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Tarsal Tunnel Syndrome: What You Need to Know

At JCMG Podiatry we see an increased number of patients dealing with acute and chronic heel pain. In some cases this pain is associated with a condition known as tarsal tunnel syndrome. Tarsal tunnel syndrome in many ways parallels carpal tunnel syndrome in the hand and wrist.

The tarsal tunnel is located along the inside portion of the ankle and contains blood vessels, the tibial nerve and its branches as well as a number of tendons. The roof of the tarsal tunnel is a structure known as the flexor retinaculum. The flexor retinaculum is a tight structure and limits the amount of space in which the tibial nerve and surrounding structures can move.

Most patients who are suffering from tarsal tunnel syndrome present with a variety of symptoms, but pain and burning seem to be the most common. Pain can and often does radiate to the heel and into the arch of the foot. Additionally, cramping of the muscles into the arch can occur in the early and sub-acute stages of this condition. Numbness and tingling routinely develop as the condition progresses. It is not uncommon for numbness and tingling to extend into the toes.

Tarsal tunnel syndrome can develop for a number of reasons. The most common causes of tarsal tunnel syndrome are:

  • A direct injury to the nerve as a result of a severe sprain or fracture
  • Venous reflux or varicose vein formation overlying the tibial nerve
  • Cyst formation deep within or superficial to the tarsal tunnel
  • Systemic conditions like diabetes
  • Foot deformities such a decreased arch height

In each of these situations the tibial nerve becomes compressed and loses its ability to send the proper signal to the soft tissue structures it controls. Once the syndrome is activated, pain develops. At first pain may be intermittent in nature and relieved with rest and elevation of the limb, but as the condition progresses, pain becomes more consistent throughout the day.

Generally speaking, patients typically wait a prolonged period of time before presenting to their doctor after the onset of symptoms. This is both understandable and problematic. Obviously, very few people run to the doctor’s office at the first sign of every ache or pain that develops, but in this case as the duration of symptoms increase, the harder it becomes for conservative care to be effective.

Multiple modalities are used to help aid in the diagnosis of tarsal tunnel syndrome for patients, but ultimately the diagnosis is primarily based on a thorough history and physical exam. Oftentimes x-rays, MRIs and even a test to check the ability of the nerve to send the proper speed and strength of its signal (this test is called an EMG/NCV) are performed to help confirm the diagnosis of tarsal tunnel syndrome.

Non-surgical treatment options are attempted in an effort reduce the symptoms associated with tarsal tunnel syndrome, but they are often ineffective. Injection therapy, custom orthotics and physical therapy can all be helpful, but unless you address the root cause of the problem the symptoms will recur and ultimately the patient will be frustrated.

In most cases the tibial nerve will require decompression via a short outpatient surgical procedure. An incision is made over the inside portion of the ankle and the retinaculum overlying the tibial nerve is released and the nerve is freed of any surrounding adhesions. If any varicosities are noted overlying the tibial nerve during the procedure they are ligated as necessary. Intra-operatively if a cyst is present it will also be excised in order to relieve the compression of the tibial nerve. Once the tibial nerve has been freed of any compressive structures, the skin is repaired and a dressing applied to the operative limb. The retinaculum is not repaired in an effort to decrease the potential of scarring in the area. Any scarring could cause recurrent compression of the tibial nerve.

Tarsal tunnel syndrome is a very frustrating condition for patients. At JCMG Podiatry we have successfully treated a large number of patients suffering from this condition. Our goal is to get each patient back to their activities as quickly and as safely as possible, and reduce the risk of recurrence for this problem.  If you have been suffering with acute or chronic heel pain that hasn’t responded to conservative care, you will benefit from a thorough podiatric history and physical examination to ensure that you are not suffering with tarsal tunnel syndrome.  Same day and next day appointments are available at JCMG Podiatry. Please call (573) 556-7724.

By |April 11th, 2018|

Ankle Sprains and Instability: How the InternalBrace™ is Reshaping Traditional Treatments

It is estimated that 32,000 people a day suffer a sprained ankle! Obviously this injury occurs most commonly during exercise and sport activities, but during the winter months when snow and ice create slippery conditions an ankle sprain can occur at any time. Unfortunately out of these 32,000 sprains 15%, or just under 5,000 people, develop chronic instability of their ankle. This instability has a negative impact on a person’s ability to complete certain exercises or even compete at their previous level of competition in sports.

The outside of the ankle is composed of three very important ligaments, the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament. When an ankle sprain occurs the ligament that is most commonly affected is the anterior talofibular ligament. When this ligament tears an instability of the ankle occurs that leads to prolonged pain and a decreased ability to return to a previous level of exercise or sport activities.

InternalBrace - Ankle Ligament SurgeryMany approaches have been used, both conservatively and surgically, to stabilize the ankle and to not only provide pain relief but increase the stability of the ankle and provide a faster return to exercise or sport activities. Some of those approaches include rest and ice application, physical therapy and even the dreaded big black boot! Surgical care has involved the simple attempted repair of the ligaments, transferring of tendons to create stability and rigidity of the ankle, and even a myriad of implants to help restabilize the ability of the ankle with weight bearing, exercise and sports.

The primary problem with each of these methods is the lack of long term strength and stability. Not to mention the prolonged recovery time that traditional surgical methods required.

Traditional surgical methods required weeks of casting and non-weight bearing with a slow and often frustrating return to exercise and sports. As medicine progressed, the casting and non-weight bearing times decreased slightly, but still the frustration of watching exercise goals slip away or watching your teammates finish a season without you remained. Until now.

The InternalBrace from Arthrex is a revolutionary approach to stabilizing the lateral ankle ligaments that provides faster recovery and more strength than prior to the injury itself. What makes the procedure so successful is the use of a material called FiberTape®. The FiberTape® is inserted via the use of two bone anchors and augments the repair of the ATAFL. Once inserted, the FiberTape® and the repair of the ATAFL have a strength greater than that of the tissue before the injury!

The procedure is typically completed in an outpatient surgery setting and takes about 45 minutes to complete. Patients are typically placed in a splint post-operatively and asked to not bear weight for a short period of time. Patients are typically transitioned to a cam boot quickly and then back to normal shoe gear. This procedure allows for a confident return to exercise and/or sports in a much shorter time frame than previous procedures allowed.

The InternalBrace is a game changer. It allows for a stronger construct of tissue from the time it is inserted and lets people get back to what they enjoy. If you or someone you know is currently dealing with a frustrating and aggravating ankle sprain we can help. Please call JCMG Podiatry at 573-556-7724 to schedule an appointment with Dr. Duke or Dr. McAleer.

By |January 22nd, 2018|

JCMG Podiatry Receives 2017 Best of Jefferson City Award

JCMG Podiatry has been selected for the 2017 Best of Jefferson City Award in the Podiatrist category by the Jefferson City Award Program.

Dr. McAleer and Dr. DukeEach year, the Jefferson City Award Program identifies companies that we believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and our community. These exceptional companies help make the Jefferson City area a great place to live, work and play.

Various sources of information were gathered and analyzed to choose the winners in each category. The 2017 Jefferson City Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the Jefferson City Award Program and data provided by third parties.

About Jefferson City Award Program

The Jefferson City Award Program is an annual awards program honoring the achievements and accomplishments of local businesses throughout the Jefferson City area. Recognition is given to those companies that have shown the ability to use their best practices and implemented programs to generate competitive advantages and long-term value.

The Jefferson City Award Program was established to recognize the best of local businesses in our community. Our organization works exclusively with local business owners, trade groups, professional associations and other business advertising and marketing groups. Our mission is to recognize the small business community’s contributions to the U.S. economy.

By |June 8th, 2017|

The Cartiva Implant: Synthetic Cartilage Replacement for Great Toe Joint Arthritis

The first metatarsal phalangeal joint, also referred to as the great toe joint, is subject to intense forces created through a combination of body acceleration and weight. Walking, running, plyometrics and cutting motions directly influence the stress and strain exerted on this compact joint. Damage can occur with repeated trauma throughout a lifetime which can result in the loss of the joint cartilage and narrowing of the joint space.

Patients suffering with great toe joint arthritis experience localized joint pain that worsens with activity, is typically relieved by rest, and is generally worse at the end of the day. However, as the joint damage progresses patients may also experience pain at rest. They have limitation of of joint motion and have difficulty with movement, crouching and rapid changes in direction. This pain and stiffness can significantly impact the ability to carry out activities of daily living.

Traditional surgical options were often tailored to patient age and desired activity level. Great toe joint fusion procedures are beneficial for individuals younger than 55 years of age and for those who would like to continue to participate in high impact sporting activities. Joint replacements are usually reserved for those of us 55 and older who live a more sedentary lifestyle.

Cartiva Implant

The Cartiva Implant provides an entirely new category of great toe joint arthritis treatment for our patients. The implant possesses characteristics similar to those of native joint cartilage and implantation is not dependent upon age. The procedure can be performed in an outpatient setting and typically takes under 30 minutes. It also has the advantage of requiring a minimal amount of bone removal and requires a smaller incision which reduces tissue trauma. Patients can bear weight immediately on the surgical foot and often return to wearing regular shoes by the third postoperative week. The Cartiva implant can withstand the mechanical forces placed upon it with various forms of activity.

Over 4,000 of these implants have been used in Europe since 2002 and it has recently been introduced to the US market.

The FDA’s decision to approve the implant was supported by the MOTION clinical study, a 236-patient, multi-center, prospective, randomized Level I study comparing Cartiva SCI to fusion. This is the largest study ever conducted for this condition.

Key study findings:

  • The Cartiva patient group demonstrated clinical success of 80% for the composite primary endpoint (pain, function and safety) at 24 months compared to 79% success for the fusion group
  • Cartiva patients achieved a 93% reduction in median pain
  • Cartiva patients demonstrated a 168% improvement in median function of sporting activities and 65% improvement in activities of daily living
  • Cartiva patients experienced a 26% improvement in range of motion from baseline

For more information regarding Cartiva and great toe joint arthritis treatment call us to schedule an appointment.

By |April 15th, 2017|

The Lapiplasty® Procedure: Advancement and Innovation in Bunion Surgery

A bunion is a bone prominence at the great toe joint which makes shoe fit and wear difficult due to irritation and pain. Bunion reduction surgery aims to alleviate this pain and realign the forefoot. 330,000 bunion surgeries take place in the United States annually. Interestingly, there are no standardized systematic approaches to the correction of these deformities. Surgeon experience, training and preference have driven procedure selection. Traditional surgical procedures do not always address the triplane nature of these deformities which can lead to recurrence and unsatisfactory results. It has been documented in the scientific literature that bunion recurrence can reach 30-50% following surgery.

Lapiplasty ProcedureThe Lapiplasty® procedure provides the benefits of a standard reproducible surgical approach that achieves tri-planar correction and supports immediate weight bearing for mild, moderate and severe bunion deformities. This ground breaking technique also reduces operative time and decreases patient exposure to anesthesia.

The procedure makes use of specialized instrumentation specifically designed to manipulate and reduce the bunion prior to making the initial bone cuts. It allows for minimal bone removal which nearly eliminates the risk of significant bone shortening. It also supports the use of biplanar plate fixation of the correction site. This technique is what makes immediate weight bearing possible. More traditional surgical approaches can require patients to be inconvenienced by 6 weeks of non-weight bearing status. The Lapiplasty® returns patients to their typical foot wear within 6 weeks of surgery and should provide lasting permanent results.

This innovative surgical solution is currently available at JCMG Podiatry. It truly provides both the patient and the surgeon many advantages and will make correction accessible to those of us who can not afford to be off of our feet.

Lapiplasty Procedure

Learn more by reading JCMG Brings the First and Best Bunion Procedure to Missouri, a discussion between our doctors and the Editor of HER Magazine about the Lapiplasty bunion correction system.

By |March 28th, 2017|

Putting Our Best Foot Forward

This article was originally published in the June 2015 edition of JCMG eMag.

Have you ever considered the workout that your feet go through in a day’s time? Your feet feel the pressure of one to two times your body weight per step when you walk, and when you run that increases by four to five times. That’s why caring for your feet is so important.

JCMG Podiatrists, William Duke, DPM and JP McAleer, DPM, have more than 25 years of combined experience in all aspects of foot and ankle care including surgical and conservative means of treatment. They care for patients with in-grown toenails, bunions and hammertoes, to more complex issues such as foot reconstruction, ankle fractures and joint fusion. In addition, JCMG Podiatry offers internal and external fixation devices and ultrasound-guided injections, which means fewer injections and significantly better response to treatment for patients.

“We see patients of all ages for anything related to the foot and ankle,” says Dr. McAleer.  “Our biggest patient complaint is heel pain. Around 15 percent of our patients come to us looking for relief from discomfort in or around their heel.”

Whatever the ailment, the podiatrists layout options for patients that will best fit their needs and lifestyle.

JCMG Podiatry has four full-time and two part time staff members dedicated to providing a positive patient experience. Dr. Duke completed his residency at Mt. Sinai Hospital in Chicago, Ill. He earned his doctor of podiatric medicine from the Dr. William M. Scholl of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in Chicago, Ill. Dr. McAleer completed his residency at Mt. Sinai Hospital in New York. He earned his doctor of podiatric medicine from New York College of Podiatric Medicine.

The podiatrists not only see patients in their JCMG location, located on the lower level of the JCMG Medical Building, but they also work closely with diabetic patients at the wound center located at SSM Health St. Mary’s Hospital. They provide cosmetic services, such as Botox for excessive sweaty feet, dermal fillers and laser fungal nail treatment at JCMG Laser & Vein Center.

“When I started in 2006, my goal was to bring world-class foot and ankle care to the Jefferson City community. Dr. McAleer and I continue to provide the latest treatment options to our patients,” says Dr. Duke.

By |June 15th, 2015|

The Foot Facelift: Dermal Filler Injections for Fat Pad Atrophy

It is human nature to lament for what has since past and to revel in the memories of our life experiences and milestones. With maturity and experience come the unfortunate side effects of time. This, for many, has ignited a desire to recapture our youth. This desire is expressed in many different ways. For some it leads them to their Plastic Surgeon’s office and for others it leads them to their Podiatrist’s office.

You may be scratching you head right now trying to figure out how plastic surgery and podiatry fit together. Well what was once ‘solely’ intended to rejuvenate the face is now being used for many applications in the foot and ankle.

Dermal fillers are injectable compounds used to “fill” or plump areas of the face which have lost volume due to age. These fillers are injected by plastic surgeons to restore a more youthful appearance in their patients. These same fillers are being widely used by podiatrists to reverse the effects of fat atrophy in the feet.

As we age, the very important fat pads on the bottom of our feet which act as shock absorbing cushions begin to shrink and shift. For many, this change in anatomy predisposes individuals for problems such as metatarsalgia, capsulitis and bursitis which can all make walking and standing painful and laborious. Common symptoms for patients with fat pad atrophy include pain that gets worse when standing and walking, toes that may feel as if they go numb and calluses that form over areas of bone prominence.

The changes in the consistency of the tissue can keep us from enjoying an active lifestyle which may involve recreational sports, dancing or even vacationing. This can pose an especially difficult problem for fashion forward women who wish to continue wearing high heel shoes.

The injection procedure is simple and can be performed in as little as 15 minutes in your podiatrist’s office. The procedure is relatively inexpensive and painless, and has virtually no period of recovery. The filler is broken down over time and dissolves in the body naturally. That means, however, that the procedure will need to be repeated in the future. The filler can last for up to one year or longer. The dermal fillers once intended for the face can now be used to make your feet feel and look younger and refreshed.

By |June 12th, 2015|

Healthy Feet for an Active Lifestyle

I have the pleasure of seeing many patients each week, and I think some of the more common questions that I am asked deal with “lumps and bumps” and changes in the appearance of nails and skin.

I would like to discuss each of these situations in a little greater detail.

Lumps and bumps can happen all over the foot. Probably the most common of these is a bunion deformity. A bunion is basically like a variation of a dislocation of your big toe joint.

The big toe starts to drift toward your second toe and sometimes even under your second toe. Then a large bump develops on the side of your big toe joint. This bump starts to become uncomfortable and painful with shoes, walking and exercise.

I guess the funniest way a patient described it to me is”…Honey, even my ugly shoes hurt!”

Many times shoes, custom-made inserts, an injection and padding can help but there are times when this bump needs to be taken off surgically through an outpatient surgical procedure. With new advances instrumentation and technique, people do a light amount of walking the day after surgery with a special shoe or boot.

Other types of lumps and bumps that develop are soft-tissue masses such as a ganglion cyst. A ganglion cyst is a benign cyst filled with a jelly-like material. I typically err on the side of caution and order a test called an MRI to ensure that the cyst is benign. I tell my patients that the more information we can gather about your condition the better we can treat the problem.

After the results of the MRI are known and a ganglion cyst is confirmed on MRI, typical treatment options include draining the cyst, injecting the cyst with steroid or excising the cyst. I will tell you that recurrence rates can be very high with the first two options. Imagine the ganglion cyst is like the portion of balloon that you blow the air through to inflate the balloon. In order to help ensure that the cyst would not come back a stitch needs to be placed around this area prior to excising the cyst.

A funny story about treating ganglion cysts can be found with the Bible. One of the earliest treatment methods for a ganglion cyst was to smack the cyst with the biggest and heaviest book around, the Bible. Can you imagine what would happen in today’s society if you went to the doctor’s office and he/she tried to hit you with a book?

Another bump on the foot is a hammertoe. A hammertoe typically involves the second, third, fourth or fifth toe or even a combination of these toes.

Essentially the toe starts to curl and point toward the ground. This can lead to callus formation on the top of the toe or even the tip of the toe. Most people call this callus a corn.

Hammertoes can be very painful with shoes and walking. Try tapping your finger on a table equivalent to the amount of times you take a step each day. The callus that would form would hurt anytime you grabbed or touched something. Then you would have to factor in that each time you take a step your feet and toes are bearing anywhere from two to five times your body weight.

There are splints that can be worn around the toes to help keep the toes in proper alignment. However, if you take the splint off, your toes will return to their crooked position.

Accommodative shoes with a wide and square toe box can help relieve pressure to the area as well, but sometimes straightening the crooked toe out surgically is your best option. The procedure take about 10 minutes per toe, and you can walk in a special shoe or booth the next day. I typically only recommend this procedure to my patients after other conservative options have been tried and failed.

My wife likes to tell me to exhaust my options, and she is right. Surgery does not have to be the first option all the time. Ask your doctor to try something non-surgical first. The bottom line is that if you notice a lump or bump on your foot, go get it checked out. Lumps and bumps are not natural and should at the minimum be examined by a podiatrist.

The second thing that we are going to discuss is changes in the appearance of the skin and nails. Most commonly this involves a fungal infection of some form. When the fungal infection involves the skin on your feet, we call it tinea pedis or athlete’s foot. This can present as blistering of the skin along the arch or a white discoloration that resembles dry skin along the bottom of our feet or even constant wetness between the toes.

Most commonly this is treated with a gel or cream that can be applied twice daily. There are over-the-counter medicines that can be used, but honestly I have not found them to be as effective as a prescription medication.

Tinea pedis can be cured in about a six week time period. There are times when an oral medication is needed, but I usually reserve this for more severe cases.

When the fungal infection involves the nails, we call it onychomycosis. You have probably seen or know someone with this problem. The toenails become very thick and yellow and are very hard to trim. Most people have seen the commercial of that ugly little guy crawling under the toenail. He is a dermatophyte, the cause of the problem.

There are many ways to treat this problem, and I think I have heard my share of home remedies. I will tell you that soaking in Listerine or tea tree oil and rubbing Vicks Vaporub on your nails will not work.

There are good topical and oral medications that can be used. There is even a topical medication, Formula 3, which I offer my patients that the company who makes the product guarantees that it will get rid of the fungus in your toenails. I’m not sure that there are many other medications that offer a guarantee to fix your problem.

Another option is an oral medication called Lamisil. This medication requires blood-work prior to starting the medication and can have some interactions but is typically safe. Regardless of which way you decide to treat the fungus in your toenails, it will likely take six to 12 months to see complete results because that is how long it takes for a toenail to grow from start to finish.

I think that no matter what type of problem you may be dealing with in your feet, it should be checked out. We lead such active and mobile lifestyles that we need our feet. If you have any questions or concerns, give me a call at JCMG at 556-7724.

By |June 1st, 2015|

Arthroscopy – A Minimally Invasive Surgical Approach in Treating Ankle Pathology

Persistent ankle pain can limit activity and disrupt the ability to comfortably carry out the most simple activities of daily living. The severity of symptoms can vary from individual to individual. Causes for generalized ankle pain and impingement can include 1) joint damage, 2) damage to the ankle joint capsule and 3) ligament and tendon damage.

These painful conditions can be acutely initiated following an injury as basic as twisting an ankle. Other factors that can contribute to bone, soft tissue and joint damage include generalized repetitive motions over a long period of time which can weaken anatomic structures resulting in overuse syndromes. In some cases, these conditions can be treated conservatively with a combination of injections, physical therapy, bracing/orthotics and anti inflammatory medications. Surgery, however, is often indicated and can prove very effective in treating certain ankle conditions.

Ankle pathology such as torn ligaments, joint cartilage damage, ankle joint capsule synovitis and loose floating pieces of cartilage/bone can all be treated via arthroscopic surgery. These conditions, typically identified through physical examination and MRI, can cause ankle joint impingement, limitation of ankle joint motion as well as joint pain with activity. In addition, many patients note clicking and popping sounds audibly recognized as emanating from the joint itself.

Surgical techniques typically fall into one of two major categories – traditional open procedures vs. minimally invasive techniques. Ankle arthroscopy is a surgical procedure which is minimally invasive and provides the surgeon access to the interior of the joint in order to repair physical damage to the affected structures. The technique is traditionally performed via two very small incisions at the anterior aspect of the ankle which allows for the introduction of a small camera or ‘scope’ and specialized instruments into the joint space. The live arthroscopic images are viewed during surgery on a television monitor in real time.

Through this arthroscopic technique regions of cartilage damage can be removed and micro fractured to encourage new tissue growth. Torn ligaments can also be debrided and repaired. Synovitis, as well, can be resected along with the removal of bone spurs and loose floating pieces of bone and cartilage found in the joint.

Post operative recovery can range from 7 – 21 days depending upon the underlying pathology addressed. In many cases physical therapy and active range of motion exercises are prescribed. In some instances patients are encouraged to begin waking within 24 hours of surgery. The limited incision size reduces recovery and provides the added benefit of limited scar tissue formation in comparison to more traditional surgical approaches. The majority of patients report an improvement in joint function and mobility following the procedure.

By |May 17th, 2015|

Listen to Your Feet

As the colder weather forces us to wear closed toe shoes, the problems that were ignored over the spring and summer are now becoming vastly apparent. Painful lumps and bumps are now more than just a nuisance. They actually start to limit our daily activities especially during this very busy time of year. I would like to discuss some of the most common foot and ankle problems that usually arise in the winter time and tend to be more aggravated by shoe wear.

The first problem to discuss is ingrown toenails. Unfortunately, patients usually do not seek treatment until the ingrown toenail becomes infected. The best treatment at this point is to remove the infected portion of the toenail. This is done through a five minute procedure in the office under a local anesthetic. There is typically very little if any pain after the procedure.

Bunions and hammertoes also become greatly more symptomatic with closed toe shoe gear. Bunions are essentially a progressive dislocation of your big toe joint and as the big toe starts to drift toward your second toe a large bump on the inside of the big toe joint becomes more problematic with footwear and movement.

Hammertoes are essentially progressive dislocations of bones and joints of each toe. The toe starts to contract and then the toe essentially sits higher and rubs on the inside portion of the shoe. We typically see this affecting the second and fifth toe. There are no sure fire conservative measures to fix these problems but there are many over the counter splints, pads and shoe wear modifications that can be applied to help reduce some of the discomfort caused by bunions and hammertoes. Purchasing a shoe with a wide square toe box can be beneficial. Custom made orthotics can also help reduce pressure to these symptomatic areas. The best treatment for bunions and hammertoes still remains to have the deformities fixed surgically through an outpatient procedure.

Neuromas are another common problem affected by closed toe shoes. The nerve supplying feeling to the toe becomes inflamed and irritated. Most people describe a feeling like walking on a rock or pebble or possibly their sock is wadded up in the shoe. Neuromas can be further irritated by pointed toe shoes or high heels. Obviously, footwear modifications are of great help but most of the time patients have waited too long for shoe gear modifications to be of great help. At this point, non-steroidal anti-inflammatory drugs (NSAID) and trigger point injections of local anesthetic combined with steroid are very helpful. In fact, these methods produce complete resolution of symptoms for the vast majority patients.

Haglund’s Deformity, or spurring to the back of the heel bone, also becomes very problematic this time of year with boots and shoes. These spurs can produce considerable pain during the first few steps following rest. Irritation from shoe wear can also cause irritation. X-rays are generally required to ensure that the spur did not crack or break off. People do very well with NSAID’s, heel lifts and physical therapy. If this course of treatment does not help an MRI is warranted to ensure that the Achilles tendon does not have a partial tear. Unfortunately, many times the spur is the ultimate problem and needs to be removed but conservative therapy can be very helpful as well.

The most important thing to realize is that foot and/or ankle pain is not normal and should be evaluated by a podiatrist sooner rather than later. More often than not patients wait because they think the pain will go away. Our feet are the foundation of our very busy, mobile lifestyles and the better we treat our feet the easier it will be to go through the year pain free.

By |April 29th, 2015|