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Amniotic Membrane Therapy for Chronic Heel Pain

By Gregory Cardinal DPM, MS

Heel pain is one of the most common complaints heard at the podiatrist office. Heel pain can be caused by myriad of things such as plantar fasciitis, Achilles insertional tendinitis among others. Usually the doctor will prescribe a host of conservative treatments such as a stretching regimen, night splint, icing, rest, orthotics and oral anti-inflammatory medication or cortisone injection.

However, when the pain keeps recurring over time despite adherence to these and other various treatments it may be time to re-evaluate for a chronic injury. Amniotic membrane therapy is an alternative for patients that have had little to no success with conservative treatment, have reached their limit of steroid injections or want to avoid them altogether.

The therapy consists of an injection to the site of injury itself. The injectable is donated amniotic membrane tissue containing natural growth factors produced by our bodies that signal cells to the site of injury. These growth factors reduce inflammation, enhance soft tissue healing and regenerate the damaged tissue. Patients usually experience some temporary soreness at the injection site following the procedure and are put on a rehabilitation schedule for optimal recovery.

So, whether you’re a runner wanting to get back on the trail or someone looking for an alternative to steroid injections or other treatments have proved unsuccessful, amniotic membrane therapy may be right for you.

Common Foot Conditions in Children

By Gregory Cardinal DPM, MS

Children can present with many worrisome problems to the new parent but some that get overlooked quite frequently occur in their feet! Yes, flat feet, in toeing and toe-walking are conditions that many children have and can outgrow, but it’s when they reach a certain age that if these have not resolved or are severe to begin with, then it may warrant a trip to see the podiatrist.

Some common milestones that one should keep track of is that it is normal for a child’s foot to look flat, usually up until the ages of 3-4. This is due in large part to the degree of thickness of the fat pad on the baby’s foot, but soon, a child’s arch can be seen taking shape around age 3 and their adult foot type is often developed by the ages of 10-12. A child 3-4 years of age with a flat foot accompanied with pain or collapsing-inward appearing ankles or who are still flat footed by age 5 should be evaluated for orthotics to support the arch and align the heel.

In-toeing is another common development in children, this is when a child’s feet point inwards, also known as pigeon-toed. The opposite of this and less common is out-toeing or duck walking when their feet point outwards. These are both caused by the degree of rotation in the child’s lower extremity and is commonly remedied by stretching, strengthening exercises, bracing and children’s orthotics.

Lastly, toe walking is another condition that usually occurs shortly after a child first begins to walk. However, if it’s 6 months to a year later and your child is still tip-toeing around, then she or he may need to be evaluated for tight heel cords, vision discrepancies and neuromuscular function.

Laser Treatment for Fungal Toenails

By Gregory Cardinal DPM, MS Podiatrist in Motion, LLC

As the weather gets warmer, it’s time to shed bulkier foot wear for sandals, flip flops and other lighter shoe gear. However, unsightly toenails may prevent many of us from publicly displaying our feet. Toe nail fungus affects millions of people worldwide and not only can be an embarrassing affliction, but the seemingly fruitless struggle to rid one’s toenails of these persistent organisms can be an exercise in utter frustration.

The medical term for toenail fungus is Onychomycosis and the usual culprit organism is Trychophyton Rubrum; this is the same species that causes Athlete’s foot (a precursor and root cause of most toenail fungus). Other species do exist such as T. Mentagrophytes which can cause the nails to have a whitish appearance and Candida Albicans, a mold that is also very common in fingernails.

Although many home remedies are out there including vinegar foot soaks, tea tree oil and baking soda; the treatments recommended by most podiatrists are topical antifungals, oral medication or laser.

All three treatments have their upside and downside. However, in my practice, I’ve found the benefits of laser to be manifold, including that the treatment session is relatively quick, non-invasive, pain free and no blood work or oral medication needed. Laser is effective on its own but is typically recommended for use in tandem with a topical.

How it works is simple, the laser transmits energy through the nail plate and nail bed and essentially kills the organisms at each treatment. Three to four sessions spread apart in monthly intervals usually is sufficient. Still, as with all fungal nail treatments, there is no immediate change in nail appearance, the nail has to grow out to see the full fruits of the treatment and this can take up to a year depending on which toe is treated.

Patients undergoing laser need to be diligent in keeping up with their foot hygiene as to not re-infect themselves. Tips for this include disinfecting or throwing away old shoes, changing shoes and wearing clean socks daily. It is also beneficial to wear breathable stockings made of cotton or wool and remembering to always wear shower shoes at the gym.

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