Monday, June 22, 2015

Patient Testimony after Shockwave Therapy with Dr Wellens

Central Florida Foot and Ankle Center, LLC.101 6TH St. NW. Winter Haven, Fl. 33881 863-299-4551

Monday, April 20, 2015

Patient Testimony after 6 months of heel pain with Dr Wellens

Central Florida Foot and Ankle Center, LLC.101 6TH St. NW. Winter Haven, Fl. 33881 863-299-4551

Friday, April 27, 2012

Keeping Kids Feet Happy

Foot and ankle problems in the child, much like many other ailments, can go unnoticed or undiagnosed for years.  The signs and symptoms can often be subtle and non-descript.  A child may not be able to explain what is wrong, and it may be up to the parents to recognize the symptoms.  Here are a few tips of what to look for.

·         Difficulty keeping up with the other kids may be a sign that something is wrong.  Often children with flatfeet have difficulty with sports and other activities due to early fatigue.  The muscles of the legs and feet can tire easily when they are not functioning properly. 
·         When a child withdraws from a sport or activity that they previously enjoyed, it may be due to pain.  Children will often not state explicitly that their feet hurt, but will rather shy away from sports.  Heel pain in a child between 8 and 14 years old may be caused by inflammation around the growth plate of the calcaneus, or heel bone.  This a treatable condition, and should not cause a child to give up something that they previously enjoyed.
·         If a child trips and falls often, it can indicate in-toeing, balance problems, or neuromuscular conditions.
·         A child not wanting to show you their feet may also be a sign that something is wrong.  Children are often scared of a trip to the doctor’s office, and if something is bothering them, they may not say anything for a while.  Ingrown toenails are notorious for going untreated long enough to become grossly infected in children.  Look for changes in the skin, hair and nails in a child, as well as any callus build-up.  These can be signs of a foot and/or ankle condition. 
·         Obviously, if a child complains of pain in their feet, ankles, or legs, it is a sign that something is wrong.  Particularly in young, otherwise healthy children, lower extremity pain should never be considered “normal”.  Children are not typically affected by the same types of overuse injuries in the adult, and thus should not be treated as adults. 

Most foot and ankle conditions in children can be treated conservatively, and very few will require surgery.  Often an orthotics or other non-surgical care is effective in relieving pain or other symptoms.  If your child exhibits any of these symptoms, they should be seen by a podiatrist for complete evaluation.  

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

Wednesday, March 21, 2012

Antibiotics – The End of an Era?

At a recent conference in Copenhagen on the topic of infectious disease, Margaret Chan, director of the World Health Organization, warned of the dangers of antibiotics resistance.  The problem is becoming so common, she stated, that it may trigger the “end of modern medicine as we know it”. 

Resistance to antibiotics occurs naturally, but the process is sped up as bacteria are exposed to antibiotics that they can survive.  This is exacerbated by improper use of antibiotics, over-prescribing for conditions like the common cold or the flu, and not following directions on the prescriptions.  The survival mechanism of the bacteria is to develop protection against antibiotics, thus creating antibiotic resistance. 

Antibiotic resistance has been sensationalized in the media as “Super Bugs”, most recently with MRSA becoming a household word.  MRSA, which stands for methicillin-resistant staphylococcus aureus, is a drug resistant bacteria that has become extremely common.  The bacteria that was once associated only with nosocomial infections is now found ubiquitously in the community setting. 

Chan discussed the “Post-antibiotic era” of medicine that may be approaching, stating that  "we are losing our first-line antimicrobials. Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.”

A number of strong, antibiotic resistant bacteria are already on the radar at most hospitals, with the infectious disease department at each hospital tracking what is common in their hospital, and which antibiotics are effective. 

One of the most commonly cited misuses of antibiotics is prescribing their use for sore throats associated with viral infections.  Because the virus causing the sore throat or cold is not affected by the antibiotics, it does nothing for the symptoms.  Furthermore, it can produce antibiotic-resistant microbes within the body, as they have now been exposed to the antibiotic. 

Podiatric physicians see the misuse of antibiotics in patients with ulcers and open wounds on their feet, ankles, and legs.  It is common practice for a physician unfamiliar with woundcare to prescribe antibiotics, even when the wound is uninfected.  However, this goes directly against the principles laid out by the Infectious Disease Society of America, in their guidelines for treating diabetic foot ulcers. 

The overuse and misuse of antibiotics is cited as the cause of antibiotics-resistant organisms, the practice of using antibiotics is difficult to get away from.  Antibiotics being manufactured today are stronger, and often more targeted towards certain organisms.  However, they can also cause more damage to the healthy tissues of the body, and that is what Chan and other doctors are so concerned with.

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

Friday, February 3, 2012

A War on Diabetes? Why Paula Deen is on Both Sides

It may not come as a surprise to find that Paula Deen has type 2 diabetes.  The woman who has made a career through a seemingly reckless approach to cooking and eating, using large quantities of cream, sugar, and butter in the majority of her recipes came out with the news earlier in January of this year.  What may come as a surprise to some is her latest paid position as a spokeswoman for Novo Nordisk, a company that makes Victoza, which is an injectable non-insulin diabetes drug. 

Yes, that is correct.  The woman who made a career of throwing caution to the wind, piling on the bacon and slathering on the mayonnaise is now promoting a diabetes drug.  The same woman that created the Brunch Burger, a hamburger that sits on a Krispy Kreme donut covered with bacon and a fried egg, revealed to the world on January 17th what she and her doctor had known for close to three years.  She had type 2 diabetes, and now she would capitalize on it to create a name for herself in the diabetic drug market. 

With Deen’s approach to cooking, it was inevitable for her to develop some sort of health condition.  In this case it is type 2 diabetes, but obesity is also a  major risk factor for heart disease, certain types of cancer, gout, and a number of other diseases.  Virtually every system in the human body is effected by obesity.  Paula Deen’s recipes certainly did not take this into consideration. 

Deen’s announcement has sparked both support from her fans as well as sharp criticism from others.  The chicken-fried-everything chef turned diabetes spokeswoman has single-handedly created a talking point about obesity in America.  Her career moves reflect the attitudes of so many people.  On the one hand, she has contributed to obesity by promoting fat-laden recipes in gigantic portions.  At the same time, she has felt the effects firsthand with her diagnosis.  The difference, however, is that the business savvy Deen has made a profit on both sides. 

While it may not be surprising to find out that she has been diagnosed with type 2 diabetes, a disease for which obesity has been indicated as one of the greatest risk factors for developing, her next moves may be even more interesting.  She has gone on the record as doing almost nothing in terms of curbing her dietary behavior, stating that she has cut down on her consumption of sweet tea.  However, her name being branded on some of the most unhealthy menu items on the planet can not be erased.  

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

Tuesday, December 20, 2011

Cutaneous Larva Migrans

Cutaneous Larva Migrans is a tropical disease that is commonly found in the foot.  It is the result of an infection with one of a variety of hookworms, including the species Ancylostoma braziliense (cat hookworm) and Ancylostoma caninum (dog hookworm).  These parasites are typically seen in tropical or subtropical environments such as the Caribbean, Mexico, Brazil, Souteast Asia, and Africa.  Humans can pick these up as an accidental end-organism from walking barefoot on the beach, or in other areas of the body from contact. 

The skin lesions are extremely itchy, and can cause great discomfort for those affected.  The migrating line that is characteristic of the infection is caused by the path that the organism takes underneath the skin.  The parasite can actually be several centimeters ahead of the trailing line, as the reaction is delayed.  The lesion that forms is linear, typically in a winding pattern, red, and raised from the skin. 

Rarely, the lesions along the body may also contain small pustules.  These are formed from the parasite becoming trapped within the sebaceous glands.  Small, pimple-like lesions may occur.  This may complicate the condition, as these small lesions may erupt and become infected secondarily.  This complication, however, is rare.

Diagnosis of cutaneous larva migrans is made through clinical examination.  A history of travel to tropical or subtropical environments is common in those affected.  X-rays and other imaging studies are not necessary for the diagnosis.

The infection is self-limiting, as humans are only an accidental host for the parasite.  The hookworm will usually die with two weeks of infection. 

Treatment for cutaneous larva migrans is with oral ivermectin, an anthelmintic drug.  Treatment with a single dose is usually curative, and has rarely induced side effects.  Albendazole has also been used orally.  This drug is usually administered over three to five days, and has a similar curative rate as ivermectin.  Topical thiabendazole has also been used.  A biopsy of the skin one to two centimeters ahead of the lesion may reveal the parasite. 

 While it may seem like a creepy, crawly problem, the condition is ultimately benign.  In the vast majority of cases, cutaneous larva migrans resolves without complication, even without treatment.  If you find new lesions on your feet or any other part of your body that are painful or itchy, be sure to point them out to your doctor.   While cutaneous larva migrans may not be the most serious of diagnoses, this creepy problem may just make you want to wear sandals on your next vacation!

Central Florida Foot & Ankle Center, LLC 
101 6th Street N.W. 
Winter Haven, FL 33881 

Monday, October 31, 2011

Chronic Venous Insufficiency

Chronic Venous Insufficiency is the most common cause of leg swelling, affecting approximately 2% of the general population and up to 20% of the elderly population.  The condition affects about 2.5 million people in the U.S. alone. 

Symptoms of chronic venous insufficiency include swelling of both legs, with a feeling of “heaviness” being a common complaint.  An itchiness or constant dull pain is often reported, and symptoms will typically worsen through the day or after a long period of standing.  Skin changes are a common finding in chronic venous insufficiency, with the skin first changing to a darker color.  This is often associated with excessive dryness and flaking of the skin, known as stasis dermatitis.  As the condition progresses, the skin becomes thicker and taught, and becomes prone to breakdown or ulceration. 

The venous system is what is responsible for returning blood from the peripheral tissues back to the heart.  In the legs, gravity allows this blood to pool when the venous system fails in returning the blood.  This is most commonly due to faulty valves in the venous system. 

Normally, the deep venous system returns most of the blood back to the heart.  The superficial venous system shunts blood into the deep system, and valves in the veins connecting the two layers create a one way system.  When these valves fail, it allows for backflow in the venous system, causing pooling and chronic venous insufficiency.  The valves can be damaged from normal aging, blood clots, varicose veins, pregnancy, or injury to the legs or vascular system. 

The gradual development of swelling in both legs at the end of the day is suggestive of venous insufficiency when there is no other obvious cause.  However, the rapid development of swelling or swelling of one leg should be more alarming, and warrants the immediate attention of a doctor.  Some things that can cause swelling of the legs include cellulitis (infection), deep vein thrombosis (blood clot), tear of the calf muscles, ruptured Baker’s cyst, lymphedema, congestive heart failure, liver disease with cirrhosis, and damage to the kidneys.  Obviously some of these conditions are more serious and life threatening than others. 

Chronic venous insufficiency is largely a clinical diagnosis, meaning that advanced testing is usually not necessary.  However, some tests may be ordered to rule out other conditions when the diagnosis is not as clear.  An ultrasound study may be ordered to rule out a blood clot, or a deep vein thrombosis (DVT).  If there is an open wound, blood cultures and swabs of the wound may be taken to identify a possible infection.  Blood work may also be used to evaluate the function of the heart, liver, and kidneys if damage to these organs is suspected. 

Treatment of venous insufficiency depends on how advanced the swelling is.  In early cases, it may be treated with elevation of the legs when possible, walking programs, and light compression stockings. These modalities will help to return the blood to the heart, and prevent the progression of swelling. 

In more advanced cases, compression therapy may be taken on more aggressively, with heavier compression stockings or temporary wraps to bring the fluid out of the legs.  Unna boots are a soft type of cast that is often used for this reason.  Other modalities may include intermittent compression devices that actively squeeze the calf muscles, shunting blood back to the heart.  These machines can be used at home. 

Medications can be prescribed to help control excess fluid as well.  Diuretics, sometimes referred to as “water pills” can help a person to increase their kidney function, which in turn increases their excretion of fluids and urination.  This medications should be used with caution, and are most commonly monitored by the primary physician. 

Aggressive therapy of chronic venous insufficiency can help prevent the complications of the condition.  Most notably, these complications include ulceration and infection.  Ulcerations secondary to venous insufficiency typically begin with a minor traumatic event which opens up the skin.  At the incident, these injuries will usually bleed a disproportionately large amount.  Once the skin is opened, the pressure from fluid build up can cause the wound to expand in a circular pattern.  These wounds are usually found around the ankles, and will typically drain a great deal while they are open.  Venous wounds can be extremely difficult to heal, as the persistent swelling interferes with the normal healing process. 

Infection can persist in one of two ways in the presence of venous insufficiency.  Because of the tendency for people with venous insufficiency to ulcerate, an open wound is created.  This acts as a portal for infection into the body.  The skin changes seen with venous insufficiency also weaken the skin, and take away from its natural infection fighting ability.

Persons with swelling in their legs should be evaluated by a doctor to determine the cause.  Whether it is an immediate life threatening condition causing the swelling, or early signs of venous insufficiency, it should be treated aggressively and appropriately.  

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