So you think a broken toes is no big deal? Just last week I had a runner come in 6 months after breaking her 5th toe by kicking a shopping cart. She didn't have it x-rayed because in her words, "I didn't think there was anything you could do for a broken toe".
Here she was six months later because not only was she having a hard time fitting her still swollen toe in a high heeled shoe for work, but now it was bothering her in her running shoes. Pain when running will always bring a runner in the office!
What had happened is that she had an oblique fracture of her proximal phalanx which was displaced and healed in an abnormal position. In English, she broke her 5th toe and the bone healed crooked making a big lump that rubbed on her 4th toe causing a blister then a large corn in between the toes.
These types of corns known as "heloma molle" are very painful and can often get infected. In a diabetic or other patients with poor immune systems, these can even lead to a toe amputation! In my runner's case, she was treated conservatively with a silicone toe sleeve to pad it off until she had time to have an arthroplasty of the toe which is a surgery that removes part of the poorly healed bone and alleviates the rubbing. This surgery could have been prevented by seeking help earlier as soon as she broke her toe.
Take home message: if you think you broke your toe, have it x-rayed and see your favorite podiatrist. They may tell you it is broken, but straight; or they may need to numb it up and pull it back into the correct position, so you can avoid surgery that will keep you laid up for weeks!
Sunday, April 8, 2012
Wednesday, February 29, 2012
Do My Swollen Legs Need Compression?
I recently had a patient who came into the office telling me that his feet and ankles hurt. When I asked him to describe his pain, he described it as “not really painful anywhere in particular, just uncomfortable because they are tight all over”. He also mentioned that “my legs get tired”. Well, the foot bone is connected to the leg bone, as is all the skin and what’s underneath as well!
Looking at this guy’s legs, feet and ankles, what was most obvious was the swelling! His exam showed no issues with bone, tendon or ligament. He just had some swelling!
Swelling (aka edema) is an excessive collection of fluid in the soft tissues of your body. In the legs, it can cause that dull, achy, heavy and tired feeling. This feeling gets worse towards the end of the day or after standing for a long period of time. Does this sound familiar? Though you might have gotten use to it, this is not normal and should really be treated.
There are many causes of swelling in the lower extremity. Some of these include high blood pressure, congestive heart failure, liver or kidney problems, medications and varicose veins.
It is important that you visit with your primary care physician to try and nail down the cause of your swelling. Once you have done so and are being treated for the underlying condition, your podiatrist can help you to get some of the fluid off of the legs. The best way of doing this from our end is with the use of compression socks or stockings.
Compression (the amount of pressure or tightness you will feel) of the sock/stocking is listed in the form of “mmHg”. You should see this on every compression garment you purchase. The lightest form of compression is in the 15-25 mmHg range and goes up from there. The amount of compression and the actual length (knee-high to thigh-high) is chosen depends of how bad your edema is and to where it is most evident. Your podiatrist will typically start you on a low level of compression and work up to a higher level as needed.
A few things to keep in mind:
1. If you have heaviness in the legs and have noticed that you have less hair growth on your legs, cramping, pain and/or cold feet /legs, this could be a sign of arterial disease. If you area not sure whether or not you have arterial disease because you have never been checked for this, it is important to discuss testing for this with your podiatrist prior to using compression.
2. Remember to wash your garment preferable daily or at least every two days allowing them to air dry out of the sun or a dryer, both of which can break down the fabric. Have at least two pairs of compression garment to trade them out.
3. Inform your podiatrist the minute you notice any bruising in the lower extremity or any bluish discoloration to the toes.
4. Let your podiatrist know if the garment feels loose. As the swelling improves, the garment will feel looser. Depending on the level of swelling you have at that stage and your tolerance, your podiatrist may recommend a higher level of compression.
Looking at this guy’s legs, feet and ankles, what was most obvious was the swelling! His exam showed no issues with bone, tendon or ligament. He just had some swelling!
Swelling (aka edema) is an excessive collection of fluid in the soft tissues of your body. In the legs, it can cause that dull, achy, heavy and tired feeling. This feeling gets worse towards the end of the day or after standing for a long period of time. Does this sound familiar? Though you might have gotten use to it, this is not normal and should really be treated.
There are many causes of swelling in the lower extremity. Some of these include high blood pressure, congestive heart failure, liver or kidney problems, medications and varicose veins.
It is important that you visit with your primary care physician to try and nail down the cause of your swelling. Once you have done so and are being treated for the underlying condition, your podiatrist can help you to get some of the fluid off of the legs. The best way of doing this from our end is with the use of compression socks or stockings.
Compression (the amount of pressure or tightness you will feel) of the sock/stocking is listed in the form of “mmHg”. You should see this on every compression garment you purchase. The lightest form of compression is in the 15-25 mmHg range and goes up from there. The amount of compression and the actual length (knee-high to thigh-high) is chosen depends of how bad your edema is and to where it is most evident. Your podiatrist will typically start you on a low level of compression and work up to a higher level as needed.
A few things to keep in mind:
1. If you have heaviness in the legs and have noticed that you have less hair growth on your legs, cramping, pain and/or cold feet /legs, this could be a sign of arterial disease. If you area not sure whether or not you have arterial disease because you have never been checked for this, it is important to discuss testing for this with your podiatrist prior to using compression.
2. Remember to wash your garment preferable daily or at least every two days allowing them to air dry out of the sun or a dryer, both of which can break down the fabric. Have at least two pairs of compression garment to trade them out.
3. Inform your podiatrist the minute you notice any bruising in the lower extremity or any bluish discoloration to the toes.
4. Let your podiatrist know if the garment feels loose. As the swelling improves, the garment will feel looser. Depending on the level of swelling you have at that stage and your tolerance, your podiatrist may recommend a higher level of compression.
Sunday, February 5, 2012
Not Motivated to Exercise?
It is the first weekend in February and it is now that all those people who decided January 1st to start an exercise program have fizzled out and returned to the couch. Are you one of those individuals? Not motivated to exercise any more? If you are, I'm sure you are wondering why that happened?
Let's look at a few reasons to why this happens and how you can turn it around:
1. Your goal was to exercise 1 hour everyday of the week.
If you have not exercised in a while, this is really unrealistic. And attempting it will cause you to fail 99.9% of the time. Start with something you CAN do...20 minutes 3-4 times a week. Progress 5 minutes each week adding another day after every 3 weeks. This is gradual increase in exercise and will reduce your chances for heel pain and Achilles tendonitis.
2. You decided to lose 30 lbs in the first month.
For healthy weight loss, 1-2 lbs per week is the best. So how do you do this if you don't have a gym membership? Easy...just walk. All you need is a good pair of tennis shoes. Want to know which shoe is right for your? The doctors at FAANT are experts in knowing what is best for your feet.
3. Your reward for losing weight is a treat of your favorite food.
Don't reward yourself with food. That will make it that much harder to lose those inches. Better yet, how about a new pair of jeans or a night at the movies (but skip the buttered popcorn!). Download the newest album from your favorite artist.
4. You keep cheating!
Before you start your week, write down excuses you have used in the past to cheat on your healthy eating. Then write down responses and ways to counteract this when the urge arrives.
5. You tried exercising everyday, but just got bored.
If you don't like walking on a treadmill, you don't have to. If you find biking to be more boring than watching paint dry, then don't do it. Do what you like. Are you a dancer? Have you tried Zoomba? How about just turning on your stereo for 40 minutes and shaking your thang! Are you a fish in the summertime? Then join a local Y with an indoor pool and swim all year long. The important thing is just to move!
Hopefully these 5 things will help in your journey for better living. Along the way, your feet are going to hurt. That's why FAANT is here! If your foot or ankle is preventing you from meeting your goals for a healthier lifestyle, call us right away!
Let's look at a few reasons to why this happens and how you can turn it around:
1. Your goal was to exercise 1 hour everyday of the week.
If you have not exercised in a while, this is really unrealistic. And attempting it will cause you to fail 99.9% of the time. Start with something you CAN do...20 minutes 3-4 times a week. Progress 5 minutes each week adding another day after every 3 weeks. This is gradual increase in exercise and will reduce your chances for heel pain and Achilles tendonitis.
2. You decided to lose 30 lbs in the first month.
For healthy weight loss, 1-2 lbs per week is the best. So how do you do this if you don't have a gym membership? Easy...just walk. All you need is a good pair of tennis shoes. Want to know which shoe is right for your? The doctors at FAANT are experts in knowing what is best for your feet.
3. Your reward for losing weight is a treat of your favorite food.
Don't reward yourself with food. That will make it that much harder to lose those inches. Better yet, how about a new pair of jeans or a night at the movies (but skip the buttered popcorn!). Download the newest album from your favorite artist.
4. You keep cheating!
Before you start your week, write down excuses you have used in the past to cheat on your healthy eating. Then write down responses and ways to counteract this when the urge arrives.
5. You tried exercising everyday, but just got bored.
If you don't like walking on a treadmill, you don't have to. If you find biking to be more boring than watching paint dry, then don't do it. Do what you like. Are you a dancer? Have you tried Zoomba? How about just turning on your stereo for 40 minutes and shaking your thang! Are you a fish in the summertime? Then join a local Y with an indoor pool and swim all year long. The important thing is just to move!
Hopefully these 5 things will help in your journey for better living. Along the way, your feet are going to hurt. That's why FAANT is here! If your foot or ankle is preventing you from meeting your goals for a healthier lifestyle, call us right away!
Friday, November 11, 2011
Joints Under the Weather??
Ahhhh. The leaves are turning, the gym junkies are getting back outdoors to exercise and the weather is, well, unpredictable! And so are the joints!! This is the time of year where your foot and ankle specialists here at FAANT are seeing an jump in the number of patients who cannot keep their joints from aching! Good and bad days are here again!
So is it true that weather affects the joints? Surprisingly, there is not a lot of research on this subject. We have to look back at a study performed in 1961 by arthritis specialist Dr. J Hollander. He tested 12 patients in a climate chamber he built and discovered that low barometric pressure and high humidity caused an increase in pain and stiffness in joints. Each weather change individually, however, did not. This study had a very small number of patients, but it is true that there seems to be a certain number of people with arthritis whose symptoms are influenced by these climate changes. Is one of them you? How can we help?
While it is easy to tell you to control your symptoms with anti-inflammatories and rest, little is said about controlling your environment!
We can treat weather in the same way we treat environmental allergies. Many people stay indoors whenever there is a high count to whatever they are allergic to.
The same can be helpful when your weather trigger is present. Remember, individual environmental changes are not have as much infulence as the combination of the weather changes (ie: pressure and temperature). If you can identify what combo affect you, you will know when to limit outdoor time in these environments. I have many patients purchase a temperature gauge that also shows pressure and humidity to help find what their trigger is. Just as many of them have changed the humidity and temperature in their homes during certain times of the year when they consistently show flare ups. It does make a difference!
For others, it is more of a muscle cramp or spasm that worsens an arthritic joint. If you fall into this group, know that when the temperature drops, you need to properly warm up your muscles with stretches and slowly progress into the exercise. In other words, if you like to jog, start off with a brisk walk before you start jogging.
Weather also plays a role in joint pain with systemic conditions such as Raynaud’s phenomenon and Lupus.
Raynaud’s phenomenon in particular can be seen in a number of arthritic conditions such as polymyositis, scleroderma, systemic lupus erythematosus, rheumatoid arthritis and mixed connective tissue disease. When the weather turns cold, the small blood vessels in the extremities constrict, causing not only the digits to temporarily lose some circulation, but can in turn cause the joints to become stiff and painful as a result! Avoiding drastic changes in climate can make a big difference in this group of people. Though it cannot be said for all arthritic patients, if you have this condition, and it is severe, you may actually benefit by moving to a warmer climate.
Systemic Lupus Erythematosus without Raynauds could benefit from cooler climates. These patients are very sensitive to sun exposure. Exposure to ultraviolet light can trigger inflammation to internal organs, including the joints. If you fall into this group, limit sun exposure and protect with sunscreen and clothing.
If your feet or ankles are feeling “under the weather”, visit with your podiatrist and let them evaluate you! You may just end up discussing the weather!!
So is it true that weather affects the joints? Surprisingly, there is not a lot of research on this subject. We have to look back at a study performed in 1961 by arthritis specialist Dr. J Hollander. He tested 12 patients in a climate chamber he built and discovered that low barometric pressure and high humidity caused an increase in pain and stiffness in joints. Each weather change individually, however, did not. This study had a very small number of patients, but it is true that there seems to be a certain number of people with arthritis whose symptoms are influenced by these climate changes. Is one of them you? How can we help?
While it is easy to tell you to control your symptoms with anti-inflammatories and rest, little is said about controlling your environment!
We can treat weather in the same way we treat environmental allergies. Many people stay indoors whenever there is a high count to whatever they are allergic to.
The same can be helpful when your weather trigger is present. Remember, individual environmental changes are not have as much infulence as the combination of the weather changes (ie: pressure and temperature). If you can identify what combo affect you, you will know when to limit outdoor time in these environments. I have many patients purchase a temperature gauge that also shows pressure and humidity to help find what their trigger is. Just as many of them have changed the humidity and temperature in their homes during certain times of the year when they consistently show flare ups. It does make a difference!
For others, it is more of a muscle cramp or spasm that worsens an arthritic joint. If you fall into this group, know that when the temperature drops, you need to properly warm up your muscles with stretches and slowly progress into the exercise. In other words, if you like to jog, start off with a brisk walk before you start jogging.
Weather also plays a role in joint pain with systemic conditions such as Raynaud’s phenomenon and Lupus.
Raynaud’s phenomenon in particular can be seen in a number of arthritic conditions such as polymyositis, scleroderma, systemic lupus erythematosus, rheumatoid arthritis and mixed connective tissue disease. When the weather turns cold, the small blood vessels in the extremities constrict, causing not only the digits to temporarily lose some circulation, but can in turn cause the joints to become stiff and painful as a result! Avoiding drastic changes in climate can make a big difference in this group of people. Though it cannot be said for all arthritic patients, if you have this condition, and it is severe, you may actually benefit by moving to a warmer climate.
Systemic Lupus Erythematosus without Raynauds could benefit from cooler climates. These patients are very sensitive to sun exposure. Exposure to ultraviolet light can trigger inflammation to internal organs, including the joints. If you fall into this group, limit sun exposure and protect with sunscreen and clothing.
If your feet or ankles are feeling “under the weather”, visit with your podiatrist and let them evaluate you! You may just end up discussing the weather!!
Tuesday, November 1, 2011
Snap, Crackle, Pop....My Ankle Hurts!
Snap, Crackle, Pop. Ankles are not supposed to make that noise.
It softball season and you just attempted to slide into second base and you managed to twist your ankle. You have done this before but this time it was followed by an audible snap you have not heard before. Oh yeah, and don’t mention that strange lump at the ankle you did not have this morning. You treat it like you have treated your previous ankle sprains, icing, elevation and trying to walk a little more gingerly, but it has not gotten better after several days, and any pressure to your foot is excruciating and unstable.
You may have an ankle fracture. Ankle fractures can typically occur during a violent injury like a car accident, fall from a height, or twisting motion of the ankle. The ankle consists of three bones that are bound to each other tightly by ligaments and allow motion of the foot up and down to allow for normal running in walking. When a fracture occurs the normal alignment of the bones of the ankle is lost as well as ligament integrity and instability, and pain ensues.
Ankle fractures need to be diagnosed and treated as soon as possible in order to provide the most appropriate treatment. Minor fractures can sometimes be treated with a period of immobilization while more major unstable fractures require surgery. If an ankle fracture is left untreated it can lead to chronic instability of the foot and ankle as well as chronic pain from arthritis.
Typical recovery from fracture to a normal shoe is around three months, so if you don’t want to miss next year’s softball season or possibly every softball season in the future, see a podiatrist immediately after any ankle injury.
It softball season and you just attempted to slide into second base and you managed to twist your ankle. You have done this before but this time it was followed by an audible snap you have not heard before. Oh yeah, and don’t mention that strange lump at the ankle you did not have this morning. You treat it like you have treated your previous ankle sprains, icing, elevation and trying to walk a little more gingerly, but it has not gotten better after several days, and any pressure to your foot is excruciating and unstable.
You may have an ankle fracture. Ankle fractures can typically occur during a violent injury like a car accident, fall from a height, or twisting motion of the ankle. The ankle consists of three bones that are bound to each other tightly by ligaments and allow motion of the foot up and down to allow for normal running in walking. When a fracture occurs the normal alignment of the bones of the ankle is lost as well as ligament integrity and instability, and pain ensues.
Ankle fractures need to be diagnosed and treated as soon as possible in order to provide the most appropriate treatment. Minor fractures can sometimes be treated with a period of immobilization while more major unstable fractures require surgery. If an ankle fracture is left untreated it can lead to chronic instability of the foot and ankle as well as chronic pain from arthritis.
Typical recovery from fracture to a normal shoe is around three months, so if you don’t want to miss next year’s softball season or possibly every softball season in the future, see a podiatrist immediately after any ankle injury.
Thursday, October 13, 2011
FAANT Popularity Contest
Dr Crane and Dr Giacalone had a bet going on in the office on who has more patients that love them! They challenged their Facebook friends to rate them on Google Places and Yelp! They tied after the first round (figures), and the other docs wanted to get in on the friendly wager (winning doctor gets dinner at the Silver Fox), so this is your opportunity to help your favorite FAANT doc (and win a free pair of running shoes or comfort sandals or slippers from Healthy Steps)! Contest ends November 1st at 7am! Here is how it works: Help your favorite FAANT doctor win by posting a review to Google Places formerly known as Google Local. If you post a review of the practice and/or review just the doctor (click on their name) Crane, Giacalone, Karpati, McCreary, Steinke and email the contest administrator a copy, they will enter you in a drawing for a free pair of Brooks running shoes or a pair of orthopedic sandals or comfy slippers from Healthy Steps Shoe Store. You can get two entries if you do both the practice and a doctor individually. We will even throw in a third entry if you review the practice on Yelp! Contest starts right now and ends on Novemeber 15th at 7am! We will keep all of you updated on how the contest is going so please help your favorite doctor win!!
Wednesday, October 12, 2011
Knowing When to Say Uncle When Treating Fire Ant Bites
Almost every fire ant attack story begins with, “I was minding my own business” and usually ends with “I never thought such a little bug could cause so much pain,” or some variation of the above. Fire ants are unfortunately something you have to learn to live with, and avoid, if you live in the Southern United States. Avoiding them can be easier said than done because they usually attack without any harassment.
When fire ants attack they inject a venom into the skin using their stinger, as if biting us wasn’t enough of a warning to stay away. This venom is theorized to induce more ants to bite so the most important thing you can do is to move to a safe area, quickly. You’ll need to brush the ants off because once they latch on they don’t usually let go easily.
The venom increases the pain of the bite making it feel like your foot or leg is on fire, hence the name fire ants. Bites usually form small red bumps, but can form small pustules that can become infected.
What to do if you are bitten/stung
• This usually goes without saying, but step off of the ant hill and move to a safe place.
• Cleanse the bite area with soapy water for several minutes and then pat dry.
• Apply antiseptic to area like hydrogen peroxide or betadine(iodine) solution.
• Apply icepack to reduce pain and inflammation.
• To reduce itching apply hydrocortisone or another over the counter steroid cream to areas of bites. Calamine lotion can be used as well, or baking soda mixed 3:1 with water. Apply twice daily.
• DO NOT POP PUSTULES!!! Popping pustules can force fluid into deeper tissues inducing infection.
• If pustules form you can apply antibiotic ointment like Neosporin to lesions.
• If redness spreads or pustules become very large, SEE A DOCTOR IMMEDIATELY!!!
o Infection has probably set in and antibiotics or stronger topical medications may be required.
Allergic Reactions
o Mild reaction - If you experience swelling and redness to site this may indicate an allergic reaction to bites, and over the counter Benadryl can help to reduce this reaction
o Severe Reaction – This is a medical emergency. You should call 911 or go immediately to the Emergency Room. Symptoms include:
Difficulty Breathing
Swelling of lips, throat or tongue
Dizziness
Faintness
Confusion
Rapid Heart rate
Hives all over body
Nausea, Vomiting and Cramping
Most cases of fire ant bites resolve on their own with time, usually after a few weeks spots are gone. Diabetics should see a doctor ASAP to help prevent infection if bitten. Recognize your limitations, and if conservative therapy is not working contact us for an appointment.
When fire ants attack they inject a venom into the skin using their stinger, as if biting us wasn’t enough of a warning to stay away. This venom is theorized to induce more ants to bite so the most important thing you can do is to move to a safe area, quickly. You’ll need to brush the ants off because once they latch on they don’t usually let go easily.
The venom increases the pain of the bite making it feel like your foot or leg is on fire, hence the name fire ants. Bites usually form small red bumps, but can form small pustules that can become infected.
What to do if you are bitten/stung
• This usually goes without saying, but step off of the ant hill and move to a safe place.
• Cleanse the bite area with soapy water for several minutes and then pat dry.
• Apply antiseptic to area like hydrogen peroxide or betadine(iodine) solution.
• Apply icepack to reduce pain and inflammation.
• To reduce itching apply hydrocortisone or another over the counter steroid cream to areas of bites. Calamine lotion can be used as well, or baking soda mixed 3:1 with water. Apply twice daily.
• DO NOT POP PUSTULES!!! Popping pustules can force fluid into deeper tissues inducing infection.
• If pustules form you can apply antibiotic ointment like Neosporin to lesions.
• If redness spreads or pustules become very large, SEE A DOCTOR IMMEDIATELY!!!
o Infection has probably set in and antibiotics or stronger topical medications may be required.
Allergic Reactions
o Mild reaction - If you experience swelling and redness to site this may indicate an allergic reaction to bites, and over the counter Benadryl can help to reduce this reaction
o Severe Reaction – This is a medical emergency. You should call 911 or go immediately to the Emergency Room. Symptoms include:
Difficulty Breathing
Swelling of lips, throat or tongue
Dizziness
Faintness
Confusion
Rapid Heart rate
Hives all over body
Nausea, Vomiting and Cramping
Most cases of fire ant bites resolve on their own with time, usually after a few weeks spots are gone. Diabetics should see a doctor ASAP to help prevent infection if bitten. Recognize your limitations, and if conservative therapy is not working contact us for an appointment.
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