Patient’s recently diagnosed with diabetes are often encouraged to visit a Podiatrist for a complete lower extremity exam, but the reason for this evaluation is unknown to the patient! Podiatrists have expert knowledge in understanding the lower extremity in addition to the affects that diabetes can take on the body, and we will evaluate you and identify risk factors for increased complications in the short and long-term. As we discussed last week, diabetes is an autoimmune disease that stimulates an increase in blood sugar levels if not managed correctly. The first complication we see in the diabetic population, relative to the lower extremity, is a loss of sensation in the feet, or diabetic neuropathy. In last weeks blog, we mentioned that prevention is most important in managing this complication, and this same ideal goes with this weeks discussion on circulation to the lower extremities in the diabetic patient.
When it comes to circulation, the complications that present themselves to anyone, but especially the diabetic patient with diabetic induced neuropathy becomes the decreased flow, and subsequently decreased healing potential in the lower extremities. The circulatory system in our bodies, beginning with the heart, carries blood, oxygen and thousands of growth factors out to the organs of our body supplying nutrition to those areas. When blood flow out to the extremities decreases, as it often does in the diabetic population, healing potential deceases because those nutrients can longer reach the affected areas. Thus, with neuropathy, if an injury to the soles of the feet goes unnoticed and blood flow to that area is compromised, healing to the site of injury becomes very difficult!
Decreased circulation in the diabetic patient comes from the root of all evils: uncontrolled blood sugar levels. Long-term, uncontrolled blood glucose levels induce damage on the arteries of the body, particular the peripheral arteries (those farthest from the heart) through weakening of the vessel walls. Weakening creates strain on the vessels and often leads to their thickening or collapsing in efforts to overcome that strain. In addition, co-morbidities often seen in the diabetic patient, including high blood pressure and high cholesterol, increase damaging risks to the vessels. These other medical issues induce atherosclerosis, which is a fancy way of saying “narrowing and hardening” of the vessel walls, making it more difficult for blood to flow easily down to the feet.
At your Podiatric appointment, in addition to checking the sensation in your lower extremities, your circulation will be evaluated. If pulses are easily palpable and there are no open wounds, at that point in time you’re good to go! However, if the pulses are difficult to feel, if your feet are a little cooler than your legs and if blood flow into the toes is slowed, it will be explained to you that circulatory issues are presenting themselves. It may be that your Podiatrist will order lower extremity arterial (blood flow) studies to evaluate your flow in addition to evaluating your healing potential so that a baseline of your circulatory status can be noted. It certainly isn’t the end-all, be-all to have circulatory issues, but it simply means that you need to be more careful and as we discussed in relation to diabetic neuropathy, prevention of further circulatory issues is the best possible scenario!
The ways in which you can prevent circulatory complications are many, but first and foremost include controlling your blood glucose levels to prevent weakening of the peripheral arteries. Next, you can decrease your risks by following up with your primary care physician regularly for management of your co-morbidities such as your high blood pressure and high cholesterol. Take medications prescribed to you as directed to lower the risk of complications by these associated medical issues. In addition, maintaining a good exercise routine, even if its 30 minutes of walking three times per week, helps increase blood flow and efficiency of the heart. (Of course, speak with your doctor before starting any exercise routine.) Finally, protect your feet! Wear shoes at all times and check the soles of your feet and in between your toes daily. Catching an opening in the skin early on significantly increases your chance of healing that wound, as the longer it goes unnoticed, the longer it will take to heal.
Next week, we will discuss the biomechanics of the feet, relative to diabetes and what you can do to decrease pressure areas that lend themselves to ulceration!
Wednesday, August 25, 2010
A Few Reminders About Diabetes
It’s been quite a while since we tackled the topic of Diabetes, and because understanding the disease and the complications it can induce throughout the body and especially your lower extremities are so important, I want to refresh your memory. Over the next few weeks we will discuss in detail the complications seen in lower extremities and what you can do to help yourself avoid or manage these.
Diabetes is an autoimmune disease that affects the levels of glucose (sugar) in your blood. In patients with diabetes, they either don’t produce enough insulin to breakdown their daily calories, or they make no insulin at all. Whichever type of Diabetes you have, either type can lead to complications in the lower extremities.
The first complication we typically see in the diabetic population is loss of sensation on the plantar aspects of their feet, also known as Diabetic Neuropathy. High glucose levels in the blood stream tend to induce changes around the nerve coverings beginning first with the hands and feet. For our purposes, it’s best to explain this as sugar molecules that grab on to the nerves in the feet and decrease their function: known as glycosylation within the medical community. There’s good news and bad news in relation to glycosylation. The good news: in the beginning stages glycosylation is reversible – yay! The bad news: glycosylation can lead to detrimental insults to the plantar aspects of your feet and eventually your legs, working its way towards the center of the body.
The first step in understanding Diabetic Neuroapathy or glycosylation of the nerves begins with understanding the symptoms. Do you ever experience numbness or tingling in your feet? Think of it as the “pins and needles” you would feel if your foot fell asleep. Do you ever experience a “burning” type pain similar to when you hit your “funny bone?” These are both early signs of nerve changes in the feet and if not detected early on, their ability to be reversed is lost.
These feelings are a sign that the glucose levels in your blood stream are too high, and better diabetic blood sugar control is necessary on your part. Whether that means changing your diet, increasing your medications etc, to lower your blood glucose level, you need to take action. Taking such measures will help to decrease the effects of glycosylation and some sensation may return. However, once the glycosylation is too far along, these simple measures will no longer be helpful! Thus early detection is important, but prevention is key! Managing your blood glucose levels from day #1 of being diagnosed with diabetes will prevent and slow progression and development of sensation complications.
The effects that loss of sensation has on your feet are great! Once you have lost the ability to feel, you’ve also lost the ability to know that you’ve stepped on something and that you now have a wound or ulceration on the plantar aspect of your foot. When you don’t realize this, you don’t realize that treatment may be necessary, the area gets dirty, gets infected and leads to, in the worst-case scenario, infected bone and loss of toes.
If you’ve reached the point where Diabetic Neuropathy has affected you, there are still things that you can do to prevent ulceration and infection. It’s as simple as checking your feet daily. So, what should you look for? You should look for any changes since yesterday on the bottoms of your feet, around your ankles and in between your toes. By checking daily, you’ll notice any small differences immediately, even if you can’t feel them, and get treatment at the get-go. In addition, there are medications available that your Podiatric Physician can prescribe to help control the symptoms (burning, numbness, tingling) but none of these medications will restore feeling.
Don’t wait until the early signs of Diabetic Neuropathy set-in; control your blood sugar levels today and help prevent this complication for tomorrow!
Diabetes is an autoimmune disease that affects the levels of glucose (sugar) in your blood. In patients with diabetes, they either don’t produce enough insulin to breakdown their daily calories, or they make no insulin at all. Whichever type of Diabetes you have, either type can lead to complications in the lower extremities.
The first complication we typically see in the diabetic population is loss of sensation on the plantar aspects of their feet, also known as Diabetic Neuropathy. High glucose levels in the blood stream tend to induce changes around the nerve coverings beginning first with the hands and feet. For our purposes, it’s best to explain this as sugar molecules that grab on to the nerves in the feet and decrease their function: known as glycosylation within the medical community. There’s good news and bad news in relation to glycosylation. The good news: in the beginning stages glycosylation is reversible – yay! The bad news: glycosylation can lead to detrimental insults to the plantar aspects of your feet and eventually your legs, working its way towards the center of the body.
The first step in understanding Diabetic Neuroapathy or glycosylation of the nerves begins with understanding the symptoms. Do you ever experience numbness or tingling in your feet? Think of it as the “pins and needles” you would feel if your foot fell asleep. Do you ever experience a “burning” type pain similar to when you hit your “funny bone?” These are both early signs of nerve changes in the feet and if not detected early on, their ability to be reversed is lost.
These feelings are a sign that the glucose levels in your blood stream are too high, and better diabetic blood sugar control is necessary on your part. Whether that means changing your diet, increasing your medications etc, to lower your blood glucose level, you need to take action. Taking such measures will help to decrease the effects of glycosylation and some sensation may return. However, once the glycosylation is too far along, these simple measures will no longer be helpful! Thus early detection is important, but prevention is key! Managing your blood glucose levels from day #1 of being diagnosed with diabetes will prevent and slow progression and development of sensation complications.
The effects that loss of sensation has on your feet are great! Once you have lost the ability to feel, you’ve also lost the ability to know that you’ve stepped on something and that you now have a wound or ulceration on the plantar aspect of your foot. When you don’t realize this, you don’t realize that treatment may be necessary, the area gets dirty, gets infected and leads to, in the worst-case scenario, infected bone and loss of toes.
If you’ve reached the point where Diabetic Neuropathy has affected you, there are still things that you can do to prevent ulceration and infection. It’s as simple as checking your feet daily. So, what should you look for? You should look for any changes since yesterday on the bottoms of your feet, around your ankles and in between your toes. By checking daily, you’ll notice any small differences immediately, even if you can’t feel them, and get treatment at the get-go. In addition, there are medications available that your Podiatric Physician can prescribe to help control the symptoms (burning, numbness, tingling) but none of these medications will restore feeling.
Don’t wait until the early signs of Diabetic Neuropathy set-in; control your blood sugar levels today and help prevent this complication for tomorrow!
Thursday, August 12, 2010
You’re Not Always What You Eat When it Comes to Gout
Although drinking alcohol or eating “trigger” foods such as seafood sometimes induces gouty attacks, it’s not always the case! Gout can be triggered by various other factors including injury, infection, and crash diets – an attack may not always depend on what you’ve eaten, however it is always related to the levels of uric acid in the blood.
Gout is a form of arthritis that can be extremely painful in its most acute state when patients are suffering from a flare. It falls into the category of arthridities because when uric acid levels are high gouty crystals settle in joint spaces, typically the big toes or the elbows, and induce boney changes, ultimately affecting the function of the joint. There may be a genetic link, but post-menopausal women and men between the ages of 40 and 50 are more likely to suffer from gout. Children are rarely affected.
High uric acid levels do not cause symptoms in every individual; some patients are able to handle high levels and never develop symptoms, nor do they develop flares. However, in patients with a predisposition, for whatever reason, high levels of uric acid (greater thank 6.0 mg/dL) induce pain, inflammation, warmth and redness around the affected joint(s). The pain comes on suddenly and can be so severe that even bed sheets cause a discomfort! Often times, crepitus (the sound of rice crispies) can be heard and felt when the joint is mobilized. Crepitus is the movement of the uric acid crystals within and around the joint!
At the first sign of a gouty attack in the lower extremity, you should seek treatment from your Podiatrist rather than suffer through the pain. To help confirm your diagnosis they may want to send you for blood work to measure the uric acid levels in your blood in addition to taking a sample of fluid from the affected joint. Your Podiatrist may also take x-rays of the affected toe joints, as uric acid deposits can be seen on plain x-rays.
In addition to using such diagnostic tools, gout provides a very distinct clinical presentation and it is very likely that your Podiatrist will immediately try to treat your flare and decrease your discomfort. There are a variety of options that can help decrease an acute attack including a steroid injection into the joint and/or an oral anti-inflammatory medication, such as Indomethacin, to decrease inflammation and subsequent pain. Immediate treatment, in addition to decreasing symptoms, can also help decrease the long-term affects on the involved joint(s). Once the initial attack has been treated and uric acid levels return to normal, preventative medications are not necessary for one-time sufferers.
However, patients who have suffered from multiple gouty attacks and are predisposed to flares may be given a medication to take daily. Your Podiatrist will determine the best medication for your long-term control based on whether you are an “over-producer” of uric acid or an “under-excreter” of uric acid. The idea behind a daily medication is to maintain “normal” levels of uric acid in the body, thus lowering your risk of subsequent gouty attacks. It’s important to keep in mind that even at times when you’re not experiencing a flare, uric acid levels may still be elevated in the body, and joint damage can still take place!
As mentioned, the food you eat may not contribute to a gouty attack, but it can! Gout used to be known as the “Disease of Kings” because of its association with rich foods that Kings typically had access too. Foods that are high in purine (the chemical responsible for producing uric acid in the body), such as red meat, seafood, spinach, alcohol, mushrooms, and oatmeal, to name a few, should be kept to a minimum in patients predisposed to gout or gouty attacks. Gout has also been linked to medical conditions such as hypertension (high blood pressure), diabetes, hyperlipidemia (high cholesterol) and atherosclerosis (narrowing of the blood vessels), so it is important to manage your co-morbidities with your primary care physician in addition to keeping a good watch on your diet to limit your flares!
Gout is a form of arthritis that can be extremely painful in its most acute state when patients are suffering from a flare. It falls into the category of arthridities because when uric acid levels are high gouty crystals settle in joint spaces, typically the big toes or the elbows, and induce boney changes, ultimately affecting the function of the joint. There may be a genetic link, but post-menopausal women and men between the ages of 40 and 50 are more likely to suffer from gout. Children are rarely affected.
High uric acid levels do not cause symptoms in every individual; some patients are able to handle high levels and never develop symptoms, nor do they develop flares. However, in patients with a predisposition, for whatever reason, high levels of uric acid (greater thank 6.0 mg/dL) induce pain, inflammation, warmth and redness around the affected joint(s). The pain comes on suddenly and can be so severe that even bed sheets cause a discomfort! Often times, crepitus (the sound of rice crispies) can be heard and felt when the joint is mobilized. Crepitus is the movement of the uric acid crystals within and around the joint!
At the first sign of a gouty attack in the lower extremity, you should seek treatment from your Podiatrist rather than suffer through the pain. To help confirm your diagnosis they may want to send you for blood work to measure the uric acid levels in your blood in addition to taking a sample of fluid from the affected joint. Your Podiatrist may also take x-rays of the affected toe joints, as uric acid deposits can be seen on plain x-rays.
In addition to using such diagnostic tools, gout provides a very distinct clinical presentation and it is very likely that your Podiatrist will immediately try to treat your flare and decrease your discomfort. There are a variety of options that can help decrease an acute attack including a steroid injection into the joint and/or an oral anti-inflammatory medication, such as Indomethacin, to decrease inflammation and subsequent pain. Immediate treatment, in addition to decreasing symptoms, can also help decrease the long-term affects on the involved joint(s). Once the initial attack has been treated and uric acid levels return to normal, preventative medications are not necessary for one-time sufferers.
However, patients who have suffered from multiple gouty attacks and are predisposed to flares may be given a medication to take daily. Your Podiatrist will determine the best medication for your long-term control based on whether you are an “over-producer” of uric acid or an “under-excreter” of uric acid. The idea behind a daily medication is to maintain “normal” levels of uric acid in the body, thus lowering your risk of subsequent gouty attacks. It’s important to keep in mind that even at times when you’re not experiencing a flare, uric acid levels may still be elevated in the body, and joint damage can still take place!
As mentioned, the food you eat may not contribute to a gouty attack, but it can! Gout used to be known as the “Disease of Kings” because of its association with rich foods that Kings typically had access too. Foods that are high in purine (the chemical responsible for producing uric acid in the body), such as red meat, seafood, spinach, alcohol, mushrooms, and oatmeal, to name a few, should be kept to a minimum in patients predisposed to gout or gouty attacks. Gout has also been linked to medical conditions such as hypertension (high blood pressure), diabetes, hyperlipidemia (high cholesterol) and atherosclerosis (narrowing of the blood vessels), so it is important to manage your co-morbidities with your primary care physician in addition to keeping a good watch on your diet to limit your flares!
Wednesday, August 4, 2010
How Many Legs Does a Spider Have?
The answer to question “how many legs does a spider have?” is eight! However, the answer really doesn’t matter, as the most important question should really be: which leg did the spider bite? Spider bites, although not extremely common in the United States, do happen, and if you know the signs and symptoms, you will be one step ahead in the treatment process.
There are two spiders in the United States that one should be worried about: the Black Widow spider and the Brown Recluse spider. The more “deadly” of the two is the Black Widow spider, which can be identified by its black color and distinct red hourglass-shaped marking it bares on its underside. Unless you notice this spider on your skin, you may not know that you’ve been bitten, as the bite only feels like a pinprick. However, within the next several hours, you will realize that you’ve been bitten by something, as the area will swell and be accompanied by intense pain and redness. If you seek treatment, as most patients do once they notice symptoms, the bite of the Black Widow is rarely lethal.
The Brown Recluse spider also has a distinctive marking on its back that identifies it: a violin shaped marking. This spider is generally less lethal than the Black Widow, but does have severe side effects. The bite initially stings and one may notice mild redness at the site with increasing pain as time passes. Eventually, within eight hours, a fluid-filled blister will develop on the skin and remain for several days. The blister will subside, draining itself of its fluid, revealing a large burrowing ulceration that goes straight through the layers of your skin, down to bone. Aside from the burrowing ulcer the systemic symptoms (symptoms felt in various organs systems) include fever, rash, nausea, vomiting and intense fatigue.
As mentioned, knowing that you’ve been bitten by a spider, and even better, identifying the type of spider that it was, puts you ahead in the treatment process. As soon as you notice the bite, wash the area with soap and cool water. This will wash away any toxin that may be left behind on the skin from the time during which the spider was on your body. Cold compresses should also be applied, as they will help to decrease the inflammation and redness around the area. Of course, Tylenol or anti-histamines (such as Benadryl) can be taken to decrease pain and skin reaction or rash, however, keep track of what you’ve taken, so that if you seek medical attention, you can relay that information to the physician. If you experience swelling or vomiting with an associated fever, seek medical attention immediately. It may be that you require “anti-venom;” a medication that will counteract the bite of the Black Widow spider. If you’ve been bitten by a Brown Recluse spider, local medications, applied to the affected area, are usually sufficient for treatment.
As Podiatrists, Brown Recluse bites are the spider bites that we see most commonly. The reason being, that the side effect of their bite, is the burrowing ulcer. If on the foot or leg, a Podiatrist is fully qualified to treat the area with local wound care, applying wound products and dressings that will encourage the defect to fill in and eventually return your skin to normal over the course of several weeks. As a specialty, we are trained and qualified in wound care, so next time you suspect a spider bite that needs treatment, (although we don’t wish that upon you) seek out your local Podiatrist!
There are two spiders in the United States that one should be worried about: the Black Widow spider and the Brown Recluse spider. The more “deadly” of the two is the Black Widow spider, which can be identified by its black color and distinct red hourglass-shaped marking it bares on its underside. Unless you notice this spider on your skin, you may not know that you’ve been bitten, as the bite only feels like a pinprick. However, within the next several hours, you will realize that you’ve been bitten by something, as the area will swell and be accompanied by intense pain and redness. If you seek treatment, as most patients do once they notice symptoms, the bite of the Black Widow is rarely lethal.
The Brown Recluse spider also has a distinctive marking on its back that identifies it: a violin shaped marking. This spider is generally less lethal than the Black Widow, but does have severe side effects. The bite initially stings and one may notice mild redness at the site with increasing pain as time passes. Eventually, within eight hours, a fluid-filled blister will develop on the skin and remain for several days. The blister will subside, draining itself of its fluid, revealing a large burrowing ulceration that goes straight through the layers of your skin, down to bone. Aside from the burrowing ulcer the systemic symptoms (symptoms felt in various organs systems) include fever, rash, nausea, vomiting and intense fatigue.
As mentioned, knowing that you’ve been bitten by a spider, and even better, identifying the type of spider that it was, puts you ahead in the treatment process. As soon as you notice the bite, wash the area with soap and cool water. This will wash away any toxin that may be left behind on the skin from the time during which the spider was on your body. Cold compresses should also be applied, as they will help to decrease the inflammation and redness around the area. Of course, Tylenol or anti-histamines (such as Benadryl) can be taken to decrease pain and skin reaction or rash, however, keep track of what you’ve taken, so that if you seek medical attention, you can relay that information to the physician. If you experience swelling or vomiting with an associated fever, seek medical attention immediately. It may be that you require “anti-venom;” a medication that will counteract the bite of the Black Widow spider. If you’ve been bitten by a Brown Recluse spider, local medications, applied to the affected area, are usually sufficient for treatment.
As Podiatrists, Brown Recluse bites are the spider bites that we see most commonly. The reason being, that the side effect of their bite, is the burrowing ulcer. If on the foot or leg, a Podiatrist is fully qualified to treat the area with local wound care, applying wound products and dressings that will encourage the defect to fill in and eventually return your skin to normal over the course of several weeks. As a specialty, we are trained and qualified in wound care, so next time you suspect a spider bite that needs treatment, (although we don’t wish that upon you) seek out your local Podiatrist!
Monday, August 2, 2010
Brachy-Who?
Brachymetatarsia is a relatively uncommon disorder of the foot, but one that is interesting in its discussion. “Brachy” means short and “metatarsia” refers to the metatarsal bones (the long bones in the middle of the foot). A short metatarsal is one that is 5mm or more shorter than the length that it “should” be when compared to the adjacent metatarsals.
Patients develop this disorder due to premature closure of the growth plate in the affected metatarsal while the surrounding metatarsals continue to grow at a normal rate. The premature growth arrest can be congenital (something that we’re born with) or acquired throughout childhood. Congenital disorders that tend to lend themselves to brachymetatarsia include Down’s Syndrome, Turner’s Syndrome or bone enlargement. The most commonly acquired causes of ‘brachymet’ include trauma to the growth plate or infection both of which also arrest growth in the bone.
Most commonly, the 4th metatarsal is affected, and patients usually know something isn’t right, not by the symptoms they experience, but simply by the appearance of their foot. Their primary complaint upon presentation to a Podiatrist is that their toe “looks funny!” They may relay symptoms of calluses with associated pain beneath the adjacent metatarsals, a dorsal corn on the affected toe that rubs with shoe-wear, or contractures of both the affected digit and the surrounding digits. However, the conversation always leads back to the look of the toe. That is, their primary concern is cosmesis!
After x-ray evaluation, your Podiatrist will determine how short the metatarsal is in relation to the adjacent metatarsals, and although the number in millimeters doesn’t mean much to you as the patient, it means a lot in terms of how your Podiatrist can correct for this abnormality, should you opt for surgical correction.
Conservative options for Brachymetatarsia only treat the associated symptoms and will not treat the look of the digit. Options for treating the associated symptoms include padding, orthotics and trimming of corns and calluses associated with the deformity. However, since the primary patient complaint is the appearance of the digit, it is common that the patient selects surgical intervention.
In terms of surgical intervention, there are two choices: one-stage lengthening of the metatarsal vs. gradual lengthening of the metatarsal. One-stage lengthening involves a surgical break of the bone with insertion of bone bank bone into the defect. This will achieve lengthening of the metatarsal in one stage, but does have complications that involve compromise of the nerves and blood vessels surrounding the digit. Gradual lengthening of the metatarsal also involves a surgical break of the metatarsal bone, but rather than filling the defect, a distraction device is applied to the foot. Over a period of several weeks the distraction device is turned so as to lengthen the area of defect, allowing the body to make its own bone. The healing process in gradual lengthening does take longer but limits the risk to the surrounding nerves and vessels.
Your Podiatrist will recommend the surgical procedure that will work best for your case, with regards to the amount of lengthening required and your postoperative weight-bearing limitations. Keep in mind, however, that with any surgical procedure, although you will lengthen the toe and improve the overall alignment of the foot, you will have a scar on the top of the foot. Careful consideration, before opting for surgical correction for your Brachymetatarsia, is necessary and it is a decision that should not be taken lightly.
Patients develop this disorder due to premature closure of the growth plate in the affected metatarsal while the surrounding metatarsals continue to grow at a normal rate. The premature growth arrest can be congenital (something that we’re born with) or acquired throughout childhood. Congenital disorders that tend to lend themselves to brachymetatarsia include Down’s Syndrome, Turner’s Syndrome or bone enlargement. The most commonly acquired causes of ‘brachymet’ include trauma to the growth plate or infection both of which also arrest growth in the bone.
Most commonly, the 4th metatarsal is affected, and patients usually know something isn’t right, not by the symptoms they experience, but simply by the appearance of their foot. Their primary complaint upon presentation to a Podiatrist is that their toe “looks funny!” They may relay symptoms of calluses with associated pain beneath the adjacent metatarsals, a dorsal corn on the affected toe that rubs with shoe-wear, or contractures of both the affected digit and the surrounding digits. However, the conversation always leads back to the look of the toe. That is, their primary concern is cosmesis!
After x-ray evaluation, your Podiatrist will determine how short the metatarsal is in relation to the adjacent metatarsals, and although the number in millimeters doesn’t mean much to you as the patient, it means a lot in terms of how your Podiatrist can correct for this abnormality, should you opt for surgical correction.
Conservative options for Brachymetatarsia only treat the associated symptoms and will not treat the look of the digit. Options for treating the associated symptoms include padding, orthotics and trimming of corns and calluses associated with the deformity. However, since the primary patient complaint is the appearance of the digit, it is common that the patient selects surgical intervention.
In terms of surgical intervention, there are two choices: one-stage lengthening of the metatarsal vs. gradual lengthening of the metatarsal. One-stage lengthening involves a surgical break of the bone with insertion of bone bank bone into the defect. This will achieve lengthening of the metatarsal in one stage, but does have complications that involve compromise of the nerves and blood vessels surrounding the digit. Gradual lengthening of the metatarsal also involves a surgical break of the metatarsal bone, but rather than filling the defect, a distraction device is applied to the foot. Over a period of several weeks the distraction device is turned so as to lengthen the area of defect, allowing the body to make its own bone. The healing process in gradual lengthening does take longer but limits the risk to the surrounding nerves and vessels.
Your Podiatrist will recommend the surgical procedure that will work best for your case, with regards to the amount of lengthening required and your postoperative weight-bearing limitations. Keep in mind, however, that with any surgical procedure, although you will lengthen the toe and improve the overall alignment of the foot, you will have a scar on the top of the foot. Careful consideration, before opting for surgical correction for your Brachymetatarsia, is necessary and it is a decision that should not be taken lightly.
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