Common Foot Injuries

Your feet take a lot of impact as they carry you from place to place. Foot injuries can really set you back.

Dr. Richard Manolian, board-certified podiatrist, discusses common foot injuries and when to see the doctor.
Common Foot Injuries
Richard Manolian, DPM
Dr. Richard Manolian is a board-certified podiatrist and loves opportunities to further promote the services at our healthcare system.

Learn more about Richard Manolian, DPM 

Bill Klaproth (Host): Your feet are amazing and an integral part of your everyday life. But the stress we put on our feet creates a lot of wear and tear and over time, can lead to injury. Here to talk with us about common foot injuries is Dr. Richard Manolian, board-certified in podiatric medicine and a foot and ankle surgeon with Harrington HealthCare. Dr. Manolian, thank you for your time. What are the most common food injuries you treat?

Richard Manolian, MD (Guest): Oh, they would be maybe sports-related injuries with an increase in activity in the population seeing plantar fasciitis which is commonly referred to as heel pain, we would see a number of tendonitis type conditions in the foot and ankle sprains and that would also include on the list stress fractures. These are common to the everyday practice, common to the surgical practice that we maintain.

Bill: For a runner or somebody that is on their feet all day and feels this heel pain or pain in their foot; when is it time to see the doctor?

Dr. Manolian: Well, most commonly, you will have a patient come in after they have done some basic at home at times to reduce inflammation or pain. This will include utilizing ice, maybe a Motrin-type product. They have adjusted their shoes, trying to get something more comfortable. They might have purchased an over-the-counter insole; then that’s the typical patient that are lined up in our chair. And that’s usually what I’ll tell people post-treatment that if you can’t manage once we have gotten you on a better road; trying those things at home, if it doesn’t work and or increasing in symptoms and pain; then that’s when you need to come in and let us reexamine or examine.

Bill: And in that examination, how do you generally diagnose foot injuries?

Dr. Manolian: Initially, for a lot of the injuries that we will see, we would perform an x-ray in the office. With plantar fasciitis; which is probably the most common of all these common injuries; you would do an x-ray. You are wanting to – with the high-definition x-ray that is available now you can see thickening in the plantar fascia or tendon structure that attaches to the heel and you can also locate the formation of a bone spur which is often times indicative of an inflammatory process occurring in that area. From there, physical exam would include pinpoint pain and symptoms at the junction of the plantar fascia and the heel structure or bone spur itself and from there, history would kind of finalize the scenario. These patients typically have pain upon first steps in the morning and symptoms that are exacerbated by increase of activity whether that’s job-related or they are trying to do some kind of exercise; treadmill, running, tennis, whatever it is for their particular exercise regimen and then treatment would ensue from there.

Bill: So, speaking of treatment; how do you go about treating those common foot injuries?

Dr. Manolian: Well very often in our office it would begin with a cortisone injection at the plantar fascial-heel bone junction. This is done with an anesthetic agent so you get a break in the pain cycle from that item and the cortical steroid, the cortisone is an anti-inflammatory that can be put at the area of highest symptoms and typically in short order, measured in days, the symptoms can begin to dissipate and then that can be augmented by oral anti-inflammatories whether it’s over-the-counter and there are prescription versions that we often would write for and then we would ask the patient to augment activity to a degree and they would then follow-up with us in three weeks to manage the condition.

Bill: So, does physical therapy ever come into the equation when it comes to common foot injuries?

Dr. Manolian: For very resistant cases of the plantar fasciitis, we would have patients augment therapies that we would do here. Before that time probably a patient would definitely have been on a prescription anti-inflammatory, probably been dispensed a walking boot to help it minimize pain and pressure at the injured area whether it’s Achilles tendonitis, a tendonitis on top of the foot, the plantar fasciitis or ankle sprain. They might have been on a course of oral prednisone and then if pain is still present or pain relief isn’t great enough or there’s lack of joint motion, some stiffness occurring; physical therapy plays in perfectly at that time.

Bill: Dr. Manolian speaking specifically about plantar fasciitis; is surgery ever necessary?

Dr. Manolian: Yes. Surgery would come into play for most likely for the resistant or recalcitrant plantar fasciitis where the inflammation did not resolve, probably less than 20% resolution of symptoms overall where a plantar fascial release would need to be done, so you are incising it from the bone in order to minimize the pull and the tension in the structure itself and that would then resolve symptoms in almost all cases following that procedure.

Bill: Dr. Manolian let’s help people out a little bit here. You mentioned runners, joggers, a lot of people doing physical activity; what about prevention? Are there any tips you can share with us when it comes to common foot injuries that we can maybe prevent through stretching or proper footwear? What kind of tips can you give us?

Dr. Manolian: We often find that one of the most common things is improper shoe gear. So, you have the patient that comes in saying I don’t understand why I have X, Y or Z pain whether it’s the heel, the Achilles, the forefoot, the arch; that they are wearing a sneaker that is either inappropriate for sports activity, it’s more like a KEDS kind of sneaker that’s good for maybe casual walking around, but they haven’t really purchased an athletic sneaker and if they have, a lot of times, it’s too old, too many miles on it. So, regular runners will know the average turnaround time to modify shoe gear would be six to eight months or 500 to 700 miles, if you can quantify your typical walking or running activity; then they are not providing you the proper shock absorption. So, we find that quite often and that can be a big plus to orient the patient to change their approach in that regard. Another common problem that we bump into is patients trying to overdo their particular activity and that we have to try to get them to based on their symptoms or ability to rebound from the previous day’s or previous event exercise to modify the time or distance or how often they are doing the particular running or whether it be tennis or some of these obstacle courses that people do now that are so popular and that can make a big headway also.

Bill: Dr. Manolian please wrap it up for us. What else should we know about common foot injuries?

Dr. Manolian: I think that people should just be aware to seek treatment that oftentimes it’s very simple items that we see all the time in the office. And I would say that we see a delay in some people wondering if they would come in or not based on fear of treatment and a lot of the times it’s very simple changes in approaches that can produce highly advantageous results and I need to get people over that hurdle and I think they would do quite fine.

Bill: So, the message is don’t wait if you feel foot pain. Better to go see the doctor first than to wait and potentially make it worse, is that right?

Dr. Manolian: That’s right. And it’s all very simple, easy to manage treatments that we do, but people are – patients are unaware of that and I would emphasize that point too.

Bill: Well, that’s great advice. If you are having foot pain, don’t delay, go see your doctor. And Dr. Manolian thank you so much for your time today. For more information please visit, that’s Thanks for listening.