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)!

Healthy Chocolate?

I just had to share since I love chocolate!!! -Dr Crane

Chocolate is Not Just for Lovers

By Susan Kitchen (Borrowed from USA Triathlon newsletter 2/11/14)

Who doesn’t crave chocolate once in a while? And it’s almost Valentine’s day, so chocolate seems to be everywhere!!! Chocolate can actually be good for you, but don’t just grab a chocolate heart and think you are eating healthy! Not all chocolate is created equal. Dark chocolate packs the biggest health punch compared to milk and white chocolate.

The secret behind dark chocolate’s powerful punch is the cacao bean, rich in a plant-based organic compound called flavonoids. Flavanols, the primary type of flavonoid in cocoa and chocolate, have powerful antioxidant properties responsible for providing numerous health benefits. The downside is cacao by itself is unappetizing with its chalky and bitter flavor. Once milk, butter and sugar are added chocolate gets its yummy, creamy taste we have come to crave. However, the processing of chocolate takes out the flavanols negating the health benefit of cacao.

Here’s the secret, so listen up! Dark chocolate containing at least 70 percent cacao (or cocoa, which is the cacao bean ground and roasted) has higher amounts of flavanols, providing powerful antioxidant benefits.

7 Health Benefits of Dark Chocolate

Boosts Heart Health
Cocoa’s flavanols improve blood flow with anti-clotting and blood thinning properties that work similar to aspirin. The increased blood flow provides an increased flexibility in the veins and arteries, helping to decrease blood pressure. Chocolate eaters benefit from lower LDL (bad) cholesterol and an overall lower risk of heart disease and stroke.

Improves Brain Function
The boost of blood flow to the brain assisted by cocoa’s flavanol improves cognitive function increasing one’s ability to focus better on tasks. In studies with mentally impaired people over 70 years old, cocoa has been shown to improve cognitive function. 

Fights Cancer and Aging
Dark chocolate is rich in antioxidants, which help to clear the body of free radicals causing oxidative damage to cells. Free radicals are known to speed up the aging process, and they’re linked to cancer. Antioxidant-rich foods help protect the body against cancer and keep it looking younger.

Decreases Insulin Resistance
Dark chocolate keeps blood vessels healthy, improving circulation and protecting against Type 2 diabetes. Flavanols help your cells function normally and improve insulin sensitivity, thus reducing the risk for diabetes.

Helps Relieve Stress
As it turns out, emotional eating (in small quantities) might not be so bad for you after all! Studies show that anxious people who ate 1 ounce of dark chocolate a day for two weeks had significantly improved cortisol levels. This can be tied into the increased blood flow to the brain, which helps improve mood. Maybe chocolate does cure a broken heart!

Aids in Sun Protection
Flavanols offer some protection from UV sun damage by increasing blood flow, skin density and hydration. One study showed that subjects who ate chocolate consistently for three months took longer to burn than non-dark chocolate eaters. 

Reduces Cravings
With the cacao bean providing fiber, dark chocolate increases satiety versus lighter colored chocolates. Research shows that dark chocolate lessens cravings for sweet, salty and fatty foods.

How to Choose the Best Dark Chocolate:

1. Make sure cocoa or bittersweet chocolate is the first ingredient on the food label, not sugar

2. Stick with chocolate that has at least 70 percent cacao

3. Avoid if it is processed with alkali (neutralizing natural acidity)

4. Look out for “dutching,” which means processed with alkali (a process that takes out the flavanols)

5. Avoid if soy lecithin is genetically modified

Recommended Dark Chocolate Brands:

1. Ghirardelli Intense Dark: 72% and 86% Cacao

2. Godiva: 72% Cacao

3. Lindt: 70%, 85%, 90% and 99% Cacao

4. Green & Blacks: 70% and 85% Cacao

5. Moser Roth: 70% and 85% Cacao

Chocolate Bars That Don’t Make the Cut (Sorry!):

1. Hershey’s Special Dark: Processed with alkali, high in sugar

2. Dark Chocolate M&M’s: Vague ingredient list, high in sugar, more like candy than dark chocolate

3. Milky Way Midnight: Processed with alkali, more sugar than cacao

4. Dove Dark Chocolate: Processed with alkali, more sugar than cacao

5. Nestle Dark Hot Chocolate: Processed with alkali, loaded with sugar and trans fat

So girls, enjoy the guilty pleasures of dark chocolate in small portions (about 1 ounce per day) while reaping the health benefits too!

Happy Valentine’s Day!

Rash or Athlete's Foot Fungus?

Around 70% of the population will suffer from athlete’s foot at some time in their lifetime! Athlete's foot is the layman’s term used for tinea pedis, which is a very common skin condition that usually affects the sole of the foot and the skin between the toes. It is usually a scaly, red, itchy eruption and occasionally may be weepy and oozing. It affects the feet of all people, not just athletes. Although it is frequently caused by a fungal infection, it can also have an overlying bacterial infection that can become dangerous.

The dermatophyte family of fungus causes athlete's foot; and these can be contracted in many locations, including gyms, locker rooms, swimming pools, nail salons, and from contaminated socks and clothing. The fungi can also be spread directly from person to person by contact. Most people acquire fungus on the feet from walking barefoot in areas where someone else with athlete's foot has walked. Some people are simply more prone to this condition while others seem relatively resistant to it.

Without the proper environment (warmth and moisture), the fungus may not easily infect the skin. Fungus loves the winter when we spend most of our time in socks and sweaty shoes!

To avoid getting athlete’s foot fungus, there are some simple things that you can do:
1.   keep your feet clean and dry,
2.   avoid prolonged moist environments,
3.   use socks in airport security lines,
4.   remove shoes periodically and allow the feet skin to "breathe,"
5.   avoid walking barefoot, especially in public areas like swimming pools and gyms,
6.   avoid contact with known infected people,
7.   avoid soaking and contaminated tool usage at nail salons
8.   Disinfect old shoes and periodic weekly or monthly sprinkling of antifungal foot powder into shoes can also be helpful.
9.   It is imperative to take your own nail instruments, including nail files, to any public nail salon, unless you know the salon practices strict instrument sterilization and/or uses all disposable supplies.

Make athlete’s foot fungus take a hike! Disinfect your shoes regularly and make sure to wear moisture wicking socks this winter!

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?

I've Got a Tumor...I Just Know It!

Several times a day I will see patients that are convinced they have some sort of soft tissue mass or tumor on the bottom of their foot.  Usually their pain is under their 2nd or 3rd toe and it feels like they are walking on a mass or as I call it a "wad".  Complaints range from stabbing, sharp pain to numbness in the toes to an overall ache across the ball of the foot.  Often this is followed by pain across the top of the arch or outside of foot.  So is this a tumor?  Rarely.

Pain and swelling under the 2nd and 3rd toes is often what is called capsulitis.  This is the swelling of the capsule or balloon that surroundings your joints.  All of our joints have a capsule who's job is to keep joint fluid in place so that the joint moves smoothly.  But when this capsule takes too much pressure, it swells causing pain and the feeling of a mass or tumor on the bottom of the foot.

So how does this happen?  Here's the most common set up:
You have a bunion.  This causes a shift of the weight when you push off from your big toe to your 2nd toe because the 1st MPJ isn't working correctly.  You wear flip flops all summer and force your 1st and 2nd toes to squeeze like crazy to keep the shoe on and now you are really pushing off your 2nd toe joint.  Now the swelling begins and all shoes hurt, so does walking barefoot.  You look at the bottom of your foot and holy smokes....there is a localized pocket of swelling under your toes!  Now it hurts to even bend your toe.  Sound familiar?

Other things that can cause this to happen:
* 2nd or 3rd metatarsals that are much longer than normal
* 2nd toe that curls up and almost (or does) cross over the big toe
* plantar plate injuries that allow the 2nd toe to dislocate
* severe arthritis in the big toe joint
* actual tumors

So what is the best way to get rid of this pain?  First, ice. This will reduce some of the swelling and improve discomfort.  Stiffer soled shoes that do not allow the toe area to bend very much, this allows rest.  Actual rest is a good too.

But the best option is to have your foot evaluated by a member of the FAANT team to explain exactly why you get this pain and how to prevent it from coming back.

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.