“Ouch!” Did you see the replay of Albert Pujols twisting his ankle sliding into base? It actually looked much worse than it was in the instant replay. Looked terrible, but he toughed it out and stayed in the game. Boy, did it look like he was going to be in pain this morning! Over and over they played the tape on Sports Center!
What should you do if this happens to you or your child athlete? The trainer from the Cardinals was immediately evaluating Pujols, but most of us don’t have a trainer on standby!
If you have an ankle sprain, you should be evaluated by a sports medicine podiatric foot and ankle surgeon if you have localized pain, swelling and bruising, as well as inability to walk more than 5-7 steps comfortably. Many a foot fracture has been missed in the emergency room when x-rays were taken only of the ankle and not the foot. The fifth metatarsal is often broken with the same mechanism of injury of an ankle sprain, so the foot should be evaluated as well. If severe ligament injury is suspected, an MRI can evaluate the grade of injury. This is really what decides whether surgery is needed for full recovery.
Treatment for ankle sprains really depends on the degree of severity, which can only be determined by your doctor. Initial treatment always includes “R-I-C-E” therapy – Rest, Ice, Compression, and Elevation. Pain and edema is usually controlled with NSAID’s (non-steroidal anti-inflammatories) like ibuprofen. Bracing or casting coupled with non-weightbearing on crutches may be needed in more severe injuries to rest and stabilize the ankle while it heals. Return to pain-free ROM(What is ROM?) and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athletes or in those patients who have had multiple ankle sprains and suffer from chronic ankle instability. Long-term ankle instability can often be avoided with an aggressive physical therapy program. Bracing should only be used in the short-term during rehabilitation because long-term bracing actually causes atrophy and decreased ROM.
Physical therapy is needed for all ankle sprains. The goals of physical therapy should be to regain full ROM, strength and proprioception (where your brain thinks your ankle is in space). Regaining strength in the peroneal tendons as well as overall balance training are the keys to successful rehabilitation of an ankle sprain. A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.
Bottom line: if you happen to fall down and go “Boom”, have your ankle sprain evaluated by a podiatric foot and ankle surgeon. Delaying treatment and rehabilitation can lead to life-long instability.
For more information on ankle sprains and chronic instability, click here.
Tuesday, June 2, 2009
Monday, June 1, 2009
Could it be Ringworm?
Rest easy, Ringworm is an infection of the skin caused by Fungus, not by actual worms. The types of fungi that cause ringworm are found on the superficial (top) layers of the skin. They grow best in warm, moist areas, such as locker rooms, swimming pools and in skin folds.
Ringworm is contagious, and spreads easily through skin to skin contact. It can also spread when you share towels, clothing, or sports equipment.
How do I know if it is Ringworm?
Symptoms of Ringworm usually include a very red itchy rash, it often makes the patttern of a ring. Your skin may be dry, scaly, and thickened in the areas of the rash. Ringworm of the feet may present between the toes and at the soles of the feet.
How is Ringworm treated?
Most times ringworm can be treated with a topical medicine (anti-fungal cream) that you can buy over the counter without a perscription. Make sure you use the cream till the rash is completly gone or you risk the rash coming back. It will take up to 2 weeks for the rash to clear up. If you do not treat the ringworm your skin could blister, have open sores and become infected with bacteria. If this happens you will need antibiotics.
Prevention of Ringworm:
Avoid walking barefoot in locker rooms and near swimming pools
Wash your hands often
Dont share pool towels with your friends
Wash clothes in hot water with fungicidal soap if suspected exposure occurs
If for some reason your rash does not go away with the use of the cream, medical attention is necessary.
Ringworm is contagious, and spreads easily through skin to skin contact. It can also spread when you share towels, clothing, or sports equipment.
How do I know if it is Ringworm?
Symptoms of Ringworm usually include a very red itchy rash, it often makes the patttern of a ring. Your skin may be dry, scaly, and thickened in the areas of the rash. Ringworm of the feet may present between the toes and at the soles of the feet.
How is Ringworm treated?
Most times ringworm can be treated with a topical medicine (anti-fungal cream) that you can buy over the counter without a perscription. Make sure you use the cream till the rash is completly gone or you risk the rash coming back. It will take up to 2 weeks for the rash to clear up. If you do not treat the ringworm your skin could blister, have open sores and become infected with bacteria. If this happens you will need antibiotics.
Prevention of Ringworm:
Avoid walking barefoot in locker rooms and near swimming pools
Wash your hands often
Dont share pool towels with your friends
Wash clothes in hot water with fungicidal soap if suspected exposure occurs
If for some reason your rash does not go away with the use of the cream, medical attention is necessary.
Monday, May 18, 2009
Dr. Giacalone Ponders Summer Shoes
Well, even your podiatrist isn’t immune to wanting and wearing those adorable, not-so-good-for-you shoes! This weekend I purchased a very comfortable pair of Fit Flops and of course, true to my style, covered with sequence. But I realized during my searching for summer shoes that I have an unfair advantage over the average shopper. I know what is good for my feet, what is not and what I can get away with.
So which shoes are good for you? All shoes with a thick supportive sole, full top and back or large strap over the arch will keep you from toe gripping while you walk. This reduces foot fatigue and will keep things like heel pain and ball of foot pain from occurring. If you are flat footed, you’ll want something with good arch support and a stiffer sole. If you have a high arch, think arch support, but a little softer. You need the shock absorption. For summer shoes, the best option is a sandal that has a strap over the arch and behind the heel. And don’t forget tennis shoes for activities requiring a lot of walking.
So what should you avoid? Obviously the new 7 inch heels are out! And the ballet slippers need to be passed by as well. Any heel height over 2 inches causes increased pressure to the ball of the foot leading to things like metatarsalgia and neuromas. They also shorten the Achilles tendon which can result in Achilles tendonitis. The ballet slippers are glorified socks. And when was the last time you went shopping in your socks alone?
So what about flip flops? Well, these fall into the “what can I get away with” category. Most of the time, you will hear us say, “don’t wear them”. But we know you are going to and here’s the reason we don’t like them. The only way you can keep a flip flop on your foot is to grip your big toe and second toe together. This is not natural and causes the smaller muscles in your foot to work harder leading to foot fatigue, arch strain and overall foot pain. For those with flat feet, they also cause the large tendon on the inside of your ankle to work harder as well, leading to posterior tibial tendonitis and ankle pain. If you have bunions, wearing flip flops on a regular basis only emphasizes the forces that can make the deformity worse. The thing about flip flops and any other shoe that may not be good for you is to think minimalist. Wear them only once a week or special occasions. And if the shoe hurts as soon as you put it on, don’t try to break it in. It should be comfortable from the very beginning.
If you are not sure what foot type you have or what shoes are good for you, our Certified Pedorthist, Janet Dixon is available to help you. She is located at Healthy Steps DFW and is available for one on one assistance with appointment or walk in. But if you are having any foot pain, our physicians would be happy to evaluate your condition and help get you back to summer fun.
So which shoes are good for you? All shoes with a thick supportive sole, full top and back or large strap over the arch will keep you from toe gripping while you walk. This reduces foot fatigue and will keep things like heel pain and ball of foot pain from occurring. If you are flat footed, you’ll want something with good arch support and a stiffer sole. If you have a high arch, think arch support, but a little softer. You need the shock absorption. For summer shoes, the best option is a sandal that has a strap over the arch and behind the heel. And don’t forget tennis shoes for activities requiring a lot of walking.
So what should you avoid? Obviously the new 7 inch heels are out! And the ballet slippers need to be passed by as well. Any heel height over 2 inches causes increased pressure to the ball of the foot leading to things like metatarsalgia and neuromas. They also shorten the Achilles tendon which can result in Achilles tendonitis. The ballet slippers are glorified socks. And when was the last time you went shopping in your socks alone?
So what about flip flops? Well, these fall into the “what can I get away with” category. Most of the time, you will hear us say, “don’t wear them”. But we know you are going to and here’s the reason we don’t like them. The only way you can keep a flip flop on your foot is to grip your big toe and second toe together. This is not natural and causes the smaller muscles in your foot to work harder leading to foot fatigue, arch strain and overall foot pain. For those with flat feet, they also cause the large tendon on the inside of your ankle to work harder as well, leading to posterior tibial tendonitis and ankle pain. If you have bunions, wearing flip flops on a regular basis only emphasizes the forces that can make the deformity worse. The thing about flip flops and any other shoe that may not be good for you is to think minimalist. Wear them only once a week or special occasions. And if the shoe hurts as soon as you put it on, don’t try to break it in. It should be comfortable from the very beginning.
If you are not sure what foot type you have or what shoes are good for you, our Certified Pedorthist, Janet Dixon is available to help you. She is located at Healthy Steps DFW and is available for one on one assistance with appointment or walk in. But if you are having any foot pain, our physicians would be happy to evaluate your condition and help get you back to summer fun.
Tuesday, May 5, 2009
Is Yoga Bad For My Feet?
I have always been curious about yoga. I have tried every possible form of exercise in my quest to find the perfect one for me (alas, I am still searching; aren’t we all?). The one form that I avoided was yoga. My mother was the one who finally convinced me to give it a try. She swore it to be the perfect form of exercise and swore it was relaxing at the same time! An oxymoron, I know!!
I avoided yoga because yoga is performed barefoot and the poses, I imagined, could put a great deal of stress on them. I could only imagine! The curse of being a podiatrist!! Seriously though, my curiosity was such that I had to see for myself just how much twisting and torque was involved.
On my first class, I used the thick mats provided by my gym. It had to be better than the flimsy mats some of the other people were coming in with right? Needless to say, I need to work on my core because I was working really hard to keep my balance and could not concentrate to keep the stretch! And I can tell you for a fact that the thicker the mat, the harder the tendons and ligaments in your feet are working along with your balance to keep you in check. It is very easy to develop a tendonitis or a muscle strain doing the required poses on a thick mat. So yes, the flimsy thin mats are better! Invest in the yoga mat if you have had a tendon or ligament injury or are prone to getting one. People with “extreme” foot types, the flatter foot type or the super high arch type are more prone to these potential yoga-induced tendon/ligament injuries.
The next week I bought this yoga mat. It is “stickier” so your feet do not have to grip as much and much thinner so you have better control of your movements. Over all, much less strain and stress. This is a trade off. If you have joint problems, the thinner mat could aggravate your pain just by the fact that there is less to cushion an aching joint. On the flip side, it can also aggravate tendon and ligament injuries for the same reason.
Beyond the mat are the poses. There are some pretty severe hyper extensions and pressure points going on here! Those “downward dogs” and “half-moons” and don’t get me started on some of the other ones I am no where near perfecting! Not for the light-footed! I can see how easy it is to cause some serious over-use injuries.
The conclusion to my curiosity is that you do not enter a yoga class thinking it will be easy because it doesn’t involve rapid movements. It needs to be approached as one would any exercise. Build your way into it slowly if you do not have foot problems to see if your feet can tolerate what is required of them. Modify the position of your feet if what the teacher is doing to her feet just doesn’t feel right to yours. I do not recommend the “standing” or “inversion” yoga poses to those of you who are trying to recover from a foot injury even though it is “non-impact” simply because of the lack of support it places. That being said, as resistant as I was to try it, I must say that, though it is not my “nirvana” form of exercise, it is now not one I will easily give up either! I have found harmony with yoga and my feet after all!
I avoided yoga because yoga is performed barefoot and the poses, I imagined, could put a great deal of stress on them. I could only imagine! The curse of being a podiatrist!! Seriously though, my curiosity was such that I had to see for myself just how much twisting and torque was involved.
On my first class, I used the thick mats provided by my gym. It had to be better than the flimsy mats some of the other people were coming in with right? Needless to say, I need to work on my core because I was working really hard to keep my balance and could not concentrate to keep the stretch! And I can tell you for a fact that the thicker the mat, the harder the tendons and ligaments in your feet are working along with your balance to keep you in check. It is very easy to develop a tendonitis or a muscle strain doing the required poses on a thick mat. So yes, the flimsy thin mats are better! Invest in the yoga mat if you have had a tendon or ligament injury or are prone to getting one. People with “extreme” foot types, the flatter foot type or the super high arch type are more prone to these potential yoga-induced tendon/ligament injuries.
The next week I bought this yoga mat. It is “stickier” so your feet do not have to grip as much and much thinner so you have better control of your movements. Over all, much less strain and stress. This is a trade off. If you have joint problems, the thinner mat could aggravate your pain just by the fact that there is less to cushion an aching joint. On the flip side, it can also aggravate tendon and ligament injuries for the same reason.
Beyond the mat are the poses. There are some pretty severe hyper extensions and pressure points going on here! Those “downward dogs” and “half-moons” and don’t get me started on some of the other ones I am no where near perfecting! Not for the light-footed! I can see how easy it is to cause some serious over-use injuries.
The conclusion to my curiosity is that you do not enter a yoga class thinking it will be easy because it doesn’t involve rapid movements. It needs to be approached as one would any exercise. Build your way into it slowly if you do not have foot problems to see if your feet can tolerate what is required of them. Modify the position of your feet if what the teacher is doing to her feet just doesn’t feel right to yours. I do not recommend the “standing” or “inversion” yoga poses to those of you who are trying to recover from a foot injury even though it is “non-impact” simply because of the lack of support it places. That being said, as resistant as I was to try it, I must say that, though it is not my “nirvana” form of exercise, it is now not one I will easily give up either! I have found harmony with yoga and my feet after all!
Wednesday, April 22, 2009
Be Careful of Those Spiders, They Are Not as Innocent as They Look.
Spring is here, the weather is warming up and we are finally able to wear those cute open toe sandals. With that being said, there are some new concerns to be aware of. All of the creepy crawlers that have been sleeping the winter months away are coming out of their favorite hiding places and we are all at risk for bug bites.
Brown Reculse Spiders are one of the more common spiders in the South part of Texas. They are yellowish-tan to dark brown in color, about the size of a half dollar. They measure around a half-inch in length.
The most common times for these spiders to bite are in the Summer Months. Spiders prefer dark, dry, undisturbed locations to live. Think garages, basements, under rocks, in piles of wood, and the attic.
How do I know if I was Bitten by a Spider? Or maybe it was just a Mosquito...
One of the first ways to tell if it was an actual spider bite:
1)It will be very painful, and the pain will not go away.
2)A central Blister may form around the bite site. The skin will often blanch(turn white in color) around the blister and the skin around that will become very red and irritated.
3)The redness will not be symmetric. We call this the "RED, WHITE, BLUE" sign. It is an excellent way of identifying a recluse spider bite.
What should I do if I think I was Bitten by a Spider?
1)Avoid exercise and avoid heat. Heat will spread the venom faster.
2)Elevation of the extremity.
3)Cold Compress
4)Cleansing of the wound
5)Topical and Oral antibiotics
6)Simple analgesics (tylenol for the pain)
7)Steroids
Typically these spider bites will heal in 1-3 weeks and the pain will usually reside in one week but, it is important to have the bite looked at by a professional. There have been studies that have shown these spider bites can cause necrosis of the skin, fever, nausea, and even renal failure. The best treatment is to avoid getting bitten at all. Learn to recognize the spider, patient awareness is the primary factor in making the correct diagnosis and forming an appropriate treatment plan.
Spring is here, the weather is warming up and we are finally able to wear those cute open toe sandals. With that being said, there are some new concerns to be aware of. All of the creepy crawlers that have been sleeping the winter months away are coming out of their favorite hiding places and we are all at risk for bug bites.
Brown Reculse Spiders are one of the more common spiders in the South part of Texas. They are yellowish-tan to dark brown in color, about the size of a half dollar. They measure around a half-inch in length.
The most common times for these spiders to bite are in the Summer Months. Spiders prefer dark, dry, undisturbed locations to live. Think garages, basements, under rocks, in piles of wood, and the attic.
How do I know if I was Bitten by a Spider? Or maybe it was just a Mosquito...
One of the first ways to tell if it was an actual spider bite:
1)It will be very painful, and the pain will not go away.
2)A central Blister may form around the bite site. The skin will often blanch(turn white in color) around the blister and the skin around that will become very red and irritated.
3)The redness will not be symmetric. We call this the "RED, WHITE, BLUE" sign. It is an excellent way of identifying a recluse spider bite.
What should I do if I think I was Bitten by a Spider?
1)Avoid exercise and avoid heat. Heat will spread the venom faster.
2)Elevation of the extremity.
3)Cold Compress
4)Cleansing of the wound
5)Topical and Oral antibiotics
6)Simple analgesics (tylenol for the pain)
7)Steroids
Typically these spider bites will heal in 1-3 weeks and the pain will usually reside in one week but, it is important to have the bite looked at by a professional. There have been studies that have shown these spider bites can cause necrosis of the skin, fever, nausea, and even renal failure. The best treatment is to avoid getting bitten at all. Learn to recognize the spider, patient awareness is the primary factor in making the correct diagnosis and forming an appropriate treatment plan.
Wednesday, March 25, 2009
Are Your Kid's Shoes Making Their Feet Deformed?
Children's Shoes Are Too Small and Causing Deformities, a New Study Finds
A new study of 250 children in Switzerland presented by the American Academy of Orthopaedic Surgeons (AAOS) found that a vast majority of young children are wearing shoes that are too small, increasing the risk of foot deformities. "The most striking finding was that more than 90 percent of children's shoes were too small," says Norman Espinosa, MD an orthopaedic surgeon at the University of Zurich. Overly-tight shoes are the leading cause of Hallux Valgus, a condition that occurs when the big toe begins to angle sideways in the direction of the second toe, causing a bump or bunion on the side of the foot.
For more information on juvenile Hallux valgus click here.
A new study of 250 children in Switzerland presented by the American Academy of Orthopaedic Surgeons (AAOS) found that a vast majority of young children are wearing shoes that are too small, increasing the risk of foot deformities. "The most striking finding was that more than 90 percent of children's shoes were too small," says Norman Espinosa, MD an orthopaedic surgeon at the University of Zurich. Overly-tight shoes are the leading cause of Hallux Valgus, a condition that occurs when the big toe begins to angle sideways in the direction of the second toe, causing a bump or bunion on the side of the foot.
For more information on juvenile Hallux valgus click here.
Tuesday, March 24, 2009
I Have a Neuroma.. Do I Need Surgery?
Neuromas can be very Irritating and Painful. A neuroma can prevent you from wanting to walk around and be active, and with summer around the corner who wants that?
Most of the time a neuroma will cause you to feel like you are walking on a pebble. It may cause shooting pain and tingling to the ball of your foot as well as to your toes, you may even experience numbness in your toes. Others might complain that it feels like they are walking on a rolled up sock in their shoes. All of these symptoms can be signs that you are suffering from a neuroma....
So what can we do to get rid of a neuroma??
There are many treatment options for neuromas.
1) Because neuromas are an inflammation and irritation of a nerve commonly from the bones in your feet, an injection into the area of the nerve can be helpful. It will calm down the inflammation and allow the nerve to become less irritated = less pain.
2) Accomodative Padding is another great option, by taking the pressure off the bones that are causing the nerve to become irritated, the nerve is able to relax and heal.
3) Custom Orthotics are another great treatment option. Nobody has a perfect foot and most people really will beefit from a custom device. An orthotic made specifically for your foot will allow a doctor to offload any areas in your foot that may be taking to much pressure.
4) Surgery is always an option once all conservative measures have been exhausted. Most of the time we are able to give patients a lot of relief from the other options listed above.
To learn more about neuromas click here.
Most of the time a neuroma will cause you to feel like you are walking on a pebble. It may cause shooting pain and tingling to the ball of your foot as well as to your toes, you may even experience numbness in your toes. Others might complain that it feels like they are walking on a rolled up sock in their shoes. All of these symptoms can be signs that you are suffering from a neuroma....
So what can we do to get rid of a neuroma??
There are many treatment options for neuromas.
1) Because neuromas are an inflammation and irritation of a nerve commonly from the bones in your feet, an injection into the area of the nerve can be helpful. It will calm down the inflammation and allow the nerve to become less irritated = less pain.
2) Accomodative Padding is another great option, by taking the pressure off the bones that are causing the nerve to become irritated, the nerve is able to relax and heal.
3) Custom Orthotics are another great treatment option. Nobody has a perfect foot and most people really will beefit from a custom device. An orthotic made specifically for your foot will allow a doctor to offload any areas in your foot that may be taking to much pressure.
4) Surgery is always an option once all conservative measures have been exhausted. Most of the time we are able to give patients a lot of relief from the other options listed above.
To learn more about neuromas click here.
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