Summer: Taking a toll on your soles?

It’s August—the height of summer—and many of us are taking advantage of the longer days to cram in more outdoor activities. For many, it just seems easier, and definitely more enjoyable, to go for an early morning run when it’s already light outside versus the dark days of winter.

But that increased activity also increases the risk of foot and ankle injuries, particularly among weekend warriors.

Aching Ankles

Sprains, which can vary widely in severity, are among the most common foot and ankle injuries. For minor problems, time-honored home remedies like icing, elevating, resting the foot and over-the-counter (OTC) anti-inflammatories are often all that’s needed. But if you don’t notice much relief after a few days of self-care, you should seek a professional opinion from a podiatrist, a doctor who specializes in foot and ankle care.

It may be that you need an ankle brace to support and protect the ligaments that were stretched or torn during the injury. More severe sprains may require a device called a CAM boot—basically a walking cast that relieves the ankle from bearing weight while it heals.

The good news is that most sprained ankles will getter better in a month or two.

Sometimes, however, what first seems like a badly sprained ankle may actually be a broken metatarsal—one of the long bones in the middle of the foot. Because the symptoms of a break, especially a Jones’ Fracture, and a sprain can be so similar, some fractures don’t get the early medical attention they may need, including surgery.

Individuals with chronic lateral ankle instability may also benefit from surgery to repair the damaged ligaments and return to a more active lifestyle. The condition is the result of cumulative injuries to the ligaments from frequent sprains, mostly due to overuse. That leaves the ankle more susceptible to chronic swelling, pain, tenderness and weakness, leading to even more sprains in the future.

Healing Sore Heels

Another quite common injury is plantar fasciitis, which occurs when you strain the ligament that connects the heel bone to the metatarsals. In 95 to 99 percent of people, it goes away with simple, conservative treatment like stretching, OTC inserts and physical therapy. If such steps don’t provide relief, however, I’m a big proponent of a promising new treatment called PRP.

PRP, or platelet-rich plasma injections, can often decrease or completely eliminate the pain of plantar fasciitis and other conditions, contributing to a speedier recovery. In the 30-minute procedure, some blood is withdrawn from the patient and then placed in a centrifuge to separate out the platelets, the component that helps with clotting, healing and tissue growth. Then the platelet-rich plasma—now containing three to five times more growth factors than normal— is injected into the affected area.

Most patients can get back on their feet within a few days and can resume regular activity within a month.

If the Shoe Fits…

Feet are the foundation of your fitness. If they’re in pain or stressed, you can’t do much of anything. But properly supported, your feet can conquer miles in comfort.

That’s where the right shoes come in to play. And it’s tricky. Some lucky people are born with a perfectly normal foot; however most of us need some sort of assistance to help achieve the right mechanical balance. For instance, a bunion, flat foot or a really high arch can put extra strain on different tendons and ligaments, leading to arthritis, pain and degeneration.

But finding that sweet spot is a matter of trial and error. Sneakers that I regularly recommend to my patients don’t work at all for my wide, highly-arched feet. You need to take time to find that brand and style that is going to be the best fit for your foot’s particular structure.

Orthotics can also help. I typically recommend that patients first try out an OTC support with a rigid sole, something like a piece of plastic, to see if that helps. In some cases, that may be all the arch support they need, while others may benefit more from a custom-made orthotic. Just be sure to avoid inserts that you can bend in half, which provide cushioning versus support.

The bottom line: Enjoy your summer activities, but don’t beat up your feet in the process. And always see a doctor in the event of any significant swelling, bruising or pain.

Listen to Dr. Zarick's full podcast here!

Bothered by Bunions?

Tune in to the full podcast interview with Dr. Raspovic.

Bunions—those unsightly bony protrusions that can develop over the first metatarsal bone or big toe joint—remain a bit of a mystery. Aside from their definition, everything else varies, including how and why they develop, who gets them and when, and what symptoms they may cause. But one thing is certain:  Bunions can be hard to ignore, especially when they’re painful.

Fortunately, there are early steps you can take that may help you from ever reaching that stage.

“My best advice is to have an evaluation with a foot specialist when you first see a bunion developing or have any pain in your big toe joint,” says Katherine Raspovic, DPM, a podiatric surgeon. “There are a few conservative treatment options that can help improve discomfort.” 

The luck of the draw, genetics, often plays a role in determining who gets bunions. But shoes are another likely culprit, with high heels and shoes with narrow toe areas leading the list of suspects. While many high-heel wearers may never have problems, Dr. Raspovic advises those who do to step away from the stilettos, pointy toes and any other shoe that aggravates the sore joint.   

“One of the best preventative and therapeutic measures for bunions is wearing the right shoe for your foot, especially one that avoids excessive pressure on your toes,” she says. “It can be helpful to go to a good store where you can get your feet accurately measured so you can then find the proper size and fit.”

Beyond a change of footwear, other helpful tactics include using orthotics for arch support, modifying or taking a break from some activities for a time and taking anti-inflammatory medication.

Surgery is only recommended when other approaches have failed and the pain is so severe that daily activities and quality of life are affected. Depending on the type of surgical correction, some patients are completely off their feet for six weeks, followed by a walking boot and physical therapy. Post-surgical swelling—which may quickly subside or last for several months—can affect a patient’s ability to wear regular shoes for 10 to12 weeks after surgery. The recovery can be different for each patient based on what surgical intervention is needed to correct the bunion properly.

But with early detection and specialty medical care, many people can avoid surgery, says Dr. Raspovic.

Tune in to the full podcast interview with Dr. Raspovic.

Morton’s Neuroma: When Feet Fight Back

What is Morton's Neuroma?

Whether you’re a runner pounding the pavement or a fashionista balancing on sky-high heels, your feet are taking a beating. And when they’ve had enough, they fight back.

Increasingly, their weapon of choice is Morton’s neuroma— an otherwise harmless cyst that causes numbness, shooting or burning pain in the ball of your foot. It’s the result of repeated irritation or compression of a nerve or nearby tissue, usually between the second or third toe.

“Toes that are forced into a tight space for a long time are subjected to extra pressure that then causes swelling and pain,” explains John S. Steinberg, DPM, director of MedStar Washington Hospital Center’s Podiatric Residency Program and a podiatric surgeon. “The same effect happens after repeated high-impact activities, including years of wearing high heels. Unfortunately, even minor pain may cause you to limp or change your gait, which leads to other problems because your natural walking mechanics are all off.”

Treatments for Morton's Neuroma

But the good news is that the pain and discomfort from Morton’s neuroma can go away with proper treatment, including some simple remedies you can try at home:

  • Take over-the-counter (OTC) anti-inflammatories to reduce swelling
  • Soak the sore foot in alternating baths of comfortably hot and cold water
  • Wear full-length, OTC arch supports with a solid shell
  • Give your feet a break from high-impact activities and high heels

If the problem persists, foot specialists typically prescribe injections of cortisone or alcohol solution to reduce swelling; custom orthotics to correct foot mechanics and separate the toes; and/or physical therapy. Surgery—once the standard approach—is reserved for only the most extreme cases, notes Dr. Steinberg.

“Nowadays, foot surgeons or plastic surgeons can perform an external neurolysis, which releases ligaments and tight tissue from around the nerve to create space.”

But as any sports fan knows, the best defense is a good offense. To avoid developing Morton’s neuroma in the first place, Dr. Steinberg offers some commonsense advice.

“Change to shoes that are better fitting, so that toes will have the space and support they need.”

Have any questions?

We are here to help! If you have any questions about Morton's or other podiatric issues Call MedStar Washington Hospital Center at 855-546-1974.

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