Plantar Fasciitis

(PF) is a painful inflammatory process of the plantar fascia, the connective tissue on the bottom of your foot that causes foot, heel and ankle pain. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be treated effectively in most cases. Another common term for the affliction is “policeman’s heel”.

The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pain, especially among runners.

How Is Ankle Pain Diagnosed?

History and Examination:

A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays:

Plain X-rays can reveal narrowing of the space in the two joints of the ankle, revealing wear and tear on the cartilage from arthritis like diseases and bone spurs that can interfere with movement.

MRI (Magnetic Resonance Imaging):

Is a noninvasive procedure that can reveal the detail of the joints, ligaments and tendons.

Myelography/CT scanning:

Sometimes used as an alternative to MRI

Diagnostic ultrasound Imaging:

Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your ankle pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors are contributing to your pain. With this information in hand, specific treatment options can be established immediately!

Treatment

Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in theankle causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

How is the procedure performed?

By taking a small sample of your blood, a special centrifuge concentrates and separates the platelets, growth factors and specialized white blood cells from the other components of the blood. This super concentrated PRP is then injected using continuous ultrasound guidance into the cracks and crevices of the damaged area. The orchestra of events is stimulated and the tissue begins to heal. The result is reduced inflammation and pain.

AmnioFix: Healing Damage – Tears and Chronic Tendinitis:

Why use AmnioFix?

When there is damage, tissue tears or arthritis this exciting new treatment can be used to heal the structures in a joint such as the labrum, tendons, muscle, ligament or cartilage.

What is AmnioFix?

AmnioFix is a new treatment that harnesses the power of 13 growth factors in a pre-packaged application. AmnioFix is hydrolyzed micronized amniotic membrane allograft containing 13 powerful growth factors. That’s a mouth full! Amniotic Membrane has been used in wound healing for many years. By placing the allograft over wounds that aren’t healing, as with burn victims, new tissue grows. Just recently, the allograft has been processed into a form that is dehydrated and micronized.

As with the explanation above regarding platelets, damage in the body is healed by an orchestrated cascade of events guided by the release of specific growth factors in the areas where damage occurs. Because joints and surrounding tendons lack a direct blood supply, damage heals slowly or often not at all.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

• Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

• Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

• The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor:

You should see your doctor if:

• You’re experiencing severe ankle pain
• You have swelling
• You have ankle pain that’s lasted more than a week
• If you have difficulty walking or weight bearing

Pain is increasing

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.