Central Florida Foot and Ankle Center - Walk from Obesity

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

2012-02-03T11:07:00.000-08:00

It may not come as a surprise to find that Paula Deen hastype 2 diabetes. The woman who has madea career through a seemingly reckless approach to cooking and eating, usinglarge quantities of cream, sugar, and butter in the majority of her recipescame out with the news earlier in January of this year. What may come as a surprise to some is herlatest paid position as a spokeswoman for Novo Nordisk, a company that makesVictoza, 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 thebacon and slathering on the mayonnaise is now promoting a diabetes drug. The same woman that created the BrunchBurger, a hamburger that sits on a Krispy Kreme donut covered with bacon and afried egg, revealed to the world on January 17^th what she and herdoctor had known for close to three years. She had type 2 diabetes, and now she would capitalize on it to create aname for herself in the diabetic drug market.

With Deen’s approach to cooking, it was inevitable for herto 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, certaintypes of cancer, gout, and a number of other diseases. Virtually every system in the human body iseffected by obesity. Paula Deen’s recipescertainly did not take this into consideration.

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

While it may not be surprising to find out that she has beendiagnosed with type 2 diabetes, a disease for which obesity has been indicatedas one of the greatest risk factors for developing, her next moves may be evenmore interesting. She has gone on therecord 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 ofthe 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
www.FLFootandAnkle.com

Cutaneous Larva Migrans

2011-12-20T05:38:00.000-08:00

Cutaneous Larva Migrans is a tropical disease that iscommonly found in the foot. It is theresult of an infection with one of a variety of hookworms, including thespecies Ancylostoma braziliense (cathookworm) and Ancylostoma caninum (doghookworm). These parasites are typicallyseen 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 walkingbarefoot on the beach, or in other areas of the body from contact.

The skin lesions are extremely itchy, and can cause greatdiscomfort for those affected. Themigrating line that is characteristic of the infection is caused by the paththat the organism takes underneath the skin. The parasite can actually be several centimeters ahead of the trailingline, as the reaction is delayed. Thelesion that forms is linear, typically in a winding pattern, red, and raisedfrom the skin.

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

Diagnosis of cutaneous larva migrans is made throughclinical examination. A history oftravel to tropical or subtropical environments is common in thoseaffected. X-rays and other imagingstudies are not necessary for the diagnosis.

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

Treatment for cutaneous larva migrans is with oralivermectin, an anthelmintic drug. Treatment with a single dose is usually curative, and has rarely inducedside effects. Albendazole has also beenused orally. This drug is usuallyadministered over three to five days, and has a similar curative rate asivermectin. Topical thiabendazole hasalso been used. A biopsy of the skin oneto two centimeters ahead of the lesion may reveal the parasite.

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

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

Chronic Venous Insufficiency

2011-10-31T13:59:00.000-07:00

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

Symptoms of chronic venous insufficiency include swelling ofboth legs, with a feeling of “heaviness” being a common complaint. An itchiness or constant dull pain is oftenreported, and symptoms will typically worsen through the day or after a longperiod of standing. Skin changes are acommon finding in chronic venous insufficiency, with the skin first changing toa darker color. This is often associatedwith excessive dryness and flaking of the skin, known as stasisdermatitis. As the condition progresses,the skin becomes thicker and taught, and becomes prone to breakdown orulceration.

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

Normally, the deep venous system returns most of the bloodback to the heart. The superficialvenous system shunts blood into the deep system, and valves in the veinsconnecting the two layers create a one way system. When these valves fail, it allows forbackflow 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 vascularsystem.

The gradual development of swelling in both legs at the endof the day is suggestive of venous insufficiency when there is no other obviouscause. However, the rapid development ofswelling or swelling of one leg should be more alarming, and warrants theimmediate attention of a doctor. Somethings that can cause swelling of the legs include cellulitis (infection), deepvein thrombosis (blood clot), tear of the calf muscles, ruptured Baker’s cyst,lymphedema, congestive heart failure, liver disease with cirrhosis, and damageto the kidneys. Obviously some of theseconditions are more serious and life threatening than others.

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

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

In more advanced cases, compression therapy may be taken onmore aggressively, with heavier compression stockings or temporary wraps tobring the fluid out of the legs. Unnaboots are a soft type of cast that is often used for this reason. Other modalities may include intermittentcompression devices that actively squeeze the calf muscles, shunting blood backto the heart. These machines can be usedat home.

Medications can be prescribed to help control excess fluidas well. Diuretics, sometimes referredto as “water pills” can help a person to increase their kidney function, whichin 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 helpprevent the complications of the condition. Most notably, these complications include ulceration and infection. Ulcerations secondary to venous insufficiencytypically begin with a minor traumatic event which opens up the skin. At the incident, these injuries will usuallybleed a disproportionately large amount. Once the skin is opened, the pressure from fluid build up can cause thewound to expand in a circular pattern. These wounds are usually found around the ankles, and will typicallydrain a great deal while they are open. Venous wounds can be extremely difficult to heal, as the persistentswelling interferes with the normal healing process.

Infection can persist in one of two ways in the presence ofvenous insufficiency. Because of thetendency for people with venous insufficiency to ulcerate, an open wound iscreated. This acts as a portal forinfection into the body. The skinchanges seen with venous insufficiency also weaken the skin, and take away fromits natural infection fighting ability.

Persons with swelling in their legs should be evaluated by adoctor to determine the cause. Whetherit is an immediate life threatening condition causing the swelling, or earlysigns of venous insufficiency, it should be treated aggressively andappropriately.

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

Ankle Arthrodesis

2011-09-26T06:33:00.000-07:00

Ankle arthritis can be an extremely debilitatingcondition. Most commonly it is seen as acomplication of ankle fracture or other ankle trauma, but it can also be seensecondary to inflammatory arthritis such as rheumatoid arthritis, infection ofthe ankle joint, Charcot neuroarthropathy, or tumors of the foot, ankle orleg.

Ankle arthritis will present with significant pain withmotion and with walking, and will typically limit the activities of those thatsuffer with the condition. It isprimarily a clinical diagnosis, with a history of a causative agent typicallybeing related. Physical examination willreveal an ankle joint with limited, painful range of motion, and pain onpalpation to the joint. X-rays are usedto evaluate the extent of the arthritis in the ankle, and to monitor it’sprogression. Occasionally an MRI or CTscan may be ordered to rule out infection or intra-articular fracture, if thereis a high index of suspicion clinically. However, these advanced tests are not always ordered.

The ankle joint is actually a combination of three differentarticular surfaces. There is anarticulation between the talus and lateral malleolus, between the talus and themedial malleolus, and between the weight bearing surfaces of the talus and thetibia. In significant arthritis, allthree of these surfaces will be involved. Arthritis will develop when there is damage to the cartilage, with aloss of joint space and growth of spikes of bone called osteophytes.

An important distinction must be made by the doctor inseparating ankle arthritis from subtalar joint arthritis. Subtalar joint pain can often feel to thepatient as if the pain is coming from their ankle, when in fact it is comingfrom the joint below their ankle. This distinction can be made by injectinglocal anesthetic into the ankle joint in the clinic. If 100% of the pain is relieved following theinjection, then it is likely to be ankle arthritis. If after injection there is still some painleft, then the subtalar joint can also be injected. If this now relieves all of the pain, acombination of ankle and subtalar joint arthritis may exist. There is often pain from the soft tissuessurrounding the joints and from the tendons of the muscles that cross the anklejoint. This is also a distinction thatmust be made clinically.

Treatment of ankle joint arthritis begins with conservativetherapy. This may include treatmentssuch as cortisone injections into the joint to relieve the pain, use of NSAIDs,orthotics, braces, physical therapy, and shoe modifications. Sometimes a rocker bottom can be placed onthe bottom of the shoe, which minimizes the motion at the ankle joint. This can relieve pain in some individuals.

When conservative therapy fails, surgery can become anoption. Most commonly, the ankle jointmay be fused. This is called ankle jointarthrodesis. Ankle arthrodesis involvesstripping the joint of its remaining cartilage, aligning the joint in anoptimal position, and placing screws through the joint to hold it in place. Holding the joint in place after thecartilage is removed allows the bones to heal to each other, thus eliminatingthe joint completely. This means thatthere is no longer motion at the joint, as it is now one solid piece ofbone. Fusing the two bones togethereliminates the motion, as well as the pain associated with motion at the joint.

A number of techniques for ankle arthrodesis have beenemployed, but generally there are two incisions made at either side of theankle. Through these incision the jointis reached, and the fusion can be performed. After surgery, the patient will likely be placed in a splint or hardcast, and will remain in the cast for several weeks. No weight can be placed on the operated footfor a minimum of 6 to 8 weeks while the bones are healing. After this period of time, the patient willlikely be transitioned to a surgical boot, which they may be allowed to walk infor 4 to 6 weeks. Once the bones arecompletely healed and there is no longer an ankle joint left, the patient maybe allowed to walk on their foot normally.

There is often a deformity of the foot as well as the ankle,which can be addressed at the same time during surgery. When the subtalar joint is involved in thepathology, it may be fused as well. Theelimination of motion at the arthritic joint is what decreases pain. Many times with ankle arthritis there isinflammation and scar tissue build-up in the soft tissues around the joint,which can be removed at the time of surgery. If there is damage to any of the tendons around the ankle joint, thesecan be repaired as well.

Of course, ankle arthrodesis is only performed when it isabsolutely necessary. It is a lengthyprocess of surgery and the post-operative course, and it is imperative thatboth the surgeon and patient prepare for this course.

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

Cheilectomy for Hallux Limitus

2011-07-14T10:09:00.000-07:00

One of the most common conditions of the first metatarsophalangeal joint (MPJ) is a condition known as hallux limitus. This is defined as a less than normal range of motion of the joint. Normal range of motion is generally considered to be upwards of 65 degrees of dorsiflexion, with some references stating numbers even higher than that. Symptoms of hallux limitus may include achy, throbbing, or dull pain in the first metatarsophalangeal joint, exacerbated by activity. It may also cause compensatory changes in the other joints of the foot, which can lead to the development of pain or arthritis in adjacent joints. A palpable bump may be present on the top of the foot at the joint level, sometimes referred to as a dorsal bunion. When the range of motion is measured at less than 10 degrees of dorsiflexion, the condition may be called hallux rigidus.

Over the years, many investigators have postulated the causes of hallux limitus. Excessive length of the first metatarsal has been considered to be a causative factor in the past, which would theoretically decrease the amount of joint space at the first MPJ, thus limiting the motion at the joint. However, researchers have disproven this as a causative factor, and it may simply be an incidental finding.

Another biomechanical etiology of hallux limitus that has been cited in the literature is the presence of a hypermobile first ray and metatarsus primus elevatus. Hypermobility of the first ray means that the first ray, which consists of the hallux (big toe), the first metatarsal and the first cuneiform, is moving during the midstance and propulsive phases of the gait cycle. This erratic movement creates instability, which leads to jamming at the first MPJ, thus decreasing the range of motion available at the joint. Metatarsus primus elevatus is a related finding, which refers to a relative elevation of the first metatarsal on the rest of the foot, which would also decrease the amount of motion available.

Other causes of hallux limitus/rigidus that have come into question over the years include osteoarthritis, direct trauma to the joint, biomechanical malalignment such as hallux valgus, and various forms of inflammatory arthritis such as rheumatoid arthritis. Regardless of the cause of hallux limitus, however, the progression of the condition is rather predictable.

Typically the condition begins with a functional decrease in range of motion, characterized by a joint that has a decreased range of motion when weight-bearing. The progresses to a structural deformity with decreased range of motion in non-weight bearing situations, and the development of cartilage damage to the joint and eventually significant pain and disability. A number of authors have attempted to categorize this progression with classification systems, which take into account both the clinical picture and the radiographic analysis of the joint.

Perhaps the most widely used classification system used for describing hallux limitus is the Regnauld classification described in 1986. This classification system involves grades I-III, and helps to communicate the destruction and limitation involved. Grade I describes a first MPJ that shows a mild limitation of dorsiflexion with a mild dorsal bump, and early evidence of osteoarthritis apparent on x-ray. In grade II hallux limitus, there is evidence of more advanced arthritis development, as well as involvement of the sesamoids apparent on x-ray. There is a greater restriction in motion, and further narrowing of the joint space. Grade III describes severe limitation of motion, extensive development of osteoarthritis include significant osteophyte formation, and possibly loose bodies within the joint known as joint mice.

Conservative treatment should always be attempted before surgical intervention for hallux limitus. Only when conservative therapy has failed does surgery become an option. Conservative therapy may include the use of non-steroidal anti-inflammatory drugs (NSAID’s) in either oral or topical forms. Some doctors will use cortisone injections as well, while others prefer to avoid the use of injectable steroids due to side effects such as atrophy of skin and soft tissues and damage to the surrounding tissues. Orthotics are typically used as well, with a modification known as the Morton’s extension, which serves to protect and accommodate the first MPJ.

Once conservative treatment has failed, surgery may be an option explored by some patients along with the treating physician. A popular option for many foot and ankle surgeons is the cheilectomy. A cheilectomy is the removal of any osteophytes from the joint. Osteophytes develop as a part of cortical hypertrophy, which results from increased pressure through the bone from jamming of the joint. The cheilectomy serves to remove these redundant pieces of bone, which typically block the hallux from moving normally over the first metatarsal head. A cheilectomy will typically double the range of motion of the joint, and serves to alleviate pain as well.

A number of modifications exist for the cheilectomy, including how much to take off of the bone, or to peroform an osteotomy (bone cut) in the first metatarsal to create a larger joint space. Some surgeons will perform a cheilectomy at both ends of the joint, removing osteophytes from the proximal phalanx of the hallux if necessary. With or without these modifications, the cheilectomy has had good results reported for early stages of hallux limitus.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Topaz Procedure for Plantar Fasciitis

2011-05-19T05:41:00.000-07:00

One of the most common symptoms that a podiatrist will hear from their patients is that they are suffering from heel pain. This is often a chronic heel pain, that is unrelenting and not responsive to conservative treatment. Several things can cause this heel pain, including stress fractures of the calcaneus (heel bone), entrapment of a nerve running into the heel, or fractures of a heel spur. Most commonly, however, the complaint is related to plantar fasciitis.

Plantar fasciitis is a term used to describe a painful and inflamed plantar fascia, which is a thick, fibrous band of tissue running along the bottom of the foot. This band of tissue attaches to the calcaneus, which is typically where the pain is located. Pain is often worse in the morning with the first steps out of bed, or after long periods of rest, such as sitting at a desk. After the first few steps, the pain may decrease, but will get worse throughout the day with a lot of activity or standing. These are very typical symptoms of plantar fasciitis.

Because of its chronic nature, plantar fasciitis may also be referred to as plantar fasciosis, indicating the chronicity of the problem. When viewed under a microscope, the plantar fascia will show signs of degeneration and a lack of acute inflammatory cells, which is more consistent with a chronic tendinosis than with an acute inflammatory reaction. The plantar fascia will appear thickened as well. These findings all indicate that the condition is non-inflammatory, and is chronic in nature.

The exact etiology of plantar fasciitis has been the subject of debate for some time. Most evidence points towards increased traction at the calcaneus as being the cause of the pain. This increased traction has been associated with obesity, a difference in limb length, increased pronation of the foot, and many other things that increase the stress on the plantar fascia. Some believe that plantar fasciitis is partially due to periostitis of the calcaneus. The periosteum is a structure that surrounds bones and supplies blood to the bone. When this tissue becomes inflamed, regardless of the cause, it is termed periostitis.

Conservative therapy for plantar fasciitis revolves around trying to relieve the symptoms while at the same time decreasing the stress on the plantar fascia. This usually involves any combination of the following:

· Rest

· Ice

· Stretching

· Orthotics

· Physical Therapy

· Non-steroidal anti-inflammatory drugs (NSAIDs)

· Heel cups

· Night splints

· Taping

· Steroid Injections

· Advanced conservative therapies such as platelet-rich plasma injections and extracorporeal shockwave therapy

Generally speaking, conservative measures are exhausted before surgical intervention is attempted. Surgical intervention today typically involves releasing part of the plantar fascia to relieve the tension on the structure. For a long time, the only option surgically was to make a small incision into the foot and release the plantar fascia. With technological advances, new options have popped up.

One option that has become popular among foot and ankle surgeons over the past few years has been the use of Topaz to address plantar fasciitis. The Topaz procedure involves the use of radiofrequency microdebridement of the plantar fascia. The Topaz equipment is a small, pen-like device that delivers a small amount of radiofrequency to the tissues, which helps to remove some of the thickened, diseased tissue that results from chronic plantar fasciitis.

The device works by stimulating angiogenesis in the chronically diseased plantar fascia. This means that it stimulates the growth of new blood vessels. The formation of new blood vessels allows for inflammatory cells to reach the poorly vascularized plantar fascia. These inflammatory cells essentially “restart” the process from the beginning, allowing the tissues in the plantar fascia to reorganize and decrease the amount of scar tissue in the structure.

The Topaz procedure is designed to be as minimally invasive as possible. Generally, the plantar fascia can be microdebrided through small holes made in the skin with a small pin. The Topaz radiofrequency device can then be inserted into the small holes, and the plantar fascia can thus be reached without opening up the foot. These small holes created surgically are small enough to heal without the use of stitches. A small bandage can be placed onto the skin in the surgical area, and the patients can walk on the foot in a protective shoe within a few days.

Short-term and intermediate-term results of Topaz microdebridement for plantar fasciitis have shown good results, with a high percentage of success. Complications involved with open procedures are effectively eliminated from the post-operative course. Because of the avoidance of open surgery, Topaz is becoming a viable option among foot and ankle surgeons. The device has also gained acceptance for use in Achilles tendonitis.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Tarsal Tunnel Syndrome

2011-04-21T06:59:00.000-07:00

Tarsal Tunnel Syndrome is a condition of the foot and ankle in which the tibial nerve becomes entrapped along its course. The tibial nerve is a branch of the sciatic nerve, which begins in the distal one-third of the thigh, and courses through the back of the leg underneath the deep muscles. It courses slightly medially through the deep posterior compartment of leg muscles, and enters the foot through the tarsal tunnel. The tarsal tunnel is an organized strip of fascia that has separate canals for the arteries, nerves, veins, and muscles that pass through the area. The tibial nerve divides into three branches; the medial plantar nerve, the lateral plantar nerve, and the medial calcaneal nerve. These divisions are typically found proximal to the tarsal tunnel.

In tarsal tunnel syndrome, there is an entrapment of one or more of the branches of the nerve. The entrapment can be of the tibial nerve before it divides into the three branches, which may lead to more diffuse symptoms through the foot. Tibial nerve entrapment is one of the most common nerve entrapments of the foot and ankle, along with Morton’s Neuroma and an anterior entrapment of the superficial peroneal nerve.

The etiology of tarsal tunnel syndrome is most commonly attributed to repetitive microtrauma of the fascia surrounding the nerve, secondary to a hyper-pronation syndrome. The tissue becomes inflamed, which can entrap the nerve. There may also be varicosities of the posterior tibial veins which also pass through the tarsal tunnel, causing engorgement of the veins through the tunnel, leading to increased pressure on the tibial nerve. Other causes of tarsal tunnel syndrome include direct trauma to the nerve, systemic disease that effects the nerve or the surrounding components, a space-occupying lesion such as a benign tunor of the nerve or nerve sheath, and hypertrophy of the abductor hallucis muscle, which can put additional pressure on the nerve as it enters the foot.

Symptoms of tarsal tunnel syndrome include a burning or tingling sensation in the ball of the foot or the heel, as well as numbness or paresthesia. As the condition progresses, there may be some associated muscle weakness of the intrinsic muscles of the foot. Pain that travels towards the foot or up towards the leg is characteristic of tarsal tunnel syndrome.

Diagnosis is made with clinical symptoms as well as reproducing the symptoms by tapping along the course of the nerve. This may send reproducible pain travelling towards the toes (Tinnel’s sign) or upwards towards the leg (Valleix sign). The pain may also be reproduced by everting the foot in the clinic. Nerve conduction studies may be helpful in the diagnosis and in locating the exact area of impingement, but are not always necessary.

Conservative treatment of tarsal tunnel syndrome includes removing the force that recreates pain. This may involve limiting pronation of the foot through the use of orthotics. These may offer some relief, but will only work when in use. In the case of varicosities being the cause of the problem, some may find relief with the use of compression stockings.

Tarsal tunnel syndrome is more commonly dealt with surgically. A small incision is made in the medial side of the foot, and the nerve is identified. The entrapments of the nerve may be obvious to the surgeon performing the procedure, but in many cases the entrapments are not so apparent. The nerve is freed from any sites that may be entrapped. Most commonly the two sites that are released are the flexor retinaculum and the tarsal canal of the nerves. Additionally, the nerve may become entrapped under the soleus muscle’s retinaculum, the fascia of the abductor hallucis muscle, the intermuscular septum in the foot that the nerve courses under, and the medial band of the plantar fascia. These areas may additionally freed and left open. Post-operatively, a patient undergoing nerve decompression will be non-weight bearing for two-three weeks while the skin and deep tissues heal. During this time they will be able to freely move the foot and ankle when sitting or lying down, but will require an offloading boot when walking.

Tarsal tunnel syndrome can be associated with other conditions of the foot and ankle, and can often mimic other forms of heel pain such as plantar fasciitis. If you feel as though you are experiencing symptoms of tarsal tunnel syndrome, talk to your podiatrist. They will be able to investigate and diagnose the problem.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Adult Acquired Flatfoot and PTTD

2011-02-21T11:10:00.000-08:00

Flatfeet can be a difficult problem for many adults. Many people will experience some form of adult-acquired flatfoot in their lifetime, some of which may become very painful and problematic. An important point to make about adult-acquired flatfoot, however, is that not all flatfeet are pathological. Only flatfeet that cause significant pain and discomfort should be considered problematic.

Adult-acquired flatfoot has many different causes, the most common of which being either a weakness or dysfunction of the posterior tibial muscle and/or tendon. Posterior tibial tendon dysfunction (PTTD) is a common etiology of flatfeet in the adult.

The Tibialis Posterior muscle originates in the deep posterior compartment of the leg muscles, and courses down into the foot. The tendon inserts mainly into the navicular bone, but also into the midtarsal bones and the calcaneus. This expansive insertion of the tendon helps to support the arch of the foot. The tibialis posterior acts to re-supinate the subtalar joint during gait. In other words, when the foot is pronating, the tibialis posterior acts to oppose this action. When the tibialis posterior is weakened or the tendon becomes elongated, this action is lost. Thus, the foot remains in a pronated position through the gait cycle. This, in turn, may lead to a pathological flatfoot.

Symptoms of PTTD/adult-acquired flatfoot include pain in the instep, or medial arch of the foot. There may also be pain the medial ankle, as well as the lateral (outside) of the foot. One of the classic tests for PTTD is to have the patient perform single-leg heel raises. By going on the tip-toes of one foot, the tibialis posterior is tested for strength. The normal foot will show the heel inverting, or turning inward. Someone with later stages of PTTD will have a heel that does not invert. There may also be difficulty in performing this test, particularly when it is repeated several times in a row.

PTTD and adult-acquired flatfoot are evaluated by the physician using both the history and physical exam, as well as several imaging techniques. An x-ray is typically taken to rule out other causes of pain, such as fracture, dislocation, infection, and other problems that may be evident on x-ray. Beyond plain films, and MRI may be taken to evaluate the posterior tibial tendon. Distinction is made between a tendon that is effected only by inflammation along the synovium (the fluid sheath that helps it move smoothly), partial tears in the tendon, and complete ruptures of the tendon. The findings of an MRI may guide the treatment and will help in surgical planning in particular.

Treatment of PTTD and adult-acquired flatfoot is dependent upon the stage of the disease. The condition was first classified by Johnson and Strom, and the added onto by Myerson. There are four stages of PTTD, the details of which are beyond the scope of this article. Essentially, stage I and II are still flexible stages, meaning that a functional foot is still attainable. Stage III and IV are rigid deformities, where a functional foot is no longer attainable, and accommodation of the deformity is the goal of treatment.

Non-operative treatment for stage I and II includes immobilization in either a cast or boot for 4-6 weeks, followed by some type of orthotic device. Depending on the severity of the deformity, a foot orthotic may be sufficient. However, many people will require an ankle-foot orthosis (AFO) for sufficient functional improvement. Stage III and IV PTTD will not tolerate a functional device, as the foot and ankle are in a rigid position. Therefore, these patients will require an accommodative device, which will allow them to walk with a decreased amount of pain.

Operative treatment is ideally done for stage I and II PTTD to address adult-acquired flatfoot. Surgery for this condition focuses on realigning the foot to be in a more functional position, and will often restore power and function to the posterior tibial tendon. This may be done with a combination of soft tissue and bony procedures, including tendon transfers, fusions of the joints in the first ray, and osteotomy of the calcaneus. Stage III and IV, because they involve more rigid deformities of the foot and ankle, will typically require fusion of involved and painful joints. This means that the joint will no longer move, but the pain at this joint will be decreased due to a lack of movement.

As you can see, the approach to adult-acquired flatfoot is multi-faceted, and requires a thorough evaluation. The foot and ankle surgeon addressing the situation should recognize all of the factors involved, and the patient should recognize the inherent risks and benefits associated with both conservative treatment and reconstructive surgery for adult-acquired flatfoot.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

2010-12-23T07:22:00.000-08:00

Lisfranc Injuries

The joint in the midfoot that connects the metatarsal bones to the tarsal bones is known as the Lisfranc joint. This joint expands across the entire width of the foot. It was first described by Jacques Lisfranc de St. Martin, a French surgeon serving in the Napoleonic Army. The joint was first described in reference to amputations through the joint.

Since the 19^th century, much has been learned about the Lisfranc joint, including injuries to it. Lisfranc injuries are a commonly missed injury, and may result from both direct (such as dropping a heavy object on the foot) or indirect (twisting the foot) forces. Most commonly, Lisfranc injuries are seen in the hospital following motor vehicle accidents.

A Lisfranc injury may describe a sprain, dislocation, or fracture, or any combination of these events. Fractures may occur as either breaks in the bones surrounding the joint, or as tiny avulsion fractures. These avulsion fractures occur when the ligaments become detached from the bones, and pull off small pieces of bone with them.

Symptoms of a Lisfranc injury will typically include pain and swelling in the midfoot. There may be associated bruising on either the top or the bottom of the foot. In severe cases, particularly in cases of fracture, it may be extremely painful to put weight on the foot.

Diagnosis of Lisfranc injury begins with an examination by a foot and ankle surgeon. The injury can commonly be missed, and can often be confused with other types of sprains and fractures. X-rays are usually required to evaluate the extent of the injury. A surgeon may also evaluate the integrity of the ligaments and joint to assesss whether they have been damaged. This is usually done under anesthesia.

With symptoms of a Lisfranc injury or any other type of serious injury to the foot, it is important to see a foot and ankle specialist as soon as possible. The injury can be assessed and evaluated, and a treatment plan can be devised. If it is not possible to see a doctor immediately, the foot should be elevated, and ice should be applied to the area in intervals. Typically, it is recommended that ice be applied for twenty minutes every hour after a traumatic injury such as a Lisfranc injury. This can help relieve some of the swelling, and may help to reduce the pain.

Non-surgical management of Lisfranc injuries may involve immobilization with a cast. The use of crutches may also be helpful in keeping weight off of the area. Anti-inflammatory medications, such as ibuprofen, are often used to manage swelling. Ice and elevation are usually continued as needed, and physical therapy may be required after the injury has healed.

Surgical management of Lisfranc injuries is often required. This is typically due to a prolonged instability of the joint following injury. This instability may lead to a loss of balance, loss of function, pain, swelling, and an increased progression of arthritis at the joint.

Surgery for Lisfranc injuries may involve fusion of the injured joints, with either temporary or permanent screws. Pins may be used to hold the bones in place while they heal. Only a foot and ankle surgeon will be able to determine the best method of correction following a Lisfranc injury.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Syndactyly

2010-10-25T06:30:00.000-07:00

Syndactyly is a condition of the hands and feet where two or more digits are fused together. It is a congenital abnormality, and is the most common abnormality of the limbs, with an incidence of about 1 in 2,000-3,000 live births.

During normal fetal development, the spaces between the developing fingers and toes are webbed. Between the six and eighth months of gestation, an enzyme functions to break down this tissue, giving the developing fetus separate fingers and toes. When this process fails, the result is syndactyly.

Syndactyly is classified based on the extent of the fusion. When it is only soft tissue that connects the two digits, it is called simple syndactyly. When the digits are connected with bone, it is called a complex syndactyly. Syndactyly can also be complete, meaning that the entire digit all the way to the tip is fused, or incomplete when the fusion does not go all the way to the tip of the finger or toe. A fenestrated syndactyly occurs when the fusion goes all the way to the tip of the finger or toe, but there is a gap in between the fused digits with normal skin on either digit. Fenestrated syndactyly is generally associated with amniotic band syndrome.

Syndactyly may be seen as a single abnormality in either the toes, fingers, or both. It is also commonly seen as a part of a syndrome, such as Apert’s syndrome.

Treatment of syndactyly is surgical, and varies widely in its application and timing. Functional limitations are usually addressed right away when they are present at birth, generally before the age of two. The goal of surgery is to restore function to the affected digits, particularly when the syndactyly is in the hand affecting the thumb and pincher grip. Syndactyly of the toes may not be addressed until later in life, particularly when there are significant cosmetic issues and associated psychological issues pertaining to the toes.

The planned surgery is dependent on the digits involved, whether the syndactyly is simple or complex, complete or incomplete, and many other factors. Syndactyly may also be seen in association with polydactyly, which is an increase in the number of digits. In these cases, the extra digits may be removed.

In just about all cases of syndactyly, a graft of skin will have to be used to cover the exposed area once the digits are separated. A skin graft is frequently taken from either the back of the hand or the top of the foot, or sometimes from the groin. In addition to grafting, rotational skin flaps are frequently used to advance skin into the area where it is needed.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Congenital Calcaneovalgus

2010-08-27T12:22:00.000-07:00

Calcaneovalgus is a fairly common finding in the foot of a newborn. It is defined as a positional deformity where the foot is in a dorsiflexed (with the foot pointed upwards) position, and the calcaneus is in a valgus position (with the heel rotated outwards). It is often described as an “up and out” appearance. It is more commonly seen in females than in males, and can present in up to 10% of live births. It can be seen in either foot, or both. The deformity is generally flexible, which improves the prognosis.

The exact cause of calcaneovalgus is unknown in most cases, however, it is presumed by many that it is the result of an increase in intrauterine pressure that causes the positional deformity. In some cases, particularly the more severe forms, calcaneovalgus may be the result of a muscle imbalance due to an underlying neurological issue such as myelomeningocele.

Some clinicians argue against the treatment of calcaneovalgus, citing the fact that many cases will spontaneously resolve as the child ages and begins to walk. However, an untreated case of calcaneovalgus, particularly in cases of moderate to severe deformity, can result in symptomatic flatfoot beginning in childhood and lasting through adulthood.

The diagnosis is made most commonly through clinical evaluation, looking for signs such as the up and out appearance, increased skin folds on the anterior ankle, and other findings. In some cases, the top of the foot (dorsum) is able to reach the anterior ankle (shown in the middle picture above). X-rays may also be used to confirm the positional deformity of the foot, and are often used to rule out other deformities as well as to track the progression of calcaneovalgus.

The treatment of calcaneovalgus is dependent on the severity of the deformity. For mild cases, treatment may include manipulation of the foot in infancy, and supportive shoes in early childhood.

Cases of moderate calcaneovalgus may involve further intervention, with various types of bracing and splinting, supportive shoes, night splints, orthotics, and other conservative treatment measures aimed at minimizing the progression of the deformity.

More severe cases may involve serial casting beginning in infancy. This involves setting the foot into alignment, and placing it in a plaster cast. Gradually, the deformity is placed more and more into an appropriate position, and serial casting is used to keep the foot in place. Orthotics are likely to be used through early childhood to prevent residual deformity or relapse. The incidence of a severe calcaneovalgus deformity is roughly one in a thousand live births.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

New Study Shows Changes in Gait with Flip-Flops

2010-07-29T06:19:00.000-07:00

Flip-flops are not good for your feet. Most podiatrists and other healthcare professionals would agree with this statement, but the evidence is purely anecdotal. More injuries are seen in young adults (ages 18-25) that wear flip-flops, yet there is very limited published evidence for the causal relationship.

A recent study published in the Journal of the American Podiatric Medical Association evaluates the differences noted in the gait patterns of people wearing flip-flops to people wearing athletic shoes. The study, written by Shroyer and Weimar, compares the gait patterns of college-aged adults when they are wearing flip-flops and when they are wearing athletic shoes.

Gait analysis in the study involved visual gait analysis, as well as measurement of the stride length and a number of angles, including the angles of the knee and ankle through the gait cycle.

The study found significant differences in the measured parameters when the subjects were wearing flip-flops versus athletic shoes. Interestingly, the differences varied greatly between the men and women in the study. For example, the women in the study had a tendency to decrease the force placed on their feet when wearing flip-flops, whereas the men in the study had a tendency to increase this force while wearing flip-flops. For most of the measurements taken in the study, the differences were much more pronounced and exaggerated in the women than in the men.

This study shows hard evidence that may account for some of the injuries that podiatrists see in people that wear flip-flops as everyday shoes. It has long been accepted that thong-style sandals offer minimal support for the foot, and may lead to significant overuse injuries. Previous publications had analyzed the increase in plantar pressures associated with wearing flip-flop sandals, meaning that more pressure is placed on the bottoms of the feet during their use.

Some of the overuse injuries that flip-flops have been blamed for include tendinitis and plantar fasciitis. It could be that these problems of the foot and ankle are due to the lack of support inherent to thin sandals; the Shroyer and Weimar study may prove to open the door into the investigation of this theory.

In addition to the biomechanically based problems that may be caused by flip-flops, the sandals do not offer the protection of the foot that an athletic shoe does. For this reason, when going on a long walk outside, particularly when the terrain is variable, a closed-toe shoe is preferable for safety and comfort.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Common Forms of Tendinitis in the Foot

2010-06-22T06:27:00.000-07:00

The term tendinitis is commonly used to refer to a chronic condition of tendon pain due to excessive and repetitive stress placed on the tendon. Tendinitis is generally considered an overuse injury, and is a very common condition that is brought to the attention of a podiatrist. The “-itis” at the end of the term implies inflammation, which is actually not present in most chronic conditions. Because of this misnomer, tendinitis is commonly referred to in scientific literature as tendinosis.

The foot and ankle is a common sight for tendinitis to occur, partially due to the fact that the tendons in the leg that control the motion of the foot have to bend through the narrower ankle to enter the foot. This places extra stress on the tendons, and injury is commonly seen at the bend in the tendon. The tibialis posterior and peroneal tendons (peroneus longus and peroneus brevis) are of the most common tendons affected.

The Achilles tendon does not fit this description of a tendon that bends to enter the foot, but is nevertheless one of the most common muscles to be effected by tendinitis.

Tendons are composed primarily of collagen, a protein found in abundance throughout the body. Through overuse, the collagen in the tendons can become fibrotic, or thickened and stiff. This can lead to pain, particularly during strenuous activities. It can also progress to partial or complete tears of the tendon, or total ruptures.

The goal of treatment is to prevent the progression of the tendinitis, alleviate the pain associated with use, and to correct biomechanical dysfunction that may be contributing to the problem. Preventing biomechanical dysfunction would include things like taping, bracing, and the use of orthotics.

The progression of tendinitis can lead to a more chronic problem if not addressed. Arthritis forms in the ankle and subtalar joint because of dysfunction of the tibialis posterior muscle. The peroneus brevis may be seen as split on magnetic resonance imaging (MRI) around the peroneus longus tendon following injury. Achilles tendon ruptures are fairly common, and are usually seen in individuals aged 30-40 with a history of an acute increase in activity.

For the acute condition involving swelling and pain, symptoms can be addressed with PRICE therapy (Protection, Rest, Ice, Compression, and Elevation). This is usually sufficient to alleviate any pain, though some may also use medications such as NSAIDs or other anti-inflammatory medications.

There are a variety of things that can go wrong with the tendons of the foot and ankle, most of which are due to overuse. The thorough clinical evaluation and technical imaging are essential to diagnosis.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

How many steps should you take?

2010-03-23T11:53:00.000-07:00

No matter what your age, gender, or physical activity level, wearing a pedometer can be an interesting experiment. The idea of simply tracking how many steps you take may make you more active.

The common goal that gets thrown around by fitness experts, pedometer companies, and walking enthusiasts is 10,000 steps. The 10,000 step threshold is where many would consider someone to live an active lifestyle. If the average person has a stride length of about 2.5 feet, this means that on average, a person takes about 2,000 steps to walk a mile. So, the goal of 10,000 steps could also be considered a goal of five miles per day.

Sound like a lot of mileage?

Try wearing a pedometer for a week and tracking your steps. If you walk less than 5,000 steps per day, it is considered a sedentary lifestyle. Between 5,000 and 7,500 steps in a day is considered low-activity, and between 7,500 and 10,000 is considered to be a somewhat active lifestyle.

For people that walk an average of over 12,500 steps in a day, that is considered to be a very active lifestyle.

However, these constraints can be rather arbitrary. When you take into consideration age, weight, and general fitness level, the goals for steps in a day can be altered. Does a ten-year old boy take as many steps as an 85-year old woman with arthritis? Should they?

Perhaps a better way of setting goals for an active lifestyle is to take a baseline reading of the amount of steps we take in a day, and add a certain amount to that baseline as a goal. For instance, if you take an average of 6,000 steps in a day, shoot for a goal of 9,000. This is an extra mile-and-a-half, on average, or about 20-30 minutes of walking.

For someone that is already at 10,000 steps per day, maybe shoot for 13,000.

Of course, adding a certain number of steps in a day is no easy task. The first thing you’ll need is a pedometer, followed closely by a pair of comfortable walking shoes.

If you’re looking for easy ways to add steps to your day, try some of these:

· Take the stairs instead of the elevator

· Park far from the door when you’re going somewhere – this can easily add anywhere from 100-500 steps, depending on the size of the parking lot.

· When you’re at work, try taking a five minute break every hour to stand up and walk around.

· When you’re at work, you can also try walking a message over to your co-workers rather than emailing or calling.

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

Sweaty Feet = Hyperhyidrosis?

2010-02-03T06:45:00.000-08:00

Got sweaty feet? It’s known in the medical community as hyperhidrosis, and it can be of considerable concern to many patients, as well as an embarrassing problem. Most typically hyperhidrosis is localized to the feet and palms of the hand, but a generalized form also exists.

Hyperhidrosis of the palms, face and feet can alter the daily lives of many individuals. An emotional response may cause a significant reaction of sweating.

The mechanism of hyperhidrosis is not completely understood, but many doctors believe that factors such as stress and drugs like nicotine and caffeine may play a role in the excessive sweating.

While the localized form effecting the feet may be more of a problem psychologically, there are some complications that may result from hyperhidrosis. Conditions such as tinea pedis (more commonly known as athlete’s foot), onychomycosis (fungal infection of the toenails), and plantar warts are seen more frequently in those with hyperhidrosis. The excessive sweating characteristic of hyperhidrosis creates a moist environment, making it easier for these conditions to persist.

The treatment for hyperhidrosis ranges from topical antiperspirant in both prescription and over-the-counter strength, to minimally invasive surgery that removes either the sweat glands themselves or the sympathetic nerve fibers that activate the sweat glands.

Other methods of controlling excessive sweating, particularly of the feet, include wearing moisture wicking socks. These socks are typically made of either a very light wool or a synthetic material that will wick the moisture away from the foot. While these types of socks may not prevent you from sweating, they will certainly allow the sweat to evaporate more quickly, cutting down on the incidence of tinea pedis, onychomycosis, and plantar warts.

It is estimated that between 2-3% of the United States population has hyperhidrosis, though the number may be significantly higher. Many do not know that there is treatment for hyperhidrosis, or simply ignore it and pass it off as normal.

In other populations, the percentages differ. It is reported that in Asian communities and countries, the incidence is about twice as much as in the United States. The reason for this is not understood.

An important distinction must be made between primary and secondary hyperhidrosis. Primary hyperhidrosis, as described above, is usually of the localized type. Secondary hyperhidrosis, on the other hand is die to an underlying medical condition. Medical conditions that may lead to secondary hyperhidrosis include metabolic disorders such as hyperthyroidism, and certain cancers. If you have developed excessive sweating recently, discuss this with 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

2000-2009 Diet Crazes

2010-01-06T10:49:00.000-08:00

Was your resolution for the New Year to lose a few pounds? In the spirit of resolutions, here is a look at some of the fad diets that reigned in the past decade, as well as some less popular hits.

1. Atkins’ Diet: The idea behind one of the most popular dieting crazes of the late 1990’s and early 2000’s actually began in 1972 when Dr. Robert C. Atkins published his landmark book. The idea behind the diet was simple – eliminate carbohydrates almost completely from the diet, while keeping a steady intake of protein and fat. By doing this, the body is forced to eliminate storage of carbohydrates, which is often stored in the abdomen and other fat deposits in the body.

Atkins’ diet worked to help people lose weight, but it also sparked the high fat content craze in restaurants everywhere. Soon places like Subway were replacing bread with low-carb wraps, filling them with bacon and ranch dressing, and touting them as health foods. Sure, the people following Atkins’ diet strictly were likely shedding pounds, but those substituting low-fat proteins for bacon and red meat may have jeopardized their health significantly.

2. The South Beach Diet: Developed by Miami cardiologist Dr. Arthur Agatston, the idea behind The South Beach Diet is to train the body to burn energy more efficiently. The author emphasizes that the idea is not to eat a low-carb or low-fat diet, but to eat the right fats and right carbohydrates. By following this regiment, the user can have a healthier lifestyle without giving up their favorite foods.

The South Beach Diet was an instant hit – the book became a #1 New York Time Bestseller, and packaged food companies began adding South Beach Diet labels to their packaging. The diet itself has three phases, so that someone training to eat a certain way can get used to eating different foods.

3. Chocolate Diet: It sounds totally absurd, but some claim that you can actually lose weight by eating chocolate every day. In fact, there are at least two different books on the topic that were published in the last decade (one by Sally Ann Voak and one by David Masters). The chocolate diets allow those who can not live without chocolate to eat it everyday, and to replace other fattening foods with raw fruits and vegetables.

4. Baby Food Diet: Yes. That’s right. A diet that centers around adults eating baby food. What started in Hollywood spread quickly across the country as a quick way to lose a few pounds. Too bad it involves eating a ton of baby food.

5. Weight Watchers: The lifestyle management system that claims not to be a diet relies on a point system that assigns a certain number of points for certain foods. People on the plan are allotted a certain number of points per week based on age, weight and goals, and can earn extra points for exercise. Weight Watchers promotes keeping a meal log to track what you’ve eaten in a week, month, etc.

6. Acai Berry Diets: After Oprah promoted Acai berries on her show, the phenomenon took off. Supplements began popping up everywhere in 2009, as the berries are packed with anti-oxidants. Though it may not help you lose too much weight, the strong anti-oxidants easily became the fastest growing and latest diet trend.

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

There Is A Fungus Among Us

2009-11-23T06:57:00.000-08:00

Fungal nail infections, otherwise known as onychomycosis, are an unsightly problem for millions of Americans. The dry, discolored, and brittle nails can grow very thick, and can even cause some discomfort in a number of people. The nails can stick to socks, and can be an embarrassing thing to reveal at the beach.

Trychophyton rubrum is the most common type of fungus that is involved in onychomycosis. T. rubrum is a dermatophyte, which means that it can live in the skin and nails. There are other organisms that can be involved in fungal nail infections as well, most of which are dermatophytes.

Onychomycosis is easily picked up from the environment. The spores of the fungus are capable of living anywhere, but are very easily transmitted through damp environments. This may include a public shower, pool, or gym.

The best treatment for onychomycosis, much like many other health problems, is prevention. This includes measures like wearing sandals in the gym shower or around the pool deck. Dry your feet completely before putting socks on, especially in between the toes. Wear socks that will keep your feet dry, and avoid socks made of nylon or other material that will promote sweating.

Fungal nail infections are commonly seen with associated fungal infections of the feet. It is common for a fungal infection of the feet to spread to the nails, but usually not from the nails to the feet. If you have had athlete’s foot before, spraying your feet with Tinactin or another athlete’s foot spray may help prevent the fungal infection from spreading to the nails.

Besides prevention, there are some treatment options if you’ve already got onychomycosis. Topical medications are available both over the counter, as well as through your podiatrist. These can help prevent the spread of the fungus any further, but will usually not be enough to get rid of the infection completely. Oral medications are available, the most popular being Lamisil. Oral medications are only available through prescription.

It is important to treat onychomycosis as well as fungal infections of the foot (also known as athlete’s foot); though it is estimated that only one in six will seek professional treatment. It may not be painful, and it may not seem like a big deal at first, but a prolonged fungal infection of the feet and nails can lead to other problems. If the integrity of the skin is compromised, a secondary bacterial infection may occur. Bacterial infections are more serious than fungal infections, and can lead to systemic illness.

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

Alternative Medications Can Bring Big Risks

2009-10-14T07:21:00.000-07:00

Alternative medicine is big business. Millions of Americans use alternative medicine, which is defined as any type of medication which is outside of mainstream medicine. Other terms for alternative medicine include neutraceuticals, unconventional medications and complimentary medications. In 2000, expenditures on this type of treatment exceeded $14 billion, and the industry has only grown larger since then.

While many of the alternative medications that are used may show some anecdotal improvement of various conditions, there are certain risks that come with using alternative medications. The biggest risk associated with this type of treatment is that much of it goes unreported. That is, many patients do not tell their doctors about alternative medications they may be taking. This can lead to serious drug interactions.

A study conducted in 1993 by Dr. David Eisenberg, et al, showed that most people using alternative, or unconventional medications at the time were not reporting their use of these treatments to their doctor. The study showed that roughly 1 in 3 people surveyed via telephone were using alternative medication, mostly for some kind of chronic condition. The most common of these conditions included things like back pain, allergies, arthritis, insomnia, sprains and strains, headaches, and high blood pressure.

More striking than the shear amount of people using alternative medications was the amount of users reporting this information to their physicians. Less than 30% of the people surveyed had ever mentioned it to their doctors.

The Eisenberg study has since been used as a training tool for doctors to point out the importance in asking about alternative medications.

Manufacturing of alternative medications is not regulated like the manufacturing of mainstream drugs. This leads to an increased incidence of impurities, which serves as the basis of many of the adverse reactions of the medications.

A random sampling of 240 Asian patented products in 1998 by the California Department of Health Services found that over a third of the products contained various levels of heavy metals far exceeding the levels allowed in mainstream medications.

35 of the products contained lead, with one product having a level of 319 parts per million. Arsenic and mercury were also found in massive quantities in some preparations, going way beyond the 10 parts per million limit that the US Pharmacopoeia has set for heavy metals.

Many people still swear by the use of supplements like garlic, echincea, and St. John’s Wort. There may be some evidence that alternative medications like these have a minor health benefit, but usually the mainstream choice is far more effective. For example, high blood pressure is easily treated with a variety of medications. Garlic has a very minor effect on lowering blood pressure, and it is usually not enough to bring the pressure down to a healthy level.

It can not be over-emphasized how important it is to discuss alternative medications with your doctor. They should know about any and all supplements that you are taking, just as they should know about any mainstream medications. This helps avoid serious drug interactions and complications.

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

Preventing Falls in the Elderly

2009-09-29T12:28:00.000-07:00

In elderly populations, a fall can be a devastating event. For adults over the age of 65, statistics show that one in three will fall once a year. Of these falls, about one in four will result in a serious injury. The most serious of these injuries is usually a hip fracture, which can lead to serious health complications, even death.

The health care cost of treating injuries resulting from falls in the elderly is enormous. In 2000, the costs were roughly $19 billion. Estimates from various agencies show that this figure will more than double in the next decade. The Archstone Foundation estimates that the cost of care will be over $43 billion by 2020.

Of the patients that fall victim to major fractures following a fall, the key finding is that a majority of these patients have either osteoporosis or osteopenia, a lesser form of bone density loss. This loss of bone density causes an increase in the risk of a fall resulting in a fracture.

It is imperative to the health of the elderly to maintain optimal bone density, particularly those that are prone to falling. Predisposing factors such as aging, being female, and having low body weight coupled with and inactive lifestyle can exacerbate the effects of osteoporosis, leading to osteoporotic fractures. Ways to combat this loss of bone density include taking calcium and vitamin D supplements, as well as getting an appropriate amount of exercise.

For an elderly person, it may be unreasonable for them to be running on a regular basis, as this could lead to serious injuries. However, in most cases a walking program can be established with the help of a doctor to ensure that the exercise will be appropriate.

Beyond living a healthy lifestyle and considering bone density a critical part of health maintenance, there are steps that can be taken to reduce the possibility of falls in the elderly.

Things like exercise programs are great for maintaining a good fitness level, particularly programs the focus on balance training. Eye examinations can be an overlooked source of balance training. For people that are prone to falls, it is important that they wear shoes in the house, especially shoes with a rubber sole. Socks and wood floors can make for a very slippery scenario!

Small adjustments can be made around the house to avoid falls as well. Loose electrical cords, unsecured rugs, and darkly lit rooms and hallways all pose a certain level of risk for the balance-compromised person. Making sure to secure loose obstructions will help to minimize the risk of a fall.

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

Maggots in the operating room? You bet!

2009-07-21T11:14:00.000-07:00

It may sound vile, but maggots, or fly larvae, are increasing in popularity as a medical tool. Maggots can be used for wound healing, as well as a treatment for antibiotic-resistant bacteria. These are not just your average maggots, though. They are medical maggots, raised specifically for use by doctors in sterile environments. The most commonly used species of fly is Phaenicia sericata, also known as the Green Blow Fly.

It comes as no surprise that maggots have made a comeback in the medical community. Historically, the efficacy of maggot therapy has been reported by Aboriginal tribes in Australia, as well as Maya Indians. During Renaissance times, the use of maggots was well recorded as being used by physicians to treat wounds. Wartime has shown the accidental discovery of maggots keeping wounds free of bacteria, preventing death and disease from secondary infection. Dr. William S. Baer recognized the effectiveness of maggots at preventing secondary disease during World War I, when he saw soldiers fallen in the battlefield, their wounds protected by the fly larvae.

Today, the use of maggots in medicine has been explained more thoroughly. The process of removing the dead tissue from a wound, known in the medical community as debridement, is essential to the healing process. Since fly larvae live off of dead tissue, their use has been very effective in treating non-healing or slow-healing wounds, particularly the wounds of diabetic patients. Other surgical methods of removing dead tissue are often used, but the maggots are able to do this with great speed and efficiency. As of now, they’re not used in all wound care procedures. But when conventional methods of debridement fail, the creepy crawlers may be brought in to finish the job. Maggots living off of dead tissue also have an anti-microbial effect, as the fly larvae kill invading bacteria.

It may sound gross, but the use of maggots certainly has its place in modern medicine. Diabetic wound care is a growing field in medicine, especially in podiatry, and the use of maggots shows great potential in treating this group of patients. Patients with diabetes often have complications that lead to large and infected wounds on the feet and legs. With the use of medical maggots, these patients may be able to heal faster and more completely.

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

Sinus Tarsi Syndrome

2009-07-06T11:50:00.000-07:00

What is it?

Sinus Tarsi Syndrome refers to pain that is localized to an area of the foot known as the sinus tarsi. The sinus tarsi is located on the top of the foot on the lateral side, just distal to the ankle, and refers to an area between the ankle and the heel. This area is filed with soft tissue, and is a common site of inflammation. With sinus tarsi syndrome, the pain is usually apparent during weight-bearing activities such as running or walking, and is apparent when palpating the area or turning the foot inwards and outwards. Patients with sinus tarsi syndrome have problems with uneven surfaces like gravel and grass in particular, as these surfaces force the foot to turn inwards and outwards to a greater extent than flat surfaces. Those with sinus tarsi syndrome may complain of a feeling of loss of balance when walking on these types of surfaces.

What causes it?

Sinus tarsi syndrome may be caused by a variety of problems with the foot and ankle. Most often it is associated with excessive pronation, or someone who walks primarily on the insides of their feet, usually with a collapsed arch. The excessive pronation causes more movement in the joints of the foot, which can aggravate soft tissue like that found in the sinus tarsi.

Sinus tarsi syndrome is also often associated with recurrent lateral ankle sprains. These sprains generally occur very close to the sinus tarsi, and can aggravate the soft tissues as well.

How is it diagnosed?

Sinus tarsi syndrome is diagnosed by first ruling out other possible causes of pain. An x-ray or CT scan is often used to rule out any fractures of the bone. An MRI may be used as well to visualize the soft tissue inflammation in the area. Most commonly, a local anesthetic is injected into the area of the sinus tarsi. This allows a doctor to isolate the pain, and conclude that the pain is in fact coming from the sinus tarsi.

How is it treated?

Treatment of sinus tarsi syndrome is usually conservative. The pain and inflammation is usually treated with a non-steroidal anti-inflammatory drug (NSAID), ice, and/or immobilization for a brief period. If it is a biomechanical issue that is causing sinus tarsi syndrome, which it commonly is, prescription orthoses may be used to help correct the biomenchanical dysfunction. These conservative treatments are usually very effective, and surgery is rarely needed for sinus tarsi syndrome.

If you believe that you have sinus tarsi syndrome, or are having any other foot and ankle pain, contact an APMA member podiatrist. If you need help finding a doctor in your area, check out the APMA website at apma.org.
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Public Health and Podiatry: Walking Keeps us Healthy

2009-06-15T10:11:00.000-07:00

With the recent headlines of swine flu outbreaks and the ongoing battle against obesity and related chronic health conditions, public health has been getting more attention lately. Public health, as defined by the American Public Health Association (APHA), is “the practice of preventing disease and promoting good health within groups of people, from small communities to entire countries”. The emphasis of public health as a discipline is the prevention of disease through public awareness and education, health policy development, and surveillance of disease in populations. Some examples of public health include vaccination programs, such as flu vaccine campaigns, as well as regulation of prescription drugs, educational programs to prevent childhood obesity, safety standards for workers, and school nutrition programs to ensure nutritious foods for children.

The American Public Health Association is the largest group of allied health professionals working in public health. This includes physicians, nurses, health educators, researchers, emergency responders, safety inspectors, community planners and organizers, and many more. The main goal of all of these allied professionals is to ensure the health, safety, and access to healthcare for all. It is vital to a successful population to be a healthy population, and public health addresses this head on.

The emphasis of podiatry as being a key aspect of public health is rapidly expanding. The American Podiatric Medical Association’s Public Health and Preventive Podiatric Medicine Committee (PHPPMC) has played an active role in promoting podiatry within the public health community, and has made great strides towards the health of the people. Last month the American Podiatric Medical Association (APMA) developed and released a very user-friendly Walking Guide in celebration of National Public Health Week. This walking guide helps people understand some of the benefits of walking for health on a regular basis, including the prevention of chronic diseases like obesity and peripheral arterial disease. The guide also helps by giving tips on how to exercise, and some precautions like picking out the right shoes and staying hydrated.

The PHPPMC will work to focus on chronic diseases that affect the feet, ankles, and lower extremities. These diseases include diabetes, peripheral arterial disease, osteoporosis, arthritis, and obesity. Through education and programs like Podiatrists Keep America Walking, an informational campaign that also stresses the importance of a healthy lifestyle through exercise, the PHPPMC is keeping pace with the goals of the American Public Health Association. Through the work of both of these groups, as well as many others, a healthier, more active population is possible.

If you would like more information on public health, check out the APHA’s website. To view the APMA’s Walking Guide, you can click here, or talk to your podiatrist at Central Florida Foot and Ankle Center for a copy and for more information about walking healthy.

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

Magnetic Therapy: Fact or Fiction?

2009-05-12T10:28:00.000-07:00

We’ve all seen the late night advertisements for all kinds of things – glue that can put your pants back together, cleaners that can clean anything in your house, and kitchen appliances that do all the work for you. But do all of these products work as well as we’re told? One of the products to be leery of are magnetic therapy products.

These are the bracelets, shoe inserts, and other products that claim to help bring pain relief to patients suffering from arthritis, fibromyalgia, general muscle aches, and other symptoms. Some have even gone so far as to attribute the alternative medicine to relief from more serious conditions, like kidney disease and even cancer. The fact of the matter is, there has been no scientific evidence that can support any of these claims.

Several studies have been performed comparing the effects of magnetic therapy to placebo treatment. While none of the studies have been perfectly designed, there haven’t been any conclusions made in support in favor of magnetic therapy. In fact, conclusions drawn from several studies have shown just the opposite – that magnetic therapy has a minimal effect if any at all.

Proponents of magnetic therapy claim that the magnetic fields induced through the body assist the body in its natural healing process. The claim is that the magnetic fields help block pain sensation, and improve circulation through the body, bringing blood and oxygen to areas of inflammation and pain to help the healing process. These claims are based on some pretty weak evidence, and mostly from subjective claims of users as well as manufacturers of the magnets.

In the past decade or so, there have been several lawsuits brought against companies that manufacture magnetic therapy supplies. In 1998, the company Magnetherapy, Inc. ended up paying a $30,000 fee to the state of Texas for making false claims about their products. The company signed a legal document stating that it would stop making claims that putting their magnets near areas of pain and inflammation would relieve the pain, as well as stop making claims that their magnets could cure any sort of disease, unless they were approved cures by the FDA. Needless to say, the company never earned this FDA-approval.

One of the more outlandish cases involves a Florida-based company selling magnetic bed covers and car seat cushions with the claim that they could cure all kinds of serious diseases, including asthma, bronchitis, and lupus. In 2002, the company was ultimately slapped with over $1 million dollars in civil penalties, in addition to full restitution to all the people who bought their products.

The promise of pain relief from magnets really does sound great, and for many, it is enough for them to give it a try. Unfortunately, it seems as though this claim is too good to be true.

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

Patellofemoral Pain

2009-04-20T10:35:00.000-07:00

Do you have an unexplained pain in your knees? Does it hurt under or around your kneecap? What you may be suffering from what is known as patellofemoral pain syndrome.

Patellofemoral pain syndrome is a condition that can affect one or both of the knees. While the exact cause of patellofemoral pain is unknown, it is most likely due to weakness of the muscles that surround and support the knee. People that suffer from patellofemoral pain syndrome typically notice that the pain is worse when performing high-impact activities (running, tennis, basketball), but also when sitting down. Patellofemoral pain syndrome is sometimes referred to as “Runner’s Knee”, as this is a common running injury.

To understand what is happening in patellofemoral pain syndrome, it is important to first understand the anatomy of the patella. The patella, or knee bone, is held in place by a large tendon. This tendon is composed of the tendons of the quadriceps muscles, which are the large muscles in the front of the thigh. It is easy to think that the patella simply moves up and down with flexion and extension of the leg, but it actually can move side to side, as well as tilt and rotate. While there is no consensus from the medical community, it is likely that patellofemoral pain is caused by overuse and overload of the patellar tendon.

For those who suffer from patellofemoral pain, the best way to alleviate the pain is with rest. Taking a break from high-impact activity can ease some of the forces on the knee, and gives the body time for some of the inflammation to go down. Try some low-impact activities, like swimming or running on an elliptical machine. Icing the knee will also help, but will really only provide temporary relief.

Strengthening the quadriceps muscles may help to stabilize the patella while running or performing other high-impact activities. Stretching the calves, IT Band, and hamstring muscles may help as well. Physical therapy is always an option, as this usually helps to keep people on a regular schedule of stretching and strengthening particular muscles. While it is possible to stretch and strengthen on your own, it is important to stay on a regular schedule.

There is also some thought that patellofemoral pain syndrome may be attributed to improper running shoes. A running shoe or training shoe for another sport should have an appropriate amount of support for the individual. Without that support, a runner can be set up for poor body mechanics, which can lead to patellofemoral pain syndrome. If you need help finding the right shoes for your particular training program, you can ask a foot and ankle specialist for help.

With the proper footwear, stretching and strengthening programs, and rest, patellofemoral pain syndrome can be overcome. Relapses may occur, but a well structured program can help to combat this. If you are experiencing pain that you think may be patellofemoral pain syndrome, bring it up with 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

Great Careers in Podiatry

2009-04-20T10:02:00.000-07:00

With the current state of the economy, many people are returning to school for additional career training. Careers in healthcare are especially popular options, with everything from radiology technicians to nurse anesthetists being in high demand.

Are you looking for a new career, and have healthcare in mind? One option you may want to consider is podiatry.

Podiatric physicians are highly trained specialists in foot and ankle medicine and surgery. They play an intricate role in the healthcare team, often working alongside fellow physicians and specialists in the treatment of patients. Podiatrists diagnose and treat all kinds of foot ailments – from corns and calluses to fractures and sprains. Podiatrists perform surgery on various foot problems, such as bunions, foot deformities, and problems with the nerves of the foot. Just about anything that can go wrong with the foot and ankle, a podiatrist will know how to handle!

According to the Bureau of Labor and Statistics, the job growth for podiatric physicians is set to increase by 9% from the year 2006 to 2016. This significant increase is based on the growing number of active baby boomers, as well as the increased demand in healthcare across almost all aspects of healthcare.

Podiatrists can earn a handsome salary as well. Different polls show different numbers, but a recent article on Forbes.com of the 25 best paying jobs in America lists podiatrists as having a mean annual wage of $118,500.

In order to become a podiatric physician, one must complete a four-year program at an accredited podiatric medical school. There are currently eight of these schools throughout the country, with a ninth on the way. After completion of the program, the student will be a Doctor of Podiatric Medicine (DPM). Once they receive their doctorate degree, at least two years of residency must be completed in order to become a licensed practitioner of podiatry. For more information on podiatric medical schools, you can visit the American Association of Colleges of Podiatric Medicine’s website at AACPM.org.

After completing a residency program, podiatrists have many options of how to practice medicine. Many will go into private practice or work in hospitals or other healthcare settings. Podiatrists may do scientific research, or specialize even further in areas like sports medicine or diabetic foot care. The demand for podiatrists is growing, and the options for employment are wide open.

If you have been thinking about a career in healthcare already, know that podiatry is an extremely rewarding choice. If you would like to find out more information about careers in podiatry, you can check out the American Podiatric Medical Association’s website at APMA.org.

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

http://www.FLFootandAnkle.com

New Approach to Old Fungus

2009-03-24T05:49:00.000-07:00

A new treatment for unsightly nail fungus may be available soon. It’s called Noveon, and manufacturer Nomir Medical Technologies is working on getting it approved by the Food and Drug Administration. Noveon is a specific type of laser that directs near-infrared light of two different wavelengths at the target. In this case, the target is nail fungus, or onychomycosis as it is called in the medical community.

Small clinical trials of Noveon show promising results. About half of the 39 toenails tested with Noveon showed no active nail infection after four treatments with the laser. Clear nail growth was seen in 76% of the volunteers, six months after the initial treatment.

Noveon is currently marketed for use in dental procedures, cataracts surgery, and laser-hair removal. Approval by the FDA for use in treatment of onychomycosis will allow Nomir Medical Technologies to market the product for fungal nail infections.

Current treatments for fungal nail infections include various types of topical creams and lacquers, as well as oral antifungal pills. However, these treatment options are usually expensive, and don’t always clear up onychomycosis completely. They can also take a very long time to show improvement, sometimes up to two years. Inclusion of laser treatment would give patients another option in treatment - possibly a much more effective one. The use of the Noveon laser works by breaking up and destroying the nail fungus, while retaining healthy tissue.

Fungal nail infections are easily spread through contact. They are often transmitted between people walking barefoot in public locker rooms or on carpeting. One of the best ways to prevent a fungal nail infection is to make sure to wear flip-flops or shower sandals in locker rooms, showers, and pools. These are areas that usually stay wet for a long time, and can be the perfect environment for nail fungus to spread.

Though they can be cosmetically unsightly, fungal nail infections are usually not a serious health condition, unless you have diabetes or are otherwise prone to infections. Onychomycosis is typically just an external infection, starting at the free edge of the nail, and working its way underneath.

With the positive preliminary findings of Noveon in the treatment of fungal nail infections, we may be seeing this treatment more often in the future. If you or someone you know have a fungal nail infection, and are thinking about treatment, talk to your podiatrist or primary doctor about different options. Laser treatment just might be in your future!

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 a diabetic foot infection?

2009-03-20T05:26:00.000-07:00

It is important to help guide you through the rather involved process of a diabetic foot infection. Properly understanding this situation can mean the difference between keeping your leg or losing it. Over the next three posts, I will be discussing this rather significant diabetic problem.

Dr’s RESPONSE: A diabetic foot infection is a serious concern. Infections typically refer to bacteria, but keep in mind many other organisms can create an infection: fungus, viruses, parasites, insects, etc. Bacteria are by far the most prevalent. Some bacteria are harmful while others are beneficial. Keep in mind, bacteria are all around us, on the floor, on doorknobs, on keys, on dishes, on pens, etc. You get the idea.

The usual route of infection for a diabetic typically begins with a break in the skin. Let’s use an example. Harry is a diabetic preparing for his grandson’s wedding in just over a months time. He is trying on a pair of rental shoes that come with his tuxedo. He unknowingly creates a small cut on the top of his foot while trying on a pair of shoes that are too small for him. Because he is diabetic and has sensory neuropathy, he is unable to feel this cut and continues to go about his day, oblivious to the fact that he has a small opening on the top of his foot. Also, because he is diabetic, his immune system is not functioning optimally and is unable to mount the proper immune response that a healthy individual would be able to do.

For an infection to occur, either the friendly bacteria has multiplied to dangerous levels or the dangerous bacteria has gain a foothold against the body. Obviously with a diabetic, this can easily occur because the normal immune system response is muted in a diabetic. Otherwise healthy bacteria can also prove harmful because they are multiplying unchecked. Additionally, this condition can also lead to large numbers of several different types of bacteria, which also limits the body’s immune response. Bacteria can be seeded by openings in the skin, corns, calluses, punctures, small fissures, ingrown nails, burns, and a variety of other methods.

So going back to our example, the bacteria have now seeded themselves on the top of Harry’s foot from the used rental shoe. They have begun to rapidly multiply after a few days and Harry is still unaware that he has a problem. After about a week, Harry begins to complain of a low grade fever and notices that he has some smelly yellow fluid on his white socks. Harry is no dummy, he already is a patient of a local podiatrist, a physician who has special training in all aspects of foot, ankle, and leg conditions. He makes an appointment to see the doctor the following week.

So what does an actual diabetic infection look like? Well, first, there typically is a sore or ulcer present. Around this ulcer, there is usually red and inflammed tissue. Also, there may be no swelling, some swelling, or significant swelling. There may also be warmth to the touch. Additionally, pus or foul smelling fluid may be draining from the ulcer. The skin in the area of the ulcer may appear to be flaking or peeling away. Also, in serious situations, there may be red streaking up the limb. There may or may not be pain because of sensory neuropathy for the diabetic patient. Diabetics cannot rely on sensation to realize that they have a problem. They must rely on their vision to detect any abnormalities on their feet. Even their sense of smell may not be that good at an older age. People with serious infections may have nausea, vomiting, fever, and/or chills.

Harry should have inspected his feet daily. Had he followed his doctors’ instructions to check his feet everyday because he is diabetic, he may have caught the infection in time when it was at a manageable level. But because Harry didn’t realize his problem until he noticed the yellow drainage on his sock, too much time had elapsed. The bacteria had a lot of time to seed itself, multiply itself, and has overcome any weakened immune response directed against it. This is where daily foot inspections are so vitally important. Missed infections can worsen to the point of amputation or hospitalization.

So now Harry is at his podiatrist’s office that afternoon in the exam room. The physician is alarmed by what she sees because when she last saw Harry, he was problem free and anticipating his participation in his grandson’s wedding. The physician has a difficult time explaining to Harry that he needs to be admitted to the hospital for IV antibiotic administration as well as advanced imaging studies. Quite possibly, due to the severity of the infection, Harry may need to stay for a few days to have this infection surgically treated. Of course, the physician relates that if prolonged, Harry may miss his grandson’s wedding.

It is important to note that all diabetic foot infections must be evaluated by a physician, no matter how minor or trivial it may seem to the patient. Misdiagnosing yourself can lead to serious repercussions involving your foot. It could even prove fatal if left untreated. Home treatment without physician evaluation is not an option in diabetics for any level of infection.

The next morning, Harry is visited in the hospital by his podiatrist. Harry has been on IV antibiotics since his arrival in the emergency room, but he has seen no change in the condition of his right foot. In fact, Harry has now lost his appetite and complains of some episodes of nausea. The physician carefully explains the situation to Harry. He has a severe infection involving his right foot. This infection is severe enough and has progressed enough that he will need to go to the operating room to remove the infected tissue and attempt to washout the bacteria present. The xray has shown no changes but the MRI has suggested evidence of possible osteomyelitis, a bone infection, in his right foot.

That evening, Harry goes to the operating room where his podiatrist debrides the infected and dead tissue. She also washes out the wound to try and reduce the bacterial load present. She also cultures the wound to help influence the correct antibiotic choice. Lastly, she takes a small piece of bone to be sent to the pathologist to check to see if there is microscopic evidence of an infection.

After three days, the cultures return with an exact bacteria identified. This is important because now the best antibiotic can be chosen to fight that particular bacteria. Harry is still in the hospital, and although he feels better and his right foot has improved, he’s about to hear the dreaded word that all diabetics hear “amputation.” Harry’s physician tells him that he needs to have part of his foot amputated because the bone sample has come back positive for infection.

Harry has now come to a fork in the road. He can have the amputation and get back on his feet quickly, possibly in time for his grandson’s upcoming wedding. Or he can elect to continue IV antibiotics only for up to six weeks, which carries a less than 5% success rate to eliminate bacteria once seeded in bone. Reluctantly, Harry agrees to the amputation. He is discharged from the hospital three days later, having spent a total of ten days there. He is able to attend his grandson’s wedding, although he is not wearing his rental shoes and he is not dancing. But he is able to appreciate the fact that he could have lost his leg had he not been properly cared for. Harry is thankful for all of these things, and he now visually inspects his feet everyday. More importantly, Harry is now well educated concerning his disease and he has taken measures to combat any problems that may develop in his future.

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

High Heels = High Number of Problems?

2009-03-11T08:40:00.000-07:00

High Heels

Did you know the average woman will wear high heels for 51 years of her life? It’s no wonder that foot problems will develop! Just what features of high heels make them so bad for your feet? It is not the color or the material of high heels that are leading to the foot problems! Rather, all the problems that stem from high heels center on their incompatibility with human anatomy!

Stress 1: The angled nature of a high heel means that your forefoot becomes the focus of pressure when walking, climbing stairs, jumping, or running! The excess force on a particular section of your foot can lead to stress fractures which are small breaks in your bones that can lead to pain and swelling!

Stress 2: When you slip on high heels you are actually elevating your foot which drastically off-balances the forces that act upon your feet. By altering the force that acts upon your big toe, you might destabilize that joint and it could lead to the formation of a bunion. That bunion can lead to discomfort and swelling which can then push the other toes out of line!

Stress 3: Wearing high heels means that your foot is slanted instead of parallel to the ground and now gravity has more of a reason to pull you down! If you have worn high heels you know that your foot slides forward into the shoe due to the gravity and this phenomenon leads to a shift in your weight. The sliding motion results in friction and in an effort to protect itself, your foot will develop thickened areas of skin called corns (top of your foot) and calluses (bottom of your foot).

Stress 4: The sliding action of your foot in a high heel forces your toes into the narrow portion of the shoe. Over time, your toes will start to deform by curling at their middle joint in order to accommodate in the cramped space. The bending at the middle joint of your toes leads to hammertoe formation and leads to the increased incidence of corns and calluses. Your joints could even dislocate and may require surgical correction!

Ladies, think about how a high heel looks and how your feet feel in them while reading this and it might help you fathom all the different stresses you are subjecting your feet to!

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 Athlete’s Foot?

2009-03-11T08:32:00.000-07:00

Athlete’s Foot – Informative Guide

What is Athlete’s Foot?

Athlete’s foot is a fungal infection that arises from moist, warm feet – the perfect habitat for the fungus to thrive. The fungus is essentially a parasite, it adheres itself to the host and proceeds to affect the skin it is on. It usually attaches itself to the bottom of an individual’s feet, soles and/or in between the toes. These happen to be the very same foot areas that are moist, warm, and exposed to the surfaces harboring the fungus.

What are the likely places to pick-up the Athlete’s Foot fungus?

Places that are notorious for contributing to fungal growth are those people may actually spend a significant amount of time in. Some common places that you should exercise caution include:

- Shower areas

- Changing spaces

- Pool locker rooms

These moist areas contribute to fungal growth and are the areas were people most commonly walk around in their bare feet. Athlete’s foot is contagious as well and is spread via direct contact.

What are the symptoms of Athlete’s Foot?

Athlete’s foot is an uncomfortable condition to have and may even spread to other areas of the body. The fungus first infects the skin surface and if the problem is not treated it will penetrate underlying skin layers and cause a secondary bacterial infection.

Indications for Athelete’s Foot

- Itching, flaking, and scaling skin

- Blisters or small bumps which may lead to cracking of the skin

- Bleeding of the feet

How do you prevent Athlete’s Foot?

Maintaining proper foot hygiene is the most effective to prevent the onslaught of Athlete’s foot.

- Make sure to soap and water to completely clean and wash your feet, especially in between the toes and underneath toenails.

- It is very important to thoroughly dry your feet so that you prevent the excess moisture from attracting the fungus.

- You may find it helpful to sprinkle baby powder over your feet and inside your socks and shoes to absorb lingering moisture

- If your feet are exposed to moisture whether from sweat, puddles and anything in between – immediately allow your feet to dry and replace those wet socks and shoes with different footwear.

In areas that are prone to moisture (as discussed above) it is important to wear some type of sandal or flip flop to avoid skin contact with possibly fungus-laden areas.

Central Florida

Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

http://www.flfootandankle.com

Do you suffer from excessive sweating?

2009-03-02T06:20:00.000-08:00

I used to suffer from excessive sweating. No matter what the weather was, cold or hot, I sweated a lot. I don't know why, I just sweated like a pig. To avoid showing the sweat stains, I wore an undershirt, pads, and shields for sweating. Sometimes I would change them several times a day. And I also took several showers daily. But these could not stop my sweating. I tried different antiperspirants and other medicines. Unfortunately, I still sweated heavily. I almost lost all of my confidence. You know, that feeling of being embarrassed, frustrated, anxious, you name it.

DR’S RESPONSE: Excessive sweating is called hyperhidrosis. “Hyper” means an over abundance of and “hidrosis” means sweating. Thus, the medical term hyperhidrosis simply refers to excessive sweating. Hyperhidrosis can affect many areas of the body. A person may sweat excessively wherever there are sweat glands. The most common areas of complaint are located in the armpits, palms, soles, and forehead.

Sweating naturally occurs when a person is excited, anxious, or afraid. Grossly simplified, sweating acts as a natural air conditioner for the body. As sweat, a liquid, is excreted, air molecules in very close proximity to the skin attach to the liquid, creating a cooling effect. Because the air molecules are drawn closer to the skin, they in effect cool the skin. Mother nature has cleverly created a mechanism that will allow the body to cool itself. There is very little immediate negative return for excreting the sweat, but the long term outlook is quite poor if the sweat is not replaced by drinking fluids.

But there are other ways to create sweat. Inflammation of sympathetic nerves can cause local hyperhidrosis. An example would be an athlete who has cold wet feet for a long period of time. Also, generalized sweating can occur if a person takes certain medications, ingests alcohol, or consumes certain foods. Specific diseases such as typhoid fever, malaria, tuberculosis, hyperthyroidism, and diabetes can cause generalized hyperhidrosis.

The feet are the most common area of over sweating prompting a visit to a physician’s office. The patient usually comes to the doctor at the behest of the significant other or parents with the complaint of foul smelling shoes and feet. The patient has often tried a variety of different treatments, all of which have failed up until this point.

Conservative measures to alleviate excessive sweating all are aimed at reducing symptoms, not eliminating the problem. The first line of defense is often anti-perspirants and deodorants. Yes, apply them to your feet like you do your armpits. Patients are advised to change their socks several times a day. They are also recommended to change their shoe type to a more breathable material. For instance, leather steel toed work boots may not be ideal. Another useful measure is to sprinkle baby powder in the shoes to help absorb some of the moisture present. Lysol is to be sprayed once weekly in all shoes, regardless of use.

Another promising treatment is botox injections. This is an extract of the botulin toxin that temporarily blocks the chemical signals sent by the brain to the nerves that control the sweat glands itself. By blocking the arm that turns on the faucet, the sweat is never released.

Other, more controversial treatments include iontophoresis, surgery, and other alternative therapies such as biofeedback, acupuncture, hypnosis, and relaxation techniques. There is little research proving the effectiveness of alternative therapies at this time. Surgery is often only in severe cases where other treatment methods have failed.

LisFranc fracture dislocation

2009-02-18T06:58:00.000-08:00

I was coming home from work one night, I am a hairstylist, and I was hit by a drunk driver. I did not realize my foot was hurt until the next day. I did hurt my neck and back. I never had problems with my foot until the accident. I am a very busy hairstylist, I am 55 years old. When I get finish with my clients by that night. of course i stand the whole day, I cannot hardly walk my left foot is paining me so bad and swells, but it is not just work now it hurts all the time from the top of my left foot sometimes sending pain into the ankle and up the leg. When lay down at night it hurts so bad I cry, even when a sheet or blanket on the bed touches the top of my foot it hurts so bad, the left foot looks from the top portion of the foot swollen at the top of the foot over to the left side of the foot. You can see a big difference in the left from the right foot. It hurts to even touch the top if the left foot with your finger, bad pain. What could be wrong with my foot?

DR.’S RESPONSE: There could be a variety of problems that you suffered as a result of your accident. The symptoms you are describing sounds like an injury called a LisFranc fracture dislocation. This could be a ligament rupture in the middle of your foot or a fracture of the bones of the middle of your foot. I would recommend that you see a podiatrist, a physician specially trained in the foot and ankle. Another condition that may be a result of an untreated injury is called complex regional pain syndrome, although this is less likely.

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

Sesamoiditis vs. Sesamoid Fracture

2009-02-18T06:52:00.000-08:00

Is it possible to differentiate sesamoiditis from a sesamoid fracture or AVN?

DR.’S RESPONSE: Sesamoiditis is an inflammation of the sesamoids, two small round bones in the ball of your foot. These bones act to help smooth the pull of your tendons from your foot to the tip of your big toe. They act like a block pulley with ropes through it to ease the load of work. A sesamoid fracture is different in that those bones are actually fractured. AVN is avascular necrosis, or diminished blood supply to those two bones. The best way to differentiate between the three diagnoses is with clinical presentation, x-rays, or an MRI.

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

Walk from Obesity -- Walk on the Capitol

2009-01-27T12:50:00.001-08:00

more about "Walk from Obesity -- Walk on the Capitol", posted with vodpod

New Walking Study Helps Stamp out Obesity

2009-01-27T11:36:00.000-08:00

What if someone told you, you could walk your way to better health? With 65 percent of American adults considered to be overweight or obese, walking may be one way to battle the bulge. However, if you lack motivation, a prescription to walk may be just what the doctor ordered. That’s the premise behind a 48-week pilot walking program conducted by 16 member physicians of the American Podiatric Medical Association (APMA).

The study, funded by APMA, examines two groups of nearly 250 overweight patients located across the country. The objective is to determine if a podiatrist’s care can make a difference in maintaining a long-term walking routine. The participants will be randomly assigned to one of two groups. Group A participants will be given a written walking program and doctor discussions about the benefits of a walking program. These patients will be given a walking prescription which will include a 12 week calendar to document steps taken per day from the pedometer.

Group B patients will receive no walking prescription, no hand-outs, and no doctor discussions about the benefits of a walking program and will only be given a pedometer and instructions to walk. Body mass index (BMI), cholesterol, blood pressure and other health stats will be monitored on a regular basis for both groups. To qualify for the study, patients must be 18 years or older, at risk for obesity with a BMI of 27 or higher and cleared to participate in the study with no major health conditions, such as a heart attack, stroke or loss of sensation in the feet. Both groups will receive a free pair of Asics walking shoes to utilize in the study.

“Our walking study helps cement two important concepts,” said Dr. Bryan Caldwell, the principal investigating podiatrist in the study and a professor at the Ohio College of Podiatric Medicine. “We have known for years the health benefits of walking, as well as the positive impact a podiatrist’s guidance can have on his or her patients' health. We hope the combination of the two will result in a positive outcome for people who struggle with their weight on a daily basis and will ultimately save lives.”

Obesity is the second leading cause of preventable death in the U.S. A poor diet and lack of physical activity are two of the biggest contributing factors. For this reason, podiatrists participating in the study will record participants’ weight and amount of steps every four weeks using software designed specifically for podiatric research and information sharing from Integrated Physician Systems.

“Implementation of a viable walking program under the care of a podiatrist has great potential,” said APMA President Dr. David Schofield. “Podiatrists have a vested interest in their patients’ well being, without healthy feet, walking is not an option.”

Doctors in the following states and towns are participating in the study: Davis, CA, Orange, CA, Monterey, CA, San Jose, CA, Lakeport, CA, Mill Valley, CA, Roseville, CA, San Francisco, CA, Altamonte Springs, FL, Bradenton, FL, Cermont, FL, Orlando, FL, Spring Hill, FL, Armory, MS, Newton, NJ, Spokane, WA, and Franklin, WI.

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