(516) 869-3300  -Manhasset
(631) 427-3678  -Huntington
(516) 681-8866  -Woodbury
(718) 639-0499  -Maspeth
(516) 741-3338  -Williston Park
(516) 741-3338  -Mineola

Posts for: April, 2017

By Dr Joseph R DiStefano
April 28, 2017
Category: Foot Care
Tags: Basketball   March Madness   shoe gear  


With March Madness over, and basketball season kicking into high gear, it is important to mention the toll that court sports play on the lower extremity and especially the feet. The side to side cutting movement required by athletes, in combination with an unforgiving, solid court, unfortunately give podiatrists frequent visits. 

Wearing proper shoe gear is a big help in preventing injuries, but even then, finding a well made shoe is difficult. Most basketball sneakers are high tops, which provide some stability and protection to the ankle, however, most are made without much support to the foot. Since the foot is the first thing to strike the ground when running or pivoting, if it is not properly supported, a biomechanical imbalance is created. The supportive structures of the foot, tendons, ligaments and bones, are called upon to rebalance the foot and stabilize the ankle. A combination of repetitive stress and imbalances in the supportive structures lead to injuries and chronic pain. 
The injuries seen vary depending on many factors, however the majority are acute, and with early diagnosis and prevention, the problems are fixed. Heel pain and ankle sprains are very common issues in athletes who play court sports, again precipitated by improper footwear and biomechanical abnormalities. Often, by ignoring pain in the foot, tendonitis, ligament tears, or stress fractures can occur. These injuries generally take longer to heal, as the feet have been damaged over a longer period of time.
The best way to keep your feet on the floor and your head in the game is to be evaluated by a podiatrist. With a proper biomechanical exam and gait analysis, your podiatrist can fabricate a custom orthotic that will rebalance the structures of the foot into their optimal alignment and reduce unnecessary stress throughout the lower extremity. Orthotics aren't PF flyers. They won't make you run faster or jump higher. They will, however, allow you to perform to your maximum capability and help prevent overuse injuries. If the court is your refuge, nothing could be better than that. Come see your friendly neighborhood podiatrist in Huntington, NY! 

By Dr. Pedram A. Hendizadeh
April 28, 2017
Category: Foot Tips
Tags: foot   Feet   Injections   Neuroma  
Sclerotherapy Injections for Morton's Neuroma:  The latest treatment with a high success rate
When it comes to the health of our feet, women are much more vulnerable to ailments than men. One such problem that targets women more than men is Morton's Neuroma (perineural fibroma), which is 10 times more likely to affect woman than men.  This painful condition is caused by an enlarged nerve, usually one that runs between the metatarsal heads of the ball of the foot.  Morton's neuroma involves a thickening of the tissue around one of the nerves leading to your toes. It is sometimes referred to as an inter-metatarsal neuroma because of its location, which is usually at the ball of the foot between the third and fourth toes. Problems often develop in this area because of two nerves that intersect and become inflamed.   These nerves are typically larger in diameter than those going to the other toes, causing the nerve to become enlarged.  The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling which eventually leads to a radiating, burning or a shooting type of pain.
Who is at Risk?

There are many factors that contribute to Morton's neuroma, though the condition can arise spontaneously for reasons yet unknown. Flat feet can cause the nerve to be pulled towards the middle of the foot, which can cause irritation and enlargement of the nerve. However, the primary reason  women are more often affected by this condition than men, is the same reason for a host of other foot problems that occur mostly in women – poorly fitted shoes. Statistics show that this condition most often afflicts women in their 30s and 40s. Sorry ladies, but wearing the latest 5-inch heels from Jimmy Choo will contribute greatly to this condition. High-heeled shoes cause weight to be transferred towards the front of the foot, increasing pressure on the ball of the foot. Narrow, pointy, and tight-toe boxes create lateral compression, which squeezes bones, ligaments, muscles, and nerves in the forefoot, causing pain and swelling. 
Morton's neuroma can also result from physical activity that over-pronates the foot. Running, racket sports, and certain dances such as ballet, often cause trauma to the foot. This trauma can lead to a build-up of pressure on the ball of the foot. Additionally, an injury or structural defect of the foot can also cause Morton's neuroma. 

Signs and Symptoms: 
The pain caused by Morton's neuroma typically develops as an ache in the ball of the foot and progresses to a burning pain. This pain is often described as an intense feeling of pins and needles and a feeling like a pebble stuck inside the ball of the foot. The burning sensation leads to numbness in the second, third and fourth toes. These symptoms begin gradually, with the discomfort occurring when walking, but easing when resting or upon removal of shoes. Some symptoms that indicate Morton's neuroma include: radiating pain from the ball of the foot to the toes, intensifying pain during activity and when wearing shoes, and occasional numbness, discomfort, and tingling. These symptoms may be relieved temporarily by simply massaging the foot or by avoiding extravagant shoes or activities. However, if these instigators are not avoided, symptoms  can become progressively worse and may persist for several days to several weeks. 
Morton's neuroma is usually diagnosed by podiatrists.  They perform an exam called Mulder's Sign, where the foot is first squeezed from the sides while pressing down on the ball of your foot, mostly between the third and fourth metatarsal bones. If this squeezing results in extensive pain, as well as a clicking sound, the results are considered positive for Morton's neuroma. Sometimes further testing is needed, such as Diagnostic Ultrasound or MRI Studies.

The podiatrist will devise a treatment plan based on the severity and duration of the symptoms. Treatment approaches vary depending on the severity of the problem. Usually, conservative measures are suggested before considering surgery. Some of these treatments include padding, icing, orthotic devices, activity modifications, changes in shoe styles, oral anti-inflammatory medications, and injection therapy. 

Better footwear is probably the first and most important step you can take to alleviate this condition. Wearing a shoe with a wide-toe box and a low heel can reduce pain tremendously. Your doctor may also recommend some sort of padding to provide support to the metatarsal arch, thereby reducing the pressure on the nerve when walking. Custom orthotic devices provide the support needed to reduce pressure and compression on the nerve. 

Modifying physical activities will also go a long way in reducing the severity of Morton's neuroma. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves. In the meantime, to ease the pain, application of an icepack to the affected area can help reduce swelling. Alternatively, non-steroidal anti-inflammatory drugs, such as ibuprofen, can also help alleviate pain and swelling. 
If after the initial treatment no significant improvement is seen, sclerosing injection therapy is now the treatment of choice with a 94% success rate. In the past, the treatment plan would have been steroid injections followed by surgical excision of the neuroma.  Sclerosing injections were developed several years ago to help alleviate the pain of neuromas.  This conservative treatment option has significantly decreased the need for surgical excision.  The treatment is performed in an office setting. Sclerosing injections consist of a cocktail of 0.5% Marcaine and 4% dehydrated alcohol.   Studies have shown that this small concentration of alcohol can shrink the neuroma and, with the use of ultrasound guidance, sclerosing injections have had an excellent success rate. The majority of patients require a series of five to seven small injections given over the course of three months.  Most patients begin to see improvement after the third or fourth injection.   This novel treatment is effective and is covered by most insurance companies.

We all have a tendon in our legs known as the Achilles tendon which attaches the calf muscles the heel bone; it allows you to walk, jump and run as well as making it possible to stand on the balls of your feet. But when you have a continuous and intense physical activity like the ones mentioned above then it can result in a painful inflammation of that tendon a problem known as Achilles tendonitis. However, sometimes there are other unrelated factors to the physical exercises which can also contribute to Achilles Tendonitis. Such include Rheumatoid arthritis and an infection.

Some of the causes of Achilles Tendonitis are as follows

•    Wearing poorly fitted shoes

•    Some sports such as tennis which require quick stops and change of direction

•    Exercising without doing a proper warm up

•    Strain on the calf muscles during exercises

•    Prolonged wearing of heels

How Is Achilles Tendonitis Diagnosed?

Your doctor will perform some physical observations along with asking you a few questions concerning your pain and swelling in the heel. The doctor will ask you to stand on the balls of your feet, and he will feel the area around where you feel most painful, and the swelling is severe. Although you will not need them, using imaging tests can also help to confirm it when necessary. These tests include X-rays, MRI scans, and ultrasounds which provide images, detect rupture or tissue degeneration and show related damage to tendon movement.

Treating Achilles Tendonitis

In regards to the severity of your problem, the doctor might suggest any of the treatments ranging from resting and using ibuprofen to steroid injections and surgery. The first treatment will be to reduce your physical activity. Aside from that, your doctor will most probably suggest that you do the following

•    Go to physical therapy

•    Use a walking boot or wear a brace to restrict heel movement

•    Foot elevation to reduce swelling

•    Opt for a less strenuous sport

Using the RICE Method

It is usually useful for the treatment of Achilles Tendonitis just after having the injury. It entails rest, ice, compression and elevation and works in the following way

Rest- you will not put pressure or weight on the tendon for at least two days until the time that you can walk without feeling any pain. It heals faster if there is no additional strain.

Ice- using a bag of ice wrapped in a clothing material and then placing the bag against your skin. You will hold it against the tendon for about 20 minutes. The ice serves to help your inflammation go down faster.

Compression- you can use a bandage, clothing or athletic tape to tie it around the tendon so as to compress the injury. It will help keep the tendon from swelling too much but remember not to tie too tightly.

Elevation- raise your foot above the level of your chest. It works to maintain the swelling down because blood will be returning to the heart as a result of your foot being higher than your heart. It is easier when you use a pillow.

If you seek treatment earlier and follow the instructions of your doctor, then you will be more likely to recover quickly.


April 23, 2017
Category: Foot Tips
Tags: Ankle Pain  

Your ankle consists of a network of bones, ligaments, muscles and tendons which are strong enough to support your and make it possible for you to move. Despite this fact, the ankle can still be prone to injuries and pain. Symptoms might be a pain on the inside of your ankle or the outside along the Achilles tendon which connects the muscles found in your lower leg to the heel bone. Ankle pain can take time to resolve despite the fact that it responds well to home remedies and for that reason, you will need to see a doctor when the pain is severe.


A physical examination to determine which among the ligaments has been torn is necessary. It will involve moving your ankle joint in the various directions to check the range of your motion.  If the doctor is not certain if it is ankle sprain or a bone fracture, he might use imaging tests such as X-rays.

In cases where there is suspicion of bone chipping, severe damage to your ligaments or any injury to the ankle joint then an MRI may be done. It utilizes a high magnetic field together with radio waves and creates detailed images of your body making it possible for the doctor to make a proper diagnosis. If the ligaments are completely torn then the surface of your ankle may be injured as well, and in that case, your ankle will not be stable even after healing from the injury.

Treatment of Ankle Pain

When you treat your ankle sprain or ankle stability, you will be treating the ankle pain too. It is important that you do so to prevent any further discomforts. A doctor can also provide you with some valuable tips along with items which you will use to care for the sprain and recover from your ankle pain with time. Always remember that putting weight on the injured area just makes it much worse, therefore, avoid it as much as possible when recovering. Treatment of ankle pain may range from medications, surgery to home remedies. The various kinds of drugs work to ease the pain and to relieve the inflammation. It will all depend on the kind of ankle pain that you have.

When it comes to surgery, it will not be necessary unless you cannot control the pain with medications. The various ankle surgeries include fracture repair, ankle fusion, ankle replacement and ankle distraction arthroplasty.

You may also be able to treat mild pains at home, and some of the recommended treatments include

•    Not putting weight on your ankle and getting plenty of rest

•    Using a brace to support your ankle to reduce pressure on the affected area

•    Placing ice packs wrapped in a piece of clothing on the ankle for 15 to 20 minutes three times each day

•    You can also use a compression bandage; it reduces the swelling too

Even with the best of care, sometimes you may experience some ankle swelling, stiffness or pain most especially in the morning or when you have been active for some weeks.

The American Diabetes Association (ADA) lists amputations and foot ulcers as the leading causes of morbidity and disability for the patients with diabetes also of which have a high cost both physically and emotionally. Diabetes can be dangerous when it comes to your feet, as a matter of fact even just a small cut can have a serious consequence. It is mostly associated with damages to your nerve as a result taking away the feelings in your feet.

It can also reduce the amount of blood flowing to your feet which will make it hard to heal any injury that you may or to resist an infection. As a result of these problems, it might be impossible for you to notice even a foreign object when it is in your shoes. In that case, it could lead to the development of a blister or a sore.

As a patient with diabetes, you can delay or even prevent the onset of more severe outcomes through patient education, early recognition and managing the independent risk factors for the ulcers and amputations.

The current Diabetic foot care focuses mainly on prevention. Such preventive strategies include the collaboration of patient education which consists of prophylactic skin, foot, and nail care. Stressing the importance of protective footwear is also part of the diabetic foot care goal. As a patient, you opt to know the importance of routine care and screenings for your foot. They can help you to prevent complications such as foot ulcers of which when left untreated could ultimately result in amputation.

Patients with diabetes need to know the value of diabetic foot care making sure that they receive an annual foot examination and establish a day to day foot care routine. The routine should include inspecting and cleaning your injuries if there are any, cuts, skin changes or scrapes. If you come across any foot problem, then it is recommended that you seek medical attention. For you to avoid any serious foot problems which could result in losing a toe, foot or even a leg, patients with diabetes can follow the guidelines below

Daily feet inspection

It includes checking your feet for cuts, blisters, swelling, redness or even any problems with your nails. To make this practice easier, you can use a magnifying hand mirror to help you look at the bottom of your feet. Do not hesitate to call the doctor when you notice anything.

Bathe your feet

Keep your feet all the time each day by washing them but always remember to use lukewarm instead of hot water to soak the feet. Lukewarm water is the kind of temperature that you would use to bathe a newborn baby.

Be gentle with your feet

It entails more especially when you are washing your feet. It is recommended that you use a soft washcloth or a sponge when doing so and then afterward carefully drying it between the toes by blotting or patting.

Moisturize your feet

You can use a moisturizer daily on your feet to keep any dry skin from itching even so from cracking. Just avoid moisturizing between your toes as it could lead to fungal infection.

Cut nails

Ensure to do that straight across then file the edges. Just do not cut the nails too short as it could result to an ingrown toenail. When you have any concerns about your nails, make sure to consult your doctor.

Wear socks

Make sure to be changing them daily. You can get socks that are made specifically for diabetic patients. This kind of socks will provide you with an extra cushioning, lack elastic tops and are much higher than your ankle which is made from fibers that remove moisture from your skin.

Contact Us

Please specify in the message section below which office you would like to be seen at Manhasset, Huntington, Coram, Woodbury, Mineola, Williston Park & Maspeth, Plainview NY

Advanced Podiatry of Manhasset at the Americana

Manhasset, NY Office
Advanced Podiatry
2110 Northern Blvd.
Manhasset, NY 11030

(516) 869-3300

Huntington, NY Office
Advanced Podiatry
181 Main St.
Huntington, NY 11743

(631) 427-3678

Coram, NY Office
Advanced Podiatry
100 Middle Country Rd.
Coram, NY 11727

(631) 696-9636

Woodbury, NY Office
Advanced Podiatry
20 Crossways Park North Suite 304
Woodbury, NY 11797

(516) 681-8866

Mineola, NY  Office
Advanced Podiatry
155 Mineola Boulevard, Suite B 
Mineola, NY 11501

(516) 741-3338

Maspeth, NY  Office
Advanced Podiatry
70-01 Grand Ave
Maspeth, NY 11378

(718) 639-0499

Williston Park, NY Office
Advanced Podiatry
479 Willis Ave,
Williston Park, NY 11596

(516) 741-3338

Plainview, NY Office
 *Recently Moved to Woodbury