The Foot Clinic Ra'anana

The Foot Clinic Ra'anana Podiatrists Warren Amler and Vernon Lever bring their experience, advanced orthotic technology and surgical skills to Ra'anana Israel.

We look forward to welcoming you to our clinic. For the latest treatments and procedures in worldwide Podiatric best practice, speak to Warren and Vernon at The Foot Clinic. Industry leaders in advanced CAD-CAM digital orthotics and minimally invasive toenail and plantar wart surgery. Our combined expertise and experience have earned the trust of thousands of patients over the last 33 years.

Your morning heel pain explained!
10/05/2026

Your morning heel pain explained!

🚨 WHY Your First Steps in the Morning Feel Like Stepping on a Nail 🚨
You wake up.
You swing your legs out of bed.
And the moment your foot touches the floor, a sharp stabbing pain shoots through your heel like you stepped directly onto broken glass.
Then something strange happens.
After walking for a few minutes, the pain starts fading away… only to return later after standing, walking, or resting again.
This is one of the most classic signs of Plantar Fasciitis — a mechanical overload injury involving the thick connective tissue running along the bottom of your foot.
And despite what many people believe, the problem is not usually “heel spurs.”
It is a failure of tension management inside the foot’s shock absorption system.
[The Anatomy]:
Along the bottom of your foot sits a thick fibrous structure called the plantar fascia.
This tissue stretches from the heel bone (calcaneus) all the way to the toes, functioning like a biological suspension bridge that supports the arch of the foot.
Every step you take places force through this structure.
Under healthy conditions, the plantar fascia stores and releases elastic energy efficiently while helping distribute bodyweight during walking and running.
But modern movement habits overload the system.
Long hours standing on hard surfaces, poor footwear, weak foot muscles, tight calves, sudden increases in activity, excess bodyweight, and collapsed arch mechanics place enormous repetitive tension on the fascia.
Eventually, microscopic tearing begins near its attachment at the heel.
[The Mechanical Failure]:
The Overnight Tightening:
While you sleep, the plantar fascia shortens slightly because the foot stays relaxed and pointed downward for hours.
The Sudden Load Shock:
The moment you stand in the morning, the tissue is suddenly stretched under full bodyweight before it has warmed up or regained flexibility.
The Micro-Tear Pain:
This abrupt tension pulls directly on the irritated attachment point at the heel, triggering the sharp stabbing pain people feel during those first few steps.
The Inflammation Cycle:
As the fascia becomes overloaded repeatedly throughout the day, microscopic degeneration and irritation continue building, especially after prolonged standing or walking.
This is why the pain often improves temporarily after movement warms the tissue up — but returns again once overload continues.
[Why Conventional Treatment Often Fails]:
Many people are told to simply rest or buy soft cushioned shoes.
But cushioning alone does not restore proper foot mechanics.
Others aggressively roll or stretch the foot without addressing calf tightness, ankle mobility, or weakness in the arch stabilizers.
Painkillers may temporarily reduce symptoms, but they do not rebuild the tissue’s ability to handle load.
Meanwhile, poor walking mechanics and repetitive overload continue stressing the fascia every day.
[The 3-Step Mechanical Fix]:
Step 1 (Morning Tissue Preparation):
Before standing out of bed, gently move the ankle and toes to warm the fascia gradually instead of shocking it instantly under bodyweight.
Step 2 (Calf & Foot Reconstruction):
Improve calf flexibility, ankle mobility, and strengthen the small stabilizing muscles of the foot to reduce tension pulling on the heel.
Step 3 (Progressive Load Management):
Use supportive footwear temporarily while gradually rebuilding the plantar fascia’s load tolerance through controlled strengthening and walking mechanics.
👉 SAVE this before temporary heel pain becomes chronic degeneration. Your foot is not weak — it is a biomechanical shock absorber that has been overloaded beyond its recovery capacity.

KEEP THOSE CALVES WELL STRETCHED …. It causes a plethora of problems.
09/05/2026

KEEP THOSE CALVES WELL STRETCHED …. It causes a plethora of problems.

🚨 STOP — Your Ankle Pain Is Actually a Calf Problem ⚠️

Frequent ankle sprains…
That constant deep ache in the joint…

👉 It might not actually be your ankle failing

👉 It could be your lower leg “suspension system” not doing its job

🧠 WHAT’S REALLY HAPPENING

Your ankle doesn’t work alone.
It depends on a network of muscles above it—especially your calf:

👉 Gastrocnemius
👉 Soleus

Together, they act like a biological shock absorber system for every step you take.

———

⚙️ HOW THE SYSTEM SHOULD WORK

When functioning properly:
✔️ calves control how the shin moves over the foot
✔️ ankle joint stays stable under load
✔️ forces are absorbed smoothly with each step

👉 Your ankle is never “alone” under impact

———

⚠️ WHAT HAPPENS WHEN IT FAILS

When calf strength or control drops:

❌ the ankle takes more direct force
❌ joint stability decreases
❌ ligaments start compensating for missing muscle control

Over time, this can contribute to:
👉 Ankle Sprain

———

⚠️ WHY IT FEELS CHRONIC

At first:
– mild instability
– occasional discomfort

Then:
– repeated “rolling” of the ankle
– aching after walking or sports
– loss of confidence in movement

👉 because the system isn’t absorbing force anymore

———

❌ WHAT MOST PEOPLE DO WRONG

They:
– only focus on ankle rehab
– ignore calf strength and control
– rely on braces instead of rebuilding support

👉 treating the symptom, not the load system

———

âś… WHAT YOUR BODY ACTUALLY NEEDS

✔️ strengthen calves (both power + endurance)
✔️ improve single-leg stability
✔️ retrain controlled landing and stepping
✔️ restore ankle-calf coordination

Often misdiagnosed …. Pain mimics Achilles tendinitis …
06/05/2026

Often misdiagnosed …. Pain mimics Achilles tendinitis …

🚨 STOP — That Heel Pain Isn’t Just “Soreness” ⚠️

Constant pain at the back of your heel?
👉 It’s not always tightness or fatigue

👉 It could be mechanical irritation happening deep inside the joint

🧠 WHAT’S REALLY HAPPENING

Behind your heel bone sits a small, protective cushion:
👉 the Retrocalcaneal Bursa

Its role:
✔️ reduce friction
✔️ allow the Achilles tendon to glide smoothly

But with repeated stress…

———

⚠️ THE REAL PROBLEM

👉 The space becomes compressed

Every step:
❌ the Achilles Tendon presses into the bursa
❌ friction increases
❌ inflammation builds

This leads to:
👉 Retrocalcaneal Bursitis

———

⚙️ WHY IT KEEPS COMING BACK

This isn’t just a “tightness” issue

👉 It’s a compression problem

Common triggers:
– repetitive running or jumping
– stiff or tight calves
– rigid shoes pressing on the heel
– sudden increase in activity

👉 The space never gets a break

———

⚠️ WHAT YOU FEEL

– swelling at the back of the heel
– redness or warmth
– pain during walking or push-off
– stiffness after rest

👉 especially noticeable in the morning or after activity

———

❌ WHAT MOST PEOPLE DO WRONG

They:
– stretch aggressively into pain
– keep loading the area
– ignore footwear pressure

👉 which keeps compressing the irritated tissue

âś… WHAT ACTUALLY HELPS

✔️ reduce compression (modify shoes / avoid pressure)
✔️ manage load (don’t push through sharp pain)
✔️ restore gradual mobility (not forced stretching)
✔️ allow the tissue to calm before reloading

NAIL FUNGUS
23/04/2026

NAIL FUNGUS

Nail Fungus Signs and Management

🟣 What it is
âžź Nail fungus usually affects the toenails more than the fingernails.
âžź It is not usually serious, but it can take a long time to treat.

🟣 Common signs
âžź Nail becomes thicker than usual
âžź Yellow, white, or brown discoloration
âžź Brittle, crumbly, or ragged edges
âžź Nail may lift from the nail bed
âžź Surrounding skin can become swollen or painful in more severe cases.

🟣 What helps
âžź Keep nails short
âžź Keep feet clean and dry
âžź Change socks daily
âžź Wear well-fitting shoes and avoid shoes that make feet hot and sweaty
➟ Treat athlete’s foot quickly so it does not spread to the nails.

🟣 Treatment
âžź Mild cases may be treated with antifungal nail medicines from a pharmacy
âžź These usually need to be used for 6 to 12 months
âžź More severe cases may need antifungal tablets from a doctor, and sometimes testing is done before starting tablets.

🟣 When to see a doctor
âžź If the infection is severe
âžź If treatment is not working
âžź If it has spread to other nails
âžź If you have diabetes or a weak immune system.

Medical disclaimer: This is general education only. Nail fungus can look like other nail diseases, so painful, worsening, or stubborn nail changes should be checked by a healthcare professional.

The TRUTH about Bunions!!
21/04/2026

The TRUTH about Bunions!!

🛑 STOP BLAMING THE BUMP.

That painful bump on the side of your big toe joint?
It’s not just a “growth” you can rub away.

That’s a bunion — and it’s a bone deformity.

Here’s what’s really happening inside your foot 👇

Your big toe should point straight forward.
But when you spend years in narrow, tight shoes…

You’re forcing that toe inward toward the others.

Now imagine this…
The toe gets pushed in…
So the long bone behind it gets pushed outward.

Over time:

The joint shifts out of alignment
A visible bump forms
And pressure + friction = pain

That’s why you feel:
⚡ Pain at the side of the big toe joint
⚡ Redness and irritation from shoes
⚡ Difficulty walking or pushing off
⚡ A toe that’s visibly drifting inward

This is what I call the “Toe Prison Effect.”
Because your toes have literally been locked into a shape they were never designed for.

Now here’s the mistake most people make ❌
They try to treat the bump…

But ignore the cause.

If you keep wearing the same narrow shoes…
You keep feeding the deformity.

So here’s how you actually fix it (or at least stop it from getting worse) 👇

First — free your toes.
Switch to wide, foot-shaped shoes.
Your toes need space to spread naturally.

Second — realign gently.
Use toe spacers to guide your big toe back toward a healthier position over time.

Third — rebuild foot strength.
Train the small muscles of your foot:

Toe spreads
Short foot exercises
Controlled barefoot work

Why this matters 👇
Because weak feet + tight shoes = deformity progression.

Think of it like this:
Your foot adapted to a cage.

Now you need to:
Open the cage → Realign → Rebuild

Will the bunion disappear completely?
Not always.

But you can:
âś” Reduce pain
âś” Slow or stop progression
âś” Improve function
:

The majority of flat feet that we see in clinical practice is genetic !
17/04/2026

The majority of flat feet that we see in clinical practice is genetic !

FLAT FEET, OVERPRONATION & THE HIDDEN BIOMECHANICS OF THE LOWER LIMB

Flat feet are often simplified as a “low arch problem,” but from a biomechanical perspective, they represent a dynamic control issue rather than just a structural variation. The medial longitudinal arch is not a rigid structure—it is a highly adaptable system designed to alternate between mobility (shock absorption) and stability (force transmission). This transition is the key to efficient gait and movement.

During the initial contact and loading phase of gait, the foot naturally pronates. This pronation allows the subtalar joint to unlock, making the foot more flexible so it can adapt to ground irregularities and dissipate forces. However, in individuals with overpronation, this phase is exaggerated and prolonged. The arch collapses excessively, and more importantly, it fails to re-supinate at the right time during mid-stance to push-off.

A critical structure here is the plantar fascia and its role in the windlass mechanism. As the toes extend during push-off, the plantar fascia tightens, elevating the arch and converting the foot into a rigid lever. In flat feet with poor control, this mechanism is delayed or inefficient. The result is a foot that remains too flexible when rigidity is required, leading to energy leaks and reduced propulsion efficiency.

From a kinetic chain perspective, excessive pronation drives internal rotation of the talus and tibia. This creates a cascade effect—tibial internal rotation leads to knee valgus (medial collapse), which increases stress on the patellofemoral joint and medial knee structures. As the femur follows into internal rotation, hip stability is compromised, often due to weak or poorly timed activation of the gluteus medius and deep hip rotators.

This chain reaction doesn’t stop at the hip. Pelvic control is altered, and compensations may extend into the lumbar spine, contributing to lower back discomfort. Essentially, what begins as a foot control issue can manifest as multi-joint dysfunction throughout the body.

Another crucial concept is load distribution and the foot tripod. In an optimally functioning foot, body weight is distributed across three key points: the heel, the base of the first metatarsal, and the base of the fifth metatarsal. In overpronation, the load shifts medially, overloading the first ray and reducing lateral stability. This imbalance increases strain on soft tissues like the plantar fascia, tibialis posterior tendon, and medial ligaments.

Muscle function also plays a central role. Weakness or delayed activation of intrinsic foot muscles (such as abductor hallucis and flexor digitorum brevis) reduces the foot’s ability to maintain arch integrity. Simultaneously, extrinsic muscles like tibialis posterior, which are crucial for arch support, may become overworked and fatigued, leading to tendinopathy.

Importantly, not all flat feet are symptomatic. The difference lies in control vs. collapse. A person with structurally low arches but good neuromuscular control may function perfectly well, while someone with normal arch height but poor control may develop significant dysfunction.

Intervention should therefore focus on restoring function rather than altering structure. Training should include intrinsic foot strengthening, improving toe mechanics, enhancing ankle mobility (especially dorsiflexion), and integrating these into global movement patterns like squatting, walking, and running. Proximal control—particularly strengthening of the hip abductors and external rotators—is equally essential to break the cycle of internal rotation and valgus stress.

In summary, flat feet are not inherently pathological. The real issue is the inability of the foot to effectively transition between mobility and stability. When this balance is restored, the foot can once again serve as a strong, adaptable foundation for the entire kinetic chain.

KNEE VALGUS… Check your feet!
05/04/2026

KNEE VALGUS… Check your feet!

Knee Valgus (Dynamic Collapse): The Hidden Stress on Your Knee

Knee valgus, often seen as the knee collapsing inward, is not just a local knee issue—it is a full lower-limb biomechanical chain problem. This position places excessive stress on critical stabilizing structures like the ACL and MCL, making it one of the most common mechanisms behind non-contact knee injuries.

The movement typically begins from the ground up. Excessive foot pronation causes internal rotation of the tibia. This internal rotation is then transferred upward, forcing the knee into a valgus position. At the same time, the femur often moves into internal rotation and adduction due to poor hip control, amplifying the inward collapse.

At the knee joint, this creates a combination of valgus force and rotational stress. The ACL becomes highly loaded because it resists anterior translation and rotational forces of the tibia. Simultaneously, the MCL is stressed due to medial joint opening. When these forces occur rapidly—like during landing, cutting, or deceleration—the ligament tolerance can be exceeded, resulting in injury.

The hip plays a crucial role in controlling this pattern. Weakness or delayed activation of the gluteus medius and gluteus maximus reduces the ability to stabilize the femur. Without proper lateral hip control, the femur falls inward, dragging the knee with it. This is why knee valgus is often described as a “hip-driven problem expressed at the knee.”

From a neuromuscular perspective, poor motor control and timing further worsen the issue. Instead of coordinated force absorption through the hip, knee, and ankle, the body relies excessively on passive structures like ligaments. This shifts load away from muscles (active stabilizers) to ligaments (passive stabilizers), increasing injury risk.

During dynamic activities such as squatting, running, or jumping, knee valgus also reduces force efficiency. Energy leaks occur because the alignment is compromised, leading to decreased performance and increased fatigue.

Over time, repetitive valgus stress can contribute not only to ligament injuries but also to patellofemoral pain, meniscal strain, and early joint degeneration due to uneven load distribution across the knee.

Correcting this pattern requires more than just focusing on the knee. The entire kinetic chain must be addressed—improving foot stability, enhancing hip strength, and retraining movement patterns to restore proper alignment and force transfer.

POSTERIOR TIBIAL TENDONITIS, is a common condition seen in our Podiatry Clinic.
20/03/2026

POSTERIOR TIBIAL TENDONITIS, is a common condition seen in our Podiatry Clinic.

Posterior tibial tendonitis ( flatfoot )

Posterior tibial tendonitis is the leading cause of adult acquired flatfoot deformity. The posterior tibial tendon is a primary stabilizer of the medial longitudinal arch; its failure leads to a progressive collapse of the foot's structure.

1. Clinical Presentation & Progression
Early Stage: Pain and swelling along the course of the tendon (behind the medial malleolus) or along the medial arch.

Progressive Stage: As the tendon fails, the medial arch collapses.

Advanced Stage: The foot shifts so far that patients may develop lateral foot pain due to impingement of structures under the distal fibula.

2. Physical Examination
A weight-bearing (standing) examination is essential for diagnosis:

"Too Many Toes" Sign: When viewing the patient from behind, the abduction of the forefoot causes more toes to be visible on the lateral side than normal.

Hindfoot Valgus: The heel tilts outward.

Single-Leg Heel Rise Test: The most sensitive clinical test. Patients with PTTD are often unable to lift their heel off the ground on the affected side because the tendon cannot "lock" the hindfoot into a rigid lever for push-off.

Flexibility Check: The clinician checks if the arch reappears when the patient is non-weight-bearing to determine if the deformity is flexible or fixed (rigid).

3. Imaging
Weight-bearing Radiographs: Essential to see the deformity under load.

AP View: Shows "talar head uncovering" as the navicular bone shifts laterally.

Lateral View: Shows a "sag" in the midfoot and plantar flexion of the talar head.

MRI/CT: Generally reserved for surgical planning rather than initial diagnosis.

4. Treatment Options
Non-Operative (First-Line)
Orthotics & Bracing: To support the arch and "offload" the posterior tibial tendon.

Physical Therapy: Focusing on strengthening the tendon and stretching a tight Achilles tendon/gastrocsoleus complex, which often contributes to the deformity.

Surgical Management
Early/Flexible Deformity: Tendon debridement, Flexor Digitorum Longus (FDL) transfer, or a medial displacement calcaneal osteotomy (shifting the heel bone to realign the mechanical axis).

Rigid Deformity: Requires hindfoot fusion (subtalar, talonavicular, or triple arthrodesis) to stabilize the joints in a functional position.

Clinical Pearl:
"In the early stages, the foot looks normal at rest but collapses under weight. By the time you see the 'Too Many Toes' sign, the tendon has moved beyond simple inflammation into functional failure. Always check the Achilles—if the calf is tight, it acts like a bowstring that constantly pulls the arch into a flat position."

DIABETICS and blisters.
18/03/2026

DIABETICS and blisters.

Why Diabetic Feet Blister More Easily From Everyday Walking Even normal walking can cause blisters in people with diabetes. Repeated pressure, friction, dry skin, and reduced sensation make the skin more vulnerable to breakdown. Stage 1 – Repeated Pressure & Friction Daily walking creates constant...

03/03/2026

Ankle injuries explained.

07/02/2026

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Giron Center, Room 207, 2nd Floor, Jabotinski 5
Ra`anana
4358152

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