Does Turning 30 = Foot Pain?

I'm sure by now you've seen the hit website, Buzzfeed, which displays popular social content on the web. Well, the other day I was scrolling through and an interesting title, 30 Unexpected Things You Learn in Your Thirties, caught my eye.

Working at Shenandoah Podiatry, naturally #16 jumped out at me:

I love the reference to orthotic shoe inserts as they really are an investment and they really do help with back pain (in addition to knee and foot pain!)

So our question is, when you hit the big 3-0 did you experience back and foot pain out of the blue? If you are experiencing any pain or discomfort, give our office a call! We do our best to work with your schedule and get you in quickly to see one of our doctors! We are conveniently located in Blacksburg (right off of 460) and in Troutville (North Roanoke right off 81).

Avoiding Heel Pain

Heel pain is the most common condition leading patients to both our Roanoke and Blacksburg offices. Pregnancy, improper shoes, and overly strenuous exercise are some of the factors contributing to heel pain. Any heel pain that persists for more than a week should be evaluated by one of our podiatrists. To avoid heel pain, always consult a podiatrist before beginning any exercise program, especially if you have been inactive for a long time. Start any exercise program with moderation, gradually increasing the duration and intensity of your workouts.

Always stretch before and after exercise including calves and Achilles tendon. Vary the incline on a treadmill to avoid heel strain. Maintain properly fitting shoes in good condition, wearing appropriate shoes for various activities. When your feet cause you pain, there are many steps you can take to get relief. The first, and probably most important, is a visit to the podiatrist. If heel pain or any other foot problems have got you down, let us do what we do best- diagnose and treat the problem so you’re back on your feet quickly!

Hunting & Hiking



Blue diamond-shaped sign used to designate hiking trails in provincial parks in Ontario, Canada. (Photo credit: Wikipedia)



Walking up and down steep hillsides and tramping through wet, slippery fields and wooded areas puts stress on the muscles and tendons in the feet and ankles, especially if you haven't conditioned properly before hitting the trail. Also, many don't realize that sneakers aren't the best choice for extended hiking and hunting. Had some of my patients worn sturdy, well-constructed hiking boots, they wouldn't have suffered sprained ankles or strained Achilles tendons.

Make the investment in top-quality hiking boots. Strong, well insulated and moisture-proof boots with steel or graphite shanks offer excellent ankle and foot support that helps lessen stress and muscle fatigue to reduce injury risk. The supportive shank decreases strain on the arch by allowing the boot to distribute impact as the foot moves forward. So if a boot bends in the middle, don't buy it.

In wet and cold weather, wearing the right socks can help prevent blisters, fungal infections and frostbite. Synthetic socks should be the first layer to keep the feet dry and reduce blister-causing friction. For the second layer, wool socks add warmth, absorb moisture away from the skin, and help make the hiking boot more comfortable.

For more information on taking care of your feet, visit http://www.shenandoahpodiatry.com/  


As brightly colored leaves dazzle the fall landscape, hikers and hunters nationwide will migrate to mountains, woods and fields, but many, unfortunately, are ill prepared for the beating their feet will take.

Hikers, hunters and others who love the outdoors often don't realize how strenuous it can be to withstand constant, vigorous walking on uneven terrain. Lax physical conditioning and inappropriate footwear bring scores of outdoor enthusiasts into our office each fall for treatment of foot and ankle problems such as chronic heel pain, ankle sprains, Achilles tendonitis, fungal infections and severe blisters.

8 Tips For Healthy Feet on the Trail

My office is located within one mile of the Appalachian Trail. Each summer, I observe the wave of through hikers making the 2,168 mile trek from Georgia to Maine and then later in the summer, those heading south from Maine to Georgia. Many end up with a visit to my office for ankle sprains, stress fractures, infected blisters and various other hiking related conditions.

Recently, I received a call from a friend that is through hiking for her second time in the past 10 years. She was in North Carolina at the time and was experiencing unrelenting pain in her foot. Having a telephone consultation and attempting to determine her diagnosis without examination was interesting and challenging. It made me think about the new trend in Internet or telephone doctor “visits”. But, that is a subject for another post on another day. I want to share with you these tips to keep your feet happy on the trail:

Train For The Hike:
If you are considering a long trip such as through hiking the Appalachian Trail, I strongly suggest that you start out training early with short day hikes. Marathon runners must train and condition for a marathon and hikers are no different. Those that are not adequately conditioned are more likely to develop overuse injuries.

Pack A Foot-Care Kit:
A small foot-care kit carried in a small Ziploc bag weighs only a few ounces. It should contain foot powder, alcohol wipes, a few tinctures of benzoin wipes to help the patch stick to your skin, several blister patches of your choice, a least a yard of duct tape wrapped around a small pencil, and a safety pin to drain blisters.

Invest In Good Footwear:
You should have a fingers width between the longest toe and the front of your boot. Be sure to also check the fit on an incline (both up and down). Any slippage of the boot will cause friction and blisters on a long hike. Try your boots on with the socks that you will be wearing while hiking.

Break In Those Boots:
Wear your boots around the house for a few days to be sure they feel OK. Then venture outside while shopping and on walks and short hikes so they mold to your feet. Leather boots are usually stiff until broken in. If a little snug, you can bring your boots to a shoe repair to have them stretched or purchase a leather expander and stretch the boots at home.

Wear Good Socks:
Wear moisture-wicking wool or synthetic socks rather than cotton socks. Consider wearing a sock liner but be sure that your boots will be big enough for two pair of socks.

Manage Your Toenails:
Toenails should be trimmed straight across the nail—never rounded at the corners. Leave an extra bit of nail on the outside corner of the big toe to avoid an ingrown toenail. Black toenails are a common hikers condition which is caused by blood being trapped under the nail.

Manage Your Skin:
Treat hot spots early! Use moleskin or duct tape to prevent blisters before they happen. Many hikers think tough callused skin helps prevent blisters but too much is never a good thing. Blisters deep under calluses are difficult to drain and treat. Use a pumice stone or callus file and apply Vaseline to manage callused areas. Blasters can be drained if painful but be sure to leave the roof intact to protect the sensitive skin underneath.

Rest Your Feet:
Take your boots and socks off when resting and eating lunch, elevating your feet to reduce swelling. In camp wear sandals or flip-flops. Your feet need the air and will appreciate the sunlight.

Long distance hiking is an incredibly rewarding experience. May these tips keep your feet healthy on the trail!

Dr. Jennifer Feeny
Happy Trails,

Salem Sprint Triathlon

Who's attending the Salem Sprint Triathlon?!

Make sure to stop by our booth and get any last minute questions answered from your friends at Shenandoah Podiatry!!

For more information about the triathlon, visit ymcaroanoke.org

Foot Problems? Get them in shape for summer!

Come learn ways to get your feet in tip top sandal shape for summer! Dr. Kate will give suggestions on ways to treat bunions, hammertoes and heel pain as well as running tips (are you a heel striker?) to reach your PR!!

Bring your questions and get answers!
No pre-registration required, this is a FREE event!

Have Heel Pain? Complete These Stretches!

Here, Dr. Kate, explains and shows 2 types of stretches you can complete daily to help heel and foot pain:

Nail Disorders

Anatomy of the Nail:

Nail Plate- Is the hard and translucent portion of the nail.

Nail Bed- Is the skin underneath the nail plate.

Matrix- Is the part in which the nail rests and is responsible for the production of the cells that become the nail plate.

Hyponychium- Distal nail groove which forms a seal that protects the nail bed.

Nail Grooves- Medial and Lateral

Lunula- The whitish crescent-shaped base of the nail.



Nail disorders are more common than people know. There are a number of different nail disorders that can be treated by your podiatrist. Nail abnormalities can show problems with the color, shape, texture, or thickness of the nails. Sometimes the nails can tell the health of a patient.


Here is a group of some common nail disorders:

Anonychia- This is the absence of the nail itself.

Beau's Lines- Is a depression across the nail plate which is caused by a stressful event.

Green Nail- A disorder of the nail that may be due to an infection caused by Pseudomonas.

Hapalonychia- A pliable nail plate that is usually caused by hyperhidrosis.

Clubbed nail- When the angle of the nail plate and proximal nail fold is greater than 180 degrees. This condition may occur in cardiac, pulmonary, or gastro-intestinal disease.

Koilonychia- This is known as a spoon nail. This condition is seen in iron deficiency anemia.

Leukonychia- Is a disorder of the nail where the nail exhibits white spots.

Lindsay's Nail- A condition that shows the far half of the nail discolored pink or brown and the near half dull and white. This disorder is seen in liver disease.

Macronychia- Is an abnormally large nail.

Mee's Line- A white band across the nail that is associated with arsenic poisoning or a stressful event.

Melanonychia- A disorder that demonstrates longitudinal, pigmented bands in the nails .

Micronychia- Is an abnormally small nail.

Onychatrophia- This disorder shows atrophy of the nail.

Onychauxic Nail- This disorder shows hypertrophy (Thickening) of the nail.

Onychia- A disorder where there is inflammation of the matrix.

Onychocryptosis- This is an ingrown nail.

Onychogryphosis (Rams horn nail) - Another disorder where there is thickening of the nail.

Onycholysis- This is a separation of the nail plate from the nail bed.

Onychomalacia- This is a softening of the nail plate.

Onychomycosis- Is a nail that is infected with a fungus.

Onychophosis- This type of nail is seen with a callus in the nail groove.

Onychopuntata- This disorder shows pitting of the nails as seen in lichen plannus, alopecia, and psoriasis.

Onychorrexia- Nails that are abnormally brittle.

Onychoschizia- This condition demonstrates splitting of the nail plate into layers.

Paronychia- Inflammation of the tissue folds around the nail. There may be infection with this type of nail.

Raquet Nail- A short and fat nail.

Subungual Hematoma- Associated with trauma. There is formation of a hematoma underneath the nail plate.

Terry's Nail- With this condition the proximal 2/3 of the nail plate is white. This disorder can be seen with hepatic cirrhosis.


So you see, there are many disorders of the nail. Some disorders may be more serious than others. If you suspect any nail disorders, make an appointment with your podiatrist to be properly evaluated.

New Year, New Foot Pain!

If you celebrated the new year with a night of dancing, you might now be having foot pain or simply wondering how you can take better care of your feet next time. Foot injuries caused by dancing are unfortunately common because we often pay little attention to our feet as long as they get us where we need to go. You need not worry, however, because Dr. Feeny and Dr. Kate are here to keep your feet healthy and pain free.

Injury prevention starts long before you hit the dance floor. Let your feet relax for a little while everyday by propping them up. This gives the small muscles in your feet a chance to recuperate from daily activities and will make sure they’re well-rested the next time you take them dancing. Another everyday thing you can do to protect your feet is proper skin care which can help to prevent blisters.

Shortly before dancing, take some time to stretch all the muscles in your feet. This will help to prevent you from pulling or straining your muscles. A good way to make sure that your feet are adequately stretched is to use them to spell out the alphabet in the air. It’s a simple, fun way to warm them up. You’ll also want to pick shoes that are comfortable and that have been broken in. Dancing in new shoes can cause blisters or other injuries so make sure that you walk in them a few times first to break them in. The best way to do this is to wear them for an hour or so the first time and gradually increase the amount of time you wear them.

When dancing, pay attention to your feet and take a break when they start hurting. Pain is your feet’s way of telling you when something is not right. A little bit of pain while dancing can be indicative of a more serious problem if not treated properly. This is especially true if you land on your ankle wrong or a partner with two left feet happens to step on yours.

If you have any blisters, foot, or ankle pain left over from your New Year's dancing, call us today to set up an appointment and we’ll have you back in your dancing shoes in no time.

Freiberg's Infraction

Freiberg's Infraction is a condition that affects the lesser metatarsal heads. The most common affected location is the second metatarsal followed by the 3rd 4th then 5th. This condition is also known as AVN (avascular necrosis). Freiberg's Infraction causes a loss of blood supply to the metatarsal head. The condition occurs at the metaphysis of the bone where the nutrient artery of the bone supplies the distal metatarsal. This results in a collapse of the metatarsal head. The condition is more common in females and usually occurs between ages 10-18 and can occur in adulthood.


Classification

Smillie’s classification (1967)


Stage 1: Subtle fracture line through the epiphysis.
Radiographic changes at this stage may be subtle.

Stage 2: Central depression of the articular surface.

Stage 3: Central depression leads to medial and lateral projections at the margins. Plantar hinge remains intact.

Stage 4: Central portion frees from the intact plantar hinge, forming a loose body. Fractures of the medial and lateral projections are present.

Stage 5: Flattening of the metatarsal head with secondary degenerative changes.


Contributing Factors:

Freiberg disease in adolescents is thought to be due to growth disturbances of the epiphysis or apophysis.

• Vascular insult- an injury of the blood supply to the metatarsal head
• Traumatic insult- a single acute injury or multiple repetitive injuries

Symptoms

• Local pain and Tenderness that usually increases with activity
• Stiffness
• Limping

Differential Diagnoses

• Metatarsalgia
• Morton neuroma
• Stress fracture

Treatment

Non Surgical:

• Stiff Soled shoe or Post Op Shoe
• Non weight-bearing cast
• Short leg walking cast or CAM boot
• Rest /Activity modification
• Steroid injection

Shoe Modifications:

• Metatarsal pads
• Rigid shanks
• Rocker bottom

Surgical Treatment:

• Simple debridement

Osteotomies:

• Dorsal closing wedge osteotomies- reorients the plantar intact cartilage to articulate with the proximal phalanx.
• Shortening osteotomies- metatarsal overloading of the is reduced

Arthroplaty

• Total joint arthroplasty- Utilizing an implant

                                                      Learn more at http://www.shenandoahpodiatry.com/

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a condition that is caused by compression of the tibial nerve or its branches.

Tarsal tunnel syndrome is analogous to carpal tunnel syndrome of the wrist.

The tarsal tunnel is a narrow space that lies on the inside of the ankle.

The tunnel is covered with a thick ligament called the flexor retinaculum.

Structures within the tarsal tunnel include:
-Arteries
-Veins
-Tendons
-Nerves

Tarsal tunnel syndrome is a compression on the posterior tibial nerve.
This syndrome produces symptoms anywhere along the path of the nerve.

Possible symptoms include:

-Tingling
-Burning
-Numbness
-Shooting pain
-Paresthesias

Contribute Factors to Tarsal Tunnel:
-Soft tissue masses:
Lipomas-is a benign tumor composed of fatty tissue
-Tendon Sheath Ganglia:
Neoplasms- is an abnormal mass of tissue as a result abnormal proliferation of cells
-Nerve tumors
-Varicose Veins

Work up:

Tinel sign- Percussion of a nerve with radiation of pain along the course of the nerve.

The doctor may order any of the following tests to help with the diagnosis:
-Electromyography (EMG) - A technique for evaluating and recording the electrical activity produced by skeletal muscles
-Nerve conduction velocity (NCV)
-Magnetic resonance imaging (MRI)- In cases of suspected soft-tissue masses and other space-occupying lesions
-Ultrasonography
-Radiography

Conservative Treatment:

-Rest
-Ice
-Non steroidal anti-inflammatory drugs-to help reduce pain and inflammation
-Immobilization- Restricting movement of the foot by wearing a cast or cam boot
-Physical therapy
-Injection therapy
-Orthotic devices. To control any abnormal bio mechanics of the foot








-Surgical Therapy

Tarsal tunnel release surgical intervention may be needed if conservative therapy fails to alleviate pain and symptoms. This procedure is used to decrease pressure on the posterior tibial nerve. Any space occupying lesions may also be excised.
                                                           Learn more at http://www.shenandoahpodiatry.com/

Tailor's Bunion

Tailor's bunion is as an acquired lesion that causes chronic pain and swelling over the outer aspect of the distal foot. It is also known as a bunionette and is characterized by a painful prominence on the outer aspect of the foot in the area of the fifth metatarsal head.

These types of lesions were often seen on tailors with a cross-legged sitting posture. The posture resulted in pressure being placed on the lateral side of the foot.

Causes

Extrinsic causes - Commonly chronic

• Tailors' posture
• Footwear

Intrinsic causes

Structural Abnormalities

• Lateral bowing of the metatarsal shaft
• Enlargement of the metatarsal head
• Congenital splayfoot

Presentation

• Symptoms - Painful keratoses on the outer, bottom, or top aspect of the metatarsal head.

Imaging Studies

• Weight-bearing x rays of both feet
• Vascular studies are important with patients who have questionable circulation

Treatment

Conservative

• Padding
• Shoe modification
• Orthotic devices
• Anti-inflammatory medications
• Corticosteroid injections

Surgical Treatment

• Can be treated with simple removal of osseous bump when there is no evidence of anglular deformity
• With an angular deformity or a deviation in the bone is present an osteotomy (cut in the bone) is made and held together with a screw. The level of bone cut varies with the level of the deformity.

Possible Complications

• Malunion- Incomplete union or union in a faulty position
• Nonunion- A nonunion occurs when a broken bone does not heal
• Nerve Injury
• Joint pain and stiffness
• Symptomatic hardware
• Infection
• Recurrence

Diabetic Education

General Education for Diabetics:

Avoid any at home care for nails and calluses

Avoid constrictive bandages

Avoid open toed or opened back shoes

Be careful with adhesives and tape on the diabetic insensate foot

Buy shoes at the end of the day when the feet are the largest

Check the bath temperature before submerging the feet

Diabetics with impaired vision need someone to inspect there feet daily

Do not use chemical substances for removing corns or calluses

Dry the feet and between the toes thoroughly after showers

Inspect the feet and toes daily for any lesions

Inspect the shoes for objects before placing on feet

Never walk barefooted

Professional nail care at a podiatry office with regular visits

Protect the feet from sunburn

The use of a high toe box to accommodate hammertoes

The use of an insert to accommodate any lesions

The use of shoes with a wide toe box with extra depth

The use of water based lotion daily without moistening between the toes

Wear a shoe with an appropriate fit to avoid friction which can cause blisters

Gout

Gout is a common disorder of uric acid metabolism. It is a medical condition that usually presents with recurrent attacks of acute inflammatory arthritis. Gout is caused by cellular reaction to uric acid and can lead to deposits of monosodium urate crystals in soft tissues and joints.



Types

Primary gout - May occur alone. Accounts for about 90% of cases of the disease.

Secondary gout- May be associated with other medical conditions or medications. Accounts for about 10% of cases of the disease.


Frequency
Approximately 1% of the general population have gout.

Sex
Predominance- 90% male


Symptoms

Gout is associated with considerable pain.

Acute episodes of gout may incapacitate a patient.

Involved joints typically have the following symptoms: swelling, warmth, erythema, and tenderness.

The first metatarsal phalangeal joint is most commonly affected, however other joints can be involved such as the ankle or the knee.


A tophus deposit may develop in the ear.


Causes

Conditions that may cause acute changes in the level of uric acid and may precipitate a gout attack:

• Hyperuricemia
• End-stage renal disease
• Alcohol ingestion
• Disorders that cause high cell turnover with release of purines
• Over consumption of foods high in purines
• Underexcretion of uric acid - renal insufficiency

Long Term Effects

Untreated chronic tophaceous gout can lead to severe joint destruction.

Deposition of uric acid crystal in the kidneys may produce renal failure or obstruction.


Differential Diagnosis

Cellulitis- A severe inflammation of dermal and subcutaneous layers of the skin.

Gonococcal Arthritis- Is caused by infection with Neisseria gonorrhoeae.

Calcium Pyrophosphate Deposition Disease- Is a type of arthritis caused by the deposition of calcium pyrophosphate crystals.

Rheumatoid Arthritis- Is a chronic systemic inflammatory disease that affects the peripheral joints.

Psoriatic Arthritis- Is a chronic inflammatory arthritis that is commonly associated with psoriasis.


Laboratory Studies

Synovial fluid- The physician may aspirate the involved joint to rule out an infectious arthritis and to confirm a diagnosis of gout.

Serum uric acid.

Uric acid in 24-hour urine sample.


Imaging

Routine radiographs reveal punched-out erosions or lytic areas with overhanging edges. These finding are not acute.



Treatment

Acute gout

• Indomethacin- is the traditional Nonsteroidal anti-inflammatory drug (NSAID) of choice for acute gout.
• Colchicine.
• Corticosteroids- May be indicated in those patients who do not tolerate NSAID or Colchicine.

Chronic gout

• Probenecid- For patients who are hypoexcreters of uric acid.
• Allopurinol- For patients who are over producers of uric acid. Allopurinol reduces the generation of uric acid in the body.
• Uloric- Prevents uric acid production and lowers elevated serum uric acid levels.

Diet

Patients with gout should avoid beer and hard liquor. These elevate levels of uric acid and may precipitate attacks of gout.

High purine foods should be consumed in moderation:

• Kidney
• Liver
• Meats
• Shellfish

Tinea Pedis

Is a fungal infection of the skin that causes scaling, flaking, and itch of affected areas. It is also known as Ring Worm or Athlete's foot.

Symptoms
The symptoms of athlete's foot or tinea pedis typically include itching and burning of the feet.

The skin may peel or crack with or without any associated pain.

Commonly the rash is localized to the soles of the feet.

Sometimes the flaking skin may spread to the sides and tops of the feet in a moccasin distribution.


The digital interspases may have some moisture, peeling, redness and flaking as well.



Types of Tinea Pedis


T rubrum is the most common cause for tinea pedis.

Trichophyton mentagrophytes, and Epidermophyton floccosum are other causative organisms.




Vesicular tinea pedis-
Usually caused by T mentagrophytes.
This type is characterized by painful, pruritic vesicles most often on the instep.






Interdigital tinea pedis-Usually caused by T rubrum seen more in hot/ humid environments
This type is characterized by redness, maceration, fissuring, and scaling between toes. It is also associated with itching




Chronic hyperkeratotic tinea pedis-usually caused by T rubrum.
This type is characterized by chronic redness on the bottom of the foot or sides with scaling.




Risk Factors

• A hot, humid, tropical environment
• Prolonged use of footwear
• Hyperhydrosis- Sweating
• Certain people may have a genetic predisposition to the infection

Work Up

In suspected tinea pedis a KOH (potassium hydroxide) staining may be ordered by the doctor for fungal detection by obtaining a sample of the flaking skin

Fungal culture- may be performed to confirm the diagnosis of tinea pedis. A culture can be used to identify the fungal species.



Treatment

Tinea pedis can be treated with topical or oral antifungals. Some topical medications are over the counter. Topical agents are generally used for 1-6 weeks


Examples of Topical Medication

Topical Imidazoles

• Clotrimazole 1% (Lotrimin)
• Econazole 1% cream (Spectazole)
• Ketoconazole 1% cream (Nizoral)

Topical Pyridones

• Ciclopirox 1% cream (Loprox)

Topical Allylamines

• Naftifine 1% cream (Naftin)
• Terbinafine (Lamisil)

Oral Antifungals

Considered in patients with extensive chronic hyperkeratotic or inflammatory/vesicular tinea pedis

• Terbinafine (Lamisil)
• Itraconazole (Sporanox)

Prevention

• Keeping your feet clean and dry
• Avoiding prolonged moist environments
• Disinfecting old shoes
• Periodic use of anti fungal foot powder in the shoes

                                                         Learn more at http://www.shenandoahpodiatry.com/

Morton's Neuroma

Is a painful benign fibrotic enlargement of one of there common digital nerves. It is caused by a shearing force of the adjacent metatarsal bone. It most commonly affects the third common digital nerve. Morton's Neuroma is found to be more common in females. This may be related to the type of shoe gear often worn by females. It is most common in the 4th - 6th decade.


History

Obtaining an accurate history is important to making the diagnosis of Morton's neuroma.

Common Findings

• Pain in the forefoot and corresponding toes adjacent to the neuroma
• Pain is usually described as sharp and burning
• Pain may radiate proximal
• Numbness and tingling often is observed in the toes adjacent to the neuroma
• Intermittent pain
• Massage of the affected area may give some relief
• Narrow tight high-heeled shoes aggravate the symptoms
• Patients may feel as though they are walking on a wrinkle in there sock

Exam

• Firm squeezing of the metatarsal heads with one hand while applying direct pressure to the dorsal and plantar interspace with the other hand may elicit radiating pain.
• Mulder Sign - A silent palpable click produced by the lateral squeeze test. The neuroma moves between the metatarsals.
• Passive and active bending of the toe in an upward direction may aggravate symptoms.
• Sullivan's Sign - Toes adjacent to the affected interspace splay apart on weight bearing.

Imaging

• Ultrasonography
• MRI

Differential Diagnosis

• Stress fracture of the metatarsal
• Rheumatoid arthritis
• Hammertoe
• Metatarsalgia- plantar tenderness over the metatarsal head
• Neoplasms
• Metatarsal head osteonecrosis
• Freiburg osteochondrosis- characterized by interruption of the blood supply of a bone followed by localized bony necrosis.
• Ganglion cysts
• Intermetatarsal bursal fluid collections

Treatment

Treatment strategies for Morton's neuroma range from conservative to surgical management.


Conservative

Bio mechanical

• Orthotics

Medications

• Injections- Corticosteroid- Anti inflammatory agent
• Alcohol sclerosing- Causes a chemical neurolysis of the nerve and used as an alternative to surgery for Morton's neuroma
• NSAID's- Non Steroidal Anti Inflammatory such as Ibuprofen or Naprosyn
• Tricyclic Antidepressants- Amitriptyline(Elavil)
• Anticonvulsants- Neurontin (Gabapentin)
• Pregabalin (Lyrica)
• Duloxetine (Cymbalta)

Rehabilitation Program
Physical Therapy

• Cryotherapy-Cold Therapy- Cold may be applied using an ice bag or a cold pack
• Ultrasonography- Sound waves that are transferred to a specific body area via a round-headed probe. The sound waves travel deep into tissue, creating gentle heat. The heat helps relieve pain and inflammation
• Deep tissue massage
• Stretching exercises
• Phonophoresis- Has been used in an effort to enhance the absorption of topically applied analgesics and anti-inflammatory agents through the therapeutic application of ultrasound

Surgical Intervention

• Neurectomy- When conservative measures for Morton's neuroma are unsuccessful surgical excision may be beneficial

Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuropathy is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes.
Neuropathies are characterized by a progressive loss of nerve fibers

Noninvasive Testing

• Nerve conduction studies and Electromyography- A test commonly used to evaluate the function and the ability of electrical conduction of the motor and sensory nerves.
• Quantitative sensory testing
• Autonomic Function Tests
• Monofilament testing - If the patient does not feel the wire at 4 or more at 10 testing sites- the test is positive for neuropathy

Pathophysiology of Diabetic Peripheral Neuropathy

Result from vascular disease:

• Endothelial dysfunction
• Deficiency of myoinositol-altering myelin synthesis
• Chronic hyperosmolarity-causing edema of nerve trunks
• Increased sorbitol and fructose

Diabetic Neuropathy can contribute to Structural foot deformities

Hammertoes

Bunions

Metatarsal deformities

Charcot foot

Eventual tissue breakdown

The symptoms of peripheral neuropathy include the following

• Hyperesthesia-Is a condition that involves an abnormal increase in sensitivity to stimuli of the senses.
• Paresthesia- Is a sensation of tingling, pricking, or numbness of a person's skin. It is more generally known as the feeling of "pins and needles".
• Dysesthesia-It is defined as an unpleasant, abnormal sense of touch, and it may or may not be, considered as a kind of pain.
• Radicular pain-Is pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation
• Anhydrosis-Means lack of sweating.

Peripheral Neuropathy Signs

• Loss of sensation in the foot- Results in repetitive stress
• Injuries and fractures
• Loss of vibratory and position sense
• Loss of deep tendon reflexes
• Trophic ulceration
• Foot drop

Treatment


Diet

• Patients with diabetic neuropathy should develop a realistic diet for lowering blood glucose. This should be guided by a nutritionist or doctor

Medicines widely used to help with painful symptoms

• Selective serotonin and norepinephrine reuptake inhibitors- example:Duloxetine (Cymbalta)
• Tricyclic antidepressants- example: Amitriptyline (Elavil)
• Anticonvulsants- example:Gabapentin (Neurontin)
• Pregabalin (Lyrica)- FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia.
• Capsaicin cream (Capsacin)- A natural chemical derived from plants of Solanaceae. This is a topical medicine and is the active component of chili peppers.
• Neuremedy (Benfotiamine)- For the nutritional management of peripheral neuropathy.

Obese children are more prone to leg, ankle, and foot injury.

A new pediatric study reveals that obese children are more prone to leg, ankle, and foot injury than other children their age. Dr. Wendy J. Pomerantz of Cincinnati Children’s Hospital in Ohio and several of her colleagues studied the patient records from the emergency room in their hospital from January 2005 to March 2008. They noticed some very interesting trends. About 30% of obese children in their study had suffered from lower extremity injuries verses the 18% of normal weight children. On the other side of the spectrum the study showed that 15% of the normal weight children suffered from head injuries compared to 10% of the obese children. The study showed that over weight children often had a longer recovery time than other children. They also found that ankle sprains where twice as common among obese children as other children their age. Although the researchers didn’t have the information explaining how these children became injured the group hypothesized that obese children are more vulnerable during walking or running while normal weight children have an easier time playing sports that carry the risk of head injury.

Of course parents want to protect their children so these numbers might scare some parents into not letting their children be active. But this is not what the study was meant to do. We want children to be active but we want them to be safe about it. Obese children (just like adults) should ease into exercise and sports instead of jumping right in.

Pomerantz’s steps following this study are to figure out why these numbers are slated this way and try to find some protective measures to help keep children safe.

5 warning signs of foot problems in children

Foot pain in children is not something to be taken lightly or ignore. Sometimes it is hard for children to tell their parents when they are having foot troubles. Perhaps the child was born with a foot abnormality so their gait, though abnormal, seems normal to them. Or, a child may feel embarrassed about how their feet appear so they don’t want to bring it up. So, it is very important for parents to keep an eye on children's feet to keep them just as healthy as the rest of their body. Remember these feet have lots of miles ahead of them!!

Here are five things to look out for that might indicate your child is having foot pain or problems.

1. If your child is having trouble keeping up with other children~ If your child frequently lags behind other children in sports or other physical activities this could be due to flat feet causing the leg muscles to tire more easily. The muscles and feet become tired easier because the feet are not functioning as efficiently as they could be.

2. If your child suddenly stops wanting to participate in activities they enjoy~ If your child is suddenly not participating in their favorite activities this could be due to heel pain that is common in children ages 8-14. Heel pain can be caused by repetitive stress that occurs while playing sports. Too much strain can lead to pain and inflammation in the growth plate at the back of your child’s heel.

3. If your child is reluctant to show you their feet~ If a child notices a change in their feet they might be embarrassed or nervous that the change could lead to a trip to the doctors office. Start making it a habit early to check your children's feet for discoloration of the skin or nails, growths, calluses, redness, swelling or ingrown nails. Seek podiatric help for any of these signs of a problem.

4. If your child trips or falls often~ Although children are often clumsy while they are getting used to their body, repeated clumsiness can be a sign of in-toeing, balance problems or neuromuscular conditions.

5. If your child tells you they have foot pain~ Sometimes we get lucky and our children will tell us that their feet hurt. If this happens be thankful and take them to see a podiatrist right away. It is never normal for children to have foot pain and since they are growing all the time foot pain should not go overlooked. If injuries cause pain or swelling for more than a few days see a podiatrist asap.

Even if no symptoms are present and your children don’t complain of foot pain it is a good idea to get a yearly check up to make sure that the feet are growing properly.

A Hiking We Will Go

I saw my first through hikers off the AT last weekend at Kroger-Daleville while doing my weekly grocery shopping. It got me thinking about all of the people that have limped into my office off the trail over the years.

Walking up and down steep hillsides and tramping through wet, slippery fields and wooded areas puts stress on the muscles and tendons in the feet and ankles, especially if you haven't conditioned properly before hitting the trail. Also, many don't realize that sneakers aren't the best choice for extended hiking and hunting. Had some of my patients worn sturdy, well-constructed hiking boots, they wouldn't have suffered sprained ankles or strained Achilles tendons.

Make the investment in top-quality hiking boots. Strong, well insulated and moisture-proof boots with steel or graphite shanks offer excellent ankle and foot support that helps lessen stress and muscle fatigue to reduce injury risk. The supportive shank decreases strain on the arch by allowing the boot to distribute impact as the foot moves forward. So if a boot bends in the middle, don't buy it.

In wet and cold weather, wearing the right socks can help prevent blisters, fungal infections. Synthetic socks should be the first layer to keep the feet dry and reduce blister-causing friction. For the second layer, wool socks add warmth, absorb moisture away from the skin, and help make the hiking boot more comfortable.

Don't ignore pain and hope that it will go away. If you are out on the trail, try and take a break to see if the pain subsides. As soon as you are able, make a visit to your podiatrist to determine the cause of your pain. Remember, pain is your body letting you know there is something wrong.

Dedicated To Your Health Feet,

Dr. Jennifer Feeny

For more information visit our website http://www.shenandoahpodiatry.com/