My Blog
By Dr Clement
April 27, 2015
Category: Uncategorized
Tags: Untagged

While in podiatry school my wife and I spent a weekend visiting her brother and sister-in-law and stayed up late one night having a foot-joke marathon. There are many good and bad foot jokes out there, and I enjoy them as long as they stay in the realm of imagination. But when a foot joke crosses over into reality, I say no thanks. Case in Point. 

Somebody has created cheese from the bacteria-laden skin scapings of the human foot. 

I don't know what possessed these researchers to do this and I wonder what else the grant money could have been spent on. Some research questions are better left unanswered. 

In our practice three big questions loom when addressing chronic pain syndromes: Which treatment will make it better? How quickly will the treatment work? How soon can my patients return to their normal lives?


Most chronic pain syndromes we deal with are tendon problems: Achilles tendonitis, plantar fasciitis, peroneal tendonitis, joint capsulitis. These structures do not always respond as well to standard treatment, and damaged or chronically inflamed tendons are never as good as they were prior to injury. By contrast, bunions and other bony deformities are repaired with straightforward surgeries; bone, once healed, is as good as new.


For conditions such as Achilles Tendonosis and Plantar Fasciitis, if the patient does not improve with a thorough course of bracing, rest, anti-inflammatories, physical therapy, etc, our options become limited to invasive treatments, the most effective of which has traditionally been surgery to cut the fascia or remove diseased tissue from the tendon.

While surgery is usually effective, recovery rarely happens quickly. The act of surgery alone causes scarring, and weeks of wearing casts or cast boots by itself requires additional weeks of physical therapy.


In recent years, new treatments are emerging which are less invasive than open surgery, require less healing time afterward, and target the diseased portions of tendon and fascia without major disruption to the skin and surrounding structures. One of these treatments is the Tenex Tx procedure (copyright Tenex Health).


Tenex uses two different types of ultrasound technology: ultrasound imaging to see the damaged portion of tendon, and a tiny, hollow ultrasound therapy wand for treating the visualized area. The ultrasound wand emits energy which cuts and breaks down injured fascia or tendon, which is then removed from the foot through the wand. Healthy tissue is not affected. The procedure takes a few minutes and doesn't require general anesthesia. It can be done at an outpatient surgery center or in a doctor's office.


ultrasound achilles tendon    plantar fasciitis ultrasound    


Recovery after the procedure is quite a bit shorter than for traditional surgery. For Achilles Tendonosis and Plantar Fasciitis, a few days of rest followed by 1-2 weeks in a protective boot is usually enough. That is considerably shorter than the usual post-operative course of several weeks of rest and several weeks more of a protective boot and physical therapy.


This procedure is an exciting new method for treating chronic tendonitis and fasciitis, and in many cases more invasive surgery has been avoided through this procedure. Contact the office to learn more!



By Dr Clement
April 13, 2015
Category: Heel Pain

Heel pain is a common problem with many elementary and middle-school aged children (8-13 years old). Most of the time heel pain is due to an inflamed growth plate, called apophysitis or Sever's disease. Occasionally, though, heel pain may be from something else. 

Plantar fasciitis, or the inflammation and pain of the plantar fascia at the heel and arch of the foot, though not usually seen in children, does happen.  It is estimated that 10% of people will develop plantar fasciitis at some time in their lives. About 80% of these are adults over 25. A small portion, maybe 5% of plantar fasciitis cases, happen in pre-teens.

Plantar fasciitis is an overuse injury in children just as it is in adults. Overuse simply means that you stress a part of the body every day heavier than it can recover from after one night's rest. Just like a bank account that has more daily cash withdrawals than deposits will eventually run out of money, the body's overuse (in this case your foot) eventually results in painful injury.

For plantar fasciitis, this means the foot isn't being supported properly during activities of daily life.  Shoes may not have enough support, calves may be tight, the foot may pronate too much, etc.

Treatment is focused on negating the factors that caused the injury. This may include changes in footwear, foot orthotics, a night splint, daily stretching/physical therapy, and anti-inflammatory medicines. The good news for children is that they heal within 2-4 weeks of treatment, a little faster than adults.

How common is plantar fasciitis in children? Not very. But it does happen, and when it happens, it gets better with the same treatments as plantar fasciitis in everybody else!

For more about plantar fasciitis, read this

For ways you can treat plantar fasciitis yourself, read this

By Dr Clement
March 20, 2015
Category: Uncategorized
Tags: Achilles Tendon   Injury  

The story of Achilles from Greek mythology tells that a great warrior was felled by a single arrow to his only vulnerable spot: his Achilles tendon, the only part of his body left unwashed by the River Styx when his mother dipped him in it as an infant. The story is an interesting way of explaining how someone so strong can be defeated by something so small. 

The Achilles tendon was named for Achilles because it is such a debilitating injury. Ruptured Achilles tendons have ended many professional sports careers and have likely been a cause of incapacitation on the battlefield, inspiring tales such as that of Achilles. 

So how does the tendon rupture? How do you know if it ruptured? What should you do about it? What can be done about it?

The Achilles tendon is the strongest tendon in the body and more force goes through it than any other. The tendon is attached to the calf muscle and the back of the heel bone. The tendon is nourished by arteries from the heel bone and calf muscle. The central, rope-like part of the tendon (the part easily seen and felt behind the ankle)  is relatively far from both the heel and calf and has the poorest blood supply of any part of the tendon, and is referred to as the "watershed area" because of the poor blood supply. For this reason t is more easily injured and takes longer to recover from the day-to-day stresses of walking and running. 

Most Achilles tendon ruptures happen in a tendon that was already chronically injured and weakened by the combination of poor circulation and daily stresses to the tendon by tight calf muscles, non-supportive footwear or excessive walking, running or jumping activity.  Many injuries happen with "weekend warriors" who put more stress on the Achilles than it is ready for. 

Most people have described a torn Achilles as being hit on the back of the leg by a ball or bat or being kicked. Many people turn around looking for someone or something that they think hit them. When the tendon ruptures there is brief intense pain followed by swelling and bruising to the ankle and inability to push off the ground with that foot. There may be a dimple or soft spot in the back of the ankle. 

In the case of a suspected Achilles rupture, do not put weight on the foot. Weight bearing may cause the ends of the tendon to separate from each other, making repair and healing more difficult. Use crutches or a similar device to stay off it and get to an Urgent Care or your Podiatrist as soon as possible. At our office we examine ruptured Achilles tendons with ultrasound technology which allows us to see the extent of the rupture. 

Treatment may be either casting or surgery. Surgery is more common today than casting. Surgical repair of ruptured Achilles tendons utilizes many newer biologic graft technology and produces excellent results. In days' past professional athletes careers ended after an Achilles injury. Today they are postponed but most are able to return to professional competition. Regular people with Achilles injuries are able to resume their pre-injury lifestyles with surgical correction

By Clement Foot & Ankle
January 27, 2015
Category: Public Heath
Tags: Winter Health  

Each season brings its own activities and weather, and therefore extra risks for injuries. An estimated 440,000 people are treated for winter sports-related injuries at emergency departments across the United States on a yearly basis. This represents a 500 percent increase in emergency room visits. While Mesa residents may enjoy warmer winter temperatures, vacationing in colder areas can bring sprains, strains, fractures and dislocations.

Stress fractures are common foot-related injuries. These occur when you engage in high-impact activities, such as running, or walking Winter Sports Injurieson slippery surfaces. If you have experienced a fall recently and experience symptoms including swelling, redness, bruising and pain in your foot, you may have experienced a stress fracture. Often, the pain will be on the top of the foot and will worsen with activity.

You may also change up your footwear in the wintertime. Breaking in new shoes or wearing older, worn-out shoes for winter sports activities can both cause injuries. Examples of injuries include blisters, plantar fasciitis or toenail-related injuries, such as ingrown toenails. Your footwear should be supportive and the appropriate size - too-big footwear can be just as harmful as too-small footwear. If you have a question if your footwear fits well, we are happy to assess your shoes at our Mesa, AZ office.

Some treatments for foot-related injuries and problems include resting your foot and taking an over-the-counter anti-inflammatory medication, such as ibuprofen. Other options include applying an ice pack to your injured foot for 10 to 15 minutes at a time to reduce swelling. However, if your pain continues to worsen or does not improve with time, make an appointment with Dr. Clement.

For more information on preventing winter sports injuries - or if you have experienced an injury and need medical assistance - please call your Mesa, AZ podiatrist, Clement Foot and Ankle, at (480) 985-3730.

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