Some people sweat, and other’s sweat a lot! What makes the difference between these two patient populations is a condition known as hyperhidrosis. Hyperhidrosis literally means “a lot of water.” It is a condition that refers to an increased amount of perspiration (sweating) in a number of locations on a patient’s body including their face, hands, armpits and feet.
The greatest complaint for people with hyperhidrosis of the soles of their feet is the odor left behind. With sweating, moisture accumulates in socks and on shoes of such individuals and eventually odor-causing bacteria build-up resulting in an increase in odor, with subsequent embarrassment.
Although hyperhidrosis may be attributed to neurologic complications or sympathetic overactivity, a large percentage of patients with this condition have no contributing factors and suffer from this “just because.” In patients that have no predisposing conditions prevention is not the goal of treatment, but rather control of their excessive perspiration.
Hyperhidrosis can be very difficult to treat, and patience is a virtue while working with your Podiatrist to find a solution that works best for you! For starters, its best to keep feet clean and to change socks daily to prevent bacteria from colonizing on your feet, your socks or your shoes. Do not spray perfumes or body sprays on the feet in attempt to decrease odor as this can often increase the odor due to chemical reactions between sweat and perfume.
Antiperspirants are the first line in treating hyperhidrosis, as many patients immediately notice a difference and thus, success is achieved! Antiperspirants for the feet come in the form of deodorant sticks that one would use for the underarm; in fact there are some over the counter antiperspirant sticks that are indicated for use on the soles of the feet. Look for products that contain aluminum chloride hexahydrate, as they are most effective in treatment. Your Podiatrist may write you a prescription for such antiperspirants containing as much as 30% hexahydrate for prevention of sweating. Through prevention of sweating, antiperspirants are often successful in decreasing bacterial build-up and eliminating odor of the feet. These products are best applied to the feet twice daily: once in the morning and once in the evening, and are applied to the soles of the feet just as deodorant would be applied to the underarms.
For patients who suffer from hyperhidrosis due to sympathetic overactivity or neurologic complications, prescription medications that act on the peripheral nervous system can be tried. However, it is uncommon that your Podiatrist will recommend or even prescribe such mediations due to the potential side effects these can induce on the body.
Iontophoresis is a completely non-invasive method for attempting to treat hyperhidrosis of the hands and feet that utilizes water to pass a mild electronic current through the patients skin. Although not completely understood, the belief behind this theory is based on a cooperative effect of the electrical current and the water to increase the thickness of the outside layer of the hands and feet. Thus, the ducts for which sweat is released from the body onto the palms and soles become essentially “blocked.” Several treatments, on consecutive days helps patients reach a significant decrease in their perspiration, with subsequent maintenance treatments as needed, usually once every 2-4 weeks.
Finally, a treatment method that has gained popularity over the last 5 years or so is Botox injections. Botulinum Toxin, or Botox (the same material used on the face for decreasing wrinkles) can be injected into the soles of the feet for relief of hyperhidrosis. The toxin works by blocking a hormone in the body that is normally responsible for turning sweat glands “on.” This toxin, by blocking that hormone, turns sweat glands “off” and leads to a reduction in sweating in the areas where it was injected. Your Podiatrist will determine how many injections you will need and based on your clinical presentation, how often follow-up injection should be given. These injections are certainly not a cure for hyperhidrosis, but they control symptoms for a significant length of time; in some patients up to 7 months.
Hyperhidrosis is a difficult condition to treat, but your Podiatrist can guide you through your treatment options and find a combination that works best for you. Having feet that smell like roses is just within your reach!
Tuesday, June 29, 2010
Monday, June 28, 2010
Still Walking Barefoot? Here’s One More Reason Not To!
Following in the path of last’s weeks Blog, where we discussed foreign object injuries to the foot, this week I would like to talk about broken toes! As with stepping on a foreign object, broken toes are more often than not suffered when there is a lack of shoe involvement: meaning when patients are barefoot. Of course, a broken toe injury can come at anytime, even with shoes, but that doesn’t seem to be the common occurrence.
Depending on which toe, the severity of the break, and exactly where the toe has been broken, can alter the course of treatment, so its important that we first talk about which bones are where in the anatomy of your foot.
A normal foot has 4 toes (2, 3, 4 & 5) and 1 hallux (“big toe”). Toes 2-5 have 3 small bones and one larger, longer bone. The small bones are called “phalanges,” and are named according to their location: distal (furthest from the body), middle and proximal (closest to the body). The larger bone is called a metatarsal and is named by the number toe that it corresponds to. To simplify, the third toe of the foot consists of the distal, middle and proximal phalanges and the third metatarsal bone. The hallux, or “big toe” contains only 2 small bones: the proximal and distal phalanx; and a larger 1st metatarsal bone.
Each bone communicates with the next across a joint, which is surrounded by a capsule and allows for motion to occur between those two bones: bending and extending of the toes. The joint of most importance, when dealing with toes is what’s called the “metatarsal-phalangeal joint” (MPJ). This is the joint between the larger metatarsal bone and the proximal phalanx. As we will discuss in a minute, determination of conservative and surgical treatment for a broken toe depends partly on the joint involved.
The typical “toe fracture” occurs when the toe is “stubbed” or “jammed” into the floor or into an object such as a step, or when an object is dropped onto the toe. The patient usually admits that injury has taken place while they were wearing no shoes, or slippers, neither of which provides any protection to the toes! Whether the toe was stubbed or an object was dropped on to it, pain will be immediate and swelling of the toe or toes will follow suit! You may immediately, or shortly notice bruising of the toe and/or changes in the look of the nail, if it has been injured. Rarely, the bone that has been fractured will be sticking out through the skin; an open fracture. Certainly, if bone is sticking out of the skin, a trip to the Emergency Room is a necessity.
Following injury, it is important to keep a close watch on the area involved for new pains, increased pain, or a worsening in appearance. Loss of sensation, numbness, tingling or an unusually cold toe should all throw up red flags and encourage you to seek medical attention immediately. In the mean time rest, ice, elevation and over-the-counter anti-inflammatory medications can be used to decrease swelling and pain to the injured area.
Differentiating between a fractured toe and one that is badly bruised is often difficult, unless the toe appears grossly deformed. Being that this is the case, if medical treatment is sought, an x-ray of the involved foot is likely. The x-ray will provide the Podiatrist will a lot of information to help guide your treatment: location of the fracture (if there is one), if the bones are displaced or if they are in good alignment, if a joint is involved in the fracture, how many pieces the bone is in, and whether or not conservative or surgical treatment is necessary.
If the fracture is located in one of the phalanges, is in good alignment and does not involve a joint, conservative treatment with the use of “buddy taping” and a surgical shoe to protect the toe while it heals will be initiated. If the bone appears as though it is displaced, involves the joint and is in several pieces, surgical treatment becomes a greater possibility. Surgery attempts to realign the pieces of the bone and hold them in position while they heal themselves.
As was mentioned before, involvement of the MPJ presents a bit more serious of a problem than if one of the smaller joints in the toe was disrupted. The MPJ plays a significant role in walking and provides a lot of structural support to the foot. Therefore, involvement of the MPJ will require surgery with “pin” fixation and non-weight bearing post-operatively to allow for appropriate healing to take place.
The moral of the story this week, as it was last week, is: don’t walk around without shoes on! Leaving the foot unprotected, whether it is the toes or the sole of the foot, greatly increases your risk of injury. Next time you get up off the beach blanket and head back to your summer beach house for lunch, make sure to put your shoes on and protect your feet.
Depending on which toe, the severity of the break, and exactly where the toe has been broken, can alter the course of treatment, so its important that we first talk about which bones are where in the anatomy of your foot.
A normal foot has 4 toes (2, 3, 4 & 5) and 1 hallux (“big toe”). Toes 2-5 have 3 small bones and one larger, longer bone. The small bones are called “phalanges,” and are named according to their location: distal (furthest from the body), middle and proximal (closest to the body). The larger bone is called a metatarsal and is named by the number toe that it corresponds to. To simplify, the third toe of the foot consists of the distal, middle and proximal phalanges and the third metatarsal bone. The hallux, or “big toe” contains only 2 small bones: the proximal and distal phalanx; and a larger 1st metatarsal bone.
Each bone communicates with the next across a joint, which is surrounded by a capsule and allows for motion to occur between those two bones: bending and extending of the toes. The joint of most importance, when dealing with toes is what’s called the “metatarsal-phalangeal joint” (MPJ). This is the joint between the larger metatarsal bone and the proximal phalanx. As we will discuss in a minute, determination of conservative and surgical treatment for a broken toe depends partly on the joint involved.
The typical “toe fracture” occurs when the toe is “stubbed” or “jammed” into the floor or into an object such as a step, or when an object is dropped onto the toe. The patient usually admits that injury has taken place while they were wearing no shoes, or slippers, neither of which provides any protection to the toes! Whether the toe was stubbed or an object was dropped on to it, pain will be immediate and swelling of the toe or toes will follow suit! You may immediately, or shortly notice bruising of the toe and/or changes in the look of the nail, if it has been injured. Rarely, the bone that has been fractured will be sticking out through the skin; an open fracture. Certainly, if bone is sticking out of the skin, a trip to the Emergency Room is a necessity.
Following injury, it is important to keep a close watch on the area involved for new pains, increased pain, or a worsening in appearance. Loss of sensation, numbness, tingling or an unusually cold toe should all throw up red flags and encourage you to seek medical attention immediately. In the mean time rest, ice, elevation and over-the-counter anti-inflammatory medications can be used to decrease swelling and pain to the injured area.
Differentiating between a fractured toe and one that is badly bruised is often difficult, unless the toe appears grossly deformed. Being that this is the case, if medical treatment is sought, an x-ray of the involved foot is likely. The x-ray will provide the Podiatrist will a lot of information to help guide your treatment: location of the fracture (if there is one), if the bones are displaced or if they are in good alignment, if a joint is involved in the fracture, how many pieces the bone is in, and whether or not conservative or surgical treatment is necessary.
If the fracture is located in one of the phalanges, is in good alignment and does not involve a joint, conservative treatment with the use of “buddy taping” and a surgical shoe to protect the toe while it heals will be initiated. If the bone appears as though it is displaced, involves the joint and is in several pieces, surgical treatment becomes a greater possibility. Surgery attempts to realign the pieces of the bone and hold them in position while they heal themselves.
As was mentioned before, involvement of the MPJ presents a bit more serious of a problem than if one of the smaller joints in the toe was disrupted. The MPJ plays a significant role in walking and provides a lot of structural support to the foot. Therefore, involvement of the MPJ will require surgery with “pin” fixation and non-weight bearing post-operatively to allow for appropriate healing to take place.
The moral of the story this week, as it was last week, is: don’t walk around without shoes on! Leaving the foot unprotected, whether it is the toes or the sole of the foot, greatly increases your risk of injury. Next time you get up off the beach blanket and head back to your summer beach house for lunch, make sure to put your shoes on and protect your feet.
Think Twice Before Kicking Off Those Summer Shoes
The top four reasons not to walk around without shoes are as follows: sewing needles, glass, wood (toothpicks) and metal.
Year after year, once the Memorial Holiday has been celebrated, shoes are often left behind in the house, around the pool, or on the beach blanket! During the summer months, patients complain that shoes can be “constricting,” “hot,” and “uncomfortable,” but I can assure you that nothing will be more uncomfortable than a foreign object that’s found its way into the sole of your foot.
If you step on an object, the initial response is to immediately extract it from your foot, but this may not always be the best course of action. Unlike splinters on the hand, when you step on an object the potential for it to penetrate far into the sole of the foot is great, for the simple fact that you’ve stepped on it! Refrain from extracting the object yourself, especially if there is immediate and profound bleeding or if you have an immediate loss of sensation to the foot/toes or burning and tingling sensations. These may be signs that important structures within the foot have been penetrated and without visualization of those structures, more damage can be induced upon retrieval of the object! Getting yourself to the Emergency Room is your best course of action with this type of injury.
In such a situation it is important that you know a few things about your health to help guide appropriate treatment once you’ve reached the hospital. It is important to know if you have been immunized against Tetanus bacteria and how current your immunization is. If your immunization or “booster” shot was within the last 5 years, it is unlikely that you will need to receive a “booster” in the emergency department, however, if your last “booster” shot was greater than five years ago, you will need to a “booster” shot to ensure coverage against Tetanus bacterium. If you have never been immunized, you will be given a series of two injections: one for immediate immunization against tetanus bacteria and a subsequent injection for long-term immunization.
Knowing which medications you are allergic to and what your body’s response to taking those medications is will help the ER Physician in prescribing an antibiotic. Whether the foreign object stays lodged in the sole of the foot or not, it carries the potential to generate infection and initiate an immune response by the body. The reason it carries this potential is because most objects encountered while walking barefoot are not sterile and thus bacteria is inherent to them. Once the skin barrier is broken and the object enters the sole of the foot, infection becomes a possibility and the body identifies that object as foreign and works to “fight against” it.
After initial treatment has been started, the Podiatric Physician “On-Call” will come and evaluate your injuries in the emergency department. Depending on the type of object that is lodged in the foot and whether there is immediate danger to your foot or not, will determine the Podiatrist’s next course of action. They may first ask for x-rays, an MRI, CT scan or Ultrasound of the foot in order to locate the object, determine what, if any structures the object is penetrating and to better determine the next course of action in treating your injury. If there is imminent danger to your foot, meaning there are concerns about viability of the tissue, nerve penetration and compromised blood supply, the Podiatrist may want to take you to the operating room immediately to extract the object, clean out the tissues, and repair any damage.
No matter what the immediate course of action, once the object has been removed you will be given a 10-day course of antibiotics for prevention of infection. You will also need to follow up with the Podiatric Physician who treated you in the hospital, for evaluation of the site of penetration and to monitor healing.
The next time you think about walking around the house or the backyard without shoes, think again! Going barefoot is certainly not worth the risk of stepping on an object, lodging it into your foot and increasing your chance of infection with a subsequent recovery period during the beautiful summer vacation months!
For the diabetic population, especially those patients with neuropathy, walking without shoes is never a good idea. You are less likely to feel an object penetrate your foot, thus you are less likely to seek treatment and more likely to contract infection with poor healing outcomes due to the nature of diabetes.
Year after year, once the Memorial Holiday has been celebrated, shoes are often left behind in the house, around the pool, or on the beach blanket! During the summer months, patients complain that shoes can be “constricting,” “hot,” and “uncomfortable,” but I can assure you that nothing will be more uncomfortable than a foreign object that’s found its way into the sole of your foot.
If you step on an object, the initial response is to immediately extract it from your foot, but this may not always be the best course of action. Unlike splinters on the hand, when you step on an object the potential for it to penetrate far into the sole of the foot is great, for the simple fact that you’ve stepped on it! Refrain from extracting the object yourself, especially if there is immediate and profound bleeding or if you have an immediate loss of sensation to the foot/toes or burning and tingling sensations. These may be signs that important structures within the foot have been penetrated and without visualization of those structures, more damage can be induced upon retrieval of the object! Getting yourself to the Emergency Room is your best course of action with this type of injury.
In such a situation it is important that you know a few things about your health to help guide appropriate treatment once you’ve reached the hospital. It is important to know if you have been immunized against Tetanus bacteria and how current your immunization is. If your immunization or “booster” shot was within the last 5 years, it is unlikely that you will need to receive a “booster” in the emergency department, however, if your last “booster” shot was greater than five years ago, you will need to a “booster” shot to ensure coverage against Tetanus bacterium. If you have never been immunized, you will be given a series of two injections: one for immediate immunization against tetanus bacteria and a subsequent injection for long-term immunization.
Knowing which medications you are allergic to and what your body’s response to taking those medications is will help the ER Physician in prescribing an antibiotic. Whether the foreign object stays lodged in the sole of the foot or not, it carries the potential to generate infection and initiate an immune response by the body. The reason it carries this potential is because most objects encountered while walking barefoot are not sterile and thus bacteria is inherent to them. Once the skin barrier is broken and the object enters the sole of the foot, infection becomes a possibility and the body identifies that object as foreign and works to “fight against” it.
After initial treatment has been started, the Podiatric Physician “On-Call” will come and evaluate your injuries in the emergency department. Depending on the type of object that is lodged in the foot and whether there is immediate danger to your foot or not, will determine the Podiatrist’s next course of action. They may first ask for x-rays, an MRI, CT scan or Ultrasound of the foot in order to locate the object, determine what, if any structures the object is penetrating and to better determine the next course of action in treating your injury. If there is imminent danger to your foot, meaning there are concerns about viability of the tissue, nerve penetration and compromised blood supply, the Podiatrist may want to take you to the operating room immediately to extract the object, clean out the tissues, and repair any damage.
No matter what the immediate course of action, once the object has been removed you will be given a 10-day course of antibiotics for prevention of infection. You will also need to follow up with the Podiatric Physician who treated you in the hospital, for evaluation of the site of penetration and to monitor healing.
The next time you think about walking around the house or the backyard without shoes, think again! Going barefoot is certainly not worth the risk of stepping on an object, lodging it into your foot and increasing your chance of infection with a subsequent recovery period during the beautiful summer vacation months!
For the diabetic population, especially those patients with neuropathy, walking without shoes is never a good idea. You are less likely to feel an object penetrate your foot, thus you are less likely to seek treatment and more likely to contract infection with poor healing outcomes due to the nature of diabetes.
Wednesday, June 16, 2010
Shin-splints May Not Be What You Think They Are!
Shin-splints, especially to a high school track athlete, can be very debilitating and recovery periods can exclude competitive participation for several weeks as the healing process takes place. The definition of a shin-splint is variable, depending on who you ask, so it is first important to begin by differentiating between what the average citizen calls a shin-splint and what a “true” shin-splint really is.
Most people diagnose themselves with shin-splints when they have pain anywhere in the front of their leg. However, true shin-splints delineate pain within the bone in the front, or anterior portion of the leg (tibia), as inflammation of the periosteum of the bone itself is what induces shin-splint pain. Every bone in the body is covered by periosteum, which is the outer covering of bone providing the bone with its blood supply and allowing it to thrive. When the periosteum is disrupted as is the case in shin-splints, the periosteum reacts generating inflammation, pain and swelling. In shin-splints, he periosteum becomes disrupted when the muscles attaching to it, and to the bone that it surrounds, apply “pull” on the bone, creating a periosteal reaction. The resultant symptoms include pain that is increased with activity, especially early in a workout session, as well as pain with pointing the toes downward (plantar flexion) of the foot.
The question becomes: why are muscles in the leg applying extra pull to the periosteum and bone, so much so that they generate a periosteal reaction? The answer: it can be a number of things!
Running on uneven surfaces is a huge contributor to the development of shin-splints. This often occurs during pre-season training sessions and in cross-country runners, who are constantly running from pavement to grass, and gravel to synthetic track surfaces. The extra stress and strain on the muscles of the leg as they adjust from one surface to the next creates disruption of the periosteum and eventually, symptomatic shin-splints. In addition to uneven surfaces, improper training techniques can also be an inducer of leg pain and increased pull of the muscles on the tibial bone, leading to shin-splints. As a young athlete it is important to have a regimented training routine that has been reviewed by a coach or trainer who can advise you on what workouts are best for your specialty, but also best for your body and your health!
There are also outside factors, unrelated to athletic activity, that can contribute to the development of shin-splints, which include flat feet (pes plano valgus) and calf tightness. We’ve touched on calf tightness before and its contribution to heel pain syndrome (plantar fasciitis), and unfortunately, the same etiology applies here! When the calf muscles are tight, they don’t allow the ankle joint to work maximally, flexing the foot upwards and downwards as intended. Therefore, in order to get the motion at the ankle joint that is needed for daily activity, the body looks elsewhere and tends to apply stress on the muscles of the anterior and posterior leg. Prevention and treatment of shin-splints in patients who have calf tightness as the sole etiology of their problem can be quickly rectified with some simple stretching exercises!
Take a look back at our blog entitled “Plantar Fasciitis,” posted on May 5, 2010 (http://advancedfootcarecenters.com/blog/?p=143). The following stretches mentioned in that blog can also apply here and should be used daily whether you suffer from symptoms of shin splints or not, as they can be great preventative exercises:
A. Wall Gastrocnemius Stretch
B. Stair Gasctrocnemius Stretch
C. Soleus Stretch
Shin-splints can be extremely painful and can result in a withdrawl from activity for several weeks as the body heals itself and the periosteal reaction subsides. Rest is certainly the best thing, but application of ice is also helpful to decrease inflammation. Anti-inflammatory medications can also be beneficial in decreasing symptomatic pain in addition to helping control inflammation of the periosteum, leading to a faster recovery! In prevention, stretching as mentioned above is extremely important in addition to wearing appropriate shoes and running on even and shock absorbing surfaces such as synthetic tracks, as opposed to sidewalks and grass. Shin-splints can be very debilitating to the competitive athlete, thus it is important to treat them at their onset, otherwise your recovery period increases as the pain and inflammation takes longer to leave the bone.
Most people diagnose themselves with shin-splints when they have pain anywhere in the front of their leg. However, true shin-splints delineate pain within the bone in the front, or anterior portion of the leg (tibia), as inflammation of the periosteum of the bone itself is what induces shin-splint pain. Every bone in the body is covered by periosteum, which is the outer covering of bone providing the bone with its blood supply and allowing it to thrive. When the periosteum is disrupted as is the case in shin-splints, the periosteum reacts generating inflammation, pain and swelling. In shin-splints, he periosteum becomes disrupted when the muscles attaching to it, and to the bone that it surrounds, apply “pull” on the bone, creating a periosteal reaction. The resultant symptoms include pain that is increased with activity, especially early in a workout session, as well as pain with pointing the toes downward (plantar flexion) of the foot.
The question becomes: why are muscles in the leg applying extra pull to the periosteum and bone, so much so that they generate a periosteal reaction? The answer: it can be a number of things!
Running on uneven surfaces is a huge contributor to the development of shin-splints. This often occurs during pre-season training sessions and in cross-country runners, who are constantly running from pavement to grass, and gravel to synthetic track surfaces. The extra stress and strain on the muscles of the leg as they adjust from one surface to the next creates disruption of the periosteum and eventually, symptomatic shin-splints. In addition to uneven surfaces, improper training techniques can also be an inducer of leg pain and increased pull of the muscles on the tibial bone, leading to shin-splints. As a young athlete it is important to have a regimented training routine that has been reviewed by a coach or trainer who can advise you on what workouts are best for your specialty, but also best for your body and your health!
There are also outside factors, unrelated to athletic activity, that can contribute to the development of shin-splints, which include flat feet (pes plano valgus) and calf tightness. We’ve touched on calf tightness before and its contribution to heel pain syndrome (plantar fasciitis), and unfortunately, the same etiology applies here! When the calf muscles are tight, they don’t allow the ankle joint to work maximally, flexing the foot upwards and downwards as intended. Therefore, in order to get the motion at the ankle joint that is needed for daily activity, the body looks elsewhere and tends to apply stress on the muscles of the anterior and posterior leg. Prevention and treatment of shin-splints in patients who have calf tightness as the sole etiology of their problem can be quickly rectified with some simple stretching exercises!
Take a look back at our blog entitled “Plantar Fasciitis,” posted on May 5, 2010 (http://advancedfootcarecenters.com/blog/?p=143). The following stretches mentioned in that blog can also apply here and should be used daily whether you suffer from symptoms of shin splints or not, as they can be great preventative exercises:
A. Wall Gastrocnemius Stretch
B. Stair Gasctrocnemius Stretch
C. Soleus Stretch
Shin-splints can be extremely painful and can result in a withdrawl from activity for several weeks as the body heals itself and the periosteal reaction subsides. Rest is certainly the best thing, but application of ice is also helpful to decrease inflammation. Anti-inflammatory medications can also be beneficial in decreasing symptomatic pain in addition to helping control inflammation of the periosteum, leading to a faster recovery! In prevention, stretching as mentioned above is extremely important in addition to wearing appropriate shoes and running on even and shock absorbing surfaces such as synthetic tracks, as opposed to sidewalks and grass. Shin-splints can be very debilitating to the competitive athlete, thus it is important to treat them at their onset, otherwise your recovery period increases as the pain and inflammation takes longer to leave the bone.
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