Arthritis Take 3

In this blog I will discuss a less commonly known type of arthritis. Psoriatic arthritis (PA), which affects 15-30% percent of people with psoriasis, can affect the foot and ankle. The skin disorder known as psoriasis is more common than the arthritis associated with it.

What are the symptoms?

PA is more common between the ages of 30-50 and it affects men and women equally. Like some of the other arthritic diseases we discussed in the past few blogs, people with PA can present with an array of symptoms. Systemically, patients can present to the physician being fatigue and lethargic.  Common symptoms are red, hot, painful and swollen joints. PA tends to affect the feet and ankles more than most other joints in the body. Patients can presents with large red toes, also known as sausage toes. Pain in the Achilles tendon and/or plantar fascia is a common symptom in this disease. Other common symptoms would be discoloration and separation of the toenails. In addition to have these symptoms a patient would have to be diagnosed with the psoriatic skin disorder in order to be diagnosed with PA. There is a genetic component to the disease, but there is little that is known about the exact cause.

Below are two pictures depicting the “sausage toe” and the separation and splitting of the toenail.

How do I get diagnosed with PA?

Just like some of the other rheumatologic disease, a Rheumatologist should be consulted to confirm or deny the diagnosis. There are no specific tests to diagnose a patient with RA, but other diseases can be ruled out.  A telltale sign to differentiate this disease from RA would be it affects the distal knuckles in the toes and fingers.  X-rays, MRI, CT scan or Ultrasounds can be performed to assess which joints are affected and the severity of the disease.  

How do I get treated for PA?
Just like the other rheumatic diseases, anti-inflammatory medications and the disease modifying antirheumatic agents are the common ways to treat it. Locally, corticosteroid injections into the affect joints can be performed as well. Exercise is important so that joints do not get stiff and cause long term disability.

This concludes the series of arthritis and the lower extremity. In conclusion, there is a lot of overlap with the symptoms and diagnosis of arthritis in the lower extremity. You should not ignore symptoms and should see a physician as soon as possible.

For more information, please see 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?

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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

The “Ins” and Outs of Ingrown Toenails

How do people develop ingrown toenails?

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In grown toenails, also known medically as Onychocryptosis,  are caused when the edges of the nail grow into the skin and cause pain. Many times this is caused by incorrect trimming of nails, tight shoe gear or nail disease. Onychomycosis, also known as  fungal nails, is a common cause of ingrown toenails. A fungus will cause the toe nail to thicken and subsequently to grow into the nail corners, causing pain. If someone has an ingrown toenail that is not treated pain can intensify to a point where shoe gear is not tolerable. If an ingrown toenail remains untreated an infection can develop. When an ingrown nail becomes infected is called a paronychia.

How do I treat an ingrown nail to prevent an infection?
Proper nail trimming is the key to prevention. Podiatrists recommend cutting nails straight across and not into the corners. Many adolescents tend to be “pickers” and this is a common age group for infected ingrown toenails. If someone is developing an ingrown it is recommend seeing a physician as soon as possible. The physician has proper instrumentation to help relieve the pressure an ingrown nail may be causing.

How do I know if I have an infection and how can it be treated?
If an ingrown nail is untreated an infection can develop. The signs and symptoms of an infected toenail, also known as a paronychia, are redness, swelling, pus, increased pain and an odor. If one is suspicious that they have an infection it is recommended to see a physician as soon as possible. If it truly is an infection your physician will recommend removing the offending nail border and draining the infection. This will require local anesthesia to the toe, which can be done in the office with minimal post-operative pain. Once the infection is drained you will most likely be placed on antibiotics for a few days. You will be given instructions on how to dress the wound and follow up with your physician in a few days.

What if I continue to get infected ingrown toenails?
If you tend to get infected toenails a few times a year it is recommend to remove the cause of the problem. This would be done via a procedure called a matrixectomy, where the root of the offending nail is permanently destroyed.  This  surgical procedure can be performed in the office with local anesthesia to the toe. Once the toe is anesthetized the physician will remove a section of the nail that has been causing the problem. At that time a chemical can be placed over the nail root to kill the root. One can also have a similar procedure where the nail root is physically removed from the body. There are different methods of removing/destroying the nail root. Whichever method you and your physician choice will determine your post-operative course. Most patients are completed healed within two weeks.

In summary, ingrown toenails and infection are preventable. If they do develop seeking medical attention is necessary, which can prevent worsening of the problem in the present and in the future.

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

Flatfeet For Everyone

On a day to day bases we hear people complain that they have flatfeet, but what exactly is flatfeet, what is the cause and how is it treated? A flatfoot, medically known as pes planus, is when the arch of the foot collapses. The biomechanical cause is when the subtalar joint, the joint below the ankle joint, is out of its’ correct alignment.
At what age can flatfeet begin to develop?
Many parents are concerned when they see their toddlers beginning to walk because it may appear to them that their toddler walks flatfooted. The fact is that before the age of five there is an increase of fatty tissue to the foot, and in addition, it takes up until that age for all the bones in the foot to be developed. Therefore, parents shouldn’t be concerned about flatfeet until around age five. There is a difference between in toeing and flatfeet and if one is concerned they should be evaluated by a physician.
How can one treat their young children and adolescents who suffer from flatfeet?
As children begin to increase their physical activity and play more sports parents may begin to notice that a flatfoot is developing. Around this time children playing sports may begin to complain of foot pain while doing their activities. Many times during this age a flatfoot develops and if treated early enough one can prevent it from worsening, which will ultimately prevent problems later in life. Conservatively it can be treated with orthotics, which are devices worn in the shoes in order to lift the arch and give more arch and heel support. If parents are interested in a more permanent fix there is a surgical procedure where an implant called an arthroereisis is place in the foot. The implant is placed in the subtalar joint, which is the joint directly beneath the ankle joint. The function of the implant is to correct the flatfoot deformity at the crux of the problem. Basically the implant acts as an “internal orthotic”. The surgery is performed as a same day procedure, with a 4 week recovery time. Children and young adults tolerate the procedure well and are ultimately fixing the cause of the flatfeet.
What about adults that develop flatfeet?
Many people don’t develop flatfeet until later in life. When adults begin to develop this problem it is usually due to different reasons than for children. Adult acquired flatfoot can be caused by illness, overuse, tendon injury etc. With an adult flatfoot it is more noticeable when one is non-weight bearing. The symptoms of an adult flatfoot may be different than with children and may only cause discomfort sporadically. Adult flatfoot is treated according to the symptoms. Many of these patients suffer from tendon pain in the arch area, which can be treated with orthotics, supportive braces, anti-inflammatory and physical therapy.
No matter what the age or cause of flatfeet there are many different treatment options for all different ages.

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