Orthoses are shoe inserts that help support and control abnormal foot and leg biomechanics. Orthotic devices can be fabricated with different materials, dispersion paddings, and motion controls depending on your specific foot condition. Your doctor will discuss your specific problem and make recommendations depending on your activity level, shoe type, and comfort needs. Some conditions may only require pre-fabricated inserts whereas others may need custom molding. Orthoses may not be a covered benefit or may only be partially covered under your insurance plan. Our office may need to check your benefits with your carrier and gain an authorization for payment and fabrication. A refundable deposit can be made to speed the fabrication of your inserts which will be returned after your insurance carrier completes payment for the services rendered.
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X-Ray

Conventional radiograph or X-Ray utilizes focused radiation to produce an image on film or digital scanner. It is the standard method used to evaluate the bony structures of the foot and ankle region. It is used to diagnose fractures, arthritis, foreign bodies, and other structural abnormalities of the foot and ankle. X-ray has limited ability to show soft tissue injury. Pregnant women, especially in their first trimester, are advised to avoid x-ray or other radiation exposure.
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MRI

MRI or magnetic resonance imaging is a type of diagnostic testing your doctor may order to help diagnose certain bone and soft tissue conditions. By use of radio waves and a large magnet, a scan of the affected area is performed giving a three dimensional image of the deep structures within the body. Your doctor and certified radiologist interpret the results to provide a better understanding of the current problem. There is no radiation exposure during an MRI. People who should avoid MRI studies are those with pacemakers, inner ear implants, surgical clips in the head, and certain artificial heart valves. Other implants or metal joint replacement parts should not pose any problems with the scanning procedure.
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CT Scan

Computed Tomography or CT scan utilizes radiation similar to an x-ray but is able to show three-dimensional and cross-sectional images of the body. It gives finer detail than a standard x-ray and is usually used for more complex foot problems. It is primarily used for osseous problems but at times can be used for soft tissue injuries. Pregnant women, especially in their first trimester, are advised to avoid CT or other radiation exposure.
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Ultrasound

Ultrasound is an imaging technique that uses sound waves to produce an image. These waves are targeted in the affected area and can show disruptions or abnormalities within the soft tissue structures of the body. Ultrasound has no radiation and is painless. It is frequently used to diagnose conditions such as bursitis, neuroma, plantar fasciitis, tendon and ligament injuries, masses, or foreign bodies.
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ESWT stands for extracorporeal shock wave therapy. It is a non-surgical treatment which is used for recurrent heel and arch pain that has not responded to traditional therapies. It is similar to the treatment which is used to care for kidney stones. It is a non-invasive treatment which uses sound waves under ultrasound guidance to target the affected tissues to help the body to stimulate its own repair mechanisms. It has been shown to stimulate revascularization, reduce sensitivity and pain, and encourage normal tissue healing.
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To qualify for ESWT therapy a patient must have failed conservative therapies for at least six months in duration including: rest, physical therapy, shoe inserts, stretching, non-steroidal anti-inflammatory medications (ie. ibuprofen), cortisone injections, and night splints. ESWT is not recommended for patients with pacemakers, patients who are currently taking medications that interfere with blood clotting (ie. coumadin), pregnant women, or children with open growth plates.

The ESWT therapy is a one time treatment. It takes about 30 minutes to perform. No hospital stay is required. It is usually done under mild sedation with local anesthesia. You can walk on the foot immediately after the procedure and can return to work in about 48 hours. Possible side effects of the procedure will be discussed with your doctor in detail but may include tenderness, redness, skin bruising, or swelling to the area.

ESWT treatment has eliminated the need for surgery in many but not all patients. It has fewer side effects and a shorter recovery period. Contact us to evaluate your condition and discuss appropriate treatment options.
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Vascular Testing

The incidence of peripheral vascular disease and peripheral arterial disease has been increasing over the last few decades. It is usually associated with other conditions such as cardiac disease, renal disease, hypertension, and diabetes. Early diagnosis and treatment of this problem may help prevent future problems such as ulceration, gangrene, and the need for amputation. Your doctor will evaluate your baseline circulatory status and recommend if you need additional vascular testing. The testing is not usually painful and consists of using blood pressure cuff like devices around your legs which squeeze and check your circulatory flow.
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Physical Therapy

Your doctor may offer physical therapy as a part of your treatment plan depending on your current condition and diagnoses. Physical therapy is usually provided by a certified therapist who is specially trained to utilize the prescribed modalities to help improve your symptoms. Physical therapy may include ultrasound, phono / iontophoresis, electrical stimulation, whirlpool therapy, deep tissue massage, stretching, range of motion exercises, muscle strengthening, and gait training. Physical therapy has been proven to increase motion and reduce the pain and swelling associated with many foot and ankle conditions.
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Botox

Excessive foot sweating or Plantar Hyperhidrosis usually occurs as a result of an over active sympathetic nervous system. It can lead to problems such as athlete’s foot, blisters, and infections. The most common complaint is embarrassing foot odor. This odor is caused by bacteria which colonize your shoe gear and eat the dead skin cells and oils produced from your body. The bacteria break down these materials into organic acids and sulfur compounds which produce the odor. Simple treatments that may help to reduce sweating and odor include: the proper daily cleansing and drying of feet, the use of cotton absorbent socks, sock changes during the day, the use of different shoes every day, the use of shoes that allow the foot to breath, the choice of shoe materials, the use of antibacterial soaps, the use of disinfectant sprays, proper shoe and insole cleansing, and the use of topical antiperspirants. If conservative treatments such as these fail to control your problem you may be a candidate for the Botox treatment for hyperhidrosis.

Botox is Botulinum Toxin Type A, it is a neurotoxin which is produced by the bacterium clostridium botulinum. It acts at the neuromuscular junction of nerve endings blocking the release of acetylcholine. Eccrine sweat glands are innervated by the sympathetic nerves and use acetylcholine as its neurotransmitter to cause sweat production. Botox injected into areas of hyperhidrosis is effective in temporarily reducing or abolishing sweat production in treated areas.

Botox injections have been seen to be an effective remedy for excessive sweating in the hands and armpit regions. It has been used safely by Dermatologists and Plastic Surgeons for cosmetic procedures for many years. The U.S. Federal Drug Administration has approved the use of Botox for many medical applications. It has not yet approved it for the treatment of excessive perspiration and hyperhidrosis. Physicians may use it to treat hyperhidrosis, but it is considered an “off-label” indication.

The treatment and injection technique can be explained by your doctor in detail. Botox has been seen to give up to six months relief of symptoms. The most common complications of the procedure are injection site tenderness, bruising and infection. A headache, fever, or flu like syndrome may occur. Botox treatment is avoided in patients that are pregnant or breast feeding. Those whom have an allergy to albumen or Botox can not receive treatment. Patients whom have neurological disorders treated by a physician.

The treatment at this time is deemed cosmetic in nature and “off label”. It is not covered by insurance carriers and is an out of pocket expense. Prescription plans may not cover the cost of the Botox injection.
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