What do Albert Pujols, Kobe Bryant, and Eli Manning have in common? Besides all being athletes, they have all suffered from plantar fasciitis. Plantar fasciitis is the most common cause of heel pain in adults, and has affected many professional athletes during their career. Unfortunately, this condition also occurs in many adults who are not athletes, so read on to learn more about what plantar fasciitis is and how it is treated.

What is the plantar fascia anyway?

The plantar fascia is a thick band of tissue that runs from your heel bone to your toes. It helps support the arch of your foot. Plantar fasciitis results from stress to the tissue, and can be very painful.

What are the symptoms?

Most patients with plantar fasciitis complain of pain in their heels. Often, the pain is worst when getting out of bed in the morning, but gets better as you walk throughout the day. As the tissue stretches throughout the day, it becomes less painful to walk. Resting allows the tissue to return to its pre-stretched state, which makes the pain come back.

What treatments are available?

There are several treatments for plantar fasciitis. Conservative treatments include icing and stretching the plantar fascia. Orthotics and physical therapy might be needed for some patients. Others still might need a night splint, which is a device that keeps your foot in a fixed position overnight to help stretch the tissue.

Many patients know that corticosteroid shots in the heel can help with the pain of plantar fasciitis. While this is true, repeated shots to the plantar fascia can do more harm than good, so not all patients need cortisone shots.

Finally, it is important to talk to your doctor if you have heel pain, because several conditions can cause pain in the heel. If your heels hurt, make an appointment with any of our doctors for an examination and discussion on the best treatment options for you.

Eric Polansky, DPM

What is it?

A “Hammertoe” is an abnormal bending down of a toe so as to resemble a hammer or a claw. It is similar to other deformities such as “claw toe” and “mallet toe,” with the only difference being where on the toe the bending occurs.

What causes it?

Hammertoes can arise from a variety of causes. Genetics are thought to play a role. They can occur due to other deformities, such as from bunions. They can also occur from poor shoe choices, such as high heels and flip flops: the constant clenching of your toes to keep flip flops on your feet can accelerate hammertoe formation, and the extra pressure and that is put on your toes while wearing high heels can also cause your toes to retract.

What are the symptoms?

If a hammertoe is present, shoes can irritate the top of the toe, causing a painful corn. A callus may also develop on the ball of the foot under the affected toe.       

What treatments are available?

For some patients, conservative treatments such as specialized orthotics may relieve some of the pain associated with hammertoes. Shoe modification is important, so pick shoes that offer wider toe boxes and avoid high heels and flip flops.

For select patients, surgery may be necessary if the deformity is advanced. In this case, our doctors here at Advanced Foot and Ankle Care would be happy to discuss all your options with you and make sure that all other reasonable options have been exhausted.

 Dr. Eric Polansky

    Sometimes I don’t know the answers to my patients’ questions.  Sometimes I don’t know exactly how to “fix” them.  There are few things that frustrate me more.  So when my patients ask me about nocturnal leg cramps I inwardly cringe, because I don’t always have a straightforward answer for why they get the cramps or how to treat them.  The truth is that the medical community at large has a poor understanding of this common ailment. 

     The International Classification of Sleep Disorders recognizes “sleep-related leg cramps” as a true sleep disorder.  These night cramps are sudden, painful, involuntary contractions of muscles in your calf, feet, or thighs.  The muscle that is cramping will feel hard and sometimes you can even see it tightening.  Some of my patients report that these severe cramps awaken them from sleep (talk about a rude awakening!) or prevent them from even falling asleep at night.  This can even lead to chronic sleep deprivation.   The incidence of night cramps has been shown to increase with age.  There is research that shows that half of people over the age of 80 reported having sleep-related cramps at least once in the past 2 months.  These types of leg cramps are also increased during pregnancy.

     While it is not known exactly what causes night cramps there are a lot of theories out there.  These theories usually point to metabolic disorders (such as magnesium, calcium, potassium deficiency, or dehydration), structural disorders (tight muscles, flat feet), positional (making a movement in your sleep that shortens the muscle), or over-exertional (fatigued muscles are more likely to cramp). 

    It is also important to rule out diabetes and peripheral vascular disease when searching for a reason for your cramping.  While both of these conditions can cause discomfort in the feet and legs at night, neither one of them causes muscles to spasm or become tight and hard.  The same goes for restless legs syndrome, which is associated with an uncomfortable urge to move the legs, not necessarily pain. 

    Treatment of night cramps is pretty easy.  It usually just involves slow and steady stretching or massaging of the cramping muscle.  A heating pad or hot compress can also aid in muscle relaxation.  Some people recommend taking a vitamin supplement or drinking water to stop the cramp, but the truth is that the cramp will be gone before either of these has time to take effect. 

    The best treatment for night cramps is prevention, which can be the tricky part since we really don’t know what causes them.  As a general rule, if there are lots and lots of treatments for one condition it usually means that no one treatment works really well for most people.  And there are a MULTITUDE of suggested treatments for preventing night cramps!  I have heard everything from drinking a glass of pickle juice to taking Quinine (which is not even available in the US because of the severe adverse effects).  

Some of the more common suggestions are:

•   Staying hydrated.  The sense of thirst diminishes with age, so a lot of older adults fail to adequately hydrate themselves.  A diuretic (“water pill”) can also potentiate dehydration.  Dehydration can lead to electrolyte imbalances that may cause cramping.  And sorry -alcohol and caffeinated beverages don’t count as adequate hydration!  In fact, they can make the problem worse.

• Maintaining adequate calcium and magnesium.  Both of these play a big role in muscle contraction.  What about potassium???  All of my patients seem to think that a banana a day will keep the cramps away.  While potassium deficiency can cause cramping, this is not common; it is more likely to cause muscle weakness.  Vitamin E is also a common treatment for cramps although studies about why and how it works are lacking. You should always consult with your primary care physician before starting supplemental calcium, magnesium, or potassium.

• Speaking of consulting with your physician, it is always a good idea to talk to your physician about whether a medication you are taking could be contributing to your cramping.  There are quite a few medications that do.  Medication-induced cramping does not usually occur exclusively at night though.

• Stretching before bed and before and after exercise.  This may be the most effective treatment for nocturnal leg and foot cramps.  A few minutes of light stretching before bed using a night splint, the wall, an exercise band, or towel can be helpful for relaxing the muscles.  Do not stretch too aggressively though as this could trigger cramps.

•  Proper supportive shoe gear and orthotics go a long way in preventing over fatigue of muscles in the feet and therefore can prevent cramps in the arch of the foot and toes, a common complaint of my patients.

If you are losing precious sleep because of cramping in your legs or feet it’s time to do something about it.  No one has all of the answers regarding night cramps, but at Advanced Foot and Ankle Care we are here for you to attempt to answer any of your questions regarding cramping in your legs or feet (at night and otherwise). We will work with you to assess the reason for the cramping and make suggestions for preventing the cramping whether it is giving you a night splint, showing you stretching exercises, giving advice on the proper shoes, or fitting you with orthotics.  You’ll be back to catching Zzzz’s before you know it!

Hillarie Amburgey, DPM

As cold weather nears, expect to see warm winter boots make their way out of the closet. Perhaps the most frequently seen winter boot is the UGG boot. These boots were originally worn by Australian surfers after they got out of the water, but are now worn by many women during the winter months to keep their feet warm.

 While UGGs may be very comfortable, they are actually quite bad for your feet. They have a flat sole, which doesn’t adequately support the arch of your foot.

They are slip-on rather than laced, which does not allow for a good fit. Finally, they don’t support your ankle, which can increase the risk of ankle sprains. If you have a pair of orthotics or inserts, try to insert them inside the boots to offer some support.

 In addition, the boot’s inner lining that keeps your feet warm has its own problems. The dark, warm, and moist environment that is produced from wearing boots all day provide a perfect breeding ground for the odor-producing bacteria and the fungus that causes Athlete’s foot. Luckily, this is reversible and preventable. Let your boots air out completely before wearing them again, and apply an antifungal and antibacterial sprays and powders frequently to make sure that fungus isn’t growing inside the boot.

 Despite all this, many women will choose to wear these boots throughout winter. If you choose to wear them, keep these hints in mind to offset some of the less desirable aspects of the boot. If you have any questions or currently have these problems, do not hesitate to call Advanced Foot and Ankle Care at our Troy Ohio, location.

 Eric Polansky, DPM

Osteoarthritis is a degenerative joint disease that affects many older Americans. It is caused by the breakdown of joint cartilage, which acts like a lubricant to allow joints to move fluidly. It commonly affects joints in the feet, hands, knee, and hip; in the foot, it most commonly affects the big toe joint.

 What are the symptoms?

 Most people experience pain, stiffness, crackling, and deformity of the joints. Pain is usually worst at the end of the day and after long periods of activity.

 How is it diagnosed?

 It is diagnosed by physical examination by your doctor and by the use of x-rays. Examination is important so your doctor can differentiate osteoarthritis from other types of arthritis, such as gouty arthritis and rheumatoid arthritis.

 How is it treated?

 Since there really is no cure, the primary treatment is to relieve pain and inflammation. Tylenol can be used for pain relief but does not treat the underlying inflammation, so it is best for mild cases. If the pain cannot be controlled by Tylenol alone, your doctor might recommend the use of a non-steroidal anti-inflammatory drug such as Aleve or Motrin.

 Your doctor may prescribe orthotics which can re-align the foot and relieve pressure on sensitive areas. Surgery is usually reserved for more severe cases.

 If you have pain in any of the joints of your foot, feel free to make an appointment with myself, or any of our doctors at Advanced Foot and Ankle Care for an examination and your doctor will discuss all your treatment options.

 Jeff Carlson, DPM