A Stress fracture is generally an overuse injury. It occurs when muscles become fatigued or overloaded, and cannot absorb the stress, shock, and repeated impact. Fatigued muscles transfer that stress to the nearby bone and the result is a small crack or fracture.

What Causes a Stress Fracture of the Foot?

Stress fractures in the bones of the foot are usually caused by over-training or overuse. They can also be caused by doing too much on hard surfaces, such as running on concrete or wood floors. Increasing the time or intensity of exercise too rapidly is another cause, as well as wearing improper footwear.

Women seem to be at greater risk than men are. This may be related to a condition called the “female athlete triad”.  This is a combination of poor nutrition, eating disorders, and amenorrhea (infrequent menstrual cycles), that predisposes to osteoporosis ( thinning of bones ).

It should also be mentioned that stress fractures could occur for no known reason.

Diagnosing Stress Fractures

Many times the foot is swollen and painful without any history of injury. Standard X-rays will usually not show the fracture until2-3 weeks after the original symptoms. A bone scan, CT scan, or MRI may be necessary to detect the stress fracture in the early stages.

Treating Stress Fractures

The best treatment is rest. It may take anywhere from 6-8 weeks for complete healing to take place. Sometimes an anti-inflammatory medication (Ibuprofen, Aleve, or stronger ) is needed. In more serious cases, an off-loading surgical shoe or walking boot is advised. In very serious or painful cases, a fiberglass cast may be needed.

Differential Diagnosis:

Stress fractures can also give the same symptoms as bursitis, arthritis, tendonitis, and gout. Sometimes a blood test will be able to help.

Your Podiatrist will be able to diagnose and evaluate your specific condition and recommend the proper treatment.

We are pleased to announce that Carl J. Hoeger, D.P.M. has joined our practice

And will be seeing patients at these locations:

Amherst Office
3980 Sheridan Drive
Amherst, NY 14226
716-839-3930

Niagara Falls
6934 Williams Road
Niagara Falls, NY 14304-3080
716-298-1600

Springville Office
27 Franklin Street
Springville, NY 14141
716-592-4540

(Opening September 1st)
Derby Office
7060 Erie Road, Suite 400
Derby, NY 14047
716-839-3930

Dr Hoeger attended Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania. Prior to embarking on his medical training, he graduated from Villanova University in Philadelphia, Pennsylvania with a BS degree in Biology and then lived and worked in East Asia for six years.

Dr. Hoeger graduated from a 3-year podiatry residence program at Sisters Hospital, Buffalo, New York. He completed that program as Chief Podiatry Resident.

We welcome Dr. Hoeger to our office. Patients may call to arrange an appointment at any convenient time.

What is a Plantar Wart?

A wart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly.

There are two types of plantar warts:

• A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional “satellite” warts.
• Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.

Causes

Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body.

Symptoms

The symptoms of a plantar wart may include:

• Thickened skin. Often a plantar wart resembles a callus because of its tough, thick tissue.
• Pain. Walking and standing may be painful. Squeezing the sides of the wart may also cause pain.
• Tiny black dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the capillaries (tiny blood vessels).

Plantar warts grow deep into the skin. Usually this growth occurs slowly, with the wart starting small and becoming larger over time.

Diagnosis and Treatment

To diagnose a plantar wart, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a wart.

Although plantar warts may eventually clear up on their own, most patients desire faster relief. The goal of treatment is to completely remove the wart.

The foot and ankle surgeon may use topical or oral treatments, laser therapy, cryotherapy (freezing), acid treatments, or surgery to remove the wart.

Regardless of the treatment approaches undertaken, it is important that the patient follow the surgeon’s instructions, including all home care and medication that has been prescribed, as well as follow-up visits with the surgeon. Warts may return, requiring further treatment.

If there is no response to treatment, further diagnostic evaluation may be necessary. In such cases, the surgeon can perform a biopsy to rule out other potential causes for the growth.

Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove warts themselves. This can do more harm than good.

Information from Podiatry Today, April 2011, “Emerging Concepts In Cosmetic foot Surgery” by Allan Grossman, DPM lead author.

Fat pad injections are another practice gaining momentum. The plantar fat pad absorbs much of the pressure that our feet must endure. Over time, this fat pad wears down and atrophies resulting in painful callouses and in some patients ulcerations. Some of the conservative treatments to approaching this situation include orthotics, gel cushion inserts and changes in shoe gear.

Attempts have been made to inject silicone into these atrophied areas with some success. Research studies have shown a reduction in pressure in areas injected with silicone but the results do not last long and the patient requires multiple injections. Other similar treatments with products called dermal fillers ( Restylane and Sculptra) have shown similar results but also require multiple treatments.

Autologous fat can augment fat pad atrophy with some relative success. Working with a cosmetic surgeon, fat removed during liposuction can then be transplanted into areas of fat pad atrophy on the foot. Another technique of fat pad augmentation is the use of acellular human dermal allograft, human tissue grown in a lab. A 2009 a study performed to measure the success of this technique showed reduced pressures and according to the lead author solves the problem “permanently and practically”.

As always one should weigh the risks versus the benefits when considering a surgical procedure, especially an elective cosmetic procedure versus non-elective procedure. You should discuss you specific condition and treatment options with a trained Podiatrist so that you can make the best, well informed decision that will give you the best long term result.

Barefoot Running appears to be the new fad. It was made very public when in 1960, Ethiopia’s Abebe Bikila, won the Olympic marathon in world record time, while running without shoes.

Of late, many runners have taken to the streets, grass tracks, sandy beaches, to name a few surfaces, without shoes.

Is there a benefit to running without shoes?

According to a 2010 study published in the journal Nature, runners who wear shoes tend to strike the ground with the heels of their feet first. This gait, called a heel-strike, generates a force up to three times the body’s weight, which can lead to injuries such as Achilles tendinitis and stress fractures. In contrast, barefoot runners land on the balls of their feet, generating less impact when their foot strikes the ground.

“We’ve oversupported our feet [in running shoes] to the point that our foot doesn’t have to do what it’s designed to do,” explains Irene S. Davis, PhD, PT, professor of physical medicine and rehabilitation at Harvard Medical School.

Ditching your shoes means the muscles in your calves and feet will have to work harder to accommodate to a different foot strike and shorter stride; it takes time for new barefoot runners to build up those muscles.

If you have a history of foot problems, check with your doctor before going barefoot. If you decide to ditch your running shoes, there are a few things you should know:

Start slow. You are more likely to suffer injuries if your foot and leg muscles are not properly conditioned for running barefoot. Start with walk-jog intervals, walking for nine minutes, running for one minute, and repeat, working up to longer distances. In addition, the skin on your feet needs to thicken to get used to barefoot running.

Think twice. Many podiatrists feel running barefoot is dangerous. “Most of my patient’s are not world class runners,” says Stephen Pribut, D.P.M., sports podiatrist from Washington, D.C. “ It doesn’t make sense to risk getting stones, twigs, and glass in your feet.”

Know when to say no. Runners who have any loss of feeling in their feet ( neuropathy ), including people who have diabetes, should wear sneakers.

There are available some new-type shoes, such as Vibram Five Fingers TM, that supposed help protect the foot, while giving the advantage of running barefoot.

The theory is still being debated and there is no real data available to make any educated evaluation of whether running barefoot is better than running in shoes. You must use your own judgment and above all be safe. Even Abebe Bilila wore shoes 4 years after his barefoot victory in Rome and still won the Tokyo Olympic Marathon.

Have You Discovered Warts On Your Feet?

No Need To Panic!
Let Podiatry Affiliates Help Rid You Of Warts And Provide All Your Foot Health Needs

Although warts are harmless, there is no doubt that they are unsightly. In addition, when one develops on your foot, it can become quite painful. Taking care of warts when they appear is an important part of maintaining your foot health.

If you have discovered a wart on your foot, the experienced podiatrists at Podiatry Affiliates can help you get rid of it with the help of one of many different treatment options.

Some of the treatment options that are available for getting rid of warts include:

• Freezing the wart with liquid nitrogen
• Laser treatment
• Chemical treatment
• Surgical removal of the wart

Each of these treatment options is aimed at destroying the growth of the wart, rather than killing the virus that causes them to form. The treatment option selected for your particular situation will have much to do with your unique situation. For instance, if you are pregnant, chemical methods cannot be used for the treatment of warts.

While these treatments have proven to be successful for many people, it is important to remember that treatment is not always successful. Warts can be quite difficult to get rid of. In fact, there are times when warts simply will not go away despite heavy treatment. Furthermore, new warts may develop while the original wart is being treated. It is not uncommon for a wart to reappear after it was seemingly destroyed, even if it has been several months since being treated.

While warts can be frustrating to deal with, the good news is that they are harmless and really are quite common. While they may bleed on occasion, particularly after they have been irritated in some way, they never become cancerous or cause other health issues. They are highly contagious, however, and if they form on pressure areas, they can push inward and cause a great deal of discomfort. Therefore, if a wart forms on your foot, it is a good idea to treat it and get rid of it before it causes problems or spreads to other parts of the foot.

If you are ready to take control of your foot health, Podiatry Affiliates can help. With four convenient New York locations – Amherst, Buffalo, Niagara Falls and Springville – we are where you are, and can help you maintain good foot health. Call us at (716) 839-3930 or send us an e-mail at questions@podiatryaffiliates.com to set up an appointment today.

Do Your Feet Hurt?
Are You Suffering From Tendonitis?

Get Relief With The Help Of An Experienced Podiatrist At Podiatry Affiliates

If you are experiencing pain and discomfort in your foot or ankle, you may be suffering from tendonitis. This condition can affect one or more of several different tendons within your foot or ankle. These include:

• Achilles Tendonitis

  This condition affects the large tendons that connect the back of the heel to the calf muscles. Those who are suffering from this condition typically feel pain when lifting their heel off the ground while walking.

• Posterior Tibial Tendonitis

  This condition affects the tendon under the foot arch. Those who are suffering from this condition feel pain in the arch when pushing off to take a step.

• Anterior Tibial Tendonitis

  This condition affects the main tendon on the front of the ankle. Those who are suffering from this condition feel pain in their instep while walking downhill or down stairs.

• Peroneal Tendonitis

  This condition affects the tendon on the outer side of the ankle and foot. Those who are suffering from this condition feel pain while standing or when pushing off to take a step.

When suffering from tendonitis, it is important to consult with an experienced podiatrist in order to determine the proper treatment plan. When meeting with a podiatrist, it is important to consider possible causes for your condition. In this way, your podiatrist will be better able to determine a treatment plan that will help you heal, while also preventing future injuries.

Some possible causes of this condition include:

• Overuse of the muscle through repetitive or excessive use
• Weight gain
• Inactivity
• Shoes that are worn out on one side
• Foot deformities such as high-arched feet or flatfeet

Each of these can lead to excessive strain of the outer covering of the tendon, which can cause the tendon to swell or to develop small tears. To get a better idea of what might have caused your condition to develop, the podiatrist will ask questions about your overall health, as well as the activities that are causing you pain. The podiatrist might also order x-rays or an MRI to get a better idea of the damage.

If you are experiencing pain in your ankle or foot, it is important to address the condition as soon as possible. Not only will treatment help eliminate the pain, but it will also prevent further damage from occurring. Stop living with foot pain. Give Podiatry Affiliates a call at (716) 839-3930 today.

Are You Considering Diabetic Shoes To Help Keep Your Feet Healthy?

Meet With An Experienced New York Podiatrist From Podiatry Affiliates To Learn More About How You Can Achieve Optimum Foot Health

Do you suffer from diabetes? If so, you are probably well-aware that foot problems are the leading cause of hospitalization for those with this chronic disease.

In fact, an estimated 15% of all people who suffer from diabetes will develop some sort of foot condition at some point in their lives. To help prevent problems from developing, it is often a good idea to invest in special diabetic shoes.

While some diabetics can find comfortable sneakers or jogging shoes that fit comfortably and allow their feet to “breathe,” others may need to have custom diabetic shoes made in order to obtain proper fit and improved comfort. These special shoes can provide the extra depth, cushioning and support needed to allow for proper circulation.

Whether you purchase special diabetic shoes or not, there are a few simple guidelines you should remember in order to keep your feet as healthy as possible.

• Check your shoes for foreign objects or torn linings before wearing them
• Avoid wearing the same pair of shoes for more than four or six hours each day
• Break in new shoes by wearing them for only a few hours at a time
• Choose socks that are well-fitted and do not have folds or seams
• Avoid wearing sandals or open-toed shoes
• Do not walk with bare feet

In addition to selecting the proper footwear, it is essential to avoid certain situations that could cause problems for your feet. Some of these include:

• Do not soak your feet in hot water
• Do wash your feet with warm, soapy water every day
• Do not use hot water bottles or heating pads on your feet
• Do make sure your feet are completely dry after washing them
• Do not use acids or chemical corn removers
• Do use moisturizing creams on your feet every day, taking care to avoid getting the cream between your toes

It is also important to schedule regular appointments with an experienced New York podiatrist to check the health of your feet, even if you aren’t sure you are experiencing any problems at the present time.

To learn more about diabetes, or your specific foot concerns, make an appointment with a knowledgeable and experienced New York podiatrist at Podiatry Affiliates. With four different locations to select from – Amherst, Buffalo, Niagara Falls and Springville – we are confident you will find a location that is convenient to you. Give us a call at (716) 839-3930 or send us an e-mail at questions@podiatryaffiliates.com today.

Think You Might Be Suffering From Bunions?

Let The Doctors Of Podiatric Medicine From Podiatry Affiliates Help!

Are you experiencing pain in your big toe? If so, you might be experiencing a bunion. But do you know what a bunion really is?

In general, a bunion is characterized by an enlargement of the area behind the big toe, though the size and exact position of the bunion can vary from one person to the next.

Contrary to popular belief, bunions are not caused by wearing shoes that are too tight or that do not fit properly. Rather, some of the more common causes of bunions include:

• A bone in the foot that was moved out of position
• Improper bone structure of the foot
• Walking incorrectly over a period of years
• Injury or arthritis to the joint

There are two primary types of bunions that a person may experience.

The first, a positional bunion, is characterized by the big toe being pushed in toward the next toe. As the big toe gets pushed toward the other toe, the pull of the ligaments and tendons is changed, which results in misaligning the joint.

The other type of bunion is called a structural bunion. With this type of bunion, the long bone behind the big toe gets out of position, causing the big toe to lean in.

The good news is that most people suffering from bunions do not have to live with the pain. In fact, there are many treatment options available. In some cases, they can be treated with shoe modifications or by inserting custom orthotics into the shoe. This treatment plan helps change the way a person walks in order to prevent the improper movement of the bone structure.

In more severe cases, surgery may be necessary in order to correct the bunion. Surgery may involve removing the enlarged bone and adjusting the ligaments, or it may involve removing a larger portion of the bone and shifting it in order to obtain the proper alignment. In some cases, a corrective pin or screw may need to be placed in the bone as well.

If you suspect you are suffering from bunions, contact Podiatry Affiliates to schedule an appointment. Our experienced and knowledgeable doctors of podiatric medicine will complete a thorough examination in order to determine the source of your pain, while developing the proper treatment plan.

Contact us at (716) 839-3930 or send us an e-mail at questions@podiatryaffiliates.com to set up an appointment with one of our experienced doctors of podiatric medicine. We have four convenient locations to serve you – Amherst, Buffalo, Niagara Falls and Springville. You don’t have to endure your bunion any longer. End you foot pain today with Podiatry Affiliates.

Platelet Rich Plasma injections has come to the forefront as a successful treatment for several conditions. Among them include tendonitis, inflammatory joint conditions, and plantar fasciitis.

Plantar fasciitis is a very common and painful foot disorder. The true etiology of plantar fasciitis is unknown and has been attributed to many factors. The plantar fascia is a fibrous, thick band of tissue on the bottom of the foot originating behind the toes and extending across the bottom of the heel and joins the attachment of the Achilles tendon.

The classic symptom of plantar fasciitis is pain when first stepping down with the foot. The discomfort eases after walking for a short time, but returns after getting up from a sitting position. The pain may also occur again after standing or walking for prolonged periods of time.

Treatment modalities include cortisone injections, oral anti-inflammatory medication, stretching exercises, physical therapy, arch supports or custom orthotics, shock wave therapy, and surgical intervention.

A new treatment that has evolved is platelet rich plasma (PRP) injection. The purpose of this treatment is aimed at taking the platelet component of blood that contains growth factors and healing factors, to initiate repair and healing.

The process involves drawing a sample of your own blood and separating the platelet component. The concentrated platelets are then injected into and around the area of discomfort or injury. This seems to help promote healing and strengthen the body’s natural healing process. Because your own blood is used, there is no risk of transmissible infection. Most people return to their jobs and activities right after the procedure.

Up to three injections may be given over a six week period, usually at three week intervals. However, considerable relief may be attained after one or two injections. Initial improvement may be seen within a few weeks, gradually increasing as the healing progresses.

Because there is not yet enough clinical data available, the majority of insurance companies do not reimburse for this procedure. The usual cost per injection is approximately $200 to $300.

Platelet rich plasma injections certainly should be a consideration of treatment in intractable, inflammatory pain prior to surgical intervention.

To learn more about this procedure or to find out if you are a good candidate, contact us at (716) 839-3930 or e-mail us at questions@podiatryaffiliates.com.