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

How can the Holiday’s affect your feet?

No matter what holiday you celebrate caution should be taken so you don’t have problems with your feet. Most holidays are filled with family, prayer and of course eating too much food.  Many of these activities can lead to problems with feet.

To start off many people go to pray with their family during the holiday, which means people will dress in their Easter best. Most times this means that shoe gear is more about appearance than comfort. I agree that it is okay once in a while to wear stylish, not so comfortable shoes, but if someone isn’t used to this type of shoe they may run into problems. As the weather is warming up and Easter/Passover is upon us many people will wear high heeled open toe shoes. I would like to warn those high heel open toe shoe wearers to be careful about developing blisters or wearing shoes that are too tight. Most importantly, twisting ankles is a common occurrence for the novice high heel wearer. A good suggestion would be to wear comfortable shoes to the event and perhaps change into a high heel shoe once at the location.

The second aspect of a holiday weekend for people to be aware of is the eating aspect of it. Most holidays are centered around families sitting and eating large quantities of food. The two groups of people to be concerned about this are diabetics and people who suffer from gout. Diabetics who over indulge are concerned about elevated blood sugar levels. As I have spoken about in past blogs, long term elevated blood sugar levels can lead to neuropathy, diabetic wounds, infections and a multitude of other problems.

People with gout can exacerbate their condition or bring on a gouty attack with certain foods. Therefore, they should be careful not to eat large quantities of meat, seafood or drink too much wine. If someone with gout has questionable symptoms of an attack they should seek attention with their physician. Remember the most common place for a gouty attack is the big toe joint of the foot.

In conclusion, holidays are times to spend with loved ones, but be careful because anything in excess can cause problems down the road.

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

Medical Foot Wear Podiatrist Shoes Podiatrist shoes 08234

What does warmer weather mean for your feet?

As this long and snowy winter finally comes to an end, everyone cannot wait to get out of their boots and into slippers, sandals and flip flops. But are sandals bad for your feet and what can you do to wear open toe shoes in the summer without any problems?

In the summer most people, including myself, like to expose their feet in some sort of open type of shoe, but before doing this think of the risks that this may involve. If you are a diabetic or have peripheral vascular disease, wearing an open type of shoe can be a disaster. If you are a diabetic with neuropathy (see earlier blog for definition) and you are wearing open toe shoes and get a cut on your foot, it can get infected and by the time you notice it there can be an infected wound. Therefore, it is highly recommended for diabetic and people with PAD to wear closed toe shoes throughout the entire year.

Another problem with wearing open toe shoes is that many sandals and flip flops that are sold in the summertime have no support built into the shoe. Therefore, many people in the summer tend to spend long hours outdoors exercising, walking and doing leisurely activities. This means that people spend more time on their feet with less support than during the winter. If someone wears a shoe with no support for hours at a time they are more than likely to begin to get achy, sore feet. Many patients actually spend weeks of the summer suffering with painful feet and by the time they seek help it is the beginning of fall and they are returning to supportive shoe gear. At the Foot and Ankle Center in Egg Harbor Township, NJ, we have a solution to this problem. We sell Spenco sandals/flip flops. Spenco’s are a sandal orthotic; the orthotic is built into the sandal. This is a great solution because this way you can still enjoy wearing a sandal during the warm months, but you can have support at the same time.

One more thing to consider when wearing open toe shoes in the summer is applying sun screen to your feet. Many people forget to do that and skin cancer can form on the feet. So don’t forget to apply sunscreen before leaving the house.

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

For more information on how to purchase Spenco sandals please call the office at 609-272-1450

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

Deep Vein Thrombosis and its relationship to podiatry

Deep Vein Thrombosis and its relationship to podiatry

What exactly is a Deep Vein Thrombosis (DVT)?

DVT is when a blog clot forms in the deep veins, this most commonly occurs in the legs. Symptoms of a DVT can include pain, swelling, redness in the leg. These symptoms can present themselves in different medical conditions, such as infection or lymphedema, therefore, if someone suspects they have a DVT IMMEDIATE medical attention should be sought.

How does a DVT develop?

There are three main risk factors for developing a DVT. They are venous stasis, hypercoagulability and damage to the endothelium. Venous stasis is when the veins are static and not moving. Hypercoagulability is when the blood has a higher change of clotting. Endothelial damage is damage to the blood vessels. Each of these causes has multiple causes. These 3 risks factors together are known as Virchow’s triad. The more risk factors a person has the higher chance of developing a DVT.

Who is at risk for developing a DVT?

Taking Virchow’s triad into consideration the following are some of the risk factors for developing a DVT: immobilization, obesity, surgery, birth control pills, age, cancer, pregnancy, trauma to the leg, infection, HIV and blood clotting disorders etc. There are many other risks factors, but these are the common ones.

How are DVT’s diagnosed and treated?

Immediate diagnosis is critical because if a DVT goes undiagnosed it can travel to the lungs, cause a Pulmonary Embolism and possible death. If a patient has a painful, swollen, red calf an Ultrasound should be performed immediately. There is a blood test that can help rule out a DVT but it is not as sensitive as the ultrasound in diagnosing a DVT.

A DVT is treated with anticoagulation medication, such as Coumadin, Lovenox, or  Xarelto . Treatment is usually required for a few months after a DVT is diagnosed. If someone has a history of DVT a filter can be placed surgically in their veins.

Can I prevent a DVT?

If someone has many risks factors they can take medication for prevention. In addition, exercise, compression stockings and staying active can help.

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

Skin Cancer of the Foot and Ankle

Skin Cancer of the Foot and Ankle

Many people are familiar that skin cancer is usually found on sun exposed areas, for example, the face, back, neck etc. Many people do not realize that skin cancer can appear on the feet and even on areas of the feet that are not sun exposed. In this blog I will discuss different types of skin cancers and how they present on the foot and ankle.

What are the common types of skin cancer that can appear on the foot and ankle?

There are three types of malignant skin cancers that I will discuss.

1.      

Basal Cell Carcinoma

This is the most common type of skin cancer that exists; it is usually localized to one area and does not metastasis. This skin cancer is found on sun exposed areas, it can be on a leg or the top of the foot.  This cancer can appear in a variety of forms, it may appear as an open sore, a pink growth, a bump or a scar. The way to treat this cancer is via excision, or removal. Moh’s surgery, which is a special surgery to remove skin cancer, is the most effective way to completely removal all the cancer cells.

2.      Squamous Cell Carcinoma (SCC)

The second most common type of cancer is SCC. This cancer can metastasis and some patient present first with a pre-cancerous appearing lesion, called Bowen’s disease. In patients that have venous leg ulcerations, a long standing ulcer can develop SCC. Therefore, as a podiatrist when I see a long standing wound I always biopsy it to rule out SCC. This type of skin cancer presents on sun exposed area. It may appear similar to a wart and may bleed. The presentation can vary. Treatment is to remove the lesion and sometimes radiation treatment is needed.

3.      Melanoma

This type of skin cancer is the most dangerous and can spread easily. It can be found on sun exposed areas, as well on the bottom of the feet and the toenails.  When one is concerned about melanoma it is important to follow the ABCs to help with diagnosis.

Asymmetrical, Borders (irregular borders), Color (multicolored), Dimensions (larger than 6mm), Elevation (lesions that are elevated).

If you have a lesion that has any of these characteristics it is important to get it examined.

Melanoma can affect the toenails as well. In Caucasian patients, a dark band that runs along the length of the toenail is concerning. This is usually biopsied to rule out melanoma. If melanoma in the foot is found immediate consultation to an oncologist is recommended for further work up.

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

Sterile Pedicures 08221 08234 New Jersey South Jersey

Last week on ABC’s 2020 there was a segment about the cleanliness at nail salons. The segment discussed how there is a high rate of infections at nail salons. I would like to discuss on this week’s blog about sterile pedicures and their advantage.

In the 2020 segment, ABC went undercover and inspected how certain salons sterilized and cleanse their equipment. Many salons do not disinfect their equipment properly. At our office we provide sterile pedicures. What this means is that all our equipment is sterilized in an autoclave. An autoclave is a machine that cleans medical equipment via steam and pressure. For example, in an Operating Room all surgical equipment is sterilized in this fashion. Using an autoclave significantly reducing the risk of infection since most of the bacteria and fungus is eradicated in the autoclave.

Another common thing to be weary of at a public nail salon is the cleanliness of the water baths. It is difficult to sterilize a water basin that is used for pedicures. The ideal situation would be for a liner in the water basin that can be replaced between each pedicure.

What is the risk in getting an unsterile pedicure?

There are two risks when getting an unsterile pedicure. The first is getting an infection. If the equipment is not clean there is a risk of getting an infection. The second risk is getting an ingrown toenail. Approximately 25% of patients that I see in the office with infected or non-infected ingrown toenails are from nail salons. These patients relate to me that at a salon the technician was trying to get a corner of a toenail out and in the process an ingrown toenail was created. At our office we have medical licensed nail technicians, who have a special certification by podiatrists, who perform our pedicures. They use sterile instruments, new paraffin wax for each patient and cut the toenails across. If the nail technicians are concerned about an ingrown toenail they do not trim the nails and have the patient see the podiatrist.

What is it so dangerous for diabetics to get unsterile pedicures?

Diabetics are immunocompromised, which means their immune system is weakened, and therefore they are at higher risk for infection. In addition to diabetics, patients with Peripheral Arterial Disease are at higher risk of not healing an infection. Patients with these diseases should be careful about getting an unsterile pedicure, if they were to get an infection they would be at high risk of a non-healing wound.  Therefore, it is highly recommended to get a pedicure at our office, where the pedicures are sterile and there is minimum risk for getting an infection.

Recently I filmed “Health Update’ with Robin Stoloff on NBC 40. I discussed the benefits of getting a sterile pedicure. Keep an eye out for the segment to air in the next few weeks.

For more information on sterile pedicures and to schedule one please call the office at 609-272-1450 or visit our website at www.footnj.com