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.

The Foot Bone's Connected to the Back Bone (and Hip and Knee...)!

I heard THE BEST saying from one of our FAANT “team” members today. She said “It’s amazing that something that far down can affect something that far up!!” No truer words have been spoken when it comes to feet and what I call “podiatry philosophy”!


I saw a patient recently who was wondering why his orthopedic spine specialist sent him to see me when they had been discussing surgical intervention for his back! This is not an uncommon occurrence for a podiatrist. In fact, I see patients who have back, knee and hip pain, at the request of their orthopedic specialist, while having NO pain in their feet!

Why is this??

Rather than get into the complicated world of biomechanics, I am going to use an analogy that I like to use quite often. Visualize if you will… Your body is your house and your feet are like the foundation of your house. Stay with me! When you build a house, you want to build it on the most stable foundation, right?! You would never build on sand or on mud. You would most likely build on a solid foundation. Your house will last longer that way. No sags, no cracks in the walls, floors or ceiling, no doors that won’t shut! The same is true for your body! When your feet are unstable, even though they may not hurt, the rest of your body has to compensate for the instability. Add those cute, but mega unstable shoes and sandals, and yikes, we start to break down! Over time, unstable feet and/or unstable shoes for umpteen years can strain and injure the “house”! A proper biomechanical exam can uncover misalignment. The good news is that, sometimes, by getting control of the instability of the foot, with proper shoes and functional orthotics, the pain “above” may be much less, if not gone!
Heed your specialist’s advice! The body works a one whole unit! Don’t let your feet become the limiting factor in your recovery!

Flip Floppin' Away to Flip Flop Injuries

Trust me! I can absolutely relate to the thoughts of so many who have waited an entire winter, (which thank goodness is not a long one in Texas!), to finally let their feet “breathe”! And what better way to do this than in a flip flop?? Even the bottom of the foot gets some air as the flip flop flips up!

As you may have already suspected, podiatrists do not love the flip flop. And as much as you may love them, deep down you know they are anything but stable, and not the best contraption to protect your feet. I wanted to give you a "leg up" on the flip flop injuries we see on an almost daily basis in case you were considering spending your days of summer in them!

You may be surprised how many injuries are as a result of the flip flop. The most common injuries to look out for are turf toe/bruising, nail injury, tendonitis from prolonged wear, heel pain, arch pain, ankle pain/sprains, and fractured toes!

Now, believe it or not, and I know it sounds inconceivable that a podiatrist could actually recommend wearing them, but I actually do recommend using a flip flop around pools and locker rooms, where athlete's foot and warts thrive! In fact, I feel strongly that in these circumstances, you should wear these (or a water shoe) for a barrier of protection! I also like the idea of wearing a flip flop at home to avoid walking around barefoot! Look for flip flops with little to no wedge in these areas and one with an arch. Now, flip flops at Disney World or sight seeing in Europe or on a long day of shopping?  Think again!

Could we possibly keep you out of a flip flop? For the die-hards, it is unlikely that we can keep you out of them!!

Ahhh, but we have just the thing for you, around the corner here at Healthy Steps! Step through our lobby door and you will find Healthy Steps carries the cutest, most stylish flip flops with, yes indeed, WITH an arch that really can provide some support!

Maybe while you are there you will also notice the arch sandals with straps around the ankles that are just as stylish and a lot more supportive! Happy Shopping!

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!

Kobe Bryant is Out for the Rest of the Season After Suffering a Torn Achilles Tendon

The Laker fans are crying this morning after their star, Kobe Bryant, suffers a torn Achilles tendon last night. Kobe felt a "pop" and stated he thought someone kicked him during a routine cut to the basket last night. He took a time out, then returned to make his free throws on one foot. He watched the rest of the game from the locker room. He is having an MRI this morning to plan for surgical repair of his torn tendon.

Several times in the last few weeks, it has been discussed whether or not this was the last season for the 35-year-old Laker. The Lakers are holding onto the last playoff spot by the tips of their fingers and it seemed like Bryant was playing them into the playoff with sheer will and determination. What will happen to the Lakers now? They are one game up on the Jazz for the last playoff spot with two games to go.

Will Kobe come back next season? Good question. He has the will and determination, but this is a devastating injury that often takes up to a year to recover from. That would put him out most of the next season as well. At 35, this could be the end. This is the same injury that ended Dan Marino's career to name just one of many stars who's bodies betrayed them before their mind had given up the game.

For more on Achilles injuries, Achilles tendon surgery. If you have chronic Achilles pain or suffer an injury like Kobe, contact us for help! The doctors at Foot and Ankle Associates of north Texas in Grapevine and Keller, Texas are here to help!

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!

For more info contactus@faant.com or click here