Foot and Ankle Pain

Foot and Ankle Pain

Foot care is an integral part of optimal health maintenance. A comprehensive bio-mechanical foot evaluation helps many of our patients target and treat chronic foot problems. We will conduct a full assessment of your feet and take a full history of your foot problems, then determine the best course of action for you. As part of your evaluation, you will receive:

  • detailed structural and biomechanical foot evaluation
  • one pair of customized removable orthotic insoles
  • shoe type recommendations
  • customized exercise program specifically for your foot type and issues

Please call to schedule your appointment: 904-996-6922

FOOT AND ANKLE PAIN

Have you ever been told, “If it hurts, don’t do it”? Whether you work on your feet, play sports to keep fit, or suffer from foot diseases like arthritis or diabetes, you know that staying off your feet is not an option. Healthy feet, ankles and legs are essential to your overall well-being, and physical therapy can help keep you on the move.

At Premier Physical Therapy, our expert therapists apply scientific principles to provide you with a vision for your recovery. We help you stay on target with detailed evaluations and customized treatment programs. If you’re concerned about taking up a new sport or activity, we can teach you how to approach new challenges safely.

What seems to be a complex problem may be easily corrected by Premier’s trained and board-certified therapists. Read on to learn how Premier Physical Therapy can help you reach your goals at work and at play.

PHYSICAL THERAPY OF THE FOOT AND LEG

Maybe you work on your feet all day. Or if you sit at work, then exercise or play sports, your feet and legs can experience large amounts of stress from the impact of running or the repetition of cycling. Pain and injury can reduce your ability to perform your job or stay active and fit. Premier’s therapists will perform a detailed exam, develop specific treatments, and provide you with a timeline for recovery. Our process involves:

  • Detailed Evaluations – We start with a complete history of your symptoms and perform a gait analysis using video to examine the entire leg’s movement.
  • Customized Treatment – Your program is tailored to the biomechanics of your feet, ankles and legs. Our therapists incorporate solutions including manual therapy, exercises
, and footwear recommendations. In addition, our AlterG anti-gravity treadmill allows you to return to walking and running sooner, by reducing weight bearing on painful or injured lower extremities.
  • Runner screenings – These evaluations benefit competitive and recreational athletes. We analyze how much and when you run, your running surfaces, and your shoes. We can also make shoe recommendations and modifications using custom orthotic insoles.
  • Bicycle Fittings – A fitting by a trained physical therapist can help cyclists avoid many problems caused by riding a bike that is the wrong size and set-up.
If you need physical therapy to overcome pain and injury, or if you want to get fit safely, Premier can help you get your whole body back on track. THE PREMIER EXPERIENCE

If you’ve already had physical therapy, you know how difficult it can be to find quality personal care. That’s why we designed a physical therapy center where comfort, exceptional treatment and convenience are at the center of your health care universe.

Then there are the people who will guide you on your path to health. Dedicated professionals who know you by name; compassionate individuals with outstanding skills and credentials.

We’re here to make sure your needs are met, your questions are fully answered, your pain is reduced, and your ability to perform at or close to your peak is restored quickly and safely.

PREMIER SERVICES

Premier’s board-certified Orthopedic Specialist has advanced training in the anatomy and biomechanics of the foot, ankle and leg. With a staff led by a national-caliber field sports athlete, we understand your drive to perform at your peak at work or in sports.

Yes Way, Galloway!

Part of Premier’s commitment to our community means supporting organizations like Jeff Galloway’s . Jeff Galloway’s Marathon and Half Marathon Training Programs are for all levels of runners, from beginning runners to Boston qualifiers. This Low-mileage, Injury-free Training Program is for those who have jobs, families, and a life!

REGISTER AND FIND OUT MORE CLICK HERE

The achievement of completing a marathon/half marathon training program and finishing the event will be your treasure for the rest of your life. The training schedule which follows is the latest evolution in a minimal mileage, low-impact training routine which has been used successfully by an estimated 100,000 marathoners since 1978.

Before Those First Steps!

There are very few people who should not exercise because of cardiovascular, structural, muscular, or other problems. It is very important to ensure that you are not in this risk category.

Before beginning any exercise, diet or other improvement program, be sure to have yourself and the program evaluated by specialists in the areas you are pursuing.The advice in this book is offered as such-advice from one exerciser to another. It is not mean to be a prescription and should be evaluated as noted above and below.

Specific structures and problems of individuals may require program modifications.In each area, find specialists who are also knowledgeable about the positive and other effects of exercise and running.Ask several respected leaders in the fitness community for recommendations of specialists.Always back off any exercise or program when you feel any risk of injury or health.The benefits come from regular exercise and steady adherence to a long-term program.Never radically increase the amount of exercise or drastically change diet and other health elements.Joining a group helps motivation!

REGISTER AND FIND OUT MORE CLICK HERE    

Total Joint Replacement

THE PREMIER APPROACH

At Premier Physical Therapy, our therapists specialize in post-operative outpatient rehabilitation for patients who have undergone total joint replacement.  We utilize cutting edge protocols, technologies, and an individualized approach to address not only basic strength and range of motion, but also agility, balance, sport-specific capabilities, and other subtle skills that often get overlooked in crowded facilities.  Our therapists go beyond the minimum requirements of standard protocols. We work with patients to help them reach their goals and return to active lifestyles without residual deficits, deviations, or asymmetries.  Our patients return to optimal function including physically demanding work, competitive sports, and other strenuous activities without feeling limited by persistent deficits that were not addressed in their rehabilitation.

JOINT REPLACEMENT STATISTICS

Ostheoarthritis is one of the ten most disabling diseases in developed countries. Joint replacement surgery is considered the most effective intervention for severe osteoarthritis, reducing pain and disability and restoring some patients to near-normal function.  New technologies have proven effective for replacing the joints of the shoulder, hip, and knee as well as some of the smaller joints in the hand and foot.  The number of hip and knee replacement has increased rapidly over the past decade in most countries.  On average, the rate of hip replacement increased by over 25% between 2000 and 2009. The growth rate was even higher for knee replacement, nearly doubling over the past decade.  The number of total knee replacements performed in the U.S. will leap by 673% reaching 3.48 million by the year 2030. Demand for total hip joint replacements will grow an estimated 175 percent by 2030.

DECLINING COVERAGE FOR PHYSICAL THERAPY

With continuing cuts in insurance reimbursement for physical therapy, patients often don’t receive the quality and quantity of rehabilitation services necessary to make a full recovery from these joint replacement surgeries.  Patients are frequently moved rapidly from the hospital to busy inpatient rehabilitation facilities and then home without achieving their desired level of function.  Patients can be left with scar tissue, range of motion limitations, gait deviations, postural asymmetries, swelling, and other issues that prevent them from getting the most out of their surgery.

ALTER-G ANTI-GRAVITY TREADMILL

Premier Physical Therapy is also home to the AlterG Anti-Gravity Treadmill which allows total knee or hip replacement patients to return to walking much sooner than normal, due to its ability to reduce the amount of weight bearing through the joints.

PRE-HABILITATION AT PREMIER

If you are considering joint replacement surgery, be sure to check with your doctor about pre-surgery therapy at Premier, as many insurance companies will cover physical therapy for pre-operative instruction, education, strengthening, stretching, and conditioning.

Patient Testimonials

“I came in with a knee replacement and within 4 weeks felt that I could end therapy sessions and get back to work.  I appreciated the exercise plan that Scott created for me to continue work at home to help develop strength in my entire leg.  I liked the individual attention during therapy. Thank you very much!”   –Marguerite B. “Scott really was a gentleman and I loved my experience with Premier Physical Therapy.  Scott was also very knowledgeable and very polite!  If I ever had to come back for anything, I would like my physical therapist to be Scott or his trainee.  Thanks guys.  Keep up the terrific work!”   –Robert V.   “I was treated after double knee surgeries in 2009 and hip replacement in 2011.  I gained strength in both cases and returned several times when weakness surfaced from lack of proper exercise.  My total body was strengthened and worked on when attention was needed.  I am grateful for all the care and direction I have received at Premier Physical Therapy and recommend them at every opportunity.  They patiently answered all my questions and never noticed the repetition because of my forgetfulness.” –Ellen E.

Shoulder Injury Rehabilitation

Orthopedic injuries, particularly to the shoulders are common. Nearly everyone has had shoulder problems at some time during their lives. That’s why our skilled, experienced physical therapy team here at Premier creates customized orthopedic rehab programs that improve your  shoulder function and body mechanics while reducing your chances of re-injury.

A combination of leading-edge treatment and compassionate hands-on care eases your discomfort and speeds your recovery from all kinds of  shoulder injuries:

  • Rotator  Cuff
  • Bursitis
  • Instability
  • Dislocation

We provide individualized assessments of your shoulder mechanics that lead to independence and better symptom management. Our programs also help increase patients’ activity tolerances for home tasks and other activities while decreasing the chances of reinjury.

You may also have suffered repetitive-strain injuries, fractures or postsurgical problems that require our help. Active physical therapy is our proven method of achieving that. We can get you back to living, playing and working sooner, with less chance of reinjury.

Here at Premier Physical Therapy we have found that these are the most common causes of shoulder pain and we have developed specific treatment plans for each of the following conditions.

Labral tears – Injuries to the tissue rim surrounding the shoulder socket resulting in a deep pain in the shoulder socket. usually this is caused by an injury that dislocates or strains your shoulder. There may be a sharp pain deep in the shoulder in certain motions.

Bursitis of the Shoulder – a common cause of discomfort from inflamed tissue meant to protect your rotator cuff from the bones in your shoulder. Usually a soreness that keeps you up at night. Unfortunately, this one comes with maturity for most people.

Shoulder Instability – your shoulder feels like it might pop out in certain positions. There is usually a  a dislocation of the shoulder from sports or past injury.

Impingement – There is significant pain when reaching overhead or behind. This condition is often caused from the normal structures in your shoulder rubbing against the tendons in the shoulder. Several factors like arthritis, inflamation or a “bone spur” could be the reason for having inpingement of the shoulder area. Repetitive limited range motion can also be a determining factor in this condition.

Tendinitis of the Shoulder – probably the most common problem. Pain when reaching up or behind. Repetitive activity and maturity will lead to this inflammation of the tendons themselves. You may feel weakness using your arm.

Rotator cuff Tears – This condition causes pain plus significant weakness trying to lift your arm. Once the tendon fails and tears away from the bone you lose your ability to raise your arm without pain. This can be from an injury or develop over time from tendonitis.

Frozen Shoulder – This is a common stiff shoulder condition. Often there is no injury or obvious cause. It often shows up without warning or trauma.

Arthritis – This is the preeminent cause of stiffness and pain, with occasional catching and grinding. Although it is not as common as other joints the shoulder joint will wear out over time.

There are several other causes for shoulder pain including  injuries, neck and chest problems. Our professional staff at Premier will take a through history of your condition followed by a comprehensive examination to narrow down your treatment options and let us create a custom treatment plan just for you.

“I have had problems with my shoulder for years and had undergone physical therapy for it with no improvements. The pain and lack of movement continued to worsen. I was told it would not get better without surgery. My surgeon insisted on pre-surgery therapy. I was skeptical because of prior experiences. After only four weeks, twice a week with Chris Kopp, there was noticeable improvement. Although it was better, I still needed surgery to completely get better. Chris assured me that I could get 100% of use back in my shoulder with no pain. He was absolutely correct. I do believe that Chris was the major contributor to my complete recovery. He knows more about therapy than anyone I have ever dealt with. I would recommend him to everyone I know. What a God – send. Thanks for everything.”

–Ina S.

 

“When I suffered a rotator cuff injury, I naturally wanted the best surgeon and therapist I could find.  Being employed in the fitness industry for over 25 years, I always strived to be in superior health and physical condition.  I fortunately found a superior physical therapist in Eric Mason at Premier Physical Therapy.  His treatments were professional and specific to my problem.  I enjoyed the sessions because I felt the therapy was returning me to my pre-injury condition.  The information provided by Eric was very thorough, concise, and effective.  As I progress with my own exercise program, I am very thankful for the excellence provided by Eric at Premier P.T.  I couldn’t be more satisfied!”

–Tom H.

   

“I was having shoulder pain, some during day to day activities, but it was seriously, negatively impacting my workout regimen which was frustrating.  Turned out, I had a shoulder impingement problem brought on by my unbalanced approach to lifting weights.  The program included P.T. at the office as well as at home.  More importantly, it included a lot of education about what I was doing wrong and how I could change it to avoid recurrence of the problem.  The pain is now gone and I hit the gym a little differently than I used to.  I continue to use the P.T. program I was put on and so far, so good.”

–Steve C.

 

Back To Normal Program

If you suffer from chronic and recurring back pain then try our Back To Normal™ program. We have developed a comprehensive program that offers permanent relief for many of our patients. Designed by board certified orthopedic Physical Therapist Chris Kopp PT, OCS, Eric Mason PT,  and Scott Entsminger DPT, Premier’sBack To Normal™ program customizes a six week treatment  just for you. This is a targeted treatment plan; specifically for your condition. Premier’s Back To Normal™ program has been specifically designed to educate, empower and encourage those patients who have given up hope of living a pain free life. Many of our patients experience back pain that originates from a variety of spinal structures including muscles, nerve roots, joints, discs, and soft tissues. Determining the specific causes of your pain and helping you understand how all these systems work together gives you a clear path to recovery.  When you are ready to experience the Premier difference, give us a call. We will talk with you, one on one to determine if this program is right for you.

Experience Matters:

Board Certified Orthopedic Physical Therapist Chris Kopp PT, OCS, Eric Mason PT, and Scott Entsminger DPTare dedicated to providing the best possible treatment options for a wide range of back conditions. Call 904-996-6922 today to schedule an appointment when you are ready to get BACK TO NORMAL! 
  • 6 Week Program

  • Evidence Based Treatments

  • Nearly All Insurances Accepted

  • No Fads, Gimmicks, or Gadgets

  • Compassionate Hands-On Approach

  • Flexible Scheduling

  • Convenient Locations

  • Proven Success Rate

  • Results Driven Interventions

Patient Reviews:

“When I first started my Physical Therapy I was having a lot of trouble walking due to my back pain.  After the initial evaluation Chris performed some manual manipulation on my back while also talking to me about my condition, clearly explaining to me what he was doing and the benefits of it.  Chris has been very helpful in restoring my back so that I am able to resume my activities. It has been a positive experience for me and I highly recommend his facility.”  –Vicki M.     “When I first started going to Premier Physical Therapy my lower back thru my legs to my feet felt like a tightly wound and twisted rubber band.  I had a popping and clicking thing going on with my hip that didn’t seem right.  After my first visit, relief was immediate!  The popping and clicking stopped with in the first two sessions. After about 9 sessions my posture had improved and it doesn’t take me 10 minutes to get out of my car now.  My back is getting stronger and my legs are no longer stiff and tight.  I THANK GOD I found Chris and believe he has a true calling to help people.  His staff is friendly and professional.  I would recommend anyone seeking relief to go to Premier Physical Therapy.”                                                                                                                                                                                                  –G.B.   “I was having spasms below my shoulder blades.  Scott Entsminger DPT did my evaluation and worked out a treatment plan.  We worked on my posture and shoulder strength.  My pain was gone and my posture improved following my treatment.  Special thanks to Scott, Laura, and Sheryl.  They made my treatment easy and successful.”   –Marianne K.   “After 6 weeks of recovery from back surgery, fusion of L4-5, I was assigned P.T.  I quickly got an appointment and met with Scott who evaluated my condition.  All the staff were always pleasant and inviting.  Scott was very knowledgeable and shared pertinent information with me and answered my questions.  We worked on strengthening my core and back, as well as balance and flexibility.  Scott continued to examine my incision and worked on that tissue area.  I progressed exceptionally well and was released after 5 weeks.  I was given exercise information to continue working on at home.  I felt that it was time and the therapist did not extend my P.T. longer than necessary.  I would recommend Premier to anyone!”   –Sherron K.   “I was referred to Premier by my PCP Dr. Browning when I injured my back exercising.  Prior to my injury, I had experienced a sore back, but my injury brought a whole new level of pain and discomfort that seemed like it would never go away.  After an MRI, it was clear that I had a herniated disc in my lower back.  Within a week of beginning physical therapy, I had regained significant mobility that had been gone for at least 3 weeks.  Within 4 weeks, I was pain free and gaining confidence that I could return to vigorous exercise.  Premier continued to work with me until I was discharged, and I feel like I have been given the tools to work through this problem should the symptoms arise again.” –Brent Z.
 

Breast Cancer

When breast cancer is a part of your life, your body is under siege by both the disease and its treatments. At Premier we examine, evaluate, screen and establish a safe and effective plan of care for individuals who have been diagnosed with cancer.

Through our individualized Breast Cancer Rehabilitation Program, our physical therapists aim to help you:

  • Improve your quality of life
  • Identify and manage your lymphedema
  • Reduce your fatigue
  • Increase your strength, endurance, and range of motion
  • Assist you in reducing your pain, anxiety and depression

Our therapists work with your doctor to provide specialized treatments for any problems with strength, endurance and range of motion you may have. Read on to learn how Premier Physical Therapy can help you meet the challenges of breast cancer.

 

LYMPHEDEMA Background

Lymphedema is a swelling of a body part usually occurring in the extremities. It can also occur in the face, neck, abdomen, or genitals. Lymphedema is the result of the abnormal accumulation of protein-rich edema fluid in the affected area. Remarkably, even though it afflicts approximately 1% of the U.S. population (nearly 3 million Americans), its serious nature and the problems it creates are poorly understood in the medical community. Lymphedema is classified as either primary or secondary. Primary lymphedema is the result of lymphatic dysphasia. It may be present at birth but more often develops later in life without obvious cause. Secondary lymphedema is much more common and is the result of surgery or is a side effect of radiation therapy for cancer. Secondary forms may also occur after injury, scarring, trauma, or infection of the lymphatic system. Lymphedema has important pathological and clinical consequences. In stage I lymphedema, the swelling consists of protein-rich fluid and may be temporarily reduced by simple elevation of the limb. If it remains untreated, however, the lymphedema causes a progressive hardening of the affected tissues which is the result of a proliferation of connective tissue, adipose tissue, and scarring (stage II lymphedema). Stage III lymphedema is characterized by a tremendous increase in volume, hardening of the dermal tissues, hyperkeratosis, and papollomas of the skin. Infections such a cellulitis, erysipelas, and lymphangitis frequently develop in individuals suffering from lymphedema. Infections are most common in stage II and III lymphedema with each infection contributing to a worsening of the condition making frequent hospitalizations necessary. Lymphedema treatments offered in the United States include surgery, medication, pneumatic compression pump therapy, Manual Lymph Drainage (MLD), and Complete Decongestive Therapy (CDT).

STAGES OF LYMPHEDEMA

  • LATENCY STAGE
  • lymphatic transport capacity is reduced
  • no visible/palpable edema
  • subjective complaints are possible
  • STAGE I
  • (Reversible Lymphedema)
  • accumulation of protein-rich edema fluid
  • pitting edema
  • reducible with elevation (no fibrosis)
  • STAGE II
  • (Spontaneously Irreversible Lymphedema)
  • accumulation of protein-rich edema fluid
  • pitting becomes progressively more difficult
  • connective tissue proliferation (fibrosis)
  • STAGE III
  • (Lymphostatic Elephantiasis)
  • accumulation of protein-rich edema fluid
  • non-pitting
  • fibrosis and sclerosis (severe induration)
  • skin changes (papillomas, hyperkeratosis, etc.)
 

Manual Lymph Drainage (MLD)

MLD, a gentle manual technique, is a potent way to activate the lymphatic system, especially when the transport capacity of the lymph vessel is reduced because of prior surgery and/or radiation therapy. However, if carried out as an isolated treatment for lymphedema, the results are very temporary and lasting evacuation of lymph fluid from a congested limb is not possible. Many MLD practitioners have been trained only in basic MLD and are not qualified to treat lymphedema at all. However, MLD alone may be used with much success in many conditions unrelated to lymphedema.

Complete Decongestive Therapy (CDT)

CDT is a combination of MLD, bandaging of the affected areas, remedial exercises, and skin and nail care. CDT is divided into a two-phase program that initially involves an intensive treatment phase and is then followed by a maintenance program continued by the patient at home. Carried out with great care and consistency by a certified lymphedema therapist, CDT is the treatment of choice for chronic extremity lymphedema. Even in advanced lymphedema, CDT achieves excellent results with no side effects. Because CDT is labor intensive, time-consuming, and requires patient compliance, many patients have difficulty committing to the program at first. However, because the results of CDT are always superior to those achieved with all other treatments, increasing numbers of patients are undergoing CDT treatment and are consequently able to maintain the reduction of their limbs through diligent participation in a home maintenance program. Because CDT is fairly new in the United States, staff training and treatment standards vary from clinic to clinic. For a lymphedema therapist to be fully competent in treating lymphedema using CDT, it is vital that the CDT training consist of the four components of CDT: (1) basic and advanced MLD, (2) lymphedema bandaging, (3) remedial exercises, (4) skin and nail care. The therapist must also have a complete understanding of the anatomy, physiology, and pathophysiology of the lymphatic system, the treatment of primary and secondary lymphedema, the indications and contraindications of CDT, and the proper measuring techniques for lymphedema support garments. Furthermore, lymphedema therapy should not begin unless the patient has been examined and diagnosed by a board-certified physician who understands lymphedema and its complications. Once the diagnosis of lymphedema has been confirmed and treatment has begun, the progress must be monitored by the physician. Whereas the clinical diagnosis of lymphedema can most often be established without invasive testing, and electrocardiogram before the treatment begins and during the course of treatment is sometimes necessary to ensure safe treatment for each patient. Lymphangioscintigraphy (LAS), CT scans, and MRIs are also recommended for lymphedema patients before starting CDT. The physician will be able to decide and inform the patient about the necessity of such procedures at the time of consultation. Because of the complications associated with lymphedema, the involvement and supervision of a qualified physician is essential for safe and effective lymphedema therapy.

Patient Testimonials

“I was extremely weak from chemotherapy.  Through Eric Mason’s guidance, expertise, and understanding of my needs, I was able to gain strength.  Eric is an ultimate professional and personable at the same time.  He’s a MIRACLE WORKER!”

–Barbara B.  

“Three weeks after my last chemotherapy session, I developed lymphedema in my left arm.  I really wanted to be seen immediately to prevent it from developing further.  I couldn’t believe that I was able to get an appointment with Premier that afternoon.  Had I gone to P.T. at another provider, I would have had to wait 2 ½ weeks.  Also I was going to fly to visit my daughter in just three days so it was important to me to learn self lymphedema massage and drainage so I could help prevent further swelling from flying.  I also appreciated that I could call and speak with Sheryl or anyone else there and they were all in the same place, as opposed to having to call central scheduling in some remote office far from where my P.T. would take place.  I loved the friendly, caring, loving atmosphere at Premier.  I was sort of scared when I first went in because I didn’t really know what I was up against with lymphedema, and Premier really helped put me at ease. They were a wealth of information.  They gave me multiple print-outs and discs on lymphedema massage and visualization.  They were so knowledgeable and really worked hard to get me better.”

–Terry M.

   

In July of ’09, I showed up at Premier’s door as a breast cancer patient having recently had a bilateral mastectomy.  Radiation was looming in the near future.  My therapist, listened to my concerns:  a possibility of lymphedema, my ability to have full use of my left arm and shoulder, and my hopes for future reconstruction.  Then, they went to work.  They worked with me throughout my radiation treatments, and afterwards, helped to prepare my skin for future reconstruction.  The exercises and massage they employed for lymphedema prevention and arm and shoulder strength and mobility were extremely beneficial.  They also gave me the tools I needed to continue my therapy at home, including lymphatic massage.  I have absolutely no doubt that Premier made all the difference in whether or not I could continue a normal life after my mastectomy.  My energy level improved.  I had a more positive outlook on the future. I could continue using my left arm with only minor restrictions.  As a teacher, these matters were of utmost importance to me.  Throughout my therapy, I felt comfortable with Premier’s friendly, professional manner.  I am grateful for the quality of concern and care for the “whole person,” the expertise and professionalism I received.  I liked Premier’s vast knowledge about breast cancer and lymphedema and also the phenomenal treatment I received on a one-to-one basis.  Also, I was given the tools necessary to continue treatment at home.

–Mary J.