April 2012 - Advanced Physical Medicine
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Neuromas and the Foot

Ouch! It feels like I am walking on a pebble!

A neuroma (also known as Morton’s Neuroma) occurs when there is irritation (also called Perineural Fibrosis) around one of the nerves that is going to the toes.  The tissue that surrounds the nerve thickens up with fibrous tissue, almost forming a ball, and this can cause splaying of the toes (the toes can form a V). 

Presentation is simple...patients often come into the office stating that it feels like they are "walking on a pebble" or like their "socks are bunched up under their toes".  Symptoms include but are not limited to numbness, burning, or sharp pains that shoot to the toes.

This condition is aggravated by pointed and high heeled shoegear.  However, in the worst cases, the neuroma can become painful with all activities or shoes, and especially with prolonged weightbearing.

Typically, a neuroma can be diagnosed with a clinical examination by a podiatrist.  A neuroma is not visible on X-Rays because it is a soft tissue problem, which is generally not visible on plain film.  Diagnostic Ultrasound and MRI can be used to identify the neuroma and also to differentiate from other possible similar diagnoses, such as stress fractures, capuslitis, metatarsalgia, avascular necrosis, and plantar plate tears.

The treatment options for neuromas include the following: padding, orthotics, antiinflammatory medication, injections, and surgery.  Conservative therapies are always attempted prior to any surgical intervention.

If you feel that you have this condition or another foot problem, please contact Dr. Bender’s Advanced Physical Medicine office at 708-763-0580 (Oak Park) or 773-776-3166 (63rd St.) Dr. Bender is an instructor at William Scholl College of Podiatric Medicine and has been in practice for the last 11 years.

Surprisingly Good-For-You Foods

Some foods have received a negative reputation for being unhealthy when, in fact, they can be healthier than other foods if consumed in moderate proportions. Expand your eating and nutritional horizons by enjoying these beneficial foods.

Bananas Lead the List

Bananas have more calories and carbohydrates than other fruits, giving it a bad name as an unhealthy food. Yes, it contains 90-110 grams of calories but it definitely has lesser calories than a blueberry muffin. Bananas contain large amounts of potassium which plays a key role in keeping your muscles healthy and operating properly. Potassium can help decrease muscle spasms, keep joints lubricated and keep your heart beating properly. Bananas contain something known as a resistant starch that fills you up by acting as a natural appetite suppressant.

Potatoes are Winners

Potatoes are surprisingly healthier than you may think. A medium-sized potato contains 4 grams of protein, 10 percent of your daily iron requirement, and 70 percent of your daily vitamin A requirement. Potatoes are also an ideal food for weight management since they are low in calories. The skin of the potato has five grams of fiber which is a natural appetite suppressant. In addition to their weight management properties, potatoes contain large amounts of potassium and other phytonutrients, which can help with blood pressure regulation.

Bring on the Eggs

Eggs have been getting a bad rap for many years for containing high cholesterol in their yolks. On the contrary, recent research reveals that there is no connection between heart disease and eggs. Even though a single egg yolk contains a day's recommended limit for dietary cholesterol, the yolk provides the egg with its nutritional wallop. The yolk has large amounts of iron, zinc, choline, vitamin A, vitamin D and protein. The protein found in the egg yolk helps quench hunger by filling you up, making it an ideal food for weight management. One egg contains only 70 calories.

Let's Have Some Dark Chocolate

Chocolate has gotten a reputation for being an unhealthy food that can play havoc on any weight loss program. But if taken in small portions, chocolates can actually make you healthy. Dark chocolate contains a wealth of health-enhancing flavonoids and antioxidants that provide a number of health benefits. Health benefits include reducing high blood pressure, lowering LDL or harmful cholesterol levels, lowering the risks of developing stiffened arteries, and possibly preventing diabetes by enhancing insulin sensitivity levels.

Avocados Fit the Bill

We know that avocados contain fat. And that is true! But what not most of us know is that the fat in avocado is a monounsaturated fat, which is the healthy kind. This fat helps protect your cardiovascular system.

Peanut Butter is Surprisingly Good for You

Peanut butter has been associated with high fat and high caloric content. When eaten in moderation, a two-tablespoon serving of peanut butter can supply you with a healthy monounsaturated fat that fills you up. It helps with appetite regulation, making it another ideal weight management food. To keep the nutritional aspect, choose only natural peanut butters.


These surprisingly good-for-you foods can be added to your diet without ruining your low fat diet plan. You need not deprive yourself from these yummy treats because they're proven to have plenty of health benefits. If you want to know more about the nutritional values of the foods included in your diet, visit LowFatDietPlan.org.

The Top 3 Methods to Help Boost Poor Circulation

The human body comprises of many organs, which function via oxygen and other essential nutrients being supplied by blood flow. Poor blood circulation is reduced or limited flow of blood to vital organs. Left untreated, poor circulation may lead to many diseases and complications such as varicose veins, kidney damage or stroke and can even become life threatening.

The reasons for poor blood circulation are many. The most common ones are arteriosclerosis, poor nutrition, diseases such as obesity and diabetes, a sedentary lifestyle, smoking or inhaling smoke and stress.

Three of the most common ways to improve blood circulation are exercise, dietary interventions and technology based solutions.


Exercise improves blood circulation, to increase the pumping of blood by the heart.

The most popular exercises to boost circulation are day-to-day activities such as walking or riding a bicycle, when done regularly and systematically. A fast walk three to times a week for about half an hour or the same time cycling strengthen and enlarge the heart muscle, improving the pumping efficiency.

Muscle-toning exercises, such as flexing the foot at the ankle strengthen the muscles. Strong muscles pump more blood.

Healthy Diet

While research has not conclusively proven any food to cure poor circulation, some foods prevent blood clotting and poor circulation.

Salicylates, a natural plant-based chemical prevents blood platelets from sticking and retard the formation of blood clots. Foods rich in salicylates include ginger, turmeric, garlic and onion.

Foods rich in Omega-3 Fatty Acid inhibit clotting and decrease the production of the pro-inflammatory compound leukotrienes. Some Omega-3 rich foods include mackerel, salmon, walnuts, flaxseed, beans and olive oil.

Pumpkin seeds, soya based foods, sunflower seeds and sesame seeds contain phytoestrogens that improve blood circulation by increasing dilation and thereby expanding small arteries.

Red fruits and vegetables such as watermelons and tomatoes contain lycopene that prevent buildup of plaque.

Green tea and grape juice contain catechins that improve circulation by stifling the growth of arachidonic acid. The pro-inflammatory arachidonic acid makes blood platelets to stick together.

Foods Containing Vitamin B3 (Niacin), Vitamin C and Vitamin E improve blood circulation by strengthening the capillary walls and making the blood vessels wider. Example of foods rich in such vitamins are almonds, most nuts, green leafy vegetables, potatoes and carrots.

Technology Based Solutions

Improvements in technology now make it possible to improve blood circulation through artificial methods.

One common non-surgical intervention is Hydrotherapy or subjecting the body to hot and cold showers. Blood rushes in to the skin when it suddenly encounters the sensation of piping hot water. A sudden change to extreme cold water causes the blood to rush to the internal organs.

Also, circulation boosters are becoming increasingly popular. They use Electrical Muscle Stimulation to stimulate nerve ends in feet.

Another technique growing in popularity is Far Infra Red Heat Therapy. Far Infra Red (FIR) ray is the portion of sun’s heat that sustains life. FIR therapy is subjecting the body to such FIR rays, which penetrate 1.5 inches to the skin and warm up the cells. This causes the cells to revitalise and thereby stimulate blood circulation.


Jonathan is a freelance writer who knows people who suffer from cold feet and hands due to poor circulation.



Heel Pain in Kids...AKA: Severs Disease

As children start to get more active during the warmer months of the year, Severs Disease becomes a common issue for many young athletes.  Severs Disease, also known as calcaneal apophysitis, is a common inflammatory condition of the open growth plate at the heel bone or calcaneus. The heel bone and surrounding structures are still developing at this age range, and the extensive pressure (often repetitive in nature) as well as the position of the foot during many sports can cause stress at the heel bone.

This condition affects active children between the ages of seven and fourteen.  Children may limp or complain of heel pain that is worse when the heel is squeezed. Increased walking, running, or changing position rapidly can cause the pain. Addditonally, the child may start walking on their toes to avoid pressure on the heel. These symptoms may start with a new sport or at the beginning of a new season of an old sport.

The good news is that Severs Disease eventually resolves on its own, without treatment. However, many children are uncomfortable, and conservative modalities can be implemented sooner to make the heel more comfortable. Icing, rest, stretching, heel cups, orthotic devices (foot inserts), medication, and physical therapy are great ways to reduce the child's pain. X-rays are often taken at the podiatry office to make sure there are no other reasons for the child's heel pain. Occasionally, other radiological or laboratory tests will be ordered.

For active children in this age range, prevention is also important. Stretching, supportive and properly fitting shoes, maintaining a healthy weight, and orthotic devices for children with flat feet or other foot deformities are helpful preventative measures.

If your child has this condition, please schedule your appointment with Dr. Mary Ann Bender, the foot and ankle specialist at Advanced Physical Medicine. Dr. Bender is a clinical instructor at William Scholl College of Podiatric Medicine and has office hours by appointment at the APM locations in Oak Park and on 63rd Street in Chicago. Please call 708-763-0580 for your appointment.

10 Tips for Sticking to your New Diet

Starting a new diet? Congratulations! Now you just need to stick to it, right? Sure, that's the hard part . . . but you can make it a lot easier by following some simple strategies. Here are ten tips to sticking to your new diet:

The right diet. Before even attempting a diet, do your research and choose a meal plan that works for you. To commit to a diet that goes against your constitution is to set yourself up for failure.

The right mindset. Diet is a four-letter word. Drop the "D" word and instead think of your new eating plan as a healthy lifestyle change - a lifestyle change that will open a whole new world to you.

Inspire yourself. Before you start your diet, create an inspiration board of quotes, pictures, reasons you want to diet and anything else that you can turn to for inspiration when you're facing a diet rut.

Cheat. One of the most important things you can do to ensure your dieting success is to give yourself a cheat day. Not only is this a great reprieve from the discipline of dieting all week, but it is also necessary to keeping your body's metabolism up. If you don't take one day to eat whatever you want, your body will go into starvation mode and work against your efforts to lose weight.

Record your progress. Keep a simple daily chart and mark it with something positive (a smiley-face or star, for example) every day that you follow through with your plan. Seeing those symbols stack up is proof of your determination, and a great motivation to keep going.

Meal prep. Do your grocery shopping once a week and prepare whatever meals you can in advance. When you have everything you need on hand, then you will be less likely to make choices that don't fit into your diet "just because" you don't have time to shop.

Team up. Choose a reliable partner who has similar weight-loss goals to yours and commit to reporting to each other on a regular basis.

Clean out your kitchen. Go through your refrigerator and cabinets and throw out everything that doesn't fit into your new diet.

Watch where you eat. When you eat in front of the television or at your work desk, it is easy to focus on anything other than how much you are eating. Avoid the slip-up of overeating by sitting down at a designated eating area during meal time, so that you are conscious of how long and how much you eat.

Pay attention. Your body will tell you when it's hungry. If you learn to listen to your body's signals, then you will realize the difference between comfort eating and hunger eating.

You can stick to your new diet. It will just take some consideration and preparation. Ensure your best chances by using these tips.


About the Author: Loria Louise recently dropped 76 pounds and has never felt better. She's now in a phlebotomist training program and feels healthy enough to pursue a lively career in healthcare!

5 Remedies for any Sleep Problem

The majority of people will experience sleep problems at some point and for most these are usually short term. Here are five remedies that can assist with any sleep issues you may be having.


The warm bath is a favourite pre-bed relaxant for many people. Try to take a bath at the same time every evening and do not have the water too hot as this will increase the circulation in the body. Because the body temperature drops at night, a bath can help to ensure warmth when going to bed. Baths are also good for relieving some of the muscular tensions that can build up during busy days, especially around the neck and shoulders. There are many products available to help you relax in the bath. Lavender appears to aid sleep and is available in a number of bath products. Sandalwood is thought to relax the nervous system and increase melatonin (which regulates sleep cycles) levels in the brain. After a long soak in the bath, curling up in a comfortable bed is a must and for those who are considering buying a new double mattress, try out as many beds as you can to get a feel for which mattress suits you.

Sleep Supplements

A number of people find these helpful with short-term sleep problems. They often contain natural products such as valerian. As a medicinal herb, valerian has been around since the time of the Ancient Greeks and Romans. Although there is some scientific evidence that it can assist with sleep, there is not enough evidence available yet for this to be conclusive.

Caffeine and Sleep

Caffeine is not only a stimulant, it is also thought to have diuretic effects that cause the kidneys to increase urine production. As well as tea and coffee, caffeine is in many soft drinks, chocolate and is often a flavour in foods. Some people avoid caffeine altogether to promote better sleep. But for those who may be reluctant to do this, setting a cut-off time of 2pm or 4pm for caffeinated products is a good idea.


Warm milk is the traditional bedtime drink and it can help with sleep, as it can warm the body up. Milk contains a tiny amount of melatonin and a small amount of an amino acid called tryptophan, which are both help in getting to sleep. Although the amounts are tiny, warm milk may also be of psychological importance because it is a traditional comfort food. For those who are not keen on milk, a little vanilla or cinnamon can make it more palatable.

Food and Sleep

Easting food before bed can cause some people to have a restless night or suffer from heartburn, whereas for others it can help them to settle. Eating causes the body temperature to rise slightly, so for those who often feel cold at night a snack can help. A sandwich, banana or a small bowl of wholegrain cereal such as wheat or oats may be suitable. Heavy, spicy or sweet foods should be avoided before bedtime. If a short-term sleep problem becomes longer term, then it may be time to speak to a doctor or other health professional as it is often an indication of underlying health issues or stress.


Zoe is an avid health blogger and freelance writer and loves to share her knowledge on health and sleep through content on the internet. Tweet your thoughts on this article to @bloggingstyle.

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