Central Florida Foot and Ankle Center - How to “HEAL” the Heel Pain

Os Trigonum Syndrome

2012-01-24T11:58:00.000-05:00

The os trigonum is an accessory bone found in the posteriorfoot. It is seen directly behind thelateral tubercle of the body of the talus in 2.5% to 14% of people. It is a round, triangular, or oval shapedbone that is variable in size, but is typically quite small compared to thesurrounding bones.

Os trigonum syndrome may be seen in people with theanatomical variant, and presents as pain in the back of the ankle. This is due to impingement of the bone, andthe condition is sometimes referred to as a posterior impingementsyndrome. Pain may be reproduced whenthe patient goes up on their toes, thus adding pressure to the posteriorankle. This is particularly noticeablein ballet dancers or in athletes that spend time on their toes.

Diagnosis of the condition is made largely on clinicalsuspicion and presentation, and is confirmed with x-rays. The accessory bone may be seen on x-ray. In conditions where the bone is not seen onx-ray, an MRI may be ordered to further assess the area. MRI may show a separation between the body ofthe talus and the accessory bone, as well as any swelling in the area.

Conservative therapy such as rest, ice, and orthotics may bebeneficial to some, although surgical excision is usually necessary to relievethe symptoms. The accessory bone may beremoved completely, in an attempt to relive pain and restore function. For the competitive athlete or ballet dancer,this may mean a period of rest from activity while their surgical site heals.

Os trigonum syndrome should be differentiated from otherpossible etiologies of pain, such as tendinitis of the flexor hallucis longustendon, which runs in close proximity to the os trigonum. Fractures and osteochondral defects of thetalus should also be ruled out, particularly in cases with a report of traumato the area. Space-occupying lesionssuch as soft tissue tumors (usually benign in nature) should also be ruled out,particularly when there is no evidence of accessory bone on plain film x-ray. The entire foot and ankle complex should bethoroughly evaluated for an other sprains and strains that may be present.

Remember that pain is an indication that something is wrong,and should never be considered “normal”. Athletes are notorious for “playing through the pain”, but should be evaluatedby a foot and ankle surgeon for any acute or chronic pain that they may behaving.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
www.FLFootandAnkle.com

Complex Regional Pain Syndrome

2011-12-19T09:44:00.000-05:00

Complex regional pain syndrome (CRPS) is an uncommon causeof chronic pain. It may affect eitherthe lower extremities or upper extremities, and is a difficult medical problemto diagnose and manage. CRPS ischaracterized by intense pain out of proportion, which is commonly described asa burning sensation. It can oftenmasquerade as peripheral neuropathy or tarsal tunnel syndrome in the foot, oras carpal tunnel syndrome in the hand.

Complex regional pain syndrome is a dysfunction of theautonomic nervous system. It can oftenbe divided into CRPS types I and II. CRPS I is also referred to as reflex sympathetic dystrophy, and occurswhen there is injury without direct trauma to a specific nerve. CRPS II involves an injury including aspecific nerve, which develops into complex regional pain syndrome. The symptoms and progression of CRPS is thesame in both types.

The symptoms of CRPS evolve in stages. Stage one is the acute stage, where the onsetof intense pain out of proportion is seen. This may develop some time after an injury. Temperature changes may be seen in theearlier stages, as well as muscle pain in the area. In the second stage, the pain will worsenwith associated muscle atrophy and weakness of the affected extremity. The toenails or fingernails may show changesin growth, and there may be noticeable hair loss on the extremity as well. The skin may begin to thin and become shiny,with associated color changes. In thethird and final stage of CRPS, there is prolonged and often permanent pain,with associated contracture of the limb. By the time the disease progresses to stage three, x-rays of theaffected limb may show atrophy of the bone.

Because of the rapid progression of complex regional painsyndrome, treatment of the condition depends on accurate and quickdiagnosis. Recent literature has pointedat triphasic bone scans as being the test of choice when a diagnosis of CRPS ispossible. However, even the bone scansfail to show changes consistent with CRPS all of the time.

Specialists in pain management typically carry out treatmentfor complex regional pain syndrome. Medications for pain relief as well as anti-depressants andanti-convulsants are often used. Steroids may be used to help reduce inflammation in the affectedlimb. Changes in bone density may betreated with drugs used for osteoporosis. Injections with local anesthesia may be used to block the sympatheticnerve fibers of the autonomic nervous system.

Other therapies include the use of topical analgesics,alternating application of heat and cold, physical therapy-assisted exercise,transcutaneous electrical nerve stimulation (TENS), and spinal cordstimulation. Attempted sympathectomy hasbeen tried, with mixed results.

Though it is an uncommon disease, complex regional painsyndrome can be extremely debilitating. Thus, early detection and treatment is the key to success once CRPS isdiagnosed.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
863-299-4551
www.FLFootandAnkle.com

Calcaneal Stress Fractures

2011-10-26T09:06:00.000-04:00

The calcaneus, or heel bone, is subject to stress fracturein the active person. A stress fractureoccurs when there are repetitive, abnormal forces being absorbed by a normalbone. This commonly occurs in thecalcaneus in runners or in military personnel that spends a lot of timemarching. It is particularly common inthose individuals who have a sudden increase in activity, such as an increasedmileage while running.

The symptoms of calcaneal stress fractures include heel painthat is made worse with activity. Theonset of pain is typically insidious, or gradual. The pain is often differentiated from plantarfasciitis by squeezing on the heel bone from the sides. This will often hurt in a calcaneal stressfracture, but not in plantar fasciitis.

X-rays are taken if there is suspicion of stress fracture,but will often not show anything until 2-3 weeks after the injury hasoccurred. By this time, it is morelikely to see evidence of healing bone in the form of callus formation on thex-ray. If a stress fracture isdiagnosed, or is a likely diagnosis, the foot must be kept non-weight bearingand the patient must rest for a minimum of 6-8 weeks while the bone can heal. If a person continues to walk and/or run on acalcaneal stress fracture, it can turn into a complete fracture of thecalcaneus, which carries a much more ominous prognosis.

If a stress fracture is suspected, activity should bestopped and the person should see a foot and ankle specialist right away. X-rays and a careful clinical examination aregenerally enough to determine the problem. Occasionally a CT or MRI may be performed for a more thorough image ofthe calcaneus and the rest of the foot.

Treatment for a stress fracture involves rest and cessationof weight-bearing activity. The patientis often placed in a cast for several weeks while the bone is allowed toheal. Crutches may be useful inoffloading the foot. Occasionallycalcaneal stress fractures are seen on both feet. In particular this can be seen in individualsbeginning a new training program, such as an amateur runner who suddenlyincreases their activity.

Upon returning to activity, it is important for the patientto begin a gradual return to activity. Increasing their activity level too quickly can result in continuedpain, additional stress fractures, and even a complete fracture of thepreviously affected bone.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.Winter Haven, FL 33881
Phone: 863-299-4551
www.FLFootandAnkle.com

Bone Grafting in Foot and Ankle Surgery

2011-09-14T09:08:00.000-04:00

The use of bone grafts in foot and ankle surgery is a topicof interest to the podiatric surgeon. Bone grafting may be used in various procedures to replace a defect inthe bone, to extend or lengthen a certain bone in the foot, to aid in thefusion of two bones, or in other instances where extra material is needed. A comprehensive understanding of the biologicprinciples of bone healing and bone grafting is necessary for the use of thesematerials. Some of the informationinvolved in bone grafting may be passed along to the patient as well.

In order for a bone graft to be useful in the body, it mustpossess certain properties. Theseproperties are osteoconduction,osteoinduction, and osteogenesis. Osteogenesis refers to the formation of newbone. This can only take place in atransplanted piece of bone that is used as a graft when the osteoblasts, or thecells responsible for laying down new bone, are transplanted with the graft andare kept alive. This is really onlypossible in a bone graft that comes from the same person that it is being usedin, such as a bone graft harvested from the iliac crest that is transplantedinto the foot.

Osteoconduction refers to the ability of a bone graft toallow as a matrix for new bone to grow into. Once a bone graft is placed into the body, it must be resorbed andincorporated into the body. A highlyosteoconductive material would allow the cells responsible for new boneformation and vascular tissues to easily maneuver into the bone graft.

Osteoinduction refers to the process by which new bonegrowth is stimulated in the host’s body. This occurs when the host’s stem cells areactivated and brought to the site of the bone graft, and differentiate intobone cells. This process is induced bybone morphogenic proteins (BMPs), platelet derived growth factors, and an arrayof other chemicals, or cytokines, that attract cells to the area.

Depending on the type of bone graft used, there is generallya mixture of osteoinductive and osteoconductive properties incorporated intothe material. The only materials thatwill have osteogenic properties are real bone of the patient.

The use of cortical bone (the tough, highly consolidatedoutside of a bone) and cancellous bone (the spongier, highly vascular inside ofa bone) is also a consideration in bone grafting. Generally speaking, cancellous bone offers astructure that is highly osteoconductive and osteoinductive, while the corticalbone offers strength to the bone graft.

Bone grafts are used with great success in foot and anklesurgery, largely due to the fact that these parameters are all considered bythe operative surgeon. The popularity ofsynthetic materials used as bone grafts speaks to the successful outcome oftheir use.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.Winter Haven, FL 33881
Phone: 863-299-4551
www.FLFootandAnkle.com

Screening for P.A.D.

2011-07-11T16:44:00.003-04:00

Peripheral arterial disease, commonly referred to as P.A.D., is a clogging of the arteries with fatty deposits. These fatty deposits, or plaques, can build up over time, slowly narrowing the arteries in the body. When the arteries become hardened and narrowed, it may also be referred to as atherosclerosis. P.A.D. is most common in the lower extremities, but can also occur in the upper extremities and in vessels supplying major organs like the kidneys or stomach. When the vessels of the legs are affected, it can lead to significant changes, which some people may attribute to “poor circulation”.

Peripheral arterial disease can often indicate a problem in not just the vessels of the legs, but in all the vessels in the entire body. For this reason, people with P.A.D. are at an increased risk for heart disease and stroke. When atherosclerosis occurs in the vessels supplying blood to the heart, it is called coronary artery disease (C.A.D.)

About 8 million Americans are affected by P.A.D., and the numbers are on the rise. This is partly due to a greater effort to screen for peripheral arterial disease, but may also be attributed to a greater incidence of the disease and an increase in risk factors across the American population. Risk factors for P.A.D. include diabetes, smoking, high blood pressure, high cholesterol, and a history of heart disease or stroke. African Americans are also at an increased risk for developing P.A.D.

Peripheral arterial disease is a slowly-developing process in the body, and as such, the signs and symptoms of the disease can be slow to develop too. In fact, they can often go unrecognized. Most commonly, the symptoms will include pain and cramping in the legs, thighs, buttocks, or feet that occurs while walking and is relieved with rest. This is referred to as claudication, and is a reproducible pain. This means that the pain will appear with a consistent amount of activity, such as walking two blocks before the pain begins. This pain is attributed to a lack of oxygen to the muscles, most commonly in the leg, due to the narrowing of the arteries supplying the muscles. Other symptoms may include pain at night in the toes or feet that disturbs sleep, or slow healing wounds in the legs and feet.

In the podiatrist’s office, screening for P.A.D. becomes routine, particularly when patients are at an elevated risk for developing the disease. Screening involves checking for pulses in the feet, and monitoring the time it takes for the skin to return to a normal color after the blood is pressed from it (capillary fill time). The pulses in the feet can also be listened to with a hand-held Doppler device. This allows your podiatrist to listen to the blood flow into your feet, and have an idea of the condition of your vessels.

Common tests for diagnosing peripheral vascular disease include the use of segmental pressure measurements, ankle-brachial indices, measurement of toe pressures, and measurement of transcutaneous oxygen pressures. These tests can give a comprehensive analysis of the blood flow to the feet. If it is necessary, an arteriogram can also be performed. This test involves injecting a dye into the arteries, then taking x-rays to visualize the vessels. This is generally only done for surgical planning, when it is determined that there is a total or nearly complete occlusion of a vessel, and it must be visualized pre-operatively.

Treatment for P.A.D may involve surgery by a vascular surgeon to stent the vessels, or to create a bypass in the arteries. There are also medical treatments that can be used to bust up the clots in the arteries. The P.A.D. Coalition, a non-profit organization that promotes screening and education about peripheral vascular disease, recommends the following lifestyle changes that can help prevent or treat mild to moderate peripheral vascular disease:

Quitting smoking
Lowering blood pressure to 140/90 mmHg, or 130/80 mmHg for people with diabetes or chronic kidney disease
Lowering LDL (“bad) cholesterol to less than 100 mg/dL. For people at an increased risk of heart disease or stroke, the target number may be less than 70 mg/dL.
Lowering HgbA1c (glycosylated hemoglobin) to less than 7% for diabetic patients
Using anti-platelet medications such as aspiring or clopidogrel under the supervision of a doctor
Eating healthy
Regular exercise, such as walking at least 30 minutes per day, 3-4 days per week.

Peripheral arterial disease has become a serious problem, and can lead to poor wound healing, gangrene, infection, and amputation. For this reason, it is commonly screened for in the podiatrist’s office. If you have any questions, or feel that you or someone you know may be affected by P.A.D., talk to your doctor today. Catching it early can make a huge difference in the outcome of the disease.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Lyme Disease

2011-05-16T11:07:00.003-04:00

Lyme disease is a complex, multisystem illness that is caused by the microorganism Borrelia burgdorferi. Borrelia burgdorferi is a tick-borne spirochete, which is transmitted by Ixode ticks. The ticks act as a reservoir for the bacteria, which can then be transmitted through their bites. Typically the tick must stay attached to a human source for 24-48 hours in order to transmit the bacteria. The disease was first recognized in 1975 in Lyme, Connecticut, for which it is named.

Lyme disease can be broken down into three stages. The first stage begins after a period of 3-30 days, and is characterized by a classic “bulls-eye” lesion, also known as erythema migrans. This is pictured above, and is seen at the site of infection. It may be accompanied by fever, malaise, headache, and joint and/or muscle pain.

The second stage occurs 1-6 months following the initial stage. Arthritis is the main presenting symptom, with associated muscle pain and swollen lymph nodes. A certain percentage of patients will neurological symptoms, including meningitis or Bell’s Palsy. Some will present with carditis as well.

The third stage may occur months to years after exposure. There is chronic neurological involvement, most commonly a subtle form of encephalopathy that affects mood, memory, and sleep. Arthritis and muscle pain may be a chronic symptom by this stage.

Treatment of Lyme disease depends on the stage of the disease at presentation as well as the symptoms. Antibiotics are used in the early stages to fight the spirochete infection. Doxycycline, tetracycline, and amoxicillin have all been used. Neurological abnormalities may be treated with cephalosporins or penicillin. As for the arthritis associated with Lyme disease, the symptoms are generally treated much like any other arthritis. NSAIDs with or without intra-articular steroid injections may be of benefit.

Of course, the disease should be treated before it progresses from the first stage. With the presence of arthritis plus a history of possible exposure to ticks and a bulls-eye rash, antibiotics should be started. Laboratory testing is typically limited to a blood draw to look for IgM antibodies. However, this will often take 3-6 weeks to show up. Therefore, antibiotics may need to be started before an absolute diagnosis can be made. An ELISA test or a Western blot can be performed to confirm the diagnosis after empiric therapy is started.

Incidence of Lyme disease is most common in wooded areas. In particular, the disease persists in the Northeastern United States, as well as parts of Minnesota, Wisconsin, and Northern Michigan.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Pilon Fractures

2011-03-24T13:33:00.004-04:00

The term ‘pilon’ was first used in 1911 by French radiologist Destot to describe the ankle joint. It is derived from the French word for ‘pestle’, and helps to describe both the shape of the ankle joint as well as the mechanism of this type of injury. Pilon fractures occur when axial compression is applied through the ankle joint, exceeding the amount of force that the ankle can transmit through the body. When this happens, a serious injury may occur, shattering the tibia and sometimes the fibula as well.

Pilon fractures are uncommon, accounting for 7% of all tibia fractures and less than 1% of all lower extremity fractures. They are an interesting subject, however, due to the orthopedic challenges that they present. Many pilon fractures will also be open fractures, meaning that the skin has been compromised in the injury and the bone may actually be visibly protruding from the skin. Higher impact injuries, such as from a motor vehicle accident or a fall from a height will involve a fracture of both the tibia and fibula. Lower impact injuries, such as skiing accidents, may only involve a fracture of the tibia. These fractures are generally intra-articular, which adds to their complexity.

Classification systems for pilon fractures include the Ruedi and Allgower classification, which was the first one described in 1969. Later, the AO/OTA classification was established in 1996, which gave further detail as to the extent of the injury. Both systems differentiate between number of fracture fragments, displacement of fracture fragments, and articular involvement. These systems are useful in communicating the extent of the injury, however little intra- and inter-observer agreement has been seen with the use of either of the two systems.

Diagnosis of pilon fractures is made with medical imaging. X-rays are typically ordered first, followed by a CT scan. CT scans will allow the foot and ankle surgeon to visualize the number of fracture fragments and the arrangement of the injury, and will help in planning the surgical correction.

Because of the type of injury that causes a pilon fracture, the patient is usually brought in to the emergency room and is treated first by the trauma team. This would include management of airway, breathing, circulation, disability, and exposure to any contaminants and/or toxins. Once the patient is stabilized, the fractures may be treated. There is a high correlation between pilon fractures and spinal fractures, so imaging should include the entire vertebral column.

While historically pilon fractures have been treated conservatively, most physicians would agree that treatment with surgery is necessary to regain function of the limb. Early reasons to avoid surgery were poor outcomes and increased risks involved with surgery, however, modern surgery has evolved to have a much greater success rate than in the past.

Surgical treatment of pilon fractures is most commonly done in a two-stage fashion. The first stage involves putting an external fixation device on the leg. These are done as either ankle-spanning (pins are placed through the talus, the bone that sits in the ankle joint) or as ankle sparring (no pins are placed through the talus). Today, ankle-sparring procedures have become more popular as they decrease damage to the joint itself. The external fixator is used to help realign the fracture fragments, and uses the theory of ligamentotaxis to do so. Once the fragments have bee realigned, and most of the initial swelling has decreased since the injury, a more definitive procedure may be performed to fix the ankle and leg

This commonly involves the use of either metal plates or an intramedullary nail, or both. Intrameduallry nails are long nails that are placed longitudinally through the bone. This gives the bone strength and helps to realign the fractures. The plates will also help to realign fragments, particularly of the fibula, should it be involved in the fracture. A variety of techniques may be used surgically, depending on the extent of the injury and the damage done to the bones.

Prognosis of pilon fractures depends heavily on the extent of injury. Numerous studies have shown that the more significant the injury, the greater chances of post-operative complications, infection, delayed union, malunion, and non-union. Good results may be seen with fractures that show minimal displacement and comminution (meaning that there are several fracture fragments), though unsatisfactory results are more commonly seen with more extensive comminution, joint involvement, and displacement of fracture fragments. Advances to surgical technique have made the outcomes more favorable in recent years, yet there is still an increased risk of post-operative sequelae with more extensive injury.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Study Looks at Limb-Length as a cause of Plantar Fasciitis

2011-02-08T08:44:00.003-05:00

A recent study published in the Journal of the American Podiatric Medical Association looked at limb-length discrepancy as a cause of plantar fasciitis. The article, written by Mahmood et al., analyzed 26 patients with unilateral heel pain that was previously diagnosed as plantar fasciitis. The limb-length of the patients was then measured, using a combination of methods. The results of the study showed that there was a strong correlation between a longer limb and unilateral plantar fasciitis pain.

Taking a further look at the results of the study, it was found that the vast majority of the unilateral heel pain was found on the same side of the body as the longer limb. Presumably, a longer limb would function in a more pronated position during stance. This would put extra strain on the plantar fascia, the large, thick strip of aponeurosis running along the bottom of the foot.

The study also looked at Body Mass Index (BMI) as a possible cause of plantar fasciitis, however, the results were not significant for these two factors to be correlated.

Plantar fasciitis is one of the most common conditions that podiatrsts see, and is the most common cause of heel pain in the adult population. There are a number of different theories on why it develops, most of which focus of the biomechanics of the foot and lower extremity. This study by Mahmood et al. is one of few peer-reviewed journal articles to research the etiology of the common disorder.

Treatments for planar fasciitis are as numerous as the possible causes of the problem. Conservative therapy includes things like stretching, ice, rest, temporary arch supports/padding, night splints, functional orthotic devices, and oral anti-inflammatory medications such as NSAIDs. Other measures may include corticosteroid injections, extracorporeal shockwave therapy (ESWT), or platelet-rich plasma (PRP) therapy. Still more drastic measures may include surgical intervention, when all other conservative therapies have failed.

The authors of the study highlight an important decision in the possible treatment of plantar fasciitis associated with a limb-length discrepancy. That is the use of a hell lift in addition to the use of a functional orthotic device. The hell lift addresses the difference in limb length, which may be the etiology of the condition. Thus, the treatment would address the root of the problem, and not merely the symptoms.

More research into the etiology of plantar fasciitis is warranted, as this is an extremely common condition. Limb-length may be just one of many possible causes, and more studies like this one will be needed to determine them.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Great Toe Joint Replacement

2010-12-10T11:33:00.004-05:00

One of the more common conditions seen in a podiatrist’s office is hallux limitus. In this condition, the range of motion of the first toe at the first metatarsophalangeal joint (MPJ) is limited to a number that is less than normal. A normal range of motion is generally considered to be approximately 65 degrees of dorsiflexion (motion of the toe upwards). Hallux limitus may be distinguished from hallux rigidus, using the latter of the terms to describe a condition where the toe is almost or completely fused, and little to no motion is available at the joint. Many will refer to the condition as Hallux Limitus/Rigidus, sometimes abbreviating it as HL/HR.

Hallux limitus is caused by jamming of the proximal phalanx into the first metatarsal. This may be caused by muscle imbalance, biomechanical deformity, trauma, osteoarthritis of the joint, and a number of other conditions. Regardless of the cause, hallux limitus can be very painful, and can lead to significant changes in gait.

Nonsurgical treatment of hallux limits and hallux rigidus typically involves the use of an orthotic device, often aimed at limiting the motion of the joint. This may prevent some of the pain associated with the condition. It may also be combined with modifications to the design of the shoe, range of motion exercises with physical therapy, anti-inflammatory medications, alteration of activities, and joint protective supplements such as glucosamine. However, with the failure of nonsurgical intervention, an attempt at surgical correction may become necessary.

It is quite common for the joint to be fused by a surgeon. This prevents any motion at all at the joint, with a goal of decreasing the level of pain. However, another option is to replace the joint.

The idea of replacing the first MPJ came into practice in the 1950’s as an alternative to fusing the joint. It became quite popular among foot and ankle surgeons, and has seen drastic improvement in the past 10-15 years with the advent of more sophisticated implant devices and materials.

Joint implants can be broken down into two basic categories; hemi-implants and total implants. Hemi-implants are not true joint replacements, but act more as a spacer for the joint. The spacer is usually placed into the head of the first metatarsal. This spacer allows the proximal phalanx to move more smoothly over the head of the metatarsal. By using a hemi-implant, more motion can be allowed at the level of the joint.

A total implant is placed into both sides of the joint. That is, it is inserted into both the head of the first metatarsal as well as the base of the proximal phalanx. Thus, a new joint is created at the first MPJ. A total implant may be used in cases of more severe arthritis at the joint, when neither of the articular surfaces that create the joint can be salvaged.

Both types of implants may be made of silicone or metal, or a combination of the two. Metals used in implants include titanium, stainless steel, cobalt chromium, and various alloys. Ceramic implants have also been used, but are less common.

A meta-analysis performed by Cook et al. in 2009 showed that the overall patient satisfaction in first MPJ replacement arthroplasty was approximately 85%. This study looked at 47 different clinical studies of first MPJ replacement, and the results from those surgeries. According to the research, when the follow-up time was increased, the patient satisfaction went up to over 94%. Thus, the procedure remains popular among foot and ankle surgeons.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Tailor’s Bunion

2010-10-05T16:43:00.003-04:00

While many may be familiar with the classic bunion that appears at the base of the big toe, a very similar condition can develop at the base of the little toe. This condition is known as a tailor’s bunion, sometimes referred to as a “bunionette”. A tailor’s bunion is an enlargement of the fifth metatarsophalangeal joint (MTPJ) and the lateral aspect of the fifth metatarsal head, whereas a classic bunion is on the first MTPJ. The development of a tailor’s bunion is similar to that of a bunion, and they are often seen together.

The development of tailor’s bunions are most commonly attributed to pathological pronation, sometimes referred to as “over-pronation” or “pronation syndrome”. Due to improper biomechanics of the foot, muscle imbalances can occur, and the fifth toe can begin to rotate in a number of ways. This rotation can cause increased forces on the lateral side of the fifth metatarsal and fifth MTPJ, causing an increase in bony growth that results in a tailor’s bunion. Wearing tight and poorly fitting shoes can exacerbate the problem, leading to pain and deformity. It is also common to find corns and calluses in association with tailor’s bunions, which are often painful.

The diagnosis of a tailor’s bunion is made clinically, though an x-ray is often required to assess the extent of the deformity. Conservative treatment of tailor’s bunion is focused on pain reduction, as well as prevention of furthering of the deformity. This may include measures such as anti-inflammatory medications (usually NSAID’s), wider shoes, padding taping, and the use of custom orthotics.

When conservative treatment fails, or if a patient desires that the bump be removed, surgical treatment may become an option. Several different surgical procedures are available for tailor’s bunions, with the extent of the deformity dictating which procedure is selected by the surgeon. Most procedures focus on removing the protruding bump from the bone, as well as realigning the bone so that the painful deformity does not recur.

Depending on which surgery is performed, it may or may not be possible to be walking on the foot right away. Typically when the fifth metatarsal is realigned at the head (the area closest to the toe) the patient will be able to walk in a surgical shoe right away. For surgeries performed at the shaft or the base of the metatarsal, crutches or a non-weight bearing shoe may be required for two weeks. Minimal pain and swelling is anticipated in most cases, and studies show a predictable and effective outcome for most surgeries.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Visual Gait Analysis

2010-08-16T11:17:00.002-04:00

One of the greatest tools of the podiatric physician is an acute eye for disturbances in gait. Walking requires an enormous amount of input from the central and peripheral nervous systems, the musculoskeletal system, and the vestibular and visual systems. A change to anyone of these inputs may alter the gait, and a keen eye for changes may lead the observer to a diagnosis.

Most commonly, described changes to gait are attributed to disorders of the nervous system. These compensatory gait patterns include:

The shuffling, slow, festinating gait seen in Parkinson’s disease
Steppage gait with foot drop commonly attributed to stroke, peripheral neuropathy, or lumbar radiculopathy
“Scissors” gait often seen in cerebral palsy
Cerebellar ataxic gait seen with alcoholism, neurotoxic poisoning, and inherited ataxia
Stooped gait from a history of lumbar spinal stenosis

Changes in gait may also be due to disturbances of the musculoskeletal system. These changes are often much more subtle than the changes attributed to neurological disorders.

To understand the changes in the musculoskeletal system that cause gait disturbances, a thorough understanding of biomechanical function is required. The human body can be thought of as a chain of linked joints that help us move, from the tips of our toes all the way up to the head. A minor change in one of the joints, bones, muscles or ligaments can have a rippling effect through the body.

Proper visual gait analysis uses a methodical approach, analytically evaluating key elements to the gait pattern. Areas of interest include the head, shoulders, pelvis, hips, knees, ankles, joints of the foot, heels, and toes. The observer will take note of things like range of motion, symmetry, speed, stride length, position of body parts, and other factors. The changes can often be very subtle, but may cause great disturbances in gait as well as painful or limited ambulation.

For the podiatric physician, musculoskeletal changes are often the area of most interest. Gait changes and positional deformities of the musculoskeletal system can often cause pathological conditions to develop in the foot and ankle, as well as the exacerbation of existing conditions. To combat these problems, orthotic devices and shoe modifications are often prescribed to the patient.

The vestibular system and visual system are the two special sensory systems that have the greatest influence on the gait cycle. The vestibular system, which is located in the inner ear, gives us the ability to balance. Disturbances to the vestibular system can cause vertigo and a los of balance, as well as dizziness, nausea, and other physical findings.

The visual system, stated quite simply, allows us to see where we are going. It relays information to the vestibular system, as well as to a number of areas of the brain that aid in walking.

Gait analysis is a vital tool, and can often help in the diagnosis of different disorders and diseases. A keen eye and understanding of the body are essential to proper gait analysis. Inversely, an understanding of gait analysis is essential to the understanding of the body.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Diabetic Peripheral Neuropathy

2010-07-22T11:06:00.004-04:00

One of the commonest complications of diabetes is the development of neuropathy. A neuropathy is a problem with the nerves of the body. This can have an effect on all of the nerves of the body, including the sensory, motor, and autonomic nervous systems.

Symptoms and types of neuropathy - The symptoms of diabetic neuropathy are dependent on the nerves involved. The sensory system relays signals from the external environment to the brain. If there is a problem with this division of the nervous system, one may experience numbness or tingling in the extremities, pain in the hands and feet, or a loss of balance.

The motor system allows us to move our muscles, and to keep the proper tone required for healthy limbs. Neuropathy to the motor system may cause muscle weakness and loss of tone to the muscles.

Sensorimotor neuropathy is commonly seen in a “glove and stocking” pattern. This means that the areas affected first are the hands and feet, and the symptoms will travel towards the body from the distal most point in each. Symptoms include pain, burning, tingling, prickly, achy, or dull sensations of the extremities.

Diabetic patients are at an elevated risk for infections of the feet in particular, due to ulcerations of the skin. The loss of feeling in the feet leads to a loss of protective sensation. This means that a diabetic patient with sensorimotor neuropathy in the feet (often referred to as peripheral neuropathy) will never feel that their shoes are too tight or that they have walking on a pebble inside their shoe all day, causing an irritation and perhaps a break in the skin. Compounded with a weakened immune system, the diabetic neuropathic patient is a prime target for infections of the foot.

Loss of motor control in the diabetic neuropathic patient can also lead to a loss of muscle mass and strength in the foot. This may be seen as contractures of the extensor muscles of the toes, which will result in the formation of hammer toes.

Perhaps the piece of the diabetic neuropathy puzzle that is of greatest value mentioning is autonomic neuropathy. The autonomic (or involuntary) nervous system controls all of the functions that we don’t have to think about. This includes controlling the heart rate, tension/tone of the blood vessels, gastrointestinal control, and control of the urinary system, to mention a few. Autonomic neuropathy can result in a loss of control over any one of these systems, and in many patients it results in a loss of control of several.

Manifestations of autonomic neuropathy are seen with ease in the feet of a patient. Signs and symptoms include a loss of hair on the foot, ankle, and lower leg over time, increased prevalence of fungal nail infections and superficial fungal infections of the feet (tinea pedis, or athlete’s foot), feet that are cold to touch, and a general decrease in blood flow to the feet. The development of peripheral neuropathy in the feet of a diabetic patient is one of the first noticeable signs of diabetic complications.

How diabetic peripheral neuropathy develops – Evidence exists for several different mechanism of how the problem develops, all of which are related to each other.

Microvascular disease is a popular idea of how peripheral neuropathy develops. Interdependence of the vascular and nervous systems is a common theme in many disease processes of each system. As vasoconstriction (the tightening of a blood vessel) is one of the first functions lost, microvascular disease to the vessels that supply the long nerves (vasa nervorum) fits as an explanation.

Other explanations include advanced glycated end products altering the function of proteins and enzymes in the body, an increased level of protein kinase C that may alter the function of intercellular proteins, and the polyol pathway (sorbitol/aldose reductase pathway), which helps explain the microvascular component of peripheral neuropathy. Further explanations of these processes are beyond the scope of this article, but much more can be found about these biochemical processes online.

Treatment of peripheral neuropathy – Assessing and evaluating peripheral neuropathy is perhaps the simplest method of tracking the progression of the problem. This is done with very simple clinical tests that your doctor may perform in the office. These tests also aid in the diagnosis of peripheral neuropathy.

Simply put, each type of nerve in the legs and feet has a clinical test that evaluates the function of a particular nerve. The different types of nerve fibers include sensory fibers that conduct vibration, proprioception (the way your brain knows where your foot is in space), deep touch, light touch, cold/heat sensation, pain, and protective sensation.

Several medications may be prescribed by your doctor to treat painful peripheral neuropathy. These include agents such as tricyclic antidepressants, serotonin reuptake inhibitors, anticonvulsant medications, and other pharmaceuticals. Experimental treatments include the use of topirimate and carbemazepine, both of which are also used to treat epilepsy and other disease processes of the nervous system. It should be noted that the vast majority of products used to treat peripheral neuropathy are used off-label, meaning that they have not been FDA-approved to treat such conditions.

Other treatments include the use of transcutaneous electric nerve stimulation (TENS) and injection of methylcobalamin (activated vitamin B12). These have both been shown to be an effective method of treatment in patients with diabetic neuropathy.

Prevention and Epidemiology – The most effective method of treating diabetic neuropathy is a tight control on blood glucose levels. High blood sugar levels, or hyperglycemia, is the characteristic trait of diabetes mellitus and high levels of blood glucose correlate with an increase in complications. An aggressive approach to glycemic control us of utmost importance, and includes diet modification, regular and appropriate exercise, and medications to help control blood glucose and insulin levels.

The prevalence of diabetic neuropathy ranges in populations from 20-50%. There are numerous studies evaluating the prevalence in different populations, all with different averages. However, what remains consistent in these studies is that Type II diabetics are more likely to develop complications that Type I diabetics (insulin-dependent). To see how the Dellon Procedure can help curb neuropathy pain click HERE.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

What is a Bunion?

2010-03-26T14:46:00.003-04:00

Bunions, those painful bony growths on the insides of your feet, are the result of a biomechanical deformity known as Hallux Valgus. While the exact etiology of the deformity is unknown, there is a strong familial connection. Hallux valgus and the resulting bunion deformity is much more prevalent in women than in men, most likely due to the difference in bone structure and center of mass.

Bunions can be a painful experience. Many women with bunions complain of not being able to wear certain shoes, especially shoes with a narrow toe box. Numbness is also a common complaint, as well as an overall dislike of the aesthetics of bunions. Rubbing of the bony prominence against a too-narrow shoe can cause a throbbing pain, with the affected area becoming red and swollen.

There are a number of treatments for bunion deformities, some much more effective than others. Conservative treatments typically focus on treating the symptoms, or preventing the deformity from progressing. Surgical treatment focuses on correcting the deformity, putting the bones of the foot into alignment.

Conservative treatments include:

· R.I.C.E. Therapy – Rest, ice, compression, and elevation make up the R.I.C.E. therapy. This is a sort of catch-all group of treatments used for a number of different complaints, from sprained ankles to sore knees. It may make the bunion-affected feet feel better temporarily, but offers little lasting effect.

· Anti-Inflammatory Medications – Non-steroidal anti-inflammatory drugs (NSAIDs) are a commonly used treatment for not only bunions, but a number of problems involving inflammation. These too offer only temporarily relief of a painful bunion, and don’t do too much to correct the problem. Steroids, both injected and topical, may be used as well. Steroids may offer a longer lasting pain relief, but is still a temporary solution.

· Bunion Splints – Commercially available bunion splints, designed to prevent the deformity from rubbing against a shoe and prevent the progression of hallux valgus deformity, are also used. These have never been studied, and their effectiveness is questionable.

· Padding and taping – Your podiatrist may use a combination of padding and taping to both hold the foot in an optimal position, as well as protect the bunion from rubbing against a shoe. These methods usually work for several days, but require a re-taping and re-application of the padding frequently.

· Custom Orthotics – Custom orthotics may be the most effective conservative therapy, as the address the underlying deformity of the foot and not just the bony prominence at the big toe joint. A custom orthotic can be designed to prevent the hallux valgus deformity from expanding, thus preventing the progression of the bunion.

In addition to conservative therapies, many patients with hallux valgus and painful bunions undergo surgery to correct the deformity. This remains the definitive treatment for bunions, and the only treatment that actually can correct the problem.

Depending on the curcumstances, different surgical procedures typically involve cutting a small piece of the metatarsal bone out, and shifting the bones of the foot and toe into a straighter alignment. Additionally, some of the bunion itself may be removed surgically, so that it does not protrude from the foot.

Bunions may also form on the outside, or lateral side of the foot. When this happens, they are called Tailor’s Bunions. Tailor’s bunions are located on the fifth toe, at the metatarsophalangeal (MTP) joint. The development of Tailor’s bunions comes from a widening of the space between the fourth and fifth metatarsals, similar to the development of a bunion on the inside of the foot. Tailor’s bunions are typically less painful than regular bunions, but can be an equal nuisance. Tailor’s bunions are usually corrected at the same time in surgical cases.

If you have bunions, discuss the options with your podiatrist. Remember that pain in the feet is never normal. It is your body’s way of saying that something is wrong. There are a number of ways to deal with painful bunions and hallux valgus deformity, and a doctor can help guide you through the decision-making process.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Pediatric Flatfoot

2010-01-12T11:27:00.005-05:00

In the world of pediatrics, an often-misunderstood condition is pediatric flatfoot. What may be considered normal at one age may not be normal at a later age, and so there is a great deal of interpretation that comes with a diagnosis such as pediatric flatfoot.

From when a child begins to walk, usually somewhere around the 12 month mark, until around three years of age, a flattened foot with a lowered arch is ubiquitous. Nearly all children in this age range will have some degree of flatfoot, caused by pronation syndrome (the tendency of the foot to collapse medially).

For many parents, this can cause alarm, sending them straight to the pediatrician. A pediatrician may then refer the patient on to a podiatrist, who can help diagnose and quantify the degree of pronation, a measurement of flat-footedness.

For many children, a flexible flatfoot will resolve on it’s own. Once the child reaches a certain age, the bones begin to mature, and the flatfoot will go away.

For a small number of children, the degree of pronation is so severe that it is highly unlikely that it is due to normal development. These children usually are symptomatic, and may have pain or disturbances in their walking pattern.

Between these two ends of the spectrum are a vast number of children who may or may not need treatment. The doctor will decide if they need treatment based on a number of factors, including the progression of the condition. If the flatfoot is getting worse, they may treat it more aggressively. If the condition is resolving over time, they may treat it more conservatively and mainly observe the progression.

Some other symptoms that may alter the decision of whether to treat the condition or not include the presence or absence of pain (including foot, ankle, and knee pain), fatigue, and decreased activity because of the flatfoot. A more aggressive approach to treatment may also be taken if there are other orthopedic conditions associated with the flexible flatfoot.

The gold standard of treatment is the use of custom molded orthotics. These can be put into a variety of different shoes, and will generally help correct the deformity, particularly if there are gait disturbances.

Surgical intervention may be an option in more severe cases, but is usually not recommended until non-surgical treatment has failed.

A condition that must be differentiated from flexible flatfoot is rigid flatfoot. In rigid flatfoot, the deformity is due to a problem with the bone structure. This problem is most commonly a tarsal coalition, which is an abnormal fusion of the bones of the mid- and rear-foot. Ideally, the rigid flatfoot is recognized early, and corrected by surgery. Unfortunately, tarsal coalitions are usually not found until later in the child’s life, or even into adulthood. At this point, surgery may cause more harm than good. With older children and adults with rigid flatfoot caused by a tarsal coalition, custom-molded orthotics are usually the best method of treatment.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Trench Foot

2009-11-23T10:02:00.003-05:00

If you’ve ever watched a movie about World War I, you’ve likely heard the term “trench foot” before. The term refers to a condition of the foot when it has been immersed in cold water for a long time, which was commonly associated with the trench warfare of World War I. The term has carried over from its historical roots into the medical books, and is considered its own diagnosis.

When the foot is exposed to a cold and wet environment, there is a change in circulation that occurs, particularly in the feet. This change is the body’s attempt to conserve heat, and move the blood out of the foot. In a shorter amount of time, this reaction allows the warm blood to stay in the core of the body, keeping the vital organs warm. However, under prolonged exposure to the elements, the change in circulation causes problems with the small arteries of the foot.

The small arteries of the foot may become permanently damaged following the inflammatory reaction that is seen in trench foot. This can lead to problems like large blisters forming on the feet and gangrene, or tissue death in the foot.

Most cases of trench foot seen today are not from trench warfare, but they are from similar circumstances involving prolonged exposure to a cold and damp environment. Hikers, hunters, and other who spend a lot of time outdoors are the most prone to the condition. If you enjoy these activities, or are often exposed to similar conditions, there are some steps you can take to keep your feet healthy.

In wet conditions, be sure to wear boots or another type of waterproofed footwear. This will help keep your feet dry, and avoid trench foot as well as other problems with your feet. Materials like Gore-Tex are good for keeping the water out of your shoes, as well as allowing your feet to breath. Look for a pair of boots with Gore-Tex or a similar material.

When the weather is cold, be sure to wear the right socks. Cotton socks have a tendency to keep moisture up against your feet, making them wet and cold for a long time. Try socks made of wool or synthetic materials that will help wick the moisture away from your feet. This will keep them dry and warmer.

You can also experiment with different thicknesses of sock. Hiking socks and other types of socks come in all different weights for different weather conditions. Trench foot can happen in water as warm as 60 degrees, so keep that in mind when you’re stomping through the muck.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Health Reform Update 10/13/09

2009-10-14T08:17:00.006-04:00

On Tuesday, the Finance Committee passed its long anticipated bill for health care reform. The bill passed with a vote of 14-9. Of the fourteen affirmative votes, 13 were from Democrats in the committee, and one was from Sen. Olympia Snowe (R-Maine).

The Finance committee’s version of the bill is the least generous in terms of subsidies for working- and middle-class Americans, and it does not carry the public option that has been proposed by other committees in congress. Nevertheless, it is a massive step towards the final health care reform bill, a bill whose progress has been defined by stalemate and postponement.

The bill does require nearly everyone to have health insurance, and provides financial subsidies for those who cannot afford coverage. It also bans insurance companies the right to deny coverage to those with preexisting conditions. The bill is estimated to cost $829 billion over ten years, which will be paid for by taxes, fees, and reductions in Medicare costs.

Though the bill has passed through the Finance committee, it marks the non-bipartisan nature of the issue. With the exception of Sen. Snowe, the bill was passed with only Democratic support. Republicans stand strong in their position, clinging to the idea that a health reform bill only brings the government into the people’s health insurance.

Another version of the pending legislation, drafted by the Senate Health, Education, Labor and Pensions Committee was approved this summer. Now that the Finance Committee has approved its version of the bill, the final draft may be ready to be debated in front of the full Senate later this month. There, support for the legislation looks good.

What is excluded from the legislation, however, is the public option that was supported heavily by some Democrats. The bill will not include a public option when presented to the full Senate.

President Obama praised the efforts of committee members, particularly Sen. Snowe for her courage in going against Republican members in the committee. He pointed out that the bill is not perfect, but it is a start in the right direction. This seems to be a common sentiment among Democrats.

The next several weeks should be telling for the final draft of the Senate health reform bill. As the bill goes to the full Senate, it will be presented to a group of 60 Democrats and 40 Republicans. Though not all Democrats are on board with the public option, 60 votes is what it would take to add this stipulation to the final bill. Regardless of whether or not the public option is added to the bill, there is strong support for the bill in the Senate, and it is very likely that the bill will be passed.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Soda Tax for Obesity?

2009-10-05T15:32:00.005-04:00

The obesity epidemic is raging. Roughly one in three adults have a Body Mass Index (BMI) of over 30, which is the medical definition of obesity. Obesity in children is increasing at an alarming rate. Over 17% of children ages 12-19 are obese, up from 5% in the late 1970’s. The statistics show that Americans are becoming more obese and a faster rate, which leads to an array of health problems, from high cholesterol and increased heart disease to an increased incidence of type-2 diabetes.

Many ideas have been explored to combat this trend – national health awareness programs and education is a start, though some more drastic ideas have been proposed. One of these ideas is the soda tax.

Studies have shown that the number one link between childhood obesity and diet is the consumption of sugar-sweetened beverages. These include items such as soda that have added sucrose, high-fructose corn syrup, and other artificial sweeteners.

The proposed tax of a penny-per-ounce on these beverages would be used to offset the health costs associated with obesity-related disease. Supporters of the bill claim that the tax would help deter people from drinking so much soda, and promote the consumption of water and milk among children.

However, opposition to the plan is great. Beverage companies and lobbyists are obviously not behind the idea, stating that it would unfairly hurt sales. They point out that soda is not the only thing in the American diet that causes obesity, and it would be unfair to single them out.

The proposed tax of a penny-per-ounce would increase prices, particularly in packaging of larger quantities. A 2-liter bottle of soda, which on average is priced at about $1.35, would go up $2.02 with the penny-per-ounce tax. A 12-pack of soda, with an average cost of $3.20, would go up 45% to $4.64.

This may seem like a huge increase in prices, but consider this: the average cost of a half-gallon of orange juice is still $3.50. That means that even with the tax it would still be cheaper to buy soda.

So where does that leave us? If the law was passed for a penny-per-ounce or similar tax on sugary soda, would consumers switch to another beverage? And let's not forget diet soda. Would the tax include these beverages as well?

As of now, the proposed soda tax is not included in the health reform bill, nor is it expected to be. President Obama has not pushed for this, though members of the Centers for Disease Control and Prevention have urged for it. Other health groups like the American Dietetic Association have also shown support for the idea.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Health Care Reform Update

2009-09-11T09:09:00.005-04:00

In a speech on Wednesday night to both the Senate and House of Representatives, President Barack Obama addressed the current state of health care reform, and the bill that could very well become the President’s defining piece of legislation.

“I am not the first President to take up this cause, but I am determined to be the last” he said to a rousing applause and a standing ovation.

Obama laid out the main goals of the health care reform bill, as well as debunked some of the myths, rumors, and misrepresentations of the bill that have been circulating for the past several months. The main goals of the legislation are to increase stability and security of the coverage to those who are already indured, to provide those without health insurance coverage, and to help slow the rising costs of health care.

For those who are currently covered, nothing in the plan will force them to change their health insurance provider, or change their current health care plan. What will change is that it will be illegal for health insurance companies to deny coverage to individuals with a preexisting condition. It will also be illegal for health insurance companies to drop coverage for people when they get sick, as well as outlaw caps that are placed on coverage for a year or lifetime term. A cap will be placed, however, on the out-of-pocket expenses incurred on the behalf of the patient. As Obama puts it, “No one should go broke because they get sick”.

The second piece of the plan is to provide insurance to those who do not currently have any insurance. This is where the public option comes in to play. For a large group to seek health insurance, they have more leverage in a market when shopping for plans. It is for this reason that large companies are able to get insurance for their employees at lower rates, and the same economics can be applied to a public option.

For those who can’t afford the public option, tax credits will be available. The President also emphasized the fact that no one will be forced to take the public option – it is simply available for those who choose it.

The third aspect of the bill is to help slow the growth of health care costs. In order to make this a possibility, it will be required of all people to carry health insurance. The reason for this is that when someone gets sick and they do not have health insurance, their medical costs are paid for by those who do have insurance. In other words, the cost of the uninsured is currently built in to the costs for those with insurance. This is a vicious cycle, and it can be stopped by making everyone carry some insurance.

In order to ensure that all Americans have coverage, all employers that can afford to do so will be made to provide health insurance to their employees, or at least help them with the cost. This is more applicable to large businesses that are currently not providing their employees with coverage. Small businesses that cannot afford to provide coverage to their employees will be exempt from this law. This represents roughly 95% of all small business that will be exempt.

Circulating rumors were also addressed by President Obama, most notably the rumor that Medicare spending would be changed and benefits would be lost. This, the President said, is untrue. Not a dollar, he said, would come out of the money that is set aside for the Medicare program.

To see the full speech with a transcript, click here.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Office Exercise

2009-08-24T09:09:00.005-04:00

Having trouble finding time in the day for exercise? Are you so busy at work that going to the gym seems impossible? Try working out in your office building!

· Taking the stairs is one easy way to burn extra calories during the workday, and it will keep you alert, too. Climbing stairs for 30 minutes can burn over 300 calories. Walking up and down stairs for 30 minutes can be pretty hard work, so keep this in mind if you plan on doing it all at once. You’ll need a good pair of shoes, too, to avoid tripping on the stairs and fatigue.

· Park far away from the door. This will give you an extra few minutes of walking every time you need to go from the door of the building to your car. If it’s an extra five minutes, this could possibly amount to twenty minutes over the course of the day (once in the morning, twice at lunch time, and once at the end of the day).

· Leave something important in your car, like a document or a briefcase. This can add another ten minutes of walking if you’ve parked five minutes away from the door.

· If you have the capability to do so, set an alarm to go off every hour. When the alarm goes off, stand up, stretch, and walk around for a couple of minutes.

· If you can, sit on an exercise ball instead of a chair. This will force you to work your core muscles all day long while you are sitting.

· If you have your own office, you can leave a few pieces of exercise equipment in the office. Try some light dumbbells, resistance bands, or ankle weights. Take a quick break, or use them while you are on the phone.

· You can also get a headset for your phone, and walk around while talking.

· Use a pedometer and track how many steps you take in a day. Aim for at least 6,000. You can set a goal for 10,000, and track your progress in a notebook.

· Use a bathroom that’s on a different floor. Take the stairs to get to the floor, and take the long way back to your desk.

· If you have a message for a co-worker, deliver it in person instead of calling or emailing.

· If you go out for lunch, be sure to eat something healthy. Eating a heavy meal in the middle of the day will not only add weight, but it can make you tired and less efficient at work. Wherever you go for lunch, park far away from the door. This is yet another way to get those extra steps in.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

What Are Plantar Warts?

2009-07-23T08:22:00.005-04:00

A plantar wart is a non-cancerous growth on the bottom surface of the foot. It is caused by the human papillomavirus (HPV), which can enter the body through tiny cuts or openings in the skin. Plantar warts can often develop at pressure points, such as the toes or the balls of the foot. While plantar warts may be painful or irritating, they are usually not a serious health concern.

Plantar warts are characterized by small, fleshy bumps that interrupt the normal skin lines of the feet. They have a well defined border, and may have a thickening of skin over the top of them. Plantar warts may also have several small black dots in them, which are clotted blood vessels.

If you think you may have plantar warts, you should see your doctor before trying to treat them yourself. Warts should be distinguished from other possible diagnoses, including cancerous tumors from carcinoma or melanoma. If the lesion has changed color recently or if you have diabetes, it is very important to show your doctor.

Once a diagnosis is made by your doctor, there are several different options in treatment. More conservative methods include using topical salicylic acid to remove the warts. Duct tape has even been used to cover the warts, preventing their spread to other parts of the foot, and to stimulate the body’s immune system. Since plantar warts are caused by a virus, it is the body’s own immune system that must fight off the virus, much like fighting off the virus of a common cold.

When conservative treatment doesn’t work, you and your doctor may opt for another method. Plantar warts are often frozen off using liquid nitrogen. This causes a blister to form around the wart, and then fall off a few days later. This sometimes takes several treatments to be completely rid of the warts, and can cause some minor pain or discomfort. Minor surgery may be performed to remove the warts from the bottom of the foot, sometimes using an electric needle or a curette. Laser surgery has also been used, effectively burning off the wart.

It is important to remember that plantar warts are caused by a virus. What this means is that treating plantar warts is a lot like treating a cold, in that a doctor is often treating the symptoms. Once a person has contracted the human papillomavirus (HPV) that causes plantar warts, it is likely that they can have recurrences of plantar warts in the future. There are literally hundreds of types of HPV, many of which only infect certain areas of the body. Plantar warts may be contagious from one area of the foot to another area, and can even spread to the hands. They may be contagious from person to person as well, but they do not spread to all areas of the body (such as the face or genitals).

The best method of treating warts is prevention. Some easy steps include wearing sandals in public bathrooms, pools, and showers, as well as keeping your feet clean and dry. Don’t pick at the warts, as this may cause them to spread more easily, and don’t touch anyone else’s warts with your bare hands. If you do touch your own warts, be sure to wash your hands thoroughly after doing so.
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Health Care Reform Update

2009-06-25T08:11:00.006-04:00

On Wednesday night, President Barack Obama hit the airwaves to discuss the idea of massive and sweeping health care reform. An unusual arrangement with ABC News allowed the president to hold a town-hall style interview, where he addressed questions directly, and drummed up support for the health care reform that is drawing much attention in the news.

There are roughly 50 million Americans without health insurance. According to Health and Human Services Secretary Kathleen Sebelius in a meeting with House Energy and Commerce Committee, lowering health care costs and providing insurance for those without insurance is “our most important domestic priority."

There have been various proposals as to how to achieve these goals, the most controversial of which is the idea of a “public option”, which goes beyond the parameters of Medicare and Medicaid. This would essentially be government provided health insurance, which would compete with the private insurance companies already in existence. President Obama is in support of this idea, as he emphasizes that this public option would keep the private insurance companies in check, and help to lower overall health care costs.

Skeptics of a public option, including current health insurance providers, claim that the public option would drive business away from private health insurance companies, and into the arms of the government. The rhetoric “socialized medicine” has been thrown around, particularly from the political right wing.

The price tag on universal coverage is estimated between $1 trillion and $1.6 trillion, and could climb as high as $2 trillion. Savings have been offered to the tune of roughly $622 billion, which leaves a remainder of at least $300 billion to come up with.

Options for obtaining that kind of money include taxing employer-sponsored health care benefits, an idea that for a long time has had many up in arms.

This proposal has gained some recent support, however, from Sen. Kent Conrad, D-N.D., and Sen. Max Baucus, D-Mont., the top two Democrats on the Senate Finance Committee. This announcement came Wednesday, with the notion that perhaps only additional benefits beyond a certain price level would be taxed.

Health care reform seems imminent, but it may take a while for the legislation to actually go through. Many special interest groups have been contacting senators and representatives this week, with each area of the health care industry wanting their voice heard.

There are loud voices on both sides of the argument of the public option, but a recent poll from CBS/New York Times shows some interesting figures. Seventy-two percent of Americans asked supported coverage for people similar to the coverage received by those qualifying for Medicaid. In the same poll, 57 percent reported that they would be willing to pay higher taxes to support the cost of that insurance.

A poll conducted by ABC/The Washington Post this month, however, found that 58 percent of Americans were “very” concerned that the quality of health care that they are currently receiving would be reduced, and another 23 percent reported that they were “somewhat” concerned about the same issue.

The video of the televised special can be seen at the ABC news website.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

What is Compartment Syndrome?

2009-06-12T13:45:00.008-04:00

Although it is not a very common condition, compartment syndrome can be a very serious complication due to a pressure build up in the muscle compartments of the body. Areas that can be affected include the muscle groups of the legs, arms, hands, and feet. Most commonly, it is the muscle compartments of the legs that are indicated in compartment syndrome. Compartment syndrome is further divided into acute compartment syndrome and chronic compartment syndrome.

Acute compartment syndrome, which is generally caused by some kind of traumatic injury, is a medical emergency, and needs to be handled promptly. The most common causes of acute compartment syndrome includes fractures to the long bones of the legs, deep bruising of the muscles, complications following surgery to the area, or a blockage of circulation to the area. The increased pressure associated with acute compartment syndrome leads to a lack of oxygen to the affected muscles. This lack of oxygen, if prolonged, can lead to nerve or muscle damage, or even paralysis of the muscles. Thus, acute compartment syndrome must be handled as an emergent situation.

Chronic compartment syndrome, while not a medical emergency, can be equally as serious. It develops over a long period of time, typically from exercise, and is associated with pain that is brought on with exercise.

Symptoms of both acute and chronic compartment syndrome are similar. Both involve pain that is localized to a particular muscle compartment. This is most commonly the anterior muscle compartment of the leg, but other muscle groups may be affected as well. Physical evidence of increased pressure is usually visible, such as swelling of the area and a hardening of the muscles when touched. Additionally there will be evidence of decreased circulation to the area (pain is recreated when the muscles are stretched) as well as evidence of nerve compression (a tingling, or a “pins and needles” sensation).

Compartment syndrome is diagnosed by a medical professional first by ruling out other possible causes. These include stress fractures of the tibia and tendonitis. If compartment syndrome is suspected, the intramuscular pressure may be evaluated at rest, one minute following exercise, and five minutes following exercise. If the muscle pressure does not decrease following exercise, compartment syndrome is suspected.

If you are concerned that you may be developing chronic compartment syndrome, see your doctor right away. This situation is much easier to deal with sooner than later.

Treatment for chronic compartment syndrome includes rest, especially from the activity that aggravates the muscle compartment. Chronic compartment syndrome is most commonly seen in runners and cyclists. Ice and anti-inflammatory medications will help to relieve some of the pressure and swelling. Elevation will also help with the swelling. Compression is not recommended, as this will increase pressure, making the problem worse.

For acute compartment syndrome, or for more serious cases of chronic compartment syndrome, surgical intervention may be recommended by your doctor. This procedure typically involves cutting some of the fascia, or the stiff connective tissue that separates muscle groups in your body. Cutting the fascia will help to relieve the pressure on the muscles.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

What is Peripheral Artery Disease?

2009-04-27T09:39:00.003-04:00

Peripheral Artery Disease, also called Peripheral Arterial Disease (PAD), is a fairly common condition of the arteries in the arms and legs. The condition is characterized by a narrowing of the arteries, most commonly of the legs, which reduces blood flow to the effected area. According to the American Heart Association, about 8 million Americans are affected by PAD, and by age 65, up to twenty percent of the population may have it.

The most common symptom of peripheral arterial disease is pain and/or cramping of the leg muscles while walking. This pain will go away with rest, but then returns when activity starts again. The most commonly effected muscles are the calf muscles and the hip muscles. Other symptoms of PAD include numbness or weakness of the leg, coldness of one leg when compared to the other leg, changes in skin coloring, hair pattern, or toenails, and sores on the toes, feet or legs that won’t heal.

Peripheral arterial disease is most commonly caused by atherosclerosis. Atherosclerosis is when plaques, or fatty deposits, build up on the walls of the arteries. This causes the arteries to narrow, leading to the symptoms of PAD. Atherosclerosis is often discussed as it relates to the heart, but peripheral arterial disease should always be brought up in the atherosclerosis conversation. This is because plaque build up of the arteries usually does affect the arteries throughout the entire body.

People with diabetes or those who smoke are at a particularly high risk for developing peripheral arterial disease. Also at high risk are people with high blood pressure or high cholesterol. Risk factors also include obesity, a family history of peripheral arterial disease or other heart/vascular disease, and increasing age. PAD increases the risk of heart attack and stroke.

PAD may be diagnosed by your doctor using a number of methods. Your doctor will often listen with a stethoscope to the arteries, listening for a whooshing sound (known as bruits). This sound gives your doctor a clue that the artery is narrowed, as normal arteries do not make this sound. One of the most commonly used tests for diagnosing PAD is the ankle-brachial index (ABI). This is a measurement of the blood pressure in the arm compared to the blood pressure in the ankle. Your doctor will use blood-pressure cuffs and a non-invasive Doppler sensor to measure and compare the two blood pressures. If the blood pressure in the ankles is low compared to the blood pressure in the arms, this is a sign of peripheral arterial disease.

Angiography may also be used to confirm the diagnosis of peripheral arterial disease. This is a procedure where the doctor will inject a small amount of dye into the blood vessels, then use either an X-ray, CT scan, or MRI to view the arteries. This method is more invasive than the others, but it allows the doctor to see exactly where the blood clot is occurring. This makes the condition much more possible to treat.

When treating PAD, your doctor will usually take a two-fold approach. The first step is to treat the symptoms, such as the leg pain, so that everyday activities are manageable. The second step is to treat the underlying causes. This may include medications for high blood pressure or high cholesterol. Lifestyle changes are also important, such as quitting smoking, a change in diet, or a monitored exercise program.

Catching peripheral arterial disease early is an important step in managing the disease and preventing complications from its progression. If you have risk factors for the disease, be sure to ask your doctor about peripheral arterial disease. If you are experiencing symptoms such as leg pain, be sure to tell your doctor about that as well.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

The foot is an extremely intricate masterpiece

2009-04-27T09:33:00.003-04:00

It consists of 28 bones, muscles, ligaments, arteries, veins and nerves. It is designed to absorb the forces of running, walking, and jumping, lessening the burden on the knees, hips, and back. Our feet serve such an important purpose in our every day lives, yet we often neglect them. We stuff them in socks and shoes, and forget about them for most of the day. So how do we keep our feet healthy? Here are a few tips…

· Don’t ignore that pain. Pain is not normal, especially when it is in your feet. If you are having foot pains, contact a podiatric physician.

· Take the time to inspect your feet. Check for any recent changes in color, thickening of nails, cuts, scrapes, or anything else that may seem a little “funny” or “new”. Many times these changes can be indicative of disease or abnormality, and it is usually much easier to treat them early rather than wait for the problem to progress.

· Wash your feet thoroughly and regularly, especially on the soles and in between the toes. Be sure to dry them well before putting on socks or shoes.

· When trimming your toenails, be careful! Cut them straight across, but don’t dig into the sides of the nail. This can lead to ingrown toenails and infection. People with diabetes should have their feet cared for by a podiatric physician, as this condition makes a person much more susceptible to infection.

· Wear shoes that fit properly. Shoes that slide around on the foot can lead to blisters and hot spots. As a general rule of thumb, try on new shoes later in the day, when the feet are a bit larger than in the morning. This way, you will know if the shoe is going to be too tight. Replace old shoes that are worn out, and always wear the appropriate shoe for any physical activity that you are doing.

· Avoid walking barefoot, especially outside. Walking barefoot opens the door to injury and infection. Walking barefoot on hard surfaces, such as a wood or tile floor, over extended periods of time can lead to heel pain or plantar fasciitis. Try a lightweight shoe or slipper when walking around the house.

· If you have diabetes, make an appointment to see a podiatric physician at least once a year. A regular check-up can avoid all kinds of complications due to diabetes. If you need help finding a podiatric physician, you can use the American Podiatric Medical Association’s Find a Physician tool.

Follow these tips, and help to keep your feet happy and healthy!

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Big Appetite… Big Foot?

2009-04-27T08:44:00.010-04:00

In our culture of enormous portions, endless temptations and the threat of ever-expanding waistlines bombarding us at every turn, it is easy to see that we all are fighting the battle of the bulge everyday! In addition, computers, television, video games and other technologies are not helping as they contribute to the lack of physical activity!

Obesity is an epidemic and one that adversely affects the human body in many ways. There are a slew of obesity-related diseases: hypertension (high blood pressure), congestive heart failure, sleep apnea, gallstone formation, osteoarthritis, gout and type 2 (adult-onset) diabetes! Research is uncovering more and more evidence about the detrimental effects of obesity on our vital organs and how it impedes normal body function.

However, did you know that obesity has now been linked to bigger foot sizes?! Apparently, the size of our feet as a population has been growing! Just 100 years ago, the typical American adult male wore a shoe size of 6.5 and the typical American female wore a size of 4.5! Today, the average male shoe size is a 9, and in the last 5 years, the size of men’s feet has increased 1 full shoe size!

What exactly is happening here?! There are several theories as to why foot size is on the rise. One guess is that the intake of highly processed and unhealthy foods during puberty may fuel growth hormone secretion in the body. Growth hormone affects all areas of the body, but may play a significant role in the waist, hands and feet. Another reason for increasing shoe size may actually be due to body weight and its effect on our feet. The increased burden due to obesity may be putting so much stress on our feet that our arches are collapsing, thus leading to the flattening of feet.

The present-day lifestyle and contemporary diet is leading to a trend of people becoming taller and larger with bigger foot sizes!

When shopping for shoes keep a few things in mind:

1. Make sure to find shoes that accommodate both your foot length and foot width.
2. Shoes that are too small will cramp your toes and lead to foot pain. Shoes that are too large will lead to a lack of stability and the formation of blisters.
3. Never assume your shoe size is the same as it always been because with time, your foot size changes.
4. Measure your foot size at the end of the day; your feet are at their largest then.
5. Ensure that you are wearing your socks when sizing for athletic shoes.
6. Always measure both feet and fit the shoes to the larger foot.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

2009-04-08T08:58:00.000-04:00

Runners’ Nightmares!

If you are an avid runner, chances are you have run into some kind of foot or lower extremity problems. Think about it: the action of running involves the repetitive pounding of the foot on surfaces and sends shock waves up your body.

It is important to understand that running too soon, running too fast, or running too long are the major causes of running injuries. The conditions you may experience are your body’s way of telling you to stop overworking it!

What are some common running ailments?

Stiff Calves

Novice runners may experience tight and stiff calf muscles and is intimately associated with the Achilles tendon. This tendon comes from your calf muscles and joins the heel to your leg. If your body is not used to exercising the calf muscles and associated structures, you will definitely experience an ache on the back of your leg.

Runner’s Knee

Have you ever walked, climbed stairs, or ran and felt a grinding and grating in your knee joint accompanied by severe pain? If so, Runner’s Knee may be one cause! This ailment is caused by an unstable patella. (The patella is your kneecap).

Shin Splints

Running on hard surfaces such as asphalt or concrete may lead to the development of shin splints. Shin splints is that burning, irritating pain originating from the center of your lower leg. Without rest or treatment, shin splints may progress into stress fractures!

What is the best way to treat running injuries?

Stiff Calves

Make sure that prior to starting your running routine that your calves experience a full, deep stretch. You can build up the area by rising on to your toes one foot at a time, holding that position for a count of five and then lowering it.

Runner’s Knee

The best way to alleviate this condition is to ease off of the physical activity for a week and work to strengthen the muscles around the knee. To improve muscle strength clench your thigh muscles as often as you can in sets of 5. It’s a simple way to work the muscles that connect to your patella.

Shin Splints

To reduce the occurrence of shin splints, it is advised to run on soft surfaces such as grass while wearing shoes with ample cushioning. You may have to hold off on running for an extended period of time.

Different injuries require different modes of treatment, but the tried-and-true methods always involve prevention and a good stretching regimen. Watch and pace yourself when exercising – do not overdo it! And of course, ALWAYS seek a podiatrist’s consult when evaluating the intensity of the injury and deciding on the best treatment option!

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

What the Heel!? Pain!?

2009-04-08T08:51:00.000-04:00

Did you know that the APMA (the American Podiatric Medical Association) recently conducted a survey of foot ailments in Americans? It was found that the most common complaint was heel pain with 16% of the population regularly experiencing it! Millions of patients visit their health professional for heel-related pain! The good news is that heel pain can be alleviated with non-invasive treatment with great results if it is detected and diagnosed early.

What are the roots of heel pain?

It is important to remember that heel pain is caused by some underlying foot deformity or by repetitive trauma. For instance, the most widespread reason for heel pain is due to plantar fasciitis. The plantar fascia is a ligament which is a tissue that connects bone to bone (from the heel bone to the base of the toes) and helps to support the arch of the foot. Plantar fasciitis is the inflammation of said connective tissue and the pain manifests itself in the center heel region. The degree of pain may fluctuate, but the overall commonality is the experience of a sudden flare up soon after becoming mobile in the morning. Excessive running or jumping may lead to this condition.

Inflammation of the Achilles tendon (known as Achilles tendinitis) is also a contributor to heel pain. This pathology has many sources for its origin: injury, increased age, bone spurs, or tight calf muscles. If medical treatment is not received early, this condition may lead to muscle tearing, formation of scar tissue, and adhesions (an adhesion is a band of scar tissue that binds two normally separate tissues together)

The degeneration of the fat pads in your foot can cause heel pain. The fat pads function as shock absorbers and if your feet strike hard surfaces it can lead to their thinning. Walking on hard surfaces with thin fat pads means your foot bones are absorbing the shock which leads to the pain.

Another reason for the development of heel pain is due to constant pounding of the foot on hard surfaces. You may irritate tissues in the foot if you participate in prolonged high-impact exercise and play sports or wear ill-fitting shoes. Most people, especially athletes try to ignore the signs of heel pain and keep on executing the action leading to their condition. As you may imagine, this ends up worsening the ailment and the heel pain could proceed into the chronic phase which leads to more problems!

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Hot and Cold Treatment for Arthritis

2009-04-02T09:07:00.000-04:00

There are many types of arthritis that can affect people. The most common form of arthritis is osteoarthritis, or degenerative joint disease. Osteoarthritis refers to the breaking down of the cartilage that helps cushion and support the joints. Osteoarthritis is particularly common in people over fifty-five, and it is estimated that by age sixty-five, 60% of patients will have clinical signs of degenerative joint disease. These signs include stiffness of the joints, inflammation of the joints, aching of the joints, and soreness of the joints especially after long periods of movement or overuse. The joints that are most commonly affected include the small joints of the fingers and toes, as well as the weight bearing joints, such as the hip and knee

Some treatments that have been shown to help ease the pain of osteoarthritis include heat therapy and cold therapy. These two methods work by stimulating the body’s natural healing powers. Heat therapy works by dilating the blood vessels, which stimulates the body’s blood circulation. Heat also helps alter the perception of pain. Cold therapy works in a different manner. The cold helps reduce swelling by constricting the blood vessels to the joints. It also helps numb the pain of arthritis.

There are two ways of using heat therapy for arthritic pain – dry and wet. Dry therapy includes things like heating blankets and microwaveable heat packs. Wet therapy usually refers to a hot bath or shower, a washcloth soaked in hot water, or a whirl pool or sauna. However, people with diabetes, cardiovascular disease, or high blood pressure are warned against hot tubs and saunas.

Cold therapy has also been shown to be effective against joint pain from osteoarthritis. A cold pack can be used, or a bag of ice. Some people use a spray such as flouromethane, which creates a superficial cooling on the skin. This helps numb the pain, and can be particularly useful on areas that are hard to keep a bag of ice on, such as the backs of the knees.

Different people have different results with hot and cold therapy. In face, some people have the best results with mixing the two therapies, often alternating between hot and cold. If you suffer from arthritis, talk to your doctor about the possibility of incorporating hot and cold therapy into your arthritis treatment.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

"Fish Pedicure" Is It the New Fad?

2009-03-04T09:15:00.000-05:00

If you live in Florida, Massachusetts, Texas, Washington, or New Hampshire, you won’t be able to find the latest trend in foot care on your local salon menu. That’s because these states have outlawed the fish pedicure, a fad that is quickly gaining press coverage throughout the country. The trend is popular in Asia, where customers can dip their feet into a large bowl of water, inhabited by dozens of tiny fish known as garra rufa, or doctor fish. These tiny, toothless fish nibble away at dead and dried up skin, removing it in a similar fashion as a normal pedicure might.

State legislatures have been quick to ban the practice, citing several preexisting rules, including the prohibition of pets and animals in a salon, as well as sanitation standards set in place for pedicures. But at a Virginia salon, customers are flocking to come get their feet nibbled on by the doctor fish. At Yvonne Salon, with locations in Alexandria and Woodbridge, VA, the practice has been all the rage, being featured on the Tyra Banks’ Show and NPR, as well as the local news.

The tiny fish don’t have any teeth, so it is more of a sucking, or “kissing” feeling for the customers. Garra rufa originate in the river basins of Turkey, Syria, Iraq and Iran, where the fish were first used as a treatment for psoriasis. While the fish did not cure anyone’s psoriasis, they did help treat the symptoms, nibbling away at the dead and dried flesh of the spa-goers. Since 2006, the fish have been used in commercial day-spas, starting in Japan and China, and finally finding their way to the United States.

While the American Podiatric Medical Association (APMA) has not officially made a statement regarding the use of fish in pedicures, there are clearly some sanitation issues that arise. The cleanliness of the fish and water that the fish live in is certainly an issue, as well as any skin conditions that the customer might have. The effectiveness of fish pedicures has also been brought up, as it is difficult to compare this process to that of a traditional pedicure.

For now, it remains a fad in foot care. But if you want to try it for yourself, it may involve traveling to Virginia, or another state where fish pedicures have not yet been banned.

Central Florida Foot and Ankle Center
101 6th St. Nw
Winter Haven, Fl. 33881
Phone: 863-299-4551
www.FLFootandAnkle.com

Do You Have Intense Pain In Your Heels?

2009-03-04T09:06:00.000-05:00

Has this ever happened to you? You wake up, swing your feet out of bed, and the first few steps you take cause an intense pain in your heels? If so, you may be one of the millions of people who suffer from plantar fasciitis every year. It is one of the most common causes of heel pain, and it can be particularly debilitating for those who enjoy an active lifestyle.

Plantar fasciitis is an inflammation of the tissue on the bottom of the foot, known as the plantar fascia. This band of tissue connects your heel bone to your toes, and helps provide the structure and support required of your feet for walking. The inflammation is caused by a straining of the band of tissue, which can happen in a number of different ways. One of the most common ways for the pain to occur is when a person who has been seated or lying down for an extended period of time first stands up, putting weight on their feet. It is for this reason that plantar fasciitis often is first noticed in people getting out of bed in the morning.

As the day goes on, the pain may temporarily goes away, only to come back later in the day or possibly the next day. The pain is usually worsened by long periods of standing, or walking up stairs. There are many methods of treating plantar fasciitis, including:

· Icing the effected area

· Stretching the plantar fascia tissue with a towel or other stretching device

· Reducing the amount of time you stand on your feet, or cutting back on some of the activities that exacerbate the pain, such as running.

· Taking an over-the-counter anti-inflammatory, such as ibuprofen, naproxen, or aspirin.

· The use of orthotics in your shoes, and getting a new pair of shoes, with arch support and a cushioned heel. The shoes should be comfortable to wear for extended periods of time.

These methods work better for some than for others, and it is often a combination of several factors that will ultimately alleviate the pain. Talk to your doctor about any heel pain you may be experiencing, as it may be a sign of a potentially more serious condition, especially if that pain occurs while lying down at night. Together with your doctor, a plan can be put in place to get you back on your feet again, pain free!

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

The Price "You Pay" to Look Good

2009-02-18T10:06:00.000-05:00

Is it just me, or has the phenomenon around Sex and the City taken the popularity of high heels and skyrocketed those to new heights? More then ever, high heels have become a fashion statement unto themselves, with each season bringing about more shocking, more vibrant, and more amazing shoes than their predecessors.

But a three or four inch shoe can be daunting. And many cannot even begin to fathom the greater heights, as we push ourselves in to 4 1/2, 5, or 6 inch heels. With the pursuit of vanity (and great gams) come warnings, fears, and frights.

DR.’S RESPONSE: High heels are the nemesis of the astute podiatric surgeon. Unfortunately, despite our best and well intentioned efforts to encourage the disuse of high heeled shoes, fashion conscious women continue to push the envelope. I’ll give you an example: Just yesterday I was at a boat show, with steps, docks, and people getting in and out of boat gunnels. I saw a middle aged woman there with 6 inch heels, obviously in intense agony walking and hobbling along. Why do women torture themselves? As a physician, I recommend the use of flats with an elevated heel of 1 inch. If heels must be worn, I encourage my patients to use heels of 2 inches or less. Anything more severely alters the biomechanics of a normally functioning foot. This can lead to a shortening Achilles tendon, bunions, deformed toes, formation of a bump on the back of your heel, balance problems, sprained ankles, blisters, and corns.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

HOW TO “HEAL” the HEEL PAIN

2009-02-10T09:30:00.001-05:00

Heel pain is a common problem that many podiatrists see daily in their busy practices. As foot and ankle physicians, we treat this malady quite frequently with a variety of treatment methods. Before we concern ourselves with the actual treatment plans, let us understand a little background information about this condition.

First, what is “heel pain?” Heel pain commonly refers to a number of conditions that can affect the heel. For the layman, it is an umbrella term that can mean a whole host of issues. For argument’s sake and brevity, let us focus on what is more correctly referred to as “plantar fasciitis” or inflammation of the plantar fascia. This entity goes by many other names, such as heel spurs, heel spur syndrome, plantar fasciosis, to name a few.

The plantar fascia is an elastic band of tissue that spans between the heel and ball of the foot. It actually continues as the plantar part of the Achilles tendon, beginning behind your leg, around the back of your heel bone, and continuing to the bottom of the foot where it separates into 5 smaller parts to insert onto the bottom of the foot where each toe connects. Normally, this fibrous band of tissue is able to withstand the years of punishment that we put our bodies through daily. It actually does quite an amazing job, supporting our arches as we walk, run, jump, dance, and generally abuse this portion of our anatomy. We don’t really think about our feet until they begin to hurt. And nothing hurts more than a sharp, stabbing pain at the heel which is worsened with every step. We are constantly reminded how much it hurts as we plod through our work day. And when you rest, it feels better, right? But then you get up off that work chair and hello that lightning like pain comes back even stronger than before. More about that later.

Before I continue, a small disclaimer is needed. It is important to note that heel pain can be due to a variety of other causes. Because of this, it is important to have heel pain properly diagnosed by a foot and ankle physician, someone who is best trained to determine the appropriate diagnosis and treatment.

For plantar fasciitis to occur, we need to understand mechanically what is happening. I like to tell my patients to think of a rubber band that is attached to two sides of a roman arch. The rubber band stretches and tightens, stretches and tightens, and so on throughout the day. To cause pain, this rubber band stretches beyond its normal length. The tissue becomes inflamed because of the excessive stresses placed upon it. Unlike a rubber band, it doesn’t snap, but it sure does feel like it. In the body’s futile attempt to “bridge the gap,” sometimes extra bone is laid down where the band begins at the heel. Thus, we arrive at the term heel spur. Instead of alleviating the pain, this oftentimes exacerbates the pain, prompting a visit to your local podiatrist.

Signs and symptoms that you may experiences include the classic “post static dyskinesia.” This term really means “it hurts when I begin movement after a period of rest.” The most common complaint I hear is “doc, my feet hurt as soon as I place them on the floor in the morning.” Think for a moment back to the rubber band. While you are sleeping at night, your feet are resting on your bed, and very little, if any, stress is placed upon them. During the night, that rubber band tightens and gets smaller because the roman arch of our foot does not need to be maintained during a period of rest. But when we wake up in the morning, bright eyes and bushy tailed, we throw our feet over the bed onto the floor and OUCH! We have suddenly and abruptly placed a stress on that foot. This doesn’t occur just in the morning either. It can occur after ANY period of rest longer than two or three minutes. Sometimes, this pain is diminished a bit after that initial first step because the fascia is being forcibly stretched.

Other symptoms include specific pin point pain at the heel, which often is easily noted. The pain often worsens as the day continues and is very quickly alleviated with rest. Also, the pain may progressively worsen over a period of months. Certain shoes may aggravate the condition as well. Obesity, shoe gear, work conditions, and foot type can all play a role in its development.

Conservative treatment is the mainstay of eliminating heel pain. Any number and combination of the following methods may alleviate your pain. They are basically divided into what you can do as a patient and what we can offer as physicians. The most important component I believe is stretching which you can read more about in HOW TO “HEAL” the HEEL PAIN part 2.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

HOW TO “HEAL” the HEEL PAIN Part 2

2009-02-10T09:12:00.000-05:00

As we discussed in the previous article the most important component in eliminating heel pain I believe is stretching. Take a belt, a towel, or that ugly tie Aunt Sallie gave you for your birthday and stretch your feet everyday BEFORE getting out of bed. Put the towel at the ball of the foot and pull both sides toward you like a horse bridle while keeping your knee straight. You should feel a pulling sensation behind your knee and down your leg. Hold this position for 30 seconds and repeat five times with 30 seconds rest between each stretch. Oh, and make sure you stretch the unaffected side as well. I’ve seen it go away on one foot only to return on the other.

Another trick is to freeze a regular ole’ bottle of water. Every night as your sitting in front of your television watching the news, roll that bottle with your foot for about ten minutes on each foot. This ices the bottom of the foot and stretches the fascia at the same time.

Non steroidal anti-inflammatories, or NSAIDs for short, are also a great option for some. Advil, aleve, celebrex, naprosyn, ibuprofen, motrin, etc. are over the counter and readily accessible for all patients. Your doctor may prescribe a more potent NSAID but they all help to reduce inflammation and swelling associated with this condition.

I can’t encourage you enough to wear shoes at all times, not just at work or play. Many houses have tile or wooden floors which will not offer any cushion to that painful heel of yours. Wear supportive sandals or thick flip flops around the house. I try to discourage house slippers because they are really not helpful. I prefer that my patients wear Crocs because they feel wonderful and offer just enough support to be worn around the house. Along that same line, I can’t over emphasize the importance of quality shoe gear. A good supportive shoe will do wonders. You cannot believe the type of shoes out there and I often find myself asking “you paid HOW MUCH for those?”

Moving into the doctor’s office, we have a variety of more in depth treatment options. Any good doctor worth his weight will give you a crash course on the conservative treatment options above. He may also offer to tape your feet, temporarily lifting the arch and assisting that rubber band. This works great but unfortunately, unless your doctor is your spouse, only lasts a few days because the tape falls off.

Night splints are somewhat expensive but they also work wonders. Maintaining the stretch on the plantar fascia during the night while you sleep certainly assists with pain control and condition remedy, but they can be awkward and some people may not be able to tolerate them. Your doctor may elect to have you wear a removable walking cast or boot that can be used to keep your foot immobile for a few weeks to let it rest up and heal (pun intended). Another item that can provide very long lasting relief is custom orthotics. They are expensive but ask anyone who has a pair, they are definitely worth it. These address the underlying structural abnormalities that may be contributing to your heel pain.

Injections seem to be the mainstay of our treatment regimen because they provide quick relief. They can be somewhat painful when administered, but offer long lasting relief when they take affect. They are usually composed of a short acting local anesthetic as well as a longer acting corticosteroid, which serves to reduce the inflammatory response.

You may also look into shockwave therapy which has been shown to have excellent results. As a last resort, surgery is an enticing option for some. More than 90% of patients routinely achieve lasting relief without surgery. You should try at least six months of conservative measures before entertaining the idea of surgery. Your foot and ankle surgeon will discuss the most beneficial approach for you.

No matter what treatment you undergo or receive for this sometimes very painful condition, remember that the underling causes of this condition often remain. Therefore, you should proceed with preventative measures to reduce the chance for recurrence. For all patients, wearing supportive shoes and using your custom molded orthotic devices will provide long term treatment.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com