Dr. Jonathan Pajouh, DPM; Neighborhood Medical Center

WHAT IS EPAT?

Extracorporeal Pulse Activation Treatment (EPAT) also known as Shock Wave Therapy, is the most advanced and highly effective noninvasive treatment method approved by the FDA. This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. Damaged tissue gradually regenerates and eventually heals. This non-invasive office/clinic based procedure represents a breakthrough treatment option for a broad range of musculoskeletal conditions.

WHAT DISORDERS CAN BE TREATED?

Generally, acute or chronic muscle pain and/or tendon pain the foot and ankle. The most common conditions treated in the foot and ankle are plantar fasciitis (heel and/or arch pain), Achilles tendonitis, and other tendon/muscle pain.

WHAT ARE POSSIBLE SIDE EFFECTS/COMPLICATIONS?

The non-invasive EPAT® treatment has virtually no risks or side effects. In some cases patients may experience some minor discomfort which may continue for a few days. It is normal to have some residual pain after intense exercise or a full-day of work.

WHAT ARE THE EXPECTED RESULTS?

The beneficial effects of Extracorporeal Pulse Activation Treatment (EPAT®) are often experienced after only 3 treatments. Some patients report immediate pain relief after the treatment, although it can take up to four weeks for pain relief to begin. The procedure eliminates pain and restores full mobility, thus improving your quality of life. Most patients treated report to be pain-free and/or have significant pain reduction.

IS IT SAFE?

Yes. This FDA approved technology was developed in Europe and is currently used around the globe. A wealth of medical experience, state-of-the-art engineering, and optimal quality have been built into each EPAT® device, and extensive clinical studies and test have confirmed its safety and efficacy. If performed by a qualified caregiver Extracorporeal Pulse Activation Treatment (EPAT®) has virtually no risks or side effects.

HOW IS THE TREATMENT PERFORMED?

Coupling gel is applied to the treatment area of interest to enhance effectiveness. After these preparations, EPAT® pressure waves are released via the applicator moved over the area of interest in a circular motion.

WHAT IS THE DURATION OF THE TREATMENT AND HOW MANY TREATMENTS WILL I NEED?

Treatment sessions take approximately 5 to 15 minutes depending on the disorder to be treated. Generally, 3-5 treatment sessions are necessary at weekly intervals.

WHAT WILL HAPPEN AFTER THE TREATMENT/PROCEDURE?

You will receive post-treatment instructions from your Podiatrist to follow during your recovery.

WHY CONSIDER NON-INVASIVE EPAT?

EPAT® has a proven success rate that is equal to or greater than that of traditional treatment methods (including surgery) and without the risks, complications and lengthy recovery time. EPAT® is performed in your Podiatrist’s office/clinic, does not require anesthesia, requires a minimal amount of time, patients can bear weight (i.e. walk) immediately, and return to normal activity on the day of the treatment.

BENEFITS OF NON-INVASIVE EPAT®

Patients are immediately fully weight bearing.
Bilateral patients can be treated at the same time.
No incision – No risk of infection at the treatment site – No scar tissue formation.
Patients are able to return to work/normal activities the same day of the procedure.
Patients evaluated for success at 12 weeks.
Non-invasive so biomechanics are not affected – future treatment options are not limited.
Cost Effective
Reduced conservative care – ends the cycle – Reduced after care and complications costs.
Reduced cost from lost work.
Fast, safe and effective.
HOW MUCH DOES IT COST?

In the past, procedures similar to the EPAT costs thousands of dollars when performed in the operating room due facility requirements (size of the machine) and the need for an anesthesiologist. Today, this technology is available at a fraction of this cost and can be performed in office without the need for local or general anesthesia. Dr. Pajouh offers a much lower cost than most for this therapy as he has seen the level of improvement it can provide patients. The current price is $450 for three EPAT therapy sessions. Some patients can use their “Flexible Payment Medical Savings Account” to cover the out of pocket expenses with pretax dollars. Our office also offer CareCredit options and well as payment plans.

Some exciting news if you are one of the thousands of people who suffer persistent foot or ankle pain. EPAT (shockwave) therapy might be an excellent and simple option for you. We are happy to announce that we are now offering in office EPAT therapy for your foot and ankle needs. Session last around 15 minutes and are done in one week intervals for a total of 3 weeks. The cost for EPAT therapy is $450. This includes one session each week for three weeks. Please contact our office at 972-726-6464 to schedule an appointment for a consultation to see if EPAT therapy is a good option for you.

Not all are the same. Conservative treatment can work for some while others require surgery to correct the deformity. If you or someone you know suffers from painful bunions, give our office a call to schedule an appointment for a consultation @ 972-726-6464

Happy early thanksgiving everyone. Our office will be closed on the 24th and 25th to celebrate thanksgiving and put up Christmas trees.

How to use a Knee Scooter or Knee Walker

Check out our new YouTube channel with some videos like this one and exciting new thing going on at the office today!

https://youtube.com/

How to use a Knee Scooter or Knee Walker Using knee scooters or Knee walkers incorrectly can be dangerous. Here at Neighborhood Foot and Ankle we recommend being extra carful with knee scooters/walk...

Make sure to see a for your foot and ankle needs!

It’s Time! APMA Diabetes Awareness Month! Diabetes can cause serious complications in the feet, including ulcers, serious infection, and even amputation. A podiatrist can help! People with diabetes should do daily foot exams and see a podiatrist for a diabetic foot exam at least once a year. Call today for an appointment! buff.ly/3WJjgDp

Achilles ruptures:
Signs and Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following:
• Sudden pain (which feels like a
kick or a stab) in the back of the ankle or calf—often subsiding into a dull ache
• A popping or snapping sensation • Swelling on the back of the leg
between the heel and the calf • Difficulty walking (especially
upstairs or uphill) and difficulty rising up on the toes

Testimonial Tuesday. Dr. Jonathan Pajouh is here for all of you foot and ankle needs. Our office is conveniently located in Dallas.

If you are looking for a great cause to support this year. Please check out or contact to get involved. The story behind this organization is amazing, as well as the work that they do. Rachel works with Up and Running Again Dallas. The organization’s main goal is to train the homeless to run half marathons and work on second chances. our team at NFA supports this great cause!

Rheumatoid Arthritis Deformities and conditions: RA may include: • Rheumatoid nodules (lumps)— these cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking • Dislocated toes • Hammertoes • Bunions • Heel pain • Achilles tendon pain • Flatfoot • Ankle pain

How Does RA Affect the Foot and Ankle? When joints become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, cause swelling and damage to the joint’s cartilage and bones. Foot problems caused by RA most commonly occur in the forefoot (the ball of the foot, near the toes), although RA can also affect other areas of the foot and ankle. The most common signs and symptoms of RA-related foot problems—in addition to the abnormal appearance of deformities—are pain, swelling, joint stiffness, and difficulty walking.

Dr. Pajouh really appreciates it when his patient take the time to leave him a review! From the NFA team we hope everyone has a great rest of your week. As always we are here when you need us! Also join us and Dr. Pajouh in our November challenges for a great cause!

Join Dr. Pajouh in these challenges for November. He’s 3 miles into this month long journey for a great cause that changes lives of children everyday. As well as one to bring more awareness to a disease that is changing the lives of people on a day to day basis. Support a great cause . NFA will be doing a raffle for all of those who complete these challenges and give away a free pair of custom orthotics to the winner of the raffle. Entry is free. Just comment on this post once you have completed the challenge!

PLANTAR FASCIITIS WHAT IS IT? ONE OF THE MOST COMMON CAUSES OF HEEL PAIN DUE TO INFLAMMATION IN THE PLANTAR FASCIAL BAND WHICH IS OF THICK TISSUE THAT GOES FROM THE HEEL TO THE BALL OF YOUR FOOT. If you are experiencing heel pain contact our office for an appointment today @972 726 6464.

What’s scarier than any horror movie? Foot pain! Don’t wait to make an appointment. If you are having foot or ankle pain call our office today @ 972 726 6464

Happy birthday to our very own Dr. Jonathan Pajouh! .jonathanp

Diabetic Limb Salvage can be one of the most challenging/rewarding aspects of being a foot and ankle surgeon. As the old saying goes “Save a leg, Save a life”, this saying is truer today than any day in the past. Most of these patients have a whole host of comorbidities that require a multi team approach in their care and it’s not just the surgery that they need. These patients are truly grateful for the care they receive and the effort placed into saving their limb so they can function and continue to do daily life activities. This means the world to them and their family and you end up becoming a part of their family. This is coming from someone who has been on the other side with a family member.

October 20th is national osteoporosis day! Osteoporosis, which means “porous bone,” is a condition in which bones become weak and thin due to lack of calcium and/or vitamin D. People with osteoporosis have an increased risk of bone fractures (breaks).

Osteoporosis is often called the “silent disease” because many people do not realize they have it. However, pain can occur when a bone becomes so weak that it breaks.

Osteoporosis is most commonly seen in women over age 50, but younger people and men can also have it. While the bones of the spine, hip and wrist are the most common bones to become fractured as a result of osteoporosis, metatarsals and other bones in the feet can be affected. In fact, some people first find out they have osteoporosis because of a fracture in the foot.

Increased pain with walking, accompanied by redness and swelling on the top of the foot, is a sign that you should see a podiatric foot and ankle surgeon for x-rays and examination.

Mortons Neuroma (Neuroma / Neuritis)

A neuroma is a condition in the foot where a nerve or surrounding tissue becomes thickened resulting in compression and irritation of the nerve. These typically occur between the bases of the 3rd and 4th metatarsal which is also known as Morton's Neuroma.

Signs and symptoms of a neuroma can include:

Tingling, burning or numbness
Pain
A feeling that something is in the ball of your foot and your walking on a pebble
Shoot pains to your toes
These symptoms can temporarily resolve or can gradually get worse overtime and become persistent.

Treatment:

There are many non surgical treatment options that can work for neuromas. Some simple changes such as changing shoe gear and avoiding tight shoes or high heels may help. Custom orthotics may also help relieve irritation by helping reduce pressure on the nerve. Injections of corticosteroids can help reduce swelling and inflammation of the nerve which may also provide relief. Certain medications may help as well. A small portion of individuals who continue to have pain following these treatment options might require surgical intervention and release of the surrounding tissue to help provide relief..Make an appointment today with Dr. Jonathan Pajouh to further discuss treatment options and which treatment option best fits you.

Hallux Limitus / Hallux Rigidus / Big Toe Pain and Arthritis

Let's talk about Hallux Limitus, Rigidus, Big Toe pain and Arthritis. First off, what is it?

Hallux rigidus is stiffness in the big toe joint that can occur from arthritis developing in the metatarsal phalangeal joint. This joint connects the head of the metatarsal bone to the base of the proximal phalanx and underneath lies two small bones known as the sesamoids. Hallux rigidus is actually a form of degenerative arthritis (wearing out of the cartilage within the joint). Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, motion of the big toe is only somewhat limited; this is called “hallux limitus.” But as the problem advances, the toe’s range of motion decreases until it potentially reaches the end stage where the big toe becomes stiff.

Symptoms:

Swelling and inflammation around the joint
Pain and stiffness in the big toe during walking, running and regular exercise
Pain and stiffness aggravated by cold
Difficulty with certain activities
Treatment

If caught early on, less aggressive treatments such as shoe modifications, orthotics, injections, medications and physical therapy may be able to provide relief. However if the condition progresses and non surgical treatments do not provide relief, surgical treatment may be required. These surgical options include bone spur removal (Cheilectomy), Joint fusion (arthrodesis) and Joint Implants. Dr. Pajouh will discuss the best treatment option for you.

Foot pain during pregnancy can be awful. Here are some tips that Dr. Pajouh recommends that can help. Remember to make sure to follow up with you OBGYN for any questions may have who can refer you to a foot and ankle specialist for further evaluation if needed.

October is Breast Cancer Awareness Month, an annual campaign to raise awareness about the impact of breast cancer. For more information check out https://www.komen.org/about-komen/our-impact/breast-cancer/breast-cancer-awareness-month/

Fractures (breaks) are common in the fifth metatarsal. Two types of fractures that often occur in the fifth metatarsal are: • Avulsion fracture. In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an inversion injury, in which the ankle rolls inward. Avulsion fractures are often overlooked when they occur with an ankle sprain. • Jones fracture. Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to injury. A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress, or trauma. They are less common and more difficult to treat than avulsion fractures. Other types of fractures can occur in the fifth metatarsal. Examples include mid-shaft fractures, which usually result from trauma or twisting, and fractures of the metatarsal head and neck. Signs and Symptoms Avulsion and Jones fractures have the same signs and symptoms. These include: • Pain, swelling, and tenderness on the outside of the foot • Difficulty walking • Bruising may occur