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.

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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

Foot and Low Back Pain: How they are interconnected

Foot and Low Back Pain: How they are interconnected

Previous to me becoming a Podiatrist I had no idea how interconnected low back pain is related to foot and ankle problems. As a Podiatrist I have good relationships with spine and back physicians since their patients suffer from foot and ankle problems and vica versa.

How is the back related to the foot and ankle?

The anatomy and physiology of the foot and ankle isn’t exclusive to the foot and ankle. As a Podiatrist when I do a foot exam I focus on 4 different components. I focus on the vascular system, dermatological exam, an orthopedic exam and a neurologic exam. These 4 components of an exam are not exclusive to the foot and they need to be investigated further if there is a deficit in one of them.

In relation to back problems, I will usually see a deficit in the neurologic exam in the foot.

What exactly does this mean?

Let’s say a patient has a pinched nerve or disc degeneration in the L4-L5 Lumbar Spine, which is causing them symptoms of pain in their low back. They will most likely have numbness, lack of sensation, weakness or burning in different parts of the foot. Many times a patient with low back pain will complain of pain that shoots from their back to their feet. It is the podiatrist and neurologist job to figure out if the pain is exclusively from the back or if there is a foot component as well.

Many times when I have this dilemma of where the pain is coming from I will order a Nerve Conduction Test and an Electromyography Test (EMG). These tests will be able to determine exactly where the problem is arising from.

How do you treat foot problems related to back problems?

When a patient presents with back and foot problems I am honest with them and I let them know that I will try to cure their foot and ankle problems but they may still have residual problems in their back. Many patients can be helped with their foot problems by changing their shoe gear, wearing a custom orthotics, ice, stretching and even anti-inflammatory medication. Physical therapy is a great modality which can focus on the foot and ankle as well as strengthen the core muscles to help alleviate back problems. In addition, there are medications to help with nerve pain, such as Gabapentin (Neurontin) and Lyrica (Pregabalin).

In conclusion, when a patient presents with symptoms in the foot and the back I like to take a multi system approach. I like to engage the patient, myself, their neurologist or back specialists and a physical therapy. Many patients with these symptoms present feeling that there is no treatment to help them, but with a little effort their pain can be reduced significantly.

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

Ball of Foot Pain Egg Harbor Township New Jersey

A very common problem that brings patients to the podiatrists is “the ball of my foot hurts”. This symptom can have many different etiologies. I will take the next couple of blogs to discuss what can cause this type of pain and how it can be treated.

What causes ball of foot pain?

Metatarsalgia, which is defined as pain in the metatarsal region, is known as ball of foot pain. Metatarsalgia is a vague term and therefore it is important for your physician to weed through the symptoms you have in order to diagnose the problem. Many different things can cause metatarsalgia such as a neuroma, stress fracture, tendonitis, capsulitis, fat pad atrophy, gout, rheumatoid arthritis etc. I will discuss each of these disease processes and how to treat them.

What is a neuroma and how can it be treated?

A Morton’s neuroma, which is an enlarged nerve between the third and fourth metatarsals, is a common cause of metatarsalgia. There is a nerve that is “entrapped” and enlarged which sits between the metatarsal. Therefore, shoes and activity can cause compression of the nerve and therefore can cause symptoms. Symptoms typically include sharp, shooting pain, numbness, tingling and burning. The most accurate way to diagnose a neuroma is with an ultrasound. Once it is properly diagnosed usually treatment is via conservative methods. Treatment is aimed at shrinking the size of the overgrown nerve; this includes orthotics and corticosteroid injections. A newer treatment method is a sclerosing alcohol injection; the function of this is to shrink the enlarged nerve. Wearing a wider toe box can also help to relief symptoms.  If conservative treatment fails then surgical removal of the neuroma may be indicated.

What about a stress fracture?

A stress fracture is an incomplete fracture of the bones. Unlike an acute traumatic fracture, this type of fracture may take a few weeks to develop. It is usually caused by over activity and increased stress to the bone. In the foot region the most common bone to have a stress fracture is the 2^nd metatarsal. Many athletes who suddenly increase their activity complain of pain in the ball of the foot. As a podiatrist I am on high alert for a stress fracture in these types of patients. Within the first 10-14 days a stress fracture will not appear on x-ray, and therefore, high clinical suspicion is needed for accurate diagnosis. Applying a tuning fork to the area of concern will cause pain, if there is a stress fracture. Placing a patient in a non-weight bearing immobilizing cast is imperative for healing. Most stress fractures are treated conservatively and do not need surgical correction.

Next week I will discuss other causes of metatarsalgia.

For more information, please visit www.footnj.com

Joint Fusions- Part II

In last week’s blog I discussed the details of what is entailed in foot and ankle joint fusion surgery. I discussed the indications, actually surgery and recovery. In this week’s blog I will discuss the pros and cons; I will also discuss when to decide whether or not to have this type of surgery.

What are the pros to joint fusion surgery?

One of the main pros to having this type of surgery is to decrease and hopefully eliminate pain. Many people have severe arthritis or disability from a trauma and have been suffering with pain for years. If this is the case then many times joint fusion surgery will help to eliminate the pain and decreased disability. Joint fusion surgery can help return a patient to a pain free life especially while weight bearing. Another advantage to having this type of surgery would be that most times fusing joints lasts a lifetime and there isn’t a need for a “re do” surgery.

What are the cons to joint fusion surgery?

With joint fusion surgery there is usually close to zero motion at the joint that has been fused. Many patients that have these types of surgeries already have significant decrease in motion in those joints, but by permanently fusing the joints there will be NO motion in that joint. This can be difficult to comprehend until after the surgery is complete. For example, fusing an ankle joint will make it almost impossible to flex the ankle. Fusing the big toe joint will make it difficult to crouch, lunge or go up and down a ladder.

Another disadvantage is that years later there can be residual arthritis that forms in the joints around the joint that was fused. Since the fused joint has no motion the joints around it tend to have increased motion, which may lead to arthritis in those joints.

How does this relate to Lori P?

As I mentioned last week our biller, Lori P., was in a severe car accident in April 2013. She had an open fracture, which is when there is a fracture in addition to bone that is sticking out of the leg. At that time the surgeon was primarily concerned about her losing her leg. When she was medically stable and it was determined that her leg was able to be saved she was in extreme pain. She had severe bone loss and SEVERE arthritis. At that time the decision was made between her and her surgeon that an ankle fusion would be the best option for her long term ability to walk. She went through multiple surgeries, a long recovery, including non-healing wounds and severe pain, but today she is doing great. She walks with a slight limp and on rainy days she complains of arthritis pain in her surgical area. When I told her I was writing this blog about joint fusions she said “the ankle joint fusion saved my life and leg, because of it I am able to walk, live life, work and most importantly, enjoy my grandson”.

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