Foot and Leg Cramps Driving You Crazy?

Foot and leg cramps can be caused by all sorts of things. Nighttime cramps are usually a sudden spasm, or tightening, of the muscles in the calf, arch and toes. They often occur just as you are relaxing and falling asleep or when waking up. The cause can be mysterious in many cases.

Muscle cramps can be caused by many condition and activities. Here are 10 of the most common:

1.       Exercising, injury or overuse of muscles

2.       Standing on hard surfaces or sitting in an awkward position for a long time.

3.       Peripheral arterial disease (PVD)

4.       Abnormal foot biomechanics like flat feet or really high arches

5.       Kidney or thyroid  disease

6.       Multiple sclerosis

7.       Peripheral neuropathy

8.       Lack of potassium, calcium, magnesium and other mineral in your blood

9.       Dehydration

10.   Many medications including diuretics, birth control pills, statin, steroids and antipsychotics

How can you eliminate the cramping?

1.       Massage and stretch the muscles involved

2.       Soak your feet in warm water or take a warm bath

3.       Stretch the areas

4.       Take a walk

5.       Over-the-counter anti-inflammatories like Advil or Aleve

6.       Drink plenty of fluids, especially an electrolyte solution like Gatorade can be helpful

7.       Wear supportive shoe gear and talk to your doctor about arch supports or custom orthotics if you feel it is foot fatigue related

How can you prevent muscle cramps?

1.       Drink plenty of water and other fluids

2.       Limit alcohol and caffeine, especially on hot days

3.       Eat healthy foods rich in calcium, potassium and magnesium

4.       Take a multivitamin every day

5.       Exercise every day, especially walking, running or riding a bike to move your muscles

6.       Stretch on a regular basis, as well as before and after exercise

7.       Don’t suddenly increase your exercise regimen. Don’t increase by more than 10% each week.

8.       Tal k to your doctor about any new medications that you are taking that may be causing the cramping.

If the cramping keeps occurring even though you are doing all of these things, a thorough exam is needed to assess for peripheral arterial disease, peripheral neuropathy, thyroid and liver disease as well as any underlying biomechanical problems that may be causing cramping. Foot and leg cramps are never normal, so don’t ignore them!

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Acute Vs. Chronic Heel Pain: New Treatments Available

Dr Marybeth Crane discusses acute versus chronic heel pain in this informative video. It is important to understand the difference between acute plantar fasciitis and chronic plantar fascists and their treatments.

Is Bunion Surgery Worth It?

Is Bunion Surgery Worth It?

Interesting question that can be answered yes and no.

Yes, if you have pain every day in your foot around the bunion and it is keeping you from doing the things you want to do.

No, if you just think the bunion is ugly and it is keeping you from wearing cute shoes.

In general, surgery for bunions is only recommended when pain from the bunion prevents a patient from wearing normal shoes and performing their normal daily activities. If your bunions only hurt when you are wearing pointy toed, high heeled shoes; surgery is not your best option. You should try padding, wider shoes, orthotics and injections; as well as much more sensible wider toe box, lower heeled shoes.

There is a common misconception that surgical treatments for a bunion are better and quicker than non-surgical treatments. Unfortunately, patients who rush into surgery may have unrealistic expectations, and may be unsatisfied with surgery.

Patients considering bunion surgery should understand the following about surgical treatments of bunions and also dispel some common misperceptions or myths about bunion surgery:

Myth #1: It is a common myth that bunion surgery is often unsuccessful or “botched”. This is simply not true. Almost 95% of patient surveyed 6 months after bunion surgery would not only do it again, but would recommend it to their friends and family. That’s a pretty good success rate. Patients must have realistic expectations. Bunion surgery can be helpful at relieving pain, but patients should not expect to have "perfectly normal" feet after surgery. And surgery cannot make your foot fit into a 4 inch heeled shoe comfortably.

Myth #2: Bunion surgery is extremely painful. Again, simply not true. Bunion surgery is not particularly "more" painful than other surgeries.  There is pain after surgery, but most patients only require narcotic pain medication for a few days after surgery then use anti-inflammatories to control their discomfort and swelling. Foot surgery, in general, can lend itself to increased pain post-operatively because the foot is below the level of the heart and blood can rush to the area, causing a throbbing feeling. This can be well controlled with a post-operative pain management program.

Myth #3: Bunions come back even after surgery. Again, not true. A majority of patients are satisfied with their outcome after bunion surgery. Recurrence is possible, but not particularly likely. And, return of a bunion is not necessarily a complication, but something that can happen over time. Some patients have excessive motion in the foot that may predispose them to recurrence. This is why functional foot orthotics are needed in many patients post0operatively to control foot function. Another possible reason for recurrence occurs when a procedure that was performed did not best suit the severity of the particular bunion -- so it's important to have the surgery tailored for your particular bunion. Discuss this with your surgeon or get another opinion prior to surgery.

Myth #4: Bunion Surgery = cast and crutches for months. While this was true years ago, more modern techniques have allowed surgeons to mobilize patients quicker. Mild bunions typically involve walking in short walking boot cast for one month, then a sneaker for another month. Surgeons consider casting with crutches with larger bunions because setting the bones is more complex. Some surgeons have moved away from bone cuts and instead perform a fusion procedure that allows for realignment of the entire deviated bone. This fusion procedure is called the Lapidus Bunionectomy, and contemporary approaches allow for early protected walking at four to six weeks postoperatively. Recent technological advances in medical implant devices have also helped surgeons modify their techniques to get patients moving quicker.

Myth #5: You have to be off work. This, again, is simply not true, and a function of the demands of your workplace. A patient can return to a sedentary desk job within a week of the surgery, and varies based on surgeon protocol and type of bunion surgery performed. Jobs that require excessive walking, standing and physical activity may require a medical leave of absence -- which can be up to two to three months depending on healing and job requirements. Getting around can be difficult and driving may be off limits if you have your right foot operated on and/or drive a manual. Job demands of a pilot certainly differ than those of a secretary.

Myth #6: Don't fix a bunion unless extremely painful. The concern with surgically correcting a non-painful bunion is that the surgery can result in longstanding post-operative pain that may not have been there prior. The old rule-of-thumb, if it ain’t broke, don’t fix it. However, people do have surgery for non-painful bunions if the bunion interferes with activity, continues to become larger, or if they have difficulty wearing certain shoes. Surgeons strongly prefer that patients have a painful bunion before they consider surgery. Fortunately, pain is the most common reason people seek treatment.

Myth #7: Bunion surgery results in ugly scars: Surgical healing is part of the process with any surgery, and bunion surgery is no different. Incisions can be minimized, or alternate surgical approaches may be used to hide surgical scars. Bunion incisions are usually located on the top of the foot and technique varies based on surgeon. A surgeon may perform a plastic surgery-type closure to keep scaring minimum. Decreasing swelling, avoiding infection in the postoperative period, and scar cream can also minimize scars.

Bunion surgery, just like any surgery, has its share of myths. Basically, because not all bunions are treated the same, information that may apply to someone with a large bunion may not apply to someone with a small bunion. Take the time to discuss your reservations and alternatives with your surgeon. Often you will find that myths like the 7 discussed are just simply not true. 

The majority of patients, having bunion surgery for the right reasons, end up with a good to excellent outcome and would tell you that bunion surgery is definitely worth it!

So You Think a Broken Toe Isn't Serious?

So you think a broken toes is no big deal? Just last week I had a runner come in 6 months after breaking her 5th toe by kicking a shopping cart. She didn't have it x-rayed because in her words, "I didn't think there was anything you could do for a broken toe".

Here she was six months later because not only was she having a hard time fitting her still swollen toe in a high heeled shoe for work, but now it was bothering her in her running shoes. Pain when running will always bring a runner in the office!

What had happened is that she had an oblique fracture of her proximal phalanx which was displaced and healed in an abnormal position. In English, she broke her 5th toe and the bone healed crooked making a big lump that rubbed on her 4th toe causing a blister then a large corn in between the toes.

These types of corns known as "heloma molle" are very painful and can often get infected. In a diabetic or other patients with poor immune systems, these can even lead to a toe amputation! In my runner's case, she was treated conservatively with a silicone toe sleeve to pad it off until she had time to have an arthroplasty of the toe which is a surgery that removes part of the poorly healed bone and alleviates the rubbing. This surgery could have been prevented by seeking help earlier as soon as she broke her toe. 

Take home message: if you think you broke your toe, have it x-rayed and see your favorite podiatrist. They may tell you it is broken, but straight; or they may need to numb it up and pull it back into the correct position, so you can avoid surgery that will keep you laid up for weeks!


 

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.