Joints Under the Weather??

Ahhhh. The leaves are turning, the gym junkies are getting back outdoors to exercise and the weather is, well, unpredictable! And so are the joints!! This is the time of year where your foot and ankle specialists here at FAANT are seeing an jump in the number of patients who cannot keep their joints from aching! Good and bad days are here again!

So is it true that weather affects the joints? Surprisingly, there is not a lot of research on this subject. We have to look back at a study performed in 1961 by arthritis specialist Dr. J Hollander. He tested 12 patients in a climate chamber he built and discovered that low barometric pressure and high humidity caused an increase in pain and stiffness in joints. Each weather change individually, however, did not. This study had a very small number of patients, but it is true that there seems to be a certain number of people with arthritis whose symptoms are influenced by these climate changes. Is one of them you? How can we help?

While it is easy to tell you to control your symptoms with anti-inflammatories and rest, little is said about controlling your environment!

We can treat weather in the same way we treat environmental allergies. Many people stay indoors whenever there is a high count to whatever they are allergic to.
The same can be helpful when your weather trigger is present. Remember, individual environmental changes are not have as much infulence as the combination of the weather changes (ie: pressure and temperature). If you can identify what combo affect you, you will know when to limit outdoor time in these environments. I have many patients purchase a temperature gauge that also shows pressure and humidity to help find what their trigger is. Just as many of them have changed the humidity and temperature in their homes during certain times of the year when they consistently show flare ups. It does make a difference!

For others, it is more of a muscle cramp or spasm that worsens an arthritic joint. If you fall into this group, know that when the temperature drops, you need to properly warm up your muscles with stretches and slowly progress into the exercise. In other words, if you like to jog, start off with a brisk walk before you start jogging.

Weather also plays a role in joint pain with systemic conditions such as Raynaud’s phenomenon and Lupus.

Raynaud’s phenomenon in particular can be seen in a number of arthritic conditions such as polymyositis, scleroderma, systemic lupus erythematosus, rheumatoid arthritis and mixed connective tissue disease. When the weather turns cold, the small blood vessels in the extremities constrict, causing not only the digits to temporarily lose some circulation, but can in turn cause the joints to become stiff and painful as a result! Avoiding drastic changes in climate can make a big difference in this group of people. Though it cannot be said for all arthritic patients, if you have this condition, and it is severe, you may actually benefit by moving to a warmer climate.

Systemic Lupus Erythematosus without Raynauds could benefit from cooler climates. These patients are very sensitive to sun exposure. Exposure to ultraviolet light can trigger inflammation to internal organs, including the joints. If you fall into this group, limit sun exposure and protect with sunscreen and clothing.

If your feet or ankles are feeling “under the weather”, visit with your podiatrist and let them evaluate you! You may just end up discussing the weather!!

Snap, Crackle, Pop....My Ankle Hurts!

Snap, Crackle, Pop. Ankles are not supposed to make that noise.

It softball season and you just attempted to slide into second base and you managed to twist your ankle. You have done this before but this time it was followed by an audible snap you have not heard before. Oh yeah, and don’t mention that strange lump at the ankle you did not have this morning. You treat it like you have treated your previous ankle sprains, icing, elevation and trying to walk a little more gingerly, but it has not gotten better after several days, and any pressure to your foot is excruciating and unstable.

You may have an ankle fracture. Ankle fractures can typically occur during a violent injury like a car accident, fall from a height, or twisting motion of the ankle. The ankle consists of three bones that are bound to each other tightly by ligaments and allow motion of the foot up and down to allow for normal running in walking. When a fracture occurs the normal alignment of the bones of the ankle is lost as well as ligament integrity and instability, and pain ensues.

Ankle fractures need to be diagnosed and treated as soon as possible in order to provide the most appropriate treatment. Minor fractures can sometimes be treated with a period of immobilization while more major unstable fractures require surgery. If an ankle fracture is left untreated it can lead to chronic instability of the foot and ankle as well as chronic pain from arthritis.

Typical recovery from fracture to a normal shoe is around three months, so if you don’t want to miss next year’s softball season or possibly every softball season in the future, see a podiatrist immediately after any ankle injury.

FAANT Popularity Contest

Dr Crane and Dr Giacalone had a bet going on in the office on who has more patients that love them! They challenged their Facebook friends to rate them on Google Places and Yelp! They tied after the first round (figures), and the other docs wanted to get in on the friendly wager (winning doctor gets dinner at the Silver Fox), so this is your opportunity to help your favorite FAANT doc (and win a free pair of running shoes or comfort sandals or slippers from Healthy Steps)! Contest ends November 1st at 7am! Here is how it works: Help your favorite FAANT doctor win by posting a review to Google Places formerly known as Google Local. If you post a review of the practice and/or review just the doctor (click on their name) Crane, Giacalone, Karpati, McCreary, Steinke and email the contest administrator a copy, they will enter you in a drawing for a free pair of Brooks running shoes or a pair of orthopedic sandals or comfy slippers from Healthy Steps Shoe Store. You can get two entries if you do both the practice and a doctor individually. We will even throw in a third entry if you review the practice on Yelp! Contest starts right now and ends on Novemeber 15th at 7am! We will keep all of you updated on how the contest is going so please help your favorite doctor win!!

Knowing When to Say Uncle When Treating Fire Ant Bites

Almost every fire ant attack story begins with, “I was minding my own business” and usually ends with “I never thought such a little bug could cause so much pain,” or some variation of the above. Fire ants are unfortunately something you have to learn to live with, and avoid, if you live in the Southern United States. Avoiding them can be easier said than done because they usually attack without any harassment.

When fire ants attack they inject a venom into the skin using their stinger, as if biting us wasn’t enough of a warning to stay away. This venom is theorized to induce more ants to bite so the most important thing you can do is to move to a safe area, quickly. You’ll need to brush the ants off because once they latch on they don’t usually let go easily.

The venom increases the pain of the bite making it feel like your foot or leg is on fire, hence the name fire ants. Bites usually form small red bumps, but can form small pustules that can become infected.


What to do if you are bitten/stung

• This usually goes without saying, but step off of the ant hill and move to a safe place.
• Cleanse the bite area with soapy water for several minutes and then pat dry.
• Apply antiseptic to area like hydrogen peroxide or betadine(iodine) solution.
• Apply icepack to reduce pain and inflammation.
• To reduce itching apply hydrocortisone or another over the counter steroid cream to areas of bites. Calamine lotion can be used as well, or baking soda mixed 3:1 with water. Apply twice daily.
• DO NOT POP PUSTULES!!! Popping pustules can force fluid into deeper tissues inducing infection.
• If pustules form you can apply antibiotic ointment like Neosporin to lesions.
• If redness spreads or pustules become very large, SEE A DOCTOR IMMEDIATELY!!!
o Infection has probably set in and antibiotics or stronger topical medications may be required.

Allergic Reactions

o Mild reaction - If you experience swelling and redness to site this may indicate an allergic reaction to bites, and over the counter Benadryl can help to reduce this reaction

o Severe Reaction – This is a medical emergency. You should call 911 or go immediately to the Emergency Room. Symptoms include:
 Difficulty Breathing
 Swelling of lips, throat or tongue
 Dizziness
 Faintness
 Confusion
 Rapid Heart rate
 Hives all over body
 Nausea, Vomiting and Cramping

Most cases of fire ant bites resolve on their own with time, usually after a few weeks spots are gone. Diabetics should see a doctor ASAP to help prevent infection if bitten. Recognize your limitations, and if conservative therapy is not working contact us for an appointment.

Ryan Howard Has Torn His Achilles Tendon

If it isn't hard enough to take a loss that exits your team from the MLB postseason, first baseman Ryan Howard of the Philadelphia Phillies ruptured his Achilles tendon. With two outs, Ryan hit a ground ball to second base resulting in an easy play at first sending the Cardinals to the NLDS. What was out of view of the play was the injury that occurred to Ryan as he tried to advance to first base. As he planted his foot to advance he crumbled to the ground. Several attempts were made to get back up and run but he was just unable to push off of his left foot. He described his injury as follows.

"I was trying to run, and I just felt this pop," said Howard. "The whole thing just went numb, like it was on fire. Just tried to keep going, and went down. It literally felt like I was on a flat tire. I tried to get up. Couldn't go." He also said, "[I] didn't have any pain. I think it was flexed trying to come out of the box. It felt like the bat hit it."

Ryan had been suffering from Bursitis near his Achilles tendon and had been given a cortisone (steroid) injection in the area to reduce inflammation and pain prior to the playoffs.

It was almost like Ryan Howard had read the textbook on Achilles tendon injuries by the way he described his injury. Ironically many people who injure this tendon describe the injury like being hit with a baseball bat, then loose the ability to flex at the ankle and can have a burning sensation. An MRI has confirmed the diagnosis of rupture.

Achilles tendon ruptures occur when one plantarflexes the foot rapidly, which is a downward force at the ankle, or when a rapid force is applied to the foot forcing it upwards while flexing the calf muscle simultaneously.

The motion alone usually does not cause the injury, but usually involves one of the following problems

1) Overuse of a diseased tendon, or overuse in people with a weak calf muscle. Your typical Weekend Warrior.

2) Use of a group of antibiotics called fluoroquinolones. Usually just taking the medication is not enough, a rapid ankle movement is needed as well.

3) Finally, the use of cortisone(steroids) near any tendon can result in rupture. Cortisone temporarily inhibits the normal healing process of the tendon.

In Howard's case, his injury is probably a combination of a diseased tendon and injection of cortisone in close proximity to tendon.

Howard is in for a long recovery. In a complete rupture of the tendon, surgery is required to repair the tendon and recovery will likely take 6 or more months.

Unfortunately for Ryan and the Phillies organization, don't expect to see Howard rounding the bases at the start of the next MLB season.

1 in 5 Women in Grapevine Will Suffer From a Fracture

Everyone hears their grandparents, parents or someone they know talk about having osteoporosis.  But what is it?  Osteoporosis is a loss of bone density causing a thinning of the bone.  Density of bone is what we call the structure of bone making it strong.  The less dense the bone, the weaker it gets.

This only happens in those 85 or older, right? 

This is not a disease of the very elder population only.  It mostly effects women over the age of 50.  Last time I checked, 50 does not count as elderly!  It is estimated that HALF of women over the age of 50 will have a hip, wrist or spine fracture in their lifetime.  Researchers estimate that 1 in 5 American women over the age of 50 have osteoporosis.  Men can also have osteoporosis, but this usually occurs after 70.

What causes osteoporosis?

There are 2 minerals that are necessary for bone strength, calcium and phosphate.  The imbalance between these two can cause a loss of bone density.

• if your body doesn’t absorb enough calcium from your diet
• if your body actually pulls calcium and phosphate out of your bone for other purposes (yes, it can do that!)
• reduced estrogen in women after menopause
• a drop in testosterone in men
• sedentary lifestyle or bed confinement
• chronic disease like Diabetes, Rheumatoid Arthritis, eating disorders
• chronic steroid use
• vitamin D deficiency

There are some at greater risk than others.  Those who have a family history of osteoporosis, a low body weight, smoking history or excessive alcohol intake can all increase the risk of osteoporosis.

Ok, so what? What’s the big deal about osteoporosis?

Because of the lack of structure to the bones, they become weak which can lead to fractures.  In the advanced stages, fractures can happen from a simple thing like getting out of bed in the morning.  It often does not take a lot of trauma, if any.  These fractures can occur anywhere, but most commonly occur in the neck, low back, hip, wrists and feet.  The bones are often painful and fractures of the spine cause stooping and dysfigurement.

How do you know if you have osteoporosis?

The easiest way to find out is a bone mineral density test or DEXA scan.  In some instances a regular xray can detect some changes in bone, but a DEXA scan is the gold standard.

So what do I do now?

If you have any of these risk factors, then talk to your doctor about a bone density test.  Increase the calcium in your diet, but you must combine it with vitamin D which helps your body absorb calcium.  Exercise is a great way to reduce fractures.  Walking, dancing, weights, yoga, biking...all great forms of exercise that help maintain bone strength.

If you are concerned about pain in your foot and think it may be related to your osteoporosis, visit us now for more information.

Knee Pain Go Away. Patellofemoral Pain Syndrome (PFPS)

Stop trying to convince yourself knee pain is a normal part of running. That aching pain just means I am working hard, right? Everyone’s knees hurt after sitting for long periods of time, I think? Knee pain when running hills or squatting is normal?

That deep ache you feel deep inside of your knee could be caused by a condition called patellofemoral pain syndrome (PFPS). Pain is caused by abnormal tracking of the kneecap (patella) in the front of the knee leading to abnormal friction between the kneecap and the thigh bone (femur). While there is some argument among doctors and researchers on what leads to the abnormal tracking, the friction between these bones in PFPS is most frequently attributed to the following three problems.

Knock knees (genu valgum)

For those of us who have knees that point slightly inward, this allows the quadriceps muscle to pull the patella laterally leading to rubbing in the joint.

Flat feet (adult acquired flatfoot)

When people have flat feet this leads to rotation of the leg bone (tibia) below the thigh bone (femur). This results in abnormal tracking of the kneecap.

Weakness of quadriceps muscle

The quadriceps is composed of 4 muscles. Weakness of one or more of these muscles can lead to poor tracking of patella.

What do you do if you think you have this problem?

First of all, take it easy. Pain is not a normal part of any training program. Relative rest is important. Pain is usually pretty predictable with this condition the pain usually begins after overuse, so rest before it becomes painful.

Try another form of cardio like swimming, biking or the elliptical.

Run on soft more forgiving surfaces like a rubber track.

Keep your affected knee(s) extended when at rest. Knee flexion can illicit pain when at rest. Get up and walk around every once and a while.

See a professional. Some knee pain can be caused by more serious conditions within the knee that can be diagnosed by a physician.

Icing knee for 20 minutes after exercise and taking anti-inflammatories can reduce swelling and pain but does not treat cause of condition.

Orthotics. Orthotics can be helpful to help support those with fallen arches when placed in appropriate running shoes.

For those with week quadriceps muscles or knock knees, strengthening of muscles can often help reduce rubbing in knee and improve tracking.

Strengthening and stretching. General quadriceps strengthening can be performed by extending the knee and holding muscle contraction for 10-20 seconds and repeat 10 times each leg. It is very difficult to isolate one muscle of the quadriceps.

Hamstring stretches can also be helpful for those with tight hamstrings which can lead to abnormal pressure to the patella during exercise.

Weightlifting can be helpful if it isolates the quadriceps muscle. Avoid exercises like squats which can aggravate condition.

Support. Knee supports designed to alter abnormal patellar movement are available, however, their effectiveness is controversial. Physical therapists and trainers can also tape the knee to reduce friction.


If you are suffering knee pain don’t wait until it is too late to see a professional. Untreated PFPS can lead to more serious condition that lead to permanent cartilage damage.