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Question: I have been diagonses with Plantar Fascititis. I work 9-12 hrs a day on my feet whole time,i have been in pain for the last 4 years but the last 8months to a year have been escrusiating pain. If I am not off my feet enough to let my feet rest and get better, wouldnt surgery be a better option to fix this, I think going on for 9 more months with this pain that i have felt for 4 yrs and always being on my feet with my occupation is crazy before surgery would be thought of, so pay this doctor lots of money for all the visits and cortizone shots until the time comes, WHY?????
Answer: Steve,   Four years is a long, long time to be having plantar fasciitis.  How certain are you and your doctor that this diagnosis is accurate?  Was an MRI or at least a sonogram done?  You may have a tear in your plantar fascia, and you may even have a stress fracture of your heel bone.   We now know for certain what works and what doesn’t work for plantar fasciitis (assuming this is what’s really going on).  The two most successful treatments are injections and wearing a night splint (to keep your foot at 90 degrees when you sleep).  We’ve even found plain lidocaine injections without the cortisone work almost as well as with a steroid.   The next two things that work second-best are stretching exercises for both your foot and your calves, and wearing some sort of orthotic in your shoe.  There is overwhelming data now that shows cheap over-the-counter arch supports actually work better than custom made orthotics!  The soft gel rubbery things don’t work.  You need a very firm, hard arch to help.   What we know doesn’t work is physical therapy, shock wave treatments and oral anti-inflammatory medication.   Surgery works, and it’s now done through a ¼ inch incision on the bottom of your heel to just simply cut the plantar fascia.  It takes about 30 seconds and there is little disability.  HOWEVER, before you consider surgery (or any more shots), you really need an accurate diagnosis.  In my 35 years of practice, I have had only ONE patient with plantar fasciitis for over 4 years, and I’m STILL doubting my diagnosis on her.   Hope this helps.  Good luck!
Question: My 16 year old daughter have both of her big toenails growing in layers. When it get to a certain point, the toenail pops off. I've had her tested for fungus last year by a podiatrist and it came back negative. He could not help us from that point on. Is there anything you can do for her? I was told to try a skin specialist. Thank you.
Answer: Hello Anna,   While it’s possible for a 16 year old to have a fungal infection of the toenails, it’s extremely rare, and the fact that only the two big toes are involved make it even less likely it’s a fungus, so I’m not surprised her previous fungal cultures were negative.  (Just so you know, there is a new staining technique for fungus nails that came out just this week that is more sensitive and reliable than the older staining methods.)   The more common cause of dystrophic (thick, discolored) toenails that involve only both big toes in younger people, especially if they’re very active, is slow, gradual repetitive trauma, like the big toes getting jammed against the tip of the shoe during athletic activities.  This is actually fairly common in people with what is referred to as a Morton’s Toe, where the big toe is the longest instead of the 2nd piggy being the longest (which is normal), making the big toe more vulnerable to repetitive tapping.   The treatment for this is a tongue pad, as strange as it may sound.  No, not anything for her mouth, but rather a ¼ inch piece of felt placed on the tongue of her shoes.  The idea is any jamming from the foot lunging forward in the shoe gets absorbed in the instep area by the tongue pad, not the big toes.  Also, and pardon me for even asking, make sure she’s wearing the correct size shoe, especially the sneaker she wears during any activity, since that, too, can cause the big toenails to jam.   Toenails, like fingernails, quills on animals and such, are specialized skin cells that grow harder.  They all tend to thicken when even small amount of pressure are applied over time, just like calluses form on skin.  It’s a protective mechanism.  With toenails undergoing this kind of repetitive stress, when the nail gets long enough (and that’s not really “long”), the repetitive trauma can break the end of the nail off.  Without seeing her foot, that’s my best “guess” as to what’s going on.   You can buy tongue pads in the foot isle of a good pharmacy, or get them on line.   Hope this helps!  Feel free to ask me any questions either by email or phone 888-552-8319.   Good luck!!
Question: How successful is chronic Achilles tendonitis repair
Answer: Well Benita, as you may already know, Achilles tendonitis is an inflammation of the Achilles tendon, usually one discrete portion of the tendon, and typically an inch or two above the ankle.  Technically, it’s the joint fluid between the tendon and the tendon sheath that’s inflamed.  The treatment is rest, wearing a heel lift, oral anti-inflammatory medication and physical therapy, usually in the form of gentle stretches, ice massages and even acupuncture.  Since tendons receive a relatively poor blood supply, they take a long time to heal.  In very stubborn cases when nothing seems to work, the patient is placed in a below-knee cast with the foot angled down, off-weight bearing, to completely rest it for several weeks.   Surgery is very rarely necessary for this, and if you’ve had all this and are contemplating surgery because nothing seems to be working, I’d first make absolutely certain you only have an Achilles tendonitis, and not a partial tear of the tendon or irritation from a bone spur.  A good diagnostic ultrasound or an MRI would detect this if the “slices” obtained are thin enough (3 mm or less).  If this involves both feet, you should be worked up for an underlying arthritic condition that can present as Achilles tendonitis before contemplating surgery.   To specifically answer your question, the success of the surgery depends on what kind of surgery you’re going to have.  If there is a shortening of the Achilles tendon and the pull on it needs to be reduced, the preferable procedure is something called a gastrocnemius recession, where the calf muscle is lengthened.  The recovery from this is far faster and better than lengthening the Achilles tendon directly, since, like I mentioned, tendons have a poor blood supply and take longer to heal than muscle, which has an excellent blood supply.  If shortening is the cause of your tendonitis, gastroc recessions are very successful.  If the tendon itself is just being “cleaned up” (releasing the tendon from its sheath and removing any fibrosis, calcium or thickened tissue), the success rate is about 70%.  While a 70% success rate is a lousy success rate for surgery, I believe the main reason it’s as low as this is because there are a number of patients who have this surgery when they aren’t properly diagnosed and worked-up and there is a tear or underlying arthritic disease or a tightness of the tendon which wasn’t also address, so it tends to come back.  If the patient is properly worked up and the diagnosis is accurate, the success is in the high 90’s.   When in doubt, get a second opinion.  It’s a stubborn problem, and I know this first-hand, since I’m dealing with a low-grade Achilles tendonitis myself now for a few years.   Best of luck to you!!!
Question: what are the treatment options for a 12 year old girl that has growth plates that have not fused with the 5th metatarsal yet.
Answer: The growth plate (apophysis) of the 5th metatarsal typically and normally fuses between the ages of 9 to 14 years.  The presence of a growth plate on x-ray in a 12 year old girl is not abnormal, just rest easy.  Unless there was an injury you didn’t mention, my best advice is to assure good bone health by regular exercise, eating a good amount of fruit and vegetables (especially legumes and green leafy vegetables, an excellent source of magnesium) including foods rich in calcium (Broccoli, Brussels sprouts, collards, kale, mustard greens, turnip greens…. You know, the stuff kids just LOVE!).   Here is a helpful link on maintaining good bone health in children: http://www.pcrm.org/health/health-topics/parents-guide-to-building-better-bones   Hope this helps!  
Question: I have a 22 year old wound on my ankle. For the past 6 months I have been experiencing pain when I am standing for prolonged periods of time or when I walk or run a mile or so. What gives?
Answer: Deidre,   It’s hard to give you a truly meaningful answer without knowing more about you, this wound and other medical issues, but I’ll try my best.    The key to closing ulcers, and I am assuming that your “wound” is an ulcer by virtue of the fact it’s celebrating its 22nd birthday, is in identifying the underlying cause of the ulcer.  One of the more common lower leg ulcers, usually just above the inside of the ankle, is a venous stasis ulcer which results from deep varicose veins that cause the blood to pool and collect in your lower legs.  This causes swelling and over time, a brownish-red staining of the skin called hemosiderin, and induration (a hardness and loss of elasticity of the skin in the area).  Since stasis or a pooling of the blood is the culprit in these cases, the treatment lies in compression, to help milk the blood back up to the heart.  In mild or early cases, this is done with compression stockings or support hose.  Once an ulcer develops, compression in the form of a soft cast (“Unna’s boot”) or a venous compression machine is used.  Keep in mind I am only guessing that the 22 year-old wound you have is a venous stasis ulcer.  Other leg ulcers that can be chronic are due to hypertension or other underlying disease.  If this is the case, nothing will close the ulcer without first addressing the underlying problem.   Venous stasis ulcers are usually painless.  They become painful when they get infected or the ulcer becomes very deep.  Pain is also associated with poor arterial circulation, which is a separate issue altogether.   The best advice I can give you is to not give up.  If this has been present for 22 years, I would speculate that you’ve been to your share of doctors about this and have gotten nowhere.  Leg ulcers are a specialized field and most doctors aren’t adept at diagnosing and treating them.  A vascular surgeon would be the best starting point for you, but if there is an underlying medical condition that is associated with the ulcer, an appropriate specialist would need to work together with your vascular surgeon to close it up.  There could very well be a serious problem here that can put your entire leg at risk, so please seek professional assistance without delay.   The best of luck to you Deidre.  I hope this helps.

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