Tag Archives: foot

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

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.

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.

Giants’ Jon Beason Sidelined With Sesamoid Injury

16 Jun

Here’s some potentially bad news for Giants fans: Middle linebacker Jon Beason injured his right foot during off season training Friday. It appears he suffered a ligament tear and a fracture of the sesamoid bone.

jon beason foot injury

Beason at work against the Redskins in 2013

“You have freak injuries,” Beason said. “I was just changing directions… the movement was a little unorthodox, I was flexing with the big toe in the ground and then I pivoted on it all the way around. It’s a movement that I often do… I literally felt like I stepped in like a sprinkler head hole. I just felt it give right away.

“I really felt that I that I had torn the extensor, which is the tendon with the muscle, it’s how your big toe functions. That would have been season-ending.”

After limping to the sidelines and huddling with the training staff, Beason was carted off the field and taken to the Hospital for Special Surgery where he underwent an array of tests: MRI, CT, and x-rays. A definitive treatment plan has yet to be announced, but Beason’s status for the Giants’ regular season opener in Detroit is up in the air, as an injury like his typically requires a 12 week recovery period.

Beason, a 3-time Pro Bowler, was drafted by the Carolina Panthers in 2007. He played only one game for the Panthers in the 2011 season when he ruptured his left achilles tendon, and in 2012, played in just four games before suffering a microfracture in his right knee, requiring surgery.

Beason was traded to the Giants in October of 2013, and played in all 12 remaining games. At the end of the season, he was second on the team with 93 tackles. The Giants re-signed him in March and expected him to be a cornerstone of their defense this year.

So what’s a sesamoid anyway?

Most bones in our bodies are connected at joints, but not the sesamoids, which are connected only to tendons or embedded in muscle. Your kneecap is the largest sesamoid in your body, and the smallest are those found in the foot, two tiny, pea-shaped bones in the front of each foot that most people are unfamiliar with until they’re injured.

Located just behind the big toe, the sesamoids act like pulleys, providing a smooth surface over which the tendons glide, increasing the leverage of the tendons controlling the big toe. The sesamoids also assist with weightbearing and elevate the bones in your biggest toe. But that’s assuming you have sesamoids – some people are born without sesamoids in their feet and experience no problems.

Read more about sesamoiditis

If you damage the sesamoid bones in your feet, you’ll feel the pain in the ball of your foot, just behind the joint of the big toe. You may simply have an irritation of the tendons around the bones – called sesamoiditis, or you may have actually broken one of the tiny bones.

If you suspect an unjury to the sesamoids, seek an evaluation from a podiatrist, the most knowledgeable physician to treat this uncommon injury. Before your appointment, stop the activity which caused the pain, take over the counter pain medicine like advil or aleve to manage the pain and soreness, and use ice to reduce swelling.

If after a diagnosis, your podiatrist confirms an injury to the sesamoid bones, she or he may recommend any of the following:

  • custom orthotics to shift your body weight off of the forefoot
  • steroid injections to relieve swelling and pain
  • immobilization with a surgical boot
  • physical therapy
  • strapping or taping the big toe
  • surgery to remove or repair the sesamoids

The podiatrists at PA Foot and Ankle Associates are experts at treating sports injuries and are the best qualified physicians to diagnose and treat uncommon injuries of the foot and ankle.

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.

What Your Feet Tell You About Your Health

28 May

foot health

Seems to us that every general physician should ask you to take your socks off. Even if you’ve gone to see your doctor complaining of a chest cold, an inspection of your feet might inform them of the early symptoms of many conditions.

Our feet are farthest from our hearts and spine, so in many cases they’re the first area to indicate problems with the nerves or circulatory disorders. The brain and internal organs receive blood before our toes and feet do, so our appendages are the first to suffer.

Nine health problems which first show up in your feet

1.Always cold feet could be a sign of hypothyroidism, a condition in which your thyroid gland is underperforming. Most common as we approach middle age, hypothyroidism can also cause hair loss, fatigue, weight gain, and depression. A simple blood test ordered by your doctor can confirm this condition, and daily oral medication can get your thyroid gland functioning properly.

2. Suddenly hairless toes and feet could be a sign of a circulatory disorder, as your feet may not be receiving enough blood flow to sustain hair growth. Your doctor should check for a pulse in your feet, and if she has any doubts, should order a thorough cardiovascular screen.

3. Foot cramps that won’t quit may indicate a nutritional deficiency or dehydration. Sure, everybody’s feet cramp up now and then, but what matters is how often and how severe. If you exercise a lot, make sure you drink plenty of water to hydrate your muscles. You also should eat a balanced diet with plenty of potassium, magnesium, and calcium, as a lack of these nutrients can also cause cramping (good sources are nuts, leafy greens, and dairy). To relieve cramps in your feet, stretch your toes up, not down. If the cramping in your feet just won’t let up, see your podiatrist so that he or she can test for circulation issues or nerve damage.

4. Yellowing toenails is a sign of aging, but may also indicate a fungal infection. Yellowing can also occur when you wear nail polish for months without a break. If your toenails are flaky or brittle, you probably have a fungal infection and should see a podiatrist for treatment.

5. Flaky, itchy, or peeling skin between your toes is a sure sign of athlete’s foot. Even if you’re not an athlete, it’s easy to pick up a case of athlete’s foot if your feet are crammed in shoes all day or you walk barefoot in common areas like a sauna or swimming pool. Use an over the counter creme to relieve the symptoms, but if your flaking, itching, or peeling continues, you may have psoriasis or eczema. Your podiatrist can determine which is which and suggest a course of treatment.

6. Your big toe suddenly becomes swollen and painful. This is an almost sure sign that you have gout, a condition that inflames the joint. But it might also indicate inflammatory arthritis or infection. If it’s due to trauma, like someone landing on your foot after a jump shot, well, you’ll probably figure that one out.

7. A sore on your foot that won’t heal is a common side effect of diabetes, skin cancer, or circulatory disorders. In the case of diabetes, blood glucose levels that have raged out of control for long periods lead to nerve damage and small blood vessel damage, which in many cases appears first in your feet.  If the sore gets infected, it can lead to an amputation. But a sore on your foot – even between your toes – can also indicate certain kinds of skin cancer, so be sure to have it checked out by your podiatrist as soon as you discover it.

8. A slowly enlarging “growth” aside your big toe is probably a bunion. Faulty, inherited foot structure leads to this common foot deformity, which can be exacerbated by poor choices in footwear like high heels and flip flops. Unfortunately, bunions rarely stop growing, so that small, slightly sore bump today may be quite large and painful years from now. The only sure way to correct a bunion is with surgery. Splints, toe separators, and the like are temporary measures which will relieve symptoms, but won’t stop the deformity from becoming worse.

9. Pain in your heel may indicate plantar fasciitis, an inflammation of the tissue which connects your heel to your arch. If you have a sharp pain in your heel when you get out of bed in the morning, which slowly subsides as you move around, you probably have PF. There are many causes of plantar fasciitis, but primarily poor footwear, obesity, or working out too aggressively are to blame. To relieve minor symptoms of plantar fasciitis, ease up on your exercise program, lose weight, or wear shoes which support your feet properly. If symptoms persist, see your podiatrist for treatment.

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