Staying Hydrated While Running

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

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

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

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

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!

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?

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

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!

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

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

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?

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

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?

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

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

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!

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