tag:blogger.com,1999:blog-75249540167556193962024-02-20T03:26:40.630-05:00Official Blog of Advanced Foot Care CentersAdvanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comBlogger139125tag:blogger.com,1999:blog-7524954016755619396.post-37614946421059989512012-11-27T14:57:00.002-05:002012-11-27T14:57:14.957-05:00Does Foot Surgery Cause Blood Clots?<div class="entry">
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
</div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-52997537624343181532012-11-14T14:39:00.002-05:002012-11-14T14:39:26.350-05:00Knock Knees and Bow Legs in Children<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
As we discussed last time, parents understandably seem to
very sensitive to any apparent deformity or perceived imperfection in their
children as they develop.<span style="mso-spacerun: yes;"> </span>Another common
concern for parents is if their children walk with their knees touching or with
their legs bowed.<span style="mso-spacerun: yes;"> </span>Let’s discuss some of
the important points regarding this subject.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some of the principles we discussed in the toe walking post
also apply to this discussion.<span style="mso-spacerun: yes;"> </span>Abrupt
changes or a sudden deviation from the normal over a short period of time are
the best indicator of an underlying problem.<span style="mso-spacerun: yes;">
</span>When children are learning to walk, they will find the easiest, most
comfortable way to get around.<span style="mso-spacerun: yes;"> </span>This
tends to not be the most normal looking gait cycle.<span style="mso-spacerun: yes;"> </span>Unless they were walking in one way and
abruptly change, variations from “normal” should not be alarming.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As a child matures, their bones go through an unwinding
process.<span style="mso-spacerun: yes;"> </span>This process is called
torsion.<span style="mso-spacerun: yes;"> </span>As the bones unwind, a child’s
gait will slightly alter until the maturation process is a finished.<span style="mso-spacerun: yes;"> </span>Depending on the age of the child, their legs
will vary from being slightly bow legged to slightly knocked kneed and
somewhere in between.<span style="mso-spacerun: yes;"> </span>This evolution
of the legs tends to resolve at about the age of fourteen, with the legs being
straight or very close to it.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Parents should seek medical attention if the deformities are
severely exaggerated in either direction.<span style="mso-spacerun: yes;">
</span>Most often, severe walking deformities can be expected with some
childhood neurological disorders and are often caught close to the birth of the
child.<span style="mso-spacerun: yes;"> </span>However, they can develop later unexpectedly
due to an underlying bone disorder or malnutrition due to malabsorption of a
certain nutrient.<span style="mso-spacerun: yes;"> </span>These are less common
but do happen.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We’ll talk about another pediatric condition in our next
post that if treated immediately can be completely reversed without any
residual effects.<a href="http://www.blogger.com/blogger.g?blogID=7524954016755619396" name="_GoBack"></a></div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-84750691520310764112012-11-07T14:36:00.000-05:002012-11-07T14:36:10.161-05:00Clubfeet and their Treatment<div class="entry">
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.<br />
<br />
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.<br />
<br />
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.<br />
</div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-77195372572585314552012-10-22T08:48:00.001-04:002012-10-22T08:48:15.920-04:00Toe Walking in Children<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
As parents, we are very concerned about how our children
develop.<span style="mso-spacerun: yes;"> </span>One thing that seems to push
parents to seek a medical profession is how their child walks.<span style="mso-spacerun: yes;"> </span>Is toe walking bad?<span style="mso-spacerun: yes;"> </span>Does it mean that they will walk like that
forever?<span style="mso-spacerun: yes;"> </span>Is it a sign that something
else may be wrong?<span style="mso-spacerun: yes;"> </span>Let’s discuss.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Toe walking in and of its self is harmless and in most cases
is simply how your child has decided to walk.<span style="mso-spacerun: yes;">
</span>Many children simply have chosen to toe walk because it is comfortable
for them at this stage.<span style="mso-spacerun: yes;"> </span>If the child has
been walking on their toes since their first step, there is additional
assurance that nothing is wrong.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>The far majority of children will be able to
do this easily and painfree.<span style="mso-spacerun: yes;"> </span>This is a
sign that there is no underlying problem or surgical issue that needs to be
addressed.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.<span style="mso-spacerun: yes;"> </span>If the child is missing other milestones of
growth, cognitive development, or other benchmarks, a pediatric physician
should be consulted.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Pinching of the spinal cord from a myriad of
possible sources could be the reason and can be addressed and reversed.<span style="mso-spacerun: yes;"> </span>It is possible, however,<span style="mso-spacerun: yes;"> </span>that the abrupt toe walking is a sign of a
muscle or nerve development problem that may not be so easy to reverse.<span style="mso-spacerun: yes;"> </span>This represents a very small percentage of
cases which your child most likely does not fit into.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.<span style="mso-spacerun: yes;"> </span>We’ll discuss some other
common worries parents have for their young children in future posts.<a href="http://www.blogger.com/blogger.g?blogID=7524954016755619396" name="_GoBack"></a></div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-12792689452907211352012-10-15T16:37:00.001-04:002012-10-15T16:37:19.950-04:00 Treatment for Heel Pain in Kids<div class="entry">
Last week we discussed Sever’s Disease, or calcaneal apophysitis, which is the major cause of <a href="http://advancedfootcarecenters.com/education_heel_pain.htm">heel pain </a>in children. Let’s now discuss how to help.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
The combination of the previous treatments should help to resolve the <a href="http://advancedfootcarecenters.com/education_heel_pain.htm">heel pain </a>in a matter of weeks, so that children can maintain their active lifestyles.<br />
</div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-34989340434272225272012-09-25T10:46:00.004-04:002012-09-25T10:46:45.297-04:00Heel Pain in Kids<div class="entry">
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
</div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-43985081319223808292012-09-14T09:34:00.002-04:002012-09-14T09:34:20.071-04:00 Surgical Treatment of WartsIf 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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-79453779308983963312012-09-11T17:17:00.003-04:002012-09-11T17:17:26.737-04:00Warts Treatment Continued<div class="entry">
Wart treatment continues to develop and newer treatment
modalities continue to come out. Let’s discuss some of the more popular
treatments.<br />
<br />
The reason why warts persist so long is that they hide from the
immune system by living in the thick skin of the plantar skin. A
popular theory now being investigated is injecting something into the
wart that will alert the immune system. Candida albicans, a yeast known
for causing oral thrush and yeast infections, has been injected into
warts. The immune system then begins to attack the yeast, and at the
same time realizes the presence of the wart and begins to attack it.
This treatment has shown promising results in some, but doesn’t work for
everyone. Talk to your podiatrist if you are interested in attempting
this mode of treatment.<br />
<br />
Another treatment for warts is called bleomycin. This may alarm some
of you who know that this medication is a chemotherapy agent for those
undergoing cancer treatments. However, when using this medication for
wart treatment, bleomycin is diluted down and is only injected into the
most superficial part of the skin, similar to how TB tests are done.
Bleomycin stays locally inside the wart and does not get into your
circulation. After one application, the wart will turn black over a 2
week period. The wart is then debrided using a scalpel. Often, only
one or two treatment is necessary. If used correctly, this treatment is
very effective in only a few office visits.<br />
<br />
Another product being used for wart treatment is canthacur. This is a
product that comes from the saliva of an exotic beetle. It is a very
potent chemical that when applied to skin will cause blistering and
lifting of the skin, which will cause the wart virus to die. This is a
newer treatment that is slowly gaining favor. The most commonly seen
problem with this treatment is that the chemical, when the foot begins
to sweat, will dissolve and not stay over the affected area. This will
obviously decrease the effectiveness of the treatment.<br />
<br />
If these conservative measures fail, there are some surgical options that can be pursued. We’ll discuss these next post.<br />
</div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-48317141357729283022012-09-10T17:23:00.002-04:002012-09-10T17:24:07.935-04:00Warts Treatment<div class="entry">
Warts have become so common that health professionals use a
myriad of treatments, not to mention home remedies and folk remedies
that are shared on personal blogs and websites alike. We’ll go over
some of the more common treatments used by professionals, and mention
some of the more popular home recipes.<br />
<br />
The best treatment for any condition is prevention. The best way to
prevent picking up the virus is to wear footwear in public areas where
water is present. Be especially careful around locker room showers at
health clubs, or at public swimming pools. If you have an open cut or a
break in the skin, be especially cautious. If you think your shower
may be contaminated, a dilute bleach cleaning solution will be
sufficient to remove the virus.<br />
<br />
A common treatment used by podiatrists is salicylic acid. This acid
works by slowly eating away at the skin infected by wart. The acid is
in a cream form, is applied every week for 5-6 weeks, and is covered
with a strong adhesive tape such as duct tape to ensure the acid stays
in the correct spot. After each treatment, the dead skin is shaved away
with a scalpel to get to the deeper skin where the wart is hiding.
This is an effective, painless way to get rid of a plantar wart. The
downside is that it requires consistent office visits over a couple
weeks.<br />
<br />
Another common treatment for warts is cryotherapy, or freezing the
warts. By using a very direct freezing solution, you can induce a local
frost bite on the wart, causing the skin and therefore the wart to
die. Similar to salicylic acid, this is a treatment that needs to be
applied several times over a couple weeks. A common mistake when using
this treatment is that the cryotherapy is not applied long enough to
penetrate the thick skin of the plantar skin. In order for freezing to
work, the therapy must be applied long enough for the treatment to be
painful. For this reason, podiatrists are using this therapy less and
less.<br />
<br />
We’ve only scratched the surface of wart treatment. We’ll discuss some more next post.</div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-26397254380410917492012-08-31T08:23:00.002-04:002012-08-31T08:24:10.994-04:00 How did I get this wart?<div class="entry">
Summer time is slowly coming to an end, a time of year that many
kids spend endless hours at the pool. It is normal to get a few bumps
and scratches along the way, especially on the toes and feet. Breaks in
the skin allow potential viruses to get into the skin and grow. One of
the most common viruses found in this environment is the virus that
causes plantar warts.<br />
<br />
Verrucae, commonly known as warts, are the result of an infection of a
virus, which is part of a family of viruses called the human papilloma
virus or HPV. If that sounds familiar to you, it is because this
family of viruses is responsible for cervical cancer and gential warts.
Thankfully, when concerning the manifestation of warts on the feet,
they are benign and will disappear on their own without any treatment in
a couple of years.<br />
<br />
The virus is confined to the thick skin on the
soles of the feet, which while it keeps the virus from spreading, it
allows the virus to hide from the immune system. This allows the virus
to grow and seed on the plantar skin.<br />
<br />
How can we tell a wart from a simple callus or IPK? When shaved with
a small blade, a wart will have small distinct pores that will bleed, a
phenomenon termed “pin point bleeding.” In addition, the skin lines on
the soles of the feet will be interrupted by the growth of the wart.
Another way to correctly diagnose a wart will be to squeeze the wart
between your fingers. This will induce exquisite pain, more so than if
direct pressure is applied to the surface of the wart.<br />
<br />
As you probably know, this is a very common problem among children
and young adults. As such, there is no end to the many treatments that
have been attempted, some more successful than others. We’ll discuss
the possible treatments in the upcoming posts.</div>
Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-72856065647486915602012-08-08T17:12:00.000-04:002012-08-08T17:12:03.574-04:00PTTD Surgical Treatments<br />
<div class="MsoNormal">
Once conservative treatments have failed in treating
posterior tibial tendon dysfunction, surgery can be looked at as a potential
way to reduce pain and correct the collapsed arch.<span style="mso-spacerun: yes;"> </span>There are a wide variety of procedures that
have been used.<span style="mso-spacerun: yes;"> </span>Some involve repairing
tendons or other soft tissues.<span style="mso-spacerun: yes;"> </span>Others
involve making cuts in bone to shift their position to reestablish their
correct position.<span style="mso-spacerun: yes;"> </span>If there is cartilage
damage or arthritis in the joint, fusing the joints may be beneficial.<span style="mso-spacerun: yes;"> </span>We’ll discuss each category of procedures.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Before any surgical decisions are made, an MRI should be
ordered and reviewed with your doctor.<span style="mso-spacerun: yes;">
</span>With the help of an MRI, the entire length of the posterior tibial
tendon can be analyzed and the extent of damage can be determined.<span style="mso-spacerun: yes;"> </span>If cartilage damage is present, this will be
obvious on the MRI images.<span style="mso-spacerun: yes;"> </span>MRI is an
important tool that is essential for determination of the best procedure.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If the condition is not too far advanced, a soft tissue
procedure can be done to help stop progression of the problem.<span style="mso-spacerun: yes;"> </span>This may involve repairing the damaged
tendon, or transferring a healthy tendon to take its place.<span style="mso-spacerun: yes;"> </span>In some cases, using a tendon graft can help
strengthen the tendon.<span style="mso-spacerun: yes;"> </span>The nice thing
about these procedures is that once the incision is healed (about 2 weeks), you
can walk on the foot which was operated on.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If the condition is too far advanced, a soft tissue
procedure will not be powerful enough to correct the problem.<span style="mso-spacerun: yes;"> </span>In such cases, bone must be cut in order to
re-align the foot under the body.<span style="mso-spacerun: yes;"> </span>These
procedures provide more correction than the soft tissue procedures.<span style="mso-spacerun: yes;"> </span>In situations where cartilage damage is
present, the surgeon may choose to fuse the damaged joint.<span style="mso-spacerun: yes;"> </span>Although these procedures are more definitive
and have more potential benefit, the recovery time is much longer.<span style="mso-spacerun: yes;"> </span>When bone is cut, the patient should be
non-weight bearing for up to 6 weeks to allow the bone to heal in proper
position.<span style="mso-spacerun: yes;"> </span>Additional non-weight bearing
time may be necessary depending on how fast each particular patient heals.<span style="mso-spacerun: yes;"> </span>The doctor will want to see you every 2-3
weeks to take xrays to insure proper healing.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
PTTD is a difficult condition to treat.<span style="mso-spacerun: yes;"> </span>Discuss with your podiatrist which procedure
option best suits your situation.<span style="mso-spacerun: yes;"> </span>Most
patients see dramatic reduction in pain and a foot that allows for normal
ambulation.<a href="http://www.blogger.com/blogger.g?blogID=7524954016755619396" name="_GoBack"></a></div>Adminhttp://www.blogger.com/profile/13199534440663711771noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-49322939392084662882012-07-25T09:53:00.003-04:002012-07-25T09:53:46.413-04:00PTTD Conservative Treatments<div style="font-family: inherit;">
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Once diagnosed with Posterior Tibial Tendon Dysfunction as
evidenced by the “too many toes” sign and the heel rise test, there are some
conservative treatments available to help support or slow the progression of
the condition.<span style="mso-spacerun: yes;"> </span>The best treatment for you
will depend on how far advanced you are with the disorder.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
If caught far enough in advance, minor modifications can be
made to shoe gear to help reduce the amount of pronation.<span style="mso-spacerun: yes;"> </span>Custom orthotics made from plaster molds can
be fashioned to give support to the arch.<span style="mso-spacerun: yes;">
</span>Modifications can be made to the orthotics with time.<span style="mso-spacerun: yes;"> </span>If pain persists, a steroid shot can be
given to help decrease inflammation.<span style="mso-spacerun: yes;">
</span>The decision to go ahead with a shot must be carefully considered as steroids
can weaken ligaments and cause the condition to progress faster.<span style="mso-spacerun: yes;"> </span>Oral steroids or anti-inflammatory medication
may provide some relief, but will not reverse or halt the progression.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
In most cases, orthotics will not provide enough
relief.<span style="mso-spacerun: yes;"> </span>In many instances, orthotics are
skipped as a treatment and the doctor will recommend a custom ankle brace as
the primary treatment.<span style="mso-spacerun: yes;"> </span>Similar to
orthotics, you will be casted for the brace, which will then be sent off to a
lab for fabrication.<span style="mso-spacerun: yes;"> </span>There are many variations
to this brace, and they will be fabricated slightly different.<span style="mso-spacerun: yes;"> </span>This b<a href="http://www.blogger.com/blogger.g?blogID=7524954016755619396" name="_GoBack"></a>race laces up the
front, extends up around the ankle, and fits into most shoes.<span style="mso-spacerun: yes;"> </span>It helps to give support to the arch and
foot.<span style="mso-spacerun: yes;"> </span>Movement of the joints in the foot
is minimized, thus reducing pain and swelling.<span style="mso-spacerun: yes;">
</span>If worn consistently, this brace can be a definitive treatment for some
individuals.<span style="mso-spacerun: yes;"> </span>However, the brace can be
bulky and difficult to wear during the warm summer months.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<span style="font-family: inherit; font-size: 11pt;">Despite our best efforts, some patients will
eventually exhaust conservative treatments.<span style="mso-spacerun: yes;">
</span>At this point, surgical options are explored.<span style="mso-spacerun: yes;"> </span>Your doctor will probably order an MRI to get
an idea of how degenerated the posterior tibial tendon is.<span style="mso-spacerun: yes;"> </span>This will help the doctor to recommend the
best surgical option.<span style="mso-spacerun: yes;"> </span>We’ll discuss
these options next post.</span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-91180754859310283202012-07-17T09:46:00.003-04:002012-07-17T09:46:29.735-04:00Signs of Flatfoot (PTTD)<div style="font-family: inherit;">
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<div class="MsoNormal" style="font-family: inherit;">
We discussed last week the development of flatfoot in
adulthood.<span style="mso-spacerun: yes;"> </span>There are some diagnostic
signs and tests that your podiatrist uses to determine if you have the
condition, as well as how far the condition has advanced.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
Pain along the course of the posterior tibial tendon is the
most important sign when diagnosing PTTD.<span style="mso-spacerun: yes;">
</span>The posterior tibialis tendon wraps around the inside of the ankle and
inserts on the arch.<span style="mso-spacerun: yes;"> </span>This allows the
muscle to support the arch.<span style="mso-spacerun: yes;"> </span>If there is
pain at the tendon’s insertion or pain when the doctor palpates the tendon as
it goes up the leg, you may be experiencing PTTD.<span style="mso-spacerun: yes;"> </span>If there is no pain, PTTD is unlikely.</div>
<div class="MsoNormal" style="font-family: inherit;">
Assuming there is pain along the tendon, there are other
tests that can be done to help confirm the diagnosis.<span style="mso-spacerun: yes;"> </span>The doctor will have the patient stand facing
the wall.<span style="mso-spacerun: yes;"> </span>The doctor will stand directly
behind the patient.<span style="mso-spacerun: yes;"> </span>Normally, the doctor
can only see the 4<sup>th</sup> and 5<sup>th</sup> toes, with the leg covering
the rest of the toes.<span style="mso-spacerun: yes;"> </span>In PTTD, when
positioned behind the patient, the doctor will be able to see almost all of
toes.<span style="mso-spacerun: yes;"> </span>This is known as the “too many
toes” sign.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
Another test your doctor will use to grade the amount of
dysfunction is called the heel rise test.<span style="mso-spacerun: yes;">
</span>The doctor will have you stand next to the wall or counter for
balance.<span style="mso-spacerun: yes;"> </span>You will then be asked to stand
on your toes, first each foot individually, then both feet together.<span style="mso-spacerun: yes;"> </span>In someone with PTTD, this will illicit large
amounts of pain in the arch and up the leg.<span style="mso-spacerun: yes;">
</span>In more advanced situations, the patient will not be capable of lifting
their heels off the ground at all.<span style="mso-spacerun: yes;">
</span>Patients often are surprised that they didn’t notice their inability to
lift up on their heels before their appointment.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<span style="font-family: inherit; font-size: 11pt;">Lastly, the doctor will watch you walk in the
office.<span style="mso-spacerun: yes;"> </span>This is called gait
analysis.<span style="mso-spacerun: yes;"> </span>The “too many toes sign” will
be seen as they walk.<span style="mso-spacerun: yes;"> </span>The heel bone will
not have normal movement, and the person will practically be walking on the
inside of the foot, the arch being completely absent.<span style="mso-spacerun: yes;"> </span>The doctor will then correlate these findings
to the x-rays taken in order to suggest the best treatment options.<span style="mso-spacerun: yes;"> </span>We’ll discuss some of those treatment options
next week.</span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-4005486521802145842012-07-12T09:34:00.002-04:002012-07-25T09:54:47.184-04:00How Did My Foot Become So Flat?<div style="font-family: inherit;">
</div>
<div class="MsoNormal" style="font-family: inherit;">
<span style="font-size: small;">It is a normal phenomenon for the foot to get larger over a
lifetime of use.</span><span style="font-size: small;"> Ligaments lose their
tensile strength and tendons can lengthen over time making the shape and size
of the foot change.</span><span style="font-size: small;"> However, these
changes happen over a long period of time, making them unnoticeable from month
to month.</span><span style="font-size: small;"> The only situation is which
noticeable changes happen normally would be in pregnancy, since women have
hormones in their body which are meant to make ligaments more flexible to allow
for child birth.</span><span style="font-size: small;"> But have you noticed
that your arch has slowly but noticeably flattened over a period of
months?</span><span style="font-size: small;"> If so, you may have a condition
termed Posterior Tibial Tendon Dysfunction or PTTD.</span></div>
<div class="MsoNormal" style="font-family: inherit;">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal" style="font-family: inherit;">
<span style="font-size: small;">The posterior tibial muscle is the main muscle that supports
the arch of the foot.</span><span style="font-size: small;"> The tendon runs on
the inside of the leg right behind the inside of the ankle.</span><span style="font-size: small;"> It is the main muscle that allows you to turn
the sole of one foot in so that it is facing the other foot.</span><span style="font-size: small;"> In certain foot types, this muscle can be
subject to a significant amount of force, causing over lengthening and
breakdown of the tendon.</span><span style="font-size: small;"> If the tendon
degenerates or loses its strength, the muscle loses its ability to hold the
arch up.</span><span style="font-size: small;"> With time, the arch slowly
loses its height, causing pain and difficulty fitting in shoes.</span><span style="font-size: small;"> This process may not produce enough
discomfort to push you to see a podiatrist until some irreversible damage has
already been done.</span><span style="font-size: small;"> There are different
stages of PTTD, thus the treatment depends on how degenerated the tendon
is.</span><span style="font-size: small;"> In most cases, an MRI is needed to
assess the current status of the tendon.</span></div>
<div class="MsoNormal" style="font-family: inherit;">
<span style="font-size: small;"><br /></span></div>
<div style="font-family: inherit;">
<span style="font-size: small;">There are a couple tests that we can do in the
office to assess if PTTD is present, and if so present<a href="http://www.blogger.com/blogger.g?blogID=7524954016755619396" name="_GoBack"></a>,
how far advanced the condition is. This
helps to determine which conservative or surgical options may help. We’ll discuss these clinical tests in the
next post.</span></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-48024091172934366682012-07-05T10:17:00.000-04:002012-07-05T10:17:48.458-04:00Ankle Sprain SurgeryAs mentioned before, the overwhelming majority of ankle sprains will
get better with conservative care in 2-3 months. Once x-rays have
confirmed there isn’t any fracture, most sprains get better with
R.I.C.E., as well as bracing and protection. However, there are some
people who will continue to have pain and discomfort despite our best
efforts. The decision to go ahead with surgery is one that is
complicated. Both the patient and doctor will have to discuss and agree
upon a plan as a team. Let’s discuss some options.<br />
<br />
One attractive
option is to do ankle arthroscopy. Similar to what is done in the
knee, a small fiber-optic camera is inserted into the ankle joint along
with a tool to remove any loose particles inside the ankle joint. With
multiple ankle sprains, pieces of bone, cartilage, or inflamed ligaments
can impinge on the ankle joint. Once loose particles are removed, pain
is lessened and improvement is seen. The main advantage to ankle
arthroscopy is that there are only 2 small incisions made where the
instruments are inserted. The incisions heal quickly and downtime is
usually 10 days to 2 weeks.<br />
<br />
Another procedure that can be done is
called a Brostrom procedure. As we discussed, ankle sprains can cause
ligaments to tear. The Brostrom procedure attempts to sew back together
a ligament that is often torn in ankle sprains. It is sewn together
with a very strong suture material, so that stability is gained and pain
is minimized. This procedure requires a longer healing period as the
ligament fiber ends need to reconnect.'<br />
<br />
In some cases, torn
ligaments are so bad that it is impossible to sow them back together.
In these cases, grafts can be used. There are many variations to what
can be done to recreate the ligaments. The doctor can use a graft made
from bovine or porcine sources, or harvest tendon from another source in
the body. Depending on which ligaments are torn, the doctor can adjust
what he uses to restore stability.<br />
<br />
There are additional
procedures that exist to help a persistent ankle sprain. Work with your
doctor to decide which procedure best fits your situation.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-65277630516701220042012-06-27T12:45:00.002-04:002012-06-27T12:45:45.891-04:00Ankle Sprain Conservative TreatmentsWe talked last week about ankle sprains, how they happen, and what conditions predispose someone to getting one. Let’s now discuss some of the initial treatment available.
Fortunately, most ankle sprains will eventually resolve without long term issues. When compared to bone or muscle, a ligament’s blood supply is significantly less. Since blood carries oxygen and healing factors within it, blood supply partially determines how fast an injury heals. For this reason, ankle sprains heal slower than bone or muscles, resulting in about a 6-8 week heal time. A person can usually engage in full activity 3 months after the initial injury.
Conservative treatment for ankle sprains is what you might expect with any foot injury. After making sure there are no fractures with x-rays, ankle bracing, ankle taping, short leg casting, protection, RICE (rest, ice, compression, and elevation), anti-inflammatory shots, and anti-inflammatory oral medication have all been used to treat these types of injuries. A common regiment for treating ankle sprains is RICE for 2-4 days, followed by ankle bracing and strengthening exercises for a couple weeks. Once you can weight bear without discomfort, a short regiment of physical therapy will help you to regain confidence in the ankle.
You’ll notice that with the exception of physical therapy and anti-inflammatory shots, most of the treatments mentioned can be obtained over the counter. So you might wonder why you need to see your podiatrist. The reason is simple. What may feel like a simple ankle sprain might actually be an ankle fracture. In some cases, an ankle sprain might actually have damaged cartilage in the ankle, or broken one of the leg bones (the fibula) up close to the knee. If these injuries go undiagnosed and undertreated, there may be some irreversible damage done. Although a simple ankle sprain is more common, these other injuries happen often enough to warrant evaluation by a doctor.
If pain persists despite conservative measures, or you are someone who has chronic ankle sprains, surgical options may need to be discussed. At this point, the doctor will probably request an MRI to assist in planning what operation needs to be done. We’ll discuss these options next post.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-31057205451681674622012-06-12T12:57:00.003-04:002012-06-12T12:57:51.039-04:00What Do Podiatrists Do?<div style="font-family: Arial,Helvetica,sans-serif;">
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Podiatrists have long been known to be the people to see for
ingrown nails, hammertoes, and heel pain.<span style="mso-spacerun: yes;">
</span>But today’s podiatrist does much more than that.<span style="mso-spacerun: yes;"> </span>Let’s first talk about their education, and
then what that allows them to do.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br /></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
To become a podiatrist, after high school, a person must
attend an undergraduate university and receive a 4 year bachelor degree.<span style="mso-spacerun: yes;"> </span>Most choose to major in a science related
major, such as biology, chemistry, exercise science, physiology etc…<span style="mso-spacerun: yes;"> </span>By completing these degrees, they have taken
the necessary courses to prepare to take the Medical College Admission Test
(MCAT).<span style="mso-spacerun: yes;"> </span>An applicant then submits their
college transcript along with their MCAT score to a podiatric medical
college.<span style="mso-spacerun: yes;"> </span>Although separate from MD
medical schools, podiatric medical school’s curriculum is held to the same
standard of other doctorate level medical programs.<span style="mso-spacerun: yes;"> </span>After 4 years of medical school and passing
of board exams, a person must then complete a 3 year residency program at a
hospital somewhere across the country.<span style="mso-spacerun: yes;">
</span>During these 3 years, a podiatrist receives their surgical training.<span style="mso-spacerun: yes;"> </span>And at last, once licensed, a person can then
practice as a podiatrist.<span style="mso-spacerun: yes;"> </span>All in all, a
licensed podiatrist receives at least 11 years of additional education after
high school.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br /></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
As academic standards and competitiveness have increased,
the level of training has also increased.<span style="mso-spacerun: yes;">
</span>Today’s podiatrist can still trim calluses and nails of high risk
patients like diabetic like we always have.<span style="mso-spacerun: yes;">
</span>But they are also trained to fix ankle fractures, repair Achilles
tendons, and even put a camera into the ankle joint and clean it out like an
orthopedic surgeon commonly does to a knee.<span style="mso-spacerun: yes;">
</span>Just like in many medical specialties, some podiatrists like to focus
their efforts in pediatrics, athletes, or geriatric patients.<span style="mso-spacerun: yes;"> </span>Even if the podiatrist you are seeing doesn’t
routinely treat your current condition, he/she surely knows of another
podiatrist in the community that does.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 11pt;">Ask your podiatrist what he can treat. You’ll be pleasantly surprised what they can
help you with.</span>Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-71152532702291913192012-06-05T11:49:00.001-04:002012-06-05T11:49:46.608-04:00Bone Scans<br />
<div class="MsoNormal" style="font-family: inherit;">
The last imaging technique we’ll discuss will be different
types of full body scans available, specifically used by podiatrists to
determine if bone infection is present.<br />
</div>
<div class="MsoNormal" style="font-family: inherit;">
A scan, either for bone or WBCs (white blood cells), is done
by injecting a very small amount of a specific type of radioactive dye into a
vein. This dye will then spread through
the body as the blood is pumped through all the bone, muscle and internal
organs. The dye contains a certain
substance that will bind to somewhere in the body. The dye for bone scans binds to bone that is
currently being remodeled. The dye for
WBCs will search out WBCs and bind to them.
The person is then scanned at different time intervals with a gamma
camera, which is able to detect where the most activity is concentrated. This can be very useful in diagnosing foot
conditions.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
When it comes to podiatry, these scans are primarily useful
with diabetic patients. Diabetic
patients struggle with two conditions, osteomyelitis (bone infection) due to
ulceration, and Charcot Foot (a non-infected bone destructive process). These two conditions are sometimes difficult
to tell apart clinically. With infected
bone, both a bone and WBC scan will be positive, whereas only a bone scan will
be positive with Charcot. Bone scans can
give the podiatrist clues to which process if going on. Scans are generally cheap tests and readily
available.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
A downside to bone scans is that they are not very
specific. There are many conditions that
will have a positive bone scan. A
fracture, infected bone, growth plates, arthritis etc. will all give positive
bone scans. So even if I suspect bone
infection, and the bone scan comes back as positive, I still have to perform
other tests to confirm my suspicions.
There could be another underlying condition giving the positive bone
scan test. This obviously limits their
usefulness. Some types of scans are technically difficult to perform, and
others are difficult to read. <a href="http://www.blogger.com/blogger.g?blogID=7524954016755619396" name="_GoBack"></a> Scans also expose the patient to some
radiation, thus making it necessary to make sure these scans are not ordered
unless absolutely necessary.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
Imaging techniques used by podiatrists are essential in
determining the source of patient’s complaints.
These techniques are very safe when used in the appropriate
situations. </div>Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-32049371716877941592012-06-05T11:48:00.002-04:002012-06-05T11:49:54.769-04:00Podiatric CT Scans<br />
<div class="MsoNormal" style="font-family: inherit;">
We’ve discussed some of the more well-known imaging
techniques used by foot doctors to help understand and diagnose foot pain. There are additional tests that podiatrists
use less routinely, but nonetheless give important information in the right
circumstances. Let’s discuss CT scans
and their use in podiatry.</div>
<div class="MsoNormal" style="font-family: inherit;">
If you remember when we discussed MRI, we talked about how a
magnet is used to take sequential slices through the foot, which are then
grouped together to give a three dimensional image of foot. CT scans are similar in that they take slices
of the foot like an MRI. However,
instead of using a magnet, CT scans use a computer that generates x-rays. Whereas regular x-rays only give a two
dimensional image, when grouped together, CT scan can give a 3D image. </div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
CT offers some very useful advantages over other imaging
techniques. CT scans allow incredible
visualization of bone. In cases of high
impact injury like falling from tall heights, or dropping a heavy object on the
foot, bone can fracture into many small fragments. In many of these cases, surgery is required
to fix the fractures. CT scans can help
the surgeon to know before surgery how many fragments there are and where they
are located. This allows the surgeon to
plan in advance how to best go about repairing the fractures, and to make the
most appropriate decisions for the patient.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit;">
CT scans do have some limitations. The main disadvantage to these scans is the
amount of radiation the patient is exposed to.
When compared to a single x-ray, a CT scan exposes you to several times
over the amount of radiation. For this
reason, in podiatry, they tend to be ordered with very badly fractured heel or
ankle bones. Although CT scans can
differentiate between bone, tendon, and muscle, MRI gives a much clearer
picture of these structures without exposure to radiation.</div>
<div class="MsoNormal" style="font-family: inherit;">
<br /></div>
<span style="font-family: inherit; font-size: 11pt;">In our next post, we’ll discuss bone scans,
another type of imaging that can be useful in diabetic conditions and
infections.</span>Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-11507090521917485452012-05-22T12:43:00.001-04:002012-05-22T12:43:06.502-04:00Advanced Imaging: MRI<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
Prior to now, we have discussed ways a doctor can get an
image of your foot in the office.<span style="mso-spacerun: yes;">
</span>However, as we discussed, there are times when a more advanced and
detailed image is needed.<span style="mso-spacerun: yes;"> </span>Magnetic
Resonance Imaging (MRI) is a great tool to use in these situations.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In order to obtain an MRI, a patient is placed in a room
with machine containing a giant magnet.<span style="mso-spacerun: yes;">
</span>This magnet causes the hydrogen ions in your bones, muscle, and other
soft tissue to give off a signal that can be detected by a computer.<span style="mso-spacerun: yes;"> </span>Depending on the tissue, different signals
will be given off.<span style="mso-spacerun: yes;"> </span>The computer analyzes
the signals and develops a picture.<span style="mso-spacerun: yes;"> </span>Once
the 1<sup>st</sup> picture is taken, the machine moves a couple millimeters and
takes the next picture. If you can imagine slicing up a tomato or onion, an MRI
is like slicing the foot into many individual sections.<span style="mso-spacerun: yes;"> </span>These individual slices are then grouped
together so the doctor can get a good picture of the inside of the foot.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The major benefit to an MRI is that it can show bone,
tendon, and cartilage in a very detailed image.<span style="mso-spacerun: yes;">
</span>This can be used by the doctor as a surgical planning tool before he
takes a patient to the operating room.<span style="mso-spacerun: yes;">
</span>MRI can be helpful to diagnose a condition, but most problems can be
diagnosed during a routine office visit without the help of an MRI.<span style="mso-spacerun: yes;"> </span>Although there are exceptions to that rule,
an MRI is not usually ordered until the doctor and patient have agreed that
surgical treatment is needed.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Another benefit to MRI is that no radiation is received by
the patient, and it does not require a dye or contrast to be injected into the
patient.<span style="mso-spacerun: yes;"> </span>MRI is a completely noninvasive
imaging technique.<span style="mso-spacerun: yes;"> </span>For these reasons,
MRIs are very safe for the patient.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On the other hand, an MRI requires you to lie motionless for
an extended period of time. <span style="mso-spacerun: yes;"> </span>If you are
moving when the slices are being taken, the image becomes distorted and
impossible to interpret.<span style="mso-spacerun: yes;"> </span>This can be
somewhat uncomfortable.<span style="mso-spacerun: yes;"> </span>In addition, if
you have metal plates or screws in your body from previous surgery, the metal
will distort the image, making it hard to see anything.<span style="mso-spacerun: yes;"> </span>For that reason, some patients may not be
able to get a useful MRI.<span style="mso-spacerun: yes;"> </span>Lastly, MRIs
are very expensive.<span style="mso-spacerun: yes;"> </span>Most insurance
providers will not pay for an MRI until multiple conservative measures have
been exhausted with no improvement in treating the patient.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
MRI is a valuable tool that has helped doctors see subtle
problems that x-ray and ultrasound miss.<span style="mso-spacerun: yes;">
</span>It is primarily a surgical planning tool to help surgeons be more
prepared before surgery.<span style="mso-spacerun: yes;"> </span><a href="" name="_GoBack"></a>However, it must be used appropriately so not as to waste
resources. </div>Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-77810885176425330662012-05-08T09:14:00.004-04:002012-05-08T09:14:41.728-04:00Podiatric Ultrasound<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
I’m sure many of you hear the word “ultrasound” and
correlate it with pregnancy and gynecology<span style="mso-spacerun: yes;">, b</span>ut ultrasound is a very safe and useful tool podiatrists have to
visualize and diagnose the source of a patient’s pain.<span style="mso-spacerun: yes;"> </span>Let’s discuss some of the pros and cons of
ultrasound.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
First and foremost, ultrasound is very safe to the
patient.<span style="mso-spacerun: yes;"> </span>Ultrasound is simply a machine
that sends out sound waves at a certain frequency, which then forms an image
from how the waves bounce back.<span style="mso-spacerun: yes;"> </span>Most
importantly, no radiation or tissue damage occurs from these sound waves.<span style="mso-spacerun: yes;"> </span>This is supported by multiple studies and its
long and continued use in visualizing babies in utero.<span style="mso-spacerun: yes;"> </span>This long history of safety has led to the
development of ultrasound machines specifically made to see bone, tendon, and
ligament<a href="" name="_GoBack"></a>.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Secondly, ultrasound gives a real-time image.<span style="mso-spacerun: yes;"> </span>X-rays, MRI, and CT scans are frozen
images.<span style="mso-spacerun: yes;"> </span>Ultrasound gives a “living image”
so that as the patient moves the foot, the image reflects that movement.<span style="mso-spacerun: yes;"> </span>This gives the doctor more information on how
the foot is functioning as it moves.<span style="mso-spacerun: yes;">
</span>Without this insight, the doctor might miss the true source of the
pain.<span style="mso-spacerun: yes;"> </span>Ultrasound can be used to
visualize bone as well as soft tissue.<span style="mso-spacerun: yes;">
</span>In addition, when giving an injection, the doctor can give it under the
guidance of ultrasound.<span style="mso-spacerun: yes;"> </span>This can help
the doctor insure that the medicine is being placed in the area of
inflammation.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Lastly, ultrasound is inexpensive and convenient.<span style="mso-spacerun: yes;"> </span>Ultrasound machines for foot and ankle
imaging are very small and can be moved from exam room to exam room very
easily.<span style="mso-spacerun: yes;"> </span>When compared to CT scans and
MRI, ultrasound is much cheaper and therefore, insurances are more likely to
cover the cost.<span style="mso-spacerun: yes;"> </span>Ultrasound does not
require a dye to be injected into your veins (often needed for CT scans),
neither does it require you to lie motionless (as is needed with MRI).<span style="mso-spacerun: yes;"> </span>All in all, is a very cost effective way to
diagnose foot and ankle conditions.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The main disadvantage to ultrasound is that it requires a
trained eye to both know the mechanics of the machine and to read the
ultrasound image.<span style="mso-spacerun: yes;"> </span>Only after much
experience can a technician consistently read an ultrasound accurately.<span style="mso-spacerun: yes;"> </span>Your podiatrist will be able to correctly
interpret your ultrasound.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Now that we have covered the ways to image the foot and
ankle in the office, we will discuss the more advanced imaging techniques of CT
scans and MRIs in our next posts.</div>Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-38194012667735514282012-04-24T09:15:00.001-04:002012-04-24T09:15:53.935-04:00Podiatric Imaging - X-rays<br />
<div class="MsoNormal">
With the exception of dermatology, most doctors are treating
conditions that they cannot see with the naked eye. In order to overcome this hurdle, many
different types of imaging techniques and instruments have been developed in
order to allow the doctor direct visualization of the problem area. Let’s discuss the imaging most often used in
podiatry.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The most commonly used imaging technique in podiatry is
radiographs, or x-rays. Although there
are many exceptions to this rule, most people who walk into a podiatrist’s
office will get x-rays. X-rays are the
best to order when a patient’s main complaint could potentially involve the
bones or joints. X-rays give only two
dimensional images, so it is necessary to take x-rays from multiple angles so
that the doctor can mentally put the images together to form a three
dimensional picture. X-rays give the
doctor important clues in figuring out the pain a person is experiencing. Fractures, foot mal-alignment, and arthritis
can be diagnosed with simple x-rays. If
a person has stepped on a foreign object, x-rays can help to locate the
position of it. X-rays also can help to
push the doctor to order additional tests or refer out to a different
specialist if certain signs are present suggesting disease like rheumatoid
arthritis, peripheral arterial disease, or other systemic disease. It may even be necessary to get an x-ray with
a severely infected ingrown toenail to see if the infection has gotten into the
bone.</div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
A concern that some patients have is the radiation
associated with x-rays. This was a
problem in past decades with more primitive x-ray machines. However, modern x-ray machines minimize the
scatter of x-rays by directing the beams directly at the target object and
having a very short exposure time. Lead
is worn to protect against the small amount of scatter. X-rays are avoided if the patient is currently
pregnant. You can be assured the amount
of radiation received by the foot is very small. In fact, an x-ray exposes you to the same
amount of radiation you would receive by spending about 5 minutes in the
sun. When compared to tanning, sun-bathing,
or going without sunscreen in the sun, the radiation of an x-ray is
insignificant.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Even though x-rays show bones and joints very nicely, they
do not show much in terms of muscles, tendons, ligaments, or blood flow. In some complicated fractures, it may be hard
to determine the extent of the fracture with only an x-ray. In these cases, ultrasound, Magnetic
Resonance Imaging (MRI), computed tomography (CT or CAT Scan), or bone scans
may be used. We will discuss each of
these imaging techniques in the upcoming weeks.</div>Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-63495667174098615882012-04-17T09:10:00.001-04:002012-04-17T09:12:47.951-04:00Wound Debridement Continued<!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p style="font-family: times new roman;" class="MsoNormal">Let’s finish our discussion on the different types of debridement.</p> <p style="font-family: times new roman;" class="MsoNormal">Mechanical debridement is another method to remove non-viable tissue.<span style="mso-spacerun:yes"> </span>This is accomplished by applying wet to dry dressings.<span style="mso-spacerun:yes"> </span>Normal gauze is soaked in some type of antibacterial solution and packed into the wound.<span style="mso-spacerun:yes"> </span>Solutions may be simple saline, Dakin’s (a diluted version of bleach), or other antibacterial solutions<a name="_GoBack"></a>.<span style="mso-spacerun:yes"> </span>This wet gauze once packed into the wound is covered by dry gauze then wrapped. This dressing is changed every day.<span style="mso-spacerun:yes"> </span>As the packed gauze is removed, dead tissue is removed with it.<span style="mso-spacerun:yes"> </span>This is a very inexpensive way to keep a wound clean, ward off infection and allows for evaluation every day during dressing change.<span style="mso-spacerun:yes"> </span>This dressing may be used prior to application of a Negative Pressure Wound VAC.<span style="mso-spacerun:yes"> </span>However, dressing changes may be a very painful as they rip superficial tissue off.<span style="mso-spacerun:yes"> </span></p> <p style="font-family: times new roman;" class="MsoNormal">Autolysis is another option for debridement.<span style="mso-spacerun:yes"> </span>Autolysis means to let the body digest or get rid of bad tissue by its own means.<span style="mso-spacerun:yes"> </span>The body produces digestive enzymes called MMP’s.<span style="mso-spacerun:yes"> </span>MMP’s at the wound’s surface liquefy the dead tissue.<span style="mso-spacerun:yes"> </span>In order to allow the MMP’s to work, an occlusive dressing is placed over the wound.<span style="mso-spacerun:yes"> </span>Occlusive dressings are not permeable to air and they keep the wound isolated from the outside environment.<span style="mso-spacerun:yes"> </span>Occlusive dressings are relatively controversial.<span style="mso-spacerun:yes"> </span>Some feel that occluding a wound keeps fluid and possibly unknown pus in a wound.<span style="mso-spacerun:yes"> </span>However, studies show occluding a wound keeps its pH low, which inhibits bacterial growth and promotes oxygen unloading from red blood cells.<span style="mso-spacerun:yes"> </span>Autolytic debridement is a more advanced way to debride a wound and requires frequent evaluation and inspection.</p> <span style="font-family: times new roman;font-family:";font-size:100%;" >All in all, each method of debridement has its place in wound therapy.<span style="mso-spacerun:yes"> </span>Different physicians prefer different dressings depending on their experience and training.<span style="mso-spacerun:yes"> </span>If you are currently working to heal a wound, work with your doctor to know which type of debridement is best for your situation.</span>Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-21557515082883483962012-04-12T10:08:00.000-04:002012-04-12T10:10:06.499-04:00Debridement of Diabetic WoundsIn light of our recent discussions on maggot therapy, I thought it would be wise to discuss different ways to debride diabetic wounds and their associated pros and cons. Wound care is continually being assessed for effectiveness and continues to evolve. This is a short review of some of the many options available.<br /><br /> The most obvious way to debride a wound is manually with a curette or scalpel blade. This is the mainstay of wound debridement due to its practicality and ease. This type of debridement can be done quickly in an office visit or bedside without any major equipment. It is cheap and fast and allows for evaluation immediately after. In more recent times, debridement using a machine producing sound waves has been used bedside to remove dead tissue. However, there is no evidence showing that it is more effective than a scalpel blade.<br /><br />Surgical methods are another way to debride wounds. This is usually reserved for unusually large or chronic wounds that need deeper or more radical debridement. Instruments like the VersaJet combine manual debridement with highly pressurized water to remove non-viable tissue. The benefit of surgical debridement is that the patient is sedated so the doctor can be more aggressive and insure all dead is tissue removed. However, taking the patient to the operating room, needing medical clearance and the assistance of an anesthesiologist makes surgical debridement less practical and is only used if medically necessary.<br /><br />Another type of debridement is use of ointments that contain enzymes that breakdown dead tissue. This is especially useful in situations where a patient has full sensation to the wound. Manual debridement may prove to be too painful for the patient to go through. In contrast, enzymatic ointments slowly dissolve making it painless for the patient. The downside of enzyme ointments is that they take longer to work. In addition, enzymes are very sensitive to small changes in pH, making it possible for them to be inactivated if the wound is too acidic or basic. <br /><br />We’ll discuss mechanical debridement, autolytic debridement, as well as how wound care dressings can effect debridement in our next post.Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.comtag:blogger.com,1999:blog-7524954016755619396.post-83769284937718377692012-04-03T11:30:00.001-04:002012-04-03T11:32:13.099-04:00Medical Maggots continuedAs more and more patients have difficult wounds to heal, we have looked to the past and brought back more primitive yet effective ways to clean and close wounds. One of these techniques is putting maggots into wounds.<br /><br />Maggots are simply baby or immature flies. There are many species of flies, some of which are not beneficial for wounds. So it is not a good idea to go diving into dumpsters trying to find a nice batch of them. Special pharmacies have them available for wound care clinics and hospitals. Once ordered, they can be shipped overnight and ready the next day for application.<br /><br />Once the maggots are placed in a wound, precautions need to be taken so that they do not escape. A mesh net is put over the wound, and the wound is surrounded by a very adherent material. This keeps them in the wound so that they can deliver maximum benefit. The maggots will then secrete enzymes that dissolve the dead and non-viable tissue at the wound’s surface over a couple days’ time. Once dissolved, the maggots consume the components of the dissolved material. After a couple days in the wound, the maggots can become much larger then when they were put in. They are removed from the wound to assess if they did their job well. It may take a couple of treatments of maggot therapy to remove all the dead tissue.<br /><br />Another great benefit of maggot therapy is that it can be combined with other wound treatments without caution. Antibiotics, hyperbaric oxygen, and even wound VACs (vacuum assisted closure) can be used after maggots to increase the chance of healing.<br /><br />Although putting eventual flies into a wound may not seem very cutting edge or fancy, some treatments stand the test of time. Maggot therapy can help wounds to heal and prevent amputations of the foot and leg. Ask your podiatrist if he feels that maggot therapy may be beneficial for the healing of your wound.Advanced Foot Care Centershttp://www.blogger.com/profile/08131787627934485009noreply@blogger.com