Ankle Health Questions

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What are really the most frequent symptoms or problems that you’re seeing in your office when your patients come in to see you?

I see a lot of people suffering with heel pain. Usually, they’ll come in complaining of pain first step in the morning getting out of bed and then also if they’re at work and they’re sitting down and they get up, they’ll have pain in that heel or bottom area of the arch. Also, a lot of people complaining of bunion pain, which is a little bump on the inside of their foot, especially with shoe pressure. We also see a pretty good amount of patients that have neuropathy or issues where they get burning and shooting pain, in not only the foot, but also extending approximately up the ankle and into the leg as well.

Then the nice thing about being a foot specialist is really the foot is the foundation to the whole musculoskeletal system. So in retrospect what that means is a lot of people we’ve been finding have a condition called talotarsal dislocation in the foot, which is under diagnosed. And if you look at it, because of that malalignment of the foot it’s causing a lot of issues with knee, hip, lower back and even up into the shoulders. So the foot is really the foundation to a lot of other issues that patients are experiencing.

And so, proper foot health and wellness I feel is really important and that’s the reason why I looked into being a foot specialist just to help people that not only are having foot problems, but also problems in the rest of their body.

 

It’s said that one out of four Americans will experience heel pain at some point in their life. Are those numbers correct and, if so, why is this happening to all of us?

I would have to say it’s probably more than that, at least from what I see. I know you say one out of four, but I would have to say that’s probably more than that statistic. But I think a lot of is just, again, caused from conditions within the foot where you get, like I was explaining earlier, there’s different problems. There could be a hyper pronation where you get a collapse of the foot or even a high arch foot we call cavus foot. But the underlying cause is something internal within the bone construct. And it’s something they had pretty much all their life. It’s a hereditary issue where they get an under development of a particular bone, usually in the ankle and it sort of causes a dislocation or a malalignment of the ankle on the heel and it throws off, not only the foot with the bones, joints and ligaments of the foot, but again causing instability of the ankle and usually internal rotation in the knee, hip, back and causing issues with those as well. So a pretty common, but very under diagnosed condition, and that’s why I feel a lot of people should at least get evaluated for this particular condition, which causes a lot of problems.

 

Why does heel pain feel worse in the morning and get better throughout the day?

So a good analogy I look to tell my patients is that if you think of a rubber band, you have a ligament on the bottom of the foot that’s sort of starts at the heel area and then it goes all the way up into the forefoot area. And what happens is if you think of a tight rubber band, as you put weight down and that stretches, you get a constant stretch and a pull on that ligament, which we call plantar fascia. And what happens is because as you bear weight and you get this extra malalignment in the foot, you get that extra pull on that ligament and it causes little micro tears in that plantar fascia band and from that is usually where the insertion point on the heel is. That’s usually where people will experience that pain, again from the inflammation in that area and even from some of the micro tears from that ligament on the heel.

So the constant pulling, eventually, with time will cause these symptoms and is’ very, very common. But, usually, I see it later on. Usually, like middle aged patients is where at least I see a good amount coming in with it. It’s something that eventually will take time, but it will also be one of those where it will come and go where a patient says they had this excruciating pain, sort of like a toothache type feeling, in the heel. Then it got better and so they never sought treatment. Then, eventually, it will come back. It’s one of those things that just is just continuously coming back. But if it’s addressed early on, then a lot of these can be alleviated even in a nonsurgical way.

 

It’s been said that in most cases over 95% you can actually alleviate or cure heel pain without ever having to resort to anything surgical. Is that number correct?

Absolutely, yeah. A very low percentage of people really need to have surgery on the heel pain or fasciitis heel spurs that hear about. Again, it’s a biomechanical problem and in the majority of the patients it’s very imperative that they not only get evaluated, but the majority of them just need something as simple as what we call a custom orthotic which I try to explain to my patients it’s similar to people that have problems with their eyes and they need glasses to correct the eyes, and correct those. These are the same for the feet where they’re sort of like glasses for the feet. And what these custom orthotics do is they correct and realign the foot to put them into neutral or normal position to really prevent a lot these patients suffering with heel pain or fasciitis or pretty much any slew of foot issues, whether it be bunions or hammer toes, neuromas, or even ankle instability. But the custom orthotic is something that I highly recommend that they see a foot specialist for evaluation and for proper fittings.

 

Are orthotics and insoles different? We’ve heard that orthotics are actually designed to correct their instability. That’s very different than the arch supports that you can get that are even called orthotics at the grocery store or for someone that’s not trained to do this. Isn’t that true?

It is. And it’s a little disappointing being a foot specialist where I think they market; especially one that comes to mind is Dr. Scholl’s. If you go to some of these Myers and these stores they have these little, they call them custom inserts. But, again, a custom insert is just something that is on the shelf. It’s no different than an over the counter prefab. It’s not custom to the individual patient, because one foot is different than the other and each individual has different foot structures that need to be properly aligned. So these are not really a custom orthotic. They name them a custom insert, but they’re not the same and it’s a use of words that they do. And I feel really sort of that it gives these patients a false hope thinking that’s what’s going to help them. And they’re pretty pricey as well for just something that’s really actually no different than just an insert.

 

What is the connection between peoples’ feet and their ankles and diabetes? And why is it important to be taken so seriously?

Diabetes is it’s, again, a very high amount of patients have it, even an adult onset as well. It’s very important if you are diabetic, to at least have your feet looked at because usually diabetics run into issues with poor, inadequate circulation.

They also run into issues with what we call peripheral neuropathy or neuropathy, which is usually a pathology from high sugar that can affect the nerve and make the patient with diabetes not able to feel something that a normal patient that has no neuropathy can feel. Like if they have something in their shoe or they have an open sore, a lot of these diabetics don’t know they have it.

Then they can run into high risks of ulcerations, which are open sores in the foot and that, again, can lead to infection in the bone, which we call osteomyelitis. And that’s where you hear the horror stories about amputations or gangrene and all that in these diabetics. But they’re diabetics that really never got checked or evaluated, especially with their circulation compromised and neuropathy or not able to feel sensations in the feet.

So, if they get evaluated, those could be checked. And it’s also imperative to use a synergistic and team approach with diabetics with their endocrinologist or primary doctor, as well as podiatrist.

 

Should someone see their primary care doctor before a podiatrist when they have a foot injury or problem?

My thoughts are I get a lot of referrals from other primary care doctors. And they’re more specialized more in the other health issues. They didn’t go to school or have extra training for foot and ankle issues. A lot of them don’t even know how to treat any foot or ankle problems. I do see a lot of primary care doctors that send them over to me. And with patients they probably don’t know. So, realistically, we are foot and ankle specialists. So if they are suffering with any foot or ankle problems, I would highly recommend that they locate a podiatrist in the area. And also I always recommend for patients to check their credentialing, whether it be online. I recommend a board certified podiatrist as well if they are going to be seen.

 

What would be an example or two of some of the things that you are doing in your office that set you apart from other podiatrists?

Podiatry has advancements pretty much on a weekly basis. I keep up on all the new state of the art of advanced technology just not only for myself, but most importantly for the patients’ sake.

A couple of things that come to mind that I have or implement are I have in my office what’s called a fluoroscopy unit, which what that allows is for me to be able to see the patient’s radiographs in a dynamic way, which what that means is as they put weight down, I can see where the bones and joints and everything what occurs with them as they put pressure down. And it’s nice. The patients could see those up on the computer screen and see sort of where pathology is and how it is. I think it’s important to educate the patients on it, because back I used to, and a lot of podiatrists currently do it, is we have what are just regular x-rays, which just shows a static image or sort of a picture of the foot. But the fluoroscan actually shows the foot in motion, which is really important. And they can sort of see with their own eyes sort of what’s going on in the foot construct, especially with that talotarsal dislocation that I talked about earlier. You could see if vividly in these imaging.

Then the other thing too, again, I guess you could call it more state-of-the-art. There is a stint that we place in between the ankle and foot for this condition that puts the foot back into alignment. So it’s sort of like an invisible custom orthotic in the foot and it’s a permanent correction for them. It’s a probably about a 15, 20 minute minimal incision procedure, a lot of times just with a local anesthetic. And patients have been doing very well. I myself have been not only doing this procedure for patients here in the US, but have been seeing a lot of patients. I’ve seen some in Ottawa and Toronto and parts of Canada as well.

So there are always new advancements. There are now some minimal incision bunion procedures now so the patients can recover and get back to work and normal activity. There are heel procedures now, if they do need it, that are nonsurgical that can be done as well. It’s a lot of advancements.

 

What could I do just in my daily life, what could your patients do to take better care of our feet and not need to come see so much because we’re just avoiding some of these problems. What advice do you have for us?

Some advice I would recommend is just try to, again, be proactive. I recommend that if they are having pain, to be seen by a foot and ankle specialist or podiatrist right away, because if you just let it go, then it’s going to just make things worse for them. Always inspect your feet, especially those diabetics. I always recommend even getting one of those little mirrors at like a dollar store and just at least once a week always check the bottoms of the feet, because a lot of people can’t see the bottoms. And just look for any type of open sores or anything out of the norm. If they are having pains not normal in the foot, I would highly recommend, again, you seek treatment and be proactive. And if you’re proactive, then you really don’t have to worry about any thing getting too advanced or to a point where you’ll need a surgical intervention.

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Your Doctor

Dr. Anthony Weinert

Anthony Weinert, DPM, FACFAS, FACCWS is a double board certified foot and ankle specialist with office locations in both Warren and Troy, Michigan. Dr. Weinert is a physician and surgeon of the foot and ankle who believes in providing his patients with the most state of the art treatments in a patient friendly environment. He believes in providing quality patient care and safety and was honored with being one of the first foot and ankle specialty centers in Michigan to receive accreditation by the Joint Commission (JCAHO) which is the gold standard in healthcare for providing patient care and safety.  He believes in the philosophy of patient education for their foot and ankle disorders and also believes to treat every patient the way he would like to be treated.

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