Heel pain is perhaps the most debilitating foot ailment one can get .Considering that the heel bone is the largest of the 26 bones in the human foot and is responsible for stabilizing the body's center of gravity during the first phase of gait. There are many causes of heel pain and naturally many new and expensive "miracle" treatments for the condition. What I will attempt to do in my modest presentation is to highlight the real common causes and sound treatment regimens for heel pain. Based on 22 years of clinical practice treating the average person as opposed to star athletes as some practices like to boast about.

The basic common causes of heel pain are the following:

Heel spurs:  a bony growth on the underside of the heel bone. They are caused by strain on the muscles and ligaments on the bottom of the foot stretching the long band of connective tissues the heel and the ball of the foot.

Plantar fasciitis: An inflammation of the band of fibrous connective tissue running along the bottom of the foot.

Achilles Tendinitis: Pain at the back of the heel caused by inflammation of the Achilles tendon due to overuse and strain of the tendon over time. The fibers of the tendon can tear and causes inflammation, pain and possible bone spur at back of heel where the tendon inserts.

Stress risers or fractures: Repeated trauma to the same area of the heel either through miss step or strenuous activity can lead to small stress fractures to the heel that can be undetectable in regular radio graphs.

Arthritis: Most of the documented arthritic conditions such as osteoarthritis, rheumatoid, gout, etc. can produce heel pain.

Diagnosis of the cause of the heel pain is of paramount importance. So for once I will be somewhat biased and suggest you seek treatment from an expert and see a podiatrist. It is simply a matter of numbers. Who would you rather see? A doctor who sees 10 patients with foot pains a year or an expert who only treats the foot.

Once a definitive clinical diagnosis is made as to the cause of the heel pain, it must be noted that the literature points out that about 85% heel pain cases respond to conservative care. This would include oral or inject able anti-inflammatory medication, exercise, taping, shoe inserts and physical therapy. So what about the other 15% of patient population that isn't being relieved by conservative care and for whom the condition becomes chronic?

For this patient population there is a whole new gambit of new advanced and expensive treatments. Most of which are not covered by any insurance. I will briefly review some of the most popular modalities.

Extra corporal shock wave therapy (ESWT) uses shock waves to break up scar tissue and allow healing of the inflamed tissue. The research on this modality indicates it is moderately successful in younger active patients.

However less effective in middle aged over weight patients. Laser treatment with level IV lasers. This modality uses high penetration laser waves to achieve the same result as the ESWT. The literature points to modest results with the same demographic as the ESWT. Radio frequency neuro ablation of the inferior calcaneal nerve. This is the branch thought to be the most affected in heel pain. Although an FDA approved modality for nerve entrapment in other parts of the body. My clinical experience has taught me that without addressing the actual cause of the heel pain. This treatment is no more effective than a steroid injection. So what is a patient with chronic heel pain to do?

First of all let's look at what are the usual causes of chronic heel pain. My experience, even in cases of conditions such as arthritis, usually points to two major causes, biomechanical and lifestyle.

What do I mean by biomechanical?

Plantar heel pain is mostly the result of mechanical overload of the central band of the aponeurosis. It is by definition a degenerative condition rather than an inflammatory process. It is caused by how the patient's foot type (I.e. flat feet, rigid feet, etc.) affects one's gait. The best way to relieve this mechanical is by orthopedic evaluation of patient's foot type and casting them for a custom foot orthosis. This is not to be confused with a prefabricated insert sold at drug or shoe stores. Studies have shown that custom orthotics relieve heel pain by improving the foot's alignment.

So what do I mean by lifestyle changes? Put down the bag of Doritos and listen up. Studies have shown that every five pounds of excess weight in the body is the equivalent of 25 additional pound of weight on our joints. This statistic is staggering. In my experience the vast majority of patients with chronic unresolved heel pain are at least 25 pounds overweight. I always insist these patients make the necessary healthy dietary changes to promote healthy weight reduction. You would be amazed how much relief of pain can be achieved by losing just 10 pounds. However, it is a permanent nutritional change that is being advocated here as opposed to a quick fix diet.

What I have brought to your attention is for the purpose of making you as a consumer both informed and skeptical when you go out into the healthcare market. Do not accept the heavily marketed wonder treatment as a solution just because it is offered by a doctor. Ask question of your physician and always make sure a thorough evaluation of your condition has been done.

Toenail fungus, otherwise known as onychomycosis is both a cosmetic and medical condition of the nail. It has proven to be very difficult to treat in spite of numerous new antifungal drugs on the market. It is particularly problematic for women wishing to wear open toe shoes or sandals. The nails appear thick, yellow with fungal debris under the nail plate. Diabetic patients with fungal nails are more likely to develop ingrown nails or even ulcerations under the nail plate. So it is a real problem .Recently lasers have been introduced as a new treatment for onychomycosis with the idea of avoiding lengthy topical treatments or potentially dangerous oral medications. This modality is being sold to patients as a new "magic" bullet that can rapidly treat the most difficult cases of onychomycosis. Laser treatment of onychomycosis isn't covered by any insurance and the average cost per treatment of ten toes is approximately $2,500.So it merits that we ask the question, does it work.

Laser treatment consists of using a specific single low energy wavelength to cause photo damage to the fungal infection in the nail. The treatment is done in the doctor's office and requires no anesthesia as it is not painful. The laser light is applied directly to the nail being treated. The average treatment period is usually between 5 to ten treatments. There is also a maintenance plan of care required where a patient most come within the year for retouch with the laser due to possible flare up of the infection.

The manufacturers claim that they have studies demonstrating an 87% cure rate. The problem with their studies is that they are very small, sometimes using about ten patients. They also use cases where the nail had less than 50% of the plate infected. I conducted a Medline search of recent independent studies regarding real cure rates of onychomycosis using laser modalities. What I found for the most part is that other than the studies sponsored by the laser manufacturers. There are no extensive studies supporting the any real eradication of onychomycosis using lasers.

So are some patients getting "cured" with laser therapy and if so why?

The answer to these questions is probably yes. How are some patients being cured of their onychomycosis with a laser regimen given what I have just told you? The answer to this dilemma lies in the actual treatment plan most laser manufacturers outline for the practitioner. They all require that the patient be on anti-fungal prior and during the treatment plan. One of the best known manufacturers even recommends the patient be on an oral antifungal medication during the laser protocol.

I thought the reason for the laser was to avoid the cost, time and potential hazards of these medications.

So what is a patient with onychomycosis to do?

Go to a doctor who will do a fungal nail culture in order to confirm diagnosis of onychomycosis and to determine the type of organism that it is. Not all fungi are the same. If it comes back negative for fungus. Then other tests can be conducted to determine what is causing the nail pathology. All these tests usually yield specific agents that can specifically kill the pathogen causing the infection. The patient must insist that the doctor evaluate, diagnose and treat their onychomycosis the same way one would expect any infection to be treated.

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Written by Dr. Rick Reyes


Podiatrists are the types physicians taking good care of problems suffered through the patients inside their legs, especially to the foot and ankle. They treat leg-related conditions like calluses, heel spurs, ingrown toenails, arch issues etc. They might even perform surgeries for correcting such issues. They prescribe the patients to put on special sort of attachements for the treatment of their health. The work of an podiatrist would be to diagnose the bottom leg with the patient for that problems that they are complaining about. Then they will have to run various tests for reaching right into a conclusion. Then a treatment procedure must be formulated.

Some of the medical ailments affecting our feet could possibly be in connection with other diseases like diabetes. In such cases a podiatrist will sent the patient to some diabetic clinic for getting better care. If unattended, several simple ailments are able to turn in the market to be serious issues later in your life. The ailments in feet should never be viewed as something simple and not important. There also many small diseases related to feet like, scarred feet and swelling in feet. A seasoned podiatrist will help you heal these with some tablets and creams.

Podiatrists find jobs in the field of sports for utilizing the athletes to keep their legs and feet in excellent. A podiatrist also performs advanced surgeries for foot reconstruction and ankle replacement. They find employment inside the healthcare centers and they also can also start-up their own clinics for giving podiatric services. Over half of the podiatrists operate in the offices of other healthcare practitioners.

To start practicing like a podiatrist you have to first posses your doctor of Podiatric Medicine degree (DPM). This program shall be taken after earning a bachelors degree with physics, chemistry, and biology as subjects. Doctor of Podiatric Drugs are a 4 year course, on finishing which, one has to take up a three year medical and surgical residency for transforming into a licensed podiatrist. The themes and courses of instruction for podiatric degree are similar to that of other medical courses. All podiatrists needs to be licensed from the state authority for working in a state. You can find alternatives for getting certifications in surgical treatment or orthopedics for even more specializations.

Getting a podiatrist may be an extremely easy task. There are tons of telephone book and internet based directories that list the names and contact information on podiatrists and related doctors near your city. In case you still cant find them, you can even explore google. Always see the reviews about these doctors. The reviews will be provided by some other clients and they can list the user experience and also the fees with the podiatrist. You are able to compare all of the available doctors in the area and select the best choice.

You can collect the information about the best podiatrist New York by visiting the given link Best Podiatrist New York.