An article published in “USA Today” this past week discussed the scary reality that many elderly patients will leave a hospital much weaker than when they arrived.  Even though the patient’s original condition will be treated, the overall health of the patient may suffer from lack of physical activity.  A similar concept can be applied to many treatments of the foot and ankle, in that even though a treatment may remove the original pain or deformity, post-treatment actions must be taken by the patient to ensure that they maintain optimum health and their condition does not return. 

One condition that requires continued maintenance even after a pain-relieving treatment is plantar fasciitis.  Stretching and orthotics are often suggested as the first line of treatment because they address the root of the problem.  However, individuals with severe plantar fasciitis may find even stretching to be too painful and can receive steroid injections for more immediate relief.  In plantar fasciitis, the fibrous band of tissue called the plantar fascia that attaches from the heel to the ball of the foot becomes irritated from having too much tension placed on it.  Overpronation and equinus, or stiffness of the ankle, can add to the tension placed on the fascia causing its inflammation.  Even though a steroid injection removes the heel pain of plantar fasciitis, the underlying causes of tension will remain and eventually allow the pain to return if they are not addressed.  For a patient to get optimal results from their treatment, they should discuss a daily stretching regimen with their podiatrist that should be easier to adhere to after their pain has been alleviated by the injection.  Simple stretches and custom orthotics will often relieve tension and thus the irritation on the tissue, allowing the patient to avoid recurrences of the condition. 

This concept of stretching and physical therapy following treatment is often used following surgeries that actually have removed the underlying problem, including those performed to remove a bunion.  While the bunion deformity is gone, physical therapy to get the toe moving after surgery can prevent complications down the road that may result from the prolonged inactivity of the toe following the operation.  Bones and tissues that have been cut need time without bearing the weight of the body in order to fuse together properly.  Unfortunately this period of rest that is necessary for bone healing may cause joints and ligaments to become overly stiff from the inactivity.  Physical therapy can be used to remove or prevent any adhesions of tissues to one another that can lead to painful limitation of motion or even arthritis. 

While for some patients, following a post-treatment schedule involving stretching, foot exercises and physical therapy may be difficult, other patients will struggle with the idea of doing as little as possible with their affected foot.  Whether you are eager to return to sports practice, or someone who does not look forward to the idea of any sort of exercise, it is crucial to follow the treatment plan your podiatrist or other doctor has provided to you to completion for your best health possible!

Please visit www.ColumbusFoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio near Worthington. If you would like to see apodiatrist in Dublin, Ohio near Tuttle Crossing, call 614-885-3338 for an appointment.

By Dr. Animesh (Andy) Bhatia

A new treatment option that may one day be of great help to all those suffering from heel pain in Columbus has been making news for its success in a clinical trial.  The study focuses on an injection that shows potential for being used to treat individuals with plantar fasciitis who have not had significant pain relief with other treatments.

Luckily for the time being, patients suffering from plantar fasciitis can visit their podiatrist for a variety of treatment options that, for the majority of individuals, will provide great pain relief.  The first step in treating your plantar fasciitis is to determine if you in fact have plantar fasciitis.  While plantar fasciitis is one of the more common causes of heel pain, there are many other problems that occur relatively frequently that can also cause heel pain.  Some of the cardinal signs of this condition include the most intense pain of the day occurring when you take your first step out of bed in the morning and pain localized primarily to the bottom of the heel, at the front edge of the heel fat pad, on the side closer to the opposite foot.  A nerve entrapment can also cause similar pain on the bottom surface of the heel.  A nerve entrapment in this area typically involves what is known as “Baxter’s nerve” which supplies sensation and power to a muscle that allows movement to the smallest toe.  When the nerve is compressed, it is similar to a bruise and is called neuropraxia.  This bruise of the nerve then causes pain and decreases its ability to transfer information.  If the entrapped nerve is caught and treated, recovery occurs in around three to four months.  In areas around the heel that could cause heel pain in a location very near to the pain of plantar fasciitis also include fractures, and tendonitis.  

Once your plantar fasciitis has been correctly diagnosed, there are a variety of treatment paths to begin with.  While treatment varies for each individual, most people begin treatment with a conservative approach using the least invasive options available to start.  Some of the conservative treatment options include:  stretching, taping, icing, and wearing orthotics.   All of these treatment options can have great success in many patients if performed correctly.  The next step in treatment for plantar fasciitis that has not responded to the previously mentioned treatments can be an injection of a steroid with numbing agents.  This is done in addition to continuing conservative treatments.  The steroid is injected for its anti-inflammatory properties which serve to “soothe” the aggravated plantar fascia and relieve pain.  While surgery would typically be the last treatment resort as a plantar fascia that is still painful, the aforementioned research study provides a potential new option.  It has suggested that injecting plasma rich protein actually provides greater pain relief and healing potential than injecting steroids.  Hopefully this new research will continue, and the information gained can allow patients to receive the highest quality treatment options from their podiatrist!

Please visit www.ColumbusFoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio near Westerville. If you would like to see a podiatrist in Dublin, Ohio near Tuttle Crossing, call 614-885-3338 for an appointment.

By Dr. Animesh (Andy) Bhatia

This is the time of year when all runners want to be in their best shape possible and stay injury free during this critical training season.  With high school and college runners beginning their season and the Columbus, OH marathon coming up in October, runners of all ages need to be functioning at their peak level. 

There are a few things runners starting up running for the first time, or those more experienced runners who are upping their intensity should do to stay injury free.  Wearing the proper running shoe is absolutely imperative to avoiding injuries.  Shoes not only need to fit properly, but they should have the appropriate amount of support, stability and cushioning for your foot.  By scheduling a checkup with your podiatrist before you have begun purchasing expensive running sneakers, they can evaluate your type of foot and how it functions so that you can use that information to make an appropriate shoe choice.  Black toe nails can develop when shoes are too small from the foot jamming against the front of the toebox and causing bruising under the nail.  Shoes that do not fit properly may allow too much slippage or rubbing of the shoe against the skin causing calluses, and blisters.  A few good tips to help ensure you get the right fit of running shoe include trying on shoes at the end of the day when feet are slightly swollen and wear the type of socks you will be wearing when you are running.  Shoe types vary based on whether you tend to overpronate, and typically have a flatter foot, or supinate, in which case shoes tend to be more worn on their outer edge.  If a person has a severe enough problem with pronation, supination, or problems in foot function, a custom orthotic may be needed to allow the foot to function to the peak of its ability and to prevent injury. 

Along with proper shoes and orthotics, stretching and warming up are other simple ways to avoid two of the most common running problems: plantar fasciitis and shin splits.  Shin splints and plantar fasciitis are both inflammations at the point where the muscle and connective tissue, respectively, attach to bone.  Stretching, warming up and slowly increasing activity all help avoid the pain of shin splints by decreasing the chances of placing extra strain on the muscle attachment to the tibia, or shin bone.    Stretching the calf muscles can help to prevent plantar fasciitis by allowing for normal range of motion at the ankle joint and thus reducing the strain placed on the deep connective tissue, plantar aponeurosis that becomes inflamed and causes heel pain. 

Happy fall training to all the Columbus and Dublin area runners and remember that if you experience foot or ankle pain while running, do not wait to contact your podiatrist until a serious injury has already progressed!

Please visit www.columbusfoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio near Westerville. To schedule an appointment with a podiatrist in Dublin, Ohio, near Tuttle Crossing Mall, please call 614-885-FEET (3338).

By Dr. Animesh (Andy) Bhatia

In July, we posted a blog on international tennis champion Rafael Nadal’s troublesome heel pain he was forced to play through at this year’s Wimbledon games.  In Nadal’s new memoir titled “Rafa” he discussed another foot problem that has worried him throughout his career and in 2005.  The pain caused by the problem was so severe that it almost caused him to give up on the game of tennis entirely and try his luck at professional golf instead! 

While plantar fasciitis, the likely culprit begind Nadal’s previous heel pain, is very common here in Columbus, OH and around the world, his 2005 foot problem was likely due to a much more rare condition called Kohler’s disease.  Nadal refers to his problem as a congenital condition in which the navicular bone of the foot did not harden completely and has caused him problems ever since.  Kohler’s disease is not truly thought of as a congenital disease, but develops in a child’s foot typically around ages 5-10 when a traumatic event has caused loss of blood supply to the bone before it finished ossifying.  While this type of blood loss causes similar diseases in other bones in kids, the navicular plays an important role in the support of the long and transverse arches of the foot and is the last foot bone to ossify.  A child with Kohler’s disease will normally limp on the affected foot; have pain over the middle side of the arch; avoid putting pressure on the middle side of the foot and redness and swelling will often be present.  Foot pain in a child should always be treated carefully to ensure that any problems with the growing and ossifying areas of bone are handled appropriately to ensure proper development.   As kids go back to school, it is important to keep this in mind that not only are the right shoes important to prevent injuries, but so is proper care when an injury or pain does develop!  While Kohler’s disease typically heals normally with no adverse effects later on, it seems that Rafael Nadal unfortunately did not find the best podiatrist for him until later on in his tennis career!

Please visit www.columbusfoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio in near Lewis Center.

Looking for a podiatrist in Dublin, OH? Columbus Podiatry & Surgery's foot doctors are now in Dublin!

By Dr. Animesh (Andy) Bhatia

Tennis enthusiasts at the Wickertree Tennis Club and Raquet Club of Columbus, as well as fans around the world are currently enjoying one of the biggest tennis tournaments of the year, the Championships at Wimbledon.  It is always interesting to follow the previous year’s champions to see how they will do.  It is even more interesting when last year’s champion is Spain’s Rafael Nadal, who is widely recognized as one of the greatest tennis players of all time. 

This past Monday, June 27 in the 4^thround of Wimbledon, Nadal began having what appeared to be some very intense heel pain.    Nadal had trainers called onto the court twice to check where the pain was located around the back and sides of his heel.  Luckily, he was able to play through his pain to win and continue on to Friday’s match which he also won, beating out Andy Murray.  Although the injury has not yet been definitely diagnosed, Nadal is taking a risk to play out his last few games at Wimbledon before taking an already scheduled vacation. 

Heel pain can be debilitating to any athlete, especially for one playing at as a high level as Nadal.  The most common cause of heel pain on the bottom of the foot in athletes is called plantar fasciitis, or heel spur syndrome.  The plantar fascia is a thick connective tissue deep on the bottom, or plantar surface of the foot, that connects the heel bone, or calcaneus to the ball of the foot.  Plantar fasciitis occurs when the plantar fascia has too much tension put on it and begins to pull at its attachment point on the heel bone, causing pain.  Pain associated with plantar fasciitis is often worse in the morning, when the individual first steps out of bed.  Individuals who overpronate, or have flat feet are at a greater risk for plantar fasciitis because of the extra tension placed on the plantar fascia when the arch is flattened and elongated.  Ultrasound can be helpful in diagnosing plantar fasciitis versus other causes of plantar heel pain such as a loss of the fat pad under the heel or a nerve entrapment.  If the diagnosis is plantar fasciitis, it can often be treated non-surgically.  More conservative methods that may be used include icing, rest, custom orthotics to relieve plantar fascia tension cause by overpronation, night splints and stretching.  If pain persists, many cases have been successfully treated by similarly non-invasive extracorporeal shock wave therapy. 

Although Nadal will have to work through his pain at Wimbledon, at least his injury at this point is not severe enough to force him to drop out altogether.  The promise of long break to rest your feet and get the best treatment and relief from pain in the near future can be a great motivator for anyone to make it through a tough time!

Please visit www.columbusfoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio in Worthington, Ohio.

By Dr. Animesh (Andy) Bhatia