Ganglion Cyst

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

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

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

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?

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?

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

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

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

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

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