Lyndon Johansen DPM

11/11/2021

Nonsteroidal injections that helped healing injuries

There are multiple injections currently that can help reduce inflammation heel tendons and muscle along with joints and other musculoskeletal issues.

These include not limited to vitamin B12 and Traumeel injections, PRP (platelet rich plasma) injections, prolotherapy, hyaluronic acid, Peptide BPC–157

Intramuscular and intra-articular Botox, intra-articular growth hormone and stem cells.

There many therapies with regards too the "biogenic" type injection therapy. In this article we will concentrate on the PRP (Platelet rich plasma) injection/therapy.

What is PRP?

PRP stands for (platelet-rich plasma) therapy and is a highly effective solution for many common foot and ankle injuries.

• Sprains
• Arthritis
• Fasciosis
• Plantar fasciitis
• Ankle ligament injuries
• Injuries or pain you experience after foot or ankle surgery

PRP treatments are an excellent alternative to surgery. However, treatments can be administered as supplemental treatments before and after surgery to speed the healing process if surgery is needed.

Why PRP?
Patients suffering from tendon, ligament, or soft tissue issues in the foot or ankle may benefit from PRP therapy. Podiatrists widely use PRP for the treatment of plantar fasciitis, Achilles tendon, and ankle ligament injuries.

PRP is an innovative new technique that speeds the healing and recovery of injured, damaged, or diseased tissues in the body. And since PRP is made from your body's plasma, it naturally boosts the body's own healing process to resolve foot and ankle issues that have proved challenging to heal.

Sufferers of plantar fasciitis who have used cortisone injections may greatly benefit from PRP treatment. While cortisone injections reduce and mask symptoms, PRP injections enhance and stimulate healing.

What are PRP injections?
PRP uses your body's plasma because it has more concentrated platelets than blood.

Your blood is composed of red blood cells, white blood cells, plasma, and platelets. Plasma is the liquid portion of blood that transports cells and contains a protein that catches platelets where a wound or injury has happened so that clotting can occur. Platelets restore the blood supply to an injured area and construct new connective tissue. Healthy blood contains about 93% red blood cells, 6% platelets. In comparison, PRP contains about 94% platelets, 5% red blood cells. It's easy to see how injecting a concentrated PRP solution encourages the body's natural healing process. And since PRP comes from your blood, you'll likely have no problems with the treatment.

How is PRP Made?

We'll take a small amount of your blood, concentrate it down into a PRP injection. The process is done onsite and generally takes about 15 minutes to prepare.

How does PRP Help?
PRP therapy activates the healing process and by stimulating an anti-inflammatory response in your body.

If you've had a foot or ankle injury, and traditional methods have not provided relief, PRP therapy may be the answer. It's the perfect alternative to surgery to heal tissue and ligament issues naturally.

How long does it take to heal?
After PRP therapy, you'll want to limit applying weight to the affected area for at least about a week. Your podiatrist may want you to use a removable walking boot, depending on your situation. Most patients find that they can return to their usual daily activities right away, but strenuous activities might need to be limited or avoided for a few weeks.

If you experience any localized soreness or discomfort after the procedure, we suggest taking an over-the-counter pain aid such as Tylenol.

Once recovered, you'll likely no longer need medications or surgery.

Are there any side effects?

Because PRP is made from your own blood, side effects are highly unlikely.

If you are interested and would like to know more about PRP Therapy, contact us to schedule a consultation.

09/14/2021

What is a Neuroma?

Morton's neuroma is a common, benign growth found between the third and fourth toes. You'll most often hear it referred to as a "pinched nerve." The main symptom associated with this type of neuroma is pain at the area of the growth and the ball of your foot. In some cases, you might also experience burning, tingling, or numbness. Some liken the pain to standing on a pebble in your shoe or on a fold in your sock. Untreated, this constant compression will cause the nerve to enlarge and may eventually lead to permanent nerve damage.

These types of neuromas are commonly linked to wearing high-heeled or tight shoes. Switching to lower-heeled shoes with wider toe boxes may relieve pain and prevent permanent nerve damage.

Causes

The most common cause of a neuroma stems from wearing high-heeled shoes or shoes with narrow toe boxes. But anything causing constant compression or irritation to the nerve can lead to its development.

People with other foot disorders like bunions, hammertoes, or flat feet and athletes whose activities require them to irritate the ball of the foot are more likely to develop a neuroma.

Symptoms
Symptoms of a neuroma usually develop over time with intermittent occurrences of pain occurring when wearing certain footwear or engaging in specific activities. You might find temporary relief by removing tight shoes, massaging your foot or avoiding activities causing pain to the affected area. But, over time symptoms will worsen and may even persist for several days or weeks. And as the neuroma enlarges, symptoms will likely become more intense.

If you are experiencing any of the following symptoms, you may have a neuroma.
• Pain in the ball of your foot between the third and fourth toes.
• Tingling, burning, or numbness in the ball of the foot.
• Swelling between the third and fourth toes.
• Pain when placing weight on the ball of your foot.

Diagnosis and Treatment

If you are experiencing any of the symptoms listed above, it's best to reach out to your podiatrist for a diagnosis right away. Your doctor will complete a physical examination and try to reproduce your symptoms during the exam or request for x-rays and other tests to be administered. Early detection of a neuroma may prevent surgery.

Treatments are prescribed depending on the severity of the neuroma. If your neuroma is in its beginning stages, you might find a pair of thick-soled shoes with a wide toe box sufficient. But, for more serious conditions, you may need advanced treatment and possibly surgery. Your doctor will provide a thorough examination and suggest a treatment plan based on the results.

Common treatments include:

Padding: Specialized padding at the ball of the foot may alter any abnormal foot function and alleviate symptoms caused by the neuroma.

Medication: Prescribed anti-inflammatory drugs and cortisone injections can be administered to ease pain caused by the neuroma.

Orthotics: Customized shoe inserts prescribed and made by your podiatrist may help control foot function and reduce symptoms preventing the worsening of the condition.

Surgical Options: Podiatric outpatient surgery may become necessary when early treatments fail and the neuroma progresses past the threshold of non-invasive options. Surgical procedures are performed to remove the inflamed and enlarged nerve with a recovery time of just a few weeks.

Prevention

The exact causes of neuromas are unknown, but avoiding the following will certainly help prevent a neuroma from developing.

• Ensure exercise shoes have enough room in the toe box and that your toes have room.
• Wear shoes with enough padding, especially in the ball of the foot.
• Avoid wearing shoes with a narrow toe box or excessive heel height of greater than two inches.

If you think you may be experiencing a neuroma, contact our office to schedule an examination.

08/06/2021

Ingrown Toenails

What are ingrown toenails?

Ingrown toenails happen when the side of your toenail grows into the flesh. Your toe will typically appear red and swollen and be painful to the touch. It's a common condition that occurs when toenails are trimmed tapered instead of straight across. Although it looks nice, this type of trimming may encourage your toenail to grow into the soft flesh on the side of your toe. And like many other foot-related conditions, ingrown toenails can be the byproduct of improper footwear.

What causes an ingrown toenail?
Many things can encourage ingrown toenails, including some health issues like diabetes, but these are the most common causes.

• Heredity. Sometimes genetics plays a factor in having repeated ingrown toenails.
• Trauma. Such as stubbing your toe, toe injuries, or activities that put repeated pressure on the toes.
• Trimming Incorrectly. Cutting your toenails too short and tapered encourages the skin to grow over the nail.
• Wearing the wrong footwear. Wearing socks or shoes that are too small pushes the toenail into the skin and promoting an ingrown nail.
• Nail conditions. Untreated fungal infections or repeated toenail loss
• Nail Maintenance: Aggressive pedicures or nail picking can likely cause ingrown toenails.
• Sweaty feet: Feet with constant sweat can cause the nail to be soft and split, leading to an ingrown toenail.
• Foot or toe deformities: People with bunions, hammertoes, and flat feet.
Complications

An ingrown toenail can infect the bone underneath and lead to a severe bone infection when left untreated. This type of infection begins at the nail border and spreads into a deeper soft-tissue infection called cellulitis, ultimately leading to a bone infection. Some common complications are scarring of the skin surrounding the nail borders, thickened fungal toenails, and enlarged soft tissue at the nail fold that easily bleeds.

How do I care for an ingrown toenail?

These options may help you heal quickly if you have an ingrown toenail.

1. Castile foot soak: You can soak your foot up to 3 times a day for 20 minutes in a Castile soap warm water soak. For added relief, add Epsom salt to your soak.
2. Shoes: Wear comfortable shoes that give the toe enough room to move. You might consider wearing open-toed shoes while the toe heals.
3. Pain Relievers: Take an oral over-the-counter anti-inflammatory medication. It will help your swelling diminish while providing some pain relief.
4. Antibiotic: If your toe is swollen and painful, you may have an infection requiring an antibiotic. Schedule an exam with your doctor for a prescription.
5. Nail Removal: If your podiatrist thinks the problem is severe enough, they might suggest a partial toenail removal to alleviate the pain. Your podiatrist will perform this procedure on an outpatient basis by applying a local anesthetic. The result is a narrower toenail on the affected toe.

When to seek treatment?

Minor foot problems like ingrown toenails can cause severe complications in people with diabetes, a compromised immune system, or poor circulation.

If at-home remedies aren't providing relief within a week or so, or if there is persistent pain or signs of infection, you should schedule a podiatric medical examination.

See your doctor right away if you are experiencing any of the following:
• Swelling
• Redness
• Streaking (redness spreading from the toe to middle of the foot)
• Pain
• Drainage that may be yellow, green, or white and purulent (containing pus)

If you have questions or concerns about an ingrown toenail, contact our office to schedule an examination.

07/30/2021

Hammer Toes

What is hammer toe?

Hammer toe occurs when an abnormal bend in the middle joint of one of your toes forms. Although hammer toe can happen in any of your toes, they usually develop in the second, third, or fourth toe.

When hammer toes are first forming, they are generally flexible and easily corrected with exercises or stretches for the toe. But if left untreated, they will likely become fixed and require surgery.

Hammer toe usually develops over time and may be caused by arthritis or wearing shoes that are too tight in the toe box, like high heels. That's why there is a high percentage of women who develop this deformity. In most cases, a hammer toe is treatable when caught early.

What causes hammer toe?

Hammer toe results from continual pressure on your toe tendons and joints due to muscle imbalance.

Since your muscles work together to straighten and bend the toes, when the toe is bent in a single position for an extended time, the muscles and joints tighten and lose their ability to stretch. And when the top part of your toe is continually forced in a downward position, it becomes difficult to move your toe, even after taking your shoes off.

As mentioned above, the most common cause of hammer toe is wearing short, narrow shoes that are too tight. These types of shoes cause the toe to bend upward. When your toes are bent like this repeatedly for long periods, the muscles and tendons in your toe tighten and become shorter, making one or more of your toes stay in the bent position.

People born with long toes, children who wear shoes they have outgrown, and people who wear very narrow or high-heeled shoes are also more likely to develop a hammer toe. Sometimes, pressure from a bunion or rheumatoid arthritis also can increase your risk of developing this deformity.

What are the symptoms of hammer toe?

One of the most common symptoms of a hammer toe is a bent toe upward at the middle joint. Although you may be able to straighten out your toe at first, it will become painful and more challenging to do so over time.

Hammer toes are extremely painful, especially when moving the toe or wearing shoes. Unless caused by trauma, hammer toe symptoms start slowly. Initially, you'll notice your toe begin to bend downward. As your joint becomes stiffer, you'll find it difficult to move your toe without pain. It's also important to note that you may also find shoes no longer fit comfortably in the toe box and begin to develop calluses or blisters. However, if you've developed a hammer toe due to injury, your toe may instantly appear bent at the joint.

A hammer toe will cause discomfort or even acute pain when walking, moving, or stretching the affected toe. If you notice that your toe is bending downward, you may want to get checked by a podiatrist.

Here are some of the most common symptoms of hammer toe:
• Your toe is angling upward at the joint
• Corns formed at the top of the affected toe
• Toe pain when wearing footwear
• Bending, swelling, and redness of the affected toe
• Restricted motion of the toe
• Your toe is unable to lie flat
• Foot pain at the ball of the foot under the affected toe

Can hammer toe be treated?
Non-invasive treatment starts with new shoes that have soft, roomy toe boxes. You'll want to stop wearing tight, narrow, or high-heeled shoes. If you can, find a shoe with a deep toe box made for hammer toe. Or, have your local shoe repair shop stretch the toe box to provide room for the affected toe.

Your doctor may also prescribe toe exercises you can do at home to stretch and strengthen the muscles, like stretching your toes manually or using your toes to pick things up off the floor. You may also receive a recommendation to use over-the-counter remedies to ease symptoms.

If conventional measures are unhelpful, surgery is an option and is typically performed with outpatient treatment. For up to 4 to 6 weeks after surgery, you may experience stiffness, swelling, and redness in your toe. Even though you can put pressure on your foot immediately after surgery, you should limit your movement while the toe heals. And you'll want to be sure to elevate your foot as much as possible to help speed up the healing and reduce the pain. After you've healed, your toe may be somewhat longer or shorter than before surgery.

If you have questions about or think you may have hammer toe, don't hesitate to get in touch with us to schedule an evaluation.

07/20/2021

Do you have chronic foot pain? Maybe you have or are considering investing in insoles for some relief. Before you do, let's take a look at the pros and cons of picking something up in the grocery aisle vs. investing in custom-fit insoles.

Over-the-counter Insoles.

Every grocery store or pharmacy carries your ubiquitous insoles claiming to ease foot pain for anyone in need. The only problem is that you are unique, and so are your feet and the cause of your pain. Even the two feet we've lived with our whole lives are different. So the idea that a factory-made insole will successfully provide you with the long-term relief you need is unlikely. Because each of our bodies is different, it would be impossible to have a one-size-fits-all insole fit your feet perfectly. According to Rock CJay Positano, DPM, "Premade inserts may cost less, but they usually do not properly correct the specific problems found in a person's foot and may end up doing more harm than good."

Your feet are the foundation of your body. That's why many people with back, knee, or hip pain may be surprised to know much of that pain stems from their feet. And it's also why chiropractors often ask about your foot health and footwear when providing adjustments to these areas.

Custom Insoles

On the other hand, custom insoles are prescription medical devices created for daily wear to correct specific foot problems related to walking, standing, or running. Your podiatrist may mold your foot or take a 3-D scan to obtain a custom prescribed insole for your feet, ensuring you have the proper support your body needs. Prescribed insoles are proven to eliminate pain and prevent further damage by providing evenly distributed pressure over the bottom of your feet.

Insoles also control the alignment and function of your foot, prevent abnormal motion or foot rolling, and aid with foot pain caused by diabetes, plantar fasciitis, bursitis, or arthritis. When you have a custom fit insole, you'll experience less pain overall.

So now that we know the difference, what are the pros and cons:

Over the counter insoles

Pros:
Cost: You can usually find them for about $10-75.

Immediate Relief: If you're in pain, you can go and get some today without a prescription. But, since most of these are constructed of cheap materials and use cushions or memory foam, they tend to wear out in a few days, leaving you in pain again.

Cons:

Harmful: Over time, these insoles will increase foot discomfort and cost you more money when you do seek treatment.

Ineffective: Because these insoles are mass-produced, they will not provide the unique support your foot needs.

Decreased foot and ankle function: Over-the-counter inserts can make it more difficult for your foot and ankle to do their job. If you have the wrong fit, shoes that were once comfortable may suddenly be too tight. You also might find that although your feet are more comfortable, your ankles are stressed and painful.

Custom Insoles

Pros:

Proven effectiveness: Because these are customized, they fit your feet precisely and correct your specific areas of pain.

Prevent injuries and relieve pain: Your foot will be molded and scanned to ensure your insoles provide you with even support under your feet. And because they are correcting problems specific to your feet, you'll experience fewer calluses, corns and may prevent a future injury from occurring.

Provide foot correction: Custom insoles eliminate foot pain and correct some abnormalities like high arches or flat feet.

Hopefully, we've provided you with enough information about why having custom insoles is the best option. If you'd like to know more about scheduling a custom fitting, contact us, and we'll see if this is the right step for you.

04/10/2021

Painful Bunions? Dr. Johansen can help with a patented new treatment option.

Learn more at https://lyndonjohansendpm.com/lapiplasty/

04/02/2021

What is Plantar Fasciitis?

Plantar Fasciitis is one of the most common causes of pain in the heel. The ligament connecting your heel to the front of your foot is called the plantar facia. It absorbs the shock of walking or running and supports the arch of your foot. Over our lifetime, these ligaments may become susceptible to inflammation, causing heel pain and stiffness.

What are the symptoms?

Plantar fasciitis commonly causes stabbing pains at the bottom of the heel or middle of the foot. Both feet can experience this pain, although it’s typically just one.

Most people who suffer from plantar fasciitis experience pain with their first steps in the morning and find the pain diminishes once they get moving. However, the pain typically returns after long periods of standing or after long periods of sitting or lying down.

When a person is active, and on their feet for long periods, plantar fasciitis’s painful symptoms can flare up due to increased inflammation. Most people don’t experience the pain during increased activity but will feel the discomfort right after.

How is it caused?

Plantar Fasciitis is most common in women. Ordinarily active men and women between 40 and 70 develop plantar fasciitis for varying reasons, including:

Pregnancy: Pregnant women may experience plantar fasciitis later in their pregnancy.

Obesity: Generally due to increased pressure on the plantar fascia ligaments, especially if there is sudden weight gain.

Activity: Runners, or people standing on their feet for long periods at work, are more susceptible.

Foot Structure: People with high arches or flat feet can cause plantar fasciitis, or if you continually wear soft sole or low arch support shoes.

How is it treated?

Common home treatments like rest, ice, heat, anti-inflammatory medications are where we start treating plantar fasciitis. If this doesn’t ease the discomfort, your doctor may use cortisone injections, splints, braces, or physical therapy and custom orthotics.

Other modalities can help with these symptoms if they become chronic, such as platelet injections, radiofrequency therapy, and surgery. Surgery can be beneficial if other treatments fail.

Recent endoscopic plantar fascial releases have been very successful for those candidates opting for surgery with minimal foot invasion and quicker recovery.

Some other causes of heel pain may be a tarsal tunnel, bursitis, posterior heel pain, and stress fractures.

How long does it last?

Most people find Plantar Fasciitis improves after just a few months of using the home remedies described above.

When active, it does help to stabilize your foot with tape to limit the amount your foot can move. And taping may provide temporary relief of heel pain.

Surgery is typically not needed for most people suffering from plantar fasciitis. When mindful use of home therapies is adopted, conditions will improve. However, you may need to use these remedies for several months to years.

03/19/2021

How to Relieve Bunion Pain

What are bunions?
A bunion is a bony bump of the big toe joint on your foot – the metatarsophalangeal (MTP) joint. Bunions can be very painful and develop over time due to pressure on this joint changing its structure. The deformity tends to increase gradually, making it painful to wear shoes or walk.
Hallux valgus can be associated with a bunion which is the big toe turning toward the 2nd toe.
Who can get a bunion?
Anyone can get a bunion, but bunions are typically more problematic with women and older individuals than men or younger people.
How do I know if I have a bunion?
The most obvious signs of a bunion are a bump on the side of your big toe or your big toe turned inward, pressing against the others. You may also see redness and experience pain in your big toe joint area due to a growing bunion irritated by footwear.
It's also important to remember that bunions start small and grow slowly, so look for hardened skin or a callus on the side of the foot and tenderness or pain at the base of the foot's big toe and ball area.
What Causes Bunions?
Bunions are hereditary and can be seen in both men and women. Women seem to have more problems with bunions because women's shoes seem to be tighter and make bunions more symptomatic.
Bunions are usually related to certain foot types. Children can have bunions but this is rare.
Treating Bunions
There are a couple of ways to treat bunions depending upon how problematic they are for you. You can opt for a non-surgical remedy, or your doctor may recommend surgery.
Some non-surgical remedies include:
• Wearing shoes that are roomy in the toe box (choose shoes based on comfort instead of size)
• Over-the-counter, non-medicated bunion pads or cushions to create a barrier between your shoe and your foot.
• Icing your bunion to relieve soreness or swelling after being on your feet for long periods.
• Shoe inserts to distribute the pressure evenly throughout your shoe to prevent the bunion from worsening.
• Anti-inflammatory medications such as ibuprofen or naproxen can temporarily relieve pain and reduce swelling.
When Should I have surgery for my bunions?
If you have difficulty walking or the pain is unmanageable, your doctor may recommend surgery. There are several surgical procedures to correct bunions with same-day options that don't require a hospital stay.
There are many types of bunion surgery and depending on the deformity the doctor would discuss the best procedure for your bunion.
Lapiplasty® 3D Bunion Correction is a new, patented treatment for bunion correction. It's a new treatment option that does more than removing "the bump." It addresses your bunion in three dimensions to correct the problem at its root.
Lapiplasty® 3D Bunion Correction uses advanced fixation technology to secure the correction in place, allowing patients to walk within days of surgery. You'll be able to walk in a surgical boot in a few days instead of 6-8 weeks and get back to a better quality of life faster.

03/15/2017

Did you know that there are more than 200 muscles, ligaments, and tendons in the feet? That is why so many people suffer from foot problems! Click ove

11/17/2016

The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma.

09/29/2016

Experiencing weird foot symptoms or pain? You may want to consider calling up your doctor! Check out what your feet are telling you about your health.

03/08/2016