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By Dr. Kuvent, September 22, 2009 12:28 pm

There’s probably not a worse way to start off your day than to have irritating heel pain with the first few steps you take in the morning. While not always the case, this deep, aching, and radiating discomfort is classically associated with “plantar fasciitis.” The well-documented condition arises from stress, irritation, and inflammation to a band of tissue which runs from the heel to the forefoot. Since it’s so common, there is a barrage of treatment options out there to treat plantar fasciitis. A Google search will no doubt leave one overwhelmed at where to start. However, for stubborn pain which is simply unresponsive to other measures, podiatrists can offer the most adequate help possible.

The first step in truly treating heel pain problems is to figure out what’s really going on. Plantar fasciitis needs to be distinguished from other potential issues such as an entrapped nerve, an infection, a fracture, or systemic disease. Once these things are ruled out, the doctor may perform some other tests to see if there is a heel spur or bony growth associated with the plantar fasciitis.

At this point, depending on what you’ve tried already and the nature of your condition, conservative treatments may be utilized. These can often be effective and helpful when applied appropriately. However, if non-invasive measures don’t seem to be working, your podiatrist may recommend a surgical approach to the problem. This, again, will be based on the nature of your situation and whether or not a heel spur is present and contributing to the pain.

The primary invasive means of dealing with plantar fasciitis is called a “release” in which a small cut is made in the irritated tissue to relieve pressure and tension in that area. The procedure can be adjusted in several ways to suit your particular needs. An “instep” method, for example, not only offers easy visibility to the surgeon but it typically provides for a quick recovery to the patient as well. This method involves a small incision just to the front and inside of the heel.

Another approach called an “open” release has the added benefit in that a bony spur can also be removed if it is present and contributing to the symptoms. The only setback with this procedure is that it requires a slightly longer recovery time with about three weeks on crutches being necessary.

Finally, an “EPF” release actually involves the doctor using a very small camera to monitor the surgery. This procedure is very quick-taking only about 8 minutes of actual operating time. Unfortunately, this procedure does not typically allow the podiatrist to remove a spur, but it does provide for a rather quick recovery time which is always a good thing.

Thanks to proper treatment options, plantar fasciitis is something that can be managed effectively. Everyone should be able to start off their mornings on the right foot!

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By Dr. Kuvent, June 16, 2009 3:24 am

Flip-flops are an extremely popular form of footwear, especially in the summer. Originally patterned after the traditional Japanese wooden-soled style known as zōri, they’re also known as “thongs” in Australia, “slip-slops” in South Africa, and “jandals” in the South Pacific. They’re most popular in India, where they’re known as “Hawaii chappals”.

Interestingly in some cultures, flip-flop shoes are occasionally used to threaten someone since they can quickly be removed and thrown or used to hit an adversary. While that practice is rare in the United States, flip-flops can still pose a threat to those who wear them. For the most part, flip-flops provide no arch support at all, expose the foot to the outside environment, and can often contribute to many foot-related injuries. Since they often have a spongy rubber sole, flip-flops make it difficult for your feet to adjust and accommodate to the ground with each step you take. Furthermore, the strap can lead to skin irritation as well.

All that said, let me back up and admit that flip-flops are indeed a fun shoe to wear, and in fact have many benefits. They allow your feet to breathe and can actually protect your feet from picking up things like plantar warts and various fungal infections from public places. There are just a few pieces of advice to keep in mind if you do choose to wear flip-flops. First, if possible, look for a quality pair with a soft, leather fabric to minimize blisters and irritation. Look for a sole that forms some contour to the ball of your foot but isn’t overly pliable either. Also, make sure your foot doesn’t hang off the edge of the sole. This problem can be exacerbated if you have wet or sweaty feet with a smooth sole, so really try to be aware.

Some other advice would be to not walk for especially long distances, and to avoid playing sports or doing yard work in flip-flops. The straps can snap spontaneously, so excessive motion is definitely not advised. Overall, be cognizant of your environment. If you’re in a location where things like insects, poison ivy, or glass have access to your feet, flip-flops are not the best choice of footwear. If you’re at the pool or beach and wearing flip-flops, remember to use sunscreen on your feet as they can burn like any other exposed part of your body.

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By Dr. Kuvent, April 30, 2009 12:31 pm

Our feet are incredible structures, and the lesser toes are no exception. Just as your thumb opposes and works opposite the smaller fingers in your hand, the lesser toes of your foot help to balance your body by working opposite from your “hallux” or big toe. Accordingly, in a healthy foot, specialized intrinsic muscles work on specifically the four small toes to allow them to stay aligned and function properly. However-as one might suspect-these toes can experience a unique set of symptoms.

Hammertoes are the most common and well-known digital deformity affecting the lesser toes. They typically will affect a single toe and will cause it to bend such that the first part of the toe is bent upwards, and the second part of the toe (the part with the toenail) is bent downwards. The typical signs and symptoms may include a corn on top of the joint where the toe bends as well as a callus underneath and behind the toe where it bears weight. Common causes of a hammertoe include tight shoes or stockings, biomechanical problems, or simply a long second toe.

A cousin to the hammertoe is the “claw toe” deformity. Whether our lesser toes are healthy or not, they typically consist of three small bones and two joints. With claw toes, not only is the first part of the toe bent upwards, but both the joints in the toe are also bent so that the second part of the toe tends to bend or curl downwards in a claw-like manner. This scenario is often associated with a cavus or high-arch foot type and neuromuscular disorders. It typically affects all the lesser toes at once, and may even affect the hallux.

In a “Mallet toe” deformity, the toe is strait except for the very end of the toe which is bent downwards. This tends to put pressure on the skin at the tip of the toe and will often lead to a callus formation there. The toenail will often become thickened and look as though it has a fungal infection. This condition is commonly associated with a long toe.

Numerous other conditions can also affect the lesser toes. “Curly toes” will typically bend downwards and underneath adjacent toes. They will often occur simultaneously on both feet. An overlapping 2nd toe will bend back and over the hallux, while both the 4th and 5th toes can be affected such that they may bend and rotate beneath the adjacent toes. Finally, a “floating toe” is commonly observed in a congenitally short toe which cannot purchase the ground.

Of course, each of these conditions has a unique set of symptoms, prognoses, and treatment options. Visit your podiatrist for an in-depth evaluation and discussion.

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By Dr. Kuvent, February 12, 2009 10:52 am

Most commonly, heel pain is caused by inflammation of the plantar fascia — the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis.
Plantar fasciitis causes stabbing or burning pain that’s usually worse in the morning because the fact that the fascia tightens overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing, increased activities or after getting up from a seated position.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Be alert to; sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot. Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe. Heel pain after long periods of standing or after getting up from a seated position. Heel pain after, but not usually during, exercise Mild swelling in your heel

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

Physical activity overload

Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

Arthritis

Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

Faulty foot mechanics

Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re on your feet, putting added stress on the plantar fascia.

Improper shoes

Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don’t protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.