Central FL Foot and Ankle Ctr

Dwayne Wade Still Sitting Out With Sprained Ankle

2012-01-24T11:50:00.000-05:00

Last Friday, Miami Heat star Dwayne Wade added yet anotherinjury to his list. After landingawkwardly on his ankle while going after a loose ball, Wade left the game anddidn’t come back. Last night he sat outagain as the Heat took on the Spurs. TheHeat were able to defeat the Spurs easily without Dwayne Wade, who remains outwith a sprained ankle indefinitely.

Ankle sprains are a common injury, particularly inathletes. Most commonly an ankle sprainoccurs from an inversion injury, where the ankle is forced to roll outward overa stationary foot. Less frequently, amedial sprain may occur where the ankle rolls medially (towards the middle ofthe body).

Inversion injuries such as Dwayne Wade suffered from onFriday can result in a number of different injury patterns, and can frequentlyinvolve a fracture of one or more bones of the ankle or foot. Thankfully, the x-rays were negative forfracture in this case.

The lateral ligaments of the ankle include the anteriortalofibular ligament, the calcaneofibular ligament, and the posteriortalofibular ligament. In a lateral anklesprain, one or more of these ligaments may be injured. Generally speaking, the anterior talofibularligament is injured first, followed by the calcaneofibular ligament. The posterior talofibular ligament is lessfrequently included in these types of injuries.

The degree of the sprain is often defined as well. The degree of the sprain refers to the amountof damage to the injured ligament. Ifthe ligament is not torn at all, it is considered a first degree sprain. In second degree sprains, a partial tear maybe seen. In third degree sprains, theligament is entirely ruptured and may even require surgical repair in somecases. The degree of the sprain is oftenevaluated with an MRI.

In Dwayne Wade’s case, he is walking without a cast orsurgical boot. This is a good sign, asit indicates that the sprain is less severe. Still, this injury comes as Dwayne Wade was already nursing a sore leftfoot and a muscle strain in the calf. Rehabilitation of these injuries is certainly a concern for the MiamiHeat, who are searching for a championship in this abbreviated season. While they seem to be able to still win withDwayne Wade on the sidelines, it begs the question if they can continue to winin the post-season without the star guard.

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

Meralgia Paresthetica

2011-12-02T12:32:00.001-05:00

Meralgiaparesthetica is an uncommon pathology of the lateral femoral cutaneousnerve. It is most commonly caused by entrapment of the nerve as itcourses through the inguinal ligament. The nerve originates from thespinal cord at the L2-L3 level, and courses underneath the inguinal ligament asit travels into the thigh. The nerve has no motor control, but it relayssensory information from the anterior-lateral thigh.

Symptomsof meralgia paresthetica include a burning, tingling, numb, or painfulsensation to the anterior-lateral thigh. Most commonly it affects onlyone side of the body, but may affect both sides at the same time. Thereis no loss of strength associated with meralgia paresthetica, as there is nomotor function of the lateral femoral cutaneous nerve.

Thecondition is most commonly caused by compression of the nerve, particularlyunderneath the inguinal ligament. This compression may come from a heavytool belt or utility belt applying pressure to the nerve, or it can come fromincreased pressure from the abdomen in obese individuals. Rarely, thesymptoms come from a space-occupying lesion along the nerve contents such as atumor, or from a lesion along the psoas muscle.

Thediagnosis of meralgia paresthetica is made through clinical exam. Tappingalong the inguinal ligament may reproduce the symptoms, which is highlysuggestive of meralgia paresthetica. Occasionally EMG or nerveconduction studies may be ordered, however, this is usually only the case whenruling out pathology of the spinal cord, nerve roots, or compression of othernerves of the lower extremity. In particular, pathology of the femoralnerve may present with similar symptoms, but will also show a loss of strengthin the quadriceps muscle.

Treatmentof meralgia paresthetica is supportive. Weight loss in obese individualshas been shown to relieve symptoms. Removal of a heavy tool belt or otherform of compression along the nerve will also generally relieve symptoms. Medications used for nerve pain such as gabapentin may also be used, with somepatients reporting good results. Injections with local anesthetics andsteroids may eliminated pain temporarily, for a long period of time, or evenpermanently. Surgical decompression of the nerve may be performed, but isreserved for unrelenting conditions. Interestingly, meralgia parestheticahas been shown to be more common in diabetic individuals than in the generalpopulation, after controlling for weight differences.

If youhave symptoms of meralgia paresthetica, or of any other nerve compression, itis important to discuss this with your doctor. Be sure to tell them of anyother symptoms that may be associated with the pain, such as muscle weakness orfatigue, changes in vision or hearing, or numbness and tingling in any otherparts 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

The Subtalar Joint

2011-09-28T08:55:00.000-04:00

The subtalar joint sits below the ankle joint, and iscomposed of the articulation between the talus and the calcaneus. It plays a crucial role in the normalfunction of the foot, and allows for motion along an axis that runs throughthree planes of the body; the frontal plane, the sagittal plane, and thetransverse plane. Motion along thesubtalar joint axis is defined as pronation and supination. The pronation and supination allows the footto adapt to uneven surfaces, and functions as the connecting joint between theankle and the rest of the foot.

The articulation between the talus and the calcaneus isactually composed of three separate articular surfaces; the posterior articularfacet, the middle articular facet, and the anterior articular facet. Together, these three articulations create ajoint between the two bones.

The joint is stabilized by a number of ligaments thatconnect the talus to the calcaneus. Theankle ligaments also help to stabilize the talus within the ankle joint, andkeep it improper alignment with the calcaneus.

Pathology of the subtalar joint may include primaryosteoarthritis, arthritis secondary to fractures of the ankle and/or calcaneus,tarsal coalition, inflammatory conditions, and a number of other problems thatcan affect bones and joints. Subtalarjoint arthritis is a very common etiology of subtalr joint pain. When the subtalar joint becomes an area ofpain, it is often confused for ankle pain. Thus, when people come to the doctor with a complaint of ankle pain,they are often shocked to find out that it is not actually their ankle thathurts, but their subtalar joint.

Subtalar joint pain, particularly when it is due toarthritis, can be differentiated from ankle pain with a careful clinical exam,as well as the use of diagnostic injections. Diagnostic injections involve injecting a small amount of localanesthetic, a numbing agent, into the painful joint. If all of the pain is relieved, than it canbe deduced that the subtalar joint is the source of pain. If some, but not all of the pain is relieved,than it is possible that the ankle or other surrounding joints, or the softtissues around the joint may be the source of the problem.

Treating subtalar joint arthritis begins with conservativetherapy. This may consist of variouspadding and strapping methods, orthotics, and the use of cortisone injectionsinto the joint. Oralanti-inflammatories, ice, physical therapy, and other modalities may be triedas well.

Occassionally, the arthritis is severe enough to warrantsurgical intervention. Most commonly,subtalar joint arthritis is treated surgically with a fusion of the joint, alsoknown as an arthrodesis. In subtalarjoint arthrodesis, the talus is fused to the calcaneus. This removes all motion available at thejoint, thus eliminating the pain associated with its movement. The joint will not move after it has beenfused.

Screws are used to hold the bones in place while they healtogether, and a period of non-weight bearing is generally employed for a minimumof 6-8 weeks. After this period of time,the patient may be transitioned to a partial weight-bearing status, for anotherperiod of 4-6 weeks. After the boneshave completely healed, normal activity may begin again.

Central Florida Foot & Ankle Center, LLC101 6th Street N.W.Winter Haven, FL 33881Phone: 863-299-4551http://www.FLFootandAnkle.com

Plyometrics for Lower Extremity Power Training

2011-08-19T10:45:00.004-04:00

Plyometrics is a form of exercise that is designed to improve muscular power, speed of contraction, and improve the response time of the neuromuscular system. It is typically used by competitive athletes as a form of cross-training, but recently has become more po pular in the non-professional athletic community. The technique involves combining muscle loading and fast contractions in order to improve muscle power. Muscle power includes not just strength of muscles (i.e., how much weight a person can lift) but also considers the speed at which that force is delivered.

In particular, plyometrics are used to strengthen and train the muscles and reflexes of the lower extremity, as well as improve core strength. Research has shown that the use of plyometrics in professional athletes has increased performance as well as decreased the incidence of injury.

Specific exercises include a variety of different lunge and squat techniques. The plyometric exercise consists of a fast elongation phase of contraction (eccentric phase) followed by an amortization or resting phase, which is then followed by a short burst contraction phase. For example, this may involve a quick squat, followed by a brief period of rest, followed by a jump off the ground.

The science behind plyometrics revolves around the specific muscle fibers being trained. The muscle fibers of the body consist of slow-twitch (type I), fast twitch type A (type IIA), and fast twitch type B (type IIB). In plyometrics, the fibers being worked are the fast-twitch fibers. Plyometrics also helps train the muscle reflexes that help control muscle contractions.

Plyometrics can be a excellent adjunct to an training or exercise program, but should only be undertaken by those in good physical condition. Because of the high impact nature of many of the exercises, those engaging in plyometrics should be ready for this impact. The technique used is of utmost importance, so as to avoid injury when training. Age is also a consideration, as many people of advanced age are advised against high impact activity due to arthiritis, osteoporosis, or other conditions that may jeopardize the safety of the individual.

There is not usually much equipment required for plyometrics. Generally a pair of sturdy training shoes designed for lateral movements, comfortable clothes, and enough space to move around is all that is needed. Many people follow instructional videos, or participate in organized classes that can help with technique. Plyometrics is an intense workout, so if you’re planning on trying it, be sure that it is safe by talking to your doctor about your new exercise plan. And bring plenty of water.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Smart Toe implants for Hammertoes

2011-06-20T10:14:00.003-04:00

Hammertoes involve a contracture deformity at one or more of the joints in the toe. The most common deformity seen involves a flexion contracture at the proximal interphalangeal joint and an extension contracture at the distal interphalangeal joint. There are also isolated deformities of the distal interphalangeal joint known as mallet toe, and dual flexion contractures at the distal and proximal interphalangeal joints known as claw toes. A deformity may also be present at the metatarsophalangeal joint in any of these hammer digit variations.

Clinically, it is important for the evaluating physician to recognize if the deformity is flexible or rigid. Flexible deformities can be treated in some cases conservatively with orthotics, which serve to neutralize the deforming forces. Hammertoes are typically caused by a biomechanical abnormality that leads to a loss of muscle balance in the digits. Flexible hammertoes can also be treated surgically with a flexor tendon transfer or a simple flexor tenotomy.

For rigid deformities, conservative therapy involves accommodation and palliation. Corns that develop from the prominent joint rubbing against shoes can be shaved down, and corn pads and toe spacers can be used to make the person more comfortable. Wider and deeper shoes will also help for many.

Surgical correction of a rigid hammertoe can involve either an arthroplasty or an arthrodesis. Arthroplasty involves cutting some of the bone out of the joint, which creates a wider, more mobile joint. Arthrodesis is a fusion of the joint, which helps to straighten out the toe. The Smart Toe implant is a newer piece of hardware that helps in arthrodesis procedures.

The smart Toe device is placed in the two bones that create the joint, either at the proximal or distal interphalagenal joints of the digit. This allows for a fusion of the joint. The hardware is composed of metal that expands once placed into the body, and keeps a rigid fusion of the joint. They are kept frozen, and heat allows them to expand. Using a Smart Toe avoids having a pin coming out of the tip of the toe, which can potentially lead to infection or loss of correction at the joint.

Smart Toe comes in both straight models and in models that have a slight bend to them. The 10 degree bend allows for the tip of the toe to touch the ground easier, and provides a more natural looking correction. Smart Toe has become a popular option in the treatment of hammertoes by podiatrists, due to the ease of use and to patient satisfaction.

If you are considering treatment for hammertoes, talk to your provider about the different options, and which options would be best for you.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Corns and Calluses

2011-04-27T08:57:00.004-04:00

Corns and calluses of the feet are a common problem for many people. They develop because of repeated friction to the area. This may be the result of poorly fitting shoes, or biomechanical abnormalities that cause a person to put excessive pressure in one area of the foot. A corn develops on either the top or outside of the foot, while a callus develops on the bottom of the foot. Corns are usually in one particular area, such as on the tops of the toes, while calluses can be more diffusely located on the bottoms of the feet. A corn can also develop in between the toes as a result of the bones of the toes rubbing against each other and the skin between them becoming thickened. When this occurs, the corn is known as heloma molle.

A corn will appear as a thickened lesion, which may or may not be painful. Because of the increased friction to the area, the body's response is to increase skin production to protect the tissues below the skin. This is what causes the skin to thicken, become dry and flaky, and to often become elevated compared to the surrounding skin. Corns and calluses may become painful if they are neglected.

Generally, corns and calluses are not a huge problem. They can cause local discomfort, but will usually resolve quickly when the outside force causing increased pressure or friction is removed. This may be something as simple as changing a pair of ill-fitting shoes or using a small piece of padding in the area.

For diabetics and other people prone to peripheral neuropathy, corns and calluses can be more of a concern. Becuase of the loss of sensation to the feet in diabetic and other forms of peripheral neuropathy, a person may never feel the pain from increased friction and callus formation. Without feeling that pain, the skin can break down and an ulcer can form. When an ulcer forms, they can be very difficult to treat and rely on off-loading the area to remove unwanted pressure. Because of this concern, it is important for diabetics to check their feet daily, and to have their doctor or podiatrist inspect them as well.

Professional treatment may become necessary when corns and calluses become painful, particularly if it is difficult for one to care for their own feet. This would include elderly and diabetic populations, as well as those with chronic back pain and other conditions limiting mobility. Removing the callus with a scalpel blade is often a quick way to make a patient feel better. Treatment should also focus on removing the causative factor of corns and/or calluses. This may include padding, strapping, or orthotics. In some situations when a bony prominence may exist causing undue pressure and pain in the area, a small piece of the bone can be removed surgically to relieve the pressure.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Achilles Tendon Ruptures

2011-03-17T09:44:00.004-04:00

The Achilles tendon, or tendo-Achilles, is a large, rope-like tendon that runs along the back of the leg and inserts into the calcaneus, or heel bone. The tendon is comprised of two muscles coming together, the gastrocnemius and the soleus. It is the longest tendon in the body, and functions to lift up the heel when the calf muscles contract. This is a vital function for activities such as walking, running, and jumping. When the calf muscles contract, the heel is pulled up, allowing us to point or toes. A complete tear through the tendon is known as a rupture, and most frequently occurs in the area 2-3 inches above the heel.

As a person ages, a tendon can become weak and thin. This underlying weakness of the Achilles tendon is typically present in a total rupture. Some medications such as corticosteroids or certain antibiotics, as well as illnesses such as arthritis or diabetes may also weaken the Achilles tendon.

Most frequently, Achilles tendon ruptures are seen in middle-aged male athletes. These “weekend warriors” will usually injure themselves during a sport that requires sudden bursts of activity, in particular racquet sports like tennis or squash, and basketball.

Symptoms of an Achilles tendon rupture are a sudden and severe pain in the back of the calf. There may be an audible popping or snapping sound when the tendon ruptures. Walking may still be possible, but strength of push-off with the toes will be weakened. Bruising and difficulty walking may follow the initial pain and swelling.

If you are exhibiting signs of an Achilles tendon injury, there are several tests that a doctor can perform in the office to determine the likeliness of a total rupture. The doctor may have you lie flat on your stomach, while they feel the back of your calf. A slight depression can often be felt where the tendon should be tight. Another test is to squeeze the calf muscles of the affected side. In a normal person, squeezing the calf will cause the foot to plantarflex, or point the toes. In someone with a total rupture of the Achilles tendon, this motion will be lost. A partial tear of the Achilles tendon will typically still cause the motion to occur, as some of the residual fibers are left intact.

An MRI or ultrasound may also be ordered in order to confirm the diagnosis. These imaging studies can show the foot and ankle surgeon whether or not the injury is a partial tear or complete rupture, and will help determine the extent of the injury.

Treating an Achilles tendon rupture can either be surgical or non-surgical. The non-surgical method involves placing the foot and ankle in a cast for 2-4 weeks, at which time the cast may be replaced. This allows the foot to be immobilized while the tissues heal. Casts are typically changes in order to allow slow stretching of the tendon so that it does not heal in a contracted position.

PRICE therapy also applies to Achilles tendon injuries. This involves protection (via a cast or brace), rest, ice, compression, and elevation to relieve some of the swelling.

Surgical treatment involves repairing the ruptured tendon by suturing it back together. Research has shown that in both competitive and non-competitive athletes, there is a decreased risk of re-rupture with surgical repair. There has also been some evidence to show that the time to recovery is faster using surgical repair than with non-surgical management. There are inherent risks involved with any type of surgery, however, including risks associated with anesthesia, infection, non-healing of wounds, scarring, bleeding, nerve injury, and blood clots developing in the legs.

Preventing Achilles tendon injuries, especially in older athletes, revolves around stretching the muscles before activity. This is a critical step in any workout, yet is often skipped over.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Jones Fracture

2011-01-11T11:32:00.002-05:00

A Jones fracture is a fracture of the fifth metatarsal base. The pain will be located in the middle of the foot in the area of the fracture. A person who has sustained a Jones fracture will have pain and swelling in the area, and will typically have difficulty walking. In injury was first described in 1902 by Sir Robert Jones, a British orthopedist.

Jones fractures are diagnosed by using x-rays. The ordering physician will usually be able to see the fracture line through the fifth metatarsal. The fracture is located at the proximal end of the fifth metatarsal, through the diaphyisis. This is the long, tubular part of the bone.

Because of the location of a Jones fracute, they can often be difficult to heal. The area of bone that is fractured lies between the insertion point of two tendons. These tendons function to pull the bone in two different directions. When there is a fracture between theses two insertion points, that can lead to a lot of motion at the fracture site and therefore, prolonged healing time.

This area of bone also has a decreased blood supply when compared to the bone surrounding it. This is sometimes referred to as a watershed area in the medical community, meaning that the area of bone is not well vascularized, which can also lead to a longer time to heal.

In order to allow a Jones fracture to heal, the patient must be non weight-bearing for a minimum of four to eight weeks. However, due to the decreased vascularity and excessive motion caused by tendon insertion and muscles originating from the area, this is often not enough time for the fracture to heal. In some cases, it may take up to twenty weeks for the fracture to heal.

Surgery is often indicated for a Jones fracture. Reattaching the broken bone using pins, screws, or plates will frequently allow a stable fixation of the fracture. This stable fixation is key to the healing process. The prognosis for Jones fracture is greatly improved with the use of surgical correction.

Other fractures of the proximal fifth metatarsal include avulsion-type fractures as well as stress fractures. These types of fractures generally heal faster and more readily than the Jones fracture, partly because of where they occur in the bone. The areas of the bone affected by these other fractures are generally more protected by the tendons inserting in the area, and have a greater vascular supply. These types of cases typically will not require surgery, and will respond well to casting and immobilization.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Tinea Pedis

2010-11-05T10:47:00.003-04:00

Tinea pedis is a superficial infection of the feet with dermatophytes, a subset of fungus that lives off of the keratin in the skin. It is the most common fungal infection of the body, and is typically characterized by a burning, tingling, or stinging feeling in the feet and toes. Tinea pedis may also be referred to as athlete’s foot.

Tinea pedis is often broken down into four distinct entities. The first is chronic tinea pedis, which is most classically described as a silvery, scaly appearance of the bottoms of the feet, in a moccasin-like appearance. This means that the extent of the infection is diffusely spread across the entire plantar surface of the foot, and commonly expands up into the toes and the sides of the foot, where a moccasin may come in contact with the skin. The organism that most commonly causes this form of tinea pedis is trychophyton rubrum, or t. rubrum.

Another distinct form of tinea pedis is the vesiculobullous or acute vesicular form. This condition is most commonly caused by the organism trychophyton mentagrophytes (t. mentagrophytes). In addition to the burning, tingling, or stinging sensations associated with tinea pedis, the acute vesicular form will also show very small blisters, typically in the arch of the foot. This form of tinea pedis shows acute inflammation, and is often treated with a topical steroid as well as a fungicide.

Acute interdigital tinea pedis is also a common form caused by t. mentagrophytes, and is seen in between the toes, extending down onto the bottom of the feet towards the ball of the foot. This condition may or may not be inflammatory. When acute inflammation is present, a steroid/fungicide combination may also be used for treatment.

Acute interdigital tinea pedis may progress to the more serious but less common ulcerative tinea pedis. Ulcerative tinea pedis occurs when a case of untreated interdigital or vesicular tinea pedis causes severe breakdown of the skin, and a secondary bacterial infection ensues. This bacterial infection superimposed on a fungal infection can cause a great amount of skin loss on the bottoms of the feet, and can lead to a disabling condition. Treatment typically involves a fungicide/steroid combination as well as oral antibiotics.

With the exception of the more serious ulcerative form, most cases of tinea pedis are successfully treated with topical medications. Topical medications consist of a fungicide with or without a very low dose of steroid. The steroid is included in forms of tinea that include inflammation, and serves to decrease some of that inflammation. However, in cases without inflammation, a steroid should not be used so as to avoid the unnecessary side effects associated with steroids. In cases such as chronic tinea pedis, a plain fungicide will suffice.

Patients with severe inflammatory tinea pedis or a case that has not responded to topical treatment after at least one month may be considered for oral medications. Oral medications do come with inherent risks, in particular the risk of liver damage. Blood work is performed before oral anti-fungal medications are prescribed for tinea pedis and/or fungal nail infections.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Ganglion Cyst

2010-10-05T16:31:00.004-04:00

A ganglion cyst is a soft tissue mass that is filled with a protein-rich fluid. They are walled off from the surrounding soft tissues with a thin wall, and may be single or multi-chambered. Ganglion cysts are most commonly found on the backs of the hands and wrists, or on the top of the foot and ankle. They can sometimes be worrisome to the patient when they develop, but it should be comforting to the patient to know that they are benign and usually harmless.

Ganglion cysts can develop in a variety of different tissues, including nerves, tendons, and joints. The exact mechanism of their development is not completely understood, but they are usually attributed to repetitive trauma. In the foot and ankle, an irritating shoe may be the cause.

The symptoms are dependent on which structures are affected and on the size of the growth. If nerves ate involved, there may be a bunring or tingling sensation, or the area may go numb. There is typically pain involved in any ganglion cyst, particularly when they grow in size and become irritated.

Historically, ganglion cysts used to be referred to as “bible bumps”. This is due to the fact that they used to be treated by slamming a large book, such as a bible, onto the back of someone’s hands with a ganglion cyst. Not surprisingly, this turns out to be a terrible treatment for ganglion cysts. It leads to a high rate of recurrence, and is probably quite painful.

Today, ganglion cysts are treated in a more precise manner. X-rays are typically taken as a first line diagnostic exam to rule out other pathological processes, such as invasive tumors, malignancy, and soft tissue calcifications. Ultrasound is becoming more popular as a diagnostic exam for ganglion cysts, as it is a quick, easy, and inexpensive method of visualizing the cyst beneath the skin. MRI may be used as well, but is more expensive, time consuming, and is generally reserved for surgical planning.

Treatment of a ganglion cyst usually begins with aspiration of the cyst with a small needle. Removing the fluid can relieve some of the pressure on the area, as well as serve as a definitive diagnosis. The area is typically numbed prior to aspiration, to provide comfort for the patient. A steroid is often injected into the area as well to reduce swelling and inflammation. Padding the area may also prove to be helpful in treatment, but is usually not sufficient on its own.

Some ganglion cysts may require surgical removal for complete relief. It should be noted, however, that the recurrence of ganglion cysts is very high in both surgical and non-surgical treatment.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Tarsal Coalition

2010-08-16T11:12:00.001-04:00

A tarsal coalition is when two tarsal bones (the bones of the mid- and rear-foot) become fused. This can cause pain and a loss of motion at the effected joint, as well as other biomechanical symptoms.

The most common joint to be effected by a tarsal coalition is the subtalar joint, which is a joint formed by the articulation between the talus and the calcaneus. There are actually three facets between the two bones that help to form the joint – the anterior, middle, and posterior facets. Most commonly, a talocalcalcaneal coalition is formed between the middle facets. When a coalition exists between the talus and the calcaneus, it may present as a rigid flatfoot deformity with considerable decrease in range of motion.

Other tarsal coalitions that are occasionally seen include calcaneo-navicular and talo-navicular coalitions, though these are much less common than talocalcaneal coalitions. Overall, the incidence of tarsal coalitions is about 1% of the population. There is a familial inheritance that is often seen with tarsal coalition, though it is not thoroughly understood.

The cause of congenital tarsal coalition has been an area of interest for quite some time. It was first proposed in 1897 that they were caused by the incorporation of accessory bones within the joint, but was later postulated that the bones actually failed to separate in the fetus. The latter of the two explanations is the more commonly accepted situation.

Tarsal coalitions may also be acquired from trauma to the joint, degenerative changes to the joint such as what is seen in osteoarthritis, and fractures through the joint space.

Diagnosis of tarsal coalition comes from a combination of clinical findings, as well as x-ray, CT, and MRI imaging. Imaging techniques allow a doctor to visualize the joints to evaluate for fusion.

Clinical findings include pain, stiffness and decreased range of motion at the joint, rigid flatfoot deformity, and local tenderness and possibly swelling.

Conservative treatment is usually initiated once the diagnosis is made. This most commonly includes custom-made orthotic devices that prevent the effected joint from moving too much. The movement of the fused joint is what causes much of the pain. Immobilization may be required with an ankle brace or other device. Physical therapy can help in some cases, as well as shoe modifications to accommodate the coalition.

Surgical treatment can include either removal of the coalition or a fusion of the joint to prevent movement altogether. There are several different ways of performing each of these types of procedures, depending on the individual patient and situation.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Heel Spur vs. Plantar Fasciitis

2010-06-25T12:22:00.004-04:00

The terms “heel spur” and “plantar fasciitis” can often be confused. The two diagnoses are unique from one another, but are related and are often seen together. It is helpful to understand the difference between the two, and to understand how they relate to each other.

Plantar fasciitis refers to a process that elicits pain in the bottom of the heel, along the bottom of the foot, and sometimes even into the toes. It is caused by excessive stress placed on the plantar aponeurosis, a thick piece of fibrous tissue that expands the length of the foot. The pain is most commonly seen at the origin of the plantar aponeurosis, or the plantar fascia, which is at the bottom of the calcaneus (heel bone).

The term plantar fasciitis is somewhat of a misnomer. The suffix “-itis” at the end of the word implies that there is inflammation in the plantar fascia. While this may be present in some cases, a majority of cases do not have any associated acute inflammation. Because of this, the term plantar fasciosis is probably a more appropriate term, which would refer to the condition as a chronic condition of pain. In scientific research, it is commonly referred to as plantar fasciosis.

A heel spur, on the other hand, is a piece of bone coming off of the bottom of the calcaneus. This is called an ostephyte. The cause of heel spurs is not completely understood, but it is generally accepted that they form from tractional pull on the calcaneus from the structures attached to the bone. This may include several muscles of the foot as well as the plantar aponeurosis.

Heel spurs are commonly associated with obesity, and can be seen in a number of different foot types. It has been reported that up to 92% of patients with heel spurs will develop ostephytes at other parts of their body. A heel spur on an x-ray can look like a very sinister problem, but it should be noted that the size of the heel spur does not correlate with the amount of pain associated with the problem. In fact, it is common to find that people will have heel spurs on both of their feet, yet only one side will be symptomatic.

Because both of the conditions are associated with each other, and the complaints of each are so similar, they may often be treated in the same manner. Generally a combination of rest, ice, stretching of the plantar fascia, and anti-inflammatory medications are sufficient in treating the conditions.

Strapping and taping are often employed by a physician to treat the problems, and orthotics may be prescribed as well. Functional orthotics may help to correct some of the biomechanical problems that lead to these two related conditions. By forcing the foot to function in a neutral position, much of the pull on the calcaneus can be eliminated. This can prevent the tensile pull on the calcaneus that can form heel spurs, as well as relieve the tension on the plantar fascia that may be causing the plantar fasciitis. Soft cushioning materials may also be used in the case of heel spurs to alleviate the pain.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Morton’s Neuroma

2010-04-19T15:59:00.005-04:00

A neuroma is a benign growth in the tissue surrounding a nerve. This growth causes an enlargement of the nerve, which can lead to pain. Neuromas are fairly common in the feet, and are typically seen in the intermetatrsal nerves. These are the nerves that run up the metatarsal bones in your foot. The most common site for a nueroma to form is in the third intermetatarsal space, which is in the ball of the foot between the third and fourth toes. This is referred to as a Morton’s Neuroma.

Morton’s Neuroma can occur in anyone, but is most typically seen in females between the ages of forty and sixty. Early symptoms of a neuroma may include sharp or shooting pains in the affected area, a burning sensation in the area, or numbness and tingling in the toes. Many of these symptoms may resolve with rest and taking off the shoes, and you may feel some relief from rubbing the area. A common compliant of patients with a Morton’s Neuroma is that it feels like they are stepping on a pebble, or that there is a lump in their shoe.

There is no single clear cut reason that neuromas form, but there have been several proposed mechanisms. The one that is the most universally accepted is the idea that the neuroma is a response to the pressure of the metatarsals sqeezing on the nerve. This may be due to poorly fitting shoes, especially high heels. Why it occurs so frequently at the third intermetatarsal nerve in particular may be due to the thickness of this particular nerve – it is slightly thicker than the other intermetatarsal nerves.

The clinical picture of a neuroma is usually enough to diagnose the problem, but x-rays are usually taken to rule out things like stress fractures and other problems. MRI may also be used to diagnose neuromas more definitively, but due to cost is not generally done.

Treatment of neuromas including Morton’s Neuroma may include a change in shoes, padding, orthotics, medications, injections, and physical therapy. Generally a wider shoe will help relieve some of the pressure on the neuroma, which is often the source of the pain. Padding the area underneath the ball of the foot can also prevent the nerve from being pinched by the bones. Orthotics are typically used to treat biomechanical problems such as over-pronation, which may be the underlying cause of a neuroma. Injections of steroids as well as oral pain-relief medication are typically used in the acute setting, but will not address the underlying cause of the neuroma.

Ultimately, you and your doctor may decide that surgery is an option. This is generally a decision that will have to be made after some other therapies are employed first.

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 Clubfoot?

2010-01-14T11:47:00.006-05:00

Clubfoot, or talipes equinovarus, is a fairly serious deformity of the foot and ankle that may be treated by a podiatrist or an orthopedic surgeon. It is defined as a deformity in which the ankle is in a fixed equinus position (meaning that the ankle is pointed down, or plantarflexed), and the rearfoot is in a fixed varus position (meaning that the heel is inverted, or pointed towards the middle of the body). These two abnormalities will additionally position the forefoot towards the middle of the body.

Clubfoot has an incidence of about 1-2 per 1000 live births. This number, however, increases with a family history of clubfoot. In those with a parent, sibling, or cousin with clubfoot, the incidence rate jumps to 1 in 20. When two family members were born with clubfoot, the chances are 1 in 5. Though the exact cause of talipes equinovarus remains unknown in the majority of cases, these numbers strongly suggest a hereditary nature of the deformity.

When a child is born with a clubfoot deformity, the situation is best addressed immediately, while the bones and ligaments of the foot and ankle are still the most pliable. This means that within the first 24 hours of the infant’s life, an attempt will be made to correct the deformity without surgery. Casting methods are used, where the foot, ankle, and leg are manipulated into a more normal position, and a cast is put on in an attempt to correct the positional deformity. Casts are changed every couple of days, until hopefully the deformity is corrected. The specifics of this casting technique were developed by Igancio V. Ponseti, MD, an orthopedic surgeon who just recently passed away at the age of 95.

In many cases of clubfoot, the Ponseti method is successful in correcting the deformity within the first six to eight weeks of life. Unfortunately, there are cases that do not respond to this casting technique, and surgery may be required to achieve a foot that is more functional. Additionally, some cases of clubfoot go unnoticed or undiagnosed until later in the child’s life, where non-surgical intervention may not be a viable option anymore.

Clubfoot is often seen co-existing with other musculoskeletal anomalies and other abnormalities. Some of these conditions include cleft lip, cleft palate, scoliosis, deformities of the upper extremities, torticollis (a fixed contraction of the sternocleidomastoid, a muscle in the neck), cardiac abnormalities, and hip dislocation. Clubfoot is also seen as an occasional or regularly occurring deformity in over fifty named congenital syndromes.

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 Deep Vein Thrombosis?

2009-11-23T09:49:00.004-05:00

Deep Vein Thrombosis, commonly abbreviated DVT, is a condition of blood clotting in the veins that lie deep within the body. A blood clot forms when the blood thickens and clumps together. A DVT can occur anywhere in the body, but most commonly forms in the deep veins of the leg.

When a blood clot forms in the deep veins, it can break off from the sides of the veins, forming what is known as an embolism. The embolus can then travel through the body, and get lodged into the small veins of the lung. When this occurs, it is known as pulmonary embolism (PE). Pulmonary embolism can cause shortness of breath and difficulty breathing, and can sometimes progress to a more serious condition, which can even cause death.

Blood clots can also form in the superficial veins of the body, or the veins closer to the skin surface. This is often seen in varicose veins. Blood clots in the superficial veins, however, are not a risk factor for pulmonary embolism.

When a clot forms in the deep veins, it may completely block off blood return to the heart through that vein. This can cause pain, redness, and swelling, typically seen in the leg around the calf.

Risk factors for deep vein thrombosis include increased age, obesity, heart disease, infections, use of oral contraceptives, and pregnancy. The major risk factor for DVT, though, is immobilization. Any situation that limits walking and movement for a prolonged period of time is a potential risk factor for deep vein thrombosis. They are common in post-operative settings, as well as in hospitalized patients.

Special care is taken to make sure that clots are prevented from forming during a hospital stay. If deep vein thrombosis does form in the hospital, they can be managed before they turn into a more serious condition such as pulmonary embolism.

Treatment of deep vein thrombosis centers around medicines that help prevent the growth of a clot, as well as break down the clot once it has formed. Blood thinners like Heparin and Coumadin are used to prevent the clot from getting any bigger, and different medications may be used to dissolve a clot that is already formed.

The most important part of treating deep vein thrombosis and pulmonary embolism is the early recognition of the condition. Doctors, nurses, and other hospital workers are all trained to recognize the symptoms, and treat deep vein thrombosis before it becomes a more serious issue.

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

Vaccinations for Pregnant Women

2009-09-30T07:43:00.001-04:00

For pregnant women, getting a flu shot will be extremely important this year. This message comes from the Centers for Disease Control and Prevention, with particular regard for the H1N1 vaccine. The H1N1 virus, known throughout the media as swine flu, can cause premature labor in pregnant women, and can keep them in the hospital for weeks. Pregnant women are at a high risk for mortality from the virus – they make up about six percent of the H1N1-confirmed deaths in the country, though they only account for about one percent of the population.

Even with all of the information available on the importance of pregnant women getting vaccinated against the flu, only about 1 in 7 will go through with it. This discrepancy may be the result of women who are hesitant to take medications while pregnant, however, the CDC stresses that the vaccination is not harmful to the mother or the fetus. In fact, it is highly beneficial to both.

The antibodies that the mother makes after receiving the flu vaccine can easily cross the placenta and be delivered to the fetus. This gives the infant protection against the virus after birth, until the child is old enough to get a flu vaccine themselves. Babies are not vaccinated until they are six months old.

Interestingly, most obstetricians do not currently vaccinate their patients against either H1N1 influenza or administer the seasonal flu vaccine. This can make it difficult for a pregnant woman to obtain the vaccination, as many are reluctant to go to drugstore or grocery store immunization spots.

Compounding this problem is the reluctance of vaccine providers, mainly pharmacists, to fill a doctor’s prescription for a flu vaccine. There have been several accounts of pharmacists refusing to fill the prescription, though the American Pharmacists Association is urging its members to follow the CDC’s guidelines.

It is the hope of the CDC and the American College of Obstetricians and Gynecologists (ACOG) to increase the number of pregnant women to get not only the H1N1 vaccine, but the seasonal flu vaccine as well. Any kind of flu can be a serious detriment to the mother. Surveys conducted by ACOG suggest that more obstetricians will be delivering vaccines to their patients this year.

Drugstores hoping to gain rights to distribute H1N1 vaccinations are jumping on board as well. Walgreen’s, if they are to receive the vaccinations, will have signs up next to pregnancy tests, as well as written reminders for women buying prenatal supplements.

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

Varicose Veins

2009-09-01T07:45:00.002-04:00

What are Varicose Veins?

In the legs there are deep veins found buried under layers of muscle, superficial veins that are closer to the skin, and perforating veins which connect the deep and superficial veins. Normally, valves in the perforating veins allow blood to flow in a one-way direction from superficial to deep. This allows all of the blood to be shunted into the deep veins, and then brought back to the heart to be re-circulated through the body.

When someone has varicose veins, there is a problem with the valves in the perforating veins. This causes blood to pool and remain in the superficial veins, which increases the pressure within the veins. The veins are capable of stretching, which makes them visible through the skin. When you’re looking at someone’s varicose veins (maybe your own!) you are viewing the blood within the superficial veins.

How are they treated?

The main goal of treatment of varicose veins is to bring the pooling blood out of the lower extremity. This may include elastic stockings or other compression device to help the veins gather enough pressure to return the blood back to the heart.

Surgical treatment includes stripping the veins, which may or may not include laser therapy. This eliminates the veins, so that the blood is forced to return to the heart through a different vein. This can eliminate a varicose vein that has already formed, but does not prevent new ones from forming.

What are the symptoms? Are they painful?

Varicose veins are usually not painful, especially in minor cases. However, the pressure of blood remaining in the superficial veins can cause discomfort. For this reason, as well as aesthetic reason, many people opt for surgical intervention to remove the affected veins.

Are Varicose Veins dangerous?

Generally, varicose veins are not a dangerous condition. Primary varicose veins are caused simply by faulty valves in the perforating veins. You may be predisposed to varicose veins based on heredity or an occupation that requires you to stand all day. Women are three times as likely as men to develop varicose veins, and they can be brought on by pregnancy as well.

Varicose veins may also be indicative of a more serious condition, known as deep vein thrombosis, or DVT. These are secondary varicose veins that are caused by a blockage within the veins. It is important to show your doctor any new varicose veins, as they should be able to diagnose a more serious underlying condition.

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

Back to School Shoes

2009-08-18T09:22:00.005-04:00

Stocking up on back-to-school items? You’ll need pencils, paper, notebooks, a new backpack, and other school supplies, but don’t forget a new pair of shoes!

Children’s footwear plays an essential role in the foot health and overall health of your child. They will be exposed to all sorts of different terrain, from the classroom to the playground, and everywhere in between. The right pair of shoes will keep them active and comfortable. Here are a few things to look for in a new pair of shoes for your kids:

· Grab the back heel of the shoe, and press down on both sides. A supportive shoe will not collapse easily.

· Take the shoe and try to flex it at the toes. A good shoe will allow for the toes to flex, but will not bend too easily. A shoe that is too stiff will not allow for the toes to function properly.

· Hold the shoe in the front with one hand and at the back of the shoe with the other hand. Try to twist the shoe. If the shoe twists easily in the middle, it is not supportive enough.

· Bring your kids with you. If you let your children have a say in their footwear, it will help promote a healthy lifestyle in the future.

· After your child has been wearing the shoes for a while, check the bottoms of the shoes. Uneven wear patterns, especially in the heel, can indicate a biomechanical problem, which should be evaluated by a podiatrist.

· Bring a pair of socks when you go shopping. Sure, you can use the socks that they have in the store, but they may not be the socks that your child wears. Different socks can have different thicknesses, which may alter the fit of the shoe.

· Look for the APMA seal of acceptance. This seal is awarded by the American Podiatric Medical Association for shoes that fit the guidelines for acceptable footwear. You can look at a complete list of these shoes here.

Keep in mind that the right shoes for your children will allow them to participate in a number of activities in school. If they are playing sports after school, it is also important that they wear sport-specific footwear. Cleats are for soccer or baseball, and running shoes are absolutely necessary for running. Taking care of your children’s feet and having them take care of themselves is the first step towards a long, healthy lifestyle.
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Heart Rate Monitors

2009-07-28T11:13:00.004-04:00

Looking to take your training to the next level? You may want to consider a heart rate monitor as a way to enhance your training. Heart rate monitors are becoming increasingly more popular in the running and cycling communities. They are generally composed of a watch that keeps track of and displays the heart rate, and a chest strap that reads the pulse while you work out.

When looking for a heart rate monitor, there are a few things to keep in mind. You’ll want to find a chest strap that fits snugly around your chest. This can sometimes pose a problem for women, as many of the chest straps are designed to fit a man’s chest. To combat this problem, many companies have developed sports bras that actually have a separate pocket for the heart rate monitor to fit into. Some of these models include the Heart Bra, made by Polar, as well as a sports bra designed by Numetrex. These items range in price from $35-50.

Another thing to look for in a heart rate monitor is the watch. Does it have a nice, big, easy-to-read display? What about the buttons – are they easy to find a press while running? If you’ll be cycling with it, is the display large enough to read when mounted to the handlebars? These are some things you’ll want to consider when investing in a heart rate monitor.

There is a wide range of features that can be added to a heart rate monitor watch. Some of the more basic models will simply tell the heart rate and the time, and will be fairly easy to use. Models like the Omron HR-100C, Oregon Scientific SE100, and Polar FS1 all get good reviews, are easy to use, and range in price from $30-50.

At the other end of the spectrum, there are models that have built in GPS units, and can track with great precision your exact location, speed, and distance ran/biked. These models are usually upwards of $400, such as the Suunto t6c, Polar RS800sd, or the Garmin Forerunner 405. In addition to tracking speed and distance, these watches are more like mini computers. They are able to log training programs, and the information on the watch can then be uploaded to a computer.

Heart rate monitors are often sold at sporting goods stores, specialty running shops, or online at websites such as amazon.com. Websites that sell this equipment will generally have lots of user reviews, which can be useful in deciding which heart rate monitor to get.

The most important aspect of purchasing an item like this is to decide what you would like to get out of the heart rate monitor. If you simply want to know what your pulse rate is, then a simpler model may be right for you. If you’re generally into electronics and gadgets, you may want to spring for the higher priced models that will offer lots of functions and training tools.

A heart rate monitor is a great way to keep track of your health and your training goals. They also make good gifts for the runner in your life, or just a nice treat for yourself!

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

New Study Compares Prescription Orthotics to Over-the-Counter shoe inserts

2009-06-26T10:46:00.006-04:00

A new study is under way to investigate the efficacy of prescription orthotics, a device that podiatrists use in practice often. The study will compare over-the-counter shoe inserts with prescription orthotics, or orthoses as they are known as in the medical community.

The ongoing three-year study, which is being funded by the American Podiatric Medical Association (APMA), will look at the success rate of the prescription orthotics in treating plantar fasciitis, a common cause of heel pain. Podiatrists have been able to successfully treat plantar fasciitis with foot orthotics for a long time as a form of non-surgical, conservative treatment – this study will serve to quantify and qualify that information.

The research is being conducted at the Scholl College of Podiatric Medicine, through the Center for Lower Extremity Ambulatory Research (CLEAR). The interim director of the research program, Dr. James Wrobel, seeks to compare the results of prescription orthotics as a treatment for heel pain with the results of over-the-counter shoe inserts. The study will also look at the overall efficacy of the prescription orthotics at treating the heel pain. In other words, did the pain go away when using the orthotics?

Prescription orthotics are generally more durable than over-the-counter shoe inserts, needing replacement only after several years. They are prescribed by a podiatrist, and are usually done fairly quickly in an appointment. The doctor will take either make a plaster casting of the foot, or a digital image using computer software.

Prescription orthotics are typically used for three different reasons. There are orthotics designed to change the function of the foot, orthotics that are designed to protect the foot from outside forces, and orthotics that are designed to be both protective and serve to alter function of the foot. Different materials are often used when manufacturing the orthotics, depending on the purpose that they will serve.

As doctors across the country focus more and more on evidence based medicine, it will be studies like this one that will back up the use of treatments such as prescription orthotics. Many remedies in the medical world are not confirmed as being any better than others, but through research like this, a fair comparison can be made.

If you have any questions about prescription orthotics, talk to your podiatrist about different options. If you are experiencing heel pain, share this with your doctor. Conservative treatments, such as orthotics, are generally used before more invasive, surgical procedures.
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Blisters? That socks.

2009-06-15T13:29:00.008-04:00

Blisters – they can drive a person crazy. Athletes, particularly runners, will often think of blisters as a common problem, something that just comes with the territory. You may have seen runners covering their feet with Band-Aids or duct tape to prevent them from forming, or you may have gone to these measures yourself. Generally people will get blisters from a poorly fitting pair of shoes, or perhaps from another source; their socks.

That’s right – your socks may be giving you blisters. When we wear cotton socks to run in, or to walk around in all day, we are trapping a layer of moisture right up against our feet. Think about getting out of the shower and grabbing a cotton towel to pull all the water off of you. This is exactly what your socks are doing, only they hold that sweat right up against your feet. This increases the friction between the sock and the skin on your foot, which will increase the friction between the layers of skin on your foot. Over a period of time, a blister will form.

So how do we combat this problem? One way to prevent blisters from forming is by switching from a cotton sock to a sock made of moisture-wicking fibers. Many brands make socks specific to running or other activities. These socks are made to fit tight, and often have extra layers of padding in areas that are most sensitive to blister formation, like the heel and ball of the foot. The materials used may be synthetic materials, such as nylon, polypropelene, or acrylic, as well as natural fibers like merino wool. All of these non-cotton fibers have the ability to spread moisture out over a greater surface area. The greater the surface area, the easier the moisture can evaporate.

When it comes to moisture-wicking socks, there are lots of options. For natural fibers, brands such as SmartWool and Bridgedale use merino wool. A variety of synthetic materials are used by brands such as WrightSock, Under Armor, and Balega. DryMax socks use a double layer sock, transferring the friction normally seen between the foot and the sock to this layer. Many brands that make running shoes also make moisture-wicking socks, such as Nike, Brooks, Asics, Adidas, and Mizuno. When it comes to choosing moisture-wicking socks, the options are about as plentiful as the options of shoes! You can purchase these types of socks directily from out online store by clicking here!

So, if you have a problem with blisters, try changing your socks. With so many options, you can try a few different brands to see which ones will be your favorite. Ask around – maybe someone you know has a favorite brand of their own. But be careful, once you start wearing moisture-wicking socks, you may not ever go back to cotton!
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Ahh! My Legs! Restless Legs Syndrome – Part 1

2009-04-15T10:35:00.003-04:00

What is it?

Restless Legs Syndrome (RLS) also known as Wittmaack-Ekbom’s syndrome is a neurological condition that is characterized by burning, itching, gnawing or creeping sensations inside the legs. Some people have even described the feeling as insects crawling up and down the insides of their legs!

Who is affected?

What are signs and symptoms of Restless Legs Syndrome?

Paresthesias which are irregular sensations and dysesthesias which are unpleasant irregular sensations are indications of RLS. These abnormal feelings usually occur in the leg – between the knee and ankle, deep inside the body. RLS may also occur in the torso, arms, hands, thighs, and feet! This condition usually occurs bilaterally (on both sides of the body), but in some cases only one side of the body may be affected.

The way to relieve the sensations is by continued movement – so people with RLS usually keep their legs in constant

It is thought that 12 million Americans may be plagued with this condition! Although both males and females are affected, it occurs slightly more frequently in women. The disorder can occur at any age – from infants to the elderly. The majority of those affected with RLS lie in the middle-age to older category. Unfortunately, the intensity of syndrome increases with age. Older individuals experience longer episodes of symptoms more often.

What are some characteristics of this condition?

The most unusual and distinguishing feature of this disorder is that relaxing or lying down will trigger the symptoms of this condition! If left undiagnosed and untreated, this syndrome will cause sleep deprivation which can lead to exhaustion and fatigue during the day as well as the lack of concentration, reduced memory, and the inability to accomplish daily activities.

motion to prevent the uncomfortable feelings from arising. A person with RLS will pace around, toss and turn in bed, and shift their legs continuously while seated.

Individuals with RLS usually find that the symptoms of the syndrome are less obvious during the day and more definite in the evening hours. This condition may be brought about by stillness, immobility, or inactivity such as sitting in a theater, airplane, or car seat for extended periods of time.

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

Ahh! My Legs! Restless Legs Syndrome – Part 2

2009-04-15T10:30:00.005-04:00

Restless Legs Syndrome is a condition where the affected person has the uncontrollable and compelling impulse to keep their body in motion in order to prevent unpleasant and uncomfortable sensations. Body movement relieves the RLS-affected individual’s symptoms.

What are some causes of Restless Legs Syndrome?

There are several associated factors/conditions that may lead to this neurological disorder.

- A family history of RLS has been noticed, suggesting that this syndrome has a genetic component.

- Individuals with iron-deficiency anemia or other vitamin deficiencies may be at risk of developing RLS.

- Individuals with unremitting diseases such as peripheral neuropathy, diabetes, kidney failure, and Parkinson’s have a connection with RLS (RLS symptoms may diminish by treating the underlying disease)

- In some instances, child-bearing women may feel symptoms of RLS. The abnormal neurological sensations usually occur in the last trimester. In most cases, RLS symptoms fade away around1 month after delivery.

- Medications such as anti-nausea drugs, anti-psychotic drugs, anti-seizure drugs, anti-depressant drugs and allergy/cold drugs (Benadryl) may increase RLS symptoms!

- Caffeine (found in coffee, teas, soft drinks, and chocolate), alcohol and tobacco may contribute to the increased intensity of symptoms of RLS.

- A very recent publication in the journal Neurology has shown there is an association between belly fat and Restless Legs Syndrome. This new study found that individuals with a body mass index (BMI) of 30 or greater were 42% likely to have symptoms of this neurological disorder than persons with normal BMI (23).

Unfortunately, a majority of RLS cases have no known cause.

How is this disorder treated?

RLS may be caused by several different factors. As such, several different treatment methods are employed to handle the syndrome.

- Iron, magnesium, and folate supplements

- Decreased use of caffeine, alcohol and tobacco

- Normalizing sleep patterns (may be achieved by moderate exercise or hot showers)

- Hot baths or leg massages

- Change in medications (talk to your doctor)

These remedies may play a role in reducing RLS symptoms and bring about relief, but do not expect them to completely eliminate the abnormal sensations.

If you feel unpleasant tingling, creeping, “pins-and-needles” or tugging sensations on or in your body, especially in the leg area – you should consult your local podiatrist. When discussing your condition, be sure to inform them of all the medications, supplements, and herbal remedies you may be taking as well as your smoking and drinking habits. They will prescribe the right treatment/medications to help reduce and may be eliminate Restless Legs Syndrome!

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

Who do you call when you find a footprint at a crime scene? A Forensic Podiatrist, of course!

2009-04-08T10:06:00.007-04:00

A small but growing trend in the realm of criminal justice and scientific crossover is forensic podiatry. Forensic podiatry deals with the evidence found at a crime scene that is related to the foot. This may include things like footprints found at the scene or the wear pattern of the sock liner of the shoe.

One of the most prominent forensic podiatrists is Dr. Michael Nirenberg. An article written by Dr. Nirenberg in 1989 stresses the importance of forensic podiatry. In “Forensic Methods and the Podiatric Physician”, Dr. Nirenberg compares forensic podiatry to the fields of forensic odontology (the handling and evaluation of forensic dental evidence) and forensic anthropology (the handling and evaluation of forensic bone evidence).

Following the publication of Dr. Nirenberg’s journal, the American Society of Forensic Podiatry was formed. This group serves to organize podiatric physicians who are involved in forensic podiatry, and promote the use of podiatric forensics in legal cases. The group also serves as a means of communication between forensic podiatrists to share information and research.

Some of the information that a forensic podiatrist may gather as evidence in a case includes the podiatry records of people involved, footprints, shoe gear that may be left at the scene of a crime, and in some cases, even a gait analysis from a security camera can be used! However, the most valuable and easily administered evidence in past criminal cases that forensic podiatrists have contributed to comes from a comparison of the wear patterns of the inside of shoes. The way that a person wears a shoe down, especially on the inside of the shoe in the sock liner, is unique to the individual. Furthermore, this wear pattern is seen in most shoes that a person will wear.

Forensic podiatry is a fascinating field that is slowly but surely gaining attention. Some predict that one day forensic podiatry will be as common as any other form of forensics, and the information collected from forensic podiatrists will be ubiquitous in the world of criminal justice.

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

IT Band Syndrome

2009-04-03T14:43:00.007-04:00

If you are a runner, chances are good that you’ve suffered from an injury at some point in your running career. It may have been hip, knee, lower back, or foot pain that brought you to a stop. In any case, the experience was likely unpleasant. Some of the most common running-related injuries are also the most preventable. One of the most common running-related injuries is iliotibial band syndrome (IT Band Syndrome).

The iliotibial band is a sheet of tissue that runs from the hip to the knee. At the hip, it connects to a muscle called the tensor fascia latae. This muscle works in abducting the thigh (pulling it away from the midline of your body) and rotating the thigh medially while walking or running. At the knee, the IT band attaches to the tibia, or shin bone, at a point known as Gerdy’s Tubercle. This point is located on the tibia just below the knee, on the outside of the leg.

Pain from iliotibial band syndrome can be quite debilitating, and will certainly bring your running to a temporary halt. The pain is generally diffuse, and is located at one of the attachments of the band of tissue. Most people complain of pain at the knee, specifically at Gerdy’s Tubercle, but the pain may also be referred to the hip.

If you have a tight iliotibial band, there may be some relief from stretching out the tissue:

Stretch #1: From a standing position, cross the injured leg behind the uninjured leg. Next, lean towards the uninjured side, with your hands on your hips for balance.

Stretch #2: While sitting on the ground, extend your uninjured leg straight out in front of your body. Next, cross the injured leg over the uninjured leg, and pull the injured leg as close to your chest as possible.

Try each of these stretches, holding the position for 30 seconds each. These should be done everyday, especially after running. If the pain persists, you may want to go to a doctor to rule out any other causes of hip or knee pain.

If you’re just beginning to run, don’t let IT band syndrome discourage you. It’s something that is easily fixed, and can often be attributed to a pair of poorly fitting shoes.

Remember that pain is not normal. It is the body’s way of warning itself that something is wrong. If pain persists, it may something more serious and should be evaluated by your doctor.

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

Please briefly explain diabetes.

2009-03-20T08:29:00.006-04:00

Dr’s. RESPONSE: Diabetes is a disease of carbohydrate metabolism. It basically occurs when the body is unable to process excess sugar in the bloodstream. It is detectable using a simple blood sugar test. The patient should test their blood sugar every morning before eating to ascertain their level. Ideally, a level below 125 mg/dl is optimal. Another test that a physician can perform is called a hemoglobin A1c level. This is done by taking a small vial of blood which is tested in the lab. The number that comes back should be less than 6. If the number is higher, it means that your blood sugar levels over the past 90 days have been high. This test is excellent because it tells the physician how compliant a patient is or has been.

There are two main types of diabetes. A type I diabetic is also known as juvenile onset and they are often less than 30 years of age. This type accounts for just less than 10% of all diabetics. Their diabetic disease is due to the fact that their pancreas cannot make sufficient quantities of insulin, a chemical needed to take sugar out of the bloodstream and store it for future use. These individuals usually discover their diabetes very rapidly and usually in the first decade of life. Treatment is lifelong insulin injections.

A type II diabetic is much more common, approximately 90% of the diabetic population. This type usually presents during adulthood, hence the name adult onset diabetes. This type usually occurs in those individuals over 40 years of age and is often slow in onset and progression. In fact, millions of Americans have type II diabetes right now and are unaware and undiagnosed. In this type, the body produces insulin in the pancreas correctly, but the body is unable to use this insulin or an improper response to the insulin occurs. This type is controlled at first with lifestyle change, but often progresses to oral medicines. These persons are often overweight and are prone to poor diet and fatigue.

Another type of diabetes is called gestational diabetes. This is quite rare and only occurs to women who are pregnant. About 3% of pregnant women have this type and it quite oftenly disappears at the end of a pregnancy, to the tune of 97%. This is much more prone to those women who are moderately to severely overweight before their pregnancy.

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

Diabetics are losing feeling in their feet! Why?

2009-03-20T08:28:00.005-04:00

According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands. Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.

Dr’s. RESPONSE:

Diabetics lose feeling in their feet. This is called diabetic sensory neuropathy. Grossly simplified, the nerves do not conduct sensations as well as they can. This is due to a variety of factors, but commonly a higher level of sugar in the blood stream diminishes the nerve action potential. Direct metabolic damage then occurs to the nerves, which results in neuropathy. There are three types of neuropathies a diabetic can have. Sensory, motor, and autonomic neuropathies are all possible.

Sensory neuropathy, the most common type, usually presents as the first type before motor neuropathy. It is classically described as a sock and glove distribution. This means than the loss of sensation occurs in the same distribution as a sock. That is, all feeling is lost or diminished below a certain level just above the ankle joint, in the same area where a sock would be around the lower leg. A diabetic will not be able to detect sensation or will have difficulty detecting two points of discrimination. A person can also have an absent protective threshold. In other words, a diabetic may not be able to feel hot water when checking drawn bath water, whereas a non-diabetic would jump, pull their hand back reflexively, and say “ow!” This example also clearly illustrates the lack of temperature discrimination. Another sequella is diminished vibration sensation.

Lastly, proprioception can also be affected. Proprioception is the ability of the body to know where a limb is in space or what movement is being performed. For example, when you close your eyes while walking over a curb, your bodys’ own sensing system takes over. It knows just how much height is required to lift the foot over the curb. It also knows when to expect your foot to land onto the ground above the curb and at what force should be expected. We are able to perform this complex task because of small receptors that line our joints and detect tiny movements made by us. These movements are interpreted by our brains like movement in space.

Motor neuropathy is a deficit of motor coordination affecting the intrinsic muscles of the foot leading to biomechanical and structural changes of the foot. These changes predispose the diabetics feet to ulcers and subsequent infections.

Another type of neuropathy that can occur is autonomic neuropathy. The autonomic nervous system is responsible for regulating body temperature among other things. It does this by creating sweat and directing blood flow to or away from an extremity. Poor control would lead to reduced blood flow, lack of sweating, and other conditions. It also is responsible for hair follicles reacting to reduce heat or gather warmth.

Morton’s Neuroma

2009-03-11T11:47:00.008-04:00

A neuroma is a benign growth in the tissue surrounding a nerve. In the foot, this most frequently happens in the space between the third and fourth metatarsals (the bones that connect your toes to the rest of your foot). When this nerve becomes inflamed, it is called Morton’s Neuroma.

Morton’s Neuroma can be quite painful. It is often described as feeling like stepping on a rock or a marble, right in the ball of the foot between the third and fourth toes. This can lead to a stinging, tingling, or burning, sharp pain. Morton’s Neuroma develops from compression of the nerve over an extended period of time. Activities that often lead to Morton’s Neuroma include running and racquet sports, which produce a lot of tension in the ball of the foot. They can also develop from wearing shoes that cram all the toes into a tight toe box, or put pressure on the ball of the foot, such as high heels. In fact, women are almost ten times as likely to develop Morton’s Neuroma as men.

Diagnosis of Morton’s Neuroma is a fairly simple, clinical evaluation of the effected foot. The podiatric physician will generally inspect the foot for areas of callus, indicating a repeated and prolonged exposure to irritation. The ball of the foot may be squeezed in the area of the neuroma, which will reproduce the pain. This is generally enough information to confirm the Morton’s Neuroma diagnosis, but an x-ray may be taken to rule out any other possible conditions.

Morton’s Neuroma may be treated in a variety of ways, with the least invasive method usually being the preferred method. A change in shoes, orthotics, or taping and padding the foot to relieve some of the pressure may be sufficient to allow the nerve to become less inflamed. A change in activity is usually required, at least temporarily, to take some of the pressure off of the swollen nerve. If the less invasive methods don’t work, or the problem persists, your podiatric physician may decide that surgical intervention is the best way to relieve the pain. There are several methods of surgery, which your doctor can discuss with you.

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

Podiatry will have a new face this fall!

2009-03-11T11:43:00.004-04:00

Podiatry will have a new face this fall, as Western University of Health Sciences in Pomona, California opens up the ninth podiatric medical college in the country. The Southern California School already boasts a wide range of programs, including osteopathic medicine, physician assistant, nursing, pharmacy, and physical therapy curriculum. This August, the school will add podiatry, dentistry, optometry, and biomedical sciences to that list.

The College of Podiatric Medicine at Western University appointed Lawrence B. Harkless, DPM as the founding dean of the school. Dr. Harkless formerly worked as a professor in the department of orthopedics at the University of Texas Health Sciences Center in San Antonio, as well as the Louis T. Bogy Professor of Podiatric Medicine and Surgery. Recently, Dr. Harkless received the 2008 Distinguished Achievement Award in Diabetic Limb Salvage, a great honor for anyone in the medical community.

The curriculum at the school will follow the “two-and-two” format, meaning that the first two years of education will focus on the basic biomedical sciences, with an emphasis on classroom learning. The final two years will be based on clinical experience. This is the typical curriculum of a podiatric medical school, as well as osteopathic and allopathic medical curriculum. Western University of Health Sciences will also take advantage of having many different programs under the same university by placing an emphasis on interprofessional health care teams.

The College of Podiatric Medicine at Western University of Health Sciences is currently in the process of getting its accreditation, through the Council on Podiatric Medical Education (CPME). There is space in the newly founded program for approximately fifty students. More information on the school, including how to apply, can be found at their website.

The Bureau of Labor Statistics anticipates a 9% increase in the employment of podiatric physicians between the years 2006 and 2016. It is in accordance to this statistic that the American Association of Colleges of Podiatric Medicine plans on opening up more schools soon. In 2007, Midwestern University in Arizona also opened up a college of podiatric medicine, with their inaugural class set to graduate in 2011. The new College of Podiatric Medicine at Western University of Health Sciences in Pomona will graduate its first class in 2013.

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

Benefits of Below Knee Cast

2009-02-18T09:03:00.006-05:00

A recent study in The Lancet shows that treatment of severe ankle sprains with a below the knee cast is more effective than a compression bandage. A total of 584 participants with severe ankle sprains from eight emergency departments were included in a study to evaluate different treatment methods. Patients were placed in a below-knee cast, an Aircast brace, a Bledsoe boot (walking boot) or a tubular compression bandage. Patients were evaluated at three months and nine months.

Those who received a below-knee cast had significant improvement in pain, symptoms and the quality of ankle function compared with the tubular compression bandage. Those placed in an Aircast brace experienced an improvement in the quality of ankle function, but had no difference in pain or symptoms in comparison to the compression bandage. Those placed in the Bledsoe boot had no benefit over the tubular compression bandage at three months. When the patients were evaluated again at nine months, there were no significant differences between the tubular compression bandage and other treatments (1).

DR'S RESPONSE: This might seem obvious, but any kind of conservative treatment that limits or prohibits motion in an area of injury would be the best treatment option. The important point to decipher is that regardless of treatment, at 9 month follow-up, there were no significant statistical differences noted. Thus, one must measure cost with effectiveness when treating injuries.

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

Running in the Dark

2009-02-18T08:45:00.006-05:00

Well yesterday I was running in the dark on my street. As I was merging into my friend's front lawn, he has this little bump on the perimeter of his lawn, you can’t even really consider it a curb since it is barely seen and black. Anyways, I did not see it running onto the grass and landed on my ankle incorrectly after somewhat tripping over this bump.

I went to sleep with what was a mild ankle pain at the time. I could normally walk, but with some discomfort. Now as I just woke up, there is no swelling in the ankle, maybe some minor inflammation. BUT, I can barely walk, I mean it really hurts to put pressure on that foot.

This is my first injury of this type, should I seek professional care or just do the standard home treatment (Ice it, and rest)

I would get it checked out by a doctor, even if it is just a sprain it's better to get it looked at by a professional. If it's just a sprain take Advil to bring down the swelling in the joint (there's swelling even if you can't see it) and ice it for periods of 10 minutes on and then 10 minutes off.

DOCTOR'S RESPONSE: Any kind of tripping, twisting, or sprains normally doesn’t require a visit to the doctor. However, any time you are “barely able to walk” after an injury should ring alarm bells that something is possibly amiss. There could be a variety of injuries. I recommend that you make an appointment with your local podiatrist, a physician with specialized training for problems in the foot and ankle.

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

Listen to your feet!

2009-02-04T10:38:00.004-05:00

Your feet are not supposed to hurt. If your feet hurt – they are telling you something is wrong. Many people who experience foot pain have a neuroma. A neuroma is a painful condition that is sometimes referred to as a pinched nerve or a nerve tumor in your foot. It is a benign growth of nerve tissue frequently found between the third and fourth toes, bringing pain, burning sensation, tingling, or numbness between the toes and in the ball of the foot. The principal symptom associated with a neuroma is pain between the toes while walking. At times, the pain is described as pain similar to having a stone in the shoe.

Causes and Treatments

The exact cause of the condition is unclear, but the following factors can contribute to the formation of the neuroma: high arch or flat feet, trauma to the nerve, improper footwear, repeated stress or occupational injuries. Treatment options vary with the severity of each neruroma. Identifying the neruroma early in its development is important to avoid surgical intervention. If left untreated, neuromas tend to get worse. Examinations include x-rays as well as an echograms in order to ensure the correct diagnosis. The most common modalities utilized to treat the neuroma are: 1. anti-inflammatory medications that can be prescribed for acute pain, 2. special padding orthotic devices 3. cortisone injections 4. revolutionary neurolytic injections (series of 4 to 7 injections) that are reported to have as high as 87% efficacy rate in making the symptoms subside or go away.

Surgical options are usually a last resort, but may become necessary when the earlier mentioned treatments fail and the neuroma progresses pass the threshold for these options. The procedure, which consists of decompression or removal of the inflamed and enlarged nerve, can usually be conducted on the outpatient basis. Recovery time is often just a few weeks and in the majority of cases patients can walk immediately after the operation.

Pain is Not Normal

Remember that foot pain is not normal, and any disruption in foot function limits your freedom and mobility. It is important to schedule and appointment with one of your podiatrists at the first signs of pain or discomfort in your feet. After being treated for a foot condition such as a neuroma, it is important to follow proper maintenance guidelines to assure that the health of your feet continues to improve. You will need quality patient care with access to state of the art diagnostic equipment, such as ultrasound and digital x-rays. Treatments may also include new revolutionary injections that eliminate the necessity of surgical intervention in the majority of the cases. Most podiatric surgeons have been trained specifically and extensively in the diagnosis and treatment of all manners of foot conditions. This training encompasses all the intricately related symptoms and structures of the foot and lower leg including neurological circulatory skin and the musculoskeletal systems which include: bones, joints, ligaments, tendons, muscles, and nerves. If you or someone you know is experiencing foot pain, your podiatric physician will be more than happy to thoroughly examine you and recommend the treatment that is appropriate for your condition.

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

Excercise = Happy Feet

2009-01-29T14:18:00.007-05:00

Over a decade ago, I went through years of problems with my feet due to plantar fasciitis. The last podiatrist I saw gave me a set of exercises and stretches to do regularly. I did them while I was his patient but eventually dropped the program over the years. My foot and ankle muscles have gradually weakened on the side where I had surgery on my foot. This has probably contributed to the weakness in the hip on the same side. Could I have prevented this by simply continuing the exercise and stretch regimen prescribed years ago? I wonder.

DR.'S RESPONSE: My first and most obvious question is this: If the exercises worked and you did them regularly, why did you stop? You need to incorporate a stretching routine into your busy schedule, just like brushing your teeth. Let me use an analogy to help illustrate the solution to your foot problems. When you get up every morning, you take a shower. This is most likely because it wakes you up, keeps you smelling fresh, and is an excellent personal hygiene quality to have. Now, let’s say you move to another part of the world for work. Would you change your routine? Would you stop taking a shower? Of course not! You should have kept performing those stretching exercises that your local podiatrist recommended to you. I would probably venture to say at the very least, your plantar fasciitis would not be bothering you.

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