If you notice pain or stiffness in your heel during activity, plantar fasciitis could be the culprit. Understanding the sources of plantar fasciitis can help ease the symptoms of this condition and prevent it from recurring.


Common Causes

Plantar fasciitis is caused by swelling of the fascia, a band of muscle tissue at the bottom of the foot, connecting the heel bone to the toes. This tendon can become inflamed with overuse, causing the symptoms associated with this condition. This injury is most common among: long-distance runners, especially those who run uphill or on uneven surfaces, people who are obese, particularly if they've gained weight suddenly, individuals who spend long hours on their feet, such as factory workers, and those who have started a new type of exercise, notably after a period of inactivity. Inflammation of the fascia can also be caused by poorly fitting shoes and by the natural anatomy of the foot, such as flat feet, high arches, or a tight Achilles tendon.

This condition is most common among those ages 40 to 60, although earlier onset may occur among athletes and others in high-risk categories.


Symptoms & Diagnosis

While there are many potential sources of foot pain, plantar fasciitis is often characterized by sharp pain that's worse first thing in the morning or upon standing after you've been sitting for an extended period. If you suspect you have this condition, it is recommended to have a full exam conducted to make a diagnosis. In some cases, X-rays are required to confirm the swelling of the fascia.



The good news is that although painful, this condition is quite treatable. In many cases, patients see relief with a combination of over-the-counter pain medication to reduce inflammation, stretching exercises, splinting the foot at night, resting the foot whenever possible, and icing the affected area twice a day for 15 minutes. Wearing shoes with good support is also essential.

In more severe cases, casting, steroid shots, or custom-made orthotics may be required to relieve plantar fasciitis symptoms.

By Dr. Donna Barrese
October 18, 2016
Category: podiatrist

Foot X-Ray - Donna Barrese, DPM East Windsor Lawrenceville Foot & Ankle

The foot is a complex anatomical structure that supports the rest of the body. Its mechanics enable a broad range of actions including standing, squatting, walking, running, dancing, jumping, and more.

A crushing foot injury can affect bones, joints, muscles, tendons, and ligaments. Diagnosing crush-type injuries requires great care to ensure every part of the foot is fully considered before beginning a treatment plan.

What Is A Crush Injury?

A foot injury can happen in many different scenarios, from something heavy falling onto the foot to an automobile accident trapping it and creating excessive pressure. It is a complicated injury that can result not only in broken bones but also soft tissue damage. Because nerves and muscles may also be affected, it's important to seek care for such an injury right away. A qualified physician specializing in podiatry – the branch of medicine that deals with the foot's anatomy and care – can fully assess the injury, treating it immediately and recommending an ongoing course of treatment until the foot has healed.

Examining and Treating a Foot Injury

A podiatrist will perform a thorough examination. This may include taking X-rays and possibly other forms of imaging, such as computerized tomography (CT) or magnetic resonance imaging (MRI). During the exam, the podiatrist will also do a visual inspection and conduct checks of the circulatory system, nerve sensation, and motor function.

If any fractures are detected, treatment may vary based on several factors. These include which bones are broken, the extent of the injury, what existing medical conditions the patient has, and whether or not a skin wound is present.

Treatments for fractures can involve buddy taping with an adjacent toe, casting, or surgery. Any wounds that are present will first need to be cleaned and bandaged to prevent infections.

Recovery and Therapy

Patients will need to follow doctors’ instructions carefully for the best possible outcome. Home care may include elevating the foot to minimize swelling, keeping wounds clean and dry, and taking pain medication to prevent infections.

Once the foot injury has healed, therapy may be required to regain any lost range of motion. Strength building may also be part of the regimen. Follow-up visits will be scheduled to monitor progress.


Ankle sprains occur when ligaments in the ankle are stretched beyond their limit, causing a tear. This type of injury is very common and usually happens as a result of falls, sports injuries, exercising on an uneven surface, and other situations and physical activities that may cause the foot to twist or turn in an awkward way. Most ankle sprains are minor injuries, requiring rest and ice packs for recovery, but some sprains can be severe and cause long-term joint pain and damage if not treated immediately by a medical professional.


Degrees of Ankle Sprains

There are two types of sprains that determine which ligaments are stretched and torn. The more common inversion sprain occurs when the foot falls inward and the outer ligaments are affected. In this case, the foot goes outward, causing tears and pain on the inside of the ankle.

The degree of an ankle sprain is determined by the severity of the injury. The three degrees are as described:

First Degree: The ligaments are stretched but are not torn. This will lead to mild pain and swelling. The joints will experience some stiffness and while a person will be able to walk, there will be some limping and difficulties in jogging, jumping or any other activity that places pressures on the foot.

Second Degree: This common injury includes a partial tear in the ligament. The ankle will experience some swelling and bruising. Moderate pain will be accompanied by some difficulty in walking and moving the ankle.

Third Degree: This is the most severe degree of sprains and requires immediate medical attention to prevent long-term foot damage. A third-degree ankle sprain is identified by severe swelling, extreme inability of motion in the foot, and significant pain and difficulties while walking.


To Care for a Sprain: Remember RICE

A person can use the mnemonic RICE to remember the steps to effectively treat an ankle injury:

R: Rest. A person must avoid pressure on the foot and ankle for the first 24 to 48 hours after the injury.

I: Ice. An ice pack should be applied in 20-minute intervals for the first two days.

C: Compression. This is to reduce swelling. An elastic bandage should fit snugly around the injury.

E: Elevation. The ankle should be elevated above chest level to reduce swelling and subsequently alleviate pain.


A person should not ignore a sprain and should generally consult a doctor after an injury. To prevent long-term disability, they should seek immediate medical attention if they are unable to move the foot, they experience severe pain or numbness in the foot, or symptoms do not improve after two weeks.


By Dr. Donna Barrese
June 27, 2016
Category: treatments
Tags: toenail fungus  

Toenail fungus is a common condition that starts as a yellow or white spot underneath the nail. As it develops, it can cause the nail to thicken, become discolored, dull, misshapen, or crumbly at the edges. Toenail fungus can also cause the nail to detach from the nail bed, and patients with an infection may detect a foul odor from the infection site.


socksFungal infections are usually caused by the dermatophyte fungus, a microscopic organism that thrives in dark, damp environments. Toenails are particularly prone to fungal infections due to regular exposure to the moisture and darkness inside shoes and socks. Also, toes receive less blood flow than hands and fingers, which makes it more difficult for the body’s immune system to ward off an infection in the area.

Older people are more likely to develop toenail fungus since poor blood circulation often occurs with advanced age. People with diabetes, lowered immune function, and other conditions that cause poor circulation are also at higher risk. Additionally, frequent and heavy perspiration and walking barefoot in damp communal areas, like gym showers and swimming pool areas, increase the risk of exposure.

Toenail fungus may or may not cause pain, but the condition can spread, and even if treatment is successful, the patients often experience a return of the infection. A severe fungal infection in the toenail can cause permanent damage to the nail and cause other infections that spread beyond the feet.

If your condition is mild, self-care strategies and over-the-counter anti-fungal medications may help. To help reduce your risk, keep your feet clean and dry and wear moisture-absorbing socks, such as wool or nylon. Wear open-toed shoes whenever possible and discard old shoes that may harbor fungi. Wear flip-flops in any communal showers, locker rooms, and pool areas, and keep your toenails short and dry. If your condition is more severe or causing pain, other treatments are available from the podiatrist, such as nail removal or laser therapy.





The Achilles tendon, running from the heel bone up to the calf muscle, is one of the longest tendons in the body. It gets its name from ancient Greek mythology. The hero Achilles was dipped into the River Styx, which was said to offer the powers of invulnerability, by his mother, and his entire body became invincible. Every part that is, except for his heel, which was held by his mom as she dunked him in the magical water. He grew up to be a legendary warrior, but this small area led to his downfall when he was shot in the ankle with a poisonous arrow during battle.


Achilles Injuries

Like Achilles, athletes and especially runners are prone to injuries in this tendon. Achilles tendon injuries can occur when a person increases the intensity or duration of their training, particularly when it comes to running. Also, adding elevation or sprints to a running routine can increase the probability of Achilles tendinitis.



What can be done to prevent this serious injury? Prevention starts with proper preparation. Simply developing a walking routine for a few minutes before training can help stave off injuries, as this will warm up the calves and ensure blood flow through the legs, which helps prevent calf tightening. A proper warm up is important because tight calves lead to tendon tugging, over-stretching, and even twisting.
Along with a pre-run walk, another way to prevent injury is to keep calves strong. Calves need to be able to withstand the pressure that comes with long, intense runs. To strengthen the calves, doctors recommend toe raises. To perform these exercises, athletes should rise on the balls of their feet and slowly lower their heels back to the ground.


To combat Achilles heel pain, quick and proper action can help the area heal and reduce the chances of an Achilles tendon rupture. At the first feeling of prolonged pain, it is important to wrap the affected area with a compression sleeve to keep swelling down and provide support. Next doctors recommend that sufferers attempt low impact activities while keeping the area iced and elevated. Massage therapy also facilitates blood flow to promote healing.
Should symptoms remain, the injured person should see a podiatrist to customize footwear and an exercise routine to help strengthen calf muscles. Also, if symptoms get worse, or if there is a sharp pain in the lower back, it is likely that the tendon has ruptured. Unfortunately, the only effective Achilles tendon rupture treatment is surgery.
Whether preventing or treating an Achilles injury, regular visits to a podiatrist will help strengthen lower extremities.

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