Thursday, April 8, 2010

Medial Tibial Stress Syndrome

One of the most common injuries that occurs among running and jumping athletes...

Medial tibial stress syndrome also been called "shin splints" is the most common injury in the legs of active individuals. Females are more commonly affected, along with 22 percent of all injuries in aerobic dancers. Anyone participating in running or jumping acitvites are likely to develop this stress syndrome.

The pain from MTSS only occurs during the activity (running) with the pain diminshing rapidly within five minutes of activity cessation. If the pain persists during walking activites the suspicion for a stress fracture is high. Most common side effects are diffuse pain and tenderness that occur along the distal aspect of the medial tibial border (inside along the ankle bone)

How is MTSS diagnosed?

Most physicians will start with x-rays but most of the time they will get an MRI which is more specific test and has the abilty to diagnose the injured athlete.

How do I treat MTSS?

After the diagnosis has been made of MTSS, ice should be applied for 20 minutes multiple times a day. Activites should be reduced, patients should focus on exercising on softer surfaces, and wear appropriate shoe gear at all times. Custom foot orthotics are recommended for the vast majority of these patients. Orthotics are able to shift the ground force; as well as reduce subtalar pronation which helps reduce the bending motion of the tibia (which is why we get MTSS in the first place)

Understanding the disease is the key to getting an athlete back to their activites as soon as possible. If you think that your symptoms sound like these make an appointment with your podiatrist.

Monday, March 1, 2010

Fine Tune Your Feet

On any given day we don’t hesitate to shower to keep ourselves clean, brush our teeth to prevent cavities. We take vitamins and exercise for healthy bodies and a strong heart. We work hard to keep everything in tune to keep ourselves going.

But what do we really do to keep our feet healthy? Aren’t our feet literally what is going to keep us going?? How many of us truly give them the attention they deserve? We only seem to start caring when they start complaining!

Foot fact: By the time we are 50 years old, we will have walked 75,000 miles! A lot of us active types are reaching that milestone much quicker! What happens at that mile mark? Well, we are at a much higher risk for developing arthritis in our feet. This with losing up to 50% of the shock absorbing fat in the balls of our feet can equal a very big OUCH!

Ingrown toe nails, bunions, hammertoes, corns, calluses, foot fungus, painful feet, to name a few, are all signs of foot abuse and neglect.

It is time to fine tune our feet!

When was the last time you really gave your feet a good look-over? That alone can make you aware of a potential problem before it starts to cause pain. Make it a habit to give them a check up every few months.

When was the last time you have your shoe size checked? Our feet spread and grow the more we use them. Next time you go shopping for shoes, take the extra time to have your feet sized. Many of you will be surprised how much they have grown!

Do you like to walk barefoot? I urge you to reconsider. When you rely on your own feet to cushion the blow of your body weight, you can count on wearing down your arch and the fat that cushions the ball and heel of your feet. In your golden years, when you are having a hard enough time keeping your health in check and your body is stiffer, you are going to wish you at least had a good set of feet to carry you through.

Do you really need to cram your foot into those stylish shoes? Yes, I do when I am going to a nice dinner or function. They do make us look great. Unfortunately, your feet can’t talk or they would be screaming for mercy!! Give them a break and alternate with a nice round toe, low or no-heeled, well-padded leather variety and your feet will that you by giving you that extra mileage!

What exercise are you choosing? Daily pounding or non-impact? Makes a big difference! Again, alternate your pounding run or step class with the ellipse, bike, swim, arc trainer or stair master. Wear and tear from a repetitive task can lead to stress fractures, tendonitis, muscle strain. The list goes on and on.

Finally, if you do have foot pain, don't wait and hope it will go away. Pain is not normal. A quick check with a podiatrist means a quicker recovery!

Wednesday, February 17, 2010

What is Peripheral Neuropathy and how do I know if I have it??

Peripheral Neuropathy is a medical condition in which the nerves that travel from your brain and spinal cord function improperly. Most people will complain that they are experiencing burning, tingling, numbness, and or shooting pains to their lower extremities. Most of the time the symptoms of neuropathy will begin in the feet. Numbness in the toes or in the ball of the foot seems to be where most people feel these sensations first.

What causes Neuropathy?

There are over 100 causes of peripeheral neuropathy. Some of the more common ones include diabetes, thiamine deficiency, alcoholism, trauma, exposure to toxins, autoimmune diseases, and infections. Sometimes no cause can be determined.

Can you treat Neuropathy?

Yes, a treatment plan can be formed based on the cause of your neuropathy. If you are Thiamine deficient (easily determined with a blood test), you can begin to take supplements of thiamine and the symptoms should eradicate.
Neuremedy is another option for treating neuropathy.

What is Neuremedy?
Neuremedy is a medical supplement that helps treat dysfunctional nerves allowing them to impulse correctly. It contains benofotiamine and has been determined to be safe and successful in treatment of neuropathy. Neuremedy is able to help alleviate the symptoms of neuropathy by delivering a highly bio active form of the micro-nutrient thiamine to the nerve cells.

Is Neuremedy safe?

The active ingredient in Neuremedy is benfotiamine. It has been used since the early 1960's to successfully treat neuropathy. It has been proven to be safe and effective. It does not have any known significant adverse effects and can be safely taken with medicines and supplements.

How Quickly does Neuremedy work?

Most people begin to notice a reduction of symptoms within the first two months of taking the supplement. Unfortunately neuremedy does not work for everyone. Ask your doctor if Neuremedy is right for you.

Monday, January 11, 2010

What Are These Labs For?

You go into your podiatrist office to have your foot problem evaluated and you walk out with a lab form for some tests. Why do you need them and what do they mean?

Well,
laboratory tests are an important tool to help us evaluate your health. Diabetics, people with swollen joints, people with foot pain symptoms that are unusual, people going on a new medication and people with infections are all candidates for blood work. Here are some of the more common labs ordered by your podiatrist, what they are for and what abnormal levels could mean:

Glucose: This tells us how much sugar is in your blood. We usually order this if you are a diabetic and we want to get a measure of your recent sugar levels or if you are not diagnosed diabetic but we suspect you may be. Too high a value is seen in diabetics. You will also see an elevation if you did not fast for this test.

Hemoglobin A1c (HgA1c): If you are a diabetic and we want to know how well you have controlled your blood sugars over the past 3 months, this test will let us know.

Blood Urea Nitrogen (BUN) is a waste product made by the liver. It is excreted by the kidneys. We see high values in people on high protein diets, people who exercise strenuously, and people who have problems with their kidneys. We will order this test if we are placing you on a medication that is processed by the kidney and want to make sure your kidney is functioning properly.

Creatinine is a waste product from muscle breakdown. This is also ordered to evaluate kidney function. A high value here with a high BUN could also mean you have kidneys that are not working well.

Uric Acid is normally excreted in urine. When your body is not excreting this properly, or if your body is producing too much of it, you could end up with gout, a condition that results in joint pain. If you have a swollen joint, we may order this to rule out gout.

If you have a swollen joint or joints and we are trying to further determine a cause, we may also order a Rheumatoid panel. This includes the Rheumatoid Factor (RF) test along with other autoimmune-related tests, such as an ANA (antinuclear antibody)along with other markers of inflammation, such as a CRP (C-reactive protein) ESR (erythrocyte sedimentation rate and along with a CBC (Complete Blood Count) to evaluate the body’s blood cells.

When we decide to put someone on a medication that may affect their liver, or we suspect that they may have liver damage, we may order a panel to check out their liver function. They may include AST, ALT, ALP, SGOT, SGPT, and GGT and
Alkaline Phosphatase, Bilirubin, Albumin, total protein.

There are patients who present with weakness of their lower extremity. CPK level is a test we order to help make this determination. If CPK is high in the absence of cardiac history or strenuous exercise (both of which could also cause an elevation), it could indicate skeletal muscle disease.

If we are trying to heal a wound and suspect possible poor healing secondary to nutrition and overall health, we may order Albumin and Globulin levels.Hemoglobin (Hgb) and Hematocrit (Hct) may also be ordered as low levels also contribute to nutritional deficiencies causing anemia

If we suspect an infection, these tests help us evaluate the severity of the infection as well as how well a particular antibiotic is working against it. Usually, the higher the value, the more severe the infection. These labs include: C-Reactive Protein (CRP), White Blood Count (WBC), Sedimentation Rate (SED rate)

It is important to get these requested labs as soon as we order them to help you with your treatment. Doing so will help “get you back on your feet” in no time!!


Sunday, December 6, 2009

Five Healthy Feet Tips for a Happy New Year

As the end of the year winds down (already?!), once again, unless you have foot pain, our tooties are the last things we focus on. Turkey, trips, tantrums and those terrifically terrible relatives are of more importance! So I challenge all of you to take this moment to make those simple changes that will keep our feet happy for a long, long time to come.

A resolution and a fresh foot start for the new year! Let’s get started!

Feet tend to swell more in the afternoon. Shop for shoes in the afternoon so you aren’t stuck with a pair you can’t get off at the end of the day! Be sure they feel good in the store. Shoes are not meant to be “broken in”. And if you are shopping for your children, bring them with you. They may feel something wearing the shoe you couldn’t possibly know without them putting them on!

If you have to wear a heel, stick to one that is no more than 1 ½ inches. Over that, you greatly change the dynamics of foot function putting 75% of your weight on the ball of your foot. Save the stilettos for short distances, not shopping trips if you can’t part with them altogether!

It is a good habit to powder up those feet with a powder that has corn starch before putting your socks on. This will help keep them dry. Moisture causes foot odor and althete’s foot. If you don’t want the powder in a sandal, pick up some Summer Soles at www.summersoles.com. This is a paper thin inlay for sandals and shoes that wick the sweat right off your feet so your feet don’t slosh and slide on it!

Avoid trimming your nails too short. This can cause an ingrown. Keep your nails trimmed so there is still a little “white” showing on the end. Round the corners with a file so they don’t dig in.

Get your pedicures at a place where you see them physically take the nail packets out of an autoclave (the device that sterilizes them). Now is not the time to skimp on nail care. The cheaper the place, the less they want to put into the cost of sterility. And if you don’t know how difficult it is to get rid of a fungus, here’s a pearl: over-the-counter topical nail solutions are only about 12% effective and less! And that is after you use it consistently for a year without painting your nails that entire time!!

Here’s an extra tip because I simply could not stop at 5!! Visit us if you have any type of foot pain that does not go away within a few days of TLC on your part. A chronic foot problem is so much harder to get rid of even with our help!

Remember, feet are our friends until they hurt! Let’s keep them on our good side!


Monday, November 2, 2009

Painful Lump In Your Arch? Could Be Plantar Fibromatosis

Plantar Fibromatosis. Wow, that's a mouthful! What is it? A lump in your arch that is firm and doesn't move. They usually start out as a very small pea sized nodule that increases in size over time. Most people don't even notice them until they get big enough to be annoying in your shoes or when walking barefoot. They can happen to anyone, but are most commonly seen in middle-aged to older patients and are much more common in men than woman. It is also more common in the Caucasian population than other ethnicities.

Most people come into the office complaining of a painful lump in their arch and are very concerned it is cancer. It is actually just an exuberant growth in the plantar fascia (a.k.a. the ligament that holds up your arch) or extra fibrous tissue. We really don't know why they occur, but it is thought that some kind of trauma plays a role in the formation of the nodules. I often see them in pilots and runners who have constant repetitive trauma to this area. Family history is also a factor. As many as 50% of patient with plantar fibromas also have nodules in the palm of their hands known as Dupuytren's contractures. There has been some correlation with medications like beta-blockers and anti-seizure medications. One study even linked an excessive amount of vitamin C with fibrous disorders. Patients with a history of chronic liver problems, diabetes, seizures and alcohol abuse seem to have a higher rate of plantar fibromas.

Treatments vary, but fall into three categories:
1. Do nothing: the nodules are annoying but usually self-limiting. They do not grow indefinitely, so if you can put them down as life's minor annoyance, most patients choose to just leave them alone.
2. Conservative or Non-invasive: Vigorous stretching, accommodative orthotics, physical therapy, and topical transderamal Verapamil.
3. Surgery: injections with a corticosteroid can be helpful to decrease the inflammation around the nodule, but if they are large and painful; most go on to surgical excision.

What should you do? A personal question, that only you with the help of your doctor can answer. In my opinion, if the nodule is small, leave it alone. If it is increasing in size, then it should be addressed. If the nodule is of moderate size, with no intrasubstance calcifications on x-ray, and is annoying; a three to six month trial of transdermal verapamil coupled with an accommodative orthotic and physical therapy can be helpful. If it meets these criteria and is a little soft, then a steroid injection may also help decrease the size. If the lesion is large, painful, or has intrasubstance calcifications on x-ray; then excision is most likely your best option. Simple excision is not enough with these lesions, removal of not only the lesion, but a large margin is necessary to decrease recurrence rates.

If you have a painful lump in your arch, seek the advice of your podiatrist. Help is only a phone call or mouse-click away!

Wednesday, October 28, 2009

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.