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Health Tips for Preventing Foot and Ankle Injuries 

Gazdag Ask the Expert Facebook ChatDr. Andre Gazdag

Aches and pains are part of exercise, and feet and ankles health has become increasingly important to many sports-minded people. While some fleeting pains can be “worked through”, others may get worse with exercise – or signal a larger issue. Orthopedic specialist Dr. Gazdag discusses what you need to know about preventing foot and ankle injuries while maintaining good health. Questions were submitted by the public via Suburban Hospital’s Facebook page.

I have a pain and the arch of my foot when I walk feels like it is pulling. How do I treat it?

Arch pain is very common but fortunately treatable. The cornerstone of treatment includes stretching exercises and proper shoe wear. Stretching both the calf muscle and the arch several times a day will help with the pain and the “pulling” sensation. Shoes should have a good arch support and have some measure of cushioning. Eventually, a shoe insert may be needed.

What kinds of precautions should one take after a cortisone shot? Is it normal to feel numbness a week after a cortisone shot?

Although there are several different minor side effects that one can experience after a cortisone injection, actual precautions are few. The most common side effect is soreness at the injection site, much like you may experience after a tetanus shot. If this soreness occurs, then modification of activities or shoe wear would be advised. For example, if you had increased pain after a shot on the bottom of your heel, then you would be advised to refrain from both high impact activities and walking barefoot until the soreness resolved. Numbness after an injection is a documented side effect, but it’s not very common. This numbness can last for a few weeks, depending on how much cortisone was absorbed by the nerve. There really isn't any treatment for this numbness other than waiting for the nerve to “wake up” on its own.

Dr. Gazdag, what recommendations do you have for those of us that frequently experience numbness and tingling in our feet and legs?

There are many different reasons why someone would experience numbness and tingling into their feet and legs. The timing, frequency, location, and severity of the symptoms help determine the cause. One common complaint is tingling and numbness into the toes during a strenuous workout. If this resolves within a short period of time after stopping the activity, then this represents harmless irritation of the small nerves passing through the ball of the foot. This is not a serious problem, but if the symptoms become more than just a nuisance, then changing the activity or changing shoes would be the first move. If tingling and numbness occur constantly throughout the day, then a workup by a physician would be advised. Continuous symptoms are suggestive of a lower back problem, like sciatica or spinal stenosis, or perhaps of a more generalized neurological condition. For example, patients with diabetes can develop a secondary neurological problem called peripheral neuropathy. To be on the safe side, a visit to your internist would be advisable to start an appropriate work up if your symptoms are frequent or constant.

I am in my early 60's and want to go on long walks with the dog but the bottom of my long toe joints hurt which makes it difficult. X-rays show that I have arthritis and my joints are bone on bone. I'm not interested in surgical repair at this time but wondered if there was anything I could do to allow me to perform exercise without pain.

Arthritis at the base of the great toe is very common. If x-rays show “bone-on-bone”, then your treatment options are somewhat limited, but can be nevertheless successful in at least reducing the pain. A cortisone injection can be very helpful. Custom molded insoles with a stiff shank under the arthritic toe can help also. Proper shoe wear is key. For instance, if there is a sizable spur on the top of the arthritic joint, then modifying shoes to accommodate the bony prominence can go a long way in alleviating pain. If, however, these approaches don’t provide desired relief, then surgery should be considered as an option. Surgery can be very successful for this problem.

In the middle of marathon training I have developed posterior tibialis tendonitis. What are your recommendations for treatment, short of wearing a boot and not running for six weeks (which one orthopedist I saw recommended)?

Treatment of this problem often depends on the severity of the symptoms. Mild cases can sometimes be treated with rest and Advil. More advanced cases usually require multiple modalities including rest, icing, anti-inflammatory medications, some form of bracing, and physical therapy. In your case, abstinence from running is a no-brainer. However, six weeks in a boot might not be necessary. In fact, depending on your initial symptoms, that recommendation might be excessive. If your pain has already come down to a manageable level, physical therapy at this time could accelerate the healing process. Eventually you will probably benefit from some custom-molded orthotics.

My friend, who is a big walker, will occasionally have her ankles "give out" while walking casually which causes her to stumble. She doesn't feel any pain, just a temporary loss of support. Is this anything to be concerned about?

These episodes when the ankles “give out” are not necessarily a red flag hinting of a serious underlying problem, but functionally speaking, it is concerning because she could end up hurting herself the next time she stumbles. If she were to fall to the ground, there are a whole host of injuries she could suffer including broken bones and concussions. If her ankles give out on a regular basis, then she should be evaluated to determine an underlying cause and to initiate some form of management. As one gets older, it is increasingly important to reduce the risk of falling.

I'm a freshman in high school and a cross country runner. They told me at the running store that I have flat feet. Are there any injuries I should be looking out for? Should I get inserts for my running shoes?

Just because you have flat feet doesn't mean you’re necessarily at an increased risk of having pain when running. Problems can arise with feet of all shapes and characteristics, spanning from feet with high arches to no arches. No matter what your feet look like, however, a good arch support is always a good idea especially if you’re running long distances frequently. The great majority of good running shoes have an adequate built-in arch support that should do the trick. If your feet don’t hurt when running in these types of good running shoes, then inserts are not necessary. However, if you were to experience pain in the back of the heel, bottom of the heel, or in the arch, then inserts from a running store would then be a good idea.

Is light running and continuous stretching ok to do post physical therapy for plantar fasciitis? I still have stiffness in my calf and the top of my foot.

If you are still experiencing calf stiffness, then daily stretching exercises is absolutely the right thing to do. Daily stretching will also help prevent the plantar fasciitis from returning. Light running is OK just as long as your current symptoms remain tolerable. If your symptoms should get worse, then you should stop all running and stick to non-impact activities like the stationery bike, the elliptical machine, or the stair-stepper.

Is there a particular brand of running shoes that are good for people with bunions?

Off the top of my head I can’t name a specific brand that is best for bunions. Running shoes, or any shoes for that matter, should have a wide toe box to better accommodate the forefoot made wider by the bunion. If the shoe is tapered or pointy at the end, then that shoe should be avoided. In addition, the material around the bunion should be soft and somewhat forgiving, like a mesh material. If you have a bunion and flat feet, then make sure that the running shoe has a good arch support.

Are Super Feet inserts good to use for running and training for a marathon? I am a runner and training for a marathon in 2 months. I have been using my current pair of Super Feet since February of this year, but not the same shoes as I switch mine every 300-350 miles. Should I get a new pair to break in now?

I think that Super Feet inserts are the best off-the-shelf orthotics you can buy without a prescription. A pair of these should last you a couple of years. If the pair you currently use still feel fine and if your feet don’t hurt, then I’d stick with them at least through the next 2 months. When you’re training for an event like a marathon, it would be advisable to change as few variables as possible, for example the orthotics, in order to decrease the possibility of a setback in your training if by chance the new insoles for some reason don’t quite fit right.

What is plantar fasciitis and how is it treated?

Plantar Fasciitis is the most common cause of heel pain and afflicts people of all walks of life. However, people that are most susceptible are those who spend a lot of time on their feet at work and those who exercise a lot, especially runners. Plantar Fasciitis is an overuse syndrome that causes inflammation of the soft tissue on the bottom of the heel. Its severity can range from occasional annoyance with certain activities to debilitating pain. But no matter how bad the case, you can be reassured that the overwhelming majority of patients with Plantar Fasciitis will eventually find full relief with appropriate treatment. Treatment starts with daily stretching exercises, icing, anti-inflammatory medications like Motrin or Advil, proper shoes, and a moderation of athletic activities. This last point is important. It’s very difficult to alleviate heel pain if you keep running 3 or 4 times a week. Some patients may eventually need physical therapy or a steroid injection. Surgery is very rarely needed for this syndrome.

Do you have any tips for buying a good pair of running shoes?

Honestly, when I get asked this question by my patients, I refer them to a good running shoe store. My advice is to shop at a reputable running store and not at a big chain sporting goods store. There are many considerations that go into the proper selection of a running shoe, and the majority of these questions are best answered by the experts who sell these shoes every day as a profession. There are many high-quality name brand shoes on the market that each have different models to accommodate different customer needs. A trained and experienced salesman at a running store is best qualified to match the nuances of your feet to an appropriate style of running shoe.

About Dr. Andre Gazdag

Dr. Gazdag graduated from the University of California, Davis and Duke University Medical School and trained in orthopaedic surgery at UCLA Medical Center. He also completed a Foot and Ankle Fellowship at Hahnemann University Hospital in Philadelphia.

Dr. Gazdag is trained in orthopaedic surgery; he is specially trained to treat all conditions of the foot and ankle, including those related to rheumatoid arthritis, diabetes and trauma. Dr. Gazdag also manages sports related injuries of the foot and ankle and performs ankle arthroscopic.

Dr. Gazdag's office
10215 Fernwood Road Suite 506 
Bethesda, MD. 20817
301-530-1010