A Warning Sign

Surgeon Urges Prompt Treatment for Growth Plate Injuries

Indoors and outdoors, youth athletes stay active year-round in competitive sports, and for many of them heel pain has become “just another part of the game.” Foot and ankle surgeon, Daniel D. Michaels, DPM, MS, FACFAS, advises that when a child complains of heel pain, it should be diagnosed promptly because it may be a warning sign of a serious foot problem.  

Dr. Michaels says heel pain occurs frequently in children ages 6 to 14 as their feet grow and the heel bone develops. “As children become more active in sports they increase their risk for growth-plate injuries and subsequent heel pain,” says Dr. Michaels. This is especially true at back-to-school time when surgeons see an increase in middle and high school athletes experiencing heel pain with football and soccer seasons simultaneously underway.  

“New bone forms in an area behind the heel, known as the growth plate, and cartilage is vulnerable to severe inflammation from strain or stress. With repeated stresses and strains from overactivity, the heel becomes very painful,” Dr. Michaels explains.

Even though growth-plate trauma is the leading cause of heel pain in young people, Dr. Michaels says the condition can be difficult to diagnose. He cautions that parents should be concerned if a child has pain in the back or bottom of the heel, limps, walks on the toes, or seems to have difficulty participating in normal recreational activities. The condition is diagnosed by a thorough examination of the child’s feet and legs and possibly medical imaging tests to rule out other serious causes of heel pain, such as bursitis, tendonitis and fractures.

In most cases, mild or moderate heel pain can be treated successfully with shoe inserts to soften the impact on the heel, anti-inflammatory medications, stretching and physical therapy. In severe cases, the foot and ankle will be immobilized in a cast and, in some instances, surgery may be necessary.

Heel pain in young people often returns after treatment because the growth plate is still forming until the age of 14 or 15. However, the risk for recurrence can be lowered by choosing well-constructed shoes with good support and restricting use of spiked athletic shoes, especially on hard fields. It also is advised that young athletes avoid competition that exceeds their physical abilities.

For further information about foot or ankle conditions, contact one of our foot and ankle surgeons at the Reconstructive Foot & Ankle Institute, LLC.  Visit us on the web at www.rfainstitute.com or make an appointment with one of our state of the art offices in Maryland:

Hagerstown 301.797.8554, 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014, 2100 Old Farm Drive, Suite D, 21702

Don’t Play with Foot Pain

Athletes and parents should monitor seemingly ‘normal’ foot and ankle pain

Many adult, adolescent and child athletes are playing with seemingly normal but persistent foot pain that could be a sign of a more serious injury, according to Dr. Daniel Michaels, DPM, MS, FACFAS, a member of the American College of Foot and Ankle Surgeons (ACFAS).

"Playing with pain often is viewed as a badge of honor among athletes, but they must be aware that the persistent pain they dismiss as normal exercise-related stress could be something far more serious," said Dr. Michaels, whose office is in Frederick and Hagerstown.

Dr. Michaels said athletes of all ages visit his office with foot pain due to overuse injuries from repetitive loading of the foot and ankle during running and aerobics. "When athletes overdo their workouts, it may be normal to experience some temporary discomfort," said Dr. Michaels. "But if pain continues longer than a few days with continued redness, warmth or swelling, the athlete should see a podiatric foot and ankle surgeon for proper diagnosis and advice on treatment options."

Athletes who ignore persistent foot pain and inflammation and continue to train risk potential complications that could sideline them for months. Among possible injuries associated with persistent foot and ankle pain are stress fractures, muscle strains, tendonitis and subtle fractures after inversion ankle sprains.

"Stress fractures sometimes aren’t debilitating and some athletes might continue their normal training despite the injury," said Dr. Michaels. "But continual rigorous activity can worsen the problem. An examination and diagnosis by a foot specialist can determine whether the pain is from overuse or subtle trauma, requiring only a few days of rest, or something that may require surgical intervention."

Heel pain in children often is caused by injuries to the growth plate and secondary growth centers in which tendons pull at the top and bottom of the growth plate of the heel. Boys and girls ages 8 to 14 are susceptible to this problem, and its major symptom is pain on either side of the heel.

"Growth-plate trauma is common in soccer and other sports that involve a lot of running," said Dr. Michaels. "Parents should make sure that their children stretch before playing and apply ice to the back of the heel after the game or practice. In some cases, anti-inflammatory drugs and shoe inserts or lifts are recommended, but the potential for recurrent injury exists until the growth plate closes," he explained.

Foot and ankle surgeons provide many forms of treatment to keep children pain free and participating in sports activities. When treating athletes of any age, they will evaluate several factors that could be the underlying cause of foot pain. They include:

Running or playing surfaces: Athletes who train on asphalt or cement are more prone to stress injuries than those who run on cushioned tracks or natural grass fields.

Shoes: Footwear should be appropriate for the sport and match the biomechanics of the individual’s foot. For example, those who engage in one sport more than three times a week should wear athletic shoes designed for the sport, and shoe technology has advanced to allow for variances in foot characteristics that require stability cushioning.

Training: Injuries often result when athletes fail to build up to a desired training goal. Accordingly, a runner shouldn’t set a goal of 20 miles a week without gradually progressing to that goal.

Behavioral factors: In children, overuse injuries sometimes occur from excessive parental pressure to achieve in sports.

Nutrition: Stress fractures can occur in athletes with poor nutritional habits.

Over-training: Sleeping problems and resultant irritability and fatigue are common among some athletes who exercise aggressively.

Physical characteristics: Variations in bone structure and muscle development are evidenced in individuals who are bowlegged or have malalignment problems.

For further information about foot or ankle conditions, contact Dr. Michaels and the Reconstructive Foot & Ankle Institute, LLC at www.rfainstitute.com or make an appointment with one of our offices in Maryland:

Hagerstown 301.797.8554, 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014, 2100 Old Farm Drive, Suite D, 21702

A Frederick and Hagerstown foot and ankle surgeon warns female runners that the combination of wearing narrow, pointed-toed shoes at work and the pounding their feet endure from running on hard surfaces can cause a neuroma, a painful nerve disorder of the feet.

Active women who enjoy running, especially those with flat feet, are prone to develop neuromas.  A nerve located between the toes becomes enlarged and inflamed and produces tingling, burning pain.

Daniel D. Michaels, DPM, MS, FACFAS, is a member of the American College of Foot and Ankle Surgeons (ACFAS). He says the symptoms begin gradually and, left untreated, progressively worsen.

“We see neuromas quite often in younger professional women who wear high heels every day at work and also are active runners,” says Dr. Michaels. “It’s a very stressful combination for their feet.” 

Dr. Michaels explains that neuromas enlarge as the condition progresses, causing pain and numbness to a consistent area at the base of the toes. Patients often complain it feels as if something is stuck inside the ball of the foot. The symptoms may go away temporarily by massaging the foot, wearing wider shoes with low heels, and avoiding running and other activities that aggravate the condition.

“Symptoms become more intense as the nerve enlarges and the temporary damage becomes permanent, so it’s best to seek treatment if discomfort persists for more than a few days,” Dr. Michaels says.

Neuromas can develop in different areas of the foot. The most common occurrence is called Morton’s neuroma, which develops at the base of the third and fourth toes.  Thickening and swelling of the nerve usually is caused by compression and irritation from wearing very narrow shoes or high heels that crunch the toes in the front of the shoe. In addition, neuromas can result from running, racquet sports and other physical activities that exert repetitive stress on the forefoot.

A neuroma isn’t detectable by x-ray, so the diagnosis is based on symptoms and a physical examination to palpate the nerve or a maneuver that elicits an audible click.    

Treatment options for Morton’s neuroma depend on how far the condition has progressed. At early stages, padding lessens pressure on the nerve, icing reduces swelling, over-the-counter anti-inflammatory medications decrease pain and inflammation, and prescription or custom orthotic devices provide support to reduce compression. Patients also are advised to wear wider shoes with low heels and take a break from running or other activities until the condition improves.

If these conservative treatments don’t help then injecting the neuroma with alcohol and utilizing digital diagnostic ultrasound needle guidance can relieve the pain in the vast majority of patients.  It may take between 6-10 injections, sometimes as little as 1-2 to get complete relief.

In severe cases, surgery might be the best option to provide relief.

“Surgery for neuromas has a very high success rate,” said Dr. Michaels. 

For further information about foot or ankle conditions, contact one of our foot and ankle surgeons at the Reconstructive Foot & Ankle Institute, LLC.  Visit us on the web at www.rfainstitute.com or make an appointment with one of our state of the art offices in Maryland:

Hagerstown 301.797.8554, 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014, 2100 Old Farm Drive, Suite D, 21702

Physician offers mothers-to-be remedies for aching feet

“Oh my aching feet” is a phrase you hear often from pregnant women. But, are sore feet a symptom they just must deal with during pregnancy? According to Frederick And Hagerstown foot and ankle surgeon Daniel D. Michaels, DPM, MS, FACFAS the answer is “no.” There are many remedies available to help alleviate foot pain.

Dr. Michaels states women often experience foot pain during pregnancy because of increased weight, foot instability and swelling.  “In the last five years, I’ve seen an increase in pregnant women with foot pain because more women than ever before are active, even running marathons, during their pregnancies,” Dr. Michaels says. He recommends the following guidelines to help reduce foot pain during pregnancy.

Painful, Swollen Feet—Pregnant women often experience throbbing, swollen feet due to excess fluid build up (edema) in the feet from the weight and position of the baby. To reduce swelling, put feet up whenever possible, stretch legs frequently, wear wide comfortable shoes and don’t cross legs when sitting.

Arch Pain—Pain in the arch can be due to both arch fatigue or over pronation (or the flattening of the arch). Over pronation occurs due to extreme stress to the ligament (the plantar fascia) that holds up the arch of the foot. The best way to prevent arch pain is to stretch daily in the morning and before and after any exercise, don’t go barefoot and wear supportive low-heeled shoes.

Foot Cramps—These painful cramps are caused by increased blood volume and high progesterone levels brought on by pregnancy. To prevent cramps, increase circulation by rotating ankles and elevating feet while sitting. If cramps persist, try a walk around the block and include daily stretching of the calf muscles. 

Ingrown Toenails—Excessive stress from tightly-fitting shoes causes painful ingrown toenails. Give your feet a break: wear wider shoes during the last trimester of pregnancy to avoid ingrown toenails. If you do experience an ingrown toenail, avoid attempting “bathroom surgery.” Repeated cutting of the nail can cause the condition to worsen over time. It is best to seek treatment with a foot and ankle surgeon.

It is also not uncommon for women to experience a change in their foot size during pregnancy. “A permanent growth in a women’s foot, up to half a size, can occur from the release of the same hormone, relaxin, that allows the pelvis to open to deliver the baby. It makes the ligaments in your feet more flexible, causing feet to spread wider and longer,” Dr. Michaels adds.

Pregnancy and pending motherhood should be a joy. If foot pain persists, call Dr. Michaels. 

For further information about foot or ankle conditions, contact one of our foot and ankle surgeons at the Reconstructive Foot & Ankle Institute, LLC.  Visit us on the web at www.rfainstitute.com or make an appointment with one of our state of the art offices in Maryland:

Hagerstown 301.797.8554, 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014, 2100 Old Farm Drive, Suite D, 21702

Study links this condition to painful foot maladies

Treatment and prevention of adult flatfoot can reduce the incidence of additional foot problems such as bunions, hammertoes, arthritis and calluses, and improve a person’s overall health

Overweight males in white-collar jobs are most apt to suffer from adult flatfoot disorder, a progressive condition characterized by partial or total collapse of the arch, according to the research. Symptoms of adult flatfoot include pain, swelling, flattening of the arch and an inward rolling of the ankle. But because flatfoot is a progressive disorder by nature, the study suggests that neglecting treatment or preventive care can lead to arthritis, loss of function of the foot and other painful foot disorders.

“Flatfoot disorder may gradually worsen to the point that many of the tendons and ligaments in the foot and ankle are simply overworking, often to the point where they tear and/or rupture,” says Frederick/Hagerstown, Maryland foot and ankle surgeon Daniel D. Michaels, DPM, MS, FACFAS

In many cases, flatfoot can be treated with non-surgical approaches including orthotic devices or bracing, immobilization, physical therapy, medication and shoe modifications. “In some patients whose pain is not adequately relieved by conservative treatments, there are a variety of surgical techniques available to correct flatfoot and improve foot function,” Dr. Michaels added.

“As in most progressive foot disorders, early treatment for flatfoot disorder is also the patient’s best route for optimal success in controlling symptoms and additional damage to the feet,” continued Michaels. “The goal is to keep patients active, healthy and as pain free as possible.”

For further information about foot or ankle conditions, contact one of our foot and ankle surgeons at the Reconstructive Foot & Ankle Institute, LLC.  Visit us on the web at www.rfainstitute.com or make an appointment with one of our state of the art offices in Maryland:

Hagerstown 301.797.8554, 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014, 2100 Old Farm Drive, Suite D, 21702