Dr. Pribut On Running Injuries

 

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USA Today Foot Hotline: Dr. Stephen Pribut

Thursday, April 10, 2003 noon ET

Washington, D.C. podiatrist Stephen Pribut

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Albany, New York: I have bone spurs, one on my instep, one on each heal. What can I do about them besides surgery, which my podiatrist did not suggest. Thank you.

Dr. Stephen Pribut: Often the part of your foot that is causing pain is the soft tissue attached to the spurs. This condition is called plantar fasciitis.

Custom foot orthotics can help, but first start with over the counter supports and wearing shoes around the house at all times.

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Huntsville, Alabama: My heel is in constant pain. I went to Dr. and had xray and cortozone shot about 6 weeks ago. No bone spurs were a shown. Now it is hearting badly again, it is sore and I can't put weight or walk without pain. My sole is also now sore which was not the case at first. I have high arches and have bought arch supports and put in my shoes. These seem to help a little. What can I do? I cannot walk without favoring that side. Thanks. Ben

Dr. Stephen Pribut: There are several things that can be tried for this condition (heel pain, most likely plantar fasciitis) that do not involve injections or surgery.

First, make sure you wear a supportive shoes during all waking moments. Do not wear sandals, slippers, socks, clogs or open back shoes either out of the house or in your quiet hours. Always wear a shoe that does not flex in the middle.

Do gentle calf stretching exercises once per day by leaning up against a wall or table (typical runners stretch) 10 seconds each side - repeat 10 times.

Try using a supportive running shoe for casual walking. Consider an over the counter orthotic.

And strongly consider a custom in shoe foot orthotic. These have a very high percentage of success.

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Surprise, Az: It feels like there is a small marble inside the ball of my foot and it hurts when I stand on it. What is it?

Dr. Stephen Pribut: This could be an injury to a small lima bean sized bone called a "sesamoid bone". Try not to go up on the ball of your foot or up on tip-toe.

If the pain continues for more then a few days you should visit a podiatrist. There is a podiatrist locator system at http://www.apma.org/ or ask your physician for a referral.

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Exton, PA: How do you get rid of heel pain? I have suffered from heel pain for the last 2 years and went to 2 different podiatrists. Without success I am now using 2 sock splints. Can you please help me? Thanks!

Dr. Stephen Pribut: Please see the 2 answers above. Heel pain is at a very high level of occurance in the U.S. I find that orthotics help almost all of my patients to lessen and usually eliminate the pain, so that this pain is no longer something that they have to think about.

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Boston, MA: Having recently moved from the UK, i'm trying to find a chiropodist who can use a blade to cut away hard/dead skin from the sole of the foot - In the US, is this done by a podiatrist? Is there a special name for this process? thank you.

Dr. Stephen Pribut: You can call a local podiatrist and tell the receptionist that you have hard skin on the bottom of your feet that you would like to have them trim.

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Pinehurst, NC: Any temporary solution to bunion trouble available without surgery? Perhaps something like braces or the like?

Dr. Stephen Pribut: There is no brace or "bunion bender" that is effective. The non-surgical treatment of bunions would be wider shoes. Make sure that the shape of the shoe follows the contour of your foot.

If started early, orthotics may help normalize the forces around the big toe joint that pulls the toe out of alignment. At at later stage the orthotic might just take up too much room in the shoe. But a consultation with a podiatrist will be helpful to determine what conservative treatment may help you best.

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Memphis, Tennessee: Dr. Pribut, My right foot foot--basically radiating in the instep--is very tender and feels "bruised." I am 57. 5'8". 194 pounds.

Dr. Stephen Pribut: You might have an injury to the posterior tibial tendon. I recommend wearing supportive shoes, not going barefoot and having a consultation soon with a foot specialist. You don't want this to become a chronic problem.

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Sharon, Massachusetts: I have just been diagnosed with plantar fasciitis. It was recommended that I pursue orthotics and buy a pair of walking sneakers/shoes. Do you have a recommendation on the proper treatment and a brand of sneakers. I just finished coaching high school basketball and being on my feet all the time. Thank you!!! Larry Fisher

Dr. Stephen Pribut: Hi Larry,

I don't recommend using basketball shoes for casual wear for people with plantar fasciitis. A good pair of supportive running shoes is probably better. Remember though, they are not designed for side to side motion that you might use in either playing court sports or in coaching them.

The American Academy of Podiatric Sports Medicine has a relatively up to date listing of running shoes at: http://www.aapsm.org/

If your plantar fasciitis is still painful, don't go barefoot at night.

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Sacramento, CA : I have had a nail fungus on my big toe for a few months, so I decided to pull it off in hopes of starting fresh. How long will it take for the toe to completely heal with new growth?

Dr. Stephen Pribut: It will take a toenail approximately 4 to 6 months to grow back completely.

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Comment from Dr. Stephen Pribut: It is not a good idea to pull off your toenails. When they are torn off you will likely cause bleeding which may then result in bacteria entering and causing an infection.

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nyc: I tore some ligaments in my ankle playing basketball about ten years ago. Unfortunately, last year I suffered the same injury to the same foot. Is there anything you can suggest to strengthen or protect my ankle again. I have a feeling my basketball days are over. Thanks

Dr. Stephen Pribut: One of the major contributors to ankle sprains and recurrent ankle sprains is a poor joint position sense proprioception).

This can be improved using a wobble board (ankle disk training). A wobble board can be used in a progressive program to enhance muscle strength and joint position sense.

I recommend starting with a 20 inch wobble board.

Start with front to back
exercises for one week (30 seconds)

Each subsequent week add in the following exercises to what you've been doing:

2) Rock side-to-side for 30 seconds.
3) Clockwise circles for 30 seconds.
4) Counterclockwise circles for 30 seconds.

You may then add in (at week 5 or 6) - one legged balance and rocking front to back.
Using a wobble board can be helpful for strength, stability and joint position sense.

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Brunswick, GA: I have been diagnosed with plantar facitis. I have always had flat feet and wear orthodics. I have been doing calf exercises to try to help my arch since reading some literature about where the arch support muscles are located. My pain has lessened and I also have some edema in my ankle of the foot affected (slight high blood pressure). One doctor suggested the sonocure or donocure - shock treatment, insurance doesn't cover it. Any suggestions. I had a flair up of this about 6 years ago - I was fine until October of 2002 when the heel started again. I got new orthodics. Thanks!

Dr. Stephen Pribut: I recommend reviewing the above suggestions of not going barefoot around the house at any time. Calf stretches have been found to be helpful so that is a good idea. Don't do them excessively.

The shockwave therapy (called ESWT) may be helpful. More insurance companies are starting to pay for it, but the prices were on the very high side when this treatment was first begun a few years ago.

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: Santa Monica, CA My mother who is 72 wanted me to ask you if there is any help or "cure" for her neuropathy in her feet? Her doctors haven't really been able to alleviate the pain she feels everyday. She is beginning to lose hope of obtaining relief.

Dr. Stephen Pribut: Neuropathy can have many causes. The cause needs to be identified as well as possible in order to be able to help. If she has not yet seen a podiatrist, a visit may find some mechanical contribution to her pain, such as an entrapped nerve (tarsal tunnel syndrome).

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Wayne, NJ: Dr. Pribut: I was recently diagnosed with plantar warts on one foot. I have been offered a number of treament options: salicylic acid, CO2 laser, and pulse dye laser. Which treatment offers the best cure rate with the least discomfort? Do plantar warts spread to other parts of the foot or to an unaffected foot? Are they contagious to other members of the family? Thank you for your assistance.

Dr. Stephen Pribut: There are many treatments for warts as you've noted. In fact there are many more treatments that aren't listed such as Aldara, freezing, etc.

Salicylic acid and considering freezing them may be good consideration for lower discomfort. Success rate may be lower with the salicylic acid - but there is no wart therapy that can be guaranteed.

They can spread to other parts of the foot and to other susceptible people. Some individuals are highly resistant to warts and do not "catch" them easily.

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Comment from Dr. Stephen Pribut: Warts are often spread on moist floors such as locker room floors. Make sure to clean your bathtub thoroughly. To prevent warts (and athlete's foot) while working out and showering in the gym - wear protective footwear at all times in the club.

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Colorado Springs, Colorado: When wearing shoes, I have a feeling of fullness like a rolled up sock is between your line of toes and the fatty pad of your foot. What is this? What will help? Have already tried orthotics.

Dr. Stephen Pribut: Sometimes these types of feelings can be caused by a neuropathy or entrapped nerve. You'll need to be evaluated by a podiatrist and/or neurologist who will consider this possibility.

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China Grove, NC: Have started a retail job where I stand for 8 hrs. My feet hurt like heck and ankles swell. Help ! Thank you.

Dr. Stephen Pribut: Make sure you don't wear high heels for all of those hours.

The best place to start is with a good supportive and comfortable shoe. It shouldn't be too flexible or too narrow. Check for shoe fitting information at the website of the APMA: http://www.apma.org/

There are several articles on shoes and shoe fitting there.

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Birmingham, Alabama: I have a chronic achilles injury, that is aggrivated by over use. When I don't exercise, it improves, but when I resume, it flares up. I play about 4 to 6 hours of dbls. tennis per week, walk 1 hr, three or four times a week, and hike in the mountains 2 or 3 hrs a week. Are there any exercises that I could do to strengthen the area?I'm 62yr. old, but in excellent health.Thank you.

Dr. Stephen Pribut: It sounds like you have been trying home remedies on this for a long time. If this has persisted, you should now seek professional help. I'd recommend a visit to a sports podiatrist.

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Ft Lauderdale, Florida: Hello, I have nail fungus on my toes and fingers, and several times the whole nail has come off(painful does not begin to describe it!). My big toe nail came off and it seems to be having a hard time growing out- any way to help the nail lift so it can grow out over the skin? Also, three months of oral Lamisil did not cure it- any new/better treatments? Thank you

Dr. Stephen Pribut: There are several other medications available. It is hard to tell if one medication is significantly better then another. There are some other reasons for thickened nails on the hands and feet. Psoriasis is one of these other potential causes. This and other possible reasons for the thickened nails should be considered by your doctors.

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cambridge,uk: hi,im a 42yo white male,5 10,210ibs,type 2 diebetic.what can i do to look after my feet.i dont smoke or do alchol.thank you,chris.

Dr. Stephen Pribut: There are some fine foot health care suggestions at:

http://www.apma.org/diabetes01pub.htm

and

http://www.apma.org/topics/diabetes.htm

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Killeen Texas: My feet have a burning sensation especially at night when I am going to bed. I use a chilled wrap to help ease the feeling and when my feet are cold to the touch it lets up. I had neuroma surgery in 2000 on both feet and the sensation has increased in intensity since that time. Would high doses of panothenic acid help?

Dr. Stephen Pribut: Vitamins can sometimes be helpful, but check with your doctor first. A burning sensation in your feet can sometimes be caused by diabetic neuropathy. But there are other potential causes, consulting with your doctors is probably a good idea. Neuroma surgery would not likely be related to this pain.

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Columbia, SC: When I first walk after waking up in the morning, or after sitting for a long period of time, my left heel hurts terribly when there is any pressure on it. I end up walking on the side of my foot and limping until the pain subsides. (If this has any relevance, I play tennis 3 days a week and it hurts also after I play). What could be causing this?

Dr. Stephen Pribut: This sounds like plantar fasciitis. There answers above are have useful information and there is more information on heel pain at: http://www.apma.org/topics/heel.htm

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Pittsburgh, PA: I have had numerous fractures on both of my ankles. My left ankle does not give me any problems, but my right ankle is severely inhibited, as far as range of motion goes. If I try to pull my toes up towards my shin, my right ankle will only allow about half the range that my left one will. The last time I had my injury, my doctor did not suggest any PT. Is there anything that I can do, short of surgery, that will get me back to full range of motion? Thanks -- TP

Dr. Stephen Pribut: Physical therapy sounds like a fine place to start.

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Comment from Dr. Stephen Pribut: If the ankle problem persists, I'd also recommend a visit to a good sports medicine podiatrist. They will evaluate your biomechanics and see what shoe modifications or orthotics may do and also offer exercises specific to your condition.

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Baltimore, Md.: My feet ache terribly as soon as I get out of bed and off & on throughout the day. They hurt all across the top and sides and of course on the bottom. Could it be arthritis? They also ache when I lay down for awhile. Thanks for any insight!

Dr. Stephen Pribut: There are many things that this can be. Unfortunately my insight won't let me see through the Internet to your foot. I'd recommend a visit to a local podiatrist whose insight should be much better after an examination. This does sound like a solvable problem.

“Improper biomechanics and often muscle imbalance play a role in the development of hammertoes.

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Santa Monica, CA: What causes a hammertoe? What fixes it? My doctor wants me to try orthotics, but my insurance won't pay.

Dr. Stephen Pribut: Improper biomechanics and often muscle imbalance play a role in the development of hammertoes.

Trying to strengthen the "intrinsic" muscles of your foot (those that start and terminate within your foot) would be good. You can try "toe curls" or pulling a towel towards you with your toes.

I'd recommend larger shoes with a "deep" toebox as a start. Surgery can correct painful hammertoes, but shoes are easier to change then the toes and that might be the better place to start.

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Lansing, Michigan: I have a tailor's bunion on the outside of my right foot. My podiatrist has given me orthotic inserts to wear. I have been wearing them for the past 8 months but I still experience some discomfort. Wouldn't it make sense just to have surgery and remove the bunion? I am 43 years old and in good health and I really don't want to have to deal with this bunion for the next 40 years. How difficult is the surgery? What is the recovery time like? Thank you.

Dr. Stephen Pribut: If changes in shoes and orthotics have not been effective surgery should definitely be considered. The surgery is straight forward but all surgery should be carefully considered and carefully performed. It will be a few months before you can start wearing regular shoes again.

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arlington, va: I have a bump on the sole of my foot that is painful. It is a hard small raised bump. The bump is located in the middle of my foot. It feels like there is something stuck right under the skin of my sole. It is painful to walk on sometimes but not all of the time and is painful to the touch sometimes. Any idea of what this could be?

Dr. Stephen Pribut: This could be something called a "plantar fibroma", but it is hard to diagnose this without performing an examination.

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Comment from Dr. Stephen Pribut: Thanks everyone for participating in this online chat.

 

 

 

 

 

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