X-rays of the hand, wrist, arm, foot, ankle, knee, or leg help determine
                                              whether a bone has been fractured or injured or damaged by
                                              conditions such as an infection, arthritis, or other disease.

                                              Other reasons for conventional X-rays on your feet include:
  • Evaluate changes in the bones caused by such things as an
    infection, arthritis, or other bone disease.
  • Help evaluate whether a child`s bones are growing normally.
  • Locate foreign objects (such as pieces of glass or metal) in a
  • To determine whether bones are properly set after treating a fracture and placing a cast on
    an arm or leg.

Pregnant women, especially those in their first trimester, are advised against having a CT exam or
any X-ray examination. Extremity X-rays usually takes only five to 10 minutes.

While extremity X-rays do a good job showing bone fractures or dislocations, they are not very
accurate when it comes to showing affected cartilage, tendons, or ligaments. A MRI or CT scan may
be prescribed



                              Musculoskeletal ultrasonography is a very powerful diagnostic tool for the  
                              diagnosis of wide array of foot and ankle problems. At Advanced Foot and
                              Ankle Specialists an ultrasound may be performed in the office to help
                              diagnose your foot problem. We use ultrasound typically for soft tissue
                              problems, not bone conditions. Typically the scan is performed by Dr. Bryan

Some of the foot and ankle disorders that ultrasound may be used for are the following:
  • Foreign bodies
  • Morton's neuroma
  • Soft tissue masses
  • Bursitis or capsulitis of the joints
  • Ligament injuries
  • Tendinitis or tendon tears
  • Heel spurs or plantar fasciitis
  • Tarsal tunnel syndrome
  • Ultrasound guided injection or aspirations

What is Ultrasound?

Most people know about ultrasound to image a baby or a gallbladder, but it has growing application
in musculoskeletal disorders. Ultrasound is based on sound waves. Sound waves are emitted from
a transducer probe that is applied to the body and these sound waves will past into the body and
then are reflected back to the transducer probe to be recorded. The recorded image is based on the
density of the object that the sound waves encounter. An object with a high density appears white or
brighter on the recorded image, while objects of low density will appear black or dark on the image.
Intermediate densities will appear gray. The sound waves are recorded back to the machine, which
will produce the image. This image will appear on our ultrasound screen and you the patient can
immediately see the area that the doctor is scanning and help to understand the problem you are
having. This helps in directing the appropriate treatment for your condition.

Ultrasound is completely safe and painless. It also has no contraindications. There is no problem in
having the examination if you are pregnant, have a pacemaker or other medical conditions that may
prevent you from having a MRI or CT scan. Ultrasound also does not produce any radiation as with a
CT scan or x-rays.

In preparing for the examination, you can eat and take your normal medications. The examination
will take from 45 minutes to an hour based on the area being scanned. It is advised that you bath
the day of the examination but avoid the use of any skin lotions or emollients. Also you should where
loose fitting clothing or shorts to make it easier to perform the examination.


                                        Extracorporeal Shockwave (ESWT)
                                        New Treatment Available for Heel Pain/Achilles Tendinitis

                                       What is ESWT?

                                       Extracorporeal shockwave treatment, also known as ESWT, is a non-
                                       invasive, non-surgical treatment option for the intense, persistent heel
                                       pain associated with chronic plantar fasciitis and achilles tendinitis.
                                       "Extracorporeal" means "outside the body". Shockwaves, also known as
                                       pressure or sound waves, are generated from a special ESWT device
                                       and focused onto the targeted tissue. The shockwaves are delivered
                                       outside the body to trigger an individual's own repair mechanisms. The
concept behind shockwave therapy in orthopedic disorders is that the shockwave stimulates and
reactivates healing to encourage revascularization and other elements necessary to advance
normal tissue healing. Additionally, shockwaves help to over-stimulate pain transmission nerves,
which can lead to a reduction in sensitivity and pain.

The doctors at Advanced Foot and Ankle Specialists have been performing ESWT since 2003 and is
now available as an in-office procedure.

What is plantar fasciitis?
The plantar fascia is a band of connective tissue on the plantar surface of the heel that plays a large
role in maintaining the normal architecture of one’s foot. Plantar fasciitis is a common clinical
condition caused by overuse or injury of the plantar fascia and is defined as traction degeneration of
the plantar fascial band at its origin on the medial tubercle of the calcaneus. Inflammation, fibrosis,
and decreased vascularization of the fascia occur, causing symptoms of heel pain. Other symptoms
that may occur include burning in the sole of the foot, recurring foot pain that is especially aching in
the morning or after sitting, or heel pain after beginning a new exercise routine.

What causes plantar fasciitis?
There are a number of predisposing factors, including foot pronation, obesity, poor fitting shoes,
minor trauma, occupational risks and change in exercise program. Although everyone is at risk,
plantar fasciitis is most commonly found in athletes, runners, overweight individuals, or those who
are required to stand on hard surfaces for prolonged periods of time. Although approximately
2,000,000 Americans suffer from plantar fasciitis ESWT is an appropriate treatment option in
approximately 5 to 10% of those cases, as the remainder of the cases can be adequately
addressed with more conservative therapies.

Who should receive ESWT for plantar fasciitis?
Prior to undergoing ESWT treatment, the patient must have been diagnosed with chronic plantar
fasciitis for at least six months. Only after the patient’s symptoms fail to respond to three
conservative treatments should ESWT be administered. Conservative treatments include rest,
physical therapy, heel cushions, non-steroidal anti-inflammatory drugs (ibuprofen, acetaminophen,
etc), cortisone injections, taping, orthotics, shoe modifications, night splinting and casting. In years
past, surgical intervention for chronic plantar fasciitis was required when these other treatments had
failed. Today, ESWT is available as an alternative, non-invasive treatment option.

Who should not receive ESWT treatment for plantar fasciitis?
Your health history should be reviewed with your doctor to see if this treatment is appropriate for you.
ESWT is not recommended for patients with certain conditions. Patients with pacemakers and
patients taking medications that may prolong or interfere with blood clotting (coumadin) are not
candidates for ESWT. Also, children or pregnant women are not considered appropriate candidates
for ESWT. ESWT is not appropriate for individuals suffering from acute plantar fasciitis.

What are the side effects of ESWT?
Compared to surgery, ESWT has fewer side effects and a much shorter recovery time. The most
common patient complaint is some minor pain or discomfort during and after treatment. Other side
effects might include minor skin bruising, reddening, or swelling of the treated area. However, these
possible occurrences usually resolve within a few days. The risks associated with surgery and
general anesthesia are eliminated.



                                  Both Advanced Foot and Ankle Specialists locations are furnished with
                                  state of the art autoclaves for the sterilization of instruments for minor
                                  procedures including:

  • Nail Surgery
  • Cyst Removal
  • Skin Biopsy
  • Soft Tissue Removal
  • Minor Bone Surgery
  • Treatment of Wounds
  • Tissue Repair from Trauma