I had an interesting conversation with a patient this morning about plantar fasciitis. The patient had classic signs of plantar fasciitis that included pain upon initial weight bearing and relief of pain with rest. In her research on the Internet, she had found that most informational sources stressed support of the arch with an arch support. “I was ready to spend over a hundred dollars at a foot care web site but thought I better check with you first.” And I think my patient was very surprised to hear from me that plantar fasciitis had nothing to do with arch support. It has everything to do with the height of the heel.
In part one of this series on heel lifts, we talked a bit about the mechanical forces that are generated by the calf and how those forces are distributed in the foot. A fine balance exists in the leg, ankle and foot that performs well in young patients, but tends to develop problems as we age. You see, the calf generates force with each step that we take. In optimal biomechanics, that force is distributed to the foot in a way that lifts the body and enables forward motion. But as we age, we start to loose tissue elasticity. We still have the strength to perform the activities that we want to, but we lack the elasticity to heal. And that’s what’s at the heart of what causes plantar fasciitis. Essentially, the strength of the calf overwhelms the ability of the fascia to heal.
And what about the humble heel lift? A heel lift is used to treat plantar fasciitis in a somewhat indirect manner. By elevating the heel, you’re weakening the force generated by the calf. Decreasing the force delivered by the calf to the foot decreases the load applied to the fascia and enables the ability of the fascia to heal. It’s pretty simple really, raise the heel and the plantar fasciitis will get better. Lower the heel (barefoot, low heeled shoes) and the plantar fasciitis gets worse.
So I ask you, if you had plantar fasciitis and were looking for cost effective treatment which would you choose; an Rx orthotic at $250(+)/pair or a heel lift at $3.95/pair. And that’s the point in our conversation that my patient said to me, “man, am I glad I stopped to see you first.”
Treatment of plantar fasciitis doesn’t have to be complicated. And it’s important to recognize that not all patients will be pain free with the use of a heel lift. But in my experience, 7/10 are at least 50% improved within 3 weeks. Not a bad success rate for the humble little heel lift.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
Turf toe is the term used in athletic circles to describe a condition called hallux limitus. Hallux limitus is a an injury to the great toe joint that results in pain with range of motion of the joint. In many cases, arthritis and continued pain are common. One of the tools used to treat turf toe is a turf toe plate.
Turf toe plates are a funny looking type of insert. Most are made out of rigid yet thin material such as carbon and graphite. The carbon/graphite composite yields a very thin and durable material for athletic use. But the most unique aspect of the turf toe plate is something called a Morton’s extension. The Morton’s extension is an extension under the great toe that limits motion of the great toe joint.
The benefit of a turf toe plate is simple. The rigidity of the turf toe plate and the Morton’s extension limit range of motion of the great toe joint. A turf toe plate may not correct turf toe. Only surgery can do that. But use of a turf toe plate can significantly decrease the pain associated with turf toe.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
lateral ankle ligaments
The term sprain refers to an injury of the ligaments of the ankle. 10 to 1 that injury occurs on the lateral or outside aspect of the ankle. The lateral ankle is supported by a much weaker network of ligaments that often fail to support the ankle as your body weight move over the ankle.
One of the often overlooked aspects of ankle sprains is the position of the heel at heel strike. If the heel is inverted at heel strike, the body’s center of gravity is thrown to the outside of the ankle setting up the stage for an ankle sprain.
For more information on ankle sprains, please check out our knowledge base pages on ankle sprains or join us in The Foot Talk Forum.
Jeffrey Oster, DPM
Medical Director
Myfootshop.com
I’m an old dog. Been in practice for 25 years. I love my autonomy but I’m finding the market being carved up by those who are part of this group or that hospital. It’s becoming a bit Darwinian out here in the medical field. Sure, I have my sense of what is right for me. I’d like to just provide patient care and forget about the issue of money. But I realize that’s not reality.
So what do we do? How do we improve this bohemouth we call health care? Health care is a huge economic engine. Change it fast and we’ll be in another bail-out situation. Change it slowly and we’ll still have far too many folks uninsured.
The starting point is utilization of services. Providers provide and consumers consume health care services at a rate that is just absurd. It blows my mind to see how much unnecessary care is provided. But who’s going to say no.
Honestly, I am sitting on the edge of my chair to see what the Obama administration is going to propose.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
MRI’s have become a common tool in the diagnosis and treatment of bone and joint deformities. Often an MRI report will refer to a bone contusion. What’s a bone contusion and how does it compare to a fracture?
Bone contusions go by a number of names including bone bruise, bone edema and bone swelling. A contusion by definition is ‘A bruise; an injury attended with more or less disorganization of the subcutaneous tissue and effusion of blood beneath the skin, but without apparent wound. ‘ Although this is the definition for a skin contusion, the same definition applies to bone. A bone contusion is an injury that involves injury to the surface bone and subsequent damage to the underlying bone sub-structure.
Bone contusions come in a variety of patterns. Some involve non-articular bone, but most are going to be both a cartilage and bone injury, involving the joint. Bone contusions that involve the cartilage go by another broad group of names; osteochondral lesions, transchondral lesions, transchondral fractures. We’ve got a bit of information on ankle transchondral fractures of the ankle on Myfootshop.com.
I look at bone contusions as a subtle form of fracture. Sure, there’s no defined break, but the bone is going to manage a bone contusion just as if the bone is fractured.
So how long does a bone contusion take to heal? Might take even longer than a fracture in that the bone is effected by a crush (contusion) injury. So plan on months for complete healing. Granted, the rate of healing will vary by the general health of the patient, the nature of the injury and the location of the injury.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
The California Public Retirement System (CalPERS) just won a $895 million (yes, million) dollar settlement against health care giant UHC for their illegal stock option granting program. These options enabled the management of UHC to draw millions of dollars from the company by back dating stock options. Bravo CalPERS and thanks for standing tall.
UHC has lowered projections for share holders. So what else is new? They’ve lowered payment to my practice for years to a degree that UHC represents my lowest paying private insurer. They also anticipate a 4000 job layoff this year.
There’s a bad intersection coming. I don’t know how it’s going to play out, but costs keep rising, reimbursement keeps dropping. Throw an election into the mix and it’s going to be an interesting next couple of years.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
Struggling to describe where your foot hurts? Trying to understand foot and ankle anatomy? We use a convenient foot and ankle anatomy page in The Foot Talk Discussion Forum. The images on the anatomy page are numbered with a legend found adjacent to the image. By using the numbers, we can talk more effectively in the forum. (all images are protected by copy right)
Damp feet are actually more than just a nuisance. Chronic perspiration can contribute to a number of chronic foot conditions including fungal nails, fungal infections of the skin and believe it or not, warts. The problem lies in the fact that each day we slip on a shoe and create an environment for the foot that damp and warm. It’s just like a green house; hot damp and warm. And those fungal filaments are down there just laughing and having a great time.
The simple solution is to keep the feet dry and open to the air. Have you ever seen fungal infections in the finger nails? We find onychomycosis (fungal infections of the nail) to be much more common in the toes. Why? It’s all about the environment.
So how to fight back? Onox is a simple drying solution that can fight the dampness of the foot and subsequently cut down on problems like fungus and warts. What else can you do? Be sure to rotate your shoes to allow them a day or two to dry out. For more information on fungal nails, check out our pages on onychomycosis.
And Onox just happens to be on sale during August…….only at Myfootshop.com.
