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How Peripheral Artery Disease (PAD) caused this man to almost lose his foot

25 Nov

Gary Kautzmann of Orefield, Pennsylvania suffered with Peripheral Artery Disease for more than 10 years. P.A.D. is a condition in which arteries become blocked, restricting blood flow to certain parts of the body. In many cases, P.A.D. is caused by fatty deposits lodged in the arteries (atherosclerosis), but in Gary’s case, arteries behind his left knee had become twisted, greatly diminishing blood flow to his lower leg, foot and ankle.

Gary had always been active – running, swimming, biking, always on the move. But the P.A.D. was now causing so much pain in his calves, that it was impossible to walk even 2 blocks. As gary puts it, “it was no way to live.”

Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

Mayo Clinic

Four doctors attempted to restore blood flow to Gary’s leg, all without success. During each of 4 arteriograms, a procedure in which stents are inserted into the blocked arteries to restore their shape, the surgeon couldn’t get past the twisted tangle of arteries behind the knee. But proper blood flow is necessary for your tissues, to feed the living cells, repair damage, feed muscles and nerves, and heal wounds.

A year ago, Gary developed a routine case of athlete’s foot between the toes on his left foot. The only difference was that this time, the athlete’s foot would not heal. In fact, it got worse and worse, resisting every over the counter treatment. Gary sought out Dr. Teichman at PA Foot and Ankle Associates to treat the worsening fungal infection, and what Dr. Teichman told him was unnerving.

Watch the video to discover what Dr. Teichman told Gary.

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Curt Schilling Shares Photo of His Stitched-Up Ankle from 2004 World Series

13 Nov

curt schilling pitchingDo you remember when Curt Schilling pitched for the Red Sox? When he led them to their first World Series win in over 100 years?

Now do you remember the bloody sock spectacle when his ankle appeared to be hemmoraging while he stood on the plate?

 
 

CHILLING BLOODY SOCK

 
 

Some naysayers said it was only ketchup, and that Schilling was putting on a show. But this week, Schilling put those rumors to rest when he tweeted this image of his stitched-up ankle from 2004.

 
 

curt schilling ankle injury 2004

 

Now we know what it looked like under that famous sock. And that it was for-real ankle injury. Wow.

We can’t even imagine the pain that Schilling endured during that spectacular game. Pitching requires an extraordinary amount of precision and control, not only from your ankles, but from your entire body. And to pitch such a legendary game with an ankle in that condition is just… SUPER HUMAN!

‘Nuff said. Back off, haters.

NBA’s Kevin Durant Out With Jones Fracture

13 Oct

kevin durant jones fracture
The NBA’s MVP and four time scoring champ Kevin Durant has a Jones fracture in his right foot and will be sitting on the bench for 6-8 weeks, Oklahoma City Thunder Executive Vice President and General Manager Sam Presti announced over the weekend. The fracture is most likely the result of stress and occurred over time, and wasn’t due to a specific event. “From what I’ve been told, a Jones fracture is the most common surgical procedure performed on NBA players as of late,” Presti said.

A Jones fracture is a potentially serious injury for an athlete. It is a stress fracture of the fifth metatarsal of the foot, the outermost bone, which begins at the base of the small toe. The Jones fracture occurs in the midportion of the bone, causing swelling and pain. Many don’t realize they have it, try to play through the at-first mild pain, and this stress on the fracture makes it much worse. Non weight-bearing is essential for proper healing.

The Jones fracture is also particularly difficult to heal well, and frequently requires surgery to successfully repair, along with 4-6 weeks of physical rehab. The good news is, Durant informed his team trainers during practice Saturday about the aching and discomfort in his foot. They performed imaging scans on the sore area, which revealed the jones fracture. Had Durant played another game or two on the injured foot, the fracture may have become much worse and kept him out all season. At this point, it appears he’ll be back on the court sometime in December to finish out the season. Durant, entering his eighth season, has only thus far missed a total of 16 games.

Treating a Jones fracture

For those who aren’t professional athletes, the normal course of treatment for a Jones fracture is to immobilize the foot in a cast, splint, or walking boot for 6-8 weeks. This is usually sufficient treatment in 75% of cases. However, if you’re an athlete and your career depends on the health of your feet, surgery is usually performed to secure the bones in place with screws, plates, wires, or pins, so the metatarsal heals as close to perfect as possible. The 5th metatarsal has a limited blood supply due to its size, and surgery insures that the bone will set correctly and hold up under the pounding of playing on a hard court every day.

jones fracture

Jones fracture symptoms

  • Pain, swelling, and/or bruising in the region of the 5th metatarsal bone – below your small toe
  • Severe pain when walking

Jones fracture treatment

  • In most cases, immobilization of the fractured foot in a walking boot or cast
  • Non weight-bearing
  • Over the counter ant-inflammatory pain relievers such as advil (ibuprofen) or aleve (naproxen)
  • Foot surgery if necessary
  • 2-3 weeks of physical rehabilitation after immobilization to insure proper healing of the bone

5 Exercises to Relieve Hammer Toes

2 Oct

Hammer toes occur when the middle joint of the second, third, or fourth toes bends in an upward position, creating a claw-like or hammer look. Hammer toes are not a serious condition, but they can become quite painful, causing shooting pains and discomfort throughout your toes and feet, and soreness where the toe rubs the inside of the shoe. They can develop at any age, even adolescence.

hammer toes hammertoes
There are a number of treatment options for hammer toes, including surgery, but you can also do these 5 exercises at home to reduce your discomfort (but they won’t cure the hammer toe). The reason that normal toes become hammer toes is due to muscles and tendons tightening and pulling the toe into an upward position. Relieving this tension via stretching exercises which pull the muscles in the opposite direction, can work wonders for alleviating pain.

1. Toe Stretch

Sitting on the floor with your legs straight head of you, wrap a bath towel under your toes, and pull towards you so just the toes move. Hold for 30 seconds. This may also be done with your hands.

2. Toe Taps

Sit on a chair and remove your sock. Extend your big toe down toward the floor while at the same time extending the rest of your toes up in the air. Hold for 10 seconds and then lightly tap the floor with your toes 12 times. Then reverse your toe position so the big toe is pointed up and the remaining toes pointing down. Repeat.

 3. Toe Crunches

Sit on a chair barefoot. Place a bath towel on the floor and place the upper half of your foot on top of the towel. While keeping your heel flat on the ground, crunch the towel up with your toes. Release and repeat 12 times.

4. Toe Squeeze

Sitting in a chair, place your foot over your thigh. Slide your fingers in between your toes and squeeze your toes together, as if to pinch your fingers. Release and repeat 12 times.

5. Toe Rolls

Toe Rolls are not pastries – they’re an exercise similar to when you tap your fingers from side to side on a table. Stand barefoot on a flat surface. Lift all of your toes upwards off the ground together, then roll them down one at a time from the little toe to the big toe. Repeat 12 times, then change directions.

Read more about hammer toes and their treatment.

Jamaal Charles and Arthur Jones Out With High Ankle Sprains

19 Sep

Your fantasy league is under great duress this week.

jamaal charles high ankle sprain

Jamaal Charles doing what he does best.

High ankle sprains have become an epidemic in the NFL lately. Jamaal Charles of the Kansas City Chiefs, and Arthur Jones, Khaled Holmes, and Joe Reitz of the Indianapolis Colts are all on the bench with high ankle sprains. Charles and Jones sustained their injuries in games this week, and Holmes and Reitz have been sitting out since pre-season games in August.

How does a high ankle sprain differ from a normal ankle sprain?

In the more common lateral ankle sprain, the ligaments that surround the ankle joint are injured through an inward twisting, causing pain and swelling around the ankle. A high ankle sprain, also known as a syndesmotic sprainis an injury to the syndesmotic ligaments above the ankle which join the two bones of the lower leg together. A high ankle sprain is caused when the lower leg and foot twists out (externally rotates). See a diagram of a high ankle sprain here.

arthur jones high ankle sprain

The Colts’ Arthur Jones gets carted off the field during their game against the Eagles.

The tibia (shin bone) and fibula run from the knee down to the ankle.  If the injury is a stable high ankle sprain, the tibia and fibula stay in their normal orientation, and the athlete may be out for as little as five or six days.

If the injury is an unstable high ankle sprain, two or all three ligaments above the ankle are torn and the tibia and fibula are free to move. A podiatric surgeon may need to place a screw between the tibia and fibula to hold the bones in proper position while the ligaments heal, and may require the athlete to be sidelined for as long as 6 months(!). High ankle sprains pose a bigger challenge to healing than common ankle sprains, which is why athletic trainers are very cautious about returning an athlete to the lineup too quickly.

Tarsal Tunnel Syndrome (TTS) Surgery – Patient Testimonial

18 Sep

Charlene Ninni of Center Valley, PA suffered with excruciating and debilitating pain which would travel from the inside of her ankle, throughout her foot, and sometimes all the way to her hip. For almost 2 years, she sought the advice of a number of orthopedic surgeons, none of whom were successful in relieving her foot and leg pain, or her swollen ankle.

tarsal tunnel syndrome surgery

The tarsal tunnel is found along the inner leg behind the bump on the inside of the ankle.

The simple things most of us take for granted, like walking up the stairs or food shopping, had become difficult to impossible for Charlene. She had learned to wait as long as possible before doing anything that required walking, and she asked frequently for assistance from friends and family. With one of her ankles all but useless, and in almost constant pain, life had become challenging.

One night at a Lehigh Valley IronPigs game, while paging through that night’s program, she saw an ad for a seminar that Dr. Adam Teichman of PA Foot and Ankle Associates was conducting on foot health. When Charlene showed up at the seminar in the walking boot her most recent orthopedic physician had given her, Dr. Teichman couldn’t help but start a conversation with her. They discussed her symptoms, he ballparked a few possible reasons for her condition, and he recommended she see him for an exam and diagnosis.

After Charlene’s exam in the PA Foot and Ankle Associates office, Dr. Teichman’s diagnosis was tarsal tunnel syndrome. He recommended surgery as the best treatment option to relieve Charlene’s pain. Charlene agreed to the surgery, and today she couldn’t be happier with the outcome.

Watch Charlene’s video testimonial below in which she discusses her symptoms and tells us how great she’s feeling now compared with 2 years ago.

About Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot condition.

The tarsal tunnel is found along the inner leg behind the bump on the inside of the ankle. Through this tunnel passes a collection of arteries, nerves, tendons, and muscles. Inside the tarsal tunnel, the tibial nerve splits into three segments – one segment continues to the heel, and the other two continue to the bottom of the foot.

When the tibial nerve becomes entrapped or “pinched” in the tarsal tunnel due to inflammation or swelling, numbness may be felt in the foot radiating all the way to the big toe and the first 3 toes. Additionally, pain, burning, tingling, and electrical sensations may be felt in the base of the foot, ankle, or heel.

Visit the PA Foot and Ankle Associates website for more information on Tarsal tunnel syndrome.

Lump On Your Foot or Ankle? It Might Be A Ganglion Cyst

12 Aug

A soft, painful lump has appeared on the top of your foot. Or maybe the side of your foot. Or maybe somewhere around your ankle. The lump changes size with activity. It might be sore, or it might just… be there.

ganglion cyst foot, lump on foot

This ganglion cyst has appeared along the path of the tendons on the side of the foot.

If these symptoms match a lump on your foot or ankle, chances are you have a ganglion cyst, a noncancerous, round or oval lump that develops along a tendon or joint. Most are less than an inch in diameter, although some are so small they can hardly be felt. The size of the cyst can vary however, especially as the joint is used.

Normally, a ganglion cyst is painless and requires no treatment. But if it happens to be pressing on a nerve, it can cause pain, tingling, numbness, muscle weakness, or interfere with joint movement.

What causes a ganglion cyst?

Repeated irritation can weaken the lining of a joint or tendon, causing the tissue to bulge, which is then referred to as a ganglion cyst. Inside the cyst is a thick fluid similar to the lubricating fluid found in joints or around tendons.

People who wear boots, especially women between 20 and 30, are more likely to develop ganglion cysts, as this type of footwear puts stress on the foot and ankle. Bone spurs may also cause ganglion cysts by irritating the joints and tendons, and joints or tendons that have been injured, even long ago, are more likely to develop ganglion cysts.

Treatment for ganglion cysts:

**Because ganglion cysts may be mistaken for tumors, it’s essential to have a complete exam performed by a podiatrist, and if necessary, tests to confirm the diagnosis.

If your ganglion cyst is causing you no pain, your podiatrist may recommend a wait and see approach, as the cyst may go away on its own. If it’s causing you discomfort, she may suggest one of the following treatments:

Aspiration: In an exam room, your podiatrist will use a needle to drain the fluid from the cyst.

Immobilization: If it’s clear that activity is causing the cyst to enlarge, your doctor may recommend an air boot or similar device to immobilize your foot or ankle. As the cyst shrinks, pain and other symptoms may be relieved.

Padding: Soft pads placed around the ganglion cyst to ease pressure and friction.

Medication: If swelling and pain are severe, your podiatrist may recommend prescription medication.

Surgery: In some instances, surgery may be recommended to remove the cysts and its surrounding tissue, which is attached to a joint or tendon.

A Question From India: Can Charcot Foot Be Cured?

6 Aug charcot foot diabetes

The PA Foot and Ankle Associates blog gets questions from all over the world about foot and ankle health. Today we received this one from Manohar in Bangalore City, India.

“Hello sir. This is Manohar from India, Bangalore City. My father is suffering with charcot joint disease and also a diabetic neuropathy. In the last month his leg is completely swelling. An orthopedic surgeon has suggested amputation. My question is how can it be cured?”

Thanks for your question, Manohar. The doctors at PA Foot and Ankle Associates, and particularly Dr. Thomas Rocchio, are one of the United States’ foremost experts on Charcot foot disorder.

Charcot foot disorder is a side effect of diabetes and is accompanied by diabetic peripheral neuropathy. Diabetes damages blood vessels, causing a decrease in blood flow to the feet. Poor circulation weakens bones, resulting in a disintegration of bones and joints in the foot and ankle. This puts the bones at high risk of fracture. Unfortunately, a diabetic who has nerve damage from DPN has a loss of sensation in their feet, and will be unaware of the bones fracturing. They continue to walk on the foot, causing the joints to eventually collapse and the foot to change shape, most notably to a rocker-bottom appearance. Sharp edges of bone may put pressure on the skin, creating the risk of chronic skin sores. It’s this end result – a combination of bone disintegration and trauma – which is known as Charcot foot disorder. It’s one of the most serious complications of diabetes.

charcot foot diagramcharcot foot disorder

Charcot is a very dangerous disease, as it is in many cases accompanied by bone infection. In highly advanced cases, sometimes amputation is the only realistic treatment. However, it is far from the only treatment.

“There are reconstruction options for many Charcot patients, but there needs to be circulation in the foot for it to heal.”, according to Dr. Rocchio. “Infection can affect the result as well. The remaining reconstructed bone must be free from infection and there must be enough healthy soft tissue to close the incisions. Usually an aggressive external fixation is needed to stabilize the reconstruction. Unfortunately, no complete answer can be given without an exam of the patient.”

Dr. Adam Teichman adds, “There are treatments to stabilize, correct, and prevent Charcot and the breakdown of the foot. For instance, if  ulcers can be healed, infection can be cured, which allows a number of options to save the foot. Amputation is not a therapy, it’s a last resort.”

Read more about Charcot foot disorder

Early diagnosis of Charcot is key to saving the foot, which is why every diabetic should have their feet checked regularly by a podiatrist. Manohar, we’d be happy to examine your father and give you a complete diagnosis and treatment plan if you and he can travel to the States.

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