One serious condition that can lead to loss of limbs is peripheral arterial disease (PAD), which refers to blockages in the arteries outside the heart.

Left untreated, PAD can lead to debilitating and limb-threatening consequences.

You should take action to minimize the complications of vascular disease. You can do this by educating yourself on PAD, examine your legs and feet for sores or changes in skin color or temperature. Practicing good foot care including podiatry visits, and having diagnostic tests done when necessary are important. Those with diabetes should be especially vigilant.

Most people will sprain their ankle at some point in their lives. It’s inconvenient, and most let them heal at home. However, the doctors at West Georgia Podiatry, advise that this can be a mistake. Too many people downplay the severity of a sprained ankle, resulting in delayed recovery and even further injury. It’s important to see a podiatrist even if nothing feels wrong. It’s the only way to be certain you’re recovering properly and that there aren’t underlying issues. 

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.

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.

Secrets of Recurring Heel Pain

Many patients are becoming even more active with age, and as this new generation of elderly patients become our community's senior citizens we are finding out more often that you are only as young as you feel. With this, there are different aches and pains, and they are more common and can be restricting towards maintaining this level of leisure. Above all other pains common to the foot and ankle, heel pain is by far the most common. Sometimes, we will be a 3rd and 4th opinion to attempt to remove this nuisance from our patient's feet. Most often heel pain is treated by cortisone injections, physical therapy, weight loss, and orthotics. 

But what about the patients who have been there and done that?

There are few treatments that are more promising in the field of heel pain management with more potential than the

Extra Corporal Shockwave Therapy for very tough heel pain. A good overview of the proposed mechanism for how this works involves using devices that generate pulses of high-pressure sound that travel through the skin and yeild natural repair from the tissues and increased blood flow networks to damaged tissues. 

For reasons that are not fully understood, soft tissue and bone that are subjected to these pulses of high-pressure energy heal back stronger and without causing further damage to the tissues like repeated cortisone injections may do. 

The FDA has approved the use of some ESWT machines for heel pain and tennis elbow. ESWT devices evolved from lithotripters (a.k.a. kidney stone shock wave machines). The discovery of the beneficial effects of ESWT came as German researchers were trying to determine what type of high-pressure pulses could be sent through the body to disintegrate kidney stones without causing harm to surrounding tissue. In laboratory animals and humans, it was discovered (with some surprise) that surrounding tissue would often heal back stronger and this applies well to our topic of heel pain. 

Physical therapists use ultrasound machines that warm internal tissue by high frequency sound waves, but the ESWT machines send higher-energy pulses 2 or 3 times per second rather than continuous lower-energy waves. Electricity is not sent into the body. It may take as long as 5 months to see the full benefit of an ESWT treatment. The beneficial effect of the high-pressure waves may be from the growth of new blood vessels ("neovascularization") in small cavities that are created by the pulses. New blood vessels to an area of tissue would promote healing either directly or indirectly by providing additional growth factors to the area of concern by way of new vascular channels.

Some studies have even shown this therapy to be equivalent to a fasciotomy, which is an invasive procedure that involves an incision to sever the medial fibers of the fascia for reduced pressure and tension on the inferior heel bone. This means that you can get equivalent results without the complications of a minor procedure. We can provide ESWT that has benefits that have been shown to work well on difficult heel pain. This can be beneficial to our patients, and if you are limping in the AM, or have trouble walking after a brief rest from activity because your heel is holding you back, you should consider a consultation with one of our doctors.

Achilles Pain ?

1) NOT all posterior heel pains are tendon problems.

We will provide a thorough examination, which includes radio graphs, and clinical exam with history taking to provide the best possible outcome for your pain. There are several other structures which are present and could be treated in a different manner than any straight forward Achilles tendinitis. Noted above, there is a bursa which is present here and can often be the root cause of pain secondary to bursitis. This is treated differently than Achilles tendinitis. This may also require MRI to determine how much of the inflammation is related to bone versus soft tissue. Additionally, and more rarely, a stress fracture can cause this pain in the calcaneus. This is not common but we check for this as well.

2) Tendon tears do NOT always require surgery.

After clinical examination and proper staging/grading of the extent of the tear, we have had success in treating Achilles partial tears and even ruptures non-surgically in select patient populations. We have a variety of techniques at our disposal in order to facilitate the healing process if surgery is not indicated. In the case of chronic tears there are several nonsurgical treatments that work, particularly PRP injections, High energy shock-wave treatments, and even physical therapy with anti inflammatory ultrasound.

3) Bone spurs are NOT always relevant.

Often times patients will state that they "Have had a spur in the past but it went away". Usually any bone protuberance which is either palpable or visible on a plan radio-graph or MRI will NOT go away spontaneously ever and always if indicated will need resection if it is the root cause of the symptoms. In most cases the spur is not the root cause of the symptoms, and is not required to remove it, but there are far too often very large spurs which are not even symptomatic that are visible on X-ray examinations in many of our patients, therefore backing up further the concept that bone spurs are not always the real problem.

Bio-mechanically a bone spur will exist in areas of either repeated chronic trauma, or areas of chronic taut insertions. Rarely is this an isolated tumor of bone, and that being said, it is often not necessary to remove the bone spur.

What you need to know about your kids flatfeet?

Pediatric (child) flatfeet can be seen at an early age and progressively affect growth, posture, and activity level if left neglected.  Literature and studies have shown that flatfeet in children are progressive and can cause debilitating effects if left, untreated.

Here are 5 must-know facts about children's flatfeet:

1. Genetics are the primary cause - although, there are different etiologies that can result in flatfeet the number one source is typically genetics
2. Foot orthotics are important - The function of those devices is to re-align the foot position and thus better align the other lower extremity joints (knees, hips) and overall posture
3. "Growing pains" is a myth - Very often, do we hear of this term but in reality if your child is suffering from persistent pain to the foot/ankle with notable "limps" and decrease in activity levels, then they need to be examined more carefully.
4. Physical therapy is paramount in treatment - the role of therapy is to stretch the tight calf muscles and strengthen the weaker tendons/muscles, which are affected by the flatfoot deformity.
5. Surgery can help! - Surgery on the pediatric population has shown very good to excellent results in a variety of scientific studies and literature.  The results are predictable and kids have a better long-term function which can avoid them from having debilitating arthritis, knee/hip pain as they get older.

Pre-operative clinical photograph of a child's feet before undergoing flatfoot surgery

Postoperative photograph of the same patient 4 months after surgery.  Note improvement in foot and leg position on the right.

If you have any questions about pediatric flatfeet, their treatment, and surgeries then please consult with your foot and ankle specialist.

Turf Toe

The simplest definition of turf toe is that it is a sprain of the main joint of the big toe. It happens when the toe is forcibly bent up into hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground.
Sprains of the big toe joint became especially prevalent in American football players after artificial turf became more common on playing fields - hence the term "turf toe." Artificial turf is a harder surface than grass and does not have much "give" when forces are placed on it.
Although often associated with football, turf toe occurs in a wide range of sports and activities.

The typical position of the foot when a turf toe injury occurs.

Anatomy
The big toe is made up of two joints. The largest of the two is the metatarsophalangeal joint (MTP), where the first long bone of the foot (metatarsal) meets the first bone of the toe (phalanx). In turf toe, the MTP joint is injured.


The MTP joint is the large joint closest to the base of the big toe.

The joint is surrounded by important structures that hold it in place and prevent it from dislocating. Together these structures are referred to as the "plantar complex."
Plantar plate. This thick, fibrous tissue under the MTP joint prevents the big toe from bending too far (dorsiflexion).
Collateral ligaments. Located on each side of the big toe, collateral ligaments connect the phalanx bone to the metatarsal and prevent the toe from going too far side-to-side.
Flexor hallucis brevis. This tendon runs under the first metatarsal bone and attaches to the phalanx. It provides strength and stability to the big toe during push-off motions.
Sesamoids. These two small bones are enveloped in the flexor hallucis tendon, and help it to move more easily. In addition, the sesamoids provide stability to the MTP joint by helping to bear weight placed on the forefoot.

Several structures work together to protect and stabilize the MTP joint.

Description
The term "turf toe" refers to an injury of any soft tissue structure in the plantar complex, such as the plantar plate or a collateral ligament. These injuries can vary in severity — from stretching of the soft tissue to partial tearing, and even total dislocation of the MTP joint.
To help them plan treatment for turf toe, doctors grade the injuries from 1 to 3 - mild to severe.
Grade 1. The plantar complex has been stretched causing pin-point tenderness and slight swelling.
Grade 2. A partial tearing of the plantar complex causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful.
Grade 3. The plantar complex is completely torn causing severe tenderness, severe swelling, and bruising. It is difficult and painful to move the big toe.

We have treated this injury on and off over the years with similar therapy. Rarely does this require surgery, and there is sparse literature which can be referenced to delineate whether grade 1 and grade 3 injuries are specifically nonsurgical or surgical. We have used a combination of PRP injections with hallux extension BK casting for this injury and have found good success. This is a non surgical approach and has had with it some good short term success. But this may still be a devastating injury for most athletes. (Even notable pros such as Deion Sanders, have had career ending versions of this injury).

Flatfeet could slow you down


How is this possible?
The results conducted by the American Podiatric Medical Association concluded that a staggering 73 percent of people asked said that they are suffering from foot pain.

The question is: why has foot pain become one of the most common complaints in the examination room?

For many people, this problem can be caused by one of the following: the kinds of shoes they wear, what activities they participate in, or how their feet are formed. Wearing poorly-fitting shoes can turn minor problems into major ones. People who engage in athletic activities are another segment of the population that are mostly affected by foot pain. Factors such as fallen arches, overpronation, and poor support can all be contributing factors to lower extremity pain. Parents can also be the cause of foot-related problems, because genetics play a role how the foot was formed in the womb. This can enhance the likelihood that someone will suffer from an array of painful foot conditions.

The Mechanics of the Foot
Flat feet can cause abnormal rotation of the feet when walking or running. Our feet handle balance, stability, and bear the weight of the body. The parts of the foot that help to keep the foot in harmony with the body include the arch, heel, tarsals and meta-tarsals. The arch provides stability by the following structures: the tendons, ligaments, and muscles. Pain can result from raised arches or abnormally-low arches, which can cause the foot to rotate abnormally. With high arches, the body’s weight is abnormally emphasized on the outer edge of the foot (oversupination). Conversely, overpronation happens with fallen arches because the weight of the body is concentrated on the inside of the foot, causing the ankles to roll inward .

Serious Foot Issues May Occur with Flat Feet A quick way to see if fallen arches or high arches are an issue is to find a good area where a foot impression can be made, such as on concrete. Immerse on foot in cold water and then stamp your foot onto the dry surface. Then, lift the foot off the ground and see the impression that is left by the foot. A flat foot with overpronation will leave a complete mark where the entire foot has touched the ground. A high arch will leave just a part of the ball of the foot’s outside portion, and heel of the foot. Either of these arch conditions can cause painful bony growths in the heel because the foot has to deal with too much pressure in places it is not intended to handle.

Orthotics Provide Effective Relief for Therapy For Plantar Fasciitis
People suffering from fallen arches, heel spurs, or who need plantar fasciitis treatment can get relief by using the best orthotics available in their shoes. They offer the needed support to fix the weak structures in the foot, such as those that make up the arch. They also offer cushioning in areas where too much pressure occurs, such as in the heel or ball of the foot. Orthotics are available in an array of sizes and types and are made to keep up with anyone’s activity level.

Make an appointment today for more information. 

5 things you must know about Achilles tendon disease

Did you know that Achilles tendon ruptures represent a large portion of sports-related injuries and are seen in younger patients and older ones as well.  The average age is 29-40 with a male to female ratio of 20:1. 
In fact, "weekend-warriors" is a term used to classify patients above the age of 35 who participate in occasional exercise activities and especially those that involve high-impact sports such as basketball and soccer.  Those patients are statistically known to be at the highest risk for sustaining Achilles tendon ruptures.

Progression of Achilles Tendon disease

Achilles tendon anatomy.  Image from Gray's Anatomy Text..

Here are Five important facts you must know when dealing with Achilles tendon disease:

• Achilles tendon disease is progressive - It involves a chronic and repetitive process of micro-tearing and degeneration within the tendon.  This process weakens the tendon and can eventually lead to spontaneous ruptures
• Pain is not always a clinical symptom of Achilles tendon disease - In fact, the more chronic is the tearing, the less likely pain is involved and thus anti-inflammatory medications would not work
• Tight calf muscle groups increase the load on the "diseased" tendon
• Foot-type and mechanics can make you susceptible to Achilles tendon disease
• Specific family of antibiotics, namely Fluroquinolones, have shown association with Achilles tendon disease and spontaneous ruptures.

Here are important elements to consider for treatment of Achilles tendon disease:

• Temporary immobilization in a boot/cast is to be expected in the initial "inflammed-state"
• Shoe-gear modifications, foot-orthoses, physical therapy and stretching exercises are pillars  in the treatment process because they loosen the load off of the tendon
• Platelet-Rich Plasma injections have shown tremendous promise and results in the treatment especially amongst the athletic/active population
• Shockwave therapy has also shown great benefits from a non-operative point of view
• Surgical intervention is warranted if no clinical improvement is seen with non-operative approaches and it involves debridement of the tendon with either a reconstruction of the diseased tendon or a tendon transfer from another tendon in the body. 
• Recovery involves immobilization in the cast for 3-4 weeks then followed with a period of 4-6 weeks of CAM boot immobilization with Physical therapy
• Results on average are rated as good to excellent.

If you have any questions about Achilles tendon disease or ruptures, then please consult with your foot and ankle specialist.

Ingrown toenails - 5 important facts and how are they treated?

Have you ever experienced pain, redness, swelling, and even drainage from the "inner" fold of your toenails? Have you been told that this can eventually "grow out"? In reality, ingrown toenails are common in the practice of the foot and ankle specialist but their treatment carries some misconceptions.


Presentation of an ingrown nail with localized infection


Note drainage from inner fold of nail consistent with infected ingrown nails

Here are 5 things you must know about ingrown toenails:
1) Untreated ingrown toenails can cause infections in the skin, bone, and result in life-threatening infections also referred to as "sepsis"
2) Genetics and foot-architecture can play a role for ingrown toenails
3) Cutting toenails too short and into the "corners" can cause ingrown toenails
4) The great (big) toenail is most commonly affected
5) Only definitive way to treat ingrown nails is surgical

Surgical treatment involves an array of different local procedures to remove the "ingrown" component of the nail without compromising the remainder of the nail. In most cases, a chemical treatment is also applied to prevent the nail from growing back "ingrown".

So what does the procedure entail?
1) Typically an in-office setting with local anesthetic infiltrated to "numb" the toe
2) Removing the ingrown component of the nail from the tip to the root
3) Draining and debridement of any infected tissue or abscess.
4) Application of chemical treatment to inhibit nail (matrix) cells from growing back in the in-grown position
5) Application of an antimicrobial dressing that stays on for one day.

Post-operative management?
Although most foot and ankle specialists have different protocols, on average most would agree on a protocol that involves the following:
1) Daily dressing change with a Bandaid until the drainage from the toe completely resolves
2) Following with your provider between 7-14 days after the procedure to ensure no infections. At that point, patients are typically given a prescription for topical solutions to prevent infections and promote the healing of the skin.

If you have any questions about ingrown toenails then please consult with your foot and ankle specialist.

Top 3 reasons why your golf game can be affected by your foot pain

Has your foot pain affected your golf game recently? Have you noticed a change in your swing because of guarding and inability to pivot your foot? The reality of the matter is that there are contributing forces to the golf swing and poor foot mechanics can result in foot pathology that would ultimately affect the quality of the golf swing.



Here are three reasons why your golf swing can be affected by your foot pain:

Great toe joint arthritis - This is a common condition that we see in a large patient spectrum and it is independent of age. The top two reasons that patients develop great toe joint arthritis are: Genetics and/or a history of trauma to the joint. Patients with great toe joint arthritis develop significant pain and stiffness over time, which results in an inability to "push-off" the toe. By guarding the pain, your foot position and mechanics are thereby compromised which leads into a less effective swing.

Plantar fasciitis - This is a condition that involves an inflammatory response at the ligament/tendon structure (plantar fascia), which inserts at the heel. This results in significant pain at the heel and "tightness" in the arch. This, in turn can inhibit the foot from completely planting and thus, will reduce the effectiveness of the swing. We often see this condition in conjunction with tightness of the posterior muscle group which contributes to the pain and inability to plant the heel on the ground.

Achilles Tendonitis - This is a condition that also involves an inflammatory response but this time at the tissues surrounding the Achilles tendon insertion. This is precisely located at the back of the heel and is also seen in conjunction with tightness of the posterior muscle group. The result of this condition is again an inability to plant the foot or push off, which would also compromise the swing.

Here are ways to address those problems:

Stretching
By relieving the contracture and "tightness" of the posterior muscle group
Physical therapy
Can comprise of ultrasound and other hands-on modalities to improve range of motion and relieve tight muscle groups
Mechanical control of the foot - Foot or Ankle and Foot Orthoses
In doing so, there is a lesser tendency or chance of aggravating the tendons.
Vitamin supplementation and antioxidants
Reduce associated swelling and pain
Shock-wave therapy
Using a combination of low intensity ultrasound guided shockwaves, an inflammatory response can be induced in the chronic tendon disease and promote healing.
Surgical repair
Most definitive but is contingent on the type of problem at hand. Typically outpatient type of setting with a brief period of Non-weight bearing (no walking)If you have any questions pertaining to any of the aforementioned conditions, then consult with your foot and ankle specialist

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.

Ankle Sprains

Ankle sprains are a common injury after a fall, sudden twist or blow to the ankle joint. Approximately 40 percent of those who suffer an ankle sprain will experience chronic ankle pain, even after being treated for their initial injury.

A review article published in the May 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) explains that tendon injuries to the ankle can be a possible cause for this chronic pain. In some cases, the condition is untreated or overlooked which prolongs the pain and the problem. "When patients injure their ankles, the injury may not seem serious at first," explains Terrence Philbin, DO, lead author of the article and Fellowship Director of the Orthopedic Foot and Ankle Center in Columbus, Ohio.

"People may not seek medical attention and they can think it will just get better on its own. I think that is why this condition often goes undiagnosed." The authors of the article describe how in some cases chronic ankle pain may actually be the result of injuries to the peroneal tendons. The peroneal tendons are located behind the outside portion of the anklebone (called the fibula). The tendons help to stabilize the foot and ankle. Tendon injuries can include tendonitis or swelling around the tendons. In more severe cases, the peroneal tendons can actually tear or there can be a swelling of the tendons behind the fibula bone. This can cause the ligament that holds the tendons together to stretch out and tear, or even rupture. Symptoms associated with peroneal tendon injuries can include: Ankle pain that is not responding to treatment Swelling and tenderness around the outside of the ankle Pain behind the anklebone Pain that transmits from the ankle down into the foot.

The use of magnetic resonance imaging (MRI) or ultrasound can be helpful when identifying and diagnosing peroneal tendon injuries and disorders. "These imaging techniques offer a more complete look at the peroneal tendons," noted Philbin. "One might consider getting an MRI or ultrasound especially if you have chronic ankle pain." If the condition is caught early, non-operative treatment options can include: Rest, ice and elevation Anti-inflammatory medication Immobilization in a cast or brace Physical therapy More serious injuries of the peroneal tendons, including tears or ruptures, will very likely require surgery. 

Peroneal tendon injuries can happen suddenly or can develop over time. The injury is most common among athletes involved in sports that require repetitive ankle motion and in individuals who have high arches of the foot. A proper diagnosis is essential in order to treat peroneal tendon injuries correctly and to help alleviate chronic pain. Philbin reminds patients, "If you have ankle pain and it is not getting better, do not ignore it. Get it evaluated by a physician who has experience treating foot and ankle injuries."

We can try a variety of measures to reduce pain and swelling and disability from this condition. PRP injections, low profile bracing, and physical therapy are excellent nonsurgical options. Ultimately surgery would be considered pending the nature and severity of the problem, and how you respond or fail to respond with nonsurgical management. 

New data gleaned from five years of studies have shown that artificial sweeteners can lead to weight gain as the body forgets how to process real sugar.


Sweet taste without the guilt — this has long been the promise of diet sodas.

But researchers at Purdue University have found by reviewing studies done over the past five years that diet soda and other artificially sweetened products could cause the same health problems as regular soda. In review, Susan E. Swithers, a Purdue professor of behavioral neuroscience, discovered that with consuming artificial sweeteners like sucralose, aspartame and saccharin, the body loses its ability to process real sugar, which could result in weight gain.

With real sugar, messages are released to the brain and the gullet via hormones that regulate digestion and intake of food, blood sugar levels, and even perception of fullness and satisfaction from the food consumed. However, with no actual calories to process with artificial sweeteners, the body doesn't know how to react.
"You've messed up the whole system, so when you consume real sugar, your body doesn't know if it should try to process it because it's been tricked by the fake sugar so many times," says Swithers to CNN.

The end result, says Swithers, is that the body's metabolic system stops reacting to real sugars and doesn’t release the hormones that say, “That was delicious, I’m full.” This can cause an endless cycle of feeling hungry and wanting more sugar.  It has also been shown that people who regularly drink diet soda have a higher risk of weight gain, obesity and type 2 diabetes and heart disease.

However, representatives of the American Beverage Association disagree and argue that low-calorie products can be effective tools for weight control, calling the study “an opinion piece,” in a released statement, according to CNN.

Theresa Hedrick, nutrition and scientific affairs specialist for the Calorie Control Council lobbying group, told WebMD, "I think it's important to remember that low-calorie sweeteners are one aspect of a multifaceted approach to health or obesity prevention. ...They aren't magic bullets."

Weight gain is a major contributor to all foot and ankle problems, and our patients need to understand that weight loss therefore will directly impact the reduction of most foot and ankle pain. Ask us about your weight loss options today, or at your next appointment.

What you should know about Gout in the foot and ankle

Have you ever suffered from a painful and swollen joint in your foot or ankle?  Has this pain persisted despite taking antibiotics and anti-inflammatory medications?  Have you had multiple episodes of this pain?  If so, then you may be one of 8.5 million Americans who suffer from gout each year (1).

Prevalence of Gout has been increasing in recent years and it is currently one of the most common causes of inflammatory arthritis in industrialized countries.  Factors that contribute to this condition include increased lifespan, dietary habits, renal and cardiovascular disease, alcohol consumption, and prescribed drugs that may raise serum uric acid levels (2).

Gout results from the deposition of uric acid crystals in a joint, resulting in acute inflammatory response.  If left untreated, chronic gouty arthropathy can develop and progress into deposition of uric acid crystals and tophi in soft tissues.  In the foot and ankle, Gout is most commonly manifested in the great toe joint.

Current treatment guidelines:

• Non-Steroidal Anti-inflammatory medications (NSAIDS) or corticosteriods in the acute phase
• Uric acid Lowering Treatments (ULT), i.e. Allopurinol, for maintenance
• Shoe gear modification – wider, supportive shoes with insoles
• Custom Orthotics – accommodations to restrict motion of the affected joints
• Ankle Foot Orthoses (AFO) – restrict motion of the ankle joint (if affected) to limit inflammatory response
• Vitamin supplementation
• Surgical reconstruction – reserved for failed conservative and pharmaceutical therapies

If you suffer from gout or symptoms resembling gout, then consult with your foot and ankle specialist for work-up and management.

Foot sprains - Are they more than just sprains?

Have you ever been diagnosed by your doctor with a “foot sprain” after an accident, fall, or foot-twist?  Were you immobilized with a boot for a short period of time without much relief?  The reality of the situation is that you may have incurred a more debilitating injury in your foot ligaments. 

Some might ask what do the National Football League athletes Santonio Holmes, Ryan Kalil, Matt Schaub, and Dwight Freeney have in common?  They all suffered from a frustrating foot injury commonly referred to as Lisfranc’s injury.

The injury is named after Jacques Lisfranc, a French surgeon in Napoleon’s army.  It refers to a ligament and/or osseous (bone) injury of the metatarsal-tarsal joints and can present with severe dislocations and fractures (1).  The mechanism of the injury involves either a direct force of trauma on a planted foot or indirectly through a complex sequence of twisting motion.

Diastasis noted in the joint complex consistent with Lisfranc ligament injury

Approximately 20% of Lisfranc injuries are misdiagnosed in the emergency room because of their vague presentation and subtle x-ray findings (2).  They are often mislabeled as "foot sprains” and thus, treatment is often delayed which results in:

• Post-traumatic arthritis
• Chronic midfoot instability
• Chronic pain

Lisfranc injuries occur in 1 person per 55,000 yearly.  67% of which are results of motor vehicle accidents, crushing injuries, and falls from heights (2).  Although those injuries are not common in the general population, certain athletes suffer a higher rate of this injury.  It is seen in 4% of football players per year, with offensive linemen incurring 29.2% (3). 

Foot and ankle specialists are trained to recognize the pathology using specific clinical examination and with the help of imaging modalities such as stress x-rays, CT scans, and even MR images.  If recognized early, prompt treatment can limit complications and potentially salvage an athlete’s season/career.

If you have sustained or suspect a foot sprain, then consult with your foot and ankle specialist.  

Unseen Dangers of Walking Barefoot on the Beach

Do you enjoy long, barefoot walks on the beach? While it may be romantic, it can be potentially dangerous. Shell fragments or other sharp debris can penetrate your skin causing cuts or puncture wounds that can be extremely painful. If not treated properly, they can become infected by a number of bacteria.

One specific bacterium of concern is Vibrio vulnificus. Infections related to this bacterium typically happen when a cut or wound occurs in salt or brackish water. This organism peaks during the warm summer months when the gulf coast water surface temperature exceeds 68° F. High concentrations of Vibrio are commonly found in filter-feeding organisms such as barnacles, and therefore any cuts or scrapes from barnacles are at an increased risk for infection. Other possible sources of infection include punctures from fishhooks and fish spines or teeth. Following exposure to Vibrio, a local skin infection with large blisters may occur. In an individual with an underlying illness such as liver disease or diabetes, the infection may spread extremely rapidly resulting in significant tissue damage, and if Vibrio infects the bloodstream, it is potentially fatal. Treatment for infection includes antibiotics and possible hospitalization and surgical debridement depending on the severity of the wound.

When it comes to cuts or wounds involving salt or brackish water, it is best to be safe and seek medical attention.

Skin Cancer and your feet..

Most people are unaware of every little pigmented lesion they may have on their foot or toes. Sometimes, a pigmented lesion may be falsely presumed to be a bruise, or a scar. If there are any questions about skin lesions, one should note that a skin biopsy is a relatively small amount of discomfort to gain a relatively large amount of information and essentially a diagnosis which can be used to effectively treat any number of skin cancers which may present as old bruises underneath a thick toenail, or even a rash on the top of the foot. Please understand, that although relatively rare (5% of all skin cancers such as melanoma are found on the foot) this is still high enough to get it looked at.