Monday, April 28, 2014

What you should know about the "Rheumatoid" foot

Rheumatoid arthritis is a chronic inflammatory disorder that affects at least 1.3 million Americans. It is also considered an autoimmune disorder, which means that the body's own immune system attacks its own body tissues. In addition to causing joint problems, Rheumatoid arthritis can affect other organs of the body such as the skin, eyes, lungs, and blood vessels. The treatment requires long-term medications to control "flare-ups" and prevent progressive autoimmune damage to joints throughout the body. It also often manifests in the foot and ankle.

Manifestation of Rheumatoid arthritis on the small joints of the hand. Note the deviation of the digitis and contractures

Manifestation of Rheumatoid arthritis on the joints of the foot. Note dislocation and contracture of the toes.

Here are some manifestations of Rheumatoid Arthirtis in the foot and ankle:
  • Joint space loss 
  • Persistent swelling 
  • Dislocations of lesser toe joints 
  • Dislocation/Deviation of the larger joints in the foot and ankle 
  • Deviation and contracture of toes 
  • Destruction of Joint capsules and supporting soft-tissue structures (ligaments) 
  • Pain 
  • Foot/ankle ulcerations or skin break-down 
Treatments can vary from non-operative to operative but controlling the inflammatory process is essential. This can be done with local anti-inflammatory medications to control the acute "flare-ups" and ultimately suppressive regimen to control the process long-term. When it comes to foot and ankle treatments, non-operative options include but are not limited to: 
  • Custom-molded orthotics or bracing - controls motion of the joints, especially if inflammed and in doing so, prevents pain and swelling 
  • Pads - Toe pads or "bunion" pads can be beneficial in preventing rubbing and irritation 
  • Physical therapy - Strengthen weak muscle groups and stretch tight tendon contractures 
  • Custom shoes - Extra-depth shoes provide protective insoles which can accommodate for contracted joints 
  • Surgical management of the Rheumatoid foot accomplishes the following objectives: 
  • Relieve inflammatory joints from pain and swelling 
  • Re-align the foot/ankle architecture 
  • Provide stability and a functional foot 
  • Prevent breakdown of the skin and ulcerations 
Surgery can be accomplished using various techniques and options that include but are not limited to:
  • Arthrodesis - Fusing of inflammed joints to prevent motion and pain. This is often seen at the great toe joint and sometimes the ankle. Screws, plates, and metallic wires are using to accomplish this fusion. 
  • Partial resection of metatarsal bones - This can help decompress contracted toes 
  • Lesser toe tendon balancing - in doing so, we can eliminate the painful contractures of the lesser toes 
  • Joint replacement - Typically reserved for the Ankle joint 

Although surgery on the Rheumatoid patient brings a lot of functional benefits, it is also important to consider the associated risk factors including but not limited to:
  • Infections - Rheumatoid patients are prone to infections secondary to long-term steroid use, which can cause an immunosuppressed state 
  • Chronic Regional Pain Syndrome 
  • Recurrence of deformity 
  • Inflammation and pain 
If you have any questions about management of the Rheumatoid foot or ankle, then consult with your foot and ankle specialist.

Thursday, April 24, 2014

Pregnancy and Varicose Veins

Varicose veins during pregnancy are one of the many body changes a woman goes through during this wonderful time in her life. Unfortunately, there are some not-so-wonderful things that happen to a pregnant body. However, the good thing about varicose veins during pregnancy is that they are usually not harmful and they will most likely disappear after giving birth. In some cases, varicose veins might cause some discomfort, itching, or pain, but for the most part, the main complaint among pregnant mothers is that they don’t like the way they look.

What are varicose veins? Varicose veins are blood vessels that bulge out and show through the skin because they are green, blue, or purple. The reason that pregnancy sometimes causes varicose or even smaller spider veins to show is because of the extra blood produced during pregnancy combined with weight gain. The pressure on the legs that are working against gravity to push the blood back to the heart causes varicose veins to emerge. The podiatrists at West Georgia Podiatry can help expectant mothers prevent or mitigate varicose veins during pregnancy and also provide consultation on how to get rid of varicose veins that do not disappear on their own within a few months after giving birth.

What Can You Do to Prevent & Treat Varicose Veins During Pregnancy?

Chances are that any varicose veins that appear during pregnancy will fade away within a few months after giving birth. However, there are still some things that expectant mothers can do to prevent or at least lessen the appearance of varicose veins.
Exercise is important during pregnancy for a number of great reasons, one of which is that keeping the blood circulating helps reduce chances of varicose veins. Make sure to consult your doctor about what types of exercises are best for you.
In addition to exercise, keep your blood circulating by elevating your feet when sitting and get up often to walk around when you’ve been sitting for long periods of time.
Another way to keep up circulation flow is by sleeping on your left side instead of your right side.
Wear support tights or support stockings, but make sure that all of your other clothes are not too tight or restricting. There are also specially made compression stockings for varicose veins.
Avoid heavy lifting or straining.
Keep weight gain to a minimum.
In addition to a healthy diet, make sure to get the recommended daily allowance of vitamin C, which specifically helps vein health.

Treatment Options for Varicose or Spider Veins that Remain After Pregnancy

In some cases, the varicose veins do not completely disappear after pregnancy or small spider veins might remain. If this happens to you, consult with our podiatrists at West Georgia Podiatry for their expert advice in this area. Treatment options can include laser spider vein removal. These treatments help to get rid of varicose veins and are just an appointment away.

West Georgia Podiatry Doctors Perform Varicose Vein and Spider Vein Treatment

We understand the body changes after pregnancy and that some veins might still present a problem for patients. Our doctors are always available to consult with you and help weigh the pros and cons of the different vein treatment options and help you determine which varicose vein remedy is right for you.