Central Florida Foot and Ankle Center's Guide To Running

Diagnosis and Treatment of Acute Compartment Syndrome

2012-01-03T12:15:00.000-05:00

The onset of acute compartment syndrome is something ofgreat concern to the emergency room physician, trauma surgeon, and podiatricfoot and ankle surgeon. It is somethingthat is routinely screened for an any lower extremity trauma.

The muscles of the foot and leg are divided intocompartments, each of which is separated by a layer of fascia. This dividing fascia is tough andrestricting, and does not allow for much expansion of the tissues within thecompartment. Normally this is a goodthing, as it helps separate and organize the muscle compartments of the footand leg. However, when the volume of thecompartment expands following injury, these bands of tissue help to restrictthe fluid, creating an increase in the compartmental pressure. This increase in pressure can cause damage tothe muscles, nerves, and vessels within the compartment, and can lead to tissuedeath if not addressed properly.

Signs and symptoms of acute compartment pressure includeintense pain out of proportion for the given injury, numbness or tingling inthe toes, loss of function of the toes or an inability to move them, andcoolness to touch caused by decreased blood flow. Later in the development of compartmentsyndrome, pulses may be absent and the toes may turn white in color.

The diagnosis of compartment syndrome is largely based onthe history and physical findings, but a device called a wick catheter may beused to confirm the diagnosis. This isan instrument that is mainly composed of a needle attached to a pressure gauge,which acts to measure the compartmental pressure. The normal pressure reading for a muscularcompartment should be between 0 and 10 mmHg. Pressures between 10-20mmHg are closely monitored, as they may continueto increase. Pressures above 30mmHg areconsidered diagnostic of compartment syndrome in most cases.

Once the diagnosis of compartment syndrome is made, thepatient must be taken to surgery right away. A delay in surgical treatment may result in irreversible muscle andtissue damage. Surgery for compartmentsyndrome involves releasing the fascia between compartments to relieve thepressure. This procedure is known as afasciotomy.

There are four muscle compartments in the leg to release;the superficial and deep posterior compartments, the lateral compartment, andthe anterior compartment. In the foot,there are also four main compartments; the medial, lateral, central, andinterosseous. Some references willdivide the central compartment into a superficial, deep, and calcaneal compartment,and also consider each of the interosseous compartments their own separatecompartment. When acute compartmentsyndrome is diagnosed, both the leg and foot compartments will oftentimes beopened together.

The incision sites are kept open, and local wound care isperformed to keep the sites clean and prevent infection. Compartment syndrome will generally keep apatient in the hospital for at least several days, while their condition can bemonitored. Any other injuries must alsobe addressed.

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

Equinus

2011-11-14T15:05:00.001-05:00

Equinus is a condition of the foot and ankle that refers toa tight Achilles tendon. The Achillestendon is composed of the tendons of two muscles – the gastrocnemius and thesoleus. Together, these two muscles formthe strongest tendon in the entire body, which inserts into the calcaneus (heelbone).

The Achilles tendon can become tight in one of severalways. Spastic equinus is the oldestrecognized form of equinus, and is seen as a result of upper motor neurondisease. This may include cerebralpalsy, stroke, or spinal trauma and disease. Congenital equinus refers to equinus typically caused by a shortenedAchilles tendon, which is present at birth. This may result in prolonged toe walking in the developing pediatricpatient.

Most commonly, equinus is an acquired deformity, due to atightness of the gastrocnemius muscle, the soleus, or both. This tightness develops over time, and can beworsened by wearing high-heeled shoes, being casted for a lengthy period oftime, or from overuse without stretching. Bony equinus can also present, which is a block of both that preventsthe ankle from dorsiflexing, or moving upwards.

Equinus is possibly the most common cause of foot pathology. When the Achilles tendon is tight, the bodycompensates for this in order to bring the heel to the ground. This is often done by pronating at thesubtalar joint, which is the joint located just below the ankle. This extra pronation can lead to a number offoot problems, such as plantarfasciitis, flatfoot, tendintis, arthritis, bunions, hammertoes, ankle pain, anda number of other conditions. Thus,equinus is not necessarily a painful problem, but the compensation for it cancause several painful problems.

Treatment of equinus should begin with an aggressivestretching program to address the tightness of the Achilles tendon. Because of it’s relationship to the plantarfascia, the two structures forming a type of sling around the calcaneus,plantar fascia stretches are often incorporated as well. Combined with the use of orthotics tomaintain foot structure when walking, conservative treatment is often helpfulfor those with equinus. Heel lifts mayalso be used to address some of the compensation for equinus at the subtalarjoint, as it effectively lessens the amount of space that must be compensatedfor.

Occassionally surgery may be necessary if the equinus is notrelieved with conservative measures, and is causing significant foot pathology. Surgery may involve lengthening of theAchilles tendon itself, or lengthening of either the gastrocnemius muscle, thesoleus muscle, or both. These proceduresare often combined with foot procedures such as flatfoot or bunion correction,as they are often indicated as the deforming force in a foot deformity.

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

Fractures of the Anterior Process

2011-09-28T08:38:00.000-04:00

The anterior process of the calcaneus is an importantstructure to consider in the incidence of ankle sprain. The bifurcate ligament attaches to thisportion of the calcaneus, and attaches dorsally to both the cuboid andnavicular. In a plantarflexion-inversioninjury, the most common mechanism of ankle sprain, the ligament is tensionedand avulsion fracture of the anterior process can occur. The anterior process may be injured lesscommonly in a compression type injury, where the foot is forced to dorsiflexand evert, thereby crushing the bone.

The calcaneocuboid joint is an important consideration inassessing these types of fractures. Thearticular surface of the anterior process of the calcaneus may become damagedfrom this type of trauma. This can leadto significant pathology at the joint.

Degan and colleagues pointed out in an article in 1982 thatthe extent of damage to the anterior process directly effects the outcome oftreatment. They suggested a classificationsystem that took into consideration treatment options. Type I injuries consisted of fractures of theanterior process that did not involve the joint, and were non-displaced. These types of fractures were treatedsuccessfully with immbolization in a cast. Type II injuries were also extra-articular, but were displaced. These fractures were also treatedconservatively with cast immobilization. Type III injuries involved the calcaneocuboid joint, and led tolong-term disability. This was most commonlytreated with surgical excision of the fragment. Prior to the publishing of this article, removal of fracture fragmentsfor anterior process injuries was controversial. Today, it is commonplace.

Another point made in Degan’s article is that it may take along time for patients to be completely symptom-free following conservativetreatment, even when the joint is not involved. In some cases, patients remained symptomatic for up to one yearfollowing injury. When this is the case,a small amount of local anesthetic can be injected into the fracturefragment. If this is found to alleviatethe pain, the fracture fragment removal is indicated.

Removal of the fragment involves a small incision placedover the calcaneoocuboid joint. Thefragment is removed, along with any other diseased tissue that may be causingpain within the joint. The surgicalwound is then closed with suture. Typically this is enough to alleviate symptoms, however, some pain andswelling is to be expected following surgery.

Because of the propensity for these fractures to be missed,it is quite common to see old fractures of the anterior process of thecalcaneus. Often times by the time theypresent themselves, the fracture fragment has either healed in a poor positionor damage to the joint surfaces has already occurred.

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

Paronychia

2011-07-22T12:38:00.004-04:00

When an ingrown toenail becomes infected, it is referred to as a paronychia. This happens due to the nail literally digging into the skin, causing a breakdown in the soft tissue, which allows bacteria to penetrate the natural skin barrier. The organism that is usually responsible for the infection is a staphylococcus species.

Paronychia will appear as a small, localized area of redness that may spread up the toe. It is generally quite painful, and there is usually a fair amount of pus and drainage from the site. In patients that are immunocompromised, such as diabetics or patients on long-term steroid regimens, a paronychia can advance to a more complicated infection of the soft tissues. These should be dealt with rapidly and aggressively by a doctor.

Treatment for paronychia includes incision and drainage of the infection site, which will help to relieve pain as well as remove much of the infection. A bandage is applied, usually with a topical antibiotic, and oral antibiotics may be used as well. Augmentin is a commonly prescribed oral antibiotic for paronychia, though it may not always be necessary. The bandage may be changed once or twice a day for the first few days, and soaks in a dilute betadine solution may be beneficial as well.

If ingrown toenails and paronychia are a chronic problem, they can be addressed with one of several more permanent procedures. A podiatrist will typically be the type of doctor that deals with this problem. After the infection resolves, a chemical matricectomy may be performed. This procedure involves using a chemical, such as phenol or sodium hydroxide, to permanently remove a portion or the entire nail matrix. The nail and nail matrix may also be surgically removed. Both are relatively minor procedures, and allow for a quick recovery. The recurrence of ingrown toenails after these surgical procedures is extremely low.

Generally speaking, a paronychia is a minor infection, and is treated as such. It is only in the diabetic or otherwise immunocompromised patient that it becomes an area of greater concern. If not dealt with rapidly, a minor infection can become a more serious, even life-threatening infection.

If you are experiencing pain from an ingrown toenail, show it to your doctor. Even if it is not infected, it should be dealt with in an appropriate manner, to relieve pain, prevent regrowth of the ingrown portion of the nail, and prevent a pending infection. With time, many ingrown toenails will ultimately become infected.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Burning and Tingling in the Feet – Is it Neuropathy?

2011-05-23T08:48:00.002-04:00

One of the most common complications of diabetes is the development of peripheral neuropathy. Along with the retina in the eye and the kidney, the nervous system is particularly vulnerable to unregulated glucose levels in the blood. This is because glucose, or free sugar in the blood, is able to freely move in and out of these cells without the use of glucose receptors.

Diabetic neuropathy comes in a variety of forms, depending on which nerves are involved. The sensory, motor, and autonomic (involuntary) nervous systems are all affected in diabetic neuropathy, but the sensory involvement is usually the first to become noticeably symptomatic. This often begins with a burning, tingling, or feeling of numbness in the feet. This may also occur in the hands at the same time. This pattern of distribution is commonly referred to as the “stocking-and-glove” distribution. Many theorize that the longest nerves are the first to be affected by peripheral neuropathy, hence the involvement of the hands and feet first. The pain is generally worse at night or at rest.

While the symptoms of numbness and pain of a burning or tingling nature may be uncomfortable, the later sequalae of peripheral neuropathy is certainly more of concern. Once the sensation in the feet is diminished or absent, the foot becomes prone to injury. This injury may go completely unnoticed, which can lead to an open, infected wound. Ulcerations secondary to diabetic peripheral neuropathy cause enormous amounts of morbidity, and can become complicated by systemic infections.

Signs of motor neuropathy in the diabetic patient include structural changes to the foot due to a loss of intrinsic musculature. This may include hammering of the digits, as well as a noticeable loss of the abductor hallucis, a muscle found on the inside (medial) of the foot near the arch. These changes may be more subtle than the subjective findings of pain due to sensory neuropathy.

Autonomic neuropathy also causes changes to the foot that can be appreciated on physical examination. Findings such as lack of hair growth to the digits, changes to the skin color or texture, changes in warmth, and decreased circulation to the foot can all be signs of autonomic neuropathy in the diabetic patient.

Unfortunately, there is no cure for diabetic neuropathy. The onset and progression of symptoms can be avoided by keeping tight control of blood glucose levels. Avoiding hyperglycemic events will prevent the nerves from being damaged by excessive glucose in the blood. In fact, many diabetics report an increase in pain after eating a carbohydrate-rich meal or if their glucose levels are running high.

Drugs that have been used to treat painful diabetic peripheral neuropathy are targeted at the symptoms rather than at the cause. This includes antidepressants such as amitryptiline or nortriptyline, gabapentin, topical capsaicin, and sedatives and pain relievers such as opiates.

A podiatrist will screen for neuropathy in diabetic patients. This is often a very simple, noninvasive test in the office where the protective sensation in the feet is tested. Further testing may be warranted for borderline cases, but is typically unnecessary. If you are diabetic and are concerned about peripheral neuropathy, have a discussion with your podiatrist or primary doctor today.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Endoscopic Plantar Fasciotomy

2011-04-25T12:28:00.004-04:00

One of the most common conditions encountered by the podiatric physician is plantar fasciitis and other forms of heel pain that may present as plantar fasciitis. In fact, one study suggested that up to a third of all Americans will experience this form of heel pain at some point in their adult lives.

The plantar fascia describes a tough band of fibrous material found at the plantar surface of the foot. This structure allows for integrity of the foot, and helps to contain the deeper structures within the foot. It functions to assist in gait and maintain integrity of the musculature of the foot, and is therefore subjected to high levels of stress, particularly in the athlete or in the non-athlete that is on their feet for extended periods of time.

Plantar fasciitis is classically described as heel pain at the bottom of the foot, which may extend into the arch or even into the toes. It is a chronic inflammatory condition, which some suggest is more appropriately described as plantar fasciosis, which indicates the chronic nature of the condition, rather than an acute inflammatory process. Other causes of heel pain include stress fractures of the calcaneus, entrapment of the medial and/or lateral calcaneal nerves, tarsal tunnel syndrome, and certain forms of inflammatory arthritis. It is very possible and quite likely that some cases of heel pain may be multi-factorial, and have elements of more than one of these causes of heel pain.

Symptoms of plantar fasciitis include pain in the heel after long periods of rest, particularly in the morning. This is often referred to as “first-step pain”, and describes the sudden stretching of the plantar fascia band after it is allowed to contract some during rest. The pain may be relieved somewhat as the plantar fascia is “loosened”, but will return with increased activity.

Conservative therapy for plantar fasciitis revolves around exercise and stretching, corticosteroid injections, anti-inflammatory medications, icing, rest, and the use of orthotic devices. Newer advancements in technology have led to ultrasound and shockwave therapy, platelet-rich plasma therapy, and other high-tech therapies.

However, conservative therapy can often fail, and surgery becomes an option. Surgical management is traditionally performed as an open procedure, with a small incision made into the medial foot and a resection of some of the plantar fascia, or a simple release. Historically, the entire plantar fascia was commonly released. However, this was found to destabilize the lateral foot, and would lead to pain in this area. In fact, this complication was often more debilitating than the original plantar fascia pain. This realization led to a more judicious release of the plantar fascia, usually only involving the medial one-third of the structure. This led to much less instability and greater results.

Another historical approach to plantar heel pain was the resection of a bone spur on the calcaneus. For a long time it was believed that this was the source of the plantar fascia pain, and resection would lead to improvement. Research into “heel spurs” as the cause of heel pain would later disprove this as an etiology of the pain. Resection of heel spurs, or infracalcaneal exostoses, is not commonly performed as a result of this information.

With a greater understanding of plantar heel pain, as well as advancements in surgical technique and technologies, the use of endoscopic methods of plantar fascia release became a popular option in the 1990’s. With endoscopic plantar fasciotomy, one or two small incisions are made in the side of the foot, and a small camera is used to visualize this plantar fascia. Then, a specialized blade is inserted and the plantar fascia is released. This minimally invasive technique causes less damage to the surrounding tissues, and can lead to a faster recovery.

Post-operatively, however, a period of non-weight bearing or partial weight bearing is still recommended. With the initial development of endoscopic plantar fasciotomy, the idea of a faster recovery led to a quicker return to normal shoes. However, it was realized that this quick return to normal shoes led to increased instability and recurrence of pain. It is now recommended that the patient remain non-weight bearing in a surgical boot until healing occurs.

The endoscopic plantar fasciotomy remains a popular option for foot and ankle surgeons in the treatment of plantar fasciitis. Advancements since its initial inception make it easier to operate and lead to greater outcomes. Conservative therapy should be initiated and followed for some time before surgical intervention. If you are experiencing heel pain or symptoms of plantar fasciitis, consult your podiatrist for evaluation. Diagnosis can only be made after proper examination and evaluation.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Metatarsus Adductus

2011-02-21T15:11:00.003-05:00

A common cause of in-toeing in the pediatric patient is a foot deformity called metatarsus adductus. This is a condition in which the metatarsals, the bones in the foot that connect the toes to the midfoot, are pointed towards the direction of the midline of the body. Metatarsus adductus may be present on it’s own, or may be a component of a more extensive deformity, such as clubfoot. It’s incidence is approximately one in every one thousand live births, which is roughly ten times as common as clubfoot.

The exact cause of metatarsus adductus is not known, though there are several theories of how it develops. An increase in intrauterine pressure and a position in the womb that causes the feet to drift inward is the cause that is most commonly accepted. There also may be a familial pattern of metatarsus adductus, indicating that there may be genetic pre-disposition to the deformity. Conditions that cause an increase in ligament laxity, such as Ehlers-Danlos Syndrome, may also contribute to the development of metatarsus adductus.

The evaluation of metatarsus adductus typically involves clinical evaluation as well as x-rays of the foot to determine the position of the developing bones. Clinically, the toes will be pointed inwards towards the midline of the body. Sometimes only the great toe will be involved, in which case the condition is called metatarsus primus adductus. More commonly, however, all five digits are involved. The outside of the foot, or the lateral side, may show a prominent bump right in the middle of the foot. This is most likely the styloid process at the base of the fifth metatarsal, a very good indicator of metatarsus adductus. There also may be an increased gapping between the first and second toes when the child is standing, another classic finding.

X-rays will often reveal the extent of the deformity. The foot and ankle physician evaluating the patient will measure the angle that the forefoot points away from the midfoot and towards the middle of the body. The higher the angle, the more severe the deformity.

Important factors in determining the treatment of metatarsus adductus are the angle of deviation from the midfoot, the involvement of the midfoot and/or rearfoot in the deformity, and the reducibility of the deformity. Reducibility refers to whether or not the forefoot can be corrected with manipulation.

Conservative therapy is typically employed first, especially in children under the age of two years old. Most commonly conservative therapy involves manipulating the foot into a corrected position, and casting the foot so it stays that way. Depending on the degree of deformity, several rounds of casting may be used. This is referred to as serial casting. Besides casting, a splint such as a Ganley splint may be used as well as special shoes to prevent the deformity from recurring.

Surgical therapy is sometimes necessary to correct the deformity in the older child, or a child that has a more severe deformity. Surgical procedures involve both soft tissue and bone surgery, or a combination of both. Soft tissue procedures may include tendon releases and/or ligament release. These types of procedures will allow the foot to be manipulated more easily so that a corrected position can be attained. Bone work may involve taking small wedges of bone out of either the metatarsals or the midfoot in order to straighten out the foot.

After surgery, the patient is typically casted for a period of no less than 8-12 weeks in order to maintain the corrected position. Special shoes may still be required for some time to prevent the deformity from recurring.

There are a number of other musculoskeletal deformities that may be present in the lower extremity that lead to in-toeing. A thorough evaluation of the legs, knees, and hips is warranted in any child that has significant in-toeing. The incidence or torsional deformities of the tibia and femur is increased in the presence of metatarsus adductus, possibly due to the same reasons that the foot deformity develops in-utero. An increased incidence of hip dysplasia has also been reported by some authors, though other refute this correlation.

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

Thromboangiitis Obliterans

2010-12-30T08:10:00.004-05:00

Thromboangiitis Obliterans is a rare disease that causes occlusion of the arteries in the hands and feet. It almost always affects men aged 20-40 with a history of cigarettes smoking or other tobacco use. It was first described by Von Winiwarter in 1879 in a patient with the affliction. It was later described by Leo Buerger, who documented and provided a full description of the disease. For this reason, it is commonly referred to as Buerger’s Disease.

The disease is caused by an inflammation of the blood vessels, particularly those of the hands and feet. When the vessels become totally occluded, a lack of blood flow to the affected area occurs. This can cause an immense amount of pain, and can lead to gangrene and ulcerations of the fingertips and/or toes.

In those with thromboangiitis obliterans, symptoms may include cold hands or feet, with the extremity appearing pale, red, or blue. Symptoms most commonly affect two or more extremities, but may also affect only one. There is usually pain in the affected limb, which may range from burning or tingling at rest to acute, severe pain. Symptoms are usually worsened by stress or cold. Thromboangiitis Obliterans is commonly seen in association with Raynaud’s Disease. The incidence is quite low, affecting approximately 6 in 10,000 people.

Treatment for thromboangiitis obliterans revolves around symptoms, as there is no cure for the disease. Increasing blood flow to the area may be achieved with vasodilators such as oral medications or nitroglycerin patches. Adding warmth and gently exercising the area can also increase blood flow.

Prevention of thromboangiitis obliterans is key to treatment. Quitting smoking and the use of tobacco products can prevent occlusions all together in many patients. Removing stress and avoiding the cold can also help.

The most serious complication of thromboangiitis obliterans is gangrene. The lack of blood flow to the hands and/or feet can cause the tissue to become gangrenous and die. If not cared for properly, this tissue can lead to serious infections, and possibly sepsis and death. Therefore, it is essential that thromboangiitis obliterans be cared for aggressively by the treating physician.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Surgery for Lateral Ankle Stabilization

2010-10-27T10:23:00.006-04:00

Chronic ankle sprains are a problem that plagues many individuals. Once the ligaments of the ankle have been compromised, they are subject to repeat injury. A person with chronic ankle sprains will often report an initial injury, possibly one that was never treated. There is usually constant swelling and pain at the ankle, and a feeling of instability, as if the ankle might give out at any time.

Chronic ankle instability can develop from damage to the nerve endings in the ligaments responsible for proprioception. Proprioception is the body’s ability to know where a particular part lies in space. Repetitive or chronic injury to the ankle ligaments can damage the proprioceptors in the ankle, leading to that feeling of instability. A person with chronic ankle injuries may also have attenuated, stretched out, and weakened ligaments, particularly of the lateral ankle.

Most commonly, the ligament that is damaged is the anterior talo-fibular ligament, or the ATFL. The calcaneofibular ligament (CFL) or posterior talo-fibular ligament (PTFL) may also be involved, as well as the extensor retinaculum, peroneal tendons, or the joints in the area such as the calcaneocuboid, tarso-metatarsal joints, subtalar joint, or the ankle joint itself. In high ankle sprains, the tibiofibular syndesmosis may also be injured.

Conservative care for chronic ankle injury revolves around protecting the ankle with high-top shoes or braces. These devices may work well in some individuals, but fail to offer enough support in others. In particular, high-performance athletes may be candidates for surgical repair of the ligaments if and when conservative therapy fails.

Surgery for lateral ankle instability focuses on reconstructing the lateral ankle and adding stability to the joint. There are a number of different techniques to do this. Most frequently, cases of chronic ankle instability are due to injury of the ATFL, or a combination of the ATFL and CFL. Depending on the extent of the injury, various procedures may serve to reconstruct and/or repair these ligaments.

Several procedures exist that use the peroneus brevis tendon, the extensor retinaculum, or both to reconstruct the ATFL and/or the CFL. These procedures may involve drilling a small hole in the tip of the fibula or the talus, and re-routing the tendon through the holes. When done correctly, this can add significant stability to the ankle joint.

Another technique involves using soft tissue from another part of the body, such as the tensor fascia lata in the hip and thigh, as a graft to reconstruct the ligaments. Cadaveric grafts or synthetic materials may also be used.

Many variables play into the decision-making of the surgeon and patient. The goals of the patient and the surgeon should be clearly communicated, as well as possible complications of the surgery and shortfalls that may exist. Lateral ankle reconstruction may not be an option for some patients, such as those with systemic conditions that may complicate the surgery or postpone healing. A thorough discussion should be had with a foot and ankle surgeon to assess the situation.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

What is Gout?

2010-09-03T16:38:00.004-04:00

Gout is a form of arthritis, characterized by an acute onset of extreme pain. Gout attacks most commonly occur in the foot and ankle, in particular at the first metatarsophalangeal joint, the joint that connects the great toe to the foot. Gout also appears in the ankle, and can theoretically occur in any joint of the foot.

During an acute attack, the affected joint will appear red and swollen, and it will be hot to touch. It will also be extremely painful to touch. The simple touch of a bed sheet or even a slight breeze can cause an immense amount of pain. Evaluation by a doctor will be used to rule out other possibilities such as a fracture, infection, or other forms of arthritis. X-rays may be taken to visualize the effected joint as well. There are generally not any changes seen on x-ray with the first gout attack, but distinct changes may be seen with repetitive attacks. These changes include bony erosions seen around the joint, with the appearance of bone that has been chewed away. This is referred to as Martel’s sign.

An excess of uric acid in the body causes a gout attack. Uric acid is a byproduct of many foods; in particular it found in high quantity in red meats, lobster, and beer. Because of its association with overindulgence of rich foods, it has been historically referred to as “the disease of kings”. The high volume of uric acid crystallizes at the level of the joints, causing a tophus to form. The crystallization most commonly happens overnight. Some believe that this is due to a drop in body temperature, particularly in the feet, while sleeping.

A high level of uric acid in the body is a condition known as hyperuricemia. The excessive uric acid may come from several different sources. It may be dietary, as in the overconsumption of red meat, beer, and seafood. Hyperuricemia may also be associated with diabetes mellitus, hypertension, psoriasis, or congenital conditions such as Lesch-Nyhan syndrome. Excessive uric acid levels can also be caused by the use of some diuretics, particularly during their early use.

The treatment of gout is twofold; it must address both the acute painful phase as well as controlling the hyperuricemia. Initially, patients may be given colchicine or indomethacin to alleviate pain. After the acute attack has subsided, the underlying hyperuricemia may be addressed with allopurinol a drug that blocks the enzyme that creates uric acid in the body.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Staying Hydrated While Running

2010-08-02T11:52:00.005-04:00

As the dog days of summer roll by, the heat index stays high while the training period continues. Whether you’re training for that fall marathon, or simply enjoy running outside, it is important to remain hydrated.

Depending on your type of workout, there are a number of options for hydration. Water is the obvious choice, but sports drinks are numerous and heavily marketed to the athlete and casual exerciser alike.

Most sports drinks have added carbohydrates and electrolytes to help with rehydration. The carbohydrates allow for added energy for your body as you are working out. The electrolytes sodium and potassium are added to help maintain fluid retention in the body, as well as key functions of muscles. For runners that are running for more than 30 minutes at a time, sports drinks are a good option to remain hydrated.

For longer distances, especially for those training for a marathon that may be running for several hours straight, there are more advanced sports drinks available. These drinks contain more complex carbohydrates that won’t breakdown as quickly, as well as protein for more sustained energy. They too have plenty of electrolytes to keep the athlete hydrated.

Enhanced and flavored waters offer vitamins and minerals in a sweetened package, but are usually not formulated for athletic hydration. They are, however, a good alternative to water for those with an aversion to the natural stuff. For workouts that last less than thirty minutes, water or an enhanced water are good choices.

A common mistake made by runners in the heat is to over-hydrate. Drinking too much water can make you sluggish and lethargic, and seriously slow down your pace. A good way to avoid this is to drink two cups of liquids two hours before exercising. This ensures that you are hydrated to begin with. Once the workout starts, it’s important to take sips of water/sports drink every fifteen minutes or so.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Ultrasound Imaging in Podiatry

2010-06-28T10:12:00.004-04:00

Ultrasound technology has been used for many years in the medical community, particularly for imaging studies. For the past fifty years or so, ultrasound imaging has been used extensively in obstetrics to view the fetus. This technology has given obstetricians the ability to diagnose congenital abnormalities that may pose a risk to the mother or the child, and to obtain the viability of the fetus. While many may be familiar with this application of ultrasound, few are familiar with the wide range of imaging studies that can be performed with ultrasound technology.

Ultrasound imaging, or sonography, has a particularly useful application in podiatry. The ability for ultrasound to be used to image soft tissues such as tendons, ligaments, and muscles makes it a valuable diagnostic tool. Some of the more common applications of ultrasound imaging in podiatry include imaging tendons and ligaments to diagnose ruptures and tears, evaluating the extent of plantar fasciitis, and evaluating soft tissue abnormalities such as ganglion cysts and neuromas.

The technology can also be used to help with injections, as it gives a clear picture of exactly what structures a doctor is injecting medications into. In some cases of plantar fasciitis, for example, a patient may benefit from an injection of cortisone into the area below the plantar fascia. Ultrasound imaging allows for a guided injection, so that the medication can be placed in exactly the right area to treat the problem.

Ultrasound works by sending out sound waves at a frequency that is inaudible to the human ear. These sound waves reflect off of the structures within the body, with different densities of tissue reflecting back different amounts of ultrasound waves. This allows for a differentiation of the structures, which is then converted into an image on the screen attached to the system. This technology is also used outside of medicine as SONAR technology, particularly in the sea when measuring the distance between two points.

Ultrasound has been shown to be a safe and effective tool in medicine. Because there is no ionizing radiation involved, such as that from X-rays or CT scans, it is considered to be a very safe test. It is also a relatively simple and quick test, which can be used to evaluate soft tissue disorders in the office. When comparing it to magnetic resonance imaging (MRI), it is much quicker, and also much less expensive. While it may not be able to produce the high quality images of an MRI, the use of ultrasound technology in evaluating soft tissues is clearly quite valuable.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Hallux Limitus and Hallux Rigidus

2010-05-20T11:32:00.004-04:00

Hallux limitus and hallux rigidus are two terms that are used to describe the progressive loss of motion that is seen in the first metatarsophalangeal joint. For normal function of the big toe, a range of motion of between 50 and 90 degrees is required. In hallux limitus, the range of motion is decreased. In hallux rigidus, there is little to no motion at all at the first metatarsophalangeal (MTP) joint.

The first MTP joint plays a critical role in normal gait. It is the area of greatest propulsion during the gait cycle, and plays a large role in balance. When the range of motion at the first MTP joint (located at the base of the big toe) is lost, significant secondary symptoms can occur, such as calluses across the bottoms of the feet.

Hallux limitus (and later, hallux rigidus) is a specific form of osteoarthritis localized to the first MTP joint. Therefore, the signs and symptoms are similar to that of common arthritis. This includes pain and stiffness in the joint when it is pushed upwards, such as when walking, running and squatting. Swelling and inflammation may be seen as well, particularly on the top of the foot around the joint. In particular, damp and cold weather may make the symptoms worse.

Later findings that are consistent with hallux rigidus include continuous pain in the joint, even when at rest. A person with hallux rigidus may have a visual bump on the top of their foot over the joint. This bump is actually a bone growth known as an osteophyte that can be seen on x-ray, and is common in osteoarthritis. Another common complaint is difficulty wearing shoes, particularly shoes that are tight in the toes, such as high heels.

When the joint becomes too painful to walk on, a limp may be apparent. The attempt to keep weight off the joint can lead to problems with other areas of the foot that are not meant to bear the weight that the big toe is designed for. Knee, hip, back and neck pain are also common conditions associated with hallux limitus and hallux rigidus.

Hallux limitus and hallux rigidus can be treated by either conservative or aggressive treatments, or a combination of both. Conservative treatment relies on stabilizing the foot, taking weight off of the big toe, and alleviating some of the pain associated with the condition. Stabilization of the foot is often achieved with a custom orthotic device or other form of padding. Symptoms may be alleviated with anti-inflammatory medications (NSAIDs), icing, rest, and padding.

More aggressive treatment is focused on the surgical management of hallux limitus/rigidus. The joint can commonly be fused, which takes away motion at the joint and alleviates the pain associated with the motion. Another option may be to use an implant, which can bring motion back to the joint. There are a number of different factors that go into the surgical decision making, so talk to your doctor about the options.

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

Hyperbaric Oxygen Chambers

2010-02-02T12:23:00.005-05:00

Hyperbaric oxygen chambers can be very useful tools in treating difficult-to-heal wounds. Ever wonder how they work?

In order to really understand what is happening in a hyperbaric oxygen chamber, you’ll have to understand a little bit of how oxygen is transported through the body.

All of the tissues in your body, from your skin to your muscles and bones, require oxygen. It’s easy to think of it as your body needing to breathe. In order to get oxygen to every tissue in your body, we must breathe in oxygen from the outside air into our lungs. This oxygen gets bound to hemoglobin, a protein found in the red blood cells. The red blood cells, now carrying oxygen, can transport that oxygen through the blood and to all of the tissues in your body.

Normal atmospheric pressure at sea level is measured as 1 atm. If we go up to the top of a mountain, the atmospheric pressure decreases; at the bottom of the ocean, the pressure will increase. At normal atmospheric pressure, it is only possible to transport a certain amount of oxygen through the body attached to hemoglobin.

If we increase the pressure at which we are breathing, however, it is possible to increase the amount of oxygen transported through the blood. In a hyperbaric oxygen chamber, the pressure is increased to 2 atm, or double the pressure at sea level. This allows for us to actually breathe in more oxygen than we would in the outside environment. The extra oxygen is actually dissolved into the plasma of the blood, making it possible to transport even more oxygen through the body. Before, we could only transport as much as the red blood cells could hold with hemoglobin.

Once there is an increase in oxygen in the blood due to it being dissolved into solution at higher pressures, the extra oxygen can drive the biochemical processes of wound healing. Different proteins in the body rely on oxygen to regenerate – if we increase the amount of oxygen available, we can increase the time it takes for the wounds to heal.

This idea of increased healing is especially important in patients with diabetes or peripheral vascular disease, two conditions that will slow the healing process.

Keep in mind that the only way to use hyperbaric oxygen is to breathe it in through the air. There are some products that are marketed as devices that will surround a wound with high-pressure oxygen, such as something that is wrapped around the leg. These products do not work in the same way, as none of the oxygen is actually being breathed in. In a true hyperbaric oxygen chamber, the patient will lie down completely enclosed in a tube.

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

2009-11-23T10:07:00.005-05:00

With cold weather approaching, it’s important to learn how to protect yourself from the bite of cold! Whether you know it or not, your skin is the largest bodily organ and comprises 15% of your total body weight! Your skin works to protect your body from a host of environmental assaults, but trauma in the form of hot or cold injury can compromise its protective properties. A cold injury, such as frostbite can cause fluid loss within the skin and increase its breakdown and the likelihood of infection.

Although frostbite is used as a general term to cover all sorts of cold injuries, there are actually different and specific types of cold injury with frostbite being just one of them. The non-freezing types of cold injury are chilblains and immersion injury (trench foot). The freezing types of cold injury are frostnip, superficial frostbite and deep frostbite.

Chillblains

The mildest form of cold injury is called chilblains and is the most commonly experienced. It occurs when bare skin is exposed to temperatures of 33 – 60 Fahrenheit. The typical places for chilblains to occur are the ears, fingers and the tip of your nose. The best way to treat chilblains is prevention: avoiding the cold and protecting prone areas. Make sure to cover yourself adequately before going out! If chilblains do occur, the best way to treat it is via rapid rewarming and the application of moisturizers.

Immersion Injury

Immersion injury is also known as trench foot because in World War I, many soldiers who fought in the trenches experienced this type of cold injury. Unlike other cold injuries that are associated with cold air, immersion injury has to do with cold water. Cold water leads to much rapid heat loss than cold air by about 25-fold! As a result of the water penetrating the skin, trench foot can occur at much higher temperatures than the cold you may associate with frostbite. As a result of prolonged skin exposure to water in cold weather, your foot may look dusky and blue with swelling or blister formation. The best way to treat the affected area is to rewarm and dress the area with dry materials.

Winter time conjures up memories of snow angels, snowball fights and snow men! However, care must be taken to prevent cold injuries as a result of prolonged exposure to the weather. Skin injuries due to the cold are due to ice crystal formation in the tissue. To prevent crystal formation from occurring in the vital tissues of your body such as your brain and heart, blood gets diverted from your extremities (arms and legs) into the core (trunk and head). The process of redirecting blood flow to more vital structures is called arteriolar shunting.

The process of transferring blood to the inner most aspect of your body means that your extremities are more prone to dying off with increased exposure to cold. In essence, your body sacrifices your limbs in order to keep its vital functions going. Without blood keeping the area supplied with oxygen, nutrients and warmth – it is easy to see why areas furthest away from the head and heart are most affected by the cold.

Frostnip

Frostnip is a freezing type of cold injury where reversible ice crystal formation occurs. This is the mildest form of frostbite and the nose, ears and extremities are the most likely areas to encounter it. When frostnip occurs your affected areas will become white and have a decreased sensation. Rapid rewarming in water over the boiling point (104-108) is the best way to rescue those areas from further damage. The reasons for the use of very hot water is to shorten the frozen state, increase the local blood flow to the area and decrease the time cells are exposed to ions in the blood.

Superficial Frostbite

Extended exposure to the elements can turn a condition of frostnip into superficial frostbite! In this case, the cold has penetrated the area of skin and its underlying subcutaneous tissue. There are a variety of signs that indicate superficial frostbite has occurred: itching/burning that is lateral replaced by ache, swelling, cyanosis (blueness), excessive perspiration, and coldness of injured parts that occurs 2-3 weeks after the injury and lasts for many months! The cold did not kill off the nerves in the affected area so there is significant pain.

With winter time upon us, it is important to discuss safety measures and treatment tips if you should encounter a cold injury. Cold injuries can be likened to burn injuries in that the trauma caused to the skin is very similar. In addition, frostbite is graded in stages just like a burn injury.

Deep Frostbite

Deep frostbite is the opposite temperature equivalent to a burn injury. Both burns and deep frostbite have degrees of severity and the greater the degree of burn, the more injury a particular area has sustained.

First degree and second degree cold injuries are actually classified as superficial frostbite whereas third degree and fourth degree injuries are of the deep frostbite category.

First degree frostbite is painful and the affected area looks white with delayed vascular supply to the area. Second degree frostbite leads to big blister formation, burning and tingling sensation, and the area will become hot and dry to touch. After rewarming the area, swelling and burning pain may occur and last for several days. Healing of the areas will occur after 3-4 weeks and pain relievers prescribed by your healthcare professional will help with the pain.

First and second degree frostbite occurs at the level of the skin and subcutaneous tissues. However, third and fourth degree frostbite (deep frostbite) involves skin and may extend to the bone!

Third degree burns are characterized by skin tissue death, blister formation, blue skin and excessive perspiration (hyperhidrosis). Throbbing/shooting pain will occur approximately 2 weeks after the injury due to nerve involvement. The fourth degree burns will involve tendon and bone with similar symptoms.

Despite healing, there will be no blood filling the affected areas with rewarming and as a result auto amputation of the area may occur. Auto amputation is basically complete tissue death and the body’s expulsion of that tissue or part! Treatment of deep frostbite requires physician supervision: rapid rewarming needs to occur and hospital admittance is the usual course of action.

With any cold injury to your lower extremity, it is important to consult with your podiatrist. They know the best way to evaluate the extent of injury and the resulting treatment. They will be able to prescribe you the appropriate medications to relieve your pain and help facilitate a recovery process. Remember that prevention is the best treatment so bundle up when you go outside into the cold this winter season!

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

Hammer time? Hammertoes!

2009-09-24T10:43:00.001-04:00

Hammertoes are a common condition that is treated by podiatrists. When discussing hammertoes, it is important to discuss exactly which joints of the toes are affected, and how they are misaligned. The picture above depicts the three classic types of hammer digits, each of which has an effect on one or more of the three joints of the little toes on the foot.

In mallet toe, only the distal interphalangeal joint is affected. The interphalangeal joints are the joints within each toe. All of the toes besides the big toe have two interphalangeal joints. The big toe has one. Mallet toe is characterized by a toe that is straight until the last “knuckle” joint of the toe, where it is pointed downwards.

In claw toe, all three of the joints of the lesser digits are affected. The metatarsophalangeal joint, the joint that connects the toe to the forefoot, is deviated upwards, while the two interphalangeal joints are deviated downwards. This creates a claw-like appearance, as is seen in the bottom diagram of the drawing.

The most common form of hammer digits is depicted in the middle diagram. This is the classic form of hammertoes. In this form, the metatarsophalangeal joint is deviated upwards, the proximal interphalangeal joint (the one closer to the middle of the foot) is deviated downwards, and the distal interphalangeal joint (the one further down the toe) may be either normal or deviated slightly upwards.

Besides the aesthetic changes to the toes, hammertoes can be a source of pain for many people. When the joints of the toe are misaligned, it forces the toes to take up more space in a shoe. This can often lead to corns on the tops of the toes, as they are rubbing against the top of a shoe.

Additionally, hammertoes are often pointed towards each other, which cause the toes themselves to rub against the other toes. This can also cause corns and calluses to form, as well as abrasions in between the toes.

Hammertoes are caused by a loss of muscle stability and balance that is formed by the muscles of the foot. The flexors on the back of the leg and the extensors on the front of the leg serve to counterbalance each other on the toes, thereby keeping the toes straight. When the balance is lost from things like loss of function of one muscle or strengthening of another muscle, the toes can become deformed. This problem is often seen in women who wear high heeled shoes.

When treating hammertoes, claw toes, or mallet toes, a podiatrist may use one of two approaches. The conservative approach would be to treat the corns and calluses formed by the toes rubbing against either each other or the shoe. This may be done by burning or shaving off the dead skin causing the pain, as well as modifying the shoe gear to accommodate the misaligned toes.

The other route is to correct the misalignment of the toes through surgery. Several different methods are used depending on the extent of the deformity – only your surgeon will be able to decide which the proper method to use is.

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

What are Stress Fractures?

2009-09-08T10:38:00.004-04:00

The term “stress fracture” often gets thrown around a lot in medicine, but sometimes it is poorly understood. In order to understand how a stress fracture occurs and what exactly it is, a little bit of information on how the bones form is necessary first.

A common misconception is that bones are dead. This is one-hundred percent false. Bones are in fact a complex organ system. They are a living tissue that is constantly remodeling itself. Some cells in the bones work to degrade the bone material, while others work to rebuild it. This constant turnover of bone material is extremely important in bone health, and defects of this system are the cause of disease like osteoporosis. It takes approximately seven years for a complete turnover of the human skeleton – if you are twenty one years old, your bones have gone through three complete cycles!

When the repetitive stresses of activities like walking and running outpace the bones’ ability to repair themselves, a stress fracture occurs. Stress fractures are extremely common in runners, where the forces on the body and the bones are increased greatly. Stress fractures account for roughly 10% of all running injuries, and 95% of all stress fractures occur in the lower extremity.

A common thought among podiatrists and other types of sports medicine doctors is that stress fractures are more likely to occur during muscle fatigue. The muscles play a large role in distributing body weight and forces throughout the body. When the muscles are fatigued, this distribution is lost and more force is placed directly on the bones. The bones are therefore subjected to greater direct forces, and a stress fracture will often be the result. For this reason, there is a large correlation between fitness level and the occurrence of stress fractures. In other words, the more in shape you are, the better your muscles are at distributing the forces associated with running and other activities.

Women are often considered to be at a greater risk for stress fracture as well, particularly women with low levels of estrogen. Estrogen plays a role in reshaping the bone – if this mechanism is lost, the stresses of running and walking can often outpace the remodeling of the bone. Other factors involved in an increased risk of stress fracture include old, worn-out running shoes that have lost their shock absorbing capabilities, a difference in limb length, changes in running surfaces (such as moving from grass or a rubber track to cement) and differences in running style.

The symptoms of a stress fracture include tenderness over the area and pain upon activity. There may be some swelling in the area as well, though this is not as common. Your doctor will diagnose a stress fracture using these clinical signs as well as with an x-ray. Stress fractures are usually treated by reducing activity, and putting the effected leg in a non-weight bearing cast.

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

Tarsal Tunnel Syndrome

2009-08-25T10:23:00.001-04:00

What is tarsal tunnel syndrome?
Similar to carpal tunnel syndrome (the condition that affects the wrist), tarsal tunnel syndrome is compression of a nerve within a limited space. The tibial nerve is the star player in tarsal tunnel syndrome.

What is a tarsal tunnel?
At the level of your inner ankles there is a narrow space right next to the bone which is covered with a thick ligament called the flexor retinaculum. (A ligament is a band of tissue that connects bones to bones).
This ligament protects the contents of the tunnel: the tibial artery, tibial veins, tibial nerve, and the tendons of 3 different muscles.

Symptoms of tarsal tunnel syndrome
The tibial nerve is the anatomical structure that is being squeezed within the space covered by the flexor retinaculum. As a result, the symptoms of this syndrome all deal with sensation – shooting pain, numbness, tingling and/or burning.
These symptoms are located at the level of the inside ankles and may extend to the bottom surface of the foot. In other instances, the pain may radiate to other areas such as the heel, toes, and arch of the foot. The sensations caused by nerve compression may be worsened by weightbearing activities such as walking or exercising!
If you are experiencing symptoms like these, it is important to have your podiatrist check out your condition right away. If it is not treated, the result may be permanent nerve damage!

What causes tarsal tunnel syndrome?
Conditions that compress the tibial nerve are the reasons that this syndrome arises.
- Flat feet: the heel tilt outwards and strains the nerve
- Swollen or enlarged anatomical structures that lie in the tarsal tunnel along with the tibial nerve such as tendon swelling, bone spurs, or varicose veins
- The nerve itself may swell up in arthritis and diabetic conditions

Treatment
There are numerous treatment options that will help keep tarsal tunnel syndrome symptoms in check such as resting and icing the area. Pain relieving medications such as ibuprofen may also reduce the pain. Consult your podiatrist for more advanced treatment options such as anesthetic injections, bracing and or surgery.
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

The Anatomy of… a Shoe!

2009-08-04T15:14:00.010-04:00

Within every profession, there are descriptive terms to specify characteristics or locations of features on an item. For a botanist, the anatomy of a plant is crucial in determining how a plant functions and plays an important role in how it reacts to its environment. For the musician, each instrument has their own sound and frequency as dictated by its anatomy – all the parts work together! For many healthcare professionals and patients, it makes sense that the human body has its own anatomy – there’s a name for every bone, joint, ligament, tendon, organ and blood vessel. And even those structures have structures on or within them that are named or classified. Each area of study has its own focus and that focus is very detailed.

In regards to biomechanics of the foot, a podiatrist must be knowledgeable of all the structures and the geography within the foot. In addition, the anatomy of footwear is also important to know. It helps the clinician evaluate the footwear and deem it worthy or unworthy of your feet. Below is a list of the structures in a typical tennis shoe. Shoe designers and shoe manufacturers must also have an expert handling of shoe terms because they work with its creation on a day-to-day basis.

For a shoe to work, all the components must be secure, comfortable and work together in harmony. Different shoes have different functions or combinations of functions: arch support, shock absorption, balance, traction and ambulation. In addition, athletic shoes designed specifically for a sport all have properties that help the activist excel in that sport.

Below is a basic diagram of a typical athletic shoe with various parts labeled. Descriptors of the terms will follow in the next article. With a little time, you too can be familiar with all the components of a tennis shoe and their functions! Who knew that even tennis shoes had such a specific anatomy!?
All the different components of an athletic shoes work together to keep the foot protected, balanced, and optimize its performance. Athletic shoes of various sports have variations of the characteristics listed above to enhance performance of the foot.

Refer back to the diagram in the previous article to help you learn the terms and their functions in regards to their placement on the shoe!

Upper – the entire portion of the shoe that covers the foot

Sole – the entire portion of the shoe that the foot rests upon

Shoe upper + shoe sole = entire shoe

Toe box – the horizontal and vertical space near the tip of the shoe to accommodate the toes, comes in different shapes

Vamp – the upper, middle section of the shoe were the laces are located – Velcro fasteners may also be found in the vamp section

Laces – one of the common closure types of shoes (Velcro is another one) – the purpose of laces is to anchor the shoe firmly onto the middle portion of your foot

Eyelets – a round cutout in the vamp section of the shoe to allow the passage of laces, the resistant material that encircles the eyelet is called the eyestay

Tongue – a thick flap of material that sits underneath the laces to protect the top of the foot from pressure of the laces

Top line – the top edge of the upper portion of the shoe

Achilles notch – always found at the back of the shoe, this notch keeps the Achilles tendon from encounter irritation from the shoe

Heel counter – stiff material employed to reinforce the shape of the back portion of the shoe, helps with shoe fit and shoe stability

Outsole – the outsole is the portion of the shoe that directly contacts the ground

Quarter – the portion of the shoe that covers the heel and connects it to the vamp

Athletic shoes in different sports have modifications of the characteristics listed above to help enhance the wearer’s performance and to protect the wearer’s feet. For example, basketball shoes have a much higher topline (hi-top shoes) to help keep the ankle in place and reduce the incidence of ankle sprains. Soccer and football cleats have large studs on the bottom of the sole (connected to the outsole) to provide traction on the playing surface. So next time you’re in a shoe store with a friend, impress them with your knowledge on shoes!
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Green Running Shoes

2009-07-08T08:36:00.005-04:00

Running shoe manufacturer Brooks recently announced plans to release a new, environmentally friendly running shoe in 2010. The shoe, which will be known as The Green Silence, will be available to customers in February 2010, and will boast a design that is made entirely of recycled materials.

The heel cups of the shoe will be reinforced with recycled CDs, while the laces, mesh, lining, and stitching will all be made from discarded plastic water bottles. Foam from old sofas will be reused in the collar, or padded area of the shoe, and the soles will be constructed out of recycled rubber. Brooks even claims that the midsole of the shoe is entirely biodegradable, a claim which the Federal Trade Administration of the United States remains skeptical of.

Even with those doubts, the trend towards more green and eco-friendly footwear is here. Shoe brands are using sustainable materials like hemp and recycled rubber more often, and companies are using more environmentally-friendly methods of producing and transporting their products.

The recycled materials that Brooks is using for its Green Silence are coming from various countries around the world, a point that many environmentalists would make that the company is not using local resources, which would be the most eco-friendly. However, Brooks states that the transportation involved only makes up a small percentage of the shoe’s total carbon footprint.

Brooks also encourages it’s customers to donate old shoes to Soles4Souls, a non-profit organization that distributes shoes to those in need. A similar program is run by Nike, called ReUse A Shoe, where the rubber from old shoes is recycled into turf for fields and other equipment.

While it may not be possible for Brooks to please every environmentalist with the Green Silence shoe, it is certainly a step in the right direction. For years now, running shoe and apparel brands have been using more sustainable products as a way of marketing a greener product. Companies have experimented with Beachwood as a material for socks, as it is highly sustainable and has great moisture-wicking properties. Merino wool has been a very popular material in running socks and clothes, as it is a natural fiber with excellent moisture wicking and cooling properties.

Companies that use silver as an additive for its antimicrobial properties have cleaned up the manufacturing process as well. What used to be a very polluting process has been cleaned up, with fewer emissions and less pollutants.

As these products become available, customers will start to request them, and look at the materials used in the products they buy. With a trend towards sustainability and greening our routines, running brands may be leading the foot race.
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

New Drug for the Treatment of Gout

2009-06-19T10:21:00.006-04:00

This Tuesday, a federal advisory committee recommended the approval of Krystexxa, a new drug that has been in development by Savient Pharmaceuticals. In clinical trials, the drug has shown to be an effective treatment for gout.

The committee recommended the approval by a landslide 14-1 vote. The drug now must be approved by the Federal Drug Administration (FDA) before Savient can begin producing, distributing, and marketing the drug. In the past, the FDA has been known to follow the advice of the advisory committees. If Krystexxa is approved, it will be the second drug for the treatment of gout approved this year, after 40 years without innovation in this particular area. Uloric, which is manufactured by Takeda Pharmaceutical, was approved for use in February.

Gout, which is a form of arthritis, is caused by a buildup of uric acid in the body. This uric acid can then be deposited in the joints. The deposits are known as tophi. The big toe is particularly susceptible to this searing pain caused by tophi, but other joints, including joints in the hands and elbows can also be affected.

The uric acid that builds up in the body is commonly associated with diet, as it is a metabolism defect. Foods such as alcohol (especially beer), red meat, and some seafood are commonly associated with gout. For this reason, gout has often been referred to as the “disease of the kings”, as these foods were historically only available to the wealthy. However, these foods have become more and more accessible to a larger percentage of the population, making gout more common, and less known as a disease of the rich. Increased incidence of gout has sparked a new interest in the medical research community.

Krystexxa is a form of uricase, an enzyme responsible for degrading uric acid in the body. The drug works by attacking the tophi, and helping to dissolve the deposits. In clinical trials, about forty-percent of patients saw significant improvement while taking the drug. Some patients reported that the tophi dissolved completely, and that they were able to walk and use their hands again without pain.

There are some side-effects that have been reported with the use of Krystexxa, including an increase in the prevalence of cardiovascular complications and allergic reactions. Committee members state that it is unclear whether the increase in cardiovascular conditions, however, is due to the drug or due to chance, based on the small trial size. The FDA, nevertheless, is expected to approve the drug, as the striking benefits for patients with chronic gout outweigh the side-effects.

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

Shin Splints! Are They Avoidable?

2009-05-26T12:00:00.004-04:00

One of the most common injuries that runners suffer from is shin splints. Shin splints can be a very painful experience, but it is fairly avoidable and very manageable. What causes the pain is an overloading of the tibialis anterior muscle and the connective tissue that connects this muscle to the bone. The tibialis anterior muscle connects to the outside of the shin bone, and plays a crucial role in keeping the foot stable while walking and running.

Because it is an overuse injury, shin splints are most often treated with “RICE” therapy – that is rest, ice, compression, and elevation. Resting is most important, because further exercise will only further aggravate the condition. Icing the area, as well as taking over-the-counter pain relievers such as ibuprofen will help to relieve some of the pain associated with shin splints. Compression with a sock or specialized compression sleeve, as well as elevating the leg while resting will help as well.

In addition to RICE therapy, check the shoes you’re wearing when you get the shin splints. If you’re running, look at your running shoes. Do they fit properly? Are they heavily worn on the bottoms? Do they support your feet well? If you’re walking when you get them, are you wearing proper walking shoes? Sometimes wearing thin sandals while walking long distances can give you shin splints quickly.

Shin splints may be painful, but know that they are usually only temporary. It is no reason to give up the morning walk or run. One way to prevent getting shin splints to add strength training to your exercise routine. Strengthening the muscles of the calves can help prevent ever getting shin splints, as these muscles help to balance the activity of the tibialis anterior during gait. Also, wearing the proper shoes will help give your shins extra cushioning, preventing some of the impact that causes shin splints. Adding low impact exercise will also help lessen the burden on your body in general. Try mixing in swimming or biking to your exercise routine, or some low impact aerobics.

As with any injury or pain that you’re suffering from, it’s important to tell a doctor about it if it doesn’t go away with rest, ice, compression, and elevation. If the shin pain develops after a fall or other impact, a doctor will need to take x-rays to rule out a stress fracture or other type of injury.

Central Florida Foot and Ankle Center
101 6th St Nw
Winter Haven, Fl 33881
Phone: (863) 299-4551
www.FLFootandAnkle.com

Achilles Tendonitis

2009-05-12T13:21:00.005-04:00

The Achilles tendon is a continuation of the calf muscles. More specifically, it is a continuation of the soleus and gastrocnemius muscles. The tendon serves as an attachment of the muscles to the heel bone, known as the calcaneus. The Achilles tendon plays a vital role in walking, by helping to lift the heel off of the ground.

Common conditions affecting the Achilles tendon include Achilles tendonitis and tendonosis. Symptoms of both of these conditions include pain and tenderness in the area directly above the heel. This pain may be worse in the morning after a long period of rest, or with a prolonged period of activity. The pain can usually be reproduced by squeezing the tendon.

Both Achilles tendonitis and tendonosis are considered to be overuse injuries. They are commonly seen in patients who have just begun rigorous exercise programs, laborers, and “weekend warriors” – those who participate in physical activity on the weekends and may be less conditioned than more regular athletes. During these activities, too much stress is put on the tendon too quickly, which can lead to micro-tears and ultimately pain. Tendonosis refers to these tiny micro-tears, while tendonitis refers to the actual inflammation. Because the activity is ongoing, the injury to the fibers of the tendon can alter the shape of the tendon, leading to a situation of prolonged pain.

Once diagnosed by a doctor, Achilles tendonitis and tendonosis will usually be treated first with immobilization. This is generally achieved by putting the affected foot in a cast or a removable walking boot. Icing the inflamed area will help bring down some of the inflammation and relieve some of the pain – anti-inflammatory drugs like ibuprofen may help with this as well. Once the pain from the tendon subsides, physical therapy may be used to strengthen the muscles, which can help prevent future cases of Achilles tendonitis and tendonosis. Physical therapy can also be used to help improve running form. Proper footwear is another important step in preventing the conditions, as well as preventing other conditions that can develop from physical activity.

If you are experiencing pain that you think may be Achilles tendonitis/tendonosis, it is important to have your ankle evaluated by a foot and ankle specialist. Only they will be able to rule out other possible causes, and treat the condition effectively. Remember that pain is never normal, and should be taken care of promptly and appropriately.

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

Got Sesamoiditis?

2009-05-06T09:34:00.004-04:00

Got a pain in the ball of your foot? One possible explanation is sesamoiditis. Sesamoiditis is a pain in the ball of the foot underneath the big toe. This is where the sesamoid bones are located.

Sesamoid bones are bones that are embedded in tendons, and help reduce friction and act as a pulley across a joint. This makes the motion of the joint much smoother, and more efficient. The sesamoids of the great toe help to increase leverage during the toe-off phase of gait. These bones are about the size of a kernel of corn.

Sesamoiditis is most common in young, active people. It is particularly common in runners and dancers, as there is a lot of pressure put on the ball of the foot during these activities. Every time that you push off with your big toe, the sesamoid bones are involved in the movement. This can eventually lead to irritation. Since the sesamoid bones are buried within a tendon, sesamoiditis can actually be considered a form of tendonitis, as the tendon encapsulating the bones are generally inflamed as well.

Cases of sesamoiditis are usually distinguished from other causes of foot pain by their gradual onset. The pain will typically begin as a mild ache during activity, that slowly progress to a more intense, but dull, pain. Most cases do not show any apparent signs of redness or bruising of the skin. Sesamoiditis generally is caused by an increase in physical activity. This may be seen in people just beginning to run or dance, or in a runner that has recently increased mileage or intensity of their training. It is also often seen in baseball catchers, who usually put a lot of weight on the balls of their feet.

Sesamoids, like any other bone in your body, can also fracture. When your doctor diagnoses sesamoiditis, they will take an X-ray to see if the bones are fractured or not.

Treatment of sesamoiditis starts with a good amount of rest. It is important to stop the activity that is causing the inflammation. Invasive measurements are usually not necessary. Icing the effected area will help lessen the pain, as well as non-steroidal anti-inflammatory drugs (NSAIDS). Sesamoiditis can be prevented by wearing a well-padded shoe when performing physical activity. Some people may simply not have a thick enough fat pad in the ball of their foot. This may be aided by a soft metatarsal pad inserted into the shoe.

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

Annual Best Walking Cities Competition

2009-04-15T15:46:00.007-04:00

The American Podiatric Medical Association, in partnership with Prevention magazine, has just published the results of the annual Best Walking Cities Competition. Topping the list this year was San Francisco.

The Best Walking Cities Competition takes an analytical look at the 100 largest metropolitan areas of the United States, and ranks them according to various categories, such as the amount of trails and public parks in a certain area, and the percentage of people that walk for fitness.

In addition to the objective analysis, a panel of nationally-recognized experts on the subject was asked to weigh in on the competition. These experts were asked to weight the criteria, as well as to rank the cities on walkability.

The top ten cities are:
1.      San Francisco, CA
2.      Boston, MA
3.      New York, NY
4.      Philadelphia, PA
5.      Chicago, IL
6.      Washington, DC
7.      Seattle, WA
8.      Honolul, HI
9.      Portland, OR
10. Pittsburgh, PA

Walking is a very healthy activity, and one of the most popular forms of exercise out there. It is easy to do, and has been shown to decrease the risk of heart disease, stroke, obesity, diabetes, and cancer.

To read more about the Best Walking Cities Competition, check out this link to the APMA website. You can find out more about the results, including where your city falls on the list!

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

Server's Disease and Osgood-Schlatter Disease

2009-04-08T09:28:00.006-04:00

If you know a young athlete that’s having some trouble with heel pain, it may be Sever’s disease. Sever’s disease is a condition common in growing athletes, where the growth plates in the heel are subjected to repetitive microtrauma. This microtrauma, or tiny cracks in the growth plate, is the most common cause of heel pain in male athletes aged 10-14.

Sever’s disease is a self-recovering ailment. That is, with rest and minimized impact to the heel (i.e. less running) the pain will subside on its own. Symptoms include pain in the heels, especially while playing a sport or immediately following, as well as pain in the heels when waking up. The pain is also felt from squeezing the calcaneus, or heel bone.

Treatment of Sever’s disease is typically rest, ice, compression, and elevation (The R.I.C.E. method). Orthotics or heel cups are often beneficial, as these tend to reduce the shock that the heel absorbs while running and playing sports. Also, the young athlete should wear a proper fitting shoe, with firm support and a heel that is able to absorb some of the shock. Stretching the calf muscles and hamstrings has also shown to be beneficial.

Osgood-Schlatter disease is a related disease that is inflammation of the growth plates at the top of the tibia, or shin bone. Similar to Sever’s disease, Osgood-Schlatter’s is often seen in young athletes. It is different however, in that it primarily presents as knee pain. This knee pain occurs in both knees about 25% of the time.

Osgood-Schlatter disease can be attributed to overuse, especially sudden overuse, of the quadriceps muscles. This is the group of muscles that are on the front of the thigh, and act as extensors of the leg, such as the motion in running and jumping. The tendon that attaches the quadriceps to the patella (knee bone) and to the tibia ends up pulling very hard on the tibia just below the knee, causing microtrauma to the tibial tuberosity, the point where the tendon attaches. This microtrauma is what causes the inflammation of the growth plates in the tibia, which in turn causes knee pain.

The treatment of Osgood-Schlatter disease is similar to that of Sever’s disease. Rest, ice, compression and elevation are the first line of defense. Usually, there will have to be a period of at least three months without intense physical activity to allow the knee pain to go away. Following this period, it is essential to begin training slowly, so as not to re-aggravate the tibia.

If you know a young athlete that is suffering from heel or knee pain, know that this pain is not normal. A doctor can evaluate the injury, and can tell if they are suffering from either Sever’s or Osgood-Schlatter disease. Each of these conditions is treatable, and young people will grow out of these conditions.

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

Runners’ Nightmares!

2009-04-08T09:02:00.005-04:00

If you are an avid runner, chances are you have run into some kind of foot or lower extremity problems. Think about it: the action of running involves the repetitive pounding of the foot on surfaces and sends shock waves up your body.

It is important to understand that running too soon, running too fast, or running too long are the major causes of running injuries. The conditions you may experience are your body’s way of telling you to stop overworking it!

What are some common running ailments?

Stiff Calves

Novice runners may experience tight and stiff calf muscles and is intimately associated with the Achilles tendon. This tendon comes from your calf muscles and joins the heel to your leg. If your body is not used to exercising the calf muscles and associated structures, you will definitely experience an ache on the back of your leg.

Runner’s Knee

Have you ever walked, climbed stairs, or ran and felt a grinding and grating in your knee joint accompanied by severe pain? If so, Runner’s Knee may be one cause! This ailment is caused by an unstable patella. (The patella is your kneecap).

Shin Splints

Running on hard surfaces such as asphalt or concrete may lead to the development of shin splints. Shin splints is that burning, irritating pain originating from the center of your lower leg. Without rest or treatment, shin splints may progress into stress fractures!

What is the best way to treat running injuries?

Stiff Calves

Make sure that prior to starting your running routine that your calves experience a full, deep stretch. You can build up the area by rising on to your toes one foot at a time, holding that position for a count of five and then lowering it.

Runner’s Knee

The best way to alleviate this condition is to ease off of the physical activity for a week and work to strengthen the muscles around the knee. To improve muscle strength clench your thigh muscles as often as you can in sets of 5. It’s a simple way to work the muscles that connect to your patella.

Shin Splints

To reduce the occurrence of shin splints, it is advised to run on soft surfaces such as grass while wearing shoes with ample cushioning. You may have to hold off on running for an extended period of time.

Different injuries require different modes of treatment, but the tried-and-true methods always involve prevention and a good stretching regimen. Watch and pace yourself when exercising – do not overdo it! And of course, ALWAYS seek a podiatrist’s consult when evaluating the intensity of the injury and deciding on the best treatment option!

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

How do I fit a new pair of shoes?

2009-03-20T08:23:00.004-04:00

Dr’s. RESPONSE: Shoes are an important component of our attire that many people take for granted. Shoes are quite important and fitting. A new pair of shoes is not as simple as buying what you want off the shelf and breaking them in.

Our feet change throughout the day. In the morning, our feet are at their smallest because they have been resting all night long while your body has been sleeping. When we first get up in the morning, our feet also begin their long day. As the day progresses, our feet begin to swell. This is due to repetitive usage as well as the effects of gravity which pull more fluids towards our feet. Also, when our feet are hot, they begin to sweat. This obviously tends to occur more as the day goes on.

So what is the true way to find a pair of shoes? First of all, when you try on a pair of shoes, you must try them on at the end of the day, when your feet are their largest. Because our feet swell, those shoes that we try on in the morning might fit just right but may be tight towards the end of the day. Also, be sure to try on both pairs of shoes. No two shoes or two feet are exactly alike. Therefore, the effort must be made to try on both pairs of shoes to ensure that there are no fitting issues. Sometimes, inner seams can irritate feet, shoe tongues can be bothersome, and slip in pads can be poorly manufactured. Also, if you know that one foot is bigger than the other, wear shoes that fit the largest foot, not the smaller foot.

Also, a knowledgeable shoe salesman, which are becoming harder and harder to find these days, should use a Braddock device. If you recall from childhood, this is that funny oval metal thing that you used to stand in to measure your foot size. These are separate ones for men and women. Your foot should be measured while you are standing. As you stand, your foot stretches to its full length as the arch of your foot slightly flattens. Another way to gauge the correct size is that when trying on a new pair of shoes, stand up and kick your heel all the way to the back of the shoe. While standing, you should be able to press a full thumb’s width from the tips of your toes to the shoe tip. If it is less than that width, those shoes are too small.

Another important tip to remember is that, in general, dress shoes are one full size smaller than sneakers. So if you wear are 13 sneaker, your dress shoes should be a size 12. Also, for women who have had children, the general rule is that for every child you have, your shoe size may increase by one half shoe size. Finally, a good supportive shoe is one that will not bend easily from tip to heel. There should be enough resistance within the sole of the shoe to prevent this.

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 gout?

2009-03-20T08:19:00.003-04:00

A swollen, red joint in the big toe is considered a hallmark sign of gout?

True or False

Dr.’s RESPONSE: This is absolutely true. In fact, it even has its own name: podagra. Gout is a recurrent acute arthritis that affects peripheral joints, most notably the big toe joint. The condition is due to a build up of monosodium urate crystals in and around joints and tendons. Highly saturated body fluids condense and then crystallize. These crystals cause severe pain in the affected joints. It’s almost as if there a tiny needles in the joints. With each movement, those small needles scrape against the tissues, causing severe pain. Acute gouty pain is unmistakable. Patients often describe it as though they cannot even bear to have bed sheets touch their foot. Another common complaint is that the air conditioner blowing on the affected foot is extremely painful. Other symptoms include sudden onset of single joint pain, low grade fever, 20:1 male to female ratio, crunchy tophi formation, and a red hot swollen big toe joint.

Acute gout may become chronic and deforming. Chronic gout causes destruction of the joint edges and actually erodes away portions of bone. It can also lead to the accumulation of gouty tophi, a substance created by the body that resembles shards of glass mixed with cottage cheese. These accumulations can develop in the feet, hands, on the elbows, knees, ears, and even the tip of the nose.

Gout classically begins in the morning or early evening and tends to occur in previously damaged joints. The well accepted theory is that gout crystals have an aversion to warm parts of the body. But they also need a large enough area to accumulate. Therefore, the big toe joint, far away from the main heat source of the body and yet large enough to allow urate crystal deposition to occur is the ideal location for these crystals to condense. Many factors contribute to the formation of these crystals, with diet being a major contributor. Avoid organ meat, lard, sardines, alcohol (especially red wine), diuretics, and certain medications.

There are basically two kinds of gout which are the “under-excretors” and the “over-producers.” Under-excretors are those individuals that can not clear enough of the crystals from the blood stream via their kidneys. This is the more common type of gout and it is also known as renal gout. The other, less common type is known as metabolic gout. This is due to a defect in genetic enzymes. Both are treated with medications and lifestyle changes.

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

Barefoot Running

2009-03-16T13:18:00.001-04:00

The barefoot lifestyle and barefoot running is a trend gaining popularity in the running community. Opinions on barefoot running vary greatly, from “Absolutely Not” to “Absolutely No Other Way”.

The barefoot community claims that running barefoot improves the runner’s form, and eliminates problems like knee and hip pain. This is due to a change in form. When wearing running shoes, which typically have a thick padded cushion in the heel, striking the ground with the heel first sends shock all the way up the leg. This force is largely absorbed by the knee, as well as the hip and back, which can be transferred to chronic pain. Barefoot running eliminates the option of heel striking, forcing the barefooter to land on the balls of the feet, with the feet lined up directly underneath the hips. This allows the force to be displaced more evenly, avoiding common running injuries.

Many claim that the barefoot lifestyle is the only way to go. Advocates of a barefoot lifestyle claim that it is the only true way to feel the ground, and that keeping your foot in a shoe all day is bad for the mind and the spirit. Barefoot running expands into barefoot walking, even barefoot driving!

But is the barefoot lifestyle a wise decision? The opinion on the other side of the spectrum is that barefoot running and walking can lead to serious health problems. Imagine walking around barefoot all day with an “improper” form, striking with your heel. This would lead to some serious heel pain. Also, a barefoot lifestyle offers no protection against the elements, and no protection against debris that may be on the ground. Puncture wounds on the foot can lead to serious infections.

Still, even with the obvious thought that a barefoot runner’s feet would get chewed up by the elements and terrain, barefoot running has a significant following. In fact, many bare footers prefer a rough terrain like asphalt to a soft terrain like grass or sand! There has been much reporting on the barefoot lifestyle, including this article found in New York Magazine, which discusses the idea of shoes wrecking our feet by wearing shoes. There are websites devoted to a barefoot lifestyle, like the Society for Barefoot Living and RunningBarefoot.org.

While many may shudder at the thought of walking to the store with no shoes on, or running on a city sidewalk barefoot, there are those who would have it no other way. Which side of the fence are you on?

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

Are Running Shoes Good for Walking?

2009-02-18T11:20:00.003-05:00

As a general rule, running shoes are good for walking, but walking shoes are not good running shoes. Podiatrist Bob Baravarian, Chief of Foot and Ankle Surgery at Santa Monica-UCLA Medical Center and OrthopedicHospital, says that walkers should look for a pair of comfortable, easy fitting shoes that combine stability, cushioning, and some flexibility to correct stride problems. The right shoes can prevent or alleviate the three most common overuse injuries walkers suffer: plantar fasciitis (pain in the heel), Achilles tendonitis (pain from the back of the heel up the calf), and posterior tibial tendonitis (sore arch or inner ankle).

DR.'S RESPONSE: Remember that when you go shopping for shoes to do it later in the day. This is because as we walk during the day and because of dependency, our feet tend to swell as the day progresses. Therefore, you should buy your shoes when your feet are their biggest. Also, there is a great disparity in sock thickness. So when you go shopping, you should wear socks that you would normally wear with those types of shoes. check out our online store for shoes

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

Cracked Heels

2009-02-18T11:19:00.001-05:00

CRACKED HEELS ARE NOT ONLY A FASHION FAUX PAS, they can be very painful...

THE CAUSE: The most common cause is open backed shoes. They offer limited stability and toes are forced to claw to keep the shoe on. This contributes to the foot rolling in which can create callus formation and cracking. There’s also the theory that continual slapping of the shoe against the heel can contributes to cracking.

THE CURE: Wear shoes with a strap around the heel or ankle to offer stability and decrease callus formation. Use a foot file weekly and a foot cream which contains a salicylic acid. If this fails you should see a podiatrist for a professional treatment.

DR.'S RESPONSE: Cracked heels are painful because they are really a result of overly dry feet. These sores are like having small cuts on the back of your heel. Because our heels are constantly in contact with shoes when we walk, this repetitive motion exacerbates the condition. The best treatment is to use a product call Carmol 40 or Kerasal. Both products are made of urea, an emollient that helps soften and moisturize your skin. Apply to affected areas three times a day, followed by the application of socks to lock in the moisture. You should notice a difference after 1 week of treatment. Try to apply after taking a shower or bath as well. After 1 week of treatment, apply to affected area twice daily and then down to once daily for maintenance.

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

Average person will walk 115,000 miles in his/her lifetime

2009-01-23T15:58:00.016-05:00

The average person will walk 115,000 in his/herlifetime. 75% of Americans will experience footproblems at some time in their lives.

Women are three times more likely to experience foot problems than men. Certain conditions, if untreated, can cause painful foot deformities which must be corrected surgically.The average person takes 8,000 to 10,000 steps a day. Each step exerts a pressure as much as three to four times a person's body weight on the feet. During an average day of walking, the total forces on your feet can total hundreds of tons. Your Podiatrist can help your feet remain healthy and pain-free despite hard use.

Diabetics are especially vulnerable to serious foot problems because of the reduced circulation and diminished sensitivity to foot pain which often accompanies Diabetes. If not properly cared for, even small problems like cuts or cracks can develop into serious conditions such as ulcers or even gangrene.

Several systemic diseases are sometimes first detected in the feet. Included are Kaposi's Sarcoma, an AIDS-related illness; diabetes, certain circulatory disorders, anemia, and kidney problems. Gout, a particularly painful and debilitating form of Arthritis, often attacks the foot joints first.

Hereditary deformities, if diagnosed early enough, can often be corrected or managed in a way which will prevent them from becoming crippling conditions later in life. For this reason it is especially important that your children's feet be professionally assessed at birth.

Even simple ailments like corns and calluses, if improperly diagnosed and treated, can lead to severe discomfort. Improper or inappropriate use of home remedies, or even over-the-counter medications, can turn a small problem into a big one, or worse yet, mask the symptoms of a more serious condition.

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

New Treatment for Chronic Heel

2009-01-23T15:35:00.013-05:00

New Treatment for Chronic Heel Pain (Plantar Fasciitis) and Tendinitis of the Foot and Ankle

Heel pain represents 15% of adult foot complaints, 25% of foot injuries and 8% of injuries to runners and competitive athletes. Chronic heel pain and painful tendinitis of the foot and ankle affect countless people limiting their ability to walk, work, participate in sports and enjoy life. The Topaz™ Microdebrideris an innovative medical device developed by ArthroCare to treat both. Using a minimally invasive approach, the Topaz™ procedure uses Coblation technology to preserve and restore the normal anatomic structure of the damaged tissue while delivering a precise amount of radio frequency energy to stimulate an immediate healing response.

What is the plantar fascia?
The plantar fascia is a very thick, inelastic ligament that attaches from the heel bone to the ball of the foot. The plantar fascia functions like a bowstring to support the arch while standing, walking and running.

What causes plantar fasciitis?
85% of people with plantar fasciitis have poorly aligned feet from arches that are either too high or too low. Poorly aligned feet allow excessive tension to develop in the plantar fascia. As the arch lowers during standing or walking, inflammation occurs as the ligament begins to tear away from the bone. Repetitive activities that stress the ligament, such as jobs that require prolonged walking or standing on hard or irregular surfaces or from sports such as running cause overuse (like tennis elbow), which leads to pain, stiffness and swelling.

In the early stages, people think it will go away because they feel pain when they get out of bed in the morning and it dissipates during the day. And for some, it resolves without treatment. For others, however, the pain increases in intensity causing them to limp.

What happened to the plantar fascia?
With chronic overuse the ligament cells become damaged and are replaced by scar tissue. This scar tissue is inelastic and hypo vascular (no blood vessels), so oxygen and nutrients necessary to heal the damaged tissue can't be absorbed properly. Additionally, production of two key growth factors has stopped, both of which are required to recruit healthy fascia cells (fibroblasts) and encourage new blood vessel formation into the damaged area. In as little as 3 months, the damaged ligament has become very thick (3-5 times normal) and now behaves like a soft-tissue mass pressing on delicate nerves causing even more pain and disability.

Professional treatment is usually required in 1-2% of the population just to be able to stand at the sink to wash dishes, let alone work, walk or play sports. Fortunately, non-surgical treatments, including Shock-Wave therapy (ESWT) are extremely effective at curing heel pain in the majority of patients. However, for those patients who have heel pain resistant to conservative treatment, this new, FDA-approved minimally invasive surgical procedure has been shown to resolve >95% of our patients chronic heel pain over the last 21/2 years since its application in our practice. Additionally, patients with chronic Achilles tendinitis as well as other tendon disorders have also benefited from this procedure.

Why is Topaz™ better the traditional surgery?
Most radio frequency-based surgical instruments such as lasers use heat-driven processes to remove or cut tissue. Coblation-based devices operate at a significantly lower temperature, allowing for more precision than would be expected by using traditional surgical tools. Coblation technology gently dissolves target tissue, minimizing damage to surrounding healthy tissue. Because TOPAZ™ is minimally invasive and induces a rapid healing response, only a small incision is required which provides for a significantly shorter recovery time.

This is very important and exciting news for those patients who live healthy and active lifestyles. Our practice continues to utilize the latest non-invasive and minimally invasive techniques for eradicating heel pain and we have extensive experience with state-of the art technologies to get patients pain-free and back on their feet quickly. For more information on the Topaz procedure, please contact our office at 863-299-4551.

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