Neuropathic Ulcerations

Ulcers can occur in different parts of the body. Many people are familiar with stomach ulcers, or an ulcer in the mouth, but ulcers also occur on the lower limbs. This week will be the first blog of a series on different ulcers podiatrists treat. Today’s discussion is on neuropathic foot ulcers, most commonly found in Diabetic patients. Ulcers are the most common precursor to lower extremity amputations. While it is estimated that 7% of the US has Diabetes, an estimated 15% of diabetic patients will go on to develop an ulcer on their lower limbs. Neuropathy, deformity, high pressure on the feet, poor blood sugar control, duration of diabetes and the male gender are all contributory factors for foot ulcers.

So how do these occur? Many diabetics develop neuropathy, where they lose the feeling of sensation in their feet due to nerve death. Neuropathic patients can cause trauma to their feet, such as stepping on a nail, dropping an object or burning their feet, and not even realize it. These tiny wounds develop into larger, deeper, infected wounds. And since diabetes affects wound healing, what was a tiny puncture wound can progress into larger limb-threatening ones. If you do develop a neuropathic ulcer, seek medical attention immediately. Your podiatrist will want to assess the wound to determine if hospitalization is necessary. Generally if it isn’t too large or infected, rapid wound care can be started at your podiatrist’s office. However in the face of severe infection, IV antibiotics and possibly surgery have to be done. The best prevention is to stop by your podiatrist’s office and get a foot checkup. He or she will test your sensation as well as assess your current footwear choices. Also, managing your blood sugar should be priority #1 to help prevent neuropathy in the first place. For more questions and concerns on this, consult with Dr.Grimm or Dr.Pattison of Foot Associates of Central Texas.

Nadal Pondered Switching to Golf After Foot Injury

Tennis star Rafael Nadal’s biography hit the US shelves recently. In it he describes a foot injury in 2005 that had the potential to end his career. He describes his thoughts of switching to golf as a career due to his pain. In the book the problem is described as a congenital (born with it) bone problem in the bridge (arch) of this left foot. Nadal more than likely had a condition called Kohler’s Disease, also known as avascular necrosis of the navicular bone. The bone is located in the middle of the foot, near the peak of the arch.

During childhood, there is an interruption of blood flow to the bone which doesn’t let it harden like it should. The causes of this aren’t known for sure, but trauma or overuse has been linked to the condition. This causes the bone to be deformed and can eventually splinter. Sometimes these effects aren’t known until later on in life, as such in Nadal’s case. And this becomes more apparent with repetitive stress to the bone, such as being a professional tennis star. Nadal’s book goes on to describe how he had pain and swelling in the area of the arch, near the top of his foot. He found this to be relatively normal since he played an intense match, but the pain became worse. The next day the swelling had increased and he couldn’t put any weight on it. His doctors couldn’t diagnose it for weeks until he saw a specialist in Spain. Nadal was forced to rest until the pain subsided. His specialist recommended insoles that would cushion the bone and try to offload the stress to that part of the foot. However there are consequences to that such as putting more stress on the knees and back.

Treatment for Kohler’s Disease is symptomatic. In Nadal’s case, his life is dependent on his ability to perform at the highest level so his treatment regimen may differ than someone else with Kohler’s. Remember that foot pain is not normal and if you are experiencing it, come by and see Dr. Grimm or Dr. Pattison of the Foot Associates of Central Texas. They have offices in Lakeway, Georgetown, Round Rock, and Taylor, Texas.

http://www.guardian.co.uk/sport/2011/aug/22/rafael-nadal-golf-injury

Prince Amukamara's Foot Injury

First, the good news: The ridiculousness that is the NFL lockout is finally over. However for one player, his season will be locked out indefinitely. Prince Amukamara from Nebraska, the #1 pick of the New York Giants, fractured his 5th metatarsal bone in his left foot during the 2nd Giants practice. In the story released by ESPN, Coach Tom Coughlin goes on to say Amukamara was sore in that area beforehand but never communicated it to anyone. Amukamara states that the incident occurred when a player he was covering cut and inadvertently stepped on his foot. This type of injury can also occur with a “rolling” of the ankle.

The fifth metatarsal bone is located toward the end of the foot, on the outside border, and is a shaft-like bone that connects the 5th toe to the rest of the foot. Amukamara’s case will require surgery and a screw to heal properly. Surgery will vary on a case-by-case basis as there are numerous types of fractures that can occur to the 5th metatarsal specifically. The type of patient can also influence treatment. Your podiatrist may use a different treatment option if you are a NFL cornerback versus an elderly patient. Healing can vary greatly with this type of fracture. This is due to the lack of blood flow to some parts of this bone. This is one reason why the ESPN article is hesitant to give an exact timeline on Amukamara’s return.

The article also points out another important point. Couch Coughlin states that he had pain there before. Now there is no precise way to know if the 2 incidences are related but it does point out that if you are experiencing any type of foot pain, it is worth getting checked out before it progresses to something more serious. Remember, foot pain is not normal. If you are having any concerns about the health of your feet, remember to get them checked out by Dr.Grimm or Dr.Pattison at the Foot Associates of Central Texas.

Source: http://espn.go.com/new-york/nfl/story/_/id/6840281/prince-amukamara-new-york-giants-breaks-foot-indefinitely

Rickets and Foot Disorders

There are a few deformities that can present in children that deal with the lower limbs. One of those is Rickets. This is a softening of bones in children due to either a deficiency or impaired metabolism of vitamin D, phosphorus, or calcium. The most common cause is vitamin D deficiency. Vitamin D is needed for your body to properly absorb calcium from your gut. We get vitamin D when the sunlight hits our skin and produces it. While this disease can occur in adults, the majority of cases are children suffering from very severe malnutrition. When this occurs in adults it is known as osteomalacia.

A toddler with rickets will have legs that are bowed outward, while older children will present with knock-knees. There is also bone pain or tenderness, dental problems, muscle weakness and a tendency for fractures. Lab results could show hypocalcemia, which means low levels of calcium in the blood. The symptoms of associated pain and fractures are what help your podiatrist set apart this disease from a structural deformity like genu valgum, or tibial varum, which is just the position your leg bones have grown from birth. Blood work also helps confirm the diagnosis.

More cases have been reported in Britain lately due to the inability of children to make vitamin D. But these kids weren’t starved or poor. The sunlight was not reaching their skin due to the persistent use of sunblock. This wasn’t allowing any sunlight to reach their skin, or they were spending too much time indoors with the TV, computer, etc. Treatment for rickets depends on the cause. Treatment for nutritional rickets includes vitamin D supplementation and a diet high in calcium. The earlier these children are diagnosed, the better. If the disease becomes too advanced, the bony deformities can be permanent. For questions about this or any other childhood foot deformity, come by and see Dr.Grimm or Dr.Pattison.

Flood Zones

For this week’s blog we look at a natural disaster less-commonly found in Texas, floods. These are still worth mentioning in light of the rain associated with the upcoming spring. This not only applies to massive flooding, but walking out to the patio or driveway where there’s standing water. Many times people in high water will walk bare foot to avoid their shoes from becoming soaked. At best, some may wear thong flip flops. This increases your risk of getting an infection or even a disease.

During a flood, damage and debris can wash as far as the water will take it. So while you may be walking on what you think is your clean driveway, there could be rusty nails from a construction site up the road. And it doesn’t just have to be a puncture wound either. Any small cuts or abrasions that were already on your legs and feet are exposed to the contaminated water. This can lead to infections such as trench foot, tinea (athlete’s foot), cellulitis, or osteomyelitis. Recently, Kevin Rudd, the former prime minister of Australia, was admitted to the hospital for such a thing. He contracted an infection while helping flood victims there.

If you think you may have an infected wound, be sure to wash it with cool water. Use soap and a clean washcloth to clean the skin around the wound. Be cautious of getting soap into the wound as this can irritate it. An antibiotic ointment can be applied to help fight infection. For a more serious wound, call your podiatrist to get it checked out. If it’s a deep wound, then it may require a few stiches. If the area becomes tender and inflamed, leaks any creamy fluid, or you start to run a temperature, call your podiatrist immediately as this could lead to more serious conditions. Your podiatrist will perform a detailed inspection and determine the best course of treatment on a case-by-case basis. For all those nicks, cuts, and foot bruises, come by and see the physicians at Foot Associates of Central Texas.

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy Syndrome (RSDS), is a very debilitating disorder that podiatrists sometimes see. This disorder begins after a nerve injury. This injury can leave the nerves in a hypersensitive and painful state. This causes patients to have “out of proportion” pain. This means that an action or stimulus that would barely hurt a person without this condition causes excruciating pain to the person with CRPS.
The exact cause of CRPS is not completely understood. It is suspected that damage to the nerves causes problems in controlling blood vessels and sweat glands. These damaged nerves lose the ability to control temperature, blood flow, and sensation to the affected area. CRPS is more common between the ages of 40-60.

There are 3 stages to CRPS but they don’t necessarily represent an ordered progression. You could be in one stage indefinitely or start out at stage 2 or 3 without going through 1. Symptoms range from severe burning, aching to the lightest touch. The skin could become dry and thin. Pain may move further up the limb. This could progress to swelling, changes in bone on an x-ray, stiff muscles and joints. And severe forms could include a painful entire limb, muscle wasting, and contractions involving muscles of the limb.

Treatment is tough for this condition. Your podiatrist commonly will take a team approach, possibly working with physical therapy and pain management specialists. Medications could include strong pain killers, steroids, and medications for blood pressure. Physical therapy can work with applications of hot and cold for pain relief. For the pain, nerve blocks could be utilized. For more severe cases, surgery would be pursued to cut the affected nerves. For help with this serious condition, see Dr.Grimm or Dr.Pattison to start building your treatment team.

Pedicures

Pedicures are nothing new. People have been manicuring their nails for thousands of years, going back to the Ancient Egyptians and the Ming Dynasty. What has changed is the number of nail salons. From 2000-2010 the pedicure industry boomed from 50,000 locations nationwide, to 100,000. So what should you look out for when getting your nails treated at one of these establishments? It has been reported that 1/100 customers develop an infection from a dirty whirlpool. The germs from these can lead to more serious complications of the foot. Here are some tips to minimize the risk:

1. Are you healthy enough for a pedicure?

-Diabetes? Poor circulation? Neuropathy? Skin problems? These could increase your risk of infection so if you’re not sure, get your feet looked at by a podiatrist to be on the safe side.

2. Give your ankles and feet a look over before the pedicure.

-Any open wounds or cuts can increase the risk of infection. Also, ladies don’t shave the day before your pedicure as this can cause breaks in the skin too small for the eye, but just the right size for bacteria.

3. Inquire your pedicurist.

-Ask if they are licensed. And ask about their instruments. Do they autoclave them (a fancy sterilization machine). Or do they use hospital grade disinfectant solution? Also notice how they clean their footbath for each customer. These baths are the big source of germ breeding and should be disinfected properly

4. How’s the place look?

-Make sure your salon looks clean and presentable. This can tell you about how the business keeps their environment clean to avoid germ build up. There shouldn’t be nail clippings on the floor or tools lying out.

5. Pain?

-A pedicure should never hurt. If it does, one of two things is wrong. They either messed up or your foot has a problem that could require medical attention.

Pedicures are a great way to keep your feet maintained and inspected frequently. These are just a few tips to keep you safe so your feet can continue to be rewarded. If you have any issues from a pedicure or anything else, come by and see Dr.Grimm and Dr.Pattison at Foot Associates of Central Texas.

Super Bowl Sunday

It might as well be a holiday. Super Bowl Sunday brings everyone together in front of their favorite TV. As we look forward to watching the battle between the Steelers and Packers, we’ll also be looking for the multi-million dollar commercial ads that rarely disappoint. With Super Bowl Sunday coming up, there’s one player who won’t be there, Tom Brady. The Patriots QB has been in the news lately for having foot surgery after their loss to the NY Jets. So what happened to him?

Tom Brady suffered a chronic stress fracture of the navicular bone. This is a small bone on the inside of your foot that gets a considerable amount of force put through it. Brady was said to have played through this injury for a major part of the season. Stress fractures are a little different than normal breaks. Stress fractures occur from a long repetitive stress on the bone, possibly caused by muscle pulling on its bony attachments. Normal fractures are usually a specific instance of trauma. The concern with a stress fracture in the navicular bone is that your weight transfers through it as you walk. So you can see how this would affect a NFL quarterback. Every time Brady plants his foot to throw a pass, he was transferring his weight through that fractured bone, leading to a great deal of pain. So what can your podiatrist do to help Tom Brady and anyone else with a stress fracture? Well it depends on a case-by-case basis, but treatment ranges from offloading the fractured foot to surgery. Tom Brady had a screw put in his bone. This was done because the screw will compress the 2 parts of bone, therefore accelerating the healing process and getting it out of that “chronic” status. These patients could also be put in a cast to help the healing. For concerns about your feet, please come by and see Dr.Grimm and Dr.Pattison of Foot Associates of Central Texas.

The Vicious Cycle

There are approximately 70 million obese Americans and that number doesn’t seem to be slowing down. Many of those 70 million are caught between a rock and a hard place. Obesity can make foot problems worse. Extra weight puts stress on the joints of the body and the foot is no exception. This can lead to flat feet and heel pain, which make it harder to exercise and lose weight. Without exercise and weight loss, many of those 70 million people’s obesity leads to other problems like diabetes, heart disease, and other serious health risks.

This is where your podiatrist can save the day and your life. Obese adults should seek help for their chronic foot conditions as soon as possible so they can start a healthy exercise program. Chronic heel pain from carrying extra weight is a common cause of the lack of exercise in obese adults. Proper evaluation by your podiatrist is the very first step. And don’t let fear delay this appointment. Many causes of foot pain can be relieved without going under the knife. Stretching exercises, orthotics, and the proper athletic shoes with good shock absorption can work quite the wonder. If a condition is severe enough for surgery, you can still participate in non-weight-bearing exercises during your recovery, such as a stationary bike, swimming, or weight training.

Many diabetic patients are worried about exercising because of the risk for foot ulcers. This should not persuade you to avoid exercise. Treadmills or elliptical machines can be used to minimize the pounding stress on the feet. And losing weight can help in the control of your diabetes. For the diabetic patient, regular foot exams are also very beneficial in assessing any problematic spots before they worsen. With the right foot care and foot wear, all patients can find a workout routine that is safe and productive for them. To get back into your workout routine, come by and see Dr. Grimm or Dr. Pattison of Foot Associates of Central Texas.

Local Anesthesia

There are three professions within the medical community that extensively use local anesthetics, also known as a local numbing solution. They are dentists, dermatologists, and podiatrists. Local anesthesia is great for clinical practice because it allows for bedside or in-house surgical procedures without having to knock the patient out cold. Dentists use this for almost all their work including fillings, crowns, and those awful root canals. Dermatologists use this to remove a lesion or a mole for biopsy. Podiatrists can use local anesthetics for a number of procedures including an ingrown-toenail surgery. They are great because of their quick action and very low chance of side effects. Some of the popular names of anesthetics you may have heard of are Lidocaine, Sensorcaine, or Novocaine, which is from back in the day.

So how do they work? Well the injections are targeted at specific nerve sites. Without going into all the boring chemistry, they basically stop the nerves from telling the brain that a painful stimulus is going on. Now here is where a doctor’s wording can be tricky. Your doctor shouldn’t tell you, “You won’t feel a thing.” This isn’t necessarily always true. You will feel the deep pressure or sensation of touch, but you should not feel any pain associated with that pressure. For example, when your podiatrist is working on your toenail when you have been administered a local anesthetic, you may feel that he is touching your toe or using a tool of some sort, but you should feel no pain associated with whatever action he is doing. Some people think that if they feel any form of pressure, they haven’t been given enough anesthetic and this isn’t the case. And as always, for any concerns with your feet, come by and see Dr.Grimm or Dr.Pattison at Foot Associates of Central Texas.

Better Boot Buying, part II

So last blog we looked at different types of boots and the up and down sides of each. This week we’re going to give you some tips of what to look for when you go shopping this winter.

• Look for a boot with plenty of toe room, a firm heel counter, and good traction to ensure stability.

• Remember as with any shoes you buy, have both your feet measured. They change throughout our whole life. Many people can’t remember the last time they stepped on a Brannock device, the metal scale used at some foot stores to measure your feet.

• Be aware that brands and boot styles vary greatly. So while you may wear a 9 in those wide Uggs, it may be a 10 in the narrow cowboy boots.

• Try on your boots in the afternoon. Feet tend to swell during the day so you want the boots to fit at their most swollen point.

• No two feet are the same exact size, so keep the longer foot in mind when you settle on a style and size.

• Carry a set of insoles or your custom orthotics when you go try on boots. The level of cushioning can change as you go from a hiking boot to a rain boot.

• Be aware of the type of boot you need. If looking for a waterproof boot with the Gore-Tex liner, watch out for excessive perspiration of the feet which could lead to an Athlete’s foot.

• A boot made of natural materials such as leather, will keep feet dry during the winter months.

These are just a few tips to keep in mind this winter. For any questions about footwear to accommodate your own feet, see Dr.Grimm or Dr.Pattison of Foot Associates of Central Texas.