Posts for: January, 2013


In the middle of your foot there is an area called the Lisfranc joint complex, this is the top of the arch of your foot. In this area there are many tiny bones and ligaments connecting the bones of the front of your foot to the bones of the middle of your foot. However, between the bones of your first and second toes there is no connective tissue supporting the ligament connecting these toe bones. Connective tissue is a structure that supports and reinforces these ligaments, and without it the ligament can be torn or the bones can pop out of place if the foot is twisted the wrong way.

This injury is very common in football and soccer players, it usually happens when the player’s foot is bent downwards and they stumble over it. Last year Houston Texans star player Matt Schaub got this injury and it ended his season. The injury is usually mistaken for a sprain and many people think they can just walk it off, however this injury is far more serious than a simple sprain. The common symptoms of this injury are swelling and bruising on the top and bottom of the foot on the same side as the big toe. The pain normally worsens when standing or walking.

A podiatrist should be seen immediately if these signs are present as this is an injury that shouldn’t be ignored. A doctor will order X-rays and MRIs to look for torn ligaments and broken bones in this area. Depending on what is found the treatment can be surgical or non-surgical.

If there are no broken bones, dislocations or if the ligament is only partially torn non-surgical treatment is the best route. This includes a non-weight bearing cast for 6 weeks, and it is very important to place no weight on the foot while it is in the cast, this could make the injury worse. After the 6 weeks weight bearing will be increased as time goes on and shoe inserts may be prescribed.

If the bones are broken, dislocated or the ligament is torn surgery will be required. In this surgery the bones will be set back into place and hardware (screws and plates) will be put in to hold the bones in place. This is usually left in place for 3 to 5 months then it is removed and rehabilitation is required.

This is a very serious and devastating injury for athletes, despite the success of the surgery it is very difficult for athletes to get back to their pre-injury activities. The best way to keep this injury from becoming very serious is to be seen right away by your podiatrist.

By: Nrupa Shah


As if growth spurts weren’t bad enough, there is a foot disease called Severs Disease that is associated with growth spurts in children ages 9 to 15. When children are growing their growth plates are expanding and getting larger, and along with this the muscles and tendons also need to grow and stretch. But sometimes they don’t. Severs Disease is caused from the growth plate in the heel bone growing, but the muscles and tendons around it are growing at a slower rate resulting in pain of the heel. As the child runs or performs any physical activity the muscles and tendons will become more stressed and will result in more pain. The most common symptoms of this injury are pain and tenderness of the heel, especially when the sides of the heel are squeezed.  Sometimes a lump may appear at the back of the heel where the tendons attach to the bone, but this is usually very small.

Treatment for this injury includes limiting physical activity, ice and supportive shoes. Orthotic inserts can also be very helpful when treating this injury. These will provide proper support and placement of your child’s feet, which will help with the pain. Also regular stretching of the calf muscle will help reduce the pain. In the most severe cases the area can be casted but this isn’t very common.

If your child is between the ages of 9 and 15 and is experiencing these kinds of symptoms take them to your local podiatrist Dr. Gujral at Affiliated Foot and Ankle Care in Edison and Monroe NJ. Your podiatrist can diagnose and properly treat this injury and get the correct shoe inserts to help your child get back to feeling normal!

By Varun Gujral


It may seem weird but there are two tiny bones embedded in the tendon under your big toe, and these bones can become irritated and can lead to the injury called sesamoiditis. This injury is caused by any activity that makes you push off on the front of your foot. Every time you push off the front of your foot these bones are involved and when activity is vigorous or the amount of activity has increased these bones can become irritated and sometimes fractured. This injury is very common to dancers and gymnasts. Some of our favorite gymnasts like Shawn Johnson and Gabrielle Douglas are very prone to this injury due to their amount of activity.  Since these bones are located inside a tendon the irritation causes the tendon to become inflamed which adds to the pain. Even though there is a lot of pain associated with this injury there is no visible swelling or bruising on the foot. So how can this be diagnosed if there are no visible symptoms? This injury is unique in that the pain isn’t immediate, it is very gradual. It will start out as an ache and over time as the activity is continued the pain will become worse and worse.

Treatment for this injury is almost always noninvasive, rest, ice and pain killers are the most used forms of treatment. Steroid injections are a common treatment for athletes to reduce the pain and swelling. The big toe can also be taped to the toe next to it to reduce the amount of pressure placed on the big toe when pushing off from the front of your foot. 

Of course we would always rather prevent an injury then treat it, so how do professional athletes like Shawn Johnson and Gabrielle Douglas prevent themselves from getting and injury like this? This is done by giving your sesamoid bones cushioning and support, this is done by orthotic insoles. These are inserts that can be placed in your shoe to help prevent extra strain from being place on these bones.

You can talk to your local podiatrist, Dr. Shah at Affiliated Foot and Ankle Care in Monroe and Edison NJ, about either preventing or treating this injury!

By Nrupa Shah


This injury got its interesting name because it is common to football players who play on turf or fake grass fields. James Starks, of the Green Bay Packers, battled with this injury leading into the 2012-2013 season, and it threatened to keep him from playing. I know you’re wondering how something so minor can keep a star NFL player from playing. This injury is more severe than one would think. Turf toe is caused by the ligaments around your big toe joint being sprained. This injury is most common on turf fields because the hard surface causes the toe to lie flat instead of bending while the player is running or getting hit. Even though this injury is named after football players it is common in other sports such as gymnastics, basketball and soccer.

The common symptoms of this injury include pain, swelling and limited movement of the toe joint. If the injury results over time the pain and swelling develop gradually and get worse over time. If the injury occurs suddenly the pain is immediate and gets worse over the first 24 hours. Sometimes a popping noise will be heard. A podiatrist will examine the toe joint and usually order and X-ray to rule out any other injuries. After turf toe has been diagnosed the recommended treatment is rest, ice, compression and elevation. Your podiatrist may also tape the toe to the toe next to it to relieve pressure and strain off of the big toe. This is recommended for two to three weeks, and sometimes physical therapy is required to help regain proper movement of the joint.

There are a few ways to help prevent this injury! One of the best ways is to wear supportive shoes, or you can have special inserts made to prevent the toe from extreme bending or force. Dr. Gujral of  Affiliated Foot and Ankle Care can help you in either of his offices in Edison or in Monroe, NJ.  He can help you with prevention and treatment of this injury!

By Varun Gujral