Raynaud's Phenomenon

As we eagerly look forward to the fall season and its cooler temperatures, let’s take a look at a condition that could be showing up at the same time. It’s called Raynaud’s and it comes in two forms: a disease and a phenomenon. Raynaud’s is considered a vasospastic disorder, meaning that the smaller blood vessels fluctuate between becoming narrower and then wider. This shows itself as an attack with color changes to the fingers and toes that are usually brought on by stress or the cold. When the blood vessels vasospasm, less blood is getting to the fingers and toes, causing a blueish appearance. When the blood rushes back in, this causes a reddish appearance. And when a normal state returns, this shows a white appearance. Usually pain isn’t associated with this condition.

So what’s the difference between the disease and the phenomenon? Raynaud’s disease occurs more often in females under 40 and shows up on both sides of the body. There is also no ischemic change, or signs of a systemic disease present. Raynaud’s phenomenon occurs more often in males, over 40 and can show up on both sides or just one side of the body. There are ischemic changes and a systemic disease present with the phenomenon. So the phenomenon is a symptom of a bigger disease whereas Raynaud’s disease is a stand-alone condition.

Treatment of this can be difficult. If you are a smoker, then quitting can help due to smoking causing vasoconstriction of vessels. Avoiding stressful situations or the cold can also help this condition. This is less frequent in Texas but I have seen it in several patients every year. This may include wearing gloves and more insulating socks. Medication could also be recommended that would open up the blood vessels in the extremities. This is less frequent in Texas but I have seen it in several patients every year. Evaluation by your podiatrist of this condition is important to determine if it’s a stand-alone disease or a symptom of a more serious condition. Be sure to check with Dr.Grimm or Dr.Pattison for this and any other foot and ankle concern.

Cortisone Injections

A rather common treatment in podiatric care is the cortisone injection or in general terms a steroid injection. This is also known by other trade names like Celestone, Kenalog, Dexamethasone Phosphate, and Depo-Medrol and is a close version of our body’s own cortisone hormone. Our bodies naturally produce cortisone, however in a relatively short-acting form. The synthetic form that podiatrists inject targets a specific site and can last up to a several weeks.

Cortisone injections are used for a variety of conditions, but the overall theme is that they are very good at suppressing the immune system. By doing so, this reduces the inflammation, pain, and swelling at the site of injury. Cortisone is not a pain-reliever, but if the foot pain is caused from inflammation then it will result in relief. Some conditions that can be treated by a cortisone injection include plantar fasciitis, Achilles tendonitis, bursitis, neuroma pain, and other inflammatory conditions. For tendon inflammation, your podiatrist may want to inject around the tendon, but not directly in it because this can cause further weakness of the tendon.

The big question among kids and adults alike…Does it hurt? Well it can be slightly painful, but it depends on the needle size and where the injection is targeted. In our office we commonly use a cold spray topically to ease the pain of injecting the medication. Numbing medication, such as lidocaine, may also be injected with the cortisone to help provide instant relief. Depending on your condition your podiatrist may need to do a second, and possibly third round of a cortisone injection to effectively knock out the pain. Often podiatrists don’t want to give more than 3 in a time frame. And as always if you have any problems with your feet, come by and see Dr.Grimm and Dr.Pattison at Foot Associates of Central Texas.

Deep Vein Thrombosis (DVT)

A deep vein thrombosis, more commonly known as a DVT, is a condition that can affect the lower extremity. It involves the formation of a blood clot in a deep vein. This can present no symptoms, but in many cases the affected leg will be red, swollen, and painful. This condition could lead to a serious complication involving the clot becoming dislodged and traveling to the lungs, known as a pulmonary embolism.

Several conditions can lead to a DVT, such as trauma, cancer, infections, smoking, obesity, pregnancy, or a period of prolonged immobilization. This is where your podiatric care can come in. If you have any kind of procedure where you will be immobilized for a while during the healing process and are put into a cast or brace, it’s important to let your podiatrist know if you feel any sudden discomfort. This would be a feeling that the cast has become too tight and painful, indicating swelling of the leg. Your podiatrist will want to make sure this is not a DVT and not expected pain of the procedure performed. This can be done by a blood test for D-dimer levels or by an ultrasound.

There are a few ways to prevent a DVT caused by immobilization. Your surgeon may administer something called a low molecular weight heparin (LMWH) or another type of blood thinner. This lowers the chances of the blood clotting together. It’s also helpful to walk and proceed in therapy as soon as you get clearance from your physician. Also ask your doctor about alternative exercises which may help like aquatics, or knee and hip extensions. When you walk, your calf muscles help blood that pools in your leg make its way back up to the heart. This also lowers the chances of forming a clot. For these and other concerns of the lower extremity, feel free to contact Dr.Grimm and Dr. Pattison at Foot Associates of Central Texas.

Posterior Tibial Tendon Dysfunction

Tendons are what attach our muscles to our bones. Sometimes with an overuse injury you can get something called tendonitis, which means inflammation of a tendon. For the foot and ankle this is most commonly found in the Achilles tendon, and the posterior tibial muscle. We have discussed the Achilles here before so let’s take a look at the other muscle problem, posterior tibial tendon dysfunction.

The posterior tibial tendon starts in the calf, runs down behind the inside of the ankle and attaches to bones in the middle of the foot. This orientation helps hold your arch up and gives you support as you walk. Any injury to this tendon may have you feeling pain on the inner ankle and your arch may progressively fall, leading to flatfoot. Other symptoms could include heel pain, pain upon weight-bearing, especially when walking or running. You may also have instability when standing on your toes and tenderness over your midfoot. So who’s at risk for this? This occurs more often in women over 50 and also can affect those that are obese, diabetic, hypertensive, or a have history of an inflammatory disease.

Your podiatrist can diagnose this through a series of clinical tests and by looking at your foot structure. They may also possibly get an x-ray, ultrasound, or MRI. To treat this painful condition your podiatrist will look at how far along in the condition you are. In the early stages this can be treated by anti-inflammatory drugs, rest, and immobilization. For later stages, custom foot orthoses may be recommended to correct the biomechanical deformity of the foot. And for severe cases, surgery may be needed to treat the dysfunction. Posterior tibial tendon dysfunction can lead to other foot ailments so be sure to see Dr. Grimm or Dr. Pattison before this condition gets worse.

Diabetic diagnosis.....now what?

Diabetes is a disease in which a person has a consistently high blood sugar, either from the body not making enough insulin to counteract it (Type 1 Diabetes), or because the cells don’t react to the insulin that is produced (Type II Diabetes). As of 2007 there are 23.6 million children and adults with diabetes. That’s almost 8% of our population. It’s also the 7th leading cause of death. So its numbers are rapidly growing and the disease itself can lead to a number of complications in the body.

Long term effects of diabetes can include poor blood flow to the legs. This poor blood flow affects the muscles, bones, and nerves. Diabetics can also be more prone to infections and tend to heal slower than someone without diabetes. This presents a problem with even the smallest sore because due to the poor blood flow that would normally bring healing agents, the wound becomes at greater risk of infection. This is where your podiatrist can save the day. Any sore or callus should be examined by your podiatrist to evaluate the seriousness and apply any aid needed to heal. Fixing these wounds by yourself could lead to an infection. It’s also important for diabetics to do daily inspections of their feet to make sure there are no abrasions.

Your podiatrist can also recommend some tips to stay out of trouble. Shoewear that’s more accommodating can be recommended to diabetics so they stay active to keep their sugar in control. It’s important to make sure the foot type is paired with the correct shoe to avoid any blisters or sores that would heal slowly. Diabetic socks could also be recommended. These socks have no seams and help control moisture which helps avoid wrinkles. This helps reduce pressure and blistering in the shoe. These are just a few of the ways that podiatrists are vital to the care of diabetics in avoiding amputation and other complications of diabetes. For diabetic concerns with your feet come by and see Dr. Grimm or Dr. Pattison at Foot Associates of Central Texas.

Podiatrists Decrease Limb Amputation

Continuing our talk on ulcers of the lower extremity, a recent study found that podiatric care decreases the instances of limb amputation. Up to 25% of those with diabetes will develop a foot ulcer. If that ulcer becomes infected and isn’t properly cared for, this can lead to an amputated limb and possibly death. With diabetes affecting 21 million people in the US and 189 million across the globe you can see how this presents a problem.

The study looked at records for 29,000 patients with diabetes, ages 18-64, and compared the risk factors for those who had seen a podiatrist and those who had not. The researchers had found that care by a podiatric physician, which was defined as at least one visit before an ulcer was diagnosed, was associated with a 15% lower risk of amputation and 17% lower risk of hospitalization. Podiatrists are trained to assess your level of risk for an ulcer and make the appropriate prevention plans. This can include offloading pressure on the foot that’s causing the ulcer in the first place.

And this study also points out that podiatrists not only save limbs. After a major amputation, 50% of patients have the other limb amputated within 2 years. And the 5 year mortality rate after limb amputation is at least 50%. This is worse than many types of cancers. So podiatrists can save lives as well as limbs. For concerns about your ulcer or anything else about your feet, come by and see Dr. Grimm or Dr. Pattison of Foot Associates of Central Texas.

Ulcers of the Foot

Ulcers are sores of the skin that are usually accompanied by the disintegration of tissue. They are quite common in the world of podiatry and they can have some difficulty healing unless medical or surgical intervention is taken. When an ulcer goes untreated, this can lead it to becoming infected which brings in a whole new set of problems for the patient.

So how do you get these? The cause of an ulcer can be varied but the main cause is impaired blood circulation. Chronic wounds and ulcers can be caused by cardiovascular issues or external pressure from a wheelchair or bed. Other causes include bacterial infections, viral infections, fungal infections or cancers.

How do I know if I have one? An ulcer is any open wound so close daily inspection will detect an ulcer either by sight or feel. If it’s infected there will be some swelling, redness, and fever with it. If neuropathy is present, then you may not feel the wound which is why a regular foot inspection is quite important.

What can a podiatrist do for this? Prevention of ulcers focuses on patient education and offloading pressure points in the foot. High pressure can break down the skin in that area and develop into an ulcer. Your podiatrist will use orthoses, shoewear modifications or padding to accommodate the foot. An x-ray may be done to evaluate the bone structure. Fixing the cause of an ulcer is an important step in the treatment plan. Ulcers constantly have their dressing changed and are debrided. Your podiatrist will want to cut away the dead tissue to allow for the healing process to continue. Some medications also help expedite growth of the wound area. If an ulcer is infected, antibiotics may be recommended as well as a hospital stay if it’s serious enough. If you have a wound in question or any other concerns with your feet, don’t hesitate to visit Drs. Grimm and Pattison at Foot Associates of Central Texas.