Ahh! My Legs! Restless Legs Syndrome – Part 2

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!

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

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.

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?

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

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!

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

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

  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!

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