What exactly is a podiatrist?

I’ve been writing this blog now for a few weeks and many of you may be wondering what exactly is a podiatrist and what can podiatrist do? In the world of foot and ankle medical care there seems to be a misunderstanding as to the level of care podiatrists can offer their patients

To start at the very beginning one must obtain a 4 year Bachelor’s degree. The major one chooses is not important but rather taking the appropriate pre-med courses, i.e. chemistry, biology, physics, are required. After completing a Bachelor’s degree, medical school is required. This is where podiatrists differ from other medical specialists. There is actually a special medical school just for podiatrist, which is called Podiatric Medical School.  This school is 4 years in duration and it is as grueling as any medical school. The first 2 years of school require didactic classes covering all aspect of the human body. The second 2 years of school are clinical rotations, including non-podiatric and podiatric rotations.

After completing a four year Podiatric Medical School, the degree of Doctor of Podiatric Medicine is granted. This is also knows as a DPM. Despite obtaining this degree, a podiatrist is years away from practicing on their own. After school a 3 or 4 year Podiatric Medicine and Surgical Residency is required. This is offered by different hospitals around the country. The residency is a grueling number of years, requiring late nights, weekend, and many “on call” days. During these few years one is trained to be an excellent foot and ankle physician and surgeon. This is the time in a podiatrist’s career that they will see a lot of diversity within the specialty. Usually during residency, the resident works with 20+ different podiatrists, and therefore, it is an opportunity to learn many skills from a wide array of physicians.
After completion of residency there are many options for what type of work a podiatrist can obtain. Many podiatrists enter private practice, with a mix of office hours and surgeries. Some podiatrists are employed by hospitals and treat hospitalized patients, and some podiatrists tent to see and treat more trauma. Despite what type of arrangements one enters all podiatrists are the same in that their expertise in all things foot and ankle are far superior to any other specialty in the medical profession.

I personally did a three year surgical residency where I was heavily trained in trauma as well as foot and ankle reconstruction. Despite this I am also well equipped to deal with day to day pathologies, such as heel pain, toe nail fungus, and tendonitis. If someone has a problem related to the foot and ankle, a podiatrist should be sought out.

For more information on what podiatrist do visit the American Podiatric Medical Associations website at APMA.org, or visit our website at www.footnj.com

High Arches; when high is too high

Recently during a patient encounter the patient said to me “Doc I was told I have high arches, but aren’t having arches a good thing”. I responded that although having an arch in the foot is good there is a point when arches become too high that it turns into a problem.
An excessive high arch, also known as Pes Cavus, literally translates in Latin to a “hollow foot”.  A cavus foot type is less common that the flat foot type, with about 10% of the population having this foot type. Despite the rarity, people that have this foot type can have just as many symptoms in the foot and ankle as people with flat feet.
How does someone get a Cavus foot?

A cavus foot can either be passed down through genetics or acquired during one’s life. Genetically there are rare neurological disorders that can be represented with a high arch foot. These disorders tent to have multiple other symptoms throughout the body. A cavus foot can be acquired whether due to muscle weakness that can cause the development of the high arch or a clubfoot deformity that was not fixed correctly. There can be many causes of high arch feet and amongst the literature there is still some ambiguity as to cause in some instances.

What are the symptoms of a Cavus foot?

The symptoms of this type of foot can vary and are hard to predict. Depending on what type of shoe gear someone wears will also predict their symptoms.  Symptoms can include pain in the metatarsal region, constant ankle sprains with weak ankles, Achilles tendonitis, difficulty with shoe fitting, stress fracture, and knee pain, just to name a few.  Formation on of hammertoes is a common side effect of a long lasting cavus foot type.

How does one treat a Cavus foot?

If someone if diagnosed with this type of foot and they have minimal pain or no pain the goal is to prevent symptoms in the future. Proper fitting shoe gear is essential. That would include a shoe with a build in arch. High heel shoes will put more pressure on the toes and metatarsals and can cause more discomfort and even metatarsal stress fractures. Custom molded orthotics can be built for a high arch foot which can prevent foot pain.

If cavus feet are causing severe symptoms surgery can be performed. Before undergoing surgery your surgeon will determine where in your foot is the deformity coming from. This can be performed by a simple test, which includes standing on a block and seeing if the deformity disappears. Once surgery is decided upon there are many options of how to fix the deformity. You and your surgeon will decided what procedure is most suited for you.

Don’t ignore a high arch just because you may think it is normal. If you are having any foot discomfort please see your physician for treatment.

For more information, please visit our website at www.footnj.com

All you ever needed to know about Ankle Sprains

Who is affected by ankle sprains?

http://footnj.com/podiatrist-new-jersey-about-us/23/233-foot-a-ankle-injuries-sprains-and-fractures

Ankle Sprains are one of the most common sports injuries. Sprained ankle can affect any type of athlete as well as non-athletic individuals. Ankle sprains typically occur from rolling ones ankle, therefore, it is common in basketball, baseball, football and many other sports. Ankle sprains are also commonly seen when someone takes a misstep, slips on ice or misses a curb.

Are there different types of ankle sprains?

There are three different levels of ankle sprains as well as three different types of ankle sprains. Ankle sprains can be graded from a level 1 to a level 3. Level 1 is when there is mild damage to the ankle ligaments, level 2 consists of a partial ligament tear and level 3, being the worst type of sprain, is a complete rupture of the ankle ligaments.

There are three different types of ankle sprains. The first being a lateral ankle sprain, which is the most common type. This is when one twists their ankle and injuries the ligaments located laterally, or on the “outside of the ankle”. This is seen with jumping injuries, such as in basketball.  The second type of ankle sprain is when there is a medial ankle sprain, or when the deltoid ligaments are injured. These are the ligament on the “inside of the ankle”. The last type of ankle sprain, which is the most severe, is a high ankle sprain, or a syndesmotic sprain. This is when there is a sprain of the ligament connecting the tibia and fibula, the two long bones of the leg. This is caused via high contact, high intensity sports. This ankle sprain is commonly misdiagnosed as the first two types of sprains.

How do I know if I have an ankle sprain?

Sprains are typically diagnosed via physical examination from a physician. X-rays are taken to rule out fractures and will help determine if there is a tear of the ankle ligaments.
What are my treatment options?
Conservative treatment is usually attempted first and is determined based on the severity of the injury. Usually ice, elevation, compression, immobilization and limited weight bearing is the initial treatment. At some point in the healing process physical therapy will be a key component is regaining strength and flexibility in the ankle. Depending on how significant the injury your physician will determine when it is necessary to begin physical therapy.

What if those conservative treatment methods don’t work?

If all of the ankle ligaments are torn in an ankle sprain of if someone has had multiple ankle sprains in a short amount of time your physician may recommend surgery to repair the ankle. The level of repair of the ankle ligaments will be evaluated via MRI or CT scan. Once your physician determines how many ankle ligaments need repair, you will undergo surgery to repair the ankle. Post operatively you will be immobilized for 6-8 weeks. Once you are out of an immobilization device aggressive physical therapy will begin to regain strength in the ankle.

Ankle sprains are very common sports injury and can affect everyone. The key is to seek treatment soon after the injury in order to avoid long term complications.

For more information, please visit our website at www.footnj.com

Common Sports Foot Injuries: Diagnosis and Treatment

Turf toe

http://footnj.com/podiatrist-new-jersey-about-us/23/235-sports-injuries
Turf toe, which is a sprain of the big toe joint, is commonly seen in football and soccer injuries. It is caused when the big toe is hyperextended. This injury is seen more when participating in sports that require wearing cleats and running on artificial turf. The big toe joint is used to push off when walking or playing sports and therefore, with this type of injury rest is the primary treatment. It is difficult to immobilize the big toe, therefore, a rigid shoe, ice, rest, anti-inflammatory medication and physical therapy is usually required. Healing times varies, but is usually a minimum of 4-6 weeks. If a turf toe injury occurs and is not treated appropriately it can become a chronic problem with pain to the big toe joint. If this is the case, long term use of the toe will become painful for the athlete. Upon initial injury, treatment should be sought out by a physician.

Shin Splints
Shin splints, also known as medial tibial stress syndrome, are an injury commonly seen in running, track and field and in general, in overuse syndrome. This is seen with pain along the lower shin, which is located between the knee and ankle joints.  It is defined as a strain on the muscles around the tibia bone. This injury can be seen as a running season ends, due to the excessive about running and stress to the tibia bone and muscles surrounding it. This can be difficult to diagnose, since there are many different causes of pain to the lower leg. X-rays as well as bone scans and MRIs can be used to help with a diagnosis. Treatment includes rest, ice, decrease activity, strapping, physical therapy, whirlpool, phonophoresis etc. Proper shoes gear, as well as orthotics, can help with the biomechanical aspect of the injury. An untreated shin splint may lead to a tibial stress fracture.

Stress Fractures
Stress Fractures or a hairline fracture is a small crack in the bone. It is most commonly seen in the tibia or metatarsal bones. It is caused by an excessive amount of activity in a short period of time. There are a variety of symptoms with this type of injury and can be difficult to diagnosis. Initially x-rays will be ordered, but stress fractures do not appear on x-rays for the first 10-14 days. Therefore, a bone scan, MRI or CT scan can help with a diagnosis. Treatment is via immobilization in a cast or walking boot. Healing time is a minimum of 4-6 weeks. If gone untreated it can lead to a complete fracture, which will require a longer healing time or surgery.
No matter what the injury, when treatment is sought out right after the initial injury the prognosis is more favorable for the long term. If the athlete hopes to participate in their activity for many years to come, these injuries should not be ignored and should be treated by a physician immediately.

For more information, visit our website at www.footnj.com