Running Doc on how to treat Plantar Fasciitis – New York Daily News

NEW YORK DAILY NEWS

Sunday, August 27, 2017, 6:00 AM

Dear Running Doc:

Good afternoon. I hope you are having a fun weekend. I have had PF for 1.5 years now. I have tried stretching, cortisone, PRP injections, etc. and nothing has worked.

I love to run but had to give up last year and would love to get back to running. I have tried a few orthotics but have not tried custom fitted ones. What would you recommend? I live in Houston. I have seen a few foot and ankle surgeons but nothing has worked.

Thank you for your advice. Where is your office? Do you treat people in your office for PF?

Best, Jeff W., Houston, TX

I and the New York Daily News hope you and family are safe during this horrific storm.

The good news is your PF (Plantar Fasciitis) should not prevent you from running for more than three weeks. In my office practice in New York City, no one has had to give up running due to Plantar Fasciitis.

Plantar Fasciitis is an inflammation of tight connective tissue on the bottom of the foot making up its arch. A simple routine of ice, stretching, golf ball exercise, custom orthotics and sometimes PRP is all that is needed to get you back to run soon. Lets go through them to be sure you are doing them correctly. Leaving one out may cause the Plantar Fasciitis to linger.

Ice: You must ice the painful area for 20 minutes twice a day. Use a Ziploc freezer bag filled with ice and water. The water raises the temperature to 32 degrees to prevent freezer burn. Just plant your foot on the ice water bag in the morning after you have woken up and the evening before you go to sleep. Avoid those ice contraptions that are too cold.

Stretching: The Plantar Fascia connective tissue attaches around the heal bone to the calf muscles. It acts as a fulcrum (as we learned in high school). Therefore, stretching both the calf muscles (gastroc and soleus) helps loosen the tight Plantar Fascia. Wall push-ups with the knee both straight and bent should accomplish this. When the Plantar Fascia is less tight, there is less inflammation.

Golf Ball Exercise: A hard golf ball rolled back and forth over the most painful part of your arch for 30 minutes daily should do the trick. Remember with this exercise that your condition will hurt more before it hurts less. Dont get discouraged. Some people use a frozen water bottle for this exercise. In my experience, using a golf ball once a day and doing the ice separately twice a day works better than trying to combine these two steps together.

Custom Orthotics: Custom full-length flexible orthotics are a necessary step to combat Plantar Fasciitis. They stabilize the ligaments and prevent it from coming back. Over-the-counter orthotics are as good as over-the-counter glasses. You do need orthotics custom made properly.

Platelet Rich Plasma (PRP): First, Jeff, stay away from cortisone injections. Cortisone weakens soft tissues and, in my experience, causes an increased risk for further problems. If you do all the above steps, you may never need to get to PRP. If you have a bone spur coming out as a pointed projection from your heal, PRP may be necessary. Usually a PRP treatment is done with two treatments 24 to 72 hours apart.

I hope Jeff that the above information helps you to regain your running at a level that makes you comfortable. If you have any further questions, please do not hesitate to write again.

Enjoy the Ride!

***

Lewis G. Maharam, MD, FACSM is one of the worlds most extensively credentialed and well-known sports health experts. Better known as Running Doc, Maharam is author of Running Docs Guide to Healthy Running and past medical director of the NYC Marathon and Rock n Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Societys Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

Want your question answered in this column? Write to running doc at runningdoc@nydailynews.com.

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Running Doc on how to treat Plantar Fasciitis - New York Daily News

Here’s Some Safer Methods To Replace Face Tightening Surgeries – News18

With age, facial skin becomes progressively lax, sagging along the jawbone and under the eyes, and many opt for surgeries for this. Experts suggest people can go for pain-free cosmetic technology to attain a youthful appearance.

Nitin S Walia, senior consultant, Dermatology at BLK Super Specialty Hospital and Navjot Singh Arora, consultant dermatologist at Dermaheal Clinic, have given a few inputs:

* Botox's contribution on the other hand, not only helps in elimination of fine lines and wrinkles but also droops at the angle of lips and correction of neck lines. It also helps achieve a slimmer and well defined jaw line. A botox injection takes a short time to administer and fixes fine lines conveniently and non-invasively.

* Injectable skin fillers have added new dimensions to the field of cosmetic dermatology, allowing new forms of facial rejuvenation and wrinkle treatment without surgery. Fillers are designed to increase tissue volume (as with lip augmentation), and improve the skin's overall contour.

* Platelet-rich plasma injections help in the generation of healthier cell production and a youthful appearance. Advanced facial skin sagging requires a necklift, a midface lift, and significant upper and lower eyelid skin excess requires a blepharoplasty. The goal is subtle, natural-looking results that make you look better, not different.

* Saggy skin is basically a part and parcel of ageing which will occur at some point of time, but it can be delayed to a great extent with the regular use of sun protection (with the help of sunscreens and physical barriers) and application of stable forms of vitamin C and aloe vera.

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Here's Some Safer Methods To Replace Face Tightening Surgeries - News18

Education briefs – Port Townsend Leader

Get ready for school with Ms. Mirandy

Preschool owner and former childrens librarian Mirandy Cook is holding Back to School with Ms. Mirandy from 9 a.m. to noon on Sunday, Sept. 3 upstairs at Aldrichs Market, 940 Lawrence.

Children ages 3-6, along with their parents or caregivers, are invited to listen to back-to-school-themed stories, sing songs, play music and more.

Back-to-school immunizations now available

Its time for back-to-school immunizations, and Jefferson County clinics are offering vaccines to children as old as 19 at no cost through the states Childhood Vaccine Program.

Vaccines are available at Jefferson County Public Health, 615 Sheridan St., 360-385-9400; Jefferson Healthcare Primary Care, 915 Sheridan St., 360-379-8031; Jefferson Healthcare Family Medicine, 1010 Sheridan St., 360-385-3500; and Jefferson Healthcare Internal Medicine, 934 Sheridan St., 360-385-5388.

There may be a charge for the office visit and an administration fee to give the vaccine. All of the clinics listed above bill insurance, both private and Apple Health. People without insurance and who cant afford the administration fee can ask for it to be waived.

Immunizations are required for school attendance, according to a press release from the county. A list of immunizations required for preschool and K-12 are listed on the Washington State Department of Health website, doh.wa.gov.

Dr. Paul Naumann of Jefferson Healthcare Medical Centers Orthopedic Clinic is offering platelet-rich plasma injections (PRP) to qualified patients as an outpatient procedure.

Patients who have endured pain from injured tendons, ligaments, muscles and joints have found relief from PRP therapy, according to Jefferson Healthcare. The nonsurgical procedure can be applied for various musculoskeletal problems, and can help heal injured tissue and improve function.

PRP is injected into the injured area to stimulate and augment healing, according to a press release.

The Orthopedic Clinic is on the second floor of the new building at Jefferson Healthcare, 834 Sheridan St. For more information, call 344-0400.

Compiled by Leader Staff writer Katie Kowalski.

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Education briefs - Port Townsend Leader

Hair Loss Got You Down? Platelet-Rich Plasma May Regrow It … – Health Essentials from Cleveland Clinic (blog)

Are you looking for a hair loss solution? A therapy that promotes healing in injured joints may help restore your lost hair.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

About 50 million American men and 30 million womenhave male- or female-pattern baldness. It can begin early in life, but is much more common after the age of 50, when more than 50 percent of men will experience some kind of hair loss.

However, an emerging treatment platelet-rich plasma (PRP) therapy appears to help regrow lost hair. And, there are virtually no side effects from PRP, except for a mild feeling of pressure at the injection site, saysdermatologist Shilpi Khetarpal, MD.

Physicians began using PRP therapy about a decade ago to speed up the healing process in damaged joints after injury or surgery.

During the treatment, a technician draws your blood and spins it in a centrifuge to separate out the platelets and plasma. Doctors then inject the plasma, which helps repair blood vessels, promote cell growth and wound healing, and stimulate collagen production.

Doctors began using PRP in dermatology after researchers found that high concentrations of platelets in plasma cells help promote hair growth by prolonging the growing phase of the hair cycle.

Doctors inject plasma into the scalp where hair loss has occurred. They typically administer injections monthly for three months, then spread them out over about three or four months for up to two years. The injection schedule will depend on your genetics, pattern and amount of hair loss, age and hormones.

Because the treatment is cosmetic, insurance does not cover the procedure, Dr. Khetarpal says. The cost ranges between $500 and $1,000 per injection session.

Other treatments for hair loss currently on the market are often more problematic for many patients, Dr. Khetarpal says.

There are two FDA-approved medications for treating hair loss: finasteride and minoxidil.But you must take these drugs consistently over time and results are inconsistent, she says.

Each drug also sometimes has side effects:

Hair transplantation is another option, but it requires cuts in the scalp and recovery time is longer, she says.

Because it is a surgical procedure, doctors typically recommend hair transplantation only for those who have dramatic hair loss. A transplant is also more costly and leaves scars. Doctors can perform PRP therapy prior to transplantation, which can provide better results with more dense hair growth, Dr. Khetarpal says.

Recent research bears out the potential of PRP therapy.

In a 2014 study, researchers in India looked at men with male-pattern baldness who used both approved medications, but saw little change in their hair growth.

After four PRP treatments, they had about 30 percent more growth in thinning areas.

A 2017 study out of Italy also found male patients had increased hair and density in areas where doctors used PRP therapy.

Dr. Khetarpal says it takes about three months to see an improvement. After that time, most of her patients both male and female have regrown 30 to 40 percent of the hair theyve lost.

Part of the success of PRP comes from selecting the right patients for therapy, Dr. Khetarpal says. PRP is safe and effective for many people. However, you should not have PRP therapy if you fall into either of these groups:

PRP therapy works better if your hair loss is recent. It is more challenging to wake up hair follicles that have been dormant for a long time, Dr. Khetarpal says.

I tell people I can get your hair back to what it was five years ago, she says. If your hair loss is older, you may see some recovery, but its likely not worth your investment of time and money.

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Hair Loss Got You Down? Platelet-Rich Plasma May Regrow It ... - Health Essentials from Cleveland Clinic (blog)

Platelet-rich plasma injections for osteoarthritis of the …

The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Platelet-rich plasma injections for osteoarthritis of the knee, in May 2014.

Osteoarthritis of the knee is the result of progressive deterioration of the articular cartilage and menisci of the joint. Articular cartilage deteriorates because of trauma and wear and tear. This leads to exposure of the bone surface. Symptoms include pain, stiffness, swelling and difficulty walking.

Treatment depends on the severity of the osteoarthritis. Conservative treatments include analgesics and corticosteroid injections to relieve pain and inflammation, and physiotherapy and prescribed exercise to improve function and mobility. When symptoms are severe, surgery may be indicated: options include upper tibial osteotomy and unicompartmental or total knee replacement.

W90.3 Injection of therapeutic substance into joint

Y53.2 Approach to organ under ultrasonic control

Z84.6 Knee joint

X36.8 Other specified blood withdrawal

In addition a code from the ICD-10 category M17 Gonarthrosis [arthrosis of knee] would be recorded.

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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Platelet-rich plasma injections for osteoarthritis of the ...

POINT OF VIEW: Battle opioid crisis by treating pain without narcotics – Palm Beach Post

The misuse of opioids, including prescription pain relievers, has led to an explosion of narcotic addiction and narcotic-related deaths. It is now considered an epidemic. Physicians are thought to be a major contributor to this increase in addiction, as they readily prescribe narcotics for pain relief following injury and surgery, leading to an increase of people who are becoming addicted to these substances. Once physicians stop prescribing these medications, these addicted individuals seek other sources. Of course, the purity and safety of drugs purchased outside the medical-pharmaceutical establishment are additional factors causing injury and death.

There is another way to treat acute injury. The solution is to find alternatives to surgery. Rapid treatment of injuries reduces the inflammation and pain, and avoids the use of narcotics.

Injury initiates an inflammatory response that protects against infection and initiates the healing response. Persistent inflammation, however, causes further tissue damage. Delayed treatment and persistent inflammation cause even further harm to the already injured part of the body.

A recent study of 111 patients compared standard physical therapy and conservative treatments to early injection therapy for acute injury. Thirty percent of the patients had neck injuries, 10 percent had mid-spine injuries and 60 percent had low back injuries. Patients treated more timely had significantly improved outcomes, and most of those treated immediately after injury demonstrated complete recovery. None of the patients medically treated immediately after injury required narcotic medication. This and other recent studies suggest that rapid medical treatment of injuries substantially reduces both the degree of impairment and the amount of narcotic use following accidents and trauma.

Physicians can help stop the opioid crisis by limiting the prescription of pain relievers and looking to other effective treatment options, including laser treatment, platelet rich plasma therapy, steroid injections and other alternatives. As physicians, we need to educate our patients on the importance of rapid treatments, getting to the source of the pain quickly and finding solutions and therapies that address those specific issues directly.

LAWRENCE GORFINE, WEST PALM BEACH

Editors note: Dr. Lawrence Gorfine is president of the Palm Beach Spine & Diagnostic Institute.

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POINT OF VIEW: Battle opioid crisis by treating pain without narcotics - Palm Beach Post

Sports hype of platelet-rich plasma ‘powerful marketing tool’ but distorts the science – CBC.ca

When injured elite athletes talk aboutusing platelet-rich plasma (PRP), the coverage fuels hype that makes it harder for average consumers to see the limitations of the potential treatment, a new study suggests.

Athletes including American golfer Tiger Woods, NFL quarterback Tom Brady and now-retired NBA playerKobe Bryant have reportedly used the decades-old approach.

When PRP is used in sports medicine circles, theperson's blood is collected and spun to concentrate the platelet component of the fluid, which is then injected back into an injured area, such as a torn tendon.

Tim Caulfield, who holds the Canada Research Chair in health law and policy at the University of Alberta, and his co-authors reviewed newspaper coverage of PRP use between 2009 and 2015in Australia, Canada, Ireland, New Zealand, United Kingdomand the United States. It waspart of their ongoing researchinto what he calls "bunk" or "science hype" exaggeration of the benefits of science and understatement of any risks or other concerns, including instem cell treatments.

"When PRP is covered in the sports pages, it's talked about in a way that if you were just a casual observer of the science, you would assume that this works and that, we think, is a very powerful marketing tool," said Caulfield.

"If you see a story about a pitcher, a football player or track and field star getting PRP and you have an injury and you know of a clinic near you that's offering PRP, I think it does make it seem like it's more legitimate and perhaps that the science is further along than it really is."

In last week's issue of the journal PLOS One, Caulfield and his co-authors reported that a large majority of PRP articles from Australia (97.1 per cent), theU.S. (87.1 per cent)and Canada (79.4 per cent) were sports-related stories.

The exception was in New Zealand, where less than 10 per centwere sports-related. The researchers found that81.8 per centof the articles analyzed were cosmetic stories.

Reality TV star KimKardashianfirst promoted PRPas an anti-aging treatment through thevampire facials she underwenton her show in 2013 to avoid wrinkles.

Caulfieldsaid he sympathizes with sports reporters but he wants the public to recognize how elite athletes are willing to try just about anything, even unproven, because they're desperate to return to play.That doesn't necessarily mean the treatment works.

"To date, the science [for PRP] is far from definitive," he said.

The researchers said their findings raise questions about why there havebeen so few well-conducted, large clinical trials into PRP to truly judge how much it helps or harms.

Dr. Ryan Degen, an orthopedic sports medicine surgeon at Western University in London, Ont., is seeking funding to conduct a clinical trial on PRP.

"The trial that we're going to try to get off the ground is to look at knee arthritis to see if [PRP is]warranted to treat the arthritis or if we should just be sticking with the conventional injections that we've been using," Degen said.

Degen advises athletes to tread cautiously.

Degen tells his patients there are a few possible indicationsto use PRP in sports medicine, but other times, it's not worthwhile, particularly given that the expense can range from $250 to several thousand dollars.

Many people look up to elite and professional athletes.But the study's findings suggest part of the cautionary message around PRP use is lost when athletes are the source of the message, said Dr. Mark Leung, director of the primary care sport and exercise medicine program at theUniversity of Toronto.

For "elite athletes, one of the names of the game is you start to try and compete and win at whatever cost and that may include your health, and so I don't thinkmany individuals [in] the general population may understandthat aspect."

The reality is, PRP injections don't replace an accurate diagnosis and reliable treatments such as exercise, weight management and rehabilitation, Leung said.

"There was some evidence for its use in tennis elbow or in partial tendon tears," said Leung. "I think that evidence is starting to become less clear [on] when to use it and what regimen, because even the way it's been studied has been a bit murky."

For non-elite athletes, Leung suggesteda more moderate approach to diet, workouts and recovery from injuries.

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Sports hype of platelet-rich plasma 'powerful marketing tool' but distorts the science - CBC.ca

Bears continue to mix and match on O-line with Kyle Long limited … – Chicago Sun-Times

With Prospect High School as their setting, the Bears continued to prepare themselves for a future without guard Kyle Long.

Long returned to practice Thursday but didnt participate after undergoing treatment on his surgically repaired right ankle a day earlier.

Coach John Fox said Long met with the doctor who originally performed his surgery in December in Charlotte, North Carolina.

It was pretty convenient, Fox said. We actually planned it about a week ago. Its just timed that way. I thought it went well. And we held him back today. The treatment they did usually requires 24 hours off, but he feels a lot better. Were excited to get him going again.

Bears guard Kyle Long. (AP)

Fox didnt specify which treatment Long underwent, but platelet-rich plasma (PRP) injections, which promote healing, can require a downtime of 24 hours.

With Long out, Hroniss Grasu practiced at center with the first-team offense, and Cody Whitehair was at left guard.

Its a look the Bears experimented with in Bourbonnais, but it also could be their starting look Saturday in the preseason game against the Cardinals.

There is flexibility that we need in the line, Fox said. Well see how it goes and how we start. We still havent met in really how were going to approach the game as a staff yet.

Another possibility is keeping Whitehair at center and playing Grasu at left guard.

[Grasu is] going to have to know both, Fox said. Hes going to have reps at both.

QB order

The Bears will maintain the same order at quarterback against the Cardinals: starter Mike Glennon, backup Mark Sanchez, then No. 3 Mitch Trubisky.

In and out

Linebackers Danny Trevathan (knee) and Nick Kwiatkoski (concussion) and defensive lineman Akiem Hicks (sore Achilles tendon) participated in practice in various capacities.

Cornerback Prince Amukamara (hamstring), defensive lineman Mitch Unrein (concussion) and nickel back Bryce Callahan (ankle) did not participate.

Follow me on Twitter @adamjahns.

Email: ajahns@suntimes.com

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Bears continue to mix and match on O-line with Kyle Long limited ... - Chicago Sun-Times

Study: Implicit hype? Representations of platelet rich plasma in the news media 5 things to know – Becker’s Orthopedic & Spine

After seeing athletes like Tiger Woods, Tom Brady and Kobe Bryant use platelet rich plasma to treat their injuries, consumers have been more motivated to treat their injuries with the same treatment.

However, a recent study by Tim Caulfield, Canada Research Chair, published in PLOS, showed this form of treatment may be exaggerated by the media.

Here are five things to know:

1. In the United States, 87.1 percent of news articles about platelet rich plasma were sports related stories.

2. Of the articles published about platelet rich plasma, 64.8 percent included a brief description of the procedure while 32.5 percent included a detailed description.

3. Approximately 67 percent of articles portrayed platelet rich plasma injections as a routine procedure and 22 percent portrayed the injections as new or cutting edge.

4. In total, 11.7 percent of the articles published described the injections as being experimental.

5. In the end, 23.8 percent of platelet rich plasma injections articles described the treatment as effective.

More articles on sports medicine: Dr. Neal EIAttrache performs knee surgery on Oklahoma City Thunder's Patrick Patterson: 4 takeaways OrthoAtlanta becomes official sports medicine provider of Chick-fil-A kickoff games: 3 insights Dr. Michael P. Bolognesi to perform knee replacement surgery on Dukes Mike Krzyzewski 4 insights

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Study: Implicit hype? Representations of platelet rich plasma in the news media 5 things to know - Becker's Orthopedic & Spine

When should you see a podiatric surgeon? – WTOP

This content is sponsored by MedStar Washington Hospital Center

Its Augustthe height of summerand many of us are taking advantage of the longer days to cram in more outdoor activities. For many, it just seems easier, and definitely more enjoyable, to go for an early morning run when its already light outside versus the dark days of winter.

But that increased activity also increases the risk of foot and ankle injuries, particularly among weekend warriors.

Sprains, which can vary widely in severity, are among the most common foot and ankle injuries. For minor problems, time-honored home remedies like icing, elevating, resting the foot and over-the-counter (OTC) anti-inflammatories are often all thats needed. But if you dont notice much relief after a few days of self-care, you should seek a professional opinion from a podiatrist, a doctor who specializes in foot and ankle care.

It may be that you need an ankle brace to support and protect the ligaments that were stretched or torn during the injury. More severe sprains may require a device called a CAM bootbasically a walking cast that relieves the ankle from bearing weight while it heals.

The good news is that most sprained ankles will getter better in a month or two.

Sometimes, however, what first seems like a badly sprained ankle may actually be a broken metatarsalone of the long bones in the middle of the foot. Because the symptoms of a break, especially a Jones Fracture, and a sprain can be so similar, some fractures dont get the early medical attention they may need, including surgery.

Individuals with chronic lateral ankle instability may also benefit from surgery to repair the damaged ligaments and return to a more active lifestyle. The condition is the result of cumulative injuries to the ligaments from frequent sprains, mostly due to overuse. That leaves the ankle more susceptible to chronic swelling, pain, tenderness and weakness, leading to even more sprains in the future.

Another quite common injury is plantar fasciitis, which occurs when you strain the ligament that connects the heel bone to the metatarsals. In 95 to 99 percent of people, it goes away with simple, conservative treatment like stretching, OTC inserts and physical therapy. If such steps dont provide relief, however, Im a big proponent of a promising new treatment called PRP.

PRP, or platelet-rich plasma injections, can often decrease or completely eliminate the pain of plantar fasciitis and other conditions, contributing to a speedier recovery. In the 30-minute procedure, some blood is withdrawn from the patient and then placed in a centrifuge to separate out the platelets, the component that helps with clotting, healing and tissue growth. Then the platelet-rich plasmanow containing three to five times more growth factors than normal is injected into the affected area.

Most patients can get back on their feet within a few days and can resume regular activity within a month.

Feet are the foundation of your fitness. If theyre in pain or stressed, you cant do much of anything. But properly supported, your feet can conquer miles in comfort.

Thats where the right shoes come in to play. And its tricky. Some lucky people are born with a perfectly normal foot; however most of us need some sort of assistance to help achieve the right mechanical balance. For instance, a bunion, flat foot or a really high arch can put extra strain on different tendons and ligaments, leading to arthritis, pain and degeneration.

But finding that sweet spot is a matter of trial and error. Sneakers that I regularly recommend to my patients dont work at all for my wide, highly-arched feet. You need to take time to find that brand and style that is going to be the best fit for your foots particular structure.

Orthotics can also help. I typically recommend that patients first try out an OTC support with a rigid sole, something like a piece of plastic, to see if that helps. In some cases, that may be all the arch support they need, while others may benefit more from a custom-made orthotic. Just be sure to avoid inserts that you can bend in half, which provide cushioning versus support.

The bottom line: Enjoy your summer activities, but dont beat up your feet in the process. And always see a doctor in the event of any significant swelling, bruising or pain.

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When should you see a podiatric surgeon? - WTOP