pain eases after you get going because the band stretches out.  Over time the pain will take longer to ease and become more intense.  At this stage the first thing you should do is avoid walking barefooted or in very flat shoes.  Pick up some Croc’s RX, Fit Flops, or Sandalistas with built in support to be worn as slippers. 

Find RX Croc's at our online store  www.ourdoctorstore.com/braun

Need more information about Plantar Fasciitis? Contact Eastern Shore Foot Center for your appointment 251-626-5065.

Need Medical Products?

Need medical products? Visit our Eastern Shore Foot Center Store www.ourdoctorstore.com/braun for all your medical supply needs. Dr. Braun can help you select the right products to benefit your foot health. Call today to schedule an appointment. 251-626-5065

LizFranc Fracture

LisFranc Fracture has benched Houston Texans QB Matt Schaub.  This type of fracture occurs in the midfoot region, it is complicated by the number of ligaments and joints involved.  The midfoot is critical in stabilizing the arch in gait and often a fracture, dislocation or ligament tear in this region is not only difficult to diagnose but treatment can vary from rest to surgery.  Typically it takes 6 to 8 weeks for most fractures to heal, soft tissue injuries may require months of rehab.  It is difficult to determine how long Matt Schaub will be out of commission,  but most likely we are looking at 4-6 months.