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!

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Why Am I Still Swelling?

We hear this question after almost every post op patient or any patient who has had a moderate to severe injury.  And as I tell my patients preop, expect swelling.  And I’m really not kidding when I say it will take 6-8 months or more to stop swelling after bunion surgery; at least a year for any major reconstructive surgery.  But the question remains, why does the foot swell?

During surgery the soft tissues (and bone depending on the type of surgery) are injured in a controlled manor.  We cannot due surgery without cutting your skin and the soft tissues directly under it.  We also have to move tendons, vessels and nerves out of the way to get to what we are working on.  This involves holding these tissues to each side of the incision with instruments.  All of this is done very carefully, but it is still an injury.  The body has to heal this injury and brings in certain cells to the area to make this happen. This healing process makes you swell.

We repair incisions in layers from deepest to most superficial (skin).  This is done purposefully to help improve incision healing and reduce swelling. The sutures or stitches we put in the deep layers are absorbable.  Your body slowly breaks them down into water and CO2.  This process makes you swell.

Remember that your foot is the body part closest to the ground and gravity.  And it is the only part of your body that you walk on, thus applying at minimum your entire body weight with each step.  Gravity pulls fluid downward causing increased swelling and walking increases pressure thus increasing swelling.

Do you have spider veins or varicose veins?  These occur from your leg veins’ inability to pump blood efficiently back up the leg which forces more blood into your vessels.  This causes fluid retention in the legs, thus causing swelling even without surgery.  So add a controlled injury and guess what....LOTS of swelling.

There must be a healing time.  How long that healing time is is very individual.  If you follow your post op instructions of keep the foot elevated and iced as much as possible, this reduces your swelling.  Staying off the foot as much as possible helps as well.  Compression is great at controlling swelling.  That is why you will have a compressive dressing on your foot or ankle and be placed in some type of shoe, boot, cast or splint.  All of these devices help control your swelling.

The hard part is estimating how long the swelling will be there.  We can give you averages, but everyone is different.  If you are noncompliant with your post op care, it is very hard to control swelling once it gets started.  If you have varicose or spider veins, expect your swelling to be present 3-5x longer than normal depending on the surgery you are having.  If you have varicose veins with swelling to start off with, you may develop severe swelling requiring chronic therapy to control the swelling.  This could take a good year to improve.

Swelling is totally normal in all surgeries.  And no matter how quickly you recovered from surgeries or injury to other body parts, the foot and ankle is totally different.  You can’t just “push through” the swelling and expect it to go away when you decide you want it gone.  Will you still be swollen at 3 weeks post op bunion surgery...you betcha!  How about 3 months?  Yep.  But each week you should notice improvements in swelling until one day you realize that it disappeared without you evening knowing it.

Shoe Gear After Bunion Surgery

You have gotten your bunions surgically corrected and have grand expectations of wearing any shoe you want, when you want, for as long as you want.  Sound familiar?  Let’s talk about realistic expectations after you have bunion surgery.

First, your shoe selection immediately after bunion surgery will be dictated by the amount of swelling you have.  When you are allowed to transition to regular shoe gear from your post op shoe or boot, we always suggest a thick soled athletic shoe.  Often a mess style is better than a full leather upper.  This allows you to continue to control your swelling, but is the most accommodating type shoe.  You want one with great support as you will have considerable arch strain if attempting to wear shoes without arch support.  In the beginning, you may not be able to wear an insert inside your athletic shoe, mainly due to swelling.  But as this subsides, put your custom orthotic or Healthy Steps insert in your shoes to improve your recovery process.

Once you are allowed to wear different types of shoe, please don’t expect to return immediately into your 4 inch heels or ballet flats or Cole Hahn loafers.  Your foot is going to retaliate and give you a lot of unwanted pain.  So be patient.  Want to wear a dress shoe or sandals?  That’s ok, but think supportive, thicker soled shoe, not thin, flat and flexible.  The stiffer the sole of the shoe, the more comfortable it will be.

What about flip flops?  You can wear them only if you want to go through the surgery process all over again!  No joke, not kidding.  The only way you keep a flip flop on is to grip the small strap between your toes with your first 2 toes.  This causes your big toe to move outward or lateral.  This is the same direction it was going before surgery and causing increased pressure on the metatarsal head inward or medial.  If worn immediately after surgery, you risk the chance of causing an immediate recurrence of your deformity.  Sooooo not worth it!  Now in many cases, I will often let my patients wear flip flops occassionally after the first year.  But there are some cases when they are just not ever an option.  But same holds true for the type of flip flops you wear.  Think thicker soled and not Old Navy throw backs!

Ok, what about those heels? If you are a lover of high heels, they will feel comfortable in 6-8 months after surgery.  But don’t expect to be able to wear them all day long in the beginning.  Again, be patient.  When in heels, you walk directly on the area where surgery was performed, so that bone has to be ready for the increased pressure.  Otherwise, you’ll have pain.  And as always, we love for you to keep heels to a minimum.  But for some, they are a dress code requirement.  In this case, think wider heel, not narrow and thicker support under the ball of the foot.  34 Minutes shoes are a great example of supportive heels that maintain great style.

Now for you gentlemen, the options are a little easier.  You will still start with your athletic shoes, but your next step if you are needing dress shoes is a lace up or full upper shoe.  Avoid loafers or slip on style shoes where the tongue of the shoe stops just passed your toes.  When wearing these shoes, there is a forced toe gripping effect that must happen to keep your shoes on, which in turn causes pain.  Make sure your shoe fully covers the top of your foot.  And you are no different than the women when it comes to the sole of the shoe...think thick and rigid.

Everyone is different in their healing process and we help you through shoe transitions based on what we see during your recovery.  Just be patient with your foot and don’t force it into a shoe that it’s not ready to be in.  

Acute Vs. Chronic Heel Pain: New Treatments Available

Dr Marybeth Crane discusses acute versus chronic heel pain in this informative video. It is important to understand the difference between acute plantar fasciitis and chronic plantar fascists and their treatments.

Foot Check-Up- What Am I Looking For?

Last night I checked my feet. I don’t know why. They do not hurt. But I gave them a good look over on the bottoms, tops, heels, in between my toes. A foot check-up!  It has been a while since I’ve done that! I see and help so many feet during the day in my occupation, and I am very good about wearing good shoes, but checking my feel regularly? Admittedly, I have not! We are all guilty of ignoring our feet unless they make us pay attention to them!

As I was looking, I realized many of you out there reading this may now be thinking about doing so yourselves, but have no clue what you are looking for. And if you found something, would it be something you would need me to look at? I thought I might share with you a list of things you may want to see your podiatrist for!

 Looking at those feet, notice the nails. Are they yellowish or opaque? Are they brittle? You may have a nail fungus. A fungus that has taken root in your nail is very rarely rid of with over the counter topical product (and that is assuming you are willing to use that product consistently for at least 8 months!)

 Do you have a dark stripe or splotch under the nail that has not grown out with the growth of the nail? Do you have a mole that has grown, darkened or become irregular? Or maybe a mole has developed that was not there before? Or maybe there is just a strange looking discoloration you did not have before. Believe it or not, skin cancer can happen on the foot or under the nail! If there is any question, have it checked out!

 Look in between the toes. Is it scaly? Is it red? You may have athletes foot (a form of fungus!) or worse, a bacterial infection! Fungus like to start here where it is especially dark and moist between the toes before spreading the sides or bottom of the feet! What is the quality of the skin on the sides and bottom? When fungus gets a hold, feet or nails, it is tough to shake off quickly. Scratching can introduce bacteria into those areas and no fungal cream out there will make bacteria go away! Get to it before it starts letting you know it’s around!

 Look for areas of the skin that look thicker. Is it a pin point callus, a broad callus or is it a wart? Or could you have possibly stepped on something? Sometimes it is hard to tell. They are all treated differently, but one thing is common for all. They all do worse in the long run if they are picked at with whatever contraption you may have gotten a hold of in the bathroom!

 Do you have what looks like a mini grand canyon invading your heels? We call these “fissures”. This condition is hereditary and does not go away with simple lotions. Worse, the deeper the canyons get, the greater the chance of you developing a bacterial infection in the deepest grooves. Treatment is advised for fissures before they become painful.

 Feel the bottoms of your feet with the pressure of a massage. (Not a bad idea in either case!) Do you feel any deep lumps? You should not have any. If you do, let us take a look and feel. It is good to get what we call a “baseline” or early measurement. Getting a look and feel and measuring these lumps will give us the best information on whether this lump something that needs to come out or whether it just needs to be monitored.

Are you checking yet? If you can’t see the bottoms, use a mirror or have someone else take a look! Don’t have either option? We won’t retire for a while! Come out for visit!

Is Bunion Surgery Worth It?

Is Bunion Surgery Worth It?

Interesting question that can be answered yes and no.

Yes, if you have pain every day in your foot around the bunion and it is keeping you from doing the things you want to do.

No, if you just think the bunion is ugly and it is keeping you from wearing cute shoes.

In general, surgery for bunions is only recommended when pain from the bunion prevents a patient from wearing normal shoes and performing their normal daily activities. If your bunions only hurt when you are wearing pointy toed, high heeled shoes; surgery is not your best option. You should try padding, wider shoes, orthotics and injections; as well as much more sensible wider toe box, lower heeled shoes.

There is a common misconception that surgical treatments for a bunion are better and quicker than non-surgical treatments. Unfortunately, patients who rush into surgery may have unrealistic expectations, and may be unsatisfied with surgery.

Patients considering bunion surgery should understand the following about surgical treatments of bunions and also dispel some common misperceptions or myths about bunion surgery:

Myth #1: It is a common myth that bunion surgery is often unsuccessful or “botched”. This is simply not true. Almost 95% of patient surveyed 6 months after bunion surgery would not only do it again, but would recommend it to their friends and family. That’s a pretty good success rate. Patients must have realistic expectations. Bunion surgery can be helpful at relieving pain, but patients should not expect to have "perfectly normal" feet after surgery. And surgery cannot make your foot fit into a 4 inch heeled shoe comfortably.

Myth #2: Bunion surgery is extremely painful. Again, simply not true. Bunion surgery is not particularly "more" painful than other surgeries.  There is pain after surgery, but most patients only require narcotic pain medication for a few days after surgery then use anti-inflammatories to control their discomfort and swelling. Foot surgery, in general, can lend itself to increased pain post-operatively because the foot is below the level of the heart and blood can rush to the area, causing a throbbing feeling. This can be well controlled with a post-operative pain management program.

Myth #3: Bunions come back even after surgery. Again, not true. A majority of patients are satisfied with their outcome after bunion surgery. Recurrence is possible, but not particularly likely. And, return of a bunion is not necessarily a complication, but something that can happen over time. Some patients have excessive motion in the foot that may predispose them to recurrence. This is why functional foot orthotics are needed in many patients post0operatively to control foot function. Another possible reason for recurrence occurs when a procedure that was performed did not best suit the severity of the particular bunion -- so it's important to have the surgery tailored for your particular bunion. Discuss this with your surgeon or get another opinion prior to surgery.

Myth #4: Bunion Surgery = cast and crutches for months. While this was true years ago, more modern techniques have allowed surgeons to mobilize patients quicker. Mild bunions typically involve walking in short walking boot cast for one month, then a sneaker for another month. Surgeons consider casting with crutches with larger bunions because setting the bones is more complex. Some surgeons have moved away from bone cuts and instead perform a fusion procedure that allows for realignment of the entire deviated bone. This fusion procedure is called the Lapidus Bunionectomy, and contemporary approaches allow for early protected walking at four to six weeks postoperatively. Recent technological advances in medical implant devices have also helped surgeons modify their techniques to get patients moving quicker.

Myth #5: You have to be off work. This, again, is simply not true, and a function of the demands of your workplace. A patient can return to a sedentary desk job within a week of the surgery, and varies based on surgeon protocol and type of bunion surgery performed. Jobs that require excessive walking, standing and physical activity may require a medical leave of absence -- which can be up to two to three months depending on healing and job requirements. Getting around can be difficult and driving may be off limits if you have your right foot operated on and/or drive a manual. Job demands of a pilot certainly differ than those of a secretary.

Myth #6: Don't fix a bunion unless extremely painful. The concern with surgically correcting a non-painful bunion is that the surgery can result in longstanding post-operative pain that may not have been there prior. The old rule-of-thumb, if it ain’t broke, don’t fix it. However, people do have surgery for non-painful bunions if the bunion interferes with activity, continues to become larger, or if they have difficulty wearing certain shoes. Surgeons strongly prefer that patients have a painful bunion before they consider surgery. Fortunately, pain is the most common reason people seek treatment.

Myth #7: Bunion surgery results in ugly scars: Surgical healing is part of the process with any surgery, and bunion surgery is no different. Incisions can be minimized, or alternate surgical approaches may be used to hide surgical scars. Bunion incisions are usually located on the top of the foot and technique varies based on surgeon. A surgeon may perform a plastic surgery-type closure to keep scaring minimum. Decreasing swelling, avoiding infection in the postoperative period, and scar cream can also minimize scars.

Bunion surgery, just like any surgery, has its share of myths. Basically, because not all bunions are treated the same, information that may apply to someone with a large bunion may not apply to someone with a small bunion. Take the time to discuss your reservations and alternatives with your surgeon. Often you will find that myths like the 7 discussed are just simply not true. 

The majority of patients, having bunion surgery for the right reasons, end up with a good to excellent outcome and would tell you that bunion surgery is definitely worth it!

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.