Saturday, December 17, 2016

Ankle Sprain? How do I treat an ankle sprain?

It is a common scenario, you step off a curb and you feel it, your foot and ankle turn in when it shouldn't! Within seconds your outer ankle starts to swell, get red, and very painful.  If you stand up and can walk I still would recommend you see your foot and ankle specialist.  It is absolutely best to see a specialist that can take an X-ray of your foot and ankle to make sure you have not broken anything.  Your specialist can give you advice on what you need to do to get better, write for a medicine if necessary and offer you devices that may help in the aid or care of your foot or ankle injury.    The reason I stress that you should see your foot and ankle specialist is because there are 6 plus different bones you could possible break with this type of injury. Also, a well thought plan of care is going to be better than your own self diagnosis and treatment. Just "googling" your symptoms, more often than not results in sub-optimal results in your health, and taking your neighbors advice on your foot problems yields pretty terrible results!

So you see your doctor and X-ray shows no fracture, SWEET, right? Well, though I think breaking a bone is not ideal, soft tissue injuries can take some time to get better, and some people struggle for an extended duration.  Convalescence of a foot or ankle injury is very important.  If you do not treat it right, it will not treat you right!

If you have been diagnosed by your foot and ankle doctor with an ankle sprain, these are our recommendations:

1.  ICE, ICE, ICE: not for the first 24 hours but everyday, at least twice a day, for 2 weeks.  There are so many great icing products that are better than the old school ice system of the ziplock bag. Below I have a link to my favorite ice pack!

2.  Support is the next piece of the puzzle and depending on the damage, one of a couple options may be best for you. Make sure you ask your doctor about an Aircast splint versus a cam walking boot to help calm down your foot and ankle pain. If you need temporary immobilization all you may need than an Aircast splint, but if you are having difficulty putting weight on the foot than a waking cast would most likely be more suitable. There is a link below for the cam walking boot we use for ankle injuries below!

Some people struggle for months and years with ankle sprains, so choosing the right course of care can make all of the difference in the world! Most people who seek treatment swiftly, take their doctor's advice and follow through with their plan of care have the absolute best results!

If you would like to learn about any other foot or ankle pathology or problems after injury visit:

Monday, December 5, 2016

What is a bone spur on the foot?

What is a bone spur or heel spur?

This is a question I get daily from patients that come into the office.  They will describe classic symptoms that we see all the time with heel pain/plantar fasciitis.  They get out of bed in the morning and they will feel intense horrible pain in their foot that often the describe as crippling or horrific! They come to the office and we take an X-ray to confirm there is no fracture. Then they see a big spur on the bottom of the heel bone and freak out, that this is the reason they are in so much pain!

Not everyone who has a heel spur or bone spur, like pictured here, has plantar fasciitis or heel pain.  But many people get a spur when their fascia is tight.  The plantar fascia is a tight band on the bottom of the foot that commonly gets tight just due to our anatomy of our lower leg.  The plantar fascia attaches the heel bone to the flexor tendons of our toes. Our calf muscle becomes our Achille's tendon that inserts across the ankle joint into the middle third of our heel bone.  When our calf muscle is tight it pulls abnormally on the heel bone which in turn pulls abnormally on the plantar fascia. When this band get tight and contracted and you take a step, the fascia pulls on a thin membrane around the heel bone called the periosteum.  This lifts or tents up and new bone is formed.  This process usually takes a long time, it is your body's mechanism to try and spare you pain, but eventually if you keep ignoring the tightness of your lower leg you eventually are going to feel the pain of plantar fasciitis and it will most likely be the soft tissue that is your problem, not the bone!

Explaining this to patients is very difficult sometimes because we like to see proof of why we hurt. But on X-ray you can not see soft tissue and it is not satisfying sometimes to the patient to accept this because, let's face it, plantar fasciitis really hurts! But even when patients have no bone spur they also are so upset because they can not believe something so simple is their problem!

Treatment is the same for me when I treat patients with the symptoms with plantar fasciitis no matter if they have a heel spur or not.  The hallmark of getting your heel pain better is stretching, icing and great support!

There are cheater ways of stretching that I favor myself like a plantar fascial night splint. This is a device you can wear while you are sleeping, but some people can not stand wearing it all night.  I had plantar fasciitis and I wore the splint whenever I was sitting down at home, so I would get at least 4 hours of stretching when I was watching TV or doing paperwork at home.  This was one of the best ways to help stretch out that fascia and help your bone spur pain.  Of course icing the foot and wearing a good support in your shoe help too! For more information about plantar fasciitis and bone spurs check out our website at

Friday, December 2, 2016

Center for Ankle and Foot Care Blogspot: Heel pain is the worst! Here are my favorite piece...

Center for Ankle and Foot Care Blogspot: Heel pain is the worst! Here are my favorite piece...: You wake up, step out of bed and then BAM! You feel it, a sharp undeniable  pain on the bottom of your foot near your heel.  Were you asle...

Heel pain is the worst! Here are my favorite pieces of advice for patients suffering from heel pain that I know work from experience!

You wake up, step out of bed and then BAM! You feel it, a sharp undeniable  pain on the bottom of your foot near your heel.  Were you asleep for a hundred years, or did you rapidly age overnight?  No, you have plantar fasciitis, most likely.  As a foot doctor we see patients with heel pain about 15 times a day.  It is one of my favorite problems to treat, because people are always in shock on how easy it is to get better if they just follow some simple instructions.

This topic is very close to home for me, because after 2 weeks of a new exercise program P90X3, I developed plantar fasciitis!  The doctor is now the patient! This exercise program is a lot of jumping and up on your heels for different exercises.  It is a great program, but I would recommend some extra stretching of the calf muscles before and after to avoid getting plantar fasciitis.

Many people find it hard to get into the doctors office, but when your foot hurts it sometimes is unavoidable.  If you think you have plantar fasciitis or "heel pain" I would recommend seeing your foot and ankle specialist. But I will share with you what I have done from Friday of this past week, when my pain first started, until today Tuesday, just 4 days later.  My pain has gone from an 8 out of 10 Friday morning to about a 2 out of 10 Tuesday morning.
What Is Plantar Fasciitis?

Plantar Fasciitis is an injury sustained as the result of repetitive stress placed on the bottom of the foot. More specifically, its damage sustained on the fascia—a thin layer of fibrous tissue that protects
other tissues within your feet. Many people develop Plantar Fasciitis from long periods of standing, running, or performing various load-bearing activities. For me it was a new exercise program with a lot of jumping.

 Plantar Fasciitis Symptoms

The most common symptom of Plantar Fasciitis is pain. This can be burning, stinging, stabbing or throbbing pain. Many people experience a dramatic amount of pain when they first get up in the morning, with the sensation lessening throughout the day. For others, the pain is consistent. The pain can be isolated to an area in the middle of foot, or it can radiate outward towards the toes. The heel is the most common area for Plantar Fasciitis pain to show up. Plantar Fasciitis pain can be very stubborn and last for months or even years. Since walking and standing cannot be completely avoided in our lives, the injury can cause serious disturbances in professional and private life.

 Causes of Plantar Fasciitis

The causes of plantar fasciitis can be multi factorial, as you can see below.  But the anatomy of our lower leg plays a major role as well.  If you look at your calf muscle as compared to the front of your lower leg, you will notice a big disparity in muscle size.  The back of our leg muscles are bigger because they have the responsibility of pushing our body forward with each step. But the more we walk or exercise with out stretching, the tighter this muscle group gets!

Several different things can cause Plantar Fasciitis, which makes classifying the condition somewhat difficult. For example, bone spurs, flat feet, high-arched feet, and hard running surfaces are all very different—but each one can be a cause of the condition. Individuals in professions that require you to stand for long periods of time—nursing, for example—are at a higher risk for developing cause Plantar Fasciitis. Another very common cause of Plantar Fasciitis is the type of shoe you choose to wear. Older or poorly constructed shoes can place your feet at a higher risk for stress. Shoes that don't have adequate padding for the heel and arch can be a problem as well. Finally, overweight individuals are at a higher risk for developing Plantar Fasciitis. As you gain weight, this naturally places more stress on the tissues of your feet, and the fascia tends to bear the brunt of this.


Below you will find my recommendations regarding treating and making your heel pain go away
People find it hard to believe that stretching, icing and support can be the perfect combo to relieve and help get rid of their heel pain, but it's true!!!! I know from experience over the last 4 days!

What I always tell patients when they come into the office with heel pain or plantar fasciitis, is that even though it hurts so darn bad the cure really does revolve around stretching believe or not, in most cases.  Sure it can require a medicine by mouth or even a shot with some extra support in shoe gear but it is usually a simple fix.

The fix is simple but, depending in how long it takes you to seek help to get better, could be the deciding factor on how long it actually takes you to get better.  The sooner you seek care, start the stretching exercises and put good support in you shoes, the sooner you are on the road to recovery.

Here are my classic three stretches performed by my lovely stick figure drawings, but simple is always better. I have done these three stretches 4 or 5 times a day for the last 4 days.  Stretching is important for your Plantar fasciitis to get better and stay away.  Yes, that is right, I tell all of my patients that they need to stretch daily after having Plantar facsiitis to prevent it from coming back! These three basic runners stretches should be performed 3-4 times a day when you have Plantar fasciitis.  You should stretch both sides for completeness sake and hold the stretch for 15-20 seconds with no bouncing.

Icing is another thing I tell people to do when they have acute Plantar fasciitis.  But how you ice can be a real key to your success.  You need get a little plastic water bottle and freeze the water inside, then take it out 2 times a day rolling it under the arch of the foot back and forth.  I tell patients this is like physical therapy without a copay.  It is a natural anti-inflammatory and stretches the arch very effectively. I currently have three ice bottles in my freezer and have been rotating the bottles for ice massage non stop when I am home.

These are the two main ways to start treating your Plantar fasciitis right now: stretching and icing. They have been the hallmark of my own treatment over the last 4 days.  But I also have used the following to  help support my fascia while I was standing like inserts and slippers.  Also, there is something called a Plantar fascial night splint that I have worn every day for the last 4 days while I was sitting.

Some people get home and kick off their shoes and then strain the fascia walking barefoot around the house.  Support, even at home has a very positive effect in your outcome and feeling better sooner. Something like a spenco slide or slipper can be a foot saver and is what I have relied on the last couple days to protect  my feet around the house.

Here is a link to our webpage, with our top recommendations for heel pain and plantar fasciitis.  I put my favorite helpers for heel pain available below, my secret trick was the night splint with a gel ice pack in the foot bed of the splint from about 7pm until 11pm while I was doing computer work.  This was great because I could not sleep with the splint on but I got a great stretch for 4-5 hours every night while I was really doing nothing: