Plantar Fasciitis Treated Using Stem Cells

Your heel hurts!  It hurts with the first steps out of bed, when you get up from a chair, and when you walk too long.  I gave you advice on stretching, ice, and prescribed an anti-inflammatory medication.  Often times we have to support that unstable arch of yours using custom foot orthoses.  What if your pain is still there?  Injecting steroids in the painful area, extracorporeal shock wave therapy, or even surgery are the traditional options remaining.  But what about stem cells?

 

The sensationalism of advertising and the media would lead you to believe that there are stem cells available for treatment of just about anything.  Is this true?  Lets look at some options:

  1. PRP (platelet rich plasma):  Blood is taken from a vein and spun in a centrifuge to separate the components.  One component would be the platelets and anything else that was relatively heavy circulating in your blood.  Would this include stem cells?  Most likely not!  The platelets contain growth factors which promote healing.  Injecting PRP into your heel would result in a time-release of numerous growth factors that could heal the inflammation that is your plantar fasciitis, thus making you feel better.
  2. Amniotic membrane derived products:  The amniotic membrane protects and covers a growing baby while inside the mother.  The placenta is part of this marvelous structure and is delivered with the baby in normal, healthy childbirth.  For this reason there is no controversy about using the placenta, as it would only be discarded if not used.  Placenta blood has long been known to contain stem cells used to treat leukemia and other illnesses.  Scientific studies have shown that there are cells very similar to stem cells in the placenta.  If you inject cells that were taken from a placenta, your body would not reject them because they are so immature.  Injecting the stem cells into an area of inflammation would in theory be able to heal the structure that is damaged or inflamed.  It has yet to be proven, but seems very promising that injecting these amnion derived products into your heel would completely resolve your plantar fasciitis.
  3. Bone marrow:  Time tested and proven, the bone marrow is the ultimate source of stem cells.  Unfortunately this requires a surgical procedure that can be painful and quite expensive.  This is probably not a reality in treating heel pain.

Now here is the kicker.  Because the scientific literature is not complete regarding using stem cells to treat plantar fasciitis, these treatments are not covered by your insurance.  That means you would have to pay for them.  These treatments are so new that not all physicians can provide them.  At Desert Foot Surgeons, we continue to advance as treatments become available.  If you have heel pain that has not responded to treatment, stem cells may be an option for you.

Happy New Year! Resolutions Can Lead to Sore Feet.

Excitement is at its peak!  Time to get those new running shoes out from beneath the tree and begin your New Year’s Resolution.  That first run of the new year feel soooo good!  So much so that the following day you might run longer or faster.  Then it begins.  You wake up to sore muscles.  There might be a stiffness or sharp pain in your heels lasting just long enough to get your attention, but then it goes away.  Because it is your new year’s resolution you continue to work through it only to get increasingly sore and stiff.

By February your heels are so sore, toes and ankles are stiff, muscles ache so much that you don’t want to run or work out today.  The next day you might return, but then the soreness is back.  People at work are noticing a slight limp.  You are thinking about skipping more and more days of exercise.  So much for that resolution.  I have been there and know how to get through it.

As I always say, “Normal feet don’t hurt!  If you have pain, get them checked out.” Let me help you get back to exercising at the level you desire.  Desert Foot Surgeons works with high level athletes and the casual weekend warrior.  We differ from other offices in our team approach.  Your needs and goals are a key component of treatment.  This is personalized foot care and Desert Foot Surgeons is the only place you will find it.

Happy New Year!  Don’t become another statistic.  Let us get you exercising at the level you desire.

Affordable Care Act: What it means for my practice.

 

In January of 2014 the Affordable Care Act will supposedly begin to have an effect on the practice of medicine in the United States.  There are numerous blogs and posts on the internet about how to best prepare for this event as a consumer and physician.  I find this interesting since no one really knows how this will effect medical payments to physicians, hospitals, outpatient facilities, and pharmacies.  There has been no communication with physicians about joining some “Obamacare” network of providers.  There is no insurance plan to participate with under this Act.  The huge internet failure was said to be due to the number of people signing up for the Affordable Care Act Plan.  I have one comment about that:  this Act was made to help something like 20 million Americans that do not have access to health care.  First of all we have a County Hospital System whose mission it is to provide care to those who do not have insurance, thus providing care to everyone in need.  As a physician working part-time in a Community Health District/County Hospital System I can tell you that most of these 20 million Americans lacking access to health care do not have a computer.  The people this Act was designed to help are not the ones who are signing up.  I’m not even going into the mental health issues that plague this population and prevents them from seeking medical care.

So what is going to happen.  I will predict that some physicians will participate with whatever plan develops under the Affordable Care Act and other physicians will not.  Some will accept insurance and some will accept cash for services.  Most of the people in poverty will not sign up for “the plan” because they just won’t know how.  It will not help those it was designed to help and will ultimately fail, in about a decade or two, going back to a similar system to what we have at this time.  What are we going to do about it?  Nothing!  Dr. Geller will still treat patients with foot and ankle deformity and pain.  If surgery is your best option, I will recommend surgery.  If insurance will not allow us to do surgery I will work with you to resolve your problem the best we can.  Your bunions and hammertoes will not have to go untreated.  Your heel pain will go away with treatment.

What do I recommend you do about this?  Wait!!  You should never be the first to sign up for an experimental plan.  Wait it out and see what becomes of the Affordable Care Act before you change.  Six months, a year, whatever works best for you.  Desert Foot Surgeons will still be here to help you with your foot care needs.

How to Choose The Best Running Shoe for You

 

Choosing the best running shoe is a common issue addressed at Desert Foot Surgeons.  Dr. Geller spends a great deal of time discussing pronation and shoes designed around this normal foot motion that when excessive leads to many common foot problems.  The link below is a nice video that demonstrates pronation and discusses the design of running shoes.  Enjoy!

http://www.runnersworld.com/running-shoes/inside-the-doctors-office-stay-injury-free-with-the-right-shoe?cm_mmc=Twitter-_-RunnersWorld-_-Content-ShoesandGear-_-PickRightShoe

Bunions Inherited: Don’t Blame Your Shoes, Some Can Help

I’ve said this before.  Glad to see more web information to support the position that bunions are not caused by shoes.

Check out my prior post, “Hate The Bunion, Not The Shoe”.

Here is the recent post that is also interesting.

http://www.medicaldaily.com/articles/15710/20130520/bunions-bunion-surgery-foot-health-podiatry.htm#

Do Your Feet Get “Tired” While Running?

I spend the majority of my day finding the flaw in people’s feet that explains why they are suffering from pain and deformity.  Usually it is this flaw that I can attribute to causing a problem with muscles, making them fatigue early.  The question always arises in the back of my mind, do people without the flaw in their foot also get muscle fatigue.  A recent study in the Journal of Podiatric Medicine answered this question.

 

The Effect of Moderate Running on Foot Posture Index and Plantar Pressure Distribution in Male Recreational Runners, took  30 men who run for exercise on a regular basis.  They examined the foot for flaws and excluded anyone who had a problem.  These men ran at 3.3 m/sec (7.3 mph) for 60 minutes.  The measurements reveal that all subjects suffered muscle fatigue leading to pronation while running.  This evil word “pronation” is the root of many problems in the foot.  The interesting part of this study is that even people who began the study with “very supinated” foot posture (that is the complete opposite of pronation) ended the run in a pronated foot posture.  This change altered the pressure on the ball of the foot and inside of the heel most.  This could explain pain in many people who run.

But what about runners who don’t have pain?  In a study of ultramarathon runners, Karagounis found the same changes in foot posture and pressure, but these changes resolved within 24 hours.  The take home message is that if your feet hurt when you run and the pain doesn’t go away in the first day after the run, you need help.  This could be as simple as adding support by orthoses or arch supports.  The risk of not getting help…stress fracture, plantar fasciitis, tendonitis.

 

References:

Escamilla-Martinez E, Martinez-Nova A, Gomez-Martin B, et al: The Effect of Moderate Running on Foot Posture Index and Plantar Pressure Distribution in Male Recreational Runners, JAPMA 103(2): 121-125, March/April 2013

Karagounis P, Prionas G, et al:  The Impact of the Spartathlon ultramarathon race on athlete’s plantar pressure patterns. Foot Ankle Spec 2: 173, 2009.

Finding the right athletic shoe need not cost a lot of money, but does require some care

A nice little article to help you select shoes.

http://www.pennlive.com/bodyandmind/index.ssf/2013/04/finding_the_right_athletic_sho.html

 

Dr. Allan Grossman shows another criteria for picking shoes

for your children, or yourself. When bending the shoe the

upper area should not expand out (left) but should remain

normal (right), otherwise you will not get proper support

from the shoe, and can be injured.

Mark Pynes | mpynes@pennlive.com