Geovany Soto and His Os Trigonum

Geovany Soto and His Os Trigonum His Os Trigonum is gone thank goodness! He should be ready to rock and roll by opening day! What is this Os Trigonum latin-sounding thing anyway?? An Os Trigonum is a small extra bone that is connected to the back of one of the bones that make up the ankle. If we have one, it has been there since birth. This bone is meant to fuse to the back to this ankle bone (known as the talus) as we grow, but sometimes it does not and ends up sitting back there, usually well behaved. When a catcher with an Os Trigonum (like Geovany Soto) squats, this bone can get pinched and cause a great deal of pain and swelling in the back of the ankle! The pain can act like Achilles tendonitis and is commonly mistaken for this. When ice, rest and anti-inflammatories don’t help, the options are to put the foot in a big black surgical boot for a while (not an option when the Rangers need him ASAP!) or to take the bone out! The surgery itself involves an incision between the outside of the Achilles and the ankle bone. The bone is carefully shelled out and the skin is sewn up!

That is it pretty much! Recovery is much quicker that an Achilles tendon surgery and the relief is outstanding! He is no worse for the wear without this extra bone and the Rangers are all the better because of it (one can only hope)!

Do Orthotics Work?

I am officially convinced after over 15 years in practice that there is no “perfect” foot. My wonderful occupation allows me to help people get back on their feet! I can do that with all kinds of conservative treatment and with surgery some times. Over the years, I have found that the most effective way of relieving pain and preventing recurrences for certain conditions is through something called a “functional orthotic”. Recently, I had a patient that made me need to clarify the question: Do functional orthotics work for everyone?? Let me first explain how these things work and how they are different from an over-the counter insert (aka arch support). In the simplest of terms, an arch support comes out of a box and is based on the size of your foot. They may call themselves “orthotics” (and most insert manufacturers will call their over-the-counter support an “orthotic”). It supports the arch fine if you happen to have the similar arch type of foot the insert was modeled after. For people wanting a little more support than what they get in a regular shoe, these are fine. An arch support can give some relief to some foot problems some of the time. I use them routinely to get feet on the right track to better foot health. They act as a good starting point. I see new patients who have been battling foot pain for months who tell me they finally made an appointment with me because “My arch supports helped some for a little while, but then it stopped working.” This happens because an arch support is made out of cheaper materials. For this reason that it will quickly flatten and lose its integrity (which is what made it work to begin with) and may flatten before you get the long term relief you are seeking. Yes, it is true an orthotic is more expensive out of pocket than an arch support insert, but this is because they are custom crafted to your foot type for your condition. What a functional orthotic can do that an arch support cannot do, is control the function of your foot. Let’s look into this a little more. The foot and ankle work best when the bones and tendons and ligaments and muscles work together to place the foot and ankle in the best position to walk. This is known as the foot’s “neutral” position. To some degree, all feet are out of alignment. There is no perfect foot. And when bones, tendons, ligaments and muscles struggle enough to where they can no longer effectively control the foot and ankle, you end up with foot and/or ankle pain. Functional orthotics work by supporting and balancing the entire foot, to neutralize the abnormal pressures, thereby relieving pain. It can actually correct your abnormal foot function for the time you wear them. An orthotic is customized to your foot like eye glasses are customized to your eyes. No one else can use them because they are made for your particular problem. They last longer because they are made of a material sturdy enough to bear your weight while you walk. Can I guarantee that they will work for your foot problem? Much to my chagrin, I can’t! I can assure you however, it is worth it every penny to take a chance on them!! It really is the best chance you may have to relieve pain, prevent recurrences and even help to avoid potential surgery! Think of the lifetime of unsupportive shoes your feet have had to put up with. Isn’t it time you give them the best of what there is to offer?

Beach Etiquette for Feet

As many of my patients know, I love to travel.  And beautiful beaches are my favorite.  During a recent trip to Grand Cayman I watched some appalling things happen to feet.  So I thought I would share my top tips for your feet at the beach.

1.  Shoes are a good thing and for numerous reasons.  But there is no need to wear cross trainers and socks all the time.  Flip flops or sandals are the way to go.  But leave the "fancy" flops for dinner out.

2.  Planning on running on the beach?  Don't do it barefoot unless you are used to running barefoot.  The sand is much softer than your treadmill and will cause things like achilles tendonitis and posterior tibial tendonitis to occur and quite possibly ruin your trip activities.  Take your running shoes for this one.

3.  Heading out in the water and not sure what type of shoreline you are dealing with?  Water shoes are great.  I've been to several beaches that looked like there was a soft sandy entrance, only to find out that  it was a rocky, spiny ledge in disguise.  But if it is soft like baby powder...let those toes free!

4.  I try to get in at least one spa day while on vacation and there is always a question of spa etiquette in different countries.  But the one thing that is never a question...wear the provided slippers everywhere!  It may be the top spa in the world but that doesn't mean the spa goers have the healthiest habits.

5.  Don't forget your feet when applying sunscreen.  One of the worst burns I ever got was on the tops of my feet.  I could wear shoes for 4 days!  Melanoma on the feet is rare, but can be the most deadly when it occurs.  And don't think that beach time is the only time your feet are getting sun.  Those walks out shopping with flips or sandals on allow plenty of sun time for those tootsies.

6.  Feel a sting or a burn while walking?  You may have stepped on glass hidden by the sand or a broken seashell.  You can also step on broken coral at the waters edge that can really hurt.  Best thing to do is immediately wash your foot with soap and water and check for anything that may be stuck in your foot.  If necessary, seek medial attention.

7.  If you are diabetic or have any problems with your sensation or circulation, always think "protect my feet"!  Check the bottom of your feet often for cuts, scrapes or burns you didn't know you had.  Again, seek medical treatment if you see any cut or burn on your feet.  The organisms that grow in the ocean can cause serious infections very quickly.

Not sure what shoes are right for your beach vacation?  Visit our certified pedorthist at Healthy Steps.

I love the beach and the water.  And I am often barefoot on the beach when I can be, I'm just careful.  But I must touch on one other topic.  If you are snorkeling and come across a beautiful coral reef, please don't touch it or stand on it.  This is not a resting area for humans.  It is a home to millions of living organisms and fish and it is our job to protect them!

Yankees Derek Jeter Out For the Season With an Ankle Fracture

New York Yankees shortstop and captain, Derek Jeter will miss the rest of the playoffs after suffering a fractured left ankle while trying to make a play in the 12th inning of Saturday night's 6-4 loss to the Detroit Tigers in Game 1 of the American League Championship Series.

Jeter walked off the field with the help of Yankees manager Joe Girardi and the trainer. X-rays revealed an ankle fracture. This will take at least 2-3 months to heal and then rehab. He is done for the season. 

Ankle fractures can be tricky and depending on the angle and separation of the fragment, he could require surgery to put the pieces back together so they can heal in the correct position.

Any time you fall down or twist your ankle, an x-ray should be taken. Yes, you can walk on some ankle fractures and delayed diagnosis can lead to a much more complicated recovery and even long term disability.

Got ankle pain? Contact us for an appointment. For more information on ankle fractures, click here.

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.

Here a Cankle, There a Cankle, Everywhere a Cankle Ankle?

We’ve all heard the term “cankle” but do we really know what it means? Media harps on Hillary Clinton’s cankles and other famous celebrities such as Kelly Clarkson and Katherine Hepburn. Cankle is a non-medical slang word to describe the absence of a defined ankle. The calf seems to extend strait down into the foot. As if the word did not have enough body parts to over criticize, we have not moved on to obsess over the size and appearance of our ankles!

A cankle a fully functional ankle and the so called “deformity” has no medical relevance other than self-esteem issues. The cause of cankles is merely due to a focal increase in adipose tissue or fat. It is thus largely associated with overweight individuals, but it is also widely seen in those who are physically fit. There is always that one part of your body that is really hard slim down. While some focus on the abs, thighs, or arms, some athletic individuals have discovered their cankles to be the problems area when trying to slim down.

Did my mom give me cankles? There does seem to be a family predisposition for the cankle syndrome. Just as some families have big noses or wide ears, some people have the genes for fat ankles. There is no medical proof that supports these claims but ask any cankle syndrome survivor and they can tell you their heart filled story on how cankles has stricken their family to wearing long wide-legged pants.

With the recent cankle phenomenon sweeping the nation, gyms and plastic surgeon have developed workouts and treatments to maximize your ankle appearance. The trick with you working out your cankle is to burn fat and thus a high cardio regimen is essential in the work out plan. In addition, defining your leg muscle will also decrease the appearance of the large ankle. Many people admit that the gym does not bring them close to their wanted appearance and have thus taken the road of liposuction.

Podiatrists, foot and ankle surgeons, do not recognize cankle as a medical term but take an increase of ankle size as a very serious matter. If your ankles seem to increase in size throughout the day or you feel as though your lower leg is swelling, this may be a sign of a more serious condition. Cardiovascular, and lymphatic diseases can cause increase swelling in the ankles. Trauma or injuries to the ligaments of the joint can also cause local changes to the ankle.

The ankle is a very influential joint in ambulation and pain in this area should never be ignored. If you are worried your ankle size is secondary to a more serious issue, seeking medical attention is not unwarranted.

Got cankles? Be reassured that there are millions across the world battling the fatty ankle. Though you may feel like the only girl in the world who is self conscious about her ankle size, you are among many who avoid short skirts, high heels, and skinny jeans. You may want to discuss possible causes of edema in the lower extremities with your doctor if your ankle size has been increasing over time.