FAQ Category: Foot

Shock wave treatment has been used in Europe for the last 15 years. It’s fairly new in the United States. There are different kinds of shock-treatment. There’s low-energy treatment. This is said to be “unpleasant” by all patients.

High-energy shock waves would be painful but doctors use an anesthetic first. This could be just a local block to the area. For example, the foot would be numb from the ankle down to the toes. In conscious sedation, the patient is put to sleep for the procedure.

Ask your doctor what kind of energy waves are going to be used and whether or not you’ll feel them. Don’t be afraid to mention your concerns before the operation is scheduled.

You’re asking some good questions that haven’t been fully answered yet. Studies are underway to find out the best way to give the shock treatments. At the present time, three months is used as a guiding point. By this time, most or all of the healing process should be completed. Whatever results you might get will be over by then.

Many patients notice a benefit as early as four weeks after the first treatment. If you’re not happy with the results, you can try it again. Retreatment takes place at least three months after the first session. In a recent study about half the patients who had a second treatment were helped.

Achilles rupture occurs in three main groups of men and women. The first and largest group is weekend athletes in their late 30s and 40s. These injuries can also occur in younger, well-conditioned athletes in their late 20s. You fall into this second group.

Any sport or activity with maximal effort or moving forward rapidly can result in an Achilles rupture. Most Achilles injuries are running injuries. Other typical sports activities linked to Achilles rupture include basketball, tennis, baseball, or softball.

In a smaller number of adults rupture can occur all of a sudden without trauma. Degenerative changes in the tendon from aging are usually linked to these injuries. The use of steroids for inflammation also increases the risk of tendon rupture.

You didn’t say but we’re assuming you had surgery to repair the torn tendon. If that’s the case, it’s likely you’ll be in a cast or cast boot for 10 days to two weeks after the operation.

Some doctors transfer patients to a rigid orthosis (brace) with a heel wedge. This keeps the foot in slight plantar flexion (toe down position).

About the time you can put full weight on that side, the heel lift is lowered to neutral. Patients are allowed to return to regular shoe wear around six weeks after the surgery. This includes cowboy boots.

You’ll need to keep up your stretching exercises since most cowboy boots have a one to two inch heel. Usually the goal is to have equal range of motion at the ankle on both sides. Patients can return to normal sports and activities when motion, strength, and endurance are similar to the uninjured leg.

Most studies agree surgery has the best results. Patients get back to normal function faster after surgical repair. There are also fewer cases of re-injury with Achilles tendon re-rupture after surgery.

In general, Achilles tendon ruptures are more common in older athletes. However, younger adults are more likely to reinjure the Achilles after surgery to repair it. Rehab must be approached with more caution than with older adults. It’s not clear what could account for this difference.

Morton’s Toe is a common forefoot disorder in which the second toe is longer than the first (big) toe. It doesn’t always cause pain for the average person, but it’s a definite problem for many dancers.

Morton’s toe results in too much pressure on the second metatarsal head when the dancer is on pointe. The metatarsal is the long bone in the main part of the mid-foot. It sits between the bones of the ankle and the ends of the toes.

Morton’s toe can be managed in young ballerinas. The first step is to choose proper footwear. Her regular shoes should have a high and wide toe box (area where the toes rest inside the shoe). Narrow, pointed shoes are a “no-no” for this condition.

If the problem is mild, a special shoe insert or liner can be used inside the pointe shoes. The cushion lies against the big toe and the third toe. This makes a space for the long second toe to lie straight. There’s no pressure from the end of the box.

You can find these cushions on-line at
http://www.dancer.com/cushion.html. They are designed by a company called Gaynor Minden, the maker of a special pointe shoe as well. If the tip of the second toe is pushed under it can cause a problem called hammer toe. If this is happening, your daughter may need to see an orthopedist first.

Charcot foot affects the mid-section of the foot. It was named after a doctor (Jean-Martin Charcot) who lived in the 1800s and was the first to describe the problem. Charcot foot is a complication of diabetes.

Nerve damage from diabetes causes a loss of foot sensation. The muscles can’t support the joints properly. The patient is at risk for foot injuries such as sprains and small fracture. The ligaments get loose or lax and the bones can no longer stay in alignment. Uneven wear and tear causes the bone to wear unevenly. Foot deformity is next.

Without the support of the ligaments and muscles the bones of the midfoot called metatarsals drop down. Instead of a curved foot arch, the bottom of the foot goes flat. It can even go so far as to look like the bottom of a rocker called a rocker-
bottom foot deformity.

With Charcot foot, it’s important to prevent more joint damage and foot deformity. Physical therapy combined with proper footwear is important. Encourage your mother to follow her doctor’s advice. If she reports any redness, warmth, or swelling in her feet, send her to the doctor right away. She shouldn’t “wait-and-see” what happens over a couple of days. Early treatment can make a big difference.

Mid-foot pain is an uncommon problem. When it does occur, it’s often caused by either a short first (big) toe or a long second toe. This is called Morton’s toe. Sports activities like track and field can put pressure through the longer toe into the metatarsal-tarsal joint. That’s where the long toe bone meets the bones of the ankle.

When your son pushes off with his foot, he jams the bones of that second toe. Whether it’s because the first toe is short or the second toe is long may not really matter unless surgery is planned.

However, to answer this question a recent study was done at the University of Washington in Seattle. They used X-rays and CT scans on patients with midfoot pain and Morton’s toe to find out which toe is the real problem. They found that adults with mid-foot pain had BOTH a short first toe and a long second toe.

Tendon pain at the elbow, heel, knee, or other tendon was always called
tendonitis. Small tears of the tendon would set up an inflammatory response. When the injury doesn’t heal before it’s injured again, chronic pain can occur. We now know that in chronic cases, there isn’t active inflammation. There’s a process called tendinosis.

In tendinosis failed healing, not inflammation is the problem. The cells are disorganized. Some of the tissue cells are growing larger called hypertrophy. There’s a loss of blood supply to the bundles of tendon cells. There may even be a lack of nutrition to the repair and remodeling cells.

You may also hear the term tendinopathy. This just means tendon injury without describing exactly what’s wrong. Tendonitis and tendinosis are two types of tendinosis.

Cuboid syndrome is a change in the position of the cuboid bone in the foot and ankle caused by a sprained ankle. Usually the force of the sprain disrupts the nearby ligament allowing the bone to slip out of position.

The manipulation you are referring to is called a cuboid whip. It’s done by bending the knee and putting the foot and ankle in a “toes-up” or dorsiflexed position. The patient is face down on a table. The operator’s thumbs are on the bottom of the foot under the cuboid bone.

The knee is straightened while the ankle is pointed down. The operator turns the foot slightly inward and applies a thrust force to the cuboid. This action moves the cuboid bone back into its proper place. There may or may not be a pop. It’s usually a painless manipulation.

An alternate way to do the same thing is called the cuboid squeeze. The foot and ankle are slowly stretched into a plantar flexed position (toes pointing down). When everything relaxes the examiner squeezes the cuboid with the thumbs putting it back in place.

The cuboid squeeze works best for people with cuboid syndrome from overuse. If the problem was caused by an ankle sprain, the joint manipulation is still the best way to go.

In general, this procedure is effective, but it’s not without complications. In a recent study of a small group of athletes, 60 percent had great results. The other 40 percent had what could be called “failed” outcomes. Why the poor results? Researchers think the athletes went back to full activity too soon, before the bones had a chance to heal completely. Researchers are now saying that patients should not resume full-impact activities until X-rays show complete bone healing at the fracture site.

A history of fracture may make good results harder to come by. In this same study, two-thirds of the failed cases had a history of fracture or symptoms. Talk with your doctor about what you can do to ensure the best possible results. And plan on avoiding high-impact activities after surgery until the bones have healed solidly together.

A recent study showed that different types of screws didn’t lead to different outcomes when tested on cadavers. The screw used is really up to the surgeon. Other researchers have echoed this and added that bigger screws should be given to patients with larger body mass.

More important than screw type is how long patients wait to return to full activity after surgery. When patients go back to their activities before the foot has healed completely, they are more likely to have another fracture. For this reason, patients–especially athletes–should not go back to high-impact activities until X-rays show that the bones have really healed together. This is true even if symptoms have already gone away.

Researchers are saying: Not so fast! When patients return to full activity too soon after this surgery, they risk fracturing the foot again. This is true even when patients’ symptoms have gone away. How do you know when it’s time? Your doctor can take X-rays to see whether the bones have healed together completely. Then and only then should you return to high-impact activities like basketball.

Be sure to get your doctor’s okay before you go back to your normal activities. Your patience will pay off in better results. In one study, patients who put off activities just two more weeks after this surgery (nine weeks total) were a lot less likely to have another fracture or other problems.

Ideally, your foot comfortably accepts the impact of your weight while running. If you pronate, the arch flattens, and the muscles supporting the arch can become strained. Over time, these muscles can actually begin to develop small tears where they attach on the shinbones. Tibial stress syndrome can result. This injury, commonly thought of as shin splints, can be very painful.

What can you do to prevent this type of injury? Certain running shoes may help correct your foot posture. You may also want to talk to your doctor about orthotics, or shoe inserts. By supporting the foot against pronation, orthotics may help prevent overuse injuries. Ask your doctor what he or she recommends in your case.

Proximal plantar fasciitis (PPF) is a newer term to describe one of the more common causes of pain on the bottom of the heel. This condition is believed to be from degeneration and inflammation of the soft tissues in the bottom of the heel where the plantar fascia attaches to the heel bone (calcaneus). With PPF, there’s usually tenderness in this area. The pain worsens when getting up and walking right after resting or sleeping. The problem can start after an acute injury to the heel, or it can begin gradually. It can come on after starting a new activity or wearing a new pair of shoes. It can also come from training errors in runners, and from weight gain or obesity.

Most health experts agree that heel spurs are not the cause of heel pain. The pain is usually from problems of inflammation in the area of the spur. This is a challenging problem to cure due to the scarce blood supply in the bottom part of the heel. Ultrasound treatment applied by your physical therapist is not designed to remove the spur. However, it may be used to help improve the blood supply as a way to speed healing time.

The pain of PPF is believed to be from degeneration and inflammation in the soft tissues where the plantar fascia attaches to the heel bone (calcaneus). To reduce inflammation, doctors will usually prescribe a nonsteroidal anti-inflammatory medication. At first, it may be necessary to take weight off the heel by altering activities, using a heel cushion, or actually casting the foot for up to three weeks. Stretches for the Achilles tendon may help relieve pressure on the plantar fascia.

Physical therapy treatments are helpful for easing pain and inflammation and improving blood flow to the sore area. Special shoe inserts, called orthotics, may take some of the pressure off the plantar fascia. If symptoms continue, a cortisone injection may be suggested. However, many doctors are cautious about using cortisone in this area because repeated injections can cause the plantar fascia to rupture.

Past studies done shortly after surgery for this condition weren’t very promising. The results appeared to worsen with time. However, a recent study of the long-range benefits of this surgery have shown the opposite is true. The study showed that 85 percent of all patients undergoing neuroma surgery reported either “good” or “excellent” satisfaction an average of five and a half years afterward. In this particular study, the surgery was done through the top of the foot.

Even though some patients still had some numbness or tenderness, it didn’t keep most of them from doing normal activities. Twenty-three people had mild problems with resuming activities. Only two had major restrictions on what they could do. Talk further with your doctor about your expectations and whether they are realistic given your current symptoms.

Most doctors think painful neuromas are from scar tissue that squeezes a small nerve that runs between the toes (the interdigital nerve). To relieve pressure, choose shoes with a wide toe-box in front. Avoid tight and narrow footwear. You may find instant relief by placing a small “metatarsal pad” within your shoe. This pad is used to spread your toes slightly and take pressure off the interdigital nerve.

Physical therapy treatments are often helpful. These can relieve inflammation around the painful spot. Treatments may include ultrasound or topical cortisone applications. Orthotics may be prescribed to support the foot and take pressure off the sore nerve. If these measures are unsuccessful, your doctor may suggest a cortisone injection.

If pain becomes unbearable and keeps you from doing the activities you enjoy, surgery may be recommended.

Time and experience indicate that working from the top of the foot has fewer complications. And the results tend to be better.

By having surgery through the top of the foot, most patients can start to put weight on the foot right away after surgery. Patients also have fewer problems with the wound.

In a recent study, the authors reported that neuroma surgery from the top of the foot had a mere three percent rate of problems, whereas surgery done through the sole of the foot caused complications up to 36 percent of the time.