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

Alternative Treatment for Peripheral Neuropathy

Alternative Treatment for Peripheral Neuropathy

In my past blogs I have discussed peripheral neuropathy and how it affects the feet. For a review, peripheral neuropathy is when the feeling/sensation to the feet decrease to a point where there is numbness, tingling and burning. This becomes a dangerous problem if a patient can’t feel their feet and they get a cut or sore. Without being able to feel the injury, it becomes difficult to treat it and this can many times lead to infection, gangrene and amputation. Many diabetics suffer from this condition, but more recently I have seen people without diabetes suffer from similar symptoms.

It is important to find the cause of these symptoms and attempt to treat the cause. If treating the cause doesn’t help with the symptoms, then this condition can be treated with medication. Traditionally there have been strong prescription medications that have been used to reduce the symptoms. These medications have many negative side effects, which cause can noncompliance issues. In addition, many patients who need these medications will be on many other prescription medications and there is hesitation about adding “another medication” to one’s regime.

Therefore, we have an alternative treatment option that is all natural, has no reported side effects and doesn’t interact with other medications. In our office we dispensed a Vitamin Supplement called NeuRx-TF. It is a vitamin supplement consisting of 4 different vitamins, which are Alpha-Lipoic Acid, Benfotiamine (or Vitamin B1), Vitamin B6 and Vitamin B12. This specific vitamin, NeuRx-TF, is different than any over the counter equivalents. Many patients will purchase an over the counter Vitamin B12 complex and have minimal changes in their symptoms. It is the exact formulary of this vitamin that helps with neuropathy.

The most important aspect of this vitamin is that the ingredients are fat-soluble. It is the fat-solubility of this vitamin that allows it to be absorbed and metabolized in the body. It is this property that allows blockage of the pathways that destroy the nerves, which entail cause neuropathy. The Vitamin B6 and B12 component of this vitamin can help reduce clotting of the circulatory system and prevent plaque from forming in the small tiny arteries to the feet.

In conclusion, there are alternatives ways to treat neuropathic symptoms. Many patients suffer way to long before coming to seek treatment. I always tell my patients that earlier you seek treatment for neuropathy the better your outcome will be.

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

2015: A new year, A new you, and new feet

2015: A new year, A new you, and new feet

As the New Year approaches many people make New Year’s Resolutions. Usually the resolutions are related to health and fitness. Foot health is related to one’s overall health. Many people run to the gym and start eating better right after January 1, but seeing your doctor is also related to your overall health. Most people go to their doctor’s’ for regular checkups, for example getting mammograms and Pap-smears yearly are common, but when was the last time you went to the podiatrist for a general foot checkup.

Many people think that they should only visit a podiatrist when they have a problem, but as podiatrist I belief it is just the opposite. Many foot related problems and injuries are avoidable with a regular checkups and exams. Many foot ailments occur with overuse, improper shoe gear and abnormal foot biomechanics.

Seeing a podiatrist for an exam is painless and most likely you will learn more about your feet than you ever thought was possible. A quick exam of your shoes and sneakers, and the way you walk barefoot can tell a lot about your foot. Many people go to the pharmacy and go to the foot care aisle and buy miscellaneous products to help their foot problems. To be honest I see many patients in the office who have tried these products and many times they have made their foot problems worse.

A big part of getting healthy in the New Year is working out. I personally love to exercise and I tell my patients all the time it is important to change your sneakers 2-3 times a years. In addition, custom molded orthotics is important to keeping your foot in a neutral position. Post people have flatfeet, some have high arches and few people have perfectly normal feet. Therefore, most people would benefit from a pair of orthotics. I personally have been wearing custom molded orthotics in my shoes for the past 25 years, without them I tend to have more pain and problems.

Many patients, who are adults, will tell me about their children’s foot problems. People are surprised to hear that I see many children. The truth is many foot problems begin in youth but are not noticed until adulthood. Therefore, having your child see the podiatrist is very important. Flatfeet are normal in an infant and even a toddler, but as your child approaches young adult hood, flatfeet isn’t normal and this should be addressed. One more thing that is important is to look at your feet, because one’s foot type in genetic. So if you are having problems with your feet, there is a 50% chance your child will also.

S

o now that the New Year is upon us make it a priority to call your local podiatrist and ask for a consultation and a general foot exam.

To book an appointment with us and for more information please visit our website at www.foonj.com

Heel Pain in Children

One of the most common causes of heel pain in young athletic children is something called Sever’s disease or calcaneal apophysitis. In this blog I will discuss what exactly is Sever’s disease, who it affects, how it can be treated and is it avoidable?

What exactly is Sever’s disease?

Sever’s disease, which is also called calcaneal apophysitis, is inflammation in the growth plate of the calcaneus (which is the heel bone). This occurs in a growing child, usually between the ages of 9-11. It presents as heel pain and is usually brought on by an increase in physical activity. If the pain in this area gets severe many times the child will be limping due to the pain. If this worsens it can lead to a red swollen heel.

How is Sever’s disease diagnosed?

Sever’s disease is usually diagnosed by signs, symptoms and clinical exam. A typical patient will be a 9 or 10 year old boy that has been playing a lot of soccer, or basketball, and has pain to the back of his heel while playing sports. He states when he rests the pain resolved. Squeezing on the back of the heel will elicit pain with Sever’s disease. In addition, x-rays can be taken, but are usually normal.

What Causes Sever’s disease?

This is caused by overuse and the stress that it causes to the bone and tendons. Many times with this disease the bones and the child are growing at an excessively quick rate.

How is Sever’s disease treated?

The principles of treatment are RICE, which include rest, ice, compression and elevation. Stretching the tendons attached to the heel (i.e. Achilles tendon, plantar fascia) is very important. Wearing good supportive shoes with custom orthotics will help. If the pain is severe oral anti-inflammatory medications can help.  Physical therapy may help if none of these other treatments resolve the pain. Many times taking a break from physical activity is required until the pain is resolved.

Even if treatment is not sought out it will resolve slowly on its own within a few weeks.

How can I prevent my child from getting Sever’s disease?

Stretching before and after activity is very important, avoiding excessive amounts of physical activity is good to prevent any type of injury. Lastly, wearing the appropriate supportive shoes with orthotics can prevent many different foot aliments.

For more information, please visit our website at http://www.footnj.com/podiatrist-new-jersey-about-us/23/237-heel-pain

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

Ball of Foot Pain Part II South Jersey Podiatrist

In last week’s blog I discussed how neuromas and stress fractures can cause pain in the ball of the foot. In this week’s blog I will discuss other causes of metatarsalgia. Just as a review, metatarsalgia is pain along the metatarsal bones. This is a general term and there are many different causes of this type of pain.

What is capsulitis?

A common complaint that many podiatrists hear about is pain along the 2^nd Metatarsal phalangeal joint. This is the joint where the 2^nd toe meets the 2^nd metatarsal. Pain in this area can either radiate to the toe or to the ball of the foot. It is important for the podiatrist to distinguish this with a neuroma, since there can be similar symptoms. Capsulitis is inflammation around the joint, most commonly being the 2^nd toe/metatarsal joint. Many times this can be caused by a patient’s biomechanics. Other times it can be caused by an increase in activity. The 1^st toe/metatarsal joint is programmed to take a significant amount of stress is able to accommodate for the body weight. If there is an excessive amount of activity the stress can shift to the 2^nd toe joint and therefore cause capsulitis. If there is chronic inflammation in the 2^nd toe joint that is not treated it can lead to ligament ruptures. The most common ligament that is ruptured in this joint is the plantar plate. This is the ligament on the bottom of the foot that holds the 2^nd toe and metatarsal in a straight position. If there are even microscopic tears in the tendon the 2^nd toe can begin to drift upward and/or to the side. When this begins to happen this is called pre-dislocation syndrome.  There can be swelling on the bottom of the foot near this joint, sometimes a callus may form in this area. Many patients will confuse this with a hammertoe. A hammertoe is a deformity within the toe joint, whereas pre-dislocation syndrome is a misalignment in the toe/metatarsal joint.

How is pre-dislocation syndrome treated?

This syndrome in the early stages is treated like any inflammation. An x-ray will be performed to rule out a fracture, tumor etc. Anti-inflammatory medications, ice, and rest will help with the symptoms. Orthotics will help in the long run to help support the joint and redistribute the pressure off of the inflamed area.  If conservative treatment fails surgery to repair the ligament and realign the joint may be necessary. Most of the time conservative treatment helps with decreasing the symptoms. If surgery is required your physician will order an MRI or ultrasound to assess the joint and where the damage is. Surgery typically includes repairing the rupture ligament and realigning the toe. Many times a pin or internal hardware is required to fuse the joint into a straight position.  Post operatively orthotics will be needed in order that the dislocation and the deformity do not return.

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

Foot Wounds: How to avoid them and how to treat them

There are many different types  of wounds that may appear on the foot and/or leg. The most common ones seen by podiatrists is a diabetic wound, which are caused by neuropathy (which is damage to the nerves, [see earlier blog on diabetes]). Many of these patients do not feel their feet, and therefore, present to a physician with an infected wound. Other types of common leg wounds are pressure wounds, the most common location being the back of the heel. These types of wounds would be found on bed bound patients. Another common type of leg wound is an arterial wound which is caused by Peripheral Arterial Disease (see earlier blog for more on PAD).  Another leg wound is a venous wound, when the veins in the legs don’t work properly and a wound develops on the inside of the lower leg. Despite what type of wound one has proper wound care, in addition to close supervision  by a trained physician in the field of wound care is critical to healing wounds.

Why are wounds so hard to heal?

Many times wounds are not treated until they are large in size. Many people with wounds many attempt, with good intentions, to treat the wounds by themselves. Usually wounds need to be treated with a multi team approach, including podiatrists, vascular surgeons, plastic surgeons etc. Many wounds tend to take a long time to heal due to other underlying medical conditions. For example, a diabetic wound can take a while to heal due to poor control of blood sugar, peripheral neuropathy and possible lack of circulation. Once all these issues are addressed the wound may have become chronic. In addition, wounds that are caused by arterial or venous disease need close supervision and many times surgery by a vascular surgeon. Without enough blood flow a wound will not heal. Many wounds that are caused by the venous disease take a long time to heal due to severe leg swelling, known as lymphedema. If the swelling is not controlled the wound will not heal.

Where do I seek treatment for a wound?

The best place to seek treatment wound be a wound center. Many hospitals around the country have a wound healing center, which employ the necessary multi specialties to help with wound healing. Internists, Infectious Disease Specialists, Podiatrists, Vascular and Plastic Surgeons are the type of physicians that wound work at a wound center. Many wound centers contain Hyperbaric Oxygen chambers, which are machines with high levels of oxygen, which help accelerate wound healing. In addition, there are many specialty, advanced wound care products, dressings and grafts, that can only be found at wound centers.

How Can I prevent a wound?

Patients that are high risk for wounds include diabetics with neuropathy, people with PAD, people with severe varicose veins with swollen legs, people with sickle cell etc. These patients should carefully inspect their feet daily to make sure there are no small cuts or openings. On the first site of an open lesion they should contact their physician. In addition, if a patient has an area on their foot that many be more prominent and perhaps be a pressure point, proper orthotics and offloading shoes can be dispensed by a podiatrist.

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

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