Plantar fasciitis is a common ailment often heard in the news for its effect on athletes but has the potential to affect non-athletes just as well.   Anatomically, the plantar fascia refers to tissue on the bottom surface (plantar surface) of the foot that spans from the heel all the way to the toes.   The area where the tissue attaches at the heel can become inflamed producing heel pain.  With plantar fasciitis the pain often manifests itself when first standing or walking in the morning.  This is because overnight or even after long periods of sitting, the plantar fascia tenses up so when standing and placing pressure on the fascia the pain is exacerbated.

There are risk factors in the development of plantar fasciitis including certain sports like running where there is continuous stress placed on the plantar fascia.  Obesity is also a risk factor since the increased weight places more pressure on the plantar fascia.  Shoe gear can also influence the development of plantar fasciitis.  Shoes with decreased arch support or a poor fit can increase the stress placed on the fascia.  Another risk factor is the biomechanics of one’s foot.  Pronation is a movement that occurs when the foot is rolled inward towards middle of the body so that the outside of the foot begins to lift off the ground.  When a person overly pronates as he or she walks the arch flattens and lengthens, putting tension on the plantar fascia.

Conservative treatment for plantar fasciitis includes applying ice and taking non-steroidal anti-inflammatory drugs to relieve the pain.  Physical therapy and night splints may help stretch the plantar fascia and relieve the tension.  Orthotic devices and padding can also be made to provide support and accommodation.  Steroid injections are also an option to alleviate pain. 

You don’t have to suffer from heel pain.   The physicians at Atlantic Foot and Ankle Associates take a conservative approach for the treatment of plantar fasciitis.  Make an appointment at one of our four offices conveniently located in Palm Coast, Orange City, Daytona Beach, and Port Orange and we’ll have you back on your feet… pain free!

By Dr. Andrew Green, DPM

A-Rod has ventured into the world of ‘Orthobiologics’.  In December of 2011 he flew to Germany where his knee and shoulder were treated with PRP (Platlet-rich plasma).

Orthobiologics is cutting edge technology which augments the body’s healing potential and in the case of PRP, it allows for healing proteins known as growth factors to aid in the repair process.  This treatment initially originated in the dental community where it was used with mandibular reconstruction.  The process for PRP is fairly simple where a small sample of blood is withdrawn from the patient, placed into a centrifuge and separated into its components. The platelets are then injected into the site of injury.  Other notable athletes who have used PRP include Tiger Woods and Cliff Lee.

PRP has been used to treat a variety of foot and ankle pathology including but not limited to plantar fasciitis (heel pain),  peroneal and Achilles tendonopathy.  Additional options include but are not limited to ankle bracing, custom orthotics, physical therapy, cross-training, activity modification and/or surgical intervention. The treatment plans for the particular problem are based on the pathology, diagnosis and clinical presentation of the patient.

From the professional athlete to the weekend warrior, our goal is to keep you on your feet at Atlantic Foot and Ankle Associates.  With four offices conveniently located in Palm Coast, Daytona Beach, Port Orange, and Orange City, Florida, we are able to provide a wide variety of both conservative and surgical options to keep you pain free.

Don’t suffer from foot or ankle pain any longer… have your feet evaluated by one of our five physicians at Atlantic Foot and Ankle Associates.  To make an appointment online visit our appointment request page or call our office and speak with one of our friendly staff members.

By Dr. Sona Ramdath Jr.  

News this week revealed Giants running back, Ahmad Bradshaw, has a stress fracture in his right foot.  Although Bradshaw has played through similar injuries, his status for the next couple of games as well as choice of treatment remains uncertain.

Stress fractures are common injuries, especially in athletes.  Stress fractures refer to cracks in bones and are very common in the feet, accounting for about 95% of all stress fractures.  They result from continuous low grade stress and force put on the foot over a period of time.  Normally when bone is put under stress it undergoes remodeling; however, the constant repetitive forces that cause stress fractures do not allow the bone time to adequately remodel. 

As for diagnosis, a patient’s history can strongly suggest a stress fracture.  Commonly stress fractures occur in people who change activities, wear improperly fitted or worn shoes, make training errors such as undertaking too much activity very quickly, or make a change in running surfaces.  Risk factors include women with amenorrhea (absent menstrual periods) or osteoporosis.  The physical examination of a stress fracture will typically shows tenderness and soreness over the affected area and pain when supporting the weight of the body or engaging in activity.  Swelling near the injury may also be present.  Once suspected, stress fractures are evaluated through physical examination and imaging studies including X-rays, bone scans, and CT scans. 

At Atlantic Foot and Ankle Associates in Palm Coast, Florida, it is recommended that to treat a stress fracture, most importantly activity level will need to decrease or be replaced with an activity that will not place the same stresses on the foot, such as swimming.  At this point it is important if the activity hurts to stop to avoid further damage.  The foot will need adequate time to heal.  Also orthoses or immobilization of the foot may be recommended depending on the cause and extent of injury.  Some more severe stress fractures may even require surgery.

By Dr. Dennis B. McBroom, DPM

Watching Ryan Howard of the Philadelphia Phillies fall and grab his leg on the last play of the NLDS was painful.  My initial thought was… oh no, not his Achilles!  As Ryan related during one of his post-game interviews, “he felt as if his bat had hit him on the back of his leg”, which was sufficient testament to a torn Achilles.  During my training progression from student, to resident, to fellow, and now ultimately private practice at Atlantic Foot and Ankle Associates, I have been exposed to similar clinical presentation in both the young athlete to the weekend warrior.

Typically we are able to primarily repair the tendon after the swelling has resolved and begin the rehabilitation program shortly thereafter.  Dr.  Amol  Saxena recently reported in a pilot study that an athlete was able to return to activity (RTA) after being able to run for 10 minutes at 85% of their body weight on the “anti-gravity” Alter-G treadmill, able to complete 5 sets of 25 single leg heel raises, post-op calf girth of 0.5 cm and range of motion within 5 degrees of the contralateral leg.  The expectation is that he should be able to return to the sport in approximately six to nine months.  But at what point will he actually return to his dominant self?  As Ryan’s Achilles went ‘pop’, so too did the Phillies’ chance at a World Series this year.

Ryan’s injury brings to mind another high profile athlete who sustained an Achilles rupture, David Beckham.  Untouched and with no surrounding players or actual injury, David tore his Achilles.  His return to his dominant form is well documented after his injury but he was unable to participate in the 2010 World Cup as a result.  He was, however, able to return just short of 6 months after his injury, so Ryan Howard has some precedence for a speedy recovery.   If you have suffered from a sports injury and need to recover quickly, do not hesitate to make an appointment at our Orange City office or any our other three locations.  Our goal is to get you back in the game!

By Dr. Sona Ramdath Jr.

Flatfeet, or Pes Planovalgus, is a term with a very vague description of decreased arch height as someone stands down on the ground.  Kelly Osborne of Dancing with the Stars has suffered from shooting pains as a result of flat feet.  It is well known that this foot condition is a precursor to foot problems ranging from general foot pain/fatigue, bunions, hammertoes, ball-of-foot pain, arch pain, and ankle pain.

There are four basic stages of flatfeet that are directly related to the degree of pain and correlating treatment, ranging from non-surgical to surgical:

1. The first stage usually is associated with general foot pain with mild to aggressive activity and long periods of standing. Initial X-rays are usually taken to determine if there are any signs of arthritis. At Atlantic Podiatry Associates, we typically recommend arch supports, good supportive shoes and anti-inflammatory medications, which are a great start and usually reduce pain significantly.
2. The second stage is associated with more pain and possible changes seen as a slight drop in the arch with more swelling. At this stage the treatment is typically a special walking boot and a possible MRI to visualize the tendons to see if there is any tear within the tendon.
3. The third stage typically is quite severe. There may be pain with every step and the foot has turned outwards; it is hard to move the joints in the arch. Treatment at this stage typically needs aggressive custom ankle-foot braces or orthotics (arch supports) for shoes. If pain is not controlled, surgery may be indicated.
4. The final stage is a painful foot and ankle that is debilitating. This is the “end stage” with a large majority needing foot and ankle fusion-type procedures aimed at moving the foot back underneath the ankle. Surgery is reserved for patients who fail conservative treatments.

A large majority of our patients ranging from Port Orange to Palm Coast find great relief with a custom arch support made from a mold of their foot. The custom inserts fit in athletic shoes and can ease the pressure on the fallen arch, decreasing pain and allowing for more activity.

It is important to address flatfeet to prevent “arch breakdown”. The idea is keep a person from progressing through any of the above stages. This can only be accomplished by supporting the weakened flat arch.

By, Dr. Dennis McBroom