Posts Tagged ‘foot injury’
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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Monday, July 26th, 2010
Corns are well known vegetables; however, on the foot, they are thick lesions that form on the top of the toe joints. In the foot and ankle community, they are also known as hyperkeratotic lesions and they form from pressure to the surface of bony prominences, especially on the toes. They can be painful as well as form abscesses if they are exposed to prolonged pressures from shoes.
Many people will purchase corn pads to help relieve pressure from the area and also attempt to reduce the lesion from the active ingredient, salicylic acid. For clarification, there are two types of corns- medicated and non-medicated. Medicated corn pads have an ingredient which is salicylic acid. The mechanism of salicylic acid is the break down the thick tissue. Basically, it causes a burn. When a burn occurs, it can lead to an infection. Once this occurs, most people will call the foot doctor.
Recently, I noticed on our schedule here in Howell that a new patient was coming to the office with an “infected toe from a corn pad.” I thought this was quite interesting because it is the summer and patients will try to “cheat” and use corn pads to get rid of the problem.
So, the patient comes into the office and he is diabetic and most diabetics have some loss of sensation in their lower extremities. Low and behold, this patient had no feeling in his feet. On top of that, the patient had a hot, red, swollen toe. It appeared to be a burn. He still had some thickened tissue on the fifth toe; so, I debrided or trimmed the lesion and an eruption of yellow, foul smelling puss came out of the toe. I took an x-ray and the bone was missing. I asked the patient, “How long have you used the corn pad?” He says, “For three weeks.” I proceeded to tell him that he had a severe infection and his toe needed to be amputated. The amputation was performed and he healed uneventfully.
The moral of this story is that medicated corn pads are not safe for some patients, especially diabetics, and they should not be used for long periods of time. If the corn is thick, patients should be seen by a podiatrist to see if the pressure is caused by a bony prominence. Medicated corn pads cause burns and in mild cases, patients are treated for burns and in severe cases, patients are treated for infection. If there is an urgency to use a pad, use a non-medicated corn pad. These are safer.
Corn pads are not used for the picnic nor for your feet…
By Dr. Jasen Langley
Tags: athletes, corn pads, Dr. Jasen Langley, Exercising, feet pain, foot, foot injury, foot pain, howell, proper footwear, runners, shoes, toe pain
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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
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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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Monday, May 3rd, 2010
This weekend was the New Jersey Marathon at Pier Village in Long Branch. I saw a lot of athletes all shapes and sizes were running to compete their best. Running is a sport for many ages and anyone can run. Plus it is cheap; you don’t need equipment or a gym, all you need is a good pair of running shoes. Because of the weather being warmer and days longer, I have seen more and more people running outside. Being a Physical Therapist at Affiliated Foot and Ankle Center in Howell, NJ many patients ask me, “Which running shoes are best for my feet?”
First you have to figure out the type of feet you have: flat feet, high arched feet, or neutral or normal feet. If you’re looking at your foot in a standing position, you’ll know you have flat feet if you don’t see any arch. The bottom of your foot, from your toes to your heel, is completely flat. If you do the footprint test, you won’t see an inward curve from your big toe to your heel. If you’re flat-footed, you’re most likely an overpronator, which means that your feet roll inward when you run. You will probably need a running shoe that maintains your stability. Look for the words “motion control” and “stability” on the box of running shoes you are considering. In addition to motion-control shoes, some flat-footed runners also need to wear orthotics. Orthotics or custom-made shoe inserts that correct foot issues can be made at our offices in Howell, NJ, Edison, NJ, Carteret, NJ or Monroe, NJ. We will make a custom mold of your feet and design an orthotic that best suits your needs.
If you have high arches, you’ll notice a high arch on your foot. If you do the footprint test, your print will curve inward, making the middle part of your foot look very thin. If you have high arches, you probably supinate or underpronate, which means your feet roll outwards as you run. You need to look for flexible shoes with a soft midsole that absorbs shock. When buying running shoes, look for options with the words “flexible” or “cushioned” included in their descriptions.
If you’ve examined your feet or your footprint and it doesn’t look flat-footed or high-arched, you most likely have a neutral or normal foot. Your footprint will have a noticeable curve inward, but not by more than 3/4 of an inch. This is the most common type of foot, and it’s also the least susceptible to injury provided it’s equipped with proper shoe gear. If you have normal feet, you can choose from a wide variety of running shoes, including ones made for neutral runners.
After you have examined your foot and you still cannot determine the type of feet you have, it will benefit you to be evaluated by a foot and ankle specialist. We can help you determine what type of feet you have and suggest shoes that are best suited for your needs.
By Valerie Gregory, MSPT, CKTP
http://www.footdoctorsnj.com/physical.html
Tags: ankle, ankle pain, arch support, Exercise, Exercising, feet pain, foot, foot injuries, foot injury, foot pain, heel pain, howell, nj, orthotics, plantar fasciitis, runner, runners, running, shin splints, shoes, sports, sports injuries, sports injury
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Tuesday, April 20th, 2010
Ankle sprains are one of the most frequent injuries that occur in athletes. The inversion ankle sprain is where the foot goes inward and is the classic rolling of the ankle. Prevention of this type of injury in athletes that have a tendency to roll their ankle has been a large debate. To tape or not to tape has been the question. Taping vs. prefabricated bracing has been researched on both the efficacy and the cost of each. It has been shown that both can reduce the risk of recurrent ankle sprains. It also has been shown that taping and bracing does help to strengthen the ankle and also improve the proprioception. Proprioception is the body’s ability to detect where it is in space, which is often damaged with a sprain, which leads to recurrent sprains.
Taping has been shown to reduce the risk of ankle sprains in the athlete that is prone to the inversion ankle injury. There are several issues with taping though. Some athletes develop irritation from the taping. There are variations in the person taping. The tape has also been shown to loose its efficacy in as soon as 10 – 30 minutes. Taping can also be more costly as you add up the cost of the tape on a regular basis and the time of the person taping. The cost of one roll of tape is on average $1.40, which is needed for one ankle plus the cost of pretape, lubricant and the person taping, it can cost over a thousand dollars per athlete per season. Taping does work very well but the cost and loss of strength has been points to advocate the use of a prefabricated brace. Taping can also not be adjusted by the athlete.
Bracing has also been shown to decrease the risk of ankle sprains. Ankle braces are prefabricated and not being custom to each athlete may cause some irritation to certain patients. The ankle brace can be adjusted by the individual athlete during the course of the game or practice, which cannot be done with the tape. The cost of the brace is anywhere from $35-$100 which is significantly less than the cost of the tape.
Overall both taping and bracing are both effective ways of reducing ankle sprains. Bracing is a more cost effective way of reducing the ankle sprain and since there is no learning curve, it is always applied properly and can be adjusted by the athlete his or herself.
By Dr. Alison DeWaters
www.footdoctorsnj.com
Tags: Alison DeWaters, ankle, ankle pain, ankle sprain, Ankle Sprains, athlete, athletes, Dr. Dewaters, feet pain, foot, foot injuries, foot injury, foot pain, runner, runners, sports, sports injuries, swollen foot
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Tuesday, February 9th, 2010
Hey, now that you have seen the Superbowl, eaten shrimp, hot wings, pepperoni and cheese platter, where are you going now? To the podiatrist!!!
Some people, more likely men, will experience terrible pain after a rich and high protein diet. This diet can consist of shellfish, oily fish, beef, pork, organ meats, cheese, and alcohol. The pain is usually in the big toe joint but it can be present throughout the lower extremity. This is a condition known as gout.
Gout is a systemic condition that patients will acquire after eating a rich diet consisting of proteins. Alcohol can precipitate a gouty attack. Even some medications can cause this painful condition.
This condition is cause by an elevation of uric acid, which is a by-product of protein breakdown. This “by-product” can precipitate in cold joints like the big toe joint, ankles, knees, elbows, and ear lobes. It analogous to pouring sugar into cold water and the sugar does not dissolve. Well, the uric acids are crystals that can invade the big toe joint and the body will react to it like a foreign body. By the same token, the joint will become very hot and swollen. Also, it will become very painful to the point that bed sheets cannot be tolerated.
The patient usually presents in the office with a severe limp and pain. Upon examination, the toe joint cannot be touched. Some patients will say they injured it with no recollection of trauma. Also, some will say it is an infection. An x-ray is taken to make sure there is no trauma or infection.
Treatments for this condition are oral and injectible steroids, aspiration of the joint fluid for lab analysis for gout. In addition, blood work is a good diagnostic indicator for uric acid levels; however, this should be done within the first 24 hours of the attack. Oral medications are used for the acute gouty attack and anti-inflammatory or pain medications. Recommendations are for follow-up with the primary care doctor for medications to prevent reoccurrence.
Elevated uric acid levels do not cause gout but can initiate the processes. Many patients will go untreated and this is bad. The crystals can cause “tophi” which are crystals that will present beneath the skin like a cheesy substance and this can present everywhere. Also, gout can cause kidney stones and cause damage. Gout should be addressed by a podiatrist for acute symptoms and the family doctor for systemic symptoms. The systemic symptoms can be genetic where the factor or enzyme that breaks the uric acid down may be missing.
So, if you get that severe pain after that seafood, beefy treat and then washing it all down with a cold brewski, chances are it is GOUT.
By Dr. Jasen Langley
Tags: big toe hurts, foot injuries, foot injury, foot pain, gout, joints, proteins, redness, superbowl, toe joints, toe pain
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Wednesday, January 6th, 2010
Charcot arthropathy is a form of arthritis that affects patients with peripheral neuropathy. The typical symptoms are a red hot, swollen foot. It usually happens to the middle of the foot and presents with pain to the area. This is unusual for patients that typically did not have pain previously. Diabetes is often the underlying cause of peripheral neuropathy. Charcot is a progressive disorder that is characterized by three stages of the disease process: acute, coalescent, and chronic. During the acute stage, there is a red hot swollen foot that is painful. This is often confused with an acute infection or cellulitis. It is necessary that there be immobilization during this stage as if it continues to progress, the joints will begin to breakdown. If there is resorption of the bones, this will allow the middle of the foot to breakdown and the arch to collapse and even bow outward. The joints will calm down and solidify in that position and develop a “rocker bottom foot.” If this develops, it is not only difficult to cut but also at risk for ulceration. Careful inspection and routine diabetic foot care is essential for prevention of this condition.
By Dr. Alison DeWaters
Tags: Diabetes, Diabetic, foot injury, foot pain, red hot foot, swollen foot
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