Category Archives: Foot Injury

Your Elf on the Shelf is watching…YOUR FEET!!!

Last Friday night,  I was working late in the office when the most interesting patient stopped by.  When I asked his name, he told me it was whatever I wanted it to be.  He signed the consent form and agreed to HIPPAA and we were on our way.

The elf had peculiar looking feet.  As I started my exam, he stopped me and said he had alarming news to share.  “Every night that I go back to Santa and report on my children, I always forget to tell him about the children’s feet.”  I told him to not put so much pressure on elf self and that he was doing a great job.  “But I don’t know what advice to give the children about their feet!” the elf said.

Holy Cow Elf

Holy Cow Elf

“No problem,” I replied, “It’s really quite simple.”  And I listed what every child should do when it comes to their feet:

  1. Always keep your feet clean.
  2. Always check your feet for funny looking things.
  3. Never wear shoes that are too small.
  4. Never pick at your toes.
  5. Always tell your parents if something hurts.
  6. Always take good care of your feet because they’re gonna be around for the rest of their lives.

“That’s easy!” said the elf, “I can’t wait to share this with my families and especially Santa himself!” And with the blink of an eye, the elf was gone….

Heel Pain is SO HOT RIGHT NOW!

One of the most common problems that come into my office is heel pain/plantar fasciitis. Plantar fasciitis is the result of faulty mechanics in the foot and ankle and results from repetitive trauma/overuse.

A lot of my patients pause when I tell them “trauma” and say, “I don’t remember any trauma!”

You probably don’t remember any trauma because WE TAKE WALKING FOR GRANTED.  (Caps lock means I’m yelling)

It’s dangerous out there in our “concrete jungle” that Jay-Z raps about. Every step that you take can lead to stress on the plantar fascia and can lead to the development of the pain you feel on the heel. Now, our population is becoming more active (Couch to whatever K, Cross-fit, Zumba, Yoga,  etc) and something like heel pain can cause a big problem.

But plantar fasciitis is different. It is a combination of pain consisting of the small tears in the ligament, the swelling that accompanies it and also nerve entrapment due to the swelling all causing you pain.

I always say to my patients, “This is why this hurts like nothing else.”

So what’s the solution? I believe in the body’ s ability to heal itself.  Rest can help, but we are walking creatures.  So we need to correct the mechanics (the way you are walking) and eliminate the causative factors.  This may involve support with an orthotic device, stretching, physical therapy and controlling the inflammation.  Nothing better than a good stretch! (See Below)


I wish I had a cookbook way of fixing this problem, but every patient is different…and special, of course. I start with my evaluation, getting a clear history and performing an x-ray to rule out any underlying problems.

With a multiple treatment approach, I have seen great outcomes.

If you are suffering from heel pain, there is nothing better than making an appointment and starting you on your way to a healthy life.

Let’s get you better. Dr. P



Fantasy Football Owners Beware!!! The Dreaded High Ankle Sprain Will Wreck Your Season!!

As I retired from competitive sports, I have settled into my second sports life as a fantasy owner.  I’m horrible at it. I’m poor at drafting and I don’t make good weekly decisions with a common occurrence of having my top performer on the bench.  I’ve noticed one injury though that can wreck a season: THE HIGH ANKLE SPRAIN.

In professional sports we often see ankle sprains occur in play and the athlete bounces back quickly.  Sometime, they return to the field during the same game.   With the high ankle sprain, though, you may find your top player on the bench for weeks.  With a short fantasy season (14 weeks on average), this could be the difference between playoffs and Dr. Pagano status (basement).

What are the differences between a high ankle sprain and a normal ankle sprain? 

In a typical ankle sprain, the ligaments that support the ankle can suffer tearing and even rupture, leaving the ankle joint unstable.  This can happen from trauma or simply taking a bad step.  There are 3 grades of ankle sprains,  Grade I being the mildest (strain on the ligaments) and grade III being the worst (rupture of the ligaments).  The injury can be very painful. Recovery involves PRICE (protection, ice, compression and elevation).  After a period of recovery, therapy is utilized to retrain the ankle and supports may need to be worn.  If conservative care fails, surgical intervention may be required to repair. 

The high ankle ligaments are above joint itself.   These ligaments hold the tibia and fibula together. When walking and running, the stability is necessary for function.  If there is weakness or damage here, every step spreads the tibia and fibula and can be excruciatingly painful.  While not as common as the ankle sprains, the damage requires a longer recovery time with possibility of surgical intervention as well. Regular recovery from a high ankle sprain can be as long as 6 months to a year.

So as I scream about the Darren McFadden’s of last year, hoping that he will start this week, I’ve learned my lesson.  Roddy White’s injury has me searching the waiver wire each week for a replacement. Ugh, it’s gonna be another long year, full of fantasy mistakes.

So should I move in on Randall Cobb and Colin Kaepernick for Drew Brees, my receivers are a joke and I’m in last place?





“Two men enter, one man leaves!” was the chant that I remember when watching Mad Max back when Mel Gibson was a good actor and only thought to be interesting instead of completely crazy.

The summer and vacation seasons bring on alot of foot injuries and pain to many patients. Immediately flip flops come to mind. But is it the flip flops themselves, or is it something else.

1. Too much too soon: The Disney World Injuries.

Many patients come home from a log relaxing vacation and don’t understand why their heels hurt or their toenails are black and blue.  We ALL work hard, but most of our jobs require us to do a fair amount of sitting and grueling it out behind a computer desk. Then we go to Disney World and chase the kids around for a minimum of 22 hours a day.  Proper training is required for any activity, this includes walking.  We often don’t look at walking as exercising, but it is; and an increase in your level of activity. You keep up this pace for a 5-7 day trip, you should expect to have some discomfort.  Believe it or not, when you are gonna go on a long trip that requires a lot of walking; you need to get in shape for it. Light walking leading up to the big trip will make your vacation more enjoyable and foot pain free

2. But Doctor, I look cute in Flip Flops!

Most podiatrists will tell you the negatives of flip flops, and I’m not going to be different.  There are certain flip flops that offer you absolutely no support at all. Unfortunately, there are some feet that need to have support. That is my only problem. Certain people require certain things. If you have the perfect foot type that doesn’t require support, god bless you and your flip flop feet! If you start with your flip flops and don’t break them in: expect injuries. If you require the extra support in your shoes, look into a company called ORTHAHEEL. They offer orthotic like support without sacrificing style. (At least thats what my wife says.)

3. The Vacation Superhero

It’s always fun to go vacation and try something new. While we may work all day and come home and go to sleep when at home, the schedule of a vacation day can be alot different. 6 am yoga class followed by a 10 am tennis lesson (that you haven’t played in ten years) and then follow it up with water skiing for 2 hours. It will be one of the best days of your life, keep in mind, but you should expect to pay some taxes in the currency of foot and joint pain for the remainder of your trip.

What can you do? Prepare.  Strengthen your feet prior to your trip. Simple exercises like marble pickups and light stretching to the foot and ankle can accomplish these things. If you expect to be a vacation superstar, be prepared to come home and still be the same wonderful 9-5 pm superhero that you always were.  There’s nothing wrong with that, but a little prevention can save you alot discomfort post pina colada.

4. Skin protection.

How many times has your friend pointed out their savage tan after a vacation, and watched them limp away due to sunburn on the feet. When your lathering up prior to your trip to the beach (SPF 50 for me, thanks to Mom’s irish skin tone thatI’ve inherited), many times we forget to protect the skin on the top (dorsum) of our feet. This can be EXTREMELY dangerous. Melanoma does not discriminate. I have had an increase in melanoma in my office and this is very preventable. So don’t forget to cover them dogs up before you go out in the sun!

The summer is fun, vacationing is fun, it’s what we all work our tails off to do. Sit back and take a break for a few cherished days. Take the time and use your head this summer and protect, prepare and enjoy your feet. They’re willing to carry you, you need to be willing to pamper.

Let me ask you a question: How many of my readers have ever had sunburn on their feet?

Have a great summer, and will be talking to you soon….the Philadelphia Distance Run is coming up, let’s get training!