What is a Bunion?

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

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

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

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?

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

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

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?

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

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?

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