Foot, Ankle & Lower Leg Center: December 2011

Thursday, December 22, 2011

How to get through the winter injury-free

Published on: Detroit Free Press

Whenever there's a snowstorm, Dr. James Kraft typically sees an influx of patients with back pain and injuries. The doctor of chiropractic medicine, who runs Kraft Chiropractic Clinic in Troy, says the avalanche of appointments is due to shoveling heavy snow.

"I see lots of patients with the same injuries after a snowstorm," says Kraft, who has been based in Troy for 22 years. His clientele includes everyone from professional athletes to 90-year-old war veterans.

Dr. Ronald Taylor advises those with a history of back or heart problems to not shovel. "With snow, you've got all that weight at the end of a long lever arm; even with proper shoveling techniques, it's a lot of stress on the body," says Taylor, chair of the Physical Medicine and Rehabilitation department at Beaumont Health System in Royal Oak.

He admits that he will occasionally shovel his own driveway if he needs to get out in a hurry. "But I'm in shape; I bike 45 minutes a few times a week and I don't have any health problems that would be affected by shoveling."

As pretty as the white stuff is, snow does bring danger. According to a 17-year study published this year in the American Journal of Emergency Medicine, an average of 11,500 snow shoveling-related injuries and medical emergencies were treated in U.S. emergency departments each year from 1990 to 2006.

The lower back was the most frequently injured part of the body, followed by injuries to the arms and hands. There's also a chance of falling and injuring yourself, especially if you're not wearing the proper footwear.

These tips can help you lift, glide, walk, trudge and bend yourself through the snowy season, injury-free.

SOLE MATES: You get the best traction with boots that have a rubber sole and deep grooves, says Dr. Jodie Sengstock, a West Bloomfield-based podiatrist who runs Feet First Podiatry and is president of the Michigan Podiatric Medical Association.

HEED THE HEEL WARNING: When walking on ice and snow or shoveling snow, avoid boots with heels over one-half inch, says Sengstock.

AVOID ANKLE ANGST: "Wear boots that are high enough to fully support your ankle to help avoid ankle sprains from slips," she says.

WARM UP: "You should always stretch before heading out to shovel," says Kraft.

"Lay on the floor on your back and pull your knees up to your chest, one at a time," Kraft suggests. "Or sit on the edge of your bed or on a chair and do some upper-body rotations." He also recommends raising your arms over your head and reaching straight up, "which strengthens the whole back."

TECHNIQUE 101: Bend your knees and lift with your legs, says Kraft. "And keep your back straight, using your shoulder muscles as much as possible."

NEAR & DEAR: "Keep the snow (on the shovel) as close to your body as possible; don't lift snow that's far away from you," he says.

SMALL SCOOPS: "If the snow is heavy, take small shovel fulls; don't fill up the whole shovel," says Taylor.

TAKE A BREAK: "Break up your shoveling," says Taylor, "into maybe 10 or 15 parcels; rest often."

BOSS OF TOSS: "Try to throw the snow straight from your shovel," Kraft says, "and not right or left; don't twist when throwing the snow."

HAND-Y IDEA: "Keep one hand closer to the shovel's blade for better leverage," Kraft says.

STOKE YOUR BODY: "You need to hydrate regularly when shoveling," he says.

DESIGN DETAIL: "Ease of shovel use is imperative," says Colleen Maiura, a publicist for Lowe's. "The best and most innovative features in snow tools are lightweight and ergonomic (which relieves stress on joints and lower back). The latest innovations include curved handles for better leverage, oversized and bent grips that provide better hand placement and maneuverability."

Two popular shovels available at Lowe's are the True Temper SnowBoss and VersaGrip.

WEIGHT UP! "If the snow you are shoveling is 6 inches deep or less, then a pusher style is an ideal snow tool," says Maiura. "However, if you're shoveling deeper snow, then a combo blade is more ideal. Combo blade shovels feature higher sides and can be used both to push the snow and shovel."

FIND A NEIGHBOR KID: "If you've had lower back pain issues in the past, and depending on your physical health, it may be best to not shovel," says Kraft.

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas anytime @702-878-2455 between Monday – Friday and we would be happy to set up an appointment for you. Please visit our website @ www.FallCenter.com. The Foot, Ankle & Lower Leg Center has Diagnostic imaging: Digital X-Rays, Ultrasound or Advanced Imaging will be used to aid in the diagnosis.

Dr. Anthony Ricciardi at the Foot, Ankle & Lower Leg Center has completed training in endoscopic/minimally invasive surgery for chronic heel pain and nerve pain, foot and ankle joint replacement for restoring pain free motion, arthroscopic surgery, bunion surgery, fracture repair, flat foot correction, external fixation for complex deformities and extensive experience in peripheral nerve surgery including diabetic peripheral neuropathy and reconstructive surgery of previously failed foot surgical procedures. In addition to his surgical training Dr. Ricciardi focuses on sports medicine of the foot and ankle through regenerative techniques using the patient’s own blood/platelets for healing chronic foot and ankle problems (pain) as a result of repetitive sport injuries. This cutting edge technology enables patients to continue training with little or no down time. Dr. Ricciardi continues to be active in teaching and training other podiatric surgeons on innovative surgical techniques in foot surgery. Dr. Ricciardi is Board Certified by the American Board of Podiatric Surgery, a Fellow of the American College of Foot and Ankle Surgeons and Fellow of the Association of Extremity Nerve Surgeons. Dr. Ricciardi’s vision is to bring each patient the most current state of the Art Technology and personalized treatment options to meet their Foot and Ankle needs (from conservative care to surgical options). Dr. Ricciardi believes in quality service and puts his patients first!

Monday, December 19, 2011

Hammertoes

Posted on: Ladue News

Among the many injuries and deformities that can occur on our feet, hammertoes are among the most obvious. This condition causes the joints in the toes to contract, forcing the toes to bend upward at the joint.

“Anything that causes damage to the top extensor tendons, making them pull harder than they’re supposed to, can pull the toe back,”explains Dr. Lawrence Iken, a St. Louis podiatrist. In hammertoe patients, the tendons that attach to the top of the toe become contracted, sometimes to the point of becoming frozen in the abnormal position.

Hammertoes may be hereditary, and Iken says this is the case for the majority of patients. However, other factors can contribute to the problem. “This is a muscle tendon imbalance or the effect of overstabilization of the toes due to flat feet. When your feet are flat, you get used to over-flexing your toes for balance,” says Dr. Michael Horwitz, director of Feet for Life Podiatry Centers.“Cortisone shots given the wrong way also are a cause of hammertoe deformity. The tendons to the digits are delicate and can be injured if the practitioner is not knowledgeable and careful with injections.”

Hammertoes do not affect the big toe but may affect one or more of the other toes. As the toe contracts and is pulled up and back, it tends to rub on shoes, causing discomfort and calluses or corns. Patients often pad the corns and attempt to ignore the problem.“People like to buy over-the-counter medicines, and that’s a very bad thing to do,” Iken says. “It leads to a lot of complications as far as infections and problems of that nature. Unfortunately, an acid pad, as found in medicated corn pads, doesn’t know the difference between thickened skin and good skin. If you get it on the good skin, it’s like a first-degree chemical burn. So I would caution people not to buy medicated over-the-counter pads.”

People who have hammertoes should wear comfortable shoes with plenty of space for the toes. Tight or pointed shoes tend to exacerbate the condition. “Orthotics are good for slowing down the progression of the deformity; but even better, frequent use of minimalist footwear without orthotics will help keep your feet strong,” Horwitz says. He explains that hammertoes occur because of foot weakness and instability. “The stronger your foot is, the healthier it is. So if you wear orthotics, get out of them for at least 16 hours a week and get into minimalist footwear. This will strengthen your feet.”

Surgical correction is the only answer for some patients, particularly if the joints become rigid. The outpatient procedure involves cutting and realigning the tendons and also removing some small pieces of bone in order to straighten the toe. Iken says that most patients who have the surgery wear a surgical shoe for a couple of weeks and limit walking and standing initially as the toe heals. Most can resume all activities within a month.

“If you have a hereditary inclination to get hammertoes, use common sense with shoes and wear a comfortable shoe,” Iken adds.“And don’t let it get too bad. If you notice a malalignment of the toe and it’s starting to get contracted, see a podiatrist.”

Friday, December 16, 2011

The high heels and tight fits of today's shoes are terrible for women's feet (photo gallery)

Posted on: The Plain Dealer (Cleveland.com)

Gallery: Shoes, heels and foot problems (7 photos) RSS

Description:

http://photos.cleveland.com/4501/gallery/shoes_heels_and_foot_problems/index.html

Women's shoes have always been about the heels. And barring the brief Earth Shoes phase in the 1970s, style has usually trumped comfort.

Maybe it was "Sex and the City" and its fetishization of Manolo Blahniks. Whatever the reason, 4-plus-inch spike heels that would have been available only at Frederick's of Hollywood in the 1980s are now seen at every department store and major shoe retailer.

That's been great for orthopedic surgeons, says Dr. Randall Marcus, but terrible for women's feet, tendons and lower backs.

Heels are only part of the problem, however. Ballet flats and flip-flops don't offer the foot enough support or shock absorption, while platform wedges can be unstable and too easy to fall off of, resulting in a torn ligament or broken bone. Adding insult to injury: Many women's shoes, even flats, taper at the front, creating narrow toe boxes.

"No human has a pointed foot," says Marcus, chairman of the Department of Orthopedic Surgery at University Hospitals Case Medical Center. "So eventually, if you wear shoes that don't conform to the shape of the foot, they will deform your foot."

Dr. Marie Blazer, a podiatrist at the Cleveland Foot & Ankle Institute of the Ohio College of Podiatric Medicine, has run into resistance from patients unwilling to make changes.

Facts and tips about shoes and foot problems

"Just last week, I had a patient who told me she was willing to put up with pain because she has well over 100 pairs of shoes that have heels of 4 to 5 inches," says Blazer. The woman, in her 40s, "wanted me to advise her on padding. I told she's got to wear different shoes.

"She said she buys longer pants to accommodate her heels, and said this is what she needs to look good as a professional."

Sooner or later, though, a woman will pay the price -- perhaps surgically -- for choosing fashion over function. And it will probably be sooner if she's forcing her feet into an unnatural shape, at an unnatural height.

Men tend to wear shoes that are close in shape to their feet, so women are at least 10 times more likely to need surgery on their feet, says Marcus, who is also chairman of the Department of Orthopedics at Case Western Reserve University School of Medicine.

Marcus and his fellow surgeons don't see many young women as patients (unless they fall off their platforms or high heels and break an ankle, which does happen). It takes a few years for damage to feet and bones to manifest.

"Then, as women get older, there's also some fat atrophy," says Marcus, so the padding on the bottom of their feet diminishes. That comes with age, and it can make it even more uncomfortable to wear high heels or thin-soled shoes.

What isn't natural is what happens to feet that have spent too many years in heels -- because of the way pointy toe boxes push the toes together, which is aggravated by the downward pressure placed on the balls of the feet in heels.

Often, bunions are the result. A bunion is what appears to be a bony projection on the inner side of the foot below the big toe. Bunions, which in reality are misaligned big-toe joints, require surgery to correct, followed by a slow healing process. Continuing to wear unsuitable shoes will bring them back, though, Marcus warns his patients.

But that's not the only thing that can happen to feet. Women can get arthritic inflammation. Or they might get a condition known as hammertoes, in which the toes begin to buckle into a clawlike position; corns form at the bent joint where the toes rub against the tops of shoes.

High heels also create problems for the rest of the body, especially the lower back, says Marcus. Wearing heels forces the buttocks out -- which is often what men find sexy about women in heels -- but this position also causes pressure and strain on the lower back.

Less serious effects of high heels, but still irritating, are corns and calluses, often caused by ill-fitting shoes and underlying bone problems in the foot. Those problems combined cause excessive irritation.

These issues are so prevalent because 9 out of 10 women wear shoes too small for their feet and 8 out of 10 women say their shoes are painful, according to a study by the American Orthopaedic Foot and Ankle Society. The research also shows 7 out of 10 women develop bunions, hammertoes or other foot deformities, and 9 out of 10 women's foot deformities can be attributed to tight shoes.

Blazer says the first sign she sees, even in younger women, is discoloration of the tops of the toes. "I'll see 20-somethings and they'll ask me about that, and if there's a cream for it," she says. "I ask them if they wear high heels a lot and the answer is always yes. They'll be wearing a shoe with too small a toe box, which creates friction and then discoloration."

It won't go away unless they start wearing reasonably heeled shoes with a wider toe box, she says.

Spiky heels are more popular than ever, says Blazer. "It looks like we're in the age of Lady Gaga. That means we'll be seeing lots and lots of patients."

Thursday, December 15, 2011

Strategies to beat stinky feet

Posted on: Post-Tribune (A Chicago Sun-Times Publication)

Dear Harriette: Great answer to “Stinky” regarding foot hygiene, but you forgot the “biggie”: Do NOT wear the same shoes two days in a row.

This recommendation came home to me during basic training at Fort Knox in 1967. We were issued two pairs of boots; one pair we marked with white dots.

When we “fell out” each morning, every soldier in the barracks had to have the same pair of boots on: white dots on one day, and no white dots on the next. No exceptions.

Failure to follow the standard meant we all returned to the barracks. When called to “fall out” again, everyone wore the correctly marked boots. The point was to alternate the boots and give them a chance to breathe, inside and out. This approach works. You cannot imagine the potential odor coming from 60 pairs of boots lined up under bunk beds in an Army barracks. Many recruits also purchased baking soda.

Further, Americans should adopt the standard of most Scandinavian households and not wear street shoes in the house. I learned this as a child. Not only does it give the feet and shoes a rest from each other, such a practice leaves outside debris carried by shoes at the front door.

It also reduces wear and tear within the home — especially in America, where wall-to-wall carpet is more the style than in Europe, where wood floors are the standard.

Service-Wise, Chicago

Dear Service-Wise: Thanks for sharing your knowledge.

Dear Harriette: Please pass on to “Stinky” some further advice. My husband could have written this letter 25 years ago. His feet (and shoes) smelled so bad that I made him leave the shoes outside the door when he took them off. Baking soda, over-the-counter foot powders and foot washing (at least two times a day) didn’t do the trick.

I finally got him to go to a podiatrist, who prescribed a topical medication for foot fungus. Within a month, the doctor’s prescription worked. Other advice from his doctor that worked was to have (at least) three pairs of shoes. Foot fungus thrives in moist environments, so letting the shoes dry thoroughly before wearing them again helps keep the fungus from recurring.

My husband also thinks that wearing natural-fiber socks (either cotton or wool) helps him keep the problem from recurring. As a wife with a sensitive nose, I am in full sympathy with Stinky’s spouse. And for a guy to write for advice shows his concern for marital harmony. It took several years of gentle suggesting (often called nagging) to get my husband to the doc. Podiatrists are really the go-to people for foot problems.

Sweet Feet in Chicago

Dear Sweet Feet: Thank you for your input. A podiatrist is an excellent idea, and you are right: Sometimes foot odor points to real health concerns that can be identified and resolved with a doctor’s help.

Friday, December 9, 2011

Zumba’d: A fitness craze can lead quickly to the ER

Posted on: The Washington Post

Astrid Riecken/For The Washington Post - Hundreds of participants join Zumba instructors Leonardo Lins and Roberson Magalhaes, both from Brazil, for a Zumba workout at the Franconia Fire Station on Beulah Street.

The patient was a healthy young woman who came into a Washington area emergency room this year because of severe heel pain, which turned out to be a potentially serious injury known as “compartment syndrome.” The syndrome is typically caused by high-impact accidents, like something involving a motor vehicle. The patient had not been in a car accident. The patient had been in Zumba.

“I have seen some interesting things,” says David Pontell, the podiatrist who ultimately treated the injury. “That was one of them.”

People can get injured doing a lot of things that are dangerous or physically punishing. Or they can get injured doing Zumba. Zumba is not inherently dangerous. Its injuries are not any more prevalent than those from any other physical activity. They are just more embarrassing.

“By the end of the class, I was on fire, and not in a ‘Hoo-hoo — I’m hot and sexy!’ kind of way,” Tonya Green, 32, says ruefully. She discovered, through a Zumba class, that she had something called snapping hip syndrome. “It was a salsa movement. I Zumba’d my hip out, real good.”

Some 12 million people worldwide now do the cardio dance bonanza that is Zumba. You know who they are, because they are everywhere. Also, because they talk about it all the time. Also because they are all infused with a golden glow, a healthy bounce, a Zumba smug. Zmug. Zumba has become like yoga or “Game of Thrones” — a hobby that is deeply enlightening and life-changing to the people who practice it. To everyone else, it’s just weird. In 20 years, nobody is going to be talking about tennis elbow. Everyone is going to be talking about reggaeton ankle.

“We see a lot of ankle strains,” says Rajeev Pandarinath, an associate professor at George Washington University’s Department of Orthopaedic Surgery. “There are a lot of lateral moves in Zumba.”

“I’ve seen some sprains; I’ve seen some stress fractures,” says Elizabeth Delasobera, an attending physician at Georgetown University Hospital’s ER. The reasoning, she speculates: A novice starting a running program will probably jog only two or three times a week, for 15 or 20 minutes. Because running is kind of awful. But somebody who starts a Zumba program? “They’re Zumba-ing five days a week.”

Ha. Maybe her patients are Zumba-ing five days a week. Our Facebook friends are Zumba-ing seven days a week, sometimes eight. They are Zumba Toning and Aqua Zumbaing and watching Zumba TV and taking mass Zumba classes in Gaithersburg at a fitness studio lit by a disco ball.

“It blows the paradigm,” says Pamela Peekes, doctor, Discovery Channel medical correspondent, Zumba fan. “You could do it naked. You could do it half-naked. You could do it alone. You could do it with 65,000 other people.”

You could do it on a boat. You could do it in a coat. You could Zumba here or there. You could Zumba anywhere. Zumba classes are populated by people who are either amazing dancers or believe themselves to be amazing dancers. Zumba is the kind of freeing experience that causes its attendees to fling themselves about in delirious passion, so moved that they do not even notice when they have Zumba’d their own bodies into unnatural and inadvisable contortions.

“We get people being so enthusiastic,” says Joy Prouty, who works for Zumba, training other Zumba instructors. She preached safety first, but there is little that even a conscientious instructor can do in the face of a determined Zumba-ist.

“It was embarrassing to talk to my doctor about it,” says Karen Montague, a 40-something cartoonist who Zumba-injured her back. But when she mentioned it to the nurse, the nurse wanted to know where she, too, could find a good place to Zumba.

Monday, December 5, 2011

Holiday Foot Fixes

Posted on: American Podiatric Medical Association, Inc. (APMA)

The winter months and holiday madness can take a serious toll on your feet. Find out how to keep your feet very merry this holiday season.

http://www.apma.org/holiday-foot-fixes

Thursday, December 1, 2011

Winter weather especially harsh for those with diabetes

Published on: ARA via The Star

(ARA) - Trekking through the mall on holiday shopping excursions, shoveling out the driveway and playing in the snow with the kids - every winter, your feet log some long, chilly hours. For people with health issues like diabetes, foot health is especially important when the weather turns cold, as the disease can affect your body's circulation even more so during the winter months.

More than 26 million Americans have diabetes, according to the American Diabetes Association. If you or a loved one have the disease, it's important to remain vigilant against complications year-round, and especially during the winter when feet are exposed to cold and remain covered up for extended periods.

The American Podiatric Medical Association (APMA) offers some podiatrist-approved advice to help those with diabetes maintain good foot health throughout the winter months:

* People with diabetes may experience loss of feeling in the toes and feet, which can be particularly dangerous during the winter. When walking outside, be sure to keep your feet protected from frostbite by wearing warm socks and proper footwear.

* Never walk in the snow in sneakers, dress shoes or sandals. Choose weather appropriate footwear that both fits comfortably and keeps feet dry and warm. You can find a list of footwear that have APMA's Seal of Acceptance by visiting APMA's website.

* You probably wouldn't dream of going barefoot outside in the winter, but you shouldn't do it inside, either. Always wear shoes and socks when walking outside, and at least wear socks inside. They afford a needed layer of warmth and protection. The type of hosiery you choose is important, too. Look for products made from breathable materials that won't constrict blood flow, such as CrocsRx footwear. Because moisturizing feet in the dry winter months is also important, foot care products such as AmLactin XL Moisturizing Lotion keep feet and skin healthy while being safe for those with diabetes.

* Wash and inspect your feet daily. Perform your self-exam at the same time every day and watch for changes in skin color, sores, swelling, blisters, peeling, cracking or other signs of problem. When you have diabetes, even a minor wound can become a problem, so don't wait to see a podiatrist if you develop an injury that's not healing.

* Stay active. Physical activity aids circulation, which is critical for people with diabetes. Don't let the cold weather be your excuse for becoming - or staying - sedentary. Get regular exercise, and don't be afraid to do it outdoors. Just remember to properly protect your feet from moisture and cold while you're outside.

Keeping feet healthy and pain-free can ensure a happy and healthy winter season. If you're unsure of how to properly care for your feet during winter, or if you experience foot pain or a wound that won't heal, see today's podiatrist immediately.

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas anytime @702-878-2455 between Monday – Friday and we would be happy to set up an appointment for you. Please visit our website @ FallCenter.com or www.walkwithdiabetes.com. The Foot, Ankle & Lower Leg Center has Diagnostic imaging: Digital X-Rays, Ultrasound or Advanced Imaging will be used to aid in the diagnosis.