Pain in the Ball of the Foot
Ask the Doc………….
“The ball of my foot hurts. I’ve been told I have arthritis and need surgery. Is there any alternative?”
The “ball” refers to the bottom of the foot just behind the toes, and it’s one of the more common areas for foot pain, especially as we age. Usually, surgery can be avoided.
The most common cause of pain in this area is a tight calf muscle. This might seem like a “stretch” (no pun intended) but when the calf muscle is tight (and most people have this to some extent) it becomes difficult to bend or flex your foot at the ankle, bending it upward when walking. So with each stride, instead of flexing at your ankle, you contract your toes bending them upward. When this happens, the bones just behind the toes (metatarsals) are pushed downward. At the same time, the natural fat pad is moved forward leaving those bones unprotected.
As the toes become more contracted and pressure continues, a painful bursitis as well as calluses can develop on the bottom of the foot. If left untreated and unprotected, ulcerations or sores may occur in those with compromised circulation (like Diabetes).
In addition, as the toes become rigid and fixed in this contracted state, painful corns (areas of hardened thick skin) may occur on tops of the toes. These can be as problematic as the symptoms on the balls of the feet.
You may have a tight calf muscle and not even realize that you are functioning this way. But if you think about it, you may have noticed that you trip sometimes or drag your feet more than you used to. This might be especially noticeable when wearing rubber soled shoes and walking on carpet. So this isn’t always simply due to old age or being clumsy, but again, to an inability to flex or bend at your ankle.
You may also notice that the ends of your shoes sit up off the ground and that the very ends of your shoes (on the bottoms near the toes) are worn excessively.
Stretching tight calf muscles and padding just behind (not on) the painful area on the bottom of the foot is often very helpful. In severe cases, injections of small amounts of cortisone into the area can be quite effective. And the use of fully custom foot inserts to redistribute the weight is often very beneficial. The combination of these therapies can often allow you to avoid the surgery you mentioned.
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
Friday, January 30, 2009
Thursday, January 22, 2009
Leg Length
Ask the Doc………
“I have one leg longer than the other. Should I be concerned?”
Although certainly not on a par with cancer or heart disease, the importance of equalizing leg lengths is greatly underestimated, usually not evaluated, and if found, left uncorrected; especially if less than a quarter of an inch, which is considered normal.
But “normal,” means what the average person has. The average person also has high cholesterol, weighs more, and is less active and more stressed than a healthy person should be. So I don’t think we really want to be average.
Unequal leg lengths can be due to structural or functional causes. It’s important to differentiate these causes and treat them appropriately.
Now, after treating arthritic patients for thirty five years, I am still amazed at the powerful, positive impact of equalizing leg lengths. For example, when a patient with an arthritic hip or knee does a simple squat with the proper amount of correction under their short leg, often there is an immediate decrease in pain.
That’s because abnormal alignment causes excessive wear on the joints, which results in destructive arthritic changes and subsequent pain. By equalizing leg lengths, arthritic patients can often be made to function on the part of their knee or hip joint that still has cartilage. This occurs in the same way that realigning the tires on your car enables you to ride on the tread that is still there, thus improving ride quality and extending the life or your tires.
Although often overlooked, it’s even more important after a knee or hip replacement because this type of surgery very often results in a leg length that is longer or shorter than it was before the joint was replaced! This causes additional stress on the new joint, as well as the other weight bearing joints of the feet, ankles, knees, hip and back.
Unequal leg lengths have the same powerful affect in sports. In golf for example, equalizing leg lengths can increase performance and decrease injuries.
So if you’re interested in preventative health, decreasing the stress on your weight bearing joints, or improving sports performance, equalize your leg lengths. And sometimes it’s as simple as putting a lift in your shoe on the shorter side!
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
Ask the Doc………
“I have one leg longer than the other. Should I be concerned?”
Although certainly not on a par with cancer or heart disease, the importance of equalizing leg lengths is greatly underestimated, usually not evaluated, and if found, left uncorrected; especially if less than a quarter of an inch, which is considered normal.
But “normal,” means what the average person has. The average person also has high cholesterol, weighs more, and is less active and more stressed than a healthy person should be. So I don’t think we really want to be average.
Unequal leg lengths can be due to structural or functional causes. It’s important to differentiate these causes and treat them appropriately.
Now, after treating arthritic patients for thirty five years, I am still amazed at the powerful, positive impact of equalizing leg lengths. For example, when a patient with an arthritic hip or knee does a simple squat with the proper amount of correction under their short leg, often there is an immediate decrease in pain.
That’s because abnormal alignment causes excessive wear on the joints, which results in destructive arthritic changes and subsequent pain. By equalizing leg lengths, arthritic patients can often be made to function on the part of their knee or hip joint that still has cartilage. This occurs in the same way that realigning the tires on your car enables you to ride on the tread that is still there, thus improving ride quality and extending the life or your tires.
Although often overlooked, it’s even more important after a knee or hip replacement because this type of surgery very often results in a leg length that is longer or shorter than it was before the joint was replaced! This causes additional stress on the new joint, as well as the other weight bearing joints of the feet, ankles, knees, hip and back.
Unequal leg lengths have the same powerful affect in sports. In golf for example, equalizing leg lengths can increase performance and decrease injuries.
So if you’re interested in preventative health, decreasing the stress on your weight bearing joints, or improving sports performance, equalize your leg lengths. And sometimes it’s as simple as putting a lift in your shoe on the shorter side!
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
Friday, January 16, 2009
Latest Research on the Cause of Arthritis
Ask the Doc…….
“What does the latest research show is the real cause of osteoarthritis?
Like most physicians I was taught that osteoarthritis was primarily due to ageing; like gray hair and wrinkles. But the fact that it primarily occurs when we are older doesn’t necessarily mean it’s due to age but rather that it, like heart disease, takes a long time to develop.
My work over forty years in this area has shown that contrary to what is currently believed, that abnormal structure wears out our joints in the same way that poorly aligned tires wear out sooner. Now more and more credible data is substantiating my premise.
A recently published arthritis textbook of the latest research was reviewed by Dr. Hunter, a preeminent rheumatologist. He said that arthritis should now be viewed as being “primarily due to mechanical factors” and that by physicians “focusing more on this, we have the opportunity to help millions of patients with arthritis.”
Dr. Jason Theodosakis is considered one of the foremost authorities in the world on osteoarthritis. In his book, The Arthritis Cure,” he continually emphasizes the important role that abnormal function plays in osteoarthritis. Dr. T states that, it is critically important to control how we walk and function if we really want to treat arthritis.
In 2001, the prestigious Journal of the American Medical Association reported that “abnormal alignment of only five degrees (as measured from the ankle to the hip) increased the progression of osteoarthritis four to five times!”
Most recently the famed Mayo Clinic’s study showed that for “each degree of abnormal alignment there was a 53% increased risk of the progression of arthritis of the knee,” and that “increasing age was only weakly associated with an increase risk of osteoarthritis of the knee.” They now consider poor alignment as “one of the most important risk factors for osteoarthritis.”
We are not born perfect. Any degree of abnormality (like a flattened foot or longer leg) increases joint friction and over time causes arthritis.
The best way to prevent arthritis of the weight bearing joints of our feet, ankles, knees, hips and neck is to be structurally evaluated and fix (on a permanent basis) the problems found. Optimizing how we function, especially after knee or hip joint replacement, is critical to staying active without pain as we age.
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
“What does the latest research show is the real cause of osteoarthritis?
Like most physicians I was taught that osteoarthritis was primarily due to ageing; like gray hair and wrinkles. But the fact that it primarily occurs when we are older doesn’t necessarily mean it’s due to age but rather that it, like heart disease, takes a long time to develop.
My work over forty years in this area has shown that contrary to what is currently believed, that abnormal structure wears out our joints in the same way that poorly aligned tires wear out sooner. Now more and more credible data is substantiating my premise.
A recently published arthritis textbook of the latest research was reviewed by Dr. Hunter, a preeminent rheumatologist. He said that arthritis should now be viewed as being “primarily due to mechanical factors” and that by physicians “focusing more on this, we have the opportunity to help millions of patients with arthritis.”
Dr. Jason Theodosakis is considered one of the foremost authorities in the world on osteoarthritis. In his book, The Arthritis Cure,” he continually emphasizes the important role that abnormal function plays in osteoarthritis. Dr. T states that, it is critically important to control how we walk and function if we really want to treat arthritis.
In 2001, the prestigious Journal of the American Medical Association reported that “abnormal alignment of only five degrees (as measured from the ankle to the hip) increased the progression of osteoarthritis four to five times!”
Most recently the famed Mayo Clinic’s study showed that for “each degree of abnormal alignment there was a 53% increased risk of the progression of arthritis of the knee,” and that “increasing age was only weakly associated with an increase risk of osteoarthritis of the knee.” They now consider poor alignment as “one of the most important risk factors for osteoarthritis.”
We are not born perfect. Any degree of abnormality (like a flattened foot or longer leg) increases joint friction and over time causes arthritis.
The best way to prevent arthritis of the weight bearing joints of our feet, ankles, knees, hips and neck is to be structurally evaluated and fix (on a permanent basis) the problems found. Optimizing how we function, especially after knee or hip joint replacement, is critical to staying active without pain as we age.
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
Thursday, January 15, 2009
Dr. Pack's Credentials
Dr. Pack has been a physician for over 35 years. Involved in teaching his entire professional career, he is a nationally known lecturer and author and has done presentations abroad as well. Dr. Pack has had a keen interest in sports performance since he began running in 1972. As he’s aged, he has become more interested in helping older people with arthritis stay active. He believes we all have structural abnormalities (a flattened foot, longer leg etc.) and that these cause decreased performance, an increased risk of injury and later, arthritic changes. In almost all instances, these performance decreasing problems remain undiagnosed until pain occurs. He believes he can take almost any athlete in any sport and help them perform better, and at times, help older patients perform better than they ever have. “Arthritis is not something you have to get as you age but is preventable to a large extent.” With a background in pharmacy, Dr. Pack is:
Founding Fellow of the American College of Rheumatology
Past Clinical Instructor of Medicine, Emory University School of Medicine
Board Certified in Foot and Ankle Surgery
Fellow of the American Academy of Foot and Ankle Surgeons
Diplomate of the National Board of Podiatric Examiners
Former Director of Residency Training and Post Graduate Education, Atlanta Hospital
Director of Certification, Functional Foot Orthotics, Division of Enhanced Performance, United States Sports Academy
Visiting Clinical Instructor, MSPO Program, GA Tech
In the 2004 Olympics he had a silver and gold medalist and helped the UGA Golf Team (2005 NCCA National Champions). Dr. Pack has worked with eight world record holders in different sports as well as many professional athletes, including a British Open and Master’s Champion. Dr. Pack’s prominence in the medical community has led him to extensive involvement with the media as well. He has written numerous newspaper columns and has been a frequent guest on many radio and television shows throughout his career. For many years Dr. Pack did the medical tips on the number one prime time show in Atlanta, P.M. Magazine, and was interviewed by Mike Wallace for 60 Minutes. For further information see his web site at www.drloupack.com.
Founding Fellow of the American College of Rheumatology
Past Clinical Instructor of Medicine, Emory University School of Medicine
Board Certified in Foot and Ankle Surgery
Fellow of the American Academy of Foot and Ankle Surgeons
Diplomate of the National Board of Podiatric Examiners
Former Director of Residency Training and Post Graduate Education, Atlanta Hospital
Director of Certification, Functional Foot Orthotics, Division of Enhanced Performance, United States Sports Academy
Visiting Clinical Instructor, MSPO Program, GA Tech
In the 2004 Olympics he had a silver and gold medalist and helped the UGA Golf Team (2005 NCCA National Champions). Dr. Pack has worked with eight world record holders in different sports as well as many professional athletes, including a British Open and Master’s Champion. Dr. Pack’s prominence in the medical community has led him to extensive involvement with the media as well. He has written numerous newspaper columns and has been a frequent guest on many radio and television shows throughout his career. For many years Dr. Pack did the medical tips on the number one prime time show in Atlanta, P.M. Magazine, and was interviewed by Mike Wallace for 60 Minutes. For further information see his web site at www.drloupack.com.
Can You Increase Sports Performance As You Age?
Ask the Doc…..
“Can you really increase your sports performance as you age?”
Although we can’t stop the actual aging process, that doesn’t mean we can’t perform better in sports as we age. One of the fastest and most powerful ways to do that is usually the most often overlooked, and that’s to increase one’s balance and stability through structural analysis.
We’re all born with structural imperfections that we seem to “get away with” until we age. Fixing these abnormalities can at times, partially compensate for the aging process. Just ask javelin thrower Roald Bradstock, who at almost 50 became the oldest man ever to compete in his event in the Olympic Trials. Or ask any of the senior golfers and tennis players we’ve been privileged to work with.
The key is to find the structural abnormalities we all have and not just negate them, but optimize them. For example, everyone has one leg longer than the other. This means that a right handed golfer or tennis player will have a much harder time getting through their swing if they have a longer left leg, and a much harder time bringing their club or racket back with a longer right leg. If you’ve been playing sports like these for 40 years, your swing has always been restricted. Now with age, you can’t compensate as easily. But often by simply putting a lift in your shoe on the shorter side, you may be able to rotate easier than you could when you were 20!
Accurately correcting a flattened (pronated) foot and eliminating tight muscles (especially one’s calves) are also important. Such structural problems not only cost you in terms of performance, but can increase injuries. Not all the soreness we get as we age is due to arthritis. The reason tour players need an entourage of physical therapists and massage specialists is not because they’re swinging a golf club, but because they’re swinging in poor alignment.
If you wish to be the very best you can be, and enjoy being active without some of the aches and pains that accompanies aging, (and perhaps even increase your sports performance), you may want to consider having a structural analysis. Fixing the bent frame we all have is a much better starting point than buying a new driver or tennis racket!
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
“Can you really increase your sports performance as you age?”
Although we can’t stop the actual aging process, that doesn’t mean we can’t perform better in sports as we age. One of the fastest and most powerful ways to do that is usually the most often overlooked, and that’s to increase one’s balance and stability through structural analysis.
We’re all born with structural imperfections that we seem to “get away with” until we age. Fixing these abnormalities can at times, partially compensate for the aging process. Just ask javelin thrower Roald Bradstock, who at almost 50 became the oldest man ever to compete in his event in the Olympic Trials. Or ask any of the senior golfers and tennis players we’ve been privileged to work with.
The key is to find the structural abnormalities we all have and not just negate them, but optimize them. For example, everyone has one leg longer than the other. This means that a right handed golfer or tennis player will have a much harder time getting through their swing if they have a longer left leg, and a much harder time bringing their club or racket back with a longer right leg. If you’ve been playing sports like these for 40 years, your swing has always been restricted. Now with age, you can’t compensate as easily. But often by simply putting a lift in your shoe on the shorter side, you may be able to rotate easier than you could when you were 20!
Accurately correcting a flattened (pronated) foot and eliminating tight muscles (especially one’s calves) are also important. Such structural problems not only cost you in terms of performance, but can increase injuries. Not all the soreness we get as we age is due to arthritis. The reason tour players need an entourage of physical therapists and massage specialists is not because they’re swinging a golf club, but because they’re swinging in poor alignment.
If you wish to be the very best you can be, and enjoy being active without some of the aches and pains that accompanies aging, (and perhaps even increase your sports performance), you may want to consider having a structural analysis. Fixing the bent frame we all have is a much better starting point than buying a new driver or tennis racket!
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
Friday, January 9, 2009
Is Arthritis Inherited?
Ask the Doc…….
“My mom and dad both have arthritis and I’m starting to get joint pain. Is there anything I can do to prevent my children from getting it?”
While there is some limitation to what can be done to prevent certain types of arthritis (like Rheumatoid Arthritis, which is inherited)), osteoarthritis (the most common form) can be prevented to some extent.
There is a misconception that osteoarthritis, is due to old age and will happen to us regardless of what we do. While age will wear out some of our cartilage, most of the damage that occurs (and is preventable), is due to poor alignment which increases joint friction. Abnormal friction and pressure wears out joints in the same way that poorly aligned car tires wear out sooner.
A recent study by the famed Mayo Clinic showed that even one degree of abnormal knee alignment (not even noticeable to the human eye) will increase the progression of arthritis 52%! And if you are carrying a few extra pounds that abnormal alignment becomes even more important.
Many times what we really inherit is the abnormal structure our parents had and not the arthritis itself. A long leg for example, can cause arthritis in the knees and hips. So symptoms in these areas may be due to our inheriting a longer leg and not an arthritis gene.
Even in the case of an inherited joint disease, abnormal structure plays a role. For example, Rheumatoid Arthritis may cause flattening of the arch. This in turn causes excessive pressure on the insides of the knees. By controlling the flattening of the foot, knee problems can often be improved, despite the fact that the cause was inherited.
So the best thing to do to prevent arthritis is to be structurally evaluated and aligned as ideally as possible. This will serve to decrease stress and pain on the weight bearing joints of the feet, ankles, knees, hips and back. And if an inherited form of arthritis does occur, repeat the evaluation to control the deformities that disease has caused.
In his book, “The Arthritis Cure,” Dr. Jason Theodosakis says that the importance of having yourself structurally evaluated and correcting abnormalities such as a longer leg or flatted foot “cannot be overemphasized.” As he says, “if you don’t correct the underlying problems, you can’t rid yourself of the disease.”
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
“My mom and dad both have arthritis and I’m starting to get joint pain. Is there anything I can do to prevent my children from getting it?”
While there is some limitation to what can be done to prevent certain types of arthritis (like Rheumatoid Arthritis, which is inherited)), osteoarthritis (the most common form) can be prevented to some extent.
There is a misconception that osteoarthritis, is due to old age and will happen to us regardless of what we do. While age will wear out some of our cartilage, most of the damage that occurs (and is preventable), is due to poor alignment which increases joint friction. Abnormal friction and pressure wears out joints in the same way that poorly aligned car tires wear out sooner.
A recent study by the famed Mayo Clinic showed that even one degree of abnormal knee alignment (not even noticeable to the human eye) will increase the progression of arthritis 52%! And if you are carrying a few extra pounds that abnormal alignment becomes even more important.
Many times what we really inherit is the abnormal structure our parents had and not the arthritis itself. A long leg for example, can cause arthritis in the knees and hips. So symptoms in these areas may be due to our inheriting a longer leg and not an arthritis gene.
Even in the case of an inherited joint disease, abnormal structure plays a role. For example, Rheumatoid Arthritis may cause flattening of the arch. This in turn causes excessive pressure on the insides of the knees. By controlling the flattening of the foot, knee problems can often be improved, despite the fact that the cause was inherited.
So the best thing to do to prevent arthritis is to be structurally evaluated and aligned as ideally as possible. This will serve to decrease stress and pain on the weight bearing joints of the feet, ankles, knees, hips and back. And if an inherited form of arthritis does occur, repeat the evaluation to control the deformities that disease has caused.
In his book, “The Arthritis Cure,” Dr. Jason Theodosakis says that the importance of having yourself structurally evaluated and correcting abnormalities such as a longer leg or flatted foot “cannot be overemphasized.” As he says, “if you don’t correct the underlying problems, you can’t rid yourself of the disease.”
A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCCA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.
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