Heel Pain and Plantar Fasciitis

Our bodies are designed to support all our physical activity. But when the stress gets to be too much, tissues can tear or be damaged, leading to inflammation. This is true of a specific heel pain caused by what is called Plantar Fasciitis.

Connecting your heel to the front of your foot, the plantar fascia is a ligament running the length of the bottom of the foot. It helps support the arch. When strain leads to inflammation of the plantar fascia, it stiffens and causes pain in the heel. Pain may appear most severe when the foot is in a long period of rest, taking some time to subside with some walking, or after an exercise session.

What puts you at risk of plantar fasciitis?

  • High arches or flat feet
  • Regular high impact activity, like running
  • Career which requires standing on a hard surface for an extended amount of time (ie. nurses, factory workers)
  • Obesity
  • Tight calf muscles

How is plantar fasciitis treated?

Luckily, majority of those who suffer with plantar fasciitis can find relief through non-surgical treatment options, including:

  • Eliminating activities that are contributing to the inflammation. Allowing your foot the proper amount of time to heal is important, in fact, your doctor may recommend a walking boot to help facilitate the rest.
  • Icing the bottom of your foot a few times a day will help reduce inflammation.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen will ease the pain.
  • Specific stretches to elongate the calf muscles will assist in releasing the stress on the plantar fascia. Your doctor may recommend you see a physical therapist who can work with you on a specific exercise program.
  • The proper footwear to reduce the stress on the bottom of the foot is recommended, along with orthotic inserts like heel pads.

Other treatments your orthopedic specialist may recommend include cortisone injection, casting, or even surgery, which is visited only when non-surgical treatments have shown no improvement.

If you’re suffering with heel pain, reach out to the orthopedic specialists at NEOSM for a consultation to plan your route to recovery.

Source: OrthoInfo

All about Achilles

You’ve heard people reference ‘Achilles’ when referring to someone’s weak spot. It comes from the Greek mythology stories of the hero of the Trojan War, Achilles, whose body was invincible except for the back of his heel, where he was most vulnerable. A nod to the legends, the tendon connecting the heel to the calf has been named after this figure, but the tendon itself is stronger than you’d think.

Function of the Achilles Tendon

The largest and strongest tendon of the body, the Achilles tendon (also called the calcaneal tendon) facilitates walking by anchoring the calf muscle to the heel bone, allowing the heel to lift. Activities like running and jumping require the functions of the Achilles which withstands a great amount stress and movement. It is a true workhorse of the human body.

Achilles Issues & Treatment

Because of the importance of the Achilles tendon in every day movement, any issues can be debilitating. Some common syndromes of the Achilles and treatment are:


Caused mostly from overuse, tendonitis of the Achilles with present itself with pain in the back of the heel, especially when walking, and swelling or tenderness in the area. Essential in overuse, stress of the tendon causes small tears. Other causes include arthritis, obesity, wearing footwear without proper support, or foot issues, like flat feet. 

Treatment for tendonitis of the Achilles include rest to allow the small tears to heal along with ice therapy. Depending on the severity, anti-inflammatories may be prescribed and perhaps physical therapy. It’s most important to be patient with recovery and follow your doctor’s orders to avoid regression.


When the fibers of the Achilles tendon are separated, it is considered a tear or rupture, a serious condition as the tendon can no longer function as normal. How can you test if the tendon is torn? There is a simple test called the Thompson test. Laying face-down on a bed with feet extended past the edge, have someone squeeze the calf muscle. Doing so should cause the foot to point down (away from the head). If there is a tear, the foot will not move.

Tear of the Achilles
Credit: orthoinfo.aaos.org

Depending on the severity, treatment for a ruptured tendon would be similar to that of tendonitis, rest and ice, and likely a boot to immobilize the foot. In many cases, surgery would be deemed necessary in order to repair the tear, followed by physical therapy to strengthen the leg muscles to support the tendon. Full recovery is about four to six months.

As stated before, the Achilles tendon is an MVP of the human body and any injury can be painful and frustrating. The orthopedic specialists at NEOSM are here to care for you and help you keep living life to the fullest. Reach out if you need us!

When the Bones are Good: 5 Keys to Bone Health

You often hear “the bones are good” when people talk about the value of a house. It’s to say the structure is sound, that it can stand up to what it may face, that it can protect those who live there. Well, the same goes for when the actual bones in your body are healthy. They can protect you from falls and fractures, and support all the functions of your body.

Let’s talk about those bones. Did you know your skeleton rebuilds itself as we age? That right, about every 10 years, our bones regenerate where new bone tissue replaces the old. As we age, though, the amount of new bone can decrease, resulting in bone loss which leads to weaker bones, increasing the risk for fractures. Thankfully, there are proactive measures we can take to better balance the process and protect our bones.  

Understand your risks for bone loss

Many individual factors can affect bone density, namely age, family history, weight and related health issues. Age: The older you get the more bone loss is projected to occur. Women, in particular, experience rapid loss following menopause, putting them at risk for osteoporosis. Family History: Bone mass is determined by our genes, so it’s important for this and other reasons to have a good understanding of your family medical history. Weight: Overweight adults are at higher risk for falls which can lead to bone breaks, and being underweight can increase bone loss and risk of fractures. Health Issues: If you have diabetes, an autoimmune disease, or are taking medications that are known to cause bone loss, be sure to discuss your risks with your doctor.


The right combination of vitamins and nutrients is needed to promote healthy bones. We hear much about the importance of calcium for bone health, which is for good reason. Calcium is stored in our bones. When our body does not have enough to function, it will steal some from its storage in, you guessed it, the bones. So load up on green leafy vegetables and dairy products, and try supplements if you need increase your daily dosage. And grab some water instead of soda, specifically, since they decrease calcium absorption. Vitamin D is also super important, as it helps our bodies absorb calcium from our diets and build those strong bones. It’s hard to get enough Vitamin D through food, so look for supplements or help your body make some by sitting in some good sunlight – just don’t forget the sunscreen!


Committing to regular physical activity is a key component to a healthy lifestyle and the benefits extend to bone health. Weight-bearing activity helps your bones become stronger and can slow down bone loss after menopause. Brisk walks, dancing, tennis, jump roping, even hopscotch! Exercise in all forms is good for your skeleton. Also, as you grow stronger and gain balance through activity, you decrease your risk of falls leading to fractures. So get out there and keep moving!

Lifestyle & Environment

We all know smoking and heavy alcohol use are no good for your overall health, so it is no surprise that both can reduce bone mass. In fact, nicotine actually suppresses bone-forming cells. There may also be other everyday risks right under your nose. Tripping hazards and obstacles can lead to accidental falls, so be sure fix that loose step or tuck that computer cord away, for instance. And adding safety features around the house, like a grip bar in the tub for instance, is never a bad idea.

Consult with your doctor

If you are at risk for bone loss, be sure to consult with your physician. A bone density test may be in order to determine if prescription medicine may be necessary to help protect and build up bone tissue. It’s better to be proactive, than try to make up for severe bone loss down the road.

We hope that with this guidance, you can make your bone health a priority. The specialists at NEOSM are here to answer any questions you have in your journey.

Source: American Academy of Orthopedic Surgeons/orthoinfo.org

Tiger Woods’ Injuries: Defining Terms and Procedures

The recent news of Tiger Woods’ horrific car accident has been startling. Watching the images of the aftermath, we see how serious the incident and the injuries sustained by the golf great are. While news outlets have been reporting on details of the necessary emergency orthopedic surgery, fans are growing more and more concerned, so we thought it would be helpful to provide some expert insight into the meaning of some common terms and procedures being reported.

High-Energy Trauma/Fracture

Injuries sustained where a large amount of energy or force are at play are considered high-energy traumas. Accidents involving a moving vehicle, like in the case of Tiger Woods, or a fall from a significant height are examples. These traumas result in more complex injuries that generally involve more tissue damage.

Open Fracture

An open fracture, historically known as a compound fracture, is a fracture in which the bone has broken through the skin of the area at the time of injury. Because the wound is open, there may be contamination at the fracture site that increases the risk of infection. Severity of the injury depends on the degree of contamination and extent of damage to soft tissues such as muscles, tendons, nerves, and blood vessels. Open fractures should always considered an emergency and treated immediately due to the increased risk of infection.

Use of Rods, Plates and Screws

When a fracture cannot be adequately treated with conservative measures, such as setting the bone and casting or splinting, surgery is indicated. In the case of open fractures, surgery is necessary to clean the area to minimize the risk of infection. Fractures treated in this way usually need to be stabilized with metal hardware, such as rods, plates and screws. This is called internal fixation. Nails or rods are inserted into the center of long bones, such as the tibia, for stabilization. These are most often used for fractures near the middle of long bones. Some fractures may require a plate and screws to hold the bones in place while they heal. In some cases, wires or pins are utilized to treat fractures in smaller bones. Depending on the case, pins and wires are usually removed once the bone has healed adequately. Rods, plates and screws are often not removed.

Compartment Syndrome

Fractures can cause bleeding and severe swelling, which can create excessive pressure within muscle compartments. If this occurs, this pressure can cause damage to muscle and other soft tissue within that compartment, which may be irreversible. This is called compartment syndrome. If this occurs, emergency surgery must be done to prevent this tissue damage. If not properly treated, this problem may lead to amputation. Treating this requires a procedure called fasciotomy, during which surgeons incise the covering of muscles (called fascia) to relieve the pressure from the injury. This release is commonly achieved through large incisions, which may heal together once swelling is reduced or may require skin grafting. Sometimes fasciotomy is performed if the injury is felt to have a high risk for developing compartment syndrome.

Until more information is released about the specifics of Tiger Woods’ injuries and treatment, it is hard to speculate on what his recovery will look like. The focus now is on successful healing from surgery and combating any complications, should they arise. Traumatic injuries are devastating to those who have had the unfortunate experience. We hope through the support of his family and all his fans, Tiger Woods will make a full and healthy recovery. We wish him all the best in his journey.

To learn more about the orthopedic trauma specialists in our practice, visit our NEOSM physician profiles.

Preventing Gardening Injuries

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year.

By: Dr. Doron Ilan

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year. Back injuries, hand lacerations/puncture wounds, infections, overuse tendinitis, bug bites, and heat exhaustion are some of the more common medical conditions seen in recreational gardeners. Here are a few tips to keep you safe this spring and summer.

  • Warm up: One of the most common mistakes is to head straight to the shed and start lifting heavy bags of mulch, soil, and equipment. This can lead to back sprains and muscle strains.  Instead, first, take a 5-10 brisk walk to warm up the muscles, loosen the joints and get the heart rate up a bit.
  • Wear gloves: This will prevent most thorn punctures, blisters, lacerations, and bug bites. It will also protect your skin from pesticides, bacteria, and fungus (often live in soil). A small cut can lead to a major infection. A light long sleeve shirt and long socks or pants can’t hurt either.  Don’t forget the sunscreen and a hat.
  • Hydrate: It is very easy to spend hours gardening without drinking. Bring a bottle of water outside with you and sip regularly
  • Rotate your tasks: Avoid overuse repetitive stress injuries by not spending more than 10-15 minutes in a row doing the same motion. Make sure your gardening activities are varied so that the same muscles are not used repetitively.
  • Use proper equipment
  • Check your skin for ticks after you finish gardening for the day. Lyme disease and other tick-borne infections are very common in our area.

Following these tips can help minimize your risk, but of course, if you do sustain an injury make sure to get medical attention as soon as possible.  Have a great spring and summer — and enjoy your gardening!

If you do encounter an orthopedic injury while gardening, contact us today to find out what’s wrong and how we can help.

5 Tips for Effectively Treating a Sprained Ankle

All it takes is that one step.

You’re stepping off a curb and not paying attention where your foot is landing. Or, maybe you’re deep in the throes of a game and you take a tumble, unaware that your foot has suddenly folded under you at an awkward angle as you tried to stay upright.

No matter the method, a sprained ankle is a common orthopedic injury that can affect anyone from the person taking a walk to the professional athlete.

What is a sprain, exactly?

A sprain is an injury to the ligaments that support and provide stability to the joint. When a sprain occurs, the ligaments are stretched too far, possibly even resulting in a partial or full tear. As a result, you may experience pain, swelling and bruising in the area.

The severity of your symptoms depends on the extent of the damage to the ligaments. If you have sprained your ankle, there are ways to get it back in shape if treatment is performed early.

Five Simple Tips to Care for a Sprained Ankle

1) Protect Your Injured Ankle

This seems simple, but most people don’t adhere to this step. Keep weight off of your ankle immediately following injury, and immobilize it with a splint or brace to prevent further injury.

2) Rest

Stay off of your feet as much as possible for the next couple of days following the injury. When resting, keep your ankle elevated to help reduce swelling.

3) Keep It on Ice

Keep swelling and pain at bay by icing your ankle for 15 to 20 minutes several times a day. (Note: Keeping ice on your ankle for more than 20 minutes could damage nerves.)

4) Wrap It Up

Keep the ankle lightly compressed with an elastic bandage when it isn’t being elevated. The wrapping should be snug, not tight. Wrapping too tightly can decrease blood circulation and slow the healing process.

5) Seek Professional Help

If a sprained ankle does not typically improve after a few days with the right self-treatment—there may be more damage than you realize. Seek the help of a physician to ensure there is not extensive damage. The doctor may recommend rehabilitation techniques to return full mobility, and provide balance and strength to your ankle.

Comprehensive Ankle Care 

At NEOSM, our physicians have years of experience in effectively treating all orthopedic conditions and injuries, including those of the foot and ankle. Our multidisciplinary approach to care ensures that patients receive the customized treatment they need to get moving again.

For more information on ankle injury or to schedule an appointment with one of our specialists, contact NEOSM today.

What Happened to My Ankle? How to Tell the Difference Between a Break and a Sprain

With the warm weather enticing you to join the outdoors and frolic through summer, injuries are bound to happen, even to your unsuspecting ankles. From seasonal sports to harmless gardening, an ankle injury can emerge from any number of situations, including:

  • A motor vehicle accident
  • Tripping over something or falling awkwardly
  • Twisting, rolling or rotating the ankle in an uncomfortable way

When an unsuspecting ankle injury occurs, knowing what kind of ankle injury will play a pivotal role in getting you back on your feet. To determine whether your ankle is broken/fractured or sprained depends upon whether you damaged the bone or the tissue. Let’s decipher how to tell the two apart…

Sprain Versus Fracture

Ankle Sprain: When a sprain occurs, one or more of the ligaments in the ankle become severely overstretched or even torn. (A ligament is a fibrous tissue that helps hold the ankle together.) 

Ankle Fracture: A fracture is a break in a bone. With regards to the ankle, the bones that make up the top ankle joint are typically the most prone to fracture. These include the shinbone (tibia), the anklebone (talus) and the bone of the lower leg (fibula). 

With definitions in tow, determining which ankle injury you’ve suffered can be tricky at best. Here are a couple of questions to consider after injury has occurred:

  • Does the pain seem to radiate from the soft tissues surrounding the ankle but not over the bone? It’s probably a sprain.
  • Is the pain over the anklebone? That may be an indication of a break.
  • Are you unable to put pressure on it or walk? It is possible that the ankle is broken.

If the injury is still unclear or if you are hesitant to rush to the doctor, it may not hurt to carefully observe and lightly treat the injury utilizing the R.I.C.E. method of treatment and assessment:

  • Rest the ankle
  • Ice the ankle to reduce swelling and pain
  • Compress the ankle with an air cast or bandage wrap to stabilize and immobilize the ankle
  • Elevate the ankle until it’s level with the heart to help decrease pain and swelling

If, after two to four days of the R.I.C.E. method, you still have a hard time moving or putting pressure on the ankle, a visit to an orthopedist is in order. This is also true if dark blisters or bruises have developed. Once the orthopedist diagnoses the injury, treatment can begin.

Treatment for a Sprained Ankle

Treatment for a sprained ankle depends on the severity of the injury, which can be graded as mild (Grade I), moderate (Grade II) or severe (Grade III):

  • Mild sprains are typically healed utilizing the R.I.C.E. method combined with range of motion, strengthening and stretching exercises.
  • Moderate sprains are also treated with the R.I.C.E. method, but for a longer period of time. A physician may use a soft cast or a splint to immobilize the ankle and prescribe range of motion, strengthening and stretching exercises. Physical therapy may also be suggested to restore full motion and use of the ankle.
  • Severe sprains are a full tear or rupture of a ligament. When this occurs, the ankle must be fully immobilized and requires a longer period of physical therapy. In some cases, surgery may be required to repair the tear.

Treatment for a Broken Ankle

Fractures may be treated surgically or non-surgically depending on the injury. If the ankle is stable, only one bone is broken and the bones aren’t out of place, the ankle may simply be immobilized with a splint or cast.

However, if the ankle is unstable, surgery is required to reinforce it. During the procedure, a metal plate and screws are used to hold the bones in place. Then, the ankle is positioned in a splint. Once the swelling goes down, a cast is utilized for several weeks as the ankle heals.

It is important to remember that, regardless of whether you suspect a sprain or a break, if often requires an orthopedist to accurately diagnose your condition.


Comprehensive Ankle Care 

At NEOSM, our physicians have years of experience in effectively treating all orthopedic conditions and injuries, including those of the foot and ankle. Our multidisciplinary approach to care ensures that patients receive the customized treatment they need to get moving again.

For more information on ankle injury or to schedule an appointment with one of our specialists, contact NEOSM today.