Tuesday, May 26, 2015

Flip Flops-Toe injuries

The warmer weather is descending on us, and that means shorts, tank tops, and sandals. Many of us will begin to wear our flip flops. Supportive flip flops are a great option for summer activities. However, the flat and non-supportive flip flops that can be purchased cheaply at various stores are dangerous for the feet! In this blog, I wanted to mention that these versions of flip flops can cause injury in several ways. First, the front of the flexible flip flop can go underneath the sole, exposing the toes to injury (cuts, abrasions, blisters, broken toes, and more). This happened to several of my patients last summer while walking dogs or going on brisk walks. Additionally, these types of flip flops (and many sandals) do not protect the toes from injury-getting bumped, stepped on, or having objects drop on them. Finally, the lack of support in the heel or back of the shoe makes us more susceptible to twisting the foot (spraining the ankle, irritating tendons, and breaking bones). Thus, a sandal that cups the heel will make us slightly safer than a flatter version.

Monday, May 18, 2015

Why do Warts Grow on the Feet?

Warts are caused by a virus, and the feet are a common location for the growth of warts. Warts thrive in warm, moist environments, like our shoes and socks. Additionally, gyms, pools, and locker rooms are places were warts can be spread, as these locations are often warm and wet! It is important to keep your feet dry (powder, changing socks frequently, etc). Additionally, wearing sandals around the pool and shoes in locker rooms is essential. If you have a funny growth on the skin of your foot, it may be a wart! Give us a call-708-763-0580.

Thursday, May 14, 2015

Women's Foot Complaints- Women's Health Week

Several years ago, I was asked to write an article about common female foot problems. Many of the conditions that I treat happen in both men and women. However, there are some things that are more common in one sex versus another. Here is the article, as I thought it would be a great blog post for Women's Health Week 2015. Women's Foot Complants The most common foot ailments in women are onychomycosis, Morton neuroma, stress fractures and plantar fasciitis. A variety of foot conditions plague women more often than men. Many are aggravated by the shoes that women wear but also can be caused by loss of bone density as women age. The most common foot ailments in women are onychomycosis, Morton neuroma, stress fractures and plantar fasciitis. Onychomycosis A fungal infection of the toenails, onychomycosis most often is caused by dermatophytes (Trichophyton rubrum and T. mentagrophytes) or yeasts and molds, primarily Candida. Although diagnosis often is based on the clinician's judgment, acceptable methods for confirming fungal involvement include use of dermatophyte test medium or a potassium hydroxide test. Onychomycosis results in cosmetically unacceptable nails that are dystrophic, lytic, thick, painful and discolored. The condition can develop as a consequence of tinea pedias, trauma to the nail, an immunocompromised state, or pedicures (removal of the cuticle creates microtears that allow fungus to enter the nail). Treatment options include debridement, oral or topical antifungal therapies, or permanent removal of the toenail with a chemcial or surgical matrixectomy. Simple removal of the toenail without treatment of the fungus will lead to regrowth of the fungal nail. Combination therapy is the most successful approach; for example, results of a 2006 study showed that oral terbinafine plus nail debridement led to higher mycologic cure rates than did treatment with oral terbinafine alone (68% vs. 63%). Morton Neuroma This condition develops from enlargement of the third common digital branch of the medial plantar nerve. Pressure from the corresponding third and fourth metatarsal heads and adjacent deep transverse metatarsal ligament causes pain in the third intermetatarsal space. Burning or sharp, shooting pain to the corresponding toes and the sensation of walking on a pebble or a marble are common complaints. Compressive forces on the forefoot (e.g., from wearing shoes with pointed toes or engaging in certain athletic activities) exacerbate these symptoms. A positive Mulder sign (clicking as the neuroma rubs on the adjacent metatarsal heads) can occur on dorsal-to-plantar or side-to-side compression of the forefoot. The diagnosis is best made based on clinical examination or with a diagnostic injection of local anesthetic in the interspace between the metatarsal heads. Neuromas can also be diagnosed with magnetic resonance imaging (MRI), ultrasound or nerve conduction studies. Other pathologies that can cause similar symptoms are capsulitis, metatarsalgia, avascular necrosis or stress fractures of the metatarsals, soft-tissue tumors, tarsal tunnel syndrome, and plantar plate ruptures. After diagnosis of the neuroma, the patient should be referred to a podiatrist or other foot specialist for evaluation and treatment. Conservative treatments include padding and strapping, orthotic devices and steriod injections. A less-widely used but successful conservative regimen involves weekly injections of a sclerosing alcohol mixture (a combination of local anesthetic and dehydrated ethyl alcohol). In a 1999 study, 82% of patients who were given weekly sclerosing alcohol injections for 3 to 7 weeks experienced complete relief. If conservative therapies are not sucessful, the neuroma can be excised surgically; however, this will lead to a decrease in sensation in the corresponding digital interspace. Stress Fractures Metatarsal fractures commonly affect women during and after the menopausal transition; however, athletes and military recruits also can suffer from the condition. The lesser metatarsals are a common location for stress fractures. Patients complain of persistent pain and swelling in the forefoot and might report recent periods of weight-bearing activity (often involving a particular repetitive motion). Initially, the injury is limited to cortical bone - but, if left untreated, the fracture can extend through the entire bone and even become displaced. Although conventional radiographs might be negative for the first 21 days after injury, bone scans or MRIs can reveal the fracture earlier. One study that included 37 female athletes (primarily runners) showed that 47% of stress fractures were identifiable with initial radiographs, whereas 96% were detectable with bone scans. Successful conservative treatment consists of compressive bandaging and immobilization (surgical shoe, cam walker boot, or cast). To prevent fracture recurrence, modification of physical activities and shoe gear should be addressed; in addition, treatment for bone density loss, if present, is warranted. Plantar Fasciitis This inflammatory condition of the plantar fascial band (which courses along the plantar aspect of the foot) is one of the most common foot ailments, accounting for 15% of all adult foot complaints. Pain often is localized to the medial plantar region of the heel. Patients report pain when they stand after periods of rest (poststatic dyskinesia). Typically, a brief period of walking offers some relief. Common causes of plantar fasciitis include foot structure, obesity, changes in physical activity, and lack of supportive shoe gear. Plantar fasciitis is best diagnosed clinically, but ultrasound and MRI often are helpful for visualizing changes in the thickness or continuity of the plantar fascial band. Radiographs can reveal the plantar calcaneal spur that often accompanies this condition. Several other conditions that can cause heel pain (i.e., nerve entrapments, bone cysts, calcaneal stress fractures, systemic arthritic conditions, and lumbar spine disorders) should be considered if the patient has an atypical presentation or is not responding to conservative measures. Conservative therapy renders successful outcomes in most patients and usually should be employed for a minimum of 6 months. The best conservative therapy employs a combination of icing, stretching, nonsteriodial anti-inflammatory drug therapy, padding, strapping, custom molded orthotics, night splints, physical therapy, steroid injections, short-term oral steroid therapy, or immobilization with a cast or cam walker boot. When warranted, surgical treatments for this condition include open or endoscopic plantar fasciotomies. Newer therapies that show promise but are not yet widely used include extracorporeal shockwave therapy, cryotherapy, and Topaz coblation (radiofrequency technology). Conclusion Several podiatric conditions have higher incidence in women than in men. Early diagnosis of these pathologies can lead to more-focused, successful treatment.

Monday, May 4, 2015

The Sesmoids-What are they?

Often, when I am taking an x-ray of the foot, people point to two circular bones with concern and ask "what are these?" The two round bones under the big toe joint (first metatarsal phalangeal joint) are called sesmoids and help the tendon that passes through that area to function properly. These two sesmoid bones are identified as the tibial and fibular sesmoids. Patients rarely notice these bones unless they are injured. High impact activities like marching, running, and jumping are common things that can injure the sesmoids. However, poor shoegear, foot structure, and trauma (falls, twisting the foot, etc) can also harm these bones. If you have pain and swelling under your big toe joint, it is important to get it checked out. Give us a call! Dr. Bender, 708-763-0580