Thursday, January 31, 2013

Fat Pad Atrophy

Between our skin and heel bone, we have a one inch thick pad which acts as a shock absorber and cushion. This cushion is called a fat pad because it's mostly made up of fatty tissue. The pad is divided into sections by ligamentous baffles which keep the fat pad from spreading out and keeping the pad where it belongs- under the heel.
Over time, this fat pad can stretch out, causing us to lose some of that cushion and creating pain in the heel. Weight bearing is often very uncomfortable when this occurs. Typically, fat pad atrophy happens to the elderly, but runners and athletes who run a lot suffer from this condition. Also, if you've landed hard on a surface while barefoot, jumped in dress shoes with a hard heel, stepped on a stone, or work on a surface that is concrete, tiled, or hardwood, you may also experience this pain.
Symptoms of this condition include:
  • Pain in the middle of the heel. This is different from plantar fascia or bone spur pain, which would be present at the front of the heel. 
  • A deep, dull aching pain that feels like a bruise.
Fat pad atrophy may or may not improve over time, so it is important to allow the heel to rest while it is healing. This will allow the inflammation to decrease. Talk with your podiatrist about a heel cup, which is inserted in your shoes and provides cushioning in the heel area. If this does not work, a heel insert may be added to your shoes to keep the fat pad in place. Other treatment options include icing after exercise or activity, wearing well-cushioned shoes, and avoiding walking barefoot on hard surfaces.
If you are experiencing heel pain, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.


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Thursday, January 24, 2013

Calcaneal Fractures

Calcaneal fractures, or fractures of the heel bone can be disabling, severe, and long-term injuries. 
The calcaneus is the most frequently fractured tarsal bone and account for 2% of all adult fractures. 60% of these fractures are calcaneus fractures. 
This injury typically occurs when a person has been in a motor vehicle accident or falls from a great height. In instances of car accidents, 10% of patients will also sustain another fracture- either in the spine, hip, or other foot. 
Injuries to this bone often damage the subtalar joint and cause the joint to become stiff, making it difficult to walk on uneven or slanted surfaces. 
There are several different types of calcaneal fractures, including:
  • Stable fracture. This is a nondisplaced fracture. The broken ends of the bone meet correctly and are aligned, and therefore will stay in place to heal properly. 
  • Displaced fracture. This type of fracture means that the parts of the bone do not meet up and therefore it will not heal properly on its own. Surgical intervention is often required to correct this fracture.
  • Open fracture. This is a broken bone that comes through the skin, also known as a compound fracture. This is a complex injury because not only does it break the bone, it causes damage to the tissue, tendons, skin, and ligaments. Open fracture require a long time to heal.
  • Closed fracture. With this injury, the broken bones do not pierce the skin, but still may damage soft tissues internally. 
  • Comminuted fracture. This type of break is very unstable because the bone breaks into multiple pieces. 
Common symptoms include: pain, bruising, swelling, heel deformity, and inability to put weight on heel or walk. In some cases, you may be able to walk with a limp, therefore thinking the injury to be minor. You will experience pain in your heel and may think it to be unrelated to your injury.
When you talk with your podiatrist, it is important to tell them the exact details of your injury. How far did you fall? Your podiatrist will look for other injuries and areas where the skin is damaged or punctured. They may test other parts of your body, like your legs and spine to see if damage was done elsewhere. X-rays will be taken to determine what type of calcaneus fracture you have.
In determining your treatment, there are several things your podiatrist will consider:
  • Cause of your injury
  • Your overall health
  • Severity of your injury
  • Extent of soft tissue damage
Since most calcaneal fractures cause the bone to widen, the goal of treatment is to restore the normal anatomy of your heel. Nonsurgical treatment will include casting or another type of immobilization. You will not be able to put any weight on your foot until the bone is completely healed, which can take anywhere from six to eight weeks.
Surgical treatment is often required in more complicated cases. If the skin around the fracture has not been broken, your podiatrist will recommend waiting until the swelling has gone down, giving the skin that has been stretched time to heal. Waiting for surgery improves your overall chances for a better recovery from the surgery and reduces your risk of infection. Open fractures require immediate surgical attention, as an open wound invites infection and disease.
There are two different types of surgical procedures a podiatrist may do. An open reduction and internal fixation is used to reposition the bone fragments into their normal alignment. The fragments are held together with special screws or metal plates and screws. A percutaneous screw fixation moves the big bone pieces back into place by pushing or pulling on them without making a large incision.
Complications from a calcaneus fracture may include:
  • Small areas of delayed wound healing
  • Nerve irritation around the incision
  • Tendon irritation caused by the screws
  • Joint stiffness
  • Chronic pain
  • Blood clots
  • Failure of the wounds to heal
  • Infection
  • Collapse of bone
  • Arthritis
Seeking immediate attention after this injury is crucial in your recovery.
If you are experiencing heel pain, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.


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Saturday, January 19, 2013

Rugby's Cameron Hitchcock Recovering from Plantar Fasciitis Surgery

Port Adelaide small forward Cameron Hitchcock had surgery to fix plantar fasciitis and will not be able to run for two weeks. The team hopes he will be recovered in time for the NAB Cup.
"He has had plantar fascia soreness in the last week," Port football manager Peter Rohde told the team's website. "He managed training on Monday but is still sore and we've planned to have him undergo surgery. He won't run for two weeks and will resume full training after about four. We think it's likely he'll be available for the opening week of the NAB Cup," which starts on February 17th against St. Kilda.
Hitchcock, 22, has had a run of injuries since making his AFL debut in 2010, with shoulder and hamstring problems that restricted him to just two games last season.
Hitchcock's surgery is the latest for the club, which currently has five players coming from surgery in the offseason: Robbie Grey (knee), John Butcher (hip), Daniel Stewart (hip), and Brent Renouf (knee).
If you are experiencing heel pain, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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Friday, January 18, 2013

Marcus Camby Out 2-4 With Plantar Fasciitis

It wasn't that long ago I blogged about New York Knicks' center Marcus Camby and his strained plantar fascia.
Last Friday the Knicks announced that Camby would be out 2-4 weeks because of an injured left foot. Camby had an MRI which revealed a strain left plantar fascia. He reinjured the ligament in the loss last Thursday against Indiana, a game which coach Mike Woodson said was the best he'd seen the veteran play all year. Camby landed awkwardly after a layup attempt early in the third quarter and did not return to the game.
Camby missed much of the early season with the injury but had moved to a starting position as power forward on Christmas Day and was starting to shake off the cobwebs he had gotten in his time off.
"It's another setback, but we've got to keep it moving," Woodson said. "We'll get him back rehabbed again and then try to get him out on the floor when we can."
Camby left the Knicks' locker room Thursday night in a walking boot and crutches. "I did something to my foot again like I did earlier in the year... I drove and felt a sharp pain in the bottom of my foot similar to before," Camby told reporters.
We cannot stress enough how important it is to rest and rehab when you have plantar fasciitis or a plantar fascia injury. If you have a job where you are on your feet a majority of the day, ignoring the pain and prolonging a visit to a podiatrist will only increase the pain. Don't suffer in pain!
If you are experiencing heel pain, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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Thursday, January 17, 2013

Acupuncture For Heel Pain

A new study concludes that acupuncture is beneficial in treating heel pain. Researchers note that acupuncture treatment is comparable to the use of medications, night splints, and stretching. Results show that acupuncture has more significant improvements in pain relief and restoration of function than a standard treatment plan, which includes anti-inflammatory medications.
Heel pain can be caused by a variety of conditions. Common causes are plantar fasciitis, fat pad atrophy, Achilles tendonitis, stress fractures, and baxter nerve compression. The baxter nerve is on the plantar side of the foot and may become entrapped, causing pain and numbness. Acupuncture is typically applied the relieve the inflammation of surrounding tissues to release pressure on the baxter nerve.
Plantar fasciitis is caused by the inflammation of the tissues around the plantar fascia, creating foot and heel pain. Patients often know when they have plantar fasciitis because they are unable to walk properly after getting out of bed first thing in the morning. Acupuncture helps enhance the micro-circulation of blood to the local region to nourish the tendons and ligaments. This allows for the healing process to decrease the inflammation surrounding the plantar fascia.
Fat atrophy of the heel pad is common in the elderly and those who have a history of steroid injections. Acupuncture helps reduce the inflammation, and therefore providing pain management for this condition.
Achilles tendonitis is a chronic condition to the major tendon that connects the heel to the muscles of the leg. When this tendon is inflamed, it makes walking very painful. Acupuncture can provide rapid relief for this condition and can also help heal the tendon and eliminate the heel pain.
Stress fractures of the calcaneous bone are typically caused by overuse and injuries. Acupuncture is used to relieve the pain by speeding the wound healing process of the fracture. Combined with rest and activity modification, acupuncture helps this type of heel pain.
If you are experiencing heel pain, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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Thursday, January 10, 2013

Plantar Fasciitis Taping

Often times when patients come in for plantar fasciitis or heel pain, we will tape their foot to ease the pain. Taping the plantar fascia acts like an external splint, but allows the foot to work normally.  But tape doesn't last forever, and when something helps you, you want to be able to replicate it yourself.
A benefit of taping the plantar fascia is you reduce the risk of tearing or rupturing this ligament. Taping provides temporary protection against further injury or progression of pain. Some patients will find taping to be extremely helpful, others will not be able to keep the tape on because of irritation to the skin. If you have diabetes or peripheral vascular problems you should not use tape as a treatment option for your plantar fasciitis.
For tape to stick properly to your foot, your foot needs to be dry and without moisture. If you have lotion on, wash your feet. The foot can also be wiped with milk of magnesia or soaked in tea water. You will need: scissors, a roll of 1 inch tape, and a roll of 2 inch tape.
Here's how to tape:

  1. Wrap around the perimeter of the foot from behind the first metatarsal toward the heel, around the heel, and then back toward the fifth metatarsal.
  2. Apply the first cross strap and tape across the bottom of the foot. Start just behind the first and fifth metatarsal- just behind the weightbearing ball of the foot. Attach the tape here and bring it up, overlapping the anchor strap on the side. 
  3. Apply more cross straps. Overlap the next piece of tape by 50% and continue taping layer by layer toward the heel. You will use 3-4 straps. It is not necessary to cover the heel.
  4. Lay another piece of tape over the anchor strap to cover all the unfinished ends on the bottom of the foot. 
  5. An optional piece of tape can be wrapped around the forefoot, like the cross straps in step 3. 
If you are experiencing heel pain, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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Friday, January 4, 2013

Lakers' Gasol Diagnosed With Plantar Fasciitis

Los Angeles Lakers' forward/center Pau Gasol has been diagnosed with plantar fasciitis, his latest ailment this season. Gasol's right foot was examined by Dr. Kenneth Jung by MRI, and the Spaniard has continued to play through the pain.
The 11 year veteran missed eight games with knee tendonitis in December, following a loss on December 2nd against the Orlando Magic. After the game, Kobe Bryant told reporters that Gasol needed to put his "big boy pants on". Chris Sheridan of SherdianHoops.com says that Gasol was unfairly blamed by Bryant for the loss. "Pau sat on the bench for the final six minutes of that game. The Lakers were up one when he went to the bench, and Orlando scored 31 points in the final six minutes," Sheridan wrote.
Gasol is a four-time All-Star and two-time NBA champion, and hasn't posted stellar numbers thus far this season. It's likely this plantar fasciitis has been bothering him for quite some time and is affecting his play. Plantar fasciitis can be extremely debilitating if ignored. Gasol has 12.7 points per game with a career low 42.9 percent shooting from the field. Fans are wondering if he's worth the $19 million he's making this season.
He's showing signs of why he's worth that $19 million, most recently on Christmas Day, posting 13 points, 8 rebounds, 6 assists, one block, one steal, and shot 38.5 from the field. With 14.4 seconds remaining he drove to the basket and made a game-winning slam dunk.
Only rest, stretching, icing, and the proper footwear will help Gasol feel better.
If you are experiencing heel pain, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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Thursday, January 3, 2013

Tarsal Tunnel and Heel Pain

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel- arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.
Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.
Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:
  • A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.
  • An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
  • An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
  • Systemic disease such as diabetes or arthritis can cause swelling, thus compressing the nerve.
Patients with tarsal tunnel syndrome experience one or more of the following symptoms:
  • Tingling, burning, or a sensation similar to an electrical shock.
  • Numbness.
  • Pain, including shooting pain.
Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
Sometimes the symptoms of the syndrome appear suddenly. Often they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
It is very important to seek early treatment if any of the symptoms of tarsal tunnel occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated.
The foot and ankle surgeon will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling. During this examination, the surgeon will position the foot and tap on the nerve to see if the symptoms can be reproduced. He or she will also press on the area to help determine if a small mass is present.
Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems- electromyography and nerve conduction velocity (EMG/NCV)- may be ordered if the condition shows no improvement with non-surgical treatment.
A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:
  • Rest. Staying off the foot prevents further injury and encourages healing.
  • Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • 'Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
  • Physical therapy. Ultrasound therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.
  • Injection therapy. Injections of a local anesthetic provide pain relief, and an injection corticosteroid may be useful in treating the inflammation. 
  • Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
  • Shoes. Supportive shoes may be recommended.
  • Bracing. Patients with flat foot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount pressure on the foot.
Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate proceudre or procedures based on the cause of the condition.
If you are experiencing heel pain from tarsal tunnel syndrome, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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