FUNCTIONAL MEDICINE FOR CHRONIC FOOT AND ANKLE PAIN
Treating chronic foot or ankle pain requires an understanding of how the human body works. Chronic pain exists for a reason(s). It is NOT caused by an immune system gone haywire. There are always underlying mechanisms that are the proximate or contributory causes of the pain syndrome. When treating chronic pain, it is absolutely critical that we not get caught up in suppressing the symptoms, but rather investigate and find the reason(s) why the pain persists and the immune system is unable to heal the problem.
In so doing, I employ a functional medicine approach. This approach involves two main areas. The first area of investigation is to rule out any structural or functional issues of the foot, ankle and leg (the walking engine) that are putting undue stresses on the involved tissues. Our initial examination looks at both structure and function of the lower extremity (biomechanics) in order to uncover and address dysfunctions in the foot’s ability to work as an efficient shock absorbing/propulsion engine. If these exist, they must be addressed first. Think of it as a patient who suffers from chronic headaches and is banging their head on the wall thousands of times daily. Until the banging is stopped, treating the symptom (headache) is doomed to fail.
The second main area of investigation is looking at physiologic/metabolic contributors to the pain. This involves an assessment of all body systems in an attempt to find the burdens on the immune system’s ability to carry out efficient homeostasis (this being the pathways that work to keep us healthy). Homeostasis is active primarily while we sleep and includes the following pathways –
- Detoxification – all cells of the human body build up metabolic by products that must be eliminated in a timely fashion. These by products, known as free radicals, are positively charged ions that must be neutralized. These ions are missing an electron and, as such, require an electron donor to neutralize their charge. The electron donors are known as anti-oxidants because they are negatively charged (they carry an extra electron) which will neutralize the free radical. If the free radical is not neutralized in a timely way, the ion will look to neutralize its charge by stealing electrons off of local cell membranes, thus disrupting the cell membrane integrity and creating cellular damage.
- Repair – every day we experience cellular stress and injury albeit often without even knowing it. It is the job of the immune system to identify these areas of cellular injury and repair them as quickly as possible.
- Replacement – there is a given lifespan of each cell of the human body. Eventually every cell of the body will die and needs to be replaced. Homeostasis will work to remove dead cells and replace them with viable living cells.
- Replenishment – in addition to the aforementioned, the body must also work to replenish hormones, enzymes, neurotransmitters, endorphins, carrier molecules, etc. in order to allow for the efficient functioning of the human body. Whatever has been “used up” must be replenished in a timely fashion.
- All four of these daily jobs of homeostasis are actually part of a system known as primary inflammation. Yes, inflammation. Primary inflammation, when efficient, will not lead to a pain syndrome since the repair of the injured cells is being managed in a timely way. However, what happens when the physical or metabolic stresses on a cell are consistent and the primary pathway of inflammation cannot repair the injury in a timely way? The immune system will then recruit a pathway designed to protect what cannot be efficiently repaired. This pathway is known as chronic inflammation. The role of chronic inflammation is to prevent cell death by minimizing the functional and metabolic stress on these injured cells. Part of this pathway is PAIN. Pain alerts the brain to the problem so that, certainly in terms of foot and ankle pain, the gait can be adjusted in an attempt to off-load the injured area (what we call limping). So, as you can see, inflammation is not an accident. It is a directed response by the immune system to manage an on-going issue. This is why treating symptoms becomes a double-edged sword.
When we work to suppress the symptoms medicinally, we have 2 approaches. The first is to utilize anti- inflammatory drugs. They can successfully suppress chronic inflammation, thereby relieving pain. Unfortunately, these medications are not pathway specific and will also suppress primary inflammation (thus inhibiting efficient homeostasis). If the medicine being used suppresses primary inflammation, we do not improve the health of the patient. In fact, we interfere with efficient detoxification (and must monitor the liver for signs of toxicity) and we impair the body’s ability to repair the injured cells thus creating a much more chronic issue over time. The other medication option is analgesics. These medications can block the pain response but have a number of complicating factors associated with them. One is that in suppressing pain but not solving the cause of the condition, a patient will begin to return to “normal” function, thus stressing the injured cells even further without realizing it. Additionally, these medications are toxic to the human body and elevate the toxic stress of every cell which adds another challenge to the pathway of detoxification. Of course, these medicines are highly addictive and can lead to decreased cognitive and motor functions, interfere with a positive life experience and in some cases, lead to overdose deaths. This is not, in my opinion, a way to solve the presenting problem. It is critically important to improve the efficiency of the immune system to IMPROVE the health of the patient, not place more burdens on an already burdened system. An understanding of each person’s epigenetics (diet, lifestyle and environmental influences on the body) must be assessed so we can understand why the patient is suffering with a chronic problem that the body cannot seem to manage successfully. This may include lab tests, dietary assessments and lifestyle adjustments. Each arm of homeostasis may sometimes require analysis to find the culprit. In addition, correcting poor sleep patterns are critical as homeostasis is primarily at work while we sleep.
HOMEOPATHIC INJECTION THERAPY
In an era dominated by the side effects and toxic load of pharmaceutical medicines, The Chronic Foot Pain Center specializes in the administration of safe, natural homeopathic medicines in injectable form. These medicines enable us to selectively stimulate and support the essential physiologic pathway(s) needed for a complete healing. Due to their natural supportive properties, homeopathic medicines foster healing by enabling the body to increase its efficiency in dealing with pathologic states, unlike drugs, which are used to suppress natural body functions, invariably interfering with the body’s ability to heal itself.
Sarapin® Injections For Chronic Foot and Ankle Pain
Preventing medication toxicity is of paramount importance in this office. I always look to utilize natural medicines before resorting to any kind of drug therapy. Sarapin® is an injectable analgesic indicated for the management of muscular or neuropathic pain that may be treated by local infiltration or nerve block. The distillate of a suspension of powdered Sarracenia purpurea (Pitcher Plant), SARAPIN® has been used safely and effectively for pain management by physicians for over 70 years. Although the mechanism of action of SARAPIN® is unknown, its analgesic properties are thought to be the result of its selective effect on the C-type nerve fibers. This targeted action effectively manages pain by acting on the sensory nerves, without any effect on motor nerves, with no tissue destruction or systemic reactions, and without any change in skin sensation. In cases where symptom relief is essential, we can use Sarapin® safely while we are working to uncover all of the aforementioned contributors to the pain syndrome. It is important to note that chronic pain will elevate stress hormones and elevations in stress hormones actually can suppress many important functions of the immune system. Relieving pain in a safe, non-toxic way makes the most sense.
Amniotic Fluid Allograft Injections
For many patients, chronic pain can be the result of arthritic, degenerated joints which, unfortunately, may be beyond repair. An arthritic joint has lost some or all of the cartilage surface which enables joints to function. The cartilage provides a gliding surface for bones to move and range of motion to be maximized. Arthritis is the end result of long term chronic inflammation. Many physicians will opt for medicating their patients in an attempt to decrease their pain. However, as with all pain syndromes, we want to identify causes and manage them. To decrease or eliminate the joint pain, I utilize amniotic fluid allograft injections. This is naturally derived, human amniotic tissue which, when injected into a joint, creates a smooth gliding surface and can dramatically reduce the joint pain. It is extremely safe and does not contain any synthetically created compounds that can cause allergic reactions. The allograft of amniotic tissues is collected from donors during planned caesarian births without harming the mothers or infants. Donors and the tissues are screened to ensure health and they are cryopreserved until needed for treatment. While its effects are not permanent, it can be repeated safely when needed.
HERBAL & NUTRITIONAL MEDICINES
Nutrition plays a vital role in overall health and well-being. Our diet and lifestyle can sometimes be the cause of our pathology. The Chronic Foot Pain Center analyzes our patients’ diets; relates it as to cause and effect; and educates and enables our patients to become responsible so that their diet and lifestyle can be an important part of their healing. By using herbs, essential nutrients, vitamins and minerals as biologic response modifiers, we can ultimately achieve internal balance and facilitate homeostasis. These natural medicines may also be employed to facilitate healing of foot and ankle surgery or trauma. This has been a highly overlooked part of medical protocols and one that we use to augment our homeopathic injection regimes.
CBD OIL AS AN ANTI-INFLAMMATORY PAIN RELIEVER
As I have already discussed in previous sections, one of the goals of helping patients in chronic pain is restoring efficiency to the pathways of homeostasis. This critical issue is the foundation of most of my therapies. We now have a revolutionary way of supporting all of my efforts with a product whose design by nature is to do just that. CBD oil, derived from the variety of Cannabis species called Hemp, enables us to deliver a natural, side-effect free, medicinal approach to supporting homeostasis. Hemp, although classified in the same species as Cannabis Sativa (the plant that gives rise to what we all know as marijuana), is high in CBD but contains almost no THC. It is the THC that has a psycho-active effect and causes the “high” associated with smoking and ingesting it. Since CBD has all of the medicinal properties of medical marijuana without the THC, there is no associated high with its use. As such, it does not require a medical marijuana prescription and is legal in all 50 states.
How it works: In our bodies there exists an intricate system of receptor sites that function as a “signaling” system. These receptor sites combine to form what is know as the Endocannabinoid System. Our bodies naturally produce compounds known as endocannabinoids which bind to these receptor sites and regulate different biological processes, particularly the pathways of homeostasis. The phytocannabinoids found in Hemp are strikingly similar to our own endocannabinoid compounds and have the same effect when they bind to these receptor sites. CBD oil is one of these phytocannabinoids. When taken regularly, CBD oil supports healthy immune function and nervous system function and has been shown to reduce inflammation, pain, anxiety, depression, improve sleep, decrease seizures, control nausea (especially from chemotherapy) and also has many other benefits (such as it has been shown to restrict the growth of cancer cells, improve anti-bacterial and anti-viral activity, increase bone density, diminish symptoms of menopause and many others). All accomplished through its support of our natural homeostasis.
It is critically important to understand that not all CBD oil is alike. There are many companies marketing it so buyer beware! Since CBD is a large, oil-based molecule, it is not easily absorbed and assimilated for use by the body. How it is grown and prepared is of utmost importance. I am on the medical advisory board of a ground-breaking company that has created a product that is 99.5% pure CBD, contains no artificial additives and has been processed via nanotechnology, rendering the size of the CBD molecules down to 30 nanometers. In this form, it is completely absorbed under the tongue (effectively by-passing the destructive action of digestive enzymes) and gives us a predictable dose and a predictable outcome. Remember that CBD oil is not a drug and does not suppress any of the pathways of the human body. Therefore, we do not see side-effects but must be patient while the pathways of homeostasis are restored and that is when we start to experience the relief we seek. For some the effects come quickly. For others with a more burdened immune system, patience is extremely important. It will not provide “magic-bullet” relief like drugs can, but it is infinitely safer and works with the body instead of against it. Many of my patients have reported very positive experiences with the CBD oil we recommend.
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Biomechanics is the study of the structure and function of the mechanical aspects of biological systems, at any level from whole organisms to organs, cells and cell organelles. As it relates to foot and ankle pathology, it is the study of structure and function of the lower extremity. The foot is an extraordinarily complex system of bones, ligaments, joints, tendons, muscles, nerves and blood vessels. Each foot contains 26 bones for a total of 56 bones. This accounts for 25% of all the bones in your entire body. This relatively small appendage is responsible for supporting your entire body weight, balancing your body weight and weight bearing forces as well as propelling your body from one point to the next. Feet work very hard and are therefore very metabolically active. The thousands of steps we take each day can place 2 to 4 times body weight in pounds per square inch on your feet with every step you take. It is no wonder that nearly 90% of the population suffers from foot problems at one time or another in their lifetime.
It is critically important to assess biomechanics when working to understand the presenting symptom complex. My approach to treating chronic foot and ankle pain includes a thorough assessment of lower extremity structure and lower extremity muscular function as it compares to ideal normal. In order to begin treating most chronic pain syndromes that have poor mechanics as the proximate cause, returning function to as close to ideal normal as we can get it is the first step on the path to foot and ankle wellness. Imagine if you were suffering from chronic headaches and you banged your head on the wall thousands of times a day! It would be next to impossible to relieve the headaches. But if we put a cushioned helmet on your head, even if you continued banging your head on the wall, we would have a much better chance of curing your headaches. The same goes for feet.
Normalizing function via custom molded foot orthotics that are patient-specific and condition-specific is extremely important in the path to healing. Once we control abnormal forces and imbalances in the foot, we can begin to look for other causes of the symptoms if they exist. If not, we can treat the symptoms naturally by supporting and stimulating healthy immune system function.
TRADITIONAL PODIATRIC MEDICINE
A traditional approach to podiatric pathology may, at times, be the best initial approach to help get the patient back on the road to recovery. Prescription medication will be prescribed when it is deemed the most prudent approach. Routine foot care, orthotics, shoe therapy, strapping and padding and other traditional therapies are available at the center.
Better known as sonography, echography is radiation-free and can image soft tissues, which are unable to be visualized by conventional radiography.
LABORATORY ASSISTED MECHANISTIC DIAGNOSIS
Due to the fact that so much of our lifestyle and diet affects our overall health, it is important to assess our physiology beyond the usual medical blood tests. Here at the Chronic Foot Pain Center, we understand the intimate connection between nutrition, hormones, environmental stressors, parasites, oxidant stress, drug toxicity, genetics, etc. and our foot and ankle health (as well as our total health). The lab tests routinely done for our patients are designed to find answers to the question, “Why is the pain syndrome chronic?” These lab tests often uncover both the underlying cause of foot and ankle problems as well as other medical problems being experienced by our patients. In following our detective work to the source of the mechanisms of pathology, we leave our patients in a much better state of health.
Tendon, ligament and joint problems are a very common reason that patients seek podiatric care. Prolotherapy supplies us with a conservative, natural approach to repairing torn, inflamed or weak connective tissues. At The Chronic Foot Pain Center, we utilize injections of a naturally derived form of calcium, which when used to bathe the involved tissues, induces a proliferation of collagen in and around the area, thereby repairing and strengthening the involved tendons, ligaments and joint tissues.
MicroVas is a patented, non-invasive treatment device, that delivers a deeply penetrating electrical waveform, that drains the venous beds and raises oxygen levels in damaged tissue to accelerate healing. An important new tool in the treatment of pain and inflammation, neuropathy, non-healing wounds, repetitive motion disorders, sports injuries and many other conditions related to vascular insufficiency, MicroVas’ therapeutic effects are dramatic and long lasting. MicroVas uses a high energy electrical impulse to stimulate neuromuscular contractions that drive the venous muscle pump, improve the rate of perfusion of blood in areas fed by microscopic blood vessels, thereby stimulating angiogenesis (the creation of new blood vessels) and dramatically improving the body’s ability to heal itself.
PLATELET RICH PLASMA INJECTIONS (PRP)
PRP therapy offers a promising solution to accelerate healing of tendon injuries, connective tissue inflammations and osteoarthritis naturally without subjecting the patient to significant risk. PRP is an emerging treatment in a new health sector known as “Orthobiologics.” The philosophy is to merge cutting edge technology with the body’s natural ability to heal itself. Blood is made of RBC (Red Blood Cells), WBC (White Blood Cells), Plasma, and Platelets. Platelets were initially known to be responsible for blood clotting. In the last 20 years we have learned that when activated in the body, platelets release healing proteins called growth factors. There are many growth factors with varying responsibilities, however cumulatively they accelerate and facilitate tissue and wound healing. Therefore after increasing the baseline concentration of these platelets, we are able to deliver a powerful cocktail of growth factors that can dramatically enhance tissue recovery. When indicated, the procedure begins with a venipuncture and collection of the patient’s own blood. The vial is placed in a special centrifuge and spun at a specific centrifugal force for a specific time period. This causes a separation of platelets and plasma from other formed blood cells. The platelet solution is then drawn into a syringe for injection directly into the area of pathology.