Thursday, November 21, 2013

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.

Wednesday, November 20, 2013

Philly Marathon Results!

Reading native makes top 3 at Philadelphia Marathon

Sunday, November 17, 2013

Highlights from 20th annual Philadelphia Marathon

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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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2013 Philadelphia Marathon

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

Tuesday, November 19, 2013

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!!!!

Monday, November 18, 2013

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!

Friday, November 15, 2013

Runners: Don't Fear the Knife!

Don't Fear the Knife

Foot surgery for runners is no longer the last resort

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.!.

Thursday, November 14, 2013

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.!

Wednesday, November 13, 2013

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

Monday, November 11, 2013

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.

Happy Veterans Day Thank You For Serving Our Country

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.

Friday, November 8, 2013

Ingrown Toenail Removal!!

An ingrown toenail (onychocryptosis) occurs when part of the nail penetrates the skin, which can often result in an infection. The ingrown nail can also apply pressure in the nail fold area without penetrating the skin - this is not technically an ingrown toe nail, but can also be painful (a corn/callus is also common down the side of the nail and is a reaction to this pressure, rather than the nail actually penetrating the skin).

What does an ingrown toe nail (onychocryptosis) look like:
Usually the side of the nail penetrates deep and it is difficult to see the edge of the nail. The severity of appearance of the nail will vary. Some will just have a nail that appears deeply embedded down the side or sides of the nail. In some the corner or a small spike of nail may penetrate the skin, just like a knife. This can result in an infection and the development of proud flesh (granulation tissue). The toe will then be red, inflamed and painful.


What are the symptoms of in ingrown toenail (onychocryptosis):
Pain is the main symptom of an ingrown toe nail - usually just starting as some minor discomfort. This may be just the pressure from the side of the nail or it may be because the nail has actually penetrated the skin down the side of the nail. The toe is not necessarily infected, but this can develop after the nail penetrate the skin to become ingrown. The infection can spread, making the toe red and inflamed (paronychia). A collection of pus may also develop.

What causes an ingrown nail (onychocryptosis):
Poor cutting of the nail is most commonly blamed as being the cause of an ingrown toe nail, but this is not necessarily the case. The following factors are involved in the cause of ingrown toenails (onychocryptosis): the primary risk factor is the shape of the nail - a nail that is more curved from side to side rather than being flat is more likely to become an ingrown nail (incurvated nails). Some nails go down the side into the nail fold area for a relatively large distance. A large portion of the nail is almost vertical rather than being horizontal. The most severe of these types of nail is called a 'pincer nail' in which both side of the nail are very curved. The shape of the nail is usually inherited (congenital), but it can be influenced by trauma and/or shoe pressure. poor cutting of these types of nails can leave a sharp corner (or if worse, a small spike) that will initially cause symptoms by putting pressure on the skin and then later penetrate the skin. Trimming too far down the sides is a common cause of an ingrown toe nail. footwear that is tighter is more likely to increase pressure between the skin in the nail fold and nail, increasing the risk on an ingrown nail. previous trauma to the nail may alter the shape of the nail, making it more prone to becoming an ingrown nail pressure from the toe next to the nail that has ingrown can sometime be a factor a 'chubby' or fleshy toe is more likely to have a nail grow into it. Those whose feet swell are a lot are more prone to having this happen.

Self treatment of the ingrown nail (onychocryptosis):
The cornerstone of self treatment and prevention of ingrown toe nails involves cutting the nail straight across to allow the corners to protrude, so that they do not penetrate the skin. Cut the toe nails straight across without tapering the corners. However, this can be difficult if the nail is very curved down the side. In this case DO NOT 'dig' down the sides - seek professional help for this (see below). It is a myth that a V should be cut in the end of the nail to treat an ingrown toe nail. The apparent reasoning behind this is that if you cut a V in the nail, the edge of the nail will grow together as the nail grows out. This does not happen - the shape of the nail is determined by the growing area at the base of the toe, not the end. Avoid wearing shoes and socks that are too tight. Keep feet clean to prevent the ingrown nail from becoming infected. Those with poor circulation or diabetes should not do any self management of ingrown toenails but see a Podiatrist. See below to find a Podiatrist. See below for how a Podiatrist would manage an ingrown toenail (onychocryptosis).

Podiatric treatment of the ingrown nail (onychocryptosis):
Initial treatment of the ingrown nail (onychocryptosis): Antibiotics are often used to treat the infected ingrown toenail, but don't forget that the cause of the infected (the ingrown nail) is still there, so there is not a lot of point in treating the infection while the cause remains. Sometimes antibiotics are used to help the infection clear after the nail has been removed. A skilled Podiatrist at Advanced Foot & Ankle Center can easily remove the corner or spike that has penetrated the skin, often with relatively little discomfort. If the ingrown nail is too painful, a local anesthetic may be needed to do this. Don't forget that unless the offending piece of nail that is causing the ingrown toe nail is removed, the infection is likely to persist. After this some antiseptic dressing for a few days is all that is needed to clear up the infection, especially if you are healthy and have no healing problems. Antibiotics and/or prolonged period of dressings are needed, especially if there is a problem with wound healing or if the circulation is poor or if you have diabetes. Occasionally, after the above treatment if the pain persist - this may be due to there being another spike of nail deeper down causing the ingrown toenail. Ongoing treatment of the ingrown toenail (onychocryptosis): Ingrown toe nails have a great tendency to happen again. They happen in the first place because of a number of reasons - the most common of those reasons is the shape to the nail. Generally, this is if the nail is curved down the side. With good self treatment (see above), it may be possible to prevent it reoccurring. Regular treatment by Dr. Raymond A. DiPretoro, Jr. can often be needed, as a conservative approach to prevent the nail becoming a problem is can be recommended. Surgical treatment of the ingrown toe nail (onychocryptosis): if the ingrown nail is severe, or if conservative care is difficult, or if the ingrown toenail does not respond well to conservative care, then minor surgical intervention is a good option. Minor surgery is a relatively simple procedure and is very successful for long term relief that is permanent. a number of different minor surgical procedures can be used by a Podiatrist to treat an ingrown toe nail. Almost all of these are done in the office under a local anesthetic. the most common procedure is the removal of a portion of the nail down the side of the nail that is causing the problem. In the worst case of a total nail which is curved, it may be necessary to remove the entire nail. After a nail or part of the nail is removed, it will grow back as the growing cells at the base of the nail are still there, unless something is done to remove them. Most commonly an acid is used to destroy the growing cells to prevent regrowth. Other options to prevent it growing back include, surgically debriding the growing area or using a laser. For some reason a few percent do reoccur. Generally, after the surgery you will need to keep your foot elevated for a few hours and rest is advisable. The following day, you can return to work or school. It is advisable not to take part in vigorous activities, such as running for 2 weeks after the surgery. The use of an open toe shoe, so that there is no pressure on the area also facilitates healing.

Wednesday, November 6, 2013

Diabetic Nerve Pain in the Foot!

Diabetes is one of the most common reasons people seek relief for painful feet. With diabetes, four types of foot problems may arise in the feet.

Nerve Problems due to Diabetes

The most common contributor to diabetic foot pain is a nerve problem called Peripheral Neuropathy. This is where the nerves are directly affected by the disease process. There are basically three types of peripheral neuropathy: sensory, motor, and autonomic neuropathy.

A large percentage of pain diabetic patients complain of is due to sensory neuropathy. This can show up as "sensitive pain," where the amount of pain is not proportional to the amount of insult that is causing it. For instance, just touching the skin or putting a sheet over your feet in bed could be painful. This can be present at the same time as numbness in the feet. Sensory neuropathy symptoms can include burning, tingling or a stabbing pain.

Relief is foremost on someone's mind when painful neuropathy has raised its ugly head. The first thing to do is to check your blood sugar for the past several weeks to see if there has been a trend toward high blood sugar (Editor's Note: The A1c test is traditionally employed to determine this, and should be repeated about every three months.) Persistent high blood sugar can contribute to this type of pain.

Massaging your feet with a diabetic foot cream, or using a foot roller, often takes the edge off the pain. Vitamin B preparations are often recommended; and there are a variety of prescription medications that do work. Using cushioned, supportive shoes and foot support inserts is always needed to protect the feet from the pounding, rubbing and irritating pressures that contribute to neuropathic pain.

Motor neuropathy can contribute to another painful diabetic condition. The nerves to the muscles become affected by the disease process. This makes the muscles feel weak and achy. Some of the first muscles to become affected are those in the thigh; other common muscles include the shin muscle and the small muscles of the feet. When motor neuropathy is present, walking imbalances can result. These can cause increased rubbing of the foot in the shoe, inflammation of the skin, increased callous formation, and pain.

Helping yourself against the ravages of motor neuropathy involves correcting those walking imbalances with supportive shoes and foot support inserts. Foot exercises, massage and using foot rolling devices are excellent ways to help keep those muscles and joints from becoming stiff.

Keep the muscles working and the joints moving!

Autonomic neuropathy affects the nerves to areas that are not under our conscious control. The sweating mechanism is altered -- so the person who suffers with this condition may have thickened, dry cuticles and nails; as well as dry, stiff, cracked skin -- which is subject to a buildup of thicker calluses with more pain. Bacterial and fungal infection could be more likely; an additional source of pain and concern.

Daily use of toenail oil and conditioning foot cream made specifically for diabetic foot care can play an essential role in preventing these problems.

Circulation Problems

Circulation problems in the feet may cause intense pain, even though the feet may feel numb to the touch. This is due to the effect of high blood sugars on the arteries, capillaries and veins. Arteries feed fresh blood away from the heart. This fresh blood nourishes and provides oxygen to the tissues. The blood enters and leaves the tissues through capillaries and goes back up to the heart to get refreshed with oxygen and nourishment by way of the veins.

The arteries most commonly affected are those behind the knee and the calf. These arteries are subject to the same fatty deposits that most people have, however, the process can be accelerated in diabetes. These fatty deposits thicken the walls of the arteries, and may develop calcium deposits. Blood flow to the feet could then be partially or totally blocked. Because the tissues are starving for oxygen, this can be an extremely painful process. Such pain is often described as though the feet are in a vise, and are being strangled.

The capillaries are known to get thickened and stiff from diabetes -- thus not as efficient in delivering oxygen and nutrients to and from the tissues.

The veins can get swollen and painful. This happens when the arteries cannot handle the blood flow, and little channels are created to direct the blood over to the veins instead of trying to push the blood through closed arteries. Sometimes there is more blood than the veins can handle. They become so full that the valves become broken. Blood then pools in the feet and legs and can leak out into the skin, creating ulcerations, which can be very painful.

With the approval of your medical doctor, support hose, exercise, massage, physical therapy, medications and various surgical procedures can be used to improve the circulation.

Muscle & Joint Problems

Muscle and joint problems in the diabetic patient are a frequent source of discomfort and pain. The muscles are affected by diabetic neuropathy, circulation problems and atrophy. The tendons (attachment of the muscle to the bones) may become stiff and contracted due to the walking imbalance associated with peripheral neuropathy.

This walking imbalance forces the foot and joints to move in ways that are not healthy and that Mother Nature never intended. In addition, they may stiffen in this bent position because of the excess blood sugar combining with the proteins in the joints. This is called diabetic glycosylation of the joints.

This, combined with the normal imbalance all people, including non-diabetics, are subject to, can lead to stiff hammertoes, bunions, spurs, and tiny fractures with dislocation of the bones (called Diabetic Charcot Deformity). These problems can be sources of pain, infection, ulceration and major medical concern.

With consent from your foot healthcare provider, foot rollers, massage and specially made shoes and inserts might be the best way to deal with these muscle and joint problems.

Frequent Infections

Diabetic persons become more susceptible to bacterial, fungal and yeast infections due to medical and nutritional changes that takes place in the body.

Bacterial infections show up in areas on the foot that become irritated, ulcerated or injured. The signs of a bacterial infection include redness, swelling, warmth, pain and tenderness as well as the presence of pus. (Editor's Note: Blind diabetics can detect foot infections by touch, and, in some cases, by smell.) This kind of infection can either be on the skin, called cellulitis, or can spread to the bone. When infection has spread to the bone it is called osteomyelitis. It is interesting that even though a diabetic may have numbness in their foot, they could sometimes feel pain when they have a bacterial infection. When a diabetic suddenly develops pain while their feet are numb, it could be a sign that an infection is present -- and a health care provider should be contacted without delay.

Fungal or yeast infections in the foot commonly occur as athlete's feet or fungal toenails. Athlete's feet can cause the skin to become blistered, scaly, red, inflamed and painful. A bacterial infection can occur on top of this because the irritated skin serves as a good place for germs to thrive. Fungal toenails can become very thick, powdery and ingrown. These thick nails can leave debris under the nails and cause severe irritation to the skin surrounding the nails. They can even become ingrown with callused nail grooves. This can cause infection to the areas surrounding the nail and is a source for medical concern.

In order to maximize a person's ability to fight off infections, think strengthen the immune system. This comes from good blood sugar control, moderate exercise, good nutrition and supplements, if recommended by your health care professional. Fungus can make the skin raw and fungus toenails can become thick, irritating, painful and infected with bacteria. Self-inspection and daily maintenance of the skin and nails is essential to prevention. Once your toenails or skin on the feet become infected with fungus, it is important to treat it right away to prevent ulceration and bacterial infection. Medications prescribed by your foot healthcare professional are recommended, but various over-the-counter and home remedies have found success. The use of tea tree oil, sesame oil, garlic, grapefruit seed extract, and galberry root soaks are among them.

It is important to note that not all diabetics can detect the pain of these problems -- and therefore should have their feet visually and manually inspected every day. Be Prudent, Be Cautious and Follow the Rules of Good Health!