dr. Martha Holzworth
Dr. Holzworth is a Foot and Ankle Specialist practicing in Boca Raton, FL. She completed her undergraduate studies the University of Georgia, graduating cum laude with High Honors. She then went to earn her Doctorate degree at Barry University where she served as President of the Florida Podiatric Medical Student Association. Dr. Holzworth then went on to complete an extensive 3 year surgical residency, specializing in Foot and Ankle Reconstruction at JFK Medical Center in Atlantis, Florida. She is an advocate for conservative management to restore pain free activity and performs minimally invasive surgery such as ankle arthroscopy and endoscopic surgery for heel pain. As marathon runner herself she understands the needs of athletes and importance of strong feet for healthy living and optimal performance. She enjoys running and has completed five Full 26.2 Marathons and multiple national and international Half-Marathons and Triathlons. During her residency training, Dr. Holzworth received advanced training in flatfoot reconstruction, trauma, wound care, diabetic limb salvage, with added credential in reconstructive rearfoot and ankle surgery. She specializes in surgical and nonsurgical treatments of many conditions of the foot and ankle. She is double Board Qualified in Foot and Ankle Surgery (American Board of Foot and Ankle Surgery) and in Podiatric Medicine (American Board of Podiatric Medicine). She is also Certified Wound Care Specialist through the American Board of Wound Management. Dr. Holzworth is on staff at Boca Raton Regional Hospital and Boca Raton Outpatient Laser and Surgery Center. She is fluent in Spanish.
Kyle Stull is the Research and Program Design Manager for Implus LLC and a Faculty Instructor for the National Academy of Sports Medicine. In these positions Kyle collaborates with universities and industry professionals conducting research that provides evidence-based support for educational material, which is used for both marketing and instructional purposes. He has achieved his Doctorate in Health Sciences, MS in Rehabilitation, is an LMT, Certified Strength and Conditioning Specialist, and NASM-CPT, CES, and PES. Kyle has 14 years of experience in personal training, corrective exercise, and manual therapy. As a member of the Fascia Research Society and the International Academy of Orthopedic Medicine, Kyle is committed to being at the forefront of industry developments and maintaining the highest standards in his practice by incorporating the latest research into his work.
Previously asked questions
This segment is designed to provide educational information on footcare in regard to the subject matter covered. Anyone seeking medical advice or assistance should consult his or her physician.
Q: I’m experiencing terrible foot pain. Could I have a stress fracture? What should I do?
A: If you have a stress fracture both the upper and lower surfaces of your foot will be tender to palpation. You might also have swelling. You will need an X-Ray of the foot and sometimes an MRI to confirm the diagnosis. If you feel a pain in your foot for days or even weeks while running/walking, and then you feel a sudden severe pain in your foot, you probably have a stress fracture. A stress fracture can also feel as generalized pain after long walks, repetitive exercise, and it is very common in patients with demineralized bone density as in the cases of osteopenia/osteoporosis. Pay attention to your shoes as they can be exacerbating your pain. Treatment depends on your clinical exam, so having an adequate diagnosis is key. Sometimes the foot needs to be rested in an immobilization boot, cast, or surgical shoe. You will then need an arch support to redistribute weight bearing forces or an orthotic to address particular biomechanical issues after fracture heals. The worse type of stress fracture in the foot is the lateral foot fracture, fifth metatarsal, as it occurs often in high arch feet. This one is often times takes the longest to heal. A foot stress fracture generally heals in 4-6 weeks if treated appropriately.
Q: I get black toenails after running or walking long distances. Sometimes the pain is severe, sometimes the nail comes off. What causes this to happen and what can I do to help it?
A: A black toenail, or subungual hematoma, is a bruise forming under the nail bed which is the delicate tissue where the hard nail plate lays on. Constant banging and pressure, frequently seen in long distance runners, causes bleeding of the nail bed and traps blood under the nail plate. This makes the toenail turn black and painful. The treatment is shoe re-sizing. The athletic, or running, shoe should allow the toes to spread out and account for swelling. Sometimes bulky socks can take too much room in your shoes and also exacerbate the problem. Your running shoes should be at least one size larger than your dress shoes. Remember that different shoes, models, or styles can vary significantly so proper individual fitting is imperative. If this is a recurring problem, in addition to shoe fitting, remember to trim toenails to adequate length, pay attention to socks, and also find shoe upper materials that are soft and expandable. Sometimes lesions can be very painful and drainage of hematoma by your doctor is the best option, but often times the lesions dry on their own, toenail falls off, and new toenail forms underneath. Proper shoe and foot hygiene is important also to prevent fungal infections affecting the vulnerable nail.
Q: I have heel pain. What do I do?
A: Heel pain can have many causes. Most importantly, if your foot hurts, see your doctor to determine the cause and get treatment. Your doctor will do an exam and some physical tests to diagnose the cause of the pain. I frequently see people who self-diagnose and they often miss comorbidities that exist taking longer to fully recover. Here are a few pearls:
Pain beneath the heel is commonly caused by bruised heel bone, plantar fasciitis, heel spur syndrome, or a plantar fascia tears. A bruised bone should go away gradually with rest, ice, activity and shoe-wear modifications, anti-inflammatories and cushioning inserts. Plantar fasciitis is the inflammation of the plantar fascia itself which runs the length of the foot from the heel bone to just behind the toe bones. The ache can be due to overstretching or partial tearing of the fascia. Be careful, because with every step, the plantar fascia tears a little more and can worsen condition. If you suffer from this injury you will probably feel the pain particularly upon arising in the morning or after sitting for a long time. The treatment is to wear an arch support under the foot immediately to prevent the arch from collapsing and condition from worsening. You must wear a supportive slipper or sandal as soon as you get out of bed and avoid barefoot walking. You can also use athletic tape along the length and across the bottom of the foot to support the arch. Rest from activities that cause pain, Anti-inflammatories, and ice help alleviate acute symptoms. If you are found to have a tight Achilles tendon complex, ask your doctor for a night splint. By doing this you should likely feel relief within two to three days. Running and jogging, inappropriately fitting shoes, or weight gain often lead to most of the injuries. One thing to remember, the management and treatment of plantar fasciitis and a plantar fascia tear is completely different so make sure you see a foot and ankle specialist for accurate diagnosis.
Q: I have pain in muscles in the outer part of my shin that swell up and cause my leg to become very sensitive to pressure. What is this?
A: The lower leg is compartmentalized where each compartment contains certain muscles, nerves and vessels divided by a dense fibrous layer called fascia. Overdeveloped muscles can increase the pressure within each compartment and put pressure on its respective vessels and nerves. If this occurs, the blood is trapped within the compartment itself, the muscle becomes engorged with blood, and the blood cannot escape causing lack of oxygen to the muscle. This causes the muscle to die which leads to loss of function. The area swells and it becomes very painful and sensitive to pressure. You must see a doctor because this is a Surgical Emergency and surgical decompression is required. The symptoms are pain, pressure, and/or muscle weakness. Elevate the leg and ice for several hours and if the swelling does not come down you must see a doctor immediately. Fortunately, the condition is rare, and there are athletes who have had both legs surgically treated and are able to resume back to their normal activity level. Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. In this case, the condition is caused by athletic exertion and surgery is typically an elective procedure.
Q: I have pain in the anterior part of my shin, do I have shin splints? What do you recommend?
A: Shin splints are the common name given to pain in front of the lower leg. True shin splints are felt at the location where the muscle responsible for raising the arch of the foot attaches to the leg. Anterior tibial leg pain can also be experienced from stress fracture or even more serious circumstances as a compartment syndrome (see compartment syndrome Q&A). Shin splints occur when the arch abnormally collapses to absorb the shock of the foot hitting the ground and as a result the muscle pulls at its origin on the shin bone. This muscle responds to the biomechanical need to stabilize the foot as it fires and pulls the arch up to continue the gait cycle. The pain is experienced in the inner side of middle third of the leg. In the pronating foot (see pronating foot type Q&A), the arch stays down longer, and as the muscle fires, the foot is still carrying weight and therefore it is unable to bring the arch up. Repetitive firing in this situation creates small muscle tears from the origin on the tibia (shin bone). It can also cause bleeding around the lining of the bone (periosteum) and severe pain. You can cross train with cycling, swimming or non-impact exercises if they do not hurt (care to be taken not to have a setback). The treatment: Arch supports or if you need them to fit in an athletic shoe try the thin . The arch supports prevent the excessive pronation and should solve the problem by preventing the pull from the muscle. In most cases these inserts can provide adequate support and that is all is needed. The more serious cases may probably need custom functional orthotics made by a sports podiatrist. Check your shoes as well to ensure they are not worsening the condition or get fitted for appropriate activity specific shoe. Rest from the activities that cause pain, Anti-inflammatories, and ice can help alleviating acute symptoms.
The condition can be exacerbated with additional rotation, or twist, in the gait cycle that coupled with the muscle pull from the origin at the tibia causes stress on the bone itself. If the twisting and loading on the tibia (shin bone) is repetitive and severe enough, the bone becomes fatigued and cracks. This is the case of stress fractures. Your doctor will be able to differentiate and diagnose. You might need X-Rays or MRI Scans. The bone tends to thicken in its cortical (outer) layer to strengthen itself from the injury and this can be visible on X-Ray, however, these X-Ray findings do not appear until a few weeks later after the bone starts to heal. Suspect this is the case if the pain worsens and/or if you experience the pain while walking not just running/sport specific activity. The treatment for this is rest. You should not push through this type of pain or you can certainly make it worse. Your doctor might recommend temporarily immobilization depending on your exam. Unfortunately, this type of stress fracture takes 6-8 weeks to heal. Follow rest period with physical therapy and footwear modifications with arch supports to stabilize the foot. Depending on the degree of instability, a functional custom device might be needed, but in most cases patients respond well with pre made arch supports such as Spenco.
Q: I have pain in the back of my ankle. Is this Achilles Tendonitis? What do I do?
A: Heel pain, whether is in the back or on the bottom of your foot can have many causes. If your foot hurts, see your doctor to determine why and get treatment. Your doctor may order imaging tests, such as X-Rays or MRI, to make sure your symptoms are caused by Achilles tendinitis and not a tear. If you have pain behind your heel, you may have inflammation at the area where the Achilles tendon inserts to the heel bone. Under the Achilles tendon, at the heel bone attachment, there is a small bursae or fluid filled sac that protects the tendon from rubbing on the heel bone. If your biomechanics are out of alignment, as it is commonly seen in pronation, the additional pressure and stress to the bursa causes it to become inflamed and painful. The treatment is therefore an arch support that can bring the Achilles tendon back into alignment. Rest from activities that caused the problem, Anti-inflammatories, and ice can help alleviate acute symptoms. You can also get this pain from wearing shoes that rub or cut into the back of the heel and therefore shoe evaluation is important. If you are found to have a tight Achilles tendon, stretch your Achilles by leaning forward against a wall with your foot flat on the floor and elevate your heel or ask your doctor for a night splint. Advanced physical therapy is very effective as it offers professional guidance and advanced modalities. However, if you are found to have an insertional tear of your Achilles tendon, the treatment is very different. Conservative management can be initiated but often times the tendon has to be repaired surgically. If there is less than 50% damage with debridement and repair, if there is more than 50% damage with a tendon transfer to add strength to the damaged tendon.
Q: My doctor told me that my young son has Severs disease. Do you have any advice?
A: Severs disease is the inflammation of a growth plate in the heel bone often times seen in young baseball and softball players. Almost always, the cause of this is over pronation. Running in less stable cleats or shoes can trigger the pronation, alter the mechanics of the foot, and cause heel pain almost immediately. Start by using a pre-made arch support , if the child pain disappears within a few days then your child does not have Severs disease. If the pain persists despite the shoe wear modifications and inserts, see a specialist to evaluate the case.
Q: My second toe is longer than the first and I have a big callus under my second toe joint. What is this?
A: A lot of people have normal variants where the second toe is longer than the big toe. However, often times this is representative of the entire ray being longer than the first. The problem arises when the necessary strength for push off of the first toe joint is diminished and taken by the second longer toe joint shifting the weight bearing forces laterally. This is often the case when people present with big pressure callus and pain under the second toe joint. Additionally, the side stresses on the big toe strains the delicate foot ligaments. The leverage needed on the first toe joint is transferred to the second one creating problems such as arthritis, metatarsalgia, rupture/strained foot ligaments and bunions. If you have this foot type, you can use an insert with a foam pad under the first toe joint, to build up the first toe joint, with a strong arch support. Depending on the degree of instability, a functional custom device might be needed, but in most cases patients respond well with premade devices such as the Total Support Insole.
Q: What is the difference between a pronating foot and a supinating foot?
A: Pronation and supination are functional terms. Both of these are common types of foot abnormalities. In regards to a pronating foot, this foot type has an inward roll that causes the entire leg to rotate to the inside. It almost looks as if a person is learning to ice skate becausethe kneecaps point towards each other and the leg and hips are pulled out of line. This foot type can be managed with an insert that keeps the foot aligned so that when the person is walking, as the foot strikes the ground, the arch is supported and the leg is prevented from rolling inward. The supinating foot is opposite to the pronating foot as it rolls to the outside. This foot type tends to be tight, more rigid, and cause the person to walk on the outer portion of the foot. The main problem here is shock absorption. As the arch does not absorb the shock on each step, this foot type often develops lateral stress fractures, inversion ankle sprains, Achilles tendonitis, and knee pain among others. In my practice I see lot worse and frequent injuries from this foot type than pronating feet. Part of it being that the pronating foot tends to be more flexible whereas the supinating foot is more rigid and lacks shock absorption. This is why the supinating foot type requires a lot of padding and cushioning on the outside of the foot. The technology in footwear and inserts has come a long way and it is extraordinary.
Q: What is the difference between an orthotic and an arch support?
A: Orthotics and arch supports are devices that contain strategically placed pads and divots designed to shift your weight allowing your foot to walk or run more naturally. They are made of different materials with different densities from foam to hard plastic. An orthotic is functional in nature and it is intended to correct patient specific issues and ultimately correct biomechanical patterns that cause pathology. Arch supports follow the same principle but they are not patient specific. Either orthotics or arch supports are not the answer to all foot problems but they can certainly be a safe and effective treatment for lower extremity and gait related ailments. I usually don’t have anyone fitted for an orthotic until they have failed with a pre-made arch support, unless it is evident that their condition is so complex that a premade device will not be effective. In that case, I order a functional custom orthotic right away. Custom foot orthotics are individually prescribed and fabricated over a model of a patient’s foot. Each orthotic is as different as the patient who needs it.
Spenco offers great alternatives. You can also use the Store Finder Feature to get professional assistance with an individualized fitting. Don’t forget to bring the shoes you intend to use the day of your fitting. If the pain goes away with the arch support, please continue using it and change it periodically. Remember that an orthotic or arch support should never be painful! If it is, take it back and have it adjusted.