Polydactyly, the name that classifies the condition of having more than 5 fingers on a single hand or more than 5 toes on a single foot, is condition usually recognized at birth. The condition is traditionally hereditary and in most cases can be visualized by the presence of an extra digit at the time of delivery. As we’ll discuss, there are varying types of accessory (extra) digits with some types non-visible and only discovered with x-rays of the foot sometime later in life.
In most cases, polydactyly is a cosmetic anomaly and presents no immediate pain or health concerns for the patient. The most involved digits are the “postaxial” digits: those digits located towards the outside of the foot. They are referred to as the “postaxial” digits relative to their position during prenatal growth, but in terms of treatment and management, this designation means very little. In half of those who are diagnosed with polydactyly, the extra digit will be present bilaterally; meaning on both feet, such that the patient may be born with 12 toes. The demographic most associated with polydactyly are African-Americans, but the diagnosis is not exclusive to that population.
As mentioned above, there are varying types of accessory digits and they are so classified according to which bones in the foot are duplicated, contributing to the extra digits presence. In addition, the classification also notes the shape of the metatarsal (long bones in the foot) and how it has accommodated to allow for the extra toe. Keep in mind when trying to understand this classification system that each digit (2-5) is made up of one metatarsal and 3 smaller bones referred to as phalanges. As Podiatrists, we typically classify into 5 categories:
Normal metatarsal with duplication of two of the three phalangeal bones, contributes to the presence of two toes, neither with the correct number of bones to create a completely “normal extra digit.”
Wide (Block) metatarsal whereby the metatarsal is widened but not duplicated. The widened portion of the metatarsal accommodates for duplication of all three phalangeal bones, yielding two “normal” toes.
Y-shaped metatarsal. Rather than the metatarsal widening, the portion of the metatarsal bone closest to the toes splits, forming a y-shaped bone. Again, this allows for duplication of all three phalangeal bones and the presence of two “normal” toes.
T-shaped metatarsal. This is much the same as the y-shaped metatarsal, but rather than looking like a “y,” the metatarsal bone looks more like a “t,” still allowing for duplication of all three phalange bones and the creation of two “normal toes” versus the traditional one.
Complete duplication is present when the metatarsal bone and all three phalangeal bones are duplicated, such that a single foot has 6 metatarsal bones (versus the traditional 5) and 17 phalangeal bones (versus the traditional 14).
Now that you’re an expert at the polydactyly classification system, and would be able to diagnose any x-ray where extra digits were present (just kidding!), lets briefly discuss how it’s treated! As mentioned above, polydactyly presents no immediate pain or health concerns to the patient, but it can complicate issues of self-confidence and present an annoyance when attempting to buy shoes. Therefore, if present at birth, the extra toe is usually removed at birth and never mentioned again. However, if it is not removed at birth or if an incomplete form of polydactyly is present where an extra digit isn’t noticed at the time of birth but extra bones are present within the foot, the extra bones may be dealt with later in life.
When polydactyly occurs your Podiatrist must first evaluate your foot with x-rays to determine which of the 2 copies of a single toe has the most potential for normal growth. Once they’ve identified which of the two will grow most normally, they will address the copy of that digit and usually opt for amputation. Amputation is a scary word and can often be associated with massive infections and commonly as a diabetic complication, but here, if the patient is in good health otherwise, amputation will be tolerated quite well. Since there is already and extra digit present, when removed, it should not affect function of the foot, and the normal amount of toes remain!
Although we hope that each new baby is born with only 10 fingers and 10 toes, if presented with a newborn that fashions 11 toes, we will know how to treat him/her!
Saturday, May 28, 2011
Oh No…What About the Growth Plate?
Whenever you hear of a child suffering from an injury, automatically your mind wanders to the topic of growth plates. We always wondering if the growth plate is affected; the concern is legitimate and needs to be thoroughly evaluated upon presentation to the doctor. When dealing with lower extremity injuries the Podiatrist will x-ray and clinically evaluate the injury to determine if the area in and around the growth plate is affected but the actual “plate” unaffected, or if the injury has directly disrupted the growth plate itself. The treatment plan changes from initial management to the possibility of surgical management and the choice of fixation (pins/screws etc) that can be utilized depending on the extent of growth plate involvement.
When understanding a pediatric injury versus the same injury in an adult, there are some important concepts to understand. The first is that in kids, the bones are very malleable meaning that the tendons and ligaments surrounding the bones, helping with normal motion are stronger than the actual bones themselves. Therefore, in a pediatric patient injury is likely to lead to bone injury versus in an adult where the bones are stronger, ligament damage is more likely. Secondly, treating injuries or fractures in the pediatric patient are much more complicated because of the presence of the growth plate.
Growth plates in the lower extremity, when visualized on x-ray, indicate that growth of the individual is still possible. When evaluating bones on x-ray, there are specific “zones” that can be identified to signify growth, disruption of growth and healthy bone. What you may not know is that when born, the bones are very soft and malleable and only harden (ossify) and change completely into solid bone in a child’s mid to late teens and sometimes not until their early twenties. What this indicates is that injury anywhere in the body, before ossification takes place, can affect growing bone with the possibility of disrupting growth, causing abnormal/irregular growth and even has the potential to halt growth altogether.
In an adult, the growth plate has closed, growth has ceased and treatment of a fracture can be initiated without fear of interrupting growing bone. If pins, screws or plates are needed for fixing the adult fracture, they can be applied without reservations or worries of disrupting growth. However, in pediatric patients certain types of fixation must be avoided and others used carefully and in specific ways so as to protect the growth plate and allow for normal growth to continue.
When the growth plate is unaffected fracture management is tricky, but can be more easily handled and the growth plate more easily avoided during treatment. When fracture across the growth plate is created by the initial injury the goal of fracture management becomes more complicated as the growth plate cannot be avoided during treatment. It must be addressed with reduction and fixation bringing the edges of the fractured growth plate into close proximity with one another. Doing so decreases the risk of interrupted or halted growth in the affected bone with the hope that restoration of normal growth occurs.
Pediatric fractures can be tricky, but they can be treated in such a way as to minimize disruption to normal growth patterns. It is important to seek treatment immediately if fracture is suspected, but refrain for pondering the worst-case scenario until your child has been evaluated!
When understanding a pediatric injury versus the same injury in an adult, there are some important concepts to understand. The first is that in kids, the bones are very malleable meaning that the tendons and ligaments surrounding the bones, helping with normal motion are stronger than the actual bones themselves. Therefore, in a pediatric patient injury is likely to lead to bone injury versus in an adult where the bones are stronger, ligament damage is more likely. Secondly, treating injuries or fractures in the pediatric patient are much more complicated because of the presence of the growth plate.
Growth plates in the lower extremity, when visualized on x-ray, indicate that growth of the individual is still possible. When evaluating bones on x-ray, there are specific “zones” that can be identified to signify growth, disruption of growth and healthy bone. What you may not know is that when born, the bones are very soft and malleable and only harden (ossify) and change completely into solid bone in a child’s mid to late teens and sometimes not until their early twenties. What this indicates is that injury anywhere in the body, before ossification takes place, can affect growing bone with the possibility of disrupting growth, causing abnormal/irregular growth and even has the potential to halt growth altogether.
In an adult, the growth plate has closed, growth has ceased and treatment of a fracture can be initiated without fear of interrupting growing bone. If pins, screws or plates are needed for fixing the adult fracture, they can be applied without reservations or worries of disrupting growth. However, in pediatric patients certain types of fixation must be avoided and others used carefully and in specific ways so as to protect the growth plate and allow for normal growth to continue.
When the growth plate is unaffected fracture management is tricky, but can be more easily handled and the growth plate more easily avoided during treatment. When fracture across the growth plate is created by the initial injury the goal of fracture management becomes more complicated as the growth plate cannot be avoided during treatment. It must be addressed with reduction and fixation bringing the edges of the fractured growth plate into close proximity with one another. Doing so decreases the risk of interrupted or halted growth in the affected bone with the hope that restoration of normal growth occurs.
Pediatric fractures can be tricky, but they can be treated in such a way as to minimize disruption to normal growth patterns. It is important to seek treatment immediately if fracture is suspected, but refrain for pondering the worst-case scenario until your child has been evaluated!
Please, check your feet!!
Diabetic neuropathy is one of the most common complications that as Podiatrist we see in our diabetic patient population. At this time of the year it is very important to review neuropathy, its causes, and the importance of daily foot checks at home to prevent complications associated with having neuropathy.
Neuropathy by definition is disease or dysfunction of one or more peripheral nerves that typically causes numbness, weakness, or both and generally begins in the extremities, especially a patient’s feet. It is thought that a combination of factors adds to the incidence of neuropathy in diabetic patients, but it is directly related to poor sugar control. Nerves are very sensitive to changes in blood glucose levels and when consistently high, the sugar molecules tend to glycosylate (collect on) both the small blood vessels and the small nerves. This glycosylation compresses the nerve to some degree and results in the symptomatic representation of neuropathy.
Several categories of neuropathy affect the diabetic population, but the most common type is Peripheral Neuropathy. Peripheral Neuropathy is also known as distal symmetric neuropathy, meaning symptoms present first in the toes and fingers on both the right and left sides of the body. As the neuropathy progresses it continues towards the arms and legs; centrally on the body. The sensory changes are minimal at first and may go unnoticed, but as the neuropathy progresses symptoms become more discernable. The best was to prevent and control the progression of diabetic neuropathy is to keep your blood glucose levels within normal range, thus protecting your nerves from glycosylation.
Comprehensive foot examinations by your Podiatrist can help diagnose peripheral neuropathy in its early stages and it is important to remember that if you are experiencing any changes in sensation to your toes or feet, you see your doctor immediately. Your Podiatrist will look for changes in light and sharp touch, vibration sense, reflexes and your ulceration risk. All of these components can hold clues to an early diagnosis of peripheral neuropathy.
Whether you’re newly diagnosed or have been dealing with neuropathy for some time, you must be doing your part at home! Checking your feet every night, identifying any open areas on your soles or between toes and any color changes that may indicate problems is imperative. The largest complication associated with having diabetic neuropathy is the patients inability to feel, thus injuries that would be painful in a non-diabetic go unnoticed in a diabetic and can lead to ulceration, infection, and loss of digits. If you notice something unusual or different from the previous day, contact your Podiatrist for an appointment. As the weather gets warmer, it’s especially important to wear closed-toed shoes only, much for the same reasons as mentioned above. Open-toed shoes open the door for more injuries, more bacteria to cultivate on your foot and larger problems. Although it might not always be ideal, it is always safer!!
What about white vs. colored socks?
This is a question we get a lot from our diabetic patients with neuropathy: why white socks over colored? The answer is non-scientific and has nothing to do with dyes in the socks that may be harmful (in fact, unless a patient has an allergy, dyes are not typically harmful). Rather, the answer lies in the fact that white socks can serve as an indicator for patients. When patients can’t feel their feet, white socks, when removed at the end of the day can be inspected for signs of staining, blood or openings that may indicate injury to the foot. They prompt the patient to explore further whether they need to be following up with their Podiatrist for problems with their feet.
Whether you’re a diabetic patient with or without neuropathy, it is important to have occasional screenings conducted by your Podiatrist helping to catch complications early and decrease risks associated with your disease!
Neuropathy by definition is disease or dysfunction of one or more peripheral nerves that typically causes numbness, weakness, or both and generally begins in the extremities, especially a patient’s feet. It is thought that a combination of factors adds to the incidence of neuropathy in diabetic patients, but it is directly related to poor sugar control. Nerves are very sensitive to changes in blood glucose levels and when consistently high, the sugar molecules tend to glycosylate (collect on) both the small blood vessels and the small nerves. This glycosylation compresses the nerve to some degree and results in the symptomatic representation of neuropathy.
Several categories of neuropathy affect the diabetic population, but the most common type is Peripheral Neuropathy. Peripheral Neuropathy is also known as distal symmetric neuropathy, meaning symptoms present first in the toes and fingers on both the right and left sides of the body. As the neuropathy progresses it continues towards the arms and legs; centrally on the body. The sensory changes are minimal at first and may go unnoticed, but as the neuropathy progresses symptoms become more discernable. The best was to prevent and control the progression of diabetic neuropathy is to keep your blood glucose levels within normal range, thus protecting your nerves from glycosylation.
Comprehensive foot examinations by your Podiatrist can help diagnose peripheral neuropathy in its early stages and it is important to remember that if you are experiencing any changes in sensation to your toes or feet, you see your doctor immediately. Your Podiatrist will look for changes in light and sharp touch, vibration sense, reflexes and your ulceration risk. All of these components can hold clues to an early diagnosis of peripheral neuropathy.
Whether you’re newly diagnosed or have been dealing with neuropathy for some time, you must be doing your part at home! Checking your feet every night, identifying any open areas on your soles or between toes and any color changes that may indicate problems is imperative. The largest complication associated with having diabetic neuropathy is the patients inability to feel, thus injuries that would be painful in a non-diabetic go unnoticed in a diabetic and can lead to ulceration, infection, and loss of digits. If you notice something unusual or different from the previous day, contact your Podiatrist for an appointment. As the weather gets warmer, it’s especially important to wear closed-toed shoes only, much for the same reasons as mentioned above. Open-toed shoes open the door for more injuries, more bacteria to cultivate on your foot and larger problems. Although it might not always be ideal, it is always safer!!
What about white vs. colored socks?
This is a question we get a lot from our diabetic patients with neuropathy: why white socks over colored? The answer is non-scientific and has nothing to do with dyes in the socks that may be harmful (in fact, unless a patient has an allergy, dyes are not typically harmful). Rather, the answer lies in the fact that white socks can serve as an indicator for patients. When patients can’t feel their feet, white socks, when removed at the end of the day can be inspected for signs of staining, blood or openings that may indicate injury to the foot. They prompt the patient to explore further whether they need to be following up with their Podiatrist for problems with their feet.
Whether you’re a diabetic patient with or without neuropathy, it is important to have occasional screenings conducted by your Podiatrist helping to catch complications early and decrease risks associated with your disease!
What to Expect When a Stray Bullet Comes your Way!
Gunshot wounds are rarely injuries that present to a podiatric practice, but they do occur and they can affect the lower extremities. However, when dealt with by a podiatrist, it’s typically in the hospital setting, where the Podiatrist has been called in during the middle of the night to see a patient in the emergency room. Hopefully this type of injury is not one that you can relate to, but as we are tackling uncommon injuries and diagnoses this month I thought it fitting to discuss this type of injury. We will only scratch the surface in discussing such injuries with the hope that you’ll never need to know the rest!
When a patient presents with a gunshot wound/injury, as Podiatrist’s we will interview the patient to determine how the injury occurred, but the answer is usually unimportant and unrelated to the treatment protocol that will be followed; the opposite of how we handle most other injuries where the mechanism is extremely important. With gunshot wounds, there’s been an injury, the damage needs to be assessed, we need to determine if the bullet or any pieces of the bullet remain in the patient, and construct a course of treatment.
Assessing the damage. Typically the emergency room doctors will treat any injuries, in addition to the gunshot wound that are life-threatening to the patient or need immediate attention. This includes a complete workup of the patient to determine if they have stable vital signs (heart rate, blood pressure etc) and any injuries to their head, abdomen, chest etc. Once any initial threat to the patient is dismissed, the Podiatrist is called in and needs to assess any damage specific to the area of injury. In past blogs we’ve talked about compartment syndrome and neurovascular compromise, and those are the two most important things that will be immediately deciphered. Does the patient have pulses to the foot below the level of injury? Is the sensation in the foot the same in comparison to the non-injured foot, below the level of the injury? Has the injury in some way blocked blood flow and/or caused compression or severance of any nerves in the foot. If the answer to any of these questions is yes, the situation becomes more urgent. If the answer to all questions is no, then the situation is less urgent, but still needs significant evaluation and treatment.
Where’s the bullet? A bullet and any pieces that may remain from the bullet (if there are any) will show up on x-ray. Therefore, x-rays in the area of interest are routinely performed on patients with gunshot injuries/wounds. Once it is determined that there are no pieces of the bullet remaining in the patient, treatment can progress. If the bullet is lodged or if there are pieces present, the location needs to be determined, as it will affect treatment. As a general rule, and for simplicity purposes if the bullet is lodged securely in the bone without fracture to the bone, it is left alone. If the bullet is in the surrounding tissues, it is typically removed and all pieces if accessible through the open wound are removed. If pieces are not accessible, they are left alone.
What’s the next step? Gunshot wounds, independent of a graze vs penetrating vs through and through injury need to be cleansed thoroughly once the initial damage has been assessed and all immediate concerns such as compartment syndrome and vascular compromises have been handled. Thorough cleaning entails a trip to the operating room where all dirt and debris brought into the area by the bullet are removed with high-pressure application of sterile solution, decreasing the risk of infection. Depending on the Podiatrist’s experience, the type of wound, and the surrounding skin, the wound may or may not be initially closed with sutures. Often times, the wound must be left open and allowed to fill in with new skin and tissue on it’s own because the edges of the affected area can not be brought back together.
Gunshot wounds are uncommon injuries and are complicated in their treatment. The Podiatrist must ask him/herself numerous questions to determine the best course of treatment for each individual patient so that they are given the best chance at a complete recovery. Although this is a simplistic view of what Podiatrists are faced with when dealing with this type of injury, it does provide some insight.
Steer clear of flying bullets and you’ll never need to see this information utilized first hand!
When a patient presents with a gunshot wound/injury, as Podiatrist’s we will interview the patient to determine how the injury occurred, but the answer is usually unimportant and unrelated to the treatment protocol that will be followed; the opposite of how we handle most other injuries where the mechanism is extremely important. With gunshot wounds, there’s been an injury, the damage needs to be assessed, we need to determine if the bullet or any pieces of the bullet remain in the patient, and construct a course of treatment.
Assessing the damage. Typically the emergency room doctors will treat any injuries, in addition to the gunshot wound that are life-threatening to the patient or need immediate attention. This includes a complete workup of the patient to determine if they have stable vital signs (heart rate, blood pressure etc) and any injuries to their head, abdomen, chest etc. Once any initial threat to the patient is dismissed, the Podiatrist is called in and needs to assess any damage specific to the area of injury. In past blogs we’ve talked about compartment syndrome and neurovascular compromise, and those are the two most important things that will be immediately deciphered. Does the patient have pulses to the foot below the level of injury? Is the sensation in the foot the same in comparison to the non-injured foot, below the level of the injury? Has the injury in some way blocked blood flow and/or caused compression or severance of any nerves in the foot. If the answer to any of these questions is yes, the situation becomes more urgent. If the answer to all questions is no, then the situation is less urgent, but still needs significant evaluation and treatment.
Where’s the bullet? A bullet and any pieces that may remain from the bullet (if there are any) will show up on x-ray. Therefore, x-rays in the area of interest are routinely performed on patients with gunshot injuries/wounds. Once it is determined that there are no pieces of the bullet remaining in the patient, treatment can progress. If the bullet is lodged or if there are pieces present, the location needs to be determined, as it will affect treatment. As a general rule, and for simplicity purposes if the bullet is lodged securely in the bone without fracture to the bone, it is left alone. If the bullet is in the surrounding tissues, it is typically removed and all pieces if accessible through the open wound are removed. If pieces are not accessible, they are left alone.
What’s the next step? Gunshot wounds, independent of a graze vs penetrating vs through and through injury need to be cleansed thoroughly once the initial damage has been assessed and all immediate concerns such as compartment syndrome and vascular compromises have been handled. Thorough cleaning entails a trip to the operating room where all dirt and debris brought into the area by the bullet are removed with high-pressure application of sterile solution, decreasing the risk of infection. Depending on the Podiatrist’s experience, the type of wound, and the surrounding skin, the wound may or may not be initially closed with sutures. Often times, the wound must be left open and allowed to fill in with new skin and tissue on it’s own because the edges of the affected area can not be brought back together.
Gunshot wounds are uncommon injuries and are complicated in their treatment. The Podiatrist must ask him/herself numerous questions to determine the best course of treatment for each individual patient so that they are given the best chance at a complete recovery. Although this is a simplistic view of what Podiatrists are faced with when dealing with this type of injury, it does provide some insight.
Steer clear of flying bullets and you’ll never need to see this information utilized first hand!
A Marathoner’s Nightmare!
After working in the medical tent at the Boston Marathon this past Monday, I’ve come to two conclusions:
A. I will never run a marathon. As a member of the medical team I saw the worst of the worst, as athletes piled in with chest pain, dehydration and electrolyte imbalances. Unfortunately, I didn’t get to see the thousands of runners who completed the race unscathed.
B. Blisters can be a marathoner’s worst nightmare, especially when they occur towards the front of the race, as with each step they are constantly reminding the runner of their presence!
The root of all evils when it comes to blister formation is moisture. Blister formation occurs when friction and moisture combine separating the top layer of skin (epidermis) from the second layer of skin (dermis) allowing the area between to fill with fluid. Typically, the fluid within a blister is clear (serous), but can be bloody or filled with infection. Even if you’re not running marathons, the following “Blister Tips” address some of the myths of blister care, guiding you towards appropriate treatment.
1. Don’t pop blisters at home! It can be rather tempting to pop a fresh blister and relieve the pressure by expressing the fluid, but that’s not recommended. Blisters, by nature, contain sterile fluid, meaning that there is no bacterium inside and infection is a remote possibility. If you decide to pop a blister with a needle that you might have “sterilized” in your bathroom, you run the risk of introducing infection. Resist the urge to pop your blister and allow your body to resorb blister fluid on its own.
2. If I shouldn’t pop blisters at home, why did the medical staff pop them during my marathon? In an acute setting, such as during a marathon, blisters are typically popped by the medical staff. The reason: immediate relief of the excess pressure allows runners to continue through the remainder of the competition. The medical staff cleans the skin surrounding the blister with alcohol, uses a sterile needle to puncture the skin, and drains fluid out at it’s lowest point of gravity. Although the method isn’t perfect, and not recommended at home, the medical staff does their best to prevent infection while providing immediately relief for the athlete.
3. What to do if your blister pops on its own: As mentioned above, once your blister is exposed to the outside environment, infection becomes a possibility as there is now an entry point for bacterium. When this occurs, you need to do your best to keep the blistered area extremely clean. Using warm water and soap is sufficient, making sure to dry the area thoroughly and protect it using a band-aid that covers the entire blister. Avoid using hydrogen peroxide to cleanse the area. If dead skin remains, leave the skin in place, as it is still capable of providing a barrier for infection while providing a good environment for new skin to grow underneath.
4. Get your feet measured for shoe-size accuracy. As we’ve mentioned, blisters are mainly caused by friction combined with moisture. Shoes that are tight in the wrong places can cause recurrent irritation and frequent blistering. Getting your feet measured for an accurate shoe size can make a difference if you’ve been wearing the wrong size! Adjusting your running shoes to fit your feet may also increase your distance and comfort level while engaging in activity.
5. Blisters can occur separate from friction and moisture. Blisters that are small in size and seem to continually appear for unexplained reasons may indicate a problem separate from friction and moisture. Check the other areas of your feet looking for scaly skin on the soles and heels. If you find areas of scaly skin, it is likely that you have a fungal infection and the blister formation is a result of that. Contact your Podiatrist for an appointment, as they can treat your fungal infection quickly with topical medications!
6. Prevention is your best option! The goal in prevention is to decrease friction and eliminate moisture, as those are the most common predisposing factors. As discussed wearing shoes that fit your foot is important in decreasing areas of pressure where friction is imminent. In addition, keeping your feet dry and wearing socks that allow the feet to breath, versus cotton socks that hold in moisture, is very important. Finally, treating any underlying conditions such as fungus that may be causing blister formation will help tremendously in prevention.
Rapid-fire Lower Extremity Pathology!
As we wind down the month during which time we’ve discussed some uncommon lower extremity pathologies, I thought this week we would take a rapid-fire approach. We will touch very briefly on several lower extremities pathologies and encourage you to comment or write in if you have questions regarding any of the areas presented. Let’s get started! Buerger’s Disease (BD): Young male patients with a history of cigarette smoke, who suffer from intermittent claudication (pain in their legs with activity) that limits the amount of activity they can perform, can often times be diagnosed with Peripheral Vascular Disease (PVD). A pathology we’ve talked about in the past, where flow of blood from the heart to the legs is limited secondary to narrowing of the blood vessels. However, Buerger’s Disease should be ruled out as the symptoms are the same as PVD, but the pathology is quite different. In BD, the blood vessels become inflamed, swollen and blocked at various levels by clots resulting in decreased blood flow. The risk factors include genetic predisposition (family history), chronic gum disease and cigarette smoking. Those patients with advanced disease must quit smoking or risk amputations as the disease progresses.
Haxthausen’s Disease (HD): This disease, often confused with dry skin and other skin conditions that produce thick, callus-like scales on the hands and feet is found in post-menopausal women. The condition is typically associated with arthritis, obesity and hypertension and is difficult to diagnose because of the numerous skin diseases in a Podiatrist’s repertoire and HD’s rarity. It has been documented that a link between HD and psycho-emotional conditions and metabolic disorders exists, however there are too few cases to predict this with any certainty. The skin lesions first appear on the soles of the feet and progress to the palms of the hands. Treatment consists of topical steroids to treat the itch and inflammation, along with heavy application of moisturizers. If left untreated, the itch can become so severe and the rash so progressed that sloughing of the skin and creation of painful fissures occurs.
Trench Foot: This pathology has a very distinct clientele associated with it: individuals with trench warfare experience. It is also known as immersion foot and is so named as it occurs as a result of immersion of one’s foot in wet and cold environments for a prolonged time period. When the feet become wet and cold at the same time, the blood vessels constrict, decreasing blood flow to the affected areas and if not treated by removing wet socks and shoes while re-warming the feet, permanent damage to the nerves and blood vessels can occur. In the unlucky soldier, permanent damage results in chronic itching, pain and swelling of the feet with blotchy skin changes, scaling and a “heavy” feeling to the feet. Patients with the long-term sequelae of Trench Foot will require long-term care by a Podiatrist.
Lobster Foot: Picture a lobster claw…Lobster Foot is a rare congenital (inherited) abnormality, present at birth where one or both feet are missing what are called the “three central rays.” What this means is that toes 2, 3 and 4 are missing, along with their corresponding long bones (metatarsals), responsible for connecting the toes to the middle portion of the foot. This absence leaves only the 1st and 5th toes and their corresponding metatarsals in place, creating the look of a lobster claw. Treatment of this pathology aims to restore function to a foot that would otherwise be non-functional and impossible to bear weight on. Each case is treated independently, but typically requires surgery where both bone and soft tissues are part of the solution.
Macrodactyly: This is a rare, congenital abnormality that is not present at birth, but rather becomes more and more obvious as the patient ages. It is a form of “localized gigantism” where one digit becomes much larger than the others with growth. Each case is different and may or may not be associated with simultaneous enlargement of tendons, nerves and blood vessels in the affected digit. One thing that is common however is an increase in the amount of skin covering the digit, as it is a necessary part of accommodating the toes growth and often presents the greatest challenge in reducing the size of the digit. Numerous surgical procedures from size reduction and amputation have been attempted, but secondary to our unclear understanding of this pathologies etiology, recurrence is very common.
Well, that concludes this weeks “Rapid-fire!” As a Podiatrist, the saying, “when you hear horse-hoofs, think horses, not zebra’s” applies, but every once in a while, a zebra might just be walking into the office. I hope you’ve enjoyed this month articles covering ‘Zebra-like’ (uncommon) pathologies!
Haxthausen’s Disease (HD): This disease, often confused with dry skin and other skin conditions that produce thick, callus-like scales on the hands and feet is found in post-menopausal women. The condition is typically associated with arthritis, obesity and hypertension and is difficult to diagnose because of the numerous skin diseases in a Podiatrist’s repertoire and HD’s rarity. It has been documented that a link between HD and psycho-emotional conditions and metabolic disorders exists, however there are too few cases to predict this with any certainty. The skin lesions first appear on the soles of the feet and progress to the palms of the hands. Treatment consists of topical steroids to treat the itch and inflammation, along with heavy application of moisturizers. If left untreated, the itch can become so severe and the rash so progressed that sloughing of the skin and creation of painful fissures occurs.
Trench Foot: This pathology has a very distinct clientele associated with it: individuals with trench warfare experience. It is also known as immersion foot and is so named as it occurs as a result of immersion of one’s foot in wet and cold environments for a prolonged time period. When the feet become wet and cold at the same time, the blood vessels constrict, decreasing blood flow to the affected areas and if not treated by removing wet socks and shoes while re-warming the feet, permanent damage to the nerves and blood vessels can occur. In the unlucky soldier, permanent damage results in chronic itching, pain and swelling of the feet with blotchy skin changes, scaling and a “heavy” feeling to the feet. Patients with the long-term sequelae of Trench Foot will require long-term care by a Podiatrist.
Lobster Foot: Picture a lobster claw…Lobster Foot is a rare congenital (inherited) abnormality, present at birth where one or both feet are missing what are called the “three central rays.” What this means is that toes 2, 3 and 4 are missing, along with their corresponding long bones (metatarsals), responsible for connecting the toes to the middle portion of the foot. This absence leaves only the 1st and 5th toes and their corresponding metatarsals in place, creating the look of a lobster claw. Treatment of this pathology aims to restore function to a foot that would otherwise be non-functional and impossible to bear weight on. Each case is treated independently, but typically requires surgery where both bone and soft tissues are part of the solution.
Macrodactyly: This is a rare, congenital abnormality that is not present at birth, but rather becomes more and more obvious as the patient ages. It is a form of “localized gigantism” where one digit becomes much larger than the others with growth. Each case is different and may or may not be associated with simultaneous enlargement of tendons, nerves and blood vessels in the affected digit. One thing that is common however is an increase in the amount of skin covering the digit, as it is a necessary part of accommodating the toes growth and often presents the greatest challenge in reducing the size of the digit. Numerous surgical procedures from size reduction and amputation have been attempted, but secondary to our unclear understanding of this pathologies etiology, recurrence is very common.
Well, that concludes this weeks “Rapid-fire!” As a Podiatrist, the saying, “when you hear horse-hoofs, think horses, not zebra’s” applies, but every once in a while, a zebra might just be walking into the office. I hope you’ve enjoyed this month articles covering ‘Zebra-like’ (uncommon) pathologies!
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