Drs. John R. Senatore & Craig Friedman

  • (410) 243-1313

  • union@unionpodiatry.com

Effective Treatments for Podiatric Disorders

ORTHOTICS

What are Orthotics?

Orthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern. Orthotics are not truly or solely "arch supports," although some people use those words to describe them, and they perhaps can best be understood with those words in mind. They perform functions that make standing, walking, and running more comfortable and efficient by altering slightly the angles at which the foot strikes a walking or running surface.

Doctors of podiatric medicine prescribe orthotics as a conservative approach to many foot problems or as a method of control after certain types of foot surgery; their use is a highly successful, practical treatment form.

Orthotics take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain.

Foot orthotics fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

How Should Your Foot Be Casted for Custom Orthotics?

There are several methods that can be used to obtain an image of the foot to make custom foot orthotics. The reality is that some work much better than others. Unfortunately not all practitioners use the methods that have been shown to be most effective. This may be because they are not familiar with the literature, because they want a faster or cheaper way to take the image of the foot, or because they were sold a “computerized” system that looks impressive but does not work particularly well. The most important criteria is the experience and skill of the medical practitioner, but regardless, there are some techniques that have been shown to be much more effective than others. The only method that has been shown in the medical literature to be effective in producing a quality functional custom foot orthotics is a three-dimensional non-weight bearing cast or image of the foot. In this technique the foot is held in a precise position – essentially the position in which it should function. The image of the foot can be taken using plaster, fiberglass, or a laser scan. 

Smartcast Digital Scanner

Smartcast Digital Scanner

Children's Heel Pain

Heel pain can also occur in children, most commonly between ages 8 and 13, as they become increasingly active in sports activity in and out of school. This physical activity, particularly jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur. When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief. Other good news is that heel spurs do not often develop in children.

Achilles tendinitis

Achilles tendinitis is an overuse injury of the Achilles (uh-KILL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It's also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends. Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor's supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.

Symptoms

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more-severe pain may occur after prolonged running, stair climbing or sprinting.

You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity.

Achilles

Achilles tendinitis

Causes

Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes.

The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury — particularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs.

Risk factors

Prevention

A number of factors may increase your risk of Achilles tendinitis, including:

Your sex.

Achilles tendinitis occurs most commonly in men.

Age.

Achilles tendinitis is more common as you age.

Physical problems.

A naturally flat arch in your foot can put more strain on the Achilles tendon. Obesity and tight calf muscles also can increase tendon strain.

Training choices.

Running in worn-out shoes can increase your risk of Achilles tendinitis. Tendon pain occurs more frequently in cold weather than in warm weather, and running on hilly terrain also can predispose you to Achilles injury.

Medical conditions.

People who have psoriasis or high blood pressure are at higher risk of developing Achilles tendinitis.

Medications.

Certain types of antibiotics, called fluoroquinolones, have been associated with higher rates of Achilles tendinitis.

Advanced treatment for Plantar Fasciitis and Achilles Tendonitis

Amniofix

AMNIOFIX

A new treatment for Plantar Fasciitis and Achilles Tendonitis

Podiatry problems can not only be debilitating, but frustrating at times. Many patients have tried everything from acupuncture to corticosteroid injections, only to find temporary or no relief from their pain.

With plantar fasciitis affecting more than one million people a year, and Achilles tendinitis plaguing many runners and athletes, I am excited to offer a new treatment option called AmnioFix® to help patients hit the ground running again. Here are some common questions about the AmnioFix® injection:

What is AmnioFix®?

AmnioFix® is a human-derived “composite amniotic tissue membrane” that’s created from healthy consenting mothers who have undergone scheduled cesarean sections. The donated tissue has been cleaned, dehydrated and sterilized. It’s then blended with sterile saline to create an injectable solution that has remarkable healing capabilities.

When injected, the growth factors will help your own cells regenerate the damaged tissue, reduce scar tissue formation and control inflammation. It essentially works like an espresso shot for the cells, making them work harder to repair tissue damage.

Is it Safe?

To date, more than 100,000 patients nationwide have been injected with AmnioFix®. There have been no reports of medical complications or serious side effects. Patients may experience some mild discomfort around the injection site for up to three days, but this is easily managed with ice and elevation to reduce any swelling that arises

How Affordable is it?

The injection is not covered by insurance. Patients simply pay $500 for the AmnioFix® injection. This cost is more affordable than surgery, and offers the added benefits over surgery of a minimal risk of infection, no risk of delayed wound healing and no downtime. Patients may be able to use HSA and Flex spending accounts to pay for treatment

How is AmnioFix® Different from Other Treatments?

An AmnioFix® injection is different from corticosteroid injections and platelet-rich plasma injections because it helps your damaged tissue regenerate. Corticosteroid injections are given after other conservative treatments fail, and they simply mask the pain. Patients often reach the limit of steroid injections and their pain remains unresolved. Platelet-rich plasma injections are more natural but do not have the growth factors for regenerating tissue.

PRP

PRP is an abbreviation for Platelet Rich Plasma. Plasma is what’s left when blood cells are separated from the liquid component of human whole blood. The plasma portion contains numerous biologic factors that have been shown to enhance healing in animal and human studies. Some of this work dates back to the early 90’s. Clotted whole blood has been used and studied for improving the success of meniscus cartilage repair in the knee joint of humans since that time. At this very moment there are many applications where human serum factors are being used to enhance tissue and bone healing.

Reasons for the increased interest in PRP injection therapy for the treatment of tendonitis and fasciitis are:

  1. It contains entirely natural products from a patient’s own blood.
  2. Traditional treatments for tendonitis are unreliable.
  3. Repeated cortisone injections into tissue can destroy and weaken it
  4. Cortisone injections into tendons of the lower extremity can lead to rupture of those tendons
  5. Long term anti-inflammatory pills only mask symptoms and do not heal tissue and often cause gastrointestinal problems
  6. The success rate for surgical management of tendonitis can vary and is unpredictable for any individual
  7. There is little if any risk for injecting one’s own blood product back into their body.

Candidates for PRP injection would be:

  1. Adult patients (over the age of 18) who have long standing problems with tendonitis
    1. who have failed previous treatment
    2. or have the inability to tolerate oral anti-inflammatory medications due to medical problems or allergies.
  2. These candidates should have sufficient symptoms to be considering surgery or repeated injections.

Patients who are NOT candidates for PRP injection

  1. Patients who are on blood thinners for medical problems such as history of blood clots or atrial fibrillation
  2. Patients who are unable to comply with the post procedure instructions of rest and immobilization due to personal or occupational demands
  3. Patients who are unable to remain off of aspirin or other anti-inflammatory products before or after the procedure
  4. Patients who will not allow removal and injection of blood products into their bodies
  5. Patients who are allergic to any of the medications used (marcaine with epinephrine and sodium bicarbonate)

The Procedure

The injection of PRP for tendonitis is an office based or an outpatient procedure in a surgical center. 30cc’s of blood is drawn from the patient’s arm. It is prepared and placed in a sterile single use container where it is spun in a high-speed centrifuge. The portion of the blood that contains the platelet rich plasma is drawn off into a syringe. The area to be injected is prepared using standard sterile technique.
The area is anesthetized and then anywhere from 3-5cc’s of the material is injected into the affected tendon or fascia.
There can be no guarantees of success with PRP injections. Currently this is a single injection and not a series. If one does not work, there is no current information that further procedures are helpful. Neither can there be any guarantee with cortisone injections, braces, physical therapy or surgery. All of these other modes of treatment have costs involved as well and financial obligations due to co-pays and deductibles required by the insurance contract. In studies going on right now in the United States and elsewhere around the world, the success rate for PRP injections seems to be better than cortisone and often more successful with less risk than surgery. Surgery remains an option for patients who do not respond, and PRP injection does not burn any bridges for patients who still have disabling pain from tendonitis.

Preparation for injection

  1. Patients who have scheduled an injection should stop all anti-inflammatory medications for 2 weeks prior to injection. This includes; aspirin (regular and mini-dose 81mg pills), Advil, Aleve, Motrin (anything that contains ibuprofen), arthritis pills such as Celebrex, Naprosyn, Arthrotec, Mobic, etc.
  2. Patients should be prepared to take it easy for about 2 days after the injection.
  3. A boot brace will be needed for the first 2-3 weeks.

After care following PRP injection

  1. Following the procedure the patient will be asked to remain for 15 minutes to insure that the procedure was tolerated well.
  2. It is suggested to go home and not go back to work or do errands.
  3. Ice should be applied to the area of injection for about 20 minutes, 3 times per day for the next 48 hours.
  4. DO NOT TAKE anti- inflammatory medications for the next two weeks.
  5. Pain can make the patient fairly uncomfortable. Pain pills are prescribed for this purpose (no driving while taking narcotic medication!!). It usually resolves in the first few days.
  6. A follow up post procedure exam will be scheduled for about 2 weeks.