Tuesday, September 3, 2013

What you should know about your feet during pregnancy

Did you know that during pregnancy, your feet experience dynamic changes attributed to fluid retention and increase in soft tissue.  Believe it or not, this is not secondary to stretching, weakness, or ligament laxity.

Here are 5 important facts to know about your feet during pregnancy:
  1. Feet measurements in width and length are increased during pregnancy.
  2. Edema (swelling) in the feet, ankles, and legs are common and can be expected.
  3. Venous insufficiency and varicose veins can be seen in the foot and leg.
  4. Conditioning exercises are not only important to maintain posture but also decrease load on the foot and ankle.
  5. During GAIT, pregnant women have increased demand on the calf-muscle group and over-pronate
In order to help prevent foot problems during your pregnancy, here are three proven methods:
  1. Compression stockings and edema control with elevation
  2. Custom or physician approved orthotics to improve foot function and mechanics
  3. Stretching and conditional exercises to help limit load on the weakened muscle groups
If you have any questions or discomfort with your feet during your pregnancy, then consult with your foot and ankle specialist.

What you should know about ankle arthritis?

Ankle arthritis can be very debilitating and although the prevalence is 9 times lower than knees and hips, the symptoms are much more magnified.  In fact, according to a recent study the quality of life of patients with ankle arthritis was in many cases worse than that of patients with hip arthritis.
Arthritic ankle joint with significant loss of joint space

5 important facts to know about ankle arthritis:
  1. Unlike the hip and knee, ankle arthritis is typically caused by trauma and/or abnormal ankle mechanics
  2. Other less common causes include: inflammatory arthropathies, hemochromatosis, neuropathic arthropathy, bone tumors, and infection.
  3. Cartilage in the ankle joint is much more stiffer and resilient in comparison to the knee joint.
  4. The ankle joint carries up to 5 times the normal body weight.
  5. Both operative and non-operative treatments exist as viable options.
5 important non-operative treatments:
  1. Ankle-Foot-Orthoses (AFO): Function to limit the mobility of the Ankle joint and thereby limiting the associated pain
  2. Corticosteroid injections: Function to limit the associated inflammatory process with motion of the arthritic joint
  3. Physical therapy: Improve GAIT, strengthen muscles, and improve function of contracted tendons secondary to the arthritic joints.
  4. Vitamin supplementation: Antioxidants can help with pain control and associated inflammatory response
  5. Hyaluronate injections: Typically indicated for knee cartilage/joint.  Those injections carry components of healthy joint fluid.  Studies have shown good results in patients with ankle arthritis
Example of an Ankle-Foot-Orthoses  used for patients with ankle arthritis
3 most viable options for operative treatment:
  1. Ankle joint diastasis: Preserves joint and encouraged in early staged arthritis.  Can be useful in select patients.
  2. Ankle joint arthrodesis: Results in complete fusion of the joint, thereby eliminating any joint motion and associated pain.  The body compensates by observing motion at the distal joints of the foot during the GAIT cycle.  It is considered to be the "gold-standard" in surgical management of ankle arthritis since it carries the most predictable of results.
  3. Ankle joint replacement surgery: The joint is completely replaced with a metallic-implant.  It does preserve some limited and pain-free motion of the joint.  It is gaining popularity in the U.S. and is indicated in a very select group of patients.  Newer generation implants carry longer longevity and are more predictable.
Ankle joint replacement with metallic implant
If you have any problems with ankle arthritis, then consult with your foot and ankle specialist.