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Mountain West Foot & Ankle Institute Mountain West Foot & Ankle Institute
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What Questions Do You Have?

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  • What is heel bursitis?

    As is the case with the knee or elbow, the foot also has a bursa to pad the ankle joint. A bursa, or a fluid-filled sac, can be found behind the heel bone that acts as a cushion and a lubricant between muscles and tendons sliding over bones in this area. Repetitive or over use of the ankle can cause the bursa to become inflamed or irritated leading to heel bursitis. The condition is often mistaken for Achilles Tendonitis. Symptoms include pain in the heel, especially when walking, running, or jumping or when the area is touched. The skin around the back of the heel may be red and warm to the touch, and the pain may worsen when standing on tiptoe or when climbing stairs. It is commonly seen in people who are just starting an aggressive exercise routine, or have changed to a flatter style of shoe. Since bursitis is typically just an inflammation of the bursa, conservative treatments can often resolve the problem once diagnosed.

  • What is Achilles Tendonitis?

     The Achilles tendon is the largest tendon (a band of tissue that connects muscle to bone) in the human body and is very strong, but is also the tendon we most often rupture. This rupture is problematic when you consider this is the strongest tendon of the body. Everyone who is active can suffer from Achilles Tendonitis, a common overuse injury and inflammation of the tendon. Symptoms of Achilles tendonitis include mild pain after exercise or running that gradually worsens, a noticeable sense of sluggishness in your leg, and episodes of diffuse or localized pain, sometimes severe, along the tendon during or a few hours after activity. Symptoms also include tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. Other symptoms can be swelling, morning tenderness in the Achilles tendon, or morning stiffness that generally diminishes as the tendon warms up with use. Often simple conservative treatments are beneficial.

  • What is tarsal tunnel syndrome?

    Carpal tunnel syndrome is an often well understood condition of the wrist. The foot and ankle have a similar, less common condition called Tarsal Tunnel Syndrome. The tarsal tunnel is a tight space in the foot that lies between bones and tough fibrous tissue extending from the ankle into the foot. A nerve called the posterior tibial nerve lies within the tarsal tunnel. If this nerve becomes compressed or squeezed, tarsal tunnel syndrome can result. Some common causes of compression can include constriction of the space, injury to the surrounding tissues, injury to the nerve, artery or vein problems (including varicose veins), or masses in the area. Symptoms include numbness over the bottom of the foot and/or pain, burning and tingling over the base of the foot and heel. Often these symptoms can be quite severe and treatment should be considered.

  • What is metatarsalgia?

     Metatarsalgia is foot pain in the ball of your foot which is the area between your arch and your toes. In this condition one or more of the metatarsal joints becomes inflamed and possibly painful. People often develop a callus under the affected joint. There are many causes of Metatarsalgia including injuries, arthritis, poorly fitting shoes, and working on very hard surfaces. Sometimes changing your shoes will fix the problem. We may also recommend orthotics or implants.

  • What are heel spurs?

     Heel spurs are bony growths on the underside of the heel bone caused by tension from a tight plantar fascia ligament. Sometimes they are found in people with plantar fasciitis, but they are rarely the source of pain. In fact, plantar fasciitis and heel spurs are often confused and although they are related they are not always the same condition. Spurs result from strain on the muscles and ligaments of the foot, stretching of the plantar fascia, and repeated tearing away of the lining or membrane that covers the heel bone. The body, as a protective mechanism, creates a spur in this area to further support the plantar fascia and limit further tearing of the plantar fascia. Close to 70% of patients with plantar fasciitis have a heel spur that can be seen on an X-ray, but rarely are these painful. Current studies now show that heel spurs rarely need to be treated, and heel pain can be resolved even when leaving the spur untreated. 

  • What is plantar fasciitis?

    It is the most common cause of pain to the heel and bottom of the foot.The plantar fascia (a ligament on the bottom of the foot extending from the heel to the toes) becomes inflamed and painful. This condition is most often caused by a tight Achilles tendon limiting the ankle motion and causing the foot to stress the plantar fascia with every step. It can also be caused by poor foot structure such as overly flat feet or high arches, by wearing non-supportive footwear on hard surfaces, spending long hours on your feet, or obesity (at least 3- 4 times your body weight passes through your foot with each step). The pain from plantar fasciitis is usually a sharp, stabbing pain on the inside of the bottom of the heel that can feel like a knife sticking into your heel. Pain from plantar fasciitis is usually most severe when you first stand on your feet in the morning. It will usually subside, but can return with prolonged standing or walking or getting up after long periods of sitting or after sleeping. As the pain progresses, it may become increasingly painful to the entire heel or may cause other pains as you walk differently (for example knee, hip or back pain may be caused initially by this heel pain). The good news with plantar fasciitis, however, is that it can and should be treated.

  • What causes wounds or ulcerations on the foot?

    When you get an ulceration or wound on your foot, it means that many layers of skin and tissue have been breaking down. Sometimes this breakdown of tissue can go all the way to the bone.They can be caused by pressure to a weight bearing point on the foot, but they can occur on top of the foot or due to pressure from shoes or a bony spur. The risk of ulcer formation is higher in patients with decreased circulation or impaired blood supply to the legs and feet. Diabetics are prone to heel ulcerations, but they can be found in patients with high blood pressure, blood clots, varicose veins, and phlebitis as well.

  • How are wounds and ulcers treated?

    Depending on the cause of the wound the treatment options will be different. The ultimate goal is always to close the wound from the inside out as quickly as possible. To this when the circulation to the area is adequate, dead tissue may be removed around the edges of the ulcer itself to promote healing. Other options include oral medications, compression and bed rest. New advances in wound care in recent years include the use of platelet-derived growth factor and the use of laser therapy to speed up the healing process.

  • What if my foot is exceptionally painful after surgery?

    Your foot will often swell after surgery and sometimes this can cause the ace wrap put on by the hospital to become rather tight. Loosening the ace wrap on the outside can help decrease the pain and give you more breathing room. As you do this, be sure to leave the gauze that is on the wound in tact so that your blood is able to clot and start to heal.

  • What if my foot is bleeding more than normal after surgery?

    If the surgery site is bleeding more than normal you can always add more gauze under the ace bandage. Never take the gauze on there off, because this will only reopen the wound in the places it has already clotted and will make it bleed more. So, add the gauze on top of what is already on there. Also be sure to give us a call when you do this so we can determine what the next course of action is. 

  • How long should my foot stay dry after surgery?

    We ask that you keep your foot dry for two weeks after surgery or until the stitches come out. You can do this by putting a plastic bag over your foot in the shower. This will help us make sure that the area under the skin doesn’t become infected.

  • What if my pain medication after surgery is making me nauseous?

    If this is occurring, be sure to give us a call. We will be able to let you know what your other options are. Most of time this sick feeling goes away after the patient is prescribed nauseas medication. We may also have a completely different option for you entirely. 

  • What if there is a numbness in my foot after surgery?

    The nerves in the foot after surgery can take up to a month to wake up. When they do wake up the patient may experience shooting pains.

  • What if I am unable to ice the surgery site directly?

    If you are unable to ice the area directly, because of the wrapping, putting ice directly under the knee of the same leg will also help. The easiest way to do this is to use a frozen water bottle.

  • How long will I be in the boot after surgery?

    Bone takes 6-8 weeks to heal, but most patients are able to take the boot off at four. An x-ray will be taken at a follow-up appointment after surgery before the patient is cleared to do so.

  • What if I am having trouble getting around after surgery?

    We recommend that patients are walking as quickly as possible after surgery. Doing so helps them get their regular range of motion back more quickly. However, if you are having problems getting around a prescription for a knee scooter can be sent in.

  • Is it Alright to Pop a Blister?

    Popping a blister is fine when you make sure to do it carefully, keeping these steps in mind:

    • Be sure to clean the area around the blister with antibacterial soap.
    •  Sterilize your needle with rubbing alcohol.
    • Drain the fluid inside by making a small puncture on one edge of the blister.
    • Use antibiotic ointment and then cover it up with a fresh bandage.

    If you are living with diabetes, it is also not advised that you treat your own skin injuries. Popping blisters can put you at risk for infection and serious complications. When you find a blister it is safer to make an appointment and have the doctor safely take care of it.

  • Should I Break in my Cleats Before Training in Them?

    Just like stretching or warming up before a workout, breaking in your cleats before wearing them for an extended period of time can help to prevent injury.

    Ways to Prevent Injury as You Break in Your Cleats:

    It is important to make sure that the shoes you wear during athletic activity gives you the comfort and support that you need. Since cleats are most often made with leather, they are easily able to stretch and mold to your feet. Here are a few guidelines to keep in mind as you start breaking in your cleats:

    • Get them fitted. Cleats are often supposed to have a tight fit to offer extra support during athletic activity, but it is crucial to make sure you are getting the right size for your foot. It is easier to make sure this is the case when you wear the same althletic socks that you would wear in a game to the fitting.
    • Bending. Moving the toe of the shoe up and down will help stretch the leather and will make the shoe more pliable when you are on the go. You can do this several times a day and may even consider applying a thin layer of leather protector to keep them flexible and to avoid cracking.
    • Slow and Steady. Day by day, gradually increase the amount of time you spend in your cleats as you work up to training in them. You should only wear your cleats on grass and dirt and you may want to wear an extra pair of socks with them the first time worn, to prevent blisters.
    • Pain is never normal. Just like any new shoes, cleats can cause blisters, corns or pains in the arches. If you are experiencing pain wear other shoes to practice for a few days. If your pain continues after returning to your cleats be sure to see a podiatrist.

  • How do Bones Heal?

    Bone healing is a carefully orchestrated process within the body to both stabilize and heal bone as quickly as possible. The ultimate goal of bone healing is to return to previous anatomy and appearance. This whole process is done in three distinct steps-

    Reactive Phase:

    Immediately following a fracture, the area forms a hematoma (or blood clot) to the area from bleeding bone and blood vessels. The vessels then constrict limiting further bleeding to the area. These extravascular blood cells then die and degenerate leaving a web or matrix of fibroblasts to support the healing process. Swelling during this stage is often utilized by the body to further immobilize the fractured area to facilitate healing.

    Reparative Phase:

    Once the area is stabilized, the bone cells transform into chondroblasts (cartilage forming cells) that start replacing the matrix with hyaline cartilage. Similarly other bone cells are transformed into osteoblasts (woven bone forming cells) that replace the matrix and ultimately the hyaline cartilage with woven bone. This restores most of the bones original strength.

    Remodeling Phase:

    Additional cells transform into osteoclasts and the woven bone is resorbed and replaced with compact bone with similar appearance and strength to original bone in this area.

  • What is the difference between custom, semi-custom and drugstore orthotics?

    We offer two types of orthotics in our office. Custom orthotics, and Quadrasteps semi-custom orthotics. These shoe inserts change the way you walk, stand, and distribute weight through your entire body. They have a many things in common, but they also have a few key differences. Sometimes patients ask a follow up question, which is, "are Quadrasteps any better than drugstore shoe inserts?"  In a word, YES. The chart below shows the differences between these three types of shoe inserts. 


      Custom Orthotics Quadrasteps

    Drugstore Shoe Inserts

    Gives support to specific areas that your foot needs Exact support based on your exact way each of your feet are individually shaped. Specialized support based on the way your feet are shaped

    Minimal support, mostly cushion


    Feels soft to the touch by giving your feet cushion


    More support than cushion More support than cushion Primarily cushion.

    Relieves stress points on feet


    Yes,with exactness Relieves stress points caused by foot shape No

    Fixes alignment in feet and body


    Yes Yes No

    Improves gait and body pains


    Yes Yes


    Recommended and evaluated by a doctor


    Yes Yes No
    Inexpensive Usually, depending on insurance Very affordable Cheap


    As you can see, custom orthotics are highly advantageous, followed by semi-custom orthotics. Unfortunately, drugstore orthotics do not offer many advantages at all. Their cheap cost and cushy feel convince many customers to buy, but they do not function as an orthotic should, and are essentially a waste of money. They do not change the way the foot is aligned or striking the ground. Custom orthotics are obviously the best choice, but if a patient is uninsured or under-insured, semi-custom Quadrastep orthotics offer most of the benefits at a more affordable cost. Call our office for help deciding which is the best route for you. 

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