Tuesday, November 27, 2012

Does Foot Surgery Cause Blood Clots?

Advancements to surgical techniques have allowed doctors to fix problems that previously were unable to be solved.  This has led to longer and better quality of life in hundreds of millions of people.  However, surgery is not benign.  There are many potential risks associated with any surgical procedure, and foot surgery is no exception.  One of the many potential risk is the formation of deep vein thrombosis (DVT), otherwise known as a blood clot.  Let’s discuss some of the ways to reduce the risk of forming a DVT.

Before we get too far along, it is important to know that blood clots after foot surgery are very uncommon.  That being said, it is still important to know what can be done to reduce the risk of blood clot formation and how to treat them, since they can have life threatening effects.

Unfortunately, there are some risk factors that we cannot change which increase the risk of DVTs.  Older people tend to be at greater risk than younger people.  Women also are more likely to have a DVT when compared to men.  If you inherited a blood clotting disorder, or something like that runs in your family, you also have increased risk of DVT.  These risk factors cannot be changed, but it is important that you understand their significance before surgery.

Fortunately, there are several risk factors that can be modified so the risk of DVT is lessened.  Obesity, sedentary lifestyle, and use of tobacco are all associated with increased DVT risk.  Specifically with foot surgery, being confined to a bed or wheelchair will immobilize your leg, which decreases blood flow and can increase the risk of DVT.  Thankfully, all of these risk factors can be addressed.  Before surgery, if a person was able to lose weight, increase their activity, and temporarily refrain from using tobacco products before and after the procedure, their risk of DVT would dramatically decrease.

Now that we understand the risk factors associated with blood clots, we will discuss in the next post how to recognize the signs and symptoms and appropriate treatment.

Wednesday, November 14, 2012

Knock Knees and Bow Legs in Children

As we discussed last time, parents understandably seem to very sensitive to any apparent deformity or perceived imperfection in their children as they develop.  Another common concern for parents is if their children walk with their knees touching or with their legs bowed.  Let’s discuss some of the important points regarding this subject.

Some of the principles we discussed in the toe walking post also apply to this discussion.  Abrupt changes or a sudden deviation from the normal over a short period of time are the best indicator of an underlying problem.  When children are learning to walk, they will find the easiest, most comfortable way to get around.  This tends to not be the most normal looking gait cycle.  Unless they were walking in one way and abruptly change, variations from “normal” should not be alarming.

As a child matures, their bones go through an unwinding process.  This process is called torsion.  As the bones unwind, a child’s gait will slightly alter until the maturation process is a finished.  Depending on the age of the child, their legs will vary from being slightly bow legged to slightly knocked kneed and somewhere in between.    This evolution of the legs tends to resolve at about the age of fourteen, with the legs being straight or very close to it.

Parents should seek medical attention if the deformities are severely exaggerated in either direction.  Most often, severe walking deformities can be expected with some childhood neurological disorders and are often caught close to the birth of the child.  However, they can develop later unexpectedly due to an underlying bone disorder or malnutrition due to malabsorption of a certain nutrient.  These are less common but do happen.

We’ll talk about another pediatric condition in our next post that if treated immediately can be completely reversed without any residual effects.

Wednesday, November 7, 2012

Clubfeet and their Treatment

Staying in the thread of pediatric conditions, clubfoot is a deformity that should be addressed.  Although it is rarely seen in adolescents and adults in our country, it occurs in about 1 in every 1000 births.  Fortunately, it is recognized very early and treated immediately when seen in the United States.  With immediate appropriate treatment, a person born with clubfoot can expect to walk normally without residual effects.

Clubfoot is when the front of the foot has turned in and wrapped itself around the back of the foot so that if the child were to walk, they would have to bear weight on the thin skin of the top of the foot rather than the thick skin on the bottom of the foot.  The foot is described as being shaped like the letter “C” turned in on itself.  Clubfoot is a deformity seen with some neurological disorders, but more often it is seen simply due to lack of room.  The lack of space pushes the feet up against the wall of the uterus.  When the baby is born, the deformed feet are easily recognized.

Fortunately, a baby’s body is very flexible after it is born, and remains very flexible while the mother is breast feeding.  This flexibility allows us to mold a clubfoot back into proper position without major surgery.  Starting as soon as possible, the baby is put into a series of casts, removed and reapplied each week, which will slowly bring the foot back around so that it will eventually function as a normally.  Within 12 weeks, a severely deformed foot can look completely normal.  The body’s ability to adapt and remodel is incredible at that young age, and we can take advantage of this by immediate treatment.  The babies who do the best are the ones who are treated only hours to days after birth.  If treatment is delayed for weeks or months, the baby may not be flexible enough to resolve the entire deformity.  If this is encountered, surgery may be required for correct the problems.

Monday, October 22, 2012

Toe Walking in Children

As parents, we are very concerned about how our children develop.  One thing that seems to push parents to seek a medical profession is how their child walks.  Is toe walking bad?  Does it mean that they will walk like that forever?  Is it a sign that something else may be wrong?  Let’s discuss.

Toe walking in and of its self is harmless and in most cases is simply how your child has decided to walk.  Many children simply have chosen to toe walk because it is comfortable for them at this stage.  If the child has been walking on their toes since their first step, there is additional assurance that nothing is wrong.  If the child is old enough to respond to verbal commands, ask them to stand on their heels and to walk with their heels touching the ground.  The far majority of children will be able to do this easily and painfree.  This is a sign that there is no underlying problem or surgical issue that needs to be addressed. 

Toe walking is only a sign of an underlying disorder when it is accompanied by other signs of slow development, or if the child was walking on their heels and then suddenly begins to walk on their toes.  If the child is missing other milestones of growth, cognitive development, or other benchmarks, a pediatric physician should be consulted.  If the child was walking normally and then begins to toe walk, or if they begin to toe walk only on one foot, this should also prompt evaluation.  Pinching of the spinal cord from a myriad of possible sources could be the reason and can be addressed and reversed.  It is possible, however,  that the abrupt toe walking is a sign of a muscle or nerve development problem that may not be so easy to reverse.  This represents a very small percentage of cases which your child most likely does not fit into.

In most cases, toe walking is not a sign of an underlying problem, and parents can be assured that their child will walk normally eventually.  We’ll discuss some other common worries parents have for their young children in future posts.

Monday, October 15, 2012

Treatment for Heel Pain in Kids

Last week we discussed Sever’s Disease, or calcaneal apophysitis, which is the major cause of heel pain in children.  Let’s now discuss how to help.

The most immediate relief can be gained by taking an anti-inflammatory medication like ibuprofen.  This will help take the edge off the pain and allow them to continue to participate in athletic events.  A higher dose of ibuprofen needs to be taken in order to have the pain relief.  Pediatric doses depend on the weight of the child and their ability to swallow pills.  This can have an very beneficial effect in a very short time.

Another easy thing that can be done it for the child to wear heel lifts.  A major component to the pain is the pull of the Achilles tendon on the growth plate.  Especially taut Achilles tendons must be relaxed in order to decrease their pull.  Heel lifts can take the tension off of the Achilles and allow the inflammatory process at the heel bone to calm down.

Achilles tendon stretching is the treatment which takes longer to have an effect, but will result in long term relief.  Stand facing a wall with feet facing forward and shoulder width apart.  Take two steps backward.  With one foot, take one step toward the wall, while keeping the other foot 2 steps from the wall.  Lean forward and place both hands against the wall while keeping both keep pointing forward.  This should cause the Achilles tendon in the foot furthest from the wall to be stretched.  This should not be painful, but should stretch the tight tendon.  Hold this position for 30 seconds then switch feet.  Do this at least 5 times a day, more if possible.  This will help to eventually eliminate this problem so that heel lifts and medication are no longer needed.

The combination of the previous treatments should help to resolve the heel pain in a matter of weeks, so that children can maintain their active lifestyles.

Tuesday, September 25, 2012

Heel Pain in Kids

Kids have an incredible ability to deal with pain.  I’ve seen young children take bad falls, run into walls, or accidently get hit by a flying object and not miss a beat.  They are stunned for a second, might shed a quick tear, but before you know it, they are back running around having fun.  Despite their ability to play through discomfort, there is a specific type of heel pain that seems to bring kids to the doctor that we should discuss.

In order for a child’s bones to grow, the body forms a “growth plate” which allows bones to grow in length.  These growth plates stay open into a child’s teenage years, allowing for maturation of their bodies.  These growth plates are very sensitive to injury and are easily irritated.  In a child’s heel, there is a growth plate which is commonly irritated as a child becomes more active in sports.  The Achilles tendon is attached to this growth plate, which leaves the growth plate susceptible to the strong pull of this strong tendon as the bone grows.   This is a very common condition in kids, which is called Calcaneal Apophysitis, or Sever’s Disease.

Symptoms that most children will experience are heel pain toward the end or after playing sports.  There may be some mild swelling, but no bruising and the child will not be able to recall a specific event that caused their heels to hurt.  Pain will slowly go away with rest, but will return if participation in sports is re-started.  Sever’s disease is very commonly seen at the beginning of a new sports season, when wearing tight cleats or new athletic shoes,  or when suddenly increasing activity after a relatively less active time period.  Most children will recognize that something is not right and complain of their feet hurting.

Thankfully, this condition is very common and is not associated with long term foot pain.  With some slight modification to shoe gear and other minor changes, most children will be pain free in 2-4 weeks and not miss any part of their athletic season.  We’ll discuss treatment options next post.

Friday, September 14, 2012

Surgical Treatment of Warts

If conservative treatment for warts is unable to effectively kill the virus, or the warts seem to recur frequently to the point that weekly visits to the podiatrist for the next couple months are needed, it is reasonable to pursue surgical removal.  Although the warts can come back, this is an effective method of treatment. This can be accomplished in different ways.

The simplest way to achieve wart removal is simply to cut it out.  If there are only a couple warts and if they are not too deep, this can be done with local anesthetic in the office.  A small amount of numbing medicine will be put around the wart to make the procedure as painless as possible.  The procedure is done with a scalpel and a curette, which allows the podiatrist to completely remove all virus infected tissue.  A small dressing and some ointment will then be applied and need to be changed for the next couple weeks while the wound heals.  The location will be tender for the upcoming weeks, so wearing a special shoe that off loads the area may be more comfortable.

If the wart is too deep or the involvement is too wide spread, it may be necessary to be taken to the operating room for removal there.  The procedure is the same as outlined above; however, the patient is sedated in addition to the local anesthetic to decrease the amount of pain.  This allows the doctor to be more aggressive to insure complete removal of warty tissue.  Cautery and/or lasers are now often used to burn the edges of the previous wart to kill any additional virus left behind.  This process of curettage, followed by cautery, then repeating the cycle can be very effective in killing the virus.

Although warts are certainly not life threatening, if they are found on the weight bearing surface of the feet, they can alter your activities and decrease your ability to experience painless exercise.  Talk to your podiatrist if you are struggling with recurrent planter’s warts.  Together, you will find a solution to the problem.