Red Hot Chili Peppers' singer Anthony Kiedis knows first hand. He sustained a fracture to a small bone in his foot, called a sesamoid, while jumping off a drum while on tour last fall. It initially went untreated and was slowly improving until he injured it again running around on the beach. I'm sure some of you Red Hot Chili Peppers fans may have seen him on winter tour dates clomping around the stage with a walking brace. However, The show must go on!

The sesamoid bones are 2 small bones that are at the bottom of the big toe joint. They are a small version of the knee cap bone. They function to increase the pull of one of the muscles that flex the big toe. Sesamoid fractures can occur as a result of direct trauma, such as a fall from a height of from a forced hyper extension of the great toe. A stress fracture of the sesamoid can occur as well, usually due to repetitive trauma. Like all fractures, treatment options are based on the severity of the injury and the amount of space between the pieces of the bone, called displacement. With minimal amounts of displacement, protected weight bearing in a surgical shoe or walking brace for 4-6 weeks is usually adequate to allow healing.

Occasionally a period of crutch walking may be needed. Sesamoid fractures with significant displacement or multiple pieces (a comminuted fracture), can also be treated with immobilization, usually for longer periods and with longer time on crutches. A competitive athlete may consider initial surgical treatment to shorten recovery time. Should the fracture fail to heal in the usual time frame, electromagnetic or ultrasound bone stimulators can be employed to hasten bone healing.

Even with a non-healed sesamoid fracture, most people will become asymptomatic and will require no further treatment. Localized pain in the area of the sesamoid can be treated by off-loading with a dancer's pad or custom orthotic. Should pain from a non-healing sesamoid fracture be persistent, surgical intervention may be necessary. Repair of the fracture with bone graft, removal of one of the pieces or removal of the entire sesamoid are the typical options. Good results have been reported with all of these methods.

Should you or a loved one have pain in the ball of the foot, book an appointment online. The podiatrists at Midtown Podiatry will quickly diagnose your problem and get you on the road to recover fast (even if you are not going out on the road with your rock band)

By: Paul J. Betschart

No, it is not caused by hitting your foot with your golf club.  It is a congenital deformity of the foot that is usually recognized at birth or shortly thereafter. It occurs approximately 1 in every 1,000 births.  The position of the foot is turned inward toward the center of the body. If untreated and left to adulthood, the foot will resemble a club when walked on, hence the name. The cause of this condition is unknown. It may be due to abnormal intrauterine position or abnormal development of soft tissue or bone. The position can be flexible, rigid or a combination.

Fortunately, in the developed world, this condition can be successfully treated. The earlier this condition is recognized and treated, the better the outcome. It is treated with serial casting, surgery or a combination of both. Most often, serial casting is employed first. This involves manipulation of the foot in a certain way to reduce the contractures of the joints and tendons. The foot is then placed in a plaster cast to maintain the correction. This manipulation and casting is done at weekly intervals for several months to achieve correction. Following casting, if there is residual deformity, surgical correction may be performed.  Good results can be achieved with these treatments, allowing children to function fairly normally. Bracing is sometimes needed after correction to prevent recurrence. 

Neglected clubfoot seen later in life usually requires more complicated surgical approaches, usually involving the fusing of multiple foot joints. Neglected clubfoot is rarely seen in this country due to the early recognition and treatment mentioned above. Other areas of the world do not have access to the treatments we take for granted in this country. Generous doctors and nurses from our country regularly participate in medical missions throughout the world bringing advanced medical care to those in need. Several of our doctors have participated in such missions. To get involved, check with the United Way, Doctor's Without Borders, The Baja Crippled Children Project, or Google “Medical Missions”.

Should you or a loved one need advanced foot and ankle care, make an appointment  with Midtown Podiatry. We will give you the best care within our borders!

By: Paul J. Betschart

HOW TO PREPARE FOR FOOT SURGERY

Now that you and your doctor have decided on surgery as the treatment for your condition, there are some things you can do to get yourself ready for a comfortable and quick recovery.

Get your mind ready: It has been shown that attitude can effect the outcome of medical care and the perception of pain. Have confidence in the course of treatment and your doctor. If you are unsure, get a second opinion before proceeding. Learn some relaxation techniques such as deep breathing or meditation. Know that pain is expected after surgery. Relaxation techniques have been shown to reduce the need for pain medication. Have a positive attitude and focus on the intended outcome of the surgery. After the recovery, you will be glad of your choice.

Get your body ready: Proper nutrition is essential for recovery following surgery. If your diet is not the best, consider consulting a nutritionist for dietary advice. Supplements to consider include calcium and vitamin D for bone health, vitamin C and zinc for skin and soft tissue and extra protein for muscle support are good starting points. Hydration is important. Be sure to drink plenty of water. Be aware that some post-operative medications can cause stomach upset or constipation. Make sure you take the medication as prescribed and eat and drink normally. Extra fiber should reduce the incidence of constipation. Should antibiotics be prescribed, a pro-biotic vitamin can reduce the incidence of diarrhea. Yogurt or Kefir can be used as an alternative. If you will need to be on crutches post-operatively, make sure your arms and non-operative leg are strong enough to support you. Simple arm and leg strengthening exercises should be performed to get you ready. You can consider a consultation with a physical therapist or personal trainer to help get you ready for crutch walking.

Get your life ready: Your mobility will be temporarily restricted after surgery. Make sure you take care of chores prior to the surgery. You will want to do as little as possible in the first few days after surgery.

Make sure you have what you need on hand, including food, water and post-operative medications. Consider having a friend or family member stay with you to help out.

Get your house ready: Much like child proofing, you will want to fall proof your house or apartment, especially if you are going to be on crutches. Take a look around for things that can impede walking or trip you up, such as furniture, rugs, cables, etc. You may not want to use stairs right away, so temporary one level living should be considered in homes with stairs. Make sure the bathroom is accessible. Some accessories that can make toileting and showering easier are: a commode that can be used as a toilet riser, a shower seat, suction grab bars and a cast/ bandage cover to keep the operated foot dry.

These items can be obtained at a surgical supply store or through catalogs. Some items may be covered by health insurance as well. Make the kitchen accessible as well. Make sure frequently used items are easily within reach. Consider preparing meals in advance for easy microwaving. Using disposable dinnerware temporarily will reduce clean up. If you will be on crutches, take a dry run around the house. You may be surprised at obstacles that you never thought of. You may want to consider crutch alternatives such as a knee walker or scooter if crutch walking is difficult for you.

Get ready to go: Depending on where your surgery is taking place, you may be required to have pre-operative testing and a medical exam done prior to the surgery. Make sure these are done at least 1 week before the surgery. Follow up with your doctors offices to make sure that the facility has all the results ahead of time. Follow pre-operative instructions to the letter. If you are having anesthesia other than local alone, make sure you don't have anything to eat or drink within 8 hours before surgery. You should continue to take prescribed medications unless otherwise directed by your doctor. Plan to arrive at the surgical facility in advance. Most hospitals and surgical centers require their patients to arrive 2 hours prior to their scheduled procedure time to allow for intake. For office procedures, 15 minutes is sufficient. Arrange for transportation home in advance. An escort is required for discharge by hospitals and surgical centers and is recommended for office surgery. Don't forget to arrange for transportation to your post-operative visits as well. Don't hesitate to call your doctor for any reason post-operatively. We are all here to make sure your recovery is safe and rapid.

If you have any questions prior to surgery, call the doctors of Midtown Podiatry.

Another New York team has been affected by a serious foot/ankle injury. New York Yankee pitcher Joba Chamberlain recently sustained a serious ankle injury while having fun with his young son. He has been on the disabled list this season after having elbow surgery. His rehab was progressing as planned before this latest incident in which Joba sustained an open dislocation of his ankle.

This is a very severe injury, where the bones become separated due to ligaments tearing. An open injury refers to the fact that the skin over the area was torn as well, exposing soft tissue and bone to the outside. These types of injuries are most commonly seen with motor vehicle accidents or falls from heights. These injuries require emergent care by a foot and ankle specialist. Most will require some form of surgical treatment to relocate the joint and clean and repair the wound. Fixation of the joint to allow for healing can be accomplished with a cast, but commonly pins, wires or external fixation devices are used, especially with open injuries, in order to tend to the wounds. Usually several months of non-weight bearing immobilization will be needed for healing. This puts Joba's return to the team this year doubtful. We wish him the best for a speedy and complete recovery.

If you or a family member ever suffers an injury to your ankle, make an appointment with the qualified professionals at Midtown Podiatry with locations in Midtown, Union Square, Gramercy Park, Wall Street and Glen Cove.

By: Paul J. Betschart 

Diabetes has become a prevalent disease in our society today. According to the American Diabetes Association, 8.3% of the population has been diagnosed with this disease. Diabetes does not limit itself to race, class or gender; affecting celebrities like Halle Berry, Bret Michaels, Nick Jonas, Paula Deen, Salma Hayek and Bears Quarterback Jay Cutler.

As podiatrists we see the impact that diabetes can have on a person's mobility. Many serious foot complications and other medical complications can be reduced or eliminated with control of blood glucose (sugar) levels. This control of blood glucose is not easy to accomplish as evidenced by the explosion of numbers of people with type 2 diabetes in this country and in the world. Type 2 Diabetes has become a major public health concern in the United States, as 26 million people in this country alone have type 2 diabetes. A large number of these cases are caused by or worsened by obesity.

Weight loss has been shown in research studies to reduce blood sugar levels and reduce need for medication and insulin for control. Weight loss is usually difficult to attain, especially for those significantly overweight, who have difficulty exercising. Two recent studies have garnered new hope for those with diabetes caused by obesity. These studies examined the surgical treatment of obesity and it's relationship to diabetes. The studies followed patients who underwent gastric bypass weight loss surgery. This type of surgery reduces the size of the stomach and redirects some of the intestine to cause weight loss. These studies showed that, not only did patients lose weight and keep it off, but their diabetes significantly improved! These studies showed over 80% of patients no longer need to take medication to control their diabetes.

Weight loss surgery has been shown to significantly improve other obesity related health problems as well, such as high blood pressure, cardiovascular disease and sleep apnea to name a few. Current NIH standards still only recommend weight loss surgery for those significantly overweight that have failed other approaches at weight loss. Recent advances in surgical techniques have made the procedure safer, with complication rates lower than other common abdominal surgery, such as gall bladder removal. Hopefully, the increased safety and the demonstrated effectiveness in managing disease will widen the NIH recommendations to give people better access to this life saving treatment.

Should you or a loved one need a recommendation for a weight loss surgeon, we can help you! Through our affiliation with Gramercy Surgery Center, we can refer you to some of the best Bariatric surgeons in New York. Give the office a call or mention it on your next visit to Midtown Podiatry, with locations in Midtown, Gramercy Park, Union Square, Wall Street or Glen Cove.

By: Paul J. Betschart, DPM

NY Giants rookie cornerback Prince Amukamara was spotted on crutches last week. He had fractured his 5^th metatarsal in training camp prior to the 2011 campaign and was relegated to just 7 games and limited playing time. Apparently the fracture has not healed yet. In order to promote healing of the fracture, his doctors have tried a novel approach.

They used a technique call Platelet Rich Plasma Injection, or PRP. This technique is most commonly used for soft tissue injuries such as tendon or ligament tears or chronic tendonitis. The use on fractures is new and exiting, should it prove to be effective in clinical practice. This technique speeds the healing process by stimulating the bodies own reparative response. It involves drawing some of the patients own blood and processing it in a certain way to separate the platelet layer from the rest of the blood. This layer contains high levels of growth factors and other healing elements that are responsible for the therapeutic benefits. This material is injected into the area of injury, usually using ultrasound to guide the injection. The area is then rested to allow the healing to take place, as if it were a fresh injury.

At Midtown Podiatry, we have been using this technique for several years with great results. It is done right in the office, with minimal down time except for resting the injured area. Maximum effect is usually realized in 4-6 weeks. The treatment can be repeated if necessary. A thorough diagnostic evaluation by a skilled specialist will determine if this technique will benefit you. If you or a loved one has an injury that just won't heal, do yourself a favor and make an appointment with us right away! We will get you back to your game in no time.

By: Paul J. Betschart

 What in the world is Brachymetatatarsia?

A condition that is seen often at Midtown Podiatry is Brachymetatarsal; a condition not as rare as it seems that results in one or more of the toes being shorter than the others. It is actually the metatarsal bone that is shorter, hence the name. The metatarsal is the bone in the foot behind each toe. It is thought to be caused by premature closure of the growth plate in the metatarsal, usually first appearing in the early adolescent age group. Significant shortening of a toe not only causes cosmetic concerns, but can cause pain and shoe fitting problems as well.

What can be done about this condition?

Conservative care with modification of shoes, applying paddings or using custom foot orthoses can provide symptomatic relief in many patients. For those that do not respond to conservative care and those that are concerned with the appearance of the foot, there are surgical options that can restore a more normal appearance and function to the foot. The goal of these procedures is to lengthen the short metatarsal.

The 2 ways to do this is with:

• insertion of a bone graft or

• a technique called callous distraction.

Bone grafting is limited to those feet with smaller than 1 centimeter shortening of the metatarsal. It has the advantage of a shorter recovery of approximately 2 months, with the first month being non weight bearing using crutches. It is a single stage procedure.

Callous distraction can be used with any size deficit. It has a longer total recovery, 3 – 4 months, but the patient can walk during the recovery. An external fixation device is used to slowly lengthen the bone as it heals. This requires the patient to turn a nut on the device 3 times a day for 2-3 weeks. The fixator is then left in place until the new bone solidifies enough for it to be removed. A second stage of the procedure involves removal of the fixator and possibly adjusting the toe position and revising the scar.

Although each method has its advantages and disadvantages, callous distraction is performed more frequently by the doctors of Midtown Podiatry's Brachymetatarsal Correction Center. This is due to the fact that most metatarsals need more than 1cm of lengthening. This technique provides the most flexibility in treating this condition, and the bone that is made is the patients own. It does require the patients participation to perform the lengthening, so an intelligent patient who can follow instructions is a must.

Why choose The Brachymetatarsal Correction Center?

Our doctors perform more of these procedures than anyone else in the country. We have the experience and expertise to handle any and all issues that may arise before, during and after the procedure. Our support staff is first rate and experienced at helping our patients in their recovery. We have access to state of the art operating facilities and equipment. Our doctors are compassionate and understanding of our patients' needs and will tailor an individual treatment plan for each patient.

Should you or a loved one have a short toe that you are concerned about, do yourself a favor and call Jasmine at 212 995-1500 and she will get you in to see one of our doctors at any of our 5 locations.

We look forward to seeing you soon!

By: Paul Betschart, DPM

Before	After

A common disorder seen by our podiatrists is brachymetatarsal, a genetic disorder in which one of the metatarsal bones of the foot is abnormally short the appearance of a short toe.

Our physicians use a mixture of conservative and surgical treatment options to fix this deformity. Our podiatrists have been featured on Fox 5 - Good Day NY News thanks to their many successful cases of fixing Brachymetatarsia.
 

To view the video click here:

http://www.youtube.com/watch?v=2GSthr2FI7M&context=C4e8afafADvjVQa1PpcFM3hB3o9WcH0ARwybbqdhxBhmAZ3sgeiAc=

If you or someone you know is suffering from this disorder, make an appointment  with Midtown Podiatry, with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove

Wishful thinking for us woeful met fans. Ryan suffered a rupture of his Achilles tendon in his final at bat of the 2011 season. As recommended for most active people with this injury, he had the tendon repaired surgically within a few days of the injury. Surgical repair has been shown to significantly decrease the recovery time and increase the strength of the final healed tendon. That being said though full recovery from this type of injury can be lengthy. It is expected to take up to 1 year to return to pre- injury strength and function. The Phillies hoped to have Ryan back for the start of the season, but realistically he should be ready to return after the All Star break. Maybe this will give the Mets a chance to grab some ground early in the season.

Achilles tendon ruptures most commonly occur in athletes, however I have seen them in all types of patients. Although direct trauma to the area may be a cause, most commonly a rupture of the Achilles tendon is the result of progression of chronic tendinosis that is not being properly addressed. Any persistent pain in the back of the heel or along the tendon should be evaluated by a foot and ankle specialist to determine the diagnosis and initial treatment to prevent long term injury. Should a ruptured tendon occur, seek the care of a Board Certified Foot and Ankle Surgeon, like the doctors of Midtown Podiatry. We have years of experience in treating these injuries and can get you back to action fast.

We even have had personal experience with this injury, as one of our doctors has had this injury himself. Fortunately he had access to the best care with his own partners!

If you, a team mate or a family member is experiencing pain in the Achilles or has experienced a rupture, come to see us immediately with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove.

As for the Mets, we can only hope!!

By: Paul Betschart, DPM,MS,FACFAS 

Will a bad toe keep tennis great Lleyton Hewitt out of the olympics?

He doesn't think so. The Australian tennis star has been suffering with pain in his big toe joint for several years. This past season, the condition became so painful, he had to get local anesthetic injections into the joint for most of his matches. The condition he suffers from is Hallux Limitus.

Hallux Limitus is a degenerative joint condition of the big toe. It can start as a result of a trauma or from mechanical imbalances such as an elevated or hypermobile fist metatarsal bone. Early in this condition, limitation of motion in the upward direction is seen. Over time the jamming of the joint at the end range of upward bending causes damage to the cartilage of the joint resulting in pain. In later stages, bone spurs form around the joint, further restricting motion and causing additional symptoms.

Due to the impact the pain and restriction of motion was having on his tennis game, Lleyton opted for surgical treatment. He had a procedure called a Cheilectomy performed at the end of the competitive season. In this procedure, damaged bone and cartilage is removed from the joint and scar tissue released to improve pain free motion. Healing takes 4 to 6 weeks and the results should last 10-15 years. Protection of the joint with an orthotic device after surgery can enhance the results.

Lleyton expects to play and be a medal contender in the upcoming London Olympics this summer following this surgery. We will be keeping any eye on his foot work!

Should you or anyone you know be suffering from pain in the big toe joint, make an appointment to see us with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove. There are many options available for treatment, but it all starts with an accurate diagnosis. Make sure you choose the right specialist. Choose the podiatrists at Midtown Podiatry!

By: Paul Betschart, DPM

Amputations of the lower extremity take a huge physical, emotional and economic toll on a person...

The Podiatrists at Midtown Podiatry put great effort in preserving limbs should infections or other complications arise that put the limb at risk. Diabetic patients, especially those with neuropathy and/or vascular disease, are at greater risk than average for the types of complications that can lead to amputation. Research has shown that people with a lower leg amputation are twice as likely to sustain an amputation of the other leg within the next 2 years, and are at a greater risk of death.

The economic impact an amputation can cause can be devastating as well. Long periods of disability and the inability to return to previous jobs can cause hardship for many of these patients. The emotional toll can be significant, with depression commonly adding to the disability. It is for all these reasons that limb preservation is a focus, not only for us, but the entire profession of Podiatry.

It all starts with prevention. The new Thompson-Reuters study has demonstrated the positive role regular podiatry visits have on prevention of foot complications of diabetics. Here at Midtown Podiatry, we like to keep a close eye on our diabetic patients. Each begins with a thorough evaluation of the current foot and health status, tailoring treatment and follow up intervals based on individual needs. Should limb threatening complications arise, we have the resources to address those immediately. Our podiatrists have extensive training and experience in treating these complications.

We have access to a team of dedicated medical and surgical specialists at Beth Isreal Medical Center to assist us in managing these often multifaced complications. Our goal is to address these issues quickly and efficiently and return people to function as soon as possible. We know despite the best efforts, some limbs can not be salvaged, and for some situations, amputation is the best alternative. Advances in prosthetics and in medical and psychological management have improved outcomes in those undergoing amputation. Continued podiatry care is essential to preserve the other limb.

With the efforts of those dedicated to limb preservation, we hope to reduce and eventually end these devastating events.

If you or a loved one has diabetes or vascular disease, please make an appointment with the podiatrists at Midtown Podiatry, with locations in Midtown, Union Square, Gramercy Park, Wall Street and Glen Cove, immediately for an evaluation and personalized prevention plan. The limb and life you save could be your own.

By: Paul J. Betschart, DPM

With school sports seasons in full swing, it’s important to remember athletes should never “play through the pain” in their feet. Left untreated, heel pain can lead to difficulty in walking that may require complicated therapy or treatment.

Our Podiatrists at Midtown Podiatry have been seeing an increase in pediatric patients reporting heel pain with sports such as football, soccer and basketball. Obesity is also emerging as another prominent cause of heel pain even with students in physical education class activities. The good news is that kids generally heal very quickly and treatment may be simple if it is taken care of promptly.

Kids undergoing growth spurts are especially susceptible to heel pain starting at age 8 until around age 13 for girls and 15 for boys. The source of the pain is usually the growth plate of the heel bone, a strip of soft tissue where new bone is forming to accommodate adolescents’ lengthening feet. Overuse, repeated pounding or excessive force on the Achilles tendon can cause inflammation and pain.

For many teenagers, the growth plate has completely closed, and heel pain is caused by other conditions such as plantar fasciitis, tendonitis, bursitis, bone bruises or fractures. The only way to know for sure what your child is suffering from is to have them examined.

People have a tendency to give it time and see if the pain goes away on its own, and sometimes that can happen. But if symptoms persist, it’s best to make an appointment at Midtown Podiatry with locations in Midtown, Gramercy Park, Union Square, Wall Street  and Glen Cove to make an accurate diagnosis and to avoid complications.

By: Paul J. Betschart, DPM

NY Giants running back Amad Bradshaw doesn't think his will keep him out of the 46^thannual Superbowl this weekend, even though he did miss 4 games earlier in the season. His fracture is not completely healed and he is hoping that off season rest will heal it without resorting to surgery.

Amad has 1 of the 2 most common 5th metatarsal fractures, the Jones fracture. This fracture is on the outside of the foot, just forward of the normal boney prominence of the 5th metatarsal base. Usually it is caused by indirect trauma, i.e. a twisting injury. The circulation to the bone in this area is not great, so these fractures can be stubborn to heal. Often, they do require surgery. Because of the potential for delayed of non-healing, we recommend most active, athletic patients have this type of fracture treated surgically. The surgery can be performed as an out patient procedure. A period of crutch walking for 4-6 weeks is needed, followed by a walking boot for another 4 weeks. Athletic activity can usually resume in 3 months. Non- surgical treatment usually involves protected weight bearing in a walking boot until signs of healing are seen on x-ray, which can take 2 to 3 months to appear. After 3 months we consider the fracture a delayed union and after 6 months without healing it is considered a non-union. Electromagnetic or ultrasound bone stimulators can be used to treat delayed or non-unions.

These fractures can be quite painful. I guess that makes Amad tough as nails! I don't recommend you continue playing with this type of fracture, but I hope he can put up some good yardage this weekend!

If you or a loved one has sustained a foot injury, even one that was treated elsewhere, make an appointment at Midtown Podiatry with locations in Midtown, Gramercy, Union Square, Wall Street and Glen Cove. We will do everything we can to get you back in the game quickly.

By: Paul J. Betschart, DPM

Its time to say goodbye to 2011 and say hello to 2012! As the New Year rolls in there are many things to get excited about for this upcoming year; the year of the Dragon according to the Chinese, the 46^thSuperbowl, the Presidental Election of the United States and the return of the Olympics! With the Olympics in mind, a particular Gold medalist has been bringing light to a disorder that is frequently looked over. Peggy Flemming, who won the Gold Medal in 1968, has a passion for spreading awareness about PAD, a disorder commonly seen in our office at Midtown Podiatry.

What is PAD?

Peripheral Arterial Disease or PAD is a disorder of the blood circulation of the extremities where the blood flow is decreased. This is usually caused by narrowing of the arteries by a buildup on their interior wall called plaque. This condition resembles clogged pipes in your home. If the pipe is partially blocked, flow is decreased. If the pipe is completely blocked, flow stops. We don't want our blood flow to stop!

How do I know if I have PAD?

Some symptoms of PAD are foot and leg cramps while walking, coldness of the toes, loss of toe hair, nail irregularity and redness when the feet are down. Late signs are rest pain, non healing wounds and gangrene. PAD is easy to identify by one of the podiatrists at Midtown Podiatry. A physical examination will reveal clues and a simple, non-invasive test can give a picture of circulatory health in minutes.

What can be done about PAD?

In the early stages, exercise is the most common recommendation. Exercise increases the overall blood flow to the extremities and can cause blood vessels to form around the blocked area. Smoking cessation is a must if you are a smoker. Nicotine causes blood vessels to constrict, making them even more narrow. Medications which improve the flexibility of the red blood cells have also been shown to decrease symptoms of PAD. In later stages, intervention by a Vascular Specialist may be needed. Recently there have been many recent advances in the surgical management of PAD. Most exiting has been the endovascular removal of those plaques. Endovascular means working inside the blood vessel. It is a minimally invasive technique that can be performed with minimal or no hospital stay.

Should you or a loved one be concerned about PAD, make an appointment online today at Midtown Podiatry, with locations in Midtown, Gramercy, Union Square, Wall Street and Glen Cove immediately for a circulatory screening. We are offering it free of charge to all our patients and to anyone that you know!

*PAD can be a marker for circulatory problems in other parts of the body as well, like kidneys, heart and brain. This test could be a real life saver!

By: Paul J Betschart, DPM

Are you experiencing sharp pains between your third and fourth toes? If so you could be suffering from a condition called Morton's Neuromas.

Dr. Adam Cirlincione discusses what neuromas are and some typical treatment options that the podiatrists at Midtown Podiatry use to fix them.

To watch the video click here 

If you would like to speak with our doctors more about neuromas and discuss options that are best for you, please contact the podiatrists at Midtown Podiatry, with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove.

Have you been experiencing severe pain from your bunions? Or are you simply embarrassed of your feet because of your bunions? If so, Midtown Podiatry can help! Our podiatrists are experts at correcting bunions and have helped thousands of patients get rid of their bunions.

Dr. John Doolan discusses what bunions are and some different treatment options that are used at Midtown Podiatry to correct bunions.

To watch the video, click here

If you would like to speak with our doctors more about bunions and discuss options that are best for you, please contact the podiatrists at Midtown Podiatry, with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove.

Most New Yorkers can’t get on a subway without reading some kind of healthcare advertisement; and yet somehow so many people are unaware of exactly what a podiatrist is. Our podiatrists at Midtown Podiatry came up with a few facts that will answer some of your questions!

1. Podiatrists must be educated. It’s true of all podiatrists — New York and otherwise — but people in NYC are much more likely to believe that it’s possible to ‘cheat the system’. Fortunately, that’s almost impossible — there’s a basic State exam that every podiatrist has to pass; and if you have been to one (or are currently going to one) that can’t show you their certificate, find a new podiatrist, plain and simple.

2. Your feet are critically important to your overall health. Especially in the Big Apple where we all walk everywhere and there’s precious little soft ground to be found, even a minor maladjustment in your foot can cause everything from back pain to intestinal distress.

3. Your feet are not made to walk in shoes. Of course, it’s not exactly hygienic to walk around without shoes on, especially in a densely-packed city, so shoes have their purpose — but studies have shown that bare feet actually deal better with the millions of tiny impacts against hard surfaces that city life forces on them. The podiatrists at Midtown Podiatry are trained to deal specifically with the kinds of small problems that creep up when you wear shoes for your entire life.

4. Podiatrists are health-care professionals. Podiatry, NYC‘s opinions aside, isn’t just about bunions and ingrown toenails. Podiatrists are intimately familiar with the effects that foot health has on the entire body, and as such they have just as much if not more anatomical and systemic understanding as a general practitioner. They treat infections, diseases, and deformities of the foot just like a GP treats any general infection, disease, or deformity — just with more focus and thus greater clarity.

5. The foot is the early-warning system for your entire body. Think about gravity. The fact is that because of that ubiquitous force, many diseases from heart disease to diabetes often leave telltale signs in the foot before they appear anywhere else in the body. That makes the podiatrists at Midtown Podiatry a lot more than just someone who helps you walk right — he can and does save lives on a regular basis.

If you would like to meet with one of Midtown Podiatry’s trained podiatrists, with locations in Midtown, Gramercy Park, Wall Street, Union Square and Glen Cove, you can conveniently make an online appointment, or call us at any of the locations.

By: Paul J Betschart, DPM

Are you embarrassed of your toenails due to unattractive discoloration? If so, Midtown Podiatry has the solution for you! Using the Cutera Genesis Laser, our podiatrists have perfected the laser surgery technique for getting rid of fungal nails!

Dr. Joseph Larsen discusses what fungal nails are caused by and some treatment options that can be performed to control the fungi. He also mentions other problems the laser surgery can correct such as removal of scars, tattoos, and warts.

To watch the video, click here. 

If you would like to speak with our doctors more about laser surgery and discuss options that are best for you, please contact the podiatrists at Midtown Podiatry, with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove.

Feel free to browse our laser website for any additional questions.

Are you experiencing pain in your foot caused by your toes being bent? If so, you could have hammertoes. 

Dr. Adam Cirlincione discusses what a hammertoe is and what typically causes a hammertoe. He also discusses both conservative and surgical treatments that we do for hammertoes at Midtown Podiatry.

To watch the video, click here.

If you would like to speak with our doctors more about Hammertoes and discuss options that are best for you, please contact the podiatrists at Midtown Podiatry, with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove.

Are you waking up in the morning and feeling severe pain when you step out of bed? If so, you may be suffering from Plantar Fasciitis.

Dr. John Doolan discusses what Plantar Fasciitis is, what causes it and what are some typical treatment options to correct it.

To watch the video click here

If you can relate to what Dr. Doolan is talking about and think you may be suffering from Plantar Fasciitis then make an appointment today to see the Podiatrists at Midtown Podiatry with locations in Midtown, Gramercy Park, Union Square, Wall Street or Glen Cove.

According to the World Health Organization, there are over 312 million people in the United States, of which 25.8 million are diabetic, which accounts for approximately 8.3% of the children and adult population. Celebrities like Halle Berry, Jay Cutler, Aretha Franklin, and Nick Jonas have all been diagnosed with Diabetes, furthermore proving that people of any demographics are at risk.

Data from the 2011 National Diabetes Fact sheet indicates that there are 18.8 million people who have been diagnosed with diabetes, 7 million who remain undiagnosed and another 79 million who fall under the pre-diabetic category.

In 2010, there were 1.9 million new cases of diabetes in people ages 20 years and older. These statistics are staggering and the reality is that diabetes has become a disease that we can no longer ignore due to its epidemic nature.

• Diabetes has become the leading cause of non-traumatic amputations. In fact more than 60% of non-traumatic lower-limb amputations occur in people with diabetes.
• In 2006, about 65,700 non-traumatic lower-limb amputations were performed in people with diabetes.

At Midtown Podiatry, our board certified podiatric physicians are highly trained in advanced wound care techniques and surgical procedures and offer all of our patients a comprehensive lower extremity physical examination. Our podiatric evaluation includes both vascular and sensory testing, involving the traditional and more advanced techniques for those patients who require more detailed assessments. We can offer our patients a diagnosis and their risk assessment.

Our goal is to concisely evaluate patients and determine those who are at low, moderate to high risk for developing ulceration. Our podiatrists will be able to initiate the proper treatment plan customized to our individual patient. There is strong evidence in the literature that states that proper podiatric evaluation and education for diabetic patients prevents amputation, lower limb infection and saves lives. Our role in a diabetic patient’s life is to help identify potential lower extremity preexisting conditions, structural deformity and other issues which if left untreated will lead an individual at risk for lower extremity infection, amputation, permanent disability and even death.

If you are suffering from Diabetes, make an appointment to come into Midtown Podiatry with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove. Our skilled podiatrists would love to work closely with you to figure out a treatment plan that will keep your feet healthy!

By: Sharon Barlizo, DPM

Dr. John Doolan from Midtown Podiatry was recently featured on Televisa, a local New York City spanish station, discussing the effects of wearing high heels and flats.

Watch the video here.

If you are experiencing foot pain, schedule an appointment today with one of the podiatrists at Midtown Podiatry with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove.

          Zumba has quickly become the new craze not only in NYC but throughout Hollywood as well; celebrities such as Kirstie Alley, Madonna, and Jennifer Lopez have all expressed their love for the new workout routine. Zumba is an intense fitness program that gets you into shape while you dance away to sensational Latin and International inspired beats.  It combines upbeat, irresistible music, created by Grammy-Award winning producers, with dynamic movements and cardio training to get visible results.  But can this contagious, body-firming, calorie-burning phenomenon take a toll on your feet??  Not if you allow the podiatrists at Midtown Podiatry to help keep you prepared and take the right precautions!!

            I’ve had several Zumba-fanatic patients present in the office with severe foot pain.  Some of the common complaints have been toe cramps, numbness, burning sensation during class, pain on bottom of feet (plantar fasciitis), ankle sprains, blisters, and knee pain.  Of all of these, the most common complaint in my experience has been a burning, numbness feeling in the toes.  The reason this pain occurs is because of to too much pressure on the toes, since most of the movements in Zumba require staying on the balls of your feet.  Several criteria can cause excess pressure, among these are:

• Ill-fitted shoes
• Internal tendon imbalances and joint mal-alignments
• Too much or too little room in the toe box of your sneaker. 

These can all be avoided if you just follow some simple rules and take some precautions:

            The type of sneaker that you choose is crucial.  Many beginners will think that any good quality sneaker is sufficient.  However, due to the types of movements required in Zumba coupled with the aerobic type of activity, improper shoe gear can put you at risk for various foot and ankle injuries.  You need a sneaker with a low tread, something that is light weight, has good shock absorption, and enough support for medial/lateral (side to side) movements.  The low tread will allow you to do the dance-like moves without causing excessive torque to your ankles and knees. 

            A running shoe is a definite no.  This has too much tread and is made particularly to control front to back motion (not side to side).  Contrary to popular belief, a dance shoe is also not the best choice (although better than a running shoe).  A “typical” dance shoe does have low treads and is light weight; however, its thin soles lack shock absorption and support.  Therefore the best sneaker is an aerobic sneaker made for dance.  This shoe will have a thinner sole, few treads, good shock absorption, and support for medial/ lateral movements.

            Also important is to make sure you take at least 5 minutes extra to stretch before and after your workout.  Stretching before exercises will warm up your muscles and will reduce the strain on them during your exercise routine.  Stretching after exercise will allow your heated up and tight muscles to gently cool down to prevent soreness a few hours later.  Doing both of these will drastically reduce your chance of foot injury.

            Lastly, custom molded orthotics can address any structural or functional mal-alignment of the joints, tendons, and muscles of your feet and ankles.  These custom foot inserts made specifically for your feet can easily replace the inserts that come with your sneaker.  At Midtown Podiatry, with locations in Midtown, Wall Street, Union Square, Gramercy Park and Glen Cove we have the proper equipment to make custom orthotics in all of our offices.

            So, there it is folks.  Continue with your irresistible, contagious Zumba programs! Have fun and rewarding workouts, but don’t forget to make an appointment with the podiatrists at Midtown Podiatry to keep those feet Zumba ready!

By: Lisa Shah, DPM

If you are having heel pain that seems to continue to get worse every day; you may be suffering from a common foot condition called Plantar Fasciitis. Plantar fasciitis is the inflammation of the tendon that runs along the bottom of our foot. Patients that come into our office at Midtown Podiatry usually complain that the pain begins with slight heel discomfort and then becomes very painful as days go by.

Plantar fasciitis is usually associated with foot deformities such as high arches and flat feet. External factors such as walking (which can easily affect New Yorkers that spend their days walking around), running and exercising with non-supportive or worn out shoes, and slight sudden weight gain can cause sudden inflammation of the plantar fascia. Eli Manning, the quarterback of the New York Giants, has been diagnosed with this painful condition back in 2009 in his right foot due to his intense exercise regimen.

This condition can be easily corrected with proper treatment.  Initial treatment for plantar fasciitis consists of cortisone injections, padding and strapping, stretching and strengthening exercise, ice therapy, taking anti-inflammatory medication, proper orthosis (insert), shoe gear and physical therapy. For very painful and long-standing plantar fasciitis we do Radio Frequency Treatment.

If you are experiencing discomfort due to a heel pain, it is time you called Midtown Podiatry in New York City. You can meet with our physicians in one of our offices in Midtown, Gramercy Park, Union Square, Wall Street or Glen Cove.

By: Ameneh Aminian, DPM

Now that the training for the New York City Marathon is over, it’s time to get those feet checked! If those dogs are barking it may be a sign that you have an injury that needs to be evaluated and treated by the experienced podiatrists of Midtown Podiatry. That ache in your foot may be a lot worse than you think…

Whether its heel pain, an ankle sprain, blisters, or a fracture - similar to what Ahmad Bradshaw of the New York Giants has previously had surgery for - you need to have those foot aches checked out.

Training for the New York City Marathon can take its toll on your body. The most common injuries following the marathon are to the feet. A common injury that can occur from everyday walking in the streets of Manhattan or training for the NYC marathon is a stress fracture. Stress fractures occur when the stress or pressure on the bone causes a break or fracture of the bone.

Most stress fractures in the foot can be picked up by x-rays which can be performed in our offices at Midtown Podiatry. In very few instances there is a need for an MRI to diagnose the injury. Once diagnosed with a stress fracture the treatment is often conservative with rest, ice and immobilization. In very few instances surgery to correct a fracture is needed to place a screw across the fracture site.

I’ve become very familiar with athletic injuries such as stress fractures having sustained a similar injury when I was a collegiate wrestler. Although my days of wrestling are long gone, I continue to work with athletes and treat their injuries.

For a post race check up of those feet please call the doctors of Midtown Podiatry with convenient locations in Gramercy Park, Wall Street, Union Square, Midtown and Glen Cove.

We are here to get those feet feeling good once again!

By: Adam Cirlincione, DPM

There are women all over New York City, and all over the world, who are dying to fit in to this season’s Manolo Blahniks, Jimmy Choos, or Christian Louboutins but are having trouble due to those darn bunions! Bunions do not only affect women however; both genders can experience extreme discomfort from them that can ultimately interfere with their daily life.

Not all bunion surgery is the same; in fact, there are over 100 different types!  At Midtown Podiatry, we have noticed that most people who come into our offices complaining of a bunion fall into one of four categories:

1. Simple Bunion -
   • This is a small bump, so the procedure for it is fairly simple. Our physicians would take just off the bump. Since this is a minor procedure the recovery period is also minor, with about 3-4 weeks in a surgical shoe(s) and one month in sneakers with weight bearing throughout.
2. Typical Bunion –
   • This is a mild to moderate deformity.  For this type of bunion, our physicians will usually take off the bump, surgically break the bone and move it into a better position, held with a screw or a pin. This type of bunion surgery is actually the most common and requires patients to recover for 3-4 weeks in a surgical shoe(s) then follow that with a month in sneakers with weight bearing throughout.
3. Severe Bunion –
   • For this type of bunion surgery our physicians will most likely fuse bones (join two separate bones together) to make a dramatic and permanent correction using plates and or screws. This type of bunion correction surgery is not as common and could require the patient to recover for up to 6 weeks in crutches and a month in a sneaker.
4. Bunion in the elderly –
   • To treat bunions in the elderly our physicians remove the bump as well as some bone. The recoveries time for this a quick one; about 3- 4weeks in surgical shoe and a month in sneakers.

It is NORMAL to have stiffness, swelling, and limited range of motion for months after a bunion procedure! The patient must always be ready for the recovery!

If you have been suffering from a bunion and have been considering getting the corrective surgery, our podiatrists at Midtown Podiatry, with New York locations in Midtown, Gramercy Park, Union Square, Wall Streetand Glen Cove, will be with you every step of the way! Our Board Certified physicians have become experts in Bunion Surgery throughout the 16 years our practice has been open. If you are ready to experience life without the pain a bunion causes or want to fit in to this next coming season’s must have high heels, don’t waste another minute! Call one of our offices today or visit us online to make an appointment!

By: John J. Doolan, DPM

The first time I had ever heard of them was about 20 years ago (I may be showing my age here). I was no Kobe Bryant, Lebron James or the next New York Knicks star, but I was playing basketball in college and one of my teammates was out of practice for an extended period of time.

He complained that he couldn’t run because of these painful "things" on the bottom of his feet. He claimed that he was going to the doctor once a week and having them "scraped down", and that the only way for him to run was to get this procedure done. After I asked him what the problem was he said he had "plantar warts". Of course at that time I was unfamiliar with what these agonizing warts were, and what caused them; all I knew is that according to my teammate he couldn’t get rid of them till 9 months later.

Little did I know at the time how familiar I would become with plantar warts.  Plantar warts are viral infections in our skin manifesting themselves mostly on the bottom of the foot. Conventional treatment has included:

• Weekly scrapings and medicine in the office and at home on a daily basis to try to get rid of the wart.

                 -This usually takes months and months and doesn’t always work as a permanent solution.

• Surgical excision

                - This tends to leave a painful open sore that needs to heal on its own over a 6 week period.

• Laser Treatment

Midtown Podiatry is excited to have the Cutera Genesis 2 Laser in our office. This laser, through a heating method, cauterizes the wart immediately with only one treatment in the office and takes less than 1 minute. After the treatment the patient leaves the office and 85% of the time, within a 6 week period, the wart falls off the foot. This advancement in treatment through laser technology has made the treatment of warts quicker, less painful, and more effective.

If you are experiencing discomfort due to a plantar wart, it is time you called Midtown Podiatry in New York City. You can meet with our physicians in one of our offices in Midtown, Gramercy Park, Union Square, Wall Street or Glen Cove.

By:  Joseph Larsen, DPM

Year round our podiatrists at Midtown Podiatry treat many dermatological problems. Jay Cutler, the quarterback of the Chicago Bears, is susceptible to some of these podiatric issues since revealing in 2008 that he suffers from Diabetes.  Diabetic patients need to pay extra attention to their feet as they can really give an insight to your current health. In New York City, we are always on our feet and with the constant daily weather changes we have been experiencing lately, our feet are having to adapt to cold, warm and even wet atmospheres. Injuries, Diseases, shoes and even weather are all reasons why New Yorkers may have problems with their feet.

In terms of podiatry, NYC is a strange population. Some citizens of the Big Apple, like Lady GaGa, Sarah Jessica Parker, and Eli Manning are extraordinarily contentious about caring for their feet, and others wouldn’t know a podiatrist if they tripped over one. In order to promote general foot health in the concrete jungle, our podiatrists put together these helpful tips to keep city-bound feet at their best:

• Get professional help determining your shoe size once a year. Contrary to what people believe, your feet do continue changing shape as you age, even once you reach adulthood, and having shoes that don’t actually fit your feet is horrible for your posture and future foot health.
• Cut your toenails. Don’t try to round them at the corners — that’s begging for an ingrown toenail. Cut them straight across, even if it’s less cute.
• Keep your feet dry and clean. Pay particular attention to drying between your toes, a common place for fungus to take hold.
• Use a powerful moisturizer on your feet on a regular basis. Our podiatrists at Midtown Podiatry NYC office can recommend a good one for you. Make applying moisturizer a part of your nightly bedtime routine.
• Look at your feet. Too often, at Midtown Podiatry, with locations in Gramercy Park, Midtown, Union Square and Wall Street, NY, we see many people who focus on things only above their deskline and ignore everything below — but the foot can offer significant early warning signs of disease. Check for abnormal discolorations, numbness, ulcers, peeling between the toes, and temperature sensitivity, all of which can be indicators of severe underlying problems.
• Change your socks! It sounds disgusting, but old socks rapidly become breeding grounds for swarms of bacteria and fungus. Put them up. As in, relax and put your feet up. Nothing to do with the doctor here, just some good all-around advice: de-stress to keep your feet healthy — and the rest of you, too.

Of course, if anything even slightly out of the ordinary is causing you any concern, come see a podiatrist at Midtown Podiatry, with locations in Gramercy Park, Midtown, Union Square and Wall Street, NY,immediately. Attempting to self diagnose a health problem in your feet is a recipe for disaster; the foot is so small and complex that almost any symptom can have multiple potential causes, and treating yourself for the wrong cause can mean the right cause goes untreated and wreaks havoc on your body.

By:  Paul J Betschart, DPM, MS, FACFAS

http://gramercyparkpodiatryblog.com

Paul J Betschart, DPM

It is believed that many factors play a role in the development of athletic performance. From cardiorespiratory capacity to skeletal muscle function, can our genetic and musculoskeletal makeup predict our talent as an athlete?

With many sports performed in closed chain environments our foot is highly integrated in lower extremity kinematics, postural stability and force production. Exactly how important is the foot type in determining athletic skill? With most attention on the association between foot types and risk of injury, what if instead we took a moment to look at certain foot variances and the advantages each may have on athletic performance?

Foot-Typing

Due to the variances in foot type and arch height we need to begin with a classification system that is reliable and consistent. Simply classifying a foot as a high arch or low arch does that reflect the dynamic biomechanics of an athlete's foot-type.

One such foot-typing system that does provide validity and reproducibility is the Foot Posture Index. The Foot Posture Index is a 6 point static foot assessment performed in multiple planes which is used to classify foot-type and degree of severity (Cornwall 2011).

A 2011 study by Cornwall et al. evaluated the reliability of the Foot Posture Index to predict dynamic foot function. After evaluating 203 subjects it was concluded that the Foot Posture Index can predict dynamic foot mobility. Those subjects with the greatest foot mobility correlated with the over-pronated or low arch foot type. Conversely those with decreased foot mobility were associated with a more supinated or high arch foot type.

Over-Supinated Foot Type

In the over-supinated foot-type the heel and subtalar joint are in an inverted position with a lateral shift in body weight and slight adduction of the forefoot on the rearfoot. Typically we think of an over-supinated foot type as more rigid with an increased risk for stress fractures, tendonitis and plantar fasciitis. But could there be any advantages to this supinated foot position?

Advantage #1 - Rapid Re-Supination

In sports such as soccer, changes in direction and cutting maneuvers require rapid activation of the posterior tibialis in order to create a rigid foot lever and push off. Although it is purely anecdotal, perhaps a more supinated foot type allows the athlete to quickly change direction and push off of the ground.

Advantage #2 - Decreased Contact Time

For a runner or athlete the ability to decrease contact time, not only makes them faster but also decreases the risk of injury. In endurance sports, time spent in contact with the ground is when the athlete gets injured.

A 2007 study by Hasegawa et al. found that when comparing different foot strike patterns, running speed and contact time, those runners with a midfoot and forefoot strike had a shorter contact time when compared to runners with a rearfoot strike.

In addition it was observed that regardless of foot strike pattern, those runners who had the greatest degree heel inversion at foot strike also had the shortest contact time. Because an over-supinated foot type has increased calcaneal inversion this may provide an advantage in reducing contact time when running (Hasegawa 2007).

Over-Pronated Foot Type

In the over-pronated foot-type the heel and subtalar joint are in an everted position with a medial shift in body weight and abduction of the forefoot on the rearfoot. This foot type is typically associated with increased plantar pressures and force distribution over the plantar foot. Typically we think of an over-pronated foot type as more mobile with an increased risk for posterior tibial tendonitis, knee pain and bunions. But could there be any advantages to this pronated foot position?

Advantage #1 - Improved Balance

A 2002 study by Hertel et al. compared balance and stability in different foot types. Interestingly it was found that the over-pronated foot type had better balance when compared to the over-supinated foot type. It was hypothesized that eue to the increased plantar contact in an over-pronated foot type there was an increase in plantar cutaneous feedback which is critical in stabilization. Sports requiring balance, such as karate, boxing or gymnastics may benefit from this foot type.

Outside of increased plantar distribution, the over-pronated foot type may not be as advantageous when it comes to athletic performance. Since many athletics are dependent on force, speed and agility - all of which relate to rapid foot contact time - the delayed strength and activation of the posterior tibialis may put this foot type at a disadvantage.

Conclusion

Although much of this information is anecdotal due to the lack of research, it does provide important considerations for the coach or parent of an athlete. We are all born with a specific foot type, so it is up to us to understand our foot type and use it to our advantage whether it be for agility or balance & stabilization!

***

To learn more about foot-typing and how to create a foot-specific program for your clients and athlete's – consult a podiatrist at Midtown Podiatry, or make an appointment online.

By: Dr. Emily Splichal 

Normal gait requires at least 10 degrees of ankle dorsiflexion, with maximum dorsiflexion occurring closed chain during late midstance. Limited ankle dorsiflexion can result in a myriad of compensations both proximally and distally.

From knee hyperextension to midfoot over-pronation, the deforming forces caused by tight calves is enough to make any Movement Specialist cringe. I refer to this lack of ankle joint dorsiflexion as a "Podiatric Epidemic" as a majority of people assessed lack adequate ankle joint range of motion.

For clients or athletes who have adequate pelvic flexibility but demonstrate decreased gastrocnemius range of motion, we want to integrate posterior group stretches.

When recommending posterior group stretches some classic stretches include the wall stretch, downward facing dog and dropping a heel off of the step. When performing theses stretches have you ever considered the role rearfoot position may have on the effectiveness of each stretch?

Impact of Rearfoot Position on Stretching

A 2009 study by Jung et al. evaluated the impact of rearfoot position on the effectiveness of gastroc stretching. Due to the prevalence of tight gastrocs in an over-pronated foot type, Jung et al. wanted to determine if the everted calcaneal position altered the effectiveness of the stretch.

Jung et al. evaluated 30 patients with both a neutral foot type and an over-pronated foot type with increased calcaneal eversion (average 4 degrees). Subjects performed a gastrocnemius wall stretch both in their relaxed calcaneal stance position and while wearing orthotics which placed the calcaneus in a neutral position.

Ultrasound technology was used to evaluate the degree of stretch as determined by the change in myotendinous length. It was observed that rearfoot position had a significant impact on the effectiveness of posterior group stretching. A 3mm difference in gastroc lengthening was achieved while stretching with the everted rearfoot shifted into a neutral position.

Considerations for the Movement Specialist

When considering articles to review and share on the EBFA Blog, I like the above study for several reasons:

1. It emphasizes the impact subtle adjustments in body positioning can have on stretching effectiveness. As evidence-based fitness professionals, if we can apply research studies such as this into our client's programming we may begin to see better results.

2. It re-emphasizes the concept of foot-specific programming which I integrate into my Barefoot Training Specialist workshops. In an over-pronated foot type with increased calcaneal eversion you want to consider the impact ankle stretching may have on the weakened posterior tibilais tendon.

3. When the calcaneus is brought out of the excessive eversion the stretch becomes more isolated to the Achilles tendon and gastrocnemius/soleus - with little stress to the posterior tibialis.

Want to integrate this evidence into your client's programming?

1. For any clients with an over-pronated foot type, isolated gastroc stretching should be performed preferably non-weight bearing to minimize the impact of rearfoot position during the stretch.

2. If a client uses orthotics that control rearfoot motion, perform closed chain gastroc stretches while wearing the orthotics and then remove the shoes for the barefoot training exercises.

3. For any clients with an over-pronated foot type and wear Vibrams or minimal footwear for daily use and training, frequent evaluation of the posterior tibialis tendon should be performed.

To learn more about this, make an appointment online or visit a podiatrist at one of our convenient locations.

By: Dr Emily Splichal, DPM

    

            Although some of you may immediately get pictures of the Grey’s Anatomy cast performing surgery in the middle of an unsanitary bathroom, bathroom surgery is actually a term we like to use for patients performing their own care for foot ailments such as corns, callouses, warts and ingrown nails using sharp implements like clippers and razors. Many people feel that this is the way to take care of these problems. In fact, the federal government has stated that the routine treatment of corns and callous and the trimming of nails is within the realm of self-care; except for those with serious medical conditions that affect the circulation or sensation of the feet, like Diabetes. 

I must state that I disagree with this position. Routine trimming of normal toenails is by all means OK, provided the person has the flexibility to reach the toes and the eyesight to see what they are doing. I have seen many serious complications though when people try to self-treat in growing nails, warts, corns and callouses using sharp implements or chemicals. These conditions are best treated by a skilled foot specialist. In the state of New York, even pedicurists are not permitted to treat these conditions with sharp instruments. So what to do?

            A visit to a local podiatrist is the place to start. Not only can the podiatrist treat these problems easily and painlessly, we can determine the cause of the problem and find long term solutions so that bathroom surgery won't be necessary any more. Be sure to look for someone who is Board Certified, like the doctors at Midtown Podiatry, with locations in Midtown, Gramercy, Union Square, Wall Street and Glen Cove. Our Mission: To get foot surgery out of the bathroom and into the hands of our specialists!  Should you or a love one be suffering from a foot problem, drop the razor and pick up the phone and call us! You will be glad you did!

By: Dr. Paul Betschart