This Little Piggie Wants to Go to the Market! (but can't because of chronic pain!)

I know, I know! We wish all our “piggies” (or our feet for that matter!) were always in good enough shape to go to the market! So why are you not better already? Have your feet been hurting you for a while? Did you think you could just shake it off or work through the pain? Maybe in the past that was the case. Why would it be any different now?

The difference is that if you have had pain for months, you are most likely suffering from a chronic injury. A chronic injury is an injury that will not get better because the body is essentially ignoring it!

When you are experiencing a “foot first hurt”, when you first notice pain in your foot, the body has recruited and shipped down its repair “squad” of cells (known as “inflammatory”cells) that work actively to try and make it better. If the foot is properly treated off the bat, more likely than not, the squad will get it healed. Realistically, unless you are a podiatrist, most of us may not fully understand the nature of what is causing the hurt. The result is that we may not fully give our foot the exact attention it needs and, unfortunately, sometimes these healing cells need outside help!

The moral of this story is basically, if you think you are doing what your foot needs to get better and two weeks later it is still not better, don’t wait the month before you see a podiatrist! Getting feet better (and ankles too!) is what we do and we are GOOD at it! Let us help find out what for sure is causing your pain! Believe it or not, sometimes just plain old wear and tear can actually cause a hairline fracture in your foot even though you may not have done anything excessive to cause it!! We can get to the bottom of what is going on. We want to get you, and most importantly, KEEP you on the right track, so your body can do what you want it to do best: keep you up and running again!

What Does an Achilles Tendon Tear Look Like?

You have probably read several articles and heard on the news multiple times about someone famous tearing their Achilles tendon.  This is no simple fete.  The Achilles tendon is the largest tendon in the leg and the force it takes to tear it has to be significant.  Often it is a force that causes the foot to come up towards the leg sharply, causing tremendous stretch of the tendon.  When this occurs, you feel a pop in the back of your leg and often describe it as being hit by a baseball bat or getting shot with a gun.

I have many curious patients who have these types of injuries and they always want to know what it looks like.  So in a recent surgery to fix this rupture, I took a couple of pictures.

In this picture, the stringy thing in the center of the incision is the ruptured Achilles tendon. You can see how large the tendon actually is and there is an obvious tear straight across the tendon.  Also note that there are multiple tears running longitudinally along the length of the tendon.  This gives it the "horse tail" appearance that we often use to describe the tendon after rupture.  

This picture shows how traumatic a rupture can be with significant bleeding and trauma to the tissues.  In this particular case there was also a large bone spur present prior to the injury which caused the tendon to be thicker than normal.  For this patient, the majority of his tendon was degenerative and there was minimal healthy tendon available for use.  So in this case, the tendon was replaced with a graft.  But in cases with healthier tendon, often repair can be done by just sewing the two ends back together if it is repaired quickly.

Recovery for this traumatic event is lengthy, but once healed this patient will return to digging holes, climbing trees, running or anything else they feel comfortable doing.

Chemotherapy Effects on the Feet

Cancer is a difficult thing to deal with.  Once you are diagnosed, there are so many decisions to make regarding your treatment options.  And if chemotherapy is in your treatment plan, your oncologist will describe the side effects and complications as well as the benefits.  But so often, you don't hear about what happens to the feet and legs from chemotherapy treatments.  What you will read below does not affect everyone undergoing chemo, but will help you understand what's happening if it does.

1.  Tinea pedis or athlete's foot
A couple of my patients have described this as "wicked athlete's foot".  It often presents as multiple small red blisters that can be filled with a clear fluid and itches like mad.  As your immune system is lowered by the therapy, your ability to fight off fungal infections is reduced. This type of blistering athlete's foot can also be very painful.  And the open areas can become infected. The best option is to use an antifungal gel instead of cream to dry the areas and kill the fungus.  We will attempt topical therapy unless the infection is so bad that pills are necessary.  Often a short course of oral antifungals is all it takes, usually less than 2 weeks.

2.  Paronychia or infection around the toenails
The skin around our toenails is full of bacteria which naturally occur on the skin.  In a patient with a lowered immune system, this bacteria can overgrow and cause redness and swelling around the nail borders and cuticle area.  The more swollen the skin gets the more likely an ingrown nail can occur.  Wash your feet and toes daily with soap and water and don't forget to get between your toes.  If you are noticing redness around the nails, topical and oral antibiotics are your best option preventing serious infections.

3.  Nail discoloration and loss
Increased stress on the body can often be seen on our toenails, just like the rings on a tree.  After significant events like major surgery and chemotherapy, the nails can become brittle, yellow, crumbly and actually just fall off.  Sometimes the color of the nails can be quite intense like blue or purple or red.  Don't worry to much if your nails change or fall off.  Often within 1-2 years after you have finished your treatments, the nails regrow.  But beware, they may look a little funny.

4. Edema
Excess swelling of the legs (and arms) can occur with cancer treatments and should be addressed by your oncologist as soon as it is discovered.The more swelling you have the more painful your extremity can be, thus making you feel worse than you already do. Oral medications can help with the swelling as well as compression garments.   It is very important to bring this swelling to your doctors attention as it could be caused from a DVT, deep vein thrombosis, or clot in your leg.  These can be serious and need immediate attention.

5.  Ulcers
Increased pressure to the heels from sitting or laying in one position too long can cause a sore or ulcer. Certain cancer treatments like radiation can also cause sores. And if you are diabetic or have neuropathy or poor circulation, you are at high risk of ulceration. While undergoing any type of treatment for cancer, if you develop a sore on your skin, it needs to be addressed right away.  This can become infected quickly and just putting neosporin or vaseline on it isn't going to help. Wound care from a wound care specialist is your best option at preventing severe infections and complications.  The team at FAANT are experts in lower extremity wound care.

If you are reading this and you or a loved one have cancer, we wish you a speedy recovery.  And we are here for all your foot and ankle needs to help you through this process.