Posts Tagged ‘foot injuries’
Monday, November 1st, 2010
Smoking and foot care are a dangerous combination; especially, if you have poor circulation, diabetes, or heart disease. There are increased incidences of infections and amputations, but it ceases to amaze me that patients will sacrifice a piece of their foot for that dreaded cigarette.
Cigarettes contain the compound nicotine and this substance causes the blood vessels to narrow which limits the blood flow to different parts of the body. The heart can be affected by limited blood flow. With diabetes, smoking can prove fatal.
Diabetes can cause calcification with the arteries and this can impede the flow of blood to the feet. When cigarettes are added to the mixture, the opening of the arteries becomes narrower. This can cause discoloration in the toes, cramping in the legs and feet and delayed healing the legs and feet.
Recently, I had the opportunity to speak with a person who has been a patient of mine since I started practice. In the past, I have advised the patient to stop smoking because of the possible danger pertaining to his feet. Just to give you a background, he has had 3 amputations on both feet; plus, he enjoys his two to three cigarettes before he comes into the office. Approximately three weeks ago, he comes to the office and says’ “Doc, I have a sore on my foot…” I knew something was strange because he came in on an odd day and he did not smell like a carton of cigarettes. Well, he had a giant hole in his foot. He told me it just started two days ago (it looked like it was there 2 weeks). I treated him that day and told him he must see the vascular specialist. While all this is going on, I still told him, practically begged, that he must stop smoking. Well, he told me to just cut it off…..I am not going to stop smoking.
Well, on the next visit, the wound got larger and there was a stench and puss. I advised him to go to the hospital and he had an amputation of one of his toes.
The moral of this story is that you have to make a healthy choice….Smoking or Your Feet!!!!!
If you have any wounds or infections of the lower extremity, come see the limb salvage specialists of Monmouth and Middlesex County, Affiliated Foot and Ankle Center, LLP with locations in Howell, Edison, Carteret and Monroe, NJ.
By Dr. Jasen Langley
Tags: blood flow, Diabetes, Diabetic, Dr. Jasen Langley, feet pain, foot, foot injuries, foot pain, howell, wound
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Sunday, October 3rd, 2010
It does take some coordination to use crutches and being an athlete I have mastered the use of crutches in 2 weeks. It is ironic that I am a Physical Therapist for Affiliated Foot and Ankle Center in Howell, NJ and I am a currently one of their patient’s. I have instructed patients for over 5 years on the proper technique of ambulating with the use of crutches. I am now filling the shoes of my patient’s.
I have suffered from an injury that has me using crutches for quite some time now. I fractured my heel while I was hiking. Immediately when I fractured my heel I was unable to weight bear because of the excruciating pain. I have been using crutches for 2 weeks and I have great sympathy for the individuals that I treat and others who have had the privilege to use crutches. Crutches will put a damper on your activities and tasks. Now that I have had the experience with crutches I have created some helpful tips for my patients or any individual who may need to ambulate with crutches in the future.
#1.) Ask yourself ….Do you have the coordination to use crutches? If not, get a knee walker. (See below)
#2.) Make sure your crutches are properly fitted for you. (See below)
#3.) Go SLOW. Think before you step. You cannot rush with crutches.
#4.) Wear a tool belt or fanny pack. This will come in handy when you need to carry things. My favorite one is a fitness fanny pack with an attached water bottle.
#5.) Prepare your clothes the day before. This will save time and energy when you are getting ready in the morning.
#6.) Set up everything you need on one level so you are not trekking up and down the stairs more than once a day.
#7.) The safest and easiest way to ascend and descend steps is on your butt!
#8.) Take rest breaks. Crutches are not made for long distances. But if you must, make sure there are chairs or benches where you intend to walk.
#9.) Crutches are not meant for leaning on them. Your underarms will thank you.
#10.) Do not use your crutches in a crowded area. A slight push or shove can easily knock you off balance.
I am planning on traveling and using crutches are tiring and not the best for sight seeing. I have researched other forms of medical equipment. I have found that a knee walker is the fastest form of transportation when you are planning to walk long distances. Insurance does not cover this device and most local surgical supply shops do carry knee walkers. You can rent them for approximately $30 a week. I had a difficult time finding a knee walker because all the knee walkers were on hold for other lucky individuals, so I purchased one online for $290.00. If I were to rent one for 8 weeks I would pay $240 so I justified $50 more to have my very own knee walker. This device is great! It is faster than being on two feet and you can travel distances in no time. I have taken my walker to the mall and shopping. The basket on the walker comes in handy when I need to shop. The walker folds up conveniently to place in your car. This is my recommendation when you need to go the distance, and you do not have access to a wheelchair.
Sizing your crutches:
Even if you have already been fitted for crutches, make sure your crutch pads and handgrips are set at the proper distance, as follows:
Crutch pad distance from armpits: The crutch pads should be 2 finger widths distance from your armpits. Make sure you are standing up straight and shoulders are relaxed.
Handgrip: Place it so your elbow is flexed 20 degrees, so you can fully extend your elbow when you take a step. Remember, your weight will be shifted into your wrists and palms (not your armpits) when you take a step. There is no need to wrap your crutch pads with towels because you do not lean on your crutch pads with your armpits.
Crutch length: The total crutch length should equal the distance from your armpit to 10 inches in front of a shoe.
By Valerie Gregory, CPT, CKTP
Tags: ankle, ankle pain, ankle sprain, Ankle Sprains, foot injuries, foot injury, fractures, howell, sports injuries, sports injury, valerie gregory
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Thursday, September 23rd, 2010
Tags: achilles, arch support, athlete, athletes, Dr. Dewaters, feet pain, foot, foot injuries, foot injury, foot pain, heel pain, howell, plantar fasciitis, sports injuries, sports injury
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Tuesday, September 14th, 2010
In a recent article, in the New York Times, dated September 7, 2010, the author reveals that there are a number of topical non-steroidal anti-inflammatories (NSAIDS) that being used in multiple specialties for pain. Some of the medications come in gels, liquids, and even patches. The active ingredient is Diclofenec Sodium, also known as Voltaren. Voltaren, in oral form, is an excellent NSAID; however, it has been linked to liver problems and GI upset.
There are a few commonly prescribed topical NSAID and they are Flector Patches, Voltaren and Solaraze Gel (which is used off the label). These medications are excellent for arthritic pain and very few side effects; however, as stated in the New York Times article, there are no known or very little randomized controlled studies available. My experiences with these drugs have been good and hopeful for patients that have trouble tolerating Voltaren. I have been employing topical anti-inflammatories for the past 6 years as a podiatrist in Howell, NJ.
In our office, I will prescribe NSAID patches for heel pain. The compliance, or in other words, patients using these drugs as prescribed, has been 90-95%. There are some patients who skeptical because they cannot understand how medication is delivered through the skin. These patients will start using the medications and they will “test the waters” by stopping use of the patch or gel and the pain returns to the foot. Patients are truly fascinated that pain relief can be delivered through the skin.
Now, these topical medications are not for everyone. Patients who have bleeding disorders, GI upset, Kidney disease, Liver disease, and also, patients who are taking blood thinners should consult with their doctor. Even though a direct and relatively minimal amount is delivered to the area of pain through the skin, there are not many studies to show the health effects of these medications.
If you are suffering with pain, consult with your doctor for an alternative to taking an oral form of NSAIDS. Even though these oral medications are relatively new in the United States, these old medications, topical NSAIDS, are going to be the future for pain management.
If you have any questions, please feel free to contact our Affiliated Foot and Ankle Center, LLP office.
By Dr. Jasen Langley
Tags: athlete, Dr. Jasen Langley, feet pain, foot, foot injuries, foot injury, foot pain, heel pain, howell, runner, runners, sports, sports injuries, sports injury
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Monday, August 23rd, 2010
No… they don’t. This has been a recurring question in our practice due to the late night infomercials. There are many products on the market, each claiming that they are able to remove metals, toxins and impurities from the body. These infomercials claim that:
“…using centuries old research to unleash the natural power of healing herbs and plants, we have created a safe naturopathic combination that draws from the acupuncture points at the bottom of the foot.”
Where you would take this patch, apply it to your feet, and as you wear it, it will remove these toxins. Then they say that you can tell the product is working because the pad will become a dark brown/black color and start to have a bad odor, which is supposedly toxins leaving your body.
These claims are entirely nonsensical. The human body eliminates toxins through the liver, which then gets filtered through the kidneys into the urine… not through the bottom of your feet. The marketing behind these products is clever because they provide you a “cure” for something that you don’t have in the first place. The discoloration you see in the pads is rust/corrosion, which occurs when the metals in the pad comes in contact with sweat. The bad odor smell is from bacteria and sweat that is trapped in the pad.
Some companies go as far to claim that “detox pads are FDA (Food & Drug Administration) approved”. There are transdermal detoxification pads that ER doctors use on patients that to help speed drug overdoses (helps pull out the narcotic), but these are NOT the same thing as “foot detox pads”. The companies are putting a spin on the truth, intentionally misleading consumers to help line their pockets. The irony is that the company that made the statement about FDA approval (implying their product was), is actually black listed on the FDA website.
If one should truly be concerned about having toxins in their body, I recommend you see your primary care physician. However, if one should have foot pain, bunions, hammertoes, heel pain, plantar warts or any other pedal complaint, you should schedule an appointment at Affiliated Foot and Ankle Center, LLP, conveniently located in Howell, NJ.
By David Hunnicutt
Tags: david hunnicutt, feet pain, foot, foot injuries, foot pain, howell
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Monday, August 16th, 2010
Amputations are a serious concern whether it is related to traumatic or diabetes. Traumatic amputations are usually from injuries sustained in motor vehicle accidents and lawn mower injuries. These injuries can make the foot and ankle unsalvageable as well as non-functional. Sometimes the debris and remnants of the injury can lead the patient to severe infections. Diabetic amputations are subjected to patients who have high sugar levels and neuropathy, which are patients who have a loss of sensation in the foot and ankle.
Podiatrists are your first line of defense if it relates to the lower extremity. Diabetic amputations are the number one cause of losses of limb. Diabetics are subjected to these surgical procedures if different parts of the foot and ankle are infected. Infections can be prevented with regular check-ups of the foot and ankle.
As many diabetic patients know, there is much fear when a diabetic has markings on their feet and ankles. Whether it is redness, bruising or an abscess, these are painful conditions that can become out of control. Some may need to be hospitalized for further work-ups such as vascular, infectious and medical.
Once the patient has been evaluated, they may have an infection or vascular condition that can limit blood flow to the foot and ankle. This can lead to a gangrenous, painful and non-functional foot. Usually this rotted part of the foot and ankle must be amputated to prevent other medical problems.
According to a recent announcement from Bloomberg Newsweek, Dr. James Wrobel states that most diabetics who visits the podiatrist once prior to a diabetic foot ulcer, reduces their risk of amputation and hospitalization by 15-17 percent! This may be due to the patients becomes educated on how to self examine their foot and also, most diabetic patients will become aware of the warning signs of pre-ulcers and infection. By the same token, patients will acquire and learn about shoes that they should be wearing to prevent ulcers and pressure spots on the foot and ankle.
All diabetics should be evaluated by a foot and ankle specialist whether there are complications are not. Education is the best prevention. Please inquire to your family doctor, endocrinologist and vascular specialist regarding having a foot exam. CDFE (Comprehensive Diabetic Foot Exam) is very important exam and as Dr. Dewaters of Affiliated Foot and Ankle Center, LLP discusses in a prior blog, this exam can be a matter of life and loss of limb.
By Dr. Jasen Langley
Tags: Diabetes, Diabetic, Dr. Jasen Langley, feet pain, foot, foot injuries, foot injury, foot pain, howell, neuropathy, red hot foot, redness, wound
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Tuesday, July 6th, 2010
Many patients will come into our office at Affiliated Foot and Ankle Center located in Howell, NJ asking the question, “Why are my ankles so swollen?” Usually this time of the year, it is caused by the increase in salt intake from too many barbequed hot dogs and the increase in humidity during the summer months. There are many possible causes for swollen feet and ankles, ranging from the common and harmless to the rare and dangerous.
Occasionally, the ankles and feet swell as the result of something localized to that part of the body. If you recently suffered a traumatic injury to one or both of your legs, for instance, it’s expected for the onset of swelling and bruising to occur. The ankles and feet can also swell as the result of an infection. For instance, a severe ingrown toenail or an insect bite that you’re having a reaction to may cause unexpected swelling. Burns, including sunburns, can also cause swelling.
Sometimes a more systemic problem can lead to edema in the ankles and feet. Problems of the heart, liver, and kidneys can eventually cause swelling in the lower legs, ankles and/or feet. Pregnancy and obesity can both cause obstructions of the circulatory system leading to swelling of the feet and ankles. Arthritis and other joint diseases can lead to pain and swelling in the feet and ankles, although this swelling will be focused in the joints themselves and you shouldn’t expect a generalized puffiness.
A certain amount of swelling in the ankles and feet is not uncommon in the summer months, especially if you’ve been standing or walking for long periods. It’s also common to get swollen ankles or feet if you’ve had to do a lot of prolonged sitting, such as during an airplane flight. I regularly visit the spa while on vacation to treat myself to a relaxing massage because of the swelling. A massage assists your body to rid of excess fluid. Some women get swollen ankles and feet during menstruation.
Medications such as antidepressants, steroids, blood pressure medications and hormone supplements are a common cause of swelling in the ankles and feet. Diet can also play a role. If you’ve been taking in too much salt, it can lead to swelling.
Finally, gaining weight and being more sedentary can often cause an increase in the size of your feet and ankles.
If you are unsure of the cause of your swollen feet or ankles it is imperative to make an appointment with one of our physicians at our office in Howell, our office in Edison, our office in Monroe or our office in Carteret. BETTER SAFE THAN SORRY.
Possible Causes of Swollen Feet/Ankles
- Foot or Ankle Injury
- Diet
- Insect Bite
- Allergic Reaction
- Pregnancy
- Water Retention
- Nephritis
- Side Effect from Medication
- Poor Fitting Shoes
- Cellulitis
- Lymphedema
- Varicose Veins
- Poor Circulation
- Deep Vein Thrombosis
- Heart Failure
- Anemia
- Kidney Disease
- Diabetes
- Gout
- Rheumatoid Arthritis
By Valerie Gregory, MSPT, CKTP
Tags: ankle, ankle pain, Diabetes, Diabetic, feet pain, foot, foot injuries, foot injury, foot pain, howell, pregnancy, swollen foot
Posted in General | 5 Comments »
Thursday, June 17th, 2010
Many sports fanatics will engage in highly competitive weekend activities. These activities may include football, volleyball, softball and even paintball. I love paintball and I broke my ankle and ruptured multiple ligaments last year while playing this exciting sport. However, one condition that plagues athletes is the dreaded Achilles tendon rupture.
This condition usually occurs while running and jumping; also, it can happen while making sharp movements. Some patients relate to someone hitting the back of their ankle or even describe as a “pop” like a gunshot. Many will fall to the ground with extreme pain. Once patients gather their wits, they try to flex there ankle and realize there no muscle power or total loss of function while trying to flex that Achilles tendon.
The weakest part of the Achilles tendon is the cord of the muscle. This cord is similar to a braided telephone cord and it compasses three muscles: medial and lateral head of the gastroc and the soleus muscle. The thin plantaris tendon runs along the side of this tendon. This tendon flexes your foot and ankle. Also, it aids in inverting and supinating your foot and ankle which is turning your foot and ankle in an inward fashion. There is very little blood flow supplied to this cord. This is known as the water shed area. Most Achilles tendon ruptures will tear approximately 2.0-2.5 cm above the insertion which is above the heel bone or calcaneus.
Their appearance is pretty frightening!!!! The back of the ankle will start changing from a normal skin color to black and blue. Patients will fear the worst like lose of circulation. The color change is related to the bleeding that is occurring at the rupture. Swelling will ensue. The most profound clinical finding is the deficit. When I examine these patients in the office or ER, you can press right in the deficit and the finger just falls in the “hole.” Other clinical test are performed, like a Thompson test, where the patient is placed on their stomach and the gastroc or the calf muscle is squeezed and this is to determine if there is any flexion. Usually there is none. An MRI is sometimes performed but it is usually not necessary if the patient is treated early.
Treatment for the rupture should be surgical repair. The patient can be immobilized with cast or CAM walker; however, with this type of non-surgical treatment, the chances of re-rupture are high. Age, medical history and social history are considered when considering surgical treatment.
Once the rupture is healed, physical therapy should be implemented and this is important. During the healing process, the patient may develop atrophy or weakness in the muscle group and regaining strength is important so the patient can return to activity.
So, you weekend warriors have fun!!!! If you do have an injury which is an Achilles tendon rupture, treat and repair the tendon early so you can return to activity. It is important muscle which help you flex your foot and ankle which you need to walk, drive and play sports.
Any injuries or trauma to the foot and ankle, please feel free to consult or call any of our office locations, which are Howell, Edison, Carteret and Monroe. We will be happy to see you in the office of emergency and tend to all your foot and ankle needs.
By Dr. Jasen Langley
Tags: achilles, achilles tendon, achilles tendon tear, athletes, feet pain, foot, foot injuries, foot injury, foot pain, sports, sports injuries, sports injury, torn ligaments
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Tuesday, May 25th, 2010
Being a podiatrist in Howell, NJ by the Jersey Shore, a large number of patients that present to the office with pain in their feet have underlying deformities but still want to wear sandals for the summer. While sneakers with orthotics are the most supportive, it is not always ideal for the summer and going to the beach or being by the pool.
Flip-flops have become increasingly popular over the last couple years but can also cause injuries to the foot due to the lack of support. I actually broke my fifth metatarsal wearing a pair when it caught on the saddle of a door. There instability is in the thin sole with only two thin straps. The important thing to remember is that they are not designed for activity but for style. There are some sandals that are designed with more support and can actually have an orthotic built in or can have an orthotic put in them. The things to look for in a pair of sandals for the summer are supportive soles that you cannot bend in half. Leather works very well and reduced skin irritation. The sandal should also be larger than the foot so the foot does not hang over. Avoid ankle straps and gladiator style sandals as they may cause irritation and blistering. Birkenstocks have larger more supportive straps on the top and similar styles provide more support and stability. Wedges also will give increasing instability and may cause ankle sprains if the heel slips off. Look for sandals that provides cushion and arch support built into to it. You should also not be wearing the same ones that you have worn for years. Like regular sneakers and shoes that should be replaced as they wear down, so should your sandals. A good rule is every 6 months for regular activity and more often for increased activity. If the shoes or sandals have worn in such a way that they are rolled in or out it is time to replace them. If you are planning to do a lot of walking, sneakers and orthotics are still going to be the most supportive and provide the most benefit. APMA has listed sandals that they recommend. Check with your local podiatrist to see if they have them in their office or where you can find these more supportive sandals.
By Dr. Alison DeWaters
http://www.footdoctorsnj.com/adewaters.html
Tags: alison, ankle, ankle pain, ankle sprain, Ankle Sprains, arch support, Dr. Alison Dewaters, Dr. Dewaters, Exercising, feet pain, foot, foot injuries, foot injury, foot pain, fractures, heel pain, howell, orthotics, Plantar fascial band, plantar fasciitis, proper footwear, sandal, sandals, shoes, toe pain
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Wednesday, May 19th, 2010
My wife and I woke in the morning and she said, “Since last night, my second and third toes are tingling.” I know what you are thinking but as you get older, the romantic night gets less and less. Well, back to the subject at hand!!!! I asked her did she injure her foot while working out and she said no!!! I look at her and gave her foot a firm squeeze from side to side and I felt some clicking. She had a neuroma!!!!
A neuroma is a nerve that gets thickened from overuse, shoes and injury. The nerves that get affected are the digital nerves which innervate or give sensation to the toes. They are not motor nerves. They are sensory nerves. Symptoms of a neuroma range from pain to tingling and numbness in the toes. It usually occurs in the second and third toes, and symptoms can be in the third and fourth as well as the fourth and fifth toes.
My wife came to the office where I took an x-ray and performed an ultrasound. X-rays are taken to make sure that no fracture is present. Ultrasounds are becoming a great diagnostic tool to evaluate soft tissue masses. On my wife’s ultrasound, a neuroma was seen and she was properly diagnosed. After the ultrasound, she proceeded to tell me that I would be sleeping on the couch because I squeezed her foot to hard!
I explained to her the treatment options. Some of the options were changing her shoes, padding the foot, cortisone injections, non-steroidal anti-inflammatories and sometimes surgeries. I suggested that she get a cortisone injection and use anti-inflammatories. She really did not want the injection but I explained, basically schmoozed her, into getting the injection. This would give her the most immediate relief from her symptoms. She got the injection and I padded her foot. Well, I saw her at home and during dinner I asked her, “How is your foot?” She said it was a little sore but it was 90 percent better. I told her she would need some orthotics, which are custom arch supports, because this would take the pressure off the area of the foot where the neuroma was present.
So, I am not in the doghouse with my wife and she was pretty impressed that I diagnosed her problem. She realized how painful a foot condition could be. Also, she realized how important feet are in regards to everyday activity. It is now a few days later and she told her aunt how much better her foot has been since the injection.
Do not let numbness in your feet get ignored. Visit our in office Howell and let Affiliated Foot and Ankle Center diagnose and treat your condition. Just as a side note, please do perform any of the exams that were portrayed in this blog…Thanks!
By Dr. Jasen Langley
www.footdoctorsnj.com
Tags: athletes, Dr. Jasen Langley, Dr. Langley, feet pain, foot, foot injuries, foot injury, foot pain, howell, Jasen Langley, neuroma, orthotics, runners, shoes, tingling, tingling in my foot, toe pain
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Watching the Giants play the Colts this past weekend was painful for many Giants fans alike.
