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Posts for tag: Dr. Saffer

We would like to briefly discuss selection of the proper athletic shoe that matches your specific foot type. We see a great number of runners and athletes in our practice. I good percentage of our patients wear an outdated shoe that often times is not ideal for their individual foot type. We would first like to review the anatomy of an athletic shoe:

Athletic shoes, especially those for running, typically stress either motion control (stability) or shock absorption (cushioning) in their design. You should consider when selecting a running shoe the toe box, midsole, and last.

1) Toe box: Front part of the upper of the shoe, where the toe lies. The size of the toe box is important for people with bunions, hammer toes, and other arthrtic issues of the foot. We generally recommend a wider toe box shoe for these foot deformities. It is recommended at the shoe store that your foot is measured in both length and width.

2) Midsole: Made of ethylene vinyl acetate or Polyurethane. It provides for cushioning and shock absorption for the body.

3) Counter: Wraps around the back of the heel and provides motion control and stability for the foot.

4) Last: The form around which the shoe is built. Type of lasts are straight last, semicurved last, and curved last. Straight last is generally for flatfeet/overpronation, Semicurved last is designed for the average foot. Curved last are designed for higher arch feet. This type of shoe is for underpronation and is usually reserved for faster runners. Faster runners are often midfoot strikers, which means they land on the front part of their feet. Many midfoot strikers also require shoes with increased cushioning in the forefoot to absorb some of the ground forces.

We generally recommend that you replace your running shoes every 300 to 500 miles. Although your shoe may not look worn out, many times the midsole or counter wil have begun to break down, which decreases support and cushioning of the shoe. This often times can lead to injury.


Do you complain about pain on the ball of your foot or radiating numbness and tingling in your toes? You may be suffering from a neuroma. As a runner myself I have experienced this running injury and it is best to recognize and treat it as early as you can. We would like to discuss the basics of what a neuroma is, how you get it, as well as simple conservative treatment to resolve it and keep you running pain free.

A neuroma is a thickening of a nerve, and on the foot this occurs most frequently between the third and fourth metatarsal bones and toes. The nerve runs in between these areas can become inflamed when the metatarsal bones are compressed together such as may occur with tight fitting shoes. It may also be aggravated by overuse micro trauma that occurs in weight-bearing sports and exercise, and by biomechanical asymmetries such as over-pronation of the feet.

The symptoms of a neuroma can include pain on the ball of the foot that may be accompanied by a feeling of "pins and needles" or numbness to the 2nd, 3rd or 4th toes.

The initial treatment for a neuroma involves the correction of the causative factors. This can include changing to a wider toe box shoe as well as getting rid of worn out running shoes (more than 400 miles or older than 6 months). A removable metatarsal pad that offloads and takes pressure off the ball of the foot is very helpful to relieve symptoms. If this is still not effective we may recommend a series of injection (NO MORE THAN 3) to help reduce inflammation around the nerve.  Alcohol sclerosing agent injections is another conservative treatment option that essentially quiets the nerve inflammation. Other conservative treatment may include the use of custom sports orthotic devices to control any biomechanical problems such as overpronation.

Finally, if aggressive conservative treatment does not resolve your symptoms, and the pain is causing a modification of your normal activities, surgery may be recommended to remove the inflamed nerve.

It is best if this foot injury is caught early and diagnosed correctly because other problems such as metatarsal stress fractures and metatarsal bursitis can sometimes mimic the symptoms of Morton's neuroma.

Among the many different causes of foot or heel pain, plantar fasciitis is the most common.  When the band of tissue that runs from the heel to the toes becomes inflamed or irritated, it can cause great pain and discomfort. It is important to know that even if you have a heel spur that is not the cause of the pain it is the inflammation of the plantar fascia.

It is also important to know that not all heel pain is plantar fasciitis. Heel pain can be caused by a stress fracture, bone cyst, nerve compression, or ligament tear.   If you’re experiencing any type of pain in your heel, it’s important to have it looked at right away so that the cause can be diagnosed and addressed.  Typically if heel pain is caught early your recovery will be faster once the proper diagnosis and treatment plan is set.

What are the symptoms?

Most people suffering from plantar fasciitis complain that the pain is most severe in the morning.  This pain is usually on the bottom of the heel or in the arch of the foot.  Within minutes of walking, the pain begins to decrease as their foot stretches.  For some, the pain goes away for the rest of the day, while others may experience additional pain if they spend too much time on their feet. 

How is it diagnosed?


At Carolina Foot Specialists, we’ll start by assessing your medical history and examining your feet.  X-rays may be needed to help diagnose the problem.  We’ll want to be sure we’re narrowing down the cause of your heel pain by careful clinical and diagnostic evaluation. Our offices have state of the art digital x-ray and diagnostic ultrasound to evaluate the heel.

How is the problem fixed?

Depending on the severity of the problem, we might simply start with some stretches that you’ll be able to do at home on your own.  We may make recommendations about what shoes to wear or what activities to avoid.  If the pain continues after several weeks, injections, strapping or splints may be prescribed.  Very rarely do we perform surgery for plantar fasciitis.

State of the art surgical treatment

Dr. Saffer and Dr. Brown stay current on the latest minimally invasive procedures for heel pain/plantar fasciitis. Currently Dr. Saffer and Dr. Brown utilize Topaz and the Instep plantar fasciotomy for chronic cases of plantar fasciitis. Our doctors are looking at the Tenex procedure and other minimally invasive procedures to allow our patients a quicker recovery time.

For more information please refer to our website at