Virtually Painless Heel Pain Injections

By Dr. Gary Prant

I volunteer at a clinic some Friday afternoons and had an unusual experience recently. There was a patient who had very acute heel pain and really needed an injection for this problem; however they were extremely afraid of getting an injection having heard from friends that it is extremely painful. This does not usually happen in my office either because patients have heard from other patients of mine that heel injections are not painful, or my assistant assures them that there is minimal pain associated with this injection.

So why are some heel pain injections extremely painful and ours not?Feet Pain

The answer is quite simple and was demonstrated very dramatically at the volunteer clinic the other day. The answer is simply to do a very quick and practically painless block of a nerve at the ankle which goes to the heel and causes the heel injection to be painful. We spray a cold spray on the skin over the nerve to the heel and inject a tiny bit of a short-acting anesthetic. This takes about a second and is barely felt. In a few minutes the nerve going toward the heel is asleep and we put the injection into the heel with little or no pain. At the clinic, it was amazing to both the patient and the medical staff to have a painless heel pain injection!

So why doesn’t everyone put a tiny bit of anesthesia around the nerve (posterior tibial nerve) at the ankle and make the heel pain injection virtually painless? Perhaps the reason is that these days as doctors are so rushed the few minutes of extra time is just not taken to do a two-step procedure where it could be a single step or perhaps the technique has just been forgotten. With my patients, I always spend a few extra minutes and obtain a little local anesthesia before a heel pain injection is given and very, very, rarely does anyone complain that it is painful.

To learn more about treating heel pain, visit our website at




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I Can’t Stand My Orthotic Foot Supports– What Can I Do?

Dr. Gary Prant DPM

Arbor Foot Health Center

Almost every day people show up in my office with orthotics they just can’t wear. Some of these were made by doctors who claim that they are experts in making orthotics, and I often wonder how they would feel if they could see their patient showing up complaining about their work. From experience I know that I have made my share of orthotics the people can’t wear. In fact, we offer 100% money back guarantee on orthotics because I know no matter how experienced or how much skill we put into making them, sometimes they just don’t work.

Dr. Prant modifies orthotics for a custom fit.

Dr. Prant modifies orthotics for a custom fit.

There are a couple things that I have learned from 30 years’ experience about the problems people have with orthotics.  If someone has a very rigid hard foot they usually cannot tolerate a hard orthotic –in fact, many adults have difficulty tolerating hard orthotics. It is also difficult for many people to run with a hard orthotic. Having said that, there are enough exceptions to those rules to make me sound like a liar, but as I said those are generalizations. If you have a tight Achilles tendon, which is the tendon of the major muscle complex in the back of your legs which propels you forward, that is a major cause of not being able to tolerate an orthotic. A tight Achilles tendon is also something you can do something about. Stretching your Achilles tendon may make an orthotic much more tolerable. Likewise, increasing the heel height of your shoe – which has the effect of loosening the Achilles tendon -will also often make an orthotic much easier to tolerate.

Some orthotics can be adjusted with a heat gun and some skill, and we do a lot of that. Even if after adjustment the orthotic doesn’t completely correct your problem it’s usually better to have something than nothing right?

Then there are those people with a completely flat foot. Their foot is like a pancake. They got an orthotic to try to support their foot but the orthotic presses up in the arch and it feels like they are walking on a rock or something. A high arch in the orthotic doesn’t fit their flat foot, but if the orthotic is made to fit their foot it will have no arch and won’t do anything. For this type of foot I make a totally flat insole which is angulated in such a way as to shim their foot. The device is basically flat so it does not press up on the arch but it rather tilts the whole foot. I have not seen one of these manufactured so I just make them in my office lab as they are needed. People with extremely flat feet usually have a very difficult time walking and they are incredibly appreciative of a simple device that allows them to walk with some comfort.

The making of orthotic foot supports I believe is as much an art as a science. If you work with a doctor who has an interest in this facet of foot care the results can be amazing!  If you want to know more about orthotics, visit our online library of foot problems.

Posted in Austin, Flat Feet, Foot care, Foot Health, Orthotics, Podiatrist, Texas | Tagged , , , , , , , | 2 Comments

Why Did My Toenails Get a Fungus Infection – Again?

It’s a story we are hearing more and more now that many people have had success getting rid of their fungal toenails with either the laser or medication. The nails used to look great — but now don’t look so great. What happened?man tries to hide his toenail fungus

Fungus is stubborn. It is everywhere in the environment but especially in warm and wet areas. It lurks in locker rooms, showers, and most especially in enclosed shoes. What can you do? In the locker room and shower you can wear flip-flops. One of the most simple and quite effective techniques is to dry your feet with a blow dryer. Certainly don’t burn your feet – but get them good and dry.

Enclosed shoes provide a dark, warm, moist environment. This is the perfect environment for fungus. It is imperative to kill the fungus in your shoes! Whatever effort and expense you go through to kill the fungus in the toenails is for naught if you are sticking them in an infected shoe. The two ways of killing fungus in a shoe are a spray that is used once a day for about two weeks and it continues to kill fungus for about four months inside the shoe. The other extremely effective way is with a device called the steri shoe which is an ultraviolet light which kills fungus in the shoe without chemicals. Of course the other option is to wear open toe shoes!

Last year at a podiatry conference I had the pleasure of eating dinner with one of the foremost podiatric dermatologists. He told me that they had evidence of a strong genetic predisposition to fungus in the feet. I know I’ve seen this in practice and just recently read a statement from a podiatric dermatologist Dr. Tracey Vlahovic who also said the same thing.

The bottom line is that toenail fungus is curable but it is a constant battle. If you have a genetic disposition to toenail fungus, yes it can be cured, but it will be that much more difficult and you will have a greater chance of it returning. At least we can do something about it… I’m still waiting for an effective cure for baldness!

Dr. Gary Prant
Arbor Foot Health Center

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Leg Length and Back Pain – Is There a Connection?

Dr. Gary Prant DPM

Arbor Foot Health Center

Sometimes the popular press is ahead of medical practice. There was an article in Vogue magazine last month entitled “Uneven Ground” which the sub headline describes as, “slight imbalances in our bodies alignment could be the culprit behind back pain, according to a persuasive new school of thought.”

Back Pain
The article states the obvious fact that people are not totally symmetrical. According to one of the largest studies of body and balance, in about 32% of people one leg is 1/5 to 3/5 of an inch longer than the other. I have seen quotes from other sources that say approximately 95% of people have at least 1 cm difference between one leg and the other. (Somehow the studies in centimeters seem more scientific – don’t they?) Anyway, these leg length differences this can mean actual bone length differences but more commonly it is the joints, muscles, tendons and ligaments which are stretched or contracted causing a functional leg length discrepancy rather than an actual discrepancy.

Leg length discrepancy has been associated with back pain for many years. A recent study also found that almost 50% of knee pain in women is associated with foot problems. Now some of these problems are related to leg length discrepancy and are caused by imbalances in the foot — almost like an out of balance tire on a car which causes the whole car to shimmy.

Now why do I say that the popular press is sometimes ahead of medical practice? That is because it seems that so few podiatrists check for leg length differences. This is an easy test that we always perform. In my office we watch people walk, and then we watch people stand with a half inch raise under the right foot then the left foot. We look at the balance of the body and can get a pretty good idea of a functional or structural leg length discrepancy. Is it 100% foolproof? Absolutely not! But it’s better than a hunch and we’ve performed this test on so many people that we are pretty good at it. If we find a leg length discrepancy we put a little lift in the shoe of the short leg. You would absolutely be amazed at how many times people return telling us that their hip or knee pain or back pain is much better from this very simple little treatment. If the lift is annoying or not helpful we just tell people to throw it out and forget about it.

We have also seen stretching, yoga, and especially chiropractic adjustments to be very helpful for leg length discrepancy problems.

If you’re unbalanced don’t worry about it. A leg length imbalance is a simple thing to correct and it may be a simple answer to nagging knee, hip, or back problems. Give us a call if you’d like to have your leg length analyzed.  512-335-1800.

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Why I Don’t Recommend Triple Antibiotic Ointment Anymore

Dr. Gary Prant DPM

Arbor Foot Health Center

A few years ago at our national meeting I heard a report about increasing problems with one of the ingredients in “triple antibiotic” ointment, brand name Neosporin. At that time a speaker at the meeting mentioned an 8% allergic response to one of the ingredients in triple antibiotic, specifically Neomycin. This past week I just returned from a seminar where an expert in wound care discussed a severe allergic response to neomycin which almost killed one of their patients. The wound care expert said that about 11% of people have an allergic response to Neomycin.OLYMPUS DIGITAL CAMERA

Both Neosporin and the generic triple antibiotic contain three antibiotics: Neomycin, Polymyxin B, and Bacitracin. These antibiotics are promoted for minor cuts and scrapes. Most people feel that triple antibiotic “prevents infection,” “helps wounds heal faster,” and “helps prevent scarring.” That is just not true!

How often does someone in the family get a minor skin cut? It can be as simple as a scraped knee or a paper cut. Our natural reaction is to do “something” to relieve pain and make the injury better. So why not put some triple antibiotic ointment on the cut?

As is often the case, Wikipedia has the answer. When you look up the entry for Neosporin here’s what it says: “Neosporin is marketed for the prevention and fighting of infections and speeding the healing of wounds. However there is little data supporting these claims, and in clinical trials, Neosporin is not more effective that simple petroleum jelly.” But even if it’s no more effective than petroleum jelly at least it does something right?

Well…. It may be a lot worse than petroleum jelly. The use of antibacterial ointment that contains Neomycin (one of the 3 antibiotics in triple antibiotic) is a problem. As I noted before, the incidence of allergy is quite significant to Neomycin. And while existing allergy or sensitivity to this drug is still fairly low some people can develop sensitivity over a relatively short period of time — especially if the ointment is used under a Band-Aid or another dressing as it usually is. It is not uncommon see rashes develop in a week or so from sensitivity to Neomycin.

A common story in our practice is that someone has an ingrown toenail and puts Neosporin and a Band-Aid on it to prevent infection. Being conscientious, our patient changes the bandage and applies more Neosporin twice daily. On day three, the area begins to look red, so fearing infection has begun, they start changing the Band-Aids and using more ointment three or four times a day. By day 7, the area has become red and angry-looking and is weeping fluid. They decide at that time to come to the doctor to treat “infection” that overcame even the power of the antibiotic ointment. I examine the patient, and asked if they have been using triple antibiotic ointment. When they wonder how I knew, I mention that what we are seeing is a common reaction to the ointment, not an infection. I tell them to just wash and clean the area, and maybe use a little steroid cream. Within a few days the problem is gone.

So what can you do? The best treatment for minor cuts and scrapes is simple cleaning and bandaging. Use of creams, ointments, etc. is rarely of any use. Second, if you insist on using an antibiotic cream, use one that does not contain Neomycin. We recommend over-the-counter Bacitracin or Amerigel. (Amerigel is my favorite since it promotes wound healing and kills a high percentage of MRSA.) If an area of injury turns red, warm or painful, see a doctor immediately.

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Everybody Sells Orthotics but Few Adjust Them

Dr. Gary Prant DPM

Arbor Foot Health Center

Several times a week people come into my office complaining about either a custom orthotics or an over-the-counter shoe insert. Usually the story goes that they spent a considerable amount of money on a device that was supposed to solve all their problems but didn’t solve anything, and in some cases made their feet feel worse!

Dr. Prant modifies orthotics for a custom fit.

Dr. Prant modifies orthotics for a custom fit.

Sometimes, certainly not always, the person that sold them the shoe insert will refund their money. However, often there are “fees” attached so the buyer does not get their full refund back. There are rarely if ever any other options offered.

I have been making both custom orthotics and over-the-counter shoe inserts for over 30 years. And even with a podiatry degree and all this experience I still don’t always get it right with an orthotic or shoe insert the first time.

Making orthotics or shoe inserts is something of an art. I can determine how much correction someone needs, however the question is how much correction can they tolerate? By watching someone’s gait, determining the flexibility of their joints, considering their body weight and type of shoes they wear, I can make a very educated and usually correct determination as to how much correction I can build in an orthotic to accomplish its task and be comfortable for the person using the device.

But, one of the most important things is that I can always adjust the orthotic!  Whether the adjustment is needed at first or even after six months or a year, a simple tune-up of an orthotic can make it work great again.  In my office I have heating devices, grinding devices, and a whole little mini lab which I use to make orthotic adjustments.

One thing I do not do as a rule however is to make adjustments on orthotics which I did not originally make. The reason for this is because they are usually made out of materials I am unfamiliar with and I do not know how they will respond when I heat them or grind them.  If for some reason the orthotics are damaged while doing the adjustment there is no recourse with the manufacturer.

At Arbor Foot Health Center, we pride ourselves on offering a wide choice of both over-the-counter and custom orthotics. We customize our over-the-counter orthotics with both heat and grinding as needed to customize the device for a particular patient’s problems. We also offer a 100% money back warranty on custom orthotics. If custom orthotics do not work after having been adjusted we will provide a full refund.

So many custom-made devices, from braces on teeth to eyeglasses for eyes, need to be adjusted. I never understood why custom foot orthotics or even over-the-counter shoe inserts should be any different.

Learn more about orthotics from Dr. Prant on the Arbor Foot Health Center website.

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The Challenge of Designing High Tech Shoe Modifications

By:  Dr. Gary Prant DPM

On the outside chance that you don’t follow the MDDI (Medical Device and Diagnostic Industry) Journal, I would like to tell you about something that I recently saw that was very exciting. The recent headline article was “3 Wireless Devices to Watch.”  (Remember they are engineers and English is not their strong suit.) The third device in the list is a shoe insole that wirelessly sends information on pressure and temperature of a patient’s foot while they are walking. The idea is that a person could be followed following surgery and during their rehabilitation to monitor skin temperature and pressure. What a wonderful idea!moticon-opengo-sensor-insoles

The pity is that I’ll bet we never see this. I can’t count the times I’ve seen wonderful ideas for shoe modifications or insoles and never came to be. I remember just a few years ago someone got a patent for a shoe which dynamically changed its arch and cushioning as one moved. It was touted as providing firm support when someone was jumping up in basketball and providing cushioning as they returned to the ground following the jump. This sounded like an idea that could be a real game changer. I followed the patent a little bit. It was developed by an engineer at MIT and it seemed that Adidas was going to pursue making the shoe. I’ve never heard any more about it. Wonder whether it was the economics or the technical difficulty that did in — or maybe it still in the works.

The one thing that any professional who deals with the feet realizes rather quickly is that the shoe is an incredibly hostile, unforgiving environment. There is little room, there’s a lot of heat and a tremendous amount of pressure.  I suspect that designing high-tech electronics to survive in that environment is much more difficult than anyone anticipates. I would be willing to bet that it is easier to design electronics to survive in outer space than in a shoe! Like I sometimes tell my patients nothing lasts forever inside shoes, not even your feet.

Here is the link to the article:

Dr. Gary Prant, Podiatrist

Dr. Gary Prant DPM


Gary Prant, DPM, FAAFAS, has been helping people of all ages in the Austin area since 1982, when he opened Arbor Foot Health Center. Dr. Prant is a board-certified foot and ankle specialist.

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