LP LogoTechnology & Technique

Podiatric medicine is an ever-evolving field, with new tools and ways of approaching foot conditions every year. Louisville Podiatry keeps up to date with the latest proven methods…

Keeping up to Date

Medicine is both art and science. New methods of treatment, tools for treatment and surgical techniques are constantly developed and re-evaluated. Constant research and communication with other medical professionals keeps Louisville Podiatry able to provide the best modern options, while decades of experience help mold those options into the best personalized treatments available.

Below are samples of newer technologies used at Louisville Podiatry:

Heel Pain Center

There are many types of conditions which cause heel pain.

Children's Heel Pain

Children may develop pain often associated with running or sports between the ages of 8 to 14. This is called Sever's disease or calcaneal appophysitis and is discussed in the common foot problem section. This condition usually responds very well to foot orthotic therapy and allows children to get back to their sports right away.

Adult Heel Pain

Adult heel pain is one of the most common problems seen in podiatry offices. The pain can com from a number of conditions. The most common are plantar fasciitis-fasciosis which is seen as pain along the bottom of the heel, those pains due to nerve injury or entrapment (such as tarsal tunnel syndrome, and lastly pain in the back of the heel.

Plantar Fasciitis or Fasciosis

Pain in the bottom of the heel is most often caused by inflammation or disease of the plantar fascial ligament, referred to as plantar fasciitis or plantar fasciosis. The plantar fascia is a heavy-duty ligament which runs from the bottom of the heel and fans out to Insert into the bases of the toes at the ball of the foot. Plantar fasciitis refers to inflammation of the ligament in it's earlier stages. Plantar fasciosis refers to degeneration of the fascia in it's later, more chronic states. When people bear weight, excess stress is placed on the ligament which shows up as pain, usually at the insertion into the heel bone. This can affect many different groups from competitive athletes to sedentary people. It becomes more common with overweight persons or those with tight Achilles tendons. It can affect persons with flat feet (which cause stretching of the ligament) or high arches (often have a higher impact in gait). Heel spurs may be present, however, these are usually not felt to be the actual cause of the pain, but rather a finding on the X-ray that is often seen associated with the inflamed ligament.

Nerve injuries as a cause of heel pain

Heel pain can also results when the posterior tibial nerve or it's branches to the heel become injured or entrapped with tight ligaments or scar tissue. This may be referred to as tarsal tunnel syndrome, which is similar to the carpal tunnel syndrome found in the wrist. This may be aggravated by people who pronated (arches flatten) excessively. Foot orthotics, injections, cryosurgery or open surgery may be used to relieve these conditions.

Pain in the back of heel

Pain in the back of heel may be cause by a bone projection or spur, or by inflammation of the Achilles tendon when it inserts into the back of the heel bone. X-rays or an imaging ultrasound examination are necessary to diagnose these conditions.

Depending on the condition and severity, foot orthotics, injections, casts or open surgery may be necessary.

The Initial Examination and Treatment:

When patients present with heel pain it is common to perform an imaging ultrasound examination to determine if the ligament is swollen. Treatment for plantar fasciitis-fasciosis is initial conservative and is usually successful 90% of the time. Initial treatment may include taping, cortisone injection, foot orthotics (custom molded inserts), stretching exercises. We are usually able to give relief to your heel pain on the initial visit.

Rarely, there will be some that do not respond to conservative treatments and will require surgery by releasing the plantar fascia ligament or removing a heel spur if present. While this is by far the exception, it should be noted that no treatment works 100% of the time.

Computerized Orthotic Lab

Our practice utilizes the latest in high-tech computerized gait analysis. This technology is the latest and most advanced method to analyze your biomechanics which start with your feet and how they function. Many common conditions we treat can often be linked to abnormal foot function resulting in foundational changes and imbalances which lead to stress points in the musculoskeletal system.

Metascan Diagnostics

The Metascan diagnostic system is simple, innovative, high tech, user-friendly and grounded in well-researched principles. It provides an efficient, highly accurate and scientific means of patient assessment. The proprietary software is unmatched in its clinical diagnostic capabilities and interactive patient education.

Metascan V5 software consists of dynamic, static and postural visual analysis capabilities. The software allows for comparison of scans, pre and post diagnosis and therapy in the various applications.

Metascan Dynamic

Our Metascan dynamic software scans the foot 150 times per second tracking 8 key points along the plantar surface of the foot. Our dynamic display captures bilateral plantar pressure during the stance phase of gait. Gait observations show each of the 8 key points relative to pressure and time in a colour corresponding to the 2D and 3D composite image and displays gait analysis data. The Full Normal Graph compares the patient�s 8-point graph to a normal graph of the stance phase of gait. The Metascan diagnostics translates the digital information along with the clinician information into a prescription for custom orthotics.

Metascan Static

Static scans capture bilateral plantar pressure distribution. The scanning technology can be incorporated into various balance testing, training and therapeutic protocols depending on the clinical approach. The scans can identify muscle/skeletal anomalies such as leg length discrepancies. Can also be used to assess the efficacy of orthotics, lifts or postings using comparison side by side scans.

Gait & Pressure Analysis

The Metascan 8-Point Gait and Pressure Analysis Report provides the practitioner with a unique dynamic analysis tool for the diagnosis and treatment of the aberrant foot function. Using the same scan data which is used to create the composite and frame images in the Metascan client software, the 8-point analysis gives specific information on the distribution and timings of pressures through the different areas of the foot and compares them to normal.

Custom Orthotic Products

The Metascan software analyzes the frame-by-frame distribution of plantar pressures throughout each individual foot. It uses the number and distribution of data points, as well as the magnitude and temporal patterns of the pressure points to calculate a set of key parameters. Through the use of tested and proven algorithms, these and other parameters are used to determine the configuration of the orthotic modules. Algorithms were developed based on pattern recognition of various functional foot abnormalities. The overall aim of the orthotic therapy is to normalize the biomechanical patterns of the feet. This is one of the parameters that Footmaxx uses to determine orthotic module shape.

Universal Ultrasound

What is Ultrasound Imaging of the Musculoskeletal System?

Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use ionizing radiation (as used in x-rays). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.

Ultrasound imaging is a noninvasive medical test that helps podiatrists diagnose and treat medical conditions.

Ultrasound images of the musculoskeletal system provide pictures of muscles, tendons, ligaments, joints and soft tissue throughout the body.

What are some common uses of the procedure?

Ultrasound images are typically used to help diagnose:
  • tendon tears, such as tears of the plantar fascia in foot or Achilles tendon in the ankle.
  • abnormalities of the muscles, such as tears and soft-tissue masses.
  • bleeding or other fluid collections within the muscles, bursae and joints.
  • small benign and malignant soft tissue tumors.
  • early changes of rheumatoid arthritis.

How should I prepare?

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined. You may be asked to wear a gown during the procedure. No other preparation is required.

What does the equipment look like?

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.

The ultrasound image is immediately visible on a nearby screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer.

How does the procedure work?

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency (whether the object is solid, filled with fluid, or both).

In an ultrasound examination, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off of muscles, bones, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images.

How is the procedure performed?

For most ultrasound exams of the musculoskeletal system, the patient is seated on an examination table. For some ultrasound exams, the patient is positioned lying face-up on an examination table that can be tilted or moved.

A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. Dr. Mauser then presses the transducer firmly against the skin and sweeps it over the area of interest.

When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, Dr. Mauser is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately.

This ultrasound examination is usually completed within 15-30 minutes but may occasionally take longer.

What will I experience during and after the procedure?

Most ultrasound examinations are painless, fast and easy.

After you are positioned on the examination table, Dr. Mauser will apply some warm water-based gel on your skin and then place the transducer firmly against your body, moving it back and forth over the area of interest until the desired images are captured. There is usually no discomfort from pressure as the transducer is pressed against the area being examined.

If scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.

Dr. Mauser may ask you to move the extremity being examined or may move it for you to evaluate not only anatomy but also function of a joint, muscle, ligament or tendon.

Once the imaging is complete, the gel will be wiped off your skin.

After an ultrasound exam, you should be able to resume your normal activities within a few hours.

Who interprets the results and how do I get them?

Dr. Mauser is specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician or the physician who referred you for the exam, who will share the results with you. In most cases Dr. Mauser can discuss results with you at the conclusion of your examination.

What are the benefits vs. risks?

Benefits
  • Most ultrasound scanning is noninvasive (no needles or injections) and is usually painless.
  • Ultrasound is widely available, easy-to-use and less expensive than other imaging methods.
  • Ultrasound imaging uses no ionizing radiation.
  • Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
  • Ultrasound causes no health problems and may be repeated as often as is necessary.
  • Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspiration.
  • Unlike the strong magnetic field of magnetic resonance imaging (MRI), ultrasound is not affected by cardiac pacemakers, ferromagnetic implants or fragments within the body. Ultrasound is also an excellent alternative to MRI for claustrophobic patients.
  • Ultrasound may actually have advantages over MRI in seeing tendon structure, which is better appreciated by ultrasound than MRI.
Risks
  • For standard diagnostic ultrasound there are no known harmful effects on humans.

What are the limitations of Ultrasound Imaging of the Musculoskeletal System?

Ultrasound has difficulty penetrating bone and therefore can only see the outer surface of bony structures and not what lies within. For visualizing internal structure of bones or certain joints, other imaging modalities such as MRI are typically used.

Digital X-Ray

What is a digital X ray?

Digital radiography is a form of X-ray imaging, where digital X-ray sensors are used instead of traditional photographic film. Advantages include time efficiency through bypassing chemical processing and the ability to digitally transfer and enhance images.

Are digital dental x rays safe?

In fact, digital X-rays use up to 90 percent less radiation than film X-rays. While conventional dental X-rays are relatively safe, digital radiography is an excellent option for those who take X-rays on a regular basis or for those who are concerned about radiation.

What is Digital Radiography (DR) Technology?

The easiest way for most people to relate to this advanced technology is to first think of the older film based personal cameras.

Before the digital age, people had cameras that had to be loaded with bulky rolls of film, that not only were difficult to load; but you were unable to manipulate, delete, or view each image after taking it. You didn't know if the image you had captured really represented what you wanted it to, or if the picture was exposed or lit correctly.

When you finished the roll, because you didn't want to waste the expensive film; the film had to be safely removed so it was not exposed to any excessive light take the roll to be developed using a process that took a long amount of time and involved environmentally harmful chemicals; all before you could see your finished product - the picture.

Once you had your pictures back to look at it was important for you to make sure the film the pictures were developed from was kept safe and dry in storage for future reference.

What a process!

With the introduction of digital technology you now take your picture, view it within seconds, manipulate it, and even have the option of sharing it electronically with friends and family. All without the use of environmentally damaging chemicals, expensive film and the commitment of storing your processed film.

Advances in technology and decreased costs of digital sensors have allowed this digital imaging process to be applied in the medical field in many formats.

Louisville Podiatry • (502) 458-8989 • 2525 Bardstown Road, Louisville, KY 40205