Dr. Doug Cutter: Foot problem needs to be evaluated

Q. My daughter is a 15-year-old soccer player who has had right foot pain for more than three weeks. She also runs track and she believes she may have first injured her foot when she ran in a track meet.

Since then, she experiences pain on the inside of her foot while running and kicking the ball. It occasionally swells on that side of her foot. She is starting to limp while at school. Should she just ice, elevate, and wrap it, or do you think this needs to be seen by someone?

A. Because she is having pain with the activities of daily living, i.e., walking around at school, I think she needs to be evaluated by a physician for either a significant tendon injury or possible stress fracture in her foot.

If the pain is on the inside (medial) side of her foot, the posterior tibialis tendon could be involved. A worse scenario would be either a fracture or stress injury to the navicular bone in her foot, which would prompt either a cast or possible surgery depending upon the severity of the injury. This injury needs to be seen by your doctor sooner rather than later because of the possible navicular involvement.

Q. I have had chronic Achilles tendinitis for more than six months with a very slow but steady response in physical therapy. I want to get back to running soon but I do not want this problem to return. Are there any alternative ways to treat chronic tendon injuries other than months of physical therapy?

A. There are a few new approaches in treating chronic tendinopathies that are being looked at across the country.

A treatment called low energy shock wave therapy (SWT) in conjunction with eccentric loading of the Achilles tendon in physical therapy seemed to promote a quicker response than either treatment alone.

A newer approach called platelet-rich plasma therapy has shown promising results in treating some chronic tendinopathies, including Achilles tendon injuries.

This treatment involves withdrawing some of the patient's blood, spinning it down in a centrifuge, and then removing the thin layer of concentrated white blood cells and platelets that is found between the spun-down red blood cells and the plasma. This supernatant is then injected into the injured tendon under ultrasound guidance to ensure proper placement.

The procedure is repeated one or two times. The effectiveness is based on the high concentration of growth factors that are found in the platelets. These growth factors promote a healing response that has been shown to be effective in treating chronic tendon injuries. More research is being done on this treatment but it may be common in the future.

Using a nitroglycerin patch has shown some promise in treating lateral epicondylitis, but I am not sure whether it has been tried on Achilles tendon injuries yet. The nitroglycerin promotes blood flow and the healing response but the side effects of headache and a quick drop in blood pressure have limited this application with tendon injuries.

Physical therapy still is the gold standard but newer treatments coupled with physical therapy may offer quicker solutions in the future.