David Ortiz Makes Progress with Heel Pain

Not good news for the struggling Phillies. The Red Sox First Baseman David Ortiz, who in yesterdays game was 2 for 4 with 1 run scored, has been able to successfully manage his right heel pain that has plagued him most of the season. David Ortiz has been suffering with Achilles tendinopathy for quite awahile but following his doctor's order he has been able to have play at a high level which includes his performance against the Phillies last night.

Achilles tendinopathy is pain at the back of the heel, not the bottom of the heel such as plantar fascitiis. The Achilles tendon, which is made up of 2 separate muscles, attaches the back of the heel bone. The Achilles tendon is the largest tendon in the body. The tendon helps the foot bend down such as when you push off the walk, run or jump. The tendon is very powerful but can be subjected to overuse and degeneration such as in Achilles tendonitis or tendonopathy. So how does this develop?

Achilles tendinopathy can occur from an number of reasons. The most common reason is tight calf muscles. These tight muscles will put a strain on the Achilles tendon where it attaches to the heel bone. Also, a sudden start of activity or and increase in the intensity of an activity can cause strain on the muscle or tendon. In addition, a heel spur can develop at the attachment of the tendon at the heel bone. When the tendon pulls on the heel bone the response of the bone is to form bone in the direction of the pull, this can result in a heel spur.

Common symptoms of Achilles tendinitis include:

• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Severe pain the day after exercising
• Thickening of the tendon
• Bone spur (insertional tendinitis)
• Swelling that is present all the time and gets worse throughout the day with activity

After a thorough evaluation by your podiatrist,  a number of conservative, non surgical treatments will be initiated. Rest, switching to lower impact activities and stopping the activity that causes pain, Ice, 20 mins on and 20 mins off at the end of the day placed on the back of the heel and Elevation, to reduce swelling, are the usual first steps in the treatment of Achilles tendonitis. NSAIDs can be used to help with inflammation and pain relief. Heel lifts to lift the heel off the ground to put less tension on the achilles can be used in the short term for treatment. Stretches can be used to treat tight calf muscles such as the wall push up,

  use a band to stretch

or even the stairs

or if even formalized physical therapy.

Achilles tendonitis or tendinopathy can be managed or even cured with the right treatments as prescribed by your podiatrist. Let's hope the Cliff Lee will have an answer tonight against David Ortiz tonight. Go Phils!

Dr. Alexandra "Sandie" Grulke
http://www.podiatrycarespecialists.com/

Ruiz catches Plantar Fasciitis

 http://network.yardbarker.com/mlb/article_external/philadelphia_phillies_catcher_carlos_ruiz_battling_painful_foot_injury/11325742

 Seems like the Phillies just can't seem to catch a break. Injury after injury have caused a frustrating season. Now their one shinning star in this Phillies line up  "Chooch" Carlos Ruiz is suffering from plantar fasciitis. What is this and what can we expect for "Chooch"?

The plantar fascia is a long ligament originates from the heel and attaches into the toes. This ligament helps to support the arch. This is one of the few foot problems that can occur in any individual, such as flat feet, high arch or normal feet. The ligament becomes inflamed at its attachment to the heel. The pain can be located at the heel or anywhere along the entire course of this ligament. The pain with the first step in the morning or after a rest or can be all day long. The pain can be aching or throbbing or even sharp. Sometimes it can be a nuisance pain and sometimes it can even be debilitating where you don't want to put your heel on the ground.

The good news is 90% of patients will get complete relief with conservative measures. Treatment goals include supporting the arch, reducing the inflammation, and stretching. Externally supporting the arch in the short term can be done by apply a taping technique directly onto the foot. In the long term, arch supports or orthotics are used. To reduce inflammation, oral medications, topical medications, ice and cortisone injections can be used. These effectively reduce the inflammation at the attachment of the ligament to the heel bone and therefore reduce the pain. Stretching is an essential for treatment, as well as, preventing recurrence of heel pain. You can stretch the foot by grabbing the ends of the towel and place it around your foot to pull your foot back or simply bend down and touch your toes. If these simple stretches do not help then a night splint can be prescribed which hold the foot at a 90 degree angle to stretch the plantar fascia while you sleep.

So the good news, with some simple treatments "Chooch" should be able to back to line up full time soon.


Dr. "Sandie" Grulke
http://www.podiatrycarespecialists.com/

Kids with heel pain - Sever's Disease ?

At my kids' morning bus stop yesterday the topic of conversation turned to kids heel pain. A number of kids on several different soccer teams are currently sidelined with heel pain. In one case, there were as many as 5 kids who were currently suffering from heel pain from just one soccer team. So what is this very common problem in children and adolescents, and how do you prevent this from occurring in your child.

Heel pain in children occurs when there is a microtrauma at the growth plate,  which is located at the back of the heel bone. This condition is called Sever's disease or calcaneal apophysitis. This mostly commonly occurs between the ages of 7 and 15,  your typical active child or teenager. The achilles tendon attaches to the growth plate of the heel. If the tendon is short (a tight heel cord), it places the growth plate under tremendous tension and causes an inflammation between the growth plate and main portion of the heel bone. The symptoms include pain while running or playing sport, pain when the heel is squeezed, and/or pain when the back of the heel is palpated. Although it can occur with any sports, soccer or sports where cleats are worn are most commonly affected. Cleats offer very little support and can often cause increased motion at the heel which can worsen the inflammation at the growth plate interface.

Treatments include rest, ice, compression and elevation (RICE) and stretching. By stretching out a tight achilles, you reduce the amount of traction placed on the growth plate. If the pain is moderate, a podiatric physician may prescribe heel lifts which will temporarily reduce the traction at the growth plate by shortening the achilles tendon. Orthotics can be placed in cleats to reduce the motion at the heel. In cases the pain is severe, the patient may be immobilized to prevent any motion or pushing off to reduce inflammation and help stretch out the achilles tendon.

To prevent Sever's disease from developing, keep the hamstrings and achilles tendons stretched out! Wear supportive shoes and consider getting an insole in the cleats. Don't allow pain to sideline your child. And remember to see your podiatrist if symptoms or pain persists.

Dr. "Sandie" Grulke
http://www.podiatrycarespecialists.com/

Tiger Woods and Ryan Howard - Achilles Injury Updates

With Tiger Woods pulling out of the Cadillac Championship at Doral, the achilles tendon has again come to the forefront. It appears to be his left leg and achilles again as he withdrew on the 12th hole clutching his foot and calf, this according to Robert Lusetich at Fox Sports http://msn.foxsports.com/golf/story/Tiger-Woods-Achilles-tendon-injury-at-Cadillac-Championship-at-Doral-might-be-Achilles-heel-031112 . This kind of lingering injury needs rest, stretching, and extensive physical therapy.

Ryan Howard is another super athlete suffering from the effects of an achilles injury. According to Matt Gelb of the Philly.com http://articles.philly.com/2012-03-10/sports/31143270_1_sam-perlozzo-ruben-amaro-chase-utley , there is no news on his infection at his achilles surgical site. He is still in a walking boot and as each day passes, he falls farther behind in his rehab.




For all of us weekend warriors, special care must be taken to properly stretch the achilles tendon before and after working out. http://www.podiatrycarespecialists.com/videos.html

 We will keep you updated on their progress and will always be available to answer your achilles questions.

The Doctors @ Podiatry Care Specialists

 http://www.podiatrycarespecialists.com/

Ryan Howard Achilles Problem

Philadelphia fans will be nervous today as Ryan Howard has to get his Achilles Tendon checked out. He was having some drainage coming from the Achilles incision site area. This can be a common thing with this type pf procedure since the skin is thin in this area. Hopefully this will not compromise his return to activity. Its already amazing that he was on tract to come back  in May. We will still keep you posted on his progress.

http://www.podiatrycarespecialists.com/