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Dr. Horlebein will be joining Advanced Regional Ankle & Foot Care LLC as a full time physician in Altoona PA, as of June 1st 2023. Feel free to call our office with any scheduling inquires/questions!

April 2024

Tuesday, 30 April 2024 00:00

Stress Fractures of the Foot and Ankle

Our bones are important aspects of our body and they are constantly changing. The heavier the workload for a bone, the more likely it is that calcium will be placed in it. When a bone isn’t used often, there won’t be much calcium within it. When stress from repetitive loads prevent the bone from being able to repair itself, cracks will start to form. Stress fractures are defined as cracks in a bone that result from repetitive force, such as overuse.

The most common cause of stress fractures is a sudden increase in intensity and duration of physical activity. For example, if you begin to run long distances without working your way into doing so, you will be more likely to develop a stress fracture.

Common symptoms of stress fractures are pain and swelling near the weight bearing area on the injured bone. When initial x-rays are performed, it is possible that the fracture will not show up. However, once the stress on the area continues, the damage will increase, and the fracture will be severe enough to show up on an x-ray. Certain parts of the foot are more likely to develop stress fractures than others. Areas that typically have these fractures are: the metatarsals, the navicular bone, the calcaneus, tibia, and fibula.

Since women are at an increased risk of developing osteoporosis, they are twice as likely as men to sustain a stress fracture. Additionally, old age causes a decrease in bone mineral density which is why elderly people are also likely to develop these fractures.

It is important for you to be professionally diagnosed by a podiatrist if you suspect you have a stress fracture, because there are other injuries that can easily be mistaken for a fracture.  Sprains, strains, shin splints, plantar fasciitis, and Morton’s neuroma can all easily be mistaken for stress fractures in the foot. Your podiatrist will likely ask you a series of questions to determine what type of pain you are experiencing. These questions will help your doctor identify whether you have a stress fracture.

The best method of treatment for a stress fracture is rest. Additionally, a walking boot, cast, or crutches, will help rest the area that is injured. The typical healing time for stress fractures is 4-12 weeks, however this depends on which bone is involved.

Stress fractures are small cracks in the bones of the foot or lower leg, typically resulting from overuse or repetitive force. Athletes or those engaging in high-impact sports like running, basketball, or dance are more likely to get stress fractures. These injuries can also occur in people who suddenly increase their physical activity without proper conditioning, or those with poor nutrition or weakened bones. One of the main symptoms of a stress fracture is a sharp pain that worsens with activity and improves with rest. The affected area is often sensitive to the touch and may show signs of swelling. The pain is typically localized, making it feel worse during movements that put stress on the specific bone. Preventing stress fractures involves gradually increasing activity levels, wearing appropriate footwear, and incorporating strength training to enhance bone density. If a stress fracture is suspected, a podiatrist can confirm the diagnosis with imaging tests like X-rays or MRI scans. The doctor may recommend rest, possibly immobilization, and a gradual return to activity to ensure proper healing and prevent further injury. If you suspect a stress fracture, it is suggested that you promptly schedule an appointment with a podiatrist. 

Stress fractures occur when there is a tiny crack within a bone. To learn more, contact John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor can provide the care you need to keep you pain free and on your feet.

How Are They Caused?

Stress fractures are the result of repetitive force being placed on the bone. Since the lower leg and feet often carry most of the body’s weight, stress fractures are likely to occur in these areas. If you rush into a new exercise, you are more likely to develop a stress fracture since you are starting too much, too soon.  Pain resulting from stress fractures may go unnoticed at first, however it may start to worsen over time.

Risk Factors

  • Gender – They are more commonly found in women compared to men.
  • Foot Problems – People with unusual arches in their feet are more likely to develop stress fractures.
  • Certain Sports – Dancers, gymnasts, tennis players, runners, and basketball players are more likely to develop stress fractures.
  • Lack of Nutrients – A lack of vitamin D and calcium may weaken the bones and make you more prone to stress fractures
  • Weak Bones – Osteoporosis can weaken the bones therefore resulting in stress fractures

Stress fractures do not always heal properly, so it is important that you seek help from a podiatrist if you suspect you may have one. Ignoring your stress fracture may cause it to worsen, and you may develop chronic pain as well as additional fractures.

If you have any questions, please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot care needs.

Read more about Stress Fractures of the Foot and Ankle
Tuesday, 23 April 2024 00:00

Biomechanics in Podiatry

Podiatry is a branch of medicine that deals with the study, diagnosis, and treatment of foot and ankle conditions. There are various subdivisions in podiatry; biomechanics is one of them. Biomechanics is the way in which the bones, muscles, and joints of the feet and lower limb interact with each other.

Our feet play crucial roles in the way we move, and it is rare to have feet that are completely symmetrical. Common biomechanical issues include high or low arches or uneven leg heights. Excessive pronation often leads to fallen arches, or flat feet, and is a common cause of running injuries. People whose feet are over-pronated tend to have flexible and unstable feet. Pain is usually experienced during walking and running.

At times, people may be able to adapt to these abnormalities without any difficulties, but in other cases, these issues can cause a great deal of pain. This pain occurs because the joints, muscles, ligaments, and tendons are put under an excess amount of stress during movement. Common symptoms of biomechanical problems stemming from the feet include hip pain, knee pain, leg cramps, ankle pain, lower back pain, weak ankles, tripping, heel pain, Achilles pain, and shin splints.

Many biomechanical issues can be treated with orthotics. Orthotics are shoe insoles that are used to help control the way the foot operates.  They can provide relief from foot pain, heel pain, and knee pain. Depending on your specific case, you may need to purchase over-the-counter orthotics or custom orthotics to fit your feet. Your podiatrist will be able to prescribe the perfect orthotic for your feet to help you walk around with ease.

Gait is defined as the way we move our bodies from one point to another. This is usually done by either walking or running. Gait analysis is a method used to assess the way we walk or run to highlight biomechanical abnormalities. Gait analyses are a great way to take a detailed look at how you walk and how your foot moves while you walk. An examination of the feet will help your podiatrist understand why you are suffering pain in other parts of your body.

There is a complex interplay of structures in the feet that provide stability, balance, and propulsion during walking and other activities. Bones, muscles, ligaments, and tendons work together in the feet to move the body biomechanically. Assessing normal foot biomechanics helps podiatrists, or foot doctors, diagnose and treat various foot issues. By using their knowledge of normal foot biomechanics, podiatrists can identify abnormalities or dysfunctions that may contribute to foot problems, such as flat feet, high arches, bunions, or plantar fasciitis. Podiatrists may analyze a patient's gait, foot structure, and range of motion. This allows them to develop personalized treatment plans that may include orthotic devices, exercises, footwear modifications, or other interventions to address underlying biomechanical issues. If you are suffering with abnormalities in gait, range of motion, or the feet in general, it is suggested that you make an appointment with a podiatrist for a personalized treatment plan. 

If you have any concerns about your feet, contact John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor can provide the care you need to keep you pain-free and on your feet.

Biomechanics in Podiatry

Podiatric biomechanics is a particular sector of specialty podiatry with licensed practitioners who are trained to diagnose and treat conditions affecting the foot, ankle and lower leg. Biomechanics deals with the forces that act against the body, causing an interference with the biological structures. It focuses on the movement of the ankle, the foot and the forces that interact with them.

A History of Biomechanics

  • Biomechanics dates back to the BC era in Egypt where evidence of professional foot care has been recorded.
  • In 1974, biomechanics gained a higher profile from the studies of Merton Root, who claimed that by changing or controlling the forces between the ankle and the foot, corrections or conditions could be implemented to gain strength and coordination in the area.

Modern technological improvements are based on past theories and therapeutic processes that provide a better understanding of podiatric concepts for biomechanics. Computers can provide accurate information about the forces and patterns of the feet and lower legs.

Understanding biomechanics of the feet can help improve and eliminate pain, stopping further stress to the foot.

If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.

Read more about Biomechanics in Podiatry
Tuesday, 16 April 2024 00:00

Achilles Tendon Injuries

The Achilles tendon is the largest tendon in the body; it is a tough band of fibrous tissue that stretches from the bones of the heel to the calf muscles. This tendon is what allows us to stand on our toes while running, walking, or jumping, it is common for this tendon to become injured. In severe cases, the Achilles tendon may become partially torn or completely ruptured. However, this tendon is susceptible to injury because of its limited blood supply and the high level of tension it endures.

The people who are more likely to suffer from Achilles tendon injuries are athletes who partake in activities that require them to speed up, slow down, or pivot. Consequently, athletes who engage in running, gymnastics, dance, football, baseball, basketball, or tennis are more likely to suffer from Achilles tendon injuries. Additionally, there are other factors that may make you more prone to this injury. People who wear high heels, have flat feet, tight leg muscles or tendons, or take medicines called glucocorticoids are more likely to have Achilles tendon injuries.

A common symptom of an Achilles tendon injury is pain above the heel that is felt when you stand on your toes. However, if the tendon is ruptured, the pain will be severe, and the area may become swollen and stiff. Other symptoms may be reduced strength in the lower ankle or leg area, and reduced range of motion in the ankle. When the Achilles tendon tears, there is usually a popping sound that occurs along with it. People who have acute tears or ruptures may find walking and standing to be difficult.

If you suspect you have injured your Achilles tendon, you should see your podiatrist to have a physical examination. Your podiatrist will likely conduct a series of tests to diagnose your injury including a “calf-squeeze” test. Calf squeeze tests are performed by first squeezing the calf muscle on the healthy leg. This will pull on the tendon and consequently cause the foot to move. Afterward, the same test will be performed on the injured leg. If the tendon is torn, the foot won’t move because the calf muscle won’t be connected to the foot.

Tuesday, 16 April 2024 00:00

Various Types of Achilles Tendon Injuries

Achilles tendon injuries encompass various conditions affecting the Achilles tendon, the large tendon connecting the calf muscles to the heel bone. Tendonitis involves inflammation of the tendon due to overuse or repetitive stress, causing pain and swelling along the back of the lower leg or above the heel. Tendinosis refers to chronic degeneration of the Achilles tendon, often resulting from untreated or recurrent tendonitis. This condition may manifest as persistent pain and stiffness in the affected area. Paratenonitis affects the outer layer of the tendon, causing pain and swelling around the tendon rather than within it. Insertional Achilles tendinitis occurs at the point where the tendon inserts into the heel bone, leading to pain, swelling, and sometimes the formation of a bony bump. Treatment may involve rest, anti-inflammatory medications, custom-made orthotic devices, and in severe cases, surgical intervention to repair or remove damaged tissue. If you suffer from Achilles pain, it is suggested that you schedule an appointment with a podiatrist for a treatment plan tailored to your condition and the severity of the injury.

Achilles tendon injuries need immediate attention to avoid future complications. If you have any concerns, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor can provide the care you need to keep you pain-free and on your feet.

What Is the Achilles Tendon?

The Achilles tendon is a tendon that connects the lower leg muscles and calf to the heel of the foot. It is the strongest tendon in the human body and is essential for making movement possible. Because this tendon is such an integral part of the body, any injuries to it can create immense difficulties and should immediately be presented to a doctor.

What Are the Symptoms of an Achilles Tendon Injury?

There are various types of injuries that can affect the Achilles tendon. The two most common injuries are Achilles tendinitis and ruptures of the tendon.

Achilles Tendinitis Symptoms

  • Inflammation
  • Dull to severe pain
  • Increased blood flow to the tendon
  • Thickening of the tendon

Rupture Symptoms

  • Extreme pain and swelling in the foot
  • Total immobility

Treatment and Prevention

Achilles tendon injuries are diagnosed by a thorough physical evaluation, which can include an MRI. Treatment involves rest, physical therapy, and in some cases, surgery. However, various preventative measures can be taken to avoid these injuries, such as:

  • Thorough stretching of the tendon before and after exercise
  • Strengthening exercises like calf raises, squats, leg curls, leg extensions, leg raises, lunges, and leg presses

If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic tools and technology to treat your foot and ankle needs.

Read more about Achilles Tendon Injuries
Tuesday, 09 April 2024 00:00

What Are Hammertoes?

Hammertoes are painful deformities that frequently form on the second, third, or fourth toe. The condition is often caused by an issue in foot mechanics. This can be caused by the person’s specific gait or the manner in which they walk, or by shoes that do not comfortably fit the deformity.  Hammertoes can be formed after wearing shoes that are too narrow or short for the foot or have excessively high heels. Shoes that are not properly sized will force the toes into a bent position for long periods of time. This can cause the muscles to shorten and toes to bend into the deformity of a hammertoe.

Hammertoe can also be caused by complications from rheumatoid arthritis, osteoarthritis, trauma to the foot, heredity, or a cerebral vascular accident. Pain and difficult mobility of the toes, deformities, calluses, and corns are all symptoms of a hammertoe.

Someone who suspects they have the symptoms of a hammertoe should consult with a physician—particularly a podiatrist. Podiatrists diagnose and treat complications of the foot and ankle. If the podiatrist discovers that the affected toes are still flexible, treatment for the hammertoe may simply involve exercise, physical therapy, and better-fitting shoes. Treatment for hammertoes typically involves controlling foot mechanics, such as walking, through the use of customized orthotics.

For more serious cases in which the toes have become inflexible and rigid, surgery may be suggested. During the operation, the toe would receive an incision to relieve pressure on the tendons. A re-alignment of the tendons may then be performed by removing small pieces of bone to straighten the toe. In some cases, the insertion of pins is needed to keep the bones in the proper position as the toe heals. The patient is usually allowed to return home on the same day as the surgery.

If surgery is performed to repair a hammertoe, following the postoperative directions of your doctor is essential. Directions may include several stretches, picking up marbles with your toes, or attempting to crumple a towel placed flat against your feet. Wear shoes that have low heels and a wide amount of toe space to maintain comfort. Closed-toe shoes and high heels should be avoided. Shoes with laces allow the wearer to adjust how fitted he or she may want the shoes to be and also allow for greater comfort. To provide adequate space for your toes, select shoes that have a minimum of one-half inch of space between the tip of your longest toe and the inside of the shoe. This will also relieve pressure on your toes and prevent future hammertoes from forming.

Other preventative measures that can be taken include going shopping for new shoes in the middle of the day. Your feet are its smallest in the morning and swell as the day progresses. Trying on and purchasing new shoes midday will give you the most reliable size. Be sure to check that the shoes you purchase are both the same size. If possible, ask the store to stretch out the shoes at its painful points to allow for optimum comfort.  

Tuesday, 09 April 2024 00:00

Types of Hammertoe Treatments

Treatment for hammertoe, a condition where the toe bends abnormally, varies depending on the severity of the condition. Treatment can range from non-invasive approaches to surgical intervention. Initially, a podiatrist may recommend conservative methods, such as wearing roomier, more comfortable shoes to accommodate the deformity and using custom orthotic devices to relieve pain. Stretching exercises may also be recommended to strengthen toe muscles and improve flexibility. For more persistent cases, where the toe becomes rigid or pain is severe, surgical options may be considered. Surgery aims to straighten the toe, and this may involve removing a portion of the bone or realigning the tendons and ligaments. Post-surgery, patients often go through some rehabilitation to restore function and mobility. Consulting with a podiatrist about hammertoe is suggested to determine the most appropriate treatment plan for your specific needs. 

Hammertoes can be a painful condition to live with. For more information, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor will answer any of your foot- and ankle-related questions.

Hammertoe

Hammertoe is a foot deformity that occurs due to an imbalance in the muscles, tendons, or ligaments that normally hold the toe straight. It can be caused by the type of shoes you wear, your foot structure, trauma, and certain disease processes.

Symptoms

  • Painful and/or difficult toe movement
  • Swelling
  • Joint stiffness
  • Calluses/Corns
  • Physical deformity

Risk Factors

  • Age – The risk of hammertoe increases with age
  • Sex – Women are more likely to have hammertoe compared to men
  • Toe Length – You are more likely to develop hammertoe if your second toe is longer than your big toe
  • Certain Diseases – Arthritis and diabetes may make you more likely to develop hammertoe

Treatment

If you have hammertoe, you should change into a more comfortable shoe that provides enough room for your toes. Exercises such as picking up marbles may strengthen and stretch your toe muscles. Nevertheless, it is important to seek assistance from a podiatrist in order to determine the severity of your hammertoe and see which treatment option will work best for you.

If you have any questions, please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot care needs.

Read more about What Are Hammertoes?
Wednesday, 03 April 2024 00:00

Heel Pain Can Be Treated!

Do you suffer from heel pain when you get up in the morning? If so, you should seek the professional help of your podiatrist and have a proper diagnosis performed. Heel pain can be caused by several different foot-related conditions.

Tuesday, 02 April 2024 00:00

Effect of High Heels on the Feet

High heels are uncomfortable, but many women sacrifice comfort to be stylish. There are many problems that stem from wearing high heels, however these issues can be avoided by wearing proper shoes.

Heels are bad because they push your weight forward toward the fall of the foot. The higher the heel is, the more weight and pressure get shifted. This process causes the back to hyperextend backwards to counterbalance which may cause pain in the leg, hip, and back. Consequently, major posture problems may occur, and these issues may eventually become permanent.

Wearing high heels is one of the leading cause of ingrown toenails. Heels create a great deal of pressure on the big toenails which disrupts proper toenail growth. This may eventually lead to the big toenail growing into the skin.  Another common problem that stems from high heels is bunions. If bunions go untreated, they can cause serious scar tissue to form along with severe pain.

However, there are ways to minimize the harmful risks associated with wearing heels. You should try to massage and stretch your legs and feet after wearing heels for an extended time. Stretching helps prevent the Achilles tendons and calf muscles from becoming too tight. A good substitute for heels are platforms which provide a better surface area to evenly distribute the body’s weight.

If you are experiencing any painful foot conditions from wearing high heels, you should consult with your podiatrist right away.

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