Innovations in Neuropathy Pain

We are performing integrated nerve blockade treatments for our patients at Family Foot and Leg Center at our East Office exclusively. 

We are currently noticing an improvement in nerve pain in the foot and ankle area, as well as some studies are finding that some patients actually have improved balance and proprioception longterm after the treatment is completed. We will see patients 2 times a week for 4 weeks, and each treatment consists of 30 minutes which combines electrical and neuroblockade consisting of lidocaine to the peripheral nerves to the ankle and foot. This treatment is revolutionizing noninvasive management of the painful condition of neuropathy. 

New Advanced Technology

The vast majority of electromedical devices available in the United States employ LF stimulation (eg, transcutaneous electrical nerve stimulation [TENS]). Balanced MF currents have been developed that produce twice the electrical current with no electrical charge. A new type of electrical current technology has been developed to enhance the stimulating lower frequencies and nonstimulating middle frequencies for increased efficacy in clinical practice. The device also combines, and simultaneously delivers, frequency-modulated (FM) and amplitude-modulated (AM) electric cell currents in the MF range. We refer to this electromedical approach as electronic signal treatment (EST).

This new technology may reach deeper into tissue structures with simultaneous modulation of amplitude and frequency between 2,500 Hz and 33,000 Hz. It is also capable of modulating its MF electric cell-signaling current down into the LF range at available frequency rates between 0.1 and 999 Hz.

In addition, we have combined the new EST with local anesthetic injections (bupivacaine 0.25%) with clinical success. This technique provides a combined (electrical and chemical) nerve block that enhances treatment of a neuropathy or a painful condition (see Tables 1 and 2). 

According to the Gould Medical Dictionary, a nerve block is defined as “[t]he interruption of the passage of impulses through a nerve, as by chemical, mechanical, or electrical means.” Because nerve blocks occur at voltage-gated channels, all nerve blocks are essentially electrical. According to Szasz, “There is no such thing as a chemical block … only an electrical block.”6 We refer to this as combined electrochemical block (CEB).

Will 3D custom foot orthotics help you?

Orthotics are devices that are placed in the shoe to put the foot in a neutral position, or provide cushioning depending on the type of orthotic.  Orthotics devices are used in foot conditions such as, flat foot, pes cavus (high arched feet), equinus (muscular imbalance limiting upward motion of foot), hammertoes, limb length difference, diabetes, bunions and many other conditions.  Orthotics can be custom made or bought over the counter.  A 3-dimensional scan of the foot is used to send to a lab that makes custom made orthotics, and the orthotics lab can add correction specific to the patients’ needs based on specific instructions in the form of a prescription from our offices.

Orthotics fall into two different categories: functional and accommodative:  

Functional orthotic devices are used to correct biomechanical deformities in the frontal plane, and reduce impact while running or walking.  Functional correction is used to reduce abnormal pronation by providing support of the arch, while accommodative orthotics are a soft supportive device used to provide cushioning, and distribute weight bearing pressures evenly across the bottom of the foot.  When making orthotics it is important to compensate for limb length differences because even a small difference can cause pathology, and affect gait.  Symptomatic differences in limb length usually occur when there is a 4cm or greater difference.  Functional orthotics devices are made of semi-rigid material to provide stability, such as graphite or plastic.  

Accommodative orthotic devices are usually made of softer materials, such as leather or foam to provide comfort.  Accommodative orthotics devices are used in conditions such as diabetes and rheumatoid arthritis to help relieve pressure and apply gentle offloading forces away from prominent structures of the foot. 

This is just a brief overview of the various uses and types of orthotics, and is not complete by any means.  For some people, orthotics devices are a way to treat foot pain conservatively and avoid surgery.  Orthotics devices are sometimes recommended post-operatively to prevent recurrence of various deformities.  However, some patients use orthotics devices to provide stability and support to the foot, and prevent injuries.  

Here, we have a 3-dimensional scanner which can allow us extremely accurate impressions of the feet in order to achieve both optimal comfort and control with our custom molded devices. 

Orthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotic are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual's unique foot structure.

Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.
Rigid Orthotics
Rigid orthotic devices are designed to control function and are used primarily for walking or dress shoes. They are often composed of a firm material, such as plastic or carbon fiber. Rigid orthotics are made from a 3-dimensional scan of the foot or feet. Rigid orthotics control motion in the two major foot joints that lie directly below the ankle joint and may improve or eliminate strains, aches, and pains in the legs, thighs, and lower back.

Soft Orthotics
Soft orthotics are generally used to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. They are usually effective for diabetic, arthritic, and deformed feet. Soft orthotics are typically made up of soft, cushioned materials so that they can be worn against the sole of the foot, extending from the heel past the ball of the foot, including the toes. Like rigid orthotics, soft orthotics are also made from a 3-dimensional scan of the foot.
Semi-Rigid Orthotics
Semi-rigid orthotics provide foot balance for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials. Semi-rigid orthotics are often prescribed for children to treat flatfoot and in-toeing or out-toeing disorders. These orthotics are also used to help athletes mitigate pain while they train and compete.

If there is any question whether these sorts of devices may help you, most likely than can, because if you are questioning if you need them most likely your feet have some symptomatic concern which does require an evaluation.

Brian Timm, DPM, FACFAS

Board Certified by the American Board of Podiatric Surgery

6 Secrets to Manage Foot Arthritis

Arthritis is the leading cause of disability in the United States.  Almost half of people in their sixties and seventies suffer from arthritic foot pain.  There is no cure for arthritis, but there are many types of treatments available that focus on pain management.  Osteoarthritis typically occurs in older individuals, or people that have had a previous injury.  Osteoarthritis is a degenerative joint disease. Over time the cartilage between joints wears down leading to inflammation, swelling, and pain.  In younger individuals that develop osteoarthritis there is usually a history of previous injury, family history of osteoarthritis, or obesity.  

The foot consists of 33 joints, but there are a select few that are more prone to osteoarthritis than others.  The ankle, the great toe, 3 joints in the hindfoot (talocalcaneal, calcaneocuboid, talonavicular joints), and the midfoot (metatarsocuneiform joint) are the most commonly affected joints.  Osteoarthritis can also be caused by abnormal foot structure, such as flat foot or a high arch.
Some people believe that cold, damp weather exacerbates their osteoarthritis, and some even say they can predict the weather.  Common symptoms of osteoarthritis include: stiffness, limitation of the joint, swelling, difficulty walking and tenderness that is persistent.  Osteoarthritis is a chronic condition, and can be debilitating.

There are many great treatments available, but here are just a few solutions for osteoarthritic foot pain that you can try prior to seeing us at the Family Foot and Leg Center:

1.      See me at least once a year to monitor changes, and modify treatment
2.      Comfortable and supportive shoes are necessary, and sometimes orthotics or ankle braces are also helpful
3.      Weight loss
4.      Anti-inflammatory medications such as NSAIDS (ibuprofen) or corticosteroid injections that can be given by your podiatrist
5.      Physical therapy and exercises
6.      Try a topical medication that has capsaicin, an ingredient that can help reduce pain

Dr Brian Timm
Board Certified by American Board of Podiatric Surgery

Masses on your foot

There are many types of tumors that affect the foot, and many are benign.    

Two of the most common types are ganglion cysts and plantar fibromas.  

Ganglion cysts are also known as bible cysts because common treatment was hitting them with a bible so that the cyst would burst.  Ganglion cysts are more common in younger people, while plantar fibromas are more common in older people.  

Ganglion cysts often occur on the top of the foot, but are also very common on the hand.  The cysts are fluid-filled, occur at joints, and often change size. Ganglion cysts are usually observed for any changes unless they reach a size that causes pain or pressure on nerves or arteries.   Immobilization of the area is also sometimes helpful because activity often causes the cyst to increase in size.  If they reach a large size, then further treatment may be beneficial.  Further treatment of ganglion cysts usually consists of draining the fluid with a needle, or aspiration.  Aspiration of the fluid is not always successful because the root of the cyst may remain, and the cyst will return.  Surgical treatment may be recommended for recurring ganglion cysts. 

Plantar fibromatosis is the most common benign tumor on the bottom of the foot.  Plantar fibromatosis is also known as Ledderhose’s disease, which is a thickening of the foot’s plantar fascia.  Over time the lump increases in size, and may start causing pain or limitations in activity.  This type of benign tumor is often associated with a family history of the disease, or patients with diabetes.  Initial treatment is off-loading to avoid direct pressure or worsening of the tumor.  Corticosteroid injections and cryotherapy are often used initially before surgical options are considered.  Surgical removal of a plantar fibroma is more difficult than removing a ganglion cyst, which is why more conservative therapy is recommended unless conservative methods have failed. 

Ganglion cysts and plantar fibromatosis are only two of many types of possible tumors, but they are the most common benign tumors presenting in the foot.  These are both very manageable conditions, but with any lump or bump in the foot it is important to see your Podiatrist to rule out something more serious.

Brian Timm, DPM, FACFAS

Diplomate: American Board of Podiatric Surgery

Board Certified in Foot Surgery