Heel Pain/Plantar Fasciitis
Heel pain is one of the most common complaints regarding the foot
and ankle. Due to the repetitive nature of walking, the structures of
the foot must resist an enormous amount of stress every day. Then they
have to get up and do it again! Walking itself is often enough injury
over time to create significant problems in the feet. Plantar fasciitis
is most often the result of overuse. Everyone has a different threshold
for symptoms, and therefore, not everyone has experienced heel pain,
but if you are over 30, you likely know someone who has struggled with
plantar fasciitis if you haven’t already.
Fortunately, our office has been successfully treating painful heels
for years. We focus on the mechanical underpinnings of heel pain and
help return your feet into efficient and pain free walking partners.
Knee Pain and Chondromalacia
Lower extremity alignment affects the leg from the ground to the
hip. Our success treating runners’ feet and ankles has also resulted in
a profound improvement in many of our runners’ knees, hips and backs.
While we (specialize in/treat) the foot and ankle, we have gleaned from
patient feedback that many running related knee problems improve with
Dr. Newell reviewed several hundred runners with ancillary knee
complaints at the time of treatment. He was able to categorize the
response of the knee complaints against duration of orthotic use. He
found that many common knee complaints improved following regular use
of orthoses. These include symptoms consistent with patello-femoral
syndrome, ilio-tibial band syndrome, patellar tendonitis, pes anserina
pain and even Osgoode-Schlatter pain in children.
Pain in front of the knee, chondromalacia, and pain underneath the
kneecap is a 1:1 relationship usually related to the way the foot
functions. By allowing the foot to be in its proper position, it allows
the leg to externally or internally rotate and line up the knee in a
proper way so that the patella tracks properly. Most of this, if caught
early enough, will respond dramatically to treatment in a short period
Back pain is becoming the second most frequent foot related problem
seen in our office. Our success rate with backs has created a steady
stream of patient referrals from physicians and others dealing with
There are many reasons for back pain and anyone who has back pain
should be screened by a physician for arthritis, disk problems, tumors,
etc. We have had much success treating low back pain with proper
alignment. We believe that chronic low back pain is aggravated by
rotation of the pelvis and spine on all three body planes,. This
abnormal motion is created when the legs internally rotate forcing the
femur into an internal rotation and the pelvis tilting to unload the
hips, resulting in the malposition of the spine. This puts the
vertebrae in an unhealthy position. By insuring that the foot, knees,
and legs are in their proper position, it takes strain off the lower
We believe that “growing pains” is a misnomer. It tends to be a term
that physicians apply to foot or leg pain that cannot be explained.
A number of years ago, we tracked 142 kids that had been diagnosed with
growing pains. On average these kids had experienced pain for 3 ½
years. Almost without exception as soon as we put the patient into a
custom Orthotic, ensuring proper alignment, the pain went away.
We believe that most of the time the knee, low back, leg, heel, arch,
Achilles, and night pain that wake them up at night, are related to
poor alignment. By doing a good biomechanical exam to diagnosis the
problem and getting these kids into a custom Orthotic they do really
If your child is experience “growing pains” please give us a call.
The largest tendon in the lower extremity, the Achilles tendon is
subjected to tremendous stress during even routine activity.
Inflammation of this tendon can be quite painful. The most common
location for tendonitis is the center of the tendon just above the heel
bone. Pressure on the side of the tendon is painful and walking or
running can be difficult. Morning stiffness is a common complaint.
Early tendonitis doesn’t result in significant swelling or other
visible changes. However, progression can result in structural changes
including swelling as large as a golf ball. Ultimately, the tendon
structure itself becomes infiltrated with degenerating tissue and
routine activity becomes very uncomfortable.
All these symptoms are related to abnormal stresses on the tendon
resulting from internal rotation of the leg, eversion of the calcaneus
which causes bowing of the tendon and ultimately, torquing of the
tendon. Aligning the foot with orthoses straightens the Achilles and
usually improves activity tolerance within a short period of time. More
advanced degeneration often requires more aggressive intervention
including casting and rarely, surgery.
Ingrown nails occur when the edge of the nail injures the adjacent
skin. The skin becomes swollen, painful and oftentimes becomes
infected. The cause can be difficult to determine. Shoe gear, poorly
cut nails, excessive sweating/moisture and occasionally, injury, can
lead to painful ingrown nails. Remedy can involve simple to significant
interventions. Some painful nails resolve on their own. Epsom salt
soaking, taping the sides of the toe back and lotion can sometimes
resolve the early symptoms of an ingrown nail. Should the symptoms
worsen, or should red streaking develop that is spreading up the toe or
foot, you should contact your podiatrist. Prevention includes avoiding
tight shoes and allowing your feet to “breathe” or dry out if they are
exposed to prolonged moisture. Unfortunately, even with appropriate
care and resolution, ingrown nails can return. In this case, your
podiatrist will discuss permanent options to avoid the recurrence of
the ingrown nail.
Neuromas are a very painful benign nerve tumor that as been caused
by the nerve being damaged over a long period of time. These are most
commonly found between the third and fourth toes. Pain is usually felt
on the bottom of the foot and you can sometimes get numbness and
tingling into the toes. Many times it is related to shoe wear.
If neuroma has been there a long time, the doctor can usually feel it
on examination. Ultrasound can sometimes be a helpful diagnostic tool.
Neuromas usually respond to early treatment. If we see them within the
first 6 months, most of the time conservative treatment works. If the
symptoms have persisted for more than a year, then sometimes surgical
intervention may be necessary.
What is a bunion? This common foot condition affects millions of
people and is widespread on any given sunny day. The difficulty with
bunions is that they can significantly affect how an individual walks,
runs, or even wears shoes. The change in shape of the foot actually
results in pain for many people with this deformity. Pressure from shoe
gear and internal stress on the great toe joint are the most common
causes for discomfort. So… what is a bunion?
Bunions are the result of a shifting in the alignment of the bones in
the front of the foot. Essentially, the bone that the big toe attaches
to starts to move away from the rest of the foot. When this happens,
the big toe moves toward the other toes, the arch drops, and the
smaller toes begin to see more stress. As the bunion progresses, the
change in position of the foot bones continues and the foot starts to
absorb more energy during walking. This results in accumulative stress
injuries that cause an inflammatory response and finally, pain.
Is my bunion worth treating? Yes! Fortunately, not every bunion
requires surgery. We have great success with conservative measures
improving a significant portion of our patients’ complaints.
Controlling the mechanics of the foot can remarkably reduce symptoms
and increase activity tolerance. Shoe selection and custom orthotics
offer the best options for improved function and comfort without
significant lifestyle changes.
Keratomas are a thickened, concentrated, hard, painful and deep
callous usually under a bony prominence. This is caused by repeated
abnormal pressure on the skin at the site of the prominence. Treament
involves reducing the keratoma and then protecting the involved area.
Most of the time these respond well to treatment and stay symptom-free
for long periods of time. We have found that we rarely have to resort
to surgical intervention.
Arthritis is a complex term with many hidden interpretations and
meanings. For most people, arthritis means PAIN! While this is true,
the insidious nature of arthritis belies the fact that it is a slowly
progressive degeneration of a joint or joints. Eventually, this
degeneration results in discomfort with the use of the affected
joint/s. The body quickly adapts to protect the joint by altering the
way that people use the joint. This may result in an evident limp, or
another more subtle alteration in motion, such as walking on the
outside of the foot. While this change might improve the symptoms at
the painful joint, it often results in pain somewhere else! This is why
we often say that “the most common cause of lateral foot pain is medial
Arthritis is generally classified as either inflammatory or
degenerative. Inflammatory arthritis includes diagnoses such as
Rheumatoid Arthritis, Gout, Reactive Arthritis, Reiter’s Syndrome,
Ankylosing Spondylitis and Mixed Connective Tissue Disease among
others. These illnesses are the result of the body’s immune system
targeting its own tissue or some other internal derangement which
results in joint inflammation, degeneration and pain among other
things. This type of arthritis does respond to mechanical control, but
will often also require the input of a Rheumatologist.
Most often, we see people with degenerative arthritis, which is also
called osteoarthritis. This is the typical “wear and tear” arthritis
that comes with overuse and age. Nearly all of us are subjected to this
eventually. Some people struggle with only one joint while other people
have difficulty with many joints. The cause is multifactorial and can
include any combination of the following: injury, weak cartilage,
overuse, poor alignment, or loose ligaments among other things.
Treatment includes anti-inflammatories, ice, change in activity level,
orthotics, shoes, steroid injections and surgery.
Ankle sprains are some of the most common injuries that humans
experience. Any emergency room or other primary care facility is very
familiar with this injury. Fortunately, ankle sprains improve rapidly
in most circumstances. However, it is not uncommon for people to
experience nagging complaints months after an ankle sprain. The
frequency of these long-standing pains after ankle sprain reflects the
complex nature of the ankle and the many tissues that can be injured
during a relatively benign “sprain.”
We commonly encounter people months after a sprain that present with
latent tendon, bone, ligament and joint problems that were the result
of the initial injury. The ankle architecture is a close association of
many different systems that may be subtly damaged with the forces
involved in a sprain. Consequently, we do not consider ankle sprains to
be trivial injuries. If you are experiencing difficulty with your foot
or ankle longer than expected after an ankle injury, please call for an
evaluation. There may be a good reason for your discomfort.