Fast, Gentle Treatment for Plantar Fasciitis and Achilles Tendonitis

Tenex for tendon pain

60 seconds to permanent relief from heel, arch and Achilles pain

60 Second, Permanent Treatment for Plantar Fasciitis, Plantar Fasciosis, Achilles Tendonitis and Achilles Tendonosis. One Treatment is all it Takes!

The innovative Tenex Health TXTM procedure is a gentle method for percutaneous treatment and removal of diseased tissue and restoration of natural tendon and soft tissue function. The Tenex Health TXTM System can be used to address the most common areas for tendon and soft tissue injuries including:
• Plantar fasciitis
• Achilles tendonitis
Based on technology developed in collaboration with the Mayo Clinic, the Tenex Health TXTM System combines conventional ultrasound imaging for visualization with the advanced TXTM MicroTipTM which utilizes ultrasonic energy to cut and debride damaged tendon tissue.

Understanding Tendon Pain

Did you know that over 10 million people in the United States suffer from tendon injuries every year? These injuries are associated with chronic pain and losing the ability to perform simple daily activities.
Tendon pain is often known as tendonitis or tendinosis.
** Tendonitis An inflammation or irritation of a tendon that can cause pain and tenderness outside of a joint.            ** Tendinosis Also known as chronic tendonitis, is caused by tiny tears in the tendon tissue that can create pain, stiffness, or inflammation around the tendon. Both conditions can occur in any joint in your body, but you will commonly experience it in the upper and lower limbs. Tendon injuries can be very painful and are slow to heal, taking months or even years.

If you suffer from tendon pain or know someone who has, there are different treatment options to help relieve your pain, as well as an innovative procedure designed to eliminate the source of your pain and aid in the healing process of the damaged tendon. In this section, you’ll learn what a tendon is and how it works, the cause of tendon pain, and the treatment options available to you.

What to Expect During Tenex Health TX

Great news! The procedure is performed using local anesthetic to numb the area. You will be fully awake and alert the entire time.

During the procedure, Dr Niccoli will use sophisticated ultrasound imaging to identify the specific location of the damaged tendon tissue. This is similar to seeing a baby in the womb with a sonogram.
Once the treatment area is located, a small MicroTipTM is inserted. The MicroTip delivers ultrasonic energy specifically designed to break down and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue. When the procedure is completed, only a small adhesive bandage is used, and no sutures or stitches are needed.

What to Expect After Tenex Health TX

After Tenex Health TX, you will be permitted to go home. If you feel any discomfort, you can take an over-the-counter pain medication.  For at least 2 weeks after Tenex Health TX, you should not perform any weightbearing exercises or activities. Dr. Niccoli will provide specific instructions based on your condition, work, and lifestyle. In most cases, you will not need physical therapy or medications before resuming normal activities.

If this sounds like a treatment plan you would be interested in call our office or make your appointment.

Click here or Call us now at 510-521-3410  ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda

 

Pain in Your Hip or Back? It Could be Linked to Your Feet

Alameda back pain from foot instability. Dr. Niccoli

If your hip or lower back has been hurting, and you don’t remember doing anything to injure it, the source of your pain could be your feet! Our bodies are like a chain, with one link–or bone–connecting at the joint to another link. Think about what would happen if the first link in the chain was out of position. The point at which it meets the next link would eventually overstress that link and adversely affect the entire chain. Changing your gait changes the mechanics of all of your joints. This can affect the whole chain of your lower body… from the ankle, to the knee, to the hip, and then to the lower back.

Get Pain-Free, from the Ground Up
The first step to removing a persistent problem is to call us and schedule a weight bearing exam and a gait analysis. (In the meantime, toss out any old or worn shoes!)

Click here or Call us now at 510-521-3410   Your back (and knees and hips) will thank you!

~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda

 

Sports Medicine: Heel Pain - When to Call a Doctor

Bay Area Foot & Laser Surgery Clinic -- Beach RunThe heel is one of those behind-the-scenes body parts we don’t think much about—until it’s injured. Home to the biggest bone in the foot, the heel absorbs a great deal of impact. When it becomes strained or inflamed, the simple act of walking can be incredibly painful—or even impossible.

Common Causes of Heel Pain
In most cases, heel pain comes on gradually, as a result of ongoing impact and pressure on the bone. Runners experience it most frequently, as the heel absorbs a whopping 2.75 times of our body weight during this activity. Plantar fasciitis, Achilles tendinitis, heel bursitis, and stress fractures are some of the common heel injuries among athletes.
Heel pain can also be caused by arthritis, viruses, infections, autoimmune deficiencies, and neurological issues. In some cases, it’s triggered by environmental factors, such as wearing flat shoes that lack support or using improper posture while walking or running.
When to Call a Doctor
If your heel pain is mild or in the early stages, you may be able to treat it yourself with rest, ice, compression, massage, or supportive insoles. But if any of the following apply, you should contact a sports medicine doctor for diagnosis and treatment:
  • Your heel is severely painful or swollen, and the pain has lasted for several days or longer
  • Walking is extremely painful or impossible
  • You find yourself compensating for the pain by changing your gait or posture, which can lead to other injuries
  • You are unable to stand on your tiptoes or bend your foot in either direction
  • Your heel is painful even when you’re at rest
  • You are experiencing numbness or tingling in your heel
If you’re experiencing any of these symptoms, contact us to schedule an exam—and get on the path to pain-free living!

Click here or Call us now at 510-521-3410  ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda

 

Run Over by a Senior Citizen!

Alameda-Podiatry active senior Dr Niccoli.I recently worked with a handful of older patients in my office on the use of a new senior balance brace—and has been working so well, I was nearly run over several times.

It all started with a new protocol we developed last summer, with the goal of helping seniors improve balance and prevent falls. While this isn’t a large part of my practice, we’ve found that devoting an entire visit to needs assessment and balance improvement can really pay off, reducing falls both inside and outside the house.

If a 92 year old can improve, so can you.

In one of my first cases, the patient was a 92-year-old female. Although she was still able to walk on her own, she was rapidly losing her balance, and had experienced several falls in her home—which is the most common location for seniors to fall. The patient was very concerned when she spoke to me about it.

We worked up a complete profile that included her medical conditions, medications, standing and gait analysis, and footwear analysis. Then we came up with a list of achievable interventions to help her improve her balance. One of them was the Moore Balance Brace, a flexible, soft and open brace that’s easy to put on and fits comfortably within the shoe.

The before-and-after was amazing to witness. In fact, after this patient put on the soft balance braces, she was able to walk without her walker—and almost ran me over as I walked backwards in front of her.  That patient convinced me that just about any patient with balance problems or fear of falling should be looked at.

Her stability and speed was improved dramatically enough for even untrained individuals to notice, including her family.

Keeping older patients safely active, longer…

I feel that the Moore Balance Brace is an excellent addition to our tools for preventing falls in seniors, which is the leading cause of death in adults over 65 years old. Click below to watch the dramatic before-and-after video on another male patient that demonstrates the incredible effectiveness of this balance brace.    *BEFORE BALANCE  BRACE    *AFTER BALANCE BRACE

Foot and Ankle Injuries: When Time Doesn’t Heal All Wounds

The phrase “time heals all wounds” is a nice sentiment, but it’s not necessarily true when it comes to wounds of the foot and ankle. This past August, I had three cases of non-healing wounds—all of them elderly patients with varying medical histories. In researching and treating them, I discovered a relatively new medical technology that delivers incredible results.

Niccoli healthy feet Bay Area podiatrist

A stubborn ankle ulceration

The first patient had a venous stasis ulceration along the outside of the ankle. The wound resisted the standard treatments of antibiotics, compression dressings, and daily dressing changes. After a month to six weeks with no change, we switched to more aggressive treatments, including activated collagen and silver sulfadiazine.

Following the switch, we did see some progress. However, the healing stalled at around 50% during the next month, and further treatments were ineffective.

At this point, we decided to take things a step further. We used an advanced technology known as Apligraf—a unique and fascinating product that contains proteins, collagens, and living cells. In technical terms, it’s cultured neonatal human tissue on a collagen matrix, which gives the wound plenty of growth factors and potential.

The results were amazing. Improvement was noticeable after one week of treatment, and what had been a chronic wound that lingered for five months was completely healed in a month.

Post foot surgery ulceration success

Soon after, we saw a patient in his 90s with a very large wound on the dorsal aspect of his foot, which had been present and non-healing for about four months. We began treatment with Apligraf right away. Not only did the wound heal with this treatment and incorporate with his normal skin, but there was no scar whatsoever left behind.

Apligraf treats a non-diabetic ulceration

Finally, we saw an 85-year-old non-diabetic man who was experiencing profound numbness. He developed a large ulceration on the tip of his toe, and had no idea the wound was there because he couldn’t feel it. While this type of wound is typical for diabetes sufferers, this particular patient was not diabetic.

In his case, we began the same standard wound care treatments applied to the venous stasis ulceration patient—compression bandages and antibiotics, followed by activated collagen and silver sulfadiazine. When the wound failed to progress into healing, we turned to Apligraf once again. The wound healed in two weeks.

Improved wound care with biologic technology

 We feel that Apligraf is a wonderful addition to the field of wound care, and has promising applications for healing foot and ankle injuries. In fact, we recently referred a patient to the Kate Creedon Center, a top wound care center in the area—and when the results were underwhelming, we brought the patient back to apply our more rigorous protocol, and achieved successful healing.

When you or a loved one is experiencing a prolonged foot or ankle ulceration, call Dr. Niccoli. We offer advanced wound care protocols and specialized wound care to deliver successful healing and relief.

Click here or Call us now at 510-521-3410  ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  patients throughout the Bay Area from San Francisco, Oakland, Fremont, and Alameda

Sports Medicine: Cuboid Syndrome - The Foot Pain That Won’t Go Away

running injury male Alameda podiatrist NiccoliA few days ago, I saw a 25-year-old male with lateral foot pain who had gone through multiple doctors and six months’ worth of tests and treatments—including x-rays, ultrasound to check blood flow, pain medication, and physical therapy—without results. He had significant swelling along the ankle and the side of the foot, and was in fact getting worse instead of better.

Diagnosing cuboid syndrome: A tricky business

The patient was referred to me with a diagnosis of “unclear.” When he arrived for his initial appointment, he indicated his pain level as severe—an 8 on a scale of 1 to 10. Based on his symptoms profile and the clinical exam we performed, I suspected that he might have cuboid syndrome. This relatively rare diagnosis is almost never pronounced outside a podiatrist’s office, which has led to controversy over whether or not it actually exists.

Just to be sure, we took x-rays to rule out the possibility of more common problems like stress fractures, bone cysts, or tumors. In some cases, a subtle dislocation of the cuboid can be seen on x-rays and assist with the diagnosis. While no dislocation appeared with this patient, the absence of this anomaly does not rule out the possibility of the condition. It’s generally a clinical judgment call.

Cuboid syndrome treatment: Relief at last

Once we had eliminated other possibilities, we performed what is called a cuboid manipulation. This is an osteopathic type maneuver designed to shift the position of a single bone in the foot—in this case, the cuboid. During the process, patients sometimes feel what’s described as a “pop” or a “click” as the bone moves back into place. The patient reported feeling this sensation.

To support the manipulation, we applied a custom-made cuboid pad, with a Kinesiotape low-dye splint to keep it in place, and scheduled a follow-up appointment for one week. Upon his return, the patient stated that the results were “amazing”—he had experienced approximately 70% relief from the months-long pain.

Long-term follow-up care

This patient was unfortunately relocating to Virginia. However, I recommended that he have the cuboid manipulation treatment repeated 4 to 5 times, with appropriate padding and support. Ultimately, he should progress to a high-quality over-the-counter insole or functional orthotic, with an appropriately placed, customized cuboid pad to maintain the proper position of the bone long-term.

If you’re experiencing prolonged or chronic foot pain that can’t be explained, Dr. Niccoli offers advanced diagnostics and state-of-the-art tools to pinpoint the issue and deliver relief.

Click here or Call us now at 510-521-3410  ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda

How Did My Foot Get So Screwed Up During Pregnancy? A strange case of fractured fibular sesamoid

A strange case of fractured fibular sesamoid

One of my recent patients is a young woman in her twenties who was pregnant, and had been suffering inexplicable foot pain for several months. She had done everything she could think of to relieve the pain, including researching on the Internet for possible causes, but was still limping and frustrated. The patient’s pregnancy was uncomplicated—in fact, she’d only gained 30 pounds over the course of the pregnancy. Her history was benign, with no apparent cause for injury, and her foot was not obviously swollen. However, the area around her big toe joint was extremely sore, particularly underneath the ball.

 Diagnosis: A fractured foot bone that’s not easy to break

 Uncertain of the source of the patient’s issue, we took x-rays to see if anything else could be causing this pain. The x-ray revealed something unusual: a transverse fracture of the fibular sesamoid, one of two tiny bones located along the underside of the joint at the base of the big toe. How was this possible? One factor could be that the foot does undergo changes during pregnancy, including lengthening. A woman’s feet during pregnancy often lengthen from a half to a full size beyond pre-pregnancy dimensions. In addition, there are weight considerations, changes in gait or stride, and changes in footwear. In this patient’s case, what I believe happened was the exacerbation of a developmental deformity that had gone undetected in her teens, because she had not previously presented with symptoms.

 Treating the tiniest broken foot bones

 Whatever the origin of the injury, fibular sesamoids require a good dose of TLC in order to heal properly and pain-free. In this patient’s case, we initiated a period of non-weight-bearing to give the bone a healing boost upfront, followed by partial weight-bearing with support delivered through a modified dancer’s pad combined with a stiff-soled shoe. These small foot bones are typically slow to heal, so this unusual injury will take time to progress to a pain-free state.

It’s important to take foot pain seriously, and be seen by a board certified, experienced podiatrist if you’re experiencing unrelieved pain. Dr. Niccoli can ensure that your foot problems are properly diagnosed and treated for long-term relief. Consult your local expert. Dr. Jeffrey J. Niccoli at Alameda Family Podiatry Group offer advanced diagnostic tools and prompt, friendly care.   Click here or Call us now at 510-521-3410  ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda

Sports Medicine: Common Myths About Foot Injuries

There are a lot of health myths that are repeated so often, many people assume they’re true. By learning to separate the truth from the common misconceptions, you’ll be prepared to avoid some serious problems.

Here are some of the most frequently believed myths about foot and ankle injuries. Do you know as much as you thought?

Myth #1: Ankle sprains are minor injuries and don’t usually cause long-term problems.

If you suffer from repeated ankle sprains, there may be a more serious issue present. Frequent sprains can mean chronic ankle stability, and without proper care, you may develop long-term problems.

Usually, an ankle sprain is a short-term condition with a routine, predictable path to recovery—so it’s easy to think of these injuries as harmless. But the fact is, serious or recurring sprains can lead to ankle arthritis or other long-term, disabling conditions.

You can reduce your risk of long-term issues due to ankle sprains with professional bracing and rehabilitation after an injury, to ensure a fast and proper recovery.

Myth #2: If you can still move it, then it must not be broken.

There are 26 bones in the human foot—a higher concentration than in any other part of the body. Quite a few of them can suffer a fracture or break and leave you still able to move your foot, though it will definitely hurt.

Some common fractures that you can still walk with include small “chip” fractures of foot or ankle bones, breaks in the thinner of your two leg bones, and a fractured toe—which is another frequently neglected injury.

Myth #3: When you hurt your foot or ankle, you should soak it in hot water.

There’s nothing more soothing than a nice, warm bath, so it’s a good idea to soak your foot pain away, right? In reality, heat is probably the worst thing you can apply to an injured foot or ankle.

Instead of reducing swelling and pain, hot water makes the situation worse by opening the blood vessels—which rushes blood to the injured area faster, increases swelling, and puts more pressure on the nerves. In fact, that pressure is probably what’s causing the pain in the first place.

To relieve pain, apply cold, not heat, to your feet. An ice bag wrapped in a towel will shrink your blood vessels, which helps prevent swelling (and the pain that comes with it). Ice cold also has a numbing effect against the pain.

 Myth #4: If you sprain your ankle, it’s best to wrap it in an Ace bandage.

While a compression bandage can decrease the pain of a twisted ankle, you’re only treating a symptom—while the problem goes unaddressed. Sprained ankles usually mean that your ligaments are seriously overstretched, or even torn. Left untreated, they won’t heal properly, and you could end up with permanent damage.

For a bad ankle sprain, you should seek immediate care from a  board-certified podiatrist. You’ll probably need an x-ray to determine if there is a fracture and assess the extent of the damage. The ankle may need to be completely immobilized with professional bracing or casting, crutches to reduce the weight on the ankle during initial healing, professional guidance after the acute injury to assist rapid progress and physical therapy to ensure a full recovery.

In some serious cases, you may even need surgery on the ligaments or tendons to avoid permanent soft tissue and joint damage.

Myth #5: You don’t need immediate care for a broken toe.

Another popular variation on this myth is that broken toes heal on their own, and there’s nothing a doctor can do for you. This is patently untrue. Any toe fracture should have prompt attention, because even if it turns out to be an undisplaced fracture—a simple crack or break where the bones are still aligned—a qualified podiatrist can help you get fast relief from the pain, and make sure the break doesn’t worsen.

With displaced or angular breaks, where the ends of the broken bone no longer align, you need medical attention to set the toe, so it heals the right way. In many untreated angular toe breaks, people develop post-fracture deformity: a toe that is painfully crooked or deformed, usually with an equally painful corn.

It’s vital to monitor the health of your feet and ankles, and take any pain or trauma to the area seriously. If you’re experiencing ongoing foot, heel or ankle pain and believe it will go away on its own, you could be setting yourself up for serious problems down the road. It’s always best to consult your local expert. Dr. Jeffrey J. Niccoli and Alameda Family Podiatry Group offer advanced diagnostic tools and prompt, friendly care for a wide range of foot and ankle problems.  Click here or Call us now at 510-521-3410  ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda

Foot Surgery: The Real Truth About Foot Tumors

Foot & ankle specialist NiccoliDid you know that you can get a tumor on the foot? It’s true—you may never have heard of a foot tumor, but it does happen. After all, tumors can happen anywhere you have live tissue.

Over the last three weeks, I’ve seen two different patients with foot tumors. One is a middle-aged woman in her fifties, and the other is a teenage girl. Like tumors in other parts of the body tend to be, these cases were very different from one another.

A hidden foot tumor with no symptoms

The middle-aged woman came into the office, concerned because she had been trying on boots, and it was suddenly more difficult to put them on. She felt fine, was not in any pain at all, and had no outward signs of foot problems.

Upon careful examination, it was discovered that she had a hard nodule, or lump, in the deep tissue along the top of her foot. The nodule was relatively immobile—it didn’t move much when prodded or shifted. X-rays of the foot didn’t reveal anything obviously wrong, so we ordered an MRI to take a closer look. The radiologist read it as a “normal-looking” ganglion cyst.  Based on my experience,  I felt that was not the true diagnosis. So just to be perfectly sure, we took a small tissue biopsy and sent it along for microscopic evaluation.

When foot tumors can be seen

In the case of the teenage girl, the tumor was visibly apparent. She arrived at the office with no pain, but there was a hard protrusion that extended from the tip of her third toe.

The concern with this foot tumor was that it had started to lift and destroy the nail of the toe. The foot was x-rayed, which revealed that the growth was a small extension of the bones in the toe, protruding beyond the normal skeleton. We recommended complete removal of the growth via surgical excision.

The outcomes: Early detection reduces later complications

When the biopsy results returned for the middle-aged woman, it was found that she had a synovial sarcoma—a malignant (cancerous) tumor of the soft tissue. Thanks to the small size of the growth and the fact that we caught it early, her outlook is relatively good. She is currently scheduled to undergo a wide margin excision, which will remove the growth and the surrounding tissues to catch any stray malignant cells.

The teenage girl was officially diagnosed with an osteochondroma. This is a benign bone tumor that’s actually quite common, presenting in a classic location and age group. The protrusion was excised, and the patient went on to full recovery with no complications.

Cases like these offer compelling reasons to pay attention to your feet. If you find that something unusual is going on with your feet or ankles—even if it’s as simple as having trouble putting on shoes—it’s best to have the issue checked out sooner rather than later. Alameda Family Podiatry Group offers state-of-the-art foot and ankle care in a friendly, patient-centric setting to meet all of your diagnostic needs for potential foot tumors and other problems.

Click here or Call us now at 510-521-3410  ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda

Sports Medicine: Got heel pain? We’ve got solutions.

bay area heel painIf you’re suffering from heel pain, you’re not alone. In fact, 1 in 5 of my patients complain of some type of discomfort or strain in the heel. The good news is, you don’t have to resign yourself to living with this chronic pain.

Why is heel pain so common?

Because it’s the biggest bone in the foot, the heel absorbs a great deal of impact. When it becomes strained or inflamed, the simple act of walking can be incredibly painful—or even impossible. If you’re a runner or athlete, heel pain can develop with ongoing impact and pressure on the bone. Heel pain can also be caused by arthritis, infections, autoimmune deficiencies, excessive weight gain, and neurological issues.

Get on the path to heel health

If you’ve already tried rest, ice, compression, massage, or insoles, and any of the following still apply, it’s best to schedule an examination:

  • Your heel is severely painful or swollen, and the pain has lasted for several days or longer
  • Walking is extremely painful or impossible
  • You find yourself compensating for the pain by changing your gait or posture, which can lead to other injuries
  • You are unable to stand on your tiptoes or bend your foot in either direction
  • Your heel is painful even when you’re at rest
  • You are experiencing numbness or tingling in your heel

Proven heel pain treatments

Using our customized heel pain treatment program, 85% of our patients experience 80% improvement in just three weeks. 90% are 90% improved in two months, and > 95% of my patients are symptom free in six months. With a little patience and the right expert guidance, heel pain will become a thing of the past.

Click here to contact us or Call us now at 510-521-3410 to schedule an exam and get the treatment you need for pain-free living! ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda