Treatment for Plantar Fasciitis: ESWT

C.J. Watson's plantar fasciitis surgery at the Weil Foot and Ankle Institute was all over the news, blogs and Twitter last week. Many fans did not know that C.J. Watson struggled with plantar fasciitis, and others did know that it bothered him so much that he needed surgery! As noted in Dr. Weil, Jr.'s blog post on plantar fasciitis, patients have several treatment options. While patients can utilize conservative treatment to alleviate symptoms, if pain persists, patients can opt for either non-invasive and/or minimally invasive treatments for plantar fasciitis, both of which have been pioneered by Weil Foot & Ankle Institute physicians.

The non-invasive procedure that Weil Foot and Ankle Institute physicians employ is called Extracorporeal Shockwave Therapy more commonly know to us as ESWT. ESWT has been FDA Approved since 2000 and uses sound waves to stimulate healing in some physical disorders, such as plantar fasciitis and Achilles tendonitis. "Extracorporeal" means "outside of the body" and refers to the way the therapy is applied. Because there is no incision, ESWT offers two main advantages over traditional surgical methods: fewer potential complications and a faster return to normal activity. 

There are two different types of ESWT that can be performed including:

Low Energy ESWT

Low energy ESWT is performed in three sessions over three weeks. Low energy ESWT sessions are performed in the clinic setting, take approximately 10 minutes and are generally done without anesthesia or sedation. Patients can return to normal work and life immediately after their treatment.

High Energy ESWT

High energy ESWT is performed in one session. Anesthesia/sedation is required for this procedure, which takes approximately 30 minutes. Someone will need to be present to drive you home afterwards.

The surgeons at Weil Foot & Ankle Institute can discuss the risks and benefits of each procedure with you so that.

If you would like to learn more about ESWT, and to find out if you are a candidate for treatment, visit here and call our office at 847-390-7666 to schedule your consultation now!

Diabetes and Manifestations in the Foot and Ankle

By: Zacharia Facaros

According to the American Diabetes Association, over 25 million people in the United States, roughly 8% of the population, have Diabetes, however, there are many more who are undiagnosed.  Diabetes can have a huge impact on the health of your feet and ankles. The Diabetes Association of America notes that 60-70% of people with diabetes develop peripheral nerve damage, and up to 29% of these patients may develop a specific type of fracture/dislocation in the foot or ankle, referred to as Charcot Neuroarthropathy.

Nerve damage, or neuropathy, is a well-known complication of diabetes, as well as other conditions, which leads to a loss of sensation in the feet. Patients with nerve damage can no longer feel when something has irritated or even punctured the skin. An irritation or puncture to the feet commonly creates a wound as small as a blister, but the wound can progress to a serious infection in a matter of days.

If you have diabetes, you need to be aware of how foot problems can arise and how to treat them.  Outlined below are important steps to take for close monitoring and management of your lower legs and feet:

CONTROL YOUR DIABETES

• ·         Work with your doctors to keep your blood sugar within a good range and to keep all other medical illnesses closely monitored.  The more stable your blood sugar remains, the less likely you are to succumb to neuropathy and/or infection.

INSPECT YOUR FEET DAILY

• Look at your bare feet every day to check for scratches, cuts, blisters, open wounds, red or warm spots and swelling.  If any are present, the risk of getting an infection is increased, and you should contact a Weil Foot and Ankle physician for an evaluation.
• Check the bottoms of your feet daily with a mirror. Checking the bottoms of your feet will reveal any potential at-risk areas that one may not appreciate if their sensation is not intact. If you have trouble bending your leg or seeing, ask a family member for help. 
• Contact a Weil Foot and Ankle physician immediately for evaluation if one foot is swollen or warmer than the other. This swelling or warmth may represent a potential urgent medical condition.

WASH YOUR FEET WELL DAILY, PARTICULARLY IN BETWEEN YOUR TOES

• Wash your feet daily in the shower or in lukewarm, not hot, water with mild bath soap. This provides a stable, clean, non-toxic maintenance.  Test the water temperature with your hand first to avoid a potential skin burn.
•  Do not soak your feet. Soaking your feet can weaken the skin, and this weakened skin will not maintain as strong a barrier against bacteria and/or fungus infections.   
• Dry your feet well, particularly in between the toes, to avoid a damp/moist environment that makes skin prone to infections.

KEEP YOUR SKIN SOFT AND SMOOTH

• Rub a thin layer of skin lotion over the tops and bottoms of your feet to prevent dry, cracked skin. Ask your Weil Foot and Ankle Physician for recommended products. Avoid putting lotion on the area between your toes. By avoiding this area, you will avoid making the skin susceptible to bacterial and/or fungal infections.
• Do not use strong antiseptic solutions, drugstore over the counter medications or heating pads.  Do not put your feet on or near radiators, nor to close to a fireplace or heating lamp. All of these actions may cause skin compromise and rapid drying of the skin.

NEVER TRIM OR SMOOTH CORNS AND CALLUSES YOURSELF OR CUT YOUR OWN TOENAILS IF IT IS DIFFICULT TO DO SO

• Following evaluation by your Weil Foot and Ankle physician, and if your feet are at low risk for problems, you may be allowed to use a pumice stone or emery board to smooth corns and calluses, but it is IMPERATIVE that you do not rub the skin too vigorously. Vigorous scrubbing may create an open wound.
• See a Weil Foot and Ankle physician right away if you have an ingrown toenail, especially if it has turned red, hot and swollen.  This condition requires expedited treatment for proper healing.
• Cut toenails straight across to limit the possibility of the corners becoming ingrown. Due to the high risk of causing a skin cut that may also lead to a potential infection, never dig into the corners of your nails. 

WEAR PROTECTIVE FOOTWEAR AT ALL TIMES

• Never go barefoot, or limit times when you do.  This will ensure proper protection of your skin or at-risk pressure points.
• Wear comfortable shoes that fit well and protect your feet. Walking or running shoes may be helpful for some diabetics, whereas others require specific therapeutic shoe gear. The Weil Foot and Ankle Institute has a great selection of shoes and can create custom shoes for diabetic patients. Be sure to ask your Weil Foot and Ankle physician about diabetic shoe options.
•  Purchase new shoes at the end of the day when your feet have natural swelling and are typically larger. Doing this will enhance a proper fit.  Check how your shoe fits in width, length, back, bottom of heel, and sole. Have your feet measured every time you buy new shoes because your foot will change shape over the years.
•  Wear new shoes for only 2 hours or less at a time, particularly if you have neuropathy. New shoes will cause increased pressure points until they are adequately broken in.
• Do not wear the same shoes everyday. Alternating the shoes that you wear will allow them to dry completely and to limit the quantity of potential infectious organisms. It will also allow your feet to maintain adaptation and functioning capacity.
• Feel the inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside, such as small pebbles or other foreign objects.
• Do not lace your shoes too tightly or loosely. Lacing your shoes comfortably will help to avoid increased friction or pressure points that may lead to blistering or even ulceration. 
• Choose socks and stockings carefully. Wear clean, dry socks every day and avoid socks with holes or wrinkles. Avoid stockings with elastic tops. Seamless socks are available for those with neuropathy, and therapeutic compression stockings are recommended if your feet and legs swell often.  In socks and stockings, certain materials are recommended over others, so check with a Weil Foot & Ankle physician for further recommendations and advice.
• Wear socks at night if your feet get cold to avoid possible irreversible abnormal sensations.
• Wear protective footwear at the beach, swimming pool or on hot pavement to avoid potential cuts or abrasions.

KEEP ACTIVE TO PROMOTE MUSCLE STRENGTH AND GOOD BLOOD FLOW TO YOUR FEET

• Wiggle your toes and move your ankles up and down for 5 minutes, 2-3 times per day. This will aid in maintaining strength and flexibility.
• Keep awareness on long walks and remember to periodically remove your shoes and socks, checking for signs of redness or bruising.
•  If you smoke tobacco products, you MUST stop. Smoking damages blood vessels by decreasing the ability to deliver oxygen to your skin. When combined with diabetes, smoking significantly increases your risk of amputation.

If you have any questions regarding good foot health practices for your specific needs, contact the Weil Foot & Ankle Institute right away to schedule an evaluation. Our doctors can make sure that you take the right steps to monitor and treat your feet, and help you to maintain your foot and ankle health for years to come.

Joakim Noah: The Real Prognosis

By: Lowell Weil Jr., DPM 

Last Friday, when the Bulls’ starting center Joakim Noah turned his ankle under his leg in a gruesome position, and the typically classless Philadelphia fans (I know...I did my residency there) cheered his injury, the Bulls’ hopes of progressing through the playoffs may have died. Bulls fans around the country held their breaths as they watched yet another star player go down in excruciating pain.

Fortunately, X-rays did not find an ankle fracture, but we can be sure that he suffered a severe sprain.

So, what exactly is a “sprain” you ask?

A sprain occurs when ligaments (tissues that connect bone to bone) are injured.  This injury can take the form of a stretch or a tear.

In Joakim Noah’s case there are many ligaments around the ankle that could have been injured, however, it was most likely the lateral (outside) ankle ligaments and/or the syndesmotic ligament (high ankle sprain). 

Regardless, I know this injury is going to take a while to get better.  While Bulls staff members keep telling the media that whether or not Joakim Noah will play will be a “game time decision,” his chances of playing in the foreseeable future do not seem likely. He is still limping with a walking boot on his foot and ankle.

I have had an opportunity to get to know Joakim a little bit, and I will say that he is a very tough guy.  As most Bulls fans may already know, Joakim will do anything possible to get himself ready to get back on the court and help his teammates win.  I have also found him to be a very nice and thoughtful person.  Once when I saw him, my nine-year-old son was with me and Joakim couldn’t have been nicer to him. My son still talks about it to this day.

You can be sure that under the direction of the Bulls’ head trainer Fred Tedeschi, Joakim is getting around-the-clock care to try and get him ready to play as soon as possible. 

So, here’s hoping that Joakim can make a quick recovery to what appears to be a very tough injury and help propel the Bulls further in the playoffs.  If it doesn’t turn out to happen this year, Joakim will certainly be ready to help the Bulls achieve their goal of an NBA Championship in 2012-2013.

Are You Ready For Pedicure Season?

By: Williette Nyanue

I think that we’ve been tricked here in Chicago. We started off with a beautiful early spring, and the weather was consistently in the upper 70s and 80s. Now it seems we can’t get a day above 70! Nevertheless, we all know that warmer weather is around the corner. As Dr. Weil Jr., noted in his previous blog post, for medical professionals at the Weil Foot and Ankle Institute, spring means the beginning of plantar fasciitis season. However, for most of us ladies, the beginning of warmer weather means that it’s time for us to start getting our feet primed and prepped regularly for open-toe shoe season.

As compared to many of our male counterparts, the amount of time and effort a lot of us women put into getting our feet as close to perfect as possible can seem downright unfair! There’s soaking and scrubbing, washing and massaging, clipping and filing, painting and moisturizing… There are also so many tools needed to get the job done! We use nail files and buffers, pumice stones and brushes, toenail clippers, cuticle clippers, foot scrubs, ointments, oils, lotions, corn pads and nail polish. I’ve even seen what I’m sure was a cheese grater and a machine that I swore you only used to sand uneven surfaces. 

But can we help it? During the warmer months, all of the women’s magazines have articles and slide shows with catchy titles such as,“Fix Ugly Feet at Home,” and, “9 Easy Ways to Get Super Soft Feet Just in Time for Summer.” In these magazines we can find all of the great summer nail polish trends for our next pedicure, as well DIY options to make sure that when you’re caught in your open-toe sandals, you have nothing to worry about. The articles all basically remind us of one thing: Having “pretty” feet for the summer should not be an option, it should be a necessity.

Although many women would cite pedicures as relaxing midday or weekend treats, trips to the nail salon can be a hassle with long wait times, expensive prices and did I mention how much that pumice stone tickles?

It may seem that we go through unnecessary lengths just to get ourfeet “pretty” for the warmer months, but all of this effort is not in vain. I’m not just talking about the compliments that you get either. Getting proper, professional pedicures is actually good for the overall health of your feet.  While a podiatrist should look at more serious foot problems such as bunions, hammertoes and infected, ingrown toenails, pedicures can actually play a part in the prevention and aid of some minor and aesthetic foot problems. According to Dr. Weil, Jr., “Pedicurists are trained to manage nails properly. They know how to cut them and the right shape to create because not all nails should be cut the same. Additionally, pedicurists have the proper instrumentation to handle more difficult nails, which are quite common.” Dr.Weil Jr. also notes that getting proper pedicures may be increasingly important for older men and women and those with medical conditions like diabetes. He states, “As we get older, it is more difficult for us to get our hands, and more importantly our eyes, to the level to properly cut a nail. By not being in the right place with our hands or eyes, we could cut the nail incorrectly. This could lead to ingrown toenails, infections, lacerations or wounds.” Pedicurists can also aid in the prevention of painful calluses and corns by sloughing off dead skin that accumulates on your feet over time.

So, as temperatures increase and you think about skipping out on the occasional pedicure because of the inconvenience or hassle that it may cause, remember that not only will pedicures make your feet look pleasing; they can also increase the overall health of your feet. We are constantly abusing our feet. Why not give them a bit of TLC once in a while?

For all of you men out there, you heard it from a doctor himself. Pedicures are good for everyone! Invest in one…just skip the nail polish if you want.

I know we’re ready for the open-toe shoe season here at the Weil Foot and Ankle Institute. Are you?

Are you looking for somewhere to get a professional pedicure? What better place to have one done than a podiatry clinic? The Weil Foot and Ankle Institute offers professional pedicure services throughout the week at our Des Plaines office. If you are in the area, stop by the clinic or call 847-390-7666 to set up your pedicure appointment today! 

Podiatry Today's Current Concepts in Plantar Plate Repair

Current Concepts In Plantar Plate Repair

• Volume 25 - Issue 4 - April 2012
 
• 2867 reads
 
• 1 comments

Author(s): 

 Lowell Weil Jr., DPM, FACFAS, and Erin E. Klein, DPM, MS

Do you find yourself in certain cases choosing between metatarsal realignment and plantar plate repair? Given this dilemma, these authors suggest that combining the Weil osteotomy with a dorsal approach to the anatomic plantar plate may be beneficial in addressing both plantar plate tears and metatarsalgia.

With any surgical procedure, there are problems and complications. The most commonly discussed problem associated with the Weil osteotomy is the “floating toe.” Studies had identified the floating toe to occur 15 to 50 percent of the time following a Weil osteotomy.^1-3 The floating toe does not touch the floor with neutral weightbearing after undergoing a metatarsal osteotomy.

   Additionally, there is weakness and decreased ability to plantarflex the toe actively. Many have theorized as to the cause of floating toe and have suggested modifications to the procedure in order to prevent its occurrence.^4-7 However, most of these changes have not altered the outcome and increased other complications (transfer metatarsalgia, stiffness, edema, etc.) and disability postoperatively.

   For years, we have been trying to find a solution to the problem, whether it is making sure to perform the procedure in the articular surface to prevent plantar translation, performing appropriate dorsal soft tissue release, encouraging early physical therapy (seven days postoperative), and emphasizing plantarflexion strength and night splinting of the toe. Nonetheless, floating toe still occurred, although at rates much lower than cited in the literature. In our most unstable metatarsophalangeal joints (MPJs), we started trying to repair the plantar plate in conjunction with the osteotomy but with limited success due to the difficulty of exposure from the dorsal approach.

   In the fall of 2007, the lead author had given a lecture on the Weil osteotomy at a Podiatry Institute conference in Florida. Immediately following the lecture, Craig Camasta, DPM, gave a lecture on plantar plate pathology and repair. Dr. Camasta was one of the real leaders in discussing the plantar plate and he made a very compelling argument as to the role of the plantar plate in lesser metatarsophalangeal joint problems. Listening to Dr. Camasta’s rationale made the lead author strongly consider the possibility that plantar plate insufficiency may have more to do with the painful metatarsalgia entity and postoperative floating toe problems than previously appreciated. It also made him think that combining the Weil osteotomy with a plantar plate repair would be the best of both worlds...

Read the rest of the article here!  

Hello Spring, Hello Heel Pain??

By: Lowell Weil, Jr., DPM

The baseball season, which marks the unofficial start of spring, is finally here.  Actually, this year in Chicago, spring has started very early with unprecedented great weather in March.  Usually we are still hunkered down with frigid temperatures, hoping and wishing for just a glimpse of spring to arrive.  Spring means many things to different people, but to those who take care of feet at the Weil Foot & Ankle Institute, it means the beginning of PLANTAR FASCIITIS SEASON.

Plantar Fasciitis is that annoying pain to the bottom of our feet, particularly in the heels, that grabs us when we get out of bed in the morning or get up from a rested or seated position.  Oh, it starts out slowly and we think we just have a heel bruise that will go away, but a month or two later we realize not only has it not gone away, your heel pain has actually gotten slightly worse.  Now we are limping a bit in the morning and have cut back on exercise, which is annoying because we know how important exercise is for our overall health.

Why is the onset of plantar fasciitis so prominent in the spring, you ask? The primary reason is that as the weather gets nicer, people want to get out and enjoy it.  Gardeners will take to their gardens for priming, pruning, and planting. Runners and walkers will begin more intense workouts embarking on faster times and longer distances. Golfers will hit the links with more vigor, and many of us will simply get out those sandals that we love, which, by the way, don’t offer much support for our feet.

But why do those things cause heel pain?  Well, heel pain/plantar fasciitis is most frequently caused from tight calf muscles and heel cords.  We get tight calf muscles for several reasons.  One reason is that as we get older, we inevitably get less flexible.  Another reason is that we rarely stretch regularly, even those of us who do yoga. The tight pull of the calf muscles and heel cords causes stress to the plantar fascia, a tissue on the bottom of the foot that connects to the heel bone.  This irritation to the plantar fascia may cause very small tears that result in pain and swelling. When our calf muscles are too tight and we increase our activities, this all results.  Soft surfaces such as grass or sand make heel pain/plantar fasciitis worse by causing our heels to sink downward and putting more stress on the tissues.  To some degree sandals, flip-flops and bare feet do the same thing and do not provide much support.

So now the question you've been waiting for: What do you do if you start getting heel pain?  There are some easy steps you can take to alleviate your heel pain and prevent it from worsening. 

1. Wear shoes that give more support.  A running shoe (I said running shoe, NOT just gym shoe) will provide excellent support and slightly raise the heel to relax the calf muscle.  Wearing shoes with a slight heel can really help.  Look for something that has 1-1.5 inches of heel.
2. Avoid bare feet, slippers, sandals and flats…until your condition gets better.  There are some good sandals, here, that have support that you may want to try out. There are also arch supports (Orthoheel and Powerstep) that can be purchased on line that are better than what is offered in the pharmacy.
3. Increase your stretching. Start stretching your calf muscle 3-4 times a day. See this site for useful stretches.
4. Use conservative treatment to alleviate symptoms. Take over-the-counter anti-inflammatory medicines (Ibuprofen, Aleve, etc.) as directed on the bottle consistently for a week or so.  Putting ice on the area for ten minutes at a time, once or twice a day will also help.

So what happens if your heel pain persists?  If your pain does not subside within a week or two, you face the possibility of having a chronic problem.  That is where physicians from the Weil Foot & Ankle Institute come in.  Physicians at the Weil Foot & Ankle Institute are renown for their treatment of heel pain.  The doctors here have done many studies, published papers and books and lectured around the world on heel pain and plantar fasciitis.  They have treated professional athletes from the Chicago Bulls, Chicago White Sox, Chicago Bears and other professional organizations, and Olympic and collegiate athletes from around the country for plantar fasciitis.Weil Foot & Ankle Institute Physicians have pioneered non-invasive and minimally invasive treatments for the treatment of plantar fasciitis. (See treatment options here and here).  They can create a specialized treatment regimen to meet your daily needs and successfully rid you of heel pain.

So as spring creates optimism for our typically disappointing baseball teams, don’t let your heel pain get you down. Protect your heels with the steps we’ve mentioned, and if that heel pain persists, come see one of our doctors at the Weil Foot & Ankle Institute. They’ll have you out and enjoying the weather, free of heel pain, before you know it!

Lowell Weil, Jr., DPM, MBA, FACFAS Fellowship Director, Weil Foot & Ankle Institute

Team Podiatrist, Chicago White Sox 
Dr. Weil Jr. has been on the staff of Weil Foot & Ankle Institute since 1996. His special areas of interest are reconstructive foot and ankle surgery, tendon and ligament reconstruction, radiofrequency techniques, Extracorporeal Shock Wave Therapy and sports medicine.

Welcome and New Announcements!

Hello and welcome to all of our old and new readers! We have some new developments that we are excited to share with you.

In an effort to connect more frequently and keep you up-to-date on what is going on here at the Weil Foot and Ankle Institute and in the world of foot and ankle news, we are currently undergoing the process of constructing a new website that is more informative and more interactive. While the process is underway, we hope to establish a more direct line of communication through the use of this blog. That is where I come in!

My name is Williette Nyanue and I have been working with the Weil Foot and Ankle Institute for over five years. Through this blog, I will be keeping you afloat on Weil Foot and Ankle Institute news as well as general foot and ankle news and developments. These updates will include blog posts on various topics written by our doctors, interesting facts and news, patient testimonials, Q&As, polls and much, much more.

We hope to use this blog not only as a way to communicate with you, but also as a way for you to connect with us. We would love to find out what questions and concerns you have and what topics you would be interested in reading about here on the blog. Please email all questions or suggestions to wnyanue@weil4feet.com.

We look forward to engaging with you int the future and hope that you are as excited as we are about the changes to come! 

For more information and updates, visit our website at www.weil4feet.com and connect with us on Twitter and Facebook