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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.

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.

NY Giant Geoff Schwartz Catches Lucky Break With Dislocated Toe

27 Aug

Those of us who aren’t pro athletes just can’t appreciate how critical foot and ankle health is.

Sprained ankle? I’ll “walk it off”

Stubbed toe? I’ll wear looser shoes for a week

A little heel pain? It will pass….

You may think that professional athletic trainers are “babying” their players at times, but they know from experience that a seemingly innocuous, minor injury that’s left unattended, can develop into an injury which costs the team a championship, and end a player’s career.

geoff schwartz

Geoff Schwarts is carted off the field Friday night.

For instance, Geoff Schwartz, starting left guard for the New York Giants, was carted off the playing field last Friday night during their preseason game with the Jets. Trainers believed the toe was dislocated, but had no idea as to its severity.

A dislocated toe is nothing to take lightly, because if serious enough, it can be a season-ending injury for an athlete. Fortunately for Schwartz, tests revealed that it’s only a minor dislocation which won’t require surgery. Geoff will be back on the field by the end of September if his rehab goes as planned.

“This is just a minor setback,” Schwartz said. “I plan on attacking the rehab program so I can get back on the field as soon as possible with my teammates and help us win games.”

How your toe becomes dislocated – and what to do about it

When the ligaments and tendons which hold the toe joint together are torn, the bones move apart and out of place. This is what’s called a dislocated toe. This can be a minor injury, as in Schwartz’s case, or quite severe, as when the toe is visibly out of joint. When the joint is properly realigned, it takes about 6 weeks for the ligaments to heal.

How can you tell the difference between simply stubbing your toe, spraining it,  breaking it, or dislocating it? You probably can’t, which is why you should see a podiatrist as soon as possible after you injure it. If the toe is dislocated, you’ll feel immediate, intense pain, extreme pain if you try and bend the toe, swelling, bruising, tenderness, or numbness, and possibly a very visible deformity. Some of these symptoms are also consistent with sprains and fractures, which is why a podiatrist’s opinion is necessary.

Never – and we mean never, ever, ever try and “pop” the dislocated toe back into place by pulling on it. That’s strictly Hollywood stuff. A dislocated toe is frequently accompanied by a fracture, so if you pull on it, you can do a lot more damage. If you suspect that your toe has been dislocated, seek immediate medical attention from a podiatrist. He or she will take x-rays, make a diagnosis, and then if it is indeed dislocated, realign the toe and provide you with a walking boot to protect the toe while it heals. Physical therapy may also be recommended to get the toe back in shape after the ligaments heal.

Take your foot and ankle health as seriously as pro athletes.

Pain in the ball of your foot could be Morton’s Neuroma

30 Jul

Does it feel like you have a pebble in your shoe between your 3rd and 4th toes?

Perhaps you have occasional shooting or burning pain in the bottom of your foot?

Do your 3rd or 4th toes occasionally sting or feel numb?

Any of these could be symptoms of Morton’s Neuroma, a painful thickening of the tissue around the nerves that lead to your toes.

mortons neuroma

Morton’s Neuroma is also known as Morton’s metatarsalgia, Morton’s neuralgia, plantar neuroma, or intermetatarsal neuroma. It typically has no outward signs, such as an obvious lump – only discomfort and pain on the bottom forefront of your foot or toes. Technically, a neuroma is a benign tumor of a nerve. Fortunately, a Morton’s neuroma isn’t a true tumor, but simply a thickening of fibrous tissue. If left untreated however, the neuroma can lead to permanent nerve damage.

How Morton’s Neuroma forms

Abnormalities in the anatomy of the foot, aggravated by injury, irritation, or wearing pointy shoes or high heels, compress and irritate the nerve that passes under the ligament connecting the toe bones in the forefoot. In response, the nerve enlarges and develops a nasty lump. It most commonly develops between the 3rd and 4th toes, and appears in women 10 times more often than in men. Those people who have bunions, flat feet, hammer toes, or unusually high arches, are prime candidates for developing Morton’s Neuroma. So are those athletes who perform on courts or hard surfaces – runners will notably feel the pain when they push off from the starting line.

Symptoms of Morton’s Neuroma

  • Feeling of having a pebble in your shoe
  • Burning or stinging pain and numbness in the area between the 3rd and 4th toes
  • Pain intensifies with activity and subsides with rest
  • Symptoms rarely appear at night

Causes of Morton’s Neuroma

Abnormality in foot biomechanics, aggravated by:

  • High heels, shoes that are too tight, or shoes that don’t fit correctly. This footwear can put pressure on the toes and ball of you foot, aggravating the nerve.
  • Sports that put unusual stress on your toes, like rock climbing, or snow skiing, or high impact aerobic sports like running or basketball.

Treatment of Morton’s Neuroma

  • Change your footwear. Swap high heels for flats, and wear shoes with a square toe box which will not constrict the movement of your toes. This lets the bones spread out, taking pressure off the nerve, and allowing it to heal.
  • Custom orthotics or pads may be worn inside your shoes. A podiatrist at PA Foot and Ankle Associates will customize an orthotic for you which will take pressure off of the sensitive area. This speeds healing by lifting and separating the toes, taking pressure off the nerve.
  • Steroidal injections can be used to reduce pain and inflammation in the affected area.
  • Over the counter anti inflammatory medicine like advil or aleve can be used to control pain, along with ice and rest.
  • If these treatments fail to relieve your symptoms, surgery may be recommended.

Getting a Pedicure? Watch out for foot and toenail infections

24 Jul

Sure, you want your toenails to look pretty, especially during sandal season. But any podiatrist will tell you that they see patients nearly every week with foot and toenail infections acquired at a nail salon – viral infections, warts, and athlete’s foot being the main players. Before your next pedicure, you can take a few precautions which will protect you from picking up any hitchhiking bacteria, virus, or fungus that may turn into a serious foot or toenail infection.

PEDICURE HOW TO AVOID INFECTIONS

Don’t mess with the cuticles

Even the most experienced pedicurist will occasionally cut into the cuticles, and that’s a mistake. The cuticle helps anchor the nail to the skin, and should never be pushed back or cut during a pedicure, as that’s when bacteria may enter.

You want your toenails cut into what shape?

If toenails are cut a little too aggressively on the sides, it can lead to ingrown toenails, which as anyone who’s ever had one knows, are absolutely miserable and will certainly not match your other toenails. Pedicurists should cut the nails straight or at a slight curve, along the contour of the toenail, and not down into the corners.

Clean tools, clean surfaces

There’s a chance of acquiring fungus at a salon, too, if the owners aren’t fastidious about disinfecting surfaces and tools. Pumice and emery boards shouldn’t be used more than once, and tools should always be sterilized in between clients, preferably in an autoclave, which uses high pressure steam to kill bacteria and fungus. Non-metal tools cannot be sterilized, so if they aren’t thrown away after one use, every client that follows is at risk.

At the very least, make sure you can see the pedicure tools soaking in that blue liquid called Barbicide, which barbers have used since… well, since at least your grandfather’s first haircut. There’s a required minimum of at least a 10 minute soak in a bacteriacide, according to Environmental Protection Agency guidelines. And UV lights? Not to be trusted for sanitizing. Some salons allow you to bring your own pedicure tools, which is your best protection.

No bubbles, please

Glass bowls for soaking your feet are preferred over fiberglass or plastic – any porous material allows bacteria to hide out. Whirlpool foot baths should be verboten, as the piping feeding the baths can harbor all kinds of bacteria and fungus, which love the warm, but not too-warm temperatures.

Shaved legs and pedicures demand distance

Wait on getting a pedicure for 2 days after you shave your legs. A razor creates microtears in the skin, which bacteria can easily enter, directly introducing them into the legs. This can lead to an infection called cellulitis, which is very serious and may require hospitalization.

And some should never show up for a pedicure

If you’re diabetic, you should think twice about getting a pedicure. One of the unfortunate side effects of diabetes is that sores don’t heal quickly, especially in the feet. Persistently open wounds, even nicks, invite all kinds of bacteria to take up residence, which can lead to a nasty infection in a diabetic foot.

Other people at high risk include those with HIV, those going through chemotherapy, and those who have circulatory disorders or vascular disease. And if you already have an ingrown toenail, avoid pedicures entirely and see your podiatrist for treatment.

We can send toenail fungus on its way with only a few treatments.

Which physician is best to treat foot and ankle pain?

25 Jun

We sure take our feet and ankles for granted, don’t we?

best doctor for foot pain ankle pain toe pain

That is, until the Millenium Falcon breaks our ankle, or a foul ball clips our right foot. Ouch.

When your feet are painful, you’re miserable. Your lifestyle is instantly affected – pain forces you to dial back or give up walking, running, dancing, standing, or your favorite sports. Prolonged pain might even cause you to go from star athlete to couch potato.

It’s appropriate to visit the ER if you have an unusual amount of pain in your feet or ankles, especially if the pain is sudden and intense, is accompanied by bleeding or swelling, or if your foot and ankle have been involved in a trauma like a fall down the stairs. Or if you tried to break a cement block in half with absolutely no martial arts training.

For less painful events, like a suspected fracture, or wounds that won’t heal, many people choose to see their primary physician, which may or may not be a good choice, depending on that  physician’s field of expertise.

And for even less worrisome injuries, like a minor sprain, or minor heel pain, some seek no medical attention at all – which is never a good idea, as both injuries can develop into more complicated conditions, especially for athletes.

Which doctor is expert in treating foot and ankle problems?

When you have trouble with your ears, you should see an ENT. Trouble with your knees, an orthopedist. When you have pain or discomfort in your feet, toes, or ankles, you should see a podiatrist.

Podiatrists and podiatric surgeons are trained exclusively in the treatment of foot and ankle disorders – they do nothing but study the foot and ankle, it’s diseases and deformities. After all, 1/4 of all of the bones in your body are in your feet, and there are many conditions unique to this area of the body. That’s a lot of ground to cover in med school. If they choose to be a podiatric surgeon, they complete further schooling to study surgical techniques to correct these problems.

In 99% of cases, a podiatrist can resolve your ankle, toe, or foot problem much faster than a general physician. Podiatrists are also expert at spotting the early signs of diseases you can easily overlook, like diabetic foot disorders, rheumatoid arthritis and cardiovascular disease.

Without your feet in good working order, your life can be…. well, challenging. Don’t take them for granted.

If there was a report card for foot care, you’d get an F

11 Jun

Unfortunately, when it comes to foot care, most of you are failing miserably. Well maybe not YOU, because you’re reading this, but everyone else is failing…

foot pain foot health

The American Podiatric Medical Association has released a very illuminating survey on American’s attitudes and experiences concerning their foot health. The results are very surprising to us in some ways, and completely predictable in others, based on the patients we see. Unfortunately, your feet continue to rank low on the list of body parts you consider important to your well-being, and you’re paying less attention to them than you should.

The survey, released in March, shows that 8 out of 10 of you have experienced foot pain at some time in your life. Those of you who’ve experienced foot pain on a regular basis, also report regular issues with other health complications, primarily back pain, eyesight issues (probably diabetes-related), arthritis or other joint pain, weight issues, knee pain, and heart and circulatory disorders.

Half of you said that foot pain has restricted your activities in some way: walking, standing for long periods, exercising, sleeping, going to work, or playing with your children or grandchildren.

You said that you understand how important foot health is, and that consistent or chronic foot pain can indicate other health problems.  You also said that you understand what a complex mechanism the foot is and that a podiatrist is best qualified to treat your foot pain.

However….

You also reported that you have little knowledge of or experience with podiatrists. When a foot problem arises, you’re more likely to visit your primary care physician for help, or try and treat it on your own. But those of you who have visited a podiatrist give them high marks for care and are more satisfied with the outcome than those of you who were treated by your primary care physician.

This last fact highlights a common misperception about the healthcare system – that your primary care physician is some kind of wizard who knows how to treat every conceivable ailment. While we respect our fellow physicians, every MD’s training is different. Primary care physicians are a sort of first line of defense and are trained to identify and treat the most common illnesses and complaints in the population. They’re also trained to flag unusual symptoms and to refer out injuries and disorders which are best treated by a specialist. Yet 60% of you say that you would talk to your PCP about a foot condition before seeking advice from a podiatrist (we understand however, that some insurance plans require this). Hello? Podiatrists know more about foot and ankle injuries and disorders than any other physician. When given the choice, always opt for a specialist.

Shame on you: Only 32% of you report doing foot, ankle, or leg exercises to keep them strong, and only 43% wear proper, supportive footwear (that explains all of the comments/questions on our blog post about why your feet hurt). Speaking of footwear, 71% of women who wear high heels experience foot pain which they directly attribute to wearing high heels. Yet they own NINE PAIR (!).

Unfortunatley, nearly 50% of you experiencing foot pain wait until it’s severe to see a podiatrist. Most of you don’t even consider a visit to a podiatrist for conditions like persistently sweaty or odorous feet, blisters, pain from high heels, hammertoes, problems with your toenails, or even diabetic wound care. Yet each of these conditions can indicate a more serious potential problem or set of problems. Treated early and properly by a podiatrist, your pain and discomfort can be relieved without further complications. In fact, 34% of you said that a podiatrist helped you identify other health issues such as diabetes, circulatory issues, or nerve damage.

But what is up with the fact that only 74% of you report keeping your toenails trimmed?  OMG! What are the other 26% of you doing? Do you have man servants to trim your toenails for you? Or extra long shoes to accommodate your lavishly long toenails?

Click here to read the entire APMA survey.

What Is A Crossover Toe?

5 Jun

Crossover toe is a painful condition in which the second toe drifts out of place, eventually crossing over and lying on top of the big toe. In some cases, the second toe lies under the big toe. Crossover toe can occur at any age, but is most commonly found in middle age and older adults.

crossover toe treatment

Crossover toes are frequently associated with bunions. This man has both.

Don’t confuse crossover toe with hammertoe. While both conditions involve a toe (any toe can be affected) that doesn’t lie in its normal position, they are quite different, and crossover toe is a much more complex condition. When a toe is described as being a crossover toe, it has become buckled, contracted, or crooked, and has literally crossed over or under the big toe (or adjacent toe).

Crossover toe is a progressive condition, usually occurring over a period of time. But it may also appear after an injury, from overuse, or after a steroid injection to an area near the second toe.

What causes crossover toe?

It’s generally believed that crossover toe is caused by abnormal foot structure and faulty biomechanics, as are bunions. The combination of these conditions leads to repetitive stress on the joint of the second toe, weakening the structures which stabilize it. The result is a toe that drifts out of place and becomes a crossover toe.

Other foot conditions accompany and may contribute to crossover toe, such as bunions, hammertoe, neuroma, arthritis in the big toe joint (hallux rigidus deformity), an elongated second metatarsal (2nd toe is longer than the big toe), a tight calf muscle, or an unstable arch.

What causes Crossover Toe?

In a normal foot, the plantar plate and associated ligaments stabilize the 2nd metatarsal joint. When chronic inflammation or damage occurs in this area, the stabilizing structures of the joint slowly change. One by one, the supporting ligaments fail, leading to chronic hyperextension on the toe joint, which then stretches or re-attenuates the plantar plate. This change in the toe’s supporting structures causes an imbalance, leading to instability in the toe, which eventually dislocates in the direction of the big toe.

Crossover toe can be difficult to diagnose in its early stages, when it’s most easily treated. A patient may have pain in the ball of the foot, but the toe exhibits no signs of dislocation. Unfortunately, without treatment, the toe will worsen and eventually dislocate. But if the crossover toe is detected by a podiatrist at an early stage, non-invasive treatments like bracing, strapping, taping, and orthotics can be employed to keep the toe from becoming a crossover toe. Once the second toe begins to drift towards the big toe, it will not return to its original position.

Symptoms of Crossover Toe

  • Pain and swelling at the base of the second toe, and/or the ball of the foot. The discomfort on the bottom of the foot is often described as feeling like there’s a marble in your shoe
  • Difficulty wearing shoes, as the toe becomes irritated by footwear
  • Pain when walking, especially in the ball of the foot
  • Soreness to the top of the crossover toe

Treatment for Crossover Toe

Taping positions the affected toe in it’s original alignment, which provides stability and relieves pain and swelling. As the inflammation of the joint decreases, healing can occur over a period of months.

Metatarsal pads and orthotics can alleviate pressure on the plantar plate and/or metatarsal and redistribute body weight across the surface of the foot. Healing can slowly occur as inflammation subsides.

Over the counter anti inflammatory medicine like aleve and advil can decrease inflammation and pain in the symptomatic joint.

If these conservative treatments fail, or if the displacement of the toe is far advanced, surgery to re-align the toe followed by physical therapy may be recommended by your podiatrist.

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