As Chelsea Foot and Ankle enters it’s 15th year, Dr. Ciment reflects on the growth of our business since it’s founding fourteen years ago, and the path forward for our practice for the years to come.
A few weeks ago, I was in the Hamptons for a friend’s wedding. Wanting to take advantage of some downtime and the sunny weather, a couple of friends and I decided to go for a run on the beach. It was picture perfect: the breeze, the sound of the gulls, the cool water as we ran along the shoreline and then BAM! A jolt of electricity ran through my foot. This was something that I’d never felt before. Where did that come from? I was so caught off guard I had to stop to ensure I had not step on something. Despite the advice I tell all of my patient in these situations, I decided to press on and ignore the lightning storm happening in my foot. A few days later I realized that I needed to get honest. I’ve seen this thing a thousand times but never known what it felt like until now. This thing, was a neuroma.
So, let’s talk about neuromas. What is it and what causes it? A neuroma is a thickening of the nerve tissue. While there are many different types of neuromas located in different parts of the foot, the most common neuroma that we deal with here our practice (and the one that was causing me so much pain) is called a Morton’s Neuroma. This type of neuroma is found between the third and fourth metatarsals (see the picture to the right) and is usually a result of irritation or repetitive compression of the nerve. Our nerves are lined with a sensitive outer layer that responds to repetitive pressure or compression by building a protective “layer” around the nerve. In my case, and with many patients I see, it was a combination of repetitive irritation to the ball of the foot from being a long-time runner coupled with a flexible flatfoot, and an affinity for a narrower type of shoe that probably did me in. Yep, wearing shoes with a narrow toe box such as high heels, flats, and certain men’s dress shoes force the toes and metatarsals to bunch up together, causing friction or compression of the intermetatarsal nerves. These are not the only triggers for neuromas; people with bunions, hammertoes, flexible feet, or flatfeet are at higher risk for developing a neuroma as well.
Let’s go over a more comprehensive list of symptoms of neuroma pain. Nerve injury or pain is notoriously described as tingling, electricity, burning or numbness that may radiate to the toes or up the foot. Some people say they are sure a pebble is in their shoe or something is stuck on the bottom of the their shoe, only to find nothing. The symptoms usually progress over time, often beginning with a tingling or burning sensation in the ball of the foot. In truth, a neuroma can cause almost any physical sensation that a nerve can cause. That’s because a neuroma is a nerve that’s gone haywire.
If you think you have a neuroma it’s best to make an appointment in the early stages of the symptoms. If a neuroma is diagnosed early, we can develop a treatment plan that is tailored to your unique situation and the resolution of your symptoms is often much quicker. Many times, neuromas can be treated conservatively with: padding/orthotic devices, icing, temporarily modifying shoe gear and activities that cause abnormal amounts of pressure on the forefoot, certain oral or topical medications, and lastly, injection therapy. For more information, give us a call!
Summer is here! You've busted out the sandals, brought out the boat shoes, and you're flaunting those flats but don’t forget the burden these beauties are carrying: your feet. More specifically, your heels. The flimsy, flexible footwear coupled with increased activity (among other factors which we will discuss), have many patients rushing in to have their heel pain evaluated. So, let’s tackle the most common cause of heel pain: plantar fasciitis – a condition coined as “heel spur syndrome” many years ago. As you might imagine, there are many other reasons for heel pain. Tendinitis, a stress fracture, nerve irritation, or a cyst are all causes of heel pain, just a to name a few. I mention these simply to point out that it’s important to have a professional evaluate your heel pain before you initiate any self-treatment.
So, plantar fasciitis. We’ve all heard of it, but what is the plantar fascia? Some people mistakenly refer to it as the “plantar fascia ligament”? Well, it’s not actually a ligament, but for the sake of our discussions, let’s think of it that way. That ligament-like band of connective tissue starts at the base of the heel bone and fans out into three major branches that span the bottom of your foot and they all insert at the joints at the ball of your foot. When the fascia becomes inflamed, the result is heel pain. So the “itis” in plantar fasciitis simply means, “inflammation of" the plantar fascia. Patients often say the pain as worst when they get up in the morning or after they have been sitting for long periods of time. The pain usually improves after walking and stretching the fascia. Of course, not everyone’s body reads the anatomy textbook and the pain for some people may get worse after spending progressively longer periods of time on their feet.
The exact cause of plantar fasciitis is a bit of a complex answer but it can be boiled down to simply faulty architecture of the foot that results in abnormal mechanics due to forces external to the foot. People who have either overly flat feet or high arches, are more inclined to developing plantar fasciitis. But there are a lot of different factors that combine to increase the risk of developing heel pain. For instance, take those flimsy, flat, unsupportive shoes, mix them with the hard surfaces of NYC streets, and add a dash of increased activity, a job that requires long periods of standing, and/or someone who is carrying an extra few pounds, and Voila! You have yourself a perfect recipe for plantar fasciitis.
How do we diagnose plantar fasciitis? Because of all of those “other things mentioned above”, it’s important that your heel pain be evaluated by a professional. Here at Chelsea Foot and Ankle we always start with obtaining a thorough medical history, getting a sense of your daily activities, and examining your foot. If we think your pain is coming from one of those “other things mentioned”, we may use diagnostic imaging studies, such as x-rays, ultrasound, or other imaging modalities to confirm the diagnosis.
Treatment of plantar fasciitis is tailored to each patient. What works for you might not work for the person sitting next to you. However, it usually begins, for everyone, with some simple things you can do right at home: Stretching exercises, icing the bottom of your foot, refraining from those high impact activities, avoiding going barefoot, shoe modification (ditch those flimsy flats), and oral medications such as NSAIDs. If after several weeks you still haven’t made a comeback, we will likely add some other treatment modalities such as injection therapy, orthotics, a night splint, or physical therapy. The important thing to remember is that, regardless of the kind of treatment you undergo, that faulty architecture of your foot remains. It’s crucial you continue to stretch, wear supportive shoes, and follow up with your doctor at Chelsea Foot and Ankle on a regular basis.
If I were to create a list of the top 3 complaints I hear from patients when they come to the office it would be: bunions, hammertoes, and heel pain. We’ve already tackled bunions so let’s explore hammertoes.
Some common questions you might have when pondering your hammertoes: what is a hammertoe? What causes it? Can I blame grandma? What can I do to be pain free?
A hammertoe is a deformity of the second, third, fourth, and/or fifth toes. The middle joint of the toe (also called the proximal interphalangeal joint) begins to bend downward. The resulting deformity starts to loosely resemble a hammer. There are a few variations of hammertoes depending on where the bend is located. For example, a mallet toe is a bend in the joint closest to the toenail (the distal interphalangeal joint). A bend in both the middle and end joints is called a claw toe. Regardless of the type of hammertoe, the causes (and treatments) are very similar.
So, can you blame your mom, dad, or grandparents for the hammertoe that is preventing you from getting into those nice pair of shoes? Unfortunately, it may the nice pair of shoes that caused the hammertoe. Hammertoes are a result of muscle imbalance brought on by ill-fitting shoes along with a couple other factors. Narrow shoes and high heels change or restrict the pull of the muscles that help straighten and bend the toe the correct amount. Over time the muscles shorten causing a contracture of the toe. Left untreated, corns and calluses may develop on the top of the toes or bottom of the feet. After a prolonged period of neglect, the toe may become rigid and fixed in the hammered position, requiring surgery.
What can you do for these pesky painful piggies? Treatments for the condition typically involve wearing shoes with a wider toe box, doing toe exercises, physical therapy, and using toe strappings or cushions. It’s important to understand that these conservative methods cannot reverse or straighten the hammertoe once it’s started to form but it often can slow down or arrest it from worsening. If you’ve tried all of the above and it’s still bothering you, then you should consider discussing surgical options with your doctor.
Up next: heel pain. Stay tuned.
Interested in having your hammertoe evaluated? Feel free to email or call our office for a consultation.
Dr. Michael Collins gives a detailed discussion about bunions, what they are, why they form and how to manage them so you can live your life without foot pain.
Flat feet are relatively common and, for most people, they don’t cause pain until well into adulthood. However, the complications associated with uncompensated flat feet can be quite severe, leading to painful bunions, hammertoes, arthritis, knee pain and low back pain.
If you are among the masses of well-intentioned Americans joining a gym or vowing to make use of exercise equipment purchased in the past, it's important to be prepared to undertake your commitment safely so as to avoid injury.
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When we speak about passive modalities, we're talking about things like heating pads, whirlpool therapy, ultrasound, e-stim/TENS and other applications whereby the treating physical therapist does something to the patient, hence the term "passive". As it turns out, getting patients to be more active in their own P.T. demonstrates better results more quickly.
Here are the top five running-related injuries that we see and treat in our practice and some practical advise on how to manage and prevent them.
Here at Chelsea Foot & Ankle we see many serious running injuries that occur when non-runners decide to take up running. Like any sport or fitness activity, there is a right way to run.