Nets' Johnson Latest Plantar Fasciitis Casualty

Basketball players are succumbing to plantar fasciitis faster than we can say "Stretch, rest, and ice!"
The latest casualty is Brooklyn Nets guard Joe Johnson, who sat out for the first time last Friday against the Houston Rockets because of plantar fasciitis in his left foot. He missed Sunday's game against the Memphis Grizzlies as well.
Interim coach P.J. Carlesimo said Johnson, 31, was in pain after Wednesday's victory over Milwaukee, when he scored just eight points. The night before Johnson had made the game-winning jumper to beat the Bucks.
C.J. Watson replaced Johnson, who plays a team high 38 minutes per game and is second in scoring, with 17 points per game.
Net general manager Billy King told ESPN New York's Mike Mazzeo Friday that Jonhson's plantar fasciitis doesn't seem like a long-term issue. "It's better than it was two days ago. They've got him on medication and I expect him to be better tomorrow, and we'll see how it is Sunday against the Memphis Grizzlies," King said.
"If it's still tender and sore, we may have to keep him out, because it's a marathon we're trying to finish, not a sprint. If it were a playoff game, he'd probably push it," King added.
Carlesimo said after the game Sunday that "Trainer Tim Walsh and Joe, I think, are both encouraged that it's gotten better, it's improving clearly. What's he gonna feel like tomorrow, whether he practices tomorrow, or how he feels Tuesday, I don't know. But again, we're gonna err on the side of caution. When he's ready to come back, we'll bring him back."
Our recommendation is to definitely err on the side of caution. If you've been following basketball this season, you've seen how many players have been sidelined with plantar fasciitis, and how long they've been out. Taking just a few days off isn't enough to stop this condition- you need to rest, stretch, ice, and rehabilitate this injury, unless you want to end up like Pau Gasol, with a plantar fascia tear.
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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Lateral Plantar Nerve Entrapment

Lateral plantar nerve entrapment causes pain in the inner, lower heel, and inner ankle area. The lateral plantar nerve is a branch of the posterior tibial nerve which passes through the tarsal tunnel. This nerve provides the skin of the fifth toe and the lateral half of the fourth, as well as most of the deep muscles. It is also sometimes called Baxter's nerve, for Dr. Donald Baxter, a Houston orthopedist who described the condition in 1984. An entrapment may occur between the abductor hallucis muscles and the quadratus planus muscle. 
Lateral plantar nerve entrapment is often seen in athletes, as it is a repetitive stress injury. 
Symptoms include pain that radiates from the inner, lower heel to the inner ankle area. Numbness is not common in this condition. Baxter's nerve entrapment is often confused with plantar fasciitis. So how do you tell the difference? Plantar fasciitis is worst in the morning when you take that first step out of bed. Pain from a Baxter's nerve entrapment gets worse as you put weight on your foot throughout the day. You'll still feel pain when you're off your feet when you have an entrapment- with plantar fasciitis, the pain is relieved. 
Treatment includes rest, anti-inflammatory medications, supporting the arch of the foot with tape, orthotics to correct the overpronation, cortisone shot, and if those options fail, surgical release. 
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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Botox Found To Help Plantar Fasciitis

A new Mexican study suggests that podiatrists should use Botox rather than steroids to relieve the pain their patients suffer from plantar fasciitis. The new research was published in the journal Foot and Ankle International.
Steroid treatment, for example cortisone shots, are often used in treating plantar fasciitis to reduce pain and swelling. It is estimated 2-6% of patients who receive steroid treatment as part of their conservative therapy will have their plantar fascia tear or rupture. Researchers from the Autonomous University of Nuevo Leon, Mexico came up with a clinical trial to compare steroid treatment with botox treatment, which works by blocking the neurotransmitter acetylcholine, weakening the muscles for several months.
In the trial, participants were treated with either steroids or Botox for their plantar fasciitis, and both groups were given the same series of stretching exercises to perform at home.
Initially, both groups were recovering at the same rate, but the Botox group took the lead with higher improved scores in foot pain, function, and alignment. Botox participants were the winners after six months, having better sustained and rapid improvement over their steroid counterparts.
The study's corresponding author, Dr. Carlos Acosta-Olivio says, "We found that a combination of BTX-A (Botox) applications into the gastroc-soleus complex and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids." He added that the stretching exercises were an integral portion of successful treatment.
This was a small-scale study, with just 36 participants. The authors concluded by suggesting future trials include measures of body-mass index, as being overweight can be a risk factor for developing plantar fasciitis. When compared to steroid treatment, Botox treatment has fewer complications.
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.

Lakers' Gasol Has Partial Tear In Plantar Fascia

Paul Gasol just can't seem to catch a break.
First he was dealing with plantar fasciitis in his foot, which seemed to clear up. In the meantime, he was out several games, and the games he played in, his performance was lackluster. Fans and sports writers alike were calling "Trade! Trade! Trade!" Now Gasol will be out six to eight weeks because he partially tore his plantar fascia.
Gasol heard a pop in his foot Tuesday evening in the game against Brooklyn when he attempted to contest a shot at the rim by the Nets' Brook Lopez. He stayed down on the court for several seconds and remained in the game after a 20 second timeout but started to limp after trying to run. He headed to the locker room with 3:52 left in the game and left Barclay Center on crutches.
After the game he said, "I'm worried about it. I never felt anything like I did tonight. It kind of felt OK a little bit putting my weight on it without walking or running. But once I started running, I was limping, I was really sore and even if I tried, I just couldn't go."
Kobe Bryant, a longtime friend and proponent of Gasol's said he was "very, very concerned it to say the least... We can't afford to lose Pau for a long stretch. We need to get him back. I don't think his spirits are going to sag. He and I talk quite a bit. He's determined. He's going to figure this thing out, what's wrong with his foot, with his fascia, and he's going to see what he can do. He's not going to be deterred."
Gasol, 32, reinjured the injury January 30th at Phoenix, where he worked with trainers for a long period after a 92-86 loss. He tweaked the injury again Tuesday night during the first half and the muscles finally gave out during the fourth quarter.
Gasol has several options: one is to rehab the injury, which would cause him to be out six to eight weeks, or have surgery to repair the tear, and be out 10-12 weeks. He had an MRI on his right foot Wednesday and flew back to Los Angeles yesterday for further examination by Lakers team doctor Steve Lombardo and foot specialist Dr. Kenneth Jung.
The injury is a blow to an already injury-stricken Lakers team, which will go from a small team to an invisible team. Dwight Howard has been dealing with a shoulder injury and Jordan Hill had season ending hip surgery last month.
Gasol has averaged 14.3 points and eight rebounds per game this season, coming off the bench six games. His strong play recently has helped the Lakers to their longest steak of the season, winning six of seven games. He has missed several games this season- eight because of tendinitis in his knees and five because of a concussion.
He tweeted Wednesday night, "I'm hoping to recover ASAP so I can be back with the team and keep fighting until the end of the season."

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.

Related articles

• Lakers' Gasol Diagnosed With Plantar Fasciitis

Joakim Noah To Return Tomorrow From Plantar Fasciitis

Chicago Bulls center Joakim Noah has missed the last few games because of plantar fasciitis.
Nick Friedell of ESPN Chicago tweeted, "Noah has plantar fasciitis in his right foot. He had it in his left foot three years ago. He isn't sure when he'll return to the lineup."
Noah missed 18 games when his left foot was affected in 2009-10 and eventually had shockwave therapy to help him with the pain. "The one in 09-10, I just kept playing through it. I probably played with it for a month until I couldn't anymore. This time, I stopped a lot earlier. I probably played on it for five or six games. I just knew what direction it was going in. In 09-10, I just tried to act like it wasn't there and played through it. That was a mistake. With a couple more days of treatment I'm hoping to be OK," Noah said.
Noah was smart this time to stop soon after he started to feel pain. Too often this basketball season we've seen players be out just a few days, return to the game, then have to be out for several weeks because they didn't rest and rehabilitate properly.
Noah said on Monday that he was hoping to return by Thursday to play against the Denver Nuggets. "I'm moving in the right direction. Give it a couple more days and try to go on Thursday," Noah said.
The center said he got some shots on the Bulls' day off on Sunday but did no running or jumping. He is resting the injury and treating it with ice and laser treatments (stretching!). "You definitely learn from your experiences," Noah said. "I've been through this before. I know what to expect. I've gotten all these treatments before. I'm hoping with a couple more days rest I'll be back at 100 percent and I won't have to deal with this anymore."
Noah has missed just one game so far this season. He is averaging 12.1 points, 11.3 rebounds, 4.2 assists, 2.1 blocks, and 1.3 steals per game, all of which are career highs. He is also averaging 38 minutes per game, 10 minutes higher than last year, which could be a contributing factor to the heel pain. Noah was also selected as a reserve for the NBA All-Star game on February 17th.
However, his production since his injury has declined. Noah shot just 42 percent during the month of January and his scoring was down, even though his rebounding was up.

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.

 Related articles

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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.

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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