Custom Foot Orthotics for Plantar Fasciitis: Elevating Your Golf Game⛳️🏌️‍♀️🏌️‍♂️

Introduction:

Plantar fasciitis, a common foot condition causing heel pain, can be a significant hurdle for athletes, especially those engaged in sports like golf. In this blog, we'll explore the causes and treatments of plantar fasciitis, emphasizing how custom inserts from the Center for Ankle and Foot Care can be the precise answer for golf enthusiasts.

Understanding Plantar Fasciitis: Plantar fasciitis is often caused by inflammation of the thick band of tissue that runs across the bottom of your foot. Factors such as overuse, improper footwear, or biomechanical issues can contribute to this painful condition.

Common Treatments: While over-the-counter inserts are a popular initial remedy, persistent pain may indicate the need for a more tailored solution. Enter custom orthotics, a game-changer in managing plantar fasciitis for athletes, especially golfers.

Benefits of Custom Inserts from the Center for Ankle and Foot Care: Our podiatrists at the Center for Ankle and Foot Care offer a remarkable process to craft custom inserts. Using advanced technology, we capture a precise scan of the patient's foot, creating a digital cast. Through intricate software, our doctors then reverse engineer the perfect insert, designed exclusively for each patient.

Fast Turnaround Time: Unlike the traditional 4 to 6 weeks wait for custom inserts, our process allows us to have them ready in just a day or two. This means golf enthusiasts can quickly get back on the course with improved comfort and performance.

Affordable Customization: While insurance coverage for custom inserts varies, our cash price for this customization process is $550, split into two payments of $275. The initial payment is due at the time of scanning, with the remaining amount payable on the date of dispensing.

Convenient Location: Located in Clermont, Florida, our facility is easily accessible, not far from Disney or Orlando. Our dedicated podiatrists are there for every step of the customization process, ensuring a seamless experience for our patients.

Conclusion: For golfers struggling with plantar fasciitis, exploring custom inserts from the Center for Ankle and Foot Care could be the key to unlocking pain-free and enhanced performance on the green. Don't let foot pain hinder your swing—invest in personalized solutions tailored to your unique needs.

Not All Bunions Need Surgery!!!

 Doctor McGowan explains in this video what a bunion is and why not all bunions need surgery. Feel free to leave a comment and let us know what you think!

Want to learn more about bunions? Check out our website at: https://centeranklefootcare.com/cafcblog/bunions-what-you-need-to-know

Jump into 2021 with 2 good feet!

Don't let your feet be a disaster in 2021!

If there is anything we have learned in 2020, it is that the future is never certain for anyone.  But we all can take precautions for our health to keep us at our best.  As this new year begins we wanted to wish everyone a happy and healthy new year! We also wanted to assure everyone that we take your health and safety very serious at the Center for Ankle and Foot Care, and want to let you know we still have all of our Covid protocols in place. 

Our doctors and staff are working very diligently to keep you healthy and our office as a safe place for you to have your foot or ankle problem addressed. Dr. McGowan and Dr. Henne want you to be safe and stress free while they help you with your problem. 

We are continuing to have no waiting room, this decreases any patient to patient contact and to decrease any gathering in an enclosed space.  Every treatment room is thoroughly cleaned in between patients. "We are lucky enough in this environment to have an office that is big enough to accommodate multiple patients in individual treatment rooms, so people rarely have to wait in their cars" Dr. McGowan explains. "Patients just call when they arrive at the office and then they are instructed to what treatment room to go into when they enter the building."

Our facility is is equipped with onsite X-ray. This becomes such a great asset to the patient who has fallen and the pain is only in the foot, ankle or lower leg. We are able to accommodate same day appointments for foot and ankle related injuries.  "I think it is a great sense of comfort for patients to be able to get into a smaller environment like our office instead of an emergency room.  You don't need to avoid treatment if you have had trauma to the foot or ankle, you need to seek out your specialist who have the capabilities in their office to treat your problem.  Covid is not a reason for you to walk around on a broken ankle for 6 weeks" Dr. Henne explains.  

 

We have about 28 bones in each foot. Our feet take a big beating sometimes with everyday wear and tear.  When we walk, about two and a half times our body weight goes through our feet and running about 4 times or more our body weight.  These are things many of us do each day.  Without the right support or protection of your feet, these simple activities can cause foot and ankle problems like: stress fractures, tendonitis, plantar fasciitis and more.  

Getting any pain in your foot or ankle means your body is telling you that something is wrong and you should go get it checked out.  Ignoring foot pain very often turns into a much bigger problem than it originally would have been.  "It is not uncommon for people to ignore foot pain, but during the fall months of 2020, we saw many patients who just ignored real foot problems for 6 months or more. These people's prognosis was much worse.  Some diabetic patients who ignored a small wound for months went on to amputations.  Other patients who thought the pain in the ankle would eventually go away, had Achilles tendon rupture or other tendon problems that pushed them to surgical intervention versus the conservative route that would have helped many months ago" Dr. McGowan reflects. 

As 2021 is off and running, we want to make sure you know we are happy to see you in our office and get you back on your feet as quick as possible. Happy New Year from our family to yours!

The Center for Ankle and Foot Care

Michele McGowan DPM 

Timothy Henne DPM

3190 Citrus Tower Blvd STE A

Clermont, FL 34711

352-242-2502

Centeranklefootcare.com

Pandemic foot pain!! Top reasons why #myfeetarekillingme during the pandemic!

 I have heard and seen so many patients over the last 3 months who think they are having foot pain due to their increased activity level.  This becomes very disheartening for the person who wants to be in shape.  You suddenly have more free time than you want. It almost is the “no excuse season” for getting into shape.  Even Dr. Henne and I, even though we are seeing patients daily and have not decreased our time in the office, but we have  a lot more time in our personal life because our kids involvement in sports and extracurricular activities is diminished.  We personally have been running, lifting and biking consistently for several months now.  Dr. Henne looks skinnier, I look the same, lol. 

So of course, if you went from doing little to a lot you may think the increase in activity is the sole reason for your foot pain.  I do agree that some people over do it and develop tendonitis: Achilles’, peroneal or posterior tibial tendonitis are the most common three we have seen in the past couple months in addition to plantar fasciitis.   But the reality is the root cause of your pain may not be just the activity.  So many people have been home, barefoot walking around their house all day. 

The barefoot walking all day in the house is one of the top reason we are seeing patients for foot pain.  If you look at your foot’s bony architecture, like on this X-ray, you will see that these 28 bones need support in all different areas.  If you don’t have enough support for example and you put too much pressure on your forefoot it is very easy to develop capsulitis under the metatarsal heads for example.  This can be very painful from the repetitive micro trauma of walking on hard surfaces with no shoes on.  Many patients come in and say they don’t want to wear their outside shoes in the house especially now during COVID-19.  I usually show them a pair of Oofos flip flops or Hoka Flip flops.  I own both of these and depending on what is going on with your feet one of these might be the correct choice for you. My Oofos I have had for about 5 years and my Hoka’s for about 4 months I love them both and they are my go to shoe gear right when I come in the house after work or on Saturday and Sunday just milling around the house.

I would recommend that if you are experiencing foot pain and have had no trauma you may want to play around with having good support on your feet around the house.  I am not saying don’t go see your podiatrist because you want to make sure there is nothing more serious happening but you can not go wrong with more support around the house.  If you want to learn about more specific foot and ankle problems visit our website at centeranklefootcare.com

The oofos will run about $50 but last for a very long time  

The Hoka’s run from $50 to about $80 on Amazon, I think I purchased mine locally for a very fair price of about $50.  The real point is that if you are walking barefoot around your house more than you normally do, you are going to develop some foot pain.  This is usually pretty reversible if just having some support while walking around your house.  

Michele McGowan DPM

Center for Ankle & Foot Care

3190 Citrus Tower Blvd Ste A

Clermont FL, 34711

Centeranklefootcare.com

Welcome back Dr. Michele McGowan to the Center for Ankle and Foot Care!

If you are a patient of the Center for Ankle and Foot Care, then you are aware that Dr. McGowan has been away from the practice for the last 6 months. She has returned this April to start seeing patients. If you do not know Dr. Michele McGowan let us introduce you. 

Dr. Michele McGowan is originally from Willingboro, New Jersey right outside of Philadelphia.  She grew up in South Jersey where she played competitive soccer well into her early 20's.  Dr. McGowan became a Nittany Lion and attended The Pennsylvania State University from 1992 until 1996 where she graduated with a Bachelors of Science in Biology with a Vertebrate Physiology emphasis.  While attending Penn State, Dr. McGowan took the opportunity to shadow many different medical specialties.  "I originally wanted to be a pediatrician, but after two weeks of shadowing 2 different pediatricians, it wasn't for me" Dr. McGowan explained.  "In my sophomore year at Penn State I shadowed an orthopedist and a podiatrist, and I really fell in love with the podiatry specialty! There is something so gratifying to be able to help someone, sometimes on the same day they come in feel better walking out of the office. "

After completing her 4 years at Penn State University, Dr. Michele McGowan went on to Des Moines Medical University in Des Moines, Iowa. "I knew I picked the right specialty for me, when I could spend 6 hours in a library studying a day and enjoyed it" McGowan explained.  Dr. McGowan loved being at the library so much she got a job there where she would work 6 hour shifts, so she could study and get paid! 

While attending podiatry school Dr. McGowan met Dr. Timothy Henne a fellow student at the time and now her husband of almost 18 years.  The two made a great team from the beginning, from journal clubs to jazz clubs they had fun whatever the venue was. Both Dr. McGowan and Dr. Henne were accepted after their 4 years in podiatry school in Iowa, to the prestigious and highly sought after surgical residency program at the Western Pennsylvania Hospital in Pittsburgh, PA.  "I was very excited to have the opportunity to attend the same surgical program as Tim.  The city of Pittsburgh was one of my favorite places I ever lived!"

While Dr. Henne was finishing up another year of surgical training, Dr. McGowan moved to Florida and opened their first office for podiatry in Clermont, The Center for Ankle and Foot Care.  "I did everything that first year almost entirely by myself. I answered phones, made appointments, did my own billing,developed x-rays(we have digital x-ray now), I roomed patient and checked them out by myself for at least the first 7 months" Dr. McGowan explained. "It was fun, patients thought I was crazy but they came back because I helped them, and that's what patient really care about. Now we have this fancy office and gadgets, but patients still just come back because we help them!"

Dr. McGowan and Dr. Henne live here locally in Lake county and have 3 amazing children that keep them on the go constantly. "I used to think when they were babies it would be easier when they were older, but now between 3 children we have the following activities: soccer, basketball, tennis, track, cross country, golf, robotics, cello, guitar and piano! But I would not change it for the world" explains McGowan.  The children of Dr. Henne and Dr. McGowan are a big part of their office life. " Our children have been a part of this family business from the beginning. When they were babies they would eat, sleep and play in the office. Now that they are big kids they have their own room to hang out in, but that doesn't stop our youngest Emma, who is 6, from coming out into the waiting room and trying to sell patients pictures she drew on her days off from school!" 

If you are having foot pain call the Center for Ankle and Foot Care to make an appointment with one of our great doctors!  

Office number 352-242-2502

Office address:

3190 Citrus Tower Blvd Ste A

Clermont, FL 34711

So you have a Bunion! What do you do?

Bunions are very misunderstood by patients in many cases.  Patients want to believe that the big bump on the inside of their foot is just skin.  I mean, they push on it and feel it's hard but want to deny the facts that are really going on here. A bunion at its core is a bone deformity, yes there is some imbalance at the joint from the capsule being overstretched on one side and over contracted on the other.  But the bone is ultimately the biggest problem that causes a patient to stroll into our office.

Some patients just want to know what's going on with their foot and some are convinced they need surgery immediately! If you have a bunion it might be worth reading this before seeing the doctor, we have broken down the most common type of patients that come in with a bunion. Knowing which one you are could save you from unnecessary foot surgery!



Not All Bunions Are Created Equal

1. The no pain bunion but someone has convinced them they need to do something before it gets worse. These patients usually are just curious what is wrong with their foot and want to make sure they are not going to be disabled if they do nothing.  These patients are educated on shoe gear and we explain that if you stay away from bad shoes, this may be what their foot is like for the rest of their life.  This visit usually ends with a relieved patient who is happy to not have to have surgery.

2. The no pain bunion but the patient hates the way their foot looks! These are sometimes the most frustrating patient to really help.  They have no pain yet they are contemplating surgery because they think their foot will be prettier.  There is a 50/50 chance this patient walks out of our office angry because we refuse to perform unnecessary surgery on a foot that does not hurt at all. We explain to the patient that even if we were to perform surgery, there is no guarantee that they are going to fit into a narrower, "cuter" pair of shoes after surgery. Some patients appreciate our open and honest opinion and others are just pissed they paid a $40 copay for me to tell them "wear wider shoes"!

3. The painful bunion that only hurts in certain shoes.  This patient demographic is identical to the #2 above, but these patients often present in a high heel stiletto with a foot that is identical to Fred Flintstone! They literally do not want to accept that their foot is just not meant for the shoes they are wearing.  Many of these patients, if they just switch to a mesh athletic shoe or wider shoe have no problems.  But getting this patient on board with this simple solution is sometimes difficult.  I explain that in order to fix their problem I have to cut their bone with a saw, move the bone over to correct the deformity and then put a screw in it.  I explain that they can not get it wet for 2 weeks and they have to wear a post-op shoe for 6-8 weeks.  Almost everyone of these irrational patients say, "can't you just shave the bump?" Because they are now the expert!  I have to almost always explain that we have to correct this problem at the level of the deformity so that the problem does not recur because I like to do my job right. These patients usually leave frustrated and seek the care of another podiatrist who decides that this a great patient selection for surgery. The patient that go to have surgery by another doctor are usually the horror stories you read when you google bunion surgery.  See if you do not have pain before, performing surgery is just cruel and unusually punishment that could lead on to lifelong disability. Pain in and out of all shoe gear is the requirement to have surgery and be happy.

4. The last bunion patient is the painful bunion in and out of almost all shoe gear.  These patients have pain that does not completely resolve with the absence of shoe gear.  This is ultimately the type of patient that does great with bunion surgery.  These people are so happy to have a realigned pain free joint and are accepting of some tingling or numbness that can occur with surgery in this area. But even these patients can decide to keep looking for the shoe that offers them comfort.  



Treatments for Bunions

Again there really are only two treatment options for bunions:

1. Modify shoe gear(go into wider shoes)
2. Surgery



There really are no great in between options for fixing a bunion.  If you have a bunion and you take away pressure to the big toe joint you get rid of what is causing the deformity to get worse and for some take away the pain. If the bunion is mild you can try something like the Yoga toes, but there is no guarantee this product will yield a great result but it may help stretch that over contracted part of the joint. Also, using a gel toe spacer may also yield some minimal improvement but both of these options are much better than surgery that may not be necessary.  If the foot is killing you and you are unable to be comfortable in and out of shoe gear, then bunion surgery may be a good options for you.  If you are looking to learn more about foot and ankle problems feel free to follow the link to our website at http://centeranklefootcare.com/services.html

Michele McGowan, DPM

If you live in the Central Florida area, it may be worth your time to take the drive to our office in Clermont to evaluate your bunion to see if surgery is really necessary or not. We are located at:

3190 Citrus Tower Blvd Ste A
Clermont, Fl 34711

Our number is 352-242-2502 if you would like to call to schedule your evaluation.

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 http://centeranklefootcare.com/heel-pain.html.

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.

 Treatments

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:
    

http://centeranklefootcare.com/plantar-fasciitis-helpers.html

To Fix or Not To Fix My Bunion!!!! The Real Deal On Bunion Surgery!!!!

If you have just left your doctors office and they have told you that surgery is your best option for your foot deformity, you may want to read this and listen to our podcast above first before going through with the surgery.  Now full disclosure Dr. Henne and myself are Board Certified in foot surgery and perform surgery weekly.  That being said we will be the first people to try and talk you out of having unnecessary surgery.  More importantly we make sure you fully understand the post operative course (how bad it really is).  We never SUGAR COAT anything.

Many people come into the office with a bunion or a hammer toe and want it fixed.  But unless they pass a very strict set of criteria to be a candidate for surgery, we turn them away.  I will jump right into the nitty gritty here folks.  Number one reason to not have surgery is NO PAIN!  Yes the old adage if it ain't broke don't fix it still stands. If you do not like the way your feet look, surgery is never the answer! Feet are for function not for entering beauty pageants.  If you want pretty feet, foot surgery will give you pain and may never guarantee a beautiful foot.

When do I operate on someone? The answer is simple: if they have pain that has not improved with a normal course of conservative care and I know that there is a great chance their foot will feel better after surgery.  I never tell someone that their foot will look so much better only that their foot will feel better. I believe the unrealistic expectation that your foot will look better after surgery plays a huge role in why some people are very unhappy after foot surgery.

Bunions are a great example of the type of deformity a lot of people have but do not have a lot of pain with it.  They present with the big bump on the side and want their foot to look thinner but have no pain.

A bunion is a enlarged bump on the inside of the foot at the base of the big toe.  A bunion, in its simplest definition, is a imbalance at the 1st metatarsal phalangeal joint(the big toe joint). A contracture of the lateral side of the joint and stretching of the  medial side of the joint further contributes to the bone getting more deformed.

Over time a bunion can become a progressive deformity that can lead to other deformities like hammertoes, blisters and more. But if you have no pain other than the bump being irritated in some shoe gear, then do not have surgery. The fix for the non-painful bunion is really an adjustment in shoe gear.  Go for a wider toe box and get a mesh sneaker, stay away from constricting leather.  The mesh will give unlike a leather or pleather material. The less pushing you have on the big toe the better to prevent any further progression of the deformity. Also if you just have to wear those fabulous shoes for the day then just do it. Yes your foot is going to hurt after, but just wear good shoes after that! 

 Hammer toes are a very similar situation to bunions as far as a guide to when to fix and when to just wear a more suitable shoe for your foot type. The hammer toe that is most common is the 2nd metatarsal joint(joint at the base of the 2nd toe) hammer toe.  People often come in and complain of a contracted toe that rubs on shoe gear on the top of the toe.  After a thorough examination, if they have no pain but just the nuisance of shoes that they want to wear not fitting right, I tell them to get new shoes.  I explain that the pain they will have after surgery and the aesthetic result they want to have may not line up to what they expect in their mind.

 There are many instances where people have hammer toe surgery and their toe is still kind of deformed looking and much stiffer than they would have expected.  My criteria, which if you are contemplating foot surgery please read closely, no pain in the toe means shoe gear adjustment and using gel sleeves to protect the toe with activity in enclosed shoes.  If there is real pain in the toe and the joint that is unable to be treated with conservative care, then we consider surgical intervention.  I tell all of my surgical hammer toe patients, "You may never be able to wear heels again, and all shoes will not be able to fit just because your toe was fixed."  I always explain the end result is functionality when you have foot surgery not beauty.  

Again, for hammer toes and bunions they make extra-depth and extra-width shoes, that don't look like ugly orthopedic shoes.  They just cheat the extra room where you need it in the shoe with out making the shoe look like it should be on Frankenstein! 

Now, I will tell you that I perform foot surgery weekly on people but only on those who truly need it. If you go see a foot an ankle surgeon and the first thing they offer you for your bunion or hammer toe deformity is surgery, you should run out on your non painful deformed feet and go get some new shoes.  I leave you with this last thought, feet are not pretty.  Feet are for transportation not to be entered in a beauty contest.  I have never seen the foot competition in Miss America for a reason, most people have ugly feet!

If you would like to learn more about other foot and ankle deformities visit our website at http://centeranklefootcare.com/services.html
Michele McGowan DPM
Center for Ankle and Foot Surgery @2014

Cracked dry heels? Get smooth heels now!!!!

We see many patients a day that come into the office for all different types of foot and ankle problems. A very common issue that is mentioned by patients after treating their foot problem is, "Hey doc, what to you recommend for dry, cracked heels or dry skin?" For years I would direct them to their local neighborhood pharmacy with a prescription for 40% Urea cream.  But about two or three years ago I started to have many angry patients who would call the office upset that I would give them a prescription for something so expensive and that was not covered!!! That is right, insurance companies stopped covering this very effective and safe way to get rid of cracked heels and dry skin.  I gave up on this for a while, sending patients to get some junk at the pharmacy that just wasn't as effective.

Over the counter, in the last couple of years, many great new Urea 40% creams have become available without a prescription but are not available in stores.  My favorite, which is available on Amazon is Revitaderm 40. What I love about this product is that, out of all of the creams available on the market for dry cracked heels this one comes with a pleasant odor while still being extremely efficient at making your skin smooth and get rid of dry cracked heels. This product has Chamomile, Tea Tree Oil and Aloe Vera which gives is a great odor.  Many other products seem just oily and a little smelly.

Urea Cream 40 / RevitaDERM - 8oz

I now just direct my patients to Amazon.com to buy the cream. Many times they can get it the next day, with out having to go to the store and hunt around for something you can not find there!  If you go to your local neighborhood pharmacy, the closest they come to this product is 10% Urea creams.  I would say this may be O.K. for areas that you do not bear weight on, but would not be effective for the problem areas like dry cracked heels and thick skin under the ball of the foot.  The 40% Urea creams will be very effective over time to get your heels and problem areas smooth as a baby's bottom:)

If you have really thick skin on the bottom of your feet, a trick I tell my patients about is the following. Before bedtime, place the Reviatderm 40 on the affected foot and (I know this is going to sound really weird) gently, not tight, wrap Saran or cling wrap around the foot and place a clean sock over it and go to sleep, take wrap off in the morning and go about your business.  If you have really bad calluses or thick dry skin you could see a big change in as little as a week doing this daily.

The link below will take you to Amazon for purchasing the RevitaDerm 40 cream.  I can say that I have seen many people have great satisfaction with this product and that is why I am sharing it with you! This product is safe for diabetics as well. Calluses on a diabetic foot can lead to ulceration (open wound) if left to continue to build up.  I consider this product an ounce of well needed prevention on the diabetic foot!

 If you have a foot or ankle problem and would like to learn more, feel free to visit our website at http://centeranklefootcare.com/

 

Running with plantar fasciitis, you can get better and keep running!

Plantar fasciitis or heel pain is a real bugger to have for anyone, but when you are a runner it is 1,000
times worse.  I speak from experience.  This summer I began to run 4-5 times a week and increased my mileage to about 4 miles a run after a month or two.  Running is one of my favorite activities to do now, other than playing with my children and hanging out with my husband!  A year ago I would have never said those words about running.

After the second month of running, it happened, I got out of bed one morning and felt the very familiar stabbing pain on the bottom of my foot, known as plantar fasciitis.  I couldn't believe that I, a podiatrist, would get what so many of my patients come in to have treated. The good news was I immediately knew what I had and I started to treat myself. Below I have wrote my steps down for other runners who may be experiencing the same problem and would like some simple advice.  My one disclaimer is, if you do not know if you have plantar fasciitis, I would recommend seeing a foot doctor before you start a treatment program. There is a small possibility of a stress fracture in the heel bone

It is also important to note, that from August until November, I experienced some symptoms on and off of the heel pain.  I continued to run and on some occasions increased my mileage.  The running , I believe was not the source of aggravation of my plantar fasciitis, the resting after running and lack of stretching were the biggest culprits!

Step 1: Stretch
Your calf muscle is a big powerful muscle group of the lower extremity.  This is also a muscle group that does the majority of work when you are running below the knee.  This muscle group plays a huge role in pro pulsing you forward with each step while you are running.  These muscles need extra attention or they will let you know they are not happy with you.  I have included the perfectly illustrated stretching exercises you should be doing before and after running and maybe two other times a day.  Also, purchasing a night splint is a nice way to get  static extended stretch while you are resting, watching TV or sleeping.   Another great tool for a deeper stretch is using a Pro-stretch.

Step 2: Ice
Icing is really important to help calm down plantar fasciitis, especially when you are continuing to run.  I always say get a 20oz bottle of water and freeze it.  Roll it under your foot for 10 minutes 2 or three times a day.  Giving you a deep stretch and ice it a great natural anti-inflammatory. This is quick, easy & very worth it for the plantar fascia. Other devices are sold kit that can help you get a deep stretch and freeze a foam roller in a Thera-band kit.      

Step 3: No Barefoot and Good shoes
Going barefoot when you have plantar fasciitis is a killer.  I always tell patient they have to have something on your feet while you are walking around even in the house.  A great alternative is a spenco flip flop.  They have a little bit of a built in support in the arch.  Sneakers really are the gold standard to help you get better, as long as they are in good condition.  Sometimes you have to ditch your dress shoes for 4-6 weeks to give good supportive care. Many sneaker have built in support in the arch too. Asics are one of my favorite running shoes for support in the arch.  Just remember that the more miles you put on  a week the quicker you will need to replace your shoe, no matter how great they are, probably every 3-5 months.  Running 3-5 miles 4 times a week I replaced my sneakers after 2 months.  If you have new shoes and just feel like you need more support I would recommend superfeet, spenco or power step over the counter inserts. If you were to go see a podiatrist, they would most likely recommend one of these over the counter inserts.


If you are a runner and have plantar fasciitis, running is usually fine to continue but remember to STRETCH, ICE, & GOOD SUPPORT are the keys to keep you running and help you get better!

Plantar Fasciitis...The Doctor Is Now The Patient!!!!!

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.

 Treatments

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 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 at :
http://centeranklefootcare.com/id114.html