PRP is especially effective at treatment Achilles Tendon injuries, both old and new.  Recent studies show that 93% of patients that have this treatment improved substancially within the first 2-6 months following injection.

PRP is also used to treat Plantar Fasciosis, which is the long term patient that has plnatar fasciitis.  Here, 70% of the patients treated have little to no pain and do not need surgery!

To me, preventing surgery is important and surgery should always be saved as the "last effort" to improve biomechanical pain or injuries.  We are always finding new ways to ge the body to heal itself.  I am happy to be able to offer this to patients.  All candidiates for this procedure must be seen for a consultation before this can be done.

The idea of barefoot running isn't really skin to ground contact. It is the use of a type of shoe called Minimalist.

One of the ideas of barefoot running is to develop the "intrinsic" muscles of the foot. They are the tiny little muscles in the foot that are similar to the hand. By strengthening them the idea is that the body will propulse with more stability, increase joint and bone mechanics, and prevent injury. By doing this it also increases the strength of the "extrinsic" or large muscles and tendons of the leg and foot. The overall result should make the body stronger.

So then, why isn't everyone doing this? Because after going around life in supportive shoe gear, the small muscles of the foot can get injured if they are pressed too hard. How many times have we gone to the gym to use the Peck Deck and to all of the sudden feel a kink in our neck. It is easy to hurt muscles we don't use when we try to train them or stress them the wrong way. For that reason, the die-hard runner may feel fine in them, while the "weekend warrior" will get injured.

Additionally, the one thing I want to stress is before you try any new type of shoe, look at your feet. If you have toes that curl, bumps of the sides or top of your foot, or calluses under the outside part of your foot, think twice about running barefoot. It is very VERY easy to hurt yourself if you already have a foot balance issue, or your bones are not strong enough. This type of running is NOT for weight loss, or for those just starting to exersise.

For those that want to do it and can do it.......go for it! But for all others....Get some Orthotics in your Cross Trainers until you’re ready!

While this may not seem like a "medical emergency", it hurts so bad you don't even want to put a shoe on, let alone walk around in a mall! To manage Gout flare ups, a type of steroid shot will help within a day, and pills will help resolve the issue in about a week. Frequent flare-ups will require specific blood tests, and may necessitate long term medication to control this type of arthritis.

More information can be seen at www.gout.com

This "skin biopsy" is not painful at all, and hurts no more than a pin prick.  the results are far more beneficial as therapy is geared towards "regrowing" the skin nerves over a 6 month to 1 year time frame.

To treat these beasts, it is important to know that a single visit to me is unlikely.  Two to three treatments may be necessary to completely remove the warts.  Treatment may start by freezing (cryosurgery) which is not painful.  If the wart is too deep or too large, I will recommend a medicine I have specially made called Cantharidin (chemosurgery).  This medicine is applied by me and requires you to return in 2-3 days for a check-up.  This treatment doesn't hurt initially, but really stings after the first day or two.  Should your wart still be resistant to these treatments (10% of all plantar warts are resistant to physical destruction) it may be necessary to physically remove them (cold steel surgery).  This may take place in my office, or an outpatient center.

When we walk, our natural stride allows us to walk over this joint and we use it to "push off" which moves us forward.  When this joint doesn't work we have to change the position of our foot which causes even more muscles and bones to work harder and can potentially damage these as well.  This often leads to tendonitis, shin splints, heel pain, and ankle pain.

Usually, orthotics and injections can help the early stages of this problem, and I urge you to see a doctor to have this diagnosed if this is the case.  The later stages of this disease usually requires surgery which remodels the joint, or if there is no cartilage left replaces the joint with prosthetic joint.  These joint implants do very well and the recovery is fairly quick, usually around 3 weeks in a special walking boot.

The point of this blog though, is to prevent the need to replace the joint.  For that matter, we must remind ourselves not to "walk through" our foot pain.  The prevention of this type or arthritis can be accomlished only at the early stages.  I also urge you to seek out a doctor to make this diagnosis, as there are more than 200 other diagnosis around the big toe joint and the foot that it could be!  Keep in mind that more than 25% of the bones in your body are in your feet!

Extracorporeal Shock Wave Therapy (ESWT) is used to treat chronic heel pain (plantar fasciitis). "Extracorporeal" means "outside of the body." During this noninvasive procedure, sonic waves are directed at the area of pain using a device similar to that currently used in nonsurgical treatment of kidney stones.

Extracorporeal Shock Wave Therapy is prescribed for patients who have experienced plantar fasciitis for an extended period of time -- six months or more -- and have not benefited from other conservative treatments. The brief procedure lasts about 30 minutes and is performed under local anesthesia and/or "twilight" anesthesia. Strong sound waves are directed at and penetrate the heel area to stimulate a healing response by the body. ESWT is performed on an outpatient basis. Although there are no bandages, someone will need to drive the patient home.

People who are not candidates for ESWT include pregnant women and individuals with neurological foot disease, vascular foot disease, pacemakers, or people taking medications that interfere with blood clotting (such as Coumadin).

This therapy is a safe and effective alternative treatment for heel pain and only requires a short recovery time. Clinical studies show a 85 percent success rate for treatment of plantar fasciitis using Extracorporeal Shock Wave Therapy.

The laser treatment will take under 10 minutes to treat both feet and there is usually no discomfort during or after the treatment. Your physician will discuss post-treatment care to avoid unsightly unwanted re-infections.

You will notice results within 2-4 months, depending on how quickly your toenails grow. New, clear growth begins to appear at the bottom portion of your nail as the diseased portion of the nail grows out.

You may return to your normal daily routine immediately after your toenail treatment, including painting your nails or pedicure treatments.  Go enjoy the outdoors, play sports, exercise or just enjoy yourself.  It’s time you can finally relax and not be self conscious.

Got a busy work day? We work longer hours, and there never seems to be enough time to go to the doctor unless there is an emergency.  The free advise and inexpenseive products offered at my online store may be the first step you need.  Here are some of the things you can try before your first visit:  Now if you have Diabetes, or poor circulation, I recommend coming in to be seen.  But if you have healthy feet....try these before your visit.

1.  Foot Odor and Perspiration:  8995 : Pedinol Ostiderm Roll-On Deodorant & Antiperspirant For The Feet

2.  Nail fungus: 30007 : Elon Dual Defense Anti-Fungal Formula (1/2 fl oz.)

3.  Dry Cracked skin:  30090 : Kerasal Professional Exfoliating Moisturizing Foot Ointment

4.  Cold feet: 618 : Infracare Socks For Cold Feet

5.  The ultimate gift to prevent Athletes Foot:  30167 : SteriShoe® Ultraviolet Shoe Sanitizer

6.  Heel Pain:  1001 : Ossur Formfit Night Splint w/Tread

7.  Great over the counter arch supports:  10103 : SPENCO Orthotic Arch Supports Full Length Insoles 
                     ... for high heels: 10296 : Vasyli McConnell Slimfit Orthtoics For High Heel Shoes

8.  Great soothing cream for athletes: 588 : BIOFREEZE® Gel with ILEX - Cryotherapy Pain Relief 4 oz Tube.

9.  Great Diabetic Socks: 8007 : NEW!! SmartKnit Seamless Socks with X-STATIC® – The Silver Fiber™ (crew

What Is Hallux Rigidus?
Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. 'Hallux" refers to the big toe, while "rigidus" indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.

This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.

Because hallux rigidus is a progressive condition, the toe's motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called "hallux limitus." But as the problem advances, the toe's range of motion gradually decreases until it potentially reaches the end stage of "rigidus," in which the big toe becomes stiff, or what is sometimes called a "frozen joint."

Causes
Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis - the kind that results from "wear and tear" - often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse - especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury, such as stubbing your toe. Or it may be caused by inflammatory diseases such as rheumatoid arthritis or gout. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment.

Symptoms
Early signs and symptoms include:

-Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
-Pain and stiffness aggravated by cold, damp weather
-Difficulty with certain activities (running, squatting)
-Swelling and inflammation around the joint
As the disorder gets more serious, additional symptoms may develop, including:

-Pain, even during rest
-Difficulty wearing shoes because bone spurs (overgrowths) develop
-Dull pain in the hip, knee, or lower back due to changes in the way you walk
-Limping (in severe cases)
Diagnosis
The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice symptoms. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.

In diagnosing hallux rigidus, the surgeon will examine your feet and move the toe to determine its range of motion. X-rays help determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.

Non-Surgical Treatment
In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include

-Shoe modifications. Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.
-Orthotic devices. Custom orthotic devices may improve foot function.
-Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
-Injection therapy. Injections of corticosteroids may reduce inflammation and pain.
-Physical therapy. Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.
When Is Surgery Needed?
In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. In selecting the procedure or combination of procedures for your particular case, Dr. Stoll will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

With the older, traditional heel spur surgery, treatment requires a large surgical incision across the inner side of the heel and outpatient hospitalization. A painful recovery period of 4-6 weeks with a gradual return to soft shoes after 2-4 weeks is normal. Often, patients miss work for many weeks and are unable to bear weight on the heel during this time. It is important to note that most heel pain can be treated effectively without surgery. Treatment may include an anti-inflammatory medication, a tape strapping of the foot to take pressure off the ligament, and in-shoe support to redirect the pressure off the spur area

Feet smell for two reasons: 1) shoe wear, and 2) sweating of the feet. The interaction between the perspiration and the bacteria that thrive in shoes and socks generates the odor. Therefore, any attempt to reduce foot odor has to address both sweating and footwear.

Smelly feet or excessive sweating can also be caused by an inherited condition, called hyperhidrosis, which primarily affects men. Stress, some medications, fluid intake, and hormonal changes also can increase the amount of perspiration our bodies produce.

In general, smelly feet can be controlled with a few preventive measures:

-Always wear socks with closed shoes.
-Avoid wearing nylon socks or plastic shoes. Instead, wear shoes made of leather, canvas, mesh, or other materials that let your feet breathe.
-Bathe feet daily in lukewarm water, using a mild soap. Dry thoroughly.
-Change socks and shoes at least once a day.
-Check for fungal infections between toes and on the bottoms of your feet. If any redness or dry, patchy skin is observed, get treatment right away.
-Don't wear the same pair of shoes two days in a row. If you frequently wear athletic shoes, alternate pairs so that the shoes can dry out. Give your shoes at least 24 hours to air out between wearings; if the odor doesn't go away, discard the shoes.
-Dust your feet frequently with a nonmedicated baby powder or foot powder. Applying antibacterial ointment also may help.
-Practice good foot hygiene to keep bacteria levels at a minimum.
-Wear thick, soft socks to help draw moisture away from the feet. Cotton and other absorbent materials are best.
Treating Foot Odor
The best home remedy for foot odor is to soak feet in strong black tea for 30 minutes a day for a week. The acid in the tea kills the bacteria and closes the pores, keeping your feet dry longer. Use two tea bags per pint of water. Boil for 15 minutes, then add two quarts of cool water. Soak your feet in the cool solution. Alternately, you can soak your feet in a solution of one part vinegar and two parts water.

Persistent foot odor can indicate a low-grade infection or a severe case of hereditary sweating. In these cases, a prescription ointment may be required to treat the problem.

Treating Excessive Sweating
A form of electrolysis, called iontophoresis, has been shown to reduce excessive sweating of the feet. However, it is more difficult to administer. In the worst cases of hyperhidrosis, a surgeon can cut the nerve that controls sweating. Recent advances in technology have made this surgery much safer, but may increase sweating in other areas of the body.

There are two types of foot fractures: stress fractures and general bone fractures. Stress fractures usually occur in the bones of the forefoot extending from the toes to the middle of the foot. Stress fractures are like tiny cracks in the bone surface. They can happen with sudden increases in exercise (such as running or walking for longer distances or times), improper training techniques, or a change in surfaces.

Most other types of fractures extend through the bone, and are called bone fractures. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. Bone fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. If the fracture does break through the skin, it is called an open fracture.

Because of the complex structures in the foot, there are some other, more specific types of fractures that can occur. For example, the fifth metatarsal, known as the little or pinky toe, is susceptible to a variety of different fractures. The relationship between the ankle and the foot can be compromised by an ankle-twisting injury, which may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is known as a Jones fracture, which occurs near the base of the bone and disrupts its blood supply. This injury may take longer to heal or require surgery.

Common symptoms for any type of foot fracture includes pain, swelling, and sometimes bruising. Be sure to seek medical attention for any suspected foot fracture.

These "smart pins" are used to decrease infection rates, increase speed of healing, and maintain the position of the toes for a lifetime. They do not bend or break, and there are no internal "rejections".

Neuromas are often treated conservatively with injections, orthotics, or change of shoes (no high heels). If the neuroma does not respond to this therapy, an MRI or Ultrasound is used to measure the size of the neuroma, and it is removed as an Outpatient procedure.

Surgery is an excellent treatment for neuroma if done properly. You can walk immediatly, the incision heals within 2 weeks, and you can return to a shoe within 3-4 weeks as soon as the swelling goes down.

The initial treatment of flatfoot is usually special strapping or orthotic management to try and keep the foot in a more "normal" position. This gets rough though because orthotics must be worn at all times....which means it is inadvisable to go barefoot or in sandals....

If you consider surgery for flatfoot, new technology allows the placement of a small stent that goes between the bones in the back of the foot to balance the flatfoot into alignment. It has a very short recovery period which is near 3 weeks until your back in regular shoes.

The alternate for this newer surgery is to lengthen the bones on the outside of the foot, which is a bit more involved, and usually takes about 6 weeks in a cast.

flatfoot surgery is one of the most gratifying surgery to perform and it has a huge impact in many patients future life and exercise routine.

That question is answered usually : "you can immediately, with good judgment!"

All but the most severe bunions that are repaired by me are allowed partial or full weight bearing privileges usually by the second or third day of surgery. Here is the "good judgment" part: Usually on day 3 I give you a special "boot" to walk in. This is your new shoe for at lease 4 weeks after surgery. I never recommend "walking the mall" after surgery, especially Lenox, and usually will keep you out of work if you stand a lot for at least 3-4 weeks if necessary.

-"It can't be broken, because I can move it." False; this widespread idea has kept many fractures from receiving proper treatment. The truth is that often you can walk with certain kinds of fractures. Some common examples: Breaks in the smaller, outer bone of the lower leg, small chip fractures of either the foot or ankle bones, and the often neglected fracture of the toe.

-"If you break a toe, immediate care isn't necessary." False; a toe fracture needs prompt attention. If X-rays reveal it to be a simple, displaced fracture, care by your podiatric physician usually can produce rapid relief. However, X-rays might identify a displaced or angulated break. In such cases, prompt realignment of the fracture by your podiatric physician will help prevent improper or incomplete healing. Often, fractures do not show up in the initial X-ray. It may be necessary to X-ray the foot a second time, seven to ten days later. Many patients develop post-fracture deformity of a toe, which in turn results in a deformed toe with a painful corn. A good general rule is: Seek prompt treatment for injury to foot bones.

-"If you have a foot or ankle injury, soak it in hot water immediately." False; don't use heat or hot water on an area suspect for fracture, sprain, or dislocation. Heat promotes blood flow, causing greater swelling. More swelling means greater pressure on the nerves, which causes more pain. An ice bag wrapped in a towel has a contracting effect on blood vessels, produces a numbing sensation, and prevents swelling and pain.

-"Applying an elastic bandage to a severely sprained ankle is adequate treatment." False; ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to ensure a normal recovery all may be indicated. Surgery may even be necessary.

-"The terms 'fracture,' 'break,' and 'crack' are all different." False; all of those words are proper in describing a broken bone.

1. Fit the shoe to the shape of your foot, if you have a fairly straight looking foot choose a shoe that has a straighter last in it.

2. Select a shoe that is rigid in the heel portion of the shoe. Heel stability is important especially if you fit a sports orthotic into it. The heel is the backbone and the supportive stucture of the shoe.

3. The shoe should be fairly flexible in the forefoot area. If the shoes does not easily flex in the front part then as the heel comes off the ground during walking and running the big toe is unable to move properly. Avoid the shoes that are so flexible that you can roll it up. Unless you have been running barefoot since infancy till now, starting to walk or run in these shoes will injure you.

4. When examining the shoe, make sure to put the shoe on the ground and make sure the entire heel touches the ground. If it doesn't, dont' buy it.

5. Feel around the inside of the shoe and check for enlarged seams that may cause irritation to toes.

This is very alarming! A Diabetic Foot Wound has a higher mortality rate that Prostate Cancer, Breast Cancer, Colon Cancer, and Hodgkins Disease.

This is why it is so important to get treatment immediately if you have Diabetes and a Wound on your foot. It may just be a scratch to some people, but to the Diabetic if could be life or limb threatening.

If you are healthy, and have tried over the counter medicines without success, it may be time to have your foot examined by me.

I see too many people that think it is normal for feet to hurt. Any annoying pain, numbness, cramping, shooting, throbbing sensations are not normal whether it is the start of the day, or the end of the day.