Guidelines to Manage Gout

Foods with High Purine Content

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!

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!

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!

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!

Want to know more about ankle fractures? Click here

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 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. 

1. 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.
2. 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.
3. 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.
4. 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)
5. 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)
6. 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!

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!

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!

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!

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!

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!

Read more: http://www.theprovince.com/health/Sport+Tips/4208239/story.html#ixzz1CrDnaM82

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