The Achilles tendon is the combination of the gastrocnemius and soleus muscles as they course down the leg and attach to the calcaneus. This large tendon is a powerful plantar flexor of the foot. The tendon is under a resting tension, ready to propel the foot forward when the brain sends it a signal. It is this resting tension that may become problematic. For example, part or a flatfoot condition involves the heel cord contracting, a condition we call "equinus." If the resting tension is excessive, even small escalations of use may cause pain to develop, a signal that the tendon is being overworked.

When tension exceeds the elasticity of the tendon small tears may develop. Small tears can scar in, but this tissue is weaker than the original tendon fibers. consequently a cycle can develop of micro tearing and repairing. Eventually, enough of the tendon is compromised and a nodule or lump may appear in the tendon. This is an indication that things have degenerated quite a bit.

Stretching and warming up the tendon before activity is the mainstay of prevention and treatment of early Achilles tendonitis. This is performed with bands, towels, or just gravity, to eccentrically load the tendon and get it ready for engagement. Unfortunately, tendonopathy (as it is more appropriately termed) is not a quick fix; it involves weeks and sometimes months to work through before returning to normal activity.

When stretching and resting do not alleviate the pain and tightness of the Achilles tendon we may resort to surgical methods. This can vary from high energy sound waves directed at the tendon, radiofrequency ablation of the scarred tissue, up to open debridement, tendon lengthening and even tendon transfers.

It is helpful to know that 80% or more patients will not escalate to this level. The vast majority will respond well to appropriate treatment and addressing underlying biomechanical issues.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Orthotics are a mainstay of treatment for many foot and ankle conditions. This is because so many conditions are a result of poor biomechanics. Pronation, a normal foot motion required for efficient gait, can be excessive in some individuals, leading to a variety of downstream problems. For example, excessive pronation leads to hypermobility, hypermobility leads to foot deformity such as bunion and hammertoe formation. Thus control of excessive pronation is a way to prevent or slow the progression of these conditions. Orthotics do just that - control abnormal motion.

Orthotics are also a way to compensate for arthritic joints, failing or weakened tendons, inflamed nerves, arch fatigue, or excessive forefoot stress. Depending on the materials used and the modifications of the device, many foot conditions can be adequately treated using these powerful tools.

If you are considering purchasing shoe inserts because of a painful foot condition wait! Listen to the episode before you spend considerable money on devices that may not work! In the long run, you may be better off evaluated by a professional to determine if these will work for you at all, and which type of device you require.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Many patients present to my clinic complaining of bunion pain. These patients range in age from adolescents all the way to my geriatric population. There is no predilection for age, gender, body weight, race, or any other factor - yet they can be painful and are quite often progressive. The major factor playing a role in development is genetics. When coupled with biomechanics, bunion formation is inevitable in most patients. Consequently, their formation is not necessarily preventable.

Progressive conditions are dynamic. In this case, the formation of a bunion is just the start of a process of deviation of bones from their original position into a buckled one. This means when a patient notices the bump near their great toe, almost always that bump does not stay the same size forever. It will grow, the great toe will shift position over time, and symptoms may eventually emerge as a painful sore great toe that becomes bothersome even without shoes on.

Understanding what a bunion is, why it progresses, and what the symptoms are can be revealing. Who will get a bunion? Why do they get worse with time? What you can do to slow that progression? We will get into all of that and more.

There are varied treatments for bunions, from conservative to surgical. In this episode we will stick with a broad overview of the deformity and touch on conservative methods of management. I will dive deeper into surgical treatments in subsequent podcast episodes for patients or clinicians who want to understand more about corrective measures.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Pronation is a complex triplanar motion: eversion of the heel, abduction of the foot, and dorsiflexion of the ankle. Supination is the reverse motions: inversion of the heel, adduction of the foot, and plantarflexion of the ankle. These motions occur at specific phases of gait, the cycle of taking a step.

Pronation is critical for proper shock absorption and adaptation to uneven terrain. Supination is the process of reversing the foot from a mobile adapter to a rigid lever to allow efficient propulsion. When either motion is excessive, prolonged, or unrestricted, specific pathological conditions may follow. Often a condition seemingly unrelated to foot motion can be traced back to an excess of either motion. For example, stress fractures occur more commonly in a supinated foot.

These motions are dynamic, and required for efficient gait. When evaluating a foot type, the static position is one part of the equation. The foot as it functions dynamically is the other. A pronated foot may supinate excessively, slightly, or not at all. Likewise for the supinated foot. It is this complex series of movements that we study when evaluating foot pathology.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Plantar Fasciitis is one of the most common conditions I see in my clinic. Roughly 1 in 10 people will experience this in their lifetime, making it extraordinarily prevalent. There can be confusion as to how the condition evolves, but I will say it mainly has to do with form and function. By that I mean our feet were not designed for the surfaces we walk on each day. This can be corroborated by the fact that a majority of sufferers spend inordinate amount of time on hard surfaces. Think teachers, warehouse workers, nurses. Not to mention the runners and athletes who can be sidelined when the condition develops.

The majority of patients I see have tried resting, over the counter pain medications, changing their shoes and possibly some stretching. I have to assume a great deal of patients have success with this. However many do not, causing them to come limping into the office seeking professional help.

We begin with evaluating precipitating events, avoiding these activities and modifying shoe gear appropriately. NSAIDs, a rigorous stretching routine, and occasionally corticosteroid injections are used initially. Shoe inserts that are appropriate for a patients foot type and activity are also instituted. The majority of patients will obtain relief with these techniques. For stubborn cases a physical therapist is brought on to aid in pain reduction and reversal of the factors that led to fasciitis developing. In more refractory cases surgery may be required.

Surgical methods vary among practitioners but most have very high success rates.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Dr. Weinstein discusses the impetus for creation of a podcast that discusses all aspects of medical and surgical treatment of foot and ankle disorders.

Dr. Weinstein has been practicing foot and ankle surgery for over 20 years. In this time new formats for public education have emerged. No single source exists where a comprehensive discussion of common pathologies and treatment algorithms are explained in short format audio or video. The hope is to change that in this series.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.