Tuesday, November 27, 2012

Secrets 2 Stopping Heel Pain

A common foot complaint is pain in the bottom of the heel. This is often referred to as heel spurs or plantar fasciitis. It commonly is painful the first few steps in the morning or after rest. Heel pain tends to get worse the longer one stands during the day. 

It is caused by subtle changes in foot structure that occurs over time. These changes result in the gradual flattening of the arch. As this occurs a thick ligament (the plantar fascia) that is attached to the bottom of the heel and fans out into the ball of the foot is stretched excessively. This ligament acts as a shock absorber while walking. As the foot flattens it stretches. If it stretches too much it gets inflamed and causes pain. 

Over time the pull of the ligament creates a spur on the heel bone. It is important to realize that it is not the spur that causes the pain and therefore the spur does not need to be removed in most cases. This condition may also cause generalized arch pain called plantar fasciitis. This is an inflammation of the plantar fascial ligament.

A common factor that contributes to this condition is tightness of the calf muscles. Women who wear high heels and people who walk for exercise will often develop this problem because of the tightness that results in the calf muscle as a result of these activities. A non-supportive shoe also contributes to heel pain. Weight gain is another factor in developing heel pain.

Home Treatments for heel pain

Stretch, Stretch, Stretch and Stretch

Calf muscle stretching is very useful. The typical runners stretch by leaning into a wall is helpful. An alternative method of stretching is to stand approximately two feet from a wall. Facing the wall turn your feet inward so you are pigeon toed. Lean forward into the wall keeping your heels on the floor and the knees extended. Also keep your back straight and do not bend at the hips. Hold the stretch for 10 seconds and do the stretch ten times in a row. Do the stretching three times each day. Always stretch the calf muscles following any form of exercise.

Over the Counter Arch Supports

Wear a supportive sport or walking shoe. This can be supplemented with a good over the counter arch support, some of the time a custom made set may be recommended / required. 

Our doctor recommends the new balance sneakers

Oral Anti-inflammatory Medications

Medications like Advil, Naprosyn or Aleve may be of some benefit. Always read the medications directions and warnings before use and seek the advice of a physician. 

VISIT www.NaplesHeelPain.com


Professional Care

If the heel pain persists your foot doctor may suggest a cortisone injection, taping the foot to support the arch, night splints to stretch the calf muscles at night while you are sleeping or functional foot orthotics. Professional physical therapy program may also be required.    The Family Foot and Leg Center has the only integrated foot and ankle physical therapy clinic in the area.  We are very proud of our excellent , knowledgeable staff with over 32+ years of experience in physical therapy.  ESWT or shockwave therapy will help patients without the complications of surgery.  
 On occasion, surgery may be required to cure this condition.  

Saturday, November 24, 2012

Greatest Fear in Bunion Surgery Addressed

Greatest fear in bunion surgery comes from hearing stories about the pain and agony of someone who knows   of someone, who heard of someone, etc who had bunion surgery and it was the worse pain ever.
In the past foot surgery can be painful, but that is a thing of the past. 
How we now decrease the discomfort or even eliminate post operative pain is a multi pronged approach. 

1) preoperative IV NSAIDs or oral NSAIDs barring allergies and kidney issues
2) preoperative anesthesia with a nerve block despite the type of other anesthesia used such as Sedation or general anesthesia. 
3) careful incision planning
4) careful soft tissue handling to minimize trauma and collateral soft tissue damage
5) intricate closure of tissue to minimize bleeding
6) post operative long lasting anesthetic that can give up to 8 hours = of numbness.    
7) post operative steroid injection to decrease inflammation 
8) post operative pain medication both narcotics and none narcotics

Most of our patients report a pain scale of  zero to three out of ten (most pain) at their post operative visit. 

Thursday, November 15, 2012

Saving Limbs and Lives with Amniotic Stem Cells

Named a National Center of Excellence for Advanced Wound Care Technologies
Drs. Kevin Lam, Ramy Fahim and W. Drew Chapman of Family Foot and Leg Center
Naples, FL
239 430 3668

The Use of Amniotic Stem Cells in Wound Healing
Stem cells are a class of undifferentiated or “primitive” cells that are able to divide and differentiate into specialized cells of the body such as skin, bone, muscle cells, blood cells, liver cells, and the like. The two main types are embryonic stem cells and adult stem cells. Embryonic stem cells are derived from the inner cells mass of blastocysts of pre-implantation stage embryos. Adult stem cells are less controversial than embryonic stem cells because their production does not involve the destruction of an embryo.
It is now possible to take stem cells from the amniotic fluid and reprogram them to a more versatile state akin to embryonic stem cells. Using stem cells from amniotic fluid overcomes the ethical opposition to using human embryos as a source of cells.
Amniotic stem cells have a wide range of applications that can be used in research and treatment. A study confirms that the amniotic fluid is a good source of stem cells. This is seen to be more acceptable because this involves no genetic manipulation. Amniotic stem cells can differentiate into various types such as muscle, skin, bone, cartilage, cardiac tissue, nerves, and have a great potential in various medical applications.
Wound healing is a major health problem. Chronic wounds such as a leg ulcer, a foot wound caused by diabetes, and other slow healing wounds have a biological or physiological cause for not healing. Among diabetics, for instance, it is estimated that 15 percent of these patients will develop an open foot sore or diabetic foot ulcer. These chronic wounds have been difficult to cure.
Today, the use of stem cell therapy along in combination with medications and proper wound care can help encourage better wound healing. Stem cell rich materials injected into the area can allow for effective wound healing that otherwise can take considerably longer to heal or may not have healed otherwise. Amniotic stem cell treatments are now revolutionizing chronic wound treatments. Recent studies show that stem cell therapy can dramatically improve the condition of chronic and deeper wounds which would otherwise require more lengthy and expensive rehabilitation.
The healing activity of stem cells is due to their ability to separate into the different component cells of injured tissues as well as release growth factors that may encourage the formation of new blood vessels in the patient. It has been evident that these cells have the ability to multiply, integrate with the host tissue, and replace the damaged cells. Using amniotic stem cells in wound healing have sped up the rate of recovery and the results have been outstanding, saving limbs / lives. 

Post Moh's surgery for skin cancer.   Cancer free, now it is toe saving time. High risk for amputation skin cancer skillfully removed by Mohs surgeon now the challenge.   Day 0
Toe Saving Time after amniotic injection and matrix graft Day 14

Toe Saving time  Day 21
Complete healing at Day 45

Thursday, November 8, 2012

Pain in the Ankle / Subtalar Joint On Uneven Surfaces

When patients presents with this complaint a full radiograph of the ankle / foot is required to help.   Surprisingly the pain is usually not in the ankle joint, but rather a very little talked about joint called the subtalar joint.   This joint is below the ankle joint in the foot.  Testing for this is involves moving the foot in and out by grabbing the heel, called an inversion / eversion stress test.   Clinical exam will review pain in the outside of the foot right underneath the small ankle bone, fibula.       Subjective complaints from the patient can be burning, shooting pain and stiffness in the morning with difficulty with uneven surfaces.

Case below is a 72 year old RN presents for second opinion on her ankle pain.  She has been to other doctors to no avail. Xray below was taken.
Symptoms: Pain in the lateral foot below the ankle joint. Pain on uneven surfaces, stiffness and pain in the morning.   Manual test shows pain upon inversion and eversion of the isolated joint.  Patient did get immediate relief with 1% lidocaine into the subtalar joint.   

Preop Xray below. 

FFLC patient preop: note the malalignment on this view.  MRI confirmed swelling  and ligament  injury in the subtalar joint

Above shows the post operative Xray of a healed subtalar joint fusion. Noted the joint is realigned now and that there is a boney bridge present. No pain per the patient and able to go about her activities as an RN at full duty. 
Post operative protocol: 
8 wks of none weight bearing in a cast.  Then a cam boot for 8 wks with aggressive physical therapy. 

Discussion: Degenerative joint disease of the subtalar joint can be treated with NSAIDS such as motrin, aleve, etc.  Injection therapy with corticosteroids may be of help, but  a dislocation as presented in this case requires a subtalar joint fusion or the pain and instability will continue on a daily basis.

Below is a poem from a subtalar joint fusion patient.

Dr. Kevin Lam
Family Foot and Leg Center, PA
Naples, FL
239 430 3668