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Tag: tendonitis

CJ’s Story: Chronic Tendon Pain (The Power of Regenerative Medicine)

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CJs testimonials chronic tendon pain

The new year is here, and for many of us that means it’s time to focus on our health, and address some of those lingering issues we’ve been putting off.

Today, I will share a success story of a patient who was dealing with chronic joint and tendon pain for several years. My goal is to help instill hope in many of you who have been experiencing similar pain, and have perhaps given up on finding a solution. So, here we go.

52, Healthy and Active

This patient is a 52 year-old female, who was healthy and active. We will call her CJ. She came into my office with a variety of foot complaints. The primary issue was chronic joint and tendon pain in her right foot and ankle, and this had been going on for several years.

Seven years prior, a horse stepped on her foot and she was diagnosed with a “hairline fracture” and wore a cast for three months. Once she was out of the cast, she could get back to activity with little pain. However, over the next five to six years, she started having more and more pain in the area that began to significantly limit her activity. This gradually led to weight gain, which only made the problem worse.

Plantar Fasciitis, Arthritis and Tendon Pain

When I first saw CJ, she was planning on having gastric bypass surgery, but was concerned that she would not be able to exercise properly after the surgery because of her foot and ankle pain. She had previously been treated for plantar fasciitis by another doctor.  She had steroid injections and wore a night splint, but neither treatment seemed to give her any relief.

During her initial exam, her X-rays showed that the old injury had been more than just a hairline fracture. She had evidence of post-fracture arthritis in two joints in the middle of her foot. The fracture had healed, but left joint damage behind. Her other main issue of ankle pain was diagnosed as a partial tendon tear. This had likely been aggravated by compensating for the joint pain.

Regenerative Medicine + Surgery

Many times, when patients present with arthritis, tendon pain, or plantar fasciitis, we use regenerative medicine therapy to help stimulate healing and avoid surgery altogether. But, in CJ’s case, we needed to use several different treatments to help address all the issues that had been accumulating for all these years.

We performed surgery to repair the tendon tear and used regenerative injections to help heal the joint damage. To better support the damaged joints, we fitted her for custom orthotics. She then began physical therapy to improve her strength, balance, and flexibility.

Ten Weeks Later

CJ was on crutches for four weeks after the tendon repair. But, once we cleared her to start walking, she progressed quickly. She was highly motivated and committed to her therapy and post-operative rehab. Ten weeks after surgery and regenerative therapy, she was already back to walking and elliptical workouts daily. She still has the occasional sore muscles, but no longer has anywhere near the pain she did before. CJ is still considering gastric bypass surgery. But, she now feels she will be able to lose the weight without it since she can exercise without pain.

So, if you or someone you love is struggling with daily foot or ankle pain, please don’t wait any longer to address it. Call today to make an appointment, and we can discuss treatment options with you.

2018 can be your last year to deal with chronic pain. It’s time to get on the path to healing, together.

Chronic Foot Pain: Why Am I Still in Pain?

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It’s never fun to suffer an injury of any kind. There is always the initial pain and limitations. But, what happens when the pain doesn’t go away even when the injury is “healed?”

Does it just need more time? Are you doing something wrong? In many cases, the injuries look completely healed on X-rays or MRI, but the pain continues. So what do you do next?

I’d like to tell you a story about a patient who had just this problem. We will call her Alice.

The Ankle Fracture that “Healed”

Alice is a 32 year-old female patient. She came to see me for severe daily pain in her foot and ankle, which initially started after she fractured her ankle. Alice fell on her ankle and heard/felt a pop. She was evaluated in the ER and properly diagnosed, and subsequently had surgery to repair the fracture. The repair went as planned and after six weeks her X-rays showed a completely healed fracture.

She was then allowed to start walking on it again. That was when her pain really started. After surgery, she had experienced the normal post-op pain, but it wasn’t until she was out of a cast that she began having constant ankle and foot pain that was not relieved by much of anything. It hurt when she walked and it hurt when she didn’t walk. The pain woke her up and kept her awake.

Time to Put on My Detective Hat

Alice was at the end of her rope, and was even considering possible amputation if the pain could not be relieved. With any patient in this much pain, my first impulse was to throw the kitchen sink at her problem to try to find some way of getting her relief. However, in order to help these patients, I know I have to put on my detective hat, do a thorough review of their injury, treatment, and health history, and then put together a step-by-step plan to hone in on the primary cause of the pain.

A Painful Scar

Alice had pain throughout her foot and ankle, but the majority of the constant pain was along the inside of the ankle and down into the foot. This area was so sensitive that any light touch would send pain up and down her leg. She was especially sensitive along a surgical scar from her ankle fracture repair.

She had mentioned this to the surgeon who fixed her ankle and he assumed it was simply a painful scar and would improve with time but instead the pain grew steadily worse. An X-ray showed the screws and plates in the bones did not appear to be causing any problem and the scar itself did not appear thickened or contracted. However, the location of the incision was right over one of the main nerves in the leg, and I considered the possibility that the nerve had been damaged or cut during the fracture repair.

Testing the Theory

A simple way to test this theory was to perform a diagnostic nerve block of the nerve higher up the leg with a long-acting local anesthetic and a small amount of steroid. This will decrease inflammation and reduce sensitivity of the nerve for 2-3 days after the injection.

If the patient’s symptoms significantly improve for a few days after the injection, then it is a good bet that the nerve itself is the source of the pain and not just the messenger. If it only feels better while it is numb, then it’s time to head back to the drawing board. Alice had significant improvement for 3-4 days after the block before the pain returned. This is normal and expected because you can only use this injection for diagnosis, not treatment.

The Source of the Pain

Once we knew the nerve was the source of her pain, it was time for treatment. In this case, I recommended a procedure called a neurectomy of the nerve. This involves making a small incision over the nerve, farther up the leg than the damaged portion. I then locate the nerve, and cut it to shut off the pain signals. It’s kind of like throwing a breaker on an electrical outlet.

Although this might sound drastic, it is a much safer and effective option than other chronic pain management options (opiates or a spinal stimulator for example). For Alice, it worked very well. Once the nerve pain was eliminated, she was finally able to participate in physical therapy to address the other tendon pain and weakness that had developed from how she was compensating for the pain.

Finally, Pain Free

At Alice’s last follow up, she was pain free. She still had a bit of residual limp that will continue to improve with therapy. I present Alice’s story as an example of the complex diagnostic work-up often involved with post-traumatic chronic pain.

No two patients are the same and no two injuries are the same. What worked on one may not work on the other. As a doctor, when I see patients with chronic pain, I have two goals in mind.

1. Identify the primary problem.

2. Do not aggravate the pain any further with unnecessary treatments.

Once we identify the root of the issue, we can then proceed with the appropriate treatment to relieve the patient’s pain.

If you are experiencing chronic injuries or unresolved pain, please come see us! We can help. Come visit your podiatrist in Fort Collins or Broomfield for further consultation.

To learn more about our treatment options, click here.

Book your appointment here. 

Which Running Shoe is Right for You?

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Whether you are new to the running game, or starting a new kind of activity like hiking or cross training, picking out the right kind of shoe can be a stressful task. As a podiatrist and an athlete, I will tell you that it is very important to find a athletic shoe that fits your specific needs. So here’s a few tips to help simplify the process. Happy shopping.

1. The shoe should fit the activity

The first step is to decide which activity you want the shoes for. Do you like to run on the road or on trails? Do you spend most of the time cross training in the gym doing classes like Zumba or Body Pump? Road running shoes are designed to be light and flexible with cushion and not a lot a tread. Trail running shoes add aggressive tread to provide protection while on rocks and uneven ground. Cross training shoes are designed to provide more contact with the ground while still giving you support and comfort. So make sure you think about what activities you will primarily be wearing these shoes for.

2. Find out your foot type

Now that you have a primary activity in mind, we can we start to look at your foot type. Typically, shoes are made for 3 different foot types.

The most common are neutral pronation shoes. This is for people whose arch is maintained during the gait cycle. When you strike the ground, initially your heel will slightly pronate or turn outward to allow for shock absorption. You may notice slight wear on the inside portion of your shoes at the heel.

The next is overpronatation. This is for people who are generally more flat footed and their arch is not maintained during the gait cycle. In this foot type you will notice excessive wear on the inside of the heel of your shoes and wear along the inside at the ball of your foot. For this foot type, added stability is placed into the shoe along the arch to help prevent your arch from collapsing. Often you will notice a different color of material along the midsole of the shoe, which is generally stiffer then the remaining portion of the sole.

The last type of shoe is for people who have high arches, or who supinate (also called underpronation). In this foot type you will notice excessive wear on the outside of the heel and along the outside of the ball of the foot. This is the least common in runners, but with this foot type, added cushioning and flexibility is necessary.

3. Now it’s time to try them on

The most important thing is comfort. Try to shop for shoes later in the day when your feet are generally a little more swollen. You will want about a thumbnail width in added length at the end of the shoes, but the width should be snug. You do not want to feel like you are sliding around in the shoe. Consider having your feet measured to ensure a proper fit.  Also, if you wear orthotics, bring them with you to make sure they will fit appropriately.

When it comes to brands of shoes, I have tried multiple over the years. Generally, most are made similarly with the different characteristics I have mentioned above. I typically will defer to comfort over a certain brand and recommend you try various brands to see which one you find the most comfortable. Most runners I talk to have found one they love, and will keep going back to that brand and model of shoe.

Here’s one more important piece of advice for all you dedicated athletes out there: if you find yourself facing a training-related injury, such as plantar fasciitis, tendonitis, or a stress fracture, it’s crucial not to push through the pain. Continuing to train on an injured foot can exacerbate the issue and prolong your recovery time. Instead, be proactive and take a well-deserved break from your training routine.

At Anderson Podiatry Center, we specialize in treating sports-related foot and ankle injuries, and we’re here to help you get back on track as quickly as possible. Our experienced team will provide you with expert care and a personalized treatment plan to support your healing journey. To make an appointment, click here.

Additionally, if you’re in need of the perfect athletic shoe to aid your recovery and prevent future injuries, we recommend visiting our friends at Runners Roost. When you drop by their store, be sure to mention that we sent you their way. They have the expertise to help you find the ideal shoe that suits your specific needs and enhances your athletic performance. Your health and well-being are our top priorities, and we’re dedicated to ensuring you receive the best care and guidance on your fitness journey.

5 Steps to Race Training (Part 1)

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As a podiatrist and a runner/triathlete, I know personally and professionally how important it is to take the proper steps to train for a race. Perhaps you have never run a race before and are training for your first 5k. Or, maybe you are more advanced and are ready to take on your first marathon. Either way, these five steps will help your body adjust properly and avoid injury so you can cross the finish line in victory.

1. Start early

If this is your first event of the season, you need start training at least 3-4 months in advance. Keep in mind that the longer the event, the sooner you should start your training. Also, if you have no base to start from, you may want to increase the time you take to prepare. For example, most half marathon programs are 10-16 weeks long, but assume that you have a running base to begin with.

If the plan has you running long runs early that are twice as long as your current long distance runs, you may want to pick another plan. Most plans are labeled beginner, intermediate, and advanced, so make sure you pick one that is appropriate for you. I also recommend a longer plan to give yourself more time and wiggle room in case you have a sick week or two.

2. Never skip the warm up

As a beginner or novice runner, the warm up is not as essential, but as you start training for longer distances and larger events, the warm up becomes critical. As you are training harder and faster, your body has the tendency to tighten up. I experienced this myself this year as I began my training.

You will need to spend more time stretching and warming up as you progress in your training. Stretching when you are finished is also essential. Your muscles are still warm, so stretching at this time provides a huge benefit.

3. Cross train

I am a triathloner for this very reason. I believe doing one repetitive motion will over-develop certain muscle groups and wear out joints sooner. At the same time, as a triathloner, you can still have the same issues. I believe in plans that have built in rest days and or range of motion days. My body is more stiff in general and so I need to spend extra focus on stretching. Spending some time on strength training as well can be very beneficial.

This can be as easy as adding push-up and pull-ups with some core exercises or light weights with high number of repetitions. Runners will typically benefit from lighter weight with higher repetitions rather than a body building style with heavy weights and fewer reps.

Stay tuned for steps 4 and 5, coming soon!

If you are having pain anywhere below the knee, come see us. We can help get you back on track as quickly as possible.

To make an appointment, click here. 

3 Common Injuries in Athletes: Part 2

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In the first blog, we talked about stress fractures being the first of the three most common injuries we typically see in athletes. Today, let’s dive into #2 and #3, and talk about causes, prevention and treatment.

2. Tendonitis

Once again, this injury is from overuse. The most common type of tendonitis we see involving athletes is Achilles tendonitis. The Achilles tendon is the most powerful tendon in the body and provides the propulsion strength needing in walking and running. It can often become very tight and repeated stress can cause micro tears in the tendon, causing pain and inflammation. Building rest days into your training can help prevent this injury. Stretching can also play a big part in prevention and can help if you are starting to develop the early signs of tendonitis. Icing the area for a short period of time can also help to resolve these symptoms.

However, if your symptoms persist, then considering more aggressive treatments can aid in the healing process. We avoid cortisone injections in this area due to the high chance of Achilles tendon rupture. We use laser therapy with the MLS laser to help reduce swelling and inflammation in the early stages of treatment. The laser also helps accelerate tissue repair and cell growth. If this has become a chronic issue, then we look at more regenerative treatment options like platelet-rich plasma therapy (PRP) and AmnioFix. These treatments can often prevent you from needing surgery and can help you resume your normal activity level more quickly.

3. Plantar Fasciitis

This is the most common complaint I see in my office. Heel pain affects many people and can be a common injury in athletes.  The plantar fascia is the main ligament that supports the arch. It runs from the heel bone to the ball of the foot. As our foot adapts to terrain, the plantar fascia can become overused and inflamed. It too can develop micro tears that cause pain and inflammation. Left untreated, it can become a chronic condition that causes the tissue to become thick and the plantar fascia loses it’s elasticity.

Symptoms often will be worst with the first step in the morning, or after sitting for long periods. In runners, it will often feel better shortly after you begin exercises, but will start to become painful again after longer distances and become progressively more and more painful. If the Achilles tendon is tight, it places added stress on the arch of the foot and often becomes the main cause of plantar fasciitis. Sometimes, plantar fasciitis can respond to calf stretching, but I would recommend coming in for an evaluation first as sometimes stretching can also make it worse, depending on the stage of the injury.

Plantar fasciitis also responds very well to regenerative injections like PRP and Amniofix.  Cortisone injections have been the traditional approach to treating this condition. However,  they often mask the symptoms, and when the injection starts to wear off, the pain returns. When using PRP or Amniofix, your immune system is recruited to aid in the healing of the tissue. The tissue is actually healing itself instead of just covering up the symptoms. Arch supports (orthotics) can also help to support the arch and prevent recurrence of pain.

Get Back to What You Love

So here’s the big takeaway. There are a myriad of injuries possible for athletes and triathletes, but these three are common because they are caused by overuse. We often treat all three injuries very similarly because of the response we see. Regenerative injections, orthotics, and MLS laser treatment have shown to get patients back to their activities, quickly. Often times, this happens in a matter of weeks instead of months.

Our goal is to heal the injury quickly, control the biomechanics of the foot to prevent the injury from returning, and get you back to doing the things that you love as quickly as possible.

To make an appointment, click here. 

How to Stop Tendonitis Progression

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tendonitis progression

We all know living an active lifestyle is an essential component to being healthy. Whether you are a mega multi-marathon runner, an avid tennis player, a yoga instructor, or a mall walker, your exercise is an important part of your daily routine. However, this healthy lifestyle of yours is threatened when injuries arise in your feet, such as tendonitis. Tendonitis is common and painful, but there are ways to keep the tendonitis progression to a minimum.

Tendonitis progression can affect various muscles in the body, including the feet. Posterior tibial tendinitis, for example, is an inflammation of the tendon that runs from the inner ankle to the shinbone. Some symptoms to look for to determine if you do indeed have tendonitis are:

  • Pain that increases when the affected area moves, such as when walking
  • A cracking or grating feeling when the injured tendon moves
  • Swelling
  • Redness and heat from the affected area
  • The development of a lump along the tendon
  • Difficulty standing on your toes
  • Pain on the inside of the foot or ankle

Tendonitis is a common injury, and is caused by the repetition of a particular movement over time. Though not as common, it may also arise after a sudden injury. Some of the risk factors which increase the likelihood of getting tendonitis are:

  1. Age- Tendons become less flexible and more susceptible to injury the older you get.
  2. Certain jobs- If your job consists of repetitive movements, awkward positions, frequent
  3. Overhead reaching, vibration, or forced extension you have a greater risk of hurting the tendon.
  4. Diabetes- Though experts are unsure why, people with diabetes tend to have a higher risk of developing tendonitis.
  5. Sports- The most common cause of tendonitis comes from sports injuries, especially in sports like running, swimming, basketball, tennis, golf, etc.

Whatever reason caused your tendonitis they all have the same risk: the injury is progressive and will worsen if untreated! 

So, how do you stop this progression? The answer is simple, start treatment right away! Treatment options include:

  • Rest, ice and elevation- these steps can often help alleviate pain.
  • Platelet-Rich Plasma Therapy and AmnioFix Therapy– Anderson Podiatry Center has been doing these treatments to repair feet and ankle tears longer than anyone in the Rocky Mountain region.
  • Custom orthotics– These are made by a podiatrist from a mold of your actual foot to help give you the best results.
  • Surgery– If the tendon is torn too badly, surgery may be the best option.

Before starting any treatment, it is extremely important to have your injury properly evaluated. All too often people think they have tendonitis, when in fact they have a tendon tear. The huge problem with this is that the two injuries are treated differently.

Dr. Anderson of Anderson Podiatry Center explains the concern with this. He says, “People have been known to stretch a suspected tendonitis, as it’s recommended sometimes. If the tendon is torn it will damage it more.” He also says how with a mild tear surgery may be avoided with regenerative medicines like Platelet-Rich Plasma Therapy and AmnioFix Therapy.

Again, the earlier you get your tendon checked by a podiatrist the better. Podiatrists are able to determine the extent of the injury, and get you the care you need before your injury progresses any further. 

Get treated, and get back to your healthy lifestyle!

tendonitis progression