How should I treat my Bunion problem?

Why do bunions develop?

Bunions develop from a weakness in the bone structure of your foot. There is a strong possibility that heredity is the underlying cause. As a result, the joints have a tendency to move out of proper alignment given the instability of the bones and ligaments that form the various joints and arches in your feet. Podiatrists will sometimes see the development of bunion deformities even in young children. The bunions are not caused by improper shoegear but are significantly aggravated by improperly fitting shoes that place an unusual degree of pressure at the bunion joint.

As bunions become more severe, the joint moves out of proper alignment and eventually arthritis damages the joint space. The large toe will move sideways towards the second toes, and the foot tends to widen across the metatarsal area. This is a mechanical consequence not usually caused by shoegear. However, shoesgear can certainly aggravate the condition and speed up the development of a more serious and significant deformity.

Some Facts You Should Know About Bunions

A large percentage of the population is likely to develop bunions, although it appears that bunions are more commonly seen on women's feet. A bunion is a swelling or enlargement of the large toe joint on the inner side of the foot. The deformity usually develops gradually and will cause pain for shoes rubbing against the enlarged bone. There may be swelling, redness and deep arching pain associated with bunion joint, causing a bursitis.

Concluding Thoughts

It is always important to carefully follow your doctor's instructions. Be sure to ask your podiatrist any questions you have before or after surgery.



Your podiatrist will direct your postoperative management and will advise you of the type of shoes to wear at the conclusion of your postoperative period.



There may be additional methods of treatment for this common foot problem. Your doctor will discuss this with you. Complete cooperation between you and your doctor is essential for a satisfactory result.

Surgical Treatment

The following are examples of the different types of metatarsal surgical procedures known as osteotomies or surgical fractures of the bone(s). These procedures are necessary to reposition a depressed or abnormally long metatarsal that could be the cause of your problem.

Treatment for Metatarsalgia

Treatment is based on a thorough history and examination of the foot and lower extremity. Further determination into the cause may require gait analysis, X-rays, advanced imaging studies and possibly blood work. Once the underlying cause has been determined, then your podiatrist can direct treatment to address the problem.

Calluses may need debridement. Warts may need to be removed. Functional or biomechanical causes may be controlled with the use of an orthotic. Orthotics could be prescribed to reduce motion and shearing forces across the ball of the foot.

In case where deformity and loss of fat pad occur, there can be relief of symptoms with the use of customized shoe-gear in combination with orthothics.

Structural causes mentioned involving a long or depressed central metatarsal could respond to off-loading or could require surgery to decrease the pressure on the forefoot. Orthotic devices are used to try and rebalance and off-load these areas of the forefoot. When that fails to relieve symptoms, surgery will sometimes become necessary.

Forefoot Pain

Painful conditions can occur in this area separately or in combination at the metatarsophalageal joint intersection. Common causes of pain in this region of the forefoot include:

Calluses, which either spread out over a broad area or are isolated beneath a single metatarsal head. Calluses may have structural or functional causes.

Some structural causes could be:

1. Enlarged Metatarsal Head


2. Depressed Metatarsal (a bone that sits lower than the others)


3. Abnormally long metatarsal


4. Abnormal Sesamoid Bone


5. Foreign Bodies embedded in the foot


6. Degenerative changes to the joints from inflammation or Arthritis

Some Functional causes could be:

1. Abnormal biomechanical function of the foot. These abnormalities include:flatfeet, high- arched feet and contracted toes. Each entity will produce specific callus patterns on the ball of the foot.


2. Loss or thinning of the fat pad naturally occurs with age. Atrophy of the fat pad can be accelerated by diseases such as Rheumatoid Arthritis. Thinning of the fat pad is also common in postmenopausal women.


3. Displacement of the fat pad exposes the metatarsal heads to abnormal pressure. Displacement occurs mostly with people who have unnaturally high-arched feet or with individuals heavily involved in sport activities over a long period of time, when there is continuous strain on the ball of the foot( i.e; jogging, basketball, tennis, and volleyball).

Other causes of forefoot pain include:

1. Rheumatoid Arthritis or Osteoarthritis


2. Bursitis with or without associated calluses


3. Warts, which commonly resemble calluses or corns


4. Foreign bodies, such as splinters, glass or embedded hairs


5. Neuroma or Neuritis, a condition or small nerves in between the metatarsals


6. Tendonitis


7. Cysts


8. Diabetes with neuropathy - causing burning pain or pins-and-needles tingling sensation


9. Trauma/Stress Fractures
   

What are Metatarsals?

Metatarsals comprise the ten long bones located in the feet, similar to knuckles on your hand. They are positioned right before the toes and sometimes referred to as the "ball of the foot." Painful conditions that involve the central metatarsal region (or second, third and fourth metatarsals) are referred to a metatarsalgia.

The entire weight of the body is distributed across the ten metatarsals and their related metatarsophalangeal joint. This area, which spreads forward from the metatarsal bones to the toes, is known as the forefoot. The forefoot encompasses an inter-related structure of bone, ligaments, tendons, muscles, nerves, blood vessels and skin.

Positioned underneath the metatarsal heads in a normal foot lies a "fat pad." The fat pad serves to protect and provide shock absorption to the ball of the foot.

Conclusion

Painful toe deformities prevent patients from being able to wear shoes comfortably and perform their normal activities.

There may be additional methods of treatment for this common foot problem. Your podiatrist will discuss these with you. Complete cooperation between you and your doctor is essential for a satisfactory result.

Postoperative Care

After surgery, you will receive instructions from your podiatrist regarding the care of your dressing, your level of activity and weight-bearing. As with all foot surgery, rest and elevation can help reduce pain and swelling. Be sure to ask your podiatrist any questions you have before or after surgery.

Osteotomy

A cut is made through the bone to allow it to be realigned. Wire or pin fixation could be required.

Bone Spur Removal

An incision is made and an instrument is used to file or excise the bone spur and remove the source or increased pressure.

Derotation/Realignment procedure for overlapping toe

A wedge of skin and a segment of bone are removed to realign the overlapping toe.

Arthroplasty with Implantation

Following excision of a joint, a plastic implant is placed inside to act as a functional spacer.

Arthroplasty with Tendon Relocation

A joint space is created and the toe is realigned by relocating the flexor tendon, which pulls the toe down.

Arthroplasty with fixation

This procedure involves joint removal and the use of a wire (pin) to stabilize or fuse an deformed toe.

Arthroplasty

This very popular procecdure involves removal of cartilage and bone in remodeling a deformed joint. it allows for relief of the painful area.

Tenotomy and Capsulotomy

The terms tenotomy and capsulotomy refer to the cutting of tendons and joint capsules. More specifically in relation to hammertoe deformities, the tight tendons and joint capsules located on the top and bottom of the buckled or contracted toe joint are released.

Once these tight, soft-tissue structures are cut and relaxed, the toe can resume its normal flattened posture.

Digital/ Toe Surgical options

These procedures help to straighten the toes by cutting the bone, tendon, joints, and/or ligaments.

Treatment

Conservative treatment can consist of one or more of the following.

1. 
   
   Trimming, digital splinting and/or padding of the corn.


2. 
   
   Orthotics or inserts in shoe to correct improper walking.


3. 
   
   Injections to relieve pain and inflammation.


4. 
   
   Larger or extra depth shoes to accommodate toe deformities.
   

If these conservative methods are unsuccessful in treating your deformity, then corrective toe surgery should be considered. Your podiatrist will conduct a thorough medical history and examination to determine your options. Lab tests, advanced imaging studies and X-rays will be scheduled if necessary.

The surgical correction or your toe deformity may be performed in the office, outpatient surgical procedures. Each case requires individual evaluation to determine the best surgical approach.

Corns

The body's response to excessive amounts of pressure against the skin manifests itself by forming thick, hardened skin or corns. Corns are most often the result of an enlarged bone or bone spur pinching the skin against a shoe. A corn can be indicative of a pressure point between the toes.

Soft corns refer to corns that exist between the toes. They are the result of two bones rubbing against each other, pinching the skin. Sometimes more than one soft corn will form.

Overlapping Toe

An overlapping toe is one that is malpositioned from birth or acquired over time. It often produces some abnormality in tendon, ligaments or skin, many times producing painful corns. All of the toe deformities, enlargement of bone tissue or bone spurs. Shoes further aggravate these conditions and can cause additional pain, inflammation and corns.

Mallet Toe

A mallet toe is similar to a hammer toe, except the deformity occurs closer to the end of the toe.

Hammertoes

A hammertoe is a flexible or rigid contraction usually affecting the second, third, fourth, or fifth toes. Most often a biomechanical abnormality results in the larger muscles of the foot and leg overpowering the smaller intrinsic muscles of the foot. muscles imbalance leads to a bending or "buckling" of the toe joints. These buckled or contracted positions create any number of problems within and on top of the toe deformity. One or more small joints become prominent on top of the malpositioned toe. Tendon, ligaments and joint capsules in that area have a greater chance of tightening and inability to wear shoes comfortably. If left untreated, these conditions can progress to ulcers or infections.

A flexible hammertoe refers to a reducible hammertoe in contrast to the rigid hammertoe where the deformity it fixed or not easily straightened. There are many causes of hammertoe. Some are congenital, hereditary or acquired. An inherited condition may mean an inherited muscle imbalance around the toe or a parent with a abnormally long toe. An acquired hammertoe refers to those with diabetic neuropathy can be more susceptible to hammertoes.

Digital/Toes Deformities

A deformed toe is one of the more common conditions known to afflict the foot, whether it be a hammertoe, mallet toe, or overlapping toe.

Concluding Thoughts

Skin loss, ulceration and breakdown is a limb-threatening, and at times life-threatening, problem. It is essential that you become proactive and a daily observer of your lower extremity to prevent ulceration. In the event you develop an ulcer, you need to partner with your podiatrist, and other members of the team used to coordinate your medical care, in resolving your ulcer condition.

What can I do to prevent ulcers?

• 
  
  If you previously had an ulcer that is now healed or have been identified as as individual who is a risk for an ulcer, the single most important step is daily inspection of your feet. Observe them for any sign of sudden redness, irritation and /or open areas.


• If you have vision loss, engage a family member or friend to help with your inspection. It is critical for you to notify your doctor or podiatrist when these manifestations present themselves.


• When you have an established disease, maintaining its effects becomes a priority.


• If you are diabetic be sure your blood sugar is under control and seek preventative foot examinations and appropriate treatment from your podiatrist.


• If you are a smoker, do all that you can to quit, as this is a factor in wound healing and in the development of poor circulation.
  

I have an Ulcer, How will it be treated?

The very first step in treating an ulcer is having a thorough history and physical exam by your podiatrist. It is necessary to determine what type of ulcer you have and what are the underlying diseases that are causing the problem. Once the type of ulcer has been determined treatment can begin. Often it is necessary to perform lab work X-rays, bone scans, MRIs and circulation tests in order to stage the severity of the ulcer. This testing very often helps to direct a treatment plan.

The cornerstone of treatment in most cases includes good local wound care and trying to address the fundamental cause. Your treatment may consist of:

1. 
   
   Consultation with other professional in vascular surgery, orthotics, endocrinology and primary care;


2. 
   
   Debridement or removal of devitalized tissue within and around the ulcer;


3. 
   
   Oral antibiotics or hospitalization for intravenous antibiotic when severe infection in present;


4. Rest, off-loading the foot to decrease pressure on the ulcer site. This could employ cast braces or splints; 4a. In case of a venous ulcer, compression or Una boot therapy might be used.


5. Use of growth factors directly on the wound;


6. Surgical intervention to remove abnormal or diseased bony prominences and skin grafting or use of skin substitutes to cover the area;


7. Once healing has occurred, the goal is prevention of re-ulceration. This could be achieved with custom molded shoes, braces, inserts.

Very often, treatment is a long, difficult, and sometimes a discouraging process. Realize that it most likely will constitute a team approach to manage the other prevailing medical problems you have that gave way to the development of the ulcer.

It is important for you to follow your podiatrist's directions in your ulcer treatment plan. You are the most important factor in resolving this problem. So be an active participant in your treatment, ask questions and be sure you understand what is being done.

What are the risk factors for ulcerations?

There are a number of co-morbidities that can set one up for ulcer formation. Risk factors include diabetes, peripheral vascular disease, stroke, smoking, loss of sensation, muscle dyfunction form neuropathy (i.e.,damage peripheral nerves), vision loss from diabetic retinopathy and bony deformities of the foot.

What are the causes of Ulcers?

There are a number of causes, but for the most part ulcers can be categorized into three part
ulcers can be categorized into three major causes.

1. Ulceration due to loss of sensation (neurotropic)

2. Ulceration due to poor circulation entering the foot (arterial) or exiting the foot and leg (venous)
3. Ulceration due to pressure (bed sores)

Ulcers can be the result of any combination of these three major causes. A variety of diseases, such a diabetes, arteriosclerosis, venous disease, leprosy, alcoholism, rheumatoid arthritis, gout, syphilis and strokes, can also cause ulcerations of the foot and leg.

Along with the above causes, presser and injury to the skin can be precipitating factors in ulcer formation. The combination of pressure on an abnormal bony prominence and ill-fitting shoes can result in skin breakdown or ulceration. The problem then becomes the ulcer, opening the door for bacteria to enter the body and trigger infection. In conjunction with poor circulation or diabetes, this skin loss or open area could develop into a limb-threatening infection.

Ulcers of the Foot and Lower extremity

What is an ulcer and why should I be concerned?

An ulceration of the skin is a disorder that results in the breakdown of skin layers. This could involve the various layers of the skin, subsequent soft tissue, muscle and bone. The skin is the largest organ system of the body that protects us from the outside. Therefore, ulcer formation is a serious problem adversely affecting the skin's protective resilience and possibly causing acute infection, tissue death, limb loss and even loss of life.

Treatment

Early on, peripheral vascular disease sometimes can be treated with just a few daily life-style changes. These changes can frequently reduce the symptoms and improve circulation. If you smoke, do all that you can to quit. If you are obes, a regular exercise program(before exercising consult your family doctor) and diet changes will facilitate the circulatory system to function more effciently.

Peripheral Vascular Disease can be treated in a variety of ways:

• Medication: In some cases, medication will be prescribed to help improve blood flow and relieve symptoms. Such drugs a Trental and Pletal could be prescribed to aid circulation. Calcium-channel blockers, a medication that helps relax blood vessel walls, can also be used.
• Minimally invasive procedures:If medications fail, your doctor may recommend minimally invasive procedures such as angioplasty ( a small balloon used to compress the plaque), stent placement( tiny tube inserted into the artery and kept there to keep it open), lasers, atherectomy and thrombolytic therapy(use of a drug injected by catheter in the artery to help dissolve the clot). These various therapies try to treat the plaque accumulation/clot in the arteries by either removing it, compressing it or dissolving it.
• Surgery:If the plaque is large or severe enough to restrict blood flow, then surgery may become necessary. At times, balloon angioplasty is necessary to open a blockage. A common surgical procedure for acute blockage is a bypass graft. Here the surgeon attempts to redirect the circulation around the blockage.

Vascular disease in the lower extremity has a wide range of effect from mild and short-term to severe and long-term. However, it is often treatable and extremely preventable. Remember to prohibit from smoking, exercise regularly and maintain a healthy diet.

Vascular Testing

ANKLE/BRACHIAL INDEX (ABI): A simple non-invasive test that measures the ratio of blood pressure in your ankle to that in your arms.

ARTERIAL/VENOUS DOPPLER TESTS: A non-invasive test using sound waves to provide an image inside your blood vessels.

EXERCISE/TREADMILL TEST: Measures the demand for oxygen in your tissues during exercise/walking.

ANGIOGRAM:Test using special dye injected into your arteries under local anesthesia, after which X-rays are taken showing any blockages or narrowing of the arteries.

MAGNETIC RESONANCE ANGIOGRAPHY (MRA): This test uses magnetic fields instead of an X-ray to take pictures of the arteries and veins. You will be asked to drink a liquid that has a special dye in it, or the dye will be injected into a vein.

Symptoms

Symptoms in the lower extremity and feet will depend on the amount of oxygen deprivation. Some indications or signs of peripheral vascular disease may include:

1. claudication or cramping in hips, caves, thighs;
2. buttocks pain;
3. burning, numbness and/or tingling in the legs, feet or toes;
4. change in skin color;
5. infections that do not heal

Other changes can be swelling in one or both legs that increases with the time of day, often with a feeling of heaviness; color variations in the hands, feet and legs along with changes in skin temperature; a deep red or purple color in the feet and legs when they have been dangling for a period of time.

Risk Factors

Studies have shown that certain factors increase your risk for peripheral vascular disease:

• Diabetes



• Smoking



• Obesity



• Lack of exercise



• High Blood pressure



• Increased cholesterol



• Stress



• Family history of vascular disease



• Prolonged bed rest



• Congestive heart failure



• Venous insufficiency



• Stroke
  

Types Of PVD

Atherosclerosis: Thickening and hardening of the arteries. Usually involving the large or medium-sized arteries. The arteries narrow and eventually become blocked. This is also known as Peripheral Arterial Disease (PAD).

Microvascular disease: It affects the smaller arteries and is most commonly associated with Diabetes Mellitus. A side effect is a lack of sensation or feeling (neuropathy) to the skin, which in turn develops into ulcerations.

Venous disease: This sluggish return of blood flow exiting the legs is due to defective valves in the veins. Defective valves produce sluggish blood and possibly deep vein thrombus (clot) formation, which in turn can travel to the lungs causing difficulty in breathing and even death. Superficial veins can develop phlebitis.

Vascular Disease

What is Peripheral Vascular Disease?

Peripheral Vascular Disease (PVD) is any number of disease processes that can affect the vascular tree in the extremitties. It can be artrial, venous or lymphatic in nature.

Arterial PVD by example is a bulid up of plaque in the arties that exist in the legs. When this occurs, blood flow is slowd and some structures of your body, such as your skin, muscle and soft tissue, do not get enough oxygen-rich blood.

Conclusion

There may be additional methods of treatment for this common foot problem. Sometimes vitamins, skin creams or topical liquids are utilized. Your doctor will discuss these with you. Complete cooperation between you and your doctor is essential for a satisfactory result.

Anesthesia/Postoperative Care

Anesthesia

Before the surgical procedures are done, with the exception of the chemical removal, the patient receives an injection of a local anesthetic near the wart.

Postoperative Care

As with all surgical procedures your podiatrist will advise you in detail about post-procedure care, local care to the wart and follow-up visits as required. If there are any problems you are experiencing, consult your podiatrist with any questions or concerns.

Traditional Surgery

In this method,two small semi-elliptical incisions are made surrounding the wart. The skin and wart are then removed. The edges of the skin are then brought together with an appropriate number of skin stitches. If this method is used you will most likely need crutches for two or three weeks to allow the incision to heal without weight-bearing, which otherwise contributes to a greater chance of thick and/or painful scarring.

Cryosurgery

Intense cold has been effective in the treatment of warts. Liquid nitrogen and carbon dioxide are most commonly used to freeze the wart and destroy the lesion. A blister can develop following treatment, but this is removed in approximately 10-14 days.

Laser Surgery

A special high frequency laser can be used to destroy warts. This beam of light destroys cell by vaporizing the moisture within them. Generally the growth is removed first with a hand currette instrument or laser. Postoperatively, bleeding, pain or scarring are less likely. This procedure is performed with the use of a local anesthetic. Ambulation is often permitted immediately after surgery.

Surgical Curettage

Curette

Surgical Galvanism

Surgical galvanism, or electrolysis, is the use of a galvanic low voltage current for the destruction of tissue. This procedure is intended to remove the growth without bleeding and normally leaves no pitting or scarring.

Wart cont..

Surgical Curettage

A special small surgical instrument called a "curette" is used to scoop or shell out each wart. This blunt instrument separates the wart tissue from the healthy tissue surrounding it. The base or bottom of the lesion may also be cauterized electrically, chemically or with a laser to discourage regrowth. The electrical method is called electrodessication.

Chemical Removal of warts

Relatively strong solutions and ointments made of acids and caustics are carefully used to destroy warts. These chemicals can be used singly or in combination. Normally a series of treatments is needed because most often the wart is not completely destroyed in one treatment. Treatment plans vary in length of time, lasting as long 10 weeks to as little as one week. However, there is very little postoperative care needed with this method.

During this series of treatments the medicines used on your feet can cause a reaction in the form of swelling and throbbing. The patient should not become alarmed if this reaction takes place. It indicates that the tissue is destroying the growth. When tissue is destroyed, a certain amount of discomfort can occur. If you have a reaction such as drainage, pain or swelling, please call your doctor's office for advise.

Foot Surgery for warts

Warts are caused by a virus and can recur. An individual who has a wart is susceptible to developing additional warts. Plantar warts are often mistaken for corns or calluses on the sole of the foot. Plantar refers to the bottom of the foot, where warts are most likely seen, although they can also occur on the toes. Plantar warts have a spongy appearance with little black, brown or red spots indicative of blood vessels feeding them. The lesions are circumscribed, which means they have a ring around each growth separating it from the surrounding skin.

There are many ways to treat these benign (non-cancerous) skin lesions. There is no best way. There is no quick way. Each method of treatment has advantages and disadvantages.Your doctor will recommend the type of treatment that is best for you. Sometimes it becomes necessary to use a combination of treatments. It depends on how your warts respond to your doctor's therapy. The most difficult wart to treat is a resistive type that appears in a pattern of groups or clusters. these are known as mosaic warts.

Conclusion

Your podiatrist has the ability to treat the below emergencies, as well as any other sprain, fracture, contusion, bruise or injury of the foot. Prompt attention can prevent future problems. Remember, if you have any underlying problems such as diabetes or poor circulation, prompt attention is even more urgent.

Foreign Bodies

A foreign body injury occurs when an object breaks through the skin and becomes embedded within the deeper tissues of the foot.

When a puncture wound occurs in the foot, a podiatrist should be consulted to assess if an object is embedded in the foot. Often an x-ray is not enough to visualize the object unless it is composed of metal. These injuries sometimes require further studies to identify the foreign body and its location. If a foreign object is left in the foot, it can continue to move into the deeper tissues and require surgical removal. This injury can also require antibiotic treatment or a tetanus shot.

Puncture Wounds

Other common traumatic injuries treated by podiatrists are puncture wounds and foreign bodies.

A puncture wound occurs when you step on a sharp or jagged object and it breaks through the skin and enters the deeper tissue of the foot. These injuries typically occur in the warmer weather when people are tempted to go outside barefoot or when they walk around their house in stocking feet.

Thermal Injuries and Chemical Burns

The two most common thermal injuries are burns and frostbite. These injuries can occur from exposure to extremes in temperature, resulting in tissue damage and loss. Burns, of course, are sustained when a hot object has contact with the skin for a sufficient amount of time to damage the skin and underlying structures. Conversely, prolonged exposure to cold results in what is commonly known as frostbite.

Chemical burns result from exposure of the skin to an acid or caustic chemical agent. Most commonly, the improper use of over-the-counter corn removers result in such burns. Chemical burns severity is dependent upon the strength or concentration of the chemical agent. Specific treatment usually involves removal and neutralization of the chemical agent.

In all of the above cases prompt treatment and evaluation can often prevent infection and further tissue loss.

Nail Trauma

Everyone at some time has either stubbed a toe or dropped something on a toe. When this happens, the nail often is injured and bleeding beneath the nail can occur. The nail may then turn black and blue and eventually be lost. Your podiatrist may need to release the blood under the nail, and it severe enough remove the entire nail. The nail bed or skin under the nail could have suffered significant laceration and/or a fracture of the bone beneath the nail.

This injury is serious and needs professional would care and possibly antibiotic therapy as soon as possible.

Regrowth of the nail after injury depends on the extent of damage to the nail "root" or matrix. These are the specialized cells of the skin that produce the hard nail plate. If the nail matrix is not involved in the injury, then the chances if having a normal nail return are good. If the matrix cells are damaged, the nail may return thickened and/or deformed

Children's Growth Plate Fractures

Epiphyseal fractures are fractures of the growth plate in children. Children's bones are not completely formed and if injured and left untreated deformities could result.

If the growth plate is injured, it may lead to a shortened bone or an angulation type of deformity in the bone. when a child sprains an ankle, limps or complains of pain, it is important to seek proper podiatric medical treatment. Children usually will not complain of pain without cause. Young patients with foot or ankle sprains may have a fracture of the growth plate in any of the foot or ankle bones. This could require immobilization in a cast.

Broken Toes

Broken toes frequently go untreated because many people believe that nothing can be done for a broken toe and therefore do not seek medical attention. The truth of the matter is many times broken toes become displaced and then require treatment by realignment. If left untreated, there is more of a chance having problems in the future.

The most common toe fracture is caused by bumping the toe against a piece of furniture. Symptoms of a broken toe include discoloration, swelling and pain. Remember, if you are a diabetic or have decreased circulation or any type of neuropathy (numbness, loss of feeling) prompt medical attention is of the utmost importance.

Ankle Sprains

Ankle Sprains

Ankle sprains are fairly common injuries. An ankle sprain is actually the stretching or tearing of both sides of the ankle. A ligament is a thick band of tissue between two bone, similar to rubber band. If you stretch it and never allow it to return to its original shape it will lose elasticity. This increases the possibility of repeat ankle sprains.

Sprained ankles can occur without fractures. When a sprain occurs with a fracture of or more of the ankle bone, treatment becomes more complex. X-rays are utilized by your podiatrist to treat fractures.

Common Foot and Ankle Injuries

In today's fast-paced world people are more likely to injure themself. Podaitrists are able to diagnose and trea emergencies in which the lower extremity (foot and ankle) is involved. Typical emergencies include ankle fractures, sprains, injuries to toenails, thermal injuries, puncture wounds, and foreign body injuries.

Heel Spur Syndorme/ Plantar Fasciitis Conclusion

There may be additional methods of treatment for this common foot problem. Your doctor will discuss these with you. Complete cooperation between you and your doctor is essential for a satisfactory result.

Heel Spur / Plantar Fasciitis cont...

Preoperative Consideration

Preoperative considerations are assessed by your doctor and include your age, occupation, physical activities or limitations and general health status. Your doctor will explain the procedure to be performed and any potential risks and complications that may occur. Surgery can be performed in the office, outpatient surgical center or as one-day hospital surgery.

Postoperative Care

After surgery, you will receive instructions from your podiatrist regarding the care of your dressings, your level of activity and weight-bearing. As with all foot surgery, rest and elevation can help reduce pain and swelling.

A gradual return to activity and soft shoe could be prescribed for the next four to eight weeks. This is a general estimate; your recovery is often based on severity of your condition, healing abilities and postoperative course. An orthotic could be recommended to control the abnormal bio-mechanical forces and thus prevent recurrence of the symptoms.

It is important that you follow your doctor's instructions carefully. be sure to ask your podiatrist any questions you have before or after surgery.

Heel Spur Syndorme/ Plantar Fasciitis Treatment

Your doctor will schedule appropriate lab tests, X-rays and advanced imaging studies, if necessary. A heel spur may not be present on an X-ray. Not all heel spurs hurt. It is the inflammation of the plantar fascia that causes the pain. Treatment is directed at reducing stress on the plantar fascia. It usually involves rest, heel cups, stretching physical therapy modalities, strapping orthotics, steroidal injections and non-steroidal, anti-inflammatory medications.

In a minority of cases when the above conservative measure fail to give relief, surgical intervention becomes necessary. The plantar fascia is released in part from its origin. when a large spur is present, reduction or removal could become necessary. Advances in surgical technology now permit plantar fascial release via the endoscope. This procedure is known as Endoscopic Plantar Fascial release or EPF. Extracorporeal Shockwave Therapy is also a new modality that is available. Remember your podiatrist will guide you as to the manner of treatment that is best suited for your individual case.

Heel Spur Syndorme/ Plantar Fasciitis

The heel bone or calcaneus is the largest bone in the foot and projects backward beyond the leg bones to provide a useful lever for the muscles of the calf. It bears all of the body's weight with each step. The stress placed on the heel bone and its associated structures is tremendous and makes it susceptible to what is known as plantar fasciitis or heel spur syndrome. The pain that results from these disorders is caused by the inflammation at the interface if the plantar fascia and heel bone. The plantar fascia constitutes the long band of fibers attached at the bottom of the heel bone and extend to where the toes begin. It also helps create the arch of the foot.

Plantar Fasciitis and heel spur syndrome are usually the result of biomechanical faults. Biomechanical faults refer to such abnormalities as flexible flat feet, high-arched foot deformities and a tight Achilles tendon. The disorder place a greater amount of stress on the plantar fascia.

Other causes of the stress on the heel and plantar fascia includes recent weight gain, high-impact athletic activities, prolonged standing or walking, trauma, lower back problems, and arthritis. Pain could also be stemming from a microtraumatic fracture of the heel, causing a heel spur as a result of this injury.

seeing alot of wart complaints in office. these are a viral infection. this happens as a result of some sort of break or insult to the skin allowing virus to seed. Once penetrated the virus creates its own blood supply. this leads to the spots one sees on the foot. the little black dots are actually capillary loops. You can prevent this by wearing flip flops at public pools and in public showers. Protect the feet! OTC wart medications such as liquid salicylic acid are a good treatment. even patches work well. Patients have not had alot of success with the dr scholl freezing treatments. when using topical treatments it is best to periodically go over the wart with a pumic stone or some similar device to remove dead skin. this allows for better penetration of medication.

THE FOOLISH WEAR FLIP FLOPS(Top Ten Reasons To Avoid These Shoes)

The warm weather has arrived and flip flops are now the shoe of choice for many. This type of footwear can be the cause of lower extremity pain in many adults and children. The next paragraphs will discuss some of the complications associated with this type of shoe gear and some tips to prevent these conditions. The following are my top ten reasons for avoiding flip flops

1.HAMMERTOES. While wearing this type of loose fitting shoe the toes are forced to contract to "grip" the shoe in order to prevent it from falling off the foot. This sustained contraction of the toes leads to tendon imbalances which can cause contracted/hammertoes.

2. BUNIONS. Often times the foot will overpronate when not wearing supportive shoes or walking barefoot. Overpronation in its simplest of terms refers to a "rolling inward" of the feet. If this is not controlled over extended period of time tendon imbalances will occur which cause the great toe to move toward the 2nd toe. This drifting of the toe leads to bunion formation.

3. HEEL PAIN. The lack of support while wearing flip flops often lead to heel pain. This is most commonly caused by excessive pull of the plantar fascia on the bottom of the foot. The plantar fascia is a soft tissue structure which is partially responsible for helping to maintain the arch. If there is lack of support to the shoe, the fascia undergoes excessive pull which creates inflammation and pain where it inserts on the heel.

4. ARCH PAIN. As mentioned with heel pain, the lack of support to the shoe often will cause inflammation of the plantar fascia. However, instead of the heel , the scource of pain will be located at the arch. The plantar fascia begins at the heel but fans out to the forefoot. Lack of support will often cause excessive stretch to the fascia along the arch thus leading to pain.

5. TIBIAL TENDON PAIN. Excessive use of flip flop type shoes can lead to pain along the medial or "inside" of the ankle. The medial side of the ankle is the same side the great toe is located. The tibial tendon is what is primarily responsible for maintaining the arch. Shoes which lack support and provide no pronation control will force the tibial tendon to work excessively to maintain the arch. This can lead to fatigue, inflammation and pain.

6. NUMBNESS. In the same anatomic area as the tibial tendon lies the tibial nerve. This is the major scource of innervation to the bottom of the foot. Shoes which lack support and pronation control lead to excessive compression of this nerve which can lead to numbness and pain. This condition is referred to as tarsal tunnel syndrome.

7. CALLUSES. Because there is no back to the shoe and no sock to protect the skin, the sole of the foot undergoes excessive shear forces when walking. These forces lead to excessive callus and fissure formation most notably to the heel area.

8. ANKLE SPRAINS. When a shoe such as a sandal or flip flop has no type of back to it, (the back of the shoe is referred to as the shoe "counter") there is an increased propensity for ankle sprains when walking on uneven terrain.

9. KNEE PAIN. Over pronation in the feet causes internal rotation of the femur (thigh bone). This internal rotation affects the alignment of the knee joint creating asymmetry in motion often leading to pain.

10. LOW BACK PAIN. As mentioned with knee pain, internal rotation of the femur also affects the aligment of the low back( sacro -illiac joint). In other words, pronation of the foot leads to internal rotation of the femur which causes abnormal alignment of sacral illiac joint thus leading to low back pain.

It is not fair to say that all these conditions are only associated with flip flops. Any type of non supportive or open back type shoe can lead to some of these problems. It should also be noted that some individials are less inclined to suffer these symptoms than others. People with excessively high arched feet or excessively flat feet or certainly more vulnerable than those with a more neutral type of foot. If your foot is more on the flat side then a shoe with a firmer type sole with less flex and a firm counter would be a better choice. If you have a higher arched foot then shock absorption is more important. As always, look for shoes with good arch support no matter what your foot type. If an individual is planning a day with extended weightbearing or walking on uneven terrain, flip flops should be avoided. If one develops any of these conditions while wearing flip flops, limit their use. If symptoms do not improve seek medical attention from a trained professional.

Now that spring is around the corner, several patients are asking about varicose veins. Questions asked include: why do they come about? what can be done to treat them?

Superficial veins close to the skin surface can become engorged and appear to bulge. These seem to occur most commonly in the legs and feet.
A common theory suggests that varicose veins are due to ineffecient valves in the vein which allows the vessel to become engorged and stretch. Over time the fluid in the vein can seep out of the vessel and into the surrounding tissue causing swelling and skin discoloration.

Some suggested treatments at home:

1. wear fitted support stockings
2. lose weight
3. elevating the legs above the heart for 30 mins 2-3 times daily
4.avoid crossing legs
5. avoid prolonged standing

More severe cases may require physician intervention. Some of these treatments include:
1. surgical ligation( surgically tying off the vessel)
2. venous stripping (actually removing the vein)
3. sclerotherapy ( injecting the vein with a solution that destroys the vessel)
4.laser ablation

multiple patients today presenting with heel pain. a very common problem. those suffering from heel pain can have all questions answered in my FREE book. this can be ordered on website www.eastberlinpodiatrist.com. For more information on other foot conditions please go to website and look up the topic that interests you. You can also shop on our online store for doctor approved medical products.

If you have any questions in regards to foot and ankle pain please post your questions and I will answer them promptly.

High Heels and Your Feet

To feel glamorous, sexy and taller are just a few of the reasons women wear high healed shoes. While heels can make a women feel more attractive, they can also be hazardous to her health.

Forcing the feet into narrow spaces in a unnatural position can creat discomfort in the low back legs and feet. Heels can force a woman to change the posture of her back and place excessive strain on the disc and postural muscles of the low back. Other conditions such as Shortening of the achilles tendon and gastroc muscles in the lower leg, bunions, hammertoes, metatarsalgia(forefoot pain), corns, calluses and ingrown toenails are commonly seen in our office.

While most conditions are treated conservatively, more severe deformities can require surgical intervention.

If a woman refuses to give up her heels, here are a few recommendations:

1. purchase shoes at the end of the day when your feet are at their largest. Feet will swell by the end of the day

2. look for shoes with a wider toe box

3. try to avoid heels higher than 2 inches.

4. avoid purhasing shoes with the hope of "breaking them in". If a shoe is uncomfortable when you try it on, chances are it will continue to be later.

5. If you have deformities such as bunions or hammertoes consider having a ball and ring stretch to the leather of the shoe that lies over these areas. any leather or shoe repair shop can do this for just a few dollars

6. wear flats instead of heels

7. have your feet measured by a trained salesman. Often times individuals will mistakenly thick they are one size but infact are really another. (more often than not, women will swear their feet are smaller than the size they actually measure!)

Examples of Diabetic Wounds

Ten Important Steps to Prevent Foot Complications for People with Diabetes

There are an estimated 14 million people in the United States with diagnosed or undiagnosed diabetes! Many of these individuals will develop foot or lower leg complications at some point in their life. This can often lead to hospitalization. The best treatment for such conditions is prevention! The following is a list of important steps in the prevention of diabetic foot problems.

1. Wear comfortable shoes preferably fitted by a foot care specialist. Shoes should have more depth in the toe box and a firmer outer sole. Higher heels should be avoided as they place too much load on the ball of the foot.

2. NEVER walk barefoot or in stocking feet! Diabetic individuals often will lose sensation in their feet. As a result, if such an individual would step on a foreign object such as a splinter, they often have limited ability to feel it. This will allow the injury to go unnoticed permitting the possibility of infection to occur. These infections can lead to more serious complications and often hospitalization.

3. Wash feet daily and dry thoroughly, especially between the toes, it is best to use pressure rather than vigorous rubbing when drying. Excessive dirt and debris especially between the toes can lead to underlying bacterial and fungal infections. If you cannot reach your toes, a soft shower brush can be used for washing.

4. Apply a gently moisturizer to the feet once or twice daily. Diabetic individuals are prone to dry skin. These subtle scales and cracks in the skin can server as an opening for bacteria invasion and lead to skin infections. A gentle moisturizer to the feet will keep the skin soft and supple. It is important to avoid applying the moisturizer between the toes. Excessive moisture between toes can lead to fungal infections.

5. Thick brittle toenails are often a sign of fungal infection and should be treated by a physician. Having toenails trimmed by a trained professional is often a covered benefit with Medicare and most insurance companies for people with diabetes and associated conditions.

6. Corns and calluses can be treated at home with the gentle use of a pumice stone to the affected areas after bathing. Avoid the use of sharp objects or blades. Accidental cuts can serve as a source of bacterial infection and more serious foot complications. Avoid the use of commercial "corn and callous" removers. These are often mild acids and can lead to open wounds if not used properly.

7. Socks should be loosely binding and be comprised of cotton blend material. Cotton serves to absorb moisture while other materials such as acrylic will "wick" out moisture. White socks enable on to visualize if there is drainage or active bleeding from the feet and therefore are preferred over colored socks.

8. Inspect your feet daily. Look or open cuts or wounds. If you have difficulty seeing the bottom of your feet, hold a mirror underneath the sole for inspection.

9. Avoid extreme temperatures------do not soak feet in hot water or walk barefooted on hot surfaces. Diabetic individuals will often have decreased sensation to temperature changes and scalding injuries can go undetected.

10. Should you develop a wound cleanse the area and apply topical antibiotic ointment with sterile gauze of band aid. Consult your family physician or podiatrist immediately if any signs of redness, swelling, or increased pain.

People with diabetes are at increased risk for skin breakdown, foot ulceration and infection. A minor cut or blister can have serious consequences. By taking these necessary precautions, one can avoid injury and reduce the risk of serious foot problems.
By, Todd A. Zeno, DPM