With the NCAA tournament well under way, players are most likely doing their best to avoid any type of injury.  An injury common in athletes refers to posterior tibial tendonitis; however, this injury can occur in nonathletes as well.  The posterior tibial tendon courses along the back of the leg then on the inside of the ankle to the arch of the foot.  It functions to support the arch of the foot.

Posterior tibial tendonitis can occur due to injury or overuse.  There are certain risk factors to the development of posterior tibial tendonitis including being overweight, diabetes, and flat feet.  When the tendon’s function is compromised the arch of the foot may drop placing even more pressure on the tendon which can lead to inflammation.

Symptoms of posterior tibial tendonitis include tenderness or pain on palpation of the course of the tendon.  There may also be pain on the inside of the foot and ankle in walking.  Standing on the tips of the toes may also elicit pain due to weakness.  These symptoms progress as the condition advances.   Treatment of the condition includes non-steroidal anti-inflammatory reactions, applying ice for about 20 minutes two times daily, and rest.  Increasing the arch support of the shoe or adding orthotics can also help control the condition. 

If untreated and with continued overuse, posterior tibial tendonitis can progress to posterior tibial tendon dysfunction (PTTD), causing a progressive flatfoot deformity.   In addition to the above symptoms this may lead to arthritis and a change in gait, or the way a person walks.  The change in gait may even lead to pain in other areas involved in mobilization such as the knees, hip, and back.   With this said, it is important once symptoms begin to seek medical attention and to follow physician instructions to avoid progression.

If you are suffering from posterior tibial tendonitis, please do not wait to see a podiatrist.  The physicians at Atlantic Foot and Ankle Associates take a conservative approach for all types of injuries.   Make an appointment at one of our four offices conveniently located in Palm Coast, Orange City, Daytona Beach, and Port Orange and get back to walking pain free!

By Dr. James Rust

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

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

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

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

By Dr. Andrew Green, DPM

The Queen of Southern cooking announced in January that she has had Type 2 Diabetes for three years, but Paula Deen has recently been spotted looking thinner. "I've dropped two pant sizes and I feel great!" Her new healthier regime includes walking 30 minutes every day – and now having portions half the size of those she used to eat. 

The American Diabetes Association has declared March 27^th, one month from today, as Alert Day.  The association is urging people to take the Diabetes Risk Test, which can be found on their website.  You may be wondering why this information is presented in a podiatry blog?  Well, diabetes can have a major effect on lower extremity health and one of the most severe complications is the development of the diabetic foot ulcer, something we treat every day at Atlantic Foot and Ankle Associates.

Diabetes can affect nerves which can result in sensory and motor neuropathy.  With sensory neuropathy, the symptoms may manifest as tingling or burning pain in the foot.  As well, there may be a loss of sensation and proprioception.  This is problematic because someone affected will lose the ability to feel pressure and damage to the foot, leading to the potential for an ulcer to develop on the foot.  For instance, a person with sensory neuropathy may step on a nail and break open skin without even noticing.  Ulcers are often susceptible to bacterial infection, which if not detected and treated may extend all the way to bone.  This chain of events may eventually lead to amputation of the foot.  With motor neuropathy, symptoms may manifest as muscle weakness or change in muscle mass.  The foot may as well undergo a change in shape which may create areas of pressure, increasing the chance of development of an ulcer.  In addition, diabetes affects the vascular system by decreasing blood flow.  Since blood flow is imperative to healing this can decrease the speed and quality of the healing of any ulcers.

Lifestyle modifications may be taken to prevent the development and complications of diabetes such as exercise and control of blood sugar through healthy eating choices like decreasing salt intake.  The cessation of smoking will also work to prevent the complications.  One month from today, please take the first step to recognizing or preventing Diabetes.  And if you are one of the 15 million people that suffer from Diabetes, please do not hesitate to visit one of our four offices located in Daytona Beach, Port Orange, Palm Coast, and Orange City, Florida for your diabetic foot care needs.

By Dr. Matthew Hentzel

Although Adele won six Grammy Awards, celebrity fashion on the Red Carpet is still a hot topic in the news.  A key feature of fashion is of course shoes, particularly high heels.  High heels, as fashionable as they are, often contribute to many foot pathologies. 

Wearing high heels which often have a narrow toe box can encourage the formation of a bunion, a swelling at the big toe joint.  Bunions may not be aesthetically pleasing and may also cause pain and difficulty in finding appropriately fitting shoewear.   To avoid the formation of bunions, the American Podiatric Medical Association (APMA) recommends not wearing shoes with heels taller than 2 inches.  However, of course high heels are not the sole cause of bunions, genetics and biomechanics are also contributing factors.

High heels may also exacerbate the symptoms of a neuroma, a benign nerve tumor that often brings feelings of pain, numbness, or tingling.  The APMA again recommends shoes with heels no higher than 2 inches due to the stress placed on the forefoot where the neuroma is often located.

Wearing high heels constantly may also shorten the Achilles tendon which may lead to pain and tendonitis.  High heels may also alter the direction and pull of the Achilles tendon causing a deformity known as the “pump bump” (Haglund’s deformity) which may become painful.

Last but not least, high heels are infamous for the foot pain associated with them.  With the heel lifted, more pressure and body weight is placed on the ball of the foot.  This can change the position of the foot during gait (or movement).

Certain steps may be taken to prevent serious complications from high heels.  At Atlantic Foot and Ankle Associates, we recommend that you limit the amount of time wearing heels.  When wearing heels, chose a pair with a wider toe box and a smaller heel.  Also, stretch your calves to avoid any complications with your Achilles tendon.

If you’ve suffered from the pain that wearing high heels cause, come in and see us at Atlantic Foot and Ankle Associates.  We have four offices conveniently located in Palm Coast, Daytona Beach, Port Orange, and Orange City, Florida.  You don’t need to suffer any longer!

By Dr. Dennis McBroom

Having never considered myself much of an athlete, let alone spent any time running, in 2004 I strangely convinced myself to run a half marathon.  The Detroit Free Press Marathon really appealed to me because it offered what no other marathon does: two international border crossings and an underwater mile through the Detroit-Windsor Tunnel.  With less than two months to train, I hit the pavement. 

Autumn in Michigan is nothing short of breathtaking.  Vibrant colors of changing leaves helped take my mind off the pain I was experiencing in just about every part of my body.  I did most of my training at a beautiful park with a scenic eight-mile pathway winding through hills and woods, often with views of the lake the path surrounded (which inevitably sparked my on-and-off-again love affair with running).  The cool temperatures were ideal, and two months later, I ran the half with an overall time of 2:13.  Being a novice runner, I had no idea if that was good or bad – I was just happy I finished.

The experience of participating in such an amazing event had me convinced; next year I was going to run the full marathon!  I was going to keep training throughout the year so I would be prepared and ready for next fall’s event!  And then winter set in.  Snow, sleet, slop.  Yuck.  As much as I despise the cold (and running in snow), my disdain for treadmills is even stronger.  

Fast-forward seven years.  The on-and-off-again love affair continues.  Although running has consistently been a part of my exercise regimen, there has been no distance training to speak of.  I now live in Florida where the weather is optimal for outdoor activities.  I had heard about a small group of runners that trained a few times a week, and decided to give it a whirl.  Within a couple of months, I’m back up to eight-mile distance runs on the on the beach (talk about beautiful scenery), and the rest is an up-hill battle at the bridge. 

I’ve always had some knee issues when running distance, but for the first time I’m finding other pains creeping in (maybe I’m just getting old).  As the Director of Marketing and Community Relations at Atlantic Foot and Ankle Associates, I have full access to five of the best podiatrists in Daytona Beach, Port Orange, Palm Coast, and Orange City.  A runner’s dream! 

When I began experiencing heel pain, (especially when I first got out of bed in the morning), I learned that I was suffering from Plantar Fasciitis, a condition common to runners.  Being the typical hard-headed runner, I wasn’t willing to hang up my shoes just yet.  With the help of custom orthotics made at our office, I have been able to continue training and have run three 5k’s, and a 10k (that is a picture of me getting my 2^nd place award at the Daytona Speedway 5k race).   My heel pain is going away and I am looking forward to the next event!

By Marisa Aitken