A Girlfriend's Guide to Foot and Ankle Health

Got Grandma's feet?

karpati@faant.com (Blog Author)66478 — Tue, 11 Oct 2011 08:00:00 EST

"I am starting to get my grandmother's feet!" I hear this a lot from my patients with bunions! And they are right on the money when it comes to this!

Bunions are these small to massive bumps on the inside of your foot where the big toe attaches to the rest of the foot. Small or large, if you have a bunion, you will notice your big toe is pointing towards the toe next to it. Over the years you may notice that you are having some soreness to the bump usually accompanied by some localized redness. Your soreness may start off as just on the occasion you decide to wear a shoe that is a little too snug. The discomfort resolves when you wear a better shoe. Many times the soreness does not progress beyond that. There is an unfortunate group of people, however, who are not so lucky. For these folks, as the years wear on, they may find that they get the same pain more often. It is now coming on not just with ill-fitting shoes, but with most shoes and during most activity, including walking! Then, of course there is every thing in between; pain only with exercise or only gardening or yada, yada, yada!

Where ever your pain is at this point, it should not be ignored. You just may end up as yet the most unfortunate group of patients, (oh yes, there is more!), who come in when it is too late to just "fix the bunion". You see, when a joint does not line up correctly (and having a bunion means your joint does not line up correctly), you develop arthritis. When the arthritis is bad, there is no way to save the joint. This means you may actually end up needing to have the joint replaced! Not a good situation.

Should you notice your bunion misbehaving, make it a point that day to contact us to make an appointment with your podiatrist. Remember, your feet are your only set of tires!

Kids Get Foot Pain Too!

crane@faant.com (Blog Author)65076 — Tue, 20 Sep 2011 08:00:00 EST

Kids Have Foot Pain Too!

School is barely in session and already my Grapevine office is overrun with kids. Lots and lots of kids! We joked Wednesday afternoon that I think I saw the entire 4th, 5th, and 6th grade in one afternoon. It really did seem that every patient that day was around 10 years old! As I was giggling with another patient, who thought she had mistakenly walked into a pediatrician's office, she really made me aware that most adults don't realize that kids have foot issues. She asked why they were all there and what kinds of things kids come in with, then laughingly suggested that they couldn't all have ingrown toenails!

After I stopped laughing, I thought I would enlighten my readers on the kinds of problems kids have with their feet. In fact, if you happen to have kids, a great way to educate yourself and them is to ask for a copy of our free coloring book with fun bunny pictures and lots of information about childhood foot issues. Here is a good summary to tide you through until you get your free coloring book.

Kids have foot pain just like adults, but because of their rapidly growing bones and tendons, they often have confusing symptoms and need to be treated in different ways.

Some kids are just born with, to put it simply, jacked up feet. Arches that are really high (caves feet) or practically non-existent (flat feet or calcaneal valgus) are common, with varying symptoms. Some kids walk and run really strange, often tripping and falling. Some kids have severe problems fitting shoes or wearing them out rapidly. Many kids experience "growing pains" or cramps in their feet and lower legs - these are never normal despite what many pediatrician's are taught to believe. Heavier kids have more foot related issues, but skinny kids have foot pain too.

Kids with abnormal feet and gait issues often suffer from traveling pains and overuse sports injuries.

The most common is calcaneal apophysitis, a.k.a. Sever's disease, a.k.a. pediatric heel pain. These kids have pain in their growth plate that worsens with activity. I saw a lot of this in the last few days due to early season football and soccer. The cleats and the increases activity are the beginning of the perfect storm of pediatric heel pain. Add to that the love of barefoot and flip flops, we have an early Fall epidemic of heel pain. The good news is that pediatric heel pain is often pretty easy to treat if you focus on the cause, improper biomechanics, or simply said, jacked up feet.

Other common foot type related ailments seen in kids are posterior tibial tendinitis (pain and swelling in the largest tendon that holds up your arch), Achilles tendinitis (pain in the largest tendon on the back of your heel), shin splints (pain in the front of your shin bone or lower legs), and Osgood-schlatter's disease (pain and swelling in the growth plate just below your knee). These are also treated primarily by realigning the biomechanics of the child's foot.

Kids with gait issues may in-toe or out-toe causing muscle and joint imbalances. Some kids are even chronic toe walkers. These types of issues can be foot type related or can be caused by some underlying nerve issues. Orthotics (shoe inserts to balance abnormal foot function) and physical therapy are usually very helpful.

Of course, kids also can suffer from traumatic sprains and strains as well as stress fractures and fractures. No one is immune to fall down and go boom!

What else do we see in kids? Lots and lots of ingrown toenails and pesky warts. Skin and nail issues are abundant and seem to be ignored all summer long. I implore all parents to take a look at their kid's feet and nails. Little problems become big headaches when not addressed. A simple ingrown toenail can become a huge abscess when picked at repeatedly by your child.

So while I replenish my kids treat drawer and balloon stash, remember that kids have lots of foot issues too and at Foot and Ankle Associates of North Texas, we treat lots of kids! Request a free coloring book for your kids and don't ignore their feet!

PS. Just so Moms and Dads don't feel left out, we have a free book for you too. Just request a copy of Got Feet for yourselves. No pictures to color, but lots of great information!

NFL Having Record Injuries of Achilles Tendons Already!

crane@faant.com (Blog Author)61899 — Wed, 10 Aug 2011 08:00:00 EST

The NFL holdout is finally over and the fans are finally ready for some football. Unfortunately, many NFL players are not. Only several weeks into the NFL training camps there have already been 10 season ending Achilles tendon ruptures. Injuries like these are not unexpected in a group of athletes who did not have consistent organized workouts during the offseason. On average a typical NFL full season has only 8 Achilles tendon ruptures, and only 2/3^rd'sof them return to play and almost always play fewer snaps than before their injuries.

Remember Dan Marino? An Achilles tendon rupture ended his career!

Achilles tendon injuries typically occur in an already diseased tendon, but lack of consistent workouts and conditioning can lead to early muscle fatigue and tendon failure, even in healthy tendons. Makes you think that even if a pro athlete can't be a weekend warrior maybe we should not be one either.

If you are experiecing pain, stiffnes or swelling in your Achilles tendon, better to get it checked out by one of our doctors than to become a statistic!

Children's Summer Shoe Tips

crane@faant.com (Blog Author)57622 — Mon, 20 Jun 2011 08:00:00 EST

Summer means new ground for little feet to cover. Whether it's sand, water, dirt or grass, kids will be busy running, swimming, climbing and jumping.

Improper foot support can lead to aches, pains and sprains.

Shoes to avoid

As a mom with three girls, I know it's hard not to buy all of the cute shoes that are out for summer! However, in order to prevent tripping and maintain good contact with the footbed of the shoe to improve support, it is best to avoid flip-flop type of sandals unless they have a built in arch support..

Flip-flops as I have previously discussed in another blog, can lead to problems including stubbed toes, broken toes, blisters, arch and heel pain, tendinitis and sprained ankles.

Flip-flops do not offer kids enough protection or support for daily wear. They are fine for brief periods of time at the pool or beach. I see many children with foot pain after a long summer of walking barefoot or wearing unsupported sandals as well as injured toes and feet from sandals and flip-flops that lack protection.

Barefoot is not a good alternative. We live in a concrete jungle. Puncture wounds can really ruin a summer vacation!

Shoes to consider

There are better alternative to your traditional flip flop. Sport-style sandals offer more coverage and support than flip-flops and are also a better choice than open-toed sandals for balance and support.

Crocs can be an option if worn correctly. Crocs tend to be worn loose on the foot and therefore offer less support and stability. However, when they fit snug, they do offer good flex of the sole as well as being closed-toe and having a back strap.

Shoes for toddlers

Toddlers and new walkers, because at this stage in development flat feet are usually normal, do not need arch support from a shoe, but instead require a shoe that provides a substantial amount of flex to allow their feet to move freely.

Toddlers benefit from closed-toe shoes that are relatively close-fitting (don't allow a lot of wiggle room side to side). Open-toed shoes do not provide the amount of stability that a closed-toe shoe does. They are learning many new gross motor skills and require good support for all of the challenging new balance activities, as well as learning to walk in the grass, mulch or sand.

Shoes for older children

School-age kids need more support and cushioning, and flexibility at the ball of the foot from their shoes. Preteens and teenagers' feet are nearing maturity and for those who play sports will require sport-specific support from their shoes.

The right fit is essential

Once you've found the right shoe for your child's need, you need to find the right fit.

Because kids have feet that are slightly different in size, the larger foot should determine the shoe size. I recommend measuring the foot while your child is standing and allowing about a half-inch of growth room at the end of the shoe. You should allow one thumb width from the end of their toe to the end of the shoe.

Always use the store's measuring stick to obtain the length and width of their child's foot as a starting point to finding the right fit. The number may be irrelevant if the shoe company has sized them slightly off, but it is a good starting point. You may be amazed how much your child has grown!

Matching the right shoe to each summer activity is also important in protecting growing feet.

I recommend that children wear sneakers during the summer for daily walking, running and jumping. There are many lightweight, breathable and washable options, with proper heel cushioning, mid foot support, flexibility, good traction and rounded edges to decrease stumbles and falls. If you do want a sandal for summer heat and splashing in the water, choose a sneaker type sandal with cutouts and mesh - a much better choice than flat, non-cushioned flip-flops.

If your child is having trouble with their feet and you know the shoe fits and is correct for their activity, contact our office and we can take a look. Many children's foot problems are due to poor shoes, but gait problems can also occur. A short office visit may sort it out and get your child running, jumping and playing with the other kids, pain free, this summer!

Running in Flip Flops is Dangerous!

crane@faant.com (Blog Author)56629 — Tue, 07 Jun 2011 08:00:00 EST

It's that time again...Summer! Kids are out of school and Texas is heating up to feel like we live on the face of the sun! Everyone is chucking their shoes in favor of sandals. I hope you have stopped by Healthy Steps and seen our wide arrray of supportive, yet cute, summer sandals.

This week is the first week of summer for most kids in North Texas, and we have already seen a number of children with toe injuries due to running in flip flops! Forget about the fact that flip flops have no support, they can be down right dangerous! Children are running around and stub their toes causing lacerations, bad contusions and even broken toes. I've already seen one great toenail half ripped off and I'm sure I will see more before the end of the summer.

So, Mom's beware! Tell your kids to stop running in flip flops unless they want to visit the office. And if your child does have a flip flop incident, bring them in right away. Small cuts and nail issues can become bad infections that keep them out of summer fun quickly!

Buster Posey Busted His Ankle!

crane@faant.com (Blog Author)55855 — Thu, 26 May 2011 08:00:00 EST

Giants are down a catcher for the season due to the Cousin's vs. Posey play at the plate Wednesday night which resulted in a broken ankle for Posey and the winning run for Cousins. Scott Cousins tagged and scored the winning run Wednesday night, putting a shoulder to Posey's chest attempting to knock the ball loose. Posey's ankle was caught under him and as he rotated through the force, the twisting also put stress on his knee. Ouch! His ankle was broken and it takes at least 2 months to get over a simple ankle fracture and much longer to be able to catch at the MLB level! Ankle fractures are actually not uncommon in baseball and are high on the list of lower leg injuries in catchers due to obstruction type collisions at home plate.

Want to know more about ankle fractures? Click here

Pregnancy and Your Feet

karpati@faant.com (Blog Author)53652 — Fri, 22 Apr 2011 08:00:00 EST

Taken from News Interview:

Pregnancy and the Feet

Pregnancy is seen by most as a time of anticipation and joy, but it can take a toll on a woman's body. Even the feet can be affected. Researchers report more than half of all pregnant women have foot complaints.

According to Adriana Karpati, D.P.M., Podiatrist in Grapevine, TX one of the most commonly encountered foot problems in pregnancy is plantar fasciitis (heel pain). As the woman nears the last trimester, production of a hormone, called relaxin, causes the ligaments to loosen in preparation for movement of the baby through the birth canal. This process also loosens the ligaments in the foot. The extra weight during pregnancy compounds the problem, and may cause the arch to flatten and the foot to roll inward while walking. This puts stress on the fascia, or connective tissue that runs from the front of the foot to the heel. The fascia becomes inflamed, leading to heel pain. The pain is worse when first getting out of bed in the morning or after sitting for long periods of time.

Foot swelling is also very common in pregnancy. It occurs due to extra blood volume to support the fetus and pooling of fluid in the lower body. Swelling can be worse after standing for extended periods or during warmer weather. The increase in foot size also makes wearing some shoes more uncomfortable.

Many pregnant women complain of foot cramps (the cramps can also occur in the legs). These become more common during the second and third trimester. The cramps can be caused by an increase in blood volume, relaxation of the blood vessels (which slows circulation) and compression of the veins in the pelvis from the added weight (affecting circulation in the feet). Foot cramps are common at night, but can also occur during the day.

Karpati says pregnant women may also develop ingrown toenails. This is usually caused when the swollen feet are stuffed inside shoes that are too tight. She says pregnant women are used to getting bigger maternity clothes to match their growing girth. However, many patients don't think about changing their shoe size. The foot can get flatter and wider, growing in length by an extra half inch.

Treating and Preventing Pregnancy-related Foot Problems

Karpati says it's important for a pregnant woman to take care of her feet as well as the rest of her body. Many foot problems can be relieved or prevented by wearing properly sized shoes. Since the feet tend to swell and enlarge, a new pair of comfortable shoes may be needed. Make sure to get shoes that have a good arch support. Orthotics can also help support the arch. If shoes in general are uncomfortable, try wearing slippers around the house. Avoid going barefoot, which doesn't give any support to the feet and can increase risk of foot injury.

To reduce swelling, take frequent breaks from standing. Sit down and prop up the feet for at least 30 minutes a day. Don't cross the legs (this impedes the ability of blood to flow back up to the heart) and avoid wearing pants with constricting ankle cuffs or tight ankle jewelry. It's also important to watch salt intake, which can contribute to fluid retention and swelling, get regular exercise and eat a healthy diet.

For both heel pain and leg/foot cramps, Karpati recommends stretching. A splint may be worn at night to keep the ankle and foot at a right angle and reduce risk of cramps while sleeping.

Women with ingrown toenails may get some relief by soaking the foot in warm water for the nail to soften. For very small ingrown nails, it may be possible to cut the nail at an angle and peel off the excess nail on the side. For larger or deeper ingrown nails, or if the nail is very red, sore or has any drainage, see a podiatrist for treatment.

Karpati says many pregnancy-related foot problems resolve after the baby is born and the woman gets back to a normal weight and routine. However, sometimes the feet may still be larger, requiring a larger shoe size than that worn needed before pregnancy.

Six Simple Exercises For Stronger Strides

crane@faant.com (Blog Author)52638 — Wed, 06 Apr 2011 08:00:00 EST

Remember that in part one of this series, we discussed that a better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.

Six Simple Exercises to Stronger Strides

Here are six simple exercises you can do daily to improve your intrinsic foot strength. I recommend you walk around your house barefoot for five minutes to warm up your feet. Then really warm up your foot muscles by pretending your big toe is a marker and writing the alphabet with your foot. Do this twice. Now you are ready to begin strengthening your feet.

Towel crunches. Your foot has tiny intrinsic muscles that stabilize your toes called the interossei and lumbricals. A great way to strengthen them is to put your foot on a towel and crunch your toes. Do this ten times, then take a 30 second break and repeat to complete three sets of ten. When you get good at this, replace the towel with a pen or marker and grab it with your toes.
Heel walking. Heel striking is what we are avoiding, but heel walking is a great way to strengthen your anterior lower leg muscles (muscles in your shin). Roll back on your heels and walk forward balancing yourself on your heels for about 30 seconds, then take a 30 second break and repeat two more times.
Deep squats on your forefoot. Roll up onto your forefoot then squat down into an almost sitting position, trying to keep your balance and avoid shifting back onto your heels. Hold this pose for 30 seconds then stand up for 10 seconds and repeat 5 more times. When you get good at this, try holding a weighted bar at you shoulder level and then squat.
Inner foot strengthening with a resistance band. (This targets the medial muscles; the posterior tibial muscle and abductor hallucis) Tie the resistance band on a chair leg then use your medial muscles to pull the band toward the center of your body. Other option is to hook the band around your foot, then use the other foot to stabilize it. Pull your foot toward the midline of your body. Hold for 10 seconds then relax for 10 seconds. Repeat 10 times. (An alternative is to balance on the inside of your foot and walk for 30 seconds, following the pattern of heel walking)
Outer foot strengthening with a resistance band. (This targets the lateral muscles; the peroneals) Tie the resistance band on a chair leg then use your lateral muscles to pull the band toward the outside of your body. Other option is to hook the band around your foot, then use the other foot to stabilize. Then move your foot towards the outside of your body. Hold for 10 seconds then relax for 10 seconds. Repeat 10 times. (An alternative is to balance on the outside of your foot and walk for 30 seconds, following the pattern of heel walking)
Proprioceptive/Balance Training. Balance on one foot with other leg bent. Hold for 30 seconds. Repeat 5 times. When you get good, then roll up onto your forefoot. If you are a pro, then put a 5 pound weight in the opposite hand and touch your toes while balancing on your forefoot. (An alternative progression is to go from one leg on forefoot on level ground, to a foam mat then a Bosu ball or wobble board)

These six simple exercises can help you strengthen the intrinsic muscles of your feet and lower legs to help you transition to a minimalist running style. Remember to also stretch your quads, hip flexors, hamstrings, and calf (gastrocnemius and soleus) as well as your plantar fascia after these exercises to warm down.

Small incremental increases in stress make us stronger. Large incremental increases in stress lead to overuse injuries! Achieve your natural stride slowly and carefully to stay injury free.

Need help, watch the video!

Should You Embrace Minimalist Shoes?

crane@faant.com (Blog Author)52411 — Sun, 03 Apr 2011 08:00:00 EST

Stronger Feet Lead To Running Zen

Why embrace minimalism? Minimalist shoes can help you achieve a more natural running stride. Why is this important? Many biomechanics gurus are finding that a more natural running stride can decrease your impact by over one third and therefore, in theory, decrease running injuries. What I have found is that it can help you find a faster, more balanced, stream lined version of you or what can be described as your running zen.

Running zen is a total state of focus that is a fusion of body and mind while running. Your goal is to develop your natural stride, which in most experienced runners, leads to being fitter, faster and staying injury free.

Your most efficient foot strike is one that lands exactly below your center of gravity, which is usually right below your hips in a mid-to-forefoot fashion, slightly towards your fifth toe. As you land, your foot rolls slightly inwards and propulses off your big toe. This slight roll is NORMAL pronation and is meant to cushion the running stride. Excessive pronation is the effect of weak foot intrinsics and lower leg muscles and is the main cause of many overuse injuries common to runners. This abnormal pronation is often mitigated by stability running shoes and orthotics, but a better long-term approach in healthy athletes should be to strengthen the underlying muscular weakness. Stronger lower leg and intrinsic foot muscles coupled with a stronger core, flexibility and better proprioception can diminish many of these abnormal forces and reduce injury recurrance.

A motion control shoe works to alleviate abnormal pronation and does a great job stabilizing your foot, especially after an injury; but it does little to strengthen the key muscles and ligaments of your feet.

A highly cushioned shoe may overprotect your foot from the stress of the road, preventing natural strengthening while you build mileage.

So, should we all go back to the ballerina flat looking shoes we wore in the seventies? Unfortunately I remember them well and the tibial stress fractures that occurred while I was in high school. No, old school is not the answer; but perhaps a happy medium.

A minimalist shoe guides your foot into a more natural stride by providing cushioning and flexibility, but does not elevate the heel to increase pronatory forces. It allows a shorter stride and softer landing, while encouraging mid-to-forefoot striking to help you manage your impact. It also allows for intrinsic strengthening while you build your mileage and hopefully puts you on the road to finding your sweet spot in your stride.

Who shouldn't try a minimalist approach? Those runners with severe foot deformities or significant arthritis. As well as people with nerve issues like diabetic neuropathy. As for the rest of the running world, a caution sign should go up here.

A side note of caution to anyone trying to go "less is more." When you begin to run with less shoe than you have been in years, it is important to realize that your stride is now very different and you have to relearn the fundamentals of running. Please avoid the "too much, too soon, too fast" syndrome that can sideline even the most cautious of runners.

A better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.

Next blog: Simple Six to Stronger Strides! Six exercises to strengthen your feet and improve your natural running stride!

Step Slowly into Minimalism

crane@faant.com (Blog Author)52154 — Wed, 30 Mar 2011 08:00:00 EST

Come join me in Boston on April 14th at 6pm

Saucony presents "Step into Minimalism"

Dr Crane joins an all-star panel of experts and coaches as they share their insights and advice on responsibly integrating MINIMALIST RUNNING into training.

Click here for more info!

Run stronger and happier!

Why Pool Running Doesn't Suck!

crane@faant.com (Blog Author)51369 — Sun, 20 Mar 2011 08:00:00 EST

11 Reasons Pool Running Doesn't Suck

As a sports medicine podiatrist, I often encourage injured athletes to cross train and keep up their cardio fitness during their "rest period". Pool running can be very helpful, but is frowned on as extremely boring and down right tedious by most runners and triathletes alike.

I also had to enter the conversation in our series "The Journey to Texas Ironman" with a shout out to everyone who has a little ache or pain in their foot or ,God forbid, a stress fracture, but still wants to join us at the starting line of the Texas Ironman in May. This was taken and liberally adapted from an article in the December 2010 issue of Triathlete magazine:

11 Reasons Pool Running Doesn't Suck

Completely stolen and altered from Holly Bennett, please forgive me....she had 10, I added one and lots of commentary!

1. It gives the barefoot movement a whole new angle -- and spares the wear and tear on your running kicks. Better than a pair of Vibrams!

2. You earn sympathetic looks from the cute boy-toy lifeguards. And at 40+, let's face it - we like to look and dream, but would have a heart attack if they were serious!

3. Until now you thought breastroke was the slowest way you could possibly travel from one end of the pool to the other. Or my pathetic looking side stroke!

4. Hello, six-pack! Water running recruits those pesky, oft-neglected core muscles. Even your arms will exhibit extra buffness, strengthening with the resistance of the water. Let's face it; most of us girls would be happy with a two pack after 4 pregnancies'!

5. If ever you long for a surrogate granny, there are plenty of gentle, smiling faces in the therapeutic lap lane. And most of them are my patients!

6. From your vertical vantage point, you can observe, admire and critique the swim strokes of the nearby lap swimmers. Maybe you'll learn something. And often times, you will realize your stroke is not so bad!

7. There are no rocks, stumps, curbs or other obstacles in the pool. In the water, you're no longer a danger to yourself. You can try running with your eyes closed. (Note: Resist the urge to fall asleep.)

8. One rarely encounters rattlesnakes while pool running. Or any kind of creature commonly seen while we practice open-water swimming on Lake Grapevine. And it's not 60 degrees!

9. If you hop in immediately following a bike session, you get to call it a "P-run."

10. If you can mentally endure two hours of water running, your next Ironman marathon will feel short. I highly encourage a swim man IPod.....I could never even train for the Ironman swim without it.

11. And of course, the most important reason pool running doesn't suck: Dr Crane won't completely bust you when she or Janet passes you on the trail when you are still supposed to be in the walking cast!

Bottom line, pool running really doesn't suck if you have the right attitude and tunes! Embrace the change and come out of the "rest period" that much stronger so none of us will be carried off by the ambulance come May!

Add a Night Splint to Alleviate Heel Pain

crane@faant.com (Blog Author)51096 — Wed, 16 Mar 2011 08:00:00 EST

Plantar Fasciitis a.k.a. Plantar Fasciosis (PF) is an extremely common foot injury usually described as heel pain. The pain is usually first thing in the morning and after rest. PF is by far the most common injury I see in my North Texas sports medicine clinic. PF is seen in most athletes, and is one of the most common running injuries. One study described PF as affecting 8% of habitual runners. 8%! When you calculate that approximately 2% of the US population runs on a regular basis (based on a survey of how many people ran a marathon in their lifetime). That is a lot of people. Actually the rough estimate is 6.2 million runners in the US alone with about a half a million suffering from heel pain. Wow! Oh my aching heel!

Why is there so much heel pain in runners? Too much, too soon, too fast syndrome. In other words, we want to be in shape way before our bodies are ready. The rule of adaptation states that our bodies become stronger with small incremental increases inn stress, but we break down with large incremental increases in stress. This is why PF is described as an overuse injury.

So how do we treat is? A protocol approach that starts with simple, stupid and follows a stepwise pattern that ends with 85% of runners having complete resolution with conservative therapy and 15% going on to move invasive surgical procedures.

Mainstays of treatment: orthotics, better and/or different shoes (that is an entire article in and of itself), lots and lots of stretching, night splint, anti-inflammatories, physical therapy, extracorporeal pulse activated treatment (EPAT), and in some cases, injection therapy (always a debate in athletes).

Simply reducing pain and inflammation alone is unlikely to result in long term recovery. Rest is usually not enough. The minute the runners gets back to activity, their pain is back! I find that most runners, especially over the age of 40, desperately need to stretch their Achilles tendon and plantar fascia. The plantar fascia tightens up making the origin at the heel more susceptible to stress. The best way to do this is a combination of dynamic stretching throughout the day (see my video on Youtube) and a night splint. A plantar fascial night splint is an excellent product which is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

Why does a night splint work, especially in athletes?

The plantar fascia is the ligament that holds up your arch. It is a thick band of fibers that go from the heel of the foot across the bottom of the foot to the toes. Plantar fasciitis is considered to be an inflammatory process following micro tears in the fascia. Plantar fasciosis is a degenerative process that occurs after several months of chronic plantar fasciitis. The reason PF causes so much pain in the morning, is that during the night the foot is relaxed and drops so the toes are pointed downwards. In this position the plantar fascia is relaxed, healing of the micro tears occurs overnight, but when the foot is put to the floor in the morning the fascia has to stretch to a longer position and this tears the new healing. Think of ripping a scab off every morning! Ouch! The idea of a night splint is that the foot is held overnight with the toes pulled upwards and thus the healing occurs with the fascia in its stretched position.

Many research studies have looked at night splints and the treatment of plantar fasciitis. There have been some mixed results due to the construct of the studies, but overwhelmingly the whole body of evidence suggests that night splints can help ease pain and assist healing, and this is especially true for people who have been suffering from plantar fasciitis for several months or more (truly plantar fasciosis).

Night splints do generally have to be used consistently for at least one month or more before significant improvement is seen. If you are a light sleeper, just make sure your wear it at least 4 hours a night.

A number of good night splints are available, and the fit and comfort is important given you will be wearing it for at least 6 weeks AFTER your symptoms resolve. A dorsal night splint will allow you to walk to the bathroom in the middle of the night without taking it off. A posterior night splint usually is better tolerated long term.

Got an aching heel, seek out a running podiatrist to get you back on the roads in better shape than you left them!

Ingrown Toenail Hurt!

crane@faant.com (Blog Author)50944 — Tue, 15 Mar 2011 08:00:00 EST

Perhaps not the most glamorous injury, but ingrown toenails are easily one of the more common and painful foot problems around. In fact, in a recent survey by the American Podiatric Medical Association, they were listed in the top three with heel pain and blisters as the other most common complaints.

Also known as Onychocryptosis, there are a variety of ways an athlete could suffer from the problem. Excessive pressure on the outside of the great toe, stubbing or having a toe stepped on, tight socks and shoes, even improper trimming of your nails can cause ingrown toenails. Don't forget the dreaded toenail fungus (Onychomycosis) which can cause an abnormally shaped nail that tends to get ingrown.

The pain isn't easy to deal with, as most athletes are usually always on their feet! With running and most other sports being a dynamic in nature, training and racing with an ingrown toenail can be incredibly painful. Soreness and sensitivity along the margins of the toenails may lead to infection (watery discharge, blood, pus). If infected, immediately visit a podiatrist.

If uninfected, treat the feet by soaking them in either salt or warm soapy water. Drying them thoroughly, applying a mild antiseptic solution, and bandaging the toe will make a difference.

However, if the athlete takes proper care of their feet, ingrown toenails can be certainly prevented. Make sure your shoes are long and wide enough. Don't forget that socks come in sizes as well. Cut your nails straight across. Keep your toenail clipper clean. Don't pick at them or try to perform bathroom surgery! And treat fungus as soon as it shows it's ugly head!

My Toenail Hurts

crane@faant.com (Blog Author)50345 — Sun, 06 Mar 2011 08:00:00 EST

Oh my aching toenails! Is this you? Are your toenail painful all the time? Or are they just painful in your shoes? Maybe just in certain types of shoes? Painful toenails can be caused by a myriad of different reasons, but here are the top 5.

1. Ingrown toenails
2. Infected toenails
3. Thick toenails from chronic trauma (onychochauxis)
4. Blood underneath your toenail (subungual hematoma)
5. Or the most common: Fungal infection (onychomycosis)

If your toenails are painful, take a close look. Are they red? Thick? Pinching your skin? Do they have fluid under them or drainig from a corner? Are they yellow, thickened and chalky? If you have any changes to your toenail, you need a podiatrist to sort it out.

Normal looking toenails, but still painful? It is usually the shoes! Too tight and usually too narrow!

Painful toanails can give you a really bad day! Call us and let us take a look!

New Innovation Rocks Chronic Heel Pain! EPAT is Here to Save Your Sole!

crane@faant.com (Blog Author)49977 — Tue, 01 Mar 2011 08:00:00 EST

EPAT is the most advanced non-invasive treatment for musculoskeletal pain. Extracorporeal Pulse Activation Treatment is a new way to conquer chronic heel pain. Pressure waves stimulate the metabolism, enhance circulation and accelerate the healing process without surgery. Dmaged tissue of the plantar fascia or Achilles tendon gradually regenerates and eventually heals. Here are the top 16 frequently asked questions about EPAT.

The Top 16 FAQ's About EPAT Therapy for Heel Pain

1. What Is EPAT?

EPAT is an acronym for Extracorporeal Pulse Activation Technology. It is a highly effective non-invasive office based treatment method that accelerates healing of injured tissues.

2. How Does EPAT Work?

The treatment utilizes a unique set of acoustic pressure waves that are delivered through the body and focused on the site of pain/injury with a special applicator. These pressure waves stimulate the metabolism, enhance blood circulation and accelerate the healing process.

3. How is the Treatment Performed?

Ultrasound gel is applied over the skin of the treatment area to enhance the transmission of the pressure waves. The pressure waves are applied using a special applicator tip. The tip is moved over the injured tissue using circular motions.

4. How Long Does the Treatment Take and How Many Treatments are Required?

Treatment sessions take approximately 15 minutes per site and vary slightly depending on the site to be treated. Generally 3 treatment sessions are necessary and are performed on a weekly interval. If you are improving, but not completely better; up to 5 treatments can be performed.

5. What Conditions Can Be Treated With EPAT?

EPAT can be used to treat many painful soft tissue injuries. Including: plantar fasciitis, Achilles tendonitis, tendon insertional pain, acute and chronic muscle pain, and myofascial trigger points.

6. Is EPAT Safe?

EPAT is a safe treatment with virtually no side effects. It was originally developed in Europe and is currently used around the world.

7. Is EPAT Safe for Pregnant Patients?

EPAT is a safe treatment, but has never been tested on pregnant patients. Patients are advised to wait at least 3 months post partum before treatment, as many foot pains subside after weight loss and hormonal equilibrium is reached.

8. Is EPAT FDA Approved?

Yes, the machine is FDA cleared for usage.

9. What are the Expected Results?

Most people will experience pain relief after 3 treatments. Some patients report immediate pain relief after the first treatment, but maximum relief can take up to four weeks after the last treatment to begin. Over 80% of patients treated report to be pain free or have significant pain reduction.

10. Are There Any Special Aftercare Instructions?

All patients receiving EPAT therapy should be off all anti-inflammatory medication for a minimum of 2 weeks prior to the procedure and 4 weeks after. This includes common over the counter medication such as, ibuprofen (Motrin, Advil), naproxen (Aleve) and aspirin. Your doctor will provide you with detailed after care instructions.

11. What are the Possible Side-Effects or Complications?

EPAT is a non-invasive treatment and has virtually no risks or side effects. In some cases patients may experience some minor discomfort which may continue for a few days. On rare occasion, the skin may become bruised or red after the treatment.

12. Who Should not Have EPAT?

EPAT should not be used in people who have deep venous thrombosis or malignancy. It is also best to avoid the procedure if you are taking blood thinners.

13. Why Consider EPAT?

EPAT has a proven success rate equal to or better than traditional treatment methods (including surgery) without the risks or lengthy recovery time. It is performed in your physician's office without the need for anesthesia.

14. Does My Insurance Pay For EPAT?

No, unfortunately insurance companies do not pay for EPAT, though the cost of EPAT can often be reimbursed from a qualified health savings account. Non-covered services and/or procedures without billable terminology are paid to the office by the patient at the time of service; a claim will not be submitted to the insurance, though our office can provide receipts for reimbursement accounts to consider.

15. How Much Does it Cost?

EPAT is an affordable alternative to invasive surgery, lengthy physical therapy and other costly treatments. The first 3 treatments are bundled at a cost of $500 for the procedure, but you are still responsible for any co-pays or costs associated with the initial and/or any follow up office visit. If a 4th or 5th treatments are deemed necessary, these cost $150 per treatment.

16. How Can I Get More Information About EPAT?

The physicians at FAANT all have experience in providing EPAT treatment and are the best people to speak with if you have additional questions regarding the procedure. Call or contact our office for a consultation.

There is also much more extensive information available at www.curamedix.com

Exercise Is Very Important For Type 2 Diabetics: New Guidelines

crane@faant.com (Blog Author)48550 — Wed, 09 Feb 2011 08:00:00 EST

New guidelines were published in late 2010 that stress the crucial role that physical activity plays in the management of Type 2 diabetes.

Exercise is important and you should not let foot pain slow down your exercise program. The physicians at Foot and Ankle Associates of North Texas, in Grapevine, Texas, encourage our diabetics to exercise and can help you reach your goals with better shoe gear, functional foot orthotics and even physical therapy to get you on the road to better diabetes control! Do not use foot pain as an excuse not to exercise, contact us and get started today! The guideline are crystal clear on the importance of regular, vigorous exercise!

Developed by a panel of 9 experts, the new guidelines are published concurrently in the December issue of Medicine & Science in Sports & Exercise and Diabetes Care.

The entire articel is in our library, just click here.

What is a Podiatric Foot & Ankle Surgeon?

crane@faant.com (Blog Author)48064 — Wed, 02 Feb 2011 08:00:00 EST

Patient are constatntly asking, "What exactly is a podiatric foot and ankle surgeon?" and "How is this different than a regular orthopedic surgeon?" The simple answer is a different degree. The complicated answer is that a podiatric surgeon is a podiatrist who has completed a two, three or even four year residency program, focused on surgery for the foot and ankle, after completing their Doctorate in Podiatric Medicine (DPM) degree.

There are an estimated 15,000 podiatrists practicing in the US today. Of this 15,000, a little more than half are considered podiatric foot and ankle surgeons. All podiatrists have a four year undergraduate degree followed by four more years of graduate school to receive a DPM degree from an accredited School of Podiatric Medicine. Dr Crane and Dr Karpati graduated from Barry University in Miami. Dr Giacalone is a graduate of Temple University in Philidelphia. Dr Karp was tortured in the cold of Chicago at the Scholl School of Podiatric Medicine.

Podiatric foot and ankle surgeons look at your foot and ankle slightly differently than most orthopedic surgeons. We focus on the functional foot as a part of a dynamic biomechanical animal. In other words, we tend to not have tunnel vision; understanding that the function of your foot affects your whole body.

If you are suffering from foot and ankle troubles, you are well served by a board-certified, podiatric foot and ankle surgeon. If you live in the DFW area, feel free to contact us. If you are out of town, you can fins a good podiatric foot and ankle surgeon at www.footphysicians.com.

Avoid Slipping and Falling on Winter Ice and Snow!

crane@faant.com (Blog Author)47951 — Tue, 01 Feb 2011 08:00:00 EST

Winter has decided to visit North Texas today. Two inches of ice covered by snow, and just in time for the Super Bowl. Time to think about trying to prevent slip and fall injuries. Lots of people fall on ice and snow every year-without serious injury. Not so fortunate were some 16,000 Americans who die each year from falls, according to the National Safety Council (NSC).

Falls rival poisoning as the number one home accident in the U.S. The number of injuries or deaths from falls due to winter conditions is not recorded by the NSC. But, safety experts agree that many injuries result from falls on ice-covered surfaces.

Safety Tips

It's important that individuals recognize the hazards of slippery surfaces. Here are helpful hints from winter-safety experts that will reduce the risk of falling when slippery conditions exist:

1. Wear boots or overshoes with soles. Avoid walking in shoes that have smooth surfaces, which increase the risk of slipping.

2. Walk consciously. Be alert to the possibility that you could quickly slip on an unseen patch of ice. Avoid the temptation to run to catch a bus or beat traffic when crossing a street.

3. Walk cautiously. Your arms help keep you balanced, so keep hands out of pockets and avoid carrying heavy loads that may cause you to become off balance.

4. Walk "small." Avoid an erect, marching posture. Look to see ahead of where you step.

5. When you step on icy areas, take short, shuffling steps, curl your toes under and walk as flatfooted as possible.

6. Remove snow immediately before it becomes packed or turns to ice. Keep your porch stoops, steps, walks and driveways free of ice by frequently applying ice melter granules. This is the best way to prevent formation of dangerous ice patches. Waiting for it to melt can sometimes take days!

Falling Safely

Even when you practice safe walking habits, slipping on ice is sometimes unavoidable.

It takes, on average, less than two seconds from the moment you slip until you hit the ground. That's precious little time to react. In that instant, the risk is an injury to your head, a wrist, hip, ankle or shoulder.

When falling, it is best to use a tuck-and-roll principle. It's important to tuck your body, lift your head and avoid trying to break the fall with a hand, which can cause a wrist injury. Ask Dr Karpati about her broken wrist from skiing the next time you are in the office. The idea is to make yourself as small as possible by rolling up into a ball.

People in North Texas hardly ever think about falling on ice and snow, but serious injuries can occur. If you are a klutz or are planning to spend a lot of time in the cold; following these guidelines may help protect you from serious injury this winter. If you do happen to fall and sprain your ankle or foot, call the office. Help is just a phone call away! And remember, just because you can walk on it doesn't mean it is not broken.

72% of Americans Don't Exercise Due to Foot Pain

crane@faant.com (Blog Author)47760 — Sat, 29 Jan 2011 08:00:00 EST

The APMA recently published a survey that verified what most of us already know: American's blame their lack of exercise on foot pain. Why is the FAANT office in Grapevine, Texas so busy? 72% of people surveyed said they do not exercise because foot pain prevents them from doing so! This finding, coupled with the staggering rate of obesity in the US makes podiatrists all that more important in the fight against chronic disease.

The study surveyed 1,000 US adults, ages 18 and older, to gain public opinion on attitudes toward foot health and foot care. Results showed that Americans view their feet as the least important body part in terms of their health and well-being. However, feet were the number one body part to experience pain, even more so than the teeth or skin. As foot pain contributes to a variety of negative health consequences, it is important that Americans seek the care of a podiatrist immediately if problems arise.

It is critical that people pay attention to their feet and seek expert treatment for foot problems. The podiatric foot and ankle surgeons at FAANT can not only help ensure Texans are able to exercise, but also help catch signs of diabetes, arthritis, and nerve and circulatory disorders, which can all be detected in the feet.

If you or one of your family members is experiencing foot pain, contact us for an appointment. If you want more information about foot and ankle woes, request a copy of our FREE BOOK, "Got Feet?" or peruse the website. We are here to help you get back on your feet and on the way to a healthier you!

To Stretch or Not To Stretch?

crane@faant.com (Blog Author)46017 — Mon, 03 Jan 2011 08:00:00 EST

Stretching 411

The jury is still out when it comes to stretching in the running community. I have been running for almost 30 years with multiple coaches on numerous competitive levels, all of them told us to stretch daily to get faster and avoid injury. Yet many incredibly competitive runners never stretch and never seem to get injured. Is there any proof that this common recommendation is actually valid? What do the studies say about stretching? Does it really prevent injury? Will it make me faster? Again, the experts really don't agree on much! In most arguments between stretchers and non-stretchers, it inevitably comes down to "stretching helps prevent injuries" and "stretching is a leading cause of injuries in runners".

The motion of running, repeated over many years, strengthens and shortens several posterior muscles. The most affected are the calves, the hamstrings and the lower back muscles. These muscles play a primary role in lifting the feet and moving the runner forward. Exercise physiologists blame shortened muscles for a reduced range of motion, decreased athletic performance and increased risk of injury. To add insult to injury, the aging process contributes to further loss of joint and muscle flexibility.

The majority of runners and coaches believe stretching improves performance and reduces the risk of injury. In the meantime, experts disagree on the benefits and dangers of stretching. While many experts credit stretching with numerous benefits, improper stretching remains the second leading cause of running injuries! So, if we believe in stretching; what is the most effective method?

First and Foremost; the warm up and cool down should never be optional in your running routine. Cold muscles are at the highest risk for injury; by warming up and increasing the temperature of your muscles they will be more flexible and have an increased speed of motion. Warming up can loosen your muscles and soft tissue as much as 20 percent. The cool down allows blood to continue flowing through your muscles, working its way more slowly from a high level of exertion to its normal resting condition. Build stretching into your regular schedule, both before and after your daily run; after warm up and as part of your cool down. Take the time, it's worth it!

The Do's and Don'ts of stretching:

Do

1. Warm up prior to stretching. Walk or slowly jog at least 10-15 minutes prior to stretching.
2. Slowly add stretching to your workout slowly. Gently stretch a little more each day. Your muscles can actually stretch almost 1.5 times their length, but if you try to achieve this all at once you will hurt yourself!
3. Relax. Tension makes it almost impossible to stretch effectively
Breathe. That may sound easy but try to breathe from you diaphragm or stomach
4. Make it a routine, try to stretch every day, even if you don't run. Follow the same order of stretches every time for consistency
5. Listen to your body. Some days, less is more!

Don't
1. Don't bounce!! Bouncing risks pulling or tearing the muscle you're trying to stretch and relax. Muscles must be stretched gradually.
2. Don't hold your breathe
3. Don't stretch if it hurts
4. Don't forcibly stretch an injured muscle, gentle and less is more
5. Don't hurry through your routine
6. Don't listen to your friends opinions about the best technique for stretching Try them all and decide what works for you

Bottom line: Most experts agree that stretching reduces muscle soreness after running and results in better athletic performance. Gentle stretching after a race or intense workout can also promote healing and lactic acid removal from the muscles. Stretching is most effective when performed several times each week; a minimum of one stretching session per week is sufficient to maintain flexibility.

Most coaches and runners believe in stretching before and after every workout. The experts never agree on much, but the majority seems to feel that stretching is beneficial to runners if done properly. So follow the precautions outlines and always warm up prior to stretching. Your body will thank you and who knows, you may even get a little faster!

Run Happy! And warm up and stretch before!