Getting Your Life Back on the Right Foot

April 30, 2019

The fact is, most of us do not take good care of our feet and the long-term result can be downright painful. Dr. Ted Lai performs surgical procedures at Shore Medical Center, he is a physician with Shore Orthopaedic University Associates and specializes in foot and ankle trauma, reconstructive surgery and deformity correction of the lower extremity.  He sees firsthand the result of years of stuffing feet into shoes that are too tight, heals that are too high, toes too pointed, soles that are too soft and patients who chose fashion over function in their choice of foot wear. The long term result can be problems not only with feet but knees, hip and back.

Dr. Lai said that our feet bear the brunt of carrying us around and that is a tough job. “We exert 3-4 times our body weight with every step on our heel, mid-foot and fore-foot and over time there can be some problems that develop,” said Dr. Lai. “Because there is so much pressure on the foot that is one of the reasons making sure to wear proper fitting shoes with support is so important.” There are 28 bones in the foot along with 33 joints and over a hundred ligaments and tendons.

Function over Fashion
“Support is absolutely key. Many people think if their shoe is flexible and easily bent that must mean that it will be comfortable and good for their feet. That is not the case at all. Shoes that you can twist and bend are just not able to give your foot the kind of support it needs, even some sneakers do not provide the proper support,” said Dr. Lai. He indicated the sole of the shoe is really important and that a leather sole on a shoe that has a minimum to no heal and that has a supportive arch is best. When Dr. Lai is demonstrating what kind of shoe a person should be wearing he will pick up a shoe give it a twist and when that shoe bends in his hand, showing that it is pliable he said patients are often surprised to learn that is not the best choice and does not give them the needed support.

Foot Pain
Heel pain is the most common reason a patient will make an appointment with a podiatrist, according to Dr. Lai. The most common cause of that heel pain the physician said is plantar fasciitis. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). It will commonly causes stabbing pain that usually occurs with the first steps in the morning. With movement the pain normally decreases, but may return after long periods of standing or after rising from sitting. Dr. Ira Fox, also a foot and ankle specialist with Shore Orthopaedic University Associates, said about 25 percent of the patients he will see complain of heel pain that is linked to inflammation of their plantar fascia tissue. “Most of the patients with plantar fasciitis will do well with an oral or an injectable anti-inflammatory and if they do what is necessary to help themselves,” said Dr. Fox. “They will need to make some lifestyle changes, do some physical therapy, they will need to stretch before they exercise, and wear arch support and 90 percent of the people who have a problem will recover quite well.” Dr. Fox did caution that people who have pain from plantar fasciitis are prone to it recurring and need to be mindful of following their physicians advice and wearing arch support to take some of the pressure off plantar fascia tissue. 

Plantar fasciitis is more common in runners, according to Dr. Lai as well as those who may be overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis.  Dr. Lai said under normal circumstances, the plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though he said in some cases of plantar fasciitis the cause of the problem is not clear.

Common plantar fasciitis risk factors

  • Age is a risk factor and plantar fasciitis is most common between the ages of 40 and 60.
  • Certain types of exercise or activities that place a lot of stress on your heel and attached tissue such as long-distance running, jumping activities, ballet dancing and aerobic dance can contribute to an earlier onset of plantar fasciitis.
  • Foot mechanics- Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you're standing and put added stress on the plantar fascia.
  • Obesity- Excess pounds put extra stress on your plantar fascia.
  • Occupations that keep you on your feet - factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.

Complications of plantar fasciitis include chronic heel pain that could hinder regular activities. Ignoring plantar fasciitis may result in chronic heel pain that hinders regular activities. Changing the way you walk to minimize plantar fasciitis pain might lead to foot, knee, hip or back problems.

Sometimes surgery is necessary
Torn ligaments and sprains, even severe ones can have a positive outcome without surgery. According to Dr. Fox most patients will benefit wearing a boot or a cast. Though strapping and bracing along with exercises are options to treat chronic foot pain sometimes surgery is the only option. Conditions like hammer toe and bunions are painful and require surgery to alleviate the problem. Both will require the patient to go through a non-weight bearing period while the repair is healing. Dr. Fox said for bones to mend properly they need time without any weight on them. “Putting weight on any bone will cause it to move and that is the enemy of successful recovery from a fracture,” said Dr. Fox.

“We are at a time that is very exciting right now in orthopedics. We are developing new techniques that are helping patients who come to us in significant pain and we are treating them and getting them back on their feet and back to their lives quickly and successfully,” said Dr. Lai.  Adding that the ability to help a patient recover and get back to their best life is one of the things that interested him in specializing in the foot and ankle as he feels he is able to make a big difference in people’s lives. “I see patients who are often in significant pain and I am able to do something to help them get back on their feet,” concluded Dr. Lai.

Technology plays a role in success
Dr. Lai also does complex ankle surgery that could be the result of a bone crushing accident or other serious trauma to the ankle. He explained that it comes down to a discussion of what will provide the patient with the best future; using plates and screws in the ankle or replacing the ankle joint. State of the art technology and some of the most innovative techniques are utilized for Total Ankle Replacement. Dr. Lai and Dr. Fox use a 3 dimensional printed cutting guide that is specific to each patient to give a completely accurate and precise placement of the implant. Dr. Lai also discusses the use of newer techniques in surgery of the foot and ankle with minimally invasive incisions. This leads to smaller scars, less swelling, less pain, and faster recovery.

Getting back to normal
A fracture will take 12-18 months to really heal and where the patient feels like they did before the fracture said Dr. Fox.  He added, “Patients that have had knee, hip or ankle replacements do very well but they will have some limitations. The patient may be advised that they are able to play golf or doubles tennis but running, playing soccer or basketball may not be advised.”

To learn more about Dr. Ted Lai, Dr. Ira Fox and the physicians at Shore Orthopaedic University Associates visit www.shoreorthodocs.com or call 609-927-1991.

Shore Orthopaedic University Associates
Stephen J. Zabinski, MD
John R. McCloskey, MD
Gene J. DeMorat, MD
Richard B. Islinger, MD
George C. Alber, MD
Thomas A. Barrett, MD
Stanley C. Marczyk, MD
Frederick G. Dalzell, MD
Damon A. Greene, MD
Charles N. Krome, DO
Ira M. Fox, DPM
Ted C. Lai, DPM