Heel Pain FAQ

Question: What is a podiatrist?

Dr. Weinert: What a podiatrist is it’s a physician, surgeon. Again, we specialize specifically in any patient suffering with foot or ankle ailments or disorders. We do both conservative and surgical intervention for anyone suffering with pain. We treat people ranging from pediatrics to the geriatric population. We do a lot of sport medicine, trauma injuries or just your normal patients that have painful bumps or burning, shooting pain in their feet, a lot of times from a nerve entrapment or neuropathy component. And we deal with any dermatological issues related to the foot or ankle, such as like fungal nails or warts or ingrown nails and that type of thing. So that’s pretty much what we do here as foot and ankle specialists.

Question: When your patients come in to see you and the diagnosis end up being heel pain, what are the most frequent symptoms that they’re describing to you and they’re telling you about when they come in to see you? What does heel pain feel like?

Dr. Weinert: Usually when they come in they’ll explain that I’ve got severe pain in the heel. It’s usually worse first step in the morning when I get out of bed like in the morning. They’ll say if they walk for a duration, it gets a little bit better. But if they sit down and get back up, that the pain will come back and it’s one of those intermittent come and go type pain. A lot of them will say it feels like a toothache in the heel area or even into the arch area. A lot of times it will get better with rest and then it will just come right back. So it’s one of those nuisance type things that just never goes away. That’s usually I would say a typical presentation for heel pain, and we do see a lot of here at my office.

Question: What causes heel pain?

Dr. Weinert: The main cause of heel pain is usually a biomechanical problem in the foot and it’s in a nutshell having a foot out of alignment. There are numerous conditions. One of the most prevalent is called talotarsal dislocation syndrome. What that is in lay terms is you’ve just got a malalignment of your ankle on your heel and as you bear weight you’re getting a collapse of the ankle on the heel causing the foot to be out of alignment.

So all the bones, the joints, ligaments and a major ligament on the bottom of the foot, which we call plantar fascia, is getting pulled and constantly getting tugged and pulled onto the heel area where the insertion point is usually right there; usually the most prevalent on the medial or the inside of the heel.

As the patient bears weight, they get the collapse of the foot and that ligament pulls. And if you think of a rubber band constantly getting pulled on that area of the insertion on the heel, you eventually start getting some micro tears in that ligament and causing inflammation and pain specifically right there in that area.

The biomechanics is really a big culprit in what causes that. That is a very, very common symptom that I see. But, again, that is caused from instability or malalignment of the foot.

Question: How common is heel pain? Do many people suffer from heel pain?

Dr. Weinert: So many people suffer from heel pain. I would say it’s definitely the top problem that I see here in my office. I would have to say I know statistics they say usually one out of four people will suffer. I would have to say even high than that. I would go two out of four or something. It’s very common. And, again, it’s one of those problems that people just don’t get looked at because it goes away, but then it will come back. So it’s one of those issues that we see a lot of.

Question: Who gets heel pain? Is it children, older people, athletes?

Dr. Weinert: Well, actually I would say all of them. You get children all the way up into the elderly population will get it. Usually, in children it’s more it’s something that we call Sever’s Disease. And what that is that on the back of their heel they’ll have a growth plate that gets inflamed and, again, you’ve got a tendon called the Achilles tendon that inserts down there into the back of the heel. And, again, you can get a pulling action, but it’s actually the growth plate that gets inflamed and causes pain, not on the bottom of the heel, but more in the back of the heel.

And then as far as with more plantar fasciitis heel spurs, again, I see that in women, males, females, athletes. It’s very, very common in runners, dancers, very, very common. So I guess it’s a wide scope of patients, again, with heel pain that I see.

Question: How do you treat heel pain? When someone comes in what are the ways that you’re able to treat it? What are some of the methods that you use? How do you treat heel pain?

Dr. Weinert: Well, again, with any patient that comes in you want to do a full examination on them. We even do a gait analysis to see the way they’re walking and the biomechanics, which is a big part of this problem. We also have a fluoroscopy unit that we utilize. What that is it’s imaging of the foot, but it shows the foot in a dynamic way, which means we can see the foot. As you put weight down, we can see it live as far as the way the bones shift and any pathology in the foot and show the movement in there.

However, with our normal x-rays those are usually more of a static image, which is sort of like a picture view of it. So the nice things with our fluoroscopy or mini C-ARM unit that we have, we could have them put a full weight bearing and sort of see how the malalignment in the foot shows. And it’s nice the patient can see it up on our computer screen so they can see it with their own eyes and it makes a lot of sense of how a lot of these issues are occurring.

So the imaging is important, the examination. And a lot of times with these I only do one injection. I’m not one that always likes to inject and mask a problem that the patient’s having. But we a lot of times do that to get them some relief. But the ultimate main reason and main culprit for these patients suffering with heel pain is a condition we call talotarsal dislocation syndrome or what it is, is you’re getting a malalignment of your heel on your ankle. And as you bear weight, your ankle bone’s collapsing and actually we call like a partial dislocating on the heel causing malalignment or just out of displacement of the bones, ligaments and joints out of their normal position.

So it throws off not only the bones and ligaments of the foot, but the area where the plantar fascia inserts on the heel that is getting disrupted and constantly pulled as well.

And so, the ultimate solution is to correct what really causes the heel pain and that’s really what you’ve got to get to is sort of to the underlying cause of it. And good custom orthotics: we do digital custom orthotics here in our office, which are a hundred percent accurate. The devices, they’re called custom orthotics that goes into your shoes. And what they do is they put that foot, both right and left foot, in a proper neutral position, which your feet should normally be in.

And the nice thing with the company that we use, they’re based out of San Diego called Pedalign. They utilize NASA and MIT technology to produce three dimensional imaging of the feet, which from those digital imaging they’re able to produce a hundred percent accurate custom digital orthotics. And they also produce a lifetime warranty on them, which is nice. They’re one of the companies that do that and I’ve been having excellent success with that. And dealing with your regular patient, but a lot of college and professional athletes these are what they use, these digital custom orthotics. They usually do very well without having to need any type of surgical intervention or any surgery.

Question: What should one expect from heel surgery for pain?

Dr. Weinert: The nice thing is nowadays the way advancement and technology, if a patient does need to have surgery for the heel, it is very minimal incision that’s done. And the nice thing is the recovery period patients are usually able to bear weight right after the surgery and able to get back into the normal swing of things usually within a few weeks. So recovery is a lot different than it used to be and a lot of it is because of doing minimal incision and decreasing trauma to soft tissues, as well as even the bone. So if surgery is needed, then again recovery is pretty quick for these patients.

Question: How could those folks who don’t currently have heel pain is there any way to do our level best to try to avoid it. Is there anything we can do to avoid it?

Dr. Weinert: The things that I would do to avoid it is to wear real good, supportive shoes. Usually, New Balance is a good shoe to wear, just for everyday shoe gear. Shoes are important and also I recommend any athletes to make sure to do stretching before and even after any of their activities. Then if a patient is starting to get a little discomfort or pain in the feet or the heel, pain is not normal. And so, if you are having pain, you’ve got to be proactive and just make sure that you go. And I would just go straight to a foot and ankle specialist in your area, a podiatrist, and have them at least evaluate you to at least give you a piece of mind. But a lot of times if you are starting to get pain, you just don’t want to let it go because then that’s where you start running into other issues. So, again, being also proactive is important as well.

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Foot & Ankle Health FAQ

Question: What is a podiatrist?

Dr. Weinert: What a podiatrist is, it’s a specialist who specializes in the care and treatment of any foot or ankle problems that a patient should have. We pretty much do anything from pediatrics to sports medicine to trauma to even some of the dermatological ailments, such as warts, ingrown nails and stuff that people are suffering with pain. And that’s pretty much what we do. We do conservative, as well as surgical treatment for pretty much any foot or ankle problems that they’re experiencing.

Question: Do podiatrists have as much schooling and knowledge as a primary care doctor? What kind of schooling and training do they have?

Dr. Weinert: Yes. We have to go through first a four year under graduate program, which I did over at the University of Michigan in Ann Arbor Michigan. Then from there we go onto to medical school, which for us is specialized specifically in podiatric medicine. But our first two years we take classes with actual MD and DO students and the curriculum is the same.

However, our last two years of medical school is specialized specifically pretty much in foot and ankle. We even have an extra gross anatomy class that’s specialized where we just focus on the lower extremity. And our rotations specialize in foot and ankle as well.

Then we go on and do a residency program, usually one up to three years. Most people nowadays are going a three year residency, which I highly recommend for the physicians and surgeons. That’s what I did. I did a three year surgical residency in foot and ankle. You’re looking at least four years undergrad, four years med school and then usually three years of a residency program.

Question: What are really the most frequent symptoms or problems that you’re seeing in your office when your patients come in to see you?

Dr. Weinert: I see a lot of people suffering with heel pain. Usually, they’ll come in complaining of pain first step in the morning getting out of bed and then also if they’re at work and they’re sitting down and they get up, they’ll have pain in that heel or bottom area of the arch. Also, a lot of people complaining of bunion pain, which is a little bump on the inside of their foot, especially with shoe pressure. We also see a pretty good amount of patients that have neuropathy or issues where they get burning and shooting pain, in not only the foot, but also extending approximately up the ankle and into the leg as well.

Then the nice thing about being a foot specialist is really the foot is the foundation to the whole musculoskeletal system. So in retrospect what that means is a lot of people we’ve been finding have a condition called talotarsal dislocation in the foot, which is under diagnosed. And if you look at it, because of that malalignment of the foot it’s causing a lot of issues with knee, hip, lower back and even up into the shoulders. So the foot is really the foundation to a lot of other issues that patients are experiencing.

And so, proper foot health and wellness I feel is really important and that’s the reason why I looked into being a foot specialist just to help people that not only are having foot problems, but also problems in the rest of their body.

Question: It’s said that one out of four Americans will experience heel pain at some point in their life. Are those numbers correct and, if so, why is this happening to all of us?

Dr. Weinert: I would have to say it’s probably more than that, at least from what I see. I know you say one out of four, but I would have to say that’s probably more than that statistic. But I think a lot of is just, again, caused from conditions within the foot where you get, like I was explaining earlier, there’s different problems. There could be a hyper pronation where you get a collapse of the foot or even a high arch foot we call cavus foot. But the underlying cause is something internal within the bone construct. And it’s something they had pretty much all their life. It’s a hereditary issue where they get an under development of a particular bone, usually in the ankle and it sort of causes a dislocation or a malalignment of the ankle on the heel and it throws off, not only the foot with the bones, joints and ligaments of the foot, but again causing instability of the ankle and usually internal rotation in the knee, hip, back and causing issues with those as well. So a pretty common, but very under diagnosed condition, and that’s why I feel a lot of people should at least get evaluated for this particular condition, which causes a lot of problems.

Question: Why does heel pain feel worse in the morning and get better throughout the day?

Dr. Weinert: So a good analogy I look to tell my patients is that if you think of a rubber band, you have a ligament on the bottom of the foot that’s sort of starts at the heel area and then it goes all the way up into the forefoot area. And what happens is if you think of a tight rubber band, as you put weight down and that stretches, you get a constant stretch and a pull on that ligament, which we call plantar fascia. And what happens is because as you bear weight and you get this extra malalignment in the foot, you get that extra pull on that ligament and it causes little micro tears in that plantar fascia band and from that is usually where the insertion point on the heel is. That’s usually where people will experience that pain, again from the inflammation in that area and even from some of the micro tears from that ligament on the heel.

So the constant pulling, eventually, with time will cause these symptoms and is’ very, very common. But, usually, I see it later on. Usually, like middle aged patients is where at least I see a good amount coming in with it. It’s something that eventually will take time, but it will also be one of those where it will come and go where a patient says they had this excruciating pain, sort of like a toothache type feeling, in the heel. Then it got better and so they never sought treatment. Then, eventually, it will come back. It’s one of those things that just is just continuously coming back. But if it’s addressed early on, then a lot of these can be alleviated even in a nonsurgical way.

Question: It’s been said that in most cases over 95% you can actually alleviate or cure heel pain without ever having to resort to anything surgical. Is that number correct?

Dr. Weinert: Absolutely, yeah. A very low percentage of people really need to have surgery on the heel pain or fasciitis heel spurs that hear about. Again, it’s a biomechanical problem and in the majority of the patients it’s very imperative that they not only get evaluated, but the majority of them just need something as simple as what we call a custom orthotic which I try to explain to my patients it’s similar to people that have problems with their eyes and they need glasses to correct the eyes, and correct those. These are the same for the feet where they’re sort of like glasses for the feet. And what these custom orthotics do is they correct and realign the foot to put them into neutral or normal position to really prevent a lot these patients suffering with heel pain or fasciitis or pretty much any slew of foot issues, whether it be bunions or hammertoesneuromas, or even ankle instability. But the custom orthotic is something that I highly recommend that they see a foot specialist for evaluation and for proper fittings.

Question: Are orthotics and insoles different? We’ve heard that orthotics are actually designed to correct their instability. That’s very different than the arch supports that you can get that are even called orthotics at the grocery store or for someone that’s not trained to do this. Isn’t that true?

Dr. Weinert: It is. And it’s a little disappointing being a foot specialist where I think they market; especially one that comes to mind is Dr. Scholl’s. If you go to some of these Myers and these stores they have these little, they call them custom inserts. But, again, a custom insert is just something that is on the shelf. It’s no different than an over the counter prefab. It’s not custom to the individual patient, because one foot is different than the other and each individual has different foot structures that need to be properly aligned. So these are not really a custom orthotic. They name them a custom insert, but they’re not the same and it’s a use of words that they do. And I feel really sort of that it gives these patients a false hope thinking that’s what’s going to help them. And they’re pretty pricey as well for just something that’s really actually no different than just an insert.

Question: What is the connection between peoples’ feet and their ankles and diabetes? And why is it important to be taken so seriously?

Dr. Weinert: Diabetes is it’s, again, a very high amount of patients have it, even an adult onset as well. It’s very important if you are diabetic, to at least have your feet looked at because usually diabetics run into issues with poor, inadequate circulation.

They also run into issues with what we call peripheral neuropathy or neuropathy, which is usually a pathology from high sugar that can affect the nerve and make the patient with diabetes not able to feel something that a normal patient that has no neuropathy can feel. Like if they have something in their shoe or they have an open sore, a lot of these diabetics don’t know they have it.

Then they can run into high risks of ulcerations, which are open sores in the foot and that, again, can lead to infection in the bone, which we call osteomyelitis. And that’s where you hear the horror stories about amputations or gangrene and all that in these diabetics. But they’re diabetics that really never got checked or evaluated, especially with their circulation compromised and neuropathy or not able to feel sensations in the feet.

So, if they get evaluated, those could be checked. And it’s also imperative to use a synergistic and team approach with diabetics with their endocrinologist or primary doctor, as well as podiatrist.

Question: Should someone see their primary care doctor before a podiatrist when they have a foot injury or problem?

Dr. Weinert: My thoughts are I get a lot of referrals from other primary care doctors. And they’re more specialized more in the other health issues. They didn’t go to school or have extra training for foot and ankle issues. A lot of them don’t even know how to treat any foot or ankle problems. I do see a lot of primary care doctors that send them over to me. And with patients they probably don’t know. So, realistically, we are foot and ankle specialists. So if they are suffering with any foot or ankle problems, I would highly recommend that they locate a podiatrist in the area. And also I always recommend for patients to check their credentialing, whether it be online. I recommend a board certified podiatrist as well if they are going to be seen.

Question: What would be an example or two of some of the things that you are doing in your office that set you apart from other podiatrists?

Dr. Weinert: Podiatry has advancements pretty much on a weekly basis. I keep up on all the new state of the art of advanced technology just not only for myself, but most importantly for the patients’ sake.

A couple of things that come to mind that I have or implement are I have in my office what’s called a fluoroscopy unit, which what that allows is for me to be able to see the patient’s radiographs in a dynamic way, which what that means is as they put weight down, I can see where the bones and joints and everything what occurs with them as they put pressure down. And it’s nice. The patients could see those up on the computer screen and see sort of where pathology is and how it is. I think it’s important to educate the patients on it, because back I used to, and a lot of podiatrists currently do it, is we have what are just regular x-rays, which just shows a static image or sort of a picture of the foot. But the fluoroscan actually shows the foot in motion, which is really important. And they can sort of see with their own eyes sort of what’s going on in the foot construct, especially with that talotarsal dislocation that I talked about earlier. You could see if vividly in these imaging.

Then the other thing too, again, I guess you could call it more state-of-the-art. There is a stint that we place in between the ankle and foot for this condition that puts the foot back into alignment. So it’s sort of like an invisible custom orthotic in the foot and it’s a permanent correction for them. It’s a probably about a 15, 20 minute minimal incision procedure, a lot of times just with a local anesthetic. And patients have been doing very well. I myself have been not only doing this procedure for patients here in the US, but have been seeing a lot of patients. I’ve seen some in Ottawa and Toronto and parts of Canada as well.

So there are always new advancements. There are now some minimal incision bunion procedures now so the patients can recover and get back to work and normal activity. There are heel procedures now, if they do need it, that are nonsurgical that can be done as well. It’s a lot of advancements.

Question: What could I do just in my daily life, what could your patients do to take better care of our feet and not need to come see so much because we’re just avoiding some of these problems. What advice do you have for us?

Dr. Weinert: Some advice I would recommend is just try to, again, be proactive. I recommend that if they are having pain, to be seen by a foot and ankle specialist or podiatrist right away, because if you just let it go, then it’s going to just make things worse for them. Always inspect your feet, especially those diabetics. I always recommend even getting one of those little mirrors at like a dollar store and just at least once a week always check the bottoms of the feet, because a lot of people can’t see the bottoms. And just look for any type of open sores or anything out of the norm. If they are having pains not normal in the foot, I would highly recommend, again, you seek treatment and be proactive. And if you’re proactive, then you really don’t have to worry about any thing getting too advanced or to a point where you’ll need a surgical intervention.

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Neuropathy FAQ

New Hope for Neuropathy

Foot and ankle neuropathy has been a very confusing and debilitating disease. Once diagnosed little hope is given. Patients are told that nothing can be done about the cause, because they really do not know why they even have developed the neuropathy in the first place. The pain and symptoms will only get worse until there is complete numbness. The pain will usually only get worse and you are doomed to many sleepless nights. It will usually take years for the pain to subside and for complete foot/ankle numbness to ensue. Once complete numbness is present there is severe risk for puncture wounds, ulcers, and infections.

Symptoms of Foot and Ankle Neuropathy

Initially, there is a numbing feeling into the middle toes/balls of the foot after prolonged walking/standing. With time there is a numb feeling to the feet during the end of the day. Eventually, there is pain/burning of the feet at night. Then the pain may wake you after going to sleep but then subsides after getting up and walking for a while. There may be cold toes to touch while there is an overall burning feeling to the foot. Just like there is an overall numb feeling (like the foot has been anesthetized) but there is feeling to touch the foot. Other times there can be very severe hypersensitivity to the feet. Due to the numbness in the feet and toes there is a loss of balance and coordination. There are many different symptoms but the overall process is the same.

Diagnosis of Peripheral Neuropathy

There have been reports that as high as 20 million Americans have been diagnosed with some form of peripheral neuropathy. The evaluation of peripheral neuropathy has often been very time consuming, painful, and costly. After all of the various tests treatment is often very limited. A careful history about the symptoms, distributaries and course of the nerves is the starting point. A detailed neurological evaluation is taken. A variety of tests are also available including: electromyography, nerve conduction studies, pressure specified sensory testing, vibration thresholds, radiographs, bone scans, as well as a battery of blood tests. Even after peripheral neuropathy little was done but to give various medications and order tests to see the progression of the nerve damage.

What happens to the nerve in Peripheral Neuropathy

Despite all the diverse medical disorders that have been linked to the cause of the peripheral neuropathies the peripheral nerves have only a few distinct pathologic findings. No one has been able to fully figure out the specific mechanisms by which the various disorders affecting the peripheral nerves induce these pathologic changes. There are three findings consistently. First is partial to complete interruption of the inner core of the nerve fiber (axon). This usually results from nerve trauma or nerve infarction. Second, is what is referred to as “dying-back” phenomenon. The axon degenerates at the end of the nerve fibers. This is attributed to the metabolic disorders. It usually occurs symmetrical (both feet and toes) and starts at the tips and comes closer to the body. Thirdly, the outer band of tissue covering the nerve which conducts the nerve impulses are destroyed. Immune and inflammatory mechanism are blames for this disease of the nerve.

Treatment of Peripheral Neuropathy

The treatment of peripheral neuropathy has been an up-hill battle and focused primarily on external application of creams/ointments, acupuncture, light therapy, massage, etc. There are also several medications that have been prescribed to treat/alleviate the symptoms. Initially, these may prove to be helpful, but since they are only working on the symptoms of the disease and not the disease itself, the symptoms will continue to get worse. Finally, these types of treatments are of no use.

New Hope for Neuropathy

Further investigation into the cause of peripheral neuropathy has revealed that in a rather large population of patients with this form of neuropathy there is actually a compression of specific nerves of the foot. Initially, it was discovered with carpal tunnel syndrome a condition of the wrist where there was constriction of the nerve in the canal of the wrist entering into the hand, with various activities there is compression of the nerve which leads to the loss of feeling in the hand. Surgeons would decompress the nerve and sensation and strength were restored. Finally, attention was directed to the foot which has a similar tunnel (tarsal tunnel) and when that nerve was compressed there was nerve damage that occurred in the foot/toes. A simple comparison is standing on a garden hose, the flow of water is decreased. Likewise with compression of the nerve, the feeling is decreased. Once the pressure is taken off of the hose there is a rush of water, so to the nerve that the sensation chemicals have been building up and once the pressure is taken off the foot there is increased pain.

The tarsal tunnel, located behind the inner ankle bone, contains the posterior tibial nerve. This nerve then divides into three branches, two of which enter into the bottom of the foot through two canals. The other nerve supplies sensation to the back of the heel. It has been found that in the majority of patients with foot/ankle neuropathy they have constricted canals and thickening of a ligament which compresses the nerves. Common sense tells us that if the condition is caused by a physical constriction of the nerves, no matter what is done topically, or internally with medications the constriction is still present.

Surgical Decompression of the Entrapped/Compressed Nerves

Dr. Anthony Weinert is one of only a handful of surgeons trained in surgical decompression associated with peripheral neuropathy of the foot. Under loop-magnification, he will decompress the entrapped nerves of the foot. The surgery, which is performed as an out-patient surgery under twilight sedation, typically takes 45 minutes to perform. Only one foot at a time is worked on. Dr. Anthony Weinert has been performing this surgery for years in metro Detroit and is the only of the only podiatrists in the area trained to perform this technique.

The Results

Previous studies have been performed which have shown a success rate of 80%. The results can be instant relief to months before any changes are noticed. There are many factors which affect the outcome of the surgery. No guarantees are given on the success of the surgery.

The Risks

As with any surgery and although rare, there are potential risks of surgery including but not limited to: blood loss, infection, delayed wound healing, scarring, increased nerve symptoms due to regeneration of the nerves, increased numbness, need for further surgery, failure of the surgery to achieve its desired goal, and death.

The Benefits

Imagine no more pain or numbness. There may be a new lease on life, instead of being house bound you can go for walk without suffering. You can increase your metabolism to decrease your weight, lower your blood sugar and blood pressure. Once sensation is restored to your feet, you’ll have no more worries about ulceration and the other complications of numb feet.

Who is a candidate for this type of surgery?

The ideal candidate for surgery is someone who is beginning to experience numbness and tingling in the feet. If the sensory loss progresses to the point where you have numbness and tingling throughout the day and weakness or clumsiness interferes with your daily activities, then you may be a candidate for surgical decompression of the nerve. The ideal candidate does not wait until there is no feeling left or until there is already an ulceration present. The ideal candidate seeks surgical consultation while there is still time to reverse the damage to the nerves.

Adjunctive Procedures

Many of the patients seen with this condition also exhibit excessive motion in their feet (hyperpronation). This is determined by clinical examination, radiographs, and gait analysis. Typically, there is partial to full obliteration of the sinus tarsi (a space between the ankle bone and heel bone).

Obliteration of this space makes the ankle bone (talus) turn inward which in the majority of cases lowers the arch, the same turning in can also be seen with a high arched foot. There is overstretching of the posterior tibial nerve and constriction of the nerve to the bottom of the feet.

The average person takes between 10,000 to 15,000 steps per day. This excessive motion is another factor which overstretches the posterior tibial nerve and constricts the medial and lateral nerves as they branch off of the posterior tibial nerve leading to further nerve trauma. This hyperpronation explains why there is increased pain in the feet with increased activity. The more walking leads to more trauma to the nerve, leading to numbness. Since the nerve is traumatized during the day it goes numb. Just like falling asleep on you arm and it goes numb it takes a while for it to “wake up” after the pressure has been released. Likewise, it takes a while for the nerves in the feet to wake up after they have been “put to sleep”. That is why the pain is worse at night once one has limited their walking. Usually, as the disease process progresses, the patient will usually get up and walk around for a while, due to the severe pain, and the pain will subside. The nerve is being put back to sleep.

Dr. Anthony Weinert treats this condition, hyperpronation, by inserting a stent into that space. There is the normal motion of that joint complex but the sinus will no longer be obliterated. Many physicians treat the obliteration of that space with an arch support (orthotic), but an orthotic cannot prevent that space from being obliterated.


There is indeed new hope for neuropathy. The surgical procedures presented here can eliminate the pain and restore sensation to numb feet. Although success cannot be guaranteed, hope is given. If you feel that you could benefit from this surgery please contact Dr. Weinert’s office. Dr. Weinert has had patients come from all over the United States to have these surgeries performed. We look forward to hearing from you.

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