drrobertkornfeld

Inspira Advantage Interview With Dr. Robert Kornfeld, D.P.M

Wed, 29 Oct 2025 14:14:22 GMT

Read My Interview With Inspira Advantage , A Leading Medical School Admissions Consulting Edtech Startup.

Dr. Robert Kornfeld, D.P.M, is the Founder of Chronic Foot Pain Center and Institute for Functional Podiatric Medicine . Learn more about how our consultants can help you get into medical school today.

What motivated you to pursue a career in medicine?

I was into running in college. I developed really bad heel pain. I went to a podiatrist and he diagnosed me, treated me and set me up with runner’s orthotics and it turned my life around. I really was impressed and decided that’s what I want to do.

Did you have any setbacks or rejections during the med school admissions process, and what did you learn from those experiences?

No. None. I was committed to being a podiatrist and was accepted to where I really wanted to go.

If someone wants to start their own practice, what does that path look like after finishing medical school?

Currently, private practice is discouraged and even shunned during residencies. I think that is tragic and unfair to doctors who wish to be in control of their practice experience. I have maintained a private solo practice for 43 years despite the brainwashing that you cannot survive privately, especially if you accept insurance. I do agree that private practice in an insurance-dependent practice is extremely challenging and requires huge volumes of patients daily to survive. But if anyone wants to succeed in a private practice, they must have a potent and powerful niche – one that gives patients a compelling reason to pay out of pocket because they cannot avail themselves of your services with an insurance doctor. My niche in functional medicine and regenerative medicine has enabled me to thrive without accepting any insurance since 2000.

What advice would you give to someone who’s looking to start their practice today?

If a doctor wishes to start their own private practice, I strongly urge them to investigate different niches and find one that resonates with their practice philosophy. Once you have trained properly in the niche, be willing to do the HARD work needed to make it successful. Making the commitment and being consistent is the key. Hard work is temporary and eventually nets an easy life. Looking for the easy way guarantees a hard life permanently. Most importantly, listen to your own desires and NOT that of others. Many people will criticize you and try to dissuade you from running your own autonomous practice that delivers complete freedom from the exploitative and abusive insurance-dependency system. Remain steadfast. You will come out way ahead in so many ways, especially your emotional and financial health.

Inspira Advantage are proud to interview experts like Dr. Robert Kornfeld, D.P.M to help future doctors understand the challenges and rewards of a medical career.

Functional Medicine for Chronic Foot and Ankle Pain

Tue, 29 Mar 2022 19:15:25 GMT

Functional Medicine for Chronic Foot and Ankle Pain

Chronic foot pain is not an uncommon malady. It has become more and more prevalent amongst the foot suffering population. Many of these patients have sought professional care and have received anti-inflammatory therapies (cortisone injections or prescription oral anti-inflammatory medications), physical therapy, orthotics and surgical procedures. Yet, in spite of all of this, there is a growing number of patients who “do not respond” to these traditional therapeutic approaches. Many are labeled “difficult patients who can’t be pleased” and others just seem to fall through the cracks of our current medical system.

Is it the therapies that are faulty? Afterall, these traditional approaches do help the majority of patients. It is not fair to condemn the therapies themselves. The fault lies in the lack of trying to ascertain why these patients do not respond to these oft successful procedures. In other words, we need to know not only what the diagnosis is (to be certain there was not a misdiagnosis), but also to understand each one of these patients’ unique epigenetics, genetics and the current health of their immune system to uncover the reasons why they are struggling to heal.

This approach to understanding each patient’s unique physiology and how it intertwines with their total health and the ability of the immune system to maintain homeostasis is called functional medicine. Patients experiencing chronic pain have a reason for the pain syndrome and a reason why they have not responded to conventional therapies. Let’s look at a case on a patient of mine so it becomes clear and easier to understand.

Our patient, a 52-year-old female, presented to her original primary care doctor with heel pain that had been present for three months and did not seem to be showing any signs of letting up. She was referred to a podiatrist who took an x-ray and diagnosed her with a heel spur. He administered a cortisone injection, prescribed an oral, non-steroidal anti-inflammatory medication and told her to stretch her calf 3 times daily. She was told to return in two weeks. Upon her return to the doctor, she reported a 75% decrease in the pain intensity and frequency. She received another cortisone injection and was told to continue the oral medication and the calf stretches. She was told to return to the office in two weeks. After experiencing no pain for a week (even after taking long walks), she canceled her follow up appointment and stopped taking the medication.

One week after discontinuing the medication, her pain returned, only it felt more intense than it had originally. Frustrated, she went to see the podiatrist again, who assured her that she simply stopped taking the medication too soon. He renewed her prescription and also gave her a third cortisone injection. She was told to return in a month. When she returned, she again reported feeling better but there was not 100% improvement. The doctor told her she needed orthotics and that would solve the problem. She was casted for the orthotics and was told they would be in the office in approximately 3 weeks. During that time, she continued stretching her calf and taking the medication.

She returned to the podiatrist to have the orthotics dispensed. She reported some good days and many more bad days in spite of the medication. Some days she reported her pain as low as 3/10 and some days 7-8/10. To sum up her situation thus far, she had received 3 cortisone injections in her heel, was taking oral medication for 6 weeks and was stretching her calf every day. The doctor told her to break the orthotics in slowly over the course of a week and to return if there were any issues. No treatment was rendered. She was just told to stay on the medication.

She returned one week later with a report that the orthotics made her pain much worse and she wasn’t able to wear them more than 3 hours a day. The doctor now seemed visibly annoyed with her and told her that he will adjust the orthotic. He came back into the treatment room, handed her the orthotics and told her to try them for two more weeks.

She returned to the office in two weeks, still asserting that the orthotics make her pain worse and she can’t wear them. She had now been on the prescription medicine for 9 weeks. Her pain levels persisted as before. The doctor gave her another cortisone shot and gave her a prescription for physical therapy. He told her to return for a follow up appointment in two months.

One month into physical therapy, she began feeling sick in her stomach every day. After 4 days of not feeling well, she went to her internist. After his exam, he suspected that the oral medication “wasn’t agreeing with her” and told her to stop taking it. He also did some blood work which came back two days later with elevated liver enzymes. Her internist told her it was from the medication but it should return to normal if she doesn’t take it. After discontinuing the medication, her stomach issues persisted and the heel pain was much worse again.

In frustration, she decided to get a second opinion and called my office. After she related the prior 6-month history of her problem and all related treatments, I started my consult with a review of systems. This means we ask questions about every part of her body to find out if there are any obvious struggles in her physiology. This patient admitted to poor sleep (had trouble falling asleep and woke up often during the night), she suffered with moderate and occasionally severe anxiety, felt bloated and gassy after eating, had a chronic low back pain syndrome, and stated that in addition to the foot pain she was suffering, her feet were always cold (sometimes painfully cold). She also stated that she only drank 1-3 glasses of water daily. Right off the bat, these are signs that this patient has problems that could very well affect the efficiency of the immune system. Poor sleep is a big one because it is during sleep that the body works to maintain homeostasis by repairing injured cells, replacing dead cells, detoxifying all of the cells in the body and replenishing what has been used up (e.g. hormones, enzymes, neurotransmitters, immune cytokines, carrier molecules, etc.). Someone who does not sleep well often has a very difficult time healing compared to the general population. Anxiety is often caused by elevations in adrenal hormones and/or imbalances in inhibitory and excitatory neurotransmitters (the chemical messengers of the nervous system). Both of these issues have direct inhibitory effects on the immune system and can make it very difficult for the repair and detoxification pathways to function properly. Couple this with the fact that the patient was taking anti-inflammatory medication which directly suppress the pathway of chronic inflammation causing her pain, but also inhibits the pathway of primary inflammation, which is the 4 arms of homeostasis - repair, detoxification replenishment and replacement.

The gas and bloating is another sign of possible impaired healing since most chronic GI symptoms have a direct relationship to immune activity (since ¾ of the immune system is found in the GI tract). Her chronic low back pain may be coming from the same cause as her foot pathology or it might be influencing the way she walks and hence putting more stress on her foot and is an important part of this functional medicine differential diagnosis. Her cold feet (known as Raynaud’s Disease) is a critically important finding for foot pathology, especially since connective tissue has no direct arterial blood flow. These tissues are fed by microscopically small capillaries. Raynaud’s Disease is a syndrome where these microscopic capillaries go into spasm, essentially reducing blood flow to the inflamed and injured tissues. Without adequate blood flow, nothing can heal. Finally, inadequate water consumption is a huge factor in healing since almost all chemical reactions in the body require water.

So, without even examining her foot, I was already seeing numerous reasons for her inability to respond to conventional therapy. The examination revealed a biomechanical issue called functional hallux limitus, which is a condition that usually worsens with an arch support type of orthotic (exactly what her first podiatrist gave her). A sonogram revealed inflammation and a small partial tear of her plantar fascia (the arch supporting ligament), which in all likelihood was caused by the steroid injections. Steroids are fibrolytic and are known to weaken ligaments and tendons. They are much more likely to cause this in patients with poor microscopic blood flow since they are unable to detoxify and remove the steroid that was injected into the area in a timely way, hence increasing the time it has to weaken the ligament. This is why her pain levels began to increase in spite of “treatment”. The heel spur had nothing to do with her pain. The spur is a symptom of extraordinary stresses on the plantar fascia which was obviously inflamed and the cause of her original pain.

Sleep disturbances, anxiety and Raynaud’s are all often due to adrenal/neurotransmitter issues, so I prescribed an adrenal stress test (saliva samples) and a neurotransmitter assay (urine sample). We also find that stress hormones or an excitatory neurotransmitter dominance can cause slow digestion as these hormones are designed to slow metabolism to preserve energy during times of stress. She had shared all of these symptoms with her internist who prescribed an SSRI called Xanax for her anxiety and Ambien for her sleep. She did not feel well taking the Xanax and did not like waking up groggy from the Ambien so had not really used these medications in quite some time. In addition, stretching only one muscle group (the calf muscles) can cause more functional imbalances since the muscles of the lower extremity are synergistic. A full lower extremity stretching regimen was prescribed to her to increase flexibility, assist with filling the muscles with more blood and facilitating release and elimination of built-up toxins in the muscles. She was also instructed to increase her water intake by one glass/day/week so that by the end of 6 weeks, she would be consuming about 8 glasses of water a day. Water is introduced slowly since the body is compensated to function without it. That is why people who don’t drink enough water are not often thirsty. Too much too soon just sends the patients scrambling to find bathrooms all day. Once the body begins to use the water, then these patients report that they are now experiencing thirst throughout the day.

The lab results revealed serious elevations in her cortisol levels as well as elevations in two excitatory neurotransmitters, Glutamate (the primary excitatory neurotransmitter) and Epinephrine (which is responsible in many patients for peripheral microscopic vasospasm). It is postulated that these imbalances cause anxiety and sleep problems. However, it is also entirely possible that chronic anxiety and sleeplessness causes changes in adrenal and neurotransmitter behavior. These changes are part of a primitive survival mechanism and are activated in times of danger. For example, our long-ago ancestors had to fear being eaten by animals. When presented with this danger, the adrenals release cortisol which is a hormone designed to extract sugar out of our cells and deposit it into the bloodstream where it can be quickly pumped to the muscles used for defense (either the arms to punch and protect or the legs to run away). They are quickly pumped as the epinephrine does two things. First, it speeds up the heart rate and second, it steals blood from the hands and feet to be able to pump larger amounts of blood to the arms and legs (thereby producing cold hands and feet). This is commonly known as the fright, fight and flight response.

In modern life, we are bombarded by stress in the form of family issues, war, murder, crimes against our homes, TV news, politics, noise, financial stress, drugs, etc. This chronic form of stress mimics what happens when our ancestors were able to escape the beast and hide in the bushes. Once safe in the bushes, they had to stay put until the beast left the area. This meant that they couldn’t go feed themselves since leaving their hiding place in the bushes made them vulnerable to attack. Physiologic changes must be induced by stress hormones, one of which is to suppress thyroid function and slow the basal metabolic rate. This preserves calories and energy while the person is unable to go find food. In addition, sleep becomes dangerous because in deeper levels of therapeutic sleep, you would not hear the beast sneaking up on you. So, sleep cycles must change. Lighter sleep is a hallmark of this syndrome. Finally, because there is no food coming in, digestive enzyme secretions begin to diminish, thus preserving the enormous amount of energy expenditure required for digestion. But if this is a person from today, they will continue to eat and suffer from slow digestion leading to all kinds of varied GI symptoms.

For this patient, the adrenal/neurotransmitter issue was addressed with Targeted Amino Acid Therapy. This is a completely natural approach to correcting this, thereby increasing blood flow in the foot and coincidentally improving her sleep disorder, reducing her anxiety and GI symptoms. Once she reported improvement in these symptoms and I knew the immune system was more efficient now, we began a course of prolotherapy which is a non-surgical, non-steroidal injection technique that fortifies and strengthens ligaments and tendons and we were able to get the plantar fascia to heal. In addition, instead of the arch support, I made her a torsional foot orthotic which addresses the biomechanical problem more efficiently. Ultimately, this patient who suffered with chronic foot pain was able to heal and at the same time, have her overall health improve. This is the goal of functional medicine. We address the causes of the problem, the reason it is chronic by discovering burdens on the immune system and then correct them.

Dr. Robert Kornfeld is a holistic podiatrist life coach and based in NYC and Long Island. He practices functional medicine for chronic foot and ankle pain at The Chronic Foot Pain Center in NYC and Port Washington, L.I. ( www.drrobertkornfeld.com ) . For foot and ankle medical problems, he can be contacted at drrobertkornfeld@gmail.com . He is also the Founder of Change Your Story Coaching ( www.changeyourstorycoaching.com ) and assists people on their journey to making their dream life happen. Sign up for his email list and get all of his timely and informative articles in your inbox.

Are you ready to change your story? Change your life? Contact him today. For coaching, he can be contacted at info@changeyourstorycoaching.com .

Is It Healthy To Go Barefoot All Day — Or Should I Wear Shoes?

Thu, 22 Oct 2020 03:02:06 GMT

Is It Healthy To Go Barefoot All Day — Or Should I Wear Shoes?

Going barefoot in an office may be a bit of a faux pas, but kicking off your shoes at home is totally acceptable. While forgoing shoes is one perk of working from home, is it healthy to be barefoot all day?

To solve the question afoot, mbg spoke with a holistic podiatrist—here's what he has to say about wearing, or not wearing, shoes throughout the day.

Is it healthy to be barefoot all day?

While there are some benefits to walking barefoot, certain factors, such as a person's foot type, the time they spend standing, and the type of surface they're standing or walking on can make it not so healthy, says Robert Kornfeld, DPM.

There are two common foot-type classifications: rigid and flexible. People with rigid foot types have less of a problem walking barefoot on grass, carpet, or other soft surfaces. Whereas people with flexible feet function better on harder surfaces, like wood or tile, he explains.

Not sure which type you have? Take a look at your feet. Kornfeld says, if you have a high arch with contracted digits and a bump on the top of the foot, it's probably rigid. If you have a low arch, bunions, or hammertoe, it's probably flexible.

When the foot's anatomy clashes with the walking dynamics (i.e., surface, activity level, etc.), Kornfeld says it's time for support.

What happens if feet aren't properly supported?

"If the foot is pushed past its physiologic limits, then cellular injury can occur," Kornfeld says. Generally, a primary inflammation pathway in the body helps to repair and replace injured or dead cells. If the injury persists or the pathway is ineffective, it may lead to chronic inflammation and pain in the foot, Kornfeld explains.

Older adults or people with compromised immune systems from poor diet, dehydration, inadequate sleep, stress, parasites, or digestive orders, are at a higher risk of chronic pain syndromes, he adds.

One of the most common injuries from prolonged standing is plantar fasciitis, which is an inflammation of the ligament that supports the arch. "The band (the plantar fascia) supports four layers of muscles running from the heel through the arch of your foot to your toes," board-certified podiatrist Doug Tumen, DPM, FACFAS, writes for mbg. "Pain is usually felt where the plantar fascia attaches to the bottom of the heel bone."

Another common injury is inflammation in the ball of the foot, Kornfeld says. This can lead to the joint capsulitis, an overuse injury, or metatarsal bursitis, which leads to inflammation and pressure.

How to support the feet to avoid injury.

Because everyone's feet are different, seeing a podiatrist or physical therapist to determine the best plan of action for yourself would be helpful. A good rule of thumb, though, would be to go barefoot or wear slippers while sitting but a supportive shoe while standing. Kornfeld recommends a soft sneaker with orthotics in them, even at home.

If you already have plantar fasciitis, it's best not to go barefoot at all. "Slip your feet directly into a shoe when you get out of bed," Tumen says. "Continue to protect the heel until it gets better." This 15-minute foot stretch may also help.

Bottom line.

"In an ideal world, we would see far fewer foot problems if we were still walking barefoot on natural surfaces," Kornfeld says. "In more ancient, traditional, shoeless societies, this appears to be the case." However, since most people's feet aren't conditioned for that, providing support when standing is the safest option.

-Published on mindbodygreen.com

Is Your Salon Causing Toenail Fungus?

Tue, 01 Sep 2020 02:56:55 GMT

Is Your Salon Causing Toenail Fungus?

I have listened over the years as countless patients have told me horror stories about their experience at the nail salon, and how before going for pedicures, their toenails were clear and beautiful. You’ve thought about it, right? All of a sudden, your toenails are looking a bit yellow, thicker, maybe they crumble and break. Worst of all, they become painful.

Blaming it on your nail salon seems like the obvious thing to do. But is this really true? Are nail salons responsible for the epidemic of toenail fungus we now see in our society? Or, is it possible that this is entirely false, and the real cause of toenail fungus is something entirely different?

While it may seem to make perfect sense that nail salons are spreading the bug, inoculating a nail bed with fungal spores is not that easy and requires two simultaneous conditions. The first is the requirement that the nail bed would need to have been cut into in order to introduce the infecting organism into the nail bed. The second would be a compromised immune system that could not fight off the infection. Wounds of this type would more likely cause bacterial infection.

Since it is more common than not to see multiple toenails infected with fungus, can we blame your nail salon for causing injury to multiple toenails? Were they on a mission to inflict pain and suffering? Logic prevails when we ponder this. I have seen thousands of patients with all 10 toenails infected. Were these people left bleeding and wounded at the salon, sitting ducks for fungal infection?

I think you can clearly tell that I firmly believe that the causative mechanism of toenail fungus is not a bad pedicure. To be honest, these organisms are ever-present everywhere. So why do some people get infected while others do not? To answer this question, I think it is important that you drop the notion that fungus crawls under your toenail and infects it. It is rarely a localized phenomenon. Even in situations where a toenail fungus occurs after injury to the toe, I believe it is still not a localized problem.

In fact, it is my assertion that toenail fungus is actually the result of an internal fungal infection. One of the ways the human body deals with these organisms is to discharge them. Since your skin (and skin structures) is the largest organ of elimination, it is not surprising that skin and toenails are frequently affected. Interestingly enough, injured tissues are more metabolically active during repair processes and serve as great sites for the body to use for discharge.

So now let’s talk about what this internal infection might be and why certain people are prone to getting them. Toenail infections are borne out of an excess of fungi in the gastrointestinal tract that leads to eventual discharge into toenails. How does this occur? The answer is right at the end of your fork!

Let’s look at what is going on in the GI tract — the digestion and assimilation of foodstuffs. So, what is it about food that may be causative? The answer is that many foods contain high levels of fungus and the mycotoxins that they secrete. Once ingested, if conditions for their growth are present, they begin to populate the intestinal lining.

The foods that most often contain high concentrations of mycotoxins are grains, nuts, sugars and cheese. Grains such as corn, wheat, barley, and rye (and their flour derivatives) contain what is known as “universal contamination” because they contain so many different species of fungi. Sugars — including sugar cane, sugar beets and sorghum — not only contain the contamination, they fuel the growth of many of these fungi, because sugar is the food of choice for fungi. All foods high in sugars, including most fruit and especially fruit juices are included in this group.

Nuts and the oils produced from nuts are heavily contaminated, peanuts being the biggest culprit. The last food category on the list is cheese. Now, everyone knows that cheese will grow mold. If you can see the mold growing, you know that fungus is present throughout the cheese.

In fact, fungus is capable of easily spreading throughout the entire GI tract once it increases its colonization of the GI tract. Fungus is competitive with our healthy gut flora (beneficial bacteria) and will displace them in time. What assists fungus in their spread are acidic foods such as alcohol, beer, fermented foods and vinegar.

So now you know if your diet is high in these types of foods, you are making yourself highly susceptible to GI infestation of fungus which may ultimately create toenail fungus as the body tries to discharge it. Are there any other things that make you more prone to toenail fungus?

Yes, there are. For one, the cavalier use of antibiotics by the medical community does much to wipe out healthy gut flora and allow the overgrowth of fungus such as yeasts, molds and dermatophytes. Other issues, such as anti-inflammatory drugs which can create a leaky gut phenomenon (incompletely digested foods that enter the bloodstream) and suppress the body’s immune protection: immunosuppressive drugs, diabetes, chronic adrenal stress (which creates high levels of cortisol in the body that suppress immune system function), digestive disorders, food and environmental sensitivities, heavy metal toxicity and any other conditions or problems that misdirect or interfere with healthy immune system function.

So, I hope you see that the toenail fungus is often a symptom of a grander issue and by addressing these issues, we not only alleviate toenail fungus, but can actually help our patients improve their overall health.

Therefore, treatment is patient specific, and is dependent upon the mechanisms in that particular patient. Once those mechanisms are addressed, the toenail fungus can be treated with gentle, natural medicines which are far safer than the pharmaceutical drugs intended to eradicate fungus. Anti-fungal drugs have been implicated in liver inflammation/damage, kidney damage and retinal damage.

U nnecessary if the causes are managed since the mechanistic approach only requires, safe, gentle, natural medicines and supplements.

Functional Medicine for Chronic Foot and Ankle Pain

Mon, 20 Jan 2020 02:52:59 GMT

Functional Medicine for Chronic Foot and Ankle Pain

This approach to understanding each patient’s unique physiology and how it intertwines with their total health and the ability of the immune system to maintain homeostasis is called functional medicine. Patients experiencing chronic pain have a reason for the pain syndrome and a reason why they have not responded to conventional therapies. Let’s look at a hypothetical case loosely based on a patient of mine so it becomes clear and easier to understand.

Our patient, a 52 year old female, presented to her original primary care doctor with heel pain that had been present for three months and did not seem to be showing any signs of letting up. She was referred to a podiatrist who took an x-ray and diagnosed her with a heel spur. He administered a cortisone injection, prescribed an oral, non-steroidal anti-inflammatory medication and told her to stretch her calf 3 times daily. She was told to return in two weeks. Upon her return to the doctor, she reported a 75% decrease in the pain intensity and frequency. She received another cortisone injection and was told to continue the oral medication and the calf stretches. She was told to return to the office in two weeks. After experiencing no pain for a week (even after taking long walks), she canceled her follow up appointment and stopped taking the medication.

In frustration, she decided to get a second opinion and called my office. After she related the prior 6 month history of her problem and all related treatments, I started my consult with a review of systems. This means we ask questions about every part of her body to find out if there are any obvious struggles in her physiology. This patient admitted to poor sleep (had trouble falling asleep and woke up often during the night), she suffered with moderate and occasionally severe anxiety, felt bloated and gassy after eating, had a chronic low back pain syndrome, and stated that in addition to the foot pain she was suffering, her feet were always cold (sometimes painfully cold). She also stated that she only drank 1-3 glasses of water daily. Right off the bat, these are signs that this patient has problems that could very well affect the efficiency of the immune system. Poor sleep is a big one because it is during sleep that the body works to maintain homeostasis by repairing injured cells, replacing dead cells, detoxifying all of the cells in the body and replenishing what has been used up (e.g. hormones, enzymes, neurotransmitters, immune cytokines, carrier molecules, etc.). Someone who does not sleep well often has a very difficult time healing compared to the general population. Anxiety is often caused by elevations in adrenal hormones and/or imbalances in inhibitory and excitatory neurotransmitters (the chemical messengers of the nervous system). Both of these issues have direct inhibitory effects on the immune system and can make it very difficult for the repair and detoxification pathways to function properly. Couple this with the fact that the patient was taking anti-inflammatory medication which directly suppress the pathway of chronic inflammation causing her pain, but also inhibits the pathway of primary inflammation, which is the 4 arms of homeostasis - repair, detoxification replenishment and replacement.

The lab results revealed serious elevations in her cortisol levels as well as elevations in two excitatory neurotransmitters, Glutamate (the primary excitatory neurotransmitter) and Epinephrine (which is responsible in many patients for peripheral microscopic vasospasm). It is postulated that these imbalances cause anxiety and sleep problems. However, it is also entirely possible that chronic anxiety and sleeplessness causes changes in adrenal and neurotransmitter behavior. These changes are part of a primitive survival mechanism and are activated in times of danger. For example, our long-ago ancestors had to fear being eaten by animals. When presented with this danger, the adrenals release cortisol which is a hormone designed to extract sugar out of our cells and deposit it into the bloodstream where it can be quickly pumped to the muscles used for defense (either the arms to punch and protect or the legs to run away). They are quickly pumped as the epinephrine does two things. First, it speeds up the heart rate and second, it steals blood from the extremities to be able to pump larger amounts of blood to the arms and legs (thereby producing cold hands and feet). This is commonly known as the fright, fight and flight response.

In modern life, we are bombarded by stress in the form of family issues, war, murder, crimes against our homes, TV news, politics, noise, financial stress, drugs, etc. This chronic form of stress mimics what happens when our ancestors were able to escape the beast and hide in the bushes. Once safe in the bushes, they had to stay put until the beast left the area. This meant that they couldn’t go feed themselves since leaving their hiding place in the bushes made them vulnerable to attack. Physiologic changes must be induced by stress hormones, one of which is to suppress thyroid function and slow the basal metabolic rate. This preserves calories and energy while the person is unable to go find food. In addition, sleep becomes dangerous because in deeper levels of therapeutic sleep, you would not hear the beast sneaking up on you. So sleep cycles must change. Lighter sleep is a hallmark of this syndrome. Finally, because there is no food coming in, digestive enzyme secretions begin to diminish, thus preserving the enormous amount of energy expenditure required for digestion. But if this is a person from today, they will continue to eat and suffer from slow digestion leading to all kinds of varied GI symptoms.

For this patient, the adrenal/neurotransmitter was addressed with Targeted Amino Acid Therapy. This is a completely natural approach to correcting this, thereby increasing blood flow in the foot and coincidentally improving her sleep disorder, reducing her anxiety and GI symptoms. Once she reported improvement in these symptoms and I knew the immune system was more efficient now, we began a course of prolotherapy which is a non-surgical, non-steroidal injection technique that fortifies and strengthens ligaments and tendons and we were able to get the plantar fascia to heal. In addition, instead of the arch support, I made her a torsional foot orthotic which addresses the biomechanical problem more efficiently. Ultimately, this patient who suffered with chronic foot pain was able to heal and at the same time, have her overall health improve. This is the goal of functional medicine. We address the causes of the problem, the reason it is chronic by discovering burdens on the immune system and then correct them.

F or more information on this approach to chronic pain, you can go to drrobertkornfeld.com .

The Challenge of Statistical Analysis of Treatment Modalities

Mon, 20 Jan 2020 02:47:34 GMT

The Challenge of Statistical Analysis of Treatment Modalities

In the world of clinical medicine, it is important to qualify and quantify treatment modalities so we have a sense of what is most likely to succeed. Analysis typically includes the diagnosis, the age and sex of the patient, the height and weight of the patient, the type and age of the pathology and are, by design, a statistical analysis of what works and what doesn’t, all in the hopes of creating the most appropriate and successful therapies for a given condition.

Whenever I read a study or a meta-analysis on treatment modalities, the parameters used for evaluating the success or failure of a therapeutic approach seem to be always absent an extremely important facet of analysis - who is the patient? What are the specific genetic/epigenetic influences on the presenting pathology? What has been tried and failed? Even though we may see many patients with the same condition, the reason(s) they cross the morbidity threshold is unique to that patient. So when we undertake a conventional statistical analysis, we really don’t have an absolutely reliable understanding of why things work and why things fail. All we have are numbers and percentages to rely on. And therein lies the problem with traditional treatment and with traditional treatment analysis.

In my era of training, we were taught to make a diagnosis and then treat the symptoms. This is fine for that percentage of the population who at the time that treatment was rendered, responded to the applied therapy. But now that I have been in practice nearly 40 years, the flaws in this paradigm are glaringly obvious and somehow still seem not to get addressed. A patient with a chronic headache won’t respond to therapy if they keep banging their head on the wall. Instead of trying to come up with “better, more effective” treatment modalities, it behooves medicine to answer the question, “why did this patient not respond to conventional therapy”?

When we work to answer this question, then we enter the world of patient-specific medicine instead of trying to come up with a more effective therapy for this patient. This question can be answered when we understand as much as we can about this patient. In addition to the diagnosis, co-morbidities and what a review of systems reveals, we need to get a deep understanding of this patient’s physiology. That means we need information about their genetics as well as their diet, lifestyle and environmental influences on their genetics. We need to take a systems approach and evaluate the health of each system of the body, i.e. the immune system, the GI system, the endocrine system, the adrenal/neurotransmitter system and other nervous system functions, the vascular system, etc. We need to look at what immune burdens there are and how those burdens interfere with the maintenance of homeostasis in the body. Is the diet inadequate? Are there food sensitivities or vitamin deficiencies? Is the patient properly hydrated? Are there any hormonal imbalances? Is there a detoxification disorder? Are there digestion,abnormalities? Are there enzyme deficiencies? Is the patient sleeping well? Are they managing stress? Do they exercise? Are there any gene mutations? The list goes on. Getting this information reveals the reasons why this patient’s immune system is struggling to heal the pathology and why their condition is chronic.

When we address these burdens and correct them, we now have a more responsive immune system, one that is more efficient at detoxification, repair, replacement and replenishment. We now have a patient in better health and this has a profound effect on outcome. Realize that this approach does not conform to the evidence-based-medicine model. Why not? Simply because in working to achieve a healthier patient, we may change their diet, add more water, add some nutritional and/or herbal supplements, balance their adrenals and neurotransmitters, teach them sleep hygiene, put them on a stress management protocol, etc. and once the patient is in a better state of health, we can then employ treatment modalities that support natural human physiology and healing. This could include PT, homeopathic injections, prolotherapy, amniotic allograft injection, platelet-rich-plasma injections or mesenchymal stem cells. All of these approaches stimulate the healing mechanisms of the body. There is no way to employ a random controlled trial on a single agent vs. a placebo to prove efficacy since there are so many pieces to the protocol. All by themselves, each one will not get the patient healed. It is the multi-tiered, multi-faceted approach that gets the job done.

It is quite obvious that in spite of all of our medical technology and surgical expertise, there has been a steady rise in patient morbidity. We are seeing more conditions overall and more conditions that do not respond as expected. Chronic pain and disease are not a function of inadequate therapies. They are a function of modern living and the effect it is having on the human immune system. Refined foods, chemical preservatives, colorings, flavorings, artificial ingredients, GMOs, air and water pollution, stress, lack of sleep, poor relationships, prescription and OTC medications, etc have all combined to cause many “lifestyle” diseases brought on by inadequate nutrition, oxidative stress, hormonal imbalance, toxicity, enzyme deficiency, etc.

If we truly want to develop reliable and helpful analytics, it is time to include the patient in the equation so we can apply the most appropriate approach to THIS patient with the highest probability of a successful outcome. This means that a meta-analysis of anecdotal medicine will give us a more comprehensive and reliable approach to treating our patients once this approach becomes universally applied to patient care. It is both frustrating and disturbing to me how reluctant the traditional medical community has been to embrace this paradigm of patient care since I have been practicing this way for over 30 years and have witnessed the benefits first hand in thousands of my patients.

Dr. Robert Kornfeld is the founder of The Chronic Foot Pain Center with offices in Manhattan and Long Island. His 39 years of experience with a sub-specialty focus on the natural treatment of chronic foot pathology makes him uniquely qualified to assess and treat all kinds of chronic pain syndromes of the foot and ankle. To learn more, check out his website at www.drrobertkornfeld.com as well as his Facebook page at Chronic Foot Pain Center – Dr. Robert Kornfeld.

Treating Achilles Tendon Injury and Inflammation

Wed, 25 Sep 2019 02:44:05 GMT

Treating Achilles Tendon Injury and Inflammation

One of the more common, yet difficult conditions to treat is Achilles tendinitis. The Achilles tendon attaches the calf muscle to the heel. The role of the calf is to lift the heel off the ground. In order to do this, it must be strong enough to overcome gravity and the full weight of the body in order to lift the heel and propel body weight into the forefoot where the action of propulsion occurs. As such, it is the largest and strongest tendon in the body.

There are many different causes of Achilles tendon inflammation and because of the fact that this tendon is a workhorse, it can be very difficult to calm the inflammation and get the injured cells to heal. When the tendon is forced into a workload that is beyond its physiologic capabilities, cells in the tendon can be pulled and injured or even torn. Sometimes the tears are microscopic and continue to happen over time. Sometimes there are more traumatic and frank tendon tears or ruptures.

Sports and fitness enthusiasts (like runners) are more prone to frank tears and ruptures but also can develop microscopic tears that lead to chronic tendinitis. What is most important in assessing the cause of tendon injury is the level and type of activity as well as the type of training (stretching and strengthening). A thorough look at biomechanics is essential (structure and function of the lower extremity) to discover any functional reason why the tendon is under stress.

Non-athletes can, of course, also develop this condition from poor biomechanics. In addition, once injury has occurred, any immune burdens, circulatory disorders or nutritional deficiencies can impede healing. A comprehensive analysis is essential in treating this condition. We must identify the mechanism (cause) and anything that blocks healthy pathways of repair (diet, lifestyle, patient-specific physiology) and make those corrections. This may include temporarily immobilizing the tendon followed by functional foot orthotics, stretching and strengthening exercises, dietary changes, addressing immune burdens, and treating the cellular injury.

My preference for driving the repair of the cells is to utilize high voltage electrical stimulation which drives more blood into the tendon along with prolotherapy, which is an injection technique that fosters fibroblastic activity (the generation of new cells that convert to tendon tissue) thereby healing AND strengthening the tendon. Cortisone injections are not recommended in a tendon that has this level of physiologic load to deal with because cortisone is fibrolytic (thereby weakening the tendon) and can lead to doctor-induced tendon rupture.

H ealing of this type of condition must be methodical and the patient must be patient with the process. There is no rapid magic bullet. Seeing it through will not only heal the tendon but make future injury far less likely. Also, when we address mechanisms of pathology along with supporting the pathways that facilitate repair, we wind up with a healthier patient than we started with. That, in my paradigm, is the most important result.

Plantar Fasciitis: Overcoming Heel and Arch Pain Naturally

Wed, 25 Sep 2019 02:39:41 GMT

Plantar Fasciitis: Overcoming Heel and Arch Pain Naturally

Have you ever thought about the work your feet do every day? Those two small appendages at the bottom of your leg not only support a body which is comparatively massive in size but are also responsible for transporting that body approximately 2,000 miles per year. Your feet are the foundation of your physical form–literally the base on which you are built–but most people treat their feet as though they could unzip and detach them at the end of the day. We mindlessly abuse our feet until we are injured or in pain. Only then do we pay them their due respect.

Sadly, the prevalence of foot and ankle problems has skyrocketed over the past three decades. Millions of Americans suffer from foot and ankle injuries every year, and many people are experiencing these disorders at a much younger age than a generation ago. I’m sure many of you reading this are part of those statistics.

One of the most common foot maladies people suffer from is plantar fasciitis. This condition arises when undue stress is placed on the ligament in your foot that supports your arch–the “plantar fascia”. When that ligament is overworked it leads to the classic symptoms of heel and arch pain which worsens when you get up to walk after periods of rest.

Understand that this isn’t the kind of pain you experience after being on your feet all day at work or walking around Disneyland with your kids. The pain from plantar fasciitis is often intense and debilitating. It is also surprisingly common. Two million Americans suffer from plantar fasciitis every year and 10 percent of the population will experience it in their lifetime. It has become recognized as one of the most chronic and, often times, most difficult foot problems to treat.

Perhaps this is because few podiatrists take an integrative approach to foot problems like plantar fasciitis. Like most people, doctors typically think of the foot as somehow separate from the rest of the body–they focus on treating only the foot and don’t look at the other physiological systems or diet and lifestyle factors that go into creating these problems in the first place.

But your foot is connected to the rest of your body. If you want to heal a chronic foot problem, you need to treat your whole body. I have had immense success treating plantar fasciitis and other difficult-to-heal foot and ankle ailments in my practice using this kind of integrated approach. Understanding the concepts in this article is critically important if you are to heal your feet and put an end to the pain and debilitation of plantar fasciitis.

Inflammation: The Pathway to Foot Health and Illness

When your plantar fascia is stressed–whether you are beating it up with improper exercise, have a congenitally short ligament (which causes a “cavus deformity” or extremely high arch), or your calf muscle complex is too tight and thus pulling it in the opposite direction–the cells in the ligament become more metabolically active and cellular damage occurs.

When this happens, the immune system is recruited to help detoxify the cells and repair the injured and damaged ones. It does this via a cascading pathway known as primary inflammation. When this pathway is operating efficiently and it is able to properly handle the extent of the injury, you will have no symptoms or they will be minor. You may experience some slight pain and swelling in the area that has been affected. This will diminish rapidly (within a few days) as your injured ligament is repaired.

When the stress you have placed on your foot is greater than this pathway can manage, your immune system employs a different set of chemical responses and a different pathway is activated. That pathway is chronic inflammation.

Chronic inflammation is designed to protect your tissues when they are under extreme stress in the hopes of preventing permanent damage to your system. The problem with chronic inflammation is that when it is left unchecked it actually creates further damage and produces profound pain, swelling, heat, and other symptoms. This is usually when people wake up to their feet–when they are hobbling into my office.

The impact that inflammation has on the body is one of the most profound discoveries in modern medicine. Chronic inflammation can contribute to a host of chronic illnesses from heart disease, to diabetes, and more. It is also the driving force in plantar fasciitis.

But what’s most extraordinary about inflammation is that it can either heal your body or make you chronically ill. It just depends on which pathway is activated. In the case of foot disorders, primary inflammation is a powerful healer. So, my job as a holistic podiatrist is to stimulate the pathway to healing (primary inflammation) and block the pathway to plantar fasciitis and other forms of foot pain (chronic inflammation). We need to utilize the body’s inherent ability to detoxify and repair the cells that have been injured, while at the same time eliminating the possibility for further injury.

Understanding inflammation this way is a fundamental shift away from the way most conventional podiatrists understand and treat plantar fasciitis. The most common treatment for the condition is cortisone, a powerful steroid that blocks inflammation. The problem with cortisone is that it blocks ALL inflammation. Sure, it relieves the immediate symptoms of the problem. But it ultimately inhibits the body’s inherent mechanisms for healing itself.

This is further complicated by the fact that cortisone is “fibrolytic,” which means it can weaken fibrous tissue. All connective tissue–tendons, ligaments and joint tissue–is fibrous tissue. Your plantar fascia is fibrous tissue. So it’s not a great idea to take medications that weaken this tissue when you are looking to heal and strengthen your ligaments.

Put simply, cortisone cannot be relied on as an effective treatment. However, there are ways you can properly support the pathway to healing and overcome plantar fasciitis. Here’s how you do it.

Treating Your Feet from the Ground Up: Diet/Lifestyle Changes to Heal Plantar Fascitiis

There are two factors we need to consider when treating plantar fasciitis. The first are the “functional influences” on the foot–that is, the mechanics of how you use your foot and how that influences its health. The second is identifying burdens on the immune system that make primary inflammation less efficient.

There are many reasons the plantar fascia can become painful and inflamed. Common problems that contribute to the condition are:

Structural deformities
Repetitive stress injury
Muscular dysfunction
Positional deformities
Abnormal muscle sequencing
Improper or excessive exercise
Secondary muscular compensations

You need to identify and address which of these issues is leading to problems with your plantar fascia. The treatment will depend on exactly what you are doing to injure your foot. For example, if you are exercising improperly you can learn better technique. Additional common interventions include:

Stretching exercises
Therapeutic exercises
Orthotic therapy (extremely important if needed)
Yoga
Physical therapy

The goal is to correct these biomechanical problems to the degree possible. Once this is accomplished, we can focus on healing the inflamed and injured tissue without fear of continued stress and injury. That is where the second factor in treatment–metabolic influences–comes into the picture.

Remember, to heal your feet you need to heal your whole body. Supporting the pathway of primary inflammation means looking at the dietary, lifestyle, and environmental influences that positively and negatively affect it. Put another way, we need to make sure you are giving your body what it needs to heal itself.

Since all injured tissue (including your plantar fascia) requires oxygen and nutrients for healing, the first place to look for any nutrient deficiencies is in the diet. Here is what I recommend you do.

For one week, journal about your current diet. Take careful notes on everything you eat and drink. Don’t just try and keep track of this in your head. Write it down. This will give you a much better sense of what you are eating every day. Then you can assess if there are any ways you can optimize your diet. Do you eat too many refined carbs? If so, cut them out. Do you consume too much or the wrong kinds of protein? If so, cut back or focus on healthy proteins full of omega-3 fats like small wild fish, nuts, and seeds. Are you eating enough vegetables? If not, up your intake. You should be getting at least 5-9 servings a day.

In addition to optimizing your diet, I often recommend the following nutritional supplements to assist in the healing process:

Omega 3 fatty acids (from fish oil) – These help regulate the inflammatory process and support the pathway of primary inflammation.
Amino acids – The building blocks of all connective tissue are a base requirement for cellular repair processes.
Anti-oxidants – Prevent the buildup of free radical compounds in the area of chronic inflammation by taking these in supplement form and you will ward off degenerative changes in your tissues.
MSM – A form of dietary sulfur, this powerful supplement aids in the healing of inflamed connective tissue and helps strengthen those tissues.
Probiotics – These healthy gut bacteria are needed for the production of short chain fatty acids which literally feed your immune system and make all immune related activities more efficient, thereby reducing inflammatory pain.
Curcumin – This extract from turmeric, is a biological response modifier and bolsters primary inflammatory efficiency. It is a powerful anti-inflammatory.
Hydration - You will also likely need to increase your water consumption. Water is the essential environment for all metabolic processes in the body. Proper hydration facilitates cellular repair, and most people don’t get enough water. You should drink a minimum of eight 8-ounce glasses of water every day.

If you still have problems after taking these steps, the next thing you need to do is identify potential immune system challenges–factors that make your immune response less efficient than desired. This usually involves some laboratory work. Here are some of the tests I typically perform to help tease out these kinds of problems:

Food sensitivity tests – These tests are done to uncover the possibility of foods that are “irritating” to the immune system. These are not allergy tests. They are done to identify foods, which may be misdirecting the immune system and increasing inflammation in your body. Finding out which foods you are sensitive to and eliminating them from your diet will free your immune system to perform its regular duties more efficiently. I often see great improvement in healing stubborn conditions like plantar fasciitis by treating food sensitivities.
Lipid peroxide assay – This test will reveal whether or not your body is properly controlling the rate of formation or elimination of free radical compounds in your body. High levels of free radicals also serve to misdirect the immune system by triggering genes that lead to degenerative diseases, such as arthritis. What does this have to do with inflammation? Well, these genes are “turned on” by the chronic inflammatory pathway–the very same pathway that leads to plantar fasciitis and the debilitating pain it causes.
Fatty acid RBC assay – This is a comprehensive test designed to identify all of the fatty acids inside your red blood cells. The test does not determine what kinds of fatty acids are being absorbed into the bloodstream, but rather quantifies the levels of all fatty acids being utilized by each of your cells. This is important because fatty acids determine the type and efficiency of inflammation in your body.
Adrenal stress hormones – This is an important test to perform in individuals battling chronic pain. Stress hormones are nature’s protection against stressful life events. They help us adapt in life threatening situations by triggering the “fight or flight response”. But when we are running from danger or protecting ourselves against danger, the body turns all its energy to the task at hand and forgets about repairing injured cells, digesting foods, and other important activities needed for healing. When your stress hormones are out of balance and chronically activated, it becomes very difficult for your immune system to function optimally. That means you heal more slowly and your plantar fasciitis does not resolve as readily.

In some cases, it is also necessary to treat local inflammation aggressively when you have plantar fasciitis. But, cortisone is not my favorite medication for dealing with this condition. So when people are in extreme pain and need immediate relief, how do we help them?

We still want to foster primary inflammation, and I have found homeopathic injections extremely helpful in facilitating the healing of inflamed tissue in a localized way. Homeopathic injections stimulate your body to detoxify and repair cells in the area they are injected with absolutely no worry of further damaging your tissues the way cortisone can. Here is how it works.

Upon injection, homeopathic molecules bind to the tissue in the area they are injected into–in this case the inflamed plantar fascia. The immune system then reads that there is something there that shouldn’t be, and enables a primary inflammatory response to detoxify the tissues–the very response you want to encourage to heal plantar fasciitis. The beauty of this is that you get immediate temporary relief from pain while stimulating your body to heal itself at the same time. With continued treatment, the pain intensity and frequency begin to wane until healed. It’s a win-win treatment.

The reason plantar fasciitis is considered so difficult to treat is because the medications conventional medicine uses do not address the cause of the problem. The key is to identify and address issues in the whole body that are either directly or indirectly impacting the plantar fascia. Once you have done that you have a much better chance for healing than simply taking injections of cortisone or anti-inflammatories. These medications do not optimize health in any way, shape, or form, and they certainly don’t treat the cause of your foot problems.

I have been treating patients who come to see me with plantar fasciitis using the steps above for over 30 years. I have never seen any negative reactions, and most people get completely well. An occasional patient does not respond completely and then, of course, there are more aggressive therapies that I may employ.

You can take most of these steps on your own. Others you can work through with a practitioner of integrative medicine. But what you want to do is focus on treating the cause of your foot pain, not mask your symptoms with medications that may actually make the problem worse.

And who knows? You may see an improvement in other areas of your life as well. Every one of the steps in this article is part of a larger path toward improved health–not only for your feet but for your whole body. That, in my opinion, should be the goal of every doctor and patient in this country.

Remember, your feet are connected to the rest of your body. They may be way down there at the end of your legs, but they are no less a part of you than your brain or heart or lungs are. Take care of them and they will take you wherever you wish to go for many years.

Functional Hallux Limitus and Foot Pain

Wed, 25 Sep 2019 02:32:21 GMT

Functional Hallux Limitus and Foot Pain

One very common condition causing foot pain is called functional hallux limitus. Literally translated, it means that during function, the large toe has a limited range of motion. This is caused by a first metatarsal bone (the long bone behind the big toe) that is hypermobile (unstable). During the gait cycle, when the heel lifts off the ground and body weight is transferred into the ball of the foot, it is essential, for a stable and powerful stride, that the toes extend up as the body weight shifts forward. This extension allows for a greater arc of contraction so the muscles can pull our body weight with a more powerful force.

The design of the foot is such that the first metatarsal should carry approximately 70% of the weight load that transfers into the forefoot. To accomplish this, it must be stable and grounded. However, when this bone is hypermobile, it elevates under body weight which prevents the large toe from extending upward. This locking mechanism creates a weak pull from the big toe, leading to a number of needed compensations. Firstly, the smaller toes will be used to pull body weight forward. Unfortunately, the small toes have tendons that go to a shared muscle which has only half the power of the muscle that pulls the big toe down. As such, since the small toes are not strong enough to pull our body weight forward, this leads to a grasping phenomenon which can cause toe contractions and hammertoe deformities. In addition, the calf muscle begins to over-contract to “throw” the body weight forward to help with propulsion. The tightened calf muscle pulls hard on the Achilles tendon as well as the plantar fascia (arch supporting ligament) because they are all connected.

When the pull on the plantar fascia and Achilles tendon is increased by the calf muscle, there are extraordinary stresses going through this ligament/tendon complex and this can lead to cellular injury, hence we commonly see plantar fasciitis and achilles tendinitis. Additionally, because there is pre-mature weight transfer to the forefoot, we often see bursitis, capsulitis and/or plantar plate tears from the extraordinary stress coming into these tissues. When the stress on the ligament is consistent, the body will not be able to repair the cellular injury and instead will protect what it cannot heal through a pathway called chronic inflammation. This is the pathway that causes pain.

In addition, because the calf is also a knee flexor, we can develop knee flexion which renders the knees unstable and can cause joint damage over time. This instability can transfer up into the hips and pelvis, ultimately leading to hip and/or low back pain/degeneration as well.

There is also a compensatory imbalance between two antagonist muscles, the posterior tibial muscle which is a rearfoot inverter (inner side of the heel tilts up) and the peroneus longus which is a forefoot everter (1st metatarsal flexes downward), both of which are in the lower leg. When the calf muscle contracts, these two muscles also fire causing a natural torsion in the foot. Unfortunately, because of the hypermobility of the 1st metatarsal and its elevation under body weight, the peroneal muscle becomes ineffective. Hence, the posterior tibial muscle will fire essentially unopposed, which can lead to posterior tibial tendinitis.

Worst of all is the fact that the big toe will jam into the head of the 1st metatarsal bone with every step, causing destructive forces in the joint. Over time, the cartilage surface is damaged and the joint becomes arthritic. Mobility in the joint decreases and with extension of the big toe there is intense pain. Since the 1st metatarsal is designed by nature to handle enormous weight load stresses, the pain becomes debilitating. This phenomenon is also the cause of most bunion deformities because of the retrograde force put into the 1st metatarsal by the jamming of the big toe into the metatarsal head.

This condition of the 1st metatarsal, as you can see, can ultimately give rise to a myriad of symptoms as the body works to compensate for the instability during propulsion.

The remedy for this condition is called a torsional foot orthotic which places the foot into its most stable positions for heel strike and toe off to insure a stable and powerful gait. The orthotic empowers the peroneal muscle (on the outer side of your leg) to pull the first metatarsal down to the ground. This grounding force allows the big toe to extend over the metatarsal and results in a more powerful stride. The orthotic also decreases the pull on the calf muscle thus easing the stresses on the knees, hips and back.

Patients suffering from symptoms such as 1st metatarsal-big toe joint pain, heel pain, arch pain, or Achilles tendon pain are candidates for this type of device if they are suffering from functional hallux limitus. There are patients who may have one or all of the prior symptoms coupled with knee, hip and back pain. These patients are often treated for their upper level symptoms, while the actual underlying cause goes unaddressed. In addition, if you have been given an “arch support” type of orthotic and your pain either remained the same or worsened, you are likely suffering from this condition and need to be placed into a torsional foot orthotic.

Once the biomechanics are well controlled, there are other therapies instituted if the pain syndrome lingers. This can include one or all of the following over time - homeopathic injection therapy, high voltage electrical stimulation therapy, platelet rich plasma injections, amniotic fluid injections, mesenchymal stem cell injections and physical therapy.

Prolotherapy For Chronic Tendon and Ligament Inflammation of the Foot and Ankle

Wed, 03 Jul 2019 02:25:11 GMT

Reducing Chronic Inflammation

Pain syndromes are on the rise in the U.S. and more people are dealing with chronic pain than ever before. No one likes pain and, understandably, people will do just about anything to get pain relief, even if it means taking medications that come with a long list of possible side effects. Many patients believe if they are not experiencing side effects that the medicine is helping them. Even if the medication is controlling the pain they experience, it is not improving their health. In truth, it could be just the opposite.

Let’s take a look at anti-inflammatory medications. They can be administered orally or by injection. The mode of action is to suppress inflammation. This makes sense on the surface since it is inflammation causing most pain syndromes (other then nerve compression, infection and vascular pain). So why not take a medication if it winds up making a patient feel better? To understand why my belief and experience shows it’s better not to, it is important to understand that humans have an immune system designed to repair and protect. When cells in your body are injured or stressed, there is a pathway called primary inflammation which facilitates the detoxification and repair of these cells. It is active predominantly at night while sleeping. When the pathway of primary inflammation is inefficient or if the injury to the cells is ongoing, the immune system will recruit a pathway of protection called chronic inflammation. This pathway is designed to protect injured cells that are not healing in a timely way. It is the pathway responsible for pain, swelling, sometimes redness and heat in the area. Without this pathway, injured cells are in danger of cell death, so it is a very important defense mechanism.

Oral anti-inflammatory medications suppress chronic inflammation, thereby relieving pain, but they are not pathway specific. They will also suppress primary inflammation. In so doing, they make it difficult for the body to detoxify, thus making it necessary to monitor these patients for liver damage since toxins are not readily removed. In addition, these drugs have other potential side effects such as internal bleeding, stomach and intestinal ulceration, abdominal pain, diarrhea, stomach upset, heartburn, muscle cramps, numbness and tingling, bloody stool, bloody urine or vomit, and rapid weight gain. There is also an increased risk for cardiovascular events in patients over 60 years old.

Injectable anti-inflammatory medication, most commonly cortisone, bypasses the GI tract and dramatically reduces most of the aforementioned side effects except it still suppresses primary inflammation and thereby blocks both the pathway of protection and the pathway of repair. In addition, injectable cortisone is fibrolytic, meaning it weakens connective tissues (i.e. tendons, ligaments and joint capsules). This is not a good idea in already injured and weakened tissues and can lead to tendon and ligament ruptures as well as an overall worsening of the pain syndrome.

So how do we get these syndromes to heal without taking on the aforementioned risks? One great way is prolotherapy injections. As a doctor specializing in chronic pain syndromes of the foot and ankle, I have used this technique thousands of times with very good success. Prolotherapy takes into account that once the immune system locks into a pathway of chronic inflammation to protect these injured tissues, it is not going to release this pathway easily. Prolotherapy is a way to send a “new signal” to the immune system to release protection and switch to repair. Through the use of “proliferants”, which cause mild tissue disruption, the immune system picks up a signal of a “new” injury which will be answered by the pathway of primary reparative inflammation. The medicines stimulate the migration of fibroblasts which are the cells that lay down the matrix for repairing connective tissue. We not only get the stimulus for healing, we can actually generate stronger connective tissue than what was there before. This is in stark contrast to the fibrolytic properties of cortisone. In fact, the medicines I use in my practice not only stimulate repair, they also simultaneously stimulate the detoxification of the injured cells. The inflammatory infiltrates are carried away much faster, clearing the way for healing.

Prolotherapy can be used for chronic plantar fasciitis and fascial tears, Achilles tendinitis, posterior tibial tendinitis, peroneal tendinitis, weak and torn ankle ligaments, ankle instability from chronic sprains, plantar plate tears, chronic joint capsulitis and any other connective tissue inflammation in the foot or ankle.

Dr. Robert Kornfeld is the founder of The Chronic Foot Pain Center with offices in Manhattan and Long Island. His 38 years of experience and his sub-specialty focus on the natural treatment of chronic foot pathology makes him uniquely qualified to assess and treat all kinds of chronic pain syndromes of the foot and ankle. To learn more, check out his website at www.drrobertkornfeld.com as well as his Facebook page at Chronic Foot Pain Center – Dr. Robert Kornfeld.

Maintaining Lower Extremity Sports Health After Injury

Wed, 03 Jul 2019 02:18:10 GMT

Getting Back to An Active Lifestyle

There is no question that this era has birthed an explosion in the areas of fitness and nutrition. Unlike past generations, baby boomers and their children are more active, more fit and more concerned with their overall health than generations past. This is a wonderful thing. Studies show that keeping physically fit and eating well improves health and longevity across the board.

If you walk into any gym or fitness club in America, you will undoubtedly see treadmills, elliptical machines, stair climbers, stationery bikes and spin bikes for cardio conditioning and weight management as well as weight stations and free weights for strength building. All of these different methods of working out (other than upper body weight training) depend on the lower extremities for results. That is, the foot, the ankle and the legs are the keystone of all of these endeavors. It is no wonder, then, that many well-intentioned people wind up developing pain syndromes and injuries of the foot and ankle. As a foot and ankle specialist for more than 35 years (with a concentration on chronic pain), I have seen thousands of these patients over the years for treatment.

When treating injuries, we must keep TWO things in mind. The first of course is healing the presenting injury or syndrome. The second is making sure that we ultimately decrease the chances of this happening to the patient again. And this is something that seems to not always be accomplished by the traditional approach to medical care. Allow me to clarify.

Pain syndromes (other than direct injury) develop from repetitive stress on tissues that are unable to withstand those stresses and wind up getting injured. Injured tissues are managed in the human body by a pathway called primary inflammation which fosters the detoxification and repair of these injured cells. However, when cells cannot heal readily and the stresses continue, the pathway is then changed. Instead of trying to repair tissues, the immune system will opt to protect what it cannot readily heal. This pathway, called chronic inflammation, is responsible for the pain you feel when your foot or ankle is hurting and seems to not want to heal.

The great majority of patients who seek medical care for these problems will meet with a doctor and are offered anti-inflammatory therapy, either via a cortisone injection or a non-steroidal anti-inflammatory medication. Both of these approaches will provide relief, but not without some risk. Cortisone is an anti-inflammatory medication and can relieve pain from chronic inflammation but it is also fibrolytic, which means it can weaken or damage connective tissue (tendons, ligaments and joint capsules). In safeguarding our patients’ future sports performance, taking this risk may not always be a good idea. Some patients are left prone to further injury because the involved tissues are now weaker than before and will not be able to handle the stresses placed on them again. Other patients go on to tendon ruptures. The other option, non-steroidal anti-inflammatory drugs (NSAIDS), should also be well understood. NSAIDS also suppress inflammation and therefore can provide relief. Unfortunately, they not only suppress chronic inflammation, they also interfere with the pathways of detoxification and repair. Patients on NSAIDS need to have their livers monitored due to the fact that detoxification is impaired while on the drug. As well, the healing of the involved tissue may, in certain patients, be incomplete because of the pharmaceutical blockade. This means that not only will the pain return when the drug is withdrawn, but further damage may have occurred during the time that the pain was suppressed and the foot or ankle was still being used and put under stress.

In my opinion, neither of these remedies makes sense in the BIG picture. I understand that patients want to be out of pain, but my job as a doctor is to heal the problem and safeguard their future sports health so that once better, they can return to their fitness endeavors with a far lower incidence of recurrent pain.

To accomplish this, we need to understand how the human body works and support the pathways that foster the repair and strengthening of the involved tissues. This means ensuring that the nutritional precursors to cellular repair are provided in the diet or by supplementation; that the patient sleeps well (the majority of healing and repair is accomplished during sleep); that they are well hydrated; that there are no current burdens on the immune system (be it elevated stress hormones, neurotransmitter imbalances, poor diet, etc) and that the therapies employed for healing have no deleterious effects on the injured tissues or their overall health. All immune burdens need to be addressed. This not only frees the body to heal better, but improves the patient’s overall health. This could include dietary changes, sleep hygiene, nutritional supplements and stress management.

Once accomplished, we can direct treatment at the involved tissues. My preference has been to utilize homeopathic injections (which I have been using for over 30 years with no negative reactions). These medicines foster the detoxification of the inflamed cells by removing inflammatory infiltrates and help to stimulate the natural pathways of tissue repair. They are not fibrolytic. They do not weaken tissues. Another direct healing approach is prolotherapy injections which also do the same thing but not quite as gently as homeopathic medicines. They are designed to create a bigger push toward healing but can cause some temporary increase in inflammatory pain after the injection is delivered. Prolotherapy is much better at strengthening the involved tissues and I use it when there seems to be some resistance to healing. Lastly, for the most difficult cases, I will use PRP (platelet-rich-plasma) injections. These injections utilize the patient’s own platelets which contain large amounts of growth factors needed to stimulate healing and repair. All three of these therapies are very successful when used in conjunction with all of the aforementioned immune support.

And, as always, when foot and ankle injuries are involved, we must look at any structural or functional imbalances that were part of the etiology of the problem. Functional custom-made foot orthotics, muscle strengthening (sometimes through high voltage electrical stimulation), stretching routines and physical therapy may be used.

Ultimately, we work toward facilitating a long sports/fitness experience for our patients. Focusing on the symptoms alone and not on the future lower extremity health is not, in my opinion, optimal medical care.

If you are experiencing a pain syndrome, foot specialist and podiatrist Dr. Robert A. Kornfeld of the Chronic Foot Pain Center in Manhattan can help. He has nearly 40 years of experience treating all types of foot-related issues, including all chronic foot and ankle pain, sports injuries, plantar fasciitis, achilles tendinitis, and torn ligaments. Call (516) 369-3172 to schedule an appointment or visit his website (www.drrobertkornfeld.com) to learn more about his therapeutic approach to relieve burdens on the immune system, improve local circulation to the foot, and enhance the body’s ability to foster homeostasis and healing.

HOW TO HEAL FROM CHRONIC FOOT PAIN

Wed, 03 Jul 2019 02:14:54 GMT

Take the Right Steps Toward Healing

The prevalence of chronic foot pain is on the rise. It is on the rise not just in the general population, but also in the population of foot sufferers who have already undergone traditional medical treatments. Many patients with chronic foot pain have been to numerous doctors. Some, more than 10 or 20 different doctors over the years. It is NOT that any of these doctors were poorly trained. It is that the paradigm of medicine we engage in in this country puts treatment first and assessment on the back burner.

By this, I mean that doctors typically make a diagnosis and then institute treatment. There is little to nothing done in the way of trying to find the mechanisms (the reasons) that explain why this patient suffers from chronic pain and has failed all attempts at trying to get the pain to resolve. As a doctor who specializes in chronic foot pain, I have treated thousands of patients over the years who come with a long history of failed treatments. This population of patients needs deeper assessments. Not just a diagnosis and therapies that attempt to suppress pain and inflammation. But assessments that begin to explain why this patient continues to suffer in spite of everything already done. Treating pain in any way without understanding underlying causes is like chasing a speeding train.

It starts with an understanding of how the human body is designed to maintain optimal health. We have endogenous (built-in) pathways that work to detoxify our cells, repair injured tissues, replace dead cells and replenish what is used up (i.e. enzymes, hormones, neurotransmitters, cytokines, carrier molecules, etc.). When these different pathways are functioning optimally, then the body can achieve homeostasis (efficient function and optimal health). In order for these pathways to function optimally, it is essential that the body has a proper supply of necessary nutrients, vitamins, minerals, proteins, fats, water etc. It is also critically important to the success of these pathways that there is adequate sleep. For it is when we sleep that the majority of work to achieve homeostasis is accomplished.

Therefore, a patient in chronic pain needs more than a diagnosis. They need a complete epigenetic assessment (of diet, lifestyle and environmental factors) and how that alone might burden the immune system and create struggles physiologically. In addition, lab assessments that can identify inefficiencies in any of the arms of homeostasis need to be done. For example, one of the most common burdens on the immune system in addition to poor diet, sedentary lifestyle and poor sleep habits is poorly managed stress. The stress response is controlled by adrenal hormones and neurotransmitters and is a primitive survival mechanism. Chronic stress causes adrenal or neurotransmitter imbalance which directly burdens the immune system making it difficult to digest and assimilate food, interfering with healthy sleep cycles, suppressing thyroid function and slowing down the basal metabolic rate (making it difficult for the immune system to keep up with the typical challenges of everyday living). Looking at lab evaluations of adrenal circadian rhythms as well as neurotransmitters can help shed light on many of the mechanisms making for a chronic pain experience and can be treated without drugs.

We can also assess the pathways of detoxification; of nutrient balance and supply; of sensitivities to foods that ramp up inflammation; of the types of circulating fatty acids (some of which when dominant feed the pathway of chronic inflammation); of gut health (the friendly bacteria in your gut are responsible for a fermentation process that gives rise to the short chain fatty acids that feed your immune system) and many others so we can get a better understanding of each patient’s unique physiology and ultimately see where we need to intervene to get these mechanisms under control (patient-specific assessment). This may include changes in diet, proper exercise regimens, nutrient supplementation, sleep hygiene, improved hydration, etc.

Once we have the physiologic mechanisms managed, then we look for other contributory mechanisms. When it comes to foot pain, one must assess the structure and function of the lower extremity. This approach, called biomechanics, can tell us how we need to control the aberrant biomechanics, thus minimizing the physiologic challenges placed on the foot and ankle. A proper physical therapy and foot orthotic approach would then be prescribed.

Finally, we institute therapies to support (rather than suppress) the body’s ability to detoxify and repair the cells that are struggling to heal. This is done through biologic response modification, meaning converting the chronic inflammation to primary inflammation (detox, repair, etc). This can be accomplished by increasing perfusion of blood into the foot and ankle with high voltage electrical stimulation (the human foot is the least perfused area of the body. Blood flow is the ultimate determinant of all healing); homeopathic injections (mild natural medicines that initiate the detox/repair pathway)), prolotherapy injections (medicines that gently disrupt cell membranes and foster the call to repair), platelet-rich plasma injections (utilizing the patient’s own platelets which are rich in growth factors that facilitate repair)or amniotic fluid allograft injections (containing stem cells and lubricants that heal and protect). All of the injection therapies foster repair in different ways. They do NOT suppress inflammation like cortisone. They actually help foster and facilitate repair and strengthening of the involved tissues. We do not need to field side-effects in the way we do when we are suppressing natural body function.

As you can see, it’s a step by step approach to ultimately not only resolve the pain syndrome, but to leave the patient in a much better state of health.