Sunday, May 15th, 2011
With nice weather finally arriving in the New York area the talk has turned to getting outside for walking, running or cycling. A few weeks ago I participated in a panel discussion at the Jack Rabbit NYC Running show on barefoot running and minimalist shoes. Joining me on the panel was Johanna Bjorken, John Durant, Nikhil Jain and Katherine Petrecca. Johanna Bjorken Johanna Bjorken has been the head “shoe geek” at JackRabbit since 2004. In that time, she has become one of the most influential shoe buyers in the specialty running industry. Johanna decides which shoes JackRabbit carries and develops all of the staff training for JackRabbit’s shoe fitting process. Johanna is a marathoner, a triathlete and a mom. John Durant John is a longtime barefoot runner living in New York City. He is the organizer of the annual barefoot race on Governor’s Island and of the Barefoot Runners NYC Meetup group. He has appeared in numerous articles and TV shows including “The Colbert Report”. Nikhil Jain Nikhil is the technical running product manager at Saucony and is responsible for the design and development of Saucony’s new Hattori, the company’s minimalist shoe. He is a longtime runner and champion hurdler. Katherine Petrecca An 11-year veteran at New Balance, Katherine is the Business Unit Manager for Running and Outdoor Specialty with a focus on technical product launches and new innovation projects. Over the last two years, she has led the development and launch of the Minimus footwear collection. My Opinion I discussed some of my concerns with barefoot running including a discussion of some of the injuries that I have seen. The injuries have ranged from Achilles tendon/calf strains, plantar fasciitis to stress fractures of the metatarsals and tibia. I also discussed the fact that there are no definitive studies that prove that running in shoes causes injuries and that running without shoes or running in minimalist shoes prevent injuries. However, we do know that running in worn shoes with broken down mid soles and outer soles can cause injury, as can running in too soft a shoe or too stiff a shoe. But is it the shoe or running form that makes the difference? I am a strong believer that improper running technique is a major contributor to running injuries. We know that approxiamately 60% of running injuries are due to overuse with training errors associated with most of them. Listening to your body and training in a responsible manner will eliminate the majority of running injuries. Approximately 40% of running injuries are due to some fault in biomechanics with subsequent abnormal impact overload, abnormal loading rate and increased joint torque (twisting). Therefore, it becomes important to get a proper biomechanical examination and evaluation of running form like what we offer at the Center for Podiatric Care & Sports Medicine. (See section on Gait Analylsis and Orthotics) The question then becomes: Can, or should, a particular runner changeover to barefoot running or running with minimalist shoes? If you are healthy and running well there is no need to do anything differently. As the saying goes, “Don’t try to fix the wheel if it ain’t broke.” If you have a history of injuries, then a change to barefoot running or to a minimalist shoe may be worth trying. To properly make this change, you will need to: retrain your running mechanics; go slowly and gradually to allow for physiological adaptation for your bones, muscles and tendons; try more forgiving running surfaces, such as dirt or grass; and strengthen calf and foot muscles. If you have a history of repetitive injuries it would be wise to make an appointment to have your running form and biomechanics analyzed to determine whether your running mechanics are contributing to your injures. Call (212) 996-1900 or (914) 328-3400.
Wednesday, February 16th, 2011
Heel pain is very common among competative and weekend athletes. The pain is localized to the bottom of the heel and along the arch.The pain can be quite persistent,lasting for months or even years. Plantar Fasciitis( heel pain that is mechanical in origin) is characterized by pain and stiffness upon arising in the morning. The pain has a tendency to decrease after a few minutes only to recur at the end of the day. In the early stages of plantar fasciitis the pain is more inflammatory in nature .The more chronic and longer lasting the pain the more the problem becomes one of Plantar Fasciosis or degeneration of the fascia.
The treatments are quite different depending on how long you have had heel pain.
Treatment options for the inflammatory type of fasciitis can consist of the following: padding and strapping,therapeutic orthotic insoles,oral anti inflammatory medication,cortisone injections,achilles and plantar fascial stretching.
As the heel pain becomes more chronic, the following can be effective treatment options: Prefabricated and custom made orthotic devices, night splint, repeat cortisone injections or our preference bio puncture with homeopathic agents( to be discussed in a later blog) , physical therapy, cast or boot immobilization.
If there has been no improvement with the previous recommendations then EPAT( Extracorporeal Pulse Activation Therapy) is a very advanced and highly effective non-invasive treatment approved by the FDA. The technology is based on a unique set of pressure waves that stimulate the metabolism,enhance blood circulation and accelerate the healing process. Damaged tissue gradually regenerates and eventually heals.
The non-invasive EPAT has virtually no risks or side effects. In some cases, patients may experience some minor discomfort which may continue for a few days. It is normal to have some residual pain after intense exercise or a full day of work.
The beneficial effects of EPAT are often experienced after only 3 treatments. Some patients report immediate pain relief after the treatment,although it can take up to 4 weeks for pain relief to begin. The procedure eliminates pain and restores full mobility. Over 80% of patients treated report to be pain free and/or have significant pain reduction.
If EPAT is not successful: PRP (to be discussed in a later blog), bipolar radio frequency, endoscopic plantar fasciotomy are further viable treatment options.
Dr. Geldwert and Dr. Lai presented a study on the conservative treatment of Plantar Fasciits at the American College of Foot and Ankle Surgeons annual meeting and they found that 87% of their patients responded to Custom made orthotic devices and a stretching program. Subsequent to that study, Dr. Geldwert found that with the use of EPAT the success rate incresed to close to 95%.
EPAT is an emerging technology in the US and, unfortunately, insurance companies do not yet cover the EPAT treatment. The EPAT treatment fee is reasonable by most patient standards and is a significant savings compared to paying deductibles,multiple co-pays and other non-insurance covered expenses as you attempt several months of conservative treatments,surgery and rehabilitation.
If you would like more information about EPAT , other treatments for Plantar Fasciitis or need an appointment for evaluation and treatment call 212-996-1900 or 914-328-3400.
Monday, January 3rd, 2011
Laser treatment for toenail fungus has recently been approved by the FDA. Prior to Lasers, the treatments for fungal nails were limited to oral anti-fungal medications which have the potential for liver toxicity and topicals which deliver marginal benefits.The laser works by penetrating the fungal nail plate and destroying the fungus by the heat it generates. This clearing of the nails of the fungus can occur after only one treatment. Sometimes it is necessary to touch up one or two nails that haven’t responded to the laser.
Unfortunately laser treatment for fungal nails is not covered by insurance plans but is a covered benefit for those that have flexible spending health accounts.
So how would you pay for the treatment?
We have broken down the laser program into two components. The first is the examination and nail treatment which may be covered by your insurance carrier. The second part is the laser treatment which is not covered by insurance. The one-time charge for three office visits and nail care is $500. There is an additional one time laser fee of $70.00 per toe,which is charged at the first visit. For example,treating one toe only would be $570.00. However, if you need all ten toenails treated,the charge would be $1200.00. We are able to provide laser treatment less expensively than other practices because we own our laser and do not lease the laser like other practices who are required to pay a fee each time to turn the laser on.
We will bill your PPO insurance policy and request any benefit payment be mailed to you. The laser portion is not a covered service and,therefore, will not be billed to your insurance company. In an effort to make sure that you maintain the best results possible,we even offer additional visits within the first year of treatment for a nominal charge,which we will bill your PPO for your coverage.
Monday, December 6th, 2010
A Bunion is a deformity of the 1st metatarsal that is characterized by the big toe pointing towards the 2nd toe and is often associated with what appears to be a bump on the side of the big toe joint. Bunions are predominately genetic( familial) in origin and progressive by nature . Sometimes there is pain in the joint or over the metatarsal and frequently the bunion will cause other problems in the foot; such as pain in the ball of the foot or contractures and hammering (curling) of the small toes. Not all bunions require surgical management but many do. There are over a hundred different procedures to correct bunions.Most of the procedures require a cutting into the bone (osteotomy) to realign the big toe joint. The osteotomies are used in conjunction with soft tissue(tendon) balancing procedures and the location of the osteotomy distal (towards the tip of the toe) or proximal (towards the heel) are dependent on the degree and location of the bunion deformity. Each of the osteotomy procedures has potential complications including malunion( poor alignment),shortening,elevation of the 1st metatarsal and angulation of the joint cartilage.
The Mini-TightRope ( Osteotomy sparing) procedure for Bunions was developed because of the determination that many bunions are a result essentially of an acquired soft tissue angular deformity and malalignment( poor position). The TightRope has been very effective in correcting the angular deformity associated with Bunions while eliminating the problems associated with osteotomies(cutting of the bone). See animation of the procedure Mini-TightRope Bunion Procedure and Mini TightRope FT .
Dr. Geldwert and Dr. Lai have been performing the Mini TightRope for 2 1/2 years with promising results. As with any procedure there are some inherent complications. The most frequent complications that we have experienced are stress fractures of the 2nd metatarsal,knot/fiberware failure or prominence of the button.Sometimes we will combine the mini TightRope procedure with other procedures depending on the type of bunion deformity. We have found that the complications associated with the mini TightRope are less profound than the potential complications of shortening,dorsiflexion,malunion,transfer metatarsalgia (pressure on an adjacent bone) and avascular necrosis that can be seen with Bunion Correction utilizing osteotomies. The typical Mini- TightRope Bunion recovery allows for immediate weight bearing in a stiff soled shoe.
Our overall success rate for bunion surgery via osteotomy is over 95%; however we are looking toward the minitightrope procedure to lessen the profound complications that can occur with osteotomies.
If you would like to know more about the Mini TightRope procedure or other bunion corrective procedures call The Center For Podiatric Care and Sports Medicine at 212-996-1900 or 914 328-3400.
Wednesday, December 1st, 2010
Within this regularly updated feature of my website, I will provide visitors with practice news and specials, as well as information regarding the most recent technological advances and new treatments in Podiatry.
I believe that patient education and open communication with your doctor are the keys to achieving healthy, fully functional results and patient satisfaction, which is why I strive to provide the highest quality of Podiatry care for patients of all ages. This is done by combining technical skill and broad experience with cutting-edge technology for impeccable medical results.
I sincerely appreciate you taking the time to visit my new blog. Please check back often to learn about the latest news, updates and additions to the practice and within the field of Podiatry, and feel free to post comments and/or suggestions on any posts that you find of interest.