Plantar Warts: Symptoms, Causes & Treatment!

Plantar Warts

Plantar Warts
(Verruca)

What is it?
Warts are the manifestation and growth of a contagious virus (HPV, the Human Papillomavirus) that invades the skin through small cuts or abrasions on its surface – even through openings that are too small to be seen with the naked eye. Once inside the skin, the virus can grow and spread, stimulating the rapid generation of cells on the surface of your skin. There are over 60 different strains of HPV. Technically, warts may appear anywhere on the skin, but only those that appear on the soles of the feet are known as plantar warts.

What to look for:
If you see a bump on the sole of your foot that changes over time, suspect plantar warts. Both plantar warts and common warts (those occurring on other areas of the body) may be flesh-colored, white, tan or pink. Plantar warts are often grey or brown. Some warts may develop an uneven surface and a cauliflower-like texture over time, or they may acquire black spots or streaky lines. The black dots or lines are characteristic of plantar warts, and are caused by the bleeding of small blood vessels into the tissue. Warts also can bleed profusely when accidentally scratched or cut.
Warts start as small bumps, but can grow to an inch or more if left untreated. They can spread to other parts of the body, or form clusters.
A wart may or may not be painful, depending on its location. Warts on the ball of the foot or the heel, for example, where weight and pressure are brought to bear, may cause the patient great pain.

Other notes:
Plantar warts (and warts in general) are not caused by toads. (That’s an old wives’ tale – toads simply have bumpy skin; they don’t carry HPV). Only people can pass warts to other people – either from direct skin-to-skin contact or from inadvertently leaving the virus somewhere where others can pick it up. For example, the virus can be spread when one person with plantar warts walks barefoot on ground where others do the same. The virus can also be spread if a patient with plantar warts loans shoes or socks, which have not been washed, to an uninfected person.
Warts can easily be spread to areas around the body other than the feet, such as when the patient touches the plantar wart, and then touches another area of his or her body, such as the hands, face, genitals, scalp, arms, legs, ears – you name it. If the wart bleeds (such as when it is nicked or cut accidentally), this creates an ideal avenue for infection of another part of the body, or another person.
Warts are also stubborn and frustrating. They may disappear for a while, and then recur in the same place. They may go away with treatment and then come back – or they may never recur. Children seem to be more prone to warts than adults, leading some medical experts to theorize that as they age, some people can develop immunities to the virus that causes warts.

What it means to you:
Plantar warts (and all warts) are often unsightly and sometimes painful, but not life-threatening. That said, however, it is important to note that there are various lesions of the skin on the foot, including corns, callouses, moles – and even a few rare cancerous growths – that have similar or identical characteristics. It’s best to have a Podiatric Physician at Advanced Foot & Ankle Center examine any growth on your foot to ascertain that it is indeed a wart. Many common warts can be addressed with over-the-counter medications; however, it depends on the specific type of wart, and how far it has progressed.

What causes it?
You acquire the wart virus through direct contact with an infected person, or by coming into contact with an infected surface, such as a shower room floor. The virus lives in a warm, moist environment. It’s generally difficult to tell when or where you came into contact with the organism, however, since the incubation period for the HPV can be up to three months, although a wart itself can lie dormant for years.

What cures it?
IMPORTANT: If you have diabetes, you should see your Podiatric Physician at Advanced Foot & Ankle Center, at the first sign of any problems with the skin of your feet or toes, no matter how minor you may think they are. The following precautions and steps may be recommended by your podiatric physician, but should not be undertaken without his/her supervision and consent.
Plantar warts are stubborn, and most of the time, will require a podiatric physician’s intervention before they’ll go away. Sorry to disappoint those who believe in home remedies, but this is not the time to try holistic medicine, your Grandmom’s favorite wart remover, a pumice stone or anything else your doctor didn’t recommend.
There are various preparations on the market which can be used to treat warts. However, it is essential to receive confirmation from your healthcare professional that the lesion you want to treat is, in fact, a wart, and not something else. By self-diagnosing and treating without medical supervision, you may actually do yourself more harm than good. Plus, since some of the remedies on the market contain acid, they can irritate, damage and scar normal skin, or worsen a condition that is not a wart.
A podiatric physician, upon diagnosing a plantar wart, may recommend a prescription medication (or in some rare cases, an over-the-counter remedy) designed for warts. If, however, the condition looks fairly entrenched – and plantar warts are known to be very stubborn – several other methods may be used to treat it.

• Because a wart is a virus, the goal of the professional is to remove the affected area that contains the warty skin cells, while keeping damage to the surrounding tissue to a minimum. In this case, the doctor may choose one of several methods: Freezing the wart (also known as cryotherapy): In this procedure, the doctor destroys the wart by treating it with liquid nitrogen. The patient will notice that the affected area develops a blister, which falls away within a week to reveal unaffected tissue underneath. This is generally many doctors’ first choice of treatments, since it is conservative and causes very little tissue damage or pain. Unfortunately, repeated treatments may be needed, should the entire wart not be removed the first time.
• Injection of medication: A doctor may choose to inject the wart with a drug that will attack the virus. Bleomycin and interferon-alpha have been used with success in these applications.
• Surgical procedures: Your podiatric physician may choose to use a technique that involves cutting away the wart via a process called electrodesiccation and curettage, which uses an electric needle. Some patients find this procedure painful, and scarring can result; however, it is an effective form of treatment that often results in long-term wart removal. Note: Do not try to cut anything you suspect to be a wart off of your own skin. This is extremely dangerous and can lead to infection and scarring, among other problems.
• Laser surgery: There are two procedures for laser wart removal; your podiatric physician can decide which is best. One type of laser cuts away the growth; another cauterizes the blood vessels that feed it so that the wart dies and falls away on its own. Laser surgery may also be painful and may require a longer healing time.
• Chemical removal. Your podiatrist may choose to use one ore more chemicals to remove the wart.

Your podiatric physician will be best able to recommend a treatment method based on your specific condition; listen to his/her recommendations, and do not be afraid to ask for a second opinion if you are concerned.

How can plantar warts be prevented?
The best way to prevent a plantar wart is to keep your feet clean, and to keep them away from surfaces on which the HPV might be lurking. Avoid walking barefoot, and wear sandals or some kind of foot covering at pools and in locker rooms and other warm, moist communal areas where people go barefoot. Change your shoes and socks daily, and allow your shoes to dry thoroughly between each wearing. Do not wear the shoes or socks of others, not even those of your closest friends. Wash socks after each wearing. (In this case, it’s the same kind of preventive medicine that is advised for athlete’s foot – another infection that can be picked up in public areas)
Keep your feet clean and dry, and since children are prone to warts, encourage them to do the same, and to follow the above rules as well. Check kids’ feet periodically and report any suspicious bumps, growths or lesions to your pediatrician. Remember that kids are easily frightened by medical procedures, and the earlier a wart is diagnosed, the easier it will be to get rid of it.
If a wart is diagnosed, do not pick, pull or try to snip at it, and don’t try to rub it with a pumice stone or with any kind of lotion. Don’t ignore it, either! Put a band-aid over the area to discourage contact with it and see a doctor. If it’s a wart, you’ll have caught it early. If it’s not a wart – well, you’ll still have caught it early, no matter what it turns out to be. Wash your hands carefully after caring for the affected area, and do not touch yourself anywhere before you wash those hands!
Remember that HPV is a highly contagious virus, and that it will spread if not treated. Don’t give it a fighting chance. If you or your children notice a wart – on your feet or on any part of your body – reduce the risk of it spreading while it’s being treated. Avoid brushing, clipping, shaving or combing the area over and around the wart in order to avoid nicking or cutting the wart and causing it to bleed. Don’t use the same nail clipper or file on hands or feet that have warts as you do on hands or feet that don’t.

Flat Foot Reconstructive Surgery

Flat Foot Surgery Relieves Pain, Restores Function

Surgical advances have dramatically improved the ability to alleviate the pain and decreased function that millions of Americans experience due to flat feet. Nevertheless, many patients and even some physicians remain unaware of the new procedures, which are best performed by a foot and ankle specialist who has the applicable training and experience such as the Podiatrists at Advanced Foot & Ankle Center!

Indications and Outcomes for the Procedure

As with most surgeries, patients and physicians should consider the surgery only after other, less invasive treatments have proven unproductive. Indications for surgery include:

• Pain
• Inability to function
• Failure to improve after a six-month course of specific, directed physical therapy
• Failure to improve after using arch supports, orthotics, or ankle and foot bracing

Once patients are at that point, the good news is that the procedure has considerably better outcomes than more traditional flat foot surgery. 

How It's Done

The procedure involves cutting and shifting the bone, and then performing a tendon transfer.

• First, the surgeon performs a calcaneal osteotomy, cutting the heel bone and shifting it into the correct position.
• Second, the surgeon transfers the tendon. Surgeons reroute the flexor digitorum to replace the troublesome posterior tibial tendon.
• Finally, the surgeon typically performs one or more fine-tuning procedures that address the patient’s specific foot deformity.
• Often, the surgeon will lengthen the Achilles tendon because it is common for the mispositioned foot to cause the Achilles to tighten.
• Occasionally, to increase the arch, the surgeon performs another osteotomy of one of the bones of the midfoot.
• Occasionally, to point the foot in a straightforward direction, the surgeon performs another osteotomy of the outside portion of the calcaneus.

Podiatrists offer both pain relief and the chance to regain a range of motion to patients suffering from this condition.

Myths About Bunion Surgery

6 Myths About Bunion Surgery

A bunion is a structural problem of the big toe joint causing a boney prominence. Surgery is commonly performed to correct the problem. Some people simply avoid surgery because they may have "heard" some misnomers that guide their decision. 

Surgery for bunions involves more than just simply shaving the boney protrusion. It typically requires that the deviated bones to be structurally realigned. Milder bunions are corrected with bone cuts close to the big toe joint. Larger bunions typically need a more "involved" bone cut or a fusion procedure to completely realign the structural problem. It takes approximately six weeks for the bones to mend in the corrected position.

Myth #1: Bunion Surgery Is Excruciatingly Painful

Bunion surgery is not particularly "more" painful than other surgeries. Foot surgery, in general, can lend itself to increased pain post-operatively because the foot is below the level of the heart and blood can rush to the area, causing a throbbing feeling. Also, the foot does not have much soft tissue surrounding the bones, so moderate postoperative swelling can aggravate the nerves, causing pain. Most patients find that the postoperative discomfort is tolerable with pain medication and a program dedicated to pain relief. 

Myth #2: Bunions Come Back Even After Surgery

A majority of patients are satisfied with their outcome after bunion surgery. Recurrence is possible, but not particularly likely. And, return of a bunion is not necessarily a complication, but something that can happen over time. Some patients have excessive motion in the foot that may predispose them to recurrence. Another possible reason for recurrence occurs when a procedure that was performed did not best suit the severity of the particular bunion -- so it's important to have the surgery tailored for your particular bunion.

Myth #3: Bunion Surgery = Cast and Crutches 

While this was true years ago, more modern techniques have allowed surgeons to mobilize patients quicker. Mild bunions typically involve walking in a surgical shoe for six weeks. Surgeons consider casting with crutches with larger bunions because setting the bones is more complex. Some surgeons have moved away from bone cuts and instead perform a fusion procedure that allows for realignment of the entire deviated bone. This fusion procedure is called the Lapidus Bunionectomy, and contemporary approaches allow for early protected walking at two weeks postoperatively. Recent technological advances in medical implant devices have also helped surgeons modify their techniques to get patients moving quicker.

Myth #4: You Have To Be Off Work

This is simply not true, and a function of the demands of your workplace. A patient can return to a sedentary desk job within two weeks of the surgery, and varies based on surgeon protocol and type of bunionectomy performed. Jobs that require excessive walking, standing and physical activity may require a medical leave of absence -- which can be up to two months depending on healing and job requirements. Getting around can be difficult and driving may be off limits if you have your right foot operated on and/or drive a manual.

Myth #5: Don't Fix A Bunion Unless Painful

The concern with surgically correcting a non-painful bunion is that the surgery can result in longstanding post-operative pain that may not have been there prior. However, people do have surgery for non-painful bunions if the bunion interferes with activity, continues to become larger, or if they have difficulty wearing certain shoes and/or if the bunion is simply unsightly. Surgeons strongly prefer (or require) that patients have a painful bunion before they consider surgery. Fortunately, pain is the most common reason people seek treatment. 

Myth #6: Healing After Bunion Surgery Results In Unsightly Scars

Surgical healing is part of the process with any surgery, and bunion surgery is no different. Incisions can be minimized, or alternate surgical approaches may be used to hide surgical scars. Bunion incisions are either located on the top of the foot or on the side of the foot, and technique varies based on surgeon. A surgeon may perform a plastic surgery-type closure to keep scaring minimum. 

Bunion surgery, just like any surgery, has its share of myths. Because not all bunions are treated the same, information that may apply to someone with a large bunion may not apply to someone with a small bunion. Take the time to sort out what is truth vs. myth for your particular problem. Obtaining medical information your Podiatrist at Advanced Foot and Ankle Center would be advisable!

Runners: Are Your Feet Marathon Ready?

Are Your Feet Marathon Ready?

Your feet need to be in tip-top shape if you expect to run 138,336 feet to actually finish a marathon.

Your feet are the connection to the ground, so they have to be primed and the necessary steps should be taken to avoid injury that can slow you down or knock you out of the race. So whether you are training to win or simply running to run, it is important to know what foot problems can occur, and hopefully treat them before they become a marathon-breaker.

Specific Marathon Foot Issues: No matter how experienced a runner, the foot is always susceptible to running injuries, and this risk amplified during marathon training. On marathon day, however, there is specific injury risk because runners tend to me more committed to "running though" a problem (new or old).

A method to remember marathon-related foot problems is the mnemonic "ABCD":

Abrasions & Blisters
Bone Breaks 
Cramping & Tendon Problems
Disorders of the Toenail

Provided below are explanations of marathon-related foot injuries as well as preventative measures.

Abrasions & Blisters: Pressure points and repetitive irritation set the stage for abrasions and blisters. Common runner pressure spots are on the top of the toes, big toe joint area and the back part of the heel. Runners with bunions and hammer toes are more likely to have skin irritation. An abrasion is a simple break in the skin, whereas a blister is lifting of the skin with a fluid collection beneath it. 

Preventive Solutions: Prevention is best form of treatment. Keep skin thoroughly moisturized, as dry skin is more prone to tearing. Callused areas should be targeted, and urea creams are specifically useful in breaking down excessive skin build-up. Callus/corn removers should be used cautiously as they contain salicylic acid and can excessively deteriorate tissue, leading to open sores.

Socks are important in the battle against skin irritation when running long distances. Specialty socks have specific protective cushioned areas dedicated to pressure spots.

Ill-fitting footwear is one of the main reason for friction, so it's important to have sneakers that best fit your foot type. Also, carefully inspect the stitching at the front of the sneaker where the toes bend to be sure that it does not rub when fully extended. Newer sneakers are more likely to be problematic.

Bone Breaks: Fractures  are the most serious problem that a runner could develop. They typically start as a microscopic fracture (stress fracture) and can progress onto a break. Most common are metatarsal stress fractures involving the second toe region. Heel strike runners may be more susceptible to stress fractures of the heel bone.

An acute stress fracture is often present with varying degrees of pain, swelling, and sometimes redness, though stress fractures may occur without you even knowing it. Running with a stress fracture is not medically advised, and most health care professionals would recommend calling off the race. Runners who don't heed such advice may fully fracture through the bone which could lead to bone displacement (malalignment) -- a potentially serious problem. Some people may have brittle bones making them more likely to develop a bone injury. Certain foot types seem to be more prone to stress fractures -- very flat feet or very high arched feet.

Preventive Solutions: Over stressing the foot is what often leads to fractures. Pain may also be an indicator that you are training beyond the current capability of your foot, so it may be necessary to scale back. Pain should not be ignored, and any could be a sign of a fracture, so seeking the care of a Podiatrist is recommended.

More cushioned sneakers do not necessarily offer more protection from developing an injury, and running form may be more important. Nonetheless, properly fitting running sneakers are important to help you become more in tune with your running technique. Depending of foot structure, orthotics may help balance the foot and take pressure off those spots prone to stress fractures.

Proper nutrition is important in maintaining strong bones. Vitamin C is necessary for collagen formation, a precursor to bone. Calcium is needed for proper bone health and Vitamin D helps promote Calcium absorption. Eating a balanced meal should be a part of your overall health plan.

Cramping & Tendonitis: Biomechanical and structural problems within the foot tend to manifest as shin splints, arch cramping, plantar fasciitis and/or tendinitis. Less experienced runners tend to develop these problems and is commonly the result of training past the capabilities of your foot. Tight muscles may also be at the root of cramping and shin splints. These problems tend to be self-limited and resolve with targeted treatment programs, but can set you back in terms of being marathon ready.

Preventive Solutions: Building strength and stamina slowly is the best method to avoid injury. Be sure to incorporate a thorough stretching program to keep muscles and tendons stretched and warmed up. Weak muscles within the foot can be strengthened with specific foot training programs. Ease cramping in the foot with post-run Epsom salt baths. Deep tissue massage is also a helpful measure.

Arch supports (orthotics) can help manage arch pain by providing support and perhaps better alignment of the foot in certain people. Of course, foot type plays a big role in selecting the proper amount of support. Running in the wrong-type of sneaker for your foot may be responsible for discomfort, so changing sneakers may be beneficial. A break from running may be necessary to resolve the problem. Runners with persistent problems should seek the advice of a Podiatrist at Advanced Foot & Ankle Center, Inc.!

Disorders of the Toenail: A black toenail is a problem that every marathon runner has experienced, and is the result of bleeding beneath the nail plate. Pressure and friction from repetitive running seem to be the culprit. The damaged nail can be painful and often results in the toenail falling off. Fortunately, a black toenail doesn't typically interfere with training and common is self-limiting.

Preventive Solutions: Prevention is difficult, as the black toenail is often the result of prolonged toenail irritation from the intense mileage of training. Again, properly fitting shoes with enough room for the toenails are helpful. Keep toenails well trimmed to not create a fulcrum for the nail to become lifted. It is unclear if moisturizing the toenails offers any protective benefit but a soft nail may, theoretically, be less prone to damage. Should you develop an acute painful black toenail, then medical attention may be needed to alleviate the active collection of blood. An irritated loose nail may become infected and this can be serious.

By the time marathon day rolls around, and if you have avoided or overcome injury during your training and your feet are pain free, then you likely have feet that are ready to start a marathon.

Philly Marathon Results!

Reading native makes top 3 at Philadelphia Marathon

Sunday, November 17, 2013

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PHILADELPHIA - November 17, 2013 (WPVI) -- From the elite runners competing in the full marathon, to first-timers just hoping to complete half the course, 30,000 runners and wheelchair competitors set off at 7:00 Sunday morning for the 20th annual Philadelphia Marathon.

"When you have 30,000 people out, flat course, tremendously scenic, all the great neighborhoods that runners get to go through, the crowds that come out to cheer the runners on, it's a spectacular event," Mayor Michael Nutter said.

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Security was tight along the course, forcing both runners and spectators to arrive early.

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However an incident-free two hours, 17 minutes and 35 seconds after the start, Abebe Mekuriya of Ethiopia crossed the finish line.
He was followed by Tesfaye Dube.
Third place went to Nicholas Hilton, a Reading native, competing in his very first marathon.
"We started to break away about 15, 16 miles, the pack started to thin out. About 20 [miles] it was just the three of us. I figured I had a spot at least in the top three or four," Hilton said.
The women's winner was Irina Alexandrova, whose coach won this race in 2006.
"She was running alone. I think it was a great result. Thank you so much for the great race," agent Larisa Mikhaylova said.
While the elite runners take home the prize money, many others were just as proud of their medals.
Those like Erin O'Donnell, who finished her marathon in just over five hours. She dedicated her run to a friend's daughter who died of cancer.
"I'm running for Team Lemon for Alex's Lemonade Stand, raising funds for pediatric cancer research," said O'Donnell.
Even for those runners who didn't make a record time, they are still proud of their accomplishments. Official results
Below are the top 5 finishers in all the Philadelphia Marathon catagories:
Men's Division Marathon 
Abebe Mekuriya, City Falls, NY 2:17:35
Tesfaye Dube, New York, NY 2:18:15
Nicholas Hilton, Flagstaff, AZ 2:19:36
Birhanu Mekonnen, Washington, DC 2:19:59
Abiyot Endale, Bronx, NY 2:20:55
Women's Division Marathon
Irina Alexandrova, Hebron, KY 2:39:06
Tezeta Dengersa, Washington, DC 2:40:13
Meseret Basa, New York, NY 2:40:51
Aregash Abate, High Falls, NY 2:42:41
Amanda Marino, Jackson, NJ 2:43:57
Men's Masters Division Marathon
Jae Yung Hyung, Alburquerque, NM 2:24:40
Rich Burke, Morristown, NJ 2:31:20
Ray Pugsley, Potomac Falls, VA 2:34:06
Doug Fernandez, Richmond, VA 2:37:49
Women's Masters Division Marathon
Mary Pardi, Falmouth, ME 2:53:39
Myriam Grenon, Longueuil, QC, Canada 2:59:16
Catherine Spiess, New Albany, OH 3:06:15
Kim Redden, Ottawa, MB Canada 3:06:45
Men's Wheelchair Marathon
Grant Berthiaume, Tuscon, AZ 2:04:26
Men's Division Half Marathon
Elijah Karanja Hebron, KY 1:02:59
Direba Yigezu New York, NY 1:03:23
Jordan Chipangama Flagstaff, AZ 1:03:28
Yonas Mebrahtu East Flagstaff, AZ 1:03:53
Henry Rutto Royersford, PA 1:04:10
Women's Division Half Marathon
Rkia El Moukim Queens, NY 1:10:53
Adrienne Herzog, Boulder, CO 1:12:59
Jane Murage, Royersford, PA 1:12:59
Ingrid Mollenkopf, Flower Mound, TX 1:13:04
Allison Mendez, Austin, TX 1:13:47
Men's Masters Half Marathon 
Eric Shafer, Pittsburgh, PA 1:13:21
Paul Thompson, Peekskill, NY 1:13:23
Kevin Beugless, Media, PA 1:17:05
Martin Fontaine, Otterburn Park, QC Canada 1:17:51
Women Masters Half Marathon
Vicky Jasparro Fredericksburg, VA 1:25:24
Jill Tenny, Harrisburg, PA 1:21:24
Susanne Vanzijl, Elkton, MD 1:29:49
Vicki Boyer, Elizabethtown, PA 1:29:42
Men's Wheelchair Half Marathon
Shannon Franks, College Park, MD 1:09:53
Daniel Wheeler, Shamong, NJ 2:11:44
Women's Wheelchair Half Marathon
Michelle Wheeler, New York, NY 1:30:51

(Copyright ©2013 WPVI-TV/DT. All Rights Reserved.)

Runners: More Foot Injuries that may Plague you!

Foot injuries in runners. Not listed in any particular order, nor is this list all-inclusive. 1. Plantar fasciitis - heel pain caused by inflammation of the tough fascia on the bottom of the foot, usually right where the fascia attaches into the heel. 2. Calcaneal stress fracture – an overuse fracture of the “heel bone” 3. Achilles tendon bursitis – inflammation of the bursa located at the attachment of the Achilles tendon to the heel. (NOTE: Although not defined as a foot injury there is also a separate condition involving inflammation of the Achilles tendon itself, higher up the ankle, referred to as Achilles tendinitis. 4. Extensor tendinitis – inflammation of the tendons on the top of the foot, usually midway along the foot. 5. Sesamoiditis -- inflammation of those tiny little free-floating “sesame seed” bones, which are located in the ball of the foot near the base of the big toe. 6. Metatarsal stress fracture – an overuse fracture of one of the metarsals. These are the long bones that start at the midway point of the foot and run right up to the base of the toes. There are 5 in each foot. 7. Morton’s neuroma – a condition caused by the chronic irritation of the interdigital nerve, usually between the 3rd and 4th metatarsals, near the toes. Runners often experience a “pins-and-needles” or “electric shock” pain. 8. Posterior tibialis tendonitis – this tendon passes underneath the medial malleolus (the inside “ankle bone”) and attaches into the medial aspect of the foot (navicular bone). Runners usually experience pain below the inside of ankle or slightly further along the inside of the foot. 9. Peroneal tendonitis – this tendon passes underneath the lateral malleolus (the outside “ankle bone”) and attaches on the lateral aspect of the foot (cuboid and base of 5th metatarsal). Runners usually experience pain on the outside part of the ankle or lateral edge of the foot up to the base of the 5th metatarsal. 10. Subungal hematoma -- bleeding underneath the nail from the chronically jamming the toe(s) into the shoe. Also may happen acutely if you drop something heavy on your toes(s). NOTE: This is just one type of toe condition – there are many others (e.g., ingrown nail). I just wanted to mention one so that the toes didn’t feel left out in the foot discussion. Should these and any other injuries persist, please do not hesitate to make an appointment with one of our Podiatrists at Advanced Foot & Ankle Center, Inc!!!!

Runners: 4 Common Foot Injuries that can easily be Prevented!

4 Common Foot Injuries that Plague Runners but can easily be Prevented!

1. Black Toenails: If sneakers do not fit properly, your foot can slide forward with each step. The constant tapping against the toenail can make it bleed underneath, also known as subungual hematoma. It can cause pain and eventually loss of the nail.

Prevention: Make sure your sneakers fit not too snug or loose. There should be about a thumbs-width distance between your big toe and the end of your shoe, without the heels sliding up and down. Also keep your toenails trimmed!

2. Plantar Fasciitis: One of the most common causes of heel pain and affects women more than men. The plantar fascia is the flat ligament that connects your heel bone to your toes. If it gets stretched too far and tears, it causes inflammation and can cause pain.

Prevention: Find a pair of sneakers that support your specific type of foot. People who have pronation (feet roll inward), high arches, and flat feet are more prone to this condition. Running long distances on hard surfaces can cause heel pain as well; try running on softer dirt trails.

3. Blisters: The skin on your feet can collect fluid between the top and bottom layers of the skins from constant friction, moisture, and heat. The fluid in a blister actually acts as a cushion, but it can be painful if the blister breaks open and could lead to infection.

Prevention: Breaking in new sneakers can lead to blisters. Try breaking in your sneakers gradually over a few weeks. Walk around in the shoes first and when you do start running, keep it to shorter distances. If you do notice a blister starting to form, apply a band-aid or piece of tape on the area to help prevent further irritation.

4. Heel Fissure: When the skin of the feet become extremely dry and the constant motion of running can cause it to crack. If the crack is deep enough, it can bleed and get infected.

Prevention: Try using a pumice stone to gently slough off dead skin cells and follow up with a thick moisturizer. When you are not running, try to avoid shoes that expose your skin, like sandals, that could dry out your skin more.

If these ailments persist or do not get better with treatment at home please contact Advanced Foot & Ankle Center, Inc. and discuss further treatment with Drs. DiPretoro & Caristo!

Runners: Don't Fear the Knife!

Don't Fear the Knife

Foot surgery for runners is no longer the last resort

By

Brian Fullem, D.P.M.

Published

November 9, 2010

Paula Radcliffe first noticed pain from a bunion (see photo, below right) after she won the 2005 world championships marathon. Over the next four years, the world record-holder in the marathon suffered a series of injuries, and despite occasional bright spots, such as winning the 2007 and 2008 editions of the New York City Marathon, she was in rehab more often than not. Finally, in May 2009, Radcliffe underwent bunion surgery.

"When we sat down and looked at my injury history prior to the surgery in 2009, we realized that every injury, bar one, since 2004 had been caused directly or indirectly by the bunion," Radcliffe says. "Even the femoral stress fracture was related to my bunion pain, as it came from imbalances caused by modifying my orthotics to enable me to run on the right foot without significant pain."

Could Radcliffe have returned to normal running sooner by taking the counterintuitive step of opting for surgery earlier? While foot surgery should usually be considered a last resort after conservative treatment has failed, there are times when surgery may allow a runner to return to training faster. As in Radcliffe's case, surgery can often provide a cure, while conservative treatment may only be treating the symptoms. Surgical techniques have improved considerably in the last decade; advances that allow for faster recovery and more predictable results can mean that the runner's traditional avoidance of surgery is based on outdated thinking.

Let's look at four common running injuries -- bunions, neuromas, Achilles tendon problems and plantar fasciitis -- in terms of when to consider surgery over more conservative treatment. First, though, these caveats: You should always understand that there aren't any guarantees with any surgical procedure. Even the best surgeon in the world has poor outcomes. It's also important to note that some people take longer than average to heal while some can return to activity faster.

Bunions

The medical term for a bunion is Hallux Abducto Valgus (HAV). The hallux (big toe) deviates towards the second toe, and the first metatarsal head protrudes in the opposite direction. The most common complaint associated with this deformity is pain at the medial aspect of the joint.

The deformity is commonly considered an inherited trait, and there is no scientific evidence that a bunion can be prevented with conservative treatment. Conservative treatment starts with making sure your shoes are wide enough. Occasionally treatments such as cortisone injections, custom orthotic devices and various paddings and splints can help to treat the symptoms, but surgery is the only option to correct this problem. I don't recommend surgical correction unless the patient has pain, but as in Radcliffe's case, some injuries elsewhere may be indirectly related to the lack of proper function of the big toe joint due to HAV.

Surgical correction typically involves cutting and repositioning the first metatarsal with the use of screws or pins to hold the bone in the proper position while it heals. Depending on the severity of the deformity, the bone may need to be cut at different spots. The severity of the bunion determines what procedure is required; larger deformities require more extensive correction, leading to a longer recovery time. Expect to miss a minimum of six to eight weeks from running and at least 12 weeks before the foot begins to function normally. The use of newer and better screws has shortened the recovery time considerably. Some screws have a lower profile, which often eliminates any discomfort associated with the head of the screw and allows the screw to remain in place permanently.

A new procedure known as "the mini-tightrope" uses a pulley system and shows great promise. The technique involves using suture material attached to the first and second metatarsals, with the first metatarsal being "pulled" toward the second metatarsal. The great thing about this procedure is that, because the bone isn't cut, recovery time is drastically reduced. However, because the second metatarsal is much smaller than the first metatarsal it doesn't always serve as an ideal anchor. This procedure is not for all bunions, as there is a risk of fracture of the second metatarsal.

Neuromas

A neuroma is inflammation of the nerve in the ball of the foot, most commonly involving the area between the second and third metatarsal heads or the third and fourth metatarsal heads. Symptoms include pain in the area directly before the toes, shooting pain into the toes, numbness in the area and sometimes a feeling of walking on a marble.

The majority of the time, conservative treatment, consisting of wider or more cushioned shoes, custom orthotic devices, cortisone injections and padding around the area, can alleviate the pain. One last resort before considering surgical intervention is a series of injections using a 4 percent solution of alcohol mixed with local anesthetic, a procedure known as sclerotherapy. The alcohol causes degeneration of the nerve fibers. The protocol involves a series of three to seven injections performed weekly. One study purported an 89 percent success rate with the procedure. I've not found anywhere close to that level of success, but there are no apparent negative side effects to sclerotherapy.

One runner I treated tried all of the above, including sclerotherapy, to deal with pain in her foot that was bad enough to interfere with her training. When none of the conservative treatments brought relief, she elected to undergo surgical excision of the nerve. Like most foot surgery, hers was performed on an outpatient basis. She was running within four weeks of her surgery. Nine years later, she's still pain-free at her former neuroma location.

A newer technique called Endoscopic Decompression of Intermetatarsal Neuroma (EDIN) is a much simpler surgery. Neuromas are close to the base of the toes, which have a ligament on the top and bottom. EDIN involves making a very small incision between the toes in the interspace, then inserting a small camera to visualize and cut the top or dorsal ligament. The theory is that this "decompresses" the nerve, thereby relieving the pain. There's little downside to this procedure. If pain persists after this surgery, then the nerve can be excised in the traditional manner.

Achilles Tendon Problems

Achilles tendinitis is one of the more difficult injuries any athlete can encounter. Within two weeks of Achilles inflammation, the tendon fibers begin to degenerate.

One of the best conservative treatments for this injury is eccentric strengthening exercises. I find that eccentric strengthening combined with a core exercise program is the most effective treatment plan for chronic Achilles tendinosis.

Shock wave therapy (ESWT) is also an excellent conservative treatment for chronic Achilles issues. ESWT sends sound waves deep into the tissue, promoting neovascularization (that is, the production of new blood vessels to allow the tissue to heal). The treatment can be expensive and the full effect isn't seen for up to three or four months. There are almost no negative side effects to ESWT, but the treatment isn't typically covered by insurance and can cost in excess of $1,000. In my practice I use the D-Actor 200 from Storz Medical, and have seen over a 70 percent success rate when used to treat Achilles tendinosis.

PRP (Platelet Rich Plasma) is a newer treatment involving giving a sample of your own blood, which is then processed to extract the plasma and injected back into the injured tendon or muscle. The treatment is costly and not covered by insurance, and scientific studies haven't shown it to be much more effective than a placebo. In a review of all the medical studies published in the British Medical Bulletin on the use of PRP, the authors found just three high-quality studies among all the literature published, and none of these studies showed any statistically significant improvement.

Surgery for Achilles pain may involve surgery on the tendon itself or, more commonly, closer to the attachment in the back of the calcaneus (heel bone) where patients may commonly have a bone spur known as a Haglund's deformity. The use of anchors has further enhanced surgery involving the back of the heel, allowing the tendon to be detached to remove any bone spurring and then reattached with the use of an anchor. Recovery involves being in a short leg cast initially, then a removable cast followed by physical therapy with a return to running in roughly three months. World championships marathoner Keith Dowling had pain for the last two years of his competitive career from a Haglund's deformity(pictured, above). After failed conservative treatment I operated on Keith using anchors. He doesn't compete anymore but is able to run with no pain in the back of his heel.

Plantar Fasciitis

This injury typically resolves over 90 percent of the time with conservative treatment. The most important factor in treating this very common injury is early intervention. Calf stretching, icing with a frozen water bottle 20 to 30 minutes two or three times per day, taping and massage are the initial treatments, and work well for up to half of patients with this injury. When those treatments don't help, then cortisone injections, over-the-counter and custom orthotic devices, Active Release Therapy and physical therapy are the next wave of treatments.

One area of treatment that deserves more attention is strengthening the foot. Weakness of the intrinsic musculature accompanies plantar fasciitis. Early introduction of restrictive shoe gear in Westernized cultures may contribute to atrophy of these muscles. As part of the rehabilitation from this injury, it is important to add a strengthening and proprioception protocol to the treatment plan following the reduction of pain. Grabbing a towel with the toes, balancing on one foot and progressing to the use of a balance board can facilitate foot strengthening. After performing these exercises athletes can progress to barefoot running in the grass. Many of the shoe companies are now making minimalist shoes that are a nice adjunct to the treatment plan when used initially in moderation.

Shock wave therapy has been found to resolve plantar fasciitis in up 70 percent of cases that didn't improve with more conventional treatments.

TOPAZ and platelet-rich plasma therapy are two other pertinent treatments, but again, neither has a significant amount of medical literature reviewing its effectiveness. Sedation and local anesthesia in the operating room are necessary to perform TOPAZ. Needle holes are placed in a square pattern on the medial and central bands of the fascia on the bottom of the heel at the area of greatest pain. The TOPAZ unit is inserted into the needle holes, and the fascia is treated with a short burst of electric energy, resulting in microscopic cutting of the fascia, increased blood supply and break-up of the scar tissue. There also seems to be an increase in strength to the fascia with this procedure. The drawbacks are the need for surgery, the cost of surgery and the fact that scar formation from the multiple incisions may be a source of pain. Although scar formation is very rare, there's a need for additional downtime with this procedure, and recovery is usually slower and more painful.

It's crucial that your physician rule out other causes of heel pain, such as nerve entrapment, before considering surgery; often an MRI should be ordered to confirm the proper diagnosis. Other surgical approaches include endoscopic plantar fasciotomy, in which the fascia is cut at the insertion point; ideally there's minimal trauma to the tissue due to the use of arthroscopy. A traditional open approach allows the surgeon to examine for nerve entrapment, but it involves a larger incision, creating the possibility of more scar tissue, which can, ironically, cause nerve entrapment. Another approach, known as an instep fasciotomy, involves making the incision right in the arch. This procedure has the advantage of causing less scar tissue.

The most worrisome complication involves creating instability of the foot. Most surgeons won't cut the fascia completely; they often leave the outside portion of the fascia intact. Calcaneal cuboid syndrome is one possible complication that can be extremely difficult to resolve. Of all the surgeries in the foot, this is the one that should absolutely be considered as the last resort.

When deciding whether surgery makes sense, here's an important question to answer:
Have you exhausted more conservative treatments that will cure your problem instead of just treating its symptoms? The best person to answer these questions with you is your local sports podiatrist at Advanced Foot & Ankle Center, Inc.!. 

Information on Orthotics: "You Don't Have to Live with Foot Pain-Orthotics Can Help!!"

Information on Orthotics 

"You Don't Have to Live With Foot Pain Orthotics Can Help"

Faqs about orthotics

What are orthotics?

Orthotics refers to custom-made shoe inserts prescribed by your Podiatrist at Advanced Foot and Ankle Center, Inc..   Orthotics are designed to accommodate or correct an abnormal or irregular walking pattern.

How do orthotic devices work?

Orthotics make standing, walking, and running more comfortable and efficient by altering the angles at which the foot strikes the ground. Orthotics placed inside your shoes can absorb shock, improve balance, and take pressure off sore spots. Doctors of podiatric medicine pioneered and are developing more high-tech orthotics.

Foot pain isn't normal.
See your Podiatrist at Advanced Foot and Ankle Center  for help.

Aren't orthotics just for runners or other athletes?

Runners and athletes have special needs, but orthotics can help non-athletes, as well. An imbalance in your feet–even a small one can change your posture and affect your entire body. Orthotics might help you if:
One side of the sole of your shoe wears out faster than the other.
You frequently sprain your ankle.
You have chronic heel, knee, or lower back pain.
Your toes are not straight.
Your feet point inward or excessively outward when you walk.

What about shoe inserts and arch supports sold at retail outlets?

Arch supports and shoe inserts made for standard shoe sizes are generally affordable and may be helpful, but are not suitable for everyone. Improper orthotics can injure healthy biomechanics, gait, and posture.

My legs hurt, not my feet. could orthotics help?

Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal foot mechanics or slight differences in the length of the legs. Orthotics may be helpful.

Can orthotics prescribed by a Podiatrist really make a difference?

Properly prescribed orthotics have relieved debilitating pain for thousands of people. Many people who could not take a step without pain are walking normally and living more active lives because of orthotics. Anyone can provide mass-produced inserts, but only doctors are trained and licensed to diagnosis medical conditions and prescribe orthotics.

Can orthotics take the place of foot surgery?

Dr. DiPretoro & Dr. Caristo often recommend orthotics and other conservative care for many foot and ankle problems before considering podiatric surgery.

What about people with diabetes?

For people with diabetes, arthritis, or other conditions, orthotics that do not fit properly can be dangerous. People with diabetes especially need proper diagnoses and prescriptions from their Podiatrist at Advanced Foot and Ankle Center, Inc.!

Hammer Toe Repair!

A hammer toe is a toe that stays in a curled or flexed position. It can be caused by a muscle imbalance, arthritis, or shoes that do not fit well.      

Hammer toe can occur in more than one toe.

Description

Several different kinds of surgery can repair hammer toe. Your Podiatrist at Advanced Foot & Ankle Center, Inc. will recommend the kind that will work best for you. Some of the surgeries include:

• Remove parts of the toe bones.
• Cut or transplant the tendons of the toes (tendons connect bone to muscle).
• Fuse the joint together to make the toe straight and no longer able to bend. 

After surgery, you may have surgical pins or a wire (Kirschner, or K-wire) to hold the toe bones in place while your toe heals.

Why the Procedure is Performed

When hammer toe is starting to develop, you may still be able to straighten yourtoe. Over time, your toe may get stuck in a bent position and you can no longer straighten it. When this happens, painful, hard corns (thick, callused skin) can build up on the top and bottom of your toe and rub against your shoe. 

Hammer toe surgery is not done just to make your toe look better. Consider surgery if your hammer toe is stuck in a flexed position and is causing:

• Pain
• Irritation·
• Sores

Skin infections 

Surgery may not be advised if:

• Treatment with paddings and strapping works
• You can still straighten your toe
• Changing to different shoe types can alleviatesymptoms

Risks

Risks of hammer toe surgery are:

• Poor alignment of the toe
• Allergic reactions to medicines you receive before or during surgery
• Bleeding
• Infection in the bones of the toe
• Injury to nerves that could cause numbness in your toe
• Scar from surgery that hurts when it is touched
• Stiffness in the toe or a toe that is too straight

Before the Procedure

Always tell Dr. Raymond A. DiPretoro, Jr. what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen, (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your Podiatrist which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow healing.
• Always let your doctor know about any cold, flu, fever, or other illness you may have before your surgery.
• You will usually be asked not to drink or eat anything for 6 - 12 hours before surgery.

If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.

After the Procedure

Most people go home the same day they have hammer toe surgery. Your doctor at Advanced Foot & Ankle Center or nurse will tell you how to take care of yourself at home after surgery.

Alternative Names

Flexion contracture of the toe

Happy Veterans Day!!!!!

Happy Veterans Day from our staff at Advanced Foot & Ankle Center Inc.!!!

  Thank you for serving our country and protecting our freedoms.  This Veteran’s Day, stand with our American heroes, and our wounded warriors.  Give them and show them the respect that they deserve.

Athlete's Foot: 13 Interesting Facts!

13 Interesting facts about athletes foot

Written by Kevin on January 5, 2012

• Probably one of the most interesting facts about athletes foot is that men get athletes foot more frequently than women.

• You may not be acquiring athletes foot from other people, you may be acquiring it from your pet. You may decide to treat your pet at the same time you are treating   athletes foot yourself. Frequently pets may respond well to treatment.

• To kill athletes foot try placing your athletes foot sneakers in a baggie, tightly close and place  them in your freezer for 24 hours to try and kill foot fungus.

• Athletes foot faq Will clorox kill athletes foot? The answer is yes. The clorox should be mixed with water and not mixed with any other cleaning agents. This may kill   foot fungus.

• If you are pregnant you should not be applying any treatment to the skin without the approval of your doctor. You may decide to use a natural treatment such as  soaking the feet in diluted apple cider vinegar for good results.

• It happens that sharing towels can spread athletes foot. Give yourself a different clean towel daily.

• Leave the feet uncovered in flipflops to allow the feet to breath. 

• Try not to dismiss advanced athletes foot for eczema as the two may look similar.

• Those with circulatory diseases may be more susceptible to athletes foot and show signs of needed therapy.

• In the 19th century scientists discovered treating athletes foot. Changing history shows that athletes foot is not caused by bug bites.

• A similiar interesting fact about athletes foot is that the same fungus that causes athlete foot is the same fungus that causes Jock Itch.

• Different facts about treating athletes foot is that it is more common in warm weather because sweat aids fungus growth.

• There are many product options that cure athletes foot fast. For getting rid of athletes foot see our athletesfootshop categories treatment section for a range of helpful  athletes foot  fungus solutions.

There are Natural Home Remedies that may work for some people.