Tuesday, February 15, 2011

Is Your Foot Fracture an Early Sign of Osteoporosis?

Foot surgeons urge patients not to ignore foot pain

CHICAGO – October 5, 2010—Unexplained foot fractures may be the first sign of osteoporosis, a bone thinning disease which affects over 28 million Americans and accounts for 1.5 million bone fractures a year.

According to the American College of Foot and Ankle Surgeons, osteoporosis is frequently referred to as the “silent crippler” since it often progresses without any symptoms or isn’t diagnosed until a person experiences pain from a bone fracture. Georgeanne Botek, DPM, FACFAS, a Cleveland foot and ankle surgeon, explains that the porous nature of bones in people with osteoporosis makes them more susceptible to bone fractures, especially in the feet. “Because the bones are in a weakened state, normal weight-bearing actions like walking can cause the bones in the foot to break,” says Dr. Botek. “In fact, many patients visit their foot and ankle surgeon suffering from foot pain only to find out they actually have a stress fracture, without having experienced an injury.”

While osteoporosis is most commonly seen in women over age 50, younger people and men are also affected. Early symptoms can include increased pain with walking accompanied by redness and swelling on the top of the foot. “Oftentimes patients don’t seek treatment for their symptoms for weeks or even months, thinking the pain will pass,” says Dr. Botek. “The best advice is, don’t ignore foot pain of any type. Early intervention can make all the difference in your treatment and recovery.”

Foot and ankle surgeons are able to diagnose osteoporosis through bone densitometry tests, which measure calcium and mineral levels in the bones through low-dose radiation x-ray, or possibly through a routine x-ray. “This is why prevention and early intervention are key; women should make sure bone densitometry tests are part of their wellness examinations when indicated by their physicians,” Dr. Botek explains.

If you are diagnosed with osteoporosis, it’s important to protect your feet from stress fractures. Wear shoes that provide support and cushioning, such as athletic running shoes, to provide extra shock absorption and protection. Custom orthotics may also be recommended to protect the foot from pressure and provide shock absorption, particularly during exercise.

For more information on osteoporosis of the foot, visit the American College of Foot and Ankle Surgeons’ website, FootHealthFacts.org.

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Foot Push-Up Test

Take this simple test to check how well your arches are performing their important functions.

   1. In bare feet, stand facing a kitchen counter.
   2. Place your palms on the counter with slight pressure.
   3. Stand with your back straight, and lift one foot off the floor.
   4. Slowly lift the heel of other foot, placing all of your weight onto the ball of your foot.
   5. Slowly lower your heel back to the floor.
   6. Do 10 foot push-ups.

Repeat steps 1 - 6 with the other foot.

    And now the results...

Did you have problems doing just one push-up?
If you cannot rise up onto the ball of your foot without putting lots of pressure on your hands, leaning over the counter or experiencing pain, your arch may have a mechanical problem. The arch tendon can stretch or rupture, leading to lowering of the arch. A foot and ankle surgeon should be consulted as soon as possible.

Were you able to do all 10 without a problem?
If you can easily rise up onto the ball of your foot, but have difficulty performing all 10 repetitions, you may be suffering from arch fatigue. Exercises focusing on strengthening and stretching leg muscles will help this problem. The foot push-up described above can also be used as an exercise technique.

Did you have pain in your arch during the exercise?
If you can easily rise up onto the ball of your foot but experience pain in your arch, your arch may be inflamed and may have been overworked. Consulting a foot and ankle surgeon for weak and overworked arches is recommended to manage the problem and keep your feet healthy and free of pain.

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What to ask your foot and ankle surgeon about bunion surgery

If you're considering bunion surgery, here are some questions to ask your foot and ankle surgeon. As a patient, you're part of the health care team. Don't be afraid to ask questions. Informed patients make informed decisions. The American College of Foot and Ankle Surgeons encourages you to print these questions and take them with you.

      Do I need bunion surgery right now?
      What happens if I wait a while?
      What procedure are you recommending, and why?
      What are the alternatives to surgery?
      How successful is bunion surgery?
      What are the risks?
      Should I get a second opinion?
      What is your training and experience to do this procedure?
      Where will the procedure be done?
      What kind of anesthesia will I need?
      How long will it take me to recover?
      Will my insurance cover this procedure?
      How will you make sure you operate on the correct foot?

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That Pain in Your Back Could be Linked to Your Feet

If your lower back has been hurting, and you don’t remember doing anything to injure it, the source of your pain could be your feet! Foot pain is something that many people try to ignore. After all, doesn’t everyone’s feet hurt now and then? But if foot pain is something that has been with you for quite awhile, it could be causing problems in your ankles, knees, hips and even your back.

That old song, “The leg bone’s connected to the thigh bone...The thigh bone’s connected to the hip bone…,” tells the whole story. Our bodies are like a chain, with one link–or bone–connecting at the joint to another link. Think about what would happen if the first link in the chain was out of position. The point at which it meets the next link would eventually overstress that link and adversely affect the entire chain.

That’s what happens when we have foot pain. If the normal way of walking is painful, we instinctively change our walking pattern. Say you have arthritis, and your big toe joint hurts, so you change our gait to avoid bending the joint when you walk. Changing your gait changes the mechanics of your ankle joint, eventually causing ankle pain. This change in your walking pattern can also affect the whole chain of your lower body... from the ankle, to the knee, to the hip, and then to the lower back.

When foot pain or a foot deformity causes you to change the way you walk, it changes the way the bones of all those other joints move with each other. Cartilage in the joints can wear down, ligaments and tendons can be stressed beyond their normal range, and arthritis can set in.

If your feet or ankles aren’t working right, don’t ignore them! Contact a foot and ankle surgeon for an evaluation. Your back (and knees and hips) will thank you!

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Friday, February 11, 2011

Heel Pain (Plantar Fasciitis)

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.
Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.
Heel PainWhat Is Plantar Fasciitis?Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.
CausesThe most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.
Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
SymptomsThe symptoms of plantar fasciitis are:
  • Pain on the bottom of the heel
  • Pain that is usually worse upon arising
  • Pain that increases over a period of months
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
DiagnosisTo arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.
In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Non-Surgical TreatmentTreatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
  • Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
  • Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
  • Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
  • Limit activities. Cut down on extended physical activities to give your heel a rest.
  • Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:
  • Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
  • Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
  • Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
  • Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
  • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
  • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
When Is Surgery Needed?Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.
Long-term CareNo matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

Learn More at Austin Podiatry

Thursday, January 20, 2011

10 Tips to Keep Your Feet Healthy

Keeping your feet pain-free is surprisingly easy. Healthy measures include good hygiene, self-examinations, and properly fitting shoes. 

Healthy feet are important for feeling good and staying active. So if you neglect your feet, that can lead to unnecessary pain and other foot problems, says Elizabeth Kurtz, DPM, a podiatrist in Chicago and spokesperson for the American Podiatric Medical Association (APMA).
Fortunately, it’s easy to keep your feet healthy. Use these tips to keep yourself active and your feet pain-free.
  1. Keep your feet clean and dry. Healthy feet start with good hygiene. Thoroughly clean and scrub your feet with soap and water when you bathe. Afterward, dry them well. Fungal organisms love moisture, so depriving them of any wetness will make it more difficult for them to thrive. “Be sure to dry well between each individual toe,” says Dr. Kurtz. “Any excess moisture between the toes can create a great environment for a fungal infection to begin.”
  2. Examine your feet for problems. Perform a foot self-exam once a week when you take a bath or shower, recommends Kurtz. As you’re drying off your feet, take a good look on the soles for any scaling and between your toes for peeling areas. That could signal athlete’s foot. Also look for discoloration of the nails, which could indicate a nail fungus. If you have diabetes, you should inspect your feet every day since diabetes leads to higher risk of foot sores and infections.
  3. Cut toenails properly. Cut nails straight across and avoid trimming too close to the skin or drastically rounding the corners of the nails, which can cause painful, ingrown toenails.
  4. Don’t hide “ugly” toenails with polish. A discolored, thick, cracked, or crumbling nail could signal a nail fungus. Applying nail polish to an infected nail could make the problem worse.
  5. Protect your feet in public areas. Be sure to wear shower shoes at the gym, in locker rooms, and at public pools. These places tend to be breeding grounds for fungi that can lead to infections.
  6. Avoid sharing footgear. “You can get fungal infections by wearing other people’s shoes, as well as socks worn by another person,” says Kurtz. This includes rentals. Always wear your own footgear to help keep your feet healthy.
  7. Head off sweaty feet. Your feet have sweat glands galore — 250,000 in each foot! Perspiration creates the perfect environment for bacteria to set up shop. Wearing socks that keep feet dry will help your feet stay healthy. “Socks made of synthetic fibers tend to wick away moisture faster than cotton or wool socks,” says Kurtz. Also avoid wearing excessively tight pantyhose, which trap moisture.
  8. Choose breathable footwear. To help keep your feet dry and healthy, wear shoes made of leather to allow air to circulate. If you’re prone to excessively sweaty feet, look for shoes made of mesh fabrics for maximum breathability.
  9. Wear shoes that fit properly. Shoes that are too tight can cause long-term foot problems, says Kurtz. Shop for shoes at the end of the day to compensate for foot swelling that occurs later in the day, and wear the same type of socks or hosiery you’ll be wearing with the shoes. Choose a broad, rounded shoe with plenty of room for your toes and a wide, stable heel. Avoid pointy shoes, which can cramp your toes and cause ingrown toenails and calluses.
  10.    Know when to see a doctor. Don’t attempt to self-treat painful foot woes. “I see many patients who have attempted what I call bathroom surgery, and they’ve made the problem worse,” says Kurtz. Any pain, redness, swelling, or discoloration that persists should be checked out by a podiatric physician. Usually the problem can be cleared up with prescription medicine or a minor in-office procedure. Allowing a doctor to take a look will help prevent minor problems from becoming major ones.
By following these 10 easy tips, you can help keep your feet healthy and pain-free.

By Jan Sheehan