Happy Halloween from Advanced Foot & Ankle Center!!!!!!

40 Fun Facts About . . .

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Halloween

Because the movie Halloween(1978) was on such a tight budget, they had to use the cheapest mask they could find for the character Michael Meyers, which turned out to be a William Shatner Star Trekmask. Shatner initially didn’t know the mask was in his likeness, but when he found out years later, he said he was honored.h The first Jack O’Lanterns were actually made from turnips.e Halloween is the second highest grossing commercial holiday after Christmas.f The word “witch” comes from the Old English wicce, meaning “wise woman.” In fact,wiccan were highly respected people at one time. According to popular belief, witches held one of their two main meetings, or sabbats, on Halloween night.g An intense and persistent fear of Halloween is called Samhnainophobia Samhainophobia is the fear of Halloween.a Fifty percent of kids prefer to receive chocolate candy for Halloween, compared with 24% who prefer non-chocolate candy and 10% who preferred gum.a The owl is a popular Halloween image. In Medieval Europe, owls were thought to be witches, and to hear an owl's call meant someone was about to die.g According to Irish legend, Jack O’Lanterns are named after a stingy man named Jack who, because he tricked the devil several times, was forbidden entrance into both heaven and hell. He was condemned to wander the Earth, waving his lantern to lead people away from their paths.g The largest pumpkin ever measured was grown by Norm Craven, who broke the world record in 1993 with a 836 lb. pumpkin.b Stephen Clarke holds the record for the world’s fastest pumpkin carving time: 24.03 seconds, smashing his previous record of 54.72 seconds. The rules of the competition state that the pumpkin must weigh less than 24 pounds and be carved in a traditional way, which requires at least eyes, nose, ears, and a mouth.d Trick-or-treating evolved from the ancient Celtic tradition of putting out treats and food to placate spirits who roamed the streets at Samhain, a sacred festival that marked the end of the Celtic calendar year.d “Souling” is a medieval Christian precursor to modern-day trick-or-treating. On Hallowmas (November 1), the poor would go door-to-door offering prayers for the dead in exchange for soul cakes.e The first known mention of trick-or-treating in print in North America occurred in 1927 in Blackie, Alberta, Canada.d “Halloween” is short for “Hallows’ Eve” or “Hallows’ Evening,” which was the evening before All Hallows’ (sanctified or holy) Day or Hallowmas on November 1. In an effort to convert pagans, the Christian church decided that Hallowmas or All Saints’ Day (November 1) and All Souls’ Day (November 2) should assimilate sacred pagan holidays that fell on or around October 31.e Black and orange are typically associated with Halloween. Orange is a symbol of strength and endurance and, along with brown and gold, stands for the harvest and autumn. Black is typically a symbol of death and darkness and acts as a reminder that Halloween once was a festival that marked the boundaries between life and death.g Halloween originated in Ireland over 2,000 years ago Ireland is typically believed to be the birthplace of Halloween.f With their link to the ancient Celtic festival of Samhain (a precursor to Halloween) and later to witches, cats have a permanent place in Halloween folklore. During the ancient celebration of Samhain, Druids were said to throw cats into a fire, often in wicker cages, as part of divination proceedings.g Scarecrows, a popular Halloween fixture, symbolize the ancient agricultural roots of the holiday.g Halloween has variously been called All Hallows’ Eve, Witches Night, Lamswool, Snap-Apple Night, Samhaim, and Summer’s End.d Halloween was influenced by the ancient Roman festival Pomona, which celebrated the harvest goddess of the same name. Many Halloween customs and games that feature apples (such as bobbing for apples) and nuts date from this time. In fact, in the past, Halloween has been called San-Apple Night and Nutcrack Night.f Scottish girls believed they could see images of their future husband if they hung wet sheets in front of the fire on Halloween. Other girls believed they would see their boyfriend’s faces if they looked into mirrors while walking downstairs at midnight on Halloween.g Because Protestant England did not believe in Catholic saints, the rituals traditionally associated with Hallowmas (or Halloween) became associated with Guy Fawkes Night. England declared November 5th Guy Fawkes Night to commemorate the capture and execution of Guy Fawkes, who co-conspired to blow up the Parliament in 1605 in order to restore a Catholic king.e Harry Houdini (1874-1926) was one of the most famous and mysterious magicians who ever lived. Strangely enough, he died in 1926 on Halloween night as a result of appendicitis brought on by three stomach punches.d According to tradition, if a person wears his or her clothes inside out and then walks backwards on Halloween, he or she will see a witch at midnight.g Mexico celebrates the Days of the Dead (Días de los Muertos) on the Christian holidays All Saints’ Day (November 1) and All Souls’ Day (November 2) instead of Halloween. The townspeople dress up like ghouls and parade down the street.d During the pre-Halloween celebration of Samhain, bonfires were lit to ensure the sun would return after the long, hard winter. Often Druid priests would throw the bones of cattle into the flames and, hence, “bone fire” became “bonfire.”f Dressing up as ghouls and other spooks originated from the ancient Celtic tradition of townspeople disguising themselves as demons and spirits. The Celts believed that disguising themselves this way would allow them to escape the notice of the real spirits wandering the streets during Samhain.f The average American will spend $66.28 on Halloween in 2010, totaling $5.8 billion The National Retail Federation expects consumers in 2010 to spend $66.28 per person—which would be a total of approximately $5.8 billion—on Halloween costumes, cards, and candy. That’s up from $56.31 in 2009 and brings spending back to 2008 levels.a According to the National Retail Federation, 40.1% of those surveyed plan to wear a Halloween costume in 2010. In 2009, it was 33.4%. Thirty-three percent will throw or attend a party.a In 2010, 72.2% of those surveyed by the National Retail Federation will hand out candy, 46.3% will carve a pumpkin, 20.8% will visit a haunted house, and 11.5% will dress up their pets.a Halloween is thought to have originated around 4000 B.C., which means Halloween has been around for over 6,000 years.e In 1970, a five-year-old boy Kevin Toston allegedly ate Halloween candy laced with heroin. Investigators later discovered the heroin belonged to the boy’s uncle and was not intended for a Halloween candy.e In 1974, eight-year-old Timothy O’Bryan died of cyanide poisoning after eating Halloween candy. Investigators later learned that his father had taken out a $20,000 life insurance policy on each of his children and that he had poisoned his own son and also attempted to poison his daughter.e Teng Chieh or the Lantern Festival is one Halloween festival in China. Lanterns shaped like dragons and other animals are hung around houses and streets to help guide the spirits back to their earthly homes. To honor their deceased loved ones, family members leave food and water by the portraits of their ancestors.d Halloween celebrations in Hong Kong are known as Yue Lan or the “Festival of the Hungry Ghosts” during which fires are lit and food and gifts are offered to placate potentially angry ghosts who might be looking for revenge.d Both Salem, Massachusetts, and Anoka, Minnesota, are the self-proclaimed Halloween capitals of the world.d Boston, Massachusetts, holds the record for the most Jack O’Lanterns lit at once (30,128).c The Village Halloween parade in New York City is the largest Halloween parade in the United States. The parade includes 50,000 participants and draws over 2 million spectators.d In many countries, such as France and Australia, Halloween is seen as an unwanted and overly commercial American influence.d Children are more than twice as likely to be killed in a pedestrian/car accident on Halloween than on any other night.d -- Posted October 4, 2010 References a “Halloween.” National Confectioners Association. Accessed: September 30, 2010. b “Largest Rutabaga-World Record Set by Norm Craven.” World Records Academy. December 6, 2008. Accessed: October 4, 2010. c Levenson, Michael and Kathy McCabe. “A Love in Common for Pumpkins.” Boston Globe. October 22, 2006. Accessed: October 2, 2010. d Morrow, Ed. 2001. The Halloween Handbook. Secaucus, NJ: Citadel Press. e Rogers, Nicholas. 2003. Halloween: From Pagan Ritual to Party Night. New York, NY: Oxford University Press. f Skal, David J. 2002. Death Makes a Holiday: A Cultural History of Halloween. New York, NY: Bloomsbury. g Thompson, Sue Elled, ed. 2003. Holiday Symbols and Customs. 3rd Edition. Detroit, MI: Omnigraphics, Inc. h “Trivia for Halloween.” IMDB. Accessed: October 2, 2010.

Daily Foot Care for People with Arthritis!

Simply defined, arthritis is inflammation of the joints.  When the joints are inflamed, they often become stiff, swollen and painful.  Although there are more than 100 types of arthritis, three stand out as types that are likely to affect the foot and ankle, according to the American Academy of Orthopaedic Surgeons.

Osteoarthritis is the most common type, usually due to wear and tear on the cartilage of the joints over time.  According to the Centers for Disease Control and Prevention (CDC), one in two Americans will get some form of osteoarthritis in their lifetime, and about 27 million adults currently have it.

Rheumatoid arthritis is a systemic inflammatory disease that affects joints throughout the body. According to the latest data from the CDC, an estimated 1.5 million US adults have rheumatoid arthritis (RA), but the prevalence among women is nearly double that of men.  Although the cause is not known, RA is believed to be an autoimmune disorder in which the affected person’s immune system attacks and destroys cartilage throughout the body.

Post-traumatic arthritis is similar to osteoarthritis and may develop years after a fracture or other injury.

Other common forms of arthritis that may affect mobility include:

Ankylosing spondylitis, which usually affects younger people (between the ages of 17 and 45), although it can affect older people, as well.  This type of arthritis often has a hereditary component, and produces inflammation that causes swelling between the vertebrae of the spine and in the joints between the spine and pelvis.  It may also affect the hips, knees and shoulders.

Bursitis is inflammation of the bursae—the small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints.

Gout results from deposits of uric acid crystals in the connective tissue near joints or in the joints themselves.

Psoriatic arthritis can produce symptoms similar to RA, and is associated with psoriasis, a common skin disorder that causes scaling and flaky skin.

Maintain a Healthy Lifestyle

A large body of research has demonstrated the benefits of regular physical activity for people with all types of arthritis. It helps reduce joint pain and stiffness, strengthens muscles around the joints, and increases flexibility and endurance.  Regular physical activity also helps promote overall health and fitness by providing more energy and facilitating sleep and weight control. 

If you have arthritis, it’s also important to have regular checkups with your doctor, including a foot exam. Take medications only as directed and follow any dietary recommendations.  Following a healthful diet can also help!

Preventive Foot Health and Footwear

• See a Dr. Raymond A. DiPretoro, Jr. for regular foot examinations and proactive/preventive foot care. Follow your podiatrist’s recommendations or prescriptions for footwear.
• Buy shoes that are shaped like your feet.  Look for shoes with a square or round toe box so that toes have room to move around.  Avoid pointed-toe shoes as much as possible. You may need special accommodative footwear to prevent damage to vulnerable areas of the feet, especially if you have any irregularities in foot shape or size.
• Choose shoes that provide a good heel counter and arch support.  Avoid slip-on shoes such as mules, loafers or flip flops, and avoid high-heel shoes.
• Look for shoes with extra cushioning in the mid soles and outer soles.
• Never depend on shoes to fit better after they are “broken in.” Your feet should feel comfortable in new shoes when you buy them.  

Foot Self Care

• Inspect your feet daily. Use an extended mirror to see the bottoms of your feet, especially if you cannot reach them or see them without assistance.
• If you have any coexisting conditions such as neuropathy (loss of sensation) or compromised blood flow in your legs or feet, be extra cautious. Check inside your shoes for sharp or rough edges that can hurt your feet.  Also check for foreign objects, including nails, sticks, rocks, etc., that may enter or become embedded in your shoes during activity.
• Wash your feet daily using lukewarm water.  Never use hot water, or you may burn your feet (use your elbow to test water temperature). After washing, dry your feet thoroughly (remember to dry between the toes) and keep them supple by applying lotion only to the tops and bottoms of the feet (never between the toes, since this may promote a warm, moist environment that is conducive to fungal infections).
• Avoid exposing your feet to temperature extremes, and avoid walking barefoot, especially if you have neuropathy.
• Do not attempt to cut toenails if you have neuropathy, joint deformation or other foot problems related to arthritis. See a Podiatrist at Advanced Foot and Ankle Center regularly for toenail care and foot examinations. Never attempt to cut or file calluses, corns or other protrusions on your feet.
• Avoid using wart removers or other harsh chemicals on your feet.
• Stay as active as possible to maintain circulation in the feet and the rest of your body, to help improve function and for overall health and wellbeing.

Foot Health Resources for People with Arthritis!

Advanced Foot & Ankle Center is committed to providing information, education and resources for people with arthritis and their caregivers to help ensure proper foot care and condition management for the many types of arthritis.  Click on the following links for more information:

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• Read about all aspects of arthritis at the Arthritis Foundation web site: http://www.arthritis.org/

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• Get information about juvenile arthritis from the Arthritis Foundation web site: http://www.arthritis.org/conditions-treatments/disease-center/juvenile--arthritis/

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• Get information for caregivers for people with arthritis from the Arthritis Foundation: http://www.arthritis.org/caregiving.php.

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• Get general information about how arthritis affects the foot and ankle from the American Orthopaedic Foot and Ankle Society (AOFAS): http://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Arthritis.aspx 

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• Get specific information about rheumatoid arthritis and its effects on the foot and ankle from the American Academy of Orthopaedic Surgeons (AAOS): http://orthoinfo.aaos.org/topic.cfm?topic=a00163 

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• Read about arthritis at the US National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223/

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• More general information about arthritis can be found at Medline Plus: http://www.nlm.nih.gov/medlineplus/arthritis.html 

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• Learn about things physicians and patients should question related to arthritis and rheumatology (this information is geared more toward physicians, but patients should also be aware): http://www.choosingwisely.org/doctor-patient-lists/american-college-of-rheumatology/

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• Caregiving and Arthritis: http://arthritis.about.com/od/caregiving/Caregiving_and_Arthritis_Information_on_Care_Needs_for_Caregivers.htm

Sports Medicine: High impact sports can result in sharp burning pain in the ball of your foot!

Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes.

Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes.

CAUSES

• This can cause a sharp, burning pain in the ball of your foot.
• Your toes also may sting, burn or feel numb or tingling in your toes.

FACTORS

• High heel Shoes. Tight or ill fitting shoes can place extra pressure on your toes and the ball of your foot.
• High Impact Sports.  Repetitive trauma to your feet from running and or sports activities with tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
• Foot deformities. People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton’s neuroma.

 ASSESSMENT / DIAGNOSTIC

1. When did your symptoms begin?
2. Did your symptoms begin gradually or suddenly?
3. What type of footwear do you wear for work?  Is the pain worse in certain pairs of shoes?
4. Does any type of activity ease the pain or worsen it?  Do you participate in sports? If so, what types in particular?
5. Are you having pain in any other part of your body?
6. What medications and supplements do you take regularly?

 TREATMENT OPTIONS 

• Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve.
• Injections. Some people are helped by the injection of steroids into the painful area.
• Decompression surgery.  Surgically removing pressure points on nerves such as the nerve, ligament or bone or growths  may provide pain relief.  Caution is advised as these procedures can result in permanent numbness in the affected toes.

BASE – SAFE SOLUTIONS

• Anti-inflammatory medications. Over-the-counter non-steroidal anti-inflammatory medications can reduce swelling and relieve pain.
• Regular ice massage may help reduce pain.
• Footwear. Avoid high heels or tight shoes. Select shoes with a broad toe box and extra depth.
• Rest. Reduce high impact activities on your feet such as jogging, aerobic exercise or dancing until your pain subsides.

Never let any painful condition go untreated. If the pain and discomfort persist for over 10 days contact Dr. Raymond DiPretoro, Jr. At Advanced Foot & Ankle Center immediately for an examination.

How Overweight/Obesity Affects Your Feet and What to Do About It!

How Overweight/Obesity Affects Your Feet—-and What to Do About It

You may be aware that being overweight or obese puts you at increased risk for heart disease, diabetes and other ills. But did you know that carrying around extra pounds also puts you at increased risk for foot pain and other foot conditions that may be preventing you from exercising regularly and functioning at your best? The National Foot Health Assessment 2012, conducted for the Institute for Preventive Foot Health (IPFH) by The NPD Group, revealed that 51% of survey respondents who described their foot health as “fair” or “poor” reported being obese. By contrast, only 21% of respondents who were not overweight or obese described their foot health as “fair” or “poor.” Other research, including an article published in the journal Arthritis Care Research in February 2012, supports the notion that, as the authors of the article state, increasing BMI is “strongly associated with foot pain and disability.” A person whose body mass index (BMI) is greater than or equal to 25 is considered overweight; a BMI greater than or equal to 30 means the person is obese.

Being overweight or obese affects not only the feet, but the ankles, knees and hips, as well. Your gait, or how you walk and move around, may be altered as you compensate for that extra weight. You’re also at greater risk for injuries such as a broken ankle or knee problems so severe that replacement is necessary. Studying the Canadian Joint Replacement Registry, researchers found that people with BMIs of 30 to 35 are 8.5 times more likely to need total knee replacement than those with BMIs of less than 25. People with BMIs of more than 35 are nearly 19 times more likely to need total knee replacement, while those with a BMI of 40 or higher are nearly 33 times more likely to require total knee replacement.

What to Do

Your foot health is one more reason to lose weight safely by following a healthful diet and engaging regularly in physical activity. The following tips can help address foot pain and discomfort related to being overweight, and may also make it easier for you to do your daily activities and participate in an exercise program.

• Because being overweight is associated with diabetes, check your blood sugar levels regularly. Keeping blood sugar levels under control reduces the risk of foot ulcers that, untreated, can lead to life-threatening infections or amputation. Click here for specific foot care concerns related to diabetes.
• Wear padded socks— to help protect against injuries to the skin/soft tissue of the foot. 
• Avoid walking barefoot, even at home, and take other important steps to avoid injury to the skin/soft tissue of your feet.  
• Practice good foot hygiene, examining your feet daily for cuts, bruises and other potential trouble spots, and taking other steps to take care of your feet. 
• Because your weight may increase your vulnerability to foot and lower extremity conditions, be sure to get regular foot examinations from your Podiatrist at Advanced Foot & Ankle Center!
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Remember: If you are under a doctor's care for any chronic condition, be sure to talk with your doctor before starting a new diet or exercise program.

Black Toe....

Black toe is a relatively common condition among runners, vigorous walkers and participants in other sports where the feet are subjected to stress and strain, such as football, basketball, baseball and soccer. The condition generally is the result of impact trauma, especially in the big toe.

People who walk and run on hard surfaces such as concrete and asphalt are more likely to get black toe than those who exercise on natural surfaces or softer man-made surfaces. Hikers can experience black toe as a result of the toes banging against the front area of their shoes or boots, especially on downhill sections of trails.

Causes

The most common cause of black toe is repeated trauma from the toe banging against the end of the shoe. Since the big toe is usually the longest toe, the banging produces bleeding and bruising of the nail, causing it to become discolored (often blue and then black). The banging of the toe against the front of the shoe or boot is usually a sign that the shoes are too short, or that they fit too tightly and do not allow sufficient room for the feet to move dynamically during walking and running.

Other causes may include the following:

• sudden trauma or injury to the toe or toenail.
• fungal infection.
• “Morton’s toe,” a condition in which an individual’s second toe is longer than the big toe.
• Rarely, a subungual (occurring under the toenail) melanoma, a form of skin cancer.

Prevention and Treatment

Cut/trim your toenails to help avoid repeated trauma to the toes. Cut toenails straight across and soften sharp edges with an emery board or clean metal file.

Wearing padded socks may also help protect the toes from impact inside the toe box of the shoe or boot, which is especially important for people who walk, run or hike in hilly or mountainous terrain.

Inserts or orthotics that provide extra cushioning are also beneficial. The insert or orthotic should not be slippery, since slippery inserts can cause the foot to slide forward. The result: the toe bangs even more than normal against the front of the shoe.

Properly designed and fitted shoes or boots have sufficient cushioning and room (about the width of a thumbnail) in the toe box so that excessive pressure is not exerted on the forefoot and the toes and toenails are not crowded too closely together.

Once black toe has occurred, it is usually best to simply leave the area alone; black toe generally disappears as the nail grows and the bruised area heals. In some cases, the nail may come loose and fall off. A new nail will take its place, but typically it takes about four to six months for it to grow to its full length.

Medical Considerations

If the black or discolored nail is the result of a fungal infection, an oral or systemic antifungal medication is often prescribed, instead of or in addition to a topical treatment.

If pain persists or swelling occurs, a Podiatrist at Advanced Foot & Ankle Center may need to relieve the pressure of the blood underneath the damaged nail or remove the nail altogether.

Severe discomfort in the toe and/or pus or redness that seems to be spreading can be signs of infection. See your Podiatrist; left unattended, an infection can spread throughout the foot and into the bones.

People with diabetes or compromised circulation in the lower extremities should never try to treat toenail injuries (or any other foot issues) on their own, especially if there is any indication of possible infection or ulceration. See your Podiatrist promptly.

If there are indications of subungual melanoma (length-wise discoloration usually limited to all or a portion of the big toe nail), see your Podiatrist immediately. Because of the possibility of subungual melanoma, many experts advise seeing a  foot specialist for all cases of black toe, simply to rule out the possibility of melanoma.

Also talk to your Podiatrist if you have soreness, pain, redness, swelling or other indications of foot problems that persist for more than a few days.

Bursitis

Bursitis

The body has a number of mechanisms that help cushion and lubricate joints and bones. One of these is called the bursa, a fluid-filled sac that separates, cushions and lubricates in order to reduce the friction between two surfaces that move in opposing directions.  These surfaces are mostly muscles and tendons that glide over bony structures or glide between bones, especially in the joint areas. In the process of protecting these structures from becoming inflamed, the bursa itself can become inflamed--a condition called “bursitis.”

In the foot, there is only one naturally-occurring bursa. It is located between the Achilles tendon and the heel bone (calcaneus). This bursa protects the Achilles tendon from the pressure of the heel bone pressing against it during walking and running. This is the most common area of bursitis in the feet, also known as retrocalcaneal bursitis.

The body also creates bursal sacs in response to damage. In the feet, these areas include the following:

• the first metatarsal phalangeal joint (the base of the big toe, often associated with a bunion)
• the base of the second metatarsal phalangeal joint (the base of the second toe)
• the base of the fifth toe (often associated with a bunionette)
• the bottom of the heel and the bottom of the forefoot
• the ankle area

Causes

The feet are subjected to ongoing stress when walking and doing other activities on unfriendly surfaces such as concrete, asphalt, and hard floors. This foot stress is often exacerbated by poorly designed and fitted shoes. Pressure, impact and shear force can damage the feet over time. The body’s response to this damage is to create a bursa that protects weight-bearing and joint areas. Many times, the bursa itself becomes inflamed.

A common condition that can cause bursitis in the heel area is Haglund’s deformity, a bony enlargement on the back of the heel. In this condition, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes, especially the rigid heel counters of high heel pumps. Haglund’s deformity is often called “pump bump,” and it generally affects women.

Other causes of bursitis include a direct blow or other injury to a foot joint, acute or chronic infection, arthritis and gout.  Risk of bursitis increases with participation in the following:

• competitive athletics, particularly contact sports
• a previous history of bursitis in any joint
• exposure to cold weather
• poor conditioning
• inadequate warming up and stretching

Prevention and Treatment

To reduce excessive rubbing or stress in the Achilles area, wear properly designed and fitted shoes or boots that provide cushioning in the heel counter.  Sufficient width in the toe box helps ensure minimal compression, helps reduce the risk of rubbing of the first and fifth metatarsal joints, and helps diminish the possibility of bursitis in the toe areas.

To alleviate the pain of bursitis, anti-inflammatory medication may be required. Talk with your Podiatrist about you options. Icing the area also may reduce symptoms. Physical therapy is also an option.

If these conservative measures fail, your Podiatrist at Advanced Foot & Ankle Center may recommend cortisone injections or draining the bursal sac--but if the root cause of the bursitis is not eliminated, it can recur even after these measures are taken.

Medical Considerations

Although bursitis can be painful, it is not usually a serious condition. Redness and swollen areas associated with bursitis can, however, indicate infection and should be addressed by a podiatrist as a precautionary measure. Always talk to your Podiatrist if you have soreness, pain, redness, swelling or other indications of problems in any area of the foot that persist for more than a few days.

Are Your Feet Always Cold???

Cold Feet

Typically, cold feet are the result of exposure to cold air; however, they can also be a symptom of an underlying medical condition.

Causes

Whenever the body temperature starts to dip below its normal range, the body redirects the blood supply to critical organs (the brain, the lungs, the heart, and others) to keep them warm.  At the same time, blood is redirected away from the extremities--the hands and the feet. This is why a person first feels the effects of coldness in the fingers and toes.

Prevention and Treatment

The key to keeping your feet warm in cold weather is to keep your entire body warm.

• Dress in layers. Layers insulate your body, helping you retain your “natural” heat and they can be removed as needed if you become too warm.
• Wear a hat, preferably one that covers your ears, because body heat escapes through the head.
• Wear good, insulating gloves to keep your hands warm and dry.
• If you get wet, your body loses heat more rapidly; stay as dry as possible.
• If you are in snow, wear an outer layer of water-resistant clothing and wear footwear with water-resistant soles and uppers.
• Choose shoes or boots that provide insulation and protection, such as those made from leather and synthetic materials.
• Wear padded socks made from insulating materials. These can be blends of wool and hollow core man-made fibers or blends of wool and man-made fibers.
• Use an insert or orthotic that can provide space for the feet to expand and spread, thus promoting good blood flow to help the feet stay warm.
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Medical Considerations

Several medical conditions can cause cold hands and feet. Peripheral neuropathy, which mainly affects people with diabetes, can produce a variety of symptoms including tingling, numbness, weakness, or a burning sensation. Peripheral vascular disease, also known as peripheral arterial disease (PAD), is associated with heart disease; it’s caused by diminished circulation in the lower body due to high blood pressure or plaque accumulation. Also linked to cold feet is Tarsal tunnel syndrome, a nerve disorder caused by compression of the tibial nerve as it passes through the ankle.

Other possible causes of cold feet that occur less frequently include hormonal abnormalities, autoimmune disorders and certain types of drugs. These include beta blockers for high blood pressure, ergotamine for migraine headaches, and cold medications that contain pseudoephedrine.

If you suspect that cold feet are caused by anything other than cold weather, or if you have cold feet for more than a few days, see your doctor.  Conditions that may signal a problem include cold feet while in a warm place, after exercising, or in any other situation where there is no apparent reason. Always talk to your podiatrist if you have soreness, pain, redness, swelling or other indications of problems in any area of your feet that persist for more than a few days.

Calcaneus (Heel Bone) Fractures

Calcaneus (Heel Bone) Fractures

Fractures of the heel bone, or calcaneus, can be disabling injuries.

They most often occur during high-energy collisions — such as a fall from height or a motor vehicle crash. Because of this, calcaneus fractures are often severe and may result in long-term problems.

The calcaneus is the most frequently fractured tarsal bone. Tarsal bone fractures account for about 2% of all adult fractures. Of these, 60% are calcaneus fractures.

The heel bone is often injured in a high-energy collision where other parts of the skeleton are also injured. In up to 10% of cases, the patient can also sustain a fracture of the spine, hip, or the other calcaneus.

Injuries to the calcaneus often damage the subtalar joint and cause the joint to become stiff. This makes it difficult to walk on uneven ground or slanted surfaces.

Types of Fractures

The severity of a fracture usually depends on the amount of force that caused the break. There are many types of calcaneus fractures, including:

Stable fracture. This type of fracture is nondisplaced. The broken ends of the bones meet up correctly and are aligned. In a stable fracture, the bones usually stay in place during healing.

Displaced fracture. When a bone breaks and is displaced, the broken ends are separated and do not line up. This type of fracture often requires surgery to put the pieces back together.

Open fracture. Broken bones that break through the skin are called open, or compound. These types of injuries often involve much more damage to the surrounding muscles, tendons, and ligaments. Open fractures have a higher risk for complications and take a longer time to heal.

Closed fracture. With this injury, the broken bones do not break the skin. Although the skin is not broken, internal soft tissues can still be badly damaged.

Comminuted fracture. This type of break is very unstable. The bone shatters into three or more pieces.

Cause

The calcaneus can be injured in a fall, twisting injury, or motor vehicle collision. A simple twisting injury may result in the calcaneus being cracked. The force of a head-on car collision may result in the bone being shattered (comminuted fracture).

Different causes can result in similar fracture patterns. For example, when landing on your feet from a fall, your body's weight is directed downward. It drives the talus bone down into the calcaneus. In a motor vehicle crash, the calcaneus is driven up against the talus. In both cases, the resulting fracture patterns are similar. The greater the impact, the more the calcaneus is damaged.

(Left) In some injuries, the talus is forced downward and acts like a wedge to fracture the calcaneus. (Right) This computerized reconstruction of a calcaneus fracture shows the amount of damage that can occur.

Symptoms

The most common symptoms of a calcaneus fracture are:

• Pain
• Bruising
• Swelling
• Heel deformity
• Inability to put weight on the heel or walk

In some minor calcaneus fractures, the pain is not enough to stop you from walking, but you may limp. This is because when you walk, the Achilles tendon acts through the calcaneus to support your body weight. If the calcaneus is deformed following an injury, the muscle and tendon cannot generate enough power to support your weight. Your foot and ankle will feel unstable, and you will walk differently.

Podiatrist Examination

It is important that your podiatrist knows the circumstances of your injury. For example, if you fell from a tree, how far did you fall? It is just as important for your podiatrist to know if you have any other injuries or medical problems, such as diabetes. Your podiatrist also needs to know if you take any medications.

After discussing your symptoms and medical history, your podiatrist will do a careful examination. He or she will look for other injuries and for areas where the skin is damaged or punctured. Your podiatrist will check to see if there is a good blood supply to your foot and if the nerves to your foot are working properly. To determine whether you have injured any other areas of your body, your podiatrist will examine the rest of your injured leg, your other leg, your pelvis, and your spine.

Tests

Other tests that may help your podiatrist confirm your diagnosis include:

X-rays. This test is the most common and widely available diagnostic imaging technique. X-rays create images of dense structures, like bone, so they are particularly useful in showing fractures.

Computed tomography (CT) scan. After reviewing your x-rays, your podiatrist may recommend a CT scan of your foot. This imaging tool combines x-rays with computer technology to produce a more detailed, cross-sectional image of your body. It can provide your podiatrist with valuable information about the severity of the fracture. Studying CT scans helps your podiatrist plan your treatment. He or she will often show you the images to help you understand the nature and severity of your injury.

Treatment

In planning your treatment, your Podiatrist at Advanced Foot & Ankle Center will consider several things, including:

• The cause of your injury
• Your overall health
• The severity of your injury
• The extent of soft tissue damage

Because most calcaneus fractures cause the bone to widen, the goal of treatment is to restore the normal anatomy of the heel. In general, patients whose normal heel anatomy is restored have better overall outcomes. Recreating normal anatomy, however, most often involves surgery. Surgery is associated with a higher risk of complications.

Dr. Raymond A. DiPretoro, Jr. will discuss the treatment options with you.

Nonsurgical Treatment

If the pieces of broken bone have not been displaced by the force of the injury, you may not need surgery. Casting or some other form of immobilization may be an option. This will keep the broken ends in proper position while they heal.

You will not be able to put any weight on your foot until the bone is completely healed. This may take 6 to 8 weeks, and perhaps longer.

Surgical Treatment

If the bones have shifted out of place (displaced), you may need surgery.

Timing of surgery. If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Keeping your leg immobilized and elevated for several days will decrease swelling. It also gives skin that has been stretched a chance to recover. This waiting period before the operation often improves your overall recovery from surgery and decreases your risk of infection.
Open fractures, however, expose the fracture site to the environment. They urgently need to be cleansed and require immediate surgery.
Early surgery is also often recommended for an avulsion fracture. Although uncommon, a piece of the calcaneus can be pulled off when the Achilles tendon tears away from the bone (avulsion). For this type of fracture, early surgery can decrease the risk of injury to the skin around the Achilles tendon.
Surgical procedure. The following procedures are used for various types of calcaneus fractures.

• Open reduction and internal fixation. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws or metal plates and screws.
• Percutaneous screw fixation. Sometimes, if the bone pieces are large, they can be moved back into place by either pushing or pulling on them without making a large incision. Special screws can be placed through small incisions to hold your bone pieces together.

(Left) A displaced fracture of the calcaneus. (Right) The fracture has been reduced and the bones held in place with screws.

The typical method of realigning the bone fragments and holding them in place with metal plates and screws.

Recovery

Bones have a remarkable capacity to heal. The more severe your injury, however, the longer your recovery may be. Patients with more severe fractures are also more likely to suffer some degree of permanent loss of function, regardless of treatment.

Rehabilitation

Whether you have surgery or not, your rehabilitation will be very similar. How long it takes to return to daily activities varies with different types of fractures. It depends on the severity of the injury. Some patients can begin weight-bearing activities a few weeks after injury or surgery; some patients may need to wait 3 or more months before putting any kind of weight on the heel.

• Early motion. Many podiatrists encourage motion of the foot and ankle early in the recovery period. For example, some patients are instructed to begin moving the affected area as soon as their pain allows. Patients who have had surgery are instructed to begin moving the affected area as soon as the wound heals to the podiatrist's satisfaction.
• Physical therapy. Specific exercises can improve the range of motion in your foot and ankle, and strengthen supporting muscles. Although they are often painful at the beginning and progress may be difficult, exercises are required in order for you to resume normal activities.
• Weight-bearing. When you begin walking, you may need to use a cane and wear a special boot. It is very important to follow your doctor's instructions for walking on your foot. If you place weight on your foot too soon, the bone pieces may move out of place and you might require surgery. If you have had surgery, the screws might loosen or break and the bone may collapse. This may not occur the first time you walk on it, but if the bone is not healed and you continue to walk on your foot, the metal will eventually break.

Six months after surgery, this patient's hardware has failed. Several screws have broken and the calcaneus has collapsed. This patient required major reconstruction, and today walks with a limp and has little motion in the foot.

Complications

There is a range of complications with calcaneus fractures. Minor complications include:

• Small or temporary areas of delayed wound healing
• Nerve irritation around the incision
• Tendon irritation caused by the screws
• Joint stiffness
• Chronic pain

Major complications include:

• Blood clots
• Failure of the wound to heal
• Infection
• Collapse of bone
• Arthritis (with or without surgery)

Smoking affects both bone and skin healing, so it is important to tell your doctor if you smoke. Some surgeons will not perform surgery on a patient who smokes because of the increased risk of serious complications. Even without surgery, your bone may take longer to heal if you smoke.
Additional surgery is usually required in cases of infection or difficult wound healing. If all methods of solving the problem have failed, amputation may be considered.

Long-Term Outcomes

If your injury is minor, such as a crack in the bone with little muscle damage, you may be able to resume normal activities 3 to 4 months after surgery. If the fracture is severe, however, it may take 1 to 2 years before recovery is complete.

Despite the best efforts of the doctor and patient, normal foot and ankle motion is rarely regained after a severe fracture. A patient who is not very active might tolerate a foot that is not normal. On the other hand, a patient whose job or recreational activities require a lot of walking or climbing will notice limitations much more.

Common Problems

Common problems that may persist after recovery include:

• Skin irritation. Footwear can irritate the skin or tendons in the affected area.
• Altered gait. In some cases, the arch of the foot has not been restored, or the Achilles tendon has not been attached at its normal distance from the ankle. Full subtalar joint motion is rarely regained in these cases, and this changes the way the patient walks. Patients may have problems walking on uneven ground, such as grassy surfaces or hills.
• Pain. If the calcaneus remains deformed, the patient may experience continued ankle pain and limited motion. Even if the heel anatomy is perfectly restored, the patient may still have discomfort. This can happen because of the injured soft tissues or limited range of ankle and subtalar motion. Although relatively uncommon, pain can be caused by irritation from the plates or screws.

Further Treatments

A simple shoe modification may help chronic problems. You may need to wear a heel pad, lift, or shoe cup, as well as special shoes with extra depth in the toe compartment.

Sometimes, another major operation is required. If the bone has healed in a deformed position, or if the subtalar joint becomes arthritic, the joint may need to be fused. The goal of this procedure is to help the talus and the calcaneus grow together and form one bone. Fusion also means that no more motion can occur between the two bones.
If the bone is badly deformed, the surgeon may attempt to correct some or all of the deformity along with fusion of the bones. These surgeries usually require several months for recovery.

Future Directions

Experts are still debating over the best treatment method for calcaneus fractures. As is usually the case, no single method works the same for everyone. Patients whose x-rays show completely normal heel anatomy often still have fracture symptoms after surgery. On the other hand, the calcaneus can look quite deformed on an x-ray, but the patient may have few, if any, symptoms.

There have also been studies that compared results in patients whose fractures were treated with and without surgery. Some studies show a significant benefit of surgery, while other studies show less benefit for certain patients.

As a result, experts continue to work to improve the outcomes of these injuries. Some new developments include:

• Using smaller incisions for reducing and fixing the fracture
• Defining which treatment method works best for which type of fracture
• Defining which treatment method works best for different types of patients; for example, smokers or people with diabetes
• Inventing better plates and screws