Article written by Dr. Bronwyn Wilke, D.P.M

I recently read an article by a woman's fashion magazine listing shoes that every woman should have.  I was stunned that sneakers did not make the list!  A good solid walking/hiking athletic shoe is number one on my list of must have shoes.  Athletic shoes are the one line of shoegear that is focused on function and has research dedicated to product performance.  I appreciate that the basis of the article was fashion.  What woman doesn't have her glam moments?  But for every moment of glamour and less than practical shoe choices there is a moment of relief when the shoes are taken off.  If you've strutted in pumps you appreciate the NYC exec who runs to appointments in her suit and sneakers with her dress shoes in her purse.  If you have danced in peep toes or platforms you understand Kim William's character wearing sneakers under her wedding gown in "Father of the Bride".  No matter how gorgeous the shoe it cannot be sexy if you have to limp.  As a lover of stilletos, pumps, peep toes, sandals and boots I must draw attention to the unsung hero of every womans closet - the sneaker.  If you are having trouble finding a sneaker that is right for you, your foot health professional will give you guidance on foot deformity and appropriate sneaker choices.  Come see us in York, Lancaster, Shrewsbury, or Hanover.  We are Podiatrists that specialize in you.

Article written by:    Maria Kasper, D.P.M. and Sonam Ruit, D.P.M.

For all you Jeopardy fans, we have a few answers:

Question 1:  It is a large ropelike band of tissue that connects the calf muscle to the back of the heel.

 Answer 1:  What is the achilles tendon?

Question 2:  He is now called the "destroyer of evil" after injuring his leg while chasing a burgler from his hotel room.

   Answer 2: Who is Alex Trebek?

That is correct.....on Tues, the 71 yo Trebek chased a burgler from his San Franscio hotel room after she allegedly stole cash and jewlery from him.  Trebek was staying with his wife in the hotel room while hosting the National Geographic Geography Bee.  Unfortunately, during the incident, while chasing the burgler down the hall Trebeck snapped his Achilles tendon. 

He is likely to require surgery to repair the tendon.

Achilles tendonitis is a painful and often debilitating inflammation of the Achilles tendon (heel cord).  It is located in the back of the lower leg, attaches to the heel bone (calcaneus),  and connects the leg muscles to the foot. The Achilles tendon gives us the ability to rise up on our toes, facilitating the act of walking.  Achilles tendonitis can make walking almost impossible due to the pain associated with it.

            Who is more prone to Achilles tendon injuries or tendonitis?

Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis. Participating in activities that involve sudden stops and starts and repetitive jumping (e.g., basketball, tennis, dancing) increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear. Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time (overuse).

The condition also may develop in people who exercise infrequently and in those who are just beginning an exercise program.    It is important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually.

Women who wear high-heeled shoes often and switch to sneakers for exercise also can develop Achilles tendonitis.  High heels have allowed the Achilles tendon and lower leg muscles to gradually adapt to a shortened and contracted position.  When this happens, wearing sneakers or flat shoes forces the Achilles tendon to stretch further than it is accustomed to, causing inflammation.  If high heels are worn every day, stretching should be done every morning and night to keep the Achilles tendon lengthened.

The symptoms associated with Achilles tendonitis and tendonosis include:

• Pain—aching, stiffness, soreness, or tenderness—within the tendon. This may occur anywhere along the tendon’s path, beginning with the narrow area directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.
• Tenderness , or sometimes intense pain, when the sides of the tendon are squeezed.  There is less tenderness, however, when pressing directly on the back of the tendon.
• When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.

If damage to the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation).

Patients are advised to:

• RESTthe tendon by keeping off their feet as much as possible;
• Apply ICE packs for 20 minutes at a time every hour for a day or two to reduce swelling;
• COMPRESS the ankle and foot with a firmly (not tightly) wrapped elastic bandage; and
• ELEVATEthe foot whenever possible to minimize swelling.

A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used to reduce pain, swelling, and inflammation. if mild Achilles tendonitis does not respond to basic treatment, or if symptoms return with the resumption of physical activity, a flexible cast may be used to immobilize the foot and reduce swelling, and crutches may be used to keep weight off the foot. This treatment may be necessary for up to 6-8 weeks .  Martin Foot and Ankle can provide Physical therapy and rehabilitation, which is also very essential in the treatment and management of Achilles tendonitis, to gradually stretch the tendon before full activity is resumed. 

When conservative therapy fails for severe Achilles tendonitis, Martin Foot and Ankle may recommend surgery at their surgical center located on S. Queen St. in York, PA. Surgery involves removing the tendon's inflamed outer covering and reattaching the torn tissues. Following surgery, the patient is immobilized in a cast or splint for 2-3 weeks, and then undergoes passive range of motion physical therapy and progressive strengthening exercises for the next 4-6wks. Most activities can be resumed in 6–10 weeks and competitive sports usually can be resumed after 3–6 months.

How can we prevent such problems?

Proper conditioningand appropriate footwear are the best defense against Achilles tendonitis. People who engage in physical activity should always warm up and stretch properly before beginning the activity. If discomfort occurs, the activity should be discontinued immediately and ice should be applied to the affected area to relieve inflammation. If the problem persists or recurs, medical evaluation by a foot and ankle specialist is necessary. It may be advisable to consult a physical trainer to determine whether a flaw in technique is contributing to the problem as well.

Martin Foot and Ankle,

Podiatrist in Lancaster, PA, York, PA, Hanover, PA and Shrewsbury, PA

By Dr. Bronwyn Wilke D.P.M  F.A.C.F.A.S.

Bunions are not just the nasty bump you saw sticking out of the side of your grandmother’s shoe.  They are a progressive foot deformity that can appear as early as the teen years.  Over time the great toe moves toward the smaller toes, making the great toe joint prominent on the inside of the foot.  Bunions are hereditary and the deformity can be worsened by pointy toed shoes.

In the early stages there is no pain with this deformity.  As a bunion progresses shoes become irritating to the bump.  Patients will usually start to wear wider shoes to accommodate the bump, and stretching out of the shoe over the bunion can be seen.  With the joint out of alignment the cartilage will start to degenerate and become arthritic.  Pain changes from an irritation over the bump from shoes to a deeper ache in the joint as the cartilage is destroyed.  If a bunion is not treated, compensation can be seen throughout the foot.  Hammertoe formation of the second toe is caused by the great toe pushing the second toe out of position.  Callouses can be seen across the forefoot and along the great toe as the mechanics of the foot and the way a step is taken changes because of the deformity.

Treatment early on for bunions includes orthotics.  An orthotic is a shoe insert that controls the mechanics/function of the foot and its joints. Podiatrist recomment  using an orthotic early on to slow down progression of a bunion deformity and ease pain.  This is important in juvenile bunions where surgery runs the risk of disrupting the growth plates. 

The type of surgery necessary to correct a bunion depends on the severity of the deformity.  It is generally an outpatient procedure, where the patient can go home the same day the procedure is performed.  The majority of bunion procedures allow the patient to walk in a special shoe or protective boot immediately after surgery.  No high impact activity (such as jogging or aerobics) is allowed until the bone heals which generally takes 6-8 weeks.  Very severe bunions may require a cast and several weeks on crutches.  Physical therapy after surgery helps restore motion to the joint and ensures the patient walks without a limp.

If a bunion is neglected and allowed to progress, the joint becomes arthritic.  Treatment options include arthritis medicines to control the pain and stiff soled shoes to limit motion at the joint.  Surgical treatments include joint replacement and fusion/arthrodesis.  Joint replacement maintains motion at the great toe joint placing a piece of metal to give a smooth surface for the joint to glide.  Joint replacement patients can start walking inmmediately after surgery.  Joint arthrodesis fuses the great toe to the long bone behind it, eliminating motion and pain.  Joint fusion takes 6-8 weeks for the bone to heel and a cast and crutches are used during this time. 

Ideally, bunions should be treated before the joint becomes arthiritic.  Maintaining alignment of the joint will prevent deterioration of the cartilage and the pain associated with arthritis. 

If you are near the York, PA; Lancaster, PA; Hanover PA;  or Shrewsbury PA area and are having these symptoms, Please call our office for treatment.  1-800-456-0076.

Achilles Tendon Injuries
by, Dr. Michael Younes, DPM, ATC, FACFAS
Martin Foot and Ankle

With the doldrums of winter far behind us, the tendency for people to initiate a more active lifestyle becomes a mainstay.  With this comes the propensity for injuries to occur.  A very common injury seen by the Foot and Ankle surgeon is an acute rupture of the Achilles tendon.  This is classically seen in the “Weekend Warrior” on the basketball court with males being most commonly affected in their mid 30’s and 40’s.   The Achilles tendon is the strongest tendon in the body. It is comprised of three muscles that combine together forming the tendon and insert in the back of the heel bone.  The most common area of rupture occurs a few centimeters above its insertion called the watershed area.  This area is prone to injury due to poor blood flow and lack of healing potential.

The mainstay of treatment in the active patient is a surgical repair to reconnect the ends of the rupture.  The repair itself is not technically difficult, but the recovery is fairly prolonged, in excess of 10 weeks in a cast post-operatively.  Although an active post-operative lifestyle is expected, the re-rupture rate has been documented to be around 15%.

Another commonly seen Achilles tendon condition is the chronic Achilles tendonitis with concomitant Heel Spur condition. This malady combines the enlargement of the insertional area of the Achilles tendon, the heel spur, causing a chronic inflammation of the Achilles tendon.  Conservative treatment measures include the use of anti-inflammatories, orthotic management, physical therapy, and alteration of activity.  If this is left untreated, it can lead to a partial rupture of the Achilles tendon. This necessitates surgical intervention.  The repair itself is similar to the above mentioned repair of the acute rupture, but the resection of the heel spur is necessary as well.  The post operative care is mildly shortened in this procedure requiring a minimum of six to eight weeks in a cast.

The cause of the chronic Achilles tendonitis has long been thought to have been caused by an excessively tight heel cord.  With long standing high tension of the Achilles tendon pulling on its insertion to the heel bone, a spur forms due to the tension imposed upon it.  With this being said, it is common to employ an additional procedure to lengthen the heel cord as well as to diminish the chronic tension post-operatively.

Overall the Achilles tendon is an amazing structure of human anatomy that is essential for normal human gait.  Its strength has been likened to that of steel, although it is vulnerable to injury as is any other part of the foot and ankle.  Early recognition and treatment of the above named conditions are the foundation for proper care as conservative measures may thwart off the need for surgical intervention.