Podiatry and the Importance of Utilizing Other Specialties

Many patients present to a Podiatrist with a variety of foot and ankle complaints. As a Podiatrist I like to take a whole body approach to treating patients. I tend to utilize other medical specialist to help with diagnosis, treatment and ultimately to heal patients. I think all physicians should use all the tools that are available to them to help treat patients.

While performing a foot exam I tend to break down the exam into four components. The four components of the foot exam are the dermatological, vascular, orthopedic and neurologic aspects. I think that during an exam it is important to listen, examine and ask appropriate questions in order to get a complete picture of what the problem is. The foot and ankle are connected to the body and even though someone may think their symptoms are in the feet many times it is related to something else going on in the body.

For example, during the winter months many patients come into the office complaining about cold, purple toes. They state that as the weather gets colder they toes change colors, from red to white to blue to purple. It is important to perform a vascular lower extremity exam, but it is also important to ask if they get similar symptoms in their fingers. This disorder can be a variety of things, include Raynaud’s, Chilblains, but what is important is to ask general questions. Once I diagnosis the problem I frequently get other specialties involved in the patient’s care. I will refer the patient to a vascular surgeon, since this is not only a lower extremity problem, but a vascular problem as well.

Another example that I see very frequently is a patient who presents with numbness, tingling and burning to the feet. When a patient presents with neurological problems in the feet the first question I ask is do they have a history of pain back, spinal stenosis or disk disease. Nine out of ten times the patients have low back complaints and nine out of ten times the foot problems are coming from the back. At this time I complete my exam and make my treatment plan. Most times a neurologist consult is recommended. Many people say “well I came to see you because of my feet but you are sending me to a neurologist”. What I explain is that the foot is connected to all other systems of the body.

So whether the foot problem is related to the circulation (vascular), the skin (dermatology), the nerves or the biomechanics I utilize other medical specialists to give my patients a complete and thorough  treatment plan.

With medicine emerging and physicians becoming sub-specialized it is importation for doctors to rely and ask for assistance from their counter parts to help treat their patients.

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

Arthritis Take 2

Last week I discussed osteoarthritis and how it can affect the foot and ankle, but that is only hitting the surface when it comes to rheumatologic diseases and the foot. Rheumatoid arthritis, psoriatic arthritis, and other connective tissue diseases are just a few that can affect that foot and ankle. In this blog we will discuss these diseases, how they affect the feet, how they are diagnosed and most importantly how they are treated.

Rheumatoid Arthritis

Rheumatoid arthritis, also known as RA, is an autoimmune disease that affects synovial joints. It is a painful disease and without treatment it can cause severe disability. 85% of people with RA have symptoms in their ankle and foot joints. Joints with RA appear to be swollen, painful, warm and may become fused over time.  Below is a picture of RA in the hands, which causes severe swelling in the joints.

RA is different from osteoarthritis in that classic RA there appears to be stiff joints in the morning, whereas with osteoarthritis there are stiff joints throughout the entire day. With Osteoarthritis it gets worse over time and then becomes stable, RA becomes worse over time to a point where one cannot function or do daily life tasks.

Diagnosis is made with a multitude of test and via clinical exam. An x-ray of the feet during the mid to late stages of the disease may show subluxed/dislocation joints. In addition, there is decreased space within the joint and an increase in swelling around the joint. A blood test to test for Rheumatoid Factor can be performed, but a positive test doesn’t always mean there is RA and vica versa. During the course of diagnosis it is crucial to see a Rheumatologist, who can help rule out other autoimmune and rheumatologic diseases.

Treatment involves prolonging the disability that comes with the disease. Anti-inflammatory medications as well as disease-modifying antirheumatic drugs (DMAIRs) drugs are the mainstay of treatment. A Rheumatologist will prescribe and monitor these medications. Exercise is also important to help to decrease the symptoms and the disability of the disease.

RA in the foot causes lateral subluxation of the toes, this means that the toes tend to drift to the outside of the foot. Below is a picture where this can be seen.

This foot deformity can be prevented as the physician begins to see the toes are drifting. Once the deformity has occurred the best way to treat this is via surgery. The surgery will re align the joints that are causing the foot to deform. A foot like this can cause a great amount of pain, callus build up and can be very difficult for someone to find shoes.

In conclusion, rheumatoid arthritis is a systemic autoimmune disease that can affect all systems of the body and all aspects of one’s life. Early diagnosis is crucial to prevent long term problems. Concomitant care by your physician and by a rheumatologic specialist is critical for proper early treatment.

For more information on RA, visit http://www.arthritis.org/conditions-treatments/disease-center/rheumatoid-arthritis/

Next week I will conclude these series with Psoriatic arthritis and the feet.

For more information please visit our website, 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