Winter and your Feet

Winter and your Feet

This year we have had a very late and cold winter. Due to the significant low temperatures I have been seeing a lot of people with complaints of cold, discolored feet. Many of these patients are young healthy woman and are concerned about losing the circulation in their feet. Many of these patients state that they have never had these symptoms before and are concerned. After testing and further questioning, these patients are diagnosed with Raynaud’s phenomenon.

What is Raynaud’s phenomenon?

Raynaud’s phenomenon is a condition of vasospasms, which means there is decreased blood flow due to the cold temperature or stress. This can cause the toes and fingers to turn different colors, including purple, red or blue. Other symptoms of this phenomenon are extreme cold extremities and pain. This phenomenon is not to be confused with Raynaud’s disease, which is a systemic condition usually caused by a disease process.

The three colors of Raynaud’s are white, which is the initial stage, when there is decrease blood to the toes. The second stage is blue fingers and toes, which is due to a decrease in the oxygen to the extremities. The third and last phase is when the toes turn red, which is when temperature increases and blood returns to the digits.

How is this diagnosed and treated?

Diagnosis can be made by either clinical appearance or via a biopsy. Many patients that first present with this have a confusing appearance to their toes. It looks like a mix of Raynaud’s and dermatitis (which is a skin irritation). A biopsy will deny or confirm the diagnosis.

There are many options for treatment. The first option for a mild case is to wait until the weather gets warmer or the stress decreases. Stopping to smoke and decreasing caffeine intake can also diminish the symptoms. There are topical medications that can be prescribed to help vasodilate, or increase blood flow to the digits. If a topical medication does not work there are oral medications, which are blood pressure medications. Since blood pressure medications vasodilator the arteries they will help to decrease the symptoms of the Raynaud’s. If a patient has a severe case, which is associated with other diseases, there is surgery to help decrease the symptoms. Lately, Botox has been used in extreme cases of painful Raynaud’s

In conclusion, during the winter months, it is important to keep your digits warm and not allow long times of exposure to cold climates. If you are unsure of what is causing your skin to change colors, please go to your physician for a consultation.

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

Your Achilles Heel: Injury and Treatment

How do I know if I have Achilles tendonitis?
Achilles tendonitis, also known as Achilles tenosynovitis or Achilles tendinopathy, is inflammation of the Achilles tendon.  Symptoms include pain in the back of the calf, usually close to the heel and most commonly 2-6 cm from the insertion of the Achilles in the heel bone.  Others symptoms may include swelling, difficult with walking or a hard time exercising. This tendonitis is usually caused by overuse syndrome while active, which can affect athletes. Treatment includes ice, rest, anti-inflammatory medication, heel lifts, Achilles tendon stretching etc. If someone does not treat this injury appropriately it may lead to an Achilles tendon rupture.

Why does it seem that so many professional sports player get Achilles ruptures and can anyone get them?
The answer to this question is that anyone can rupture their Achilles rupture. An Achilles rupture is more common in men, ages 30-40. It is common in what is known as a “weekend warrior”, someone who is not quite athletic and then pushes themselves to exercise on their free time and these people tend to overdo it and then tear their Achilles.
Ruptures are caused my many different things such as overuse, Achilles tendonitis, certain antibiotics etc. When one tears their Achilles traumatically they usually hear a “pop” in the back of their calf and then they are unable to bear any weight. If someone experiences these symptoms they will most of the time present to the Emergency Room with them complaints. If the patient is a young, healthy, athletic patient most of the time the surgeon will recommend repairing the tendon. If one is older, more sedentary they may choose to allow the tendon to repair with conservative methods.
Many famous sports players have suffered from Achilles ruptures. Ryan Howard, from the Philadelphia Philles and Kobe Bryant, from the Los Angeles Lakers, are athletes who have ruptured their Achilles. These professional sports players ruptured their Achilles from an excessive amount of exercise and pressure placed on their calf and ankles. Both of these athletes opted for surgery in order to return to their pre injury athletic abilities.

How do I treat an Achilles tendon rupture?
If one chooses conservative treatment it includes a minimum of 8 weeks in a cast with no weight to the affected leg. There is a high chance of re rupture if one chooses this method of treatment. This is recommended for someone who is not very active and whom may be medically unstable for surgery.
Surgery is the primary method to fix an Achilles tendon rupture. Surgery usually requires general anesthesia as well as a long recovery period. The type of surgery one will have will depends on how bad the rupture is. Sometimes one can repair it with sutures or it may be more extensive where a graft from within your body or from a cadaver is needed. Recovery includes 6-8 weeks in a cast non weight bearing. Following that physical therapy will be needed to regain strength in that extremity.
In conclusion, these injuries, whether tendonitis or a rupture, can be quite debilitating and need treatment from a physician. If someone is unsure of what they are suffering from a visit to their physician will help with a diagnosis and treatment. These symptoms should not be ignored since they can cause long term problems with ambulation.

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