Which physician is best to treat foot and ankle pain?

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

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.

Millenium Falcon Breaks Han Solo’s Ankle

Harrison Ford, the original Han Solo in the Star Wars film franchise, broke his ankle Thursday while filming a scene in the series’ reboot. He’ll be off the set of “Star Wars: Episode VII” for 6-7 weeks until his ankle heals.

Harrison Ford as Han Solo in the original Star Wars

Harrison Ford as Han Solo in Star Wars: Episode VII

Ford, 71, is reprising his role as Han Solo in the movie. As all things are not magical in filmmaking, a hydraulic door fell off the iconic Millenium Falcon spaceship while he was stepping from it. The injury was serious enough that Ford was air lifted from the set to a local hospital in Oxford, England. The ankle may require surgery to fixate the bones with a plate and screws.

***Yes, we noticed that too – he was airlifted to a hospital for an ankle injury – but YOU never helped save the entire universe, and he did!

You’re not a famous Hollywood actor with a helicopter at your disposal, but your broken ankle needs treatment, too.

A broken ankle, also known as an ankle fracture,  can range in seriousness from a hairline fracture in one bone, to multiple fractures which make the ankle very unstable. In addition to the broken bones, soft tissue is usually damaged as well, most commonly the ligaments which hold the ankle bones in position. In Ford’s case, his broken ankle was caused by trauma, but an ankle can also break after a sudden, forceful twisting, rolling, or by tripping or falling. The ankle is a very complex anatomical structure with many parts and a break in one of the bones poses risk to others.

If you suffered a broken ankle, you may feel immediate and severe pain, swelling, bruising, an inability to move your toes or bear weight, and/or a cold or blue foot. Treatment by your podiatrist may include splinting the broken ankle, immobilization with a cast or walking boot, crutches, or surgical realignment of the bones if necessary. Physical therapy is always recommended to strengthen the muscles and the bones after the injury heals.

We’re excited about this movie, because Ford’s original Star Wars cohorts are in this one as well: Carrie Fisher (Princess Leia), Mark Hamill (Luke Skywalker), Anthony Daniels (C-3PO), Peter Mayhew (Chewbacca), and Kenny Baker (R2-D2).

“Episode VII,” the first installment of a brand new “Star Wars” trilogy, is scheduled to be in theaters Christmas, 2015.

Landscaping: How To Protect Your Feet From Injuries

Which would you rather say to your podiatrist?

“I got this monumental ankle sprain when I was pushing my lawnmower and rolled my foot in a gopher hole.”
or
“I got this monumental ankle sprain when I rolled my foot AFTER THE MOST SPECTACULAR JUMP SHOT EVER!”

If you picked “gopher hole”, you’re in the minority.

Landscaping – and even gardening – cause their share of foot and ankle injuries, especially in spring when we’re out of shape. We tend to jump right in where we left off in October, and our bodies just aren’t up to it. Bending, twisting, and lifting or pushing heavy and sharp equipment can cause an injury quite quickly if you don’t take a few precautions.

We hope he’s wearing a good pair of work boots

Wear proper footwear.

It may have been fine when you were a teenager to wear worn-out sneakers when you cut the lawn. As an adult, you should wear athletic shoes which support your feet well and will protect them if you step on a rock you didn’t expect to be there. Or in the groundhog hole which magically appeared overnight.

If your ankles or feet have been subject to injuries in the past, or if you’re landscaping with sharp equipment, wear a quality pair of work boots (not garden boots, which offer little protection beyond moisture). If you’re a landscaper, work boots with good support and metal-tipped toes should always be on your feet. Work boots will also protect your feet in the event you accidentally drop any equipment with sharp blades or heavy bottoms (like a tamper).

Don’t work on a wet lawn.

When grass is even a little wet, it can be very slippery. If you have a slope or hill on your lawn, cutting it when wet can be especially dangerous. Wait to mow your lawn until the turf is completely dry.

Use equipment with safety shutoffs.

Decades ago, equipment with sharp blades only stopped turning when you intentionally shut it off, which allowed chainsaws to run out of control, and feet to slide under lawnmowers while the blades were still turning. Fortunately, most modern lawnmowers, edgers, tillers, cultivators, post hole diggers, chain saws, and other equipment with high speed, rotating blades or teeth, stop as soon as you let go of the handle or trigger. If you’re still using decades-old equipment which doesn’t have a shutoff feature, it’s time to upgrade.

Shovels and other step-on equipment can cause surprising damage to your feet.

If you’re doing a project that requires a lot of digging, or using equipment like manual aerators for your lawn, wear quality work boots at all times. The repeated stepping-on-with-force required with these tools can cause injuries like sesamoiditis, plantar fasciitis, sprains and fractures.

If you have ankle, foot, leg, or back issues, stretch before you start.

In gardening and landscaping, lots of bending, squatting, twisting and turning is required, sometimes while holding or moving heavy equipment. Injuries happen remarkably quickly when your body isn’t prepared for them. We recommend that those who have previous injuries of the back, hip, legs, feet, or ankles, or are over 50, stretch before they begin their activities.

Taking these precautions and wearing work boots when you garden or landscape may not make you look like the coolest guy or girl on the block, but they’ll keep you out of the podiatrist’s office. Or the ER.

 

Why You Should Skip the Flip-Flops This Summer

Flip-flops are just so easy – slip ’em on and run out the door. Seems like everybody starts wearing them as soon as outdoor temps climb above 50 degrees.

Unfortunately, flip-flops are just about the worst thing you can wear on your feet. In fact, there is a growing problem of heel pain among teens and young adults, which podiatrists are attributing to wearing this paper-thin footwear (no doubt intensified by the obesity epidemic).

Walking barefoot is better for your feet than walking in flip-flops. If your feet have any abnormal biomechanics, flip-flops can accentuate these problems, leading to plantar fasciitis and accelerating other foot problems.

Think about it: the bones in your feet are the base of your skeleton and your body weight is riding on them. If your feet aren’t supported correctly, the rest of your bones, joint, tendons, and muscles have to make up for it. The stress shifts elsewhere and that leads to foot pain, heel pain, leg pain, hip pain, bad knees, sore back, and any number of other ailments.

Naturally, wearing flip-flops in the sauna, locker room, or by the pool won’t cause any harm. But as everyday footwear, we suggest you make a smarter choice.

So how exactly do flip-flops affect your feet?

Toes: That little thong that slips between your toes actually makes the muscles in your feet work overtime. The perpetual gripping this requires of your feet can lead to a nasty case of tendinitis, hammertoes, and bunions. Additionally, bare skin rubbing against the plastic or leather thong can lead to nasty blisters.

Fractures: With no support under your feet, all of that pressure from your body weight can create stress fractures in the bones of your feet. If you spend a lot of time on your feet in flip-flops, this is very likely to occur.

Bottom of your feet: The flip-flop isn’t stationary on your foot like an athletic shoe is. Since the bottom of your foot is in a constant sliding motion against the material, it can create a burning feeling or blisters, especially on hot days.

Arch and heel pain: If your footwear doesn’t support your arch, you run an excellent chance of developing plantar fasciitis, the inflammation of the band of tissue which runs along the bottom of your foot, connecting your heel to your arch. Pain may be felt anywhere along the plantar fascia.

For summer footwear, we suggest that you always wear athletic shoes that fit properly or a solid, rugged pair of sandals with significant arch support and a heavy sole.

Thanks to Huffington Post for this excellent infographic on what happens to your feet when you wear flip-flops.

Why are my ankles and feet swollen?

Swollen feet, ankles, and lower legs are a common problem and frequently appear together. The cause for the swelling can run from simply being on your feet too long, to a traumatic injury. And of course every woman knows how pregnancy can cause your feet to swell.

Swelling in the feet, ankles, or lower legs which does not resolve with rest and elevation, indicates a dysfunction and should be evaluated as soon as possible by your podiatrist.

Reasons for swollen feet and ankles

Too much time on your feet or in your chair

Your ankles may simply be swollen because you spend a lot of time sitting or standing, which impedes circulation, allowing fluids to build up. Movement is key to reducing the swelling, and when possible, elevating your feet above your heart.

Edema

The word edema means that there is fluid in the tissues. Peripheral edema is a circulation problem, usually seen in both ankles and lower legs. This is generally due to aging of the veins which leads to chronic swelling. Obesity and varicose veins play a role also. Read more about edema.

Side Effects of Medication

Although it will usually say so on the label, sudden swelling after starting a new medicine may come as a big surprise. Medications such as steroids, certain antidepressants, and medications for diabetes can cause a considerable amount of fluid retention, which manifests as swelling around the lower legs or ankles.

Diseases

Any disease which affects the movement of fluids in your body can cause swelling. Heart disease and liver disease are good examples.

Traumatic injury

If you sprained your ankle or fractured your ankle, chances are that you’re aware of it. Occasionally, a sprain or fracture may be minor, and left untreated, worsens. In this case, swelling will usually be accompanied by bruising – but not always.

Gout

Gout occurs when uric acid crystals build up within the fluid of your ankle. The crystals lead to inflammation and swelling. Read more about Gout.

Arthritis in the ankle

Ankle arthritis is very painful, and is most common in patients with rheumatoid arthritis or in those who’ve previously injured their ankle joint. Surgery may be necessary to alleviate the symptoms, and in some cases an ankle replacement may be necessary.

Infection

An infection of the soft tissue around the ankle joint may cause it to swell. The ankle joint itself may also swell. This can usually be treated with medications, but surgery is sometimes necessary.

Vascular obstruction

Problems with blood flow can affect circulation, which in turn leads to swelling in the ankles. Most commonly, the cause is a blood clot and will usually appear in just one of your legs. The swelling may appear throughout your foot, ankle, or lower leg.

Swollen feet, ankles, or lower legs may be caused by other conditions as well. Please see a podiatrist for a diagnosis.

Basketball: How to avoid the most common foot and ankle injuries

It’s safe to say that no sport demands more from an athlete’s feet and ankles than Basketball. Every movement on the court starts with the player’s feet – every shot, every rebound, and every pass.

The sudden turns, side-to-side cutting, running, stopping, sudden acceleration, changes in direction, jumping, and landing, combined with the immense size of pro basketball players, creates an almost perfect storm of injury possibilities for the lower extremities. Professional athletes train constantly on and off-court, in-season and out of season, yet their bones still fracture and their tendons and ligaments tear.

Here are the most common basketball injuries to the foot and ankle:

Deron Williams of the Nets suffered an ankle sprain in 2013

Ankle Sprains

An ankle sprain occurs when the foot rolls inward or outward and stretches or tears the ligaments in the ankle. In basketball, this usually occurs when the player lands improperly after a layup, or steps or lands on another player’s foot. Swelling and bruising occur, and the foot can’t bear weight. Mild ankle sprains heal relatively quickly, but a severe sprain can disable a player for 8 weeks or more.

Watch a video of Dr. Teichman from PA Foot and Ankle Associates explaining how an ankle sprain occurs.

Fractures

Fractures of the metatarsals (the long bones in your feet), the tibia (shinbone), and the navicular bone (on the top of your foot near the ankle), are what podiatrists refer to as overuse injuries. As an athlete trains, bones actually develop tiny fractures which heal quickly and strengthen the bone. However, their adjustment is slow, and when outside stress exceeds the bone’s capability to withstand it, the bone fractures. The repeated pounding of running, jumping, and landing is especially difficult on the 5th metatrasal bone on the outside of the foot, and is the bone most often fractured by basketball players.

Read more about foot fractures

Plantar fasciitis

Another overuse injury, plantar fasciitis is an inflammation of the plantar fascia, the band of tissue which connects the arch of the foot to the heel. Repeated pounding on hard surfaces – the basketball court – subjects the plantar fascia to stress, and it reacts with inflammation and pain. Treatment and rest are essential at the first sign of pain from plantar fasciitis, because if an athlete continues to play on the sore foot, the condition will only worsen.

Read more about plantar fasciitis

Achilles Tendonitis

Your achilles tendon is responsible for every step you take, and you couldn’t make that jump shot if you didn’t have one. You’re asking a lot of this tendon during the game and sometimes it can’t keep up, and becomes strained and irritated (itis).

The achilles tendon attaches your calf muscle to your heel, and when you damage it, you’ll usually feel a knife-like pain in your leg, just below the calf muscle. It maybe accompanied by swelling. If you really do a job on it and cause it to rupture, you may be able to walk, but it will be impossible to jump until it’s healed. An evaluation from a podiatrist is absolutely essential to speed its healing.

Read more about achilles tendonitis ​

For any of these injuries, the sooner that RICE begins, the less secondary damage you’ll incur. (Rest, Ice, Compression, Elevation). Do not continue to play or the injury may become much worse. Have your injury examined by a podiatrist as soon as possible.

How to avoid basketball injuries

Proper athletic conditioning

Strong and flexible ankles reduce the occurrence of injuries, improve performance on court, and decrease the time lost to an injury. Weekend athletes in pick-up basketball games are most frequently injured due to their lack of conditioning and weight training. That Michael Jordan-style layup looks beautiful, but hurts like mad coming down, especially if you land on another player’s foot.

Cold muscles are more prone to injury, so stretch and warm up before games with a light run, walking, biking, or calisthenics like jumping jacks and basic stretches. Stretch your muscles after the game also. If you’re out of shape, ease into it and don’t try to play like you did when you weighed 25 pounds less.

Wear new basketball shoes

They’re called basketball shoes for a good reason – they’re designed to support and accommodate the foot for the unique stresses of the game. If you play every weekend, your shoes should be updated every two months, as the padding and support wears out quickly. If you’re in high school or college, and working out almost every day, you should replace your shoes every month during the season.

The padding and stability a good pair of basketball shoes offer is your best defense against injury. Once your foot begins to rock or slide, even a little inside your shoes, your chance of injury goes up exponentially. As you accumulate playing hours on the shoe, the synthetic uppers slowly begin to fatigue and stretch in response to your starting and stopping motion. Slowly, the foot gains more and more rotational movement within the shoe, which in turn offers less and less protection to the foot.

Wear custom orthotics if you had a previous injury

Hands down, the best way to avoid re-injuring your foot or to provide additional arch support is to have custom orthotics made by a podiatrist. Proper balance, support, and foot/leg alignment are not only necessary for you to consistently play at your best level, but for your protection as well. In fact, the use of custom orthotics in the NBA has increased from about 40% in 1990 to more than 80% today.

Purple, bulging, painful veins in feet or ankles may be Varicose veins

Pregnant young women get them. So do aging women and men.

Varicose veins, which  lie just under the surface of the skin and appear swollen, twisted, and enlarged, may or may not represent a threat to your health. In some, they’re simply an aesthetic issue. In others, they can lead to serious conditions, like leg swelling, pain, changes in the skin, blood clots, and deep vein thrombosis. This is especially true as we age.

Varicose veins may appear anywhere in the legs, feet or ankles. They form when the valves in the veins which keep blood moving toward the heart weaken or fail to work properly. Blood backs up in the vein, and it swells from the pressure. Spider veins? They’re mini versions of varicose veins.

They’re also very common in pregnant women. During pregnancy, veins become more relaxed, and more blood travels through them. When the additional baby weight is gained, the pressure on the veins below the leg may cause problems with the valves, which in turn cause varicose veins to form.

In the aging population, varicose veins are more common. They may pose no health risk, but they also may indicate the presence of blood clots or a blockage deep in the veins. They may also be caused by a blockage or injury in the veins which connect the small veins near the surface of the skin to the veins deep within the muscle.

Varicose veins typically become worse over time, due to the malfunctioning vessel or valve. If the at-home treatments listed below don’t work for you, please make an appointment with your podiatrist for an evaluation.

Symptoms of varicose veins

• Veins appear dark, blue, red, swollen, or twisted
• A heavy feeling in the legs
• Areas around the veins are itchy
• Swelling, cramping, or pain in the feet, ankles, or lower legs
• Changes in skin color
• Dry, irritated, scaly skin
• Skin sores which are difficult to heal
• Thickening and hardening of the skin in the legs and ankles

 

Varicose veins can become very painful and cause sores to develop. They can also indicate a more serious underlying problem.

Who is most likely to develop varicose veins?

• Women over 50, and some men
• Those born with defective valves in their veins
• Those who are obese or overweight
• Pregnant women
• Smokers
• Those with a history of blood clots in their legs
• Those with a family history of varicose veins

At-home treatment for varicose veins

• Compression stockings gently squeeze your legs and keep blood flowing towards your heart. They also decrease swelling.
• When sitting or standing for long periods, move your legs a little to keep blood flowing.
• When resting, raise your legs above your heart for 15 minutes at a time.
• If overweight, develop a weight management plan with your physician.
• Low impact exercise like swimming or walking is helpful for managing your weight and keeping blood flowing.
• Dry or cracked skin can be relieved with moisturizers. However, check with your physician to be sure it’s appropriate for your condition.

If at-home treatments fail to relieve your discomfort, your physician may recommend:

• If the veins are small, such as spider veins, laser therapy may be effective.
• Sclerotherapy, in which a solution is injected into the vein which makes it disappear.
• Radiofrequency Ablation, which uses heat to close off and destroy the vein. The vein slowly disappears.
• Surgical vein stripping. Small cuts are made in the leg near the damaged vein, which is then removed.
• Surgical valve repair
• Surgical bypass to reroute blood flow around the damaged vein.
• Angioplasty or stent to open the vein, if it has narrowed.

Sochi Winter Olympics: Kelly Gunther’s amazing return after devastating ankle injury

While skating in Olympic trials in 2010, the unthinkable happened to Kelly Gunther. She was looking more and more like a potential Olympic medalist – she’d been skating since the age of six, had won several relay gold medals as a member of the Junior World Championship squad for inline skating, and had narrowly missed a spot on the 2010 U.S. Olympic team for Long Track Speedskating.

In March of 2010, during a 500-meter race at the American Cup series in Utah, Gunther suddenly, unexpectedly fell. She lost control when one foot tangled with the other, and she slid toward the barrier blades first.  One skate stuck in the wall, and the other came down on her boot, slicing the bone just below her left ankle. She had a double compound fracture and the skin on her ankle was lacerated, exposing bone, tendon, muscle, everything. And she was losing lots of blood. “My foot was hanging off my leg,” she said, and later remarked that if the paramedics hadn’t had the training and good sense to cut her skate from her foot, it would have probably come off in the boot. “I knew my ankle was broken, but I had no idea it wasn’t attached to my leg.”

Yet – and you may find this hard to believe –  Gunther skated two personal best times a year later, made the World Cup Team for 2011-2012, and placed third in the 1000 meters at the 2011-2012 National Championships. At the 2014 U.S. Olympic Trials, she skated her best-ever time in the 1000 meters to place fourth, winning her a spot on the U.S. Olympic Long Track Speedskating Team headed for Sochi. They don’t call her the comeback kid for nothing.  “I’ve definitely come through a lot”, she says, “and it just shows right there that you can never give up. You have to keep fighting for what you want.”

How did she come back?

While she was still on the ice, paramedics started an IV, and doctors worked furiously to save her foot. Later, surgeons inserted 10 screws and a metal plate into Gunther’s foot and ankle to keep the broken bones together. She spent four months in a cast, and two months in a walking boot. Twice each day she underwent intensive rehabilitation at the U.S. Olympic Training Center in Colorado Springs, performing exercises like picking up marbles with her toes and then thrusting her foot into a bucket of ice to wriggle the cramps out. All the while her doctors feared that the bone which had been shorn off by the blade might die, and Kelly would lose half of her foot.

But six months later, she was back on the ice. Most thought her chances of competing again on an Olympic level were a distant dream, yet Gunther’s on her way to Sochi.

The memory of her accident is with her every day, a not-so-gentle reminder of how easily dreams can be dashed. Before each event, Kelly has to have her leg worked on for 15-20 minutes – stretching and massage – so she can get her ankle into her clap skate. “It’s a reminder every day of how bad it was,” she says. “To keep fighting and how strong [the leg] is now, it’s almost stronger now than before I had fallen.”

What a remarkable story of determination. Kelly Gunther joins her fellow athletes on the Women’s Olympic Longtrack Speedskating Team: Brittany Bowe, Lauren Cholewinski, Maria Lamb, Heather Richardson, Anna Ringsred, Jilleanne Rookard, and Sugar Todd.